COVID: Stop Pretending There’s a Coherent National Policy We Can Change

T he Great Barrington Declaration is an eight-paragraph statement from many leading skeptics of the First World’s aggressive reaction to COVID-19. It was organized by the American Institute for Economic Research, a free-market think tank, and signed by lockdown skeptics including Jay Bhattacharya of Stanford, Sunetra Gupta of Oxford, and plenty of others. Scott Atlas, the Stanford health-care expert who’s drawn fire for the role he’s playing in the White House’s approach to the pandemic, has endorsed it as well.

There’s good and bad in the declaration itself. More than anything, though, it makes me wonder if the kind of big-picture thinking it presents even matters, at least in the U.S. Truth be told, we’ve never had a coherent national strategy for fighting this thing, and we’re not going to start now.

The concept at the declaration’s heart is “focused protection.” We’ve known from the very beginning of the pandemic that COVID-19 is incredibly dangerous to seniors while posing much less of a threat to the young and healthy. Now that the strictest lockdown phase is in the rearview mirror, it makes a ton of sense to focus our remaining efforts largely on the old and sick. As the authors write,

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.

That’s great. But for the Great Barrington posse, the flip side of protecting seniors is doing almost nothing to protect anyone else. In their own words:

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. . . .

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.

That’s where I depart from the declaration. We absolutely do need fewer restrictions on the young than we have on the old, and the declaration is right to harp on the harms of “lockdown policies,” though such policies are basically over anyway. But it’s crazy to believe that anything beyond “simple hygiene measures” for younger people — even having them work from home when possible, or restricting major spectator gatherings that could easily turn into super-spreader events — is never worthwhile.

Getting infected with COVID-19 can be bad, even for the young. Younger age groups are at low risk of death, but these folks do sometimes wind up hospitalized. We’re still not sure how badly the disease damages lungs and hearts after the infection has passed. We’re also not sure how long immunity lasts, or how many more people need to get infected before we reach herd immunity. And it’s hard to let the virus run wild among most of the population while isolating seniors: Nursing homes are staffed by younger adults and visited by family members; about a quarter of Americans 85 and older live in multigenerational households. On top of all that, treatments improve, and a vaccine likely gets closer with each passing day.

There’s value in delaying infections. There isn’t infinite value, not by any stretch, but there’s value. The idea shouldn’t be focused protection for the elderly while everyone else packs into crowded bars and spits in each other’s mouths; the idea should be focused protection for the elderly and mild, reasonable, sustainable precautions for the general population. Work from home if your job can be done that way, wear masks, keep six feet apart, avoid densely crowded gatherings, meet friends outdoors when possible, and take a test and quarantine if you get sick — but don’t isolate yourself from the things that make life worth living, don’t shut down businesses that can operate safely, and definitely don’t severely undermine important activities such as school.

Frankly, though, does any of this high-level discussion even matter in this country? We have a federalist system, and every state is doing its own thing, making decisions based on the immediate political and epidemiological realities on the ground, not on any greater theory of how to minimize the total pain. The Great Barrington Declaration won’t get my local politicians to reopen the schools; at most it’ll provide cover to politicians who already wanted a laxer approach anyway.

In fact, confusion about what we’re trying to achieve has reigned from the beginning. When the lockdowns started, people talked about “flattening the curve” or taking “14 days to slow the spread,” but hardly anyone admitted that mere curve-flattening or spread-slowing would just ease us into herd immunity. (Say what you will about the Imperial College people and their doomsday scenarios, but they didn’t sugarcoat anything: They were the ones saying you needed to suppress the disease, possibly with repeated lockdowns over many months, to avoid mass casualties.) Some of us hoped a brief lockdown could buy us time to massively ramp up testing and tracing, but these efforts achieved less than one might hope. When the time came, the lockdowns were extended, but eventually they gave way to other ad hoc restrictions. In the end, we did squelch the first wave — but then we went through a second and now seem to be getting a third, because we never figured out a way to control the spread in a sustainable manner.

Fortunately, each wave seems less severe than the last because treatments have improved and we’ve gotten better at protecting the elderly. But more than 200,000 people are dead, and no one should pretend that American COVID policy has a coherent vision behind it that we can debate and change.

Right now, on the whole, our measures roughly approximate a rational approach — with more effort dedicated to protecting seniors and a basic recognition of the fact you can’t keep people locked down forever over a disease that poses relatively little threat to most of the population — but there are infuriating exceptions. Here in Fairfax County, Va., my family can dine at restaurants indoors, but I can’t send my kindergartener to public school. That’s just American democracy for you, though, and if we’re going to fix it, it will have to be at a local level.