COVID-19: I Fear that the Minimizers and Proponents of the “Get them infected so that we will have herd immunity” have done Great Harm to Many

My role of trying to educate the public about this developing pandemic and the actual and potential risks that SARS-CoV-2 infection presented back in the first two years, when misinformation and disinformation were rampant, and when the evidence was still unfolding, and especially prior to the availability of vaccines, was greatly challenging.

On one hand, there was the loud voice of minimizers who likened COVID-19 to a cold or possibly even the flu and discouraged precautionary measures, and  on the other hand, but not mutually exclusive, a group of physicians with more promotion on social media, cable networks, and even some of the mainstream media, who advocated for the unhealthy and elderly to stay home, but to have children and young adults return to all their normal activities, including those known to be high-risk for infection, to promote infection with the pronouncement that our country would then achieve herd immunity and COVID-19 would no longer present a significant threat to society. One well-known and nationally renowned physician even wrote an article for a major news outlet that predicted that we would achieve herd immunity as a country by April of 2021. I tried to warn the public that that prediction was not based upon any sound facts or science and was completely unreasonable. In fact, nearly 3 ½ years later, we still have not achieved “herd immunity.” I wrote at length about what herd immunity is, what factors are necessary to achieve herd immunity, and why herd immunity was not a reasonable expectation with the SARS-CoV-2 virus, at least for the foreseeable future in our book, Preparing for the Next Global Outbreak: A Guide to Planning from the Schoolhouse to the White House, https://www.press.jhu.edu/books/title/12896/preparing-next-global-outbreak.  

Another challenge that was frustrating and challenging to deal with was the fact that the public’s and government’s focus and attention was on hospitals being overwhelmed and people dying from the disease. I tried repeatedly to raise the point that it often takes years after we first recognize a new virus to determine the long-term health consequences of infection, and sometimes these consequences can be serious and even disabling. I urged people to consider that we may learn of such health consequences from infection with SARS-CoV-2, so those who were being encouraged to take a cavalier approach to this virus because they were not in any of the identified high-risk groups, might still want to take reasonable steps to minimize the risks of infection, or at least guard against multiple reinfections, which would very likely increase any such long-term health risks. It is hard to know if my warnings made much of an impact.

Unfortunately, since then, we have learned that there are many potential long-term health risks, some that I had not even contemplated, and that these risks do, in fact, appear to increase with increasing number of infections.

In this blog post, I am only going to review two studies (more to come). The first is a study that would never be approved in the U.S. because the study took healthy individuals and exposed them (we call this a challenge study) to SARS-CoV-2 to study the effects of infection. Published by The Lancet, the investigators of this study, Changes in memory and cognition during the SARS-CoV-2 human challenge study – eClinicalMedicine (thelancet.com), took 34 healthy volunteers who had no history of COVID-19 and who were tested by serology (antibody testing) to ensure that they had no antibodies to the virus that would suggest prior asymptomatic or pauci-symptomatic infection of which the subjects were unaware, and inoculated them (introduced the virus directly into their nasal passage) with the wild type (original strain) of SARS-CoV-2. The investigators then conducted cognitive tests on the subjects (some who developed evidence of infection: measurable and sustained viral loads by PCR testing and some who did not become infected who then served as the comparison group) during their period of quarantine and at 30, 90, 180, 270, and 360 days following their artificially-induced infections in order to compare the results to their pre-infection, baseline cognitive testing. Of the eighteen subjects that developed laboratory evidence of infection, one was asymptomatic and all the others suffered only mild illness (i.e., not severe enough to require medical attention or intervention).

The infected subjects demonstrated statistically significant lower global composite cognitive scores than uninfected volunteers, and this difference occurred both during the acute infection, as well as through the follow-up period of 1 year. Memory and executive function tasks showed the largest between-group differences and this was despite the subjects generally having no awareness of the cognitive decline.

Although this was a small number of subjects tested, it was concerning that cognitive decline was detected in all cases, whether the infection was asymptomatic or mild. It remains an unanswered question as to how many of these subjects ever returned to their baseline level of cognitive functioning. While these subjects were not aware of their cognitive decline, it is not uncommon for people during and after COVID-19 to report “brain fog,” which generally refers to loss of memory, difficulty focusing, and difficulty maintaining attention for prolonged periods of time. Keep in mind that these subjects ranged in age between 18 and 30; these were not elderly individuals, but rather young adults in the prime of their lives. It also raises concern that with this impact on young adults, what is the impact on children with still developing brains?

The second study was a review article published in the New England Journal of Medicine in February of this year: Long Covid and Impaired Cognition — More Evidence and More Work to Do | New England Journal of Medicine (nejm.org). I have previously written about some of the neurologic and psychiatric sequelae of COVID-19, but this study looks further into a recent analysis of the U.S. Current Population Survey that showed that after the start of the Covid-19 pandemic, one million U.S. residents of working age reported having “‘serious difficulty’ remembering, concentrating, or making decisions” than at any time in the preceding 15 years. While in the previous paper, the investigators established cognitive decline with infection with the original strain of SARS-CoV-2 that occurred even with asymptomatic or mild infection and persisted at least a year, these authors point to the fact that cognitive decline has been reported with every variant since the original 2019 virus.

Concerningly, these researchers state:

As compared with uninfected participants (control), cognitive deficit — commensurate with a 3-point loss in IQ — was evident even in participants who had had mild Covid-19 with resolved symptoms. Participants with unresolved persistent symptoms had the equivalent of a 6-point loss in IQ, and those who had been admitted to the intensive care unit had the equivalent of a 9-point loss in IQ.

They go on to point out:

Memory, reasoning, and executive function (i.e., planning) tasks were the most sensitive indicators of impaired function, and scores on these tasks tended to correlate with brain fog. Vaccinations provided a small cognitive advantage. Reinfection contributed an additional loss in IQ of nearly 2 points, as compared with no reinfection.

It is hard to know the significance of these findings without longer follow-up and surveillance. But, these findings are concerning enough that I believe it prudent to try to protect our children is schools with better air handling, ventilation, and filtration. It is frustrating to me that minimizers, promoters of herd immunity, disinformation purveyors, and even our own public health messaging no doubt contributed to such a high population infection burden. I hope all of these changes in cognitive function reverse over time, but given that prior studies have shown that imaging can detect structural alterations to the brain, including loss of brain tissue, I am skeptical that all persons will experience recovery.