William Watson: Herd mentality versus herd immunity and the coronavirus
How to weigh the trade-off between what’s best for a population’s physical health and what’s best for its material well-being?
Herd immunity was a term I didn’t know until 10 days ago. It came up, of course, in discussion of establishing immunity for a country’s population against the you-know-what. It’s humbling for us humans to think of ourselves as a herd. On the other hand, we often behave like one, exhibiting herd mentality, another phenomenon much in evidence lately. So why not herd immunity to describe us?
I first heard the term when British officials used it to explain that herds become immune after a certain per cent of their members have individual immunity. In the extreme, imagine everyone in your society has had the virus except you. You’re not going to get it (which might lead you to believe vaccination doesn’t work: You didn’t get vaccinated and, see!, nothing happened to you.) In general, a virus seeking new bodies to inhabit will have trouble when most of the bodies it encounters are immune. That, of course, is what a vaccine is supposed to do. It’s much better if you can quickly inoculate your entire population against a deadly new disease. Unfortunately, vaccines take time so you may have to rely on natural methods, which in this case means enough people catching the disease and surviving to get the percentage of your population thereby immune up to levels that effectively protect uninfected members of the herd. (Reading all this makes me wish I’d taken Grade 10 biology instead of Latin, though Latin did teach me English.)
The seemingly perverse idea here is that it’s actually good for people to become infected, so long as they survive, of course, and don’t have too bad a time of things during their infection. As a result of these considerations, you don’t necessarily try to suppress a disease entirely. Rather, you let it work its way through the population while protecting those members most at risk of dying from it. In fact, that initially seemed to be the British strategy — controlled spread, however difficult it might be to gauge the right amount of control — until herd mentality came into play.
Herd mentality, for its part, is that everybody thinks the same way. I learned about how real herds behave many years ago on an actual dairy farm, trying to help the family of someone I was dating at the time move a herd into a new field. I made some rookie misstep that spooked them all — the herd, that is, not the family, though the family was none too pleased — and off the cows all ran.
What has been interesting over the past few weeks has been how often herd mentality has come into play. People were paying attention to COVID-19 early this month but not entirely wholeheartedly. We even went to lunch with another couple in a restaurant one day, something you wouldn’t dream of doing now. But then on March 11 — not two weeks ago yet — the NBA suddenly postponed its season. Yikes! This is serious, everybody thought. I know I did. And all the other sports leagues followed suit.
Then last week maybe the herd at least twitched a little again. A Wall Street Journal editorial, “Re-thinking the coronavirus shutdown,” pointed out that the cost of shutting down a modern economy for an indefinite period could be enormous and might well have severe public health consequences itself. An article in the online life sciences journal Stat by Stanford epidemiologist John Ioannidis suggested shutting down the economy was “a fiasco in the making.” The New York Times’ conservative columnist Bret Stephens linked to the Ioannidis piece, calling it a “must-read.” Then on the weekend the Times ran a piece by Yale epidemiologist David L. Katz called “Is our fight against coronavirus worse than the disease?” Katz suggested there were more surgical, targeted ways to fight the disease than trying to smother it and he explicitly recommended a herd immunity strategy that concentrated preventive efforts on vulnerable populations and let those less vulnerable return to something closer to life as we knew it just a couple of weeks ago. As he put it:
“The clustering of complications and death from COVID-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing — saving lives and not overwhelming our medical system — by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.”
Finally — not in the sense of the debate being over but in the sense of its having achieved purchase in the mainstream — the Times’ Thomas Friedman endorsed Katz’ suggestions in a column, “A plan to get America back to work again,” that in parts reads more like a précis of Katz and in fact featured a phone interview with him.
I am an economist, not an epidemiologist, so nothing I say about epidemiology is worth the bytes it’s written with. (Maybe not so much on economics, either, some readers have occasionally suggested.) On the other hand, both economists and epidemiologists study “general-equilibrium systems” in which human behaviour is crucial. They’re also at the moment confronted by a big complex problem in which cratefuls of crucial information are missing — transmission rates, recovery rates, infection rates for the epidemiologists; all sorts of reactions to not-very-precedented policies and events for the economists. In general, though, we do seem to understand that there may be a trade-off between what’s best for the population’s physical health and what’s best for its material well-being, which may actually feed back to its physical health.
Even if we had all the missing information, it would be a very hard problem, both in the complexity of the literal calculations but also in the moral calculus. Even if it’s “just” a question of trading-off deaths against deaths it’s hard enough. If you shut down the economy for months and practice extreme social distancing, you save so many lives from coronavirus; on the other hand, you condemn so many lives to eventual breakdown from what could be a very slow recovery or maybe even not a recovery for a while but a depression. But the virus deaths could all be in the next few months while the lingering deaths could be over years, maybe decades. It’s a little like the (surely unreasonable) fear of death from nuclear accident vs. the well-documented large-scale certain deaths from continued coal mining.
Deaths of one kind vs. deaths of another is hard enough. But as an economist, I’m bound to say that even if it’s deaths saved against dollars of GDP lost, it can still be a difficult balancing. The everyday decisions of governments about how much to straighten a highway, whether to put a median in a road, or where power lines or pipelines should go carry with them implicit valuations of a so-called statistical human life. If we could do the calculations, even approximately, and if it turned out we were spending several multiples of this normal statistical value of a human life on coronavirus suppression, that would be information we shouldn’t ignore.
I don’t actually anticipate precision in any such estimates may be forthcoming. But it seems on the basis of how the media herd has moved over the weekend that we may actually start discussing the trade-offs and that after weeks, maybe even a month or two, of suppression, we may decide to relax the restraints somewhat and move on to something more surgical, along the lines proposed by Katz and Ioannadis.
I should declare an interest here. I am over 65 and diabetic, so a strategy of “preferentially protecting the medically frail and those over age 60,” as Katz’ would do, would provide me with just such preferential protection. On the other hand, many of us, especially those of us who are retired, don’t have the social connections that we used to or the non-retired still do. The main obligation social distancing has imposed on me, apart from hand-washing, is to stand just a little farther from the other owners in the local dog park. I’ve worked from home — the column-writing part of my work, that is — for 40 years. And of course, being a WASP, social distance comes naturally. “Only disconnect” is our longstanding credo. (I’m not actually an anglo-saxon Protestant but was raised as a Presbyterian, which sets the standard in dourness.) In any case, the point is that for many of us older folk, the disruption from what would amount to being effectively quarantined from the other, more robust segments of the population would not be as great a shock as for those who would now be allowed to get on with their economic lives and in so doing keep the collective enterprise afloat.
Trump’s ‘Herd Mentality’ Is Going to Kill Us
The good news, Trump said, is that the virus will go away on its own. He didn’t mention the bad news: It would take two million or so of us down with it.
As Donald Trump found himself under such harsh criticism for having no plan for handling the coronavirus pandemic as the death poll approached 200,000, he concluded that revealing he has one, however appalling, is better than having none at all.
Washington only does one thing at a time and Trump is thrilled to change the subject to ramming through a Supreme Court nominee. But out in the country, death has a way of focusing the mind and more than 70 percent of Americans believe Trump is not doing enough to stop the killing.
Time then for Trump to reveal that he’s doing something other than downplaying the virus (to keep us from panicking, but let’s be serious). He divulged The Plan. “It’s going to disappear — I still say it.” He went on. “You’ll develop herd—like a herd mentality.” He meant immunity, not mentality, but hey. “It’s going to be—it’s going to be herd-developed, and that’s going to happen. That will all happen.”
Yes, and as the economist said, eventually we’re all dead. Herd immunity is a fancy term for letting Mother Nature, at her most terrifying, have her way. It relies on standing down as the virus tears through the population purposely unimpeded. When enough people get sick and die, a broad immunity occurs. At the current 2.97 percent rate of fatalities in a country of 300 million, that could mean nine million lives sacrificed to, arguably, save the rest. Using the World Health Organization’s conservative .65 percent, a figure that assumes a lower fatality rate due to undetected asymptomatic infections, leaves a mere 1.4 million Americans dead.
Even at the lower estimate, that’s a high price to pay. But with polls showing the virus is his greatest vulnerability and that voters are holding his inaction against him, Trump knows he needs to say more than “I’m not responsible, call your governor,” and “If we didn’t test so much we wouldn’t have so many cases.” Time to say the quiet part out loud: I’m doing nothing for a reason, and a “phenomenal” job of it, to boot.
The beauty of herd immunity for Trump is that it doesn’t take time from his busy TV-watching schedule to pursue it. To the contrary, herd immunity does the pursuing. It’s free, rewards passivity and works silently—at White House meetings, his convention and rallies, where taking precautions might send the signal that something’s gone terribly wrong.
Herd immunity also plays into Trump’s world view: let markets cure shortages, a simple solution is the best one, short briefings are better than long ones. Olivia Troye, the White House aide who organized the coronavirus task force briefings and just quit, described Trump, at the rare meeting he attended, complaining about his coverage, the unfairness the virus was causing him, and, on the bright side, that at least he’d no longer have to shake hands with disgusting people. The White House quickly added Troye to the long list of “disgruntled” employees, like the ones who accused him of calling the American soldiers buried in Belleau Woods suckers and losers.
Herd immunity also justifies blocking the CDC, the crown jewel of public health agencies in the world, from doing its job. Political appointees Alex Azar and Michael Caputo, now spending unplanned time with his family, overrode the CDC on school reopenings and recently put out a ridiculous advisory that people exposed to the virus don’t need a test, consistent with Trump’s belief that there is way too much testing going on for our own good, by which he means his.
To formally nip action in the bud, Azar’s issued a sweeping memo last week ordering that agencies within his department, for instance, the FDA, issue no new rules about, for instance, vaccines, unless he authorizes it. Or, to be thorough, about anything else—e coli in your lettuce, anyone? The CDC quickly ran afoul of that power grab and was quickly reined in when it posted guidance Friday stating that airborne viral droplets could travel beyond the 6 feet previously thought and attention should be paid. By Monday, droplets—and science itself—were back on indefinite leave.
Finally, there’s an explanation for all this inaction. It’s herd immunity and it explains Trump watching as Dr. Anthony Fauci presents a three-tiered plan for reopening the country but immediately telling friendly governors to ignore it. It accommodates nihilism: Have the Post Office load up 650,000 masks but not deliver them. Contradict Dr. Robert Redfield’s sworn testimony—that mask wearing is essential, more effective than a vaccine that won’t be available on Trump’s timetable—right after he gives it. The doctor was confused, said Trump, and he had radiologist Dr. Scott Atlas, whom he brought to the White House after hearing him discuss herd immunity on Fox, promise 100,000 doses of an unspecified vaccine in November and millions next year. Dr. Redfield was under oath; the president and Atlas were not.
Well before Trump talked about herd immunity on ABC, his doctor friend, Mehmet Oz, road tested it on Fox. Oz, who has the credentials of an actual M.D. but chooses to practice quackery on TV, has a smooth bedside manner, a huge female audience, and a lot to sell. If you started drinking too much red wine a few years ago, you may have heard Oz preaching the anti-aging virtues of the resveratrol in it. He loves a diet, the more extreme the better. He was early to preach the charms of hydroxychloroquine.
There was an uproar after Oz told Hannity that a mortality rate of 2 to 3 percent was an “appetizing” trade-off for jump-starting the economy and opening schools. When Oz defended himself by explaining he wasn’t targeting children, we moved on to other outrages, overlooking that he was saying to expose everyone, as Trump just reiterated on national television.
Those who would let Trump get away with shooting someone on Fifth Avenue are all-in on herd immunity, whether they realize it or not. As for the rest of us, Dr. Ashish Jha, dean of Brown University’s School of Public Health, said after Trump’s endorsement that herd immunity “is a terrible strategy that no serious medical professional thinks is a good idea.”
This month, we again commemorated the 3,000 lives lost on 9/11, the lasting sadness from that tragedy standing in sharp contrast to our collective failure to grieve the loss of more Americans in half a year than were lost in all the wars of the last half-century. Perhaps 200,000 dead is too many to absorb, no wall tall enough for that many photos, no field big enough for that many flags.
We need a president who will mark the passings, although that may be too much to ask of Trump who only stopped briefly on his way to tee time at this golf club in New Jersey to see his dying brother.
The first in-person voting has begun, each ballot cast a small act of democracy and a moment to remember the dead. It’s also an opportunity to elect a president who will grieve with us. We know why Trump has never shed a tear. For him, everything’s going according to plan.
