By Marty Makary | The Wall Street Journal
ILLUSTRATION: MARTIN
KOZLOWSKI
Covid cases have dropped 77% in six weeks. Experts should level with
the public about the good news.
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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Against the urging of medical experts,
city of Sarasota eliminates mask mandate
By Timothy Fanning | Sarasota Herald-Tribune
SARASOTA, FLORIDA – Going against the urging of four medical doctors and other local health experts, the majority of Sarasota city commissioners have agreed to eliminate the city’s mandatory mask ordinance.
The mandate for face coverings in public, put in place last July, was largely rendered symbolic in September after Gov. Ron DeSantis cut local governments’ ability to enforce it.
Those in the majority on the City Commission felt that masks were too “burdensome” for residents and businesses, and because the city could not punish those who did not comply, what was the point in keeping the mandate in place? Besides, people are just going to do what they want, they contended.
“This was one of those ordinances that was done as a public spectacle,” said Vice Mayor Erik Arroyo. “People don’t really respect us as a commission for us trying to regulate every single little thing. It might make us feel good about passing it, but it just doesn’t work, and I think we need to stop this now.”
