Covid-19: What you need to know today
In effect, the declaration , named after Great Barrington, Massachusetts, where it was drafted on October 4 at the American Institute of Economic Research — a libertarian think-tank that doesn’t really believe in the climate crisis — advocates herd immunity as the way out of the pandemic.
What does the handle of a water pump have to do with a counter to the Great Barrington Declaration, which has struck a chord with the Trump White House?
Dispatch 183 on October 15 referred to the Great Barrington Declaration. The operative part of this declaration is: “The most compassionate approach that balances the risks and benefits of reaching herd immunity 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. We call this Focused Protection.”
In effect, the declaration , named after Great Barrington, Massachusetts, where it was drafted on October 4 at the American Institute of Economic Research — a libertarian think-tank that doesn’t really believe in the climate crisis — advocates herd immunity as the way out of the pandemic. It was authored by Dr Sunetra Gupta, an Indian-origin epidemiologist at Oxford University; Dr Jay Bhattacharya, also of Indian-origin, and a professor of medicine at Stanford; and Martin Kulldorf, a professor of medicine at Harvard. There’s no denying the academic credentials of the authors. And the declaration has its share of supporters; among others, Dr Scott Atlas, one of President Trump’s advisers, has supported the declaration. Atlas is Bhattacharya’s colleague at Stanford, and was in the news recently for claiming that masks are not effective in the fight against Covid in a tweet that pointed to an article by the American Institute of Economic Research that claimed this. Atlas subsequently walked back on his position, and over the weekend, Twitter removed his original tweet.
In response to the Great Barrington Declaration, another group of experts published the John Snow Memorandum in The Lancet on October 14.
This memorandum reinforces many of the truths we have come to know about Covid-19 (and which regular readers of this column and newspaper will be familiar with): that “Sars-CoV-2 spreads through contact... and longer-range transmission via aerosols, especially in conditions where ventilation is poor”; that it spreads rapidly across communities; that the fatality rate of Covid-19 is higher than that of other flus; that there is such a thing as long Covid; that “it is unclear how long protective immunity lasts”; and, most importantly, that the “transmission of the virus can be mitigated through physical distancing, use of face coverings, hand and respiratory hygiene, and by avoiding crowds and poorly ventilated spaces”.
The memorandum also advocates the test-trace-isolate approach that many countries, including India, have adopted in their fight against Covid-19.
The authors speak of the dangers of any approach that pushes for herd immunity, pointing out that this is “unsupported by scientific evidence”, that “uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population” and that a rash of infections could “overwhelm the ability of health care systems to provide acute and routine care”.
The John Snow Memorandum is named after a 19th century Englishman considered the founder of modern epidemiology. Urban legend has it that Snow curtailed a sharp outbreak of cholera in a part of London by identifying and removing the handle of a water pump in Soho, although, like most urban legends, the explanation is more nuanced. Snow’s contribution to epidemiology is actually far more significant — he conducted among the first known double-blind studies (when investigating the cholera outbreak, which he believed came from water supplied by a utility). In his seminal book On The Mode of Communication of Cholera (1855), Snow spoke of how he was able to conduct his study on a huge sample which was completely random (“three hundred thousand people of both sexes, of every age and occupation, and of every rank and station, from gentlefolks down to the very poor, were divided into two groups without their choice, and, in most cases, without their knowledge”) with one group getting water he suspected was unclean (because the companies supplying it sourced it from the Thames and didn’t treat it). Even today, the so-called randomised double-blind study is a valued technique in epidemiology, and such studies where one of the two groups is given a placebo form the basis of human clinical trials.
Jon or John, I’ve always been on the side of the Snows.