UPDATE: Another Change in the Dialogue of COVID-19

In July I wrote about the emergent study of T-Cell immunity (Babich, 2020, July 16) towards the impact of COVID-19. Since then, even more studies have been released discussing the importance of T-Cell immunity relating to the fight of COVID-19, however, leaders in government seem to have not taken into account this important concept to helping fight COVID-19 using our inherent immune system rather than external measures.

The original study from my July article suggested that T-Cells immunity from other coronaviruses cross-react with immunity for COVID-19 (Le Bert et. al, 2020). More studies have come to the forefront with even more knowledge about T-Cells and their importance in the conversation on COVID-19, herd immunity, vaccination, and the return of our normal lives. After the Le Bert article, another article from Braun et al. (2020) suggest they found cross-reactive T-Cells in 35% of the healthy donors (not previously exposed to COVID-19) to be an effective method towards evidence-based risk evaluation. Later on in August and September, both the NIH and JAMA introduced the emergent evidence of T-Cell immunity and its role as an adaptive response to COVID-19 citing the divergence from antibodies and should be a focus for vaccine development, all while stating our development of neutralizing T-Cells as an important factor for this understanding (Hicklin, 2020; Stephens & McElrath, 2020).

It was Doshi (2020, September 17) with the British Medical Journal that outlined the additional research suggesting that the population immunity may be underestimated which has now been confirmed based on the CDC current estimates of seroprevalence with updated IFR (Center for Disease Control and Prevention, 2020, September 10), and the WHO suggesting almost 700 million people worldwide have been infected with COVID-19 (Keaten, 2020, October 5). Now in late October, CEBM at Oxford University acknowledges the impact of T-Cell immunity not only for its potential in cross-reactivity, but its potential in long-term immunity with T-Cells identified in seronegative individuals (Plüddemann & Aronson, 2020). In addition, the latest edition of the New England Journal of Medicine discusses the high prevalence of seropositivity concluding with seroprevalence mortality in Iceland was around 0.3% (Gudbjartsson, 2020).

What does this mean from a mathematical standpoint? Well from the seroprevalence studies the threat of COVID-19 on the population renders a mortality in between 0.1 – 0.3% which is anywhere in between the common flu and a bad flu season. It is simple using the mathematics such as the IFR from the CDC and seroprevalence from the W.H.O. which outline the cases in the United States roughly being 12-17 times more.

United States

Current Cases: 9,000,000

Seroprevalence: 9,000,000 x 12 = 108,000,000 to 9,000,000 x 17 = 153,000,000

IFR with seroprevalence: 230,000 / 108,000,000 = 0.2% to 230,000 / 153,000,000 = 0.15%

Global

Current Cases: 46,000,000

Seroprevalence: 46,000,000 x 15 = 690,000,000

IFR with seroprevalence: 1,200,000 / 690,000,000 = 0.17%

With seroprevalence the data is abundantly clear that the lethality of the virus is not nearly as high as previously thought considering the global survival rate with seroprevalence staying consistent at 99.8 – 99.93%. However, this does not resonate with most people, and I am still unsure why? The key dissenting opinion towards thoughts like this are the lack of community and looking at individuals and families as statistics as heartless and arrogant.

This is an interesting topic of discussion considering the measures from the lockdown such as in Australia who are expected to report at a minimum their 2018 numbers of 24 deaths of despair per 100,000 population, making that a total of 7000 deaths (Australia Institute of Health and Welfare, 2020). Suicides across the world are expected to rise given the peer-reviewed studies of suicide and unemployment may extend beyond the global yearly average of 800,000 (Reger, Stanley, & Joiner, 2020; Ritchie, Roser, Ortiz-Ospina, 2015). Or perhaps the almost 100,000,000 that will be thrust into extreme poverty worldwide (Lopez, 2020, October 13).

This seems to be largely ignored by the pro-lockdown advocates in the public, media, and in government. I can see their willingness to want to keep people safe, but with the lack of vision on the terrible implications from COVID measures, to the willingness to not even observe the data on this, it introduces the question: Who are the heartless and arrogant ones?

Using the data from Australia and the globe, estimates could probably suggest for every 1 COVID death, roughly 8-10 deaths of despair may be the result, and that may be only a liberal estimate. From a humanistic-utilitarian approach, this looks at the lockdowns and mandates as more of a harm than a good. I think it would be beneficial to let our leaders in the government know about the 1:8 ratio, as it may provide some clarity and some rationalization to the topic, especially when we discuss protecting lives.

References

Australian Institute of Health and Welfare. (2020). Suicide and self-harm monitoring. Australian Government. https://www.aihw.gov.au/suicide-self-harm-monitoring/data/behaviours-risk-factors/deaths-of-despair

Babich, C. (2020, July 16). A change in the dialogue on COVID-19. Carson’s Education Blog. https://carsonbabich.wordpress.com/2020/07/16/a-change-in-the-dialogue-on-covid-19/

Braun, J. et al. (2020). SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19. Nature. https://www.nature.com/articles/s41586-020-2598-9_reference.pdf

Center for Disease Control and Prevention. (2020, September 10). COVID-19 pandemic planning scenarios. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html

Doshi, P. (2020, September 17). Covid-19: Do many people have pre-existing immunity? British Medical Journal. https://www.bmj.com/content/370/bmj.m3563

Gudbjartsson, D. F. (2020). Humoral immune response to SARS-CoV-2 in Iceland. New England Journal of Medicine, 383, 1724-1734. https://www.nejm.org/doi/full/10.1056/NEJMoa2026116

Hicklin, T. (2020, August 18). Immune cells for common cold may recognize SARS-CoV-2. National Institutes of Health. https://www.nih.gov/news-events/nih-research-matters/immune-cells-common-cold-may-recognize-sars-cov-2?fbclid=IwAR20MQaEu_m64mWJkHxSVkCqxsF_vRtifrD_lWQBErM9UxC_yySzo9q-4tQ

Keaten, J. (2020, October 5). WHO: 10% of world’s people may have been infected with virus. Associated Press. https://apnews.com/article/virus-outbreak-archive-united-nations-54a3a5869c9ae4ee623497691e796083

Le Bert, N. et al. (2020). SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls. Nature. https://www.nature.com/articles/s41586-020-2550-z_reference.pdf

Lopez, A. L. (2020, October 13). COVID-19 could push 100 million more people into poverty. National Geographic. https://www.nationalgeographic.com/magazine/2020/11/covid-19-could-push-100-million-more-people-into-poverty-feature/

Plüddemann, A., & Aronson, J. K. (2020). What is the role of T cells in COVID-19 infection? Why immunity is about more than antibodies. The Center for Evidence Based Medicine: Oxford University. https://www.cebm.net/covid-19/what-is-the-role-of-t-cells-in-covid-19-infection-why-immunity-is-about-more-than-antibodies/

Reger, M. A., Stanley, I. H., Joiner, T. E. (2020). Suicide mortality and coronavirus disease 2019-A perfect storm? Journal of the American Medical Association. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2764584

Ritchie, H., Roser, M., & Ortiz-Ospina, E. (2015). Suicide. Our World Data: Oxford University. https://ourworldindata.org/suicide

Stephens, D. S., & McElrath, M. J. (2020). COVID-19 and the path to immunity. Journal of the American Medical Association. https://jamanetwork.com/journals/jama/fullarticle/2770758