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More herd immunity, less herd mentality


Our delayed response to COVID-19 has been rash and driven by fear, not data. This may end up costing us double because health depends on many factors. As we learned in the aftermath of the 2008 market crash, economic shocks have a direct impact on public health. The United States experienced a historical decline in life expectancy due to an epidemic of deaths of despair. In a matter of months, people lost their jobs, lifetime savings, and their homes. A strikingly similar situation is happening now.

Fact is a public health and stable economies go hand in hand. But in the current COVID-19 response, we have pitted these against each other. We either save lives by going on total lockdown or we go back to business as usual and sacrifice the lives of those most at risk. I stand for a middle of the road approach: maximize protection for seniors and vulnerable people, while letting the young and healthy with proven immunity to the virus go back to work. In order to do this, we need more data about immunity.

While we pay attention to the growing number of COVID-19 cases, we are overlooking the fact that there are now nearly 200,000 people worldwide who have recovered from it and survived. Many have yet to be tested, but the majority of survivors are young, healthy and eager to reengage in life and work. We also know that reinfection cases are extremely rare and unlikely.

Unfortunately, serology testing has been missing in US data-gathering efforts during the initial period of the epidemic. Serology tests measure COVID-19 antibodies in our blood rather than the virus presence in our bodies and are critical for understanding and managing an "iceberg epidemic." Why? Because at the end of the day, super-spreader COVID-19 is likely to infect a majority of the population, no matter how far apart we stay from one another in the coming weeks. The good news is that once immune, most people can go back to work. Our containment efforts must focus on the most vulnerable: the elderly and patients with underlying cardiopulmonary diseases.

We need to flatten the curve for the elderly but accelerate herd immunity for the healthy so that we don’t kill the economy trying to outrun the pandemic in lockdown. While home isolation for one month might stop an outbreak, it merely sets the clock back as the virus may return if it is not globally defeated.

Most economies, including that of the US, can’t survive the strong lockdown medicine for a whole year. Let’s use data from serology tests to get a full picture of the iceberg, craft policies that protect the elderly and avoid an economic catastrophe that will negatively impact public health for years.

Ariel Pablos-Mendez, M.D., MPH is a professor of Medicine at Columbia University Medical Center, New York and former head of global health at the US Agency for International Development (USAID).

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