COVID-19 is a horrifying disease, one that can leave people hospitalized, ventilated, debilitated by long-term health problems, and, in the worst case, dead. So how could it possibly be the case that some people getting intentionally infected by doctors in a controlled way—variolation—could help mitigate the damage of the disease?
Bear in mind that this is all in the context of people voluntarily choosing this path; no one is talking about forcing people to get infected. How this might work in the military is beyond our scope.
Variolation can work because how much of the virus a person is exposed to and how a person is exposed seem to play a large role in how sick a person becomes. This means that if doctors intentionally infect people with the virus, they should be able to do so in a way that minimizes the risks of severe illness and death. Obviously a variolated person would be isolated and intensely monitored, hence dramatically cutting the risk of that person spreading the disease to others relative to accidental infection.
Relative to accidental infection, variolation would cut the risk of dying by a factor of three to thirty, economist Robin Hanson expects. (See my recent video interview with Hanson along with Hanson’s recent article on the topic.) The point is for a person to be able to develop antibodies to the disease with relatively less risk to health and life to that person as well as to others. Variolated people would then be freed to fully reenter the word and do important work with much less risk of falling ill or infecting others. As a bonus, perhaps variolated people would provide a large pool of donors of blood antibodies.
Another key dynamic is that COVID-19 is far more deadly for the elderly than for the young. As of April 21, Colorado suffered a total of 508 related deaths. Of those, 51 (ten percent) were of people under age 60. And 23 of those deaths were of people under age 50. Over half the deaths, 261, were of people age 80 or over. So obviously variolation would involve only younger and healthier people, which by itself would dramatically reduce risk of death relative to the average.
The term “variolation” derives from the variola virus that caused smallpox, as the Centers for Disease Control notes. Prior to the development of a vaccine, many people intentionally infected themselves with the disease in the hopes of getting a mild case on purpose rather than a severe case accidentally. George Washington famously variolated (or inoculated) his troops against smallpox to help win the Revolutionary War. Although the terms variolation and inoculation are tightly linked to the practice of intentionally infecting people with the smallpox virus, I am using the term “variolation” more broadly to refer to the intentional infection of any viral disease.
If we had the capacity to effectively test people, trace contacts, and isolate the sick, as South Korea and Taiwan do, we would not be talking about variolation. Hanson proposes it as “Plan B.”
As governor Jared Polis made clear during his April 20 media conference, Colorado has neither the testing nor the tracing capacity to control the disease mainly through those means. Polis’s plan of partial reopening with sustained and substantial social distancing might or might not limit spread of the virus to a minority of the population. Polis openly discussed the possibility of eventually reaching herd immunity, meaning most people will catch the disease.
So, assuming herd immunity is the end game, and assuming you are young and healthy, ask yourself this basic question: Would you rather catch the disease accidentally, at a dose you don’t control, and such that you probably won’t even know you have it for several days (if at all), or would you rather catch it on purpose, in a controlled way to mitigate risks, with immediate and monitored isolation? I know how I answer that question.
Maybe something dramatic will happen with testing such that health officials will be able to catch COVID-19 by the tail and eventually cage the monster. Then perhaps only a small fraction of the population would get the disease prior to the rollout of a potential vaccine. But that would mean a many-fold expansion of testing, and I’ve seen no strong signs of that happening. I’d love to be proven overly pessimistic on this point. On April 22 Polis said that Colorado soon will receive a substantial order of tests, but that doesn’t seem to be nearly enough to change the basic dynamics.
The main story of COVID-19 in the United States has been the catastrophic failure to develop testing. As the CDC developed a test that didn’t work, the FDA throttled outside testing. And now testing capacity has largely stalled nationally and in Colorado, even though a major premise of the shutdown orders was to give government working with outside labs time to ramp up testing capacity. The story of that massive, economy-crushing failure is one that deserves a full telling.
For now all we can do is take that failure as a given and decide what to do from here. We can either correct the testing failure somehow, keep the economy largely on ice indefinitely (until there’s a cure or a vaccine), which is catastrophic, or move to Plan B, variolation.
Naturally, Hanson suggests a large-scale trial to figure out how best to variolate people and how much it reduces risks relative to accidental infection. He points out that many people in government and in medicine resist this plan, but such resistance may erode if (and note the “if” here) it becomes obvious that herd immunity is inevitable.
As for the concern that variolation would consume healthcare resources, Hanson points out that it consumes fewer resources than just letting people randomly catch the disease. And Colorado is intentionally limiting its expansion of hospital capacity anyway. As the Denver Post points out, the emergency hospital facility at the Convention Center, originally slated for 2,000 beds, was scaled back to 600. Why not place those extra beds and fill some of them with those variolated patients who needed them?
The idea of variolation at least deserves public consideration. I see small potential downside to running a serious study of the proposal and a huge potential upside. Variolated people with antibodies would have something like a superpower, able to work and aid the sick with far less fear of falling ill or infecting others. They would be on the forefront of restarting the motor of the world.