Frequently Asked Questions About COVID-19

  “Shared expectations lead to predictability.”

  136. Increased infections with coronavirus-19 is encouraged by Trump.

          Q.Where is Trump getting his information that herd immunity is the right strategy?

          A:  Increasingly, president Trump has been holding rallies and giving speeches that refer to wearing masks as a personal decision, social distancing is optional, and that we need to “open up the economy” and that “schools must open up.”  The concept of herd immunity has been previously discussed in this column[1]  Scott Atlas, MD is now informally the White House medical authority who advocates letting everyone become infected with COVID-19 as a way to build population or herd immunity.

The American Institute for Economic Research is located in Great Barrington, Massachusetts.  The stated mission of this Libertarian think-tank includes, “educating Americans on the value of personal freedom, free enterprise, property rights, and limited government.”  The Media Bias/Fact Check group states “They often publish factual information that uses loaded words (wording that attempts to influence an audience by using appeal to emotion or stereotypes to favor conservative causes.”  While many academics participate in the Institute, it is an independent 501c(3) organization maintained by donations.  On October 4, 2020, this Institute signed a declaration that appears to have been adopted as the current national policy of the White House!  It advocates that people at low risk of death from COVID infection should individually decide if they will immediately resume their normal pre-pandemic living habits by working away from home, socializing in bars and restaurants, and gathering in large numbers at sports and cultural events (and Trump rallies!).  The goal is to contract COVID-19.  No binding government rules should prevent this.  It is presumed that most of these people won’t die, and this would build up population immunity.  If the elderly and those at risk are protected, the nationwide spread of COVID-19 would create herd immunity reducing future case loads.

Institute representatives call this “focused protection.”  They are against mandatory “stay at home orders” and other governmental mandates such as wearing masks and maintaining social distancing.  They advocate that the focus should instead be on “shielding” those at risk.  Individuals, based on their own perception of risk of dying from COVID-19, should personally choose the risks, activities and restrictions they prefer.  On October 5, the day after the declaration was signed, three Institute representatives from Oxford University, Stanford University and Harvard University met with Alex Azar, US Secretary of Health and Human Services and the new White House medical advisor Scott Atlas MD.  Secretary Azar, at this meeting stated, “we heard strong reinforcement of the Trump administration’s strategy of aggressively protecting the vulnerable while opening schools and the workplace.”  It is quite apparent that Trump has adopted the Great Barrington Declaration as the new national strategy for his combatting COVID-19.

  1. Public health officials and medical professionals declare the Great Barrington Declaration an ethical nightmare

          Q: What do scientists feel about the Great Barrington Declaration?

          A:  Medical and public health officials are opposed to this approach to COVID-19:

  • “Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic,” World Health Organization Director General Tedros Ghebreyesus said this week. “It is scientifically and ethically problematic.”
  • Natalie Dean, a University of Florida biostatistician said, “It just presumes that with this level of control you can really wall off people who are at high risk.” Society doesn’t neatly separate itself into risk groups.  We’ve seen outbreaks that began in younger people move on to infect older ones. How do we isolate and protect the poor, and the socially scattered people with pre-existing health conditions?
  • To achieve a minimum 60% of the population contracting COVID-19 to reach natural herd immunity, the resulting number of US deaths would exceed 2,000,000 people – ten times the number who have already died from the disease in the US.
  • Joshua Michaud, PhD, associate director of Global Health Policy at the Kaiser Family Foundation stated, “It remains unclear that COVID-19 confers immunity from reinfection. You may never be able to reach that magic ‘herd immunity’ threshold at all if people can be re-infected.”  Reinfected patients are now being reported.
  • A group of 80 researchers and epidemiologists reported in a letter published in the Lancet – a peer-reviewed medical journal – warning that  “herd immunity approaches  are a dangerous fallacy unsupported by scientific evidence.” They also noted that “protecting our economies is inextricably tied to controlling COVID-19.”
  • An alliance of 14 public health organizations known as the Big Cities Health Coalition issued a statement calling the Great Barrington Declaration “a political statement” that is “NOT based in science and would “haphazardly and unnecessarily sacrifice lives.” Further, “It preys on a frustrated populace.  Instead of selling false hope that will predictably backfire, we must focus on how to manage this pandemic in a safe, responsible and equitable way.”

No matter how the forthcoming elections turn out, the Great Barrington Declaration has sown many seeds of false expectations that will lead to unpredictable outcomes before returning to proven public health measures that can effectively overcome this pandemic.

  1. New research: coronavirus-19 can remain virulent for 28 days on cell phones and hard surfaces

          Q:  Is there any new research on how long coronavirus-19 stays alive on surfaces?

          A: The Australian national science agency CSIRO conducted a recent study that found the virus remains viable – able to infect people if picked up and taken near the mouth, nose or eyes – for up to 28 days.  This includes on cell phones, especially the glass on touch screens.  Sharing a cell phone with others can thus be an easy mode of transmission.  This is a longer time interval than found in earlier studies.  The results were published in the peer-reviewed Virology Journal.  “It really reinforces the importance of washing hands and sanitizing where possible and certainly wiping down surfaces that may be in contact with the virus,” said the study’s lead researcher, Shane Riddell.  To clean cell phones, use a cloth moistened with a disinfectant rather than a spray.  Otherwise, moisture might penetrate by the keys and openings to short out and damage the interior electronics.

  1. The Phase 3 trial of a vaccine by Johnson and Johnson is paused.

          Q: Under Trump’s “Warp Speed” vaccine development, will vaccines be safe?

          A: There is a wide-spread perception that the first vaccines to be available may not be safe.  Many people may not want to receive it.[2]  As a result, the FDA and vaccine developers are being careful to demonstrate that all vaccines will be safe.  Johnson and Johnson announced last week that it was pausing its Phase 3 trials to allow an independent board to review data on one patient who developed an unexplained illness.  During this pause, no additional patients will be given trial vaccines while those already in the trial will continue to have the effects of their vaccinations studied.  Under the guidelines of the FDA, the board review on this one case will be submitted for FDA approval before the trial can reopen.  Johnson and Johnson said such pauses are normal in large trials.

140. Essential nursing staff caring for COVID-19 patients are under stress.  

          Q. Is anyone looking at the long-term impact of stress on health care workers?

          A: One of the significant causes of stress on nursing staff in hospitals, long-term care facilities, clinics and other areas of congregant living is the persistent lack of personal protective equipment (PPE).   This and the emotional stress of the constant and intense issues of tending to overwhelming numbers of critically ill patients are leading to significant burn out and psychological distress.  On October 9, which was World Mental Health Day. the International Council of Nurses (ICN) also cited that many nurses face abuse and discrimination outside of work.  Howard Catton, RN, a British nurse who is the ICN’s chief executive, reported that roughly a quarter of its national nursing associations in the greater than ICN’s 130 countries participated in a recent survey.  More than 70% of those surveyed cited they have been subject to discrimination or abuse.  Many who are considered essential workers say they have been unable to find child care to allow them to work.  Others have cited fear of exposing their own families to COVID-19 at home, and some have been threatened with discrimination by landlords refusing to renew their leases.  But paramount among the stresses cited by Catton, “We still continue to see problems with the supplies of personal protective equipment.”  These are factors to consider if a “herd immunity” strategy is followed.  Added stress could result in a shortage of nursing staff just as the number of seriously ill patients expands and overwhelm the health care system.

[1] See FAQ #84, 3102, and #120

[2] See FAQ #109