Dr. Jay was not a "fringe" epidemiologist

Articles from experts early in the pandemic shared many of the ideas behind The Great Barrington Declaration

I have taken a long break from publishing any new articles, and paid subscriptions are still paused indefinitely, but I wanted to send out the following article in honor of Dr. Jay Bhattacharya, as a show of support for his nomination as NIH Director.

With Dr. Jay Bhattacharya in DC today for his confirmation hearing, you’ve probably heard a lot about the Great Barrington Declaration again. You’ve probably heard how the previous NIH Director, Francis Collins, called Dr. Jay a “fringe epidemiologist” and insisted we needed a “quick and devastating published take down” of the GBD. What you may not realize is how many people were saying things very similar to the Great Barrington Declaration in early 2020. Many of the principles behind the GBD were commonly-held beliefs in epidemiology and public health, and often found in basic pandemic plans until Covid hit. Phrases like “herd immunity” and “focused protection” and “shielding the vulnerable” from GBD authors were lambasted as irresponsible and impractical, but in reality, they are not that different from what many experts were saying early-on.

Of course, many of these experts later changed their tune, and I’m sure they justify their about-face for one reason or another, but it’s hard to argue that Dr. Jay’s ideas were “fringe” or completely unorthodox. The truth is, they echoed what many people said in early 2020 before panic took over. That’s when so many of the “experts” seemingly chose to ignore basic public health principles of balancing risks and benefits of interventions and maintaining a functioning society, and instead adopted a wildly different approach to Covid.

As Collins later acknowledged, the public health establishment in the government had a monomaniacal focus on stopping Covid, without giving any consideration at all to whether the response “totally disrupts people's lives, ruins the economy,” and harms children by keeping kids out of school for extended periods. He claimed this is the “public health mindset” — but it’s not supposed to be! Public health training is supposed to be all about balancing benefits and harms; but considering most public health experts either abandoned or forgot that during Covid, I have to wonder if maybe that's no longer a fundamental aspect of the current field of public health industry.

Below are some highlights of experts who sounded very reasonable about Covid early on about how we should respond:

Michael Osterholm

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota (and later a member of the Biden transition team’s COVID-19 Advisory Board), wrote an op-ed in the Wall Street Journal in March 2020, titled “Facing Covid-19 Reality: A National Lockdown Is No Cure.” It was hard to even choose quotes to highlight from this article, because the whole thing reads like the Great Barrington Declaration, with discussion of minimizing harms to the economy and society, carefully considering second-order effects of things like business and school closures, emphasizing the impact of herd immunity, and protecting the elderly and at-risk while the young and healthy keep society running. (Osterholm was also vocal about cloth masks being oversold as a way to stop the pandemic.)

“Covid-19 will go away eventually in one of two ways. Either we will develop a vaccine to prevent it, or the virus will burn itself out as the spread of infection comes to confer a form of herd immunity on the population.”

“Hong Kong closed schools; Singapore did not, and there was hardly any difference in the rate of transmission. The second-order effect of shutting schools is that hardest hit will be those least able to afford to miss work to care for homebound children.”

“Consider the effect of shutting down…. The likely result would be not just a depression but a complete economic breakdown…. We can’t have everyone stay home and still produce and distribute the basics needed to sustain life and fight the disease.”

“Facing Covid-19 Reality: A National Lockdown Is No Cure”

Jeremy Faust

Jeremy Faust, an ER doctor at Brigham and Women’s Hospital who teaches at Harvard Medical School, wrote this reassuring article about Covid for Slate in March 2020, encouraging protection of those at high-risk instead of “worrying about preventing systemic spread among healthy people”. Sound familiar?

“This all suggests that COVID-19 is a relatively benign disease for most young people, and a potentially devastating one for the old and chronically ill, albeit not nearly as risky as reported. Given the low mortality rate among younger patients with coronavirus … we need to divert our focus away from worrying about preventing systemic spread among healthy people—which is likely either inevitable, or out of our control—and commit most if not all of our resources toward protecting those truly at risk of developing critical illness and even death: everyone over 70, and people who are already at higher risk from this kind of virus.”

(Of course, he later became a Covid alarmist. Somewhat ironically, He wrote an op-ed in The New York Times with Rochelle Walensky in December 2020, titled, “People Thought Covid-19 Was Relatively Harmless for Younger Adults. They Were Wrong,” in which they blamed all excess mortality in young people on undiagnosed Covid, incorrectly dismissing other causes of death, like overdoses. Just two months later, in February 2021, he released a new paper, acknowledging that drug overdoses, murders, and motor vehicle accidents, all increased sharply in summer 2020, contributing significantly to excess mortality among young people in 2020.)

Anthony Fauci

Anthony Fauci (NIAID), Clifford Lane (NIAID), and Robert Redfield (CDC), published an editorial in Feb. 2020 in The New England Journal of Medicine about Covid, in which they also predicted the fatality rate would be less than originally reported, and suggested that the US may need to move to mitigation efforts such as voluntary isolation of sick people (in contrast to required quarantine of healthy individuals, which became a key part of the US response):

“If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968)…”

Marc Lipsitch

In February and March of 2020, Harvard epidemiology professor Marc Lipsitch was interviewed by reporters for The Atlantic and CBS News. He predicted that the majority of people would ultimately become infected with Covid and that it would not be able to be contained, noting that the risk was concentrated in the elderly, and that many would have mild disease. Like the NEJM article, he also recommended the age-old advice of staying home when sick, and suggested voluntary limitations on public gatherings were likely.

In February 2020, he told The Atlantic’s James Hamblin, “I think the likely outcome is that it will ultimately not be containable,” and that “it’s likely that many will have mild disease, or may be asymptomatic….”

In March 2020, he spoke to CBS News about the inevitability of widespread disease and death, focused in the elderly:

“If it really does spread as widely as that projection says, and that's what I think is likely to happen, then there are gonna be millions of people dying. And I don't think there's any way to get around that…. So the susceptibility to symptomatic infection seems to go up strictly with age, and especially up at the very oldest ages. Among those who are symptomatic, the risk of dying goes up further. So it really is concentrated in those older age groups, the high risk…. I think it is now almost inevitable that this will transmit in a global fashion and take a big toll on essentially the entire globe. I just don't see any way around that….”

Henderson, Inglesby, and Nuzzo

For more reading on this topic, I suggest reading the 2006 paper by famed epidemiologist D.A. Henderson, “Disease Mitigation Measures in the Control of Pandemic Influenza,” which concluded with this “overriding principle”:

Unfortunately, D.A. Henderson, who is credited with the worldwide eradication of smallpox, died in 2016. But two of his co-authors on that paper, Tom Inglesby and Jennifer Nuzzo, were quoted early on expressing some of the same views discussed in the paper. Tom Inglesby wrote a long Twitter thread in early February 2020 that included these key points:

“If (SARS-CoV-2) starts spreading in the US it’s not because (the US government) failed to contain it, it’s because it’ll have been a (disease) that was not possible to stop.”
— Tom Inglesby, February 2020

Jennifer Nuzzo told New Scientist in February 2020 that she was concerned about the harms of stringent interventions in China and discussed how she thought the US should be preparing for Covid.

“…Nuzzo thinks it is already too late to stop the virus going pandemic, and that China’s drastic measures to contain it will cause a lot of harm. ‘I’m really worried about the potential disruption that their measures will cause,’ she says. Nuzzo thinks efforts should focus on preparing communities to cope with the virus rather than trying to halt its spread.”

She was also an early outspoken critic of both travel bans/quarantines and school closures. In a February op-ed for The Washington Post about travel bans, she wrote:

“If leaders use their influence in support of evidence-based measures, rather than ones that risk increasing the social and economic tolls of the epidemic, it will be helpful to the coronavirus response.”

In March 2020, she wrote an op-ed in The New York Times, arguing against school closures:

“Though there may be an inclination to present school closings as a well-established tool to protect public health, their full impact is simply unknown. Downplaying the disruption these measures may cause or overstating their benefits can erode public confidence in government at a time when it is needed the most.”

“Downplaying the disruption these measures may cause
or overstating their benefits can erode public confidence…”
— Jennifer Nuzzo, March 2020

In closing, imagine what our Covid response would have been like if those in charge had retained some of these critical principles of epidemiology and public health beyond March 2020. While experts may take issue with some individual elements of The Great Barrington Declaration, I saw it as an attempted return to sanity, and an opening to discuss the harms of our approach. Unfortunately, there was coordinated effort to discredit the ideas in it, and the people behind it. Five years later, I wonder if we have learned anything from the massive global panic that accompanied Covid. I hope Dr. Bhattacharya is given the opportunity to take the reins at NIH, and see if we can move towards a more evidence-based approach to US public health.