Covid cases have dropped 77% in six weeks.
Experts should level with the public about the
good news.
By Marty Makary
February 19, 2021 "Information
Clearing House" - Amid the dire
Covid warnings, one crucial fact has been largely
ignored: Cases are down 77% over the past six weeks.
If a medication slashed cases by 77%, we’d call it a
miracle pill. Why is the number of cases plummeting
much faster than experts predicted?
In large part because natural immunity from prior
infection is far more common than can be measured by
testing. Testing has been capturing only from 10% to
25% of infections, depending on when during the
pandemic someone got the virus. Applying a
time-weighted case capture average of 1 in 6.5 to
the cumulative 28 million confirmed cases would mean
about 55% of Americans have natural immunity.
Now add people getting vaccinated. As of this
week, 15% of Americans have received the vaccine,
and the figure is rising fast. Former Food and Drug
Commissioner Scott Gottlieb estimates 250 million
doses will have been delivered to some 150 million
people by the end of March.
There is reason to think the country is racing
toward an extremely low level of infection. As more
people have been infected, most of whom have mild or
no symptoms, there are fewer Americans left to be
infected. At the current trajectory, I expect Covid
will be mostly gone by April, allowing Americans to
resume normal life.
Antibody studies almost certainly underestimate
natural immunity. Antibody testing doesn’t capture
antigen-specific T-cells, which develop “memory”
once they are activated by the virus. Survivors of
the 1918 Spanish flu were found in 2008—90 years
later—to have memory cells still able to produce
neutralizing antibodies.
Researchers at Sweden’s
Karolinska Institute found that the percentage
of people mounting a T-cell response after mild or
asymptomatic Covid-19 infection consistently
exceeded the percentage with detectable antibodies.
T-cell immunity was even present in people who were
exposed to infected family members but never
developed symptoms.
A group of U.K. scientists in September pointed
out that the medical community may be
under-appreciating the prevalence of immunity from
activated T-cells.
Covid-19 deaths in the U.S. would also suggest
much broader immunity than recognized. About 1 in
600 Americans has died of Covid-19, which translates
to a population fatality rate of about 0.15%. The
Covid-19 infection fatality rate is about 0.23%.
These numbers indicate that roughly two-thirds of
the U.S. population has had the infection.
In my own conversations with medical experts, I
have noticed that they too often dismiss natural
immunity, arguing that we don’t have data. The data
certainly doesn’t fit the classic
randomized-controlled-trial model of the old-guard
medical establishment. There’s no control group. But
the observational data is compelling.
I have argued for months that we could save more
American lives if those with prior Covid-19
infection forgo vaccines until all vulnerable
seniors get their first dose. Several studies
demonstrate that natural immunity should protect
those who had Covid-19 until more vaccines are
available. Half my friends in the medical community
told me: Good idea. The other half said there isn’t
enough data on natural immunity, despite the fact
that reinfections have occurred in
less than 1% of people—and when they do occur,
the cases are mild.
But the consistent and rapid decline in daily
cases since Jan. 8 can be explained only by natural
immunity. Behavior didn’t suddenly improve over the
holidays; Americans traveled more over Christmas
than they had since March. Vaccines also don’t
explain the steep decline in January. Vaccination
rates were low and they take weeks to kick in.
My prediction that Covid-19 will be mostly gone
by April is based on laboratory data, mathematical
data, published literature and conversations with
experts. But it’s also based on direct observation
of how hard testing has been to get, especially for
the poor. If you live in a wealthy community where
worried people are vigilant about getting tested,
you might think that most infections are captured by
testing. But if you have seen the many barriers to
testing for low-income Americans, you might think
that very few infections have been captured at
testing centers. Keep in mind that most infections
are asymptomatic, which still triggers natural
immunity.
Many experts, along with politicians and
journalists, are afraid to talk about herd immunity.
The term has political overtones because some
suggested the U.S. simply let Covid rip to achieve
herd immunity. That was a reckless idea. But herd
immunity is the inevitable result of viral spread
and vaccination. When the chain of virus
transmission has been broken in multiple places,
it’s harder for it to spread—and that includes the
new strains.
Herd immunity has been well-documented in the
Brazilian city of Manaus, where
researchers in the Lancet reported the
prevalence of prior Covid-19 infection to be 76%,
resulting in a significant slowing of the infection.
Doctors are watching a new strain that threatens to
evade prior immunity. But countries where new
variants have emerged, such as the U.K., South
Africa and Brazil, are also seeing significant
declines in daily new cases. The risk of new
variants mutating around the prior vaccinated or
natural immunity should be a reminder that Covid-19
will persist for decades after the pandemic is over.
It should also instill a sense of urgency to
develop, authorize and administer a vaccine targeted
to new variants.
Some medical experts privately agreed with my
prediction that there may be very little Covid-19 by
April but suggested that I not to talk publicly
about herd immunity because people might become
complacent and fail to take precautions or might
decline the vaccine. But scientists shouldn’t try to
manipulate the public by hiding the truth. As we
encourage everyone to get a vaccine, we also need to
reopen schools and society to limit the damage of
closures and prolonged isolation. Contingency
planning for an open economy by April can deliver
hope to those in despair and to those who have made
large personal sacrifices.
Dr. Makary is a professor at the Johns
Hopkins School of Medicine and Bloomberg School of
Public Health, chief medical adviser to Sesame Care,
and author of “The Price We Pay.”
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