 On October 4th, 2020, epidemiologists from Harvard, Oxford and Stanford authored the Great Barrington Declaration. Because of grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, they argued that all COVID-19 lockdown should end. Instead, we should adopt a strategy they call focus protection, which is aimed at protecting elderly and vulnerable populations while allowing everyone else to resume normal life. Opponents of focus protection say it's the most compassionate approach to minimize mortality and social harm until we reach herd immunity, which is the goal of all COVID-19 mitigation strategies. This is the saner approach, the more moral approach, the more scientifically based approach. Critics of the Declaration issued a counter memorandum stating that any pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed. Uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population. Should the coronavirus lockdowns be lifted and replaced with a targeted strategy that protects the old and other high-risk groups? That was the subject of an online SOHO forum debate on Sunday, December 13th. It featured Martin Kulldorf, a Harvard biostatistician and epidemiologist and co-author of the Great Barrington Declaration versus Andrew Neumer, an associate professor of population health and disease prevention at University of California, Irvine, who signed the so-called John Snow memorandum written in response. Here's Martin Kulldorf and Andrew Neumer in an online debate moderated by SOHO forum director Gene Epstein. Martin, you're first up to defend the resolution. You have 17 and a half minutes. And Jane, please close the initial vote and take it away, Martin. Thank you, Gene. The way we have approached the COVID-19 pandemic is the worst public health disaster ever. The lockdowns and contact tracing strategy that has been employed by most countries have led to many excess unnecessary deaths, both from COVID-19 as well as from other health outcomes. And it's a very tragic and it's a strategy on a worldwide scale. The failures can be split into two. One is we have failed to properly protect the high-risk older people among us, which have left two unnecessary deaths in COVID-19. Also there has been enormous collateral damage from the lockdowns as well as from the fear that's associated with the lockdowns and that has caused a lot of damage for younger people and that's something that we are going to have to live with and die with for many years to come, even if the lockdowns would end tomorrow. Now among the professionals like lawyers or journalists or scientists like me, things have turned out quite okay. There has not been as many deaths, especially mortality, among our group. On the other hand, these lockdowns and this strategy that we use for the pandemic has been the worst assault on the working class in half a century in the United States. The worst in segregation and the Vietnam War. Especially it has hurt urban working class and the inner cities. So again, very, very tragic and while it has affected everybody, it has especially affected the working class. So the question is what went wrong? What happened here? One thing that went wrong was that most Western countries had prepared pandemic preparedness plans beforehand before this year started. Because we knew as epidemiologists that sooner or later there will be another pandemic and after this one there will be many more pandemics because that's part of human history. So we knew what we were going to come but when COVID-19 came at the beginning of this year, most countries threw these pandemic preparedness out the window. And there were four fundamental mistakes that we made that we ignored basic public health principles. One is that in public health we cannot look only at one disease, COVID-19. In public health we always have to look at health as a whole. So other diseases, general health. And by looking at, by focusing on COVID-19 and ignoring other things and the collateral damage caused in other diseases, we have done a lot of these service to public health and thrown that principle away. A second principle that we have ignored is in public health one has to look at the long term and not the short term. If you're a cancer patient, you want to put a long life another six months or 12 months. You look at it short term because that way your grandmother or grandfather if they can live another year that's great for the family and if they can spend more time with children and grandchildren and so on. But to postpone things in public health, postpone epidemic or pandemic, that just pushes the same parallel into the future. So in public health we have to think of it long term, not short term. The third one is we have to look at the whole population and not only some parts of the population. Public health means health for everybody, old and young, rich and poor, urban, rural, etc. And that has been ignored during this approach to this pandemic. And the fourth principle that we have throughout the window is risk communication. And with that goes the trust between the population and public health officials which has deteriorated enormously and which is going to be a big problem for the future. So I'm going to go through a little bit of each of these four in turn. Before I do that, the other thing we know more and more about COVID-19. There are still things we do not know but one thing we knew all the day from the very beginning from the winter and beginning of this year is that there is an enormous difference in risk between ages. So while anybody can get infected by this disease, by COVID-19 and all ages do get infected, the risk for mortality is very different. So there's a more than a thousand-fold risk, a difference in risk between the oldest and the youngest. So for old people in their 70s and 80s and 90s and also somewhere in the 60s, COVID-19 is a disease that's worse than the annual influenza, more serious, more dangerous. On the other hand, for children, this is not a serious disease. It's much less, for children, there's much less risk from COVID-19 than there is from the annual influenza. And there are many other health issues that are much more serious for children. So that's something that we should have taken into account when we devise a strategy for how to deal with this disease. We call that in what we wrote in October with two colleagues, the Great Barrington Declaration, where we educate for focus protection, where we do a better job at protecting the high-risk old people. At the same time as we let younger people live lives more normally, they should still do general preventive measures like washing hands and staying home when sick. But they should be able to live normal lives, to keep the society going, to avoid all the collateral damage from the lockdowns, because that's the highest risk factor for them. Much, much higher risk from these lockdowns than from COVID. And so that's why we wrote the Great Barrington Declaration in October, which I did together with two colleagues. One is Dr. Snotter Gupta at Oxford University, who in my view is the preeminent infectious disease technologist in the world, as well as Dr. J. Baratria from Stanford University, who is an expert on infectious disease technology and how public health policy affects the most vulnerable among us. So I want to go back a little bit to the four principles. And we start then with the fact that we cannot focus on one disease. We have to focus on all health. So what are the collateral damage from these lockdowns? Well, it has been devastating for children who have not been allowed, many who have not been allowed to go to schools. And that's not only important for the education and it's also important for their physical health and their mental health. And it's important for social development. And the effects are, of course, in short term right now, but also long term, if you lose one year of education of school, that has long term effects on both your general education as well as on long term health effects. At the same time, children are not at risk themselves. So we are asking the children to sacrifice themselves for something that even has almost zero benefits. And you would say that, well, maybe there's very few children who got COVID-19 because they were in our schools. So to look at that, what the effect is of school closings on children, we have to look at, if you want to be scientific about it, we have to look at the one Western country who did not close the schools during the height of the pandemic in the spring, and that was Sweden. So in Sweden, daycare and schools were open for all children ages one to 15 throughout the height of the pandemic when there was a lot of transmission in society. And among the 1.8 million children in Sweden at this time, there were exactly zero COVID-19 deaths. So not a single child that died from COVID-19 in Sweden during this time, even though the schools were open. And this was done. There was no testing in the schools, no testing of the children. There were no masks used and there were no social distancing. If a child was sick, had a cough or a sneezing or runny nose, they were asked to stay at home. And if they came to school, they were sent home. And there were also extra cleanings in the schools. But that was the preventive measures. And despite that, there were no single COVID-19 deaths. There were a few hospitalizations, but not a single death. And if we look at the teachers, because they are also in schools, the teacher had the same COVID-19 risk as the average of other professions. So they are not at excess risk because they deal with children all day. And if we look at multigenerational homes, if you were over 17, in which case you had higher risk for COVID, you had a higher risk if you lived with working at adults compared to adults your own age. But if you also lived with children, that didn't decrease the risk any further. So all the people in multigenerational homes, they are at excess risk, but not from children, but they are from the adults living in the same home. And we can also see for children, like the vaccination rates have plummeted because of the lockdowns. It has recovered a little bit, but not fully. And we have seen in some parts of the world that we have had, for example, measles outbreaks now. And there might be more to come, most likely. There are other health outcomes that has been devastated by the lockdowns, either because appointments are canceled or because people are afraid to go to the hospitals or they think the hospitals are full and so on. So cardiovascular disease outcomes have worsened, like heart attacks and strokes and so on. So that has led us to many excess deaths. We have also cancer, there are fewer cancers this year. You would think that that would be a good thing, because we don't like cancer. Five minutes, five minutes, yeah. Yeah, so nobody is going to die from, or very few people are going to die from cancer this year because they don't have their screening. But they are less cancers diagnosed, but they are still cancers there, but they are just detected later. So there is, and then you get the treatment later. So somebody maybe who didn't get the pap smear screening, a woman might not die from cervical cancer three or four years from now, instead of living 15 to 20 years more. So these are things that we're going to see in the future. There are also, of course, mental health and in the third world, in the developing world, the consequence has been devastating with children starving to death because of the lockdowns. And while the politicians are excused from not thinking about their own jurisdiction, I think as academics, as scientists, and public health scientists, we don't have that excuse. We have to also think about the rest of the world and the enormous damage that happened in Africa, Asia, and Latin America because of the lockdowns there. One example of these consequences of the lockdown is if we look at those who are 25 to 44 years old in the US, among the deaths in the US so far in this age group, about 4% have been due to COVID-19. But the excess mortality in this age group is 26% according to recent CDC study published in MNWR. So that sort of shows the effect of the lockdowns on mortality in this age group. And we don't know yet exactly which, if it's cardiovascular or mental health issues like suicide or so on. We don't have those numbers yet, but we know it is enormous. So again, even if these lockdowns ended tomorrow, if we need to get back to normal tomorrow, these are consequences of the strategy, the lockdown and contact for the city that has failed to prevent older people from dying from COVID-19 at the same time that generated enormous damage on other disease outcomes. And we've only seen some of that so far. We're gonna see much more of that in the years to come. And we will also know the numbers eventually. So it will be very clear now, many of the numbers are not there, but we will eventually have the health statistics to be able to quantify that in greater detail. So thank you very much. That was my initial remark. Okay. All right, thank you. You came in under your allotment, but we don't trade allotments. Andrew Neumar speaking for the negative. Take it away, Andrew. Thank you very much, Jeanne. Thank you for having me. Thank you to everyone at the SOHO Forum for inviting me and for hosting this event. Thank you for the audience, for watching both live. And I assume this will be available on YouTube or something later on. So thank you for joining us. And thank you to Martin for agreeing to be the opponent today. And if you wanna see what I feel about this ongoing epidemic as the crisis evolves, I'm active on Twitter. You can follow me or block me at Andrew Neumar. I have no financial conflicts of interest to report. So a number of people in my profession discouraged me from joining this debate today. But I just wanna say that academic freedom and rational discourse is a hill that I will die, that I'm willing to die on. So I think it's important for us to have an open exchange of ideas and to let the public who are after all stakeholders in all of this see both sides of a debate. So even though I have very strong feelings about the topic of the day, I'm really glad to have this opportunity to engage with someone who thinks otherwise. This debate has become extremely polarized and most of you are probably tuning in to watch two scientists sort of talk past one another and so that you can cheer on the decide that you have already made up your mind on. But I hope nonetheless that you will engage with this material in an open mind. And I hope that I can persuade you if you voted in favor of the resolution to begin with. First of all, I don't think we should call these measures that we're taking against the coronavirus pandemic as lockdowns. I think calling them lockdowns was a horrendous blunder from the get-go. And I have stopped using that word. I will refer to them as public health orders. And I hope I don't slip up and refer to them by any other name during the rest of this debate. But if I do, it's just because that word has entered the public discourse so much. And I think public health orders are the way we should describe these, what we're doing. Now, why are public health orders necessary, temporary public health orders necessary to combat COVID-19? There's a lot of misunderstanding in the public discourse about the risks of COVID-19. And my interlocutor referred, in fact, to risk communication as being a key area. There has been a lot of debate from the early days of this pandemic of comparing COVID-19 mortality rates to those of influenza, which is a disease with which we're all familiar. So it's kind of a natural mile post, a natural comparison. And I will concede that the infection fatality rate for coronavirus is in the same ballpark as that of influenza. It is, in fact, a little bit higher. It's about two or two and a half times higher than that of flu, with the exception of children in which case flu has a much higher infection fatality rate. But fatality rates by age often go with logarithmic scale. So a two times factor is actually sort of still in the same ballpark as flu. And so I will readily concede that the infection fatality rate of coronavirus is not a wholesale greater than flu, but there is a complete misunderstanding of that statistic as it applies to the risk it poses for us in the pandemic. And one of my greatest regrets is that it's not more widely understood that the IFR, the infection fatality rate, is not the key metric to understand this pandemic. And in fact, some of the debates that have been emerging about, oh, it's the same as flu or so and so was right all along which have kind of descended really into purile name calling at some points, really just misunderstands the importance of the immunoniativity of the human population to SARS-CoV-2. There are more people who will be infected with SARS-CoV-2 in the 24 months or so that will represent the emergent phase of the COVID pandemic than are infected in a flu season or even two flu seasons. It's because the human population is immunon naive to SARS-CoV-2. Now you may say, well, there's some cross reactivity with previous coronaviruses, that may be, but more people will become infected with COVID-19 in the 24 months of the emergent phase of the pandemic than are infected with flu in one or two flu seasons. So this is a very serious health crisis that will kill a lot of people. It doesn't matter if the infection fatality rate is only two times higher than flu. It doesn't matter if the infection fatality rate is the same as flu. It is more dangerous. This is a more dangerous virus right now on planet Earth than flu. And that is important. This is a very severe crisis and we need to treat it as such. Now, the Great Barrington Declaration and the position laid out by my opponent is that we need to protect the vulnerable and let everyone else get on with society. Therefore, thereby improving their quality of life relative to adhering to public health orders. We need to follow what's proven to work. Protecting the vulnerable does not work. The Great Barrington Declaration does not go into any detail about how we will protect the vulnerable and the fact of the matter is it's a great idea on paper. I would be on the opposite side of this debate if it had any prospect of working. Protecting the vulnerable hasn't worked in any country. And it will not work in the United States. It will not work in Western Europe. It does not work. Most ideas, it's a good idea, but most ideas fail and this is failing. The world is full of great ideas that we're all familiar with because of survivorship bias. The good ideas persist. The failures are relegated to the slag heap of history. The only magic bullet tech solution that's gonna get us out of this pandemic is the vaccine and thank goodness the vaccine is on the way. The fact that the vaccine is on the way and as we speak is being distributed is all the proof you need that we just need to adhere to these public health orders for a little bit while longer. There is a pot of gold at the end of the rainbow. We will get through this and there is no magic bullet. It's gonna take a lot of hard work and the vaccine to get us out of the pandemic. The question is not, you know, is it a good idea to protect the vulnerable? It is in theory. One of my favorite aphorisms is that in theory there is no difference between theory and practice but in practice there is. These ideas of protecting the vulnerable will not work in practice in part because it is hard up priori to identify everyone who is vulnerable. It just, it's a great idea. It's not working and it won't work in the real world. We need ideas that will work. 26% of all the COVID deaths in the county in which I live, which is the sixth most populous county in the United States, are among individuals younger than age 65. This is not exclusively a problem of older people. We cannot predict who will have a severe mortality from COVID. The death rates in the United States among communities of color are double that among the white population. This is not just an age issue. This is a race and ethnicity issue and a class issue. And it's not a question of protecting professional people as my opponent said and hurting working class people. The non adherence to lockdowns, what I said I wasn't gonna use that term, the non adherence to public health orders does as much damage to working class people as anything else in this pandemic. So let me give you an example. The Latino population of Orange County, California where I live is highly impacted, disproportionately to their population. A lot of people in the Latino community in Orange County work in the service industry where they have to come to restaurants and be front of house staff in the restaurants interacting with patrons who are unmasked. A patron spends 45 minutes in a restaurant, a waiter or waitress spends all day in the restaurant and then goes home to a less affluent community at night. This exposure increases the risk of the working person. And so we cannot always predict who the vulnerable are. 26% of the mortality where I live is among people less than 65. And it's really, that's represented, that's similar, it's repeated similarly in communities across the United States and across the world. And we're talking about real excess mortality here. The United States will see 10% more deaths this year than we would have expected for 2020. And these are genuine deaths. This is not a reassortment of people are dying of COVID who would have died of heart disease, which is an argument we hear all the time. This is, we're not robbing Peter to pay Paul. Dests are increasing. What we really need is better fiscal policy to help those who are impacted. So small business owners who own a restaurant say and people who work in the restaurant who are impacted by public health orders need to receive assistance to get them through this crisis. And this is something we've done before. We did more for fiscal policy in the aftermath of the 2008. Five minutes, five minutes. We did more in the aftermath of the 2008 crisis than we are doing now. And that is unconscionable. And if you look at the countries that have been some of the brightest lights like South Korea, the surveillance regime that the South Koreans have been following is positively draconian by American standards and is something that would not fly here. And so if we cannot do that kind of surveillance and it will not work. And again, we need ideas that will work not just on a piece of paper but will work in the real world. Given the lack of cooperation we're seeing with contact tracers in the United States, I can assure you that the South Korean scenario will not work here. And so what we need is for us all to make temporary changes to our life, not going out to restaurants for a few more months. We can still order takeout so someone else can still prepare our food if that's our choice. And that is how we will get through this pandemic. The mortality that we're seeing is substantial. It's at all ages except for childhood ages. And my opponent today and people who share his views are very clear on what they perceive are the dangers of what they are characterizing as a lockdown. But very evasive about the real mortality and real dangers that COVID-19 is posing to us now. The postulates about how scarred children will be from doing hybrid schooling or having to wear a mask at school are absolutely hyperbolic and we do not know the future. And I would say the children also benefit from having their grandparents around for a while. So we need to do what works. We gained 30 years of life expectancy in the United States in the 20th century by doing public health programs that worked, not by targeting only those at risk. And that's what we need to do now. And I'll have more to say I guess in the rebuttal stage but I just really wanna summarize my central argument that protecting the vulnerable sounds great as a homily. It sounds like, yes, of course, why aren't we doing this? But it doesn't work in practice. We cannot predict who will die, who will get a severe case of COVID. There's so many examples of healthcare workers who are in their 20s and 30s who have died from COVID and other people in those age groups who have died from COVID and the thousand times difference by age in COVID mortality rates is completely orthogonal, all mortality changes by a factor of 1,000 over age. The point is that COVID risks for younger people are real and they are a real multiplier. One minute. Of the mortality that we normally see. This is the greatest public health crisis in 100 years since the 1918 flu. And it's certainly the worst pandemic of any acute infectious disease that we've seen since the 1918 flu. And we need to act temporarily to get through this. Thank you. Thank you, Andrew. Well, that concludes the initial presentations. We now go to five minutes of rebuttal from each side. Take it away, Martin, your five minutes of rebuttal. Thank you. So we agree that COVID-19 is a very serious issue and a serious disease. So that is good. In terms of protection, in a pandemic, you can never protect anybody 100%. And there are a few people, not that many who argue for zero COVID to try to sort of completely suppress it. But that's unrealistic and that will actually lead to more deaths. So we cannot protect everybody 100% no matter how low or high risk they have. But we have shown actually that we have been able to protect their fluent at the expense of the lesser fluent. For example, if you look at a graph from Toronto, they saw that the cases went up equally in the higher fluent than lesser fluent neighborhoods. But then when you did the lockdown in Toronto on March 23rd, they diverged and the high fluent neighborhood sort of went straight and then down while the lesser fluent neighborhood is went still up for a half up and then had a big, big peak. So we have successfully protected the fluent members of society. And likewise, it is possible to protect older people. We have failed to do so certainly. So I agree with Andrew about that, but it is possible. And in the parental declaration, we lay out a number of ways to do that both in the declaration itself, but then more details in the FAQ. For example, in nursing homes, which is the most vulnerable, we need to frequently test all the staff and we need to test all the visitors. There are still nursing homes where they do not test the staff regularly. And to me, that's a scandal. We need to minimize staff rotations so that a resident in a nursing home are exposed to a few people as possible. And we should not have any staff working in more than one nursing home. We still have nursing homes or nursing home staff who work in more than one nursing home. And that is also very dangerous. So there are examples of countries who have done well protecting the nursing homes, for example, Norway. So it is possible if you want to do it and if you take the measures that are needed to do it. Another thing that we can protect, when I go to the supermarket, I see older people there. And it's important for older people to be outside and exercise and see family and grandchildren and so on. But maybe a supermarket is not high on their wish list of what they absolutely have to do. So we should allow them to have their groceries delivered to them. That's very important. And then of course, when they do see other people, they should be able to have in-home tests that you don't have to go, you can just sort of over the counter testing that you can do yourself that can help deciding testing when you have visitors. Also, Andrew talked about the takeout. Well, there are people in those restaurants who work as a chef who are in the 60s and they're exposed to other people. So they are at risk to provide the takeout so that we who are working at home can enjoy. So what we need to do is people are over 60, they should not have to work. If they can't work from home, great. If they are a teacher, they should not be in school. They should work from home with online teaching or they can help other teachers with homework, grading homeworks or exams. And if that's not possible, we should let them take a few months of sabbatical during the height of transmission using for example, disability insurance or social security as a temporary measure. That's very feasible to do and it's nothing we have tried. One minute, one minute. Another example is for protecting the elderly. We have taken college students who hang out, who normally would be at the university and send them home to their parents which are maybe in their 50s and 60s or even older. So by doing that, we are increasing the intergenerational mixing and that puts older people at risk. It's better if they are at the universities where they infect other people that are young in case they're getting infected. So there are many things that we could have done and that we still can do to protect the old high-risk people. And now we soon has one more thing which is the vaccine, which is another perfect tool for focus protection in terms of two things. One is to vaccinate older people at high risk. And two, the second, another priority is to vaccinate caretakers of all people, nursing home staff and the hospital staff working with your applications. So there certainly is many things that we could have done to protect the elderly that we didn't do. It wouldn't have to take them 100% but we could have done a lot more better and saved many lives if we had used those public health orders. Thank you. Andrew, five minutes of rebuttal. Take it away, Andrew. Thank you. I have a number of points of disagreement with my interlocutor and I will do my best to fit them all into five minutes. But so I mean one of the things that Martin said just now about seeing people at the supermarket really emphasizes in fact that my original point that calling what we are doing now a lockdown is really inappropriate. These are public health orders. And here in California, even under my stay at home order, I can go for a walk anytime I want. I can go to an essential business anytime I want. I can go to the hardware store. I can go to the grocery store. I can do lots of things. My individual freedoms aren't really curtailed. Now I know many people are probably thinking, well, that's because I don't work in a movie theater which has been shuttered or whatever. But I mean that only speaks to the point I think in which Martin and I both agree that we need to use fiscal policy to help make whole people who are impacted. I mean he said to use social security or other forms of social insurance. But that is something that we haven't been doing. And it's really a pity that we haven't been using fiscal policy to help people get through this. And we have an eviction crisis and so on. And that would be perhaps an area of agreement between the two of us. But in any case, it just shows that we need to do more on that side. Now as far as the public health orders protecting the affluent, I disagree. I mean those of us who study pandemics, we know that pandemics are inequality accelerators. And that is part of the reason why pandemics are so bad. But these health shocks at the population level never affect rich and poor alike. And this COVID pandemic is not affecting rich and poor alike. And to lay that at the feet of the public health orders is not fair. In fact, one of the things that I find so that I disagree with so much in the public discourse is that everything bad that's happening is laid at the feet of the so-called lockdowns. And none of it is laid at the feet of the fact that we're in the worst pandemic in 100 years. The fact that there are demand shocks for certain services and goods has as much to do with the pandemic as it does with any public health orders. I agree that long-term care facility policy has been handled in many cases extremely poorly. And again, that is perhaps another point of agreement between Martin and I, but we're almost a year into this pandemic in the United States and Europe. And if we haven't found the special sauce to keep nursing homes protected by now, I don't understand how we can assume that we're just gonna do that overnight. The idea is we're just gonna hyper-protect the vulnerable who as I've said several times, we cannot predict who they all are and include many younger people. But the idea that we're gonna replace public health orders with the targeted protection of long-term care facilities. I mean, long-term care facilities protection is part of public health orders now, but it's just not working very well. And it's because things, as I've said, don't always go to plan. And it's gonna go even worse to plan if we adopt the Great Barrington Declaration as our governing principle of how we move forward. The opponents of public health orders are very certain that everything that's bad is due to the public health orders. And none of it is due to the pandemic. And typically very dismissive of the real risks that the pandemic causes and focusing on the infection fatality rate when, as I said, that is not the most important statistic. It's the immunotnive nature of the population. So there's just, I mean, I have so many fundamental differences with the Great Barrington Declaration. And we will get through this and we need to keep protecting everyone in society because we are all stakeholders in a society. Thank you, Andrew. That concludes the initial presentation and rebuttal portion of the evening. We now go to the Q&A portion. And let me just reset. And I've got a couple of questions coming in for you, Andrew. Maybe I could ask them. Well, let me focus on this one. It begins with a statement that citing data that 94% of those people who die of COVID-19 have an underlying condition, have a comorbidity. And so wouldn't that be an identifier of the vulnerable? And so if you do have a comorbidity, you are vulnerable, because 94% of those who die of COVID are vulnerable in terms of a comorbidity. And since you endorse Martin Koldor's idea of social security, of fiscal policy helping people, wouldn't that be a marker in order to protect the vulnerable? That's a great question. As is so often the case in this debate and in the larger public discourse around COVID-19, there are statements made which don't have any kind of comparison group. Death certificates have an underlying cause and they have many entries for contributory causes. You can have 15 or more contributory causes on a death certificate, and it's not uncommon to see multiple causes of death with one being nominated as the underlying cause. And so comorbidities are a fact of life. They're a fact of life in normal pre-pandemic and life. They will be a fact of life in post-pandemic life. So the fact that there are comorbidities in COVID really doesn't differentiate it from other causes of death. And moreover, the comorbidities that have often been cited as being really salient, for example, diabetes and hypertension and obesity are things that people live with for decades. I mean, hypertension is very often in many cases, in most cases, well-managed by a modern therapies and obesity does not shave 30 years off of life expectancy. So the people who die are dying with comorbidities that they could live with for decades. So it's really the COVID that is the issue. And I don't foresee using data on people who've died so far to protect those who are still living as a viable option. I'm sorry, well, okay, the focus, not a viable option, but then the question is like, why isn't, you said that it's impossible to identify the vulnerable. So the focus here is the objective identifier of the vulnerable would be to say that if you have a comorbidity, you are vulnerable. So wouldn't that be a reasonably objective identifier of the vulnerable, given that you said, we can't identify the vulnerable, but can't we, since 94% of them have comorbidities, wouldn't that be the focus of the question? I mean, what percentage of the US population has some sort of comorbidity? I mean, these things are always obvious after the fact, but, you know, obesity and hypertension are extremely prevalent as is type two diabetes. So again, it sounds great, but it's not practical in my opinion. Martin, you wanna address that question as well? Yes, so there are comorbidities that increases risk of COVID-19 mortality, but age is by far the biggest risk factor, is an enormous difference in risk, as I said, more than 1,000 for between the oldest and the youngest. So anybody who is about 60 should consider themselves to be in a high-risk group. And of course, if you order them that, even more so, but if you have comorbidities like Andrew was saying, for example, diabetes or obesity, that also increases your risk. And I don't know the exact thing, but I think having those comorbidities is equivalent to about five years in age. So if you're in your fifties and you have diabetes or you're obese, I think you should also be very, very careful. Okay, another question for you, Andrew, relating to the argument that Martin was making with respect to the schools, arguing, citing data that zero deaths occurred in Sweden and stipulating that vulnerable teachers might be exempted, but a question, would you lift the public health measures, as you call them, with respect to the schools? So first of all, I don't expect any childhood deaths in a country as small as Sweden for reasons that we have both talked about. I mean, that COVID-19 is unlike flu in that it doesn't kill children. I mean, and that's just, that's why you have no deaths in Sweden from kids, because the death rates are extremely low, extremely, extremely, extremely low for children from COVID-19. I mean, that's an area where I think Martin and I probably agree the most. I think schools, but Sweden, I mean, I don't wanna make this about Sweden necessarily, but Sweden has done worse than its neighbors, Norway and Finland, for example. So, I mean, I don't see why we need to keep sort of fetishizing Sweden in the debate, but the question about schools is a good one. And I know that people in the audience have very strong opinions about schools. I think schools can carefully continue to be running in-person and certainly more primary schools than high schools, and high schools need to be watched very carefully, and we're debating public health orders, or if you insist on calling them lockdowns, fine. So, this is not a debate about schools exclusively, and I don't wanna see bars and nightclubs open in schools closed, that is absolutely perverse. I wanna see bars and nightclubs and restaurants for in-person dining closed before we closed schools. In some circumstances, some communities have seen fit to include distance learning for kids, and it's probably a very worthy debate to have as to how effective, if you're in the second grade, how effective Zoom instruction is, and it's not something that anyone wants to see. I do think that the remedies, we may have to experiment with doing a 13th year of primary and secondary education for some cohorts to make up for this disruption, which again, is a disruption caused as much by the pandemic as it is by any public health order. And also, we're extrapolating from studies in the past of kids who have missed a year of education or something like that, where everyone around them has had that year of education, and then we're saying, see, well, look how terrible it is, and look at your future job market outcomes if you lose out on education. But when an entire cohort has the same effect, there are ways that we can remedy it such that the comparative disadvantage will be lessened. So I mean, there's all sorts of doom and gloom extrapolation from very limited data about the scarring that these children will have. And I believe the other side is being overconfident in predicting the future 30 years from now in terms of the outcomes of these children. Well, okay, but if I did hear you correctly, you seem to indicate that you would rescind the public health orders that have shut down or partially shut down the schools, at least up to perhaps the, up to the high school level. Is that right? I mean, only if everything else hasn't already been tried. I mean, I don't want to see schools closed, but bars and nightclubs open. But I think in many cases, schools can remain open, at least for elementary, but to me, it's not beyond scope to allow certain jurisdictions to say that we're gonna do Zoom education for schools, at least temporarily. But I mean, it needs to be approached on a case-by-case basis. Schools are the most important in social institution in society and they should be closed last and opened first. Okay, thank you. Martin, do you want to comment on that question and Andrew's response? Yeah, so in focus protection, the two things that in my view is the most important, if I could only pick two things, one is to open all the schools for in-person teaching. And they're open in some parts of the country, but there are many kids who are not getting in-person teaching. And that is of course affecting the working class the most, because children of more fluent parents, they can arrange a tutor or post-schooling or some, I know some people have sent their kids to private school when the public school is closed. So this is something that's very tragic for working class children, especially, but of course for all children as well. So I'm very happy to hear that Andrew is also sort of prioritizing keeping schools open for in-person teaching. The other priority of the Great Barrington Declaration is to do a better job with nursing home residents since they are the most vulnerable. So I also very much appreciate that Andrew acknowledges that we have not done as good a job as we could with that and that we need to do a better job. So there certainly is areas of agreement between me and Andrew. So I think that's very nice. Okay, now question for you, Blanton, having to do with Andrew's statement about people being immune, immuno-naive, which has interpreted to mean then that the idea of herd immunity, the idea that we have in some cases or could, in many cases, achieve herd immunity where 50% of the population are immune, Andrew seems to be saying that that's not really achievable. So this is of course an issue of your different scientific perceptions. Immuno-naive, we're immuno-naive. That's what he says. And could you respond to that statement on Andrew's part? Well, he is correct that this is a new virus which many people do not have immunity. For some reason, children seem to be handling it very well. There's probably some cross immunity from other coronaviruses and that's probably what's explaining the low mortality in Japan, for example, what could be one of the reasons there. But I mean, we are naive to this and that's why it's a pandemic. And I agree with him that the infection fatality ratio is not the only thing that we need to compare because it's also the number of people who actually get infected. That's a key issue in terms of how serious. So on those sort of empirical things, there's complete agreement, I think, between us. Well, you have mentioned, in the Great Bannington Declaration, herd immunity. Are you basically saying then that herd immunity is not likely in this case? No, I mean, on the contrary, we will reach herd immunity or whatever strategy we use. So whether we do lockdowns or focus protections or whatever we do, we will eventually reach herd immunity because that's a scientific established phenomenon, I guess, like gravity is in physics. So it's like if you're an airplane, you will, gravity will eventually show that you do hit the ground. No matter what you do, how you fly the airplane. So the key thing is how do we minimize mortality until we reach herd immunity? And herd immunity can be reached through either natural infection or from vaccines or what's gonna happen for COVID-19 with the combination of the two. And well, that actually gives rise to the other question. Andrew has said, we do have the vaccines developed. They are being delivered. Would you then say that logically then we should wait for the vaccines to be dispensed so that we can achieve herd immunity and then continue the public health orders that he favors? Should we do that and wait for that vaccine to bring herd immunity? So when we have a vaccine now, we still don't know very much about it, but we know that it reduces symptoms in adults up to about age 70. So we don't know how it affects mortality. We don't know how it affects transmission yet, but what we need to do with the vaccine is to use it as a tool for focus protection to vaccinate people in nursing homes, for example. That's the top priority, to vaccinate your atric patients in hospitals, also to vaccinate the older population in general, as well as, which is also important to vaccinate staff members, staff at nursing homes, and people working in hospitals who are taking care of all people there. So we can use vaccines as one additional tool in doing focus protection, but we should not only rely on that. We still have to do a better job at testing nursing home staff, for example. And there is absolutely no reason to keep school closed waiting for the vaccine. And with the vaccine coming, that's just one more argument, I think, for opening all schools for in-person teaching. Andrew, do you wanna comment then on those questions and then on my response? Yeah, let me make two quick points. Thank you, Gene. First of all, the point I made about immunonitivity, it's basically in service of the idea that we shouldn't worship the IFR, the infection fatality rate, being relatively low. That's not what's important about COVID, but we're immunon naive at the start of the pandemic, but we won't be immunon naive at the end of the pandemic. So when I use this term immunon naive, I don't mean to imply that herd immunity is impossible. Indeed, as Martin said, herd immunity is the outcome, no matter what. I mean, the end game is, I think we both agree it's herd immunity. I think we're debating how we get there. And Martin and I have quite different visions of how the road works from here to herd immunity, but herd immunity is the outcome. My comments about immunonitivity were to sort of discount this continual drumbeat of the IFR. Now, let me make one other quick point. The vaccine is the piece of tech that's most important here. And I'm certainly looking forward to getting my vaccination. And obviously I'm low down the list because people like nursing home staff should be prioritized. And I agree 100% there with Martin. But we still don't, and I hate to be sort of a little bit glass half empty all the time, but we still don't know if this is a transmission blocking vaccine or simply if it reduces symptoms. So we know that the vaccine is gonna do us a lot of good and it's gonna drop mortality down. But we're not 100% sure yet whether people who are vaccinated, whether they are absolutely have sterilizing immunity and are completely vulnerable to infection or if they simply get a much, much, much milder case of COVID when they are exposed to the virus. And therefore there's still a possibility that they can shed virus. So vaccinating a nursing home staff member while certainly appropriate does not mean that that nursing home staff member doesn't still need to mask when she is on duty at the nursing home because we're not 100% sure that she cannot shed virus asymptomatically even post-vaccination. And this is exactly why we need to keep up the public health orders so as to reduce the community transmission so that even a vaccinated nursing home staff member doesn't acquire infection going to the movie theater or something like that until it's safe to do so because this vaccine could render infections to be asymptomatic rather than preventing them entirely but that doesn't entirely reduce transmission to zero. So there's a lot of tricky nuance here but I do agree with Martin that in the as we come up with priorities of who gets vaccine first that a nursing home staff member should be high up the list. I mean, getting a number of questions about the public health measures, Andrew, I guess one in particular is where is your end game? At what point, given that you even seem to be expressing doubts about the vaccine, at what point would you lift the public health measures that you favor? What has to happen before you say, let's end it? And how many months is that gonna likely to take? That's a great question and my vision for these public health orders is that they're temporary and over the summer we saw transmission go down in many locales that had had a spring wave and the key is to get the effective reproductive number well below one and that means that each case on average is producing less than one new case and we're not gonna eradicate COVID. I mean, there's all sorts of pie in the sky stuff about COVID zero and I mean COVID is most likely gonna become another seasonal like flu like illness that kind of is just sort of in the background. We have four coronavirus strains that circulate worldwide now that caused the common cold in the winter time and this will likely in years or decades become like the fifth such syndrome that it'll just be, it'll be there. The genies out of the bottle on COVID we're not gonna eradicate it. I mean, my anticipation with the between the vaccine and seasonal effects and people getting to herd immunity the hard way, my anticipation would be that summer of 2021 in the Northern hemisphere will be essentially a normal summer in terms of restrictions but the answer is when cases come down and the effective reproductive number is significantly below one then we can start to lift public health orders. It's certainly nothing that I envision us doing indefinitely and not because I expect us to eradicate COVID. I just think we're in the emergent phase now and this is the first winter in which the Northern hemisphere starts the winter with COVID on the ground and therefore even though people are already exhausted from all of this it's really still early days. Comment from you Martin on that. Yeah, Andrew's correct that this virus is gonna become endemic but the nature of it is actually quite promising for the future because what happens is when you have an endemic you get new people are born and of course they don't have immunity and then they will be exposed but they will be exposed as children and for children this is not a serious virus. So it's gonna be with us for many decades but most people are gonna be exposed when they are children and then they're gonna build up immunity. So I think the long-term prospects of this disease is actually quite favorable that and when I first heard about COVID in Wuhan I sort of quickly tried to figure out about it and it was immediately obvious that this was gonna be a pandemic that's gonna tour the whole world but it was impossible to keep it out from sort of hitting most parts of the world. At the same time as a parent you're always mostly concerned about your children and I have three kids ages 55 and 18 and after being worried about 10 minutes I could clearly see that this is not a dangerous thing for children so my children will be fine. Thank you. Question for you Andrew and from Martin as well but let's start with you Andrew. Basically the questions have to do with toning up on one side of the ledger those who likely have died from the public health measures and the focus of many is that the unseen especially is that because of recessions in the rich countries of the world a lot of people are starving in the poor countries so there's an enormous amount of death attributable to that to the recessions that the public health measures have caused and so that seems to be a big number as many argue and then you speak of all the deaths that have occurred even though we've had public health orders so then you have to presumably focus on the deaths that have been prevented because of the public health orders and I guess further so many other questions are what evidence you have that the public health orders have made much of a difference when we have so many different public health orders in different states and difficulty showing any difference in deaths so that's a long question but the short version of it is how many lives have been saved by the public health orders and how many in your view including looking globally in the poor countries how many lives have been lost? Well this is a very multi-dimensional question and but I mean if we look at the mortality in the United States I'll get to the world in a minute but if we look at mortality in the United States I mean if you look at the excess deaths in the United States in with a painting with a broad brush stroke here in 2020 the deaths that are over and beyond what we would expect at this stage in the year based on the pretty regular patterns of mortality in previous years the number of deaths we've had about 300,000 maps pretty well onto the excess deaths so that the deaths that have been counted as COVID deaths because it's a good faith determination of a healthcare provider that this person died of COVID are mapping pretty well onto I mean not perfectly but pretty well onto the excess deaths that we've seen and so I mean I think that this idea that I'm confident in fact that this idea that public health measures are causing other deaths is going to be shown to be minimal in its effect and it's not just public health orders that cause deaths it's the pandemic I mean hospitals in Orange County are over where I live are overflowing with COVID patients right now and the director of EMS of the county has advised hospitals to postpone elective surgeries that is not because of the public health orders that is because of the pandemic and it's true that in the absence of a vaccine if we just run the clock for 25 years with COVID sooner or later everyone will get it and the idea of these interventions is to flatten the curve so that we don't crush the hospitals at any given point in time but the area under that curve whether it's steep or whether it's flat is 100% of the population or 70% of the population or whatever but we've seen for example in the Dakotas where the government took a very light touch to interventions we see the highest infection rates and very high mortality rates compared to other states that have been more proactive and given that the vaccine is on our doorstep it really makes all the more sense just to steal ourselves for a few more months of adherence to orders and then we can start to get mortality under control as far as children starving to death in developing countries I mean that's a very stark that paints a very stark picture but the reality on the ground is much more complicated than that I mean when you look at mortality statistics in many countries are still a lot of guesswork and I mean people in my profession of demography spend a lot of time trying to estimate mortality statistics from different regions I truly believe that these accounts will be shown to be exaggerations and I haven't seen anything reliable that suggests that there's wholesale famine mortality in the developing world at the moment much less caused by COVID-19 recessions in North America and Europe. Just let me rephrase that question just briefly that with respect to the lives saved from the protective health measures you cite all the deaths that have occurred and yet we've had protective health orders so do you think that a substantial do you think that Florida has been contrasted Florida doesn't have a whole lot of protective health measures as a lot of old people who are vulnerable South Dakota do you think that there's overwhelming evidence that hundreds of thousands of lives have been saved from the protective health orders? No, not hundreds but triple double the number of deaths if we did not have the public health orders. Well, first of all, hundreds of thousands of lives, no. Second of all, the United States has been absolutely abysmal in adherence to these public health orders. I mean, there's a public health order here in California and a number of restaurants have just openly said that they're going to defy these orders and so, you know, I mean, so it's very hard to quantify you know, in the middle of things what the impact is of public health orders especially since the most important mortality statistics are going to be the final mortality statistics. So I will concede that we are in a crisis and that it's hard to measure these outcomes as the crisis unfolds because some countries, for example, shifting for the moment to Europe, some countries that did well early on have been hammered later on. And so we need to, you know, I'm appealing to principles really rather than statistics in terms of, you know, doing what we know works for controlling infection spread and not pursuing an ideal of targeted protection which I have asserted, you know, does not work and will not work. Thank you, Andrew. Martin, would you hopefully you'll agree that since we have actually run out of normally a lot of time for the Q and A, you have seven and a half minutes of your summary. And so if you want to comment on what Andrew has just said in your summary, please do so. But let's go to the summary portion of the evening, seven and a half minutes for you, Martin, to sum up your case. Please take it away, Martin. Thank you. So I guess one disagreement that we do have, which is big is the collateral damage on other health aspects, which I think is enormous. We don't have all the statistics in because we are very good statistics or very sort of up-to-date, daily, weekly statistics on COVID-19 cases, civilizations, mortality and so on. But a lot of these other, the collateral damage on cardiovascular health, cancers, mental health and so on is things that we know a little bit about but something that we will learn more and more about as time goes. But we do already know a lot about it now and there is a website that's very, that has many of these scientific studies on this is called Collateral Global. So the collataglobal.org where you can see about effects on starvation, which once that it thought it was 10,000 children starving to death in the world every month. And that means that there's also many who are malnutrition, which will have long-term public health effects. Tuberculosis has gone up, polio is worse and so on. So there's enormous damage from the lockdowns and from people being afraid to go to the doctor and so on. Now, the Great Barrington Declaration and focus protection is nothing something that is novel or fringe. It's in accordance with the many pandemic preparedness plans that countries have made up that in the pandemic, you focus your attention on protecting those at high risk. It's also something that's not unique to the three of us who wrote it. There are many people who, including the three of us, but many others who back in March and April was arguing for a focus protection using different names, age, targeted strategy, et cetera, a risk-based strategy. So this is nothing novel and there were, so many people were advocating for that very early on, but the reason you don't necessarily realize that is that as we were doing that, we were not sort of in the media. I tried to publish my thoughts in the US, but failed to do so. I had no problems publishing in my native Sweden in the major daily newspapers there, but I was unable to publish anything in March, April and the United States despite several attempts. So I think this has been a very good and informative discussion. I think I agree with Andrew Neumar that this kind of scientific discourse is critical, and I'm also willing to die for it on the same hill as Andrew is doing. I'd like to thank Eugene and everybody at Soho Forum for organizing this. Most of all, though, I would like to thank Andrew for doing this debate and this discussion and for doing it in such a logical, scientific and polite manner. But most of all, for him being willing to do so, I did another debate about a month ago, a month debate, and they were unable to get any epidemiologists to debate me. So they found a psychologist instead. So there was a good debate, but I really, really appreciate Andrew for doing this. So thank you so much, Andrew. All right, and that concludes your summary. Nothing further? Yes, that's good, thank you. All right, Andrew, you can take your seven and a half minutes to summarize. Take it away, Andrew. Thank you, Gene, and thank you, Martin. My pleasure to debate you. I'll debate you again if you'd like as the pandemic continues to unfold. And thanks also, as I said to the audience, and it's so important that we maintain channels of scholarly debate because there will be disagreements. There are differences of opinions among people who can reasonably claim expertise in the area. And I hope I've made my case to the audience. We're in the midst of the greatest infectious disease pandemic of an acute illness in over 100 years. And we are all stakeholders in our communities, in our national societies, and in the human population world society. And the way we are going to defeat this pandemic is together. It is impossible to target certain people for protection and to pull it off. It's a great idea, but there are plenty of great ideas that just don't work. Nothing succeeds like success, the historian EH Carr said. And the world is full of ideas that we still have because they were successful. This idea of targeted protection will not be successful. It will be an abject failure. And to the extent to which the United States is undergoing really painful throws of this pandemic right now is reflected because it's a terrible pandemic and because we're not really adhering to public health orders. I agree that we should find a solution so that a 60 year old person or older can have someone to do their shopping for them. And my interlocutor said that he sees people in the grocery store who are elderly doing their own grocery shopping. But we're not funding the fiscal, we're not funding programs that would make that happen. And in absence of that, we need to just lower the temperature of the pandemic. We need to lower the effective reproductive number by all contributing to these public health orders. It's an evidence that the public health orders aren't being followed, that we can all just go to the supermarket whenever we want, and there's no controls of the number of people who are admitted in in most cases at any given point in time. So I know people are tired of everything, but what they're tired of is the pandemic, not the public health orders. And the other thing I wanna say is that we cannot take everything bad about the pandemic and lay it all at the feet of public health orders and none of it at the feet of the pandemic itself. That is so intellectually dishonest to me. We are in a really grave pandemic and the public health orders are not exacerbating pandemic mortality and I seriously doubt they're exacerbating non-pandemic mortality in significant ways. The net benefit is enormous in terms of cutting down on COVID-19 mortality in the community. And right now where I live, we're experiencing a surge, a hospital surge, both in hospital occupancy and in the ICU. And this is caused by the pandemic. This is people in the hospital with COVID-19. This is caused by the pandemic. Now if someone cannot receive care for a stroke or a heart attack because the ICU's are full in Orange County and they are, how is that a result of the lockdown? That is the result of the pandemic. We are facing a crisis. That crisis is COVID-19. We need to do what's proven. It's a great homily to say we're gonna protect the vulnerable, but the vulnerable includes far, far more people than just the elderly. It includes communities of color and it includes other people whom we cannot always predict. 26% of the deaths where I live are among people younger than age 65. So I thank again, Martin, you and everyone who organized this debate. And I thank the audience for making this debate happen. I hope I've changed your mind. And we will all get through this and we will get through it using the public health techniques that expanded life expectancy by 30 years since the 20th century. And those are public health approaches that aim to help everyone, not just a few people. Those are the ones that work best, those are the ones that are proven and those are the ones that will succeed. Thank you. Thank you, Andrew. Okay, so that concludes the debate. Jane, please open the final vote. We have the results and this is, oh my gosh, wow. All right, I'm gonna deliver the punchline, the punchline is that according to Oxford style voting, it was a tie. But although I'll send you guys the numbers since of course it's part of the game, it's go to funding. The yes vote on Martin's behalf began at 68.06% and went up. It gained 5.56% points, went to 73.61. But you are rated on how much you move the needle. So Martin got an overwhelming majority, however, he went up by 5.56%. The no vote began at 19.44 and went up to 25. It too gained 5.56 points. So it was an even split and I guess you guys are gonna have to split the Tutsi roll. Congratulations to you both and thanks so much for participating and see you all hopefully for our next debate. Good evening all.