The Munk Debates Podcast - Be it resolved: The public health response to COVID-19 should focus on protecting the old and letting the young get on with living normal lives

Episode Date: November 18, 2020

We're heading into the twelfth month of a global pandemic and in many places the spread of COVID-19 shows no signs of slowing down. As infections continue to surge, countries in the northern hemisphere have started to reimpose lockdowns restricting people's movement and social interactions and closing portions of their economies. Many political leaders and their public health advisors argue that these kinds of restrictions are necessary as a crisis measure when infections spiral out of control, threatening a collapse of hospitals and devastating health consequences. They also advocate a strategy of suppression to keep infections low once the crisis is brought under control. But some politicians and public health experts are criticizing what they believe is an overly draconian approach. They say that it makes no sense to prevent the healthy and young from going about their normal lives when their risk of dying from the virus is less than the flu and they suffer considerable collateral damage from lockdowns. They argue that countries should adopt a focused approach to fighting the pandemic that zeroes in on protecting elderly and vulnerable. Arguing for the motion is Martin Kulldorff, Professor of Medicine at Harvard University. He is one of the authors of the recently released Great Barrington Declaration which advocates an alternative, risk-based approach to combating the COVID-19 pandemic. Arguing against the motion is Stephen Reicher, Professor of Psychology at the University of St. Andrew's in Scotland. He sits on a subgroup of SAGE, the official scientific body advising the UK government on its COViD 19 response. Sources: Global, ABC, NBC, City TV, CBC, NDTV, CBS 6 The host of the Munk Debates is Rudyard Griffiths - @rudyardg.   For detailed show notes on the episode, head to https://munkdebates.com/podcast. Tweet your comments about this episode to @munkdebate or comment on our Facebook page https://www.facebook.com/munkdebates/ To sign up for a weekly email reminder for this podcast, send an email to [e-mail].   To support civil and substantive debate on the big questions of the day, consider becoming a Munk Member at https://munkdebates.com/membership Members receive access to our 10+ year library of great debates in HD video, a free Munk Debates book, newsletter and ticketing privileges at our live events.This podcast is a project of the Munk Debates, a Canadian charitable organization dedicated to fostering civil and substantive public dialogue - https://munkdebates.com/ The Munk Debates podcast is produced by Antica, Canada's largest private audio production company - https://www.anticaproductions.com/   Executive Producer: Stuart Coxe, CEO Antica Productions Senior Producer: Christina Campbell Editor: Kieran Lynch Associate Producer: Abhi RahejaBecome a Munk Donor ($50 annually) to get 72-hour advanced access to the full length editions of Friday Focus and Munk Dialogues. Go to www.munkdebates.com to sign up. Hosted on Acast. See acast.com/privacy for more information.

I think it's time for this toxic binary zero-sum madness to stop. We're not an imperial power. We're a revolutionary power. We are no longer in a world where you can plot out moves statesmen to statesmen like a chessboard. You don't know anything about my background to where I came from. It doesn't matter to you because fundamentally I'm a mean white man. We can't do this to the next generation because America will cease to exist. Welcome to the Monk Debate. Every episode we provide you with a civil and substantive debate on the big issues of the day. Free of spin, focused on the facts and animated by smart conversation.

To arm you, the listener, with enough information to make up your own mind. Today's debate, be it resolved, the public health response to COVID-19 should focus on protecting the old and letting the young get on with living normal lives. The pandemic is slowing down. Think again. On Thursday, the World Health Organization reported a record single-day increase of global COVID-19 cases. Meanwhile, there are now 45 million coronavirus cases recorded worldwide and 46% of new infections are in Europe. Popping new warnings from health officials' deaths in the U.S. hitting 230,556. And according to an internal memo, cases are on an upward trajectory. about the entire country. Hello, I'm your moderator, Rudyard Griffith.

Well, we're heading into the 12th month of global pandemic, and in many places, the spread of COVID-19 shows no signs of slowing down. As infections continue to surge, countries in the northern hemisphere have started to reimpose lockdowns, restricting people's movement and social interactions and closing significant portions of their economies. From Thursday until the start of December, you must stay at home. You may only leave home for specific reasons. The hammer has dropped on a wedding receptions and other celebrations of life here in Peel region as the number of COVID-19...

Broken glass in Turin as Italy breaks another record for daily cases of COVID-19. This, the result of anti-lockdown protests on Monday. Many political leaders and their public health. health advisors argue that these kinds of restrictions are necessary as crisis measures when infections are spiraling out of control, threatening to collapse hospitals and devastate public health. They also advocate a strategy of infection suppression to keep infections low once the crisis is brought under control and a vaccine is widely available. That is our major weapon against this virus right now. We don't have a vaccine that's deployable.

This is the only thing we have, and we can get through it if everybody really leans forward and pushes on this. But some politicians and public health experts are criticizing what they believe is an overly draconian approach. White House officials have cited the Barrington Declaration, signed by dozens of doctors, stating in part those who are not vulnerable should immediately be allowed to resume life as normal. The Great Barrington Declaration proposes that we allow, people who are young and healthy and very unlikely to die of COVID-19 to return to life as normal. They also argue that countries should adopt a focused approach to fighting the pandemic that zeroes in on protecting the elderly and vulnerable.

On this installment of the monk debates, we challenge the essence of these arguments by debating the motion, be it resolved, the public health response to COVID-19 should focus on protecting the old and letting the young get on with living normal lives. Arguing for the motion is Martin Koldorf, professor of medicine at Harvard University. He's one of the authors of the recently released Great Barrington Declaration, which advocates an alternative risk-based approach to combating the COVID-19 pandemic. Arguing against the motion is Stephen Reischer, Professor of Psychology at the University of St. Andrews in Scotland.

He currently sits on a subgroup of SAGE, the official scientific body advising the UK government on its COVID-19 response. Martin, Stephen, welcome to the Monk Debates. Thank you. It's a great pleasure. Hello, from Damp, Scotland. Well, look, gentlemen, I'm really looking forward to this conversation today. This is a moment, I think, where much of the world now faces a proverbial second wave of COVID-19. We're anxious about what the coming weeks and months pretend, and we're having a fairly vigorous debate in society

in the corridors of power about how we should manage this second wave. Our resolution today is be at resolve. The public health response to COVID-19 should focus on protecting the old and letting the young get on with living normal lives. Martin, you're going to be arguing in favor of our motion, so I'm going to put two minutes on our clock for opening statements and pass the proverbial microphone over to you. Thank you. So the lockdowns that we've seen from this pandemic has been the worst assault on the working class in many decades in the United States since segregation and the Vietnam War. What we're doing is we are protecting low-risk college students and low-risk young professionals who can work from home.

people like lawyers, journalists, and scientists, while older working class people who are high risk, they must be out there making a living, driving a bus or a cab, working as a janitor, working in the supermarkets. And these older high-risk people are being exposed to the virus, and they are the one who are building up the immunity in the population that will eventually protect all of us. What we're doing is we are both having a strategy that results to far too many deaths in the United States. It's over 200,000 deaths in the United States, many which could have been avoided if we have taken a more basic public health approach to this pandemic. And it's similar in many European countries. So the key feature with COVID-19 is that there's a thousandfold difference in risk.

Everybody can get infected, but there's a thousandfold difference risk in mortality in death. between the oldest and the youngest. And that's something we have to utilize as we fight this enemy. So what we proposed, and which is part of the Great Barrington Declaration that was signed six weeks ago, is we have to be much better at protecting older people. And for younger people, children have less risk for COVID-19 than they have from the annual influenza. On the same time, the burden of the lockdown is enormous on these children and on young adults because of the collateral damage and other aspects of public health. Thank you, Martin, for that opening statement, clear, concise. We appreciate it. Stephen, we're going to now have you argue against our motion, your opening remarks on our resolution,

be it resolved. The public health response to COVID-19 should focus on protecting the old and letting the young get on with living normal lives. Let's have your opening remarks, please. Well, let me start by saying that I completely agree with Martin on two things. The first is that certain groups, the young, the poor, ethnic minorities have had a raw deal out of this pandemic and we need to do something about it. And secondly, the way we're doing things, this cycle of restrictions and relaxations of second and possibly third and fourth lockdowns, is not the right way to do things. There is another way. My concern is. that the strategy, the great Barrington Declaration strategy,

actually will make these things worse, not better. You see, it's one of those things that sounds in the abstract rather appealing, but it rests on a series of assumptions, a series of ifs. And when you look closely at each of those ifs, you realize they're impossibilities. So the first thing, protect the vulnerable. If we were to say that people over 65 should be sequestered, Well, something like 20, 25% of the population is in that bracket. In the United States, it's 54 million people.

In Canada, 7 million in the UK, it's 13 million. And if you add people with comorbidities, which makes them vulnerable, you're going even higher to about 30%. Now, you cannot tear society apart and sequester those people away. It's simply not possible. Look at the people who care for them. In fact, in Canada, there are more carers unpaid. carers, than there are people aged over 65, 7.8 million, in fact. So it's an impossibility to

sequester these people. Martin, you will know that your colleague, William Hannage, has likened it a little bit to having a fire in your house and putting your valuables in one room and fanning the flames elsewhere. In the end, the sparks will get in. Secondly, when you talk about sending people out, the people who will go out and catch the infection will be the underprivileged. And when you talk about the damage, it's not a binary, it's not death or life. We know, and increasingly we know, that long COVID causes huge amounts of damage. So, for instance, 25% of people who have COVID have long-term symptoms akin to PSTD. 308% of them, two months later, have abnormal chest radiographs. 70% of them, two months later,

have got fatigue. And the notion that there will be soon, a point where we can let the elderly out because there will be immunity amongst the majority of the population again doesn't stand up. We don't know how long it will be, first of all, nobody can say. And secondly, we don't know if that immunity will build up. And we've seen in big studies recently, the amount of antibodies has fallen. We saw it in Meneas in the Amazon rainforest, where there was a huge amount of infection the first time round, it's now having a huge second spike. So the notion that we will somehow solve things this way also is a fantasy. But the biggest fantasy of all, biggest mistake of all is another binary, the notion that we think it's either focus protection or lockdown. Lockdown is an emergency

measure. And the ultimate irony is that the notion that you should simply avoid restrictions has simply postponed restrictions, which has meant that when they have to be put in place, they take longer and more severe than before. Thank you, Stephen. Now our chance for some targeted timed rebuttals. This is an opportunity for both of you to kind of zero in on the key points in each other's arguments that you'd like to take exception with. Martin, I'm going to put another two minutes or so on the clock for you. What you've just heard from Stephen would you like to bring to our listeners' attention?

So there were a few mischaracterization of the great-parenting declaration. but one of them is that we're not proposing to lock down older people. The more we drag out this pandemic, the harder it is for all the people to actually protect themselves. And it's very hard for all people who now having been protecting themselves for many, many months to have to continue to do that. Another aspect that I think has to be said very clearly is that we have immunity to COVID-19. We don't know if it would be lifelong immunity or if it will last a number of years, my guess is the latter probably, but that is sort of irrelevant in terms of building up the immunity

that we need to end this pandemic. There has been a misunderstanding that immunity is only those who have antibodies, that detectable antibodies, and that's not correct completely biologically. They will often have detectable antibodies for a while, but then you can't detect them anymore, but that doesn't mean that they aren't immune. And we know that because people don't get infected in large numbers. Also, there's other types of immunity like T-cells. immunity. So the notion that we don't have immunity to this disease is mistaken. Thank you, Martin. Stephen, your opportunity to provide a rebuttal, take out the proverbial marker and underline any key points in Martin's argument that you'd like to flag for our audience.

Well, let me start off where Martin started by saying this has had a huge effect on poorer people, on the working classes, and he's quite right in that respect. But the response, for that is not to expose people more, those aged under 65. The response to that is to address the inequalities in our society, including within the pandemic. And so, of course, if you bring in measures that restrict people, you have to do something which makes it possible to abide by those restrictions. So the answer there doesn't lie in removing protections. It lies in actually providing those resources. And a number of places in the world have done that. One of the most remarkable remarkable places being Kerala in southern India.

With over 1,000 local bodies across Kerala, Chief Minister Penrae Vijayan has announced for one community kitchen to be set up by each of them in next one week to provide free, cooked, hot meals to anyone in need. A challenge for many as India is under lockdown. The second point is about the notion of lockdown. And again, I want to stress that I'm not suggesting that lockdown is the solution. Lockdown is a short-term emergency measure to get things to a point where you can manage

them through more proportionate measures. And the reason why things are spiked again is that when we lifted those restrictions in the summer, we didn't put those measures in place. We didn't in the UK, in the US, have decent test and trace systems. They failed us. That's one key reason. Secondly, we didn't have good regulation to make sure that workplaces and public spaces were actually safe for people. And thirdly, we didn't support people. In the UK, for instance, no more than 11% of people self-isolate and ask to do so, because for most of them, it's financially and practically impossible. So if you had proportionate, sensible measures to suppress the virus, then you wouldn't need lockdown. Thank you, Stephen. Well, look, now it's an opportunity for the three of us to have a

conversation to move through some of the key issues regarding our motion today. And that's what I want to start with. I want to just refocus us on our resolution that we're debating, which is be resolved, the public health response to COVID-19 should focus on protecting the old and letting the young get on with living normal lives. So Martin, to come to you first, I'd like to hear a bit more from you on Stephen's point, how one can practically do that, let the young get on living normal lives and protect the old simultaneously when it's clear that this is a highly contagious virus, much more contagious than normal influenza. Let's hear a bit more from you about why, you know, that isn't a powerful argument against allowing this virus to spread.

amongst younger populations? So first of all, nobody's arguing to let the virus spread. What we're arguing is let people live their lives, even though some of them will be infected. So that's different from letting the virus spread. Everybody should wash their hands, and everybody should stay home and sick and so on. What we have to stop is the lockdowns that are extremely damaging

to collateral damage on other aspects of public health, on education, and so on. So the argument to say that we can separate the old and the young is sort of very disingenuous for two reasons. One is that it hasn't been tried in the UK or in the US, for example. So it's sort of difficult to say that, well, it can't be done if you haven't even bothered to trying it. There are very good measures we can do, basic public health measures to better protect the old. The other reason that is very disingenuous is we have actually been extremely successful. in shifting the risk of infection from the professional class to the working class. If we look at the data, there's much more infection and much more mortality among the working class

and especially the inner city working class. We're learning more this week about why the coronavirus is still hammering two of Canada's biggest cities, Toronto and Montreal. It's now spreading rapidly in the community among essential workers, people like taxi drivers, retail employees, and factory workers. So we were actually very successful in protecting the more affluent members of society and the professionals. Well, we absolutely failed to protect the less affluent and the working class and the poor. So it is possible to shift this risk.

And the way to do it, it depends on the living. situation of these older people. There are a lot of things we can do to better protect the nursing home, and I think it's a scandal that we're not doing it. A second group are older people who live at home. For example, we need to help them so that they can have groceries and other necessities delivered to them so that they don't have to go and expose themselves in the supermarket. We could use pension funds or disability funds who will let those older working adults be protected during the height of the transmission so that they can stay home, not go to the working place. Okay, let me bring Stephen and have him react to those policy prescriptions.

And maybe, Stephen, if you could just address a question that's really been on my mind and that Martin brought up in his opening statement is that that thousandfold differential between the groups least at risk of dying of this virus and those most at risk, that would seem like something that is so large that it really has to be baked into the public health response. Well, first of all, the thousand is the extreme of very young people and very old people. And we're not talking about just the very young and very old.

We're talking about the difference between those over 65 and those under 65, and there the differential is far, far less. Once you get over 45, then there begin to be reasonably substantial dangers. Secondly, of course, it is already there in the responses. So, for instance, in the UK, at the moment, we have restrictions, but schools are kept open because we recognise the huge lifelong harms of keeping schools closed. So of course it's recognised. And the third point, of course, is that people, it's not just about the individual who is infected.

It's about spreading the infection. And as Andrew Cuomo put it beautifully, early on in the pandemic, he said, this isn't an eye thing. It's not about what happens to. me. It's a wee thing because what you do can infect me and get your head around the we concept. And when you say things haven't been tried, well, let me give you a couple of examples. I am a keen cyclist. If you saw the great cycling tours went ahead to some of the tour of Spain, the tour of Italy and the tour of France, the greatest of all. And at each of

those, they try to create hermetically sealed bubbles. They tried to do absolutely everything they could to seal off the tour from the rest of the society. As the cyclists are under strict guidelines to isolate as much as possible, there won't be the usual autographs and selfies. And they'll get regularly tested for COVID-19 throughout the race. To reduce the risk of infection, the usual crowds are, for now, a thing of the past, with only 50 people at the starting point in Nice. Large black panels have been set up to stop crowds forming.

a series of measures which go far beyond what would be practical for 25% of the population, and they failed. The infections got in. Quite a lot of people got infected. Again, you cannot separate things like that. You can't tear society apart in that way. And the other point I'd want to make is that when you talk about the inequities of the pandemic, absolutely true.

They are there. But if you say to people, go about your ordinary lives, Of course, it's not a choice. It's not a choice because some people have got the privilege to be able to work at home and some people don't. So what you're saying when you say let people go about their ordinary lives is you're saying, let's take away the state protections, which ensure that people don't have to go out. And when you take away those protections, again, it's the most vulnerable who are going to be most exposed. So you're describing the problems with the lockdown approach that we've had during this year.

so that's sort of kind of strange. But Martin, time and time again, I have argued that I don't support lockdown. Lockdown, as I say, is an emergency measure when things are running out of control and the alternative would be even worse. They reflect the failure of the proportionate measures by the state, by employers, by owners of hospitality spaces and by the public to be able to live with this, bring levels of infection down so that we can. go at? So I think this was an argument that was used in the spring for the lockdown that we were

supposed to have a lockdown for a while and then we were going to be fine. And I think those of us who was arguing against lockdown in the spring were saying, well, we can suppress the disease temporarily, but it will be back. It's the same thing in Ireland now. They are going into a sort of a circuit break lockdown and they have been able to suppress the disease by doing so. But as soon as they lift it, the disease is going to be back. So contact tracing and testing and isolation, that's an enormously important tool in the toolbox in infectious disease technology and dealing with infectious disease outbreaks. The problem is that you can't use every tool for every disease because every disease is different. You can't use contact tracing for annual influenza, for example,

if nobody's even attempting it because it's impossible. The same is true for COVID-19. We can suppress the virus with very fierce lockdowns, but once that is suppressed, we cannot continue to do that with the contact tracing. It doesn't work. It's just going to come back. So we would have to keep the lockdowns in place until we have a vaccine that can create the immunity that is needed to then end the pandemic. And the damage from the lockdowns to date is already much bigger enormously and something that we're going to have to live with and die with for many years to come. For example, childhood immunization rates have plummeted. And we see now in some parts of the world that we have measles cell break that we shouldn't

have in this age if people were getting their proper vaccines. So people are dying from cardiovascular disease when they shouldn't be. You have less cancers this year. But that's not because there are less cancers. It's just that we're not diagnosing them. The mental health has deteriorated. It is devastating in all age groups. I have a close colleague at my university who work with families with children with autism.

And it's actually brutal what they have had to go through because of these lockdowns with less schooling and less care for artistic children. And that's just one tiny example of mental health issues. There are so many more. So these consequences of this very misguided lockdowns that we have had and that many countries, honestly, is continuing to push for, that's having very long-term consequences. So that also goes against one of the basic principles of public health is that we don't only look at the short term. We have to look at the long term. Hi there, Rudyard Griffiths, the moderator of this podcast. This we know, our society is dangerously polarized. We don't listen to each other. We don't search out opposing views. Instead, too many of us live in tribes, convinced that we are right and they are wrong. It's time to put a stop to polarization before it wrecks our democracy. This is what the monk debates is all about, ending polarization, searching for common ground. We do this. We do this.

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Now, back to our program. I'd be remiss if I didn't bring up for our audience the topic of herd immunity. And maybe to come to you first on this, Stephen, you know, I'm just curious, why can't hurt immunity be a good thing working in concert with a vaccine and why shouldn't we encourage, in effect, from the public health response, younger people who are not particularly at risk to acquire natural immunity now? Well, first of all, I don't like the term herd immunity. As a psychologist, I'm aware that it has a rather dismissive attitude towards the public. I think population immunity is probably a better

term. And if you want to influence people, it's not a very good idea to start off by calling them are herd. The point about so-called herd immunity is it is normally seen as something which comes from a vaccine. We have never historically just said to people, well, let's get immunity by letting the virus rip. And if we did that, I think the number of deaths would just be absolutely intolerable. It would also overwhelm our health services and therefore mean we would get all that other form of damage because we can't treat people in all sorts of other ways. It's not something to pursue. It's not responsible to let something this damaging spread through the population. As I say, one of the points that we've got to get away from is the fact that if you don't die,

you're fine. If we're talking about psychiatric effects of the pandemic, well, there are studies which show that 25% of people, a quarter of all people who get COVID, have got symptoms which are akin to PTSD. It has all sorts of other physical effects. and we're learning about them virtually every day. It affects the heart, the lungs, the kidney, the liver, the brain. One recent study showed 70% of people had some form of heart damage. This latest study just published in JAMA cardiology really breaks down what we're learning about longer-term effects on the heart.

This study looked at 100 COVID patients in Germany. Not all of them had severe disease. Then did a cardiac MRI. and this MRI showed evidence of ongoing inflammation in 60% of those patients and some type of cardiac involvement in 78% of patients. So again, a strategy which tries to get safety by exposing so many millions of people to a disease whose harms we're learning more about every day seems to me very deeply irresponsible. But I just want to come back again because I think it's such an important.

point that you often can win an argument by setting up false oppositions, right? If the alternative between something bad and something truly terrible is given, you're going to choose something bad. And if it were the choice, the choice is between the strategy of so-called focus protection and eternal lockdown, I wouldn't support eternal lockdown. But that isn't the strategy. What's more, a strategy of proportionate responses. And the first thing that would be involved in that is indeed a better test and trace system, which would include backward tracing so you could find the sources of outbreak and then deal with them. And then isolation for those people with full support, not self-isolation, supported isolation. And then if on top of that, you make sure

that all your public spaces are safe, then you can suppress the virus. And while it hasn't been perfect, I would prefer to live in those countries which have tried that, countries like New Zealand, like Australia, like Taiwan, like South Korea. And finally, when it comes to the economy, Paul Krugman, the Nobel winning prize winner, pointed out that those countries which have had more robust reactions and which have had better results in terms of public health have also done better on the economy. With proportionate measures, we can minimize the economic damage, we can minimize the public health damage in the short term and in the long term. Thank you, Stephen. Let's, Martin, just have some thoughts from you on population immunity and why you think this is a viable and

necessary strategy for governments to incorporate into their official COVID-19 response, because this is clearly a point of differentiation and argument between you and Stephen. Actually, it's not. I agree with Stephen that herd immunity is not a strategy. Her immunity is well-established scientific phenomena. Before they were a vaccine, every epidemic and pandemic ended with herd immunity. So to talk about herd immunity as a strategy, it's like saying that an airplane pilot should use gravity as a strategy to land the plane. I would hope that the pilots will take into account gravity

as in their strategy for landing the plane, but the strategy is to land the plane with as few casualties as possible so that people don't die, and that's the same thing here. We will reach herd immunity sooner later for COVID-19. There's no doubt about that. And the strategy is to minimize the mortality until we get there. And we do that by doing as good a job as possible in protecting the high rate.

risk elderly. And when it comes to the young people, nobody should get out there and deliberately get infected. But if we have a staff person for a nursing home who has had COVID-19 and who is immune, that's a good thing because it means that person cannot give the disease to the nursing home residents. So young people that have had the disease and who are immune is actually a good thing for society and a good thing for protecting the high-risk elderly. And the longer we postpone this pandemic, the harder it is to protect the elderly. Thank you, Martin. Look, just before we move to closing statements, I want to have both of you reflect on where we are today and how you think about the public policy response, not in terms

of what might be ideal at some point in the past, but what do we do right now? You know, looking, especially, let's take the example of the United States, Martin, I begin with you. I mean, North Dakota, almost 9,000 cases per 100,000. Wisconsin, close to 6,000 cases per 100,000. Iowa, much the same. I mean, it looks in these states and in much of the United States that this virus has truly become endemic. Why wouldn't a reset, a circuit breaker, whatever you want to call it all? a lockdown. Why isn't that the right public policy response now to deal with something that has

gotten out of control? What, Martin, is your advice right now? One thing we have to stop doing is counting cases. That's not very useful from an epidemiological point of view because cases depends a lot how much testing we do. If we do testing among students, for example, most of them will be asymptomatic, some will be mildly symptomatic. So the three major metrics, that we want to use is hospitalizations, mortality, and ultimately the most important one is the excess death. And the United States has over 200,000 COVID-19 deaths, but it has over 300,000 excess deaths from this year compared to the same periods in previous years. So that means that we have almost 100,000 excess death that's not diagnosed as COVID-19 for other reasons, like

cardiovascular disease. The study found deaths from dementia and heart disease significantly increased. Doctors believe people with acute emergencies and chronic diseases like diabetes that weren't properly cared for also fell victim. If the trend continues, researchers say the US could see more than 400,000 excess deaths by the end of 2020.

These are consequences of the disastrous lockdowns that we had in the spring, and we can compare For example, the US with Sweden, what is interested in that Sweden has 6,000 COVID-19 deaths, but the number of excess deaths compared to the previous five years is only 2,000. So unlike the United States that has more excess deaths than COVID-19 death, Sweden has only a third of excess death compared to COVID death. And Sweden did not lock down in the same way as most other countries.

They kept the schools open throughout the height of the pandemic from ages 1 to 15. So I think Sweden is something about which there's been a lot of misunderstanding. So first of all, in Sweden, there were a whole series of restrictions on gatherings, on hospitality. In schools, the older kids are doing online teaching at home, which hasn't happened in other countries. So quite a lot of restrictions in Sweden. Number two, in Sweden, when you do comparisons, of course, there are a thousand and one factors that feed into those comparisons. So we need to compare like with like. So let's compare Sweden, not with very different countries, Britain and the United States, where there's been austerity, huge cuts in public services, huge cuts in the health service.

Let's compare them with other Scandinavian countries. So look at deaths per million. In Sweden, it's 574. in Denmark it's 108, in Finland is 61, in Norway it's 47. So Sweden is about six times as high as the next country and about 15 times as high as its neighbour Norway. And has that saved their economy? No, the hit to their economy has been every bit as big. And has having more deaths and more infections early on mean less of a second wave? No, right now, the hit to their economy has been every bit as big. the infection rate in Sweden is three and a half times that of its neighbour Norway.

So in many ways, Sweden is not a success story. It's actually a failure story. In terms of your question of what we should do now, let me tack to something we haven't really talked about, which is that when you look at the countries that have done really well, then what you find is that one of the critical things is public trust between government and the population, so that the population understand the need for restrictions

and go along with them. So in many ways, I think that proportionate restrictions need to be combined with public trust. And here I suspect that Martin and I might agree that one of the critical things that a government has got to do is not wag its finger at people and tell them what to do, it's to support them to do the right thing. Stephen, let's go to closing statements.

We've had a fulsome debate here. This is an opportunity for you to sum up any of your key arguments. Well, I think we'd all agree we're in a crisis right now. A global crisis, probably the greatest global crisis of most of our lifetimes. And when there are crises, people in Britain often like to roll out Winston Churchill. So I'm going to adapt a quotation, famous quotation from Churchill, which actually he made about Russia, but that's irrelevant. And I want to suggest that the Great Barrington Declaration might sound seductive,

but in the end, it's an illusion wrapped up in a dream inside a misunderstanding. It's an illusion to believe that you can isolate and protect 30% of the population. The less that you sequester them, the more you put them at risk. The more you protect them from risk, the more you lock them away in a way that is unequal and unfair. And in the end, the sparks will always get in. The dream is that we can send out the other 70% of the population without there being massive damage. We are talking about probably in the United States, hundreds of thousands, if not more, of people actually dying, and then clogging up the health system so people will also die because they can't be treated in other ways.

The fact that more people are dying of other things is precisely because the levels of infection are too high. And don't forget long COVID. To send out that many millions of young people who've made such sacrifices to keep the pandemic under control and expose them to a disease where we don't know the consequences and above all the people who are, you're forcing to go out, are going to be the least privilege, the ones who can't work at home, the ones who are working in forward and public-facing jobs, the ones who are in crowded accommodation, the ones who have to use public transport. It is absolutely unethical, quite apart from ineffective to think you can send out that many people in the middle of a

pandemic without terrible consequences. And the third point is this. This is not a choice. between lockdown and focus protection. So it's not lockdown versus Great Barrington. Both of those, I think, are unhelpful and destructive responses. We can suppress this virus. As I say, if the government takes its responsibilities to support us, if employers and owners make sure that premises are safe, and if we take our responsibilities seriously to go along with those restrictions,

then we can live largely safely until such time that medical advances allow us to see COVID-19 as part of history. Thank you, Stephen Martin. We're going to give you the last word in this debate, two minutes on the clock for your summation. So first, I would like to thank both the monk debate and especially Stephen for engaging in this scientific discourse. Stephen talked about trust in public health. And I think that I 100% agree that is so critically important. And one important way to get trust in the public is to have this kind of open scientific discourse and debates. Back in March, April, even though I have worked on infectious disease outbreaks for two decades,

I work at a reasonably respectable university. It was impossible for me to publish any of my thoughts on the pandemic in the United States. And there are many others like me who had similar difficulty doing. that. So to have this debate now, I think it's incredibly important both for dealing with the pandemic as well as to try to restore some of the trust from the public in public health. Another aspect of trust, I think, is highly responsible to send out predictions of hundreds of thousands or millions dead in COVID-19, as has been done by some scientists. The number number of deaths will depend on the strategy. If we let this go freely in society and just

rip through society, there will be many deaths because many old people will be infected and some of those will die. If we protect everybody equally, we will postpone things in the future, but still we will have a fair amount of old people who die because they will be infected. So the way to minimize death is through this focus protections. And another scaremongering is the long COVID things. There has not been a single study that I have seen that shows that these complications is more from COVID-19 than they are from annual influenza. And the percentages that was given earlier in this presentations, they are based on people who actually have some severe form of COVID. It doesn't include those who are asymptomatic or mild asymptomatic,

doesn't even know they had COVID. And when it comes to politicians, there are three things. that I think every politician should have to understand and should demand from any advisors that they use. And that's the three principles of public health. One is it's not just short-term, it's long-term. It's not one disease COVID-19 is public health as a whole. And it's not only the safety of us scientists and journalists and politicians and lawyers and other professionals.

It is the safety and well-being of the whole population. including working class and the poor, the inner cities, as well as the poor in the rest of the world. So thank you so much for having this debate and thank you, Stephen, for engaging in it in a very civilized and good mannered way. Thank you so much. Well, I want to second that note. You know, this is an incredibly polarized moment that we're all living through. So much of our collective discourse is shrill, incoherent, and deeply unsatisfying.

And I think today both of you have shown how civility and substance provides for a real opportunity for education, learning, and coming away from this conversation with some new and important insights, whatever your perspective is on how we should proceed to fight COVID-19 from here on out.

So on behalf of the Monk Debates community, thank you both so much for being generous with your time, for coming on, for engaging with each other, other, for listening to each other's arguments and for providing us with such a terrific conversation. Thank you. Thanks. While that wraps up today's debate, I want to thank our participants, Professor Stephen

Reischer and Martin Koldorf. The Monk Debates podcast is that special place for civil and substantive debate on the big issues of the day. To listen to more debates on everything for the latest developments on the U.S. election, to what COVID-19 means for the future of, well, just about everything. To great debates on climate change, religion, you name it, we've got it all at www. www.munkdebates.com. You can also find detailed show notes on today's debate.

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