A common refrain among advocates of extreme “lockdown” measures in response to the novel coronavirus pandemic has been that we must trust scientists specializing in infectious diseases to guide policymaking, and if such experts as Dr. Anthony Fauci say we need to be implementing such measures, then that is what we must do.
A recent example is a New York Times article that advocated lockdown measures by characterizing Dr. Scott Atlas, a vocal critic of lockdown policies who has joined the White House coronavirus task force, as holding radical and untenable views. The headline declares that Atlas has “Unorthodox Ideas”, and the summary description calls him “a coronavirus contrarian”.
The first thing the Times does is to suggest that Dr. Atlas does not have the credentials to be weighing in how the government ought to be responding to SARS-CoV-2, the virus that causes COVID-19. Below the headline, a photo of Atlas includes a caption saying, “Dr. Scott W. Atlas is neither an epidemiologist nor an infectious disease expert, but his frequent appearances on Fox News Channel and his ideological surety caught the president’s eye.”
In the second paragraph, we learn that Dr. Atlas is a “radiologist and senior fellow at Stanford University’s conservative Hoover Institution”, but then we are quickly reminded that “Dr. Atlas is neither an epidemiologist nor an infectious disease expert, the two jobs usually associated with pandemic response.”
Near the end of the article, the Times also notes that Atlas was “chief of neuroradiology at Stanford University Medical Center from 1998 to 2012 and editor of the textbook ‘Magnetic Resonance Imaging of the Brain and Spine’”, which is a medical background, the Times adds, that “appears incongruous with his current role.”
We should be listening instead to supposedly more qualified experts, the Times asserts, like Dr. Anthony Fauci, Dr. Deborah Birx, and Surgeon General Jerome Adams, who, we’re told, find Dr. Atlas’s ideas “misguided—even dangerous”.
In sum, the Times’ argument is essentially that only epidemiologists and infectious disease experts are qualified to issue policy advice about how government should respond to the outbreak of SARS-CoV-2, the virus that causes COVID-19.
Since that is an opinion, we cannot rate it as “true” or “false”. What we can do, however, is judge whether it is reasonable or not.
A contrary opinion is that there is a much broader range of expertise required to analyze and assess not only the impacts of the virus but also the impacts of any potential government responses to it.
Epidemiologists and infectious disease experts might be well qualified to weigh in on the impact of the virus and give ideas about how best to rise to that challenge, but a corollary of the Times’ own logic is that they are not qualified to weigh in on the economic harms of lockdown measures or the moral and ethical considerations related to the accompanying infringements on individual liberty.
An agency that does not specialize in infectious disease control but that is certainly qualified to weigh in on the economic harms of lockdown measures is the United Nations University World Institute for Development Economics Research (UNU-WIDER), which “provides economic analysis and policy advice with the aim of promoting sustainable and equitable development.”
In April, this UN agency issued a report estimating the impact on global poverty of the political and societal responses to the pandemic. Its authors expressed the concern that the result could be an increase in global poverty that “could represent a reversal of approximately a decade in the world’s progress in reducing poverty.”
For the world’s poor, the economic costs of lockdown are not a mere inconvenience. Policies that wittingly cause harm to the global economy have costs measurable not only in dollars but also in worsened health and lost lives.
Another report from the UN in April specifically on the impact of the economic harms on children assessed that lockdown measures “may inadvertently do more harm than good”.
By causing a global economic downturn, these policies “could result in hundreds of thousands of additional child deaths in 2020, reversing the last 2 to 3 years of progress in reducing infant mortality within a single year. And this alarming figure does not even take into account services disrupted due to the crisis—it only reflects the current relationship between economies and mortality, so is likely an under-estimate of the impact.”
The “rising malnutrition” among hundreds of millions of children and “risks to child mental health and well being are considerable.” There was also a “heightened risk of children witnessing or suffering violence and abuse” under “shelter in place measures”.
While children are thankfully at low risk from the disease itself, the consequences to children of the economic shutdowns “risk being catastrophic”.
The “potential losses that may accrue” from school closures “in learning for today’s young generation, and for the development of their human capital, are hard to fathom.”
The “hastily implemented lockdown measures risk disrupting food supply chains and local food markets”, with “potentially grave consequences for food security.”
Another foreseeable consequence would be “hundreds of thousands of additional child deaths” that “would effectively reverse the last 2 to 3 years of progress in reducing infant mortality within a single year.” (The bold emphasis is the original.)
In late July, the United Nations Children’s Fund (UNICEF) warned that the economic impact to the global economy could result in an estimated 6.7 million children under five years of age suffering from wasting, a life-threatening form of malnutrition, which “would translate into over 10,000 additional child deaths per month with over 50 per cent of these deaths in sub-Saharan Africa.” This estimate, the UN added, was “only the tip of the iceberg” in terms of the harms caused.
The UN cited a paper published in The Lancet medical journal on the impacts of the global economic downturn on childhood malnutrition and nutrition-related mortality, which described the consequences as an “unprecedented global social and economic crisis” that “poses grave risks to the nutritional status and survival of young children in low-income and middle-income countries”. While the policies that have caused this economic crisis are ostensibly aimed at reducing deaths from an infectious disease, the authors of the paper noted that “wasted children are at increased risk of mortality from infectious diseases.”
The International Food Policy Research Institute estimated that “an additional 140 million people will be thrown into living in extreme poverty on less than US$1.90 per day in 2020.” The World Food Programme estimated that the number of people “facing acute food insecurity will nearly double to 265 million by the end of 2020.”
The authors added that “even fairly short lockdown measures” had a large impact on per capita gross national income, decreases of which “are associated with large increases in child wasting.” They estimated “a 14.3% increase in the prevalence of moderate or severe wasting among children younger than 5 years”, which “would translate to an additional estimated 6.7 million children with wasting in 2020”.
Combined with the reduction in coverage of nutrition and health services, they estimated that “there would be 128,605 (ranging from 111,193 to 178,510 for best and worst case scenarios) additional deaths in children younger than 5 years during 2020,” more than half of which would occur in Sub-Saharan Africa.
These estimates, they said, “are likely to be conservative”. Other forms of malnutrition, including child stunting and maternal malnutrition, were also expected to increase along with “the deepening of economic food systems crises” and the “disruption of other health services during lockdowns” that “will further compromise maternal and child health and mortality”.
The “profound impact” of the global economic downturn “on early life nutrition could have intergenerational consequences for child growth and development and life-long impacts on education, chronic disease risks, and overall human capital formation.”
In an accompanying Lancet article, the Executive Director of UNICEF, the Director-General of the Food and Agriculture Organization of the United Nations, the Executive Director of the World Food Programme, and the Director General of the World Health Organization noted that policy responses to the SARS-CoV-2 pandemic were “undermining nutrition across the world”, with the “worst consequences” being “borne by young children.”
As they pointed out, “Some of the strategies to respond to COVID-19—including physical distancing, school closures, trade restrictions, and country lockdowns—are impacting food systems by disrupting the production, transportation, and sale of nutritious, fresh, and affordable foods, forcing millions of families to rely on nutrient-poor alternatives.”
The resulting malnutrition could counterproductively “exacerbate the effects of COVID-19 in mothers and children”, and without immediate action to mitigate the economic harms, there would be “devastating long-term consequences for children, human capital, and national economies.”
While lockdown advocates have remained singularly focused on minimizing cases of and deaths from COVID-19, there are innumerable other factors that must be considered, including the foreseeable harms from lockdown measures. The idea that only those with training in sciences like epidemiology, virology, and immunology are qualified to offer guidance on how governments should act is ludicrously and dangerously narrow-minded.
Presently, over 908,000 deaths have been attributed to COVID-19 globally, but the data show that most fatalities occur in elderly people with other underlying medical conditions, and if we consider the numbers in terms of quality-adjusted years of life lost, given the estimates of the negative consequences of lockdown policies, including hundreds of thousands of excess childhood deaths, the argument can easily be made that these policies are causing more harm than good.
Dr. Atlas and several coauthors made precisely that argument in an article published in The Hill on May 25, in which they focused more narrowly on the US but pointed out that policymakers must also take into account the statistical association between loss of economic output and increased mortality, with foreseeable deaths also related to lost income and the stresses of unemployment including an increase in suicides, alcohol and drug abuse, and stress-induced illnesses. Additionally, lives were being lost due to delayed or foregone health care, which in most hospitals was not an unavoidable outcome of the epidemic itself but a result of shutdowns and the fear they generated—along with the fear generated by the vocal advocates of these policies.
It is striking that when lockdown measures were implemented, little if any thought was given to the economic costs and whether the potential harms of effectively shutting down the economy might outweigh the benefits. Notable lockdown advocates have candidly acknowledged that economic analysis has not weighted heavily into their considerations.
For example, in their the mid-March modeling study that was so influential in convincing policymakers in the UK, the US, and elsewhere to implement extreme lockdown measures, Neil Ferguson and his coauthors from Imperial College London explicitly stated that they “do not consider the ethical or economic implications” of the policy they were advocating.
How can one reasonably advocate a policy of effectively shutting down the economy without considering the potential economic harms of that policy, which must be measured not only in dollars but also in terms of the negative health consequences and lives lost due to the lockdown measures?
Furthermore, how can one reasonably advocate policies of such an authoritarian nature without considering the implications for fundamental human rights and the precedents of infringing on individual liberty, such as people essentially being told that they have no right to earn a living because their jobs have been deemed “non-essential” by bureaucrats who have no comprehension of how the economy functions?
To do so is by no means reasonable.
Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) under the NIH and also an advisor on the White House task force, has similarly acknowledged, “I don’t give advice about economic things. I don’t give advice about anything other than public health.”
Fauci’s lack of expertise on matters of economics or civil liberties has not stopped him from advocating extreme lockdown measures, including having urged state governments to be “as forceful as possible” in their executive mask-wearing orders and to force businesses to close as well as having called for a federally mandated “stay-at-home” order.
Unlike the New York Times, however, Dr. Fauci did not express the view that only epidemiologists and infectious disease experts like him should be consulted about what the government’s response to the virus should be. Rather, he prefaced his remark about not offering economic advice by acknowledging the need for a broader range of advisory opinions by saying, “I’m a scientist, a physician, and a public health official. I give advice, according to the best scientific evidence. There are a number of other people who come into that and give advice that are more related to . . . the need to get the country back open again, and economically.”
Thus, while the Times argues that only people like Dr. Fauci who have supported lockdown measures are qualified to offer policy guidance, Dr. Fauci himself appears to reject that view. While he doesn’t appear to have weighted the economic harms heavily in his own considerations, he at least appears to recognize the need for experts in other fields to weigh in with other assessments.
One would think that a renowned physician like Dr. Atlas would have relevant knowledge for policymakers to consider—especially since his expertise relates to investigation of “the impact of government and the private sector on access, quality, and pricing in health care, global trends in health care innovation, and key economic issues related to the future of technology-based medical advances.”
He has previously advised policymakers frequently, briefed directors of government agencies, and testified before Congress. The textbook the Times mentions for which he is the editor is “the leading textbook in the field”, and he is also the author of several books on health care.
Additionally, he “has been an editor, an associate editor, and a member of the editorial and scientific boards of many journals as well as national and international scientific societies during the past three decades and has written more than 120 scientific publications in leading journals.”
To the New York Times, none of these additional credentials—which the article does not inform us about but which can be found on Dr. Atlas’s bio page at Stanford University—qualify Dr. Atlas to offer his opinions to the White House on how best to mitigate the societal impact of the novel coronavirus. Because he has criticized the extremity of lockdown measures and advocated re-opening of the economy, the Times dubs him a “contrarian”.
But being a “contrarian” to the opinion expressed by the New York Times that lockdown measures have been necessary and appropriate is precisely why we need voices like Dr. Atlas’s to be heard both in the public discourse and in the halls of government.
Clearly, not only the potential benefits but also the potential harms of any given policy must be considered. To fail to do so is reckless and unreasonable.
The New York Times argues that to analyze and assess the impacts of the virus, we should look to epidemiologists and infectious disease experts for guidance, which is sensible. But by the same reasoning, to analyze and assess the impacts of policy responses to the virus, we should look to a broad range of other experts that the Times is suggesting we should not listen to. That suggestion is utterly preposterous.
In conclusion, the New York Times’ argument that we should only listen to epidemiologists and infectious disease experts to know how best to respond to the SARS-CoV-2 epidemic is dangerously myopic and irrational.