"The Great Barrington Declaration" opinion from a local Doctor

I was asked to comment on "The Great Barrington Declaration", which has gone "viral" in the last few days.  It advocates for us to change our approach to the COVID pandemic to "allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk."  


This is a very attractive message, as we are all tired of disruptions caused COVID-19.  At the time I wrote this, the website for the declaration reported that it has been signed by around 500,000 concerned citizens and 40,000 scientists and medical professionals (although they only list ~100 of the names), which seems to lend legitimacy to this attractive idea.  


1) Their idea is instead of trying to flatten the curve, we let most people get sick at once.  The biggest short-term problem with this idea, is that even with our current policies designed to decrease spread, many hospitals in Missouri are running at or near capacity, and there are few open ICU beds (see https://showmestrong.mo.gov/public-healthcare/ for frequent updates).  Recognizing that best estimates are that only 10% of us have had COVID so far, our Healthcare system in Missouri is ill prepared for double or triple or more patients that need our care in hospitals.  There would not be enough hospital beds, oxygen machines, Airvo units, BiPAP machines, ventilators, drugs etc, and many people we are helping now (and are surviving), would not get the same level of care.  Early in the pandemic, there were multiple meetings around the state (including in our county) about how we would decide who gets treatment, and who doesn't, if there are not enough machines and staff to care for everyone.  I am VERY thankful none of us in Missouri have been put in the position of deciding who gets care and who doesn't...yet.  


2) The Declaration focuses on risk of death, but makes no mention of disability.  Some people (even young, previously healthy people), who have survived COVID-19, have developed serious complications (heart, lung and neurologic problems have been prominent), and sometimes months after infection, patients still suffer severe problems.  While there aren't many articles in the medical literature yet about this, an internet search for "COVID long haulers" will give you an idea of the emerging scope of this problem.  We are just beginning to learn about the frequency and severity of these longer-term complications.


3) Even if we as a society decided that the cost of excess deaths and disability to members of our community was worth it to get back to "normal" life, it is not clear at this point how long natural immunity to COVID will last.  Right now we know antibody levels drop in many people to very low levels ~90 days after infection. That is, we might find ourselves in the same situation we are today (without herd immunity) in a few months.  Our sincere hope is that vaccine immunity will be longer lasting, but it is possible that people will need to get annual COVID shots (like we get annual Flu shots) each year.  


The Great Barrington Declaration came out of a convention hosted by a libertarian group called the American Institute for Economic Research, which is based in the small town of Great Barrington, Massachusetts.  I think it is interesting that the town leaders of Great Barrington have rejected this declaration (https://thehill.com/homenews/state-watch/521320-great-barrington-mass-comes-out-against-great-barrington-declaration).  The Lancet (a prestigious medical journal) posted a more eloquent and referenced response than what I have written here, called "The John Snow Memorandum" on 10/14.  By the time I wrote this ~18 hours later, it had been signed by over 2000 medical professionals (https://www.johnsnowmemo.com/), and all of those signatures are available to view.  


In summary, no matter how superficially attractive this policy might seem, I believe it is irresponsible for medical professionals to advocate for this policy that would allow for unchecked spread of COVID in people at "minimal risk of death," which would result in us not have enough hospital and ICU beds to care for sick patients (even young patients), where we almost certainly would run short of the limited treatments we currently know can at least help some, while exposing these people to risks of serious long term problems, just as we are beginning to learn about why they happen and to whom they occur, without even assurance that the immunity will last.  


I would also remind your readers that Gasconade County, according to the Missouri Covid Dashboard (https://showmestrong.mo.gov/data/public-health/), has the highest rate of death in the state (at the time I wrote this, 163 deaths per 100,000 population), over double the rate in St. Louis and nearly 5 times the rate of Franklin County.  

Very Respectfully,

Michael Rothermich, MD

Physician who proudly served overseas and on CV-79 (USS JFK) in the US NAVY, 

before moving back to Missouri, where I have lived and worked in Gasconade and Montgomery Counties since 2006.