Complete lockdowns may not be a sustainable way to combat the COVID-19 pandemic, but experts are still debating which public health interventions the U.S. should impose to reduce viral transmission in the coming months.
Medical and public health experts contested methods put forth in the Great Barrington Declaration and the John Snow Memorandum in a virtual panel on Friday, disagreeing about whether the U.S. should adopt a “focused protection” method to achieve natural herd immunity, or continue further restrictions. The panel was hosted by Johns Hopkins University.
“Herd immunity is the endpoint of this pandemic no matter what strategy we pick,” said Jay Bhattacharya, MD, PhD, a health economist at Stanford University in California and co-author of the Great Barrington Declaration. “The only question at hand is, how do you get there the safest?”
The Great Barrington Declaration, which was written by Bhattacharya and two other scientists in early October, encourages governments to lift lockdown restrictions on young and healthy people while placing protection measures on vulnerable groups. This “focused protection” method would allow COVID-19 to spread in a population where it is less likely to be fatal, achieving widespread herd immunity that is not dependent on a vaccine.
The John Snow Memorandum was written in response to proposals for natural infection to achieve herd immunity, which was called “a dangerous fallacy unsupported by scientific evidence.” The memorandum, which received more than 6,400 signatures of support from scientists and health experts, does not encourage complete lockdowns, but states that restrictions should continue to suppress viral transmission, and advocates for social and economic programs to prohibit further turmoil.
At the debate, Bhattacharya defended his proposal to achieve herd immunity through natural infection of the young and healthy, stating that there is a wide difference in the threat of infection for older people compared with younger populations.
“An infection is a severe problem for older populations, and also for people who have certain chronic conditions,” Bhattacharya said. “For younger populations under 70, it’s much milder.”
He said that since a “zero-COVID outcome” is not possible, allowing young and healthy individuals to resume normal activity might help prevent further collateral damage from lockdowns, including depriving kids from going to school, falling rates of childhood vaccinations, and prohibiting people from seeking preventative medical care.
But David Dowdy, MD, PhD, an infectious disease epidemiologist at Johns Hopkins School of Public Health, who defended the John Snow Memorandum, argued that it’s not just older individuals in long-term care facilities and nursing homes who are vulnerable.
“I don’t think that it’s feasible or right to label some people as vulnerable and others as not vulnerable,” Dowdy, who has not signed the John Snow Memorandum, stated at the panel. “I think vulnerability is a spectrum and not really just based on age.” The best way to protect the elderly and those with underlying conditions, he argued, is to reduce transmission in the community, imposing temporary restrictions in areas where outbreaks are happening.
Dowdy added that the U.S. should use diagnostic testing to help public health experts understand where best to respond. “We should be using it to figure out where transmission is occurring, where cases are popping up, and therefore how to focus our response. Without knowing that, it’s really difficult to come up with targeted responses for reducing transmission,” he said.
Stefan Baral, MD, MPH, also an infectious disease epidemiologist at Johns Hopkins School of Public Health, argued for a position of “resources before restrictions,” stating that the most feasible solution is for the federal government to provide states and smaller jurisdictions resources for local public health interventions.
Baral said there is a defining characteristic of this infection, which is that “it has undermined and shown us all of the inequalities that exist.” He added that there have been few to no evidence-based interventions to date that focus on the needs of individual or marginalized groups.
“The fundamental problem I’ve seen in COVID is that we’ve wanted individual people to take on what should be social costs,” Baral stated. He said the U.S. has asked people who are generally well to quarantine and isolate — yet officials have provided no real means for them to do that.
“We’re asking people already on the economic margins to absorb social costs,” Baral said. “That disconnect between social cost and personal benefits doesn’t feel like a sustainable strategy to me.” He suggested paid leave for employees in long-term care facilities, as well as housing support for individuals who are in quarantine — particularly for people who live in multigenerational homes.
In response to how the U.S. might employ a middle-of-the-road approach, Bhattacharya said that “focused protection is the balance,” acknowledging both the harms of lockdown and the danger of the virus to vulnerable populations.
Dowdy agreed that targeting the approach is key: “We need to be thinking about how to be focused in our protection,” he said. “But it’s not a one-size-fits-all strategy.”
Source: MedicalNewsToday.com
