A live discussion about The Great Barrington Declaration vs. The John Snow Memo, including recent excess mortality data from the CDC.

And here’s a brilliant editorial from our friend and recurring guest Dr. Vinay Prasad.

Transcript Below!

I wanted to talk about, a lot of people has messaged me, including some of the people who wrote these petitions about these two dueling petitions. I don’t know if you guys have heard about this. One of them is the Great Barrington declaration, which basically stated that, hey, we scientists who signed this puzzle petition would like to say the following about how we should manage this pandemic. And the Barrington guys basically said that we should allow healthier people that are in lower risk categories to become naturally infected, in other words, to go out, live their lives and in the process of potentially getting infected, developing immunity while protecting more vulnerable groups, people with comorbidities and people who are older, which means opening schools, opening bars, opening restaurants, basic hand hygiene, and, you know, basically waiting for vaccine, but continuing to live our lives because the costs of the pandemic response outweigh the damage to the vast majority of people from the pandemic itself. So that’s Great Barrington Declaration.

In response came the John Snow Memo. Now this one was a little bit longer and it basically said, hey, we scientists who sign this one, think that herd immunity is not a real thing that the Barrington Declaration more or less is scientific fallacy, that the only way to stop this pandemic is basically aggressive public health measures, which early on included lockdowns, currently include keeping particular businesses shut down and doing aggressive testing and contact tracing in a way to try to get the pandemic to a level of suppression that then you can eradicate it, at least to a level that we can then get a vaccine and finish it off. And they cited New Zealand and Vietnam and South Korea as examples of that, that we’re doing this. Okay.

So what, what, which one should you sign? Which one is true? Is this a good thing, what’s going on? Well, let’s back up a second and talk about important data that just recently came out. So, you know, there’s a lot of controversy. Are we actually measuring the deaths from coronavirus correctly? And are we even measuring like, are we measuring things like long haulers and complications, things like that correctly? Well, CDC releases something called excess mortality data, which means year over year on average, how many people die and let’s compare this year and you can subdivide by age, by race, by, you know, those sort of things, let’s compare it to previous years.

Well, it turns out this year, this latest data shows from January to October, the number of excess deaths above the average we would expect from previous years is around 300,000 Americans. And I’m gonna focus on America. So 300,000 Americans, more than we would expect to have perished. Now the number of documented COVID-19 deaths is roughly 220,000, roundup a little bit for now. It’s rounding up today, I think. So what’s the discrepancy? That’s significantly less than the 300,000.

Are we under counting COVID deaths? Are other things at play like substance abuse, overdose, heart attacks, strokes, people that are not going to the hospital, diseases of despair, these kinds of things that are making up that difference, or is it all of the above? And the answer is we don’t yet know. We do know this. The excess mortality for black people is 50% higher than in previous years. The excess mortality for white people is 11% higher than in previous years. That’s a big difference. Again, highlighting how the minority community is being vastly overrepresented in numbers of deaths, probably both from COVID and from the response, the economic turmoil. So we know overdose deaths are up. We know we’re not keeping a handle on domestic abuse because schools are closed. We don’t know what’s happening with kids. People are not going to the doctor because we know visits for heart attacks and things like that are down, but why would heart attacks be down? So this is a big deal.

Now that’s the background of why these two petitions exist, both camps and they are camps. We’ve chosen sides in a war, it seems, even though this is science and we’re supposed to have dissenting ideas and argue them. And in fact, these kinds of petitions remind me of the good old days of Hamilton, right? Or Hamilton would write off a, a petition and put it up about, you know, the King being a bad guy. And then the Kings people would respond. And that’s how you would argue. And that’s how you would debate. And that’s how civil society worked. But what we’re seeing here is two groups that feel very differently about the same data. And both petitions tend to paint this in a pretty black or white way. So Great Barrington says, look, the, the harm from the response is killing us and we need to back down pretty aggressively. And their big failure, and again, my friend, Doctor Vinay Prasad wrote an amazing op-ed in Medpage Today about exactly this. I will link to it. It really summarizes all this beautifully and more eloquently than I can.

So the Barrington guys basically don’t say, okay, well, we want to let young people get it, develop immunity while protecting older people and people at higher risk. But how do we do that? How do we protect older people and people at higher risk if young people get infected and they can, asymptomatically transmit it to older people? So that’s not really hashed out. It’s also not clear how long immunity lasts. Now, the John Snow people argue that well, we don’t know that immunity lasts at all, which by the way, makes it really tough to make a vaccine sometimes, which they’re also advocating for. We don’t know that immunity lasts. We don’t know what’s happening with long haul stuff. And herd immunity is a lie, basically. It’s not a scientific truth, but actually none of these guys are fully, right?

Because the John Snow people fail to talk about how will you protect the vulnerable? The people who are economically vulnerable and socially vulnerable from our response. They say, well, you need social programs. How are you gonna do that in the US where we can’t even get a bill passed for pandemic relief? And they say, you need aggressive contact tracing. Well, how are you gonna do that in the US where we won’t give up our privacy like the South Koreans have where their phones are basically tapped by the government.

Look, I’m personally fine with that. I don’t care. I’m a public figure. My privacy doesn’t exist, but most Americans won’t go for that. So we have to really understand that it’s shades of gray here, there isn’t just a John Snow approach or a greater Great Barrington approach. There really isn’t, it, both approaches are true, but partial. Both approaches need to be combined into something that is flexible, that changes with new data and understands that there are hierarchies of need.

So bars and Vinay points this out beautifully, bars, opening bars, right? It’s important for the bar owner. It’s important for the landlord. It’s important for some community aspects, important for economy. Is that more important than opening schools, which is the ladder to success in this country? Still one of the few equalizers, arguably. Where kids can actually get meals who don’t have them, sadly. It’s true. And where abuse can actually be detected. So we’ve closed those and the bars. The Barrington guys want to open both, the John Snow guys want to keep both closed. Where’s the answer? Probably in some nuanced truth that’s in between.

Now looking back at the excess mortality data, how does it actually break down by age? This is fascinating. So the older people, yeah. They had an increase in mortality. Sure. We expect that. But the biggest bump in mortality was in 25 to 44 year olds, 25 to 44 year olds. Not classically old people had the biggest bump relative bump in mortality year over year. And why would that be? Well, first of all, their baseline mortality, isn’t that high because they’re younger. So it’s easier to have a bump and coronavirus does kill people in those age brackets, right? Although less so than in the higher age brackets, but also that’s the group most affected directly by economic turmoil, job closure, lack of access to healthcare and prevention, cancer screenings, things like that. So it’s probably very complicated.

You know what’s fascinating? 25 and younger that age demographic, had a 2% drop year over year in excess mortality, probably within the statistical parameters of the test, but still it didn’t go up. What does that tell you? Either it’s pretty much unaffected by COVID, which we kind of knew. There are very few deaths and long-term morbidity in that population. Also, you have to look at the bigger picture. Our response probably has decreased the number one top, one of the top killers, young people, car accidents, so it’s as always, much more nuanced and complicated. And there isn’t a one size fits all. Every locality is different. Herd immunity, as a thing, depends on population characteristics. There isn’t a number you throw on the virus that says, this is how it behaves in every population. This is how much of the population needs to be immune or exposed before they’re immune. It depends on are people washing their hands? Are they wearing masks? Are they distancing?

Are they gathering in large crowds? What’s the innate susceptibility of that genetic population or the populations previous exposure to coronaviruses. And maybe they have some pre-existing T-cell immunity. We don’t know, but all those things go into that. So when you end up creating these dual petitions, all you’re doing is saying, I’m gonna pick a tribe. I’m gonna signal to the rest of the world that I am in that tribe, and I’m gonna sign this thing. Honestly, that’s what I think. I think that’s what those petitions exist for. They don’t exist to get us much closer to truth. I love the debate between the two. I love that both exists so that then we can start to pick out the nuance from the alt-middle of where it is, both by the way are associated and have been politicized.

So the Great Barrington coming from the right, John Snow coming from the left. Is that how we really want to determine our future by how many signatures a petition gets? I think we need to stop silencing any voices on either side, by the way, both sides think they’re being silenced, right? And it’s really, really, really difficult and heartbreaking. So look at this excess mortality data, look at the bigger picture of harms and benefits, both from the virus and from the response, read both petitions so you can understand each angle, you will have an unconscious bias towards one or the other.

But what I would argue is this, look at the other petition, apart from the one that, that doesn’t fit your bias and try to see what they’re talking about. Try to see what if some aspects of that were actually true. How would it change how you think about the pandemic? Now, if you’re a scientist, if you’re a leader, if you’re a politician, then this becomes a really important thing because you’re leading thought you’re actually pulling levers of power and potentially changing ideas and changing policy. So you need to look at it on both sides.

If you’re a member of the public, a patient, a nurse, an LVN, doesn’t matter what you are. And you look at that, you got to ask yourself, what am I going to do? What risk group am I in? Am I gonna wear a mask and wash my hands and social distance? Do I consider those things relatively easy and low cost to, to allow further opening of the community? Am I going to continue to live the way I am doing absolutely nothing differently. So these are useful mental exercises for all of us. And I’ll tell you, you know, again, I was asked to sign both of these petitions and I don’t feel like any of my views fit, something like that, that I can sign.

Really, we have to think for ourselves, take the data, process it, go through and actually make a decision based on changing data. Like for example, if you start, if you, if you tribally identify with one of those, how are you gonna change your mind if data changes and suddenly you realize, oh, schools are actually terrible transmission vectors. They’re spreading the disease everywhere and old people are dying because of it. It’s a big surge or the opposite, which actually is more likely. You see where my bias is, but my bias is also based, I mean, again, could I be cherry picking data, just backing up studies and articles that support what I believe, absolutely, which is why I always read the opposing articles and try to see if I can, can be convinced that I’m wrong.

I actually was convinced that I wasn’t fully right on masks early on. I thought they were a terrible idea. Now I said, well, you know what? They’re actually probably harm reduction, even if they’re placebo, right? ‘Cause it allows us to open up. But I think they do along with Monica Gandhi, has been on my show, reduce inoculum. This is how we have to think about things. They’re constantly going back and forth. At first, I actually was like, hmm, school closures may be a good idea because this thing is blowing up.

Like, what do you do when hospitals are overwhelmed? You better do everything until you know what you’re doing so that wasn’t wrong. And taking that option fully off the table. Like what if all our hospitals suddenly overflow in the winter? I don’t think it will happen, but what if it did? Well, we’d want to be able to respond agilely based on new data. And again, if you’re just going straight Barrington or straight Snow, you can’t do that effectively. That’s why those are bad ideas, all right. That’s what I wanted to get out on the table. People who want to tune out can tune out.

I’m gonna scroll through and look at some of your comments now. ‘Cause I see them streaming on every single platform.

So Alexander K on LinkedIn says on top of this folks don’t understand what exponential function is. It grows really slowly than it blows up, trying to control levels of infection at low levels is not easy and it can’t be done with a simple solution, but America is a bit too anti-intellectual to go for a complex solution. Well Alexander I’d go a little further and say the Americans we’ve already let this out of the bag to try to squeeze it to suppressive levels where we can do aggressive contact tracing and all that, I think we’re too late. I really do. Early on I was advocating for that myself. Okay, if we’re gonna do lockdowns, then let’s do the right thing. They actually said this in the John Snow memo, squeeze the lockdown and then spin up contact tracing, spin up the ability to test, spin up our ability to isolate people who are sick. We didn’t do that here. And maybe that we couldn’t do that. But honestly, if we had a united front where we spent a ton of money on it, we could have done it, but we didn’t. So now we’re in this thing where it’s like push and pull waves coming, this and that, did we do it? Did we not do it? Europe’s resurging. ‘Cause there are a lot of countries in Europe that didn’t do that as well. And so now we’re in a very nuanced position of trying to choose between evils on all sides and understanding that bad things have happened. They’ll continue to happen. How do we minimize harm for the most number of people? That’s really it.

Let’s see people talking about putting apps on their phone. Karen Brown. I put the app on my phone because I want to know if I’m near some random stranger for 20 minutes, within six feet. And again, even CDC has to revise these guidelines. You have to be around people for long time and within a certain proximity. But they’re saying now that can be repeated short-term exposures as well. We just, our knowledge about this thing is evolving as we go. Janet Amico at Facebook says follow the data. Exactly.

James Davani says flexible approach. That’s really what we need. And Jamie Burke says it’s way too late in the, and it’s I think there’s a component of that. So let’s see here. Andy Lawrence says, what’s the deal with blood type impact on susceptibility severity? Couple of things saying type O shows less severity of illness, fewer hospitalizations, right? This has repeatedly come up. That type A seems to be at higher risk from a correlation standpoint. And we always have to look at why is that? Is there something else that’s associated with type A blood that correlates to worse outcomes with coronavirus? The answer is we don’t know. We do know that the SARS coronavirus 2 seemS to have a endothelial, the lining of the blood cells, a blood component, it creates, creates increasing clots and things like that. So there may be some reason that blood type has an effect, but again, what are you going to do about it, apart from add it to another risk profile that you’d say, okay, I’m at higher, lower risk and what am I going to do about that? Well, if I was gonna wash my hands, wear a mask and distance anyways, it doesn’t change anything to know that type A is worse than O, ’cause you can’t change your blood type. Now it may lead to research down the line that looks at mechanistic reasons for why that could be in that may help us understand something new about the coronavirus.

On YouTube, Kevin NC says immunity, disease, immunity of infection or sterilizing immunity before someone can discuss herd immunity, do you have to define which one? Data shows it’s only to disease? Right? So when you’re talking about herd immunity, you’re saying you’re immune, there’s enough resistance in the population to a particular disease agent that it doesn’t have anywhere to spread. And the reproductive number dips below one, meaning each person infects less than another person and slowly the infection disappears in that population or is at a very low level And you can attain that through and people disagree about this, they say you can’t do herd immunity through natural infection. But a lot of natural pandemics have born, have ended because of natural immunity, right? You didn’t have a vaccine, so it can happen. The question is how many people need to be infected? What’s the duration of immunity? How many people would die i you let a viral agent rip through a population until you reached a herd immunity threshold, when you don’t know what that threshold is, but you’ve got to ask those questions, right?

Let’s see, I’m looking through a lot of comments here. Peter Lou, can we have Monica Gandhi and Anders Tegnel debate on face mask. So Monica was on my show. Anders is the public health guy in Sweden, doesn’t think masks are very important there. That’d be a fun debate. And again, it’s, to a degree it’s picking data, support your bias already, and making a case. Now Monica’s bias is very much looking at data and going. It seems like there are a lot of correlates. Again, it’s hard to show causation. There’s a lot of correlates between mask use lower and viral inoculum being lower and better outcomes, more asymptomatic disease, less hospitalizations, less death. Now we may find that that’s not true. Here’s another thing. And Vinay said this beautifully, in his editorial, why aren’t we using this time to study the crap, science the crap out of all of this, we ought to be studying masks in a population. We ought to be studying how much distancing works. We ought to be studying the opening and closing of schools and bars and things like that in communities that have different approaches and then saying, okay, what can we learn from this for the next pandemic, and for this one? Why aren’t we doing more of that? I know what’s happening in fits and starts, but without that data, we can’t make very good educated decisions.

Akikoaba asks about the data from Manaus in Amazonia. So they had like, I think 60 or 80% seroprevalence of infection and they had a high mortality, but it wasn’t, I haven’t looked at all the data. So don’t quote me on this, but it wasn’t catastrophic. And depending on how you define catastrophic, now, each population is different because some people have speculated that, you know, 25% prevalence is enough to generate some semblance of a kind of immunity in a population since there’s preexisting immunity to coronavirus, which wasn’t felt to be the case. That’s very controversial and needs to be studied more. So some scientists really disagree that that’s true, but I think it’s worth studying. Let’s see, these comments are great. I love seeing them across different platforms.

So Davis Romney better check the data cases in Sweden are going up much like the rest of Europe, they have not reached herd immunity. No one said that the Swedes have reached herd immunity, Davis. Whoever’s saying that, it’s we don’t how, how can we show that? Cases are rising throughout Europe, there’s a little blip in Sweden as well, but deaths, deaths are what you want to look at, and hospitalizations as well. Because if it’s younger people getting infected, you’re gonna expect cases, especially when you’re testing. If you increase testing, you’re going to catch those cases in young adults that weren’t caught early on. We actually don’t know what the early cases really were because we weren’t testing properly, remember that? So it could be that we’re seeing increases, but they pale next to early days. And it also depends on what you think the infection fatality rate is, in other words, the actual fatality rate for everyone who’s infected, even people who haven’t presented for for care or been tested. If you look at seroprevalence data on average, that ranges, but you know, Ioannidis a pretty respectable guy, but he’s become politicized as well with his early seroprevalence stuff. Just got a paper approved, the WHO’s I think going to release it and basically said on average, they’re looking at an infection fatality ratio of 0.27. So 0.27 of a percent. And that’s about double and a bit of what seasonal influenza is. But again, that’s on average. Each population has its own IFR because it depends on the susceptibility of the population. What the kind of medical care there is, the age of the population, and what their pre-existing conditions as a whole are. There’s a lot of things, and what their behavior is. Are they masking? Are they distancing or they’re washing hands or are they cramped together, what, how do they live? Right? So again, we ought to be having these conversations in civil society, not necessarily signing petitions. That’s what I think anyways, my friend Vinay would agree and he’s smarter than me. Of course you can’t appeal to authority like that, but still he’s smarter than me. That is so, and the other thing I want to say is, you know, we’re coming up on an election. There’s a debate tonight.

God, I can’t wait for that one. We’ve become so tribalized that we can’t see clearly. I mean, good friends of mine are falling in these camps that are really just straight on political lines. And the science just falls in line. The confirmation bias just falls in line. Man. The most powerful thing you can do is look past your own political bias, to look at the science and say, okay, what actually is the science telling us? And the truth is it’s conflicted. That’s why the political bias pushes us in one direction or another. What do we value? Do we value the economy, education, jobs, people’s livelihoods that may ripple out generations down or do we value deaths right now? Of vulnerable people, particularly minorities and the elderly. Boy, that’s a tough question you have to answer. And politics is the way of hashing out what your science then is translated into policy based on values and conflicting, conflicting values. What are we gonna do with our resources? Right? John Snow guys wanna close things down and protect vulnerable people and give money to people to support them through the economic turmoil that will follow. They don’t say how to do that. The Barrington guys say no, the turmoil is gonna hurt more people and cost more lives long-term than the virus.

So let’s try to minimize it by focusing on the, on the vulnerable people, to the virus. Well, they don’t really say how to do that. So both are true, but partial. All right, that’s the punchline of all this. Thank you guys for joining me for this. I got to run. I have a call at four. You guys can start talking nuance in the comments, I hope. Do me a favor. If you like this kind of discussion, what we often do is after the show, we’ll go deeper in our supporter group. It’s where you subscribe on YouTube or Facebook. And it’s the kind of internet that, you know, everybody kind of wants where people are nice to each other, but we can disagree as family. And it’s means that you’re actually paying for content like this that keeps us afloat during difficult times, we don’t have to sell out to big sponsors or worry about ad clicks. We just worry about giving you guys truth and going back and forth. And we’re only accountable to you. So that’s something that would really help us if you can’t, if you don’t want to do that, that’s great. Just share the episode, leave a comment, hit like if you’re on YouTube subscribe, and then click the little notification bell because it sends you notifications when we put out messages and on Facebook hit, like, and share it to a friend of yours. All right. I love you guys. And we are out.

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