I was driving down the street to get frozen custard for my beautiful pregnant wife the other day when it hit me like a lightning bolt—
Herd immunity doesn’t exist.
It suddenly brought everything I’d been seeing into stark relief and made the pieces of the jigsaw come together.
Herd immunity doesn’t exist.
I think this makes our path forward clear, if we can embrace this idea. Let’s dig in.
Back in spring 2020, several people I followed on social media were talking about what to expect in the coming years. What they said was that generally a new pandemic working its way through a population will come through in two big waves, then enough people will have gotten the disease and recovered, will have antibodies, and now will be unable to pass it on. Eventually, the virus when trying to find new targets will only find a lot of people with antibodies and will recede.
This is the herd immunity threshold. For something like measles, this is really easy to understand. When enough kids are vaccinated, the unvaccinated kids are protected by those who are, because the virus is more likely to run into a vaccinated kid than an unvaccinated. This is a function of a virus’s R0 (pronounced R-naught) number, or how contagious a particular virus is. If a virus is highly contagious, the percentage of the population that needs to be vaccinated needs to be higher.
Let’s break this down for measles, as an example. The R0 for measles is 12-18, meaning in a naïve population every person who gets measles will infect 12-18 other people. Because it’s so infectious, about 95% of people need to be immune, either through vaccination or recovery, in order to stop its spread.
Let me stop to make an important point here. When a virus is moving from person to person, it doesn’t know whether the person has antibodies from a previous encounter with the virus or from a vaccination. It just knows “I can’t do what I need to do here”. This makes it curious that the World Health Organization changed its definition of herd immunity last year from “vaccinated + recovered” to “just vaccinated”.
My logical conclusion is that the WHO did this to:
Take a stance against something like “COVID parties”, where people try to intentionally catch the virus so they would be immune going forward, or
Prepare for a wide-scale vaccination effort, and minimize options other than vaccination.
But let’s go back to our measles example. Measles doesn’t have a significant replication in the nasal passageways before it hits the blood stream, so the antibodies have a chance to get on top of the infection before it can spread. So the measles vaccine is a sterilizing vaccine, meaning that an infected person is sterilized from the virus and can’t pass it along if infected.
COVID isn’t like this. It replicates in the nasopharynx for a day or two before hitting the blood stream, leading to the concern about asymptomatic or pre-symptomatic spread. This was the reason that everyone - infected or uninfected - was told to wear a mask to prevent the spread. (We see how well that’s doing.)
As I’ve stated before, this is the problem with how the COVID vaccines have been sold to the American public, and the problem with thinking these are the “way out”. COVID vaccines are non-sterilizing.
To be as fair as possible, I believe there’s some evidence that for some people, in the early days after vaccination — something like the first 90 days — they can be non-contagious if they’re infected. I think that’s what the push for boosters is presumed upon — that a higher serum antibody level can render the vaccine sterilizing.
No studies have been done to test if boosters would work, or if they’re even safe. But presumably, with the way the serum antibodies drop off, we would require a booster every 4-6 months with no end date to keep levels high. And from what I can tell, there’s every chance that they would be asymptomatic-infectious.
(You should read through this Twitter thread that breaks down how the antibody response continues to build memory cells even as antibody levels wane. So being singularly focused on serum antibodies misses part of the picture and the actual strengths of the vaccines.)
So let’s now think about COVID through the herd immunity paradigm. In order for herd immunity to exist, the virus would have to look for people to infect but find mostly people who cannot pass it on to others. But, in some significant number of people, the virus can replicate before the host can mount an antibody defense to neutralize. This means the virus can always find targets for replication.
I believe this is a function of the infection process of the SARS-CoV-2 virus, because the blood-borne antibody process lags to some degree the infection/replication process. If there were something that were applied directly to the nasopharynx to interrupt that early replication cycle, that potentially would lead to that infected person being a dead-end.
As I’m putting this piece to bed, I find this study on using nitric oxide nasal sprays to reduce viral load in the nasopharynx. Something like this, if effective, would definitely change the calculus of our approach.
This could also be a function of typical coronavirus mutations. Most coronaviruses affect us as the common cold, which will infect a single person multiple times across a lifetime. But although a person has encountered that coronavirus before and has antibodies in memory-T and -B cells, they can still catch the virus, they can still be symptomatic, and they can still be infectious.
All of this means that the herd immunity paradigm does not apply to COVID. Because of COVID’s infection process and the non-sterilizing immunity granted by the current generation of vaccines, it is more likely than not that the virus will find a target who can replicate and pass it along. This will happen more in the winter in the northern US and in winter and summer in the southern US, as Edgar Hope-Simpson observed in the early 1980s. When conditions are favorable, the virus will surge. When conditions are not, the virus will diminish.
Consider influenza. Many people receive flu shots every fall — mainly those who are susceptible to a bad infection, the old and the young. But influenza still comes and goes every year, as the virus continues to infect and spread. This is the paradigm we need for COVID.
There are a few takeaways I want to convey here, which are logical conclusions based on the above paradigm shift:
Even if every single person, from 0 to 100 years old, gets vaccinated, COVID is still going to spread as an endemic virus and come and go with the seasons. Every person is infected multiple times with existing coronaviruses, and SARS-CoV-2 is no different. This is what we see in communities with high vaccination percentages.
A virus is not a value judgment. Getting COVID isn’t a sign that you haven’t been careful, or that you were unvaccinated, or that you were deserving of it because of your lifestyle.
Vaccine mandates to protect people in schools, restaurants, sporting events, and concert venues only provide the appearance of safety, because if the virus is surging in an area, even a highly vaccinated population with a non-sterilizing vaccine does not remove targets.
We can’t reduce the number of cases any more than I can hold back the tides. There are larger natural forces that govern COVID’s rise and fall that we cannot dare to stand against. As such, no vaccine mandate, mask mandate, or lockdown can get us to zero-COVID. Zero-COVID cannot be our goal.
The best we can do now is to pivot from a focus on case counts and contact tracing to one supporting those who become ill. Vaccines are certainly a part of that, as they greatly reduce your chance of becoming seriously ill. But therapeutics treating the patient as a sick person and not just a disease vector are equally important.
These therapeutics seem to be gaining more respect in the medical community. Dr. Fauci stated in a press briefing this week that early use of monoclonal antibodies can reduce hospitalization and death by 70-85%. They have to be used early in the course of the infection, but they can help lessen the course of the disease.
Bamlanivimab plus etesivimab has good data around its efficacy. The antiviral remdesevir has evidence to show it lessens hospital stays and shortens recovery time. Fluvoxamine is an old SSRI that also acts as an anti-inflammatory and may work as an early treatment or as a treatment for the Long COVID side effects of fatigue and brain fog. There are plenty of therapeutics we can use without even touching some of the more controversial pharmaceuticals I won’t name here.
I don’t know how to get there from here. What it requires is willingness on the part of public health officials, elected officials, and medical professionals to change their paradigm. This requires a measure of humility — admission that their paradigm was ill-suited to our current viral challenge, and an openness to consider different frames.
I do what I can to encourage this paradigm shift by speaking openly and honestly about what I see, and encouraging others to do the same. But as long as we continue to hear “vaccines are the only way out”, we will never escape.
Best info yet on technical science of how this virus works. And with this and studies from leading institutions I've read, make me wonder why the world (with a few exceptions) has chosen this "vaccine" approach. That gets political and requires much speculation. I'm content that I've had the virus, easily got thru it and should have immunity to future infections.
You are an excellent bridge bringing science to the masses in an easy to understand way. Thank you. This is the key: "What it requires is willingness on the part of public health officials, elected officials, and medical professionals to change their paradigm. This requires a measure of humility — admission that their paradigm was ill-suited to our current viral challenge, and an openness to consider different frames." ... And if they refuse to see, people have to and will protest, speak out, etc. They can't ignore the facts forever. Great essay!