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On Oct. 4, three scientists met in Great Barrington, Mass. to author a petition proposing a strategy that has been called “focused protection” as a response to COVID-19. These writers were Dr. Martin Kulldorff of Harvard Medical School, Dr. Sunetra Gupta at Oxford University, and Dr. Jay Bhattacharya at Stanford University Medical School. Their declaration calls for those with the lowest risk of death from the virus to go about their lives as they would have prior to the pandemic while keeping the more immunologically vulnerable under continued social distancing — hence the term “focused protection.” The idea behind this strategy rests on herd immunity, which is when a large enough proportion of the population becomes immune to a disease that its transmission becomes unlikely. Immunity without a vaccine, however, requires infection.
Reaching herd immunity would require a significant portion of the population to become infected with the virus. As of Nov. 3, the COVID-19 pandemic has already infected 47 million people and has caused 1.2 million deaths worldwide. This approach would result in millions more needless deaths, with particular concentration in under-resourced communities and among Black and brown people, as has been the case nationally thus far. The human cost of reaching herd immunity before the development of an established and accessible vaccine or treatment makes it an immoral strategy, as it will cause suffering far outweighing any societal benefits.
Beyond the pure immorality of this declaration, its strategy operates on an exceptional amount of assumption and speculation. The concept of “focused protection” relies heavily on the rather arbitrary line that divides high-risk populations from low-risk populations. Taking the explicitly stated metric of age as an example, this means that younger family members, who may be physically attending school, must stay away from their older family members until herd immunity is reached. This measure assumes that 20 percent of Americans who live in multigenerational homes will have the means and the willingness to adhere to these standards.
The strategy also implies that low risk is equivalent to invulnerability. Although a less common occurrence, young people can and already have lost their lives to COVID-19. To dispose of precautions for this population is to offer them as a sacrifice for the sake of opening business and resuming life as normal. This conveniently disregards the immense death and suffering taking place due to the pandemic and provides fertile ground for it to proliferate under the guise of wellness and long-term public health concerns.
In both of these oversights, minority populations carry most of the burden of suffering — Black, brown, and Asian families live in multigenerational homes at higher rates than white populations, while the majority of children and teens who have died from the virus were Black or Hispanic.
Further, age is just one of the risk factors of COVID-19. Vulnerability to this virus is complicated and cannot be simplified into the binary that this strategy proposes. Among the underlying conditions that increase risk as noted by the Center for Disease Control are cancer and heart disease, two conditions that frequently go undiagnosed and can be asymptomatic for long periods of time. Under a focused protection strategy, people who are unaware that they are affected by these conditions will fall squarely outside of the range of prevention measures, leaving them completely open to serious illness. These people cannot become sacrifices in our country’s attempts to sideline the pandemic in favor of short-term economic and sociocultural continuity.
Finally, the reality of the situation is that the very principle of herd immunity Dr. Kulldorff and company are promising is questionable at best. With each passing month, we continue to learn more about this virus and make adjustments based on this new information. Focused protection does not allow for this flexibility, but rather operates on assumed constants — that people who contract the virus become immune and that the immunity is permanent. Without those assumptions, the plan to achieve herd immunity via focused protection collapses. We have already seen that immunity following infection is variable, with many recovered patients showing a significant decrease in immune response as early as a month after initial recovery. We have also seen that it is possible for people to become reinfected following their initial infection. Under these conditions, focused protection may create a perpetual cycle of infection and re-infection that lasts until a reliable vaccine is made widely available.
It is for these reasons that we — along with others signing onto a petition opposing the Great Barrington Declaration — condemn the idea of focused protection as a means to achieve herd immunity. We condemn the needless death and suffering that this strategy would cause, and we condemn this departure from the standard of doing no harm, taught by the Hippocratic Oath, the Belmont Report, and the central tenets of all health professions. The caregivers of our society can and must do better.
Tyler S. LeComer ’19 is a first-year student and Class President at Harvard Medical School. Arushi Saini is a first-year student and Vice President of Advocacy at Harvard Medical School. Barune Thapa is a second-year student and Vice President of Student Advocacy at the Harvard School of Public Health.
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