What people get wrong about herd immunity, explained by epidemiologists

““Herd immunity is the only way we’re going to move to a post-pandemic world,” says Bill Hanage, an epidemiology researcher at Harvard. “The problem is, how do you get to it?”

Typically, the term herd immunity is thought of in the context of vaccination campaigns against contagious viruses like measles. The concept helps public health officials think through the math of how many people in a population need to be vaccinated to prevent outbreaks.

With Covid-19, since we don’t yet have a vaccine, the discussion has centered on herd immunity through natural infection, which comes with a terrible cost. Confusing matters, too, is the persistent and erroneous wishful thinking by some who say herd immunity has already been reached, or will be reached sooner than scientists are saying.”

“Hypothetically, yes, there are situations under which herd immunity to Covid-19 could be achieved. Manaus, Brazil, an Amazonian city of around 2 million people, experienced one of the most severe Covid-19 outbreaks in the world. At the peak in the spring and early summer, the city’s hospitals were completely full, the New York Times reported.

During this period, there were four times as many deaths as normal for that point in the year. But then, over the summer, the outbreak sharply died down. Researchers now estimate between 44 percent and 66 percent of the city’s population was infected with the virus, which means it’s possible herd immunity has been achieved there. (This research has yet to be peer-reviewed.)

But that’s much higher than 22 percent, and the cost of this herd immunity was immense: Between 1 in 500 and 1 in 800 residents died there, the researchers estimate.”

“the oft-cited example of Sweden, which has pursued a laxer social distancing strategy than its European peers (partially with the goal of building up herd immunity in younger people, while protecting older residents and trying to keep hospitals from exceeding capacity), has paid a price, too: a much higher death rate than fellow Scandinavian countries.”

“Regardless of the exact figure, as a country, the US is nowhere near reaching this threshold. In New York City, which experienced the worst coronavirus outbreak in the US, around 20 percent of residents got infected and 23,000-plus people died. Overall, a new Lancet study — which drew its data from a sample of dialysis patients — suggests that fewer than 10 percent of people nationwide have been exposed to the virus. That means we have a long, sick, and deadly way to go if the US is going to reach herd immunity through natural infection.

So far, there have been more than 200,000 deaths in the United States, with relatively few infections. There’s so much more potential for death if the virus spreads to true herd immunity levels. ”

“The herd immunity threshold can be lower than estimated. But hypothetically, the threshold could be higher as well. It’s also the case that the herd immunity threshold can change over time. Remember the simple math of how herd immunity calculated: The threshold is dependent on the contagiousness of the virus.

Well, the contagiousness of the virus isn’t a fixed biological constant. It’s the result of the biology of the virus interacting with human biology, with our environments, with our society. As seasons change, as our behavior changes, so can the transmissibility of the virus. The herd immunity threshold is not one fixed target.”

“Once you hit the herd immunity threshold, it doesn’t mean the pandemic is over. After the threshold is reached, “all it means is that on average, each infection causes less than one ongoing infection,” Hanage says. “That’s of limited use if you’ve already got a million people infected.” If each infection causes, on average, 0.8 new infections, the epidemic will slow. But 0.8 isn’t zero. If a million people are infected at the time herd immunity is hit, per Hanage’s example, those already infected people may infect 800,000 more.”

““I think it’s impossible to think that you can have infections only among younger people, and not let them spread to other groups with populations that might be more vulnerable,“ Tedijanto says. People just don’t separately themselves so neatly into risk groups like that.

“We can try and insulate” older people, Hanage says. “We can do a very good job of insulating them. But the fact is, the larger the amount of infection outside them, the higher the chance that something’s going to get into them.””

Drug overdoses were increasing before Covid-19. The pandemic made things worse.

“Even before the pandemic, there were signs that the drug overdose crisis was worsening. Preliminary data from the Centers for Disease Control and Prevention (CDC) found drug overdose deaths hit 72,000 in 2019, up almost 5 percent from nearly 69,000 in 2018. A preliminary study from researchers at Stanford, UCLA, and the Los Angeles LGBT Center found that fentanyl, a synthetic opioid more potent and dangerous than heroin, has started to spread to illegal drug markets in the West — a trend that will likely cause more overdoses.”

“The demands of social distancing have worsened social isolation, possibly leading more people to use drugs to cope. Social services and addiction treatment programs — many of which already lacked funding and rigor — have fallen to the side as the economic collapse has crushed public and private revenues, and social distancing has forced some places to close.
Meanwhile, the actions that different levels of government have taken to shore up the gaps caused by the pandemic simply haven’t been enough. As experts told me, telemedicine — while certainly helpful for many and better than nothing — simply can’t make up for being able to pick up new syringes or naloxone, the opioid overdose antidote, at the local needle exchange program.

The result: As America sees more than 166,000 Covid-19 deaths (and rising), it’s also suffering tens of thousands of drug overdose deaths due to a decades-old crisis now likely worsened by the coronavirus pandemic.”

America is failing Black moms during the pandemic

“Black women are disproportionately impacted, dying in childbirth at three to four times the rate of white women.”

“Many factors contribute to overall maternal mortality in the US, from underlying conditions like diabetes to a lack of adequate health insurance. All of these disproportionately impact Black women — Black Americans, for example, are 60 percent more likely than whites to be diagnosed with diabetes. And 11.5 percent of Black Americans were uninsured as of 2018, compared with just 7.5 percent of whites.”

“For Black women, “even when we get prenatal care,” Crear-Perry explained, “even when we are normal weight and not obese, even when we have no underlying medical conditions, we are still more likely to die in childbirth than our white counterparts.” In New York City, for example, a 2016 study found that Black patients with a college education were more likely to have pregnancy or childbirth complications than white patients who hadn’t graduated from high school.”

“Part of the issue is that providers treat Black patients differently from white ones. Black women and other women of color often aren’t listened to when they express pain or discomfort, Jamila Taylor, director of health care reform at the Century Foundation, told Vox.
Racist beliefs about people’s bodies and their ability to experience pain are shockingly widespread: Half of the white medical students and residents surveyed in one 2016 study, for example, believed at least one myth about racial differences in pain perception, such as the idea that Black people’s nerve endings are less sensitive than white people’s. The more myths someone believed, the more likely that person was to underestimate a Black patient’s pain.”

“Advocates have long been calling for greater access to non-hospital births, whether at a birthing center or at home, as a way to combat the discrimination Black patients and other patients of color can face in hospital settings. “Other countries that have better outcomes than we do create a system and a network of birth centers and home births that allow for people to make choices based upon their needs,” Crear-Perry said.”

Daily COVID-19 Deaths in the U.S. Have Fallen Dramatically Since April

“The seven-day rolling average of daily deaths, which peaked at 2,210 on April 18, had fallen to 605 as of yesterday—a 73 percent drop. The downward trend has continued for more than a month since mid-May, when the impact of post-lockdown infections should have started to show up in fatality figures. In Texas, for example, the seven-day average fell from 58 on April 30, when the statewide lockdown was lifted, to 20 on June 13 before climbing to 30 as of yesterday.

Some states, including Texas, have seen notable increases in confirmed cases and hospitalizations since late May. Those increases, which cannot be fully explained by expanded virus testing, may be related to Memorial Day gatherings and the mass protests against police brutality triggered by George Floyd’s death. The spike in cases that states such as Texas have seen can be expected to result in more deaths during the next couple of weeks than otherwise would have occurred. But if epidemiologists are correct in thinking that superspreading events on and after Memorial Day explain recent surges in infections—which makes senses given the timing—the resulting rise in daily deaths should be temporary.”

Do more guns facilitate more deaths? Video Sources.

Homicide Harvard Injury Control Research Center. Havard T.H.Chan School of Public Health. FIREARMS AND FAMILY VIOLENCE Arthur Kellermann, Sheryl Heron. 1999. Emergency Medicine Clinics of North America. https://www.sciencedirect.com/science/article/abs/pii/S0733862705700924 Firearm possession and violent death: A critical review Wolfgang Stroebe. 2013. Aggression and Violent

How the Supreme Court enabled police to use deadly chokeholds

“injunctions. When a court enjoins a particular defendant, they don’t just order that defendant to cease a particular behavior, they also can enforce that order with criminal sanctions or by imposing escalating fines until the defendant ceases their illegal conduct. A party subject to an injunction, in other words, can be squeezed so hard by court sanctions that they have no choice but to change their behavior.

Consider the case of Eric Garner, who was killed by a New York police officer’s chokehold in 2014. Although the NYPD had a formal policy barring chokeholds, it was frequently unenforced. The city’s Civilian Complaint Review Board received 219 chokehold complaints against NYPD officers in just one year.

If one of the victims of those chokeholds had obtained an injunction against the NYPD, then a court could have imposed strict sanctions on the city until police chokeholds ceased. And Eric Garner might be alive today.”

Has Sweden found the best response to the coronavirus? Its death rate suggests it hasn’t.

“using the Our World in Data website’s coronavirus statistics, helps put Sweden’s situation in perspective. It compares countries’ rates of coronavirus deaths per 1 million people.
As the chart shows, Sweden is actually faring worse than other Scandinavian nations and even worse than the United States, which has the highest number of confirmed total cases in the world.”

“Following the advice of the country’s chief epidemiologist, Anders Tegnell, the Swedish government chose not to impose strict lockdowns, curfews, or major border closings because the government felt it would hurt the economy and would only push the crisis further down the road.”

“while experts say the vast majority of Swedes followed the government’s social distancing guidelines and voluntarily stayed home, those who continued to drink at bars and shop at stores likely spread the disease around.”

“Sweden’s public health officials now admit: That “more than 26 percent of the 2 million inhabitants of Stockholm will have been infected by May 1.””

“Where Sweden does compare favorably to the US is the country’s death rate when compared to New York City’s (not the whole US). About 12,000 reported deaths as of April 28 in a city of 8 million is surely worse than 2,300 deaths in a country of 10 million.

But there are three main reasons why the Big Apple would be worse off than the entire country of Sweden, experts say.

The first is population density: New York City has more than 38,000 people per square kilometer, while Sweden has just 25 people — meaning it’s harder to socially distance in New York.

Second, some hospitals in New York City were overwhelmed while Sweden still has about 250 hospital beds unoccupied. There are indications, though, that the hospital surge in New York City is declining.

Finally, there is significantly more international travel to New York City than there is to Sweden, which means there were more opportunities for people from countries suffering from severe outbreaks to spread the virus to the city than to the European country.

But when zooming out, it’s clear that Sweden as a whole is worse off than the US as a whole. That could, of course, change down the line, but any current arguments that Sweden got its outbreak response right are premature at best and dangerous at worst.”

Russia’s coronavirus outbreak is getting bad. Putin says the worst is yet to come.

“As of April 28, Russia reported nearly 100,000 confirmed coronavirus cases and nearly 1,000 deaths. Those numbers make Russia the eighth-hardest-hit country in the world.
Russian President Vladimir Putin on Tuesday admitted that the country had a shortage of critical personal protective equipment for health care workers, and warned that the worst the pandemic is yet to come.

“Ahead of us is a new stage, perhaps the most intense stage of the fight against the epidemic,” he said in a national address, in which he also announced an extension of his nation’s lockdown until May 11. “The risks of getting infected are at the highest level, and the threat, the mortal danger of the virus persists.”

“Russia has managed to slow down the spread of the epidemic, but we haven’t passed the peak yet,” Putin continued.

His pessimism is warranted. Hospitals have become overrun with patients, leaving ambulances stuck idling in long lines outside hospitals just to deliver sick patients. At least one driver had to wait about 15 hours. Moscow might run out of intensive care unit beds before the end of this week. And nurses have quit en masse to protest poor working conditions and low pay.

Millions of Russians could lose their jobs this year due to the lockdown and oil revenues, which make up a significant portion of Russia’s economy, have dropped sharply as people around the world have stopped traveling and business have shuttered due to the coronavirus.”

Trump is keeping meatpacking plants open — but employees are scared to show up for work

“More than 3,000 meat processing workers across the country have tested positive for the virus in recent weeks, leading to additional spread in their communities, and more than 15 have died. Dozens of facilities have been forced to close temporarily or indefinitely.

Executives at America’s largest meat and poultry processing companies have warned of disastrous consequences for consumers should these facilities stay closed: Tyson Foods chair John Tyson said on Sunday that the “food supply chain is breaking.” Livestock prices have plunged because farmers have nowhere to send their animals for slaughter, while the price of consumer-ready meat has spiked.

While supply chain experts don’t anticipate a nationwide shortage of meat in light of the recent closures, they say there could be spot shortages at local grocery stores of certain types or cuts of meat.

But reopening the plants could come at great cost to their workers, who assert that their companies are doing too little to protect them from the virus. They say companies are failing to enforce social distancing on the production line and only recently beginning to offer additional protective equipment, if they do so at all.

Many employees also say they don’t have paid sick leave, health benefits, or substantial savings, offering them little assurance should they get infected and incentivizing them to work while sick.”

“Trump’s executive order instructs the Department of Agriculture to ensure that meat and poultry plants can continue operating uninterrupted as much as possible while abiding by guidance for Covid-19 preparedness issued by the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. The executive order leaves room for the agency to provide personal protective equipment to workers or issue additional regulations concerning worker safety — but it doesn’t explicitly provide any additional worker protections.”