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Illustration of the morphology of coronaviruses; the club-shaped viral spike peplomers, coloured red, create the look of a corona surrounding the virion, when viewed electron microscopically (from here (

I heard about The Great Barrington Declaration this morning on WMAL‘s Mornings on the Mall. Here is how the declaration begins.

As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection. 

Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the…

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  1. I would like to do a little experiment and collect some data on perceptions of vulnerability from Tom and his readers here. One of the known, important risk factors is age (it is not the only one, but let’s focus on it for the moment). We know, that young adults have a low risk of death from covid, so let us use them as a reference. We do know that the risk increases with age. Rather than setting an arbitrary age threshold directly, I would like you to set a threshold of risk. I would like to know, in your opinion by what factor the risk of an age group needs to be higher than that of young adults reference group to be considered vulnerable. Two? Five? Ten times? 100 times? 1000 times? Just give a number without explanation. I would like to stay discussions on this until, say Friday, such that opinions are given with little influence from others. And please do not give in to temptation and investigate numbers in order to tailor your reponse to the age threshold you deem correct (And yes, I am disqualified from my own survey, as I have looked 😉 ).

    1. @marmoewp

      Not exactly a careful statistical study you have proposed.

      When I make an argument, I try to keep myself out of the argument. I don’t think something is true or false just because I believe or disbelieve or just because it it good or bad for me.

      COVID-19 is a serious hazard for a relatively small number of people. Some who are vulnerable don’t know it. Life is full of uncertainty. Therefore, like many of the hazards we deal with we have to guess at where the cost/benefit ratio is optimum. That is, we have to guess at how much effort we should make to avoid the virus.

      Frankly, it is not my job to define who is or is not vulnerable to COVID-19. I think everyone has to make their own personal assessment how much effort they should make to avoid the virus. That includes looking at the people around us and try to avoid spreading the virus to those who fear it. That includes ostracizing the people who are careless of spreading the virus to the vulnerable.

      You don’t think it is safe to go to a campaign rally, restaurant, or send your child to school. That’s something you should be able to decide for yourself, but I doubt the wisdom of imposing one’s personal fears upon everyone else.

      You think government officials have the right answers for such a complex problem? I think that entrusting busybodies with power poses more hazards than COVID19.

      1. “You don’t think it is safe to go to a campaign rally, restaurant, or send your child to school. That’s something you should be able to decide for yourself, but I doubt the wisdom of imposing one’s personal fears upon everyone else.”

        You should have told me earlier what I think. I’ve been to a restaurant last week, the children are going to school in Germany and given the current circumstances that is the right thing to do. But yes, large congregations like campaign rallies are a recipe for a super-spreader event.

        I find it kinda cute, that you claim you want to protect the “vulnerable”, but dance around saying who it actually is you consider to be those “vulnerables”.

        1. @marmoewp

          I am ruggedly handsome, not cute. 😀

          The statistics are fairly clear about who is vulnerable, but there are exceptions that don’t fit statistical models. Since bureaucrats don’t manage exceptions well, I would just as soon that people decide for their level of vulnerability for themselves. Similarly, if it is safe to go to demonstrations, riots, and Wal-Mart, I think we can manage church gatherings and campaign rallies without the help of Liberal Democrats.

          1. “The statistics are fairly clear about who is vulnerable”

            Dr. Kullmann, the first signer of the Great Barrington Declaration, puts that threshold at the age of 50. He proposes to let those under 50 produce the herd immunity that is then meant to protect those older than 50. I am not quite convinced, that 50 years is the number you had in mind. That’s why I am asking and I would like to have you give an age or age range.

    2. Well, Chris Christy is in his late 50s, and morbidly morbidly obese. Pretty much a walking advertisement for unhealthy. He was out of the hospital in 6 days (no vent). So a healthy person with no co-morbidities except for age is probably good well into the early 70s at least. Trump spent two days in the hospital and he’s overweight. That was mostly for observation.

      I would like to know, in your opinion by what factor the risk of an age group needs to be higher than that of young adults reference group to be considered vulnerable. Two? Five? Ten times? 100 times? 1000 times? Just give a number without explanation.

      I couldn’t hazard a guess as to the number. Nor apparently can experts with much more information than I do. We know the number of cases is going up as the number of deaths is going down. Doesn’t seem to be the same as it was back when the lockdowns were first in place. Neither here nor elsewhere.

      1. The graph shows that deaths are going up, but are a way lower level than in the first wave. What is substantially lower than during the first wave is the case fatality rate. As Marco Piani points out in accompanying tweets, during the first wave a lot less testing was done, which, according to him, is the main reason for the low CFR we see today.

    3. @marmoewp

      Latest CDC survival rate stats are as follows:

      0-19. 99.997%
      20-49 99.98%
      50-69 99.5%
      70+. 94.6%

      Now obviously whether a person has comorbidities can change those percentages, but those are the overall numbers. And yes the risk of dying to a 50 year old is much higher than for an 18 year old, but it’s still pretty slim.

      Individuals would need to assess their own situation to decide if they want to participate in fully opening up. People are doing this anyway, I don’t see why we need to kneecap the economy at the same time..

      Anyway, here is a link to a great discussion among the GBD authors. It digs deeper in to their views if you’re interested.

      1. Allow me to translate the numbers to deaths. Based on these assumed IFRs, with 70% of the population going through infection you get about
        1,700 younger than 20
        18,000 aged 20 to 50
        280,000 aged 50 to 70
        138,000 aged 70+
        for a total of about 1.7 million dead.

        I simply do not see, how you can isolate the 36,6 million Americans aged 70+ (11% of the population), while the rest of the population is aiming for herd immunity. I am not even starting to speak about the 50 to 65 years bracket that is still part of the work force.

        1. Sorry, got the 70+ age bracket wrong; an IFR of 5.4% and 70% of them infections is equivalent to 1.38 million deaths, a factor of 10 more than stated above.

        2. But that’s assuming all 70% who test positive actually show symptoms and become a case, which we know comes nowhere near close to happening. It’s also assuming therapies that have proven effective won’t become even more mainstream and reduce death rates further (steroids, antibody cocktails, hydroxy, antivirals, etc…). On top of that the virus does seem to be changing with positive tests skyrocketing while death rates remain flat, at least here in the U.S.

          At the end of the day though, it has to be a voluntary thing measured against quality of life, which would reduce the isolation number even further. If I were 70+ and healthy I’d take certainly take my chances of living freely. Shoot even if I was unhealthy there is something to be said for not living life just to prevent death.

          Enjoy the vid 🙂

          1. @Tricia
            The number 70% of the population infected, irrespective of whether they get tested, show symptoms or stay unsymptomatic. It requires about 70% of the population to aquire immunity before herd immunity for the populaion is achieved.

            Dexamethason works in the late phase of a bad case, Remdesivir if you are still in the early stages. Hydroxy has been shown not to work. Regeneron is still experimental and untested at the necessary large scales. Trump’s cocktail would be $100,000 co-pay for the normal Americans, AFAIK.

            Please keep in mind: If you do not care, whether you get infected or not, you take that decision for your neighbor, too.

          2. You’re completely ignoring steroid therapy which has proven very effective in combatting the deadly cykotine storm, the success many doctors have had with hydroxy (yes, several studies have shown it to work and the infamous Lancet one showing poor results was retracted quite some time ago), antibody cocktails which gotten many hospitalized folks out of the hospital and away from ventilators and the fact that most people in vulnerable categories are either self quarantining or have weighed the risks and choosing freely to participate. If they are doing this anyway there is no reason to not open things up more fully.

            That 70% herd immunity number but the way has been directly challenged by the GBD authors and several prominent scientists who have done studies on t-cell immunity and how past coronavirus infections have likely built up immunity to Covid in many folks. At the very least it’s probably a major factor in why people’s reaction to the virus varies so much. They peg the HI number at closer to 20%.

            If you choose to press against going for a natural herd immunity approach, please be mindful that you are doing nothing to squelch the virus, merely extending the time period we get to deal with it and thus extending the misery of negative lockdown effects.

          3. @Tricia
            Dexamethasone that I mentioned _is_ the steroid you are refering to. So we both agree that this one is helpful. Your other talking points have been proven to be wrong by now.

            Hydroxychloroquine _fails_ to show positive effects as soon as you look at randomized trials. See the CDC’s Treatment Guidelines (updated October 9, 2020)
            The only studies that I have seen that _claim_ an effect, are those that chose medication (including HC) based on the state of health of the patient. Give HC to those that have a higher chance of survival to begin with and you will manufacture an “effect”.

            More bad news: Remdesivir and interferon fail to show effects in randomized trials

            Coming to the testing, case numbers in March/April are difficult to compare to today, as testing and tracing capabilitie has changed a lot. The early case numbers were seriously undercounted by todays standards.

            Gupta, second signee to GBD, claimed back in spring that as much as half the UK had gone through a Covid-19 infection, when actually it was 5% to 10%. She never retracted that claim. You trust her now on 20% HI and general immunity due to past CV-infections at your peril.

            Kulldorf, first signee to GDB, puts the age cut-off for vulnerability at age 50. 20% of those in the age bracket 50-65 are _working_. How much of a free choice do these people have to self-quarentine? “If they are doing this anyway there is no reason to not open things up more fully” is a nonsequitur if I have ever heard one.

            “that you are doing nothing to squelch the virus”, other than winning time to develop vaccines and preventing the health care system from getting overwhelmed, as it has happened, e.g., in Spain, Italy and New York in the spring. Yeah, that is nothing at all.

          4. I’m sorry but you are citing cherry picked studies, particularly when it comes to hydroxy. I know you want to believe the narrative about it not being effective but it’s simply not true. Talk to some doctors personally about it, you may be very surprised.

            The bottom line is this is not March, we know so much more about both how to treat the virus and who it effects most seriously and thus it’s no surprise that as positive cases sky rocket, death rates have remained flat and hospitals empty outside fo some select areas (here in the U.S). Another reason for this is simple but harsh; it’s burned through the low hanging fruit of the most susceptible population and the majority of infections now are younger with strong immune systems.

            Covid 19 is a serious virus for a select population that we are failing miserably with sledgehammer solutions that treat everyone as facing the same risk. this takes away focus and funds from shielding this vulnerable population and turns life completely upside down for those for whom the virus poses little to no threat in and int he process destroys livelihoods, civil liberties and overall human flourishing.

            Lockdowns have really not been proved to have much of a positive effect you know. It’s a highly communicable virus remember that spreads through the air so outside of some common sense hygiene and distancing practices there isn’t much, IMO that we do to stop it. The selfishness of those that want to continue to promote lockdowns knowing everything we do now about the drawbacks and how this only drags things out longer is stunning to me though and a reflection on the lack of political courage and moral vapidity of western culture. Doesn’t bode for the future at all.

            Ok, I’m out. Enjoy the weekend.

          5. @Tricia
            I am simply relying on the CDC to give a good overview of the state of the art.

            As for lockdowns, you are talking to me, not some strawman. Lockdowns are a means of desperation, when hospitals are threatened to be or are overwhelmed.

            You are advocating to only protect the vulnerable and let the virus roam free amongst the younger. Fine. By now I have watched the video. The GBD (document and video) is very vague on what detailed measures “Focused Protection” is supposed to encompass, on who they consider vulnerable and on how to protect anyone outside of nursing homes, other than to have food delivered and self-quarentine. I find it interesting, that Dr. Bhattacharya puts the age threshold conveniently at 65 years, and as we all know, nobody above that age will do any kind of work. Dr. Kulldorff however put that threshold at 50 years in another podcast. That one is a bit of a head scratcher, as they do not seem to advocate that everyone above 50 take a sabatical, whether or not they can afford to do so. When asked, what to do in a scenario, where children and grandparents live in one household, they simply sidestep the question. Let us not even get started on that we do not know for how long natural immunity from an infection lasts, or that we have way too little data on long covid incidence, much less so grouped by age. Nevermind, that long Covid does not even seem to exist in the GBD world.

            BTW, that video makes it look like the GBD was the product of three medical doctors meeting of their own accord, while in reality “From October 1-4, 2020, the American Institute for Economic Research hosted a remarkable meeting of top epidemiologists, economists, and journalists, to discuss the global emergency created by the unprecedented use of state compulsion in the management of the Covid-19 pandemic. The result is The Great Barrington Declaration, which urges a “Focused Protection” strategy.”

  2. Yes, excellent post. I’ve been following the authors of the GBD for some time as they were truly the lone wolves at the beginning of the pandemic calling for sanity. The site allows for the general public to sign, everyone who agrees should.

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