Lockdown to herd immunity: How COVID-19 has created a web of tough choices

Herd immunity comes at the cost of biologically "weakest" individuals while lockdown creates a huge livelihood deficit.

Swati Satheesh

The US has recently seen people out on the streets when they have been strongly advised not to; social distancing is the only way we can see out of this calamity that humankind is staring into. The alarm this has caused to health care workers and those involved in the actual management of the crisis is understandable; the risk of people who have chosen to break curfew contracting the disease is very real, whether they volunteered for it or not, and when the virus does get the better of their bodies, medical staff who begged them to stay indoors would be roped in to look after them- it would not be an option to treat selectively. People are defying Coronavirus restrictions across the globe; after all, when one’s options are sure death from hunger and possible death from the virus, it really isn't much of a choice. The economic crisis has spiralled out of control for most governments, and already policy makers are fast realising that this war has many battles to be fought at diverse fronts. India's leading epidemiologist, Dr Jayaprakash Muliyil has stated what may appear obvious to experts in the field - the solution is to achieve herd immunity. Herd immunity is the idea that an individual of a herd (or group) is as immune as the herd taken as a whole; in effect, it is the percentage of individuals in that herd to be immune to a disease so that the group as a whole does not contract it- the immune ones do not spread it further leading to the "flattening" of the curve we are all so eagerly waiting for. Dr Muliyil further suggests that we must ensure that the lock down is lifted in such a way that a manageable population is exposed to the disease so that they achieve immunity - effectively a sort of vaccination of controlled groups of the population. The idea is that the 65% of India's young population- between the ages of 15 to 65 can be immunised intentionally.

India is at an advantage, first because we have this enviable proportion of young population, which other countries cannot boast of, and second because, so far India has done a commendable job at reigning in the exponential curve of the COVID-19 cases.

Is beating the virus this easy? Simple logic says yes. Batches of youngsters could be infected under controlled environments and within two to four weeks. Whole cities could achieve immunity, and since everyone is in isolation, no one passes the disease on while still infected and therefore, it's a win-win. However, the picture is too rosy to be true. What we are forgetting is that herd immunity comes at the cost of the "weakest" individuals. The immunity is achieved in nature by eliminating individuals who cannot survive, and therefore, as the absolute numbers in the herd falls, the proportion of immune individuals rises. In case of the Novel Coronavirus, these weakest links are the elderly and individuals with compromised immune systems.

The questions then are four-fold: 1. It's not how many "weak" individuals will succumb to the disease, but when they will. 2. When they do, how many ill individuals can our healthcare infrastructure support? 3. How much more or less than 65% is the actual proportion of the population that needs to attain immunity to achieve herd immunity? 4. Finally, how long can we go on containing a pandemic when livelihoods are lost?

The advocates for achieving herd immunity at the earliest are indirectly prescribing what Herbert Spencer observed in Charles Darwin's work, On the Origin of Species - a phrase that has gone on to be very familiar - "Survival of the fittest". The young, and therefore the healthier population is expected to come out relatively unscathed. But what about the population which in a biological sense would be considered "weak"? The older populace is automatically included in this category for the most part-combined with other medical conditions, we have already seen across the world that the virus is not lenient to them. But this is not the only section of people who could be categorised as "weak". Persons with suppressed immune systems, irrespective of age would not fare well. In a country like India with rampant poverty and undernourishment, the poor would then suffer fatalities. More than 50% of Indian women suffer from anaemia, and other nutrient deficiencies. Persons with various levels of disabilities are obviously in disadvantage. This preliminary analysis makes it clear that the 65% of young population on which we had based our optimistic argument stands on very shaky foundations. It is true that sooner rather than later, we must take a decision. And the decision can be only one of the two - whether to pace the spread of the virus out so that our health infrastructure is not overwhelmed, or to get this crisis done and over with, so that we can go back to some semblance of normalcy, whatever that might be. The first requires humanity going through one of the greatest crises the capitalist world system has faced in its history, and the second requires the same humanity to go through the greatest health crisis in recent times. Both have us facing a sizeable number of the human population being wiped out. Unlike previous instances, we cannot rely on international organisations to support any one country or region because this is a catastrophe of the world. We are, painfully, left to our own devices.

The Utilitarians would propose to make that decision which can maximise the well-being of the maximum possible number of people.

As Jeremy Bentham puts it, “Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do.” So, what really does utilitarianism really tell us here? On the one hand, we can try and contain the spread of the virus by tracing the path and sending all people with contact into quarantine, as we have been doing till now. But, as we have seen, in many cases, it is just a matter of time before the virus resurfaces in a recovered individual and they then become further sources. This process goes on till finally the whole population is acquainted with the virus. Till that day we must continue stringent restrictions on mobility and spend a good part of our pandemic budget on testing the entire population to quarantine the persons found positive. The flip side is that both hunger and the virus will kill till these restrictions are in place. The other way is to expose populations in a controlled fashion. The health budget can be diverted to medicines and machinery to help with the recovery of patients, and testing is to be done only to ascertain that it indeed is the Coronavirus that has infected the individual. The flip side is that the health infrastructure will soon be overburdened. In either case, the pandemic stops only when the theoretical herd immunity is reached. The choice is whether to reach here sooner or later. Utilitarianism would prefer the latter. Either way it’s a devil’s choice

(The author is a research scholar at Centre for Historical Studies, Jawaharlal Nehru University, New Delhi and is currently pursuing her Masters in Ancient History.)