Andy Gong: Herd Immunity as a Public Health Measure to control COVID-19—Possible or Ridiculous?

Haoyang Shi
Oct 14, 2020
9 min read

Beneficial or detrimental

Safe or too risky

Plausible or impossible

This is a guest article by [ink.] reader Andy Gong from Vancouver, Canada. Email him at donkerklaw@gmail.com, or visit his YouTube channel at Fun Facts Fun World and his seminars hosted on iExplore.

Introduction

COVID-19 and Herd Immunity Appearance

At the start of 2020, countries around the world were ravaged by the emergence of a brand new disease, COVID-19. This disease is a highly transmissible lung infection that can lead to serious complications. COVID-19 quickly spread around the world, with governments frantically trying to control the situation and halt the outbreak. Amidst all the calls for strict lockdowns, quarantine and vigorous testing came a different and somewhat controversial opinion surfaced. This opinion was supported by public health experts and government officials in the UK. This was the idea to utilize a naturally occurring reaction when an infectious disease starts an outbreak: herd immunity. The UK Department of Health believed that herd immunity would be an effective way to control COVID-19 and considered implementing it. This would mean no measures of containment whatsoever. After this plan was publicized, there was widespread criticism of the UK Government. Of course, soon after the plan was revoked, and the UK settled back to the usual quarantine and containment measures. The question is, was herd immunity a radical and invalid idea? Were the experts actually incompetent? In order to answer these questions, first, we need to understand some facts.

Mechanisms of the Human Immune System

First of all, we need to understand how the human immune system operates, specifically, how immune memory works. When a pathogen is detected by the immune system, it is engulfed and broken down by the immune cell that found it, usually a macrophage. This cell would then travel to a CD4-Plus T-Cell, and present these cells with an antigen, or a piece of the pathogen. This can trigger one of two responses. One possible response is that the T-Cell recognizes the antigen as benign and ignores it. Another possible outcome is that the T-Cell recognizes the antigen as harmful and initiates an immune response. In the case of the immune response, the antigen is remembered by the immune system. This is done by the body producing memory B-Cells. These cells only look for that one specific antigen, and if they ever detect that antigen, they will produce antibodies and start an immune response.

Two ways of utilising Immune Memory Response

Immune memory is commonly used by humans in the form of vaccines. Vaccines use none disease-causing antigens taken from the actual pathogen itself. This can be dead or deactivated forms of the pathogen. The injection of these antigens then allows the immune system to recognize the antigen and start the immune response and memory process. After that, when the real antigen invades the vaccine recipient, it will be annihilated by the memory mechanism. It is worth pointing out, however, that developing a vaccine is no easy task.

Epidemiologists first would have to find out which form of the pathogen is safe to inject and also be enough to cause the desired immune response. Then clinical trials take place: clinical trials aim to make sure the vaccine is safe and effective. Clinical trials also allow medical care providers to learn the side effects or complications for a specific vaccine. There are typically 4 to 5 stages of clinical trials, and starting from stage three there are large numbers of participants. A vaccine can be approved for usage if its test results from stage 1, 2, 3 are all positive and the situation is severe enough. Stage 3 trials usually take months to years, however, so in the meantime, what else can we do to create herd immunity? To trigger herd immunity, there needs to be a course of action that allows the trigger of the immune memory response in large groups of people.

There is one other way to trigger the immune memory, and that is to catch the disease itself. This works well against diseases with a very low death rate, as during the whole process the patient will only experience light illness. This effect is naturally occurring and useful when the vaccine to the specific disease is still in the “developing” stage. Disease outbreaks can create the phenomenon in such a great number that a large number of individuals in a community ends up being immune to the disease. The rest that is not immune will no longer contract the disease as there is no one to spread it to them, all others are all immune. This is known to science as herd immunity. Herd immunity is effective against highly transmissible but less fatal diseases, as these types often die out if the number of vulnerable people are low. This is because many pathogens cannot survive very long outside of a host. All these naturally occurring phenomena can be utilized to help humans face down our current issue of COVID-19, as at the time of writing there is no vaccine for COVID-19, and the disease is only a threat to certain groups of people and is highly transmissible.

Discussion

Comparing the effectiveness of quarantine measures with herd immunity Utilizing Herd Immunity to control the spread of COVID-19 could lead to the same result as strict quarantine measures and global lockdown: turn COVID-19 into a seasonal disease. A great example of quarantine measures resulting in this is China. At the beginning of the outbreak, China took extreme measures of containment against COVID-19. A documentary during the early stages of the pandemic in Wuhan revealed containment measures on another level to the rest of the world. For example, any items brought into an ICU ward of a COVID-19 patient will never leave that room until after the entire outbreak is over. The reporters who filmed the ward had to use a waterproof camera that was later submerged in disinfectants for 2 whole days before being allowed out of the ward. Cities across China set up quarantine stations and testing stations. Online registration of health status was implemented in multiple cities, as well as door-to-door inquiry conducted by healthcare officials. China has currently lifted the majority of its containment measures, and citizens are continuing their lives as normal. Yet there are still a few thousand cases of COVID-19 in China, and the occurrence of these cases does not seem to be permanently stopping anytime soon.

This signals that COVID-19 is here to stay, causing a handful of cases here and there occasionally. This is because since COVID-19 is so similar to the flu, most epidemiologists speculate that COVID-19, unlike smallpox, cannot be directly wiped out by a vaccine campaign. COVID-19 will more likely become either similar the situation with MERS (Middle East Respiratory Syndrome), and become local nuisances in some countries. COVID-19 also has the potential of becoming a disease like the seasonal flu, causing outbreaks in certain seasons and then dying down as the season progresses. This means that we can choose to put the world on pause by continuing quarantine measures and turn COVID-19 into a seasonal nuisance, or we can consider herd immunity as an alternative, which will allow us to operate our world normally and still achieve the same or better result. Scientific data from the WHO, CDC and Mayo Clinic suggests that part of the reason seasonal flu is seasonal is herd immunity. Typically, seasonal flu outbreaks infect too many people, thus creating a natural here immunity barrier for itself, and then they die down, mutate, and come back after they acquire enough mutations to bypass the herd immunity barrier or the barrier disappears due to time. Or in other words, every disease outbreak will create a herd immunity barrier for itself.

Epidemiologists also agree that every disease outbreak has a peak point, doing which high numbers of people are infected. Then, as the number of vulnerable individuals drops, so does the number of confirmed cases. For diseases like the black-death, vulnerable individuals dropped in number due to high fatality. For COVID-19, the flu and other milder diseases however, the number of vulnerable individuals drop due to herd immunity. This means that implementing herd immunity can allow a disease to stop itself.

Downsides of Quarantine

For diseases such as a COVID-19, implementing quarantine measures can be very taxing on a country. During a pandemic, if a country chooses to implement measures of containment, there will be sacrifices made. For example, implementation of social distancing and banning large gatherings severely undermined businesses like restaurants and bars. Travel restrictions took a big toll on the aviation industry and the cruise industry. Lockdowns in cities, widespread testing and setting up quarantine facilities taxed the economy greatly. Let alone the negative impact on the quality of education that school closures have had, especially on those with learning disabilities or are of a very young age. A lot of people also became unemployed due to the pandemic, and are struggling to sustain their lives. Another commonly ignored impact is that people with chronic and terminal diseases will not be able to access treatment due to containment measures in hospitals. From a list of doctors that died fighting the pandemic in China, 3 died because their terminal illness could not be treated because of COVID-19 control measures. Terminal and chronic diseases can include TB, Hepatitis, Cancer and more. All these factors combined can have significant negative impacts on any country. This leads to tension and conflict, both inside a country and on an international level. For example, historians believe that the Spanish flu outbreak of 1918 contributed to the start of WW2. For a current day comparison, tension has risen between China and the US due to COVID-19. Many countries have seen protests related to the outbreak, as well. This amount of negative impacts and sacrifices are made as an attempt to get the same result that we would get from herd immunity: COVID-19 changes from a pandemic into a controlled seasonal illness.

Potentials of herd immunity

Additionally, the implementation of herd immunity goes with the principle of Utilitarianism. Utilitarianism means that society as a whole should perform actions that benefit the most people. When comparing herd immunity to strict quarantine measures, it is apparent that while quarantine can save a certain number of lives, the fact that it also happens to destroy the lives of every single person in the entire world is very much undeniable. However, while herd immunity will see more casualties in the short term, it does not require the whole world to be put on pause. herd immunity can also reduce the amount of resources required to mass-produce vaccines in the future.

Herd immunity will lead to a drastically smaller chance of a reemergence of COVID-19. If a country implemented very strict containment measures to stop a pandemic of a very infectious disease, the measures can end the outbreak as time goes on. However, The containment measures leave a majority of the population still susceptible to the disease. This means that there is a high chance that the disease can come roaring back after containment measures are dropped. This is due to the fact that after quarantine measures are lifted, there are still massive numbers of individuals that are still susceptible to the pathogen causing the outbreak. If we move into more realistic grounds and take COVID-19 as an example, we can see that China’s response to COVID-19 resurgence in Beijing basically set everyone back into panic mode with half the city under lockdown. The Beijing resurgence is also only a small one. A resurgence on a massive scale can be even worse than the initial outbreak, as the country affected is exhausted from bringing down the previous wave. On the other hand, herd immunity will not face a similar problem. First off, herd immunity has a lesser chance of allowing a resurgence. This is due to the fact that most of the population would be immune to the disease and thus leaving it no room to spread. Studies conducted on diseases similar to COVID-19, like the seasonal flu, shows that viruses usually take up to almost a year to mutate around the barrier herd immunity creates, thus buying time for more research to be done on a COVID-19, allowing the production of vaccines, cures and prediction of the pattern seasonal COVID-19 would form. This means that we can easily control COVID-19 and prevent future outbreaks. Also, even if COVID-19 resurges in a country that had high numbers of vulnerable individuals, it will not be able to cross borders due to herd immunity, whereas quarantine measures could be the crashing of a country's economy, the disease resurges after measures drop and another outbreak starts. Repeated outbreaks can mean endless cycles shutdowns and reopenings, utterly destroying a country's economy. Citizens of the country will lose trust and confidence in their government's ability to deal with the situation, leading to civil unrest.

Conclusion

In the face of a pandemic, humanity faces many choices. To survive and continue our society, we must choose wisely. In certain cases, that would mean choosing the option that seems like it is wrong. Herd immunity might seem like a counterintuitive choice, but in some cases, it is the right choice. Herd immunity, as a naturally occurring phenomenon that is triggered by the outbreak of disease, can be utilized to contain a disease outbreak that meets certain requirements. A common argument against herd immunity is the high death toll, which is why herd immunity is only effective against highly transmitted but low-fatality diseases. Even though herd immunity is only effective in some cases, it is the best option however, when it becomes an option.

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