The piece “Externalities of Herd Immunity” discussed the dangers of the approach of adopting herd immunity as a panacea for combating the virus originating from Wuhan. While this was suggested by few British experts, it found favour rather than Britain in many other places. In India, where there exists little original thinking on most of the Indian right, they blindly adopt the British approach and suggest the same as the only panacea for the same. Yet, the right wing economists shouting from roof tops on and off seem to miss a few basic economics. There are trade-offs entailed in any approach and this too comes with the same. The post mentioned above sought to bring these elements into the fore.
Thomas Smith has come out with a post that talks about the trade-offs or rather the price one has to pay if herd immunity approach is adopted. Sweden is paying a stiff price relative to its Scandinavian neighbours without gaining anything marginal in terms of economic growth. Economic growth does not flow smooth from absence of lockdown but is a contextual interplay between supply and demand, the latter a function of propensity to self-protect.
Though Smith does not talk about herd immunity explicitly, it is evident from his analysis the negative effects that arise from herd immunity. While this blog focused on the economic angle as one approached herd immunity, Smith’s emphasis is on the personal angle. To Smith, any analysis on Wuhan flu focuses on the metrics that are easy to measure and immediate. As one observes the data through any portal or site, the metrics are the total infections recorded, the total recoveries, and the total deaths that have occurred. The information thus obtained enables calculation of the active cases. Yet these are relatively easy. Either the person is dead or alive. The infections are easy to record given the plethora of tests that have been developed over the last few months. A negative test indicates a recovery though increasingly, doctors and authorities are using the clinical resolution of the symptoms or time based resolution as measures for recovery.
Given the absence of cure, the emphasis has to be on managing the symptoms till such time the body develops its antibodies to combat the disease. In any disease since the emergence of human mankind, it is these antibodies that are bulwark of the battle against these invaders of the body. When there exists a cure, it implies there exists an external intervention that creates antibodies from within. If there is no external intervention available, the body has to develop its own antibodies whilst externally, the medical authorities seek to help the victim manage the symptoms.
Sharon Maolem who has been discussed in the earlier posts in his book Survival of the Sickest talks about few interesting theories on the microbe-human relations over the millennia. In his thesis, genetic selection is an outcome of inter-temporal choices exercised by the body. The body’s genes mutate to ensure today’s survival at the cost of some price to be paid in the future. In Maolem’s book, instances are many that attribute the cause of many disease or disorders of today that can potentially be fatal if unchecked to the genetic selection at some point in the past to counter an immediate threat to the human mortality. Smith’s assertion apparently revolve around this precise trade-off between genetic dispositions towards current saving as against the possible side effects or the price in the distant future.
Smith therefore introduces a concept of trade-off between mortality and morbidity. As Smith elucidates, any conventional analysis is revolving purely on the perspective of infection, recovery and mortality. Yet, few months in the pandemic, little discussion has happened on the morbidity dimension of the pandemic from Wuhan. There is infection which in some cases deteriorate to a critical condition. It requires hospitalization and recovery is perhaps long. The virus perhaps dies out soon though the traces of the dead virus might remain for long though not infectious. Similarly to many, symptoms might not materialize or at best may be mild or in some cases moderate. These resolve itself in a few days or so. Yet, these are immediate and do not portend anything about the future.
Discussions on mortality and morbidity are not unusual. In fact, as one glances the internet, there are numerous papers and reports that discuss about the possible morbidities that might arise due to the occurrence of the infection or some disease or the other. In many diseases, there has been extensive research that has happened linking these morbidities with mortality. The mortality might not even be immediate or short term but might result out of a contraction of a disease or disorder that might have occurred years before. Morbidity refers to the negative outcomes (not even death) that arise due to the complications or other health issues that arise out of the infection.
Morbidity needs a lot of time before they emerge or any discussion might happen around the same. The measurement of morbidity thus is not straight forward. There could be long term impact. Thus as one begins to understand the facets of COVID-19, it is important to understand these long term evaluation. The current approach without doubt is focusing on the present. The emphasis without dispute is on the recovery from the disease. It is perhaps not easy at this stage to track the co-morbidities that might arise out of contracting the COVID-19. Smith is perhaps right in the belief that the current strategy of managing the pandemic is focusing on the recovery or minimizing the mortality. Yet the focus on the long term morbidities also must begin. There are indications of the morbidities that are emergent out of this disorder. Therefore, the importance of prevention cannot be under-stressed. It is not about simple contraction and recovery or about low mortality rates. It is about the morbidities that brings with itself which can have a long lasting impact on the population that needs to be prevented. Prevention through lock-down or through compulsory wearing of masks or social distancing are not about the immediate. It is about protection from the future. The proponents of herd immunity remain ignorant of this either willingly or the statement has the lowest opportunity cost without any skin in the game themselves.
Thoughts on Theory and Practice 