 Have the government mandated coronavirus lockdowns save thousands of lives, or were they a terrible mistake? That was the subject of an online SOHO forum debate held on June 1, 2020. Defending the claim that the COVID-19 lockdowns were the right move is Martin McCary, a surgical oncologist at Johns Hopkins, and the author of the 2019 book, The Price We Pay, what broke American healthcare and how to fix it. Arguing the other side was epidemiologist Knut Witkowski, who's the CEO of Astera, a company discovering novel treatments for complex diseases from data of genome-wide association studies. Witkowski also served for 20 years as head of the Department of Biostatistics, Epidemiology, and Research Design at Rockefeller University in New York. The Zoom conference was intermentally marred by weak internet connection and audio lags, meaning that there were a few moments where Witkowski wasn't audible that we had to edit out. But thankfully, the recording is mostly intact, so here it is, Martin McCary and Knut Witkowski in an online debate moderated by SOHO forums director Gene Epstein. Tonight's resolution reads, the lockdown has saved hundreds of thousands, if not millions of lives, and spared American hospitals the horrors of rationing care. Speaking for the affirmative, Dr. Marty McCary, a surgeon and professor of health policy at the Johns Hopkins School of Public Health. Speaking for the negative, Dr. Knut Witkowski, former head of biostatistics, epidemiology, and research design at Rockefeller University in New York. Guys, Marty and Knut, when each of you has five minutes and one minute remaining in your allotted time, I'll be briefly interrupting to inform you. Jane, please close the initial vote. Defending the resolution, Marty McCary, take it away, Marty. Okay, great. Thank you, Gene. It's great to be with you, and I want to thank the Reason Foundation, and Jane here, and Nick and everybody. You know, it's too bad we couldn't meet in New York, not just because New York is a great city, but because you've got a 30% immunity right there, which is highly sought after. So, thank you, Nick, and I hope all of you are getting your haircut scheduled. We consider a haircut in surgery to be a minor procedure, so it should be relatively safe. So let me get into this discussion here, and it's great to have Knut, who's really one of the great minds on this topic, sharing the forum with me. It's really an honor. I want to talk about what was on our minds going into this pandemic. You know, there were a lot of unknowns, and while we were watching horrors take place in Wuhan and in Italy, we were also watching sort of a general disregard for this infection in the United States. It was almost as if the idea of American exceptionalism crossed over into our immune systems. That is, people thought that we could somehow fight the infection off with the American immune system, and that we were resilient or immune, or that we could simply contain it early. The reality is that pandemics have a certain pattern. And as we saw this infection start to scroll over towards the United States, there were a lot of fears. We in healthcare were concerned about rationing at the doorsteps of our hospitals. If you remember, we didn't have good data. Going into this thing, we were told that the case fatality rate was between one and 3.4 percent. And while we all knew there were more asymptomatic carriers and those who were also infected but simply had mild or moderate symptoms and were never tested, it was an unknown. We didn't know if the number of confirmed cases represented half, one-tenth, or 2 percent of the true number of cases out there. So rather than play horse betting, and everybody take an opinion and estimate what they think the true incidents would be in the United States, many of us took the approach that we need to plan for the worst and hope for the best, because the concern that what we saw in Wuhan could happen in the United States was very real. We knew the Chinese Communist Party was massively underreporting both deaths, hospitalizations, and infections in China. How do we know that? Because many of us called doctors in China and asked them, what are you seeing on the ground? Why have you stopped all transplant surgery in the country of China to have only had to have several doctors relocate and to operate field hospitals? Wuhan, a city of 11 million, had 19 field hospitals and plans to build five more. Those 19 were completely overwhelmed. We heard from the doctors directly. So to think that because of American exceptionalism, there was no risk of that happening in the United States. I think really was gambling, playing with fire. We had to prepare for what we were seeing there and what we were seeing unfold in Italy. For the two months leading into this thing, from January 15th when the first case was in the United States walking on US soil, all the way until March 15th, we saw very weak guidance from the CDC. We saw only a recommendation to consider testing in those who had recent travel to China, although we knew many cases came from Europe through New York City. We saw guidance from Anthony Fauci really for that two months only to say it's not something we need to worry about right now or to say that old people should not get on cruises. That was it. Two months, January 15th to March 15th, and the media had every politician and political pundit and strategist give their opinions with little word from any physicians, infectious diseases specialists, epidemiologists, public health experts. I became deeply involved in this in my capacity as editor-in-chief of MedPage today. And in talking to the true experts in virology and epidemiology and those at my institution, Johns Hopkins, and although I don't speak for Johns Hopkins, my opinions were informed by many of the experts there. It was pretty clear to me that we were about to experience a tsunami. Many of us reached out to Mardi Gras, South by Southwest, the NCAA. Every public event that we could think of that had plans to have events with mass gatherings all throughout what was expected to be a major wave of the infection. We asked them to postpone the plans. Some of them listened. South by Southwest, which normally draws in 200,000 people from all over the country and all over the world made a last-minute decision, really, because many people begged them to postpone it. And I think many lives were saved because of that. The NCAA did the same. Mardi Gras, unfortunately, did not, and it became a hotspot soon after the epidemic in New York City. So we needed to do all of these things, not to be draconian, but to save lives. We did not know what we were dealing with. We still are learning from this infection. So we did what we needed to do, calling for all nonessential activities to postpone their travel, their gatherings, their business in-person endeavors until we could understand what we were working with. We needed people to do that to buy time. We needed to buy time not just to get to a vaccine. That's, I think, a myth. That's not the sole reason to buy time. It was also for us to understand what the medical best practices are. That is, what is this virus? How does it affect physiology and what can we do about it? Well, it turns out that we're still learning, even this week, almost three months into it, how to treat patients with illness from COVID-19. For example, we're learning there's a big vascular component. We started hearing early on that there were strokes in young people. We heard about COVID toes. And in April, there was a research study and circulation research, a publication of the American Heart Association, that showed that 40% of all deaths from COVID-19 were related to vascular complications. This was a study done by respected people, Dr. Mehra from the Brigham and Women's Hospital Heart and Vascular Center. He actually said, and I quote, if you start to put all the data together that's emerging, it turns out the virus is probably vascular tropic. That means it affects blood vessels. The New England Journal of Medicine had a paper showing how it affects the lining of blood vessels even though it's a respiratory virus. Something is happening that we have not quite identified in terms of the mechanism. Even though it's a respiratory virus, there is an impact, maybe due to a protein that it activates that affects the vascular system. This has been a journey. We have been learning. And because of it, we're treating patients better. You know, a JAMA paper three days ago found that 79% of patients in an ICU had blood clots. That's new. Now we're treating patients with anticoagulation because we are learning as we have bought time from flattening the curve. Before we were not treating patients with anticoagulants. Now we are. The criteria to go on a ventilator changed dramatically. Why? It's not a problem with elasticity. That is the stretch capabilities of the lung tissue. In fact, it appears to be some sort of problem with oxygen exchange. And while we don't fully understand it, it appears that patients don't meet the standard criteria to go on a ventilator. Many of them can be managed with supplemental oxygen, CPAP or BiPAP. So all of a sudden the need for ventilators dramatically went down because we were learning. We learned about the cytokine storm. And even last week, Rosh announced a drug called Actrema, which is an immune modulator. And it is now in trials. We learned about the pediatric conditions, the post-viral syndrome in children. We learned from the data. We are learning from the age distribution what the true case fatality rate is. It does turn out that for young, healthy people, it's much lower than we thought. In fact, it's hard for this virus to really hurt someone young and healthy. And it does happen. And young people can be transmitters, but we are now learning the age distribution. For example, 43% of all deaths in the United States from COVID-19 were in nursing home residents or staff. We didn't know that meatpacking would be a hotspot, meatpacking plants, low-income housing where people have a dense population under a common roof. People with diabetes and high blood pressure. So we needed to buy time, and because we did, we are much more successful in implementing best practices and treating patients. We have about eight vaccine trials now in human phases. By the end of the year, we'll have tens of thousands of doses. And they will be delivered by the end of this calendar year, according to the schedule of many of these vaccines, probably a lot more. That will help. That will help increase the amount of immunity that already lives in certain parts of the United States. So we're learning a lot, and patients are doing much better because of it. So I would ask you, in the spirit of this discussion, would you rather be sick early on when your doctors knew little about the infection, or would you rather be sick now when your doctors know a lot more about the condition and are reporting much better success in treating it? We were on the brink of rationing. And while we were buying time to understand this condition, we were also buying time to develop therapeutics, but we were buying time to avoid the risk of rationing. New York City was on the brink of rationing. Doctors, some of whom were already burnt out, dealt with incredible things that they had to witness. There were even stories of splitting ventilators, but they were on the brink of rationing care. We were told there wasn't enough PPE. We were told that ships in China with PPE were told not to leave their harbors. We were told in the United States to stop elective surgery, something that I do, because we were going to burn valuable PPE, and if the surgery wasn't essential, to hold off. That's the situation we were in. People forget that. We also did what we needed to do to stop super spreaders. That is, things like one person in a church giving the infection to 60 plus other people. That was documented in Washington State. Meatpacking plants, similarly. We know now mass gatherings and high density are big drivers. We know the high-risk groups. We know we've got to protect our nursing homes. We're learning about the impact of heat and climate. So stopping super spreaders is something we can only do with the information that we have gathered. You know, when the Spanish flew during that time, there was a debate whether or not to send more U.S. troops to Europe to fight the war. The doctor of the president actually urged the president, President Woodrow Wilson, not to do it, arguing that the infection could cost a lot more lives than anyone appreciated. Well, on March 11th, 1918, a cook in the army named Albert Gitchell from Fort Riley, Kansas, was sick. Five minutes. Five minutes. Go ahead. Five minutes. Got it. He gave the infection, and I'm going to try to show you here what happened. He gave the infection to what ended up being 522 individuals. He went on one of the crowded ships over to Europe. Some of the army soldiers, 522 of whom got infected, went on this crowded ship to Europe. In the end, the most common cause of death among soldiers in World War I was not bullets or mortar shells. It was the Spanish flu. Being super spreaders is something you can only do with data. I was one of those people that called for a closure of non-essential activities, but now we need to change our strategy. Our strategy needs to evolve. There's a lot that we can do. There are papers now coming out suggesting that what we did did save lives. As a matter of fact, at the time it was controversial, but now it was well recognized that super spreaders had a major impact on mortality in World War I. In fact, the doctor and the army basically assured everybody saying infectious diseases that formerly took a lot of lives have all yielded to our modern knowledge of their causes. I mean, look at the pride in this comment. This is the surgeon general of the Navy and that there were measures taken for their prevention. I mean, that is sort of the misinformation that needed to be challenged at the time. And I think we were challenging at the time of this increase. At that time, Philadelphia had basically no precautions taken to stop the Spanish flu, but St. Louis did a lot. And you can see the results of both cities here in terms of the number of cases. One completely overwhelmed the local hospitals and doctors, and the other was able to manage it with an overall lower mortality rate. On April 14th of this year, there was a study published by researchers at the University of Wyoming looking at the number of lives saved through a controlled approach, and they showed that it was much less. On average, reducing contact and transmission by 38%. And they argue that the peak was reduced in half. Another study that came out in the National Academy of the Sciences and in full disclosure, I'm a member of the National Academy of Medicine, looked at in Europe the reduction in cases due to taking severe mitigation steps. And finally, looking at the travel and resultant transmission in China because of the lockdown, researchers have described that there would have been 65% more cases had there not been a lockdown. Now, if you think about it, China had breakouts in Wuhan and Harbin. Those are cities of about 11 million people. China is much larger. China is over 1.1 billion. How was China able to move on and manage the infection after massive outbreaks in two of their cities? And it's because they took it seriously and engaged in a shutdown for a temporary period of time. And because of that, they were able to manage it. I would argue they were also able to manage it because of masks, distancing, and good hygiene. And someone who- One minute, one minute left, somebody go. Someone who called for a closure of non-essential activities. I'll be the first to tell you. That closure has had a death toll. And it's not a death toll that anyone should take lightly. We were worried about rationing. We were worried about people dying on the doorsteps of hospitals. We were worried about what happened in Lombardi and Wuhan happening in the United States. We asked people to do it on a temporary basis. But as the data has come in, our strategy needs to evolve. And unfortunately, I think we live in a polarized society where people dig into their positions. It's often fed by the media, sometimes by politicians. And it's been disappointing to watch this issue become politicized. I've got about 15 seconds, Marty. Everything changes, everything changes. And we need to evolve our strategy. And that's why last week in the New York Times, I wrote a piece calling for a reopening, but for us to reopen carefully in a way that still respects the dangerous nature of this virus. So with that, I'll say thank you, and looking forward to the conversation. Thank you, Marty. Okay, Knut, you're next. Opposing the resolution, Knut Witkowski, take it away, Knut. Okay, I will argue and I will try to do that based on papers that I have published and I will give you the sources so that you can check it yourself that what people were hoping for didn't happen. So the lockdown was based on bad science. Immunity has already widely spread. And now we have more deaths, drop losses end since a few days ago, massive social unrest. And there will be never a second wave. Hospitals are not at the risk of becoming overwhelmed. So there's no justification anymore to continue the lockdown. And it should be ended immediately. There's no need to have it lingering on. As I mentioned, the results that I present here were published end of March. And in part based on the data we have from South Korea, which is 51 million people. And until today, they had only 260 deaths, even though they had no shutdown. What you will see on the right side are often the references. So when you see this, you can check what I did. So I published in end of March. And at that time, we already knew in New York, the horse was out of the barn. We had substantial positive testing all over New York, in particular, in Brooklyn and the Queens up to, in some areas, more than 50% of all tests were positive. So there was no way we could contain that. And still at the same time, Fauci said, now, starting in March 31st, there were 30 days we would have to slow the spread of the epidemic. There was a gross misunderstanding of the dynamics. Actually, two weeks later at the White House meeting, Robert Redfield, one of the HIV scientists in the team, presented data. And when I saw the graph that you see in the background, I couldn't understand why people were not jumping to their feet, because it was an extremely important graph. And here it is in more detail. This was the smoking gun. What we see here is year by year the curve of people showing up in emergency rooms with influenza-like infections. The first peak this year in red was Influenza B end of December. The second B was Influenza A in early February. And the third peak was COVID-19, mid of March. Now, to show up in an emergency room on March 18th, the infection must have been occurred at least 10 days before the incubation period. And then you were not going with the first symptoms to the emergency room. You were waiting a couple of days, and maybe you see your physician first, and if it doesn't get better, then you go. So what we see here is that the peak of the number of infections was early in March. And chatting down the country later, two weeks later, when the number of infections was already weighed down, is useless. It was, as in Rossini's opera, the barbier of Severea, a useless precaution. So the SARS-CoV-2 infections peaked in early March. The models that help us to understand show that in the beginning of the epidemic in blue, on the left side, everybody is susceptible. And then somebody, red infectious, enters the population. And for about two months, nothing happens. And then suddenly we see the first cases indicating that the number of infections must already have started quite some time ago. And the number of infection goes up until the number of immune people, and most people become immune after getting infected, is as large as the number of susceptible people in the population. And at that time, the curve turns down and the epidemic ends. This is what all respiratory disease epidemics do. And with a week or so late after the peak in the infections, there is the peak of the cases in yellow, or as it's read before, some people think this was orange. And now yellow is in the cases, and gray at the bottom are the deaths. So this is a normal respiratory disease epidemic. It happens with all of them. And eventually we end up with a lot of people being immune, which gives us long-hurt immunity for a couple of years. Now if we were to, after the peak, some intervention reducing the transmission, we will not flatten the curve. We will actually sharpen the curve, because we're already at the peak. We cannot flatten it anymore. We will make it a bit more narrow. We will have a few fewer deaths, but it will come at the price. And that is we will have hurt immunity at a lower level, and the next epidemic is coming earlier. But the difference is not big, and the difference in the number of cases is totally irrelevant. So we cannot save our hospitals by doing an intervention after the peak of the number of infections has already occurred. So the lockdown came too late to flatten the curve. Now fast forward to where we are now. The hospital ship that was in New York with 1,000 beds left in April 26, because it wasn't needed. There was. The hospitals were not stressed to the level that they would need additional capacity. The deaths came a bit later, as one would expect that. And if we overlay the data in New York and the data that Robert Redfield presented, we see that it all nicely fits. The epidemic was essentially over as far as the infections are concerned in early April. But actually, we see the effect of immunity a bit earlier. And that is at the inflection point where the infections don't increase anymore, but start to slow down. This is where epidemic immunity starts to kick in. And when we are looking at when did that happen, and we're looking at the hospital admissions or the ER visits, we see that this epidemic, or epidermal immunity kicking in, that this already happened even earlier in March or maybe in late February. So even more evidence that at the time in mid-March when all these interventions and restrictions started, it was futile. In the meantime, what you also can see here now at the end, we are already way down the number of cases. There are no more hospital admissions for COVID. The critical care beds are not utilized, they're not overutilized anymore, at least not by COVID. What we see here is not only COVID, it's also other diseases. And the number of tests has dropped dramatically right now, less than 5% of all people tested in New York, down from 70%. Less than 5% show up with positive test results. And they're mostly in hospitals or elderly people and nursing homes and other places. So from all of that data, we know that there were no ER visits for COVID by children. This is here at the center where it says 1-17. This was another epidemic where children showed up. But COVID, it wasn't COVID. The spread in Dallas slowed from early March, much earlier than the interventions started. The US hospitals will not be overwhelmed. There's no risk anymore whatsoever. And there's no circulating virus in New York City since about May 1st. Why then continuing the lockdown? Now you have seen such curves as the second HIV expert on the task force explained. She said, well, we have to flatten the curve to reduce the number of cases. Now here is what she is presenting. And that is a cross misunderstanding of what is happening when we are intervening in an epidemic. Because we cannot make the intervention before the epidemic is there. But even if we start, and that's on the right side very early before the number of new infection peaks, then there is still, there's a lower curve, yes. But that curve, as soon as we stop the intervention, then we will have what people call the second wave. Because we haven't reached herd immunity. And it has herd immunity that stops the spread and nothing else. So that's what people thought might happen. But they forgot that the intervention didn't happen early enough for that ever being a risk. So there is no concerns necessary about the second wave or the need to drag on, as people have feared for years, the new normal. We can go back to the old normal and then we can learn whatever we want from the experience. So because the lockdown did not flatten the curve, there is no risk for the second wave. In fact, we now know that when we are testing in New York, for instance, many more people are still infected. So the lockdown has not stopped infections. And if we look into Europe, so I mentioned South Korea before and now I'm mentioning Europe, including Italy. We see that in all countries in Europe, the number of new cases is dropping dramatically. The number of cases all over Europe is now one per 100,000 people per day. And that is a drop in the bucket. It doesn't make in Germany, for instance, in a population of 85 million people, there were 8,500 deaths. That is less than car accidents. So neither in Europe nor in the US did the lockdown have a major effect on the spread of the virus. But it had substantial side effects. One was already mentioned and was a bit more conservative here, as had at least 30% of all 100,000 deaths in the US occurred in nursing homes. Why? Well, it was this totally exaggerated number of new Ferguson in the United States, the United States, in the United States Kingdom that projected 15 million hospitalization and would have been too much for 1 million hospital beds. So it seemed that flattening the curve was necessary, but even that would not reduce the number to what was needed. So starting in late March, New York State, for instance, mandated that nursing homes accept COVID-positive cases in order to reduce pressure on the hospitals. Well, in fact, increasing the number of cases, because it increased the number of secondary cases in the nursing homes, and thus increased the hospital ICU use. Why did people send back the infected patients to the nursing homes? The New York State issued an executive order that was pulled from the web, but of course, you cannot delete anything on the web. So you find even the things that the governor wants to us not to see. And it stated that there is an urgent need to expand hospital capacity in New York State to be able to meet the demand for patients with COVID-19 requiring acute care. So it was the hype that created the dangerous situation that patients who were infectious but stable were sent to the nursing homes where they could infect all the other people in the nursing homes. So it was the fear behind the lockdown that actually increased ICU use and cost more than 30,000 deaths. So the other consequences are also severe. One good thing is air quality was better. So the lockdown was really good for air quality. But other than that, among the elderly with comorbidities, we saw higher ICU use and more deaths. But then we now see riots. And as of today, 11 people died. And I'm sure there will be more deaths. Medical treatment for surgery, schema, therapies, and organ transplants was delayed and caused death in many cases. People are avoiding emergency room visits. We had suicides from bankruptcies and depression. We have more homicides. And 50% of all children were not vaccinated. So they will have often life-threatening diseases later. So I have tried to walk you through this step by step. So this is not an opinion that I have. These are facts, and you can look them up. I gave you all the references. So the infections peaked in March, early March, long before the intervention started. There was no flattening of the curve. There were no ER visits for COVID by children. The hospitals will not be overwhelmed. There is no more circulating virus, at least in New York and in other states. Many other states and then others, the situation will be the same very soon. There is no risk for a second wave that was all based on the misconception of the epidemiological modeling because there were no people involved in epidemiology in the knowledgeable of respiratory diseases in the task force. There is no significant effect on the spread. So in summary, the lockdown increased the ICU use and increased the number of deaths by more than 30,000. And so I think the cost of thousands of lives were increased. It did cost 10,000 of lives, increased hospital utilization. And therefore, it was not such a good idea. What I wanted to prove. So we have the difference. I have a few minutes. So I would like to... Well, you have less than a minute, Knut. Less than a minute. OK, then I stop. Then I stop. All right. OK, all right. So that concludes Knut's case for the negative. Marty, we now go into a rebuttal phase. Marty McCarrie, you have five minutes to release your rebuttal. Take it away, Marty. OK, well, thank you, Knut. Knut, you're a good man, and that was a great presentation. I think there were a lot of truths in it. And I agree with what you said, that there is no longer a need for a lockdown, because the lockdown has had a heavy toll on health outcomes. We know the biggest driver of health status and health complications is really socioeconomic status. And as some families are pushed into poverty, that has an impact on health. Suicide rates, child abuse, calls to the child abuse hotline in Washington, D.C., are up 77%. New cancer patient visits, not follow-ups, but new cancer visits are down 30% to 50% in New York hospitals. So I agree, there is a heavy toll that we pay for having a shutdown. And that's why I've called for us to reopen carefully. But remember, going into this thing, for those weeks that we were going into this thing, we didn't know, and we still don't know, what did we prevent? What did we avoid? And I do think the severe mitigation steps that everybody took as we began to understand this disease medically and epidemiologically did have a positive impact. But we were on the brink of collapse of some of our infrastructure. We essentially shut down the health care system in New York City and in other parts of the country. New York City had a COVID-only health care system, where unless you had some other emergency, it was only accepting really COVID patients or other health emergencies. That was pretty remarkable for New York's health care system to be on the brink of being overwhelmed. And the COVID epidemic is not over. And I remind people that make conclusions that it's still ongoing. Let me share with you a quote from the mayor of Montgomery, Alabama from 10 days ago. Okay, we're in June right now. This was just 10 days ago. As you know, Montgomery, Alabama, despite it being in the sunbelt, had an outbreak, not from nursing homes and meat packing plants, sending a lot of patients to the hospital, but instead routine regular daily activities. The infections has spread in Montgomery, Alabama, and the mayor told NPR 10 days ago, we are in a health care crisis, quote unquote. We are short on PPE. If you need an ICU bed, you're in trouble. He reported a few days later that they were out of all ICU beds in Montgomery, Alabama hospitals. Montgomery, Alabama is still dealing with an outbreak. And while it's not everywhere, and some of the data that Dr. Birx and Dr. Redfield showed are it's aggregate data from the United States. If you look at a particular area or an area that's been hit hard, and let's face it, this first wave has had many waves within it, depending on region. Some areas did get hit extremely hard. We know that second waves happen. We know they happen with some infections. By the way, Dr. Frieden, the former director of the CDC said today that he expects another 20,000 deaths in the month of June. So it's still ongoing. We were hoping that this was gonna be more seasonal, that heat would have a greater impact in mitigating the infection through increased humidity, or through the direct UV light, or the fact that people in warmer states tend to do more things outdoors. They may have less public transit. They may be less congested than the states that got hit really hard, like the colder, the states with the longer cold season and increased density, like New York City, Chicago, Detroit. But the reality is that Hong Kong flu had a second wave. H1N1 died down in June, and then it surged back up again in the fall, and luckily its contagiousness was lower. But second waves do happen, and my concern is that we had this coronavirus with essentially one third of our cold season, one third of the winter. Imagine next cycle we have the coronavirus with the entire- Yeah, one minute, one minute guys. And influenza, which could be a mild, moderate, or severe influenza season, and potentially no available therapeutic at that time. So I am concerned about the second wave, and I'm hoping it's not gonna be a serious resurgence. I'm very much hoping that it's manageable, and I believe it will be manageable. In other words, I don't think we'll need to go into another extreme lockdown, but I do think in the bottom of my heart that when we look at the hospitals that had, that were overwhelmed and on the brink of rationing, and hospitals that essentially transformed into COVID-only hospitals plus emergencies, that the measures that people took early on were helpful during the incline. We all thought we'd have a rapid steep incline, what we call a symmetric epidemic curve, a steep rise, and then a steep decline. We didn't see that. We saw a more prolonged stretched out decline and a longer stretched out plateau. And maybe that's due to variations in the adoption of the mitigation, but that's perhaps one of the reasons why we're not at the point we were hoping to now as we reopen. Thank you, Marty. And now Knut, you have five minutes for your rebuttal. Take it away, Knut. I understand that this epidemic was scary, and that there are lots of things that trigger emotions, especially when you're scared. I don't think, however, it is wise to pick individual localized events for a national strategy. Let's take the hospital in Montgomery, Alabama. The same article said that the reason for that they were over-filmed field is that the hospitals in the surrounding cities didn't open, and so everybody else from the surrounding cities ended up there. This is something that can be avoided without shutting down or keeping the country shut. The whole story, as I tried to explain, of the second wave, there are no second waves with respiratory diseases. We haven't seen any second wave so far anywhere with this one, and the last one was in 1918-19, and this is because the virus did something very unusual. It started mutating into something that was not recognized by cross-initiates, but we have to go back to, all waves is very, very rare, and not something we should need to think of. And we have very positive events where both in China, actually, and in South Korea, we had the typical wave of the curve, of the symmetric curve, very similar. And that is after a while of the United States of keeping and more and more of the negative side effects of the shutdown should not be endured. We should reopen as is and deal. If there should be a problem, let's deal with it, but let's not drag on something that is known to be bad. You conclude it, Knut? That's it? We have more time, Knut? More time, and I would say one more thing. We have, as epidemiologists, we have always advocated to isolate the vulnerable, but here, something entirely different was done for the first time ever, and it failed badly. We have isolated the healthy. That does not make sense. It would have made a lot sense to isolate the nursing homes. We could have saved tens of thousands of lives if the nursing homes would be isolated as people have done that, for instance, in South Korea. This is the failure of the United States. If that had been done, we wouldn't have needed anything else. Knut, I want to tell you, you froze a little bit. Your audio was not perfect. I don't know what you can do to adjust at your end, but just wanted to tell you that, so for what that's worth. But I mean, you came through okay, but whatever you can do to improve would be good. So Knut, you're hearing me. You've concluded you are- I'm hearing you. All right, you seem to be coming in well now, and you were okay, but we're just a little concerned. So what are- So I apologize to everybody who couldn't hear me. Well, yeah, well, indeed. Yeah, I'm sure that your apology is accepted. Do what you can to improve. We now go into the Q&A portion of the evening, and the prerogative on the part of the moderator, me, as well as prerogative on the part of either debater applies to ask a question of the other. And you too can access the prerogative at any time. First Knut, do you have a question to put to Marty? Marty, do you have a question to put to Knut? Marty, do you want to put a question to Marty? Marty, why do you think that the epidemic of 1918-19 is so important now 100 years later when we have antibiotics and we are not at war? That's a great question. Yeah, I do think we can learn from history. I think if you look at what happened in 1918, there were a lot of commonalities. For one, essentially every governor in the United States in 1918 assured the population that there was nothing to worry about, that it was under control, that it was essentially almost finished. The infection had run its course, and during the entire pandemic, there were assurances given. And that's what I find so ironic about the quote from the surgeon general of the Navy, suggesting that in 1918, science and medicine and best practices and public health strategy had modernized so much that there was essentially no appreciable risk of the infection. We did see a denial early on with this infection. And the reason that some of us took to the airwaves and decided to start writing op-eds, talking about this, posting on media and going on television is we generally felt that the guidance we were given was not sufficient and that we were underprepared. If you think about us going into the shutdown mode, the shutdown of non-essential businesses, it was a last minute scramble. It was disappointing. It was entirely unnecessary to be scrambling so that people were driving home from work, hearing that their state could be shut down and racing to the grocery store to get groceries. Well, we had been watching this thing play out since December in China. And I don't know why anyone thought with three flights a day leaving Wuhan province for Europe that we thought somehow this was gonna be contained. We knew the characteristics of it, although we didn't know the distribution in case of fatality rate. So I do think that we can learn from history. I would ask Dr. Witkowski if perhaps he has some comments and I ask this sincerely. And like I said, I do agree with a lot of what Dr. Witkowski has been saying, especially about the need to reopen at this point, carefully given the toll on public health. Well, can you comment on Brazil? Brazil right now is seeing a raging infection. They're still on the increase, that is they're on the incline of their epidemic curve. They have over a thousand deaths per day for a country that's a little larger than half the size of the United States. And the scariest thing to me is that it's very warm. We understand this to be a seasonal coronavirus like the other four coronaviruses that circulate year to year. There is a seasonality. We saw the south and the sunbelt got hit less severe than projected. But in Brazil, part of the country is on the equator and it's very warm and they're getting get very hard right now. I was wondering if you could comment. I can answer the question. I don't want to comment on Brazil because I don't have enough information about Brazil. And I'm one of the people who talk when they know something and otherwise they shut up. Okay, well. I want to shut up. Okay. Passes on the question. Okay. I want to, I thought I could make a comment instead. Okay. That is also related to what Marty said. And that is during the discussion in March, not a single epidemiologist was ever heard in the United States. And like him as a surgeon, we as epidemiologists have also tried to be heard but being more theoretic, nobody wanted to listen it. Everybody was in tune to hear horror stories that had no justification and led the country into a situation where the cure was much worse than the disease. Okay. I want to step in and ask, and take moderator's prerogative to sort of take a deep dive into what seemed to be the data that you've submitted for consideration by us all, including, of course, by Marty. You claim to have data taken from the Center for Disease Control itself, showing that, and let me verify this, showing that nationwide hospital visits peaked on March 18th. And from that you infer that infections must have peaked days earlier, you approximated at the eighth. And so that's nationwide data. And then secondly, you infer from that that since the lockdowns occurred about starting of the week of 18th, that the lockdowns started too late to flatten the curve. First of all, Knut, is that a fair summary of the data you submit and the inference you draw? Could you tell us that, first Knut? Okay. First is, I am not claiming. I'm just interpreting the data that the head of the CDC, Robert Reffield, presented on April 17th. And I'm inviting everybody to take a look at the data. Yes, okay. It was not about hospitalization. And I did not say hospitalization. I said hospital visits. Hospital visits, right. To the ER room. Yeah, yeah. So that is, it is one of the problems that might be as precisely as it's necessary to accurately assess the dangers that we have. People talk about death rates and they don't talk about it. Don't say, is it the infection or the case fatality rate? Is it mortality overall? All of these words have a meaning. And if you misuse them, you get yourself into a lot of trouble. Okay, is that all you, good. When I, hospital visits, and you inferred from the hospital visits peak that the infections happened something like 10 days earlier. And I suppose- About 10 days before. 10 days before March 8th is what you said. And I believe that you are interpreting that to mean then that, that since the lockdowns occurred about starting about the week of March 18th, this is nationwide data that seems to be the linchpin of your argument that the lockdowns came too late to flatten the curve. Is that a correct interpretation of what you're saying? This is one of the data sources pointing. And then I provided other data sources that confirmed this result. That does not mean that there is not in some other parts of the United States where we have very lower number of cases that the dynamic might look a bit different. But this is what we can say about the whole Northwest. And this is more than 50% of all AIDS, sorry, of all cases in the United States. So that's okay, it tends to be nationwide data. Okay, Marty, is there, do you have any, so Ken, can you notice during that inference, Marty, do you have any response to that particular set data claim and the interpretation that places on it? Sure, first of all, I do think that hospitalizations is perhaps the most powerful metric and the one that I track most closely. If you look at Texas, for example, there are areas of Texas for hospitalizations. Right now, if you look at a seven day moving average are on the rise, Alabama, Wisconsin, Minnesota, tragically, where there's been riots related to the recent incident there. So I do track hospitalizations as they go up and the case positivity rate goes down. It usually means that there's more testing available. I just wanna point out that Dr. Witkowski raises a good point. We did not hear enough from epidemiologists and this wonderful forum that you have here, Jean, to talk about these issues is exactly what we should have been doing as a country instead of listening to all the politicians and pundits with no background in virology, public health, medicine, epidemiology, or anything healthcare. They were talking to the country for two straight months from January 15th till March 15th. And all we heard was sort of the party line and people's guesses as if they were course betting. We should have been having this debate ahead of time. I think the data was convincing enough to say that the realm of possibilities was concerning enough that we should temporarily either stop or reduce non-essential activities. And then once the data was in, once it was clear that we had sort of passed the point of potential rationing, which happened relatively soon. It happened in April. Then we could go into the mode of learning from the data to change our practices. We told people, for example, to stay at home. We probably should have told them to be outdoors. We told businesses to close. We probably should have told them to distance and wear masks. We told schools to close. We probably now that we have the information, looking back, we know that the risk in schools is primarily to at-risk teachers and that the risk to children rivals the same risk of viral meningitis for regular seasonal influenza in that age group when there are no other risk factors. So look, we gave out blanket recommendations because we didn't have the data. As the data came in, our strategy needs to evolve and because it did not evolve quick enough, it did not respond to the data quick enough and the data did not become available promptly. We have paid a price because of strategies that have lingered. Okay, thank you, Marty. I want to then pick up on what Marty said. Marty, could you address the specific guts of this data point? Marty is talking about hospitalizations. I know you had a graph on that. So you have issue about hospital visits to emergency rooms, hospitalizations, and then infections. Marty is saying hospitalizations is the key data point to interpret. Could you address that specific technical issue? Take it away. It depends on both are important. It depends on what it is you want to learn from the data. So I wanted to learn from the data when did the infections happen? And the hospital visits are closer to that even. Therefore, and they are also data that are unbiased because they were collected every year without any question of testing and anything. So we get early unbiased data and that is better than the later bias data. But I want to pick on one thing that Marty said and he said he would point it to mid-April. And even though epidemiologists would never ever, at least not people who are reasonable epidemiologists, would never ever have quarantined the healthy and let the vulnerable run around and actually infect vulnerable. That is a no-no among epidemiologists. They would have said we can learn from China and from South Korea that we have to protect the elderly and shut down the nursing homes and not the schools. Yes, okay. I want to pick up on another key claim and then first we'll run it by you, Knut and then get Marty to respond. You were claiming that, if I understand you correctly, that the hospital system was overwhelmed and you were focusing specifically on New York because as a result of the policy, old people with the virus were told to go to the nursing homes and if I followed you correctly, they then infected a lot of other old people in the nursing homes, which in turn meant that all of those old people infected in the nursing homes were overwhelming the ICUs. So you seem to be claiming that the overwhelming effect was from that effect of the policy. Does that summarize correctly what you were saying, Knut, about the overwhelming of the hospital system, especially in New York? Yes. Do you have a response to that particular point, Marty? Well, like if we look back and identify the key mistakes that we made, I think one of those key mistakes is that we failed to protect nursing homes. We should have made them bulletproof. We should have undergone the strictest protocols you could possibly imagine to those that were extremely high risk. And not only that, when an outbreak starts in a nursing home, that is an opportunity to respond. And so the nursing home story will end up being, I think, one of the great tragedies of this. And I hope that this will address one of the ails of our modern society, and that is how society has for decades been oddly complacent with the problem of influenza deaths each year, because that problem is very similar and is managed in a very similar way. So I hope that is one of the silver linings of this pandemic. But do you agree with Knut's argument that the lockdown itself, especially in New York, caused the policy of driving the sick old people to the nursing homes, which in effect overwhelmed the New York City system because they had to be treated at ICU. You see the relationship between the lockdown and the nursing home problem, Marty, do you see that relationship, or do you just think from it? Not sure about what was happening in New York. What I do know is that patients with the infection were sent to nursing homes. That should not have happened. And that patients in the nursing home that were sick were often sent to the hospital when potentially they could have been managed differently in isolation. I see. And then finally, the good news, which Knut has stated, but perhaps not as triumphantly as some of us would like in listening to what he said, is that we have achieved herd immunity. And Knut, since you're the one who claims we've achieved herd immunity, first of all, we pretty much nationwide, you're claiming that in most areas of the US, including New York City, herd immunity has been achieved. The good form of herd immunity reasonably long lasting. And first Knut, would you define for ignorant folks like me exactly what you mean by herd immunity? And then would you tell me whether you believe it's been achieved before I give it back to Marty? Take it away Knut. Okay. Is substantial proportion and Marty a refer to that? A substantial proportion of people got infected and survived, which means they're now immune, like with every other respiratory disease. And that means anything else that would come, that virus will have a very hard time spreading if it can at all. There was another aspect and that was mentioned very early on by the Oxford group in London. And that is Gupta, the lead scientist. She said that she thinks that up to 60% of the population could have cross immunity from exposure to other coronaviruses in the years before. And it now seems that her position was correct so that we now have not only the 30% we see when we are testing, but actually more 50, 60, maybe 70% of people are immune. And you were saying, and if I understand you correct, when you get to that threshold Knut, then the other 30%, including as long as you protect the really frail people, they're not gonna catch it and why is that Knut? Well, the virus dies off. If the virus cannot find any people to infect, the virus simply disappears. And at that point, the elderly people can come back and meet their grandchildren and children and be back. And there's no risk anymore because the virus is not there anymore. And we already see in New York how rapidly the circulating virus declines. And you are saying again, to put a fine point on it, you're saying we can ironically be thankful that the government was late in imposing a lockdown because had they been early, we might not have had the degree of herd immunity we have seen, so we can ironically be thankful for the ineptitude of government, the silver lining of that ineptitude, which is quite a fun. If the government does the wrong thing, it's better for the government to do the wrong thing later than earlier. Which is what you said has happened. So it all fits in very neatly to a fantastically optimistic outlook. And now I wanna turn it on to over to you, Marty, to maybe strike a pessimistic note. Marty, please take it away. How do you respond to what could have said? Well, I'm an optimist by nature, so I'll do my best here to explain what I think is true to the science. So there are unknowns and there are knowns. And I think what we're discussing are some of the remaining unknowns. I personally look at the data and believe that because we engaged in mitigation because of the secession or postponement of non-essential activities, that we were able to buy more time. If you look at the way this infection has spread around the world, we were able to buy time. And we're still buying time in many parts of the country. And what I tried to explain in my comments was the benefits of buying time and the reduced overall number of deaths because our approach and our doctoring and our therapeutics get better as we buy time. And we learn as to who's most vulnerable and where to put all of our resources. There are those three studies that support that. Of course, any study can be criticized. I remember at the School of Public Health and Graduate School, they would give you 10 research papers and your job was to rip them apart regardless of how well done they were. And you can always poke holes and the question is at what point does it cross a reasonable level of methodology where you believe that the results are likely true. And of course, many studies do meet that criteria. I do think we did flatten the curve and save lives. So those are my general thoughts. Yeah. Okay, Marty, a few questions dressed to you. And of course, the normal recitation of the few countries, you mentioned Brazil, but as you probably know, the audience is of course citing Japan, Sweden, South Korea, mainly I guess those three as examples of a very limited lockdown, which they seem to be doing about as well as other countries. And so how do you react to that challenge? How did they get away with it? Take it away, Marty. Well, great questions. And first of all, I'll point out that Japan is still dealing with, it's hard to make conclusions when it's an ongoing epidemic. Same in South Korea. Now South Korea was able to do a terrific job early on with contact tracing and isolation. And we know that has a powerful effect. And doctors tried to do that in Washington state, but they've met all sorts of barriers with FDA regulators about getting testing done. There's an excellent article written in the dispatch on the crazy regulations at the FDA that prevented early testing, including one of the doctors in Washington state being told he had to resubmit his application, not just electronically, but also by mail, including a CD-ROM with the files burned on the CD-ROM. And that we lost a valuable six weeks because of those regulatory shenanigans. So South Korea did a great job with it. Now Sweden is an interesting story because first of all, Sweden is a different population, okay? We have a far more obese and comorbid population than Sweden. And I would say a far more at-risk population. Sweden, we're learning a lot of the drivers of this infection and some of it is public transit, density, socioeconomic status, a number of people living under one roof. We're learning a lot of these drivers and some of those factors are not as common over there just as they're not as common in Oklahoma where we have not seen the same level of transmission as we have say in New York City, Detroit, Chicago or Los Angeles. So Sweden is the subject of a lot of criticism within Europe and the idea of, hey, we'll take our deaths up front really sort of goes completely counter to the idea that we as doctors are getting better at treating COVID illness and the therapeutics are on the way. The battalion is coming. And so if we, by time, I personally believe that there are benefits. Look at the vaccine. We didn't even think we'd be able to come up with a coronavirus vaccine that had never been done before. Three months after we started working on a coronavirus vaccine, it's been shown to work in Rhesus Monkeys. It's been shown to make a different virus altogether. It was shown to be able to produce neutralizing antibodies in human beings. So now it's a matter of figuring out the dose and the safety and the efficacy and mass production but we're pretty far along in a short period of time. Thank you, Marty. Good, could you comment on the question that was just put to Marty about Japan? Okay. And there's also Hungary, there is Iceland. And the other countries in Europe have not all done the same thing at the same time. And still most of them, if not all go down. I actually comment the Swedish government to have done something the US government so far has not done. And they have admitted that keeping the nursing homes open was an error. And I wish American politicians would also admit that they make errors when they make errors. Okay. And that's it. Any comment? Okay. A question then, do you think that these countries have, like Sweden, have probably achieved herd immunity? Japan, Sweden and South Korea? I think we have seen that all over Europe. Heard immunity. And we have seen that in most of the United States and we will see it in those corners where the virus come late a bit later. The problem is if these states where the virus came later started actually the mitigation before they have the peak, they have a problem. But you are saying again that in most areas of the country, including the epicenter where you and I live, Knut, herd immunity has been achieved and Mayor de Blasio should say, let Broadway bloom. Let the movie theaters open. Let the restaurants flourish. Forget social distancing. Yes, yesterday is possible. In your court working around New York City not wearing a mask. Am I correct Knut? Why should I wear a mask? Okay. It's time of obedience. Okay. So you want a government in most areas of the country, you want a complete lifting of the lockdown. And Marty, what's your response to that? Complete lifting of the lockdown? Well, it turns out the most important aspect of the lockdown was it was a vehicle to promote distancing. At a time when we did not understand how to do distancing, what the right distancing was, we didn't know the role of masks. We are, you know, even myself as somebody who has worn a mask most of my adult life as a surgeon, now I spend most of my time in public health and public health research and public policy. But for most of my adult life as a surgeon, I wore a mask. I was skeptical that a mask would reduce the transmission of this infection. And it wasn't until I talked to so many people around the world where I really became convinced that the droplet transmission, even from speaking, breathing or shouting, singing, that droplet transmission is a powerful vehicle of the infection spreading. And if you can reduce that with a simple cloth mask, it's a highly effective generalizable intervention that can be done. And in fact, when I asked doctors in China, how have the Chinese medical community, how have they been able to manage this infection in a country of over 1.1 billion after two citywide outbreaks in cities of about 11 million? How could you possibly contain it? And their answer was Marty, everybody wears a mask. And in fact, it's true of most of the Asian countries. And in fact, if you saw somebody at a grocery store two years ago wearing a mask at random, chances are they were Asian. Why? Because it's an accepted part of Asian culture. We are now recognizing the benefits. It's just not been a part of our culture. It's not been a part of our medical teaching when we talk about public health mitigation of infections. And so this is something where I've come around. I've come full circle. And in the New York Times piece that I wrote, I basically said, we'd need to reopen at this point as Connecticut said. Okay, Marty, as a matter of fact, it sounds like you're going into your summary. So let me just to clear your summary starts. So pick it up Marty, go ahead. Well, I was just gonna say the basic points that I've sort of come to. And I do think what Connecticut said is important. We need to be humble. I think in this country, we tend to get entrenched in a position. I even hear businesses tell me, we wanna know what we should do right now as a business. And I tell them, what you do right now will change. Okay, what the policy that you should have for customers, the policy you should have for people working from home could change every day as the background level of the viral burden changes as science learns more about this infection. So I think in general, we could use more humility in healthcare. I think we can learn from the data better. I think we as a country now tend to get very dug into our positions. Unfortunately, we're seeing the sort of politicalization of this issue. And it's probably promoted by a lot of the social media now, right? People tend to shout, if you look at Twitter, it's all shouting, right? And many people are shouting with no information and no expertise. I value what Knut is saying because he's somebody with respected credentials, okay? I wanna learn from him. I think if we look at how we've talked about this issue, by and large, going into it and during it, people have dug into their positions. And I think that has been one of the problems and one of the reasons why we've seen a lack of adoption of mitigation best practices in some parts of the country. We've seen some local governments act in complete disregard for public health. We've seen some get lucky as if they're virology geniuses when in fact, there was a seasonality to this virus that we were unaware of. It was an unknown going into this thing. So wearing masks is one of those things where I have evolved my position. And along those lines, businesses can redesign their business processes. We can encourage people to do things outdoors. We can encourage businesses that can do things outdoors for not every business they can, but for many they can to encourage that. And at the same time, we need to focus on those who are high risk and bulletproof nursing homes. So that's my overall feeling on where we are now. Instead of, and to get away from the position of today, it's a lockdown or total full reopening. It's not, it should be a sort of continuum based on the prevalence of the virus in a particular community based on best practices. And it should be moving in the direction of reopening with precautions, being careful. Thank you, Marty. Okay, you wanna conclude that your summary there. You are given seven and a half minutes to conclude. I just wanna mention to you, can it be for you, because I have been getting a number of questions about the data. And you seem, aside from the fact that you don't wear a mask and Marty does, I'm my wife is Japanese and I know that Marty is right about people wearing masks in Tokyo because I've been there and that's over the years. So that's absolutely valid. But aside from the masks, questions have come in about the data. And so perhaps in your summary, you wanna touch on the high points of your data, which seem to drive your analysis about herd immunity and about how the lockdown came too late and was not effective. Take it away Knut. Okay, first I would like to mention the credentials. I don't want anybody to believe anything I say based on my credentials. I have made a very big effort to put all the evidence and the sources out there so that people, anybody who is interested can actually look at the data. And it is data that we were trying to get as comprehensive data as possible so that we don't need to argue with anecdotal evidence and personal experience. I think if we want to understand something as complex as the dynamics of respiratory disease epidemics, we have to do hard work and we cannot rely on anecdotal evidence and credentials of people. It needs to be scientific. And we have seen how dangerous it is when people rely on credentials because in the White House, there are three virologists. And so I give credentials to virologists even if they have never worked on a respiratory disease and they have no idea of epidemiological models. And the same is for businesses. I can feel that there is people are afraid or not, but if I see that in the city of New York, the tests of viruses are as close to one or 0% as it gets to ask people to wear masks at the time when there is no virus around because Fauci thinks that is what we need to do to show that we are willing to do the things that we should do. Masks as a proof of willingness to do the right thing is something that I cannot support. So I think we should not talk about willingness and obedience. We should not talk about what our personal fears and experiences are. When we are imposing things on people, we should do that based on science and on sound and thoroughly collected evidence. And you have four and a half more minutes. Do you want to go for your data? What do you want to do? Okay. Review your data to your scientists. What do we do your data to look at? No, I don't want to go. I think there's something else that I have been said many times and I would like to say it again. If we want to live in a democracy, we have to actually actively interact both with others and with our representatives. Just sitting there and letting the government do without questioning. And without the questioning, the media, the media are not questioning because right now the media are not questioning. The media are just regurgitating what the government says. I think if we want the democratic process to actually function, we need to become active. We have to ask questions and we have to get engaged. Just sitting there and being obedient will not help with the progress of our democratic system. Okay, all right, you're concluding your remarks. That's it? Yeah? That's it. Okay, thank you very much to you both for a friendly and a spirited debate. Jane, please open the final vote. Many who have not seen this live stream have cast an initial vote and will be viewing this debate in a few days. Once it's released on video and audio, we'll be keeping the final vote open to give them a chance to cast their final vote. The results will be announced a week from today. Give or take a couple of days. Thanks to you all for watching. Thank you, Marty McCarrie and Knut Witkowski for participating. We'll certainly have more online debates like these, but I hope to see you all at our physical space at the Subculture Theater in the not too distant future. Good night.