Episode 67- The Great Barrington Declaration
Welcome to Richard Helppie’s Common Bridge. The fiercely nonpartisan discussion that seeks policy solutions to issues of the day. Rich is a successful entrepreneur in the technology, health and finance space. He and his wife, Leslie, are also philanthropists with interest in civic and artistic endeavors with a primary focus on medically and educationally under-served children.
Richard Helppie:
Welcome to the Common Bridge. Our guest today is a professor of medicine at Harvard University in the division of pharmacoepidemiology and pharmacoeconomics and is a bio statistician and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations. Dr. Martin Kulldorff earned a master痴 degree and doctorate from Cornell University with a concentration in applied probability and statistics. He has developed new statistical and epidemiological applications for disease surveillance, many of which are relevant for cancer research and for public health. And you will hear on today痴 episode of Common Bridge he is consulted by governments, agencies, and other policy makers regarding disease outbreaks.
In the news recently as a co-author of the Great Barrington Declaration, Dr. Martin Kulldorff teamed with two other subject matter experts for this important view on the COVID-19 pandemic. The co-authors are Dr. Sunetra Gupta, Professor at Oxford University, who is an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases. Also, Dr. Jay Bhattacharya , a professor at Stanford University Medical School who is a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations. They recommend an approach they call focused protection. We値l discuss the Great Barrington Declaration and we値l talk about what some of its critics have to say, and I知 sure we池e going to learn a lot. So welcome Dr. Martin Kulldorff. Thanks for being with us today.
Martin Kulldorff:
Thank you for having me, Rich, I appreciate it.
Rich Helppie:
Let’s let our audience get to know you a little bit. Tell us something about yourself. What were some of your early days and academic preparation and perhaps some of the professional work you’ve done?
Martin Kulldorff:
Well, I have two areas of research that I’m heavily involved in. One is for a couple of decades now. I have worked with infectious disease outbreaks and specifically how to detect them quickly and then how to monitor them on a population basis. And I have developed methods that are used by most-almost all-the state health departments in the US, by CDC, and similar agencies throughout the world to look at the geographical distribution of disease outbreaks. And for example, these methods were used five years ago when there was a Legionnaire’s disease outbreak in New York City, in Bronx, it was this method that first detected that outbreak.
Rich Helppie:
And is this something that you have generated through your teaching or your research at Harvard?
Martin Kulldorff:
Yes, through the research.
Rich Helppie:
And what is your job today? What occupies your time?
Martin Kulldorff:
So that does occupy my time. I had, just before this, I had a conference call with the people at the New York City health department talking about their work on monitoring COVID-19 in New York. I also work a lot with vaccine safety. So after a vaccine is approved, we still want to monitor its safety, because if there’s something common, adverse reaction, we would know it before it’s approved and then not approve it, but we still want to monitor rare, but serious adverse reactions. So I’m working with CDC to set up the plans for monitoring the safety of any future COVID-19 vaccine that might come around.
Rich Helppie:
Well, that broad-based 360 degree look from a learner perspective is something that listeners to the Common Bridge tell us that they like. Today Newton’s third law says for every action, there’s an equal and opposite reaction. And since the pandemic outbreak, we as a society, have taken many actions. I know some of our listeners are ardent supporters of those actions and still many chafe at the restrictions. Today we’re going to look at the actions and the reactions to policies to combat the COVID-19 pandemic. I anticipate some education and some policy ideas.
So Martin, if I may call you that, in Episode 38 of the Common Bridge, which was published in April, April 27th of this year, Judge Milton Mack talked that even at that early date, we had already seen a significant uptick in suicides, a 50% increase in domestic violent cases, as well as a host of acute mental illness cases. And he linked them to the existing stay at home orders that were, as we now know, in their early stages.
I read in your fascinating paper, the Great Barrington Declaration, which we have placed on the website, RichardHelppie.com, that your group is alarmed by things like lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings, and as reported locally here in Michigan, fewer cancer treatments, and deteriorating mental health, all which lead to a greater excess mortality now and in years to come. And tragically the working class and the younger members of society are carrying the heaviest burden of these policies. And indeed students that are out of school-think you characterize as a grave injustice. Other analysts are now saying that sustained lock-downs are the luxury of the rich. People who have the time and the resources for telehealth, people who are employed in jobs they can do from home, people who have childcare, technology, and space for remote schooling. You and your colleagues have studied the pandemic and policy reactions. So remember that our audience are not seasoned scientists. So could you explain to us what is the Great Barrington Declaration? Is it more than herd immunity, as some critics say, and just maybe fill us in-what problem is the Great Barrington Declaration addressing? How are you hoping to solve it? And why are you and your group, the ones to solve it?
Martin Kulldorff:
So thank you. So two principles of public health that has been thrown out the window with this epidemic is the following. One is that you can’t look at a single disease only, you have to look at health overall. So we can’t just focus on COVID-19. We also have to focus on all this collateral damage that the measures that has been put in place is causing and that you described. The other principle, the second one is we can’t just look short term. We have to look long term So with the general lock-down, we can push the COVID-19 into the future. We can reduce the number of deaths this month and next month, but with the pandemic, with COVID-19, it’s going to catch up with us sooner or later. So we are pushing it into the future and doing that makes it actually more difficult to protect the older high risk groups, because instead of isolating themselves for let’s say three months, we are in a situation where they have to isolate and protect themselves for over a year, and it could be even longer than that. And that makes it-it’s both inhumane to do that, but it also makes it much more difficult to be successful with it. So that’s putting them at higher risk and therefore we’ll have higher mortality because of that.
So these two principles has been thrown out the window, and that’s why we’re speaking up and instead suggesting a focused protection. This is nothing revolutionary or novel or new because it’s the same thing of protecting the high risk people that was in almost every pandemic preparedness plans that different countries had prepared before we knew this was coming. Because we knew that sooner or later there will be a pandemic and there will be more pandemics after this. But all of those pandemic preparedness plans was basically thrown out the window, with exception of Sweden, I would say.
Rich Helppie:
I hope that we get a chance to spend some time on Sweden and perhaps some lessons from other countries. I do want to let our listeners know that prior to coming on, we did ask Dr. Kulldorff: about conflicts relative to funding or boards or patents or publications or promotions, and he has no conflicts. This is a man who is serving in the public health. And with that background, what was the impetus to producing the paper? Who said, let’s write this paper and publish it?
Martin Kulldorff:
So the three of us have been trying to come out with this message for a long time since March and April, and not with much success in the beginning. I think in September, we were a little bit more able to get out this message. But when one person says these things, they will often be dismissed as some strange person who is not following the scientific consensus, which was very strange to us because ever since the beginning, what the media was talking about, the scientific consensus, was things that we did not agree with. And we all have all worked in this area for a long time. Dr. Sunetra Gupta is, in my view, the world’s pre-eminent infectious disease technologist. So somehow other people were listened to instead of what I thought was the most prominent people. So we thought that if we get the three of us together, then we can explain that. And the original deal was actually to make a video, which we did also, which can be found on the GBDeclaration.org website, to have the three of us explain what’s going on. And then by being three of us, instead of only one, that that might have a bigger impact. And then we decided to, to when we were gathered together for the video, we decided to also the write this declaration, which we did in basically two and a half days.
Rich Helppie:
Well, I think it’s a fascinating document and I hope everyone does go to the website, which we have put a link up on our website. And I was struck that all three of you have devoted your careers to protecting people. I think it’s very balanced and it’s got a deep scientific foundation, but just mind you, my disclaimer is that I’m coming from a lay perspective.
Dr. Kulldorff other policy analysts have reached different conclusions or opinions. So something that just-continued stay at home orders are the key until the virus, I don’t know exactly how it’s supposed to leave, that it’s going to either burn out or we have a vaccine, and others are saying, well we just need to have more aggressive masking and social distancing protocols. And that’ll be a permanent part of life, including American life, and still others that say there will be no exit from this pandemic until we get a vaccine. How does the conclusions put forward by the Great Barrington Declaration either agree with or differ from these other policies?
Martin Kulldorff:
Well, we differ from those and the key is, look we don’t know [everything] about COVID-19, but something we do know that’s very important that we have known since March. And that is while anybody can get infected whether young or old, the risk for mortality is greatly different by age. And when people know that-they don’t really know, I think, realize how enormous the difference is because it’s not a twofold difference in risk, or five fold, or ten fold, it’s not even a hundred fold difference of risk. It’s more than a thousand fold difference in mortality risk between the oldest and the youngest. And that’s an enormous difference.
So for older people COVID-19 is more dangerous and more serious than the annual flu. So they have to be much more careful and we have to be doing much more to protect them than we’re doing now. That’s a huge failure in several of the states in the United States, failing to protect the old who are the high risk. Instead, these days we’re protecting the young, the students who don’t need protection, because for children COVID-19 is typically asymptomatic or mildly symptomatic. And it’s much less dangerous than the annual flu for children. So every year the annual flu kills between 200 and a thousand children in the United States which is very tragic. The number depends on if it’s a severe or less severe flu season. But we don’t close the schools for that.
So for COVID-19, the risk is much less. And for example, if you look at the children and the risk in children, there was one major western country that didn’t close all the schools, and that was Sweden, where schools were open from daycare age one to age 15. So there were 1.8 million children in Sweden, through the height of this pandemic, went to school every day. And among these 1.8 million children, they were exactly zero that died from COVID-19 during this time period. There were a handful of children who were hospitalized, but they all survived. So for children, this is not a serious disease, and it’s actually better if they get infected as a child than if they get infected later on when they are at higher risk.
For teachers, also they looked at the teachers, because there’s concern that maybe the kids are infecting the teachers. And the teachers in Sweden, with going to school and having all the children around them had the same risk of COVID-19 as the average of other professions. Now, some other professions actually were working from home. If you compare the teachers with other professions that went to a work site, the teachers will actually have less risk. And it has also been confirmed from studies-from a very interesting study in Iceland-where they looked at genetics of the virus to see who is actually infecting who. And they found that while parents will often infect children, children will not infect parents very often. So this all shows that the teachers are more at risk from other teachers than they are from the students.
So it would make sense, I think school should be open for in-person teaching. I think it’s a grave injustice we’re doing to the children. They need schools, not only for the [inaudible], but also for their physical and mental health. This is a grave injustice we are imposing on our children right now. The teachers, they should try to maybe stay away from other teachers because that’s where the risk is. If they are above 60, they are sort of in the high risk group, so there it might make sense to have them work from home, either teach from home or help other teachers with grading exams and essays or homework. So that kind of recommendation should be done. Then if the child is sick, we don’t have to test them, but if they have a cough or runny nose send them home until they don’t have [any] symptoms, but there’s no reason to test children or university students, there’s no public health reasons for that. There’s absolutely no public health reason to keep the children away from in-person teaching. And it does much more damage in terms of the health of the children, almost no-minuscule-risk from going to school.
Rich Helppie:
It’s really interesting what you’re talking about in terms of the schoolchildren. And today, colleges and universities, as they’ve begun to reopen, have had increasing infections. One learned healthcare expert said, we’ve moved the infections from the nursing home to the frat house. But these infections have not followed with hospitalizations and deaths. And of course, those students are going to return home at some point, any thought to the risks at the college and university level?
Martin Kulldorff:
I think they are higher risk driving home to their parents from having a car accident. I have a son, he’s 18 and he is in college. And I’m much more concerned about traffic accidents than COVID-19. If we have cases in nursing home, that’s a huge problem because they are very at high risk. So there are many that are going to die. So that’s the major problem, the major risk that we have to prevent, do everything we can to prevent. That there are cases at university campuses where they are hanging out with each other may be infecting other students, they are at so low risk that this is not something I’m worried about. There’s no need to go on testing these children or these students. If they are sick, if they have a runny nose or coughing, they could stay in the dorm room until are well, but they should be able to enjoy the life as normally. And there have been suicides in the colleges. And we are, again, just like with the schoolchildren, we are putting a lot of burden on these kids and doing things to them that we shouldn’t do to them.
Rich Helppie:
I share your being troubled by the impacts on disadvantaged communities, particularly when it comes to schooling, that the students may not have the technology resources, they may not have a place to work from home, they may have to care for younger siblings, the parents in those homes may not have transportation because they have to be on the bus or the subway. And worse, conversely, I’m seeing more and more affluent families almost embrace the lock-down restrictions. They’re moving to a remote location, or they’re actually doing RV traveling. And I just wonder, are we going to be at some risk someday of just settling into a new normal of restrictions without a clinical basis, just because it’s an attractive lifestyle and furthering divisions within the country, but perhaps that’s for another day.
Martin, when you look at some of the earlier policies and back in March, the White House was talking about aggressive guidance to combat the COVID-fifteen days to slow the spread, of course, that became more days. Were any of those policies effective? I know that hospitalization rates came down, the ability to resupply with PPE and the like, but when you kind of look back at some of those policies that were put in place, are those still tools that we have available to us at the right time?
Martin Kulldorff:
So at the beginning of the pandemic in the spring, there was a need to flatten the curve because we don’t want everybody to go to the hospital at the same time, because then we can’t give people the proper healthcare. So Italy and Spain had problems where they had so many cases that they couldn’t provide proper healthcare to all the COVID-19 patients. And that was important to avoid that problem in other places of the world, and the rest of the world were by and large successful, that they were [able to] free capacity so everybody who needed the care could get it. So to flatten the curve made sense there, if you have to take drastic measures for two or three weeks to do that I think the damage from that is sort of limited compared to the benefits of making sure that the hospitals are not overburdened. So there was consensus among ethnologists that that was a right thing to do. But then somehow we silently slipped into this idea that this pandemic can be suppressed and get down to zero cases, and that became the goal of governments-just doing lock-downs to push this, everything into the future, which can decrease short term mortality, but increases long term mortality, both from COVID-19 as well as from other aspects of health. So that was, I think, a major mistake done by a number of governments around the world, a very tragic mistake.
Rich Helppie:
I’ve read a number of comparisons to the Spanish flu of 1918. And now we’re beginning to enter the winter season in North America, typically the cold and flu season. Are there parallels for a second wave of COVID 19, perhaps worse than the first, any parallels between the Spanish flu and COVID-19?
Martin Kulldorff:
There are some similarities. I think the Spanish flu was worse than COVID, in terms of mortality. And I don’t think we’re going to reach that same mortality. Another thing that was much worse with Spanish flu was it was actually young and middle aged people who were affected the most. In this case the children are safe. So as a parent, I have three children, the children are my major concern in terms of safety. So it was a huge relief back in the early days when I realized that no, this is going to be serious, it’s going to be a pandemic around the world, but my children are going to be safe. So that was a huge relief at that time.
But in terms of the second wave, I think those places, which sort of had a successful lock-down in the sense that they managed to keep the disease out, there the people are still susceptible. There’s very little immunity in the population. So I would expect that in those places, there will be COVID-19 coming up now. And the key then is that we protect the older high risk people during that time when there’s a lot of transmission in the community. And then once once there is enough immunity among the younger people, then the older people will also be protected by herd immunity-which has become sort of a bad word for some strange reason that I don’t understand because herd immunity is actually something good in the sense that once enough people have been infected, those who are still not infected do not have much risk. So we can actually protect those. It allows us to protect the high risk older people by the fact that we have herd immunity. Herd immunity is not some strategy or something controversial because herd immunity is just scientific fact, scientific phenomenon that is proven, that we will reach sooner or later with this COVID-19, that’s unavoidable. It’s just like gravity. So to discuss whether we’re going to do herd immunity or not, every strategy will lead to herd immunity. So that’s absurd from an epidemiologist’s point of view. It’s like two pilots up in the air talking about, oh, how should we get the plane down? Should we use the gravity strategy or some different strategy? Gravity will ensure that the plane eventually will come down to the ground. The key thing is how do you land the plane to minimize the casualty because you don’t want everybody to die in a plane crash. And it’s the same thing with COVID-19. The focus should be, how can we minimize the mortality until this pandemic is over? And we haven’t thought of it in this long term perspective, we have thought about it minimizing short term COVID-19 death, and that has been a disaster. And because of that, those places that sort of successfully-in quotation marks-w able to lock down to prevent the disease to come, it’s my prediction that they will now see cases increase.
Rich Helppie:
I do think that we’re seeing that. And as a former pilot, I do appreciate the analogy to flying. And that was one of the things, the airplane’s coming down at some point, whether you control it or not, it’s going to come down.
I’m reading a story in the medical journal, the Lancet. And they’re saying that herd immunity is a quote, dangerous fallacy, unsupported by scientific evidence. They want to say, there’s no evidence for lasting protective immunity to the SARS COV2 following a natural infection. They don’t think it’s actually practical to isolate parts of the population that might be vulnerable. How do you keep the 65 year old away from their ten-year-old grandchildren and such, what do you say to those critics?
Martin Kulldorff:
So I disagree with them. So there were several points there, so if I forget some of them remind me. So one thing is, can we isolate the older high risk group? So if they mean that we can’t do it a hundred percent and do it completely correct, then they are correct-that’s impossible. And when we have a pandemic like this, there are going to be mortality. There are going to be death. That’s unavoidable. It’s absolutely impossible to prevent all deaths and attempts to do that will actually lead to more deaths. But let’s take a comparison. So what we have done now with the current strategy is we are protecting low risk college students and low risk professionals who can work from home bankers, insurance agents, journalists, like you, scientists like me. So those more professional, more privileged people are being protected while the working class has to be out there working as the bus driver, as a janitor, working in the supermarket, et cetera, including those that are old. So the question is, did this separation work? Well, it didn’t work a hundred percent because there are some people in the professional class, who have died. But it has worked to maybe 90/10% to 80/20%. And we can look at various studies, for example, there was a very interesting study from Toronto in Canada, that before the lock-down mortality was the same in all socioeconomic groups, but then after the lock-down went in place, the highest socioeconomic groups, they flattened with the mortality while the lower socioeconomic groups continued to rise until it then eventually sort of came down again, because of the increasing immunity. So we were actually-again in quotation marks-successful to protect the privilege the more professional class, shifting the burden on the working class. So that was a “success”. And again, in quotation marks, because I think it’s a terrible outcome.
So in the same way, we can do what the Great Barrington Declaration is arguing for, is we should do that separation instead of by privilege versus working class, we should do it by age because that’s where the risks are. We should protect all older people, whether or not they are a lawyer or a janitor, because they’re all at high risk. We should let younger people live their life, whether they are a banker or a bus driver, because they have lower risk. So yes, we were able to shift it from the privileged to the working class, it’s also able to shift it from the old to the young, and that’s what’s going to minimize mortality. And it won’t be that hundred percent, but if we can do it 20/80%, instead of having 50/50% to do it 20/80% or 10/90%, that will reduce mortality.
Rich Helppie:
I think that the data, as early as April, I know I was digging through data that said, if you’re under 45, you don’t have an underlying health condition you’re asymptomatic and [if] you aren’t around at-risk populations that you’re probably good to just live your life. And of course, be careful with your hand washing and distancing and the like, but get back out there. And I did notice that while the World Health Organization, the director general is quoted as saying that never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic. And he said it’s scientifically and ethically problematic. He agrees with you that sections of the world and sections of the country did experience additional surges of the virus as the restrictions are lifted. And I couple that with some other reading that I’ve done that said this policy absent some effective vaccine could last for three years. And I just don’t know what the end game is with the continual lock downs. And of course those advocating the lock-downs and said, well, there’s going to be higher mortality, which is an arguable point. But, but the other part is this, and I don’t know if you’ll agree with this or not, Oxfam produced a report that said, if we continue with these lock-downs that 130 million people are going to be pushed to the brink of starvation due to supply chain disruptions. And I thought that through and I said, well, that makes a lot of sense, if we can’t get farmers and truck drivers and boats that ship product, eventually that food supply chain will break down and then we’re going to have an even more widespread problem. Is that consistent with what you’re saying?
Martin Kulldorff:
Yes. It’s a major, major concern and I was actually on television in India this morning and in South Africa a couple of days ago. There you have situations where the poor people, they make their living selling food or toys in the market. And with the lock-down, the rug was pulled out from them. And we have, because of the lock-downs in these countries, we have children who are now starving and that should not ever happen. So this pandemic is worldwide, the virus is worldwide, it effects all of us, but the collateral damage from the lock-down is also worldwide and it affects the poor or the working class the most.
Rich Helppie:
I think that’s a great jumping off point to perhaps some lessons from elsewhere in the world. You did make mention of Sweden. We have had a couple of guests on the program that are in Asia, particularly in Hong Kong. The reports from Hong Kong is that because they’ve dealt with so many different viruses that when there’s a virus, they mask up, they stay apart, but they’re basically back to normal. Are there lessons from other countries that we should take as a effective or perhaps as a warning?
Martin Kulldorff:
So I think Sweden is a good example because they took a number of measures, but they didn’t lock-down. They didn’t close to schools, for example, they didn’t close restaurants and so on, and they were physical distancing practice and they banned large gatherings for a little while and so on. But in Europe now we see emerging problems in many countries. So they are now re-instituting lock-down measures again, while Sweden who for a while had a higher mortality rate but now it’s less than both the US and the UK. They are continuing to gradually release, limit the restrictions, and they never have severe restrictions in the first place. So I think that’s a good example that you can get through a pandemic while still keeping schools open, while keeping businesses open and have a more normal life.
I am a native of Sweden. So I talked to my brother and sister there, and other people in Sweden and life is very normal. They might still have another bump because I think there are certainly some areas of Sweden that wasn’t that bad, we hear. So my guess is that there will still be a bump maybe during this winter season. But I think it will be much less than the other countries who went for earlier lock-down with much less disruption to society. And especially in terms of the public health and the well being of both children and old people.
Rich Helppie:
One of the elements of this particular virus is the asymptomatic spread or community spread. And in the early stages here in North America, there were cases that were discovered on the West coast and they could not tie them back to travel from China or from Europe. Is the fact that this virus spreads asymptomatically, does that make us respond differently than we may have responded with other pandemics and other outbreaks?
Martin Kulldorff:
Yes. So one thing that’s been discussed is contact tracing-that’s the isolation. That is a very important method to deal with many infectious diseases. So for example, we had a few cases of Ebola in in the United States. And when that happens, it’s critically important to quarantine the cases and then ask who were they in contact with, talk to them and test them if they are sick, maybe put them in isolation as well. So this is the standard method that’s done for many infectious diseases, but to think that that will work for COVID-19 is an illusion. And the reason-one of the reasons-is what you’re saying-there are many asymptomatic or very mildly symptomatic cases. So we don’t even know who brought us first to the US-and probably more than one. We don’t know who brought it first to the UK. We don’t know who bought it first to Italy. We don’t know who brought it first to France.
So if you can’t track it like that, even in such a setting, doing a contact tracing and so on, is hopeless. And also because it’s so widespread now that it’s a hopeless system, and it’s actually a very damaging thing to do, to try contact tracing for COVID-19. And the reason is that, now there are some places that are doing it, and I’ve talked to at least two people that are involved in this, and they are saying that most people, when they call them up say, well, I’ve been home all the time, I haven’t met anybody, because they don’t want to sort of snitch on their friends or neighbors. And then there are a few who will tell them everything, of all the hundreds of people that I met during the last week or so. But it’s not helpful for COVID-19, it reduces the trust that people have in public health authorities, not wanting to cooperate with public health. So suppose now, three years from now, we have a different, much more dangerous disease like Ebola or something else, which we actually have to do that, it’s going to be much more difficult now to do contact tracing for future diseases, where it is the critical component to keep people safe.
Rich Helppie:
A couple of real quick questions here, because I know this is on the minds of our listeners. How effective are masks?
Martin Kulldorff:
There has been a number of studies on that, and I actually haven’t read up on all of them. So my expertise is in infectious disease outbreaks and how they move in society and move in the population. So that’s my area of expertise. There are other people who are experts on sort of the immediate transmission from person to person or where the mask works or not. I would say one thing that I think is very important from a public-which has to do with how it transmits in the population in terms of public health. And that is for older people, if they think that they are safe just because they wear a mask and that other people wear masks, if they are in the crowded setting, that is very dangerous because they are not. Nobody’s claiming that masks work so well that it gives complete protection, we can see from the data that that’s not the case. So older people who are at risk, they should not trust the mask to protect them if they are out with other people. And if it gives them a false sense of security, that would actually have a damaging effect on overall mortality to COVID-19.
Rich Helppie:
Is hand hygiene, the only cleaning practice that we need?
Martin Kulldorff:
Everybody should wash their hands, whether you’re young or old. So those things that are very simple to do, and that helps because hand washing helps, that should be done. It’s always good to be outside, ventilation for indoor spaces is good, not just for COVID-19, but for everything-just for general health. So all of those things are things that we should do and that everybody should practice and it’s very important to practice. So yes, wash your hands more frequently and when the pandemic is over, continue with those habits, because they also actually beneficial for influenza, rota virus, and many other diseases.
Rich Helppie:
Well, thank you. I hope all my listeners hear that. Tell all your friends and family that too.
As we begin to wrap up, if we could take just a minute on vaccines. I will tell you this as a lay person, that my perception is that we don’t really know how this virus attaches, we don’t know what it does, we don’t know what the antibody reaction is, we don’t know how effective antibodies are in fighting a future infection. And we don’t know how long those antibodies might last. And again, this is my lay understanding. I have a hard time understanding-with that many unknowns-how we can get a vaccine that’s both safe and effective. It seems like we’re aiming at a target that we can’t even define. Is there a way you can help a person like me understand the vaccine research and what target we’re shooting at and how it might work.
Martin Kulldorff:
So first with immunity. So there’s clearly immunity, people who have had COVID-19 have immunity. There have been a few secondary infections, but considering the enormous amount of people that have been infected that there are so few reports of secondary infections means that we have good immunity to this disease in the short run. And if you have antibodies, you are immune, but there’s also many people who don’t have antibodies who are immune, because either they didn’t develop them, or they’re no longer detected. So amount of people who are immune are more than the people who have detectable [inaudible] antibodies. Now, we don’t know how long antibodies will last, because it hasn’t been around for long enough. So for some diseases, we have lifelong immunity, but there are other diseases-including other corona viruses-for which it’s not lifelong. But even if it’s not lifelong immunity, we still have some protection from it, and maybe a second infection will be milder than now. So we will, as a population, go into a stage for this [where it] will be endemic-it’s still present, but not pandemic in a sense we won’t have major outbreaks of it.
Now, those who argue that we can’t reach herd immunity because we don’t have immunity to natural infection. If we can’t get immunity to national infections, we are not going to get immunity from a vaccine, because natural infection is always the best, most effective way to get immunity-of course, the more dangerous way, because we could die from it, especially if you’re old. But if natural infections can not create immunity-I think we put it, if that wasn’t the case-it is the case-but if that wasn’t the case, then viruses will be, vaccines will be sort of hopeless.
Now, I think there are several dozen in vaccines that are in the pipeline. And my guess is that most of those are not going to come out into the market because most of them are going to fail, but hopefully there will be at least one or two or maybe three that will succeed. But we don’t know. And it’s very hard to predict at this point if we have a successful vaccine, it might not be a hundred percent. It might be 50% because, for example, the flu vaccines, they are only partially effective. So we don’t know what the efficacy is and what the safety is at this point. If anybody says that, yes, I will get vaccinated, I will not get vaccinated-I would not say that because we don’t have that information yet. I will wait to decide those things until we know something about the vaccine. And it could be that the vaccine makes sense for certain age group to be vaccinated, but not other age groups.
Rich Helppie:
I was anticipating that that might be the case. Say if you’re over a certain age or you’ve got asthma or diabetes or something, that it might be prudent in the risk and reward. So this has been a great conversation. And if you had to sum up the cost of the focused protection and herd immunity to us as a society, I think the benefits you’ve called out: we’re back to work, we’re back socializing, we’re back in education, and we’re keeping those of us that are more vulnerable out of the line of fire, so to speak, those are clearly benefits. On the other side of the ledger, what are some of the costs?
Martin Kulldorff:
You mean cost of the focused protection?
Rich Helppie:
The increased mortality in the short run would clearly be a cost. And I’m wondering if there are others that we want to consider as we look at the policy.
Martin Kulldorff:
So if we wanted to minimize short term mortality, then we could do that with more intense lock-downs But that’s cost of COVID-19 was [inaudible], because I think already now the cost of collateral damage, including both morbidity and mortality is already very high. So I don’t even think that short term, mortality overall might be beneficial with lock-down at this point. I think that was the case in the spring, but I don’t think there’s evidence for that. That that would be the case now. There are of course costs in terms of protecting the elderly, for example, nursing homes, those are the most high risk. We need to do more testing there unless the staff is already immune because they’ve had COVID, staff should be frequently tested so that they don’t bring it into the nursing home. And it’s not the residents. We should also test the residents, but it’s not the residents that are most important to the test. It’s the staff and not for their benefit, but for the benefit of the residents, so that they don’t bring in the virus to the nursing homes. Also, we need to invest in testing the visitors to nursing homes. We also need to do less rotation or staff in nursing so that each residents don’t see too many patients. And I know that Scott Atlas, who is the COVID advisor at the White House, he’s been pushing for increasing this testing to protect the elderly a lot, so he’s done a great job with that. At the same time, we shouldn’t waste money on testing school children or college students. So that’s one example.
Another thing is those people who are in their sixties, who are in the working age group, if they can work from home, yes, they should continue to work from home. But if they cannot, I think we have to help protect them so that they can take a sabbatical for three to six months while the transmission is high in society. And we could, for example, say that well for four months or three or six or whatever, you can use your social security funds to take a sabbatical, but you don’t have to go out there and drive the bus or drive the cab or work as a janitor or work in the supermarket or any of them, and a number of other things that younger people should take on at this moment. So there’s a cost to that to make sure that they can take that sabbatical. You’ve seen the social security funds-that’s much less cost than the cost of the lock-downs because that’s also an enormous economic cost. So there are those things that we have to do, and hopefully the petition can increase the protection that we are giving to the old and high risk people.
Rich Helppie:
Well, I like to use a quote that I believe is attributed to Winston Churchill about Americans-that Americans will always do the right thing after we’ve tried everything else.
Martin Kulldorff:
That’s a good quote. I hope so, too.
Rich Helppie:
So I’m hopeful that we’ll get to the right answer. Professor Kulldorff, this has been a tremendously educational session and I’m very, very grateful and I know our listeners will be too. What didn’t we cover today that perhaps we should have discussed?
Martin Kulldorff:
I think you’ve asked excellent questions.
Rich Helppie:
Are there any policy actions or personal actions that you would recommend people take today or perhaps, what would be the worst thing we could do from a policy or a personal point of view?
Martin Kulldorff:
I think the one thing, if only one thing changed and I could pick one thing to change and that is to open all the schools for in person teaching for all the children. I think that is so important, if there was only one thing that changed, that will be one that I would pick. One thing that is important to realize also is that public health decisions about these things are actually done at the state level. So it’s the governors who have the responsibility for public health. So the CDC and the federal government, they can come in with advice and they can come in with resources to, for example, increase testing capacity and so on. But it’s the state governments that have the responsibility for this. Some States have done a good job. For example, South Dakota has done an excellent job. Others have done [a] terrible job, which has led to many more deaths than would have been necessary had we instituted a focused protection plan from the very beginning.
Rich Helppie:
Thank you very much for that wrap up. We’ve been talking with Harvard University professor and researcher, Dr. Martin Kulldorff. He is coauthor of the Great Barrington declaration, a pivotal work for our time, the greatest issue that we face in the world today, this is Rich Helppie, your host of the Common Bridge signing off. Thank you everybody.
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