Jay Bhattacharya on Responses of Public Health and Economic Experts to Covid-19

Scott (00:00):

Hello and welcome to Two Think Minimum, the podcast of the Technology Policy Institute. Today is Monday, October 10th. I'm Scott Wallsten, president of the Technology Policy Institute. I'm here with my co-host, TPI Senior Fellow and President Emeritus Tom Lenard, and today we're speaking with Dr. Jay Bhattacharya. Dr. Bhattacharya is a professor of health policy at Stanford University and a research associate at the National Bureau of Economic Research. He directs Stanford Center for Demography and Economics of Health and Aging. As research he focuses on the health and wellbeing of vulnerable populations with a particular emphasis on the role of government programs, biomedical innovation, and economics—including the epidemiology of Covid-19 and evaluating policy responses to the epidemic. His broader research interests encompass the implications of population aging for future population health and medical spending, the measurement of physician performance tied to physician payment by insurers, and the role played by biomedical innovation on health. He's published 135 articles in top peer-reviewed scientific journals in medicine, economics, health policy, epidemiology, statistics, law and public health among other fields. He holds an MD and PhD in economics, both from Stanford University. We spoke with Jay back in 2020 and we're delighted to speak with him again today. Jay, thanks so much for joining us again.

Jay (01:06):

Thank you, Scott. Great to be here. Thank you, Tom.

Scott (01:08):

So let's start off with—what, you know, I, I know you're probably tired of talking about by now, but—Covid. And in the early days of the pandemic, you co-authored the Great Barrington Declaration, which to put it mildly, I guess, was widely criticized. And as I read it, it had sort of three main components, and correct me if I'm sort of reading it wrong, but the first was the assertion that lockdowns would be- were extremely costly in terms of lost education, people who couldn't get standard medical care, even if it was urgent financial costs and so on. And then based on that, we should focus on targeting the vulnerable, at least until there was a vaccine, which meant letting the least vulnerable go about their lives. And the third being worked towards herd immunity, which did include using vaccinations. By now, of course, we know the first point is true.

We know that the costs of the lockdowns and school closings were enormous. You can talk to any parent, they know that just intuitively, by seeing their kids and the kids’ lack of progress. But studies have shown that we know 3 million kids disappear from schools and the poorest suffered the most. Lockdowns might have done more to worsen inequality than any other single event in, in recent history. Now, you know, it's hard to argue with that first point, but how do you feel about the other recommendations? What do you feel you got right? What did you get wrong? And what would you have said differently if you knew then what we know now?

Jay (02:16):

So that's a great question, Scott, and I do agree with you about the harms of the lockdowns. They're devastating, and we still haven't paid them all, especially for the poorest countries in the world. We're going to continue to pay them for a very long time. The schooling loss in the U.S. was bad, but you should look what happened in Ghana where four and a half million kids never came back to school after two years out. The generational inequality we've developed—but we sort of pushed through—but the lockdowns is almost unimaginable. But so let's leave that aside. I think we agree on that. There's two other points that we talked about in the Great Barrington Declaration. One was that we could do focused protection for older populations that we could shield them with policy potentially, to protect them from Covid-19, because there's this thousand-fold difference in the risk of dying from — if, if you get Covid for older people, much more than younger people.

That point, I think has been, has been validated and it- now you have to say like- bring your back to October, 2020. We wrote it, the vaccines were still not there. Right? I think that was probably the most legitimate criticism of the, of the Great Barrington Declaration is how do you do focused protection? Now, the Great Barrington Declaration was a one page document. It wasn't aimed at producing a comprehensive strategy for—a detailed tactical strategy for how to do focused protection in every single setting. What it was, was, was a change in principles, how we are managing the pandemic and an invitation to discussion and thinking and creative thinking by local public health. Right? So we gave some suggestions for how this might be accomplished in some settings, right? So for instance, in dense urban settings with lots of multigenerational homes, it might have involved making hotel rooms available for older people who live in multigenerational homes.

(03:48):

So they've, if someone is exposed in the house, they can call local public health. Local public health, then offers them hotel room for a few days until they get cleared. Or organizing home deliveries. It would've been difficult no matter what, especially in very, very crowded places, very, very poor places, without the vaccine. But it would, I think it would've been possible, certainly, if we'd had that as a part of, as the main part of our strategy, we would never have sent Covid-infected patients back to nursing homes. Right? That came about because we were thinking about protection of hospital systems rather than protection of people. But I made a claim that I think it's been validated. I think the validation comes in countries that followed a focused vaccination strategy for older people. Right? So I'll just give the example of Sweden, but you could also point to the UK and other places.

(04:31):

But Sweden's clean. Between November and March in February of 2020 and 2021, it was a massive wave of cases in Sweden. And you know, the cases everywhere around the world in the Northern hemisphere in winter. So that's not surprising. But a lot of deaths came with that, Covid-19 deaths came with that wave. But then there was a second spring wave in Sweden, a very large number of cases that happened in spring of 2021. In the interim, Sweden had vaccinated maybe 10, 15% of its population, but they were very systematic. They went from the oldest on down and they were very, very strict. So like, there was a guy that was in local, in public health in Sweden, was like 40 years old, jumped the queue, got the vaccine, and they fired him because he jumped the queue. And what you saw in Sweden in that spring wave was absolutely remarkable. You had a very large number of cases, but very few deaths per case. You see this decoupling. Just by vaccinating the old, they had decoupled cases from deaths. That's what herd immunity looks like. So both focused protection and herd immunity point comes back to that, what it ought to look like. So herd immunity looks like a decoupling of cases from deaths.

Scott (05:32):

But it- and also, you know, I mean Sweden is the example of that, but you know, there are other countries that had fewer deaths. I mean, Germany ended up having fewer cumulative deaths per capita than Sweden did. And I don't think they took that across.

Jay (05:43):

That's not true anymore, Scott.

Scott (05:44):

In a cumulative sense? I mean, it's true according to…

Jay (05:48):

Yeah cumulative… yeah it’s shocking. But actually I think like— as far as, like, the overall excess death per person, it's actually lower in Sweden through the whole pandemic cumulatively than Germany.

Scott (05:57):

Okay so that's a good point. So you're talking about- it's excess mortality, not just Covid deaths.

Jay:

Yeah.

Scott:

Which probably should be the right measure, right?

Jay (06:04):

Yeah. Uh huh. I mean, I think Sweden is—other than I think Norway, maybe Denmark, but I think it's better than Finland—it's the best in Europe. And it's Norway and Sweden, Norway, Finland— are all four together. The Scandinavian countries did really quite well, and they had a much lighter touch than you know, much of the rest of Europe and certainly much of the United States, again, in terms of overall excess deaths per capita.

Scott (06:25):

Right. And I'm looking through the data here and that, that's right, in terms of just Covid deaths, Germany had fewer per capita than Sweden, but in terms of excess mortality, Sweden did have fewer than Germany or just about anybody else. Yeah.

Jay:

Yeah.

Tom (06:38):

So let's talk about the, the how the various professions behaved during this. I mean, you've been very critical about both the public health professions and the economics professions— both of your hats, I guess. And you know, I find it actually pretty persuasive. But if you could just talk about how the public health community reacted, how the economics community reacted, and what lessons are there to be learned from that?

Jay (07:04):

Well, if I, I have to grade the failure, I- I'd say the public health community did worse. The public health community, I mean, like public health is a funny thing, right? So it's, it's not exactly science, it's related to science, but not exactly science— but the norms of science, which involve free exchange of ideas—lots and lots of people, like, you know, yelling at each other about being wrong and then showing data, correcting each other and learning from each other. That's the norm in science. In public health that is actually seen as not the right thing. Cause it, the idea is it'll confuse the public if you allow that. Public health has this norm of unanimity of messaging. The problem was that in order to have that unity message, to have a moral basis for it, you have to actually have settled science.

(07:44)

And there just wasn't, like the fact that the Great Barrington Declaration drew so many signatories, it's evidence that the science wasn't settled from, you know, prominent scientists. Nobel Prize winners signed it. And yet public health put out this unified messaging and used its power to demolish the reputations of people who signed it. You saw four days after I wrote the Great Barrington Declaration with Sunetra Gupta and Martin Kulldorff, tens of thousands of people have signed it already. The head of the National Institute of Health, Francis Collins wrote an email to Tony Fauci calling the three of us fringe epidemiologists. I mean, I actually, I gotta gotta show you a card— a friend of mine sent me a card, made a card that says “fringe epidemiologist.” I don’t know if you can read it backwards.

Scott:

<Laughs>.

Tom (08:29):

Well I read about that at the time, when it was first publicized. I was shocked, but-

Scott (08:33):

Yeah sorry, I left that out of your bio. <Laughs>

Jay (08:36):

That might be thing though, my epitaph when I die. Fringe Epidemiologist. So, you know, it's, it's kind of an extraordinary thing. He, basically, what they wanted to do was they wanted to create this illusion of consensus that didn't actually exist. It was deeply unethical. Instead of seeking a conversation to say, “Okay, well maybe I'm wrong.” I mean, there's legitimate, as we've had in this podcast in and afterwards, we've had legitimate conversations. The parts where I'm wrong, parts where I'm right. That's how science works, right? There's no, we're not God, nobody's right all the time, but literally everything. So we correct each other. Instead, they organized- public health organized propaganda campaign to destroy this conversation. I started getting calls from reporters asking me why I want to let the virus rip when what I was calling for was focused protection of vulnerable people. I did not want to let the virus rip. Essentially it's like they wanted to create this like idea that was morally wrong to question public health.

(09:23):

That itself was wrong. And that was a, I think, a violation of the obligations the public health has to the public. So I think my criticism of public health is worse than economics. Economists, I think— my main criticism of economists is, we were cowards and it was partly public health that did this, right? So public health made it so that if you brought up costs at all, then there was something wrong with you. You didn't like lives, you valued money over lives. And I think that silenced many economists. Now, there were some intellectual argument that economists made in the early days of the pandemic to try to justify this. They would say things like, “Well, people voluntarily shut down, lockdown kept themselves away, therefore, the formal imposition of lockdown had no marginal harm.” And frankly, I'm unpersuaded by this mainly because if you look at the mobility data, it's only a certain smallish fraction of the population that actually reduced their mobility for extended periods of time.

(10:13):

Essentially, relatively well off people who could afford to work from home with no harm to their livelihood. They're the ones who reduce their mobility, reduce the amount of exposure. Other people serve them, and those people that serve them didn't, you know, people delivering food to their door and so on. If you look at, there's a NBR paper that estimated something like 20% of jobs in the U.S. were replaceable with work from home. I think that group, the economists’ argument that people voluntarily locked down is true for that group, but not for the other 80%. And so I think it was partly because of sort of, I think, bad economic arguments like that. And partly because of— essentially fear of being called a, you know, a grandma killer, economists stayed silent as things that were obviously going to cause tremendous economic harm and health harms happened. We have, I think, I mean, <laugh>, like I, okay, I'm an economist, right? I'm a health economist, right? So like, one of the things that I do in my job is to like point out costs even when it's not popular to do so. That's our- isn't not like our first item in our job description, you guys? But economists just failed at that during the pandemic. And I think we need to have a conversation as economists why that is, and then figure out ways so that we don't fail at that next time.

Scott (11:20):

So economists failed to discuss costs in a meaningful way, and I totally get what you're saying and also how people reacted to it. Bob Hahn and I, a long long time ago, had an article-- an op-ed in the, in the Washington Post called “How Much is Granny Worth?” Just, you know, about the golly of statistical lives. And of course people hated it, which was great, and I love it. I mean, it was great, but it's, it was kind of the same sort of thing, except then it was abstract, and so it didn't, you know, didn't matter. But the other is, sort of a, a refusal to acknowledge uncertainties, I guess. And that's not the way science is supposed to be. I mean, everything is, there's uncertainties involved in everything.

Tom (11:56):

Well, I mean, do you think this is more, I mean, it seems more apparent now, but in this area and, and in some other areas that there's this kind of groupthink and anybody who dissents is <laugh> kind cast out <Laughs>.

Jay:

Onto the fringe.

Tom:

And obviously you’ve experienced some of that personally. I mean, do you think that's- I mean, just as an observation, gotten worse recently than it used to be? I mean, it seems to me there used to be much more discussion of controversial issues than there is now.

Jay (12:22):

It really has. I mean, economists generally, I had always thought were immune to that. Like, we are a contentious bunch. Some of my very favorite memories involved fights in seminar rooms with other people who then we go out and like, just enjoy each other's company afterwards, right? I mean, it's just, that's just normal. It- but economists, I think during the pandemic really did censor themselves. Again, out of fear of being accused of being grandma-killers or whatnot. I'm not sure exactly, but a lot of the, the sort of contentiousness the economists would have with absolute extraordinary economic policy that created inequality and poverty on a grand scale, we stayed silent around. We should have been pushing back. And Scott, I completely agree with you about the uncertainties. It was actually, it's not just uncertainty. It's the asymmetrical way that economists dealt with the uncertainty. Right? So like, take the, the idea of the precautionary principle. Well, what does that mean? You have deep scientific uncertainty about how damaging this virus is. Well, in the precautionary principle, the idea would be, I'm allowed to say, assume the worst, consistent with the evidence about how bad the virus is. But what I'm not allowed to do is assume the best about the interventions I do undertake to manage the virus.

Scott (13:27):

Mh-hm. <Affirmative>

Jay:

Right? I have to still honestly consider the cost of them. I have to honestly consider the likelihood that the DC interventions lack to succeed in managing the virus. All of that is, you don't get to assume that away just by saying “precautionary principle.” And economists who normally would push back very hard against the sort of woolly thinking didn't do so. When it came to thinking about uncertainties, I mean, that's, that's another thing I thought we were really good at, is thinking systematically and rigorously about uncertainties, Scott. But we didn't really do that very well.

Scott (13:54):

Do you think there's a case to be made that economists, that some of the, some-- not the way people reacted to the Great Barrington Declaration and you, because that seems really over the top-- but that it wasn't just cowardice or not thinking about it the way they used to, but there were these models predicting, you know, millions and millions of deaths and we have seen over a million deaths in, in the U.S. and so that there was maybe a rational reason for them to think that the costs of Covid itself would be much, much higher than it turned out to be.

Jay (14:23):

I mean, I think- first, those models were, I mean, they were a thin read, Scott. I mean like-

Scott (14:27):

Right. No, and they were wrong <laugh>.

Jay (14:28):

Yeah. Cause like they, they predicted the millions of deaths within a couple of months of the virus starting to come out, which, You know,

Tom (14:33):

But they also only focused on one thing: Covid.

Scott (14:36):

Yeah, that's right. No, were never…

Jay (14:38):

Exactly. So they were like, they were narrowly focused, proven incorrect, within real time. And then the other thing is, what's the marginal benefit of intervention…

Scott (14:47):

Right.

Jay (14:47):

The models vastly overstated the marginal benefit of lockdown. Just by the design, by assumption they have as the central animating idea that disease spreads when people are physically close to each other. Well, okay, that's, I guess that's true. But then in the model, you just- counterfactual, as you physically keep people apart from each other and oh my gosh, the disease doesn't spread, we've saved, solved everything. The lockdowns in the real world don't act like that. Right? Newborns and moms can't be separated. Parents and kids can't be separated. We need interaction with each other and we're going to seek it out no matter what a model says in a, in a counterfactual. So I think the models were, I mean, as a whole, you're absolutely right. I agree Tom, that, that, that they were like, like economists were romanced by them to some extent, but it was a bad, bad romance. If, if you- if I can just quote the great Lady Gaga song and just, it was it- cause it really just, it, it ended up making us overly incredulous about lockdowns and their efficacy and ignoring their- and we ignored their harms.

Tom (15:42):

So on kinda a related point, I mean, we're a tech think tank and one of the things we focus on or discuss is content moderation on the internet and social media. Now, I know that the social media companies-- I don't know what-- censored or you know, or the anti-vaxxers, and I don't put you in a camp with the anti-vaxxers, so that's not- but did they also censor of people who were talking, who were raising questions about the efficacy of lockdowns?

Jay (16:06):

They did. So when we wrote the Great Barrington Declaration, spiked-online wrote this article, basically Google suppressed it. So if you did search in almost most countries, “the Great Barrington Declaration,” what you would see was the propaganda campaign against us. And on page three, you might see the document itself. That lasted for a few weeks, I think. Facebook pulled down the page for a week for no good reason. Twitter kicked Martin Kulldorff off for a month while- they suspended him for a month. And he could, I mean, it was, although that was for a, a tweet where he said that it doesn't make sense to treat every single person at the same age of all ages with the same vaccine policy. They really put their thumb on the scale. So I'm, I'm involved in a lawsuit that the Missouri and Louisiana Attorney General's office has brought against the Biden administration and discovered from a lawsuit to show that there was a- basically across the federal government, a dozen or more federal agencies worked to tell social media what could and what could not be said. I think that's incredibly dangerous for democracy. I think that it's, you know, of course it's- social media shouldn't permit violent threats against single individuals or that, I mean, those kinds of things. I completely don't make any sense to allow… but

Scott (17:13):

But wait to be clear though, the lawsuit is not against the social media companies for May, for their, you know, for their decisions on what's allowed to go up. It's for the federal government, for the government to be telling the social media companies what they can do. Right? Cause it's very big difference.

Jay:

Exactly. It is a big difference,

Tom (17:28):

The First Amendment lawsuit, that's the First Amendment lawsuit, is that correct?

Jay (17:32):

Yes, it's the first. I think it's the biggest first- I mean, I- I'm biased admittedly, but- but I think it's the most important First Amendment lawsuit since New York Times v. Sullivan. Like, it, it is, it's some ways, analogous. You have the government telling the social media companies here's what can and can't be said in polite company. And then the social media companies- now, I have to say the social media companies, many of them just follow along, and in some cases happily. But it's unclear how happily, right. So when the government says you should be censoring this, it's very difficult for social media companies to say no. Right? I- I or we're not gonna do that because they're always an implicit threat of some sort of punishment. So yeah, we're not going after social media companies, we're going after the government for doing this campaign. In principle, I think the, the government should never be putting its thumb on the scale in this way in terms of the scientific debate. And that's exactly what it did.

Tom (18:20):

Even, even aside from First Amendment issues, what are your about this observations about this, you know, there's, there's a lot of discussion about “fact checking” and “fake news” and, and really, as if it's always obvious what the correct facts are, and what's fake news and what's not. And this seems to be kind of a prime example of how you can go wrong with it. You know, that's a very risky enterprise.

Jay (18:44):

I mean, Tom, what I've noticed during the pandemic was that basically those fact checkers got nearly everything wrong. Nearly everything wrong. Right? Like one of my earliest interactions with them was this, I did this like estimate of the infection fatality rate using this study that I ran early in the pandemic-- couple studies I ran early in the pandemic. And there were fact checkers that were going after- saying things like- basically where they confused the case fatality rate, which is the fatality rate among people I like, showed up and tested positive for Covid versus the infection fatality rate, which is an estimate of, in the population at large, even people who didn't show up and have Covid, but they have antibodies for instance, have evidence of having a Covid. I mean, they confused that. Then they confused questions about whether Covid after you recover from Covid, whether you, whether you get some sort of immunity against Covid.

(19:26):

Absolutely you do, strong evidence of that even early in the pandemic. And yet fact checkers squash that. Over and over and over again I've seen fact checkers get facts wrong and suppress legitimate thinking. And Tom, you're right, I might be wrong also. How do you know? Like, why is it some 24 year old intern at YouTube has a better way to tell whether I'm right or wrong than, you know, than just letting the debate happen? You know, there's some basic things which are, you know, if someone says the earth is flat, they got it wrong. But that really is not all that consequential a problem. If someone says-

Scott (19:57):

You know, how do you deal with the issue of misinformation? I mean, some things you can just let people say whatever they want- it doesn't matter, you know, flat earthers can do whatever nonsense they want- they wanna do and nobody cares. But, you know, sometimes misinformation is real and can cause harms and you know, we know that Russia sets up bot farms to make certain kinds of misinformation spread more quickly. But then, like you say, who decides what is misinformation? I mean, it seems like it's just an impossible problem. We know there are real harms, but who gets to decide what's real and what's not? I, I don't know what one does because not doing anything seems awful and doing something seems awful.

Jay (20:33):

Yeah. I- I think the key thing is, to me is trust, right? So like, let's leave aside like foreign policy, which I have literally no expertise in and, and like that kind of propaganda misinformation, let's just stay on public health.

Scott:

Mm-Hmm. <Affirmative>

Jay:

In public health, the key is trust, right? So you have somebody that goes and says vaccines cause you to be magnetic. Covid vaccines cause you magnetic. It's ridiculous, right? It doesn't cause you to be magnetic. It's, it's just, it's just a nonsense thing. If you have a public health that's trustworthy, then you can legitimately say no, it doesn't cause you magnetic. In fact, you could just do a little experiment. Last time that it was just injected, put a magnet on. Magnet drops. You're like, okay. And that's it. That's a very, very effective counter, if it's put out by somebody who's trustworthy. The fundamental problem here is that public health squandered the trust of the public. And so it had no capacity to counter even the most nonsense things. If it had that, then the right answer is in censorship, the right answer is just speech by trustworthy people.

Scott (21:29):

So the problem wasn't the fact checkers then. I mean, they were going with the- who they thought were the trustworthy experts, who turned out to be not so much.

Jay (21:37):

Well, I mean, the problem, like the fact checking enterprise in this case essentially picked winners and losers before the fact actually was resolved. And so like, it, it put this like pall of, oh my gosh, I, someone just did a fact check of me. I'm telling falsehoods or something, pants on fire or whatever. Well that diminishes, you know, the person who has that put against them- their credibility. And if it does it unfairly, when in fact they were right, they just, the- the science was still being resolved. Essentially what you've done is you've created an incentive to not speak up when the facts as you're seeing them in the scientific evidence you're seeing, which hasn't yet become widely known, you're gonna stay silent about those because you don't wanna be labeled as un- incredible or uncredible. What’s the right word to say? I don't know what the right word is.

Tom (22:19):

To be more sympathetic, let's say towards the public health community. Wasn't the--I mean especially the government officials--do you think they were just in the position early on at least? I'll say, Well, we, we really don't know a lot of stuff, but we can't say that because that's gonna diminish confidence in us even more <laugh>.

Jay (22:40):

<Laugh>. Well, that's the irony. I think Tom, I think if they had said that,

Tom (22:43):

I, I don't think it worked out that to their…

Jay (22:45):

Yeah, I, I think if they just said we don't know we, we like, so like just take immunity after Covid recovery, right? So this new disease arrives, it's a coronavirus, other coronaviruses produced some degree of immunity after you've had them- not forever. You can get coronavirus as the second, third or fourth time. That- that's normal. But we don't know with this disease, So it's like March of 2020, right? So if I were the head of the CDC then, I would've said to the public, “Look, we are not certain that you get immunity after this. Scientists are working hard to see if it's true if you do or don't, but this is another coronavirus. With the other coronaviruses, you do get immunity. So we're gonna see, and I'll update you as soon as new scientific information comes out.” And then July, when the first studies start coming out that show T-cells are recruited, get neutralizing antibodies.

(23:32):

That was like before July. I think it was like June. Then I would've gone on TV and I would've said, “it's looking like there is immunity after covid recovery. We don't know how long it lasts. We don't know how effective it is.” I mean, I just, I think telling the public the truth, saying, “I don't know” when it actually is true now you don't know, builds much more credibility and trust than pretending. I mean this happens in medicine rather, like I, I remember as a medical student, I would get in front of a, you know, you get in front of a patient and you know, a medical student, I don't know a lot of things, right? So you just have to like resist the temptation that just cause you're wearing a white coat to say false things, pretend knowledge you don't have. It's a really important lesson the medical students learned and public health somehow didn't learn this.

Scott (24:13):

I'm not sure that lots of doctors learned that either, frankly, having just dealt with somebody in an ICU, so many doctors don't even seem to understand the Bayesian principle. They cannot update any information based on, I mean, update their views of, of a, of an intervention based on new information. Just drove me crazy. Anyway, that's a, a separate issue. But I mean on the uncertainty and, and being able to admit when you don't know something, I hate to criticize you since you've certainly been subject to so much of it, but I'm not sure the Great Barrington Declaration did that either. Right? You sort of assumed you knew what things were gonna look like too, or you didn't acknowledge that you weren't sure either.

Jay (24:45):

Yeah, I mean I think that's fair. I mean we were-

Scott (24:47):

And I'm sorry, lemme just finish that cause actually I didn't really mean it so much as criticism as that when you're trying to convey something that's difficult and- and nuanced and scientific to a broad community, it's hard to add that in a way that people will understand.

Jay (25:00):

Yeah. I mean I think that's- that's fair as- as far as it goes to Scott. I mean it was a one page document. Yeah. It was written for the public. It wasn't a scientific document in that sense. It was- it was aimed at the public. You read it, anyone can read it. That was the purpose of it. And it was to tell the public that there was actually a legitimate set of alternate scientific view for how to manage the pandemic. But it wasn't specifically a scientific document.

Scott:

Mm-Hmm. <Affirmative>.

Jay:

So I guess the aim, like if I was writing the, you know, sort of paper that was gonna go get published in New England Journal Medicine, I would've written it very differently. But I think the thing about the certainty that I had about the Great Barrington Declaration, it stemmed mainly from history, right? The Great Barrington Declaration, actually, Scott, it was, it's probably the least original thing I ever worked on. By far. It's the old pandemic plan.

Scott:

Mm-Hmm. <Affirmative>

Jay:

Gussied up to look like, I think we wrote it was some style, but that's about it. I mean, it wasn't- there's not a single new idea in it. And so the confidence that I had in it had to do with the fact that for a century we followed that plan for respiratory viral pandemics and it worked, right? It's not that those viral pandemics didn't cause some damage. That's inevitable. It's that we didn't multiply that damage with policies that harmed the poor, the vulnerable. We sought to address the damage from the viruses by developing vaccines and therapies and seeking to protect the vulnerable. Those were the old plan. And so my confidence around that, by the Great Barrington Sclaration Scott, had to do with the fact that it was actually the old plan.

(26:20):

We were just trying to tell the public that the thing we were doing, these lockdowns, all this stuff was brand new and really untested and hadn't worked through October. And it was unlikely they’d work if we continued it. So that's- that's partly my defense. I don't have a complete defense. God, I ju- it's, you know, I'm a scholar, mainly not a public relations person. So I don't know exactly how to convey all of that all at once. What we wanted to do is wanna bring the attention to the public that there was an alternative view and that I think we succeeded.

Tom (26:45):

Well, as far as the economics is concerned, you kind of go beyond criticizing economists for not basically not talking about the trade offs appropriately to also censoring themselves as far as maybe been a relationship there. But as far as what would happen if we did these with this massive stimulus plan and they basically censored themselves. Very few people, very few economists were critical of it. Certainly early on. Is there a connection between the two, between not looking at the trade offs and then staying kind of quiet about the- the risks of a massive stimulus?

Jay (27:20):

I mean, none of the normal economists I would've thought would speak up about spending $6 trillion over two years said very much. I, I don't think at the time. It was really, it was really something. Like all of the debates that had characterized American economic policy over budgeting for decades just went away overnight. Yeah. I just, I- I don't know if any other answer for that other than self censorship. Like, I don't think that people honestly thought they wouldn't have enormous consequences on the economic future of the United States to have this kind of borrowing happen. The inflation is not a surprise really. I think there are some other elements of this too, Tom. So like, you know, in 2008 a lot of people predicted inflation that never came and it sort of discredited a lot of the sort of like rational expectations, school of macro types of people.

(28:05):

And so they were, I think, a little gun shy to speak up when this big stimulus happened. But I think we learned a lot in ma- I mean, I don't do macro, but like I try to follow a little bit of the literature. So I mean, I think we learned a lot about why there wasn't inflation out of the Great Recession. And in quantitative easing, I think we'd learned the circumstances didn't pertain now. Didn't pertain in 2020. The stimulus was a stimulus given to, you know, small businesses to- so they didn't fold huge amounts of unemployment insurance, basically enormously inflationary transfers financed by borrowing and printing money. It's gonna cause infla- I mean that just, if economics knows anything, it's that.

Tom (28:40):

Especially with all supply constraints there were.

Jay:

Yeah.

Scott (28:43):

Although, you know, there were people, though, who did talk about the inflationary effects. Larry Summers, Jason Furman. And so, you know, these were notable Democrats who were-- I guess it's not right to say they were opposed to the plans, but just that they would, they would have major inflationary effects. But it didn't seem like there was Jason Furman or Larry Summers on the public health side?

Jay (29:02):

No, no. I, I actually, I think Furman and Summers were actually quite brave. I don't mean to say that all economists failed and there, there were few. Scott, you had, you and Tom had me on the, the podcast in 2020. That was an act of bravery, actually honestly.

Scott (29:15):

<Laugh>  Well I don't wanna use the word hero, but you know, I-

Jay (29:18):

<Laugh> I will and mean look, really, it was, it was. So I think economists, like I said, I think I have much more criticism for public health than I do for economists. Although, although I- I do criticize economists, I don't think we have, we didn't acquit ourselves well. We should have been yelling bloody murder. Like I think part of this is, okay, it's natural and health economics to think about the economy as vitally important for health, right? The economy is not simply a matter of money, but a matter of life and death for me. And if for, it's just, it's not, it's not like there really is a live money trade off here. It's just is- it's lives and lives. Like you- when you destroy supply chains around the world, you're gonna cause unemployment that hits the poorest of the poor. And you're gonna get starvation, you're gonna get dire poverty, which is exactly what's happened, right? That's lives being lost because of the economic damage done by the policies we followed. But for some economists we're almost shy. Not you Scott, but like, we're shy to say that. We're shy to say, “Look, if you ignore the money here, you're gonna kill people. People will die as a result of it.” We're dealing with lives. That's what economists do for a living. It's not any different than what public health does in that sense.

Tom (30:23):

But that debate, that debate has been going on with respect to, you know, health and safety regulatory issues for a long time. And it's, you know, it's a hard sell to <laugh>.

Scott (30:34):

Right. The economists didn't weigh in this time. Except for Jay.

Tom (30:37):

The economists didn't weigh in this time.

Jay (30:38):

Yeah. I mean, that's the problem. Like we, I think, I think part of it, I mean I hesitate to bring this up, but I think it's true and it's true for not just economists, but, but almost everybody. We economists and many academics we work in, we are laptop-class folks and we are also scared for our own health and we had the means to protect ourselves. And I think that played some role in some of the reticence to speak up. It's not an excuse, it's just- I think a- a fact. So I, I, yeah, and, and I think, I don't really judge folks who do that. I mean, it's- people are human. But I do think, you know, there were some economists that like actively tried to essentially attack any other economist who spoke up

Scott:

Mm-hmm <affirmative>

Jay:

And that I have less sympathy for, I don't really don't feel like naming names cause it's not really not constructive, but that was really not a very constructive thing for them to do.

Scott (31:24):

Has that affected your research since then? I mean, maybe you know, who you can co-author with and who's willing to work with you or has your research sort of continued, been able to continue and collaborations continued the same way?

Jay (31:36):

I guess it'll change, it may change over time, but my closest friends who I've written with for years have continued to stand by me and we've worked together on papers since then. I'm sure that there are people who I've worked with in the past that probably don't wanna work with me, but on the flip side of that, Scott, there's other people, many people who I, who now want to work with me that didn't, that I never would've known before. So I mean, it's, it is what it is. I wouldn't change what I did. I mean, I kind of, I felt like I had an obligation because I did wear these two hats, this public help hat and this- the economist hat, to speak up and I think it was the right thing for me to do. I do wish that our professions had been more open and tolerant of dissent than they were, so that you didn't have to be, you know, you didn't have to be a hero or whatever brave to speak up. It shouldn't be like that. We're just scholars. We're just people trying to like learn about the way the world works and we should do it with humility, thinking that maybe what I'm doing is not right. That's just normal. We should have conversations without trying to destroy each other. And unfortunately, I think both fields have found out, especially public health found out that's not true.

Tom (32:33):

So my impression is unfortunately, that even though I think you're right, we followed the wrong strategy and the tremendous costs that are gonna be with us for many, many for decades probably. But that lesson has not really been learned by politicians, government officials, the general public. It's just in that sense, it's, it's just a way, it's just a waste that we're not learning the appropriate lessons. Is there anything we can do to kind of correct that or, and then there's no real, like in an war, I guess there's an, what do they call the military? Call it an-

Jay:

After action report.

Tom:

After action report. Yeah.

Jay (33:04):

In medicine we call it- if there's a morbidity and mortality conference, right? So you have a conference where you get together all the doctors who managed the patient that just died and try to figure out what went wrong. It can get heated, but the finger pointing doesn't leave the room. Like the- what leaves the room is, here are the lessons we've learned, let's not do these things again. We absolutely have to have that. Tom. Absolutely have to have that. And I think they, it will come, There was like the US House did this thing, this ridiculously partisan thing where they, they did the coronavirus task force. They have blamed Scott Atlas for the entire debacle, somehow. Just nonsense. It, I mean it's just persuades basically nobody. It in fact it harms, it just poisons the well of discussion. I think the- if the United States doesn't do this, other countries will. The UK is gearing up for a parliamentary inquiry just like it did- did after the Iraq war.

(33:50):

There's talk in Australia of a royal commission. Even in the United States, unfortunately, it's just mainly Republican senators and Republican House members that are talking about this. But if and when they take control of the House and Senate, they will have some push to have some kind of inquiry. I'm gonna work very hard to make sure that that inquiry is not aimed at finger pointing, but rather an honest assessment and evaluation of the policies. I think any honest evaluation of the policy will lead to the conclusion that lockdown should be a dirty word, that we should remove it from our lexicon of thinking and never adopt it again as a strategy for dealing with this kind of respiratory viral pandemics.

Scott (34:24):

Are you, do you think that I, if it's just sponsored by the Republicans, it'll be honest?

Tom (34:29):

<muffled> partisan, it wasn't just Republicans. Yeah,

Jay (34:32):

It really would help to have Democrats come on board. And I think, you know, I think as the pandemic fades and the opportunity for political wins out of this fade with it, and I think that that's coming, honest people on the Democratic side will start to say, Gosh, maybe we shouldn't have closed schools in blue areas for two years. Maybe that really wasn't a smart thing to do. We really heard a lot of people we care about. And I think that those folks will start to open up their minds and come over. I think you asked if it's possible for Republicans to do an honest assessment. I think it is possible. It's just not as good as it would be if it were truly a bipartisan assessment. I think the question is- is, can Republicans, if they do it by themselves, resist the temptation to point fingers and not- cause you know, like the blame here is on both sides.

(35:15):

Therefore, just being honest, like the Trump administration instituted the lockdowns, right? It's blue states that instituted the longest school closures. An enormous number of political actors were in favor of the lockdowns. You don't get $6 trillion of spending unless it's bipartisan. And so a lot of people don't wanna talk about this because it's not really cleanly partisan. It's not a blue- it's not, you know, you think about lockdowns as a left wing thing, but it's not actually. A socialist Swedish government declined to lock down, right? You know, a right wing Tory government in the UK locked down. I, I just, it's not, it's not at all clear that it's obviously left wing to lock down. And so if we can get that through, we can have an honest assessment of the policy. That's what I'm trying to aim at.

Scott (35:52):

Do you think there's a chance for some time in the near future a Covid morbidity and mortality conference among people in the public health and economics professions? You know, from people who argue different sides? Or is it still too raw?

Jay (36:07):

So like six months ago, I, I approached the dean in my medical school and asked him if you would host such a conference. And he said it’s not, not possible. It's too many people are raw on the other side. We can't have an academic discussion over this. I don't know about public health. Like public health still seems to me to be in denial about how badly things went.

Scott:

Mm-Hmm. <affirmative>

Jay:

And until that, until they come to terms, it may be, have to be forced on from the outside. The people that were harmed by, you know, like, like the education activists are finally starting to realize the harm done to American children from these two years of school closures, especially poor children. They're starting to speak up, you're starting to see stories in the New York Times about this.

Scott (36:43):

But that has become very mainstream now.

Jay (36:45):

Yeah. So I think the non-public health people who speak for the poor, the vulnerable, when they start to speak up, their voices will get heard and it will force public health to respond. That is coming. Although I- I don't think we're there at this point yet.

Tom (36:58):

I- I have one final question. Why was it called the Great Barrington Declaration?

Scott:

Good question.

Jay (37:03):

So we called it that because it was written in Great Barrington, Massachusetts. Tom, I said it was unoriginal, but I say- my, that my one original contribution was the name of the thing and what the reason was, I'd never been to Great Barrington, I'd never heard of Great Barrington. On the taxi right in, I asked the guy what town we're going to <laugh> and he's like, well this is Great Barrington, Massachusetts and sounds like it struck me as a cool name. And then when we wrote the declaration, I was thinking in my head of the Port Huron Statement, this is like this famous sixties era thing, right? I'm like, okay, we can call it the Great Bar- and it has this like fantastic thing where you don't know if great refers to the Declaration or to Barrington <laugh>.

Tom (37:38):

Why did you, why did you all meet in Great Barrington?

Jay (37:40):

So the conference where Martin, Sunetra and I met was hosted by the American Institutional Economic Research, which is in Great Barrington, Massachusetts. And it's relatively close to Martin's house. So that's the main reason. Right.

Tom (37:52):

Right. Okay.

Scott (37:52):

Okay. I think that's probably where we should wrap it up. Really fascinating conversation. Just like last time. We really appreciate your coming on and talking to us, taking your time for this really. All this was great and I'm glad we would now, now we actually have wrapped up solving that mystery. So Jay, thanks. Thanks so much. Really fun talking to you.

Tom (38:13):

Thank you.

Jay (38:14):

Thank you.