The revisionist history of COVID-19 threatens public health

The revisionist history of COVID-19 threatens public health
The revisionist history of COVID-19 threatens public health

By Perry Halkitis, PhD, and Boris Lushniak, MD

It’s budget season in Washington, and while the general conversation revolved around the typical topics — government funding, immigration, the presidential election — an undercurrent was surprisingly the COVID-19 pandemic. Like the virus itself, the controversies swirling around the response to the pandemic have never gone away.

Unfortunately, this simply cannot be ignored. To date, 1.2 million people in the US have died from the pandemic. We lead the world in deaths from COVID-19 registered in the last week, in the last 28 days and since the start of the pandemic. 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 only 1 in 5 Americans have taken advantage of the most current vaccine formulation.

Drs. Anthony Fauci, President Trump’s former chief medical adviser, and Frances Collins, former director of the US National Institutes of Health (NIH), recently provided closed-door testimony before the House Select Subcommittee on the Coronavirus Pandemic to discuss the response of the government to COVID. This will be followed by what is sure to be a heated hearing this spring, in which some members are likely to suggest that we would be better off if the US had taken a less restrictive approach as a public health strategy.

Congress has and continues to justify cutting funding for COVID-19 vaccines, testing, and research on the grounds that we will soon reach herd immunity, making them unnecessary. But this is a fallacy, and has been so since the beginning. During the debt deal negotiations last year, Congress returned «over $13 billion to 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.» products’.

Libertarians, who opposed all public health measures, focused on Barrington’s Great Declaration. Written in October 2020, when there was no vaccine for COVID-19 and thousands were dying every day, the Declaration suggested quarantining only those whose immune systems were compromised — as if that were an option for those economically stressed and other disadvantaged groups. Everyone else would go on with their lives, contract the COVID-19 infection, and probably survive without consequences, acquiring a level of immunity from the antibodies generated by the infection, blind to the reality of long-term COVID-19 and the unknown long-term outcomes of this infection

The Declaration places individual preference and self-care above public health, assigning blame to the individual rather than the duty of our society—regardless of the death toll. We are now seeing members of Congress re-enact Barrington’s Great Declaration.

Yes, efforts to minimize in-person social interaction are potentially harmful to mental health and well-being, especially for the young — even though, unlike many of us older Americans, the younger prefer their electronic interactions. And yet, we believe that using public health measures to protect more people is far preferable – «the good of the whole» is the basis of our social contract. The declaration calls for «taking measures to protect the vulnerable», which makes sense, but the idea was to isolate the most vulnerable, namely the elderly, while allowing the rest of society to function as usual.

While it is true that older people are much more likely to die if they contract COVID-19, more than 275,000 Americans have died who were not of retirement age. We also saw that many elderly people who were «isolated» in nursing homes were not actually adequately protected from COVID because the people caring for them themselves could not be isolated. Sometimes they inadvertently carried the virus into nursing homes. Proponents of herd immunity also failed to take into account that hospitals would (and in fact did) become overwhelmed with COVID-19 patients, leading to severe bed shortages, reductions in elective procedures (among them cancer screenings) , staff shortages and many people leaving the health care field.

The policies of Sweden and China have also shown the limitations and dangers of the herd immunity approach. At the start of the pandemic, Sweden took the approach that it would isolate the elderly and let everyone else go about their normal daily lives. This has led to a much higher death rate in Sweden than other Scandinavian countries, which have urged everyone to stay at home and wear masks.

In China, there was a huge effort to lock down the country, and at first it prevented many people from getting COVID. These measures were so draconian that people revolted and the country rushed to reopen without mechanisms to protect its citizens. More than 1 million people are estimated to have died in the ensuing wave.

In short, Barrington’s Grand Declaration ignored altruism, a cornerstone of effective prevention strategies. When the Declaration was released, the public health community strongly opposed it in a statement that said in part: “The Declaration is not a strategy, it is a political statement…Fighting the pandemic with lockdown or full reopening is also not a binary system/ or choice. We must adopt sound public health practices that allow for a safe reopening of the economy and a return to personal work and learning, while using proven strategies to reduce the spread of the virus.”

As Congress continues to review the federal response to COVID-19, we can all agree that it is virtually impossible to avoid mistakes when dealing with a new pathogen. But the response to COVID-19 compares favorably with the missteps made at the beginning of the AIDS crisis, when a laissez faire attitude like that in the declaration cost hundreds of thousands of lives and perpetuated the pandemic 40-plus years later.

Instead, the federal government successfully bent the curve and made it possible for millions to receive a vaccine in one year, saving countless lives.

In preparing for the next pandemic, public debate is important. But evidence-based public health approaches to combat this pandemic have had a significant impact. We must not dismiss this lesson and distort the history of COVID-19, imperfect though it may be, as we are bound to see more pandemics in our lifetime.

Perry N. Halkitis, PhD, MS, MPH, is Dean, Distinguished Professor, and Hunterdon Professor of Public Health and Health Equity at 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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