rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating
mental health – leading to greater excess mortality in years to come, with the working class
and younger members of society carrying the heaviest burden. Keeping students out of school
is a grave injustice.
Keeping these measures in place until a vaccine is available will cause irreparable damage,
with the underprivileged disproportionately harmed.
Fortunately, our understanding of the virus is growing. We know that vulnerability to death
from COVID-19 is more than a thousand-fold higher in the old and inrm than the young.
Indeed, for children, COVID-19 is less dangerous than many other harms, including inuenza.
As immunity builds in the population, the risk of infection to all – including the vulnerable –
falls. We know that all populations will eventually reach herd immunity – i.e. the point at
which the rate of new infections is stable – and that this can be assisted by (but is not
dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social
harm until we reach herd immunity.
The most compassionate approach that balances the risks and benets of reaching herd
immunity, is 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. We call this Focused Protection.
Adopting measures to protect the vulnerable should be the central aim of public health
responses to COVID-19. By way of example, nursing homes should use staff with acquired
immunity and perform frequent testing of other staff and all visitors. Staff rotation should be
minimized. Retired people living at home should have groceries and other essentials delivered
to their home. When possible, they should meet family members outside rather than inside. A
comprehensive and detailed list of measures, including approaches to multi-generational
households, can be implemented, and is well within the scope and capability of public health
professionals.
Those who are not vulnerable should immediately be allowed to resume life as normal. Simple
hygiene measures, such as hand washing and staying home when sick should be practiced by
everyone to reduce the herd immunity threshold. Schools and universities should be open for
in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-
risk adults should work normally, rather than from home. Restaurants and other businesses
Great Barrington Declaration https://gbdeclaration.org/
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