Ep. 35: Anti-Lockdown Epidemiologist Martin Kulldorff
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In the interests of staging a fulsome debate over the pandemic-management strategies dominating the globe, Eat Move Think invites on an advocate of the counterintuitive approach followed by Sweden. Leading the argument against lockdowns and stop-the-spread coronavirus strategies is Martin Kulldorff, a professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations. As a founding signatory to the Great Barrington Declaration, Prof. Kulldorff believes most COVID-19 government policy is wrong. Protect the vulnerable, he says, and allow the virus to spread through the young healthy population to achieve herd immunity. In this episode, in a feature interview with host Shaun Francis, Prof. Kulldorf describes his logic.
LINKS AND HIGHLIGHTS
The Great Barrington Declaration is the petition that Prof. Kulldorff founded along with two other infectious disease experts: Oxford University’s Dr. Sunetra Gupta, an epidemiologist with expertise in immunology, vaccine development, and mathematical modelling of infectious diseases; and Stanford University’s Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.
Since the declaration was signed Oct. 4, many other scientists and journalists have responded. Some arguments against the declaration.
Prof. Kulldorff has argued his case in numerous different media, including:
Prof. Martin Kulldorff’s Twitter feed, and his academic web page at Harvard.
Please subscribe and rate us on your favourite podcast platform. Eat Move Think host Shaun Francis is Medcan’s CEO and chair. Follow him on Twitter @shauncfrancis. Connect with him on LinkedIn. And follow him on Instagram @shauncfrancis. Eat Move Think is produced by Ghost Bureau. Executive producer is Chris Shulgan. Senior producer is Russell Gragg. Social media support from Emily Mannella.
The Argument Against Lockdowns with Harvard’s Martin Kulldorff final web transcript
Christopher Shulgan
Hi, I'm Christopher Shulgan, executive producer of Eat Move Think. On this show, we pride ourselves on exploring how best to approach human wellness from a number of different viewpoints. So with respect to the coronavirus, we've had on epidemiologist David Fisman and the general internist Irfan Dhalla. Both of whom advocate stopping the spread at all costs. Similarly, we've also had on journalist Jonathan Kay and the public health expert Vivek Goel, both of whom question official COVID-19 guidance.
Chris
In this episode, we have our most controversial guest ever: the Harvard Medical School bio-statistician Martin Kulldorff. The strategy for COVID-19 is to keep case numbers as low as possible until a vaccine saves the day. But Kulldorff believes this is exactly the wrong approach for three reasons: it prolongs the pandemic, it destroys the economy and three, lockdowns create public health effects like higher suicide rates and more domestic abuse.
Chris
Recently, Professor Kulldorff gathered with experts from Oxford and Stanford to draft a mission statement for a different pandemic strategy called The Great Barrington Declaration, after the town where they met. The declaration has garnered Kulldorff and his colleagues a tremendous amount of attention, including a meeting with such top White House health officials as Scott Atlas.
Chris
Today, the show features Professor Martin Kulldorff himself in conversation with Eat Move Think host Shaun Francis.
Shaun Francis
Hi, Martin. So thanks very much for your time. I know you're a very busy man these days. And I want to first thank you for taking the time to join us here on Eat Move Think. Martin, The Great Barrington Declaration is really fascinating and unprecedented with the amount of coverage you've been getting. Can you tell us the story of how that came to be?
Martin Kulldorff
Well, I invited Dr. Gupta, Dr. Bhattacharya to come to Massachusetts. And we worked on the declaration together on Friday, Saturday, and then it was done on Sunday. Then we released it on Sunday. So it was nothing that had been in the making for a long time, we started working on it on that Friday, two days before it was published.
Shaun Francis
And how did you get connected? I mean, were you friendly prior to the pandemic?
Martin Kulldorff
So I obviously knew about Sunetra Gupta's work, because she's such a great technologist, but I had never met her in person. I had not met Jay Bhattacharya in person either before the pandemic. I'd met him once before in August. So we connected because we were both desperately trying to get this message out in our own ways. And we thought that, if you do it alone, it's not as effective as if you can actually go together as a group of three, that will be more powerful. It's harder to ignore, if there's three of us.
Shaun Francis
Why did you feel the need to do something? I mean, it amounts in some ways to a petition of sorts. What do you hope to achieve right through this mechanism?
Martin Kulldorff
Well, the scientific discussion has been very strange because in the media, it has been given the impression that there is scientific consensus for lockdowns and contact tracing. While among my colleagues that I talked and infectious disease technologists, we have a very different view that we should have a focus on protecting the high-risk people by letting young people build up the immunity that will eventually protect everybody. And the current strategy with lockdowns goes against every principle of public health that we had before this year. So it's sort of a new invention that suddenly went through almost the whole world. And as a public health scientist, it's been really stunning to observe.
Shaun Francis
Martin, one of the things I think that you have explained that seems so insightful is the difference of the impact of COVID-19 on different age groups, and how that might be a way for us to mitigate its impact. Can you get into that more for us?
Martin Kulldorff
I mean, everybody knows that the older are high at risk. But it's not like they're twice as high risk, it's not that they're five times higher risk. It's not even 10 times. And it's not 100 times. The difference in risk between the oldest and youngest, it's more than 1,000 fold. So there's an enormous difference in risk by age. And while there are other risk factors, age is by far the most important one. So, for example, being obese or diabetic, that also increases the risk, but maybe with a few years, corresponding to a few years. So age is by far the biggest risk factor for COVID. And I think the median age of people who have died is somewhere in the low-80s or something. So it's really a very dangerous disease for older people, but a very mild disease for children and younger adults. So COVID-19 is our enemy. And if you fight an enemy, you have to look where's the weaknesses of the enemy. And the weakness of the enemy, it's unable to kill young people, very difficult to kill young people. So we have to use that fact of the disease, which is nothing that we decided upon. That's just the way it is. So we have to utilize that to minimize the overall burden of this disease in the population as we pass through it.
Shaun Francis
I first read a very good article that you authored in The Spectator magazine in the UK, where you talked about the concept of herd immunity. And I thought it was a very simple, well-written message. Could you maybe reiterate what you were trying to communicate at that point to our listeners?
Martin Kulldorff
Yeah, so first of all, herd immunity is not a strategy, or something that you sort of deliberately try to pursue by infecting people. Herd immunity is a well-established and proven scientific principle, just like gravity in physics. So it's something that exists. And with COVID, it's a state that we're going to reach eventually. The key feature with herd immunity is that as soon as a certain percent of the population, a certain proportion has had the infection and is immune, then the rest are protected. So the question is, who do we want in these two groups, in the infected versus the ones who are protected by herd immunity? If we just let the COVID rip through society, we're going to have a mix of old and young people. If we instead do a general lockdown, so that we try to sort of protect everybody, then we're going to drag it out over a longer time, but there will still be some older and some younger people who get infected. And then we will also have higher mortality because the more older people who get infected, the higher mortality we have. But if instead we do a focused prevention so that we protect the old people and other high-risk groups, let's say those over 60, while we let children and young adults—those less than 50—live normal lives, then most of the people in the infected group will be young, while most people in the protected group will be old. And that is going to reduce total mortality by the end of this pandemic.
Shaun Francis
So that's a great and very simple message, and one that clearly we haven't been following. And when we talk about herd immunity, you know, we hear often, certainly at the beginning of this, that it's—you need at least 80 percent of the population to get to that point. So some of the critics would say, in herd immunity is letting it rip, because it's going to have to go through 80 percent of the population to get there, which would have a lot of, you know, negative consequence.
Martin Kulldorff
So I've heard those numbers. Sometimes they say 80, sometimes 70 or some other numbers, but we have absolutely no idea what that number is. And it depends on the location. So it will be presumably higher in urban areas, because people have more contacts. And it will be lower in rural areas. But it also depends on what strategy we have, because each person is not equally likely to transmit the disease to others. So if you have an aunt who lives by herself mostly and doesn't interact so much with other people, if she is infected, and becomes immune, she doesn't contribute a lot to herd immunity. On the other hand, maybe you have a cousin who is always out there, hanging out with other people, maybe working as a bus driver, that person is exposed and exposes other people a lot. So if the people who have many contacts, if they are the ones who are infected and exposed, then it could be a very small number needed for herd immunity.
Martin Kulldorff
For example, Dr. Sunetra Gupta with her colleagues Jose Lourenco and others at Oxford, they had a paper showing that for COVID-19, the threshold for herd immunity was compatible with anything from, like, a little bit less than 20 percent to much higher numbers. So we don't know what is needed for herd immunity, nor do we know how many people at this stage already are immune, because with COVID, there are many who are asymptomatic. So there are many people who have been sick, but we don't know about it. And not everybody develops antibodies. So there's more immunity than the antibody surveys tells us.
Shaun Francis
So in this strategy, how do we minimize risk for those at risk? You know, are we truly talking about locking them down? Or do they have some self-agency in how they go about this?
Martin Kulldorff
So it doesn't have to be locking people in. For example, Sweden is the only country who has pursued a strategy of this type. People, older people were advised to stay home, but they were not forbidden to go out. So most people are smart enough, and maybe they go out if there's something very important, but otherwise, they will stay home. Or when they go out, they go outside outdoors for a walk, which is healthy, that's a good thing to do. So nobody should sort of stay inside. It's good to be outside and get fresh air and so on. So it doesn't have to be sort of a strict lockdown that's enforced by law enforcement.
Martin Kulldorff
One place where one has to have some measures like that are nursing homes, because if you're an old person in the nursing home and you have a visitor, you're not only risking yourself, but also the other residents. So there I think, in nursing homes and similar settings, it's very important to have sort of strict rules that, unless the staff is already immune by having had COVID, they need to be frequently tested. And any visitors should also be frequently tested. So there it's sort of important to have strict rules of testing to make sure that nobody gets infected. If you're visiting your grandmother, for example, in a nursing home and you've tested positive, then you should not visit her that week, but maybe wait another three weeks and visit her then.
Shaun Francis
I've read as well that, you know, some would say so we understand the aging population and how they may mitigate it, and certainly how we might better lock down nursing homes. What do you say to those who say that those most socioeconomically underprivileged, who may cohabitate with aging parents or people at risk, are more at risk. So, in fact, letting this take its course, and then trying to mitigate risk for those multi-generational families is an impossible task.
Martin Kulldorff
Yeah, so first of all, the lockdown strategy that we have pursued in most places, is sort of throwing the working class under the bus, because what we're doing is we're protecting low-risk college students, and low-risk professionals who can work from home. While older working-class people like bus drivers or cab drivers, janitors, supermarket clerks, etc., they are the ones who are out there exposing themselves even though they are high risk, and they are building up the herd immunity that protects the lower-risk college students and young professionals. So that doesn't make any sense. So the current strategy is sort of very unequitable in that sense. It's not only that it generates more death, more mortality, it's also sort of unfair that we're putting the burden on the working class here.
Martin Kulldorff
Now, with multi-generational homes, I think that's the most challenging. With general lockdowns, we're sort of pushing out the pandemic for a longer time. And the longer it goes on, the harder it will be for those multi-generational families to protect themselves. So even if they do nothing, it's better to have gone through this quicker rather than dragging it out. But there are things that can be done for them. I had that situation in my own family, and we arranged it. For example, a grandparent living with their son, daughter and grandchildren might temporarily live with a sibling, so that they can isolate themselves together. Because it's been shown from Stockholm that older people who live with other older people that can self-isolate with have less risk than if they live with a working-age adult. So that's one thing. Also, there are many empty hotel rooms. So if somebody from a multi-family wants to stay in a hotel room, we can sort of try to make that available for them. And you don't want to do that for a year, or even six months if we drag this out, but to do it for a month during the height of transmission might be okay for some people.
Shaun Francis
So let's dig into that a bit, the timeline. So pursuing a strategy like this, does this go on for years? Or does it go on for months?
Martin Kulldorff
If we do this focused prevention strategy, I think this pandemic will be over in three to six months.
Shaun Francis
People in this mitigation or elimination camp, it seems like they're fixated on a vaccine, and the vaccine is going to arrive and effectively get us all to herd immunity. You know, what's your take on vaccines in general and that possibility?
Martin Kulldorff
So I do a lot of work with vaccines. And at this point, there are many vaccines in the pipeline, and hopefully—not all of them are going to work out but hopefully some will. But we don't know if and when we will have a vaccine and how good it will be and it will have adverse reactions and so on. We don't know that yet. But I'm a native from Sweden, and I had a discussion in the biggest daily newspaper with an oncologist who was arguing for Sweden should lock down like the rest of Europe. And his argument was, in a few months we're going to have Remdesivir because it was already in phase three clinical trials, and therefore if we just lock down for a few months, we'll be fine, we'll have a cure and then few people will die. So my thought was, well maybe, but we can't really rely on that. Because for other viruses, it has taken a long time to get treatments or vaccine. And sometimes we still haven't done it. So we don't have a vaccine for HIV, for example.
Martin Kulldorff
So from the bottom of my heart, I wish that I was wrong then and that he had been right. Because that would have been better for the whole world. But unfortunately, I was correct. So we could gamble on having a vaccine. And I think that's, for example, what New Zealand is doing. They are locking down very severely with closing borders and stuff. And they are hoping to have a vaccine at some point. And their choice is basically to keep locking down like they are now until the vaccine is there, or open up and then use focus prevention strategy protecting the old. The irony though, with New Zealand is that, since they don't have any cases there, you can't develop the vaccine in New Zealand. So for New Zealand to get a vaccine, they are actually dependent on those countries like the UK, Canada and the US where the disease is actually circulating. So if everybody did like New Zealand, we would never have a vaccine.
Shaun Francis
Just play that out for a moment. What if we do get to this organic herd immunity, for lack of a better term, early next year, there is no vaccine. What do countries like New Zealand, and it appears even Australia is following this strategy, what do they do?
Martin Kulldorff
At some point, they're going to have to open their borders, and then they have to go through the epidemic in their country. Then they should use the focus prevention to protect the elderly. But the lockdown that they have now has severe economic consequences for New Zealand. Presumably for Australia, also, but I'm more familiar with New Zealand.
Shaun Francis
In talking about the vaccine, it may not be 100 percent either, is that not the case, in terms of its effectiveness?
Martin Kulldorff
Correct. So like the flu vaccine, if a flu vaccine is 50 percent effective, that's a good year. So we don't know what the percent would be. So even if we have a vaccine, it's very likely that the vaccine by itself will not be enough. We need a combination of vaccines and natural immunity from natural infection. But those things are all up in the air. There are many things we don't know, but at this point, the collateral damage from the lockdown is so severe with children not going to school, that's not just bad for their education, it's also bad for their physical health and for their mental health, because children need to socialize and engage with others of their age. So these are already severe consequences of collateral damage from the lockdown. Childhood immunizations have been plummeting, cancer screening is down, people are not getting the proper treatment for cardiovascular disease. And that's the main flaw in this whole approach to COVID, that people are looking at it in terms of yes, COVID-19. And you can't do that in public health. That goes against all the principles of public health. You have to look at health as a whole, all aspects of it. And we have completely failed doing that.
Martin Kulldorff
And to do a lockdown for a month or so in the spring to flatten the curve, not to overburden the hospital, I think that was a good idea, to sort of make sure that didn't happen. But to continue that after the hospitals were fine, that I think is the biggest public health failure in history, and also the worst assault on the working class in half a century.
Shaun Francis
Testing and tracing is almost all we hear in the media. That's where I'm disoriented.
Martin Kulldorff
I'm also disoriented. So we're in this—yeah.
Shaun Francis
We're in this together.
Martin Kulldorff
So contact tracing works in situations when there are few people who have the disease. And when it's easy to find them. So for example, Ebola. We had a few cases of Ebola in the US. And it's important that it doesn't spread to others. Then it's important to quarantine those who have Ebola, to do contact tracing to see who else they were in contact with, test them, and maybe isolate some of them as well. So this is a standard practice for certain infectious diseases. But to think that it will work for a pandemic, that's nonsensical. By definition, you can’t do contact tracing and testing and isolation for a pandemic.
Martin Kulldorff
So in a pandemic, we have a situation where a lot of people have the disease. So there's no sense in doing contact tracing when there are so many people who have it. Also, it's very difficult for COVID, because many people are asymptomatic, and it's very difficult to do contact tracing when a lot of them are asymptomatic. Also, when people infect others, it's done before they become symptomatic. So that also makes contact tracing harder. And then somebody will say, "Well, they did it in New Zealand." Well, if you do a very, very harsh lockdown, then on top of that, if you find cases, which you will, then contact tracing can work slightly on top of that. But with a pandemic, lockdown will reduce infections, it will push them into the future, but it won’t eliminate them.
Martin Kulldorff
Also, for example, with measles, we have herd immunity. So then if you have a small outbreak, we can do some contact tracing of the measles. And maybe when we have herd immunity for COVID, we can do something similar if we have an outbreak in a nursing home, for example. But to do it right now, in the middle of a pandemic does not make, in my opinion, any sense.
Shaun Francis
I mean, you are Swedish by origin. And that's how Sweden is playing it out at the moment.
Martin Kulldorff
Yes. So for example, Sweden was the only major western country who did not close its schools during the height of the pandemic in the spring. And all children from daycare at age one to age 15 were normally in school. And during this time, there were exactly zero deaths from COVID-19 in Sweden. There were a few hospitalizations, but again, less than for annual influenza. Less risk. Also, the teachers, their risk was the same as the average of all other professions. So there was not an increased risk by hanging out with children all the time. And what did Sweden do with the schools? Well, if a kid was sick, they were told to stay home, and if they got sick, like a cough or a runny nose at school, they were sent home immediately. They did some extra cleaning, but there were no masks, there was no social distancing. So the children were allowed to live their normal lives, which I think children need to, which is very important.
Shaun Francis
This has proved though, would you say equally controversial in Sweden? Or are people more appreciative of this strategy there?
Martin Kulldorff
There's a lot of support among the population for the strategy that Sweden has pursued.
Shaun Francis
Yet Sweden has become—I mean, what do you say to people that say, "Well look, Sweden's had a higher death per million, and their economy has also done terrible?"
Martin Kulldorff
It depends on what country you compare it to. So Sweden has had more death per population than, for example, Denmark or Norway, but less than the US, the United Kingdom and many other countries who did lock down. We have to look at mortality in the long run. So if a country has higher mortality but also higher immunity, that country's actually in a better situation than a country who had very low mortality and almost no immunity. Because that country is going to have to go through this whole thing again, unless there's a very effective vaccine coming up soon. And I think in terms of the economy, Sweden is doing better than many other countries.
Shaun Francis
And certainly the quality of life, right? Having some consistency, to know they're not going to go into a sudden lockdown has to provide some level of positive mental health.
Martin Kulldorff
Very much so. Certainly. And for children to be able to live a normal life, I think is very, very important. And this has long-term benefits on public health.
Shaun Francis
In Europe and in North America, we're quote unquote, "In a second wave." So we're seeing cases, we're seeing some increase in hospitalizations, but the data isn't great and we're bracing for this onslaught. How do you expect this to play out?
Martin Kulldorff
It's hard to predict. There might be some places that already have herd immunity, so that when all the restrictions are released, there will be no outbreaks. But I'm also sure that there are places who have not reached herd immunity, so that there will be increased cases. And that's when it's really critical to do this focus prevention, where we protect the high-risk people and let the younger people sort of take the burden of generating the immunity that will protect everybody down the road.
Shaun Francis
Did you ever think you would find—I mean, this has been hyper-politicized. The joke is, you know, no one could pronounce epidemiologist a year ago, let alone, you know, find yourself, I'm sure, with thousands and millions of followers or haters. Did you ever think you'd find yourself in this situation? And what's it been like in the academic environment? Is it still collegial, or is it as partisan as we see it in the media?
Martin Kulldorff
From a scientist's perspective it's stunning. And the lack of open discussion, that certain views have been shut down. For example in England now, Sunetra Gupta is the preeminent infectious disease technologist in the world, and people are not listening to her until very recently. Now I think she is in the media instead of—people are listening to people like Tom Brady for example, who is not a technologist, or Neil Ferguson. There are many of us who've sort of tried to speak up, but there's been silence. So I think that's a huge problem for how scientific discourse, and I think is creating a lot less trust, public trust in science and scientists. But that's also a huge disappointment I have with some of my colleagues and technologists, because they have mixed their public health messages with their political message. And I have made a conscious decision that my political views right now are irrelevant. What's important to me is my knowledge of public health. So I have deliberately not mixed the two, because if I say I like this politician or dislike that politician, then I get half the country against me automatically and they're not going to listen to me. And we have to do this together, because we share this beautiful world together. And we also share the viruses. And I care about everybody no matter what their political leanings are. So I understand that journalists and politicians, they always make politics out of it. But I don't understand why serious public health scientists are mixing their public health message with their political viewpoints. To me, that's irresponsible to do that.
Shaun Francis
Professor Kulldorff, thank you very much for your time today. I know you're super busy. But I truly think you're doing a great service for the world. You probably never thought you would be in this position a year ago.
Martin Kulldorff
I did not.
Shaun Francis
None of us did, but in particular yourself. And I actually think it takes great courage to do what you've done with your colleagues. And I want to thank you for your courage in addition to your time today.
Martin Kulldorff
Thank you so much for having me on. It was a great pleasure talking to you.
Shaun Francis
Thank you, Martin.
Chris
That’s a wrap for this episode of Eat Move Think. Professor Martin Kulldorff is on Twitter @martinkulldorff, with two Ls and two Fs. To learn more about the Great Barrington Declaration we’ll post links as well as the full episode transcript at Eatmovethinkpodcast.com.
Chris
Eat Move Think is produced by Ghost Bureau. Senior producer is Russell Gragg. Social media support from Emily Mannella. Additional direction from Chantel Guertin.
Chris
Remember to rate and subscribe to Eat Move Think on your favourite podcast platform. Follow Shaun on Twitter and Instagram @shauncfrancis—that's Shaun with a U—and Medcan @medcanlivewell. We'll be back soon with a new episode examining the latest in health and wellness.