There is no herd immunity

In order for an infectious disease (e.g. COVID-19) to spread, the infectious agent (e.g. SARS-CoV-2) must jump from one person to another. The rate of this happening depends on the rate that an infectious person will come into contact with a susceptible person multiplied by the rate of the virus making the jump when the two people are nearby. The reproduction number R is obtained from the rate of infection spread times the length of time a person is infectious. If R is above one then a single person will infect more than one person on average and thus the pandemic will grow. If it is below one, then the pandemic will diminish. Herd immunity happens when enough people have been infected that the rate of finding a susceptible person becomes low enough that R drops below one. You can find the math behind this here.

However, a major assumption behind herd immunity is that once a person is infected they can never be infected again and this is not true for many infectious diseases such as other corona-viruses and the flu. There are reports that people can be reinfected by SARS-CoV-2. This is not fully validated but my money is on there being no lasting immunity to SARS-CoV-2 and this means that there is never any herd immunity. COVID-19 will just wax and wane forever.

This doesn’t necessarily mean it will be deadly forever. In all likelihood, each time you are infected your immune response will be more measured and perhaps SARS-CoV-2 will eventually be no worse than the common cold or the seasonal flu. But the fatality rate for first time infection will still be high, especially for the elderly and vulnerable. Those people will need to remain vigilante until there is a vaccine, and there is still no guarantee that a vaccine will work in the field. If we’re lucky and we get a working vaccine, it is likely that vaccine will not have lasting effect and just like the flu we will need to be vaccinated annually or even semi-annually.

Another Covid-19 plateau

The world seems to be in another Covid-19 plateau for new cases. The nations leading the last surge, namely the US, Russia, India, and Brazil are now stabilizing or declining, while some regions in Europe and in particular Spain are trending back up. If the pattern repeats, we will be in this new plateau for a month or two and then trend back up again, just in time for flu season to begin.

Why we need a national response

It seems quite clear now that we do not do a very good job of projecting COVID-19 progression. There are many reasons. One is that it is hard to predict how people and governments will behave. A fraction of the population will practice social distancing and withdraw from usual activity in the absence of any governmental mandates, another fraction will not do anything different no matter any official policy and the rest are in between. I for one get more scared of this thing the more I learn about it. Who knows what the long term consequences will be particularly for autoimmune diseases. The virus is triggering a massive immune response everywhere in the body and it could easily develop a memory response to your own cells in addition to the virus.

The virus also spreads in local clusters that may reach local saturation before infecting new clusters but the cross-cluster transmission events are low probability and hard to detect. The virus reached American shores in early January and maybe even earlier but most of those early events died out. This is because the transmission rate is highly varied. A mean reproduction number of 3 could mean everyone has R=3 or that most people transmit with R less than 1 while a small number (or events) transmit with very high R. (Nassim Nicholas Taleb has written copiously on the hazards of highly variable (fat tailed) distributions. For those with mathematical backgrounds, I highly recommend reading his technical volumes: The Technical Incerto. Even if you don’t believe most of what he says, you can still learn a lot.) Thus it is hard to predict when an event will start a local epidemic, although large gatherings of people (i.e. weddings, conventions, etc.) are a good place to start. Once the epidemic starts, it grows exponentially and then starts to saturate either by running out of people in the locality to infect or people changing their behavior or more likely both. Parts of New York may be above the herd immunity threshold now.

Thus at this point, I think we need to take a page out of Taleb’s book (like literally as my daughter would say), and don’t worry too much about forecasting. We can use it as a guide but we have enough information to know that most people are susceptible, about a third will be asymptomatic if infected (which doesn’t mean they won’t have long term consequences), about a fifth to a tenth will be counted as a case, and a few percent of those will die, which strongly depends on age and pre-existing conditions. We can wait around for a vaccine or herd immunity and in the process let many more people die, ( I don’t know how many but I do know that total number of deaths is a nondecreasing quantity), or we can act now everywhere to shut this down and impose a strict quarantine on anyone entering the country until they have been tested negative 3 times with a high specificity PCR test (and maybe 8 out of 17 times with a low specificity and sensitivity antigen test).

Acting now everywhere means, either 1) shutting everything down for at least two weeks. No Amazon or Grubhub or Doordash deliveries, no going to Costco and Walmart, not even going to the super market. It means paying everyone in the country without an income some substantial fraction of their salary. It means distributing two weeks supply of food to everyone. It means truly essential workers, like people keeping electricity going and hospital workers, live in a quarantine bubble hotel, like the NBA and NHL or 2) Testing everyone everyday who wants to leave their house and paying them to quarantine at home or in a hotel if they test positive. Both plans require national coordination and a lot of effort. The CARES act package has run out and we are heading for economic disaster while the pandemic rages on. As a recent president once said, “What have you got to lose?”

The battle over academic freedom

In the wake of George Floyd’s death, almost all of institutional America put out official statements decrying racism and some universities initiated policies governing allowable speech and research. This was followed by the expected dissent from those who worry that academic freedom is being suppressed (see here, here, and here for some examples). Then there is the (in)famous Harper’s Magazine open letter decrying Cancel Culture, which triggered a flurry of counter responses (e.g. see here and here).

While some faculty members in the humanities and (non-life) sciences are up in arms over the thought of a committee of their peers judging what should be allowable research, I do wish to point out that their colleagues over on the Medical campus have had to get approval for human and animal research for decades. Research on human subjects must first pass through an Institutional Review Board (IRB) while animal experiments must clear the Institutional Animal Care and Use Committee (IACUC). These panels ensure that the proposed work is ethical, sound, and justified. Even research that is completely noninvasive, such as analysis of genetic data, must pass scrutiny to ensure the data is not misused and subject identies are strongly protected. Almost all faculty members would agree that this step is important and necessary. History is rife of questionable research that range from careless to criminal. Is it so unreasonable to extend such a concept to the rest of campus?