Thread by @GidMK

So, I have had a proper read of this document, and I thought it might be worthwhile to actually go through and carefully analyze the document

Let's do some peer-review on twitter 1/n

https://twitter.com/MartinKulldorff/status/1337379606739841036

2/n The document is a brief essay by the three authors of the Great Barrington Declaration, which I've screenshotted here for later reference, because it comes up in the essay:

3/n The essay discusses what the authors call "focused protection", so I think it's worth noting at the outset that the GBD explicitly argues against closures/restrictions of any kind, so that we can build up herd immunity

4/n The essay itself is a bit problematic from the start. The authors poison the well with this straw man - it is simply not true that anyone anywhere is advocating for indefinite lockdowns

5/n The essay then goes on to argue that focused protection is not a laissez-faire or herd immunity approach

Again, let us read their own words from the GBD

6/n Next, we have some statements that are broadly true, and some very spurious statements mixed in. Age is certainly the biggest defining risk from COVID-19, but the statement about children is not quite true, and the "infection survival rate" statement is misleading at best

7/n For children, the authors reference the CDC. Here is the table for influenza vs COVID-19 mortality for 2020 from the CDC THAT THEY REFERENCE

For infants, COVID-19 is more deadly. For 1-4, less deadly, 5-14 about the same, and 15-24 MUCH worse

8/n It is factually inaccurate to state that "Children have lower mortality from COVID-19 than from the annual influenza" as the authors do. For some ages, the risks are similar, but for infants COVID-19 appears to be worse

9/n As to the fatality rate, 0.05% is very misleading. This is somewhat close to the MEDIAN risk of death for <70s, which is 0.04% (at age 35), but given the exponential gradient it rises to about 1 in 100 people by age 60!

10/n Moving on, the authors establish that the harms of lockdown are "manifold and devastating"

Except, well, none of these references really support that statement

11/n For example, reference 11, for "worse cardiovascular disease outcomes" shows a decline in ED presentations and admissions, but not only was this sustained after lockdown the authors found nothing about worse outcomes 👀

12/n The statement that social isolation has led to a greater number of drug-related deaths is referenced to this brief, which actually shows that the drug epidemic in the US has been increasing since January and talks about remedies to that during COVID-19

13/n The statement "Social isolation of the elderly has contributed to a sharp rise in dementia-related deaths around the country" is referenced to this document, which disagrees with that assertion

14/n The authors then reference the problematic JAMA Open paper that we have critiqued here to show that school closures have killed more people than COVID-19

osf.io/9yqxw/

15/n And we finish this paragraph with the suggestion that, since suicidal ideation is high in a survey by the CDC, the excess deaths attributable to young people are probably due to suicide (even though this is not supported by the references cited)

16/n Next, we have this paragraph, which basically says that lockdowns cause older adults to be in constant contact with younger people who are out of work, and therefore die more

17/n This is supported largely by this study. While the work is interesting, the basic methodology - correlating residence statistics from 2018 with some ecological measures of COVID-19 deaths - don't really give us much information

18/n The other statements - that economic harms are inequitable - are both true and a bit pointless

COVID-19 harms are also inequitable

In a system of inequity, EVERYTHING IS INEQUITABLE

19/n Finally, we get to some actual policy proposals for this idea of "focused protection"

I, for one, am unimpressed by these

20/n They range from obvious things that every aged care home in the world is already doing (i.e. staff rotations) to obvious nonsense (i.e. temporary accommodations for older people - this is just creating aged care homes of a different sort)

21/n Scientifically, what we have in this document is a mixture of facts and fiction, with some very misleading language thrown in

22/n Logically, the document is fairly incoherent, and ignores some basic realities of the COVID-19 situation 😕

23/n For example, we've shown that at at age 60 the death rate from COVID-19 is 1 in 130. Does "focused protection" extend to this age group?

If so, that's >25% of the entire United States 🤷‍♂️

24/n And, not to belabor the point, but the GBD authors have explicitly called for a herd immunity approach constantly for the last few months. They may not like the moniker, but it is transparently their aim

25/n Moreover, the authors go on about the secondary harms of lockdown, but completely ignore the secondary harms of large COVID-19 epidemics, which have been estimated to be just as bad if not worse

26/n Because some people will inevitably say that I'm calling for lockdowns here, I should point out that I'm not, but that any scientific evaluation of good public health policy requires us to be transparent about the facts

27/n This document instead obfuscates and misleads, in a very deceptive way. We should discuss the pros and cons of govt action, but as a starting point that requires us to, for example, acknowledge that COVID-19 is pretty dangerous even for relatively young people

28/n Worth noting that this thread is *not* a review of the GBD itself. The GBD does not cite evidence and is clearly not intended as a scientific document, and as such is impossible to really review except from a political perspective