A trio of public health experts from Stanford, Oxford, and Harvard universities are championing a controversial alternative to widespread coronavirus-driven lockdowns. They call their approach "focused protection" and their main argument is that those who are less vulnerable should return to their normal lives, while those who are more vulnerable should be given extra protection and resources.

The scientists staked their claim in a 500-word document called the Great Barrington Declaration, which is stirring up significant backlash from other public health experts. 

"It's not meant to be a detailed policy proposal," said Dr. Jay Bhattacharya, an epidemiologist with Stanford University. "It's meant to undergird the philosophy that you bring to COVID."

Bhattacharya developed the declaration with epidemiologists Martin Kulldorff of Harvard University and Sunetra Gupta of Oxford University, following a summit held by the libertarian American Institute for Economic Research in Barrington, New Hampshire. 

The politicized origins of the proposal have led some scientists to question the motivations of those backing the idea of focused protection. 

"I think it's important to not view this as a scientific debate," said Justin Feldman, a social epidemiologist and a research fellow at the Harvard FXB Center for Health & Human Rights. "There are no people who are serious public health pandemic response experts who have any level of responsibility that say, 'Let's try to build herd immunity.' These are a few idiosyncratic scientists who have been cultivated by right-wing think tanks." 

Indeed, as a former research fellow at the right-wing Hoover Institution, Bhattacharya comes to the initiative with ideological baggage, though he insists his politics don't factor into his advice. 

"This is not ideologically driven," he said. "We arrived at these conclusions from our scientific fields that we work in. Is it good for business? Maybe, but that's really not the motivation."  

Beyond questioning the political motivations of the declaration, Feldman is skeptical of the idea that vulnerable and non-vulnerable populations can be separated in terms of public policy when you consider the number of families and households that contain both groups. 

"Once you look at the basic ways we're connected, there can't be focused protection because the population that needs to be protected is very large," he said. 

He pointed to a recent study out of Health Affairs, a peer-reviewed journal, which found that as many as 44 million high-risk people in the U.S. are connected to K-12 schools directly or through households. Generally, Feldman noted that more vulnerable populations often require contact with less vulnerable populations in the form of care work at nursing homes and hospitals. 

Underlying the Barrington Declaration's arguments, however, is the assumption that shutdowns have their own mental and physical health effects. 

"What we have is an incoming public health disaster on a scale I've never seen before as a consequence of the lockdowns," Bhattacharya said. "We've basically ignored all these vital public health goals in lieu of a policy that looks just at COVID." 

Specifically, he referenced a CDC survey from August in which 40 percent of respondents reported adverse mental or behavioral health conditions due to COVID, while more than a quarter of respondents aged 18–24 said they seriously considered suicide in the last 30 days. 

He also singled out a report from the United Nations in July that said the coronavirus pandemic could push up to 132 million people into hunger by the end of 2020. 

"While it is too early to assess the full impact of the lockdowns and other containment measures, at least another 83 million people, and possibly as many as 132 million, may go hungry in 2020," the report said. 

Drawing a line between these public health impacts and shutdown measures specifically is another aspect of the declaration's argument that critics take issue with. 

"They like to treat the economy as a natural object," said Feldman, referring to those who decry the economic impacts of shutdowns. He added that governments can and should take steps to mitigate the economic damage of shutdowns, rather than getting rid of them altogether. 

Perhaps the most controversial aspect of focused protection is whether it would lead to herd immunity, which even supporters of the declaration admit is not well understood at this point. 

"There's a lot of fight in the literature about what fraction of the population you need to get infected," Bhattacharya said. "I don't know that number. I don't think anyone honestly can tell you that they know that number."

Regardless of this uncertainty, Bhattacharya argued that focused protection is still the right approach because it "protects the people who are actually at risk while not imposing collateral damage on people who are not at high-risk." 

Feldman sees this ultimately as reckless, whatever the justification. 

"There's no precedent in public health for a strategy of any kind where you just let the virus rip and try to get herd immunity to infection," he said. "What does exist is this debate over corporate interests versus the health of the public. I see it through that lens."

In the meantime, scientists who argue this approach is reckless and not based in rigorous science are getting organized. The Lancet, a peer-reviewed medical journal, published a letter signed by 80 international researchers called the John Snow Memorandum. Named after the founder of modern epidemiology, the memorandum calls any approach allowing uncontrolled transmission, even among less vulnerable populations, to be extremely dangerous.  

"Any pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed," said the letter. "Uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population. In addition to the human cost, this would impact the workforce as a whole and overwhelm the ability of healthcare systems to provide acute and routine care."

Feldman stressed that we can't afford to look at this issue as a healthy scientific debate. 

"There's no precedent in public health for a strategy of any kind where you just let the virus rip and try to get herd immunity to infection," he said. "What does exist is this debate over corporate interests versus the health of the public. I see it through that lens."

Updated: October 15, 2020, 12:29 pm: Added details on the John Snow Memorandum.

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