Trump’s New Coronavirus Adviser Wants to Copy Sweden Approach
"Trump’s allies back up his attacks on CDC chief "H.H.S. backs Trump reelection, blocks C.D.C. science expertise - C.D.C. Testing Guidance Was Published Against Scientists’ Objections "hookrider, C.D.C. Now Says People Without Covid-19 Symptoms Do Not Need Testing "cdc-quietly-changes-testing-guidelines: IMO, Trump doesn't like the numbers so high from testing. So change the guidelines so he can say the numbers went down. Then he can say he is doing a great job!!! Like all things Trump it's lies & bull shit!!!" P - Trump history suggests you likely are right. It sounds almost criminally negligent to me. Potentially, at least."""
Aug. 31, 2020 By Benjamin Hart @realaxelfoley
PHOTO - Trump and his “anti-Fauci.” Jabin Botsford/The Washington Post via Getty Images
As COVID-19 swept through Italy and other parts of Europe in February and March, most nearby countries instituted strict, or semi-strict, lockdowns. Sweden went a different way. Instead, it embarked upon a strategy of “herd immunity,” hoping that enough healthy people would contract and recover from the virus for life to resume pretty much as normal.
Naturally, this is the model President Trump is now interested in replicating.
The president’s new, trusted adviser on the pandemic is Scott Atlas, a senior fellow at Stanford’s conservative Hoover Institution who endorses a Sweden-style approach for America that would protect specific vulnerable populations, like those in nursing homes, while largely allowing the coronavirus to spread unchecked through other sectors of society. And his philosophy may at least partially explain several shifts in federal policy over the last few weeks.
Atlas reportedly calls himself the “anti-Fauci,” positioning himself in opposition to Anthony Fauci, who has become a villain in conservative media and who has been all but invisible in White House messaging in recent weeks. And indeed, Fauci, plus a raft of other experts, maintains that the approach Atlas advocates is deeply misguided.
The central problem is that even as the virus has run rampant across America — the country’s mortality rate is very near Sweden’s as is .. https://twitter.com/dwallacewells/status/1300426540187082752 — nowhere near enough people in the United States have contracted the coronavirus to hit that threshold. The country has now surpassed 6 million cases, but the World Health Organization’s chief scientist says that 65 percent of the population would need to contract the virus to reach herd immunity. That would mean tens of millions of new cases and hundreds of thousands, if not millions, of deaths.
- While age appears to be the strongest predictor of death and severe disease, other risks like diabetes and obesity correlate with bad outcomes. About 10% of Americans have diabetes, and 40% are considered obese. Young people can fall seriously ill. About 40% of hospitalizations in Sunbelt states in the last week of June were in people ages 18 to 49. Then there are those who survive but don’t fully recover. There’s growing evidence that the virus can damage the heart and cause dangerous autoimmune and inflammatory conditions, including in children.
Covid spreads too easily to think it can be confined to the young. The summer epidemics in Sunbelt states initially affected mainly a younger cohort and then seeped into an older population. A wedding in Maine caused an outbreak that spread to a rehabilitation center and a jail. It is neither possible nor desirable to lock away the elderly and people with underlying health conditions. -
But despite the obvious flaws in Atlas’s thinking, the federal government is taking actions that would seem to endorse it, as the Post reports:
- The Department of Health and Human Services, for instance, invoked the Defense Production Act earlier this month to expedite the shipment of tests to nursing homes — but the administration has not significantly ramped up spending on testing elsewhere, despite persistent shortages. Trump and top White House aides, including Atlas, have also repeatedly pushed to reopen schools and lift lockdown orders, despite outbreaks in several schools that attempted to resume in-person classes.
The Centers for Disease Control and Prevention also updated its testing guidance last week to say that those who are asymptomatic do not necessarily have to be tested. That prompted an outcry from medical groups, infectious-disease experts and local health officials, who said the change meant that asymptomatic people who had contact with an infected person would not be tested. -
Given the mistrust among many governors engendered by the Trump administration’s fumbling response to the pandemic, plus the fragmented response that was perhaps an inevitable by-product of American federalism .. https://nymag.com/intelligencer/2020/04/federalism-is-a-bad-prescription-for-handling-coronavirus.html , it is unlikely that Atlas, or Trump, will be able to direct most of the country’s health-care infrastructure toward the “herd mentality” model. But the president’s embrace of the idea is yet another sign that — at least until January — a rational federal approach to fighting a virus that has killed more than 180,000 Americans will have to wait.
Scott Atlas, MD, has advocated using the Swedish approach, allowing people to become infected naturally in order to build immunity to COVID-19 while focusing on protecting the vulnerable, like nursing home residents. The Post's report is based on interviews with five people who were familiar with the discussions.
"There's news, there's opinion, and then there's overt lie," he said. "And that was never a strategy advocated by me in the administration. The President does not have a strategy like that. I have never advocated that strategy."
Public health experts roundly criticized that approach, noting that it hasn't worked in Sweden .. https://www.medpagetoday.com/infectiousdisease/covid19/87812 , which has the highest COVID-19 mortality rates among the Nordic countries. Its 574 deaths per million people far outnumber Denmark's 108 deaths per million, Finland's 61 deaths per million, and Norway's 49 deaths per million. The Swedish figure is closer to Italy's 587 deaths per million.
"Sweden tried this 'herd immunity' approach and had many more deaths than their European peers per capita and hasn't escaped the economic carnage they had hoped by this strategy," tweeted Gregg Gonsalves, PhD .. https://twitter.com/gregggonsalves/status/1300393181318709249?s=20 , an epidemiologist at Yale School of Medicine.
"Herd immunity? Sweden model? Sweden had a higher death rate than Denmark, Norway, and Finland, AND its economy did worse. The only alternative to controlling the virus is more deaths and more economic devastation. Choose health," tweeted Tom Frieden, MD, MPH .. https://twitter.com/DrTomFrieden/status/1300449586096541700?s=20 , a former CDC director.
"Dr. Atlas, a radiologist, has no training or expertise in infectious diseases, but what he does have are the words the President wants to hear: you can let the virus spread widely throughout the US if you just try to keep the elderly safe, open up everything and let 'er rip," he tweeted .. https://twitter.com/gregggonsalves/status/1300392873657917440?s=20 .
According to the California Medical Board, Atlas is board certified in diagnostic radiology and neuroradiology.
The Post reported that Atlas was hired because Trump was looking for a doctor whose opinions on the pandemic were more in line with his own vision. Other physicians on the White House coronavirus task force, notably Anthony Fauci, MD, and Deborah Birx, MD, have fallen out of favor with the president.
The Post reported that he meets with Trump every day, more than any other health official.
Moreover, according to the Post, other administration actions are in line with a herd immunity strategy, even if officials don't admit it. For instance, the Department of Health and Human Services has ramped up shipments of tests to nursing homes, but hasn't increased spending on testing in other areas.
The newspaper noted that countries that have best controlled the virus implemented strict lockdowns that were heeded by citizens, imposed mask mandates, and deployed widespread testing and contact tracing.
It's not certain what percentage of the U.S. population of about 328 million would need to be infected to achieve herd immunity. Given its transmissibility, the World Health Organization (WHO) estimates that 65% to 70% of a population would need to be immune to the virus before it would burn itself out -- though in some recent reports, experts have argued .. https://www.nytimes.com/2020/08/17/health/coronavirus-herd-immunity.html .. that the number may be closer to 40% or 50%.
Currently, the U.S. has a case fatality rate of about 3%, based on 187,000 deaths and 6.2 million infections; however, the infection fatality rate is likely lower since most asymptomatic infections probably aren't detected. The CDC uses 0.65% .. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html .. in its pandemic planning scenarios.
Using the WHO (65%) and CDC (0.65%) figures, 213 million people in the U.S. would need to be infected to achieve herd immunity, leaving 1,385,800 Americans dead.
Stress on the nation's hospitals could also be tremendous. Thus far, about 370,000 Americans have been hospitalized with COVID-19. If we assume that, for each case diagnosed so far, five cases occurred without symptoms or diagnoses, that leads to a hospitalization rate of about 1%. With 213 million infections, then, about 2.3 million could be expected to end up hospitalized.
Those hospitalizations come with a cost, of course. Studies have yielded a wide range of median or average costs, from just over $10,000 to more than $70,000 .. https://www.healthcaredive.com/news/health-affairs-covid-treatment-cost-predictions/576693/ . If for simplicity we assume it averages $30,000, the total hospital bill to achieve herd immunity is about $80 billion.
And herd immunity works only if people can't get re-infected with the virus, which isn't a certainty, according to Leana Wen, MD, of George Washington University.
"We don't even know if we can achieve lasting immunity -- most likely, we can't," Wen tweeted .. https://twitter.com/DrLeanaWen/status/1300811190768144384 . "And even if we could, it would take hundreds of millions more #covid19 infections & millions of preventable deaths. That cannot be our price."
Kristina Fiore .. https://www.medpagetoday.com/people/kf5618/kristina-fiore .. leads MedPage’s enterprise & investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to k.fiore@medpagetoday.com. Follow
Conservatives, especially Trump supporters have established that they're okay with collateral damage of over 200K human lives lost as the cost of opening the economy and keeping Trump in office. No wonder a greedy "doctor" from the Hoover Institute is now promoting an agenda that runs counter to the goal of most of us in healthcare. Watching Trump bumble through the protest site in Kenosha while ignoring the recommendation (and law) to wear a GD mask, just confirms that he has no other goal than to become a dictator, and he's actually getting closer every day. Be careful people, as the Republic is on very shaky ground.
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