Let’s begin with this provocative article: Perspectives on the Pandemic II, A conversation with Dr. Knut Wittkowski, a transcript from an interview of Dr. Wittkowski conducted in NYC on April 1 and 2, 2020
About the Author
Dr. Wittkowski received his PhD in computer science from the University of Stuttgart and his ScD (Habilitation) in Medical Biometry from the Eberhard-Karls-University Tuüingen, both Germany. He worked for 15 years with Klaus Dietz, a leading epidemiologist who coined the term “reproduction number”, on the Epidemiology of HIV before heading for 20 years the Department of Biostatistics, Epidemiology, and Research Design at The Rockefeller University, New York. Dr. Wittkowski is currently the CEO of ASDERA LLC, a company discovering novel treatments for complex diseases from data of genome-wide association studies.
The following notes are abstracted from the interview, based solely on what I thought was most interesting and important. I would encourage your own reading of the article.
KW: As with every respiratory disease, we should protect the elderly and fragile because when they get pneumonia, they have a high risk of dying of the pneumonia. So that is one of the key issues that we should keep in mind. On the other hand, children do very well with these diseases. They’re evolutionarily designed to be exposed to all sorts of viruses during their lifetime, and so they should keep going to school and infecting each other. Then, that contributes to herd immunity, which means after about four weeks at the most, the elderly people could start joining their family because then the virus would have been extinguished.
KW: With all respiratory diseases, the only thing that stops the disease is herd immunity. About 80% of the people need to have had contact with the virus, and the majority of them won’t even have recognized that they were infected, or they had very, very mild symptoms, especially if they are children. So, it’s very important to keep the schools open and kids mingling to spread the virus to get herd immunity as fast as possible, and then the elderly people, who should be separated, and the nursing homes should be closed during that time, can come back and meet their children and grandchildren after about 4 weeks when the virus has been exterminated.
Q: What do you make of the policy that was enacted in the United States and England and most places throughout the world, this policy of containment, shelter-in-place, etc.?
KW: what people are trying to do is flatten the curve. I don’t really know why. But, what happens is if you flatten the curve, you also prolong, to widen it, and it takes more time. And I don’t see a good reason for a respiratory disease to stay in the population longer than necessary.
KW: We had two other SARS viruses before. Or, coronaviruses. It’s not the first coronavirus that comes out, and it won’t be the last. And for all respiratory diseases, we have the same type of an epidemic. If you leave it alone, it comes for two weeks, it peaks, and it goes for two weeks and it’s gone.
KW: There are no more new cases in China and in South Korea. The number of new cases in Europe is already beginning to decline. The virus came later to the US, so here we see a bit of an incline, maybe, and leveling off within the next couple of days. And if we see that the cases are not increasing dramatically, that means that the number of new infections has already declined substantially and peaked about a week ago.
Q: During the press briefing yesterday, Fauci, and the President, and the rest of the people assembled, were saying that, had they not done the containment strategy that they have done, that upwards of 2 million people would have died in the United States. What do you think of that figure?
KW: I’m not paid by the government, so I’m entitled to actually do science. If the government, if there had been no intervention, the epidemic would have been over, like every other respiratory disease epidemic.
Q: And how many, in your estimation, would have died? Would it have been that much?
KW: We have, right now, let’s take realistic numbers in the United States we have about 25,000 cases every day, that is probably the upper limit—make it 30,000—who knows? But let’s talk about 25,000. 2% of them will actually have symptoms—that is 500 cases a day. Maybe a third or a fifth—let’s say half of them—will need to be hospitalized. That’s 250 patients a day. If they have been hospitalized for about 10 days, that means that we will have—our hospital system will have to deal with 2,500 patients every day for a certain period of time—that could be 3 or 4 weeks, and then the number will dramatically decrease again and the whole epidemic will be over.
Q: And of those hospitalized cases, what, in your estimation, how many would die?
KW: Of all symptomatic cases. 2% of all symptomatic cases will die. That is 2% of the 250,000 a day. So that is 500 people a day, and that will happen over 4 weeks. So, that could be as high as 10,000 people. Now, that compares to the normal numbers of flus during the flu season, and we have in the United States about 35,000 deaths due to flu every year during the flu season. So, it would be part of the normal situation during the flu season.
Q: What do you think about their latest figure that because of, they claim that because of social distancing, that we’ve saved ourselves from the 2 million dead, but that we are probably looking at 150-200,000 dead, though they’ve said that it’s possible that it could be lower, if we are really, really good about social distancing, etc. What do you think about their new estimate of death?
KW: I don’t know where these numbers are coming from—they’re totally unrealistic. There are no indications that this flu is fundamentally different from every other flu. We know what happened in China, we know what happened in South Korea, we know what happened, or is happening, in Europe. There are no indications that anything is different from a regular flu. Maybe it’s a bit worse than other flus—could be?
For a respiratory disease, the flu ends during springtime, that people spend more time outdoors because outdoors, the viruses cannot easily spread. That is a form of containment, spending more time outdoors.
Q: We’ve been told to go indoors. Isn’t that—doesn’t that help keep the virus going?
KW: It keeps the virus healthy, yeah. Going outdoors is what stops every respiratory disease.
Q: At Imperial College, you know Neil Ferguson has changed his estimate of the number of dead in England from 500,000 to 20,000 or less, and he says that that is because of social distancing. Now, we also know that the way in which social distancing was implemented in England was not very severe, or extreme, or efficient, so this was after one day of lock down, he announced that in fact, it would be 20,000 or less. Is there any possibility that that number would have changed that way because of the social distancing?
KW: So, both in China and in South Korea, social distancing started only long after the number of infections had already started to decline, and therefore had very little impact on the epidemic. That means they had already reached herd immunity or were about to reach herd immunity. They were very close. But by installing the social distancing, they prevented it to actually getting to the final point, and this is why we are still seeing new cases in South Korea, several weeks after the peak.
Q: Why doesn’t containment work for an airborne disease?
KW: You cannot stop the spread of a respiratory disease within a family, and you cannot stop it from spreading with neighbors, with people who are delivering, who are physicians—anybody. People are social, and even in times of social distancing, they have contacts, and any of those contacts could spread the disease. It will go slowly, and so it will not build up herd immunity, but it will happen. And it will go on forever unless we let it go.
Q: Let me ask you, you don’t feel this requires a vaccine?
KW: We don’t have a vaccine against the common cold. We don’t have—we have some vaccines against flu, but they are not that effective. Would it be nice to have a vaccine against SARS? Yeah. It would be nice. But it would help to create herd immunity a bit faster, because those who have the vaccine are already immune, and those who don’t, they just need to be exposed to become immune.
KW: We can see that in China, in Korea, the epidemic went down, and the epidemic did exactly what every other epidemic did, and it’s not that 400% of all people died. Maybe it’s 3 rather than 1%—maybe! But nothing is fundamentally different from the flus that we have seen before. Every couple of years there is a flu that is a bit worse than the other flus were, and it goes away in exactly the way the other flus went away, and this one behaves exactly the same way. The epidemic has ended in China, at least, in the provinces where it was. It has ended in South Korea. In Europe, it’s declining and will be ending anytime soon. Could be a bit longer than typically, because of the containment, which flattened and prolonged the epidemic. And so, if we really—that’s really good if we want to be affected by it as long as it gets. And in the United States we are doing the same thing. We are prolonging the epidemic to flatten the curve. But eventually, it will end.
Q: what do you think are the possible health risks of the policy that we are following now, the shelter in place?
KW: Well, we will see maybe a total of fewer cases—that is possible. However, we will see more cases among the elderly, because we have prevented the school children from creating herd immunity. And so, in the end, we will see more death because the school children don’t die, it’s the elderly people who die, we will see more death because of this social distancing.
Q: We keep being told now about the second wave that will come in the fall. Now, tell us what your thoughts about the second wave are and how—it seems like from everything you’re saying is that we’ll have a second wave because of social distancing—
KW: If we had herd immunity now, there couldn’t be a second wave in autumn. Herd immunity lasts for a couple of years, typically, and that’s why the last SARS epidemic we had in 2003, it lasted 15 years for enough people to become susceptible again so that a new epidemic could spread of a related virus. Because typically, there is something that requires cross-immunity, so if you were exposed to one of the SARS viruses, you are less likely to fall ill with another SARS virus. So, if we had herd immunity, we wouldn’t have a second wave. However, if we are preventing herd immunity from developing, it is almost guaranteed that we have a second wave as soon as either we stop the social distancing or the climate changes with winter coming or something like that.
Q: And so, to summarize, you are saying that’s going to flatten and extend the epidemic and create the second wave that we are being told to fear?
KW: Yes. The second wave is a direct consequence of social distancing.
KW: We should be resisting, and we should, at least, hold our politicians responsible. We should have a discussion with our politicians. One thing we definitely need to do, and that would be safe and effective, is opening schools. Let the children spread the virus among themselves, which is a necessity to get herd immunity. That was probably one of the most destructive actions the government has done. We should focus on the elderly and separating them from the population where the virus is circulating. We should not prevent the virus from circulating among school children, which is the fastest way to create herd immunity.
Q: Can you explain, just one more time, as clearly as you can, what’s the concept with natural herd immunity? What happens to the virus when it’s gone through the population in the way you’re describing?
KW: If 80% of people have had contact with the virus and are therefore immune, and that, typically, that contact is just a form of immunization. So, there is no disease, there’s nothing happening, and still there is immunity. If 80% of people are immune and somebody has a virus and is infectious, it will be very difficult for that infectious person to find somebody who is still susceptible, not immune. And therefore, this person will not infect anybody else and therefore we won’t have the disease spreading. That is herd immunity.
Q: What do you think we should do at this point? Should we pivot to what you suggested earlier or is it too late for what you suggested?
KW: It’s difficult to tell. It may be too late. It may not be too late. The problem is, if we are artificially keeping the number of infections low among low-risk people like schoolchildren and their parents, we may not have reached herd immunity yet, so if we are stopping, we may have an increase in the number of new infections. That is the downside of starting containment. We should not believe that we are more intelligent than Mother Nature was when we were evolving. Mother Nature was pretty good at making sure that we’re a good match for the disease that we happen to see virtually every year.
Q: But is this a pandemic? That’s the big question.
KW: It is a pandemic like every flu every year is.