THE FEDERALIST disgraces itself

I would be embarrassed to work for a publication that continues to describe COVID-19 with the word "flu." As we'll see later, it is very far from being any kind of influenza. But never in a million years did I expect any conservative publication with any pretense to credibility, much less The Federalist,  to run an article seriously suggesting that we seek volunteers to deliberately be infected with the virus, be quarantined, recover, and then returned to the general population to eventually confer "herd immunity" on the population at large.

The article in question was written, not by an epidemiologist, but by a dermatologist. Dr. Douglas A. Perednia has no particular expertise in epidemiology. That should be made clear at the outset.

Now, it's certainly true that the disease is generally much less serious in younger, healthier folks such as those from whom the volunteers would be drawn. How many of the current generation of young folks would deliberately risk their lives for the sake of their elders? It seems an odd suggestion since some of the president's supporters suggest that old folks should be willing to go without medical help and die to preserve the economy for those young folks. Personally, I would expect more of the old folks to volunteer for certain death than the younger ones for a comparatively small risk of it, though I admit that I may be doing today's young folks an injustice.

But we hit a bottleneck before we even get there. As Dr. Perednia says in his article, "A critical component of this program is widespread testing of the general population to determine exactly who has and has not already become immune to coronavirus. Those who have previously been infected and developed immunity would also be given a certified clean bill of immunity."

That raises two problems. The first is that it's not yet even clear how much immunity recovering from COVID-19 confers. Presumably, it's some, if their immune systems have managed to flush the virus. But we have no idea at this point how long the immunity would last, or whether it would prevent re-infection or only mitigate the illness if re-infection occurred.

The second is that Dr. Perednia's plan requires, as a first step, that everybody in the country is tested for the presence of antibodies to SARS-CoV-2 in their systems- or at least close enough to everybody that the difference wouldn't matter much. At present, we are struggling to test the small percentage of the population we think may actually have the disease for the presence of the active virus. And we've never tested everybody like that. Never. It's an almost impossibly huge task, and even if it could be accomplished, it would take an awfully long time. It might not be possible at all.

But let's say that we manage to do it. True, COVID-19 seldom results in serious illness in young adults, although the CDC emphasizes that serious outcomes are possible regardless of age. And altruistic people often do heroic things. We have no idea how many volunteers would we get. But without knowing that (as well as many other things we currently don't know about SARS-CoV-2), there is no way we can possibly know how many batches of volunteers would we have to go through to confer "herd immunity" on the general population. It's very possible, and in fact, seems quite likely, that by the time we get there the pandemic may have run its course! And who knows how long the complete process might take, from testing virtually the entire population to deliberately infecting enough admittedly heroic young people with a deadly virus to achieve "herd immunity?" The odds seem strong that by that time, nature would already have bestowed it on us!

This is a crucial point because Dr. Perednia's entire plan is based on the premise that weathering the storm by continuing on the present course is impractical.

After all, it would take too long.

But Dr. Perednia has an answer to the question of what it would take to confer "herd immunity" he arrives at by inference from the Imperial College report:

Crunching data from the MRC Centre for Global Infectious Disease Analysis at Imperial College London implies that based on the Wuhan virus’s reproduction number, we can achieve herd immunity by immunizing somewhere between 33.3 to 71.4 percent of the population, with an averaged guess of 61.5 percent. Given the age demographic breakdown of the population, there is a good chance a safe and responsible CVI could get us close to herd immunity months before a vaccine makes 100 percent immunization possible.

Is that all? Excuse me if I'm not as sanguine about the timing your plan would take as you are!

It might be well at this point for us to consider what, in more ways than one, is the elephant in the room. There is a reason why Mr. Trump and his supporters don't like the present state of affairs and want to shorten it by as much as possible. It's the same reason why all of us would like the same thing: the economy is taking a terrible hit, and a recession seems inevitable. The Great Recession of 2008 is still so fresh in the memories of most of us that the prospect scares us to death. The human suffering it would inflict would be enormous- though Mr. Trump's claim that it would be greater than the virus will inflict is beyond ridiculous.

Just how serious would the damage be if we don't get the pandemic under control? Well, once again, we fact the same frustrating answer: we don't know.

But it seems very likely that if it's not before November, in January Joe Biden will become President of the United States. In fact, I think that's very likely anyway. But if Mr. Trump's greatest selling point- a booming economy he had far less to do with bringing into being than he and his supporters claim- were to go away before November, the chances of a president as personally unpopular as he is being re-elected would be nil.

So the right has an even stronger motivation than the rest of us to be eager for the nation to return to its normal way of life. Saving the economy requires that it happen relatively soon. All of us want that! But we don't always get what we want. The consequences of easing up too far too fast would be dire. First, there's the probability that we would have to quickly re-impose the present restrictions on ourselves to deal with a second wave of the pandemic. And the recession would still come- only it would likely be deeper and longer because the epidemic might well be worse and it would take even longer to actually get past the virus.

Secondly, there's the question of how many Americans would die as a result. I have to admit that I'm appalled by the number of people who will come right out and say that they favor Ebeneezer Scrooge's solution to the problems of poverty and overpopulation: let some of us die to achieve the unlikely goal of preventing a recession and (the part they don't say, probably even to themselves) re-electing Donald Trump.

Dr. Perednia bases his article on a paper from the Imperial College in London on how pandemics- and specifically this pandemic- might best be contained. It outlines two potential strategies: mitigation, which focuses on slowing but not necessarily stopping the spread of the infection; and suppression, which amounts to what the experts are recommending today and what we and most of the countries in the West have now begun.

It concludes that where it is possible, suppression is the more effective approach. Half measures yield less satisfactory outcomes. And Dr. Perednia's approach is very much a half measure.
It's a fact to which Mr. Trump and many on the right these days seem oblivious, but pandemics tend to come in waves. A country begins to recover, the number of those infected declines, and life returns to normal.  And the spread of the virus resumes precisely because life becomes too normal too soon, or because of changes in the way people behave sometimes due to the time of year. Sometimes the second wave is milder. At least as often it's even more severe than the first; after all, the virus has had a chance to mutate and become harder for the human immune system to deal with.

The worst pandemic in human history was the so-called "Spanish Flu" of 1918. It infected between one-fifth and one-third of the world's population and killed 50 million people- more than died World War I. It came in three waves. The first occurred in the Spring of 1918.  According to a study published by the Royal Society of factors that led to these rises and declines in the United Kingdom, the first wave probably petered out for three reasons: schools let out for the summer, the weather became less conducive to respiratory infections, and mild forms of informal social distancing began to be practiced.

Mitigation.

And where did mitigation lead? In the Fall, when school was once again in session and normal activities resumed, the flu returned with a vengeance. It should be mentioned that it was also at this time that large numbers of American troops began to return from Europe.  It was this second wave that killed most of the people who died of the "Spanish Flu." It was only then that stores began to close and widespread public health education and other efforts at mitigation similar to those being utilized today were employed. The second wave subsided because a consistent strategy of suppression was followed.

It wasn't quite enough. Perhaps the foot was taken off the brake a little early. In any case, the third and mildest wave occurred during the early winter of 1918 to 1919, The policy of eradication was again temporarily followed, and by February, the flu was all but eradicated.

The paper upon which Dr. Perendia basis his article points out that the strategies of mitigation and suppression each have a downside.  A strategy of mitigation could reduce the demands on the healthcare system by two-thirds and the number of deaths by half.  "However," the study continues,  "the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over."

The study frankly says in so many words that at least in nations wealthy enough for it to be feasible, suppression is, therefore, the strategy of choice. But suppression, too, has a downside:

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised (sic) that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.

Dr. Perednia's flabbergasting argument hangs on this nearly microscopic thread:  "We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative (sic) short time windows, but measures will need to be reintroduced if or when case numbers rebound." In other words, maybe the best solution might be to vary how draconian the containment measures need to be according to how serious the threat is in a given area at any given time, relaxing them for brief periods in given areas when rates of infection show strong signs of declining but slamming them on again if- as the authors of the studies fear it might- the rate of transmission begins to rise again.  Restrictions in rural Wyoming might be milder than restrictions here in Iowa, for example. They would be much more severe in places like New York or Los Angeles or New York. And to a point, that's exactly what's happening. The governor of Iowa merely advises us to stay in our homes if we can avoid going out; the other day I found it necessary to go to the store for food. Even that is allowed in Chicago or New York.  But in Des Moines, no cop stopped me to demand my reason for being out of my house, much less arrested me if my reason wasn't good enough. That's exactly what is happening in New York and Chicago.

The kind of solution the study recommends obviously needs to be handled at something other than the national level, with restrictions determined by local authorities. As things stand, they're being handled at the state level- and for the most part, handled quite well. But travel within states tends to be fluid enough that it probably would be impractical to devolve the authority to a level more local than that.

I have no doubt that state authorities will indeed cautiously relax restrictions if events warrant it. To all intents and purposes, what the study Dr. Perednia cites suggests is exactly what we're doing at the moment!

Since Dr. Perednia's article uses the example of "chickenpox parties-" social events for children arranged by their parents for the specific goal of getting as many of them as possibly infected with now basically harmless virus and get a normal if a mildly unpleasant aspect of childhood in America out of the way- it's worth remembering that since the development of a vaccine, the death rate from chickenpox is 0.000166666667%. The current mortality rate for COVID-19 worldwide is 4.5%, though no one doubts that it will fall as the virus "loses steam." It was four percent in China. Currently, it's 10% in Italy, about 7.6% in Iran, less than one percent in Germany and, while it's still early here, 1.5% in the United States. President Trump's "hunch" that it would turn out to be less than one percent isn't panning out very well.

By comparison, the mortality rate for the 1918 flu was 2.5%  Sorry, Mr. President, but as has turned out to be the case so often in the past four years, the information you have given us is sheer malarky. COVID-19 is far more lethal than the virus which caused the worst pandemic in history.

The 2009 H1N1 for the handling of which Trumpworld bizarrely criticizes President Obama had a mortality rate of 0.02%. That's only a little higher than the seasonal flu, which has a death rate of 0.1%. Current trends suggest that COVID-19 could wind up being 34 to 45% deadlier than the flu.

The 1957 "Asian Flu" pandemic had a mortality rate of 0.6%.

No, Mr. President. No, Federalist staff. COVID-19 is not "the Wuhan Flu, " and the comparison isn't merely a lie. It's a particularly reprehensible lie because by minimizing the seriousness of this pandemic it encourages irresponsible behavior, and it is literally costing people their lives. Not just the toilet-bowl and grocery-shelf lickers and those who actually do attend COVID parties or hold huge services that are the moral equivalent of snake-handling are endangered. So too are the old and frail folks with whom they subsequently come into contact.

Some suggest that the death rate from COVID-19 might turn out to be lower than experts expect by several orders of magnitude because of the very healthcare system whose ability to function at all the pandemic threatens. Let us all pray that this turns out to be the case! But it probably won't be if we let up too much too fast on the measures we're taking to contain and eventually eradicate it. We have to be guided by the data we have now,  and the data we have right now not only suggests but demands that we not relax our current posture not only until the break-point- the point at which the rate of infection begins to slow down- and almost certainly at least until it begins to actually fall.

Then, as the real epidemiologists and even the study from the Imperial College which Dr. Perednia cites make clear- will it be responsible or productive to begin to return things to normal. That is the time for the staggered, brief loosening of restrictions the study suggests might be helpful.

When a tweet containing a link to Dr. Perednia's outrageous article was posted by The Federalist,  a firestorm composed of equal amounts of outrage and incredulity swamped Twitter, which removed the Federalist's tweet and temporarily suspended its account for violating its rules by posting such irresponsible and dangerous nonsense. As well it should have.

The staff of The Federalist should be ashamed of itself for running the article, and Trumpworld, in general, should be ashamed of itself for what everybody realizes is the subtext for its the eagerness to
rush a return to "business as usual:" a willingness to risk large numbers of human lives for the non-existent chance that doing so might prevent a recession.

Shame on you for even thinking it.


ADDENDUM: The day after I wrote this word came out of several "game-changing," simple
tests in development that might theoretically make Dr. Perednia's first step at least somewhat plausible. Britain is reportedly days away from announcing a simple pin-prick test, and there are reports that other tests involving nasal or cheek swabs may be in the works.

The catch is that scientists are skeptical about their accuracy. Testing the entire nation would still be a lengthy, Herculean task, and achieving Dr. Perednia's minimum level of individual immunity for "herd immunity" to result (assuming that recovering from COVID-19 even confers a complete and permanent immunity) would still probably take longer than the pandemic would last.

ADDENDUM II: Things get curiouser and curiouser, as Mark Twain would say.

Dr. Perednia says in an interview that he only used the term "chickenpox parties" in a footnote as an example of historical instances of deliberate infection being used to address contagious diseases. It was The Federalist that moved the reference into the text of the article and made it the headline.

Further, he insists that the manuscript he submitted to The Federalist referred to the virus as "COVID-19." But The Federalist changed his references to it to "the Wuhan virus."

Now, as I've said in this blog, I'm not entirely opposed to that nomenclature, given China's ongoing propaganda campaign to avoid responsibility for the pandemic, which directly resulted from negligence on the part of its government. "Chinese virus-" an open invitation for racist scapegoating of anybody of Chinese or even Asian background- is right out the window.

I've already addressed the term "Wuhan flu" and its use by The Federalist. At least they didn't change Dr. Perednia's use of "COVID-19" to that.