The Great Barrington Declaration: Focused Protection

The goal of the Focused Protection approach, as stated in the Great Barrington Declaration, is to find balance between protecting the most vulnerable cohorts in society from infection, while minimising the harm done by lockdowns to the physical and mental health of the rest of the population. Focusing our policies and our medical resources on older and higher-risk cohorts will ensure that they remain well-protected until a vaccine can be distributed. In the meantime, the removal of lockdown restrictions would allow the lower-risk cohorts to return to work, to continue with their education, and to engage in all the activities that support the economy and that allow our society to function as normal.

In the short run, this approach would lead to a rebound in activity – both physical and commercial – as large parts of our society would be relieved of the restrictions that had constrained their movements and operations. However, that relief would only be temporary. Within a couple of months, infections would inevitably rise again and activity would once more be forced to slow down.

Voluntary Social Distancing

There is a large cohort in society that adjust its behaviour to the perceived health risk at the time; the higher the health risk, the lower their activity levels and the larger their number. This point has been supported by the IMF’s October Economic Outlook, which found that ‘voluntary social distancing’ accounted for about 50% of the fall in activity levels across advanced and developing countries during the first half of 2020. The Focused Protection approach would lead to a surge in cases which would encourage large numbers of people to voluntarily withdraw from society, and the social and economic benefits of lower restrictions would be lost.

Significant Aggregate Health Costs

The Focused Protection approach would lead to a significant increase in the number of people becoming infected with COVID-19 and then suffering adverse health effects, including death. Advocates of a Focused Protection approach are quick to point out that very few young people have died from COVID-19, but they are slow to aggregate the total health effects across all cohorts of the population.

The authors of the Great Barrington Declaration quote a COVID-19 infection survival rate of 99.95% for those under the age of 70, or 5 deaths for every 10,000 people. There are over 4 million people under the age of 70 in Ireland, so with this infection fatality rate we would expect over 2,000 deaths in otherwise healthy people. That number alone is an unacceptable cost, but it doesn’t account for hospitalisations, ICU admissions, or those who would go on to suffer from ‘long COVID’ either. The rates of harm among healthier cohorts may be small, but when multiplied by millions of people, the aggregate damage to the public’s health would be enormous.

A Potential Public Health Disaster

Even if Focused Protection’s protocols were implemented perfectly – with all vulnerable populations completely protected – the laissez-faire approach in the rest of society would see daily cases soar. This would place huge demands on an already burdened health sector, including demand for testing, GP visits, ambulances, hospitals, and ICU beds. Health care workers would be at increased risk of infection. With less health care capacity available, routine treatments, health risk screening, and other non-urgent elective and preventative procedures would have to be postponed. These health care costs are very real, even though we cannot observe them directly.

It took Ireland only a month over the Christmas 2020 period for daily cases to go from the low hundreds to the high thousands, and the pressure that that put on every part of our health care services was plain to see. If that surge had been allowed to continue for another couple of weeks, daily cases would have soared past 20,000 a day and we would be looking at queues of ambulances outside hospitals on the front page of every newspaper. This would not be a desirable outcome.

A Self-Defeating Approach

In order to prevent those outcomes, and to protect the public health care system itself, some degree of social distancing and restrictions on movement would be likely be required to manage the demand on our health resources, including testing capacity, GP visits, health care workers, ambulances, hospitals, ICUs. But if we are placing restrictions on people’s movements and activities, once again, Focused Protection would appear to have defeated itself.

For the reasons described above, the Focused Protection approach is unlikely to produce either the health benefits, the economic benefits, or the social benefits that it purports to secure. It would expose every individual in the nation to unquantifiable health risks that we can’t treat and which we don’t fully understand. The economic benefits would likely be short-lived, and not least because of the aggregate economic cost of days lost due to illness, and the knock-on effect for businesses that would not be able to trade due to a lack of staff. These conditions would not make for a happy population, and our quality of life is unlikely to improve.

I have some sympathy for those in large, land-bordered nations who advocate for a Focused Protection approach. They are justifiably frustrated with their current circumstances, and since they have little chance of eliminating the virus in the presence of long and porous borders, perhaps it would be the right approach for them. But Ireland is different. We are a small, island nation, and our beliefs and our policies should reflect those immutable, geological fact.

Post Script: Focused Protection and Vaccination

The advocates of the Focused Protection have faded from the media discussion of COVID-19, and it seems highly unlikely that Ireland would adopt this approach. However, we should keep in mind the weaknesses and likely consequences of this strategy as it will inform our policy response as we progress with vaccination. Focused Protection is equivalent to vaccinating the most vulnerable in the population, and then removing restrictions on the rest of our society. There are many who would advocate for this approach or who believe that this is in fact the direction we will take when we have reached that level of vaccination, but it would not be advisable. Focused Protection – whether through cocooning or vaccination – would soon lead to 20,000+ cases a day and a broken health care system.