Would you be willing to get sick for a few weeks and risk an approximately 1 in 700 chance of dying, in order to safeguard the lives of elderly and immune-compromised persons, and to return to normality in a month or two, rather than have everything shut down for potentially many months?
Here I want to put out exactly this idea. On the one hand, as a serious suggestion, though I don't think it likely to be taken up on a wide-scale. On a small community scale, I wouldn't be surprised if somewhere some few family groups actually take the proposed step. On the other hand, as food for thought for those unhappy with the measures currently being taken: what is the real alternative, if we don't want to have a pandemic comparable to that of the Spanish flu or the plague?
In attempts to contain or slow down the spread of the new corona virus SARS-CoV-2, governments have been taking fairly strong measures over the past months. Italy has been in varying degrees of lock down for some time. Beginning Monday in Austria, there are to be no public events, including no public Masses, classes in schools will stop beginning Monday or Wednesday depending on the school level (for the upper levels learning is expected to contain with electronic contact with teachers), employers are being encouraged to allow employees to work from home as far as that is possible, etc., to reduce social contact as far as possible, etc.
At least until recently, not a few persons argue that the current number of cases and deaths is still far below that of influenza, and so these measures are excessive.
The goal of these measures is, in most cases, not to stop the spread of the virus altogether or eliminate it, which is almost certainly no longer possible (unless a self-test for the virus that gave immediate results could be mass produced and distributed to all households or something), but to slow it down, to keep hospitals and other medical support systems from being overloaded, so that the mortality rate among those who WILL get sick can be kept as low as possible, and to gain time to test treatments against the sickness COVID-19 and perhaps to develop a vaccine.
In many countries people have been stocking up on non-perishable goods (beans, rice, pasta, toilet paper), though no real shortage of these on the production side is to be expected, and in most cases, even in the event of a quarantine, family or friends would be able to take care of purchasing what was needed. In some respects solidarity in countering the virus has been increasing, but the stocking up or hoarding there still seems to be a bit of the attitude of "every man for himself".
Here I want to throw out a radical approach, somewhat akin to the approach Austria is taking, yet still more radical, requiring still greater solidarity and selflessness, but very possibly more effective in the long term. Basically, the idea is that young and healthy persons voluntarily expose themselves to the virus, then remain in strict quarantine until the risk of passing it on the others has passed.
If the reports are correct, the UK is inclined to resign itself to the fact that the virus will be stopped until a kind of herd immunity is reached, and measures are intended only to slow down the infections until that point is reached. Well, why not do it the other way other around, hurry up and get it over with? More rapidly reach herd immunity or resistance, while limiting it to those least affected and least likely to die of it?
The relative newness of the virus means that our data on its transmission, symptoms, treatment, etc. is quite limited.
The measures currently being taken, reducing social contact etc., are only effective for as long as those are in effect. On the other hand, it is highly likely, though not 100% certain, that those who have been infected and recovered, are not able or are unlikely to be reinfected, and so also unlikely to be carriers.
Now, the virus hits older persons much harder than young persons. Current statistics show no deaths for children under 10, a 0,2% death rate in those under 40 years of age who get sick, whereas a death rate rising from 3% to 15% in those 60 to 80+ years of age. And a higher death in those with preexisting conditions. So, finally, it is the elderly and those who preexisting health conditions that one is most concerned with protecting.
The worst case scenario with a uncontrolled spread of the virus would entail around 50-60% of the population getting infected within the next 6 months to 2 years. If 50% of those over 60 get sick, and these make up 15% of the population, that would mean the death of 1% of the population, probably more, given that intensive care could not be provided for all.
So, one possible approach, in the absence of a vaccine (and given that it could quite possibly be a year or more till a vaccine is widely available) to rapidly increasing herd resistance to the virus is to have all, or many of those who are relatively unlikely to die of the sickness (Healthy individuals under 40 with no preexisting conditions), and who are able to stay in strict quarantine for two weeks, to voluntarily expose themselves to the virus. Of course, some small percentage of these would in consequence die, so they would all have to be willing to undergo the risk of their own death for the sake of the common good. Let's say around 25% of the population is young enough, in good health, able to cease work for the next weeks (so probably not those in the medical profession). In terms of overall deaths, that might end up being around 0,05% of the population, much less than the worst case scenario and even less than some of the mid-case.
If such measures were to be taken without delay, there would still be medical facilities available to care for the small proportion of those voluntarily infected individuals who do wind up more seriously effected.
This step would, on the one hand, greater increase herd resistance to the virus, and therefore greatly slow down the spread of the virus. At the same time, since we would have many persons infected at a known point in time and be able to observe them, we would be able to more rapidly acquire knowledge about the virus, and be more quickly equipped to deal with it.
Such a radical step requires, of course, on the economical side, the ability for many working persons to voluntarily take off the next two weeks of work. In the USA this would probably require government intervention, and be politically nearly impossible.
With the social and political system in Austria such a step might be feasible, and, with the right presentation of the idea, might even be acceptable.
Of course, on the social level, the proposed step could be taken in various degrees: families with children under 10 able to stay at home for four weeks could let their children expose themselves to the virus and have their child remain in quarantine for that time, doing everything possible to avoid older children or the parents being infected — to mitigate even the small risk of death for the parents, while increasing the herd resistance. Or again, younger persons in the medical profession might seek immunity through voluntary infection at this time, to ensure that they are able to care for others in the event that many of their colleagues get sick involuntarily.
On the morality of such a step, it seems clear that, if deliberately infecting yourself were, in fact, determined to be the best means of protecting your family members (in particularly the elderly) or society as a whole from the virus, it would be a morally acceptable means. "Greater love has no one than this, that one lay down his life for his friends." (John 15:13) The same applies to risking one's life for others.
Disclaimer: the idea just occurred to me today, I haven't thought through all the implications; there are a lot of uncertainties, including the effectiveness of this step, as it is theoretically possible that those infected and recovered might, after a certain period of time, lose their immune response and be able to be reinfected. I am NOT encouraging any individuals to deliberately expose themselves to the virus, much less encouraging any states to deliberately have people infected.
4 thoughts on “Approaches to the Coronavirus – a Radical Idea”
This is an ingenious idea, but rests on the unconfirmed view that COVID 19 is not susceptible of second attacks. Before the development of the yellow fever vaccine, survivors of yellow fever, which does not strike twice, were used, for example, in clinical settings.
Thus far, neither CDC nor WHO has stated whether second attacks occur with COVID 19. Until they do, your ingenious idea should, I think, remain in posse rather than in esse.
The other difficulty is that rendering large numbers of the population infected will lead to herd immunity if and only if herd immunity sets in at a low level. Unfortunately, herd immunity against measles, to pick but one example, sets in only at about 95 percent protection (whether by vaccination or by exposure to the measles virus). There were, in the pre-vaccine era, "measles parties" held in many American communities so that the susceptible children would be infected and then recover. This, unfortunately, did not stop transmission, since only comprehensive vaccination, after 1962, was capable of assuring high enough levels of community protection to assure herd immunity.
Bob Davis, Johns Hopkins '78
Thanks for your response.
I agree that the idea "rests on the unconfirmed view that COVID 19 is not susceptible of second attacks." I noted that uncertainty in the last paragraph.
As far as I've gathered, it is generally considered at least probable that a substantial degree of immunity is attained by those who have been infected at then recovered. Even the persistence of the virus for a period after the disappearance of symptoms lends some support for this view, as the viruses that last longer often provoke more lasting immune system responses.
But it is, of course, not certain.
It would be valuable, if persons were willing and it is considered ethically acceptable, to accelerate the gathering of evidence by, e.g. healthy young persons who have recovered from the virus some time ago and had mild symptoms or were asyptomatic, voluntarily exposing themselves again to the virus. That still wouldn't tell us how long immunity lasts, if it does, but might show that it lasts at least two months or however long the period is from the first recoveries till today. If I were to have been infected relatively early with the virus, had only mild symptoms and recovered, I would be willing to take part in this (only slightly risky) clinical experiment.
Measles is many times more infectious than corinavirus, that is why herd immunity requires 95%. Corinavirus wouldn't require as much.
Again, what I called herd resistance kicks in before that, slowing down the spread and reducing while not eliminating the risk of individuals getting sick.
Robin Hanson made a similar suggestion: http://www.overcomingbias.com/2020/02/consider-controlled-infection.html , and http://www.overcomingbias.com/2020/02/deliberate-exposure-intuition.html