The Great Barrington Declaration

[Mr.Know-It-All]

The Great Barrington Declaration

As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.
Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.

Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.

Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.
As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.

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.

Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.

On October 4, 2020, this declaration was authored and signed in Great Barrington, United States, by:

Dr. Martin Kulldorff, professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations.
Dr. Sunetra Gupta, professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases.
Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.

Co-signers
Medical and Public Health Scientists and Medical Practitioners
Dr. Alexander Walker, principal at World Health Information Science Consultants, former Chair of Epidemiology, Harvard TH Chan School of Public Health, USA
Dr. Andrius Kavaliunas, epidemiologist and assistant professor at Karolinska Institute, Sweden
Dr. Angus Dalgleish, oncologist, infectious disease expert and professor, St. George’s Hospital Medical School, University of London, England
Dr. Anthony J Brookes, professor of genetics, University of Leicester, England
Dr. Annie Janvier, professor of pediatrics and clinical ethics, Université de Montréal and Sainte-Justine University Medical Centre, Canada
Dr. Ariel Munitz, professor of clinical microbiology and immunology, Tel Aviv University, Israel
Dr. Boris Kotchoubey, Institute for Medical Psychology, University of Tübingen, Germany
Dr. Cody Meissner, professor of pediatrics, expert on vaccine development, efficacy, and safety. Tufts University School of Medicine, USA
Dr. David Katz, physician and president, True Health Initiative, and founder of the Yale University Prevention Research Center, USA
Dr. David Livermore, microbiologist, infectious disease epidemiologist and professor, University of East Anglia, England
Dr. Eitan Friedman, professor of medicine, Tel-Aviv University, Israel
Dr. Ellen Townsend, professor of psychology, head of the Self-Harm Research Group, University of Nottingham, England
Dr. Eyal Shahar, physician, epidemiologist and professor (emeritus) of public health, University of Arizona, USA
Dr. Florian Limbourg, physician and hypertension researcher, professor at Hannover Medical School, Germany
Dr. Gabriela Gomes, mathematician studying infectious disease epidemiology, professor, University of Strathclyde, Scotland
Dr. Gerhard Krönke, physician and professor of translational immunology, University of Erlangen-Nuremberg, Germany
Dr. Gesine Weckmann, professor of health education and prevention, Europäische Fachhochschule, Rostock, Germany
Dr. Günter Kampf, associate professor, Institute for Hygiene and Environmental Medicine, Greifswald University, Germany
Dr. Helen Colhoun, ,professor of medical informatics and epidemiology, and public health physician, University of Edinburgh, Scotland
Dr. Jonas Ludvigsson, pediatrician, epidemiologist and professor at Karolinska Institute and senior physician at Örebro University Hospital, Sweden
Dr. Karol Sikora, physician, oncologist, and professor of medicine at the University of Buckingham, England
Dr. Laura Lazzeroni, professor of psychiatry and behavioral sciences and of biomedical data science, Stanford University Medical School, USA
Dr. Lisa White, professor of modelling and epidemiology, Oxford University, England
Dr. Mario Recker, malaria researcher and associate professor, University of Exeter, England
Dr. Matthew Ratcliffe, professor of philosophy, specializing in philosophy of mental health, University of York, England
Dr. Matthew Strauss, critical care physician and assistant professor of medicine, Queen’s University, Canada
Dr. Michael Jackson, research fellow, School of Biological Sciences, University of Canterbury, New Zealand
Dr. Michael Levitt, biophysicist and professor of structural biology, Stanford University, USA.
Recipient of the 2013 Nobel Prize in Chemistry.
Dr. Mike Hulme, professor of human geography, University of Cambridge, England
Dr. Motti Gerlic, professor of clinical microbiology and immunology, Tel Aviv University, Israel
Dr. Partha P. Majumder, professor and founder of the National Institute of Biomedical Genomics, Kalyani, India
Dr. Paul McKeigue, physician, disease modeler and professor of epidemiology and public health, University of Edinburgh, Scotland
Dr. Rajiv Bhatia, physician, epidemiologist and public policy expert at the Veterans Administration, USA
Dr. Rodney Sturdivant, infectious disease scientist and associate professor of biostatistics, Baylor University, USA
Dr. Simon Thornley, epidemiologist and biostatistician, University of Auckland, New Zealand
Dr. Simon Wood, biostatistician and professor, University of Edinburgh, Scotland
Dr. Stephen Bremner,professor of medical statistics, University of Sussex, England
Dr. Sylvia Fogel, autism provider and psychiatrist at Massachusetts General Hospital and instructor at Harvard Medical School, USA
Dr. Udi Qimron, professor of clinical microbiology and immunology, Tel Aviv University, Israel
Dr. Ulrike Kämmerer, professor and expert in virology, immunology and cell biology, University of Würzburg, Germany
Dr. Uri Gavish, biomedical consultant, Israel
Dr. Yaz Gulnur Muradoglu, professor of finance, director of the Behavioural Finance Working Group, Queen Mary University of London, England

Great Barrington Declaration and Petition

As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection

gbdeclaration.org

 

[lenny2]

The Great John Snow Memorandum:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by the World Health Organization as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19.

SARS-CoV-2 spreads through contact (via larger droplets and aerosols), and longer-range transmission via aerosols, especially in conditions where ventilation is poor. Its high infectivity(1) combined with the susceptibility of unexposed populations to a new virus, creates conditions for rapid community spread. The infection fatality rate of COVID-19 is several-fold higher than that of seasonal influenza(2) and infection can lead to persisting illness, including in young, previously healthy people (ie, long COVID(3)). It is unclear how long protective immunity lasts(4) and, like other seasonal coronaviruses, SARS-CoV-2 is capable of re-infecting people who have already had the disease, but the frequency of re-infection is unknown(5). 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. Rapid testing, contact tracing, and isolation are also critical to controlling transmission. The World Health Organization has been advocating for these measures since early in the pandemic.

In the initial phase of the pandemic, many countries instituted lockdowns (general population restrictions, including orders to stay at home and work from home) to slow the rapid spread of the virus. This was essential to reduce mortality(6),(7) prevent health-care services from being overwhelmed, and buy time to set up pandemic response systems to suppress transmission following lockdown. Although lockdowns have been disruptive, substantially affecting mental and physical health, and harming the economy, these effects have often been worse in countries that were not able to use the time during and after lockdown to establish effective pandemic control systems. In the absence of adequate provisions to manage the pandemic and its societal impacts, these countries have faced continuing restrictions.

This has understandably led to widespread demoralisation and diminishing trust. The arrival of a second wave and the realisation of the challenges ahead has led to renewed interest in a so-called herd immunity approach, which suggests allowing a large uncontrolled outbreak in the low-risk population while protecting the vulnerable. Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable. This is a dangerous fallacy unsupported by scientific evidence.

Any pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed. Uncontrolled transmission in younger people risks significant morbidity(3) and mortality across the whole population. In addition to the human cost, this would impact the workforce as a whole and overwhelm the ability of healthcare systems to provide acute and routine care.

Furthermore, there is no evidence for lasting protective immunity to SARS-CoV-2 following natural infection(4) and the endemic transmission that would be the consequence of waning immunity would present a risk to vulnerable populations for the indefinite future. Such a strategy would not end the COVID-19 pandemic but result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccination. It would also place an unacceptable burden on the economy and healthcare workers, many of whom have died from COVID-19 or experienced trauma as a result of having to practise disaster medicine. Additionally, we still do not understand who might suffer from long COVID(3). Defining who is vulnerable is complex, but even if we consider those at risk of severe illness, the proportion of vulnerable people constitute as much as 30% of the population in some regions(8). Prolonged isolation of large swathes of the population is practically impossible and highly unethical. Empirical evidence from many countries shows that it is not feasible to restrict uncontrolled outbreaks to particular sections of society. Such an approach also risks further exacerbating the socioeconomic inequities and structural discriminations already laid bare by the pandemic. Special efforts to protect the most vulnerable are essential but must go hand-in-hand with multi-pronged population-level strategies.

Once again, we face rapidly accelerating increase in COVID-19 cases across much of Europe, the USA, and many other countries across the world. It is critical to act decisively and urgently. Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programmes that encourage community responses and address the inequities that have been amplified by the pandemic. Continuing restrictions will probably be required in the short term, to reduce transmission and fix ineffective pandemic response systems, in order to prevent future lockdowns. The purpose of these restrictions is to effectively suppress SARS-CoV-2 infections to low levels that allow rapid detection of localised outbreaks and rapid response through efficient and comprehensive find, test, trace, isolate, and support systems so life can return to near-normal without the need for generalised restrictions. Protecting our economies is inextricably tied to controlling COVID-19. We must protect our workforce and avoid long-term uncertainty.

Japan, Vietnam, and New Zealand, to name a few countries, have shown that robust public health responses can control transmission, allowing life to return to near-normal, and there are many such success stories. The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months.

We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.

To support this call for action, sign the John Snow Memorandum.

The John Snow Memorandum was originally published in The Lancet on 14 October 2020 .

SIGNATORIES

Prof. Kristina Alexanderson, Stockholm, Sweden Dr. Rochelle Ann Burgess, Lecturer in Global Health, Institute for Global Health, University College London, UK Prof. Laura Bear, Professor and Head of Department, Department of Anthropology, London School of Economics, UK Prof. Reinhard Busse, co-director, European Observatory on Health Systems and Policies; Professor and Head of the Department of Health Care Management, Technische Universität Berlin, Germany Prof. David Fisman, Professor, Division of Epidemiology, University of Toronto, Canada Prof. Lynn R Goldman, Professor of Environmental and Occupational Health, Michael and Lori Milken Dean of the Milken Institute School of Public Health, George Washington University, US Mr. Adam Hamdy, Ligandal Genetic Medicine, San Francisco, US Prof. David Hunter, Richard Doll Professor of Epidemiology and Medicine; Director, Translational Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK Prof. Paul Kellam, Professor of Virus Genomics, Imperial College London and VP of Infectious Diseases and Vaccines, Kymab Ltd, UK Prof. Ilona Kickbusch, Founding director and Chair, Graduate Institute of International and Development Studies, Switzerland Dr. Krutika Kuppalli, Assistant Professor, Department of Medicine, Medical University of South Carolina, US Prof. Jose M Martin-Moreno, Professor, Department of Preventive Medicine and Public Health, University of Valencia, Spain Prof. Alan McNally, Professor in Microbial Evolutionary Genomics, Director of Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, UK Prof. Julian Mamo, President, Chronic Diseases Section, European Public Health Association, Associate Professor, Department of Public Health, Faculty of Medicine & Surgery Medical School, Mater Dei Hospital, Msida, Malta Prof. Jacob Moran-Gilad, Professor of Clinical Microbiology, School of Public Health, Faculty of Health Sciences, Ben-Gurion University, Israel Dr. Ali Nouri, President of the Federation of American Scientists, US Dr Alexandra Phelan, Assistant Professor, Center for Global Health Science & Security, Georgetown University, US Dr. Saskia Popescu, Term Assistant Professor, Biodefense Graduate Program, George Mason University, US Prof. Stephen Reicher, Bishop Wardlaw Professor, School of Psychology and Neuroscience, University of St. Andrews, UK Dr. Johanna Riha, Research Fellow, United Nations University-International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia Prof. Carlo Signorelli, Professor of Hygiene and Public Health at the University of Parma University of Vita-Salute San Raffaele of Milan, Italy Prof. Devi Sridhar, Professor and Chair of Global Public Health, University of Edinburgh, UK Prof. Walter Ricciardi, Professor of Hygiene and Public Health, Director of the Department of Public Health and Deputy Head of the Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy Prof. Joshua Silver, Professor of Physics, University of Oxford, UK Prof. Charles Swanton, Group Leader CEGI Laboratory, Francis Crick Institute, UK; Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK Prof. Rochelle P. Walensky, Chief of the Division of Infectious Diseases, Massachusetts General Hospital, Professor of Medicine, Harvard Medical School, USA Dr. Hisham Ziauddeen, Clinical Senior Research Associate, Dept. of Psychiatry & Wellcome Trust-MRC, Institute of Metabolic Science, University of Cambridge, UK; Honorary Consultant Psychiatrist CAMEO, Cambridgeshire and Peterborough Foundation Trust, UK

Dr. Christian L. Althaus, Head of Interfaculty Platform for Data and Computational Science (INPUT) Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland Dr. Simon Ashworth, Clinical Director of Critical Care, Imperial College Healthcare NHS Trust, UK Dr. Nahid Bhadelia, Medical Director, Special Pathogens Unit, Boston Medical Center; Associate Professor, Section of Infectious Diseases, National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, US Dr. Colin J. Carlson, Assistant Research Professor, Centre for Global Health Science and Security, Georgetown University, US Prof. Tim Colbourn, Associate Professor, Institute for Global Health, University College London, UK Prof. John Drury, Director of Research and Knowledge Exchange in the School of Psychology, University of Sussex, SPI-B advisory sub-group of SAGE, Independent SAGE, UK Prof. Isabella Eckerle, Head of the Centre for Emerging Viral Diseases, University Hospitals of Geneva and University of Geneva, Switzerland Prof. Karl Friston, Wellcome Principal Research Fellow and Scientific Director, Wellcome Trust Centre for Neuroimaging; Professor, Institute of Neurology, University College London, UK Prof. Trisha Greenhalgh, Professor of Primary Care Health Sciences, Nuffield Department of Primary Care Health Sciences, University of Oxford, Co-Director, Interdisciplinary Research In Health Sciences (IRIHS) Unit, UK Prof. William Hanage, Associate Professor of Epidemiology, Harvard T.H. Chan School of Public Health, Center for Communicable Disease Dynamics, US Dr. Zoë Hyde, Researcher, Western Australian Centre for Health and Ageing, The University of Western Australia, Australia Dr. Michelle Kelly-Irving, Inserm research scientist, Epidemiology and Public Health Unit, Inserm & Université Toulouse III, France Prof. Sir David King, Former UK Chief Scientific Adviser, Independent SAGE, UK Prof. Alastair H Leyland , Professor, Institute of Health and Wellbeing, Associate Director, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK Prof. Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine, Research Director, European Observatory on Health Systems and Policies, and Independent SAGE, UK Dr. Michael Mina, Assistant Professor, Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA Prof. Susan Michie, Professor of Health Psychology, University College London and Independent SAGE, UK Prof. Elias Mossialos, Brian Abel-Smith Professor of Health Policy, Deputy Head of Department, London School of Economics, UK Prof. Anna Odone, University of Pavia, Italy Prof. Deenan Pillay, Professor of Virology, Division of Infection and Immunity, University College London and IndieSAGE, UK Dr. Viola Priesemann, MPRG Group Leader & Fellow of the Schiemann Kolleg, Max Planck Institute for Dynamics and Self-Organization & Bernstein Center for Computational Neuroscience, Göttingen, Germany Prof. Ken Rice, Professor of Computational Astrophysics, Institute for Astronomy, University of Edinburgh, UK Prof. Tara Smith, Professor of Epidemiology, Kent State University College of Public Health, US Prof. Kevin Watkins, CEO, Save the Children, UK Dr. Clare Wenham, Assistant Professor of Global Health Policy, London School of Economics and Political Science, UK Prof. Gavin Yamey, Professor of Global Health and Public Policy, Duke University, USA

Dr. Nisreen Alwan, Associate Professor in Public Health, University of Southampton; Honorary Consultant in Public Health, University Hospital Southampton NHS Foundation Trust, UK Dr. Rupert Beale, Group Leader, Cell Biology of Infection, Francis Crick Institute, UK Prof. Debby Bogaert, Scottish Senior Clinical Fellow, Professor of Paediatric Infectious Diseases, Center for Inflammation Research, University of Edinburgh, and Honorary Consultant in Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK Dr. Yves Charpak, Fondation Charpak, l’esprit des sciences, France Prof. Anthony Costello, Independent SAGE, UK Prof. Jennifer Dowd, Associate Professor of Demography and Population Health, Deputy Director, Leverhulme Centre for Demographic Science, University of Oxford, UK Prof. Jacques Fellay, Associate Professor, Groupe Fellay, EPFL; Head of Precision Medicine at the University Hospital (CHUV) in Lausanne, Switzerland Dr. Valentina Gallo, Neuroepidemiologist, University of Groningen, The Netherlands Dr. Deepti Gurdasani, UKRI Health-Data Research UK Fellow, and Senior Lecturer in Machine Learning, Queen Mary University of London, UK Dr. Emma Hodcroft, Molecular Epidemiology Postdoctoral Fellow, Biozentrum, University of Basel, Switzerland Prof. David Ingleby, Centre for Social Science and Global Health, University of Amsterdam, The Netherlands Prof. Kamlesh Khunti, Professor of Primary Care Diabetes & Vascular Medicine, University of Leicester and Independent SAGE, UK Prof. Florian Krammer, Professor of Microbiology, Icahn School of Medicine at Mount Sinai, US Prof. Marc Lipsitch, Professor of Epidemiology, Harvard T.H. Chan School of Public Health, Director, Center for Communicable Disease Dynamics, USA Dr. Paul McLaren, Adjunct Professor, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Canada Dr. Maimuna S. Majumder, Computational Health Informatics Program (CHIP), Boston Children’s Hospital, Research Associate, Harvard Medical School, US Prof. Melinda Mills, Nuffield Professor of Sociology at Nuffield College and Head of the Department of Sociology, Director, Leverhulme Centre for Demographic Science, University of Oxford, UK Prof. Stuart Neil, Professor of Virology, Head of Infectious Diseases Department, King’s College London, UK Prof. Christina Pagel, Professor of Operational Research, Clinical Operational Research Unit, University College London and Independent SAGE, UK Dr. Dominic Pimenta, Hospital doctor, Chairman, Healthcare Workers Foundation (HEROES), UK Dr. Angela L. Rasmussen, Associate Research Scientist, Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, US Prof. Harry Rutter, Professor of Global Public Health, University of Bath, UK Prof. Gabriel Scally, Visiting Professor of Public Health, University of Bristol, Member of Independent SAGE, UK Prof. Anthony Staines, Professor of Health Systems, Dublin City University, Ireland Prof. Robert West, Emeritus Professor of Health Psychology, University College London, UK Dr. Kit Yates, Co-Director of the Centre for Mathematical Biology, University of Bath, and IndieSAGE, UK

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The John Snow Memorandum

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