By Perry Halkitis, PhD, and Boris Lushniak, MD
It’s budget season in Washington, D.C., and while the general conversation has revolved around the typical topics—funding the government, immigration, the presidential election—an undercurrent has surprisingly been the COVID-19 pandemic. Like the virus itself, the controversies swirling around the pandemic response never went away.
Regrettably, this just cannot be ignored. To date, 1.2 million people in the U.S. have died in the pandemic. We lead the world in COVID-19 deaths recorded over the past week, the past 28 days, and since the pandemic started. We need to focus on how to prevent more deaths, not how to ignore them. In short, people continue to get sick and die, in part because a mere 1 in 5 Americans has taken advantage of the most updated vaccine formulation.
Drs. Anthony Fauci, the former chief medical advisor to President Trump, and Francis Collins, the former Director of the U.S. National Institutes of Health (NIH), recently provided closed-door depositions before the House Select Subcommittee on the Coronavirus Pandemic to discuss the government’s response to COVID. This will be followed by what is sure to be a boisterous hearing this Spring, which some members are likely to imply that we would have been better off if the U.S. had embraced a less restrictive approach as a public health strategy.
Congress has and continues to justify funding cuts for COVID-19 vaccines, tests, and research on the grounds that we will soon reach herd immunity, rendering them unnecessary. But that is a fallacy, and has been from the very beginning. During the negotiations for the Debt deal last year Congress clawed back “over $13 billion across the Centers for Disease Control and Prevention, the Food and Drug Administration and other response agencies for vaccine distribution, research and pharmaceutical supply chain recovery.”
Libertarians who opposed all public health measures focused on the Great Barrington Declaration. Written in October 2020, when there was no vaccine for COVID-19 and thousands were dying daily, the Declaration proposed quarantining only those whose immune systems were compromised -- as if this was an option for those economically stressed and other disadvantaged groups. Everyone else would go about their lives, contract the COVID-19 infection and presumably survive without repercussion, gaining a level of immunity from the antibodies generated by the infection with a blind eye to the reality of long COVID-19 and the unknown long term results of this infection
The Declaration placed individual preference and self-service above the public health, assigning the blame to the person and not the obligation of our society—regardless of the death toll. Now we see members of Congress embracing the Great Barrington Declaration yet again.
Yes, efforts to minimize in person social interaction were potentially harmful to mental health and well-being, especially for the young—although, unlike many of us older Americans, younger ones prefer their e-interactions. And yet, we believe using public health measures to protect more people was far preferable — “the good of the whole” is the basis of our social covenant. The declaration called for “adopting measures to protect the vulnerable,” which makes sense, but the idea was to isolate the most vulnerable, namely older adults, while allowing the rest of society to operate as usual.
While it is true that older adults were much more likely to die if they contracted COVID-19, more than 275,000 Americans died who were not retirement age. We also saw that many older people who were “isolated” in nursing homes were, in fact, not adequately protected from COVID because the very people caring for them could not be isolated. At times, they inadvertently brought the virus into the nursing homes. Proponents of herd immunity also failed to consider that hospitals would (and, in fact, did) become overwhelmed by COVID-19 patients, which caused severe bed shortages, a reduction of elective procedures (cancer screenings among them), staffing shortages and many people leaving the health care field.
The policies of Sweden and China also demonstrated the limitations and dangers of the herd immunity approach. At the outset of the pandemic, Sweden took the approach that they would isolate the elderly and let everyone else go about their normal daily lives. This resulted in a much higher death rate in Sweden compared to other Scandinavian countries that urged everyone to stay home and wear masks.
In China, there was a massive effort to shut the country down, and at first, this prevented many people from getting COVID. These measures were so draconian that people rebelled, and the country rushed to re-open without mechanisms to keep its citizens safe. More than 1 million people were estimated to have died in the ensuing wave.
In short, the Great Barrington Declaration ignored altruism, a cornerstone of effective prevention strategies. When the Declaration was published, the public health community forcefully opposed it in a statement that said in part, “The declaration is not a strategy, it is a political statement… Combatting the pandemic with lockdowns or full reopening is not a binary, either/or choice. We need to embrace common-sense public-health practices that allow for a safe reopening of the economy and a return to in-person work and learning while also using proven strategies to reduce the spread of the virus.”
As Congress continues to rehash the federal response to COVID-19, we can all agree that it is practically impossible to avoid mistakes when dealing with a novel pathogen. But the COVID-19 response compares favorably with the missteps made at the beginning of the AIDS crisis, when a laissez-faire attitude like the one in the declaration cost hundreds of thousands of lives and the perpetuation of the pandemic 40-plus years later.
Instead, the federal government successfully bent the curve and made it possible for millions to obtain a vaccine in one year, which saved countless lives.
In preparing for the next pandemic, public debate is important. But scientifically proven public health approaches to combatting this pandemic made a significant impact. We must not discount this lesson and distort the history of COVID-19, imperfect though it may be, as we are bound to see more pandemics in our lifetimes.
Perry N. Halkitis, PhD, MS, MPH, is Dean, Distinguished Professor, and Hunterdon Professor of Public Health and Health Equity at the Rutgers School of Public Health.
Boris D. Lushniak, MD, MPH, is Dean and Professor at the University of Maryland School of Public Health.
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