"Lockdowns are a very bad idea - they cause economic havoc, stop people getting medical attention for non-COVID problems, and increase loneliness, isolation, and mental health problems. Instead, we should be shielding the vulnerable, and allowing younger, healthier people to live their lives, building natural herd immunity when they catch the virus.
Tens of thousands of medical practitioners, scientists, and concerned citizens have signed the Great Barrington Declaration to make the above argument."
We have vaccines now. The Great Barrington Declaration was misconceived right from the beginning, for reasons we'll discuss below. But now that we have very effective vaccines, the case for "natural herd immunity"—that is, letting the virus burn through certain parts of the population—is weaker than ever. There is now an end in sight, and a great many people now have the possibility to never get the virus in the first place.
Nobody really knows how to "shield" vulnerable people. It sounds very simple: keep the older and more vulnerable people safe, and let everyone else go about their business. But it's really not that straightforward. Practically, how do you keep those vulnerable people safe? Take, for instance, multi-generational households. A great many students and other adult children live with their parents (according to one report, this is around a third of all homes in the UK). In some communities, grandparents often live in the same home as grandchildren. Sharing a home with an infected person is one of the most common ways of catching the coronavirus - one study from South Korea found that home contacts of an infected person were more than six times more likely to have the disease than other contacts. So the question is: where are all the high-risk people supposed to go to "shield" while their younger family members go out and about, merrily catching the virus? The authors of the Great Barrington Declaration have never given anything approaching an adequate answer.
The number of people isolating would be enormous. There were 14,843,119 people in the UK who lived in a household with someone aged 65+ in 2019, and 2,240,850 patients on the Shielded List - though some of these are over 65, so there's some overlap. That would have meant at least 15 million people being required to self-isolate, requiring food and medical attention at home while the virus was spreading unimpeded in the outside world. It's unclear how we would have provided food and medical supplies to such a large number of people while the rest of the population was living through the worst pandemic in a century, with all the disruption and work absences that would entail.
"Focused protection" would still mean a very large number of deaths among the wider population. Applying a rough age-based infection-fatality ratio based on this table, and assuming half the wider population caught Covid and only a small number (5%) of pensioners ended up getting it, that would still mean 90,000 extra deaths. If 15% of pensioners caught Covid in this scenario, it would mean 175,000 deaths. However, even this is likely to be an underestimate, for reasons discussed in our next point.
The health service would be overwhelmed in this scenario, leading to a potentially much higher death rate among the rest of the population. On top of the deaths we could expect based on the fatality rates from the pandemic so far, so many other people in the rest of the population would be hospitalised in the Great Barrington scenario that the NHS would be totally overwhelmed. Applying the hospitalisation rates from this article to the rest of the population, and assuming 50% of the younger population caught COVID along with 5% of pensioners, that would mean 860,000 people would be hospitalised. If 15% of pensioners accidentally caught the virus, it would mean around 1.1m hospitalisations. This would overwhelm the health service. There are only 4,123 adult critical care beds in England, so many or most patients requiring hospitalisation would not be able to receive full treatment, and would have a much higher mortality rate.
Younger, healthier people don't want this virus either. Just because younger, healthier people who catch the coronavirus die at lower rates than the elderly or those with pre-existing medical conditions, it doesn't mean that it's fine for them to catch the virus. Many sufferers of the coronavirus have found it to be an unpleasant few weeks, have been hospitalised, or have developed "Long Covid" - symptoms that persist long after the initial infection. The evidence for "Long Covid" is growing, although it remains inconclusive. Doctors from intensive-care units have written about their experience of watching as even young patients die from the disease. Hospitalisation rates, although highest for the elderly, have been accelerating in the UK across all age groups. Even for young people, Covid risks being far worse than just a bad cold or bout of the flu.
Natural herd immunity is bad for other reasons. Allowing a virus to go on jumping from person to person is a significant risk: it encourages the evolution of new variants, which might be more dangerous, undermining our response and our treatments. Even if a population develops herd immunity to a disease by infection, that doesn't mean the disease will go away. Changes in the population (such as new births and migration) and waning immunity will mean that people will continue to be susceptible to the disease over time, and new outbreaks could still occur in the future. Every person who catches the disease gives it another opportunity to mutate; only with eradication can we be sure it will not develop into a more dangerous form.
Another response to the Great Barrington Declaration can be found published in The Lancet, here.
Page added on 19 January 2021