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Slowing down the pandemic: What if herd immunity is closer than we thought?
In what could possibly be the world’s most important mathematic puzzle, researchers the world over are trying to figure out how many people in a community must be immune before the coronavirus fades into oblivion
We’ve known from the beginning how the end will arrive. Eventually, the coronavirus will be unable to find enough susceptible hosts to survive, fading out wherever it briefly emerges. To achieve so-called herd immunity — the point at which the virus can no longer spread because there are not enough vulnerable humans — scientists have suggested that perhaps 70 per cent of a given population must be immune, through vaccination or because they survived the infection. Now some researchers are wrestling with a hopeful possibility. In interviews with The New York Times, more than a dozen scientists said that the threshold is likely to be much lower: just 50 per cent, perhaps even less. If that’s true, then it may be possible to turn back the coronavirus more quickly than once thought.
The new estimates result from complicated statistical modeling of the pandemic, and the models have all taken divergent approaches, yielding inconsistent estimates. It is not certain that any community in the world has enough residents now immune to the virus to resist a second wave. But in parts of New York, London and Mumbai, for example, it is not inconceivable that there is already substantial immunity to the coronavirus, scientists said.
“I’m quite prepared to believe that there are pockets in New York City and London which have substantial immunity,” said Bill Hanage, an epidemiologist at the Harvard TH Chan School of Public Health. “What happens this winter will reflect that.” “The question of what it means for the population as a whole, however, is much more fraught,” he added.
Herd immunity is calculated from the epidemic’s so-called reproductive number, R0, an indicator of how many people each infected person spreads the virus to. The initial calculations for the herd immunity threshold assumed that each community member had the same susceptibility to the virus and mixed randomly with everyone else in the community. “That doesn’t happen in real life,” said Dr Saad Omer, director of the Yale Institute for Global Health. “Herd immunity could vary from group to group, and sub-population to sub-population,” and even by postal codes, he said.
For example, a neighbourhood of older people may have little contact with others but succumb to the virus quickly when they encounter it, whereas teenagers may bequeath the virus to dozens of contacts and yet stay healthy themselves. The virus moves slowly in suburban and rural areas, where people live far apart, but zips through cities and households thick with people. Once such real-world variations in density and demographics are accounted for, the estimates for herd immunity fall. Some researchers even suggested the figure may be in the range of 10 to 20 per cent, but they were in the minority. Assuming the virus ferrets out the most outgoing and most susceptible in the first wave, immunity following a wave of infection is distributed more efficiently than with a vaccination campaign that seeks to protect everyone, said Tom Britton, a mathematician at Stockholm University.
His model puts the threshold for herd immunity at 43 per cent — that is, the virus cannot hang on in a community after that percentage of residents has been infected and recovered. Still, that means many residents of the community will have been sickened or have died, a high price to pay for herd immunity. And experts like Dr Hanage cautioned that even a community that may have reached herd immunity cannot afford to be complacent. The virus may still flare up here and there, even if its overall spread is stymied. It’s also unclear how long someone who has recovered may be immune, and for how long.
The coronavirus crashed this year’s Purim celebrations in the Orthodox Jewish neighbourhoods of New York City, tearing through the parades and masquerades in Brooklyn on March 9 and 10. Schools and synagogues soon shut down to quell the spread, but it was too late. By April, thousands in the Brooklyn communities were infected, and hundreds had died. “It’s like a black hole in my memory because of how traumatic it was,” said Blimi Marcus, a nurse practitioner who lives in Borough Park, which was hit hard by the virus.
But all that has changed now, Marcus added: “The general feeling is one of complacency, that somehow we’ve all had it and we’re safe.” Is it possible that some of these communities have herd immunity? In some clinics, up to 80 per cent of people tested had antibodies to the virus. The highest prevalence was found among teenage boys. But people at clinics are more likely to be showing symptoms and therefore more likely to be infected, said Wan Yang, an epidemiologist at Columbia University’s Mailman School of Public Health in New York. Random household surveys would probably find lower rates — but still well above the 21 per cent average reported for New York City, she said. Researchers in Mumbai conducted just such a random household survey, knocking on every fourth door — or, if it was locked, the fifth — and took blood for antibody testing. They found a startling disparity between the city’s poorest neighbourhoods and its more affluent enclaves. Between 51 and 58 per cent of residents in poor areas had antibodies, versus 11 to 17 per cent elsewhere in the city.
The lowest-income residents are packed tightly together, share toilets, and have little access to masks. “These factors contributed to a silent infection spread,” said Dr Jayanthi Shastri, a microbiologist at Kasturba Hospital in Mumbai who led the work. Most researchers are wary of concluding that the hardest-hit neighbourhoods of Brooklyn, or even those in blighted areas of Mumbai, have reached herd immunity or will be spared future outbreaks. But models like Dr. Britton’s hint that it’s not impossible. Other researchers have suggested, controversially, that herd immunity can be achieved at rates of immunity as low as 10 or 20 percent — and that entire countries may already have achieved that goal.
Criticism trailed Sunetra Gupta, a theoretical epidemiologist at Oxford University, after a widely circulated interview in which she said that London and New York may already have reached herd immunity because of variability among people, combined with a theoretical immunity to common cold coronaviruses that may protect against the new one.
“That could be the explanation for why you don’t see a resurgence in places like New York,” she said. Most experts reject that notion. Several studies have shown that certain immune cells produced following infection with seasonal coronaviruses may also recognize the new coronavirus. But “where is the evidence that it’s protective?” asked Natalie Dean, a bio-statistician at the University of Florida. These cities have not returned to pre-pandemic levels of activity, other experts noted. “We are still nowhere near back to normal in our daily behaviour,” said Virginia Pitzer, a mathematical epidemiologist at the Yale School of Public Health. “To think that we can just stop doing all that and go back to normal and not see a rise in cases I think is wrong, is incorrect.”
Apoorva Mandavilli is a health reporter with NYT©2020
The New York Times