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NEW Profs @SunetraGupta @MartinKulldorff and Jay Bhattacharya met over the weekend in the US to write a declaration calling for a different #Covid approach. They're in Washington DC today meeting admin officials. Text and interview up now on @unherd unherd.com/2020/10/covid-

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First, let's knock down the straw man up front. No one is supporting massive, across-the-board lockdowns everywhere, all the time. This is the foil for these arguments. And it's a convenient bogeyman. 2/

6:44 PM · Oct 5, 2020

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Second, we can do better than we have been to date. This requires more testing of asymptomatic individuals to "know our epidemics" locally, so we can tailor responses in time and place. 3/

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In a place like Connecticut for example, with low rates of new infections, a strategy based testing, tracing, isolation with the requisite resources would go a long way, in addition to a mask mandate for all, distribution of PPE liberally to anyone interfacing with the public. 4/

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But we are going to have to decide: is it more important to us to open bars or open schools? If it is the latter, we invest heavily in testing, reconfigure ventilation, require masking, shrink class sizes or increase physical space by taking over other closed establishments. 5/

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In fact, many schools in my state are open at least in part. They need support to be safer now as the risk increases this winter of new outbreaks. 6/

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But as we see outbreaks emerge, we may have to shut spaces again to address these events as we scale-up to test those involved. 7/

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"We are nearing a crisis," Wisconsin doctor says as state marks record high of Covid-19 related...

This is Connecticut. But other states and cities have different epidemiological profiles and decisions should be based on local realities. For instance, Wisconsin. 8/

cnn.com

Wisconsin leaders and health experts are sounding the alarm as the state reported its highest death count on record Thursday — 27 people died of Covid-19 Wednesday, according to the state's Covid-19...

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Right now, places with high rates of spread have to get their rates down now. This isn't going to happen by magic. Shutdowns are going to have to happen along with all the other interventions I've described. 9/

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All of what I've mentioned here is what is the view of most epidemiologists and clinicians working in infectious diseases. Just is. No conspiracy. No secret agenda. 10/

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Now for

and Jay Bhattacharya. Let's go through their "Great Barrington" Declaration. 11/

For a start, we are in agreement that the pandemic has created indirect harms for many beyond the direct effects of infection with the virus itself. These cannot be ignored and need to be addressed head-on. BUT...12/

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Rather than address the real indirect effects this pandemic has caused, they suggest that the best way to deal with the matter is to increase the DIRECT causes of harm instead. 13/

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They suggest that we should focus on protecting the elderly and vulnerable, and let everyone else go about their business, get infected to build herd immunity in the population. That's the main gist of it. 14/

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Let's start with the elderly. Most of the elderly in the US are NOT in nursing/care homes. Yes, we should protect those in nursing homes, where we have seen much of the mortality in the US, but the track record even there is terrible thus far. 15/

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Now, a large chunk of the elderly in the US live with family or are alone or with their similarly elderly spouses--that is they are integrated into the community. How do you pull these older people to safety? What's the plan? 16/

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If you're going to turbo-charge community spread, as everyone else at "low-risk" goes about their business, I want the plan for my 86 year old mother to be more than theoretical. They do NOT have one. 17/

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Estimated County-Level Prevalence of Select Underlying Medical...

Now let's deal with the vulnerable. This is where their strategy goes even further off the rails. CLOSE to 50% of ALL Americans have underlying conditions that predispose them to severe #COVID19 outcomes. 18/

cdc.gov

Risk for severe coronavirus disease 2019 (COVID-19)–associated illness (illness requiring hospitalization, intensive care unit [ICU] admission, mechanical ventilation, or resulting in death)...

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and

have suggested these herd immunity strategies are about culling the herd of the sick and disabled. It's grotesque. 19/

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So, we have now arguably the majority of the population--the elderly, chronically ill and disabled, who are going to have be sequestered while the young and fit go about their business, catching the disease, building up herd immunity. 20/

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And for these three, #COVID19 isn't something to worry about if you're young and healthy, if you're young and not so healthy, well, you're out of luck in their brave new world. 21/ jamanetwork.com/journals/jamai

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Virus Cases Surged in Young Adults. The Elderly Were Hit Next. (Published 2020)

And we have not been able to sequester people in the US as the young and fit go about their business. 22/

nytimes.com

Infections among young adults eventually may have spread to older, more vulnerable people, the C.D.C. reported.

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And though

will defend Sweden's experiment with a similar strategy, and where they had more deaths than their peer nations nearby, didn't the avoid economic pain, he never mentions the context that makes Sweden different than the US. 23/

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Sweden simply has a better healthcare and social service system than we do. Trying the Swedish model here offers less protections than they had in Sweden to deal with the consequences of their failed strategy. 24/

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I get it. We're all tired. This pandemic sucks. The measures we've had to take are terrible too. But beware of the answers you want to hear: it's OK, if you're not at high-risk, get back out there, help build herd immunity, it's scientific! 25/

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We need to do better, but better means more resources to do things right--it's not a fantasy to suggest this, as many others countries have been better at this than we have been. But there are going to, even then, be set-backs. It's the nature of the beast. 26/

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And a few last things. Some have suggested that it's a fantasy to think we can treat each other better rather than cutting ties to the vulnerable, while the rest go about their business. 27/

And that's the "tell," the lie in the strategy. If we cannot treat each other better, invest in a better world, there is no chance of creating a net to catch the elderly, the vulnerable when this pandemic comes for them, comes for us. 28/

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They all want the second part--let us go back to our lives--and would be content to leave the rest of us behind. That's the appeal of this strategy for many. 29/

And for those of you who don't know me. I've been fighting for the rights of people with HIV, TB, HCV and other diseases since I was in my 20s. I watched a botched response to the AIDS pandemic in two countries up close: the USA and South Africa. 30/

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And the calls to social justice by these three fall flat. When this all started, many of us were calling for vulnerable communities to be protected, focused on as a priority. Those of us in health & human rights made it our mission. These three were nowhere to be found. 31/

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