President Trump's New COVID-19 Adviser Is Making Public Health Experts Nervous

Sep 4, 2020
Originally published on September 4, 2020 10:32 am

Dr. Scott Atlas has literally written the book on magnetic resonance imaging. He has also co-authored numerous scientific studies on the economics of medical imaging technology.

"He's an MRI guy," says Dr. Ashish Jha, the dean of the Brown University School of Public Health. "If I was confused about some brain lesion and what the MRI findings were, I'd be happy to call him up."

But President Trump has tapped Atlas for a very different role — as an adviser on the coronavirus pandemic. As such, he is counseling the president on life-and-death decisions about the virus, which has already killed more than 180,000 Americans so far this year.

That has Jha and others worried.

"He has no expertise in any of this stuff," Jha says. "He's been bringing out arguments that have been refuted week after week, month after month, since the beginning of this outbreak."

Here are some of Atlas' ideas and why they have scientists and public health experts fretting.

The controversial strategy known as "herd immunity"

In April on the conservative Steve Deace Show, Atlas spoke in favor of allowing the virus to pass through the younger segments of the population, while trying to protect older Americans.

"We can allow a lot of people to get infected," he said. "Those who are not at risk to die or have a serious hospital-requiring illness, we should be fine with letting them get infected, generating immunity on their own, and the more immunity in the community, the better we can eradicate the threat of the virus."

We can allow a lot of people to get infected. - Scott Atlas, President Trump's coronavirus adviser

He described the process by name as "herd immunity" and described it as a "basic principle" of biology and immunology.

It is true that building up immunity can limit or even stop the spread of a virus like COVID-19, says Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington.

But in the past, that strategy has only worked through vaccination. The idea that you somehow could allow the virus to spread through healthy populations without also putting older and sicker Americans at risk is naive, he says.

"It's very difficult to protect vulnerable populations once the virus is transmitting extensively," he says. "We haven't seen any success of that."

Murray's group estimates that if the virus were allowed to spread easily, deaths could exceed 360,000 by December. Even if the roughly 50% of the population the Centers for Disease Control and Prevention considers vulnerable to complications from COVID-19 were somehow protected, potentially thousands of young and healthy Americans would die.

"COVID is dramatically more risky for everybody than the flu," he says. "There's just no comparison. It's at least an order of magnitude worse — tenfold or more."

Moreover, people face a range of experiences with COVID-19. It's not a dichotomy of death or recovery. There is increasing evidence that some people who beat COVID-19 have lingering side effects. CDC data indicates that roughly a third of COVID survivors ages 18-34 suffer health effects like fatigue and cough for weeks after they're no longer infectious. There's also reports of strokes and more serious complications, though the data isn't quite clear on how common that is.

"I'm not so cavalier as to say, 'It's fine. You might have long-standing lung damage, you might have long-standing heart damage, but at least you won't die, it's OK,' " Jha says.

In a statement to NPR, Atlas says that he has never told the president or the White House to pursue a herd immunity strategy. However, he continues to push to reopen as much of the economy as possible, while trying to protect vulnerable populations in nursing homes and senior centers.

Economy against public health

In his frequent media appearances, Atlas often talks about the economic toll of lockdowns — arguing that restrictions are doing as much, if not more damage than COVID-19 itself.

Speaking on Fox News last month, Atlas pointed to missed medical appointments and an increase in suicidal thoughts since the pandemic began. "American lives are being destroyed," he told host Martha MacCallum. "The lockdown must end."

That message resonates with the president and his political and economic advisers, who have presided over the largest contraction of the American economy since the Great Depression.

"His voice is really very welcome combating some of the nonsense that comes out of Fauci," says free-market economist and White House adviser Stephen Moore, referring to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. "So I think he's a real asset for the president."

But public health experts say that the best way to rebuild the economy is by crushing the coronavirus.

"The way you improve the economy is by controlling the virus, that's what we have seen in other countries," says Jha. "South Korea's economy is doing much much better than ours, because they controlled the virus."

Some European countries such as France and Spain are seeing the virus surge as a result of reopening too quickly, Jha points out, and that will have economic consequences as well.

"The persistent argument that somehow there's a trade-off between the economy and health, to me is false," Jha says.

Open schools, while minimizing some of the risks

Atlas wants to see schools nationwide opened as quickly as possible.

"We cannot sacrifice our children," Atlas said during a press conference earlier this week with Florida Gov. Ron DeSantis. "The harms of not opening schools are really tremendous and all that goes with the known evidence that children really have very, very low risk from this illness."

The closure of schools is taking an enormous toll on children and families. While it is true that children generally recover from the coronavirus quickly, there is also substantial evidence that they can transmit it to others.

"It's not just the children who are part of school communities, it's also the families they go home to. It's the teachers and staff and it's the community broadly," says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. Atlas does advocate for allowing vulnerable teachers and children to continue remote learning during the pandemic, but in the worst-case scenario, opening schools could dramatically accelerate an outbreak of COVID-19 through a city or town, raising the risk for everybody.

"That's one of the situations we really need to avoid," she says.

Darkest days are behind us ... or not

In his email statement to NPR, Atlas said, "Americans today should have cautious optimism as we move beyond the worst phase of this pandemic."

This is not the first time that an administration official has claimed the pandemic has turned a corner, says Jha. He points to a Wall Street Journal editorial in June by Vice President Pence that claimed the worst was behind us. "And then we saw just a horrible number of deaths in July and August," Jha notes.

"The worst is most assuredly not behind us, unfortunately," Murray says. So far, he says, coronavirus has followed the predictable course of many other respiratory viruses, and there's no reason to think that will change. "It'll only get slowly and steadily worse through the fall. And then it'll really start to pick up, unfortunately, in late November and December."

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