The case for Controlled Voluntary Infection

Dr. Douglas A. Perednia, a physician in Portland, Oregon, writes in part in the Federalist,

By now, we all know America’s immediate COVID-19 action plan is to avoid rapid spread of the virus through good hygiene and isolation. The logic of this mitigation strategy is quite sound. As Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, has repeatedly explained, this approach will buy us time and flatten the curve of the national infection rate.

Both of these steps are needed because intensive care unit (ICU) resources are essential to managing the disease in older and sicker patients, but are inherently expensive and finite. We cannot afford to overwhelm them.

The problem with mitigation is that it is entirely defensive; it does little to make the country safe for a return to widespread social and economic activity. If and when social isolation and quarantine measures relax, coronavirus infection rates will rise in tandem.

The Imperial College has modeled the effect of imposing four interventions — social distancing of the entire population, case isolation, household quarantine, and school and university closure — then relaxing them periodically to allow daily life and economic activity to partially recover. They found, “Once interventions are relaxed … infections begin to rise, resulting in a predicted peak epidemic later in the year. The more successful a strategy is at temporary suppression, the larger the later epidemic is predicted to be in the absence of vaccination, due to lesser build-up of herd immunity.”

In other words, a mitigation strategy based on shutting down the economy is like asking society to hold its breath to keep from inhaling a toxin. It can’t keep up forever, and when it does breathe, all that gasping for air is going to undo much of the benefit we’d hoped to derive.

The alternative to mitigation is active suppression of the disease. The conventional approach for suppressing epidemics is the development of: 1) an effective vaccine and 2) drugs that could be used to reduce the severity. Despite record-time development of potential vaccines and the beginning of Phase I clinical trials, we are not likely to have a coronavirus vaccine widely available until at least mid- to late-2021. We can certainly hope effective drug therapies become available in that time, but there are certainly no guarantees.

Neither mitigation nor waiting for a vaccine is acceptable given the magnitude of the problem we are facing. Economies are like a living organism — as soon as their normal functions are shut down, they begin to die. Savings, capital, income, and taxes all evaporate. Companies begin to close, and many will not have the resources to begin again. Massive deficits will become a huge burden for future generations. Meanwhile, the regular health care system is all but shut down.

It is time to think outside the box and seriously consider a third, somewhat unconventional alternative: controlled voluntary infection (CVI).

What Is Controlled Voluntary Infection?
CVI involves allowing people at low risk for severe complications to deliberately contract COVID-19 in a socially and medically responsible way so they become immune to the disease. People who are immune cannot pass on the disease to others.

If CVI were to become widespread and successful, it could be a powerful tool for both suppressing the Wuhan coronavirus and saving the economy. It could reduce the danger of passing COVID-19 to vulnerable populations, drastically reduce the amount of social isolation needed, reopen businesses, and even help achieve the level of “herd immunity” needed to stop the spread of the disease within the population.

Herd immunity, of course, is the phenomenon whereby contagious infections can no longer spread if a large enough percentage of the population is immune to the disease, and CVI is a means to achieve it. Many over the age of 60 might remember an interesting historical precedent for CVI: chickenpox parties.

Before vaccinations for childhood diseases such as chickenpox and German measles were developed, families would hold chickenpox or German measles “parties” when one child contracted the disease. All the neighborhood children were invited to play with the infected child with the understanding that they would probably become infected as a result. The entire community would get the disease out of the way in one little local epidemic. Since many childhood diseases are far more severe if contracted as an adult, voluntary infection minimized the potential for future adverse consequences.

CVI for COVID-19 is based upon a unique characteristic of the Wuhan virus: Its infections are known to be clinically mild in much of the population, specifically healthy young people — even to the point of being asymptomatic. According to data collected from the National Health Institute in Italy and a recent article in the Journal of the American Medical Association, the mortality rate for the disease is 0 percent in patients 0 to 29 years old. Mortality then begins to increase with age and with underlying defects in respiratory function or certain other disease conditions.

Read more here.