Important COVID-19 science the public should know
Virtually everyone who has made public announcements or passed official mandates regarding COVID-19 has said, “The science will govern us.” Familiar names who have used this phrase include President Trump, Vice President Pence, Drs. Fauci, Birx and recently Scott Atlas, and most governors and state health officials, along with numerous talking heads.
Important established scientific facts are not being reported to the public. Responses to COVID-19 appear driven more by politics than medical evidence.
Health risk of COVID-19
The latest report shows 215,307 U.S. deaths associated with COVID-19 and 7,694,213 “cases,” which would calculate a death risk of 2.8 percent. This calculation is incorrect for several reasons.
The numerator of deaths/cases ratio is inaccurate. The risk of death varies greatly by population. Between 73 and 94 percent of COVID-19 deaths occurred in elderly persons with one or more pre-existing conditions such as diabetes (25 percent), cancer, immune compromise, or chronic lung disease. These were the primary cause of death. If the virus directly caused only six percent of deaths (12,895 Americans), the risk to the general, healthy population is 0.17 percent, not 2.8 percent. Even this low risk is falsely high because the denominator is also invalid.
“Cases” are individuals who have tested positive. A Stanford study done in the general population of Santa Clara, California, in April 2020 suggested that 50-85 times more individuals have or had COVID-19 than the reported “cases.” If the seven million case number is only ten times underestimate, the denominator becomes 76 million and the risk to the general population becomes 0.017 percent, lower than seasonal flu.
Some writers have denigrated a comparison of COVID-19 with seasonal flu. In 2017-2018, 48.8 million Americans were infected with the flu, 959,000 were hospitalized, and 79,400 died. In 2018-2019, 42.9 million got the flu, 647,000 were hospitalized, and 61,200 died. The risk of death from the flu is thus 0.15, higher than the risk of death from COVID-19 in healthy persons.
A second risk factor is age. Since serious comorbidities are statistically concentrated in the elderly, it is difficult to analyze older age alone as a risk factor. By contrast, children are overwhelmingly healthy. CDC COVID-19 data indicates 576 hospitalizations in children less than 15 years old and 45 deaths. Their risk of death is thus 0.006 percent. Children in the U.S. have a greater chance of serious injury or death from a traffic accident, 0.035 percent.
An August 2020 report of COVID deaths around the world revealed that regardless of location, COVID deaths increased rapidly in the early phase of contagion, then rapidly declined and stayed low everywhere. While the second wave of “cases” may occur, a spike in deaths is unlikely.
As the topic is health risks, no consideration was given here to the economic devastation created by our anti-COVID-19 policies.
Flatten the curve
Social distancing, lockdowns, and PPE (personal protective equipment such as face masks, gowns and gloves) were widely deployed to flatten the curve, meaning to prevent a deluge of sick COVID-19 patients that could swamp our medical facilities, especially ICU beds and mechanical ventilators. (We have now learned that ventilators should be avoided as they tend to harm rather than help the patient survive respiratory insufficiency.)
In March and April 2020, several mayors and governors demanded federal assistance to avoid overloading the local medical facilities with a flood of COVID-19 patients. The medical tsunami never happened.
The hospital ship, U.S.N. Comfort, with 1000-bed capacity and 1200-person crew, anchored in New York harbor in March 2020. Over the following month, the ship cared for 182 patients, 127 of whom had COVID-19. Comfort then departed as it was not needed.
In April 2020, the Army set up a 250-bed emergency field hospital inside the CenturyLink Event (convention) Center in Seattle to handle COVID-19 patients’ overflow from local hospitals. After treating no patients at all, the hospital was taken down.
Herd immunity is an indirect form of protection against the spread of any contagion. When enough members of a population, the herd, are immune through extensive prior infection or mass vaccination, they form a defensive barrier that stops the virus from reaching those susceptible, i.e., not immune.
If a person is immune, illness cannot occur because the virus is destroyed before it can multiply.
Numerous vaccines against COVID-19 are in clinical trials. Hopefully, one or more will prove effective. However, that happy time is in the future. Even with a vaccine, if many Americans refuse vaccination, this could preclude herd immunity.
In addition to mass vaccination, humans can develop herd immunity naturally. When enough healthy people become infected, their immune systems develop two responses: antibodies and T-cells.
Antibodies, the first line of defense, are circulating proteins that attack and kill the virus. When an infection is stopped, antibodies break down and disappear. That is why some people say there is no lasting protection against COVID-19. These people forget about T-cells.
A recent, large medical study provided scientific evidence that COVID-19 induces a vigorous T-cell response. In contrast to antibodies, T-cells are long-lived and have long-term memory. If the virus returns, T-cells can quickly mount a response even without antibodies present. Thus, once immune, humans have lasting protection against COVID-19.
When enough Americans become immune, naturally or by vaccination, we create an impenetrable shield protecting those with pre-existing conditions.
When the first COVID-19 patient was identified in the U.S. in January 2020, there was almost no information about the biology, immunology, and human illness associated with the virus. Our responses were done blindly. Today, we have enough good information to design a COVID-19 policy based on hard medical science rather than mathematical models.
First, develop natural herd immunity. Allow COVID-19 to spread throughout the general, healthy population where the death risk is similar to or lower than the flu. Reverse mandates for lockdowns, school closures, social distancing, and PPE, and re-open our country.
Second, a “spike” in cases without a corresponding increase in hospitalizations or deaths is a cause for celebration, not restoring lockdowns and school closures. Such a spike represents people who will contribute to national herd immunity that will stop the pandemic.
Until we achieve herd immunity, offer strict quarantine to the high-risk population, who have pre-existing conditions. We should not order quarantine as this would amount to incarceration in solitary confinement without due process. In the interim, aggressively pursue research in both anti-viral drug treatments and effective, safe vaccines.
Deane Waldman, M.D. MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of Center for Healthcare Policy at Texas Public Policy Foundation; and author of multi-award-winning book, Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.