Commentary: New vocabulary in the age of COVID-19

By Robin Hayes

You may have heard of herd immunity if you live or work in an agricultural industry.

Herd immunity considers the degree of transmission of infection – a basic reproduction rate. Vaccinations are one way to stop the chain of transmission. The belief is that since a certain percentage of a population is vaccinated, then we can significantly manage the spread or degree of contagion.

Without immunization to a certain pathogen, the pathogen will easily spread. Data shows that historically, the federal or regional government would euthanize a herd to minimize exposure (an extreme option).

For humans, a shut-down seemed to be the only option.

When thinking about infections, it should be thought of in terms of three groups:

1. The infected

2. Those capable of contracting

3. Those who have immunity because they have been exposed

What experts have learned is that the mode of transmission for SARS-COV-2 (aka COVID-19 and coronavirus) can either come from breathing, coughing, or sneezing, or from contact exposure. It is for this reason that from the very beginning we have all heard about the necessity of wearing a mask and of using hand sanitizer.

Truth be told, health care professionals and those industries who have needed to adhere to strict hygiene protocols have been using “universal precautions” for decades. It is only just recently that have many come to understand just how important frequent hand washing, using a paper towel to turn off faucets and to open doors, and sneezing/coughing into the crook of the arm are when trying to minimize contact with pathogens.

What has been concerning scientists, epidemiologists and government officials is the understanding of: How many people can 1% of the population make sick?

For the SARS-COV-2 virus, it is believed that it would take 3-6 days – a very fast spread – to infect 2-3 healthy people. This is what is called a doubling effect.

Early on, as alleged data came in from other countries, it was determined that the SARS-COV-2 virus has a doubling effect in about 3-6 days and then drops within 10-13 days to 0. The belief is that if someone has been infected and is now immune, then they have developed antibodies. The immune person becomes someone who can help to break the chain of spread either because they have had the infection and has built an immunity, or they have had the vaccination. Either way, when outbreak occur, it can run its course and the risk of infection eventually diminishes because of the increased number of immune individuals.

The complexity of reality is the idea that as many people as possible must not slip below the threshold of vaccination immunity. For example, it has been suggested that if 100 million people become sick, approximately 14% would require oxygen and 4-5% would require ventilation. This would result in a huge death toll and an incredible strain on the healthcare system. Health care staff would become ill.

The current expectation is that 85-90% herd immunity is acceptable. The reason for the shutdown was because experts did not fully understand who is vulnerable. So, the normal course of action to combat an epidemic is to protect susceptible individuals and to reduce the disease reproduction rate to the point that the infection becomes stable within a population.

I found it fascinating to learn what other countries were trying to do to combat the second wave of outbreak.

In Germany, they are testing for SARS-COV-2. Individuals receive certificates if they have good results. It establishes immunity and allows the individual to go out into the community. This is a way of allowing individual towns to open. It does not prevent travel to other places, however, and it creates a class system until immunity develops.

In the United Kingdom they want to create herd immunity by trying to make their population sick. Some of the most recent news reports I have heard suggest that they may be the closest to developing a vaccination.

Yet, in Sweden, their approach has been based on individual responsibility and voluntary compliance versus legal enforcement. The controversy lies in the lack of resources available for the vulnerable to comply.

It appears that much of the debate has been how slowly or how quickly do we encourage people to become sick. Perhaps this was the logic behind much of the worldwide shutdowns: allow people to become sick slowly to allow a smaller amount of people to go to the hospital.

So, when we come out of the lockdowns, we will still be exposed to infected/ill people and the concern will be that the “healthy” people are now the vulnerable population. Strangely enough, there has been an acknowledgement that people within the lockdown community can be infected and will now come out to infect.

The ideal course of action would be to have a vaccination; but as we all know this could take quite some time, and there is no clear idea that the vaccination would work enough to be satisfactory and to reduce the strain put on all of us both emotionally and financially.

In my training as a dietitian, I was taught that those of us living in the 20th Century were fortunate because it was the first time in history that we had sustained health and the ability to grow and to develop more than our forefathers. Better quality nutrition and the onset of immunizations were credited.

As I reflected on my training and refreshed my understanding of how certain vitamins can benefit the immune response naturally, I was encouraged to learn that we might be able to stall the application of the virus because we will give ourselves a chance to develop immunity. Paying a little more attention to the quality of our meals is always a smart investment in our overall health.

Robin R. Hayes, MS, RD, CDCES, LDN, is a dietitian/diabetes care and education specialist, as well as owner and clinical director of Nutritionally Speaking in Dover.