Atlas, Mugged

S tanford’s campaign against Dr. Scott Atlas for the sins of working for former president Donald Trump and advocating for balancing the costs and benefits of COVID-19-mitigation measures has taken a new and ugly turn. In September, 105 Stanford medical and health-policy faculty members published an open letter accusing Atlas, their former Stanford medical-school colleague and then White House coronavirus-task-force member, of deliberate misrepresentations of the “established science” surrounding COVID-19 that “will lead to immense avoidable harm.” The letter writers did not cite any publications or statements by Atlas to support their claims. Now two of the letter writers, joined by psychiatrist David Spiegel, a third Stanford colleague who did not sign the original letter, have doubled down. In an article in the Journal of the American Medical Association, they repeat the allegations and suggest that miscreants such as Atlas should be censured by professional medical societies, medical-licensing boards, and universities where they are faculty members. This vendetta has to stop.

Like the earlier letter, the JAMA article provides little evidence of Atlas’s alleged misrepresentations. Indeed, the sole source cited is a New York Times article that misstates Atlas’s positions. Moreover, some of Atlas’s alleged misstatements of science are not misstatements at all. None of this stops the three JAMA authors from insinuating that Atlas is comparable to physicians who promoted eugenics, conducted the racist Tuskegee syphilis experiments, and fraudulently linked vaccines to autism.

The JAMA authors and the Times article they cite claim Atlas questioned the efficacy of mask wearing and social distancing. But that article inaccurately cited an interview with Tucker Carlson of Fox News in which Atlas said people need not wear masks when they are alone but should wear masks if they can’t socially distance around others. Similarly, the Times article cited a different Times piece to claim, as the JAMA authors do, that Atlas pressured the Centers for Disease Control and Prevention (CDC) to change its guidance so that exposed, asymptomatic people would not be tested. But the second article acknowledged “conflicting reports on who was responsible” for the policy change and never suggested it was exclusively Atlas. It reported that Dr. Brett Giroir, the coronavirus-testing director, stated the new guidance was made with input from the CDC director and approved by all the task-force doctors.

The JAMA authors’ remaining three accusations echo claims made elsewhere that Atlas advocated exposing young people to the virus in order to promote herd immunity. Atlas vehemently denied proposing this and the JAMA authors provide no evidence that he did. Atlas did write and testify that isolating the entire population is unnecessary since most people — especially the young — have little risk of severe disease or death from COVID-19, and that we should focus on protecting the most vulnerable (the elderly and those with underlying medical conditions). Most infected people will recover and become immune. This would, along with vaccinations, lead to herd immunity. That is different from proposing that the young be deliberately exposed and infected.

The JAMA authors claim Atlas erred in maintaining “that young people are not harmed by the virus and cannot spread the disease.” What Atlas actually said in an interview pushing to reopen schools was that people under 18 have “little risk” of serious illness and “essentially no risk of dying” and that children “almost never transmit the disease.” The evidence shows that Atlas has the better of the argument.

As of February 3, there were only 735 COVID-19 deaths nationwide in people 24 and younger, less than 0.2 percent of total COVID-19 deaths, and most of these deaths (601) were in the older, 15–24 age group. The American Academy of Pediatrics concluded that “the preponderance of evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from SARS-CoV-2 infection” and that “children may be less likely to become infected and to spread infection.” A review by the editors of Clinical Infectious Diseases wrote that COVID-19 is a “milder disease in children” and that children “are not generally thought to play a major role in community spread.” A CDC review found little evidence of community transmission during in-person schooling, outside of indoor-sports practices and competitions. Sweden, which kept its schools open throughout the pandemic, had an extremely low incidence of severe COVID-19 disease and no deaths in nearly 2 million schoolchildren (ages 1–16) and no increase in age-adjusted risk of severe COVID-19 illness for teachers.

The JAMA authors also erred in criticizing Atlas for making “unsupported claims about the immunity conferred by surviving infection.” Viral exposure normally elicits an immune response that protects against future transmission and decreases disease severity in subsequent exposures. This natural immunity is almost always better than vaccine immunity. COVID-19 is no different — people infected by the causal virus, SARS-CoV-2, develop an immune response. A study of health-care workers in English hospitals found that having positive antibodies substantially reduced the risk of new SARS-CoV-2 infection over the following six months. And an article in the prestigious journal Science found that antibodies and other components of immunologic memory were still present in most subjects six to eight months after infection.

From early on, some commentators, including Atlas, pointed out that COVID-19-mitigation measures such as lockdowns have economic and health costs that must be balanced against their benefits. These costs include massive unemployment, which can lead to increased mortality, decreased academic achievement, and excess deaths resulting from delayed or foregone medical care and increased mental-health and substance-abuse problems, often resulting in suicide. Four Stanford health-policy experts — none of whom signed the Stanford letter from September — found no evidence that the most restrictive COVID-19-mitigation measures, stay-at-home orders and business closures, had significantly reduced COVID-19-case growth. In fact, there was a statistically insignificant increase in the growth rate of cases, suggesting that these restrictive mitigation measures may have increased person-to-person contact and disease transmission. A less restrictive measure, school closures, had a small but insignificant negative impact on case growth in most countries studied.

One of these four Stanford authors was a co-author of the Great Barrington Declaration, signed by over 50,000 medical and public-health practitioners worldwide. Like Atlas (and others, including this author), the Declaration expresses concerns about the damaging physical- and mental-health impacts of COVID-19 policies. It suggests that the best way to minimize the risks of death and social harm on the way to reaching herd immunity is to allow those at minimal risk of death — the young and healthy — to resume normal life, which will lead to increased natural infection and immunity, while focusing protection on those most at risk, the elderly and infirm. The Declaration’s proposal is closer to the one condemned in the JAMA article than anything Atlas has said. The large number of Declaration signers gives the lie to the JAMA authors’ claim that “nearly all public health experts were concerned that [Atlas’s] recommendations could lead to tens of thousands (or more) of unnecessary deaths in the US alone.”

Not content to write articles, Dr. Spiegel asked an October Stanford Faculty Senate meeting to censure Atlas and questioned the university’s relationship with the Hoover Institution, a conservative think tank at Stanford where Atlas is a fellow. A month later, the faculty Senate condemned Atlas for “promot[ing] a view of COVID-19 that contradicts medical science” but stopped short of recommending sanctions after concerns emerged that such steps would chill freedom of speech, academic freedom, and the willingness of academics to enter government service.

It is reassuring that Stanford faculty were willing to preserve whatever vestiges of academic freedom remain in our elite institutions. But their failure to critically examine the evidence against Dr. Atlas before censuring him suggests a mob mentality. It is doubtful that the Stanford Senate, which largely consists of non-medical faculty, reviewed the relevant scientific literature.

Dr. Atlas does share Trump’s former proclivity for controversial tweets. The Stanford faculty appropriately singled out his tweet urging Michigan residents to “rise up” against new public-health measures. While Atlas claimed he wasn’t advocating violence, his language was ill-advised and bordered on incitement. Nevertheless, on medical matters, there is no proof that he intentionally or unintentionally misled anyone. It is much less certain this is true of his accusers. Atlas should not be pilloried simply because he had the audacity to work for President Trump and to question public-health orthodoxy.