COVID-19: Shelter-in-Place or Natural Immunity?

With a background in public health/health promotion and sociology, a lot of people have asked me what I think about COVID-19 (the disease)/SARS-CoV-2 (the pathogen) and how we’re handling the outbreak as a global community.

‪For what it’s worth, here’s what I think.

Shelter-in-Place

Some people believe that shelter-in-place is an ineffective strategy for handling the pandemic because it reduces our immune response. This idea – at least the idea that shelter-in-place reduces our immune response – is objectively true, and is also the point. Shelter-in-place protects people from the virus by preventing them from contracting it in the first place, until a (safe and effective) vaccination is ready for distribution.

‪Because public health professionals understand how devastating a highly-infectious disease with a high mortality rate can be to a newly-exposed population (re: Spanish Flu, Bubonic Plague, etc.), it follows that their immediate reaction to SARS-CoV-2 would be shelter-in-place.

Shelter-in-place is NOT — and I cannot stress this enough — a fear tactic that the government is using to control the population. Control them to what end? Power? Unlikely, considering its detrimental consequences to the global economy as a result.

Natural Immunity

An alternative approach to handling a pandemic is to send the least-vulnerable demographic out into the world to contract the virus so their body can develop the immune response naturally.

This approach would probably bring the population into herd immunity much faster, but would also result in significantly more lives lost (the way mortality percentages work: the higher the number of infected people, the higher the number of deaths due to infection).

‪This natural immunity approach is especially dangerous for a virus like SARS-CoV-2, which walks the fine line between having a high mortality rate (i.e., killing a lot of people) and being highly infectious (i.e., killing few enough people slowly enough that it has a lot of opportunity to spread).

Because public health professionals’ (e.g. WHO, CDC, etc.) main goal is to reduce the number of lives lost, they, of course, vehemently resist this approach.

Personal Protection (Masks)

A sort of middle-ground approach is to allow people to go out, but protected by masks and gloves. This approach isn’t perfect either though because, just like herd immunity, it only works if all able-bodies participate (i.e., because non-surgical masks don’t protect against all air/germ flow, you can still be infected by someone breathing/talking/sneezing directly into the air in close proximity even if you’re wearing a mask yourself. The risk of infection is much lower if all parties are protected).

Additionally, just like herd immunity, the natural-immunity people will encourage people who are “worried about the virus” to wear a mask, but will refuse to wear one themselves — further perpetuating the spread of the pathogen (re: the higher the infection rate, the higher the death toll).

And here’s where the sociology comes in — I’m convinced this problem stems from people nowadays being more concerned about their own comfort and convenience than they are about the way their behavior affects the greater population. But that’s a conversation for another day.

All Roads Lead to Rome (Hopefully Italy's Doing Okay)

‪So what do I think? I think both approaches (shelter-in-place and natural immunity) will eventually protect us by bolstering our immune response to SARS-CoV-19.

‪Shelter-in-place will do it with fewer deaths but greater damage to the economy, while natural immunity will get us back to normal more quickly but with a higher death toll (the current mortality rate for SARS-CoV-2 is 14.6%-23.6%, according to recent data from the CDC; for reference, the mortality rate for the flu is 0.1% and kills 12,00-61,000 people annually in the United States).

If you ask a public health professional or infectious disease specialist, the best option for handling COVID-19 is to shelter-in-place until a vaccine is developed and distributed.

If you ask an economist or osteopathic doctor, they’d probably say natural immunity is the way to go.

If you ask a sociologist, they’ll tell you this is why the general public is having such a difficult time determining the “best” way to move forward — there isn’t one right answer about how to proceed because it really comes down to what you believe is worth sacrificing.

Regardless, it doesn’t take much to wear a mask when you’re out in public until a vaccine is ready -- even if you're not worried about contracting the disease, do it for the greater good of your community.