From here to immunity: charting COVID from pandemic to endemic

2020 has proven a testing year for the culture and capacity of governments around the world. Many governments have failed. Governments far away and close to home have failed. The State of Victoria in Australia, where I call home, has failed more in proportion to the real spread of the virus among its resident population than most, and certainly more than the usual targets of criticism without facts, such as Donald Trump or Sweden.

Disease outbreaks arising from pathogens have disrupted regimes or even induced collapse of empires in the past – the Justinian plague, or the impact of the bubonic plague on the Mamluk sultanate, with an elite of military governors, of Egypt in the 14th and 15th centuries. Those disease outbreaks have been deadly serious. The Black Death killed one-third of the population. By contrast, SARS-COV-2 appears to have added 7 days to excess mortality, and less in some countries. In Australia, there appear to be less death than normal in this year of lockdowns and mass panic.

In January and February there was a genuine, reasonable concern that this blooming pandemic would have a dramatic impact on health, but also on the operations of the inter-connected global economy. Markets and governments acted in anticipation. Was this a black swan event that the masters of the universe would need to get on top of with rapid speed? Would we see a repetition of the 1918 pandemic that had a death toll estimated between 25 and 100 million people, when the world’s population was 1.8 billion, one quarter of today? Or was it, as historian Niall Ferguson wrote, more likely, a Dragon King or Gray Rhino event?

As February and March faded into April, May and June, the evidence accumulated that this virus would never have the direct impact on mortality of the direst predictions. It was likely a Gray Rhino – a predictable and manageable event. Michael Levitt, Jon Ioannides, Sunetra Gupta, Carl Henegan, Jaya Bhattachara questioned the science. Niall Ferguson, out of curiosity, began developing a 1000-slide powerpoint deck that would evolve into a powerful critique of the catastrophic errors of strategic judgement of many government leaders. These errors of judgement could have been prevented with a little dose of scrupulous pessimism and some perspective grounded in reading and interpreting history.

Instead, the bureaucratic and medical utopians exploited some confused, opportunistic political leaders – who sensed a chance to lift their standing by seeming to save lives in an emergency – with that old saw of sorcery, attributed to Barack Obama’s adviser, to never let a crisis go to waste. And that could only happen by exaggerating the threat. As a result, the reaction to the virus has been more devastating, than the virus and related disease themselves.

On the sniff of a snotty rag, large swathes of the governing elite decided in February and March that this virus was a Dragon King. Or perhaps more realistically, they decided to portray the virus as a catastrophic event so they could pose as the Dragon Queen who would break the wheel. Political, bureaucratic and public health leaders jumped on the train that named this virus as an “unprecedented” or “100-year event”. They were suddenly thrown into the spotlight and provided an opportunity to be world leaders. It created a firestorm of political rhetoric and over-excited decision-making. Hugely consequential decisions were made with barely any facts or settled understanding of disease patterns. The public health leaders – too often mere statisticians, mere pretenders, or burnt out doctors who don’t want to see patients any more but explain every disease by the “social model of health”- urged these frightened leaders to devastate society on a hunch and a gamble that for the first time in human history we could eliminate a new disease pathogen within a year. Like Daenerys Targaryen, they rode the dragon, drove themselves mad with power, and burned King’s Landing to the ground.

Underlying all of this madness were some false assumptions about the pandemic, some very bad history, and clumsy misunderstandings of mathematics. The saturation level of the virus in the population was assumed to be 80 per cent – wrong: it appears closer to 20 per cent. The deadliness of the virus was high and uniform – wrong, the infection fatality rate appears to be in the range of 1 to 5 in a thousand, and heavily skewed towards the old and others with diseases that otherwise weaken their ability to fight off viruses. Everyone was susceptible – wrong, many had protection from cross-immunity and other coronaviruses. The only immunity could come from antibodies and a sterilising vaccine – wrong: T-cell immunity and other protections from resisting the common cold also work. We could reliably test how many cases were infected – wrong: reported cases from PCR-tests are vastly below even infections identified through blood tests. The pandemic was “unprecedented” or a “once-in-a-hundred year event” – wrong: this virus is more equivalent to a bad influenza year, and has more in common with the influenzas of 1957 and 1969, than the Spanish Flu of 1918, in the wake of a world war. The virus was spreading with “exponential growth” – wrong: the spread of a virus follows a Gompertz curve with decaying and limited growth, as Professor Michael Levitt has demonstrated comprehensively.

Our Governments and governing elites must chart a course away from these disastrous policies on the pandemic. The new course must be guided by one simple idea: we are no longer stopping a pandemic wave; we are living with an endemic virus. As Sunetra Gupta has stated bravely for months, the virus will reach a point of endemic equilibrium, and then life can return to the old normal.

Of course, we will have learned some lessons – the value of good personal hygiene; the need for care for post-viral syndromes; ways that the elderly and vulnerable can be better protected against respiratory viruses; the importance of real work, rather than fabulist knowledge workers; the stupidity of forecast models constructed without understanding the phenomena they model. Most of all, we will have been warned about the folly authoritarian temptations of our governing elites and the Public Health Rulez, OK crowd.

The course our leaders should chart is that set out in the Great Barrington Declaration (named after the place where it was written, Great Barrington in Massachusetts). Let me quote its final paragraphs:

“As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.

Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.”

Great Barrington Declaration (Sunetra Gupta, Martin Kuldorff, Jaya Bhattacharya, and others 2020)

I have signed the Great Barrington Declaration, and I encourage any readers to do so too. Our health, culture and freedom depend on its ideas – and not the diseased rhizomes of lockdowns, fear and masks – shaping our response to SARS-COV-2 and other pathogens.