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Only one way to get to herd immunity

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Historian Michael Jarvis's opinion last week on previous epidemics in Bermuda was timely.

We all have a role to play: if every person who has been immunised persuades one other person to get immunised, too, Bermuda can reach its goal of herd immunity (Photograph by Akil Simmons)
Bermuda is now in phase three of its vaccine strategy, and anyone over the age of 16 is eligible for it

He rightly said it has been so long since countries in the Western world experienced epidemics, let alone pandemics, that it is easy to assume that the Covid-19 pandemic is unprecedented and that the ways of fighting epidemics have to be invented from scratch.

Dr Jarvis reminded us that this is not so and the means of dealing with epidemics are well established. Covid-19 has unique characteristics, but history can help us to understand how to fight it.

It is worth asking, however, why the world is no longer afflicted by waves of fatal diseases such as bubonic plague, smallpox and yellow fever.

The answer, simply, is science. Scientists’ better understanding of the diseases and the means of treating them mean the world is no longer victim to these terrible afflictions, provided we look at what has been tried and tested — the empirical evidence — and follow it.

Smallpox, which Dr Jarvis focused on in his opinion, was initially treated by quarantining people who had the disease from the rest of the population in designated houses or on islands. This kept the epidemic in check until it passed or until enough people developed immunity. In the case of smallpox, that could take months or years and the fatalities were massive. Even those who survived were left with ghastly disfigurements that could turn them into pariahs.

Only with the development of inoculations, and then vaccinations, did the world begin to eliminate this dreadful scourge.

Then, as now, epidemics began when people ignored the rules or were sceptical about the science behind vaccinations and other treatments.

Eventually, it appeared that science won. Smallpox was fully eradicated in 1980 and a host of other diseases and childhood illnesses such as measles and mumps also vanished, all owing to safe and well-run vaccination programmes and better public health.

Then a funny thing happened. Towards the end of the last century, scepticism about vaccinations, spurred in part by a single, poorly designed and never replicated study tying particular combinations of vaccinations to a rise in autism, began to grow.

Suspicion, some of it justified, about big pharmaceutical companies, also grew. Black communities were already suspicious of scientific studies as a result of scandals such as the Tuskegee Study. And these suspicions have since been multiplied through the growth of the internet and social media. As a result, Bermuda and the world see a worryingly high level of vaccine hesitancy just when the need for people to get vaccinated from Covid-19 has never been greater.

The Covid-19 vaccine is not a cure-all. But it is demonstrably better than natural immunity, although people should certainly do all they can to boost their natural immunity — not just to mitigate against Covid-19, but to live longer and healthier lives in general.

With vaccinations, it is not clear yet if booster shots will be needed; they likely will. How long vaccinations will be needed for it is not known, either. The world may have to live with Covid-19 the same way it lives with the flu. Annual vaccinations may be necessary.

But the alternative is worse. Worldwide, those countries that are vaccinating are seeing infections drop, provided they maintain social-distancing measures as well.

But Bermuda has recently experienced the opposite effect. Vaccinations are rising steadily but infections rocketed several weeks ago and active cases remained at stubbornly high levels until very recently.

This is because the UK variant struck the community hard and developed into community transmission. Contact tracers could not keep up with the new cases fast enough to get people who may have been exposed to Covid to isolate. That meant that people were unknowingly out in public transmitting the virus. That Covid-19 can be asymptomatic increased the risk, as did the discovery that the UK variant symptoms were similar to ordinary flu.

For that reason, the lockdown was critical. With hindsight — and this newspaper suggested it, although perhaps not forcibly enough — it should have happened a week earlier. And restrictions, even with the recent drop in cases, may be being eased too quickly as well.

Regardless, the breathing space was needed and the recent results suggest it is beginning to work. But Bermuda, it is far too early to declare victory or ease restrictions in a dramatic way.

There may be more deaths before the spike eases, especially among the old and most vulnerable. As it is, almost half of all of Bermuda's deaths from Covid-19 have occurred since April 1.

There is still some confusion in the community as to what vaccinations and herd immunity mean. Full immunisation, which for the Pfizer vaccine means receiving two doses and waiting a further two weeks, reduces the risk of contracting the virus by 95 per cent. For the 5 per cent or less of those people who do contract the virus, the vast majority will suffer negligible symptoms and their risk of passing on the virus is even lower. As Kim Wilson, the health minister, said last Thursday, there are no fully immunised people in hospital.

What would be helpful is for the Chief Medical Officer to update the statistics that he provided several weeks ago. At that time, some 666 cases that had been recorded since the beginning of March were analysed. Of that number, only 23 of the people who were fully immunised had contracted the virus. That is 3.4 per cent of the total number of cases — better than the effectiveness figure achieved by Pfizer in its trials. Further, of those 23 people, only three had strong enough infections to pass on to others, a minimal amount.

There have been some suggestions that there is a link between the increase in vaccinations and the increase in Covid-19 cases. This is a case of correlation, not causation. The cause of the rise in Covid-19 cases was the UK variant getting loose as a result of several house parties where social distancing was not observed. This was proved through contact tracing.

That a vastly smaller proportion of people who were immunised got the virus puts the lie to this theory. Even if it were not a scientific impossibility, If people with the vaccine were likely to give Covid-19 to others, these numbers would be much higher. Instead, Bermuda should be glad so many people were already immunised; it does not bear thinking about how many more people would have ended up in hospital or died were that not the case.

What is needed now is to get Bermuda to herd immunity as quickly as possible. The numbers being immunised now do not suggest Bermuda will meet the end of May target unless the rate increases dramatically. A good start was made in the latest figures when 5,000 doses were administered in a week. That number needs to be sustained and increased to make it to the target.

Expanding hours and encouraging walk-ins will help, as will the advertising campaign now under way. But it will require all people living in Bermuda to encourage their friends and families to get vaccinated. If every person who has been immunised — and there are now about 20,000 — persuades one other person to get immunised, too, Bermuda can reach its goal.

Once that is accomplished, the movement towards a semblance of normality can begin in earnest and with reasonable confidence that the era of lockdowns is behind us. Certainly, many Bermudians are feeling Covid fatigue. But Bermuda is so close to emerging from this that those who wish to ignore the rules or refuse to get vaccinated will have only themselves to blame if we do not accomplish it.

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Published April 28, 2021 at 8:00 am (Updated April 27, 2021 at 6:50 pm)

Only one way to get to herd immunity

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