By Lambert Strether of Corrente.<\/strong><\/em><\/p>\n Readers will remember that, based on their Covid performance under two administrations, I have often called for the CDC to be burned to the ground, the rubble plowed under, and the ground salted. Now President-elect Trump has picked \u201cJay Bhattacharya, who backed COVID herd immunity, to lead National Institutes of Health<\/a>,\u201d so perhaps the same fate awaits NIH. and I should not be too picky about the accelerant used or the match thrown there, either. <\/p>\n Bhattacharya is a professor of medicine, economics, and health research policy at Stanford University, notionally allowing him to appropriate the honorific \u201cDr.,\u201d which the press obseqiously bestows upon him, but out here in reality he\u2019s no more a \u201cDr.\u201d than Jill Biden. Bhattacharya also allows himself to assume the title \u201cphysician\u201d in his Wikipedia entry<\/a>, which is unfortunate. According to the Federation of State Medical Boards<\/a>, \u201c[M]ost jurisdictions restrict individuals holding a physician credential from publicly representing themselves as physicians unless they hold a medical license in that jurisdiction.\u201d However, no \u201cJay\u201d (Jayanta) Bhattacharya is licensed to practice in the state of California<\/a>. Wikipedia also deems Bhattacharya to be a \u201cscientist\u201d \u2014 as does (\u201creal scientist\u201d<\/a>) an uncharacteristically careless Matt Taibbi \u2014 but that\u2019s only true if you regard mainstream economics as a science. It isn\u2019t<\/a>. <\/p>\n Bhattacharya is also an author<\/a> at the dark-monied Brownstone Institute[1].<\/b> Readers will recall that Brownstone\u2019s Tom Jefferson was First Author for John Conly\u2019s now discredited<\/a> anti-masking study at the Cochrane Institute (actual scholarship here<\/a>), and that Brownstone\u2019s Carl Heneghan was functionally an Unlisted Author, though he didn\u2019t list himself in credits. Neither disclosed their Brownstone affiliation. All this violated Cochrane\u2019s famously strict standards<\/a>, although when Cochrane Library editors \u201cengaged<\/a>\u201d with the authors while writing their \u201cStatement,\u201d these matters never came up. Suffice to say I don\u2019t have a great deal of confidence in how Brownstone, or its authors, do business.<\/p>\n Which brings us to Bhattacharya\u2019s main claim to fame: his co-authorship (with Martin Kulldorff and Sunetra Gupta) of the Great Barrington Declaration (so called; the town of Great Barrington, MA has repudiated any connection<\/a>). The Great Barrington Declaration (GBD) was published on October 4, 2020 (that is, not even a year into our multi-year Covid pandemic, and before the first release of Operation Warp Speed vaccines<\/a> in December, 2020). GBD takes the form of an open letter; there are signatures at the bottom and everything<\/a>. Formally, then, GBD is a genre piece, as Science-Based Medicine<\/a> points out:<\/p>\n I\u2019d like to take a trip down memory lane to revisit various examples of science denialists using similar \u201cdeclarations,\u201d \u201cpetitions,\u201d and \u201copen letters\u201d to give the false appearance of strong scientific support for their positions. Why? Because declarations like this, although they can be used for good (such as when US climate scientists recently signed an open letter to Congress reaffirming the overwhelming scientific consensus that human activity is the primary driver of climate change and the overall warming of the climate), more frequently such letters are propaganda for pseudoscience. Indeed, such \u201cdeclarations,\u201d \u201copen letters,\u201d and \u201cpetitions\u201d signed by physicians and scientists represent a technique that goes back at least to the tobacco companies lining up lists of doctors to testify to the safety of cigarettes. (One particularly ludicrous example from R.J. Reynolds in the 1940s claimed that 113,597 doctors preferred their cigarettes.) The idea was (and is) to give the false impression of a scientific controversy where none exists and to appeal to the authority of scientists and doctors to support their claims.<\/p>\n<\/blockquote>\n GBD uses the RJ Reynolds technique, even having a form at the bottom for \u201cco-signers,\u201d which eminent \u201cMedical and Public Health Scientists and Medical Practitioners\u201d like Dr Johnny Bananas and Prof Cominic Dummings<\/a> happily took advantage of.<\/p>\n Substantively, GBD is \u2014 ideology aside \u2014 remarkable chiefly for its utter lack links or cites, or evidence of any kind; if we published GBD as a post at Naked Capitalism, readers would laugh at us, as well they should. Be that as it may, GBD has two main points: herd immunity and focused protection. The Harvard Crimson<\/a> summarizes:<\/p>\n Their declaration calls for those with the lowest risk of death from the virus to go about their lives as they would have prior to the pandemic while keeping the more immunologically vulnerable under continued social distancing \u2014 hence the term \u201cfocused protection.\u201d The idea behind this strategy rests on herd immunity, which is when a large enough proportion of the population becomes immune to a disease that its transmission becomes unlikely. Immunity without a vaccine, however, requires infection.<\/p>\n<\/blockquote>\n To quote GBD itself<\/a> \u2014 I\u2019d pull on my yellow waders, but my hazmat suit has booties already \u2014 on herd immunity:<\/p>\n As immunity builds in the population, the risk of infection to all \u2013 including the vulnerable \u2013 falls. We know that all populations will eventually reach herd immunity \u2013 i.e. the point at which the rate of new infections is stable \u2013 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. <\/p>\n<\/blockquote>\n And on focused protection: <\/p>\n 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 [reverential caps in the original].<\/p>\n 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 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.<\/p>\n 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, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.<\/p>\n<\/blockquote>\n Since 2020, an enormous literature, a vast and tangled polemic, has grown up around GBD; it would take many days for your humble blogger to follow the twists and turns. So I will simplify matters by asking the following question for each claim:<\/p>\n What did the authors have to know at the time they made the claim<\/em> for the claim to be true?<\/p>\n<\/blockquote>\n That seems to me to be the most fair, since we\u2019re not holding Bhattacharya responsible for scientific work done subquently from October 2020. Let\u2019s take each in turn. I\u2019ll quote the initially plausible same passages, but this time I\u2019ll add some helpful notes. First, Herd Immunity[2]:<\/p>\n As immunity builds[A] in the population, the risk of infection to all \u2013 including the vulnerable \u2013 falls. We know that all populations[B] will eventually reach herd immunity \u2013 i.e. the point at which the rate of new infections is stable \u2013 and that this can be assisted by (but is not dependent upon[C]) a vaccine. Our goal should therefore be to minimize mortality[D] and social harm until we reach herd immunity. <\/p>\n<\/blockquote>\n [A] For this to have been true, there must be no waning immunity. How did the authors know that? (In fact, \u201cbreakthough infections<\/a>\u201d were real, and a mountain of evidence shows that multiple reinfections<\/a> are frequent.)<\/p>\n [B] For this to have been true, there must be no immune escape. How did the authors know that? (In fact, SARS-CoV-2 mutates often<\/a>, as the continuing waves of infection from new variants show.)<\/p>\n [C] For this to have been true, there must be a case of herd immunity being achieved through infection, without vaccinations[3]. Were the authors familiar with such a case?<\/p>\n [D] For this to have been true, mortality must be the only medical test of successful anti-Covid policy. How did the authors know this, in October 2020, without knowledge of long-term sequelae? (In fact, Long Covid is a serious issue<\/a>, as is the impact of Covid on the labor force<\/a> generally.<\/p>\n Now, Focused Protection. There are many more notes, because there\u2019s so much more handwaving:<\/p>\n 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[E] to live their lives normally to build up immunity to the virus through natural infection, while better[F] protecting those who are at highest risk. We call this Focused Protection [reverential caps in the original].<\/p>\n Adopting measures[G] to protect the vulnerable[H] 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 testing of other staff and all visitors[I]. Staff rotation should be minimized[J]. Retired people living at home should have groceries and other essentials delivered to their home[K]. When possible, they should meet family members outside rather than inside[L]. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented[M], and is well within the scope and capability of public health professionals.<\/p>\n Those who are not vulnerable[N] should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing[O], 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[P]. 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, sport and other cultural activities should resume. People who are more at risk[P] may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity[R].<\/p>\n<\/blockquote>\n [E] Comment: As in [D], mortality must be the only medical test of successful anti-Covid policy. <\/p>\n [F] Comment: \u201cBetter\u201d is doing a lot of work there. \u201cBetter\u201d than nothing?<\/p>\n [G] For this to have been true, the proper measures must have been known. Did the authors know them? (In fact, there was great controversy, helped not at all by CDC\u2019s twists and turns on non-pharmeceutical interventions, isolation periods, etc.)<\/p>\n [H] For this to have been true, the vulnerable must be separable from the non-vulnerable. How do the authors know that is possible? (In fact, it is not; see here<\/a> and here<\/a>).<\/p>\n [I] For this to have been useful \u2014 that is, to convert \u201cshould\u201d into \u201cshall\u201d \u2014 there must be sufficient staff on the labor market with acquired immunity, and nursing homes must be able to test for it. How did the authors know that was possible? (In fact, nursing home practice on Covid was a scandal and a debacle<\/a>, and that\u2019s before we get to Cuomo turning them into death traps<\/a>).<\/p>\n [J] For this to have been true, nursing homes must be capable of minimizing staff rotation. How did the authors know they could? (In fact, many nursing home staff are part-time, and work at several nursing homes<\/a>.)<\/p>\n [K] [I] For this to have been useful \u2014 that is, to convert \u201cshould\u201d into \u201cshall\u201d \u2014 \u201cessentials\u201d must be known. How did the authors know that was possible? (For example, prescription drugs would vary by the household.)<\/p>\n [L] Comment: Bhattacharya seems to have no notion \u2014 or carefully omits \u2014 indoor ventilation, as with HEPA filters, Corsi-Rosenthal boxes (invented August 2020<\/a>), or simply opening windows.<\/p>\n [M] For this to have been true, multi-generational approaches must be implementable. How did the authors know that they were? (Since Bhattacharya merely handwaves with \u201capproaches,\u201d it seems likely they are not (unless one considers non-pharmaceutical interventions, which I don\u2019t think Bhattacharya has in mind. See here<\/a> and here<\/a>.)<\/p>\n [N] Comment: As in [H].<\/p>\n [0] For this to have been true, Covid would have had to be transmitted by fomites. How did the authors know this? (In fact, #CovidIsAirborne<\/a>. [L], meeting outdoors, suggests that Bhattacharya advocates airborne transmission. Here, Bhattacharya advocates fomite transmission. Does Bhattacharya believe that protecting the vulnerable \u2014 or even a coherent \u201cDeclaration\u201d \u2014 is possible with no theory of tranmission?)<\/p>\n [P] For this to have been true, airborne tranmission in school facilities would have had to be ruled out. Did the authors know that it had been? (In fact, airborne tranmission of Covid in schools is significant<\/a>.)<\/p>\n [Q] For this to have been true, people would have to be aware of that their risks are. How did the authors know that was possible? (In fact, Covid transmits asymptomatically<\/a>. You might not even know that you have it. Since the damage from Covid is cumulative, people already infected with Covid cannot necessarily know their own risks, absent frequent testing, with Bhattacharya does not advocate.)<\/p>\n In summary, I hesitate to use the word \u201cfantasy\u201d to characterize GBD. However, \u201chandwaving\u201d and \u201cwishful thinking\u201d will certainly do. \u201cProtecting the vulnerable\u2019 my sweet Aunt Fanny<\/a>.<\/p>\n So much for the charlatan part. Now for eugenics. Why would be characterize Bhattacharya\u2019s work as eugenicst? Respectful Insolence<\/a> makes the case:<\/p>\n I would argue that eugenics has basically won out over public health. Because SARS-CoV-2 killed mainly\u2014although far from exclusively\u2014the elderly and those with chronic illnesses, views aligning with that of antivaccine crank Del Bigtree<\/a>, in June 2020 encouraged his followers to \u201ccatch this cold<\/a>\u201d in order to help achieve \u201cnatural herd immunity.\u201d The unspoken subtext that reveals the eugenicist intent\u2014usually denied and maybe even not acknowledged, but there nonetheless\u2014is how Bigtree also ranted about those most at risk of COVID-19 having made themselves that way by engaging in high risk behaviors that led to chronic disease, such as drinking and smoking to excess and overeating. (Obesity is a major risk factor for severe disease and death from COVID-19.) Of course, the one risk factor for severe disease and death from COVID-19 that no one has any control over is how old we were when the pandemic hit, given that the risk of severe disease and death climbs sharply with age. I like to point out that, as much as GBD proponents claim that \u201cfocused protection\u201d would keep the elderly safe, it couldn\u2019t, can\u2019t, and won\u2019t, because unless you quarantine all the elderly indefinitely they will have interaction with the \u201clow risk\u201d younger people out there necessary to help take care of them. One only has to look at the debacles that occurred in nursing homes early in the pandemic to appreciate how \u201cfocused protection\u201d was always a pipe dream, a concession tacked onto the eugenicist vision of the GBD to make it seem less eugenicist.<\/p>\n If you think I\u2019m going too far, just look back a bit. Do you remember how often COVID-19 minimizers would justify doing less (or nothing) to stop the spread of disease because it \u201conly kills the elderly\u201d? I do, and such rhetoric came not just from bonkers antivaxxers like Del Bigtree, either. Do you remember the arguments against vaccinating children against COVID-19 because it \u201conly\u201d kills a few hundred of them a year? I do. Never mind that, on a yearly basis, COVID-19 kills about as many children as the measles did before the vaccine was licensed 60 years ago, adjusted for population? It\u2019s a leading cause of death among children now<\/a>. \u201cBioethics\u201d-based arguments not to vaccinate children against COVID-19 are the same old antivax arguments<\/a> against vaccinating children, just recycled for a new virus, with \u201cesteemed\u201d doctors telling us that we need to accept children dying of COVID-19 \u201cas a matter of course<\/a>.\u201d<\/p>\n<\/blockquote>\n Lebensunwertes Leben<\/em>. In practice, that\u2019s exactly what GBD brought about. I\u2019d find Bhattacharya and GBD\u2019s \u201ccompassion\u201d a lot more persuasive if they\u2019d run a full court press on ventilating schools (and not just shoving kids back into air filled with lethal pathogens), and if their idea of delivering essentials to the elderly was anything more than a pipe dream. I mean, don\u2019t these guys have the budget to write some model legislation?<\/p>\n In any case, the first Trump administration embraced GBD immediately upon its release<\/a>, in October 2020:<\/p>\n The White House is embracing a controversial \u201cherd immunity\u201d strategy in response to the coronavirus, according to a briefing given by anonymous senior officials.<\/p>\n The strategy would allow the virus to spread freely with the belief that most of the population would develop a degree of immunity. It advocates shielding the more vulnerable to limit loss of life.<\/p>\n Two administration officials, who were not authorized to give their names, gave the briefing to media organizations\u2026.<\/p>\n They cited a controversial document, the Great Barrington Declaration\u2026.<\/p>\n<\/blockquote>\n Of course, it didn\u2019t take long for reality to catch up with the \u201cherd immunity\u201d fantasy. To cite but one of many example, in 2021: \u201cCOVID-19 herd immunity? It\u2019s not going to happen, so what next?<\/a>\u201d<\/p>\n Any notion that COVID-19 was going to last for just a few months was very much misplaced in 2020. Especially after it was recognised that the SARS-CoV-2 virus was largely spread through the airborne route, all indications were that it would cause repeat bouts of waves. This is what happened in the flu epidemic of 1918.<\/p>\n In addition very few scientists predicted that we would see the type of mutations that occurred over such a short period of time. This has resulted in the virus becoming both more transmissible and more able to evade immune responses.<\/p>\n The evolution of the virus has been so rapid that the Delta variant, which is currently dominating the world, is at least twice as transmissible as the ancestral virus that was circulating.<\/p>\n What this means is that herd immunity is no longer a discussion the world should be having. We should start to avoid using that term in the context of SARS-CoV-2, because it\u2019s not going to materialise \u2013 or is unlikely to materialise \u2013 during our lifetimes.<\/p>\n<\/blockquote>\n Oh well. Never mind<\/a>[4]. Let \u2018er rip (which Biden, after all, did, rationalizing and normalizing GBD with his \u201cvax only\u201d policy of mass infection without mitigation<\/a>). Let\u2019s look on the bright side: Bhattacharya is now head of the NIH (rather like David Frum becoming a Democrat and venerated editor of The Atlantic after doing so much to get us into Iraq). Jake, it\u2019s The Swamp. You can still make bank even when your mistakes are deadly! Normalcy hath its charms, I suppose.<\/p>\n NOTES<\/strong><\/p>\n [1] From DeSmogBlog<\/a>:<\/p>\n According to its website, \u201cBrownstone Institute accepts no quid pro quo donations and receives no money from governments, pharmaceutical companies, or other large and well-known foundations such as the Gates Foundation.\u201d21<\/p>\n The Brownstone Institute offers potential contributors the option to donate via cryptocurrency, which it describes as a \u201cnon-taxable event,\u201d suggesting that \u201cdonors do not owe capital gains tax on the appreciated crypto that is donated and can typically deduct the fair market value of the donation on their taxes. The organization states that it \u201cdo[es] not and will not share donor names.<\/p>\n<\/blockquote>\n Those names presumbly being one or more squillionaires, quite possibly from Silicon Valley, and perhaps crypto bros.<\/p>\n [2] Taking Bhattacharya\u2019s version of herd immunity as read. For a less simplified version, see here<\/a>.<\/p>\n [3] JAMA, \u201cHerd Immunity and Implications for SARS-CoV-2 Control<\/a>\u201c:<\/p>\n [T]here is no example of a large-scale successful intentional infection-based herd immunity strategy.<\/p>\n There are only rare instances of seemingly sustained herd immunity being achieved through infection. The most recent and well-documented example relates to Zika in Salvador, Brazil. Early in the COVID-19 pandemic, as other countries in Europe were locking down in late February and early March of 2020, Sweden made a decision against lockdown. Initially, some local authorities and journalists described this as the herd immunity strategy: Sweden would do its best to protect the most vulnerable, but otherwise aim to see sufficient numbers of citizens become infected with the goal of achieving true infection-based herd immunity. By late March 2020, Sweden abandoned this strategy in favor of active interventions; most universities and high schools were closed to students, travel restrictions were put in place, work from home was encouraged, and bans on groups of more than 50 individuals were enacted. Far from achieving herd immunity, the seroprevalence in Stockholm, Sweden, was reported to be less than 8% in April 2020,7 which is comparable to several other cities (ie, Geneva, Switzerland, and Barcelona, Spain).<\/p>\n The population of the United States is about 330 million. Based on World Health Organization estimates of an infection fatality rate of 0.5%, about 198 million individuals in the United States are needed to be immune to reach a herd immunity threshold of approximately 60%, which would lead to several hundred thousand additional deaths.<\/p>\n<\/blockquote>\n\n
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