FOUR - Heppner Gazette-Times, Heppner, Oregon Wednesday, December 2, 2020
Guest Editorial
A sensible and compassionate anti-COVID strategy
By Jay Bhattacharya
Jay Bhattacharya is a Professor of Medicine at Stan-
ford University, where he received both an M.D. and a
Ph.D. in economics. He is also a research associate at the
National Bureau of Economics Research, a senior fellow
at the Stanford Institute for Economic Policy Research
and at the Freeman Spogli Institute for International Stud-
ies, and director of the Stanford Center on the Demogra-
phy and Economics of Health and Aging. A co-author of
the Great Barrington Declaration, his research has been
published in economics, statistics, legal, medical, public
health and health policy journals.
The following is adapted from a panel presentation
on October 9, 2020, in Omaha, Nebraska, at a Hillsdale
College Free Market Forum.
My goal today is, first, to present the facts about how
deadly COVID-19 actually is; second, to present the facts
about who is at risk from COVID; third, to present some
facts about how deadly the widespread lockdowns have
been; and fourth, to recommend a shift in public policy.
1. The COVID-19 Fatality Rate
In discussing the deadliness of COVID, we need to
distinguish COVID cases from COVID infections. A lot
of fear and confusion has resulted from failing to under-
stand the difference.
We have heard much this year about the “case fatality
rate” of COVID. In early March, the case fatality rate
in the U.S. was roughly three percent—nearly three out
of every hundred people who were identified as “cases”
of COVID in early March died from it. Compare that to
today, when the fatality rate of COVID is known to be
less than one half of one percent.
In other words, when the World Health Organization
said back in early March that three percent of people who
get COVID die from it, they were wrong by at least one
order of magnitude. The COVID fatality rate is much
closer to 0.2 or 0.3 percent. The reason for the highly
inaccurate early estimates is simple: in early March, we
were not identifying most of the people who had been
infected by COVID.
“Case fatality rate” is computed by dividing the
number of deaths by the total number of confirmed cases.
But to obtain an accurate COVID fatality rate, the num-
ber in the denominator should be the number of people
who have been infected—the number of people who
have actually had the disease—rather than the number
of confirmed cases.
In March, only the small fraction of infected people
who got sick and went to the hospital were identified as
cases. But the majority of people who are infected by
COVID have very mild symptoms or no symptoms at all.
These people weren’t identified in the early days, which
resulted in a highly misleading fatality rate. And that is
what drove public policy. Even worse, it continues to
sow fear and panic, because the perception of too many
people about COVID is frozen in the misleading data
from March.
So how do we get an accurate fatality rate? To use
a technical term, we test for seroprevalence—in other
words, we test to find out how many people have evidence
in their bloodstream of having had COVID.
This is easy with some viruses. Anyone who has had
chickenpox, for instance, still has that virus living in
them—it stays in the body forever. COVID, on the other
hand, like other coronaviruses, doesn’t stay in the body.
Someone who is infected with COVID and then clears it
will be immune from it, but it won’t still be living in them.
What we need to test for, then, are antibodies or
other evidence that someone has had COVID. And even
antibodies fade over time, so testing for them still results
in an underestimate of total infections.
Seroprevalence is what I worked on in the early days
of the epidemic. In April, I ran a series of studies, using
antibody tests, to see how many people in California’s
Santa Clara County, where I live, had been infected. At
the time, there were about 1,000 COVID cases that had
been identified in the county, but our antibody tests found
that 50,000 people had been infected—i.e., there were
50 times more infections than identified cases. This was
enormously important, because it meant that the fatality
rate was not three percent, but closer to 0.2 percent; not
three in 100, but two in 1,000.
When it came out, this Santa Clara study was contro-
versial. But science is like that, and the way science tests
controversial studies is to see if they can be replicated.
And indeed, there are now 82 similar seroprevalence stud-
ies from around the world, and the median result of these
82 studies is a fatality rate of about 0.2 percent—exactly
what we found in Santa Clara County.
In some places, of course, the fatality rate was higher:
in New York City it was more like 0.5 percent. In other
places it was lower: the rate in Idaho was 0.13 percent.
What this variation shows is that the fatality rate is not
simply a function of how deadly a virus is. It is also a
function of who gets infected and of the quality of the
health care system. In the early days of the virus, our
health care systems managed COVID poorly. Part of this
was due to ignorance: we pursued very aggressive treat-
ments, for instance, such as the use of ventilators, that in
retrospect might have been counterproductive. And part
of it was due to negligence: in some places, we needlessly
allowed a lot of people in nursing homes to get infected.
But the bottom line is that the COVID fatality rate is
in the neighborhood of 0.2 percent.
2. Who Is at Risk?
The single most important fact about the COVID
pandemic—in terms of deciding how to respond to it
on both an individual and a governmental basis—is that
it is not equally dangerous for everybody. This became
clear very early on, but for some reason our public health
messaging failed to get this fact out to the public.
It still seems to be a common perception that COVID
is equally dangerous to everybody, but this couldn’t be
further from the truth. There is a thousand-fold difference
between the mortality rate in older people, 70 and up,
and the mortality rate in children. In some sense, this is
a great blessing. If it were a disease that killed children
preferentially, I for one would react very differently. But
the fact is that for young children, this disease is less
dangerous than the seasonal flu. This year, in the United
States, more children have died from the seasonal flu than
from COVID by a factor of two or three.
Whereas COVID is not deadly for children, for older
people it is much more deadly than the seasonal flu. If
you look at studies worldwide, the COVID fatality rate
for people 70 and up is about four percent—four in 100
among those 70 and older, as opposed to two in 1,000 in
the overall population.
Again, this huge difference between the danger of
COVID to the young and the danger of COVID to the old
is the most important fact about the virus. Yet it has not
been sufficiently emphasized in public health messaging
or taken into account by most policymakers.
3. Deadliness of the Lockdowns
The widespread lockdowns that have been adopted in
response to COVID are unprecedented, lockdowns have
never before been tried as a method of disease control. Nor
were these lockdowns part of the original plan. The initial
rationale for lockdowns was that slowing the spread of the
disease would prevent hospitals from being overwhelmed.
It became clear before long that this was not a worry: in
the U.S. and in most of the world, hospitals were never at
risk of being overwhelmed. Yet the lockdowns were kept
in place, and this is turning out to have deadly effects.
Those who dare to talk about the tremendous eco-
nomic harms that have followed from the lockdowns are
accused of heartlessness. Economic considerations are
nothing compared to saving lives, they are told. So I’m
not going to talk about the economic effects—I’m going to
talk about the deadly effects on health, beginning with the
fact that the U.N. has estimated that 130 million additional
people will starve this year as a result of the economic
damage resulting from the lockdowns.
In the last 20 years we have lifted one billion people
worldwide out of poverty. This year we are reversing
that progress to the extent—it bears repeating—that an
estimated 130 million more people will starve.
Another result of the lockdowns is that people stopped
bringing their children in for immunizations against dis-
eases like diphtheria, pertussis (whooping cough), and
polio, because they had been led to fear COVID more
than they feared these more deadly diseases. This wasn’t
only true in the U.S. Eighty million children worldwide
are now at risk of these diseases. We had made substantial
progress in slowing them down, but now they are going
to come back.
Large numbers of Americans, even though they
had cancer and needed chemotherapy, didn’t come in
for treatment because they were more afraid of COVID
than cancer. Others have skipped recommended cancer
screenings. We’re going to see a rise in cancer and can-
cer death rates as a consequence. Indeed, this is already
starting to show up in the data. We’re also going to see
a higher number of deaths from diabetes due to people
missing their diabetic monitoring.
Mental health problems are in a way the most shock-
ing thing. In June of this year, a CDC survey found that
one in four young adults between 18 and 24 had seriously
considered suicide. Human beings are not, after all, de-
signed to live alone. We’re meant to be in company with
one another. It is unsurprising that the lockdowns have
had the psychological effects that they’ve had, especially
among young adults and children, who have been denied
much-needed socialization.
In effect, what we’ve been doing is requiring young
people to bear the burden of controlling a disease from
which they face little to no risk. This is entirely backward
from the right approach.
4. Where to Go from Here
Last week I met with two other epidemiologists—
Dr. Sunetra Gupta of Oxford University and Dr. Martin
Kulldorff of Harvard University—in Great Barrington,
Massachusetts. The three of us come from very different
disciplinary backgrounds and from very different parts
of the political spectrum. Yet we had arrived at the same
view—the view that the widespread lockdown policy has
been a devastating public health mistake. In response, we
wrote and issued the Great Barrington Declaration, which
can be viewed—along with explanatory videos, answers
to frequently asked questions, a list of co-signers, etc.—
online at www.gbdeclaration.org.
The Declaration reads:
As infectious disease epidemiologists and public
health scientists we have grave concerns about the dam-
aging physical and mental health impacts of the prevailing
COVID-19 policies and recommend an approach we call
Focused Protection.
Coming from both the left and right, and around the
world, we have devoted our careers to protecting people.
Current lockdown policies are producing devastating
effects on short and long-term public health. The results
(to name a few) include lower childhood vaccination
rates, worsening cardiovascular disease outcomes, fewer
cancer screenings, and deteriorating mental health—lead-
ing to greater excess mortality in years to come, with the
working class and younger members of society carrying
the heaviest burden. Keeping students out of school is a
grave injustice.
Keeping these measures in place until a vaccine is
available will cause irreparable damage, with the under-
privileged disproportionately harmed.
Fortunately, our understanding of the virus is grow-
ing. We know that vulnerability to death from COVID-19
is more than a thousand-fold higher in the old and infirm
than the young. Indeed, for children, COVID-19 is less
dangerous than many other harms, including influenza.
As immunity builds in the population, the risk of
infection to all—including the vulnerable—falls. We
know that all populations will eventually reach herd
immunity—i.e., the point at which the rate of new infec-
tions is stable—and that this can be assisted by (but is
not dependent upon) a vaccine. Our goal should therefore
be to minimize mortality and social harm until we reach
herd immunity.
The most compassionate approach that balances the
risks and benefits of reaching herd immunity, is to allow
those who are at minimal risk of death to live their lives
normally to build up immunity to the virus through natural
infection, while better protecting those who are at highest
risk. We call this Focused Protection.
Adopting measures to protect the vulnerable should be
the central aim of public health responses to COVID-19.
By way of example, nursing homes should use staff with
acquired immunity and perform frequent PCR testing
of other staff and all visitors. Staff rotation should be
minimized. Retired people living at home should have
groceries and other essentials delivered to their home.
When possible, they should meet family members outside
rather than inside. A comprehensive and detailed list of
measures, including approaches to multi-generational
households, can be implemented, and is well within the
scope and capability of public health professionals.
Those who are not vulnerable should immediately
be allowed to resume life as normal. Simple hygiene
measures, such as hand washing and staying home when
sick should be practiced by everyone to reduce the herd
immunity threshold. Schools and universities should be
open for in-person teaching. Extracurricular activities,
such as sports, should be resumed. Young low-risk adults
should work normally, rather than from home. Restaurants
and other businesses should open. Arts, music, sports,
and other cultural activities should resume. People who
are more at risk may participate if they wish, while soci-
ety as a whole enjoys the protection conferred upon the
vulnerable by those who have built up herd immunity.
I should say something in conclusion about the idea
of herd immunity, which some people mischaracterize as
a strategy of letting people die. First, herd immunity is not
a strategy—it is a biological fact that applies to most in-
fectious diseases. Even when we come up with a vaccine,
we will be relying on herd immunity as an endpoint for
this epidemic. The vaccine will help, but herd immunity
is what will bring it to an end. And second, our strategy
is not to let people die, but to protect the vulnerable. We
know the people who are vulnerable, and we know the
people who are not vulnerable. To continue to act as if
we do not know these things makes no sense.
My final point is about science. When scientists have
spoken up against the lockdown policy, there has been
enormous pushback: “You’re endangering lives.” Science
cannot operate in an environment like that. I don’t know
all the answers to COVID; no one does. Science ought
to be able to clarify the answers. But science can’t do its
job in an environment where anyone who challenges the
status quo gets shut down or cancelled.
To date, the Great Barrington Declaration has been
signed by over 43,000 medical and public health scientists
and medical practitioners. The Declaration thus does not
represent a fringe view within the scientific community.
This is a central part of the scientific debate, and it belongs
in the debate. Members of the general public can also sign
the Declaration.
Together, I think we can get on the other side of this
pandemic. But we have to fight back. We’re at a place
where our civilization is at risk, where the bonds that unite
us are at risk of being torn. We shouldn’t be afraid. We
should respond to the COVID virus rationally: protect the
vulnerable, treat the people who get infected compassion-
ately, develop a vaccine. And while doing these things
we should bring back the civilization that we had so that
the cure does not end up being worse than the disease.
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