Opinion: A better COVID-19 prevention strategy

Jay Bhattacharya

In discussing the deadliness of COVID-19, we need to distinguish COVID cases from COVID infections. A lot of fear and confusion has resulted from failing to understand the difference. 

In early March, the case fatality rate in the U.S. was roughly 3% — nearly three out of every hundred people who were identified as “cases” of COVID in early March died from it. Compare that to today, when the fatality rate of COVID is known to be less than 1%. 

The reason for the highly inaccurate early estimates is simple: In early March, we were not identifying most of the people who had been infected by COVID.

In March, only the small fraction of infected people who got sick and went to the hospital were identified as cases. But the majority of people who are infected by COVID have very mild symptoms or no symptoms at all. These people weren’t identified in the early days, which resulted in a highly misleading fatality rate. And that is what drove public policy. 

In early March, we were not identifying most of the people who had been infected by COVID, Bhattacharya writes.

So how do we get an accurate fatality rate? To use a technical term, we test for seroprevalence — in other words, we test to find out how many people have evidence in their bloodstream of having had COVID. 

This is easy with some viruses. Anyone who has had chickenpox, for instance, still has that virus living in them — it stays in the body forever. COVID, on the other hand, like other coronaviruses, doesn’t stay in the body. Someone who is infected with COVID and then clears it will be immune from it, but it won’t still be living in them. 

In April, I ran a series of studies, using antibody tests, to see how many people in California’s Santa Clara County, where I live, had been infected. At the time, there were about 1,000 COVID cases that had been identified in the county, but our antibody tests found that 50,000 people had been infected — i.e., there were 50 times more infections than identified cases.

When it came out, this Santa Clara study was controversial. But science is like that, and the way science tests controversial studies is to see if they can be replicated. And indeed, there are now 82 similar seroprevalence studies from around the world, and the median result of these 82 studies is a fatality rate of about 0.2% — exactly what we found in Santa Clara County. 

In the early days of the virus, our health care systems managed COVID poorly. Part of this was due to ignorance: We pursued very aggressive treatments, for instance, such as the use of ventilators, that in retrospect might have been counterproductive. And part of it was due to negligence: In some places, we needlessly allowed a lot of people in nursing homes to get infected.

But the bottom line is that the COVID fatality rate seems to be in the neighborhood of 0.2%.

The single most important fact about the COVID pandemic — in terms of deciding how to respond to it on both an individual and a governmental basis — is that it is not equally dangerous for everybody. This became clear very early on, but for some reason our public health messaging failed to get this fact out to the public.

The widespread lockdowns that have been adopted in response to COVID are unprecedented — lockdowns have never before been tried as a method of disease control. Nor were these lockdowns part of the original plan.

The initial rationale for lockdowns was that slowing the spread of the disease would prevent hospitals from being overwhelmed. It became clear before long that this was not a worry: in the U.S. and in most of the world, hospitals were never at risk of being overwhelmed. Yet the lockdowns were kept in place, and this is turning out to have deadly effects. 

Those who dare to talk about the tremendous economic harms that have followed from the lockdowns are accused of heartlessness. Economic considerations are nothing compared to saving lives, they are told. So I’m not going to talk about the economic effects — I’m going to talk about the deadly effects on health, beginning with the fact that the U.N. has estimated that 130 million additional people will starve this year as a result of the economic damage resulting from the lockdowns. 

Another result of the lockdowns is that people stopped bringing their children in for immunizations against diseases like diphtheria, pertussis (whooping cough), and polio, because they had been led to fear COVID more than they feared these more deadly diseases.

Mental health problems are in a way the most shocking thing. In June of this year, a CDC survey found that one in four young adults between 18 and 24 had seriously considered suicide. Human beings are not, after all, designed to live alone. 

In effect, what we’ve been doing is requiring young people to bear the burden of controlling a disease from which they face little to no risk. This is entirely backward from the right approach.

Recently, I met with two other epidemiologists — Dr. Sunetra Gupta of Oxford University and Dr. Martin Kulldorff of Harvard University in Great Barrington, Maine. The three of us come from very different disciplinary backgrounds, yet we had arrived at the same view— the widespread lockdown policy has been a devastating public health mistake. In response, we wrote and issued the Great Barrington Declaration

It reads in part:

"As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection. 

"The most compassionate approach that balances the risks and benefits of reaching herd immunity is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk."

I should say something in conclusion about the idea of herd immunity, which some people mischaracterize as a strategy of letting people die.

First, herd immunity is a biological fact that applies to most infectious diseases. Even when we come up with a vaccine, we will be relying on herd immunity as an end-point. The vaccine will help, but herd immunity is what will bring it to an end.

And second, our strategy is not to let people die, but to protect the vulnerable. We know the people who are vulnerable, and we know the people who are not vulnerable. To continue to act as if we do not know these things makes no sense. 

My final point is about science. When scientists have spoken up against the lockdown policy, there has been enormous pushback: “You’re endangering lives.” Science cannot operate in an environment like that. I don’t know all the answers to COVID; no one does. Science ought to be able to clarify the answers. But science can’t do its job in an environment where anyone who challenges the status quo gets shut down or cancelled.

Jay Bhattacharya is a professor of medicine at Stanford University, where he received both an M.D. and a Ph.D. in economics. He is also a research associate at the National Bureau of Economics Research, a senior fellow at the Stanford Institute for Economic Policy Research and at the Freeman Spogli Institute for International Studies, and director of the Stanford Center on the Demography and Economics of Health and Aging.

This piece was adapted from a panel presentation on Oct. 9, 2020, in Omaha, Nebraska, at a Hillsdale College Free Market Forum. It first appeared in Imprimis, a publication of Hillsdale College.