By Charles Nicolson

A new word I came across recently is ‘cognogen’ as used in the context that cognogens are infectious bad ideas which can spread rapidly throughout areas such as our currently highly-stressed pandemic environment.

On the subject of new words, this is the time of year when new words which have appeared during the course of the year are mentioned and explained (as much as they can be sometimes), and words which have some novelty (including what they are intended to mean) become candidates for ‘Word of the Year’.

However, because so many words have been put forward as candidates, 2020 has become the first year for which the Oxford English Dictionary has been unable to decide on a single word or expression as ‘the Word of the Year’. Not surprisingly, several words attributed to the Covid-19 pandemic, including the words ‘Covid-19’ and ‘pandemic’ are on the list of candidates. Others are ‘social-distancing’ and ‘coronavirus’ which replaced ‘time’ as the most commonly used noun in the English language.

A recent event now increasingly being labelled as a cognogen is the ‘Great Barrington Declaration’, issued by the American Institute for Economic Research on 4th October 2020 at Great Barrington, Massachusetts. This Declaration recommends an attitude to the Covid-19 pandemic called ‘Focused Protection’ to concentrate on people most at risk and calls for avoidance or minimisation of societal harm resulting from Covid-19 pandemic lockdowns.

To achieve this minimisation, the declaration calls for individuals at significantly lower risk of dying from Covid-19, as well as those at higher risk, who so wish, to be allowed to resume their normal lives, working normally at their usual workplaces rather than from home, socialising in bars and restaurants, and gathering at sporting and cultural events.

The declaration claims that increased infection of those at lower risk would lead to a build-up of immunity in the population which presumably refers to the now commonly-used term ‘herd immunity’. There is, however, no mention in the declaration of physical distancing or use of  masks, nor of testing and tracing, nor of ‘long Covid’ which is the term used to describe people who continue to suffer from debilitating symptoms for weeks or even months after an initially mild infection.

The Great Barrington Declaration – a summary

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 further 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 minimise 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 polymerase chain reaction (PCR) testing of other staff and all visitors. Staff rotation should be minimised. 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 4 October 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 modelling 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.

A further 48 medical and public health scientists and medical practitioners at similar levels of qualifications and experience also signed the declaration.

Having been intentionally kept to a single-page statement which avoids details wherever possible “in order to make it more publicly-appealing and accessible”, the declaration does not recommend who should be protected or how they can be protected. It does not mention testing any people outside of nursing homes, does not mention contact tracing, does not mention wearing masks or social-distancing. It refers to multi-generational households but does not provide any information about how, for example, low-risk people can get infected without putting higher-risk members of their household at risk of death.

The declaration implies that lockdowns have adverse effects on physical and mental health as a result of people postponing preventive healthcare. Recommendations are for ending mandatory restrictions so that without these restrictions, more people will develop Covid-19. They believe that accumulation of infections will produce herd immunity which is the notion that when enough people become immune, the virus will stop circulating widely, A further envisaged effect is that eventually it will become less likely that high-risk people will be exposed to the virus.

The declaration names specific economic changes that the signatories favour: resuming “life as normal”, with schools and universities open for in-person teaching and extracurricular activities, re-opening offices, restaurants, and other places of work, and resuming mass gatherings for cultural and athletic activities. By October, many of these things had already happened in some parts of the world, but likewise were being restricted elsewhere; for instance the UK saw quarantines of students, travel advisories, restrictions on meeting other people, and partial closures of schools, pubs and restaurants.

The World Health Organisation and numerous academic and public-health bodies have stated that the proposed strategy is dangerous, unethical, and lacks a sound scientific basis. They say that it would be impossible to shield all those who are medically vulnerable, leading to the probability of a large number of avoidable deaths among both older people and younger people with underlying health conditions, and they have issued a reminder warning that the long-term effects of Covid-19 are still not fully understood.

Moreover, they say that the herd immunity component of the proposed strategy is undermined by the limited duration of post-infection immunity. The more likely outcome, they say, would be recurrent epidemics as has happened previously with numerous infectious diseases before the advent of vaccination. The American Public Health Association and 13 other public-health groups in the United States warned in a joint open letter that the Great Barrington Declaration ignores sound public health expertise, preying on a frustrated populace. They further emphasise that “instead of selling false hopes, the focus must be on how to manage this pandemic in a safe, responsible, and equitable way.”

These are extraordinary criticisms amounting to virtually a repudiation of the Great Barrington Declaration. Summaries of the main points of criticism as well as arguments will appear in forthcoming issues of RACA from March 2021.

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