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--:-- Sean Rameswaram: Not all journalism is the same. Take The Guardian. Our coverage has something unique, fierce independence.
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--:-- Sean Rameswaram: Nobody owns us or tells us what we can and can't say. So we're free to report the whole picture.
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--:-- Sean Rameswaram: We connect what's happening in Washington to the rest of the globe, expose corruption wherever we find it, and give first perspective on everything from wellness and soccer to culture, the climate and more.
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--:-- Sean Rameswaram: Read, watch and listen to The Guardian for free at theguardian.com.
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--:-- Sean Rameswaram: There's a new kid on the block of 1600 Pennsylvania Avenue. His name is Dr. Scott Atlas, and he's recently become one of President Trump's top pandemic advisors.
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--:-- Sean Rameswaram: So, like, he's an infectious disease expert like Fauci, right? Nope, nope, nope, nope, nope.
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--:-- Sean Rameswaram: Oh, but he's obviously an epidemiologist. Nope, nope, nope, nope, nope.
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--:-- Sean Rameswaram: Oh, okay, all right, but Atlas is probably a physician with loads of experience advising politicians, yeah? Nope, nope, nope, nope, nope.
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--:-- Sean Rameswaram: OK, well, tell me he's not just some guy who the president saw on Fox News a bunch. Bingo.
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--:-- Sean Rameswaram: Those who are not at risk to die or have a serious hospital requiring illness, we should be fine with letting them get infected.
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--:-- Sean Rameswaram: The policy of total isolation is actually destructive and is literally killing people.
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--:-- Sean Rameswaram: By having total population isolation, we are preventing natural immunity from developing.
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--:-- Sean Rameswaram: Great. After six months of various states of lockdown, quarantine, social distancing, and mask wearing, 200,000 deaths, and some 6 million cases, President Trump has brought in Fox News' neuroradiologist-in-chief to advise him on COVID-19.
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--:-- Sean Rameswaram: And the worst part is, according to reports from The Washington Post, he's kind of into herd immunity as a path forward for the United States.
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--:-- Sean Rameswaram: When you get immunity and low-risk groups infect each other, there's a blockage of sort of the pathways to the vulnerable. This is called herd immunity.
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--:-- Sean Rameswaram: I don't think herd immunity is the way out for any place. I don't think any place is even close to herd immunity.
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--:-- Sean Rameswaram: And as a strategy, it's dangerous.
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--:-- Sean Rameswaram: This is Dr. Howard Foreman. He's a professor of public health at Yale University.
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--:-- Sean Rameswaram: And as you just heard, he's less into herd immunity, but he also knows a lot about it.
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--:-- Sean Rameswaram: So we asked him to explain.
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--:-- Dr. Howard Foreman: I think about 50 years ago or 60 years ago is when herd immunity was first talked about, that if you got to a certain level of immunity in the community from vaccination, that you could no longer have epidemic outbreaks.
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--:-- Dr. Howard Foreman: You would no longer have an outbreak develop in the community, even if somebody from outside the community came in with an infection, let's say measles, that they could not then cause an outbreak to happen in the community, even if there were hundreds or even thousands of people that were not vaccinated, it would not take off again as long as you were above a certain percent threshold.
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--:-- Dr. Howard Foreman: Well, since we don't have a vaccine yet, how many Americans would have to get COVID-19 for herd immunity to be plausible in the United States?
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--:-- Dr. Howard Foreman: So first things first, we don't even know that having had COVID-19 gives you true immunity.
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--:-- Dr. Howard Foreman: You know, there's several different things that may be the outcome of having prior COVID-19.
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--:-- Dr. Howard Foreman: One is that you cannot be infected anymore. That would be full immunity.
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--:-- Dr. Howard Foreman: The other is that you could be infected, but you wouldn't get the disease again.
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--:-- Dr. Howard Foreman: A third is that you might get infected, can't get the disease, but you could shed the virus, but at a much lower level, let's say, so that you're not spreading it nearly as much.
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--:-- Dr. Howard Foreman: So we don't have answers to those questions yet.
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--:-- Dr. Howard Foreman: As you know, in the last few weeks, we've learned of at least four cases around the world where reinfection has occurred.
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--:-- Dr. Howard Foreman: In Hong Kong, a patient is believed to be the first person to become reinfected with COVID-19 and other cases in Europe are being investigated.
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--:-- Dr. Howard Foreman: This as health officials prepare for a full flu season lurking just around the corner
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--:-- Dr. Howard Foreman: But let assume for the moment that anybody who gets COVID has full immunity and can no longer spread it.
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--:-- Dr. Howard Foreman: Under those circumstances, the estimates for what level of infection we'd need to have to have herd immunity vary between sort of reasonably estimates of 47 percent to as high as maybe 70 percent.
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--:-- Dr. Howard Foreman: So we're talking about hundreds of millions of Americans, potentially.
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--:-- Sean Rameswaram: Correct. You would need to have hundreds of millions.
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--:-- Sean Rameswaram: And by the way, the other issue about that is that they'd have to be homogeneously across the country infected.
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--:-- Sean Rameswaram: So if you had, for instance, 100 million people infected in the Great Northeast area, and that got them to 95% prior infection.
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--:-- Sean Rameswaram: That would do nothing to protect people in, let's say, the midsection of the country if their prior infection rate was 20%.
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--:-- Sean Rameswaram: How many Americans would we expect to perish from the disease if we had that level of infection?
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--:-- Dr. Howard Foreman: Right. So let's say that you had 150 million Americans infected.
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--:-- Dr. Howard Foreman: and let's imagine that the infection fatality rate across the entire population ends up being around, you know, 0.4 or 0.5 percent.
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--:-- Dr. Howard Foreman: You're starting to talk about, you know, anywhere between 600 and a million people, depending on where the numbers fall out.
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--:-- Sean Rameswaram: What would that look like for American cities, American states, not to mention families, friends destroyed, lives destroyed?
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--:-- Dr. Howard Foreman: Yeah, look, I think when we just count the deaths, and I say just in a very sort of facetious manner, we're underestimating all the harm from this.
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--:-- Dr. Howard Foreman: The deaths are the tip of the iceberg.
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--:-- Dr. Howard Foreman: A small fraction of people that have serious illness and then death, a lot of people are becoming sick from this and are still in recovery now.
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--:-- Dr. Howard Foreman: We have no idea what outcomes look like for this.
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--:-- Sean Rameswaram: So when I'm looking and thinking that in order to get to, let's say, minimum herd immunity in every community across the country, you might need to have 200 million or more people infected.
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--:-- Sean Rameswaram: And you're starting to talk about 800,000 or a million deaths.
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--:-- Sean Rameswaram: You're also talking about at least 10 times that with very serious illnesses and recovery associated with it.
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--:-- Sean Rameswaram: So I think that's a catastrophic proposition, particularly when we're only talking about the subacute effects.
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--:-- Sean Rameswaram: We have no idea about long-term effects.
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--:-- Sean Rameswaram: And has something like this ever happened before in the known history of mankind? To get herd immunity from infection?
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--:-- Dr. Howard Foreman: Yeah. Not on any large scale.
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--:-- Dr. Howard Foreman: There's, I think, one community or one city where people have said it happened with Zika, but I don't even think that officially would qualify as herd immunity.
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--:-- Dr. Howard Foreman: That would probably be more characterized as reduced spread and endemic spread, but not to this degree.
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--:-- Sean Rameswaram: But there have been countries that have publicly talked about this as a potential strategy, right? I mean, Sweden, maybe? England? Is that right?
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--:-- Dr. Howard Foreman: Right. So England briefly contemplated it.
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--:-- Dr. Howard Foreman: But after models showed how badly UK hospitals would be overwhelmed in such a scenario, and the potentially hundreds of thousands of deaths it would cause, priorities have shifted.
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--:-- Sean Rameswaram: Sweden briefly contemplated it and then really has not pursued that strategy.
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--:-- Sean Rameswaram: Sweden took a different tack, not shutting down, trusting citizens to follow social distancing on their own, and putting a priority on so-called herd immunity.
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--:-- Sean Rameswaram: The results were mixed.
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--:-- Sean Rameswaram: And right now, in fact, there's a letter signed by a lot of scientists urging Israel to pursue the Sweden approach slash herd immunity.
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--:-- Sean Rameswaram: So they do use this term.
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--:-- Sean Rameswaram: But I just don't, you know, when I read what they're actually saying, either they don't know what's going on in Sweden or they are trying to misuse this term.
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--:-- Sean Rameswaram: So the long and short of it is, herd immunity is not a solution for this country or really any other to consider unless they're ready to see a significant portion of their population die.
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--:-- Sean Rameswaram: die, a much more significant portion of their population come down with serious long-term health consequences and to face whatever it is, catastrophic oversaturation of hospitals and infrastructure.
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--:-- Sean Rameswaram: Is that fair?
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--:-- Dr. Howard Foreman: Potentially.
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--:-- Dr. Howard Foreman: You know, I think we can manage the infrastructure of the hospitals and so on.
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--:-- Dr. Howard Foreman: I think the deaths are not manageable.
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--:-- Sean Rameswaram: And when you sitting there and trying to make a calculation today of do you actively encourage the infection of a large part of society
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--:-- Sean Rameswaram: And by the way infecting younger people and giving them this infection may even be more consequential than some older people because they have more years to suffer potential consequences.
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--:-- Sean Rameswaram: So we just don't know, but actively doing that.
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--:-- Sean Rameswaram: And then on the flip side of that, we're talking about having a vaccine in potentially two, four, five months.
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--:-- Sean Rameswaram: We have therapeutics coming out all the time.
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--:-- Sean Rameswaram: We're learning more about this.
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--:-- Sean Rameswaram: It just seems like a failed strategy that doesn't even have an upside to it.
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--:-- Sean Rameswaram: Okay, so herd immunity is out.
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--:-- Sean Rameswaram: Even the White House is now denying it's considering herd immunity as a potential path forward.
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--:-- Sean Rameswaram: So what can the United States do in the meantime?
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--:-- Sean Rameswaram: More with Dr. Forman after a break on Today Explained.
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--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards.
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--:-- Sean Rameswaram: Okay, Dr. Foreman, we've established that herd immunity is certainly an option, albeit one where a ton of people die or get sick for the rest of their lives.
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--:-- Sean Rameswaram: So not a great one.
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--:-- Sean Rameswaram: Then there's the vaccine. What do we have in the meantime?
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--:-- Sean Rameswaram: We're not doing great on contact tracing.
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--:-- Sean Rameswaram: Is it testing? Is testing our one way to stave off even more of a disaster?
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--:-- Dr. Howard Foreman: Yeah, there's just no question that testing works.
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--:-- Dr. Howard Foreman: We've seen it work in so many places with and without contact tracing.
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--:-- Dr. Howard Foreman: We know that if you can test and isolate early enough, if you can remove people from circulation when they're at their highest likelihood of spreading this, we can effectively reduce spread in the same way that herd immunity is supposed to allow us to reduce spread so that outbreaks can no longer occur.
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--:-- Dr. Howard Foreman: It's not to say that nobody gets disinfectant anymore.
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--:-- Dr. Howard Foreman: It's to say that we hold the numbers down dramatically because we're no longer allowing it to spread so quickly.
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--:-- Sean Rameswaram: And we could stand to get a lot better at testing, yeah?
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--:-- Dr. Howard Foreman: I've only, you know, gone and gotten the nasal swab test once and it took several days to get results.
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--:-- Sean Rameswaram: What's the promise of rapid testing looking like?
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--:-- Dr. Howard Foreman: The rapid tests that we're talking about are things that for very, very low cost will have perhaps a slightly reduced sensitivity perhaps a significantly reduced sensitivity, so that they'll have a lot of false negatives, meaning that people will be told they're negative when in fact they're infected, but that those tests will give you results in 15 to 45 minutes typically.
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--:-- Dr. Howard Foreman: And there's all different types of tests out there right now, and they're still being evaluated.
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--:-- Sean Rameswaram: But I believe, you know, over the next eight weeks, we're going to start to see more and more of these.
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--:-- Sean Rameswaram: Abbott Labs will double its main workforce by starting to produce a rapid and inexpensive coronavirus test.
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--:-- Sean Rameswaram: Obviously, the Abbott announcement was probably, you know, the biggest signal that this is happening.
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--:-- Sean Rameswaram: Now, the company will produce a $5 test that purports to give you results in 15 minutes.
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--:-- Sean Rameswaram: So when you hear about you know rapid testing being available at some party in the Hamptons or at the White House or at the NBA bubble in Disney World It isn the kind of rapid testing that we talking about with Abbott and that going to be coming soon
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--:-- Dr. Howard Foreman: Yeah, no, these are typically much quicker.
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--:-- Dr. Howard Foreman: They're on a single swab.
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--:-- Dr. Howard Foreman: They're more akin to what pregnancy tests look like than they are to the nasal swab that you and I have had as a COVID or coronavirus test.
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--:-- Sean Rameswaram: And how do they differ in terms of accuracy, if at all?
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--:-- Dr. Howard Foreman: So the word on the street is that their sensitivity is much lower, but their specificity is still very high, meaning that we'd have a lot of false negatives.
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--:-- Dr. Howard Foreman: I know of some manufacturers that are claiming that their sensitivity is on par with PCR tests, the typical nasal swab, which we consider to be sort of the gold standard at this point.
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--:-- Sean Rameswaram: But even if they're much less sensitive, remember that the goal here is not to be 100% certain that someone's not infected as they might want to be around the president.
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--:-- Sean Rameswaram: The goal here is to take as many people as possible out of circulation before they can infect people.
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--:-- Sean Rameswaram: So if out of five people who are currently infected and potentially spreading, I can take three of them out of circulation, I've had an enormous impact on the spread of this disease.
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--:-- Sean Rameswaram: And it looks like we'll have rapid testing that works to at least a high level before we have anything resembling a vaccine?
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--:-- Dr. Howard Foreman: That's right.
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--:-- Dr. Howard Foreman: And certainly we could have done it even faster if we would have made this a priority.
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--:-- Sean Rameswaram: But we didn't.
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--:-- Sean Rameswaram: To the best of my knowledge, there has been some funding for the development of testing, but certainly not on the scale of, quote, operation warp speed, and certainly not with the same intensity.
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--:-- Sean Rameswaram: And that was a real missed opportunity, it sounds like.
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--:-- Dr. Howard Foreman: Yeah, look, I think that the lack of attention to testing from the beginning has been probably the biggest fatal mistake.
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--:-- Dr. Howard Foreman: From day one, we didn't set up testing properly.
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--:-- Dr. Howard Foreman: We made mistakes on that scale.
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--:-- Sean Rameswaram: Then when we could have scaled up traditional testing, we weren't able to.
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--:-- Sean Rameswaram: And then when it comes to this type of rapid testing, it has not been the highest priority of our leaders.
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--:-- Sean Rameswaram: For all the people who can't wait to return to whatever version of normalcy they've sacrificed, I wonder, do you think rapid testing will be enough, at least in the United States, to get them to that place once we have enough of it available?
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--:-- Dr. Howard Foreman: That's my hope.
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--:-- Dr. Howard Foreman: I mean, I don't, you know, I think every step along the way, anytime we're talking about loosening our current restrictions.
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--:-- Dr. Howard Foreman: We need to figure out how do you counterbalance that?
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--:-- Dr. Howard Foreman: How do you prevent it from leading to greater spread?
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--:-- Sean Rameswaram: So testing has always been, from the first time I wrote about this in February to now, has always been the way out of this.
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--:-- Sean Rameswaram: Because if you can ramp up testing, you can also relax other things.
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--:-- Sean Rameswaram: You may be able to allow people to go into a less crowded but still movie theater.
--:-- [Sound effects: A brief pause]
--:-- Sean Rameswaram: You may be able to allow people to be in a less crowded but still filled indoor restaurants.
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--:-- Sean Rameswaram: You might be able to do sporting events again.
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--:-- Sean Rameswaram: There's so many things that you can imagine doing if you have something to counterbalance it.
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--:-- Sean Rameswaram: I would say that of all the things that I've failed at in the last six or seven months, the one that I think is my biggest failing is how naive I've been.
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--:-- Sean Rameswaram: I was absolutely certain when Vice President Pence said that we're going to have those test kits out, that we were going to have them, I was absolutely certain, even though I don't necessarily believe from other things, that when the president said, if you want a test, you'll be able to have a test.
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--:-- Sean Rameswaram: So I think it's unfair for me to continue to be naive and say, I believe this, but I've been optimistic because talking to people in this field about what they're doing and what they're innovating with.
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--:-- Sean Rameswaram: I have optimism in entrepreneurs, and I think entrepreneurs are telling me that by November, we're going to have more rapid testing available.
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--:-- Sean Rameswaram: I hope it scales up as fast as I'm saying, but I'm pretty sure we're going to have substantially more than we do today.
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--:-- Sean Rameswaram: Dr. Howard Foreman is a professor of public health at Yale University.
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--:-- Sean Rameswaram: I'm Sean Rameswaram.
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--:-- Sean Rameswaram: This is Today Explained.
