President Trump’s newest White House pandemic adviser, Scott Atlas, reportedly is advocating for the strategy of building “herd immunity” to stop the spread of coronavirus. Atlas, who is a neuroradiologist and fellow at the Hoover Institution, would allow the virus to spread as widely and quickly as possible to build immunity in the overall population. Think of it as the opposite of closing businesses and requiring social distancing and masks—all aimed at slowing the spread of the disease.

Atlas’s strategy could have catastrophic consequences for frail older adults—those already at the highest risk for serious illness and death from covid-19. As of Aug 26, nearly 80 percent of those who have died from covid-19 in the US are over 65 and 57 percent are older than 75.

Risks to seniors

Atlas and other advocates of the herd immunity idea are well aware of the risks to seniors. His solution would be to continue to segregate older adults from the broad population, effectively extending the lockdown of many seniors that already has gone on for nearly six months. This strategy ignores the well-documented health risks of social isolation.

According to his plan, interactions between the general population and residents of nursing homes and other at-risk people would be “strictly regulated.” Testing and masks would be required before any contact is allowed. His description of the plan is here.

Already, cases and deaths in long-term care facilities are beginning to rise again, after falling through the summer. And many public health officials fear a bigger spike in the fall.

More cases or more isolation

With that background, there are three enormous risks to older adults of the herd immunity strategy.

The first is that six months into the pandemic, long-term care facilities still are struggling to get access to quick, accurate tests. The White House has begun delivering tests to some nursing facilities and promises them for others as well as for assisted living facilities.

But the Administration is offering so-called point of care antigen tests. These are cheap (about $5) and produce results in about 15 minutes. But they also are considered less reliable than the more commonly used, but much slower and more costly, laboratory-based polymerase chain reaction (PCR) tests. One false negative can be catastrophic in long-term care facilities, where the disease can spread rapidly.

The second problem is that allowing the virus to spread aggressively in the broader population inevitably will increase risks to long-term care patients, who will have contact with aides, family members, and others who live in the communities where the policy would be to drive up infections.

Several research studies have shown that a long-term care facility located in a community with widespread covid-19 cases is more likely to have outbreaks—and deaths–itself. The herd immunity strategy will increase community cases throughout the country.

The third risk is that, with the virus spreading widely and rapidly in the broader community and with testing still unreliable, operators of long-term care facilities will default to what they have been doing for months—locking down their residents.

How much longer?

How much longer would this isolation continue? Quite a while.

Research suggests that somewhere between 40 percent and 60 percent of the population would need to be infected before widespread immunity occurs.  Today, there have been about 6 million reported covid-19 cases in the US, less than 2 percent of the population. Some analysts think that, counting unreported, asymptomatic cases, the number could be much higher. But there is no credible evidence supporting that estimate.

Sweden tried a version of the herd immunity strategy Atlas is promoting but the idea failed. The nation has among the highest rates of covid-19 disease and deaths in the world. The only other way to achieve   herd immunity is through a vaccine. But it remains unclear when one will be widely available.

Atlas’s idea a real thing? Hard to tell. Another White House coronavirus adviser, Deborah Birx, insisted yesterday that the White House would not adopt a herd immunity strategy.  “Neither I, nor anybody in the administration, is willing to sacrifice American lives for herd immunity,” Birx told reporters.

But the White House response to the pandemic has been chaotic and seemingly based on the president’s whims for months. And Atlas is telling President Trump what he wants to hear: There is a way to create widespread immunity that does not require business closings or mask-wearing.

One thing is certain: If the White House does adopt this strategy, the first victims will—once again—be frail older adults.