On October 20, 2020, with large parts of the country still in lockdown as a virus control measure, WBUR Radio Boston’s Tiziana Dearing conducted separate interviews with epidemiologist Martin Kulldorff of Harvard University and Rochelle Walensky, then at the Massachusetts General Hospital and later to be named by the Biden Administration as the Director of the Centers for Disease Control.
The station permitted Walensky to respond to Kulldorff but did not allow Kulldorff to respond back. The tone was obviously hostile toward the Great Barrington Declaration which pushed a program of focused protection over lockdown.
In her interview, Walensky praised the “really strict lockdowns” of China, and condemned Sweden’s policy of keeping schools and businesses open. She cited China’s good outcomes (deaths of 3 per million), though the data from China is highly suspect, and also cited Sweden’s high deaths, even though 74 counties in the world that locked down had higher Covid deaths per capita. She further cast doubt on the idea that natural immunity with Covid would be lasting or robust, though data has since shown her to be completely incorrect on this point too.
Finally, she opined without evidence that the mental health crisis was due not to lockdowns but instead “could be related to the fact that their loved ones have passed.”
The entire interview is transcribed below.
WBUR: We are going to talk now about a stewing controversy over how to fight the coronavirus pandemic. It emerged after a small group of scientists argued that the US should pursue herd immunity. That is, let most people go back to normal, try to protect the most vulnerable and ride this out until enough people have had the virus and are immune to it that the spread naturally stops. Those scientists signed their Great Barrington Declaration at a think tank meeting in Great Barrington, Massachusetts.
Some members of the Trump administration have embraced it. Now backlash from other parts of the scientific community has been swift and harsh. Critics argue that a herd immunity approach is well outside the mainstream of science and would have a catastrophic death toll. Now, a quick reminder on the numbers, 220,000 Americans have died from the pandemic with more than eight million cases in the country.
Scientific consensus is, the virus is airborne and currently there is no approved vaccine. The Centers for Disease Control and Prevention gives the coronavirus an infection fatality rate of 0.65%, many times higher than that of the seasonal flu.
We have two local voices for you now. One is a co-author of the Great Barrington Declaration, and one is a co-author of the John Snow Memorandum condemning it. We welcome first Martin Kulldorff, a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. He is one of the three authors of the Great Barrington Declaration professor Martin Kulldorff. Welcome to radio Boston.
Dr, Martin Kulldorff: Thank you.
WBUR: So your declaration has been widely criticized. I would say that in some circles it’s been reviled. In penning it, did you anticipate the strength of the reaction to your argument? And if you did anticipate that, what made you decide to write it anyway?
Dr. Martin Kulldorff: I expected some reaction. Yes. And the way we have handled the pandemic so far with lockdowns is the worst assault on the working class in half a century, since the segregation and since the Vietnam war. What we are currently doing is, we are protecting very low risk college students and professionals like lawyers, bankers, journalists, and scientists who are at very, very low risk.
And instead the working class is building up the population immunity that would eventually protect all of us. And that includes high risk, older working class people who are in their sixties, who maybe are driving a cab, who work at a janitor, working the supermarket, et cetera, and who have no choice, but to work. So we are increasing the mortality with the current tactic. So what happens is, with COVID-19, everybody can be infected anybody, but there’s more than a thousand fold difference in mortality between the oldest and the youngest. So among old people, COVID-19 is worse than the annual flu; it will be worse. So it’s much more dangerous for them. On the other hand, for children, it’s the opposite. For children, COVID-19 is much less dangerous than annual flu. So-
WBUR: Okay, I’m going to stop you there because there’s a lot in what you just said. And there are a few things I want to unpack before we go further into more information. The first part of what you said sounded like an ideological statement. You know, the worst assault on the working class, since the Great Depression. I want to focus on a scientific discussion here in these next few minutes. So I want to start with this where you talked about we’re building up immunity among the working class.
Immunity in fact, is in dispute in terms of the data with the coronavirus. I mean, we are not sure, we’re seeing evidence that there are repeat cases. We’re not sure how long that immunity lasts. Can’t we question your fundamental principle, that immunity is achievable in the way it would need to be for herd immunity to protect the population.
Dr. Martin Kulldorff: So, first of all, if we don’t have immunity from natural infection, then the hope for a vaccine is very, very slim, but there are a lot of people who’ve had COVID-19 so far since the start of this year. And we have seen only a handful of reinfections. So if there was not immunity to COVID-19, we would have seen many, many of those reinfections. So it’s very clear that there is immunity to COVID 19. And-
WBUR: But is that really a binary? I really want to understand this. Is that a binary concept? There is immunity or there is not immunity. Or is this an issue of gradations? How immune are you and for how long does that immunity hold?
Dr. Martin Kulldorff: Well, we don’t know for how long it stays for obvious reasons because it’s been around for less than a year. So for some diseases we get lifelong immunity, for others we don’t. It eventually [inaudible 00:05:18]. My guess is that we don’t get lifelong immunity from COVID, but I don’t know for sure. And nobody knows for sure.
WBUR: Okay. Then the other thing you said in those opening remarks was that there’s a thousand fold higher mortality for certain portions of the population than for other portions of the population. It seems as if the argument in the Great Barrington Declaration is based in the concept that the appropriate metric is mortality. But I do want to ask, we have seen data that suggests, for example, that people who are otherwise healthy and maybe have light or no symptoms experience damage to their heart, damage to their lungs. And as you just said, we’ve had this virus or been aware of it for less than a year. How do we know that there aren’t other serious lasting impacts of getting the virus, I mean that morbidity part, even if mortality is not an issue.
Dr. Martin Kulldorff: So in terms of long term effects, let’s say half a year, there are cases of COVID-19 with leads to that. Yes, like there is for annual influenza and many other infectious diseases. I have not seen any study that shows that it’s more after COVID-19 than after annual influenza. When it comes to long term effects beyond a year, obviously we do not know anything about that.
What we do know is that the lockdowns that we are implementing with school closures, et cetera, has led to catastrophic collateral damage. Education is very important for school children, but not only that, we also have school… In person schooling is important for physical health and for mental health. Cardiovascular disease outbreaks are much worse because of this. So people are dying from that. The childhood immunization rates have plummeted, cancers are down, but that’s not because people don’t get cancers because they’re not detected.
They’re not the same cancer screenings. So somebody who might would have lived for maybe 15, 20 years might now die of cervical cancer, maybe three or four years from now, because we don’t do the screens. And of course the mental health is a catastrophe. And if you talk to a psychiatrist, for example, they will confirm that the burden on people have increased. And there was one survey from June that said that among young adults in their early twenties, 25% had been thinking about suicide. So suicidal rates-
WBUR: All right, so that’s-
Dr. Martin Kulldorff: That’s much more than normally.
WBUR: So you’re making it-
Dr .Martin Kulldorff: So there’s collateral damage.
WBUR: Yeah. So you’re making a trade off argument there. Let’s stay there for a minute. In the criticism of your argument. So for example, Dr. Anthony Fauci has said, the idea could lead to, “an enormous death toll.” And there have been a range of estimations in the criticism of the Great Barrington Declaration. On the high end, a million, maybe five million conservative estimates in the 500,000 range. So are you arguing that that level of death, if we let this thing go among less vulnerable populations, is the appropriate trade off for the other kinds of losses that we are experiencing that you just laid out? Is that the argument?
Dr. Martin Kulldorff: No, that’s not the argument. The argument is that the focus protection plan that we are proposing in the Great Barrington Declaration is the way to minimize mortality from COVID-19. And there’s basically three strategies that we could pursue with COVID.
One is to do nothing, almost nothing. If we do that, then some old people will get infected and some young people will get infected. Among the young, there will be very little mortality, among the old there will be considerable mortality and we will have many deaths. So that is not a good strategy. So very, very bad strategy. Another option is to do another a general lockdowns across all ages. So everybody’s protected equally. If we do that, we are pushing the pandemic forward in time. So we are reducing short term mortality, but it will still catch up with us.
And if we do protect everybody equally, then some old people will be infected and some young people be infected. And again, since many old people are infected, we can have high mortality. So that’s not a good strategy either. And that’s the strategy we’ve pursued now for over half a year. What we are proposing with focus protection is the older people and other high risk group has to be much, much better protected so that we have very few people and those are infected. The young people can live their lives normally because they are very, very low risk. So that is the way to reduce the overall mortality in the society.
WBUR: So think of the massive disruption into lives that focus protection should we be able to do it, that focus protection would require so that people who are vulnerable, a significant percentage of the American population is at risk or high risk when it comes to implications or complications from the coronavirus. You talked at the beginning, and I know you have talked about the vulnerable populations that have been disproportionately affected by this virus, but they would also be disproportionately affected by or unable to do this kind of isolation. Have you seen this actually work any way… It didn’t work in Sweden for example, where there was some attempt to it. I mean, in the nursing homes, it went badly.
Dr. Martin Kulldorff: So in Sweden, the problem for the nursing home was in Stockholm, which have a much higher mortality rate than the rest of Sweden, despite the same strategy. So in Stockholm, the nursing home was a catastrophe. It wasn’t quite as bad as in Massachusetts on New York or New Jersey, but it was bad. So they didn’t properly protect the people in the nursing homes in Stockholm and the rest of the Sweden, they did fine, but certainly not in Stockholm.
WBUR: So for my last, excuse me, just a second, excuse me, for my last question. I do want to switch gears. You and your colleagues put this proposal forward through the American Institute for Economic Research in Great Barrington, Massachusetts. That is funded in part by Charles Koch. There have been accusations that there was a politicization because of that political funding and the position has been adopted by people who are creating this framing of binary framing, politically of the lockdowners versus the herd immunity crowd. If you could go back and do it again, would you release this under auspices that were not so politically patina?
Dr. Martin Kulldorff: So of the three of us who signed, who authored this declaration, myself, the world’s preeminent infectious disease, Sunetra Gupta, Oxford university, as well as Dr. Jay Bhattacharya at Stanford university. None of us is taking any money from any pharmaceutical companies, any other large corporations, certainly not from the Koch brothers. None of us have received any funding, any stipends or salary from the Institute which was signed, not from anybody else.
We are all putting our own personal funds, to spending personal funds, to be able to do this work. The Institute had not seen this declaration before it was completed and signed. And the idea about Koch brothers, that’s nonsense actually. The Koch brothers has funded Neil Ferguson of Imperial College was a very pro-lockdown person who was one of the initiators of proposing lockdowns. So to accuse us of getting funds from the Koch for us is just abusive to do so.
WBUR: Well, no, I mean, either they funded the Institute or they didn’t. I mean, I think that’s just a matter of fact, I’m afraid we’re going to have to stop there. That’s Martin Kulldorff, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. One of the co-authors of the Great Barrington Declaration. Professor Kulldorff thanks for joining us.
Dr. Martin Kulldorff: Thank you.
WBUR: Listening to that conversation with Dr. Rochelle Walensky, she’s also a professor of medicine at Harvard Medical School, a practicing infectious disease physician at Massachusetts General Hospital and Brigham and Women’s and the chief of the division of infectious diseases at mass general. She’s also a co-author of the John Snow Memorandum, which condemned this herd immunity approach and was originally published in the lancet. Dr. Walensky, welcome back to Radio Boston.
Dr. Rochelle Walensky: Good afternoon, thank you for having me.
WBUR: Yeah, I know you were listening just now. So my first question for you is, is there anything in particular that stood out to you in Martin Kulldorff’s discussion with me just now?
Dr. Rochelle Walensky: Yeah. You know, what I want to say is, he is correct in that he and his colleagues are deeply respected epidemiologists and experts. So I want to just give him a huge amount of credibility in that space. I want to acknowledge that I fundamentally agree that we need to protect our vulnerable people through this pandemic. I very much disagree on how that happens. And I don’t think that the plan that he and his colleague to put forward has ever had evidence that it worked.
When I think about vulnerable communities, one of the things that I think about is the CDC data that suggests that… Or when I think about vulnerable people, I think the CDC data suggests that about 47% of the American population has some sort of comorbidity that puts them at higher risk for poor outcomes with COVID-19. Those clearly are people that are going to have to be protected, but I don’t exactly know how given his plan.
WBUR: So I let’s talk… Oh, sorry, go ahead.
Dr. Rochelle Walensky: And then the other thing I want to say is about vulnerable communities, and that is people who live in multi generational households who may not have the resources to properly quarantine. And also in that space, I’m not exactly sure how we would protect them through this plan.
WBUR: Have you seen examples of this kind of focused protection work either? You know, other countries here in the United States at other times, is this something that we know can work?
Dr. Rochelle Walensky: Well, that’s actually my biggest challenge with it is. I think that this is what Sweden tried to do. This was their plan. What we know from Sweden is that their death rate, their per capita death is 591 per million that rivals the United States at 593 per million, to give you a sense of what lockdowns were able to do in other countries. And I mean, really strict lockdowns. In China, their death rate is three per million. So when you look at what Sweden was trying to do and what they are trying to emulate in Sweden, it didn’t work. They were unable to protect them.
WBUR: A term that’s often used by a lot of different disciplines is collateral damage. I want to use a little bit different term, which means other harm, I think is the term that I’ll use. These lockdowns carry other harm. You heard Martin Kulldorff talk about some of that mental health implications, economic implications. The CDC estimates that, excess deaths is the term that gets used.
Dr. Rochelle Walensky: Yeah.
WBUR: Have been almost a 100,000 Americans. So what of that, is there a trade off in epidemiology where one starts to say that the cure is more painful than the disease? I don’t want to sound glib here. I’m really asking.
Dr. Rochelle Walensky: Right. So there are two places I want to talk about with regard to that. One is the issue of mental health and the other is the issue with sort of the other diseases and collateral damage. So Dr. Kolldorff commented on higher rates of cardiovascular disease deaths, lower rates of cancer screening that are then manifesting in more disease.
There was a piece that was out last week that demonstrated actually the excess deaths that you’re talking about between March and August and the country were about a quarter of a million, 225,000. So the challenge there is that only two thirds of those were related to COVID. The other third of those excess deaths were likely related to either not accessing care or not being able to access care. We did in our hospital system, see lower rates of heart attacks, lower rates of strokes, concerningly lower rates of strokes, because we knew they weren’t coming to care.
And so I believe that the fact that if we overwhelm our hospital systems as could very well happen, if we sort of let everybody get to a herd immunity approaches being proposed, that we’re going to overwhelm our health systems. And we’re going to see more of these excess deaths because people won’t present.
The other piece on the mental health, I think is really important. And that is, we do not know why people are having… I mean, we have many reasons why people are having mental health challenges. It’s extraordinary what’s happening right now, but many of those could be related to the fact that their loved ones have passed, that their loved ones have been sick, that they’ve had to say goodbye via a zoom or a FaceTime. And that’s really extraordinary times, they haven’t been able to visit their loved ones in the hospital. So while I do agree that there most definitely are mental health decrements by having our school closed, I don’t necessarily agree that the answer is that we should get to a herd immunity approach and that these excess deaths will improve our nation’s mental health situation.
WBUR: You heard me at ask professor Kulldorff about this framing that is out there of the lockdown folks versus the herd immunity folks. And I want to acknowledge that, that is a binary that doesn’t exist and can be a problematic framing. I also want to say that we don’t hear a lot of states as numbers start to get worse again, we don’t hear a lot of states talking about engaging in the type of lockdowns that we did necessarily in the spring when we were trying to flatten the curve. Are we going to need to… In absence of other approaches, are we going to need to go back to that level of lockdown or is the way Massachusetts, for example, is doing it in this kind of phased and targeted and frankly uncoordinated way, is that what we’re likely to be continuing to do?
Dr. Rochelle Walensky: I believe that the lockdown worked in terms of, “flattening the curve.” We needed to do that in March. I mean, you saw the scenes of what was happening in our own hospitals, in New York hospitals that was not sustainable. I would like to think that we could get national leadership that would endorse a plan where people are wearing masks, where people are distancing, where we can have leadership that will allow for all of these things to occur and therefore can protect ourselves. I believe actually that the schools should be open preferentially over some of the things that are open right now. And I think we could safely get in a space to do that without having a full lockdown, because I understand the toll that, that takes.
WBUR: So there were signatories to the Great Barrington Declaration and there was controversy there because some of them were clearly not verified or fake names. I know the John Snow Memorandum, which by the way, is named after an epidemiologist, not a Game of Thrones character had a lot of people who were scientifically verified, also signed on to it. Is this back and forth, healthy for the field. And will it get us to better public health outcomes or is this in some way, because of the politicization of this discussion, especially unhealthy for us. Which is it likely to turn out to have been?
Dr. Rochelle Walensky: I don’t think any of us went into this wanting to have a dialogue via signatories and memoranda. I think what happened was, we were starting a group of us internationally in effect at the same time the John Snow Memorandum came out. I also co-authored a piece in the Washington Post with colleagues, Yale, Gregg Gonsalves, Marc Lipsitch at the Harvard school of Public Health and Carlos del Rio at Emory, because we understood that this was becoming part of an administration endorsed policy. And we were very worried that if that started taking shape, that the other side of the story would not be heard. And that there were certainly many of us who work in the field of public health and infectious diseases and epidemiology who very much believe that that was the wrong approach. And that was really our intent.
WBUR: All right, well, we are actually going to have to stop there. Dr. Rochelle Walensky is a professor of medicine at Harvard Medical School, and practicing infectious disease physician at Massachusetts General Hospital and Brigham and Women’s and the chief of the Division of Infectious Diseases at Mass General, also a co-author of the John Snow Memorandum. Dr. Walensky. I appreciate you being on.
Dr. Rochelle Walensky: Thanks so much for having me.