Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion at CNN.
In the week or so since the White House inner circle added yet another Covid-19 adviser to President Donald Trump, many have become confused about what he thinks the country should do about the pandemic.
Because the adviser, Scott Atlas, a retired radiologist, has opposed the widespread use of masks and testing and is strongly pushing a reopening of schools, businesses and general society, some concluded that he favors herd immunity. That he is one of those people who think we should let the pandemic run its course until so many people are immune (or dead) that the virus has no one left to infect.
In July, Atlas told Fox News radio that “when you isolate everyone, including all the healthy people, you’re prolonging the problem because you’re preventing population immunity … Low-risk groups getting the infection is not a problem. In fact, it’s a positive.”
Still, Dr. Atlas has recently and energetically denied a direct embrace of orthodox, hands-off herd immunity, saying he is being misrepresented.
Even so, his view is actually a variation of that bad idea. It’s herd-immunity adjacent. Dr. Atlas would ignore the mostly healthy and focus only on highest risk groups, such as the old, the sick and those with chronic medical conditions, such as weakened immune systems.
He calls this the “smart” approach, which he laid out in a recent opinion piece. He claims to favor “highly detailed, real-time monitoring; a smart, prioritized, intensive testing strategy for nursing home staff and residents; deployment of massive extra resources, including point-of-care testing, personal protective equipment (PPE), infection control training and rapid mobilization of CDC strike teams for nursing homes; and extra PPE and point-of-care testing for the environments with elderly individuals outside of nursing homes, like visiting nurse in-home care and senior centers.”
This focus on the high-risk group is absolutely a great idea for problems like smoking, asthma, obesity and diabetes. Only those at risk need resources. We don’t close down schools because of childhood asthma.
But Covid-19 is a highly contagious disease. It spreads easily from the strong to the weak. Without a vaccine or a treatment, you really can’t stop it. So even if it were true that the young have no real risk for serious disease, as Dr. Atlas misleading states in his article, (Dr. Atlas cites a May 11 article of just 48 children to make this very wrong point) we would still have a problem.
Simply put: Kids are contagious. Teenagers are contagious. Young adults are contagious. Everyone with coronavirus may infect someone else. All the articles suggesting this or that age group does or does not have high amounts of virus and therefore is or isn’t contagious have gone in pointless circles. Covid-19 is a respiratory virus; all respiratory viruses are contagious regardless of age. The relative degree of contagiousness is one for the academics to duke out, not those trying to stop the pandemic.
In pushing his hodge-podge, Atlas overlooks a very important fact: The debate about the role children play in spreading contagious diseases was settled long ago. Infants are vaccinated against influenza for two very different reasons. Those younger than two have higher rates of severe disease, and vaccines help them stay alive.
But at the societal level, we give influenza vaccine because it is more efficient than vaccinating the entire adult population – many of whom, are the elderly and the sick, and if vaccinated would probably not mount a protective response to a vaccine.
When a disease, like Covid-19, has no vaccine or surefire treatment, preventing spread among children and teenagers is essential because so many younger people don’t develop symptoms. As they happily go about their business, they can unwittingly spread the virus, mostly to their peers, but also to Mom or Dad or the older guy selling them the microbrew.
Indeed, it is likely that the best use of the Covid-19 vaccine will be to give it first to the young, whose immune systems will respond extremely well. This will stop them from being pandemic spreaders. As with influenza vaccine, it is likely that many of those in greatest need of protection – the elderly – will have a sluggish and sub-optimal response. This would be a “smart, prioritized” strategy.
Dr. Atlas is wearing the mantle of a “common sense” scientist who has been in the game for decades. He made his mark as an expert in the radiology in MRI scanning of the brain and spine. He proudly declares that he is all about the evidence. But in his dismissal of the current approach, he is overlooking the outcome of the tragic experiment of nature that has happened over the past six months. We already know how to control the pandemic. And we also know what sounds good but simply does not work.
We have seen directly that the basic mask-wearing, social distancing and test-and-track strategies work in cities like New York and countries like South Korea and Germany, and professional sports teams worldwide.
We also know that opening schools and indoor restaurants does not work. Infection spreads catastrophically. Newly re-opened colleges right now are becoming overwhelmed with infections (51,000 and counting, according to the New York Times), with many switching back to remote learning as quickly as they can. Yes, few of the college kids will be hospitalized or die from their new infection, but the prognosis for their parents and older neighbors and friends is not so secure. Deaths have gone up in the states where the “don’t worry, be happy” approach has been used.
And most important of all, these trends are not in obscure medical journals but right here in front of us all. Real numbers, real facts, and more than 187,000 dead Americans.