The Health 202: Health officials call an anti-lockdown paper ‘dangerous.’ Its authors say they just want the idea debated.

“I suspect if we had a chance to talk with Dr. Collins about what these ideas actually say instead of the misrepresentations, he wouldn’t have that response,” Bhattacharya told me in an interview yesterday.

The Barrington Declaration is triggering a heated and fraught debate over shutdowns as the winter approaches and infections rise.

The paper, co-written by two epidemiologists at Harvard University and the University of Oxford and signed by other academics and scientists, says measures to protect those most vulnerable to the virus should be the central goal of the public health response, rather than current shutdown policies. 

The authors argue that the harm from shuttering schools and businesses is so extensive that it’s not worth trying to limit the virus’s spread among healthy children and non-elderly adults. Targeted protections for the elderly and sick are the best way to minimize mortality and social harm, they wrote.

“The most compassionate approach that balances the risks and benefits … 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,” the paper says.

Yet the paper has provoked a firestorm within the scientific community — and is exposing fractures in the Trump administration.

The online document, published Wednesday by the medical journal Lancet, acknowledges the shutdowns have been damaging to people and the economy. Yet it rejects the idea that allowing the virus to spread unchecked among low-risk populations – an idea known as gaining herd immunity – would ultimately protect the vulnerable. The authors point to the nation’s already-steep death toll, noting that there could a hundreds of thousands more deaths if the virus is allowed to spread even among healthier Americans.

“This is a dangerous fallacy unsupported by scientific evidence,” says the memo, co-written by Harvard epidemiologists Bill Hanage and Marc Lipsitch and signed by more than 80 scientists. “Any pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed.”

Bhattacharya and his co-authors met last week with Health and Human Services Secretary Alex Azar, who tweeted praise of their ideas afterward. 

Azar tweeted this last week:

But both Collins and Fauci have sharply criticized the declaration as departing from consensus among epidemiologists.

“Anybody who knows anything about epidemiology will tell you that that is nonsense and very dangerous, because … you will have killed a lot of people that would have been avoidable,” Fauci said.

Bhattacharya called the tension provoked by his letter “overwhelming.”

But he feels it sparked a conversation that was ignored up until now. While some have interpreted the declaration as a “let ‘er rip” strategy, he says that is a mischaracterization of the approach he is promoting. While the country will eventually reach herd immunity, the point at which 60 to 70 percent of the country is immune either from being infected or getting vaccinated, his aim is to protect the lives and well-being of the maximum number of people until that point is reached.

Bhattacharya insists there is “significant dissent” in the scientific community about whether the shutdowns are justified, given the significant negative downstream effects of the pandemic such as lost income, increased poverty, diminished education and heightened rates of depression and suicide.

Yet he acknowledged his view is a minority one at Stanford and many other U.S. universities. He said he has received better reception to his ideas from epidemiologists in other countries, especially the United Kingdom.

“It’s very difficult to talk about these issues at the moment at Stanford,” Bhattacharya told me. “Until covid, I’ve always felt free to express my thoughts. But I think since the covid era that has changed. I wish I could change it back.”

Critics of the Barrington Declaration fear it could lead to even more Americans ignoring safety guidelines.

This is a particular concern when it comes to how President Trump talks about the pandemic.

The president has repeated flouted precautions recommended by the Centers for Disease Control. At an town hall last night, Trump repeatedly and falsely claimed that 85 percent of people wearing masks still contract the novel coronavirus — even as he insisted he supports mask-wearing.

Trump also repeated a phrase he has used frequently when asked about the merits of shutdowns. “The cure cannot be worse than the problem itself,” he told NBC News’s Savannah Guthrie. 

The possibility of further shutdowns is growing as coronavirus infections rise.

Yesterday, the United States topped 62,000 new coronavirus cases, the country’s highest daily count since it reported more than 66,000 cases on July 31, my colleagues report.

“Cases in the Midwest began to surge during October,” they write. “On Thursday, Wisconsin, Ohio, Indiana, North Dakota, Montana, New Mexico and Colorado tallied new single-day highs for positive test results. Fourteen states exceeded their seven-day averages of new infections.”

A mash-up of models used by the CDC now projects 23,000 more coronavirus deaths over the next four weeks because of the rise in cases.

More from the dueling townhalls

Biden left open whether he would be willing to mandate a vaccine.

Former vice president Joe Biden dodged a question about whether he would make a coronavirus vaccine mandatory if elected president during Thursday’s ABC News town hall, which took place at the same time as Trump’s appearance on NBC News. The Democratic nominee suggested he might be open to requiring a vaccine, saying, “We should think about making it mandatory.” 

When pressed by moderator George Stephanopoulos about how he would enforce such a mandate, however, Biden quickly backtracked, saying he did not think it was within his power to order it.

“You can’t say, ‘Everyone has to do this,’ ” Biden said, adding, “just like you can’t have a mask mandate.”

Biden’s suggestion that he would not have the authority as president to impose a national mask mandate goes against comments he made last month in which he said his legal team thought a mandate would be possible. Legal scholars are divided on the question. Biden told the audience he would urge governors and mayors to push for masks and set a good example, as an alternative.

The Democratic nominee also affirmed he would be willing to receive a vaccine before the end of the year if it was approved by scientists. Both Biden and his running mate, Sen. Kamala Harris (D-Calif.), have expressed concerns that Trump could rush a vaccine not properly vetted before Election Day, a scenario that is now impossible under stricter approval standards the White House has signed off on.

Trump wouldn’t say whether he took a coronavirus test before his debate against Biden.

The president said during the town hall he did not remember if he took a test before the first presidential debate on Sept. 29. The terms of the debate stipulated that both candidates would receive a test, but doubts emerged over whether the president had complied with these rules when he tested positive for the virus just two days later. 

“I don’t know. I don’t even remember. I test all the time,” Trump said in response to a question from Guthrie about when he last received a negative test. Trump said he thought he “probably” took a test the day of the debate and told Guthrie she should ask his doctors.

Trump refused to say whether he supports overturning Roe v. Wade.

The president said he has not spoken to Supreme Court nominee Amy Coney Barrett about Roe v. Wade and that it would be inappropriate to do so. 

When Guthrie pressed him, noting that most antiabortion conservatives would like to see the ruling overturned, Trump punted.

“I don’t want to do anything to influence anything right now,” Trump said, suggesting if he weighed in on the abortion case, it could be perceived as a signal to Barrett in the nomination hearings. 

During the presidential debates in 2016, Trump said he would nominate Supreme Court justices who would overturn Roe v. Wade, a commitment that was seen as an important appeal to religious voters with antiabortion views.

Ahh, oof and ouch

AHH: Trump’s Medicare drug discount plan faces uncertainty.

“Three weeks after President Trump announced the government would send tens of millions of older Americans $200 to help pay for medicine, the election-season idea is mired in uncertainty over whether such drug discount cards are legal, proper or will ever exist,” Amy Goldstein writes.

Since Trump included the idea in a health-care speech on Sept. 24, administration officials have scrambled to draft a proposal that would make the cards a reality. Health and Human Services Secretary Alex Azar and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, were told of the plan less than a day in advance.

Meanwhile, a group of three senior Democratic lawmakers is calling for the Government Accountability Office to issue an expedited review of the legality of the plan, which must be approved by the White House Office of Management and Budget. Even some conservatives have perceived a “a whiff of vote-buying” in the plan, which the president has said he wants out before the election, Goldstein writes.

The project would be authorized through a legal provision allowing Medicare to try experiments to test the efficacy of changes in payments or reimbursement. Administration officials have said Trump’s plan will test whether lower drug costs increase compliance with medications, although experts have criticized the proposed experimental design for lacking a control group.

OOF: An investigative report from ProPublica details how the CDC lost the trust of the public.

The CDC came into its fight against the coronavirus already diminished by decades of budget contractions. The agency had cut over 300 posts oversees and no longer had an office inside the Chinese Center for Disease Control and Prevention at the time the virus hit. 

In February, a series of crucial mistakes in developing a coronavirus test resulted in the agency sending faulty test kits to public health agencies across the country and losing precious time in the pivotal early days of the pandemic. It took three weeks for the CDC to send out new kits.

Perhaps the biggest obstacle for the CDC came from near-constant interference by the White House and political appointees at the Department of Health and Human Services. Officials from HHS sought to monitor and restrict communications from agency scientists. Meanwhile, the Trump administration ignored scientists’ suggestions about everything from quarantining cruise ships to guidelines for safe school reopenings. 

“Employees spoke openly about their ‘hill to die on’ — the political interference that would prompt them to leave. Yet again and again, they surrendered and did as they were told,” Bandler, Callahan, Rotella and Berg write. “Many feared that if they left and spoke out, the White House would stop consulting the CDC at all, and would push through even more dangerous policies.”

OUCH: Remdesivir did not decrease mortality among covid-19 patients, according to a World Health Organization study.

“Results from the WHO’s highly anticipated Solidarity trial, which studied the effects of remdesivir and three other potential drug regimens in 11,266 hospitalised patients, found that none of the treatments ‘substantially affected mortality,’ or reduced the need to ventilate patients, according to a copy of the study seen by the Financial Times,” the Financial Times’s Donato Paolo Mancini and Clive Cookson report.

The study, which has not yet been published in a peer-reviewed journal, found “remdesivir, hydroxychloroquine, lopinavir and interferon regimens appeared to have little effect on in-hospital mortality,” the Financial Times reports.

Trump received a course of remdesivir earlier this month after he tested positive for the coronavirus. The therapy, which was initially developed as a treatment for Ebola, received emergency use authorization in the United States after a National Institutes of Health trial found that it decreased the average recovery time for patients with covid-19. The WHO trial did not find that the drug had a major impact on the length of hospital stays, although its focus was primarily on mortality.

“The WHO’s findings mean that the only drug proven to increase Covid-19 survival rates is dexamethasone, a cheap steroid that can be taken orally and is widely available around the world. The WHO has recommended the use of steroids for patients with severe cases of Covid-19,” Mancini and Cookson write.

Coronavirus latest

  • Coronavirus cases in Europe set records this week, overtaking the number of cases per capita in the United States, Michael Birnbaum reports.
  • Across 26 countries, eldercare home residents have accounted for an average of 47 percent of recorded coronavirus deaths, according to data collected by the International Long-Term Care Policy Network, a global collaboration between academics and policymakers, Adam Taylor reports.
  • Fauci told “CBS Evening News” that Americans may need to “bite the bullet” and cancel Thanksgiving.

  • Trump called for Treasury Secretary Steven Mnuchin to offer more money in stimulus negotiations with House Democrats, even as Senate Republicans advance a slimmed-down relief bill, Erica Werner and Jeff Stein report.
  • A nonprofit watchdog filed a complaint against Trump’s physician, Sean Conley, calling for the Virginia Department of Health Professions to revoke the doctor’s license. The Checks and Balances Project alleges that Conley engaged in “unprofessional conduct” by failing to enforce public health guidelines in the White House and by misleading the public about the president’s condition during his hospitalization with covid-19.

Sugar rush

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