Eric Feigl-Ding, ScD, an epidemiologist and health economist and an adjunct senior fellow at the Federation of American Scientists (FAS) in Washington, D.C., was as one of the first to alert the public to the pandemic risk of COVID-19 in January 2020, and is now part of FAS's work to stop COVID misinformation to the public. Feigl-Ding is also a co-founder of .
In the second part of this exclusive 鶹ý video, Editor-in-Chief Marty Makary, MD, MPH, of Johns Hopkins University in Baltimore, speaks to Feigl-Ding about the B.1.1.7 variant and what it means for school openings, cases, and deaths.
Following is a transcript of their remarks; note that errors are possible.
Makary: Hi, I'm Marty Makary. I'm here with Dr. Eric Feigl-Ding and he is an epidemiologist and a scientist at the Federation of American Scientists. Eric, thanks for being with us.
Feigl-Ding: Thank you. Happy to be here.
Makary: The CDC guidelines as released 3 weeks ago didn't spend a lot of time talking about ventilation, and it was one of the sources of criticism of those guidelines. You've outlined a very good plan for good ventilation in schools, but there were a lot of other infrastructure requirements that had set up in order for schools to open up in person. Given those requirements for testing and other things, about 4% of U.S. schools could really open up at a very high capacity in person right now. How do you feel about that versus the harm that kids experience from schools being closed? A study came out showing a 300% increase in self-harm claims in insurance database claims from Fair Health. The downside of schools being closed has been something we haven't talked a lot about. You have a nutrition background. You're a nutrition expert. The hunger crisis is something you're close to. How do you feel about kids being back in person right now?
Feigl-Ding: Right. This is a very good question. Obviously, there is balance. I'm a father. I have a 7-year-old kid and these are really tough issues. I would say first of all I am an epidemiologist as well as a nutrition scientist. I have a doctorate in both, but I think... first of all, there is still debate about the self-harm of... I think, first of all, suicides, there was another study that shows suicides did not increase during lockdowns. But regardless of these, I agree.
Children should not be at home and be forgoing education for that long. This is one of those really incredible frustrating things in bioethics. The bioethics says, "do no harm," or "do net less harm." How do you define the net less harm?
The pandemic is raging. We know the pandemic has cataclysmic effects on global economy and global health, and so at the same time we know children transmit. Children, even according to the U.K. SAGE government advisory panel, it says children are some of the leading infectors. They're top transmitters. They are the first to bring it to a household, and we know the more children in a household the greater the risk of COVID, according to the Danish CDC of 3 million people.
We can't ignore one side versus the other, but at the same time ending the pandemic right now I would say is the most urgent thing and I cannot emphasize that enough. Because I do not want us to send our kids back, have outbreaks... and there are going to be outbreaks because most schools are not safe yet, even though the ventilation, by the way, is, there is upgrade money for that in the Biden $1.9 trillion bill that's going through Congress and will likely pass.
Makary: It'll take a long time though, right, for those upgrades to happen?
Feigl-Ding: Yeah. For the HVAC it will take a long time, but for the portable HEPA filters it will be faster. But I agree, it will take a while for it to be 100% safe. Now, I'm glad teachers are being vaccinated by the end of March in the U.S. That is incredible news, and I hope every teacher takes that opportunity to get vaccinated, but kids' vaccines are still way off on the horizon.
I would say like later this summer at the earliest, although there are some Chinese groups that are finishing pediatric trials very soon, but it's not going to be arriving for kids until next fall reopening. I think stopping the pandemic. Waiting, allowing it to spread is... previously we could afford to send kids to school when we could keep it under control and afford a little bit of transmission.
For example, if you had the R low enough from other mitigation but you kept schools open, that allowed a little bit of transmission. You could afford and still keep the R, the net R below one, but I'm not sure that's possible soon because A, B.1.1.7 is surging. It's about 20%, 25% of the U.S. but it's 36% in Florida right now and it's more transmissible, and what used to work in containing the virus won't work for B.1.1.7, and we know B.1.1.7 attacks kids at an unusually higher rate than the old strain.
This is going to be a problem, and we're going to have these yo-yoing, and I think this purgatory yo-yoing is actually going to cause more harm long-term, more chaos for our economy. Right now, we can still slow it down when the B.1.1.7 hasn't dominated the country yet, but once we lose this window and B.1.1.7 becomes the dominant strain, then what we do now to mitigate it won't even work. Basically we can pay a discount, discounted mitigation. We can mitigate without doing as much now, but once B.1.1.7 sets in we would have to work maybe twice as hard to mitigate to keep it below a 1, and that is the hard part.
Right now, it's easier to mitigate than later... and again, later you'll also have more vaccine, so if we wait and buy us time for more people to get vaccinated at a cheaper mitigation cost to keep it under 1, this is the sweet spot right now. But once we let it out of control and B.1.1.7 dominates, we're going to lose this unique opportunity and that is what I'm very worried about.
Makary: You describe the B.1.1.7 dominating as if it's inevitable. If it dominates a very small number of infections, is that a problem? Is the U.K. in a good spot where the B.1.1.7 strain is dominant already, but they're at numbers 85% off their peaks? Does that mean more persistent infection or does that mean a surge of infection?
Feigl-Ding: Right now, the U.K. is in a very tight lockdown. The U.K. has been in lockdown for quite a while, except for 25% of primary school kids of essential workers who still go to school, and you can see that because of that the children's cases are rising. I will eat my shoe if the cases don't rise after March 8th, like within the 2 weeks of March 8th after schools reopen in the U.K.
It is inevitable, like those... there's a lot of sweet little lies that we tell ourselves, "It will be okay." It is not okay. They don't even have mask rules. We're not even talking about ventilation, and the B.1.1.7, it is inevitable that it will dominate. German models say it, Danish models say it, U.K. models initially said it and then people didn't believe it. Well, now it's 95% to 99% of all U.K. viruses are B.1.1.7. Canadian models have also said it, and CDC models have said it.
Basically everywhere in the world where there was sufficient surveillance, they've all said B.1.1.7, it is inevitable it will become the dominant, greater than 50% common strain. It will be the new common. This is why I say that is 100% certain and we know it's 40% and 60% more contagious. That is also by now 100% certain.
Then also the severity in Denmark. I trust the Danish data the best. Denmark CDC sequences every single case, not a sampling of cases, every single case every week now for the past month, and they can see the trend.
Danish, they were actually in a lockdown. But once it passed 60%, B.1.1.7, even in a lockdown their cases started going back up. This is one thing, B.1.1.7 is so contagious current mitigation and lockdown measures don't work against it, and the U.K., I'm foreseeing a really bad resurgence, and just like Denmark is seeing a resurgence, and the U.S. is going to see a resurgence, and we're already kind of seeing the resurgence.
The CDC director, Rochelle Walensky, just warned just yesterday that there will be a resurgence. We're on the cusp of basically spoiling all the gains that we have made and Fauci has warned this as well. This is a foregone conclusion that the B.1.1.7 will dominate. It will be more contagious, and if we'd let it, especially in the laissez-faire, "Oh, let's reopen businesses." That Mississippi and Texas are doing, it is going to be a disaster. This is why I'm very worried also for Florida, where I think this week Miami-Dade County is also seeing a resurgence as well.
Makary: Yeah. I wanted to ask you about the announcement from Texas and Mississippi, but the vaccines do cover B.1.1.7 pretty well in terms of covering like key outcomes. You may want to keep an extra shoe around in case we revisit this topic down the road.
Let me ask you about herd immunity. A lot of different definitions of herd immunity. People that go to our general Johns Hopkins website on pandemic information see that it defines it very broadly as a majority of people who have had immunity of some form, and it even says 50% to 90% as an example. Is there a false perception out there, Eric, that once we hit herd immunity cases will go to zero? And what will life look like after we start seeing significant slowing of transmission?
Feigl-Ding: Herd immunity is a very controversial topic, and before I get there, Mississippi and Texas, Texas has the 4th lowest per capita immunization of people getting their first shots. Mississippi is the 7th lowest in terms of per capita of people vaccinated with their first shots. That's not a great position to be in if you're going to be swinging all the businesses open and 100% removing mask mandates. I think that's a terrible position. As for herd immunity, I would say I want to differentiate. There is natural infection herd immunity, the kind that Scott Atlas and Sweden and those who've signed that declaration that shall not be named, those are advocates for that type. Now...
Makary: As a strategy? You're referring to the strategy for the immunity?
Feigl-Ding: As a strategy, right. Vaccine herd immunity is better. Because vaccines, we know, offers a much more robust immunity. Like, for example, we see huge re-infections in the Novavax trial in the placebo group. Basically, there was almost no protection from previous seropositivity against reinfection, but Novavax trial among HIV-negative people in South Africa where the South Africa strain was dominant it was still 60% efficacious. 60%, that's still quite good.
That's overall, and not even for severe, so clearly there's a difference between vaccine-based immunity and the natural infection immunity. The vaccine's much stronger, and you see that in so many other examples. Johnson & Johnson was also interested in South Africa.
I think it won't be a magic bullet, and again, the more contagious something is, the higher the herd immunity. With B.1.1.7 it's not 75% anymore. It's more like 85%, and hopefully, knock on wood, no reinfection risk, but it won't go away. But if we have to get to 85%, and potentially 90%, 95% for P.1 if it's really that contagious, that is going to be a tall order because we know vaccine hesitancy in the United States is about 30% of people who are probably not going to take it and very likely not taking it.
30% of adults, and in addition we have about 20% of kids who the vaccine's not even here yet. We know that we're going to, around 70%, assuming all the kids take it, we're going to hit a wall in terms of people being immunized. 70% is not enough to stop a more contagious B.1.1.7 or the P.1 strain. I'm worried about reaching that final mile, of reaching 85%, reaching 90%.
That is my biggest worry right now and I think people have to realize there's a new norm potentially. Because without mitigation outside of vaccines... vaccines and mitigation can add together to get us to a level of slowing the transmission, but relying on one or the other is not enough.
That's why we have to do both, and to do it now is cheaper in terms of economically and human effort and politically than it would be later on, because once we vaccinate all the elderly, which we are getting close to in most states -- not consistent. My parents who are elderly still have not gotten their vaccines yet -- once we get to that level there's going to be a political willpower, a loss of political willpower to keep things closed, especially in Republican states, and even Democratic states. We're going to California with Gavin Newsom. That political loss of willpower to keep things closed or shuttered and mitigated is going to have a... it's going to fire back.
It's kind of like reflexivity, as we say in the financial markets. It's going to bounce back and actually make it worse, because people are going to open businesses way more and take their precautions off-guard way more once the elderly are vaccinated. That could actually lead to another wave, and that's why I'm pretty certain... I'll bring an extra shoe, but I'm pretty certain that April or May there will be a surge of some sort.
Makary: Okay, good. Well, good talking with you here, Eric. Anything that you'd like to say that we haven't covered that you feel needs to be said?
Feigl-Ding: I would say that this pandemic, we have a choice. Do we want this to go for years and years with booster shots, and more variants, and more booster shots, and an endemic purgatory of quarantines for even international travel, quarantines and testing, or do we want to collectively gather as a country, as a planet, to say, "We don't want more of this open and shut, close-reopen purgatory, and we want to go for zero"?
And zero COVID is doable. It is not that much harder. Once you're so much lower... Britain is so much, 85% lower than it was in its peak. Just going the extra mile from now, from that 15% down to zero is doable if we just invest in it instead of caving in to temptation to reopen and start everything all over again.
I feel like our human capacity to go that final mile is the ultimate test here of our generation and our political leadership. I hope we could end this, and I hope we don't have to go into more of the cyclic open and close, more booster shots and other surveillance. I want to end this so we can get our lives to a new normal again.
Makary: Well, I think we can all agree that we want to get back to a new normal again soon. Dr. Eric Feigl-Ding, great to be with you. Awesome to hear your perspective. Keep up the good work with everything that you're doing.
Feigl-Ding: Thank you.
Makary: You've had a distinguished career, a long run at Harvard, at the Federation of American Scientists now, speaking up on this issue. It's great to have you with 鶹ý.
Feigl-Ding: Thank you so much.