The Evidence is Clear: The US Public Wants Science-Based Policies for COVID-19

You would think that after 190,000 COVID-19 deaths, the Trump administration might finally develop a national strategy to control spread of the coronavirus. No. Instead, it foists on us a new member of the coronavirus task force with no expertise in infectious disease or epidemiology. Scott Atlas, a radiologist and conservative pundit at the Hoover Institution, essentially believes we should drop our masks and inhale the virus to create "herd immunity." Back in April, on a day that saw 33,774 infections and 2,169 deaths, he claimed on a conservative talk show:

We can allow a lot of people to get infected. 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.

The ascendancy of Atlas and his attitude conspicuously corresponds with a new directive from the Centers for Disease Control and Prevention that asymptomatic people do not need coronavirus tests, even if they have been in close contact with someone who is infected. It also corresponds with plans by the Department of Health and Human Services (HHS) to launch a $250 million public relations campaign.

Instead of urging robust testing and tracing or salvaging crumbling public credibility for a vaccine amid government politicization, HHS, as reported by Politico, wants to "defeat despair and inspire hope," to "instill confidence to return to work and restart the economy."

The only possible conclusion is that the federal government is waving a white flag to the virus even though the nation is still averaging 40,000 new cases and between 800 and 900 deaths a day (the equivalent of a typical domestic-distance passenger plane dropping out of the sky every five hours). At the start of the pandemic, the only strategy the administration had, in President Trump's own newly-reported words to journalist Bob Woodward, was to "play it down." Its only strategy now is to continue to obscure how much disease is out there. Its only strategy seems to be to obscure how much disease is out there, as 36 states plus Puerto Rico are either trending poorly or in uncontrolled spread as of last Thursday, according to Sept. 7 tracking by the Atlantic.

With such levels of uncontrolled spread, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington's School of Medicine last week dramatically revised its COVID-19 death forecast. The institute now predicts 410,000 deaths by January 1, 2021--more than double the current US toll.

The institute clearly said it does not have to be so. It emphasized that we could save 122,000 lives with universal masking and strict social distancing. If, instead, we took Atlas's advice and officially adopted a herd immunity strategy, the IHME estimates we could see 620,000 deaths, rivaling the 675,000 deaths in the United States from the 1918 flu pandemic. Seconding that assessment is a Washington Postanalysis predicting at least 656,000 deaths from pursuing a strategy to achieve herd immunity. As IHME director Christopher Murray puts it, herd immunity "ignores science and ethics and allows millions of avoidable deaths. It is, quite simply, reprehensible."

There is one sizable glimmer of hope in all this, however. The US public has not waved the white flag on science.

Public support for science

Throughout the COVID-19 crisis, most people in the United States have displayed a far deeper understanding of science and public health than many in the White House, in governors' mansions, and corporate headquarters seem to have.

Even before the pandemic hit the United States, a Gallup poll found respondents ranked nurses and medical doctors in the top three professions, along with engineers, for ethics and honesty. A June New York Timespoll found that while only 26 percent of respondents trusted the president to deliver accurate information about the coronavirus, 84 percent said they trusted medical scientists, 77 percent expressed trust in the Centers for Disease Control and Prevention, and a full two-thirds said they trusted Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, on the subject of COVID-19.

Or consider that, despite the absence of a national mask mandate, the AP found that 75 percent of people polled in the United States approved of mask mandates as a strategy to blunt the spread of disease.

Equally notable, for the past six months, the US public has consistently told pollsters that staying alive is more important to them than cramming into offices, jumping on airplanes, dining out, or huffing and puffing at the gym. With very few exceptions, like that now-fatal super-spreader motorcycle rally in Sturgis, South Dakota or the deadly wedding party in Millinocket, Maine, most people have even reluctantly endorsed the idea that protecting their health is more important than gathering in large groups--even for marriages and funerals, or worshipping in church.

In April, two of every three people polled told CBS News, Pew Research, and the Wall Street Journal and NBC News that they were worried that the country will reopen the economy too quickly, costing more lives.

Of course, many states reopened recklessly nonetheless, their governors unmoved by the Damocles sword the virus had unsheathed on people of color and seniors of all colors. Some of these governors even banned cities for critical periods from enforcing the most basic protections, such as face coverings while, nationally, daily confirmed case counts of the virus soared to 75,000.

All the while, a July Washington Post/ABC Newspoll found the same 2-to-1 margin of people (63 percent vs. 33 percent) saying it was "more important" to control the virus than restart the economy. An Associated Press poll in the same month found that 72 percent of the public supported using restrictions to control the virus, compared to 27 percent who wanted to remove restrictions to help the economy.

Even in August, with 29 million people receiving some form of unemployment insurance, the expiration of the $600 monthly pandemic relief checks, and much uncertainty about evictions for renters and landlords meeting their mortgages, a Monmouth University poll still found 2-to-1 concern (61 percent vs. 31 percent) that the country was reopening too quickly. An NBC News tracking poll similarly found that 57 percent of respondents remained more worried about reopening the economy too quickly than too slowly. Only 40 percent felt the other way around.

It seems most people, unlike the administration and some governors, have understood all along that getting the virus under control is the true key to restoring the economy.

The fight over school openings

A similar dynamic is on display in the new school year.

Across the country, many governors have shoehorned students back into K-12 classrooms and college presidents desperate for revenue have reopened their campuses as we continue to clock more daily cases than any single day of the April surge and register double the daily deaths of early July, when lockdown measures led to a relative lull.

The nation is already paying a new price for these choices. Thousands of COVID-19 infections are being recorded on college campuses, particularly in the South and Midwest. In the absence of a national tracking system, the New York Times has identified more than 51,000 COVID-19 infections across more than 1,000 colleges since the pandemic began. Many colleges have walked back plans for in-class instruction.

In the absence of federal leadership to closely track COVID-19 cases at the nation's schools, a Kansas high school theater teacher, Alisha Morris, created a Pre-K-through-12 coronavirus tracker that she has since given to the National Education Association. As of late August, she had received reports of nearly 4,300 COVID cases and 75 deaths at nearly 1,100 schools.

Morris told the Washington Post that she was shocked when her project "exploded into something pretty overwhelming and pretty depressing." She told National Public Radio that part of her shock came from reading many anecdotal reports of outbreaks that had not been reported in the local press. She said she is concerned that "there are tons of schools that have been purposely trying to keep this on the down-low."

As the federal government and many state governments seem to be also trying to keep COVID-19 data on the down-low (as my UCS colleague Anita Desikan reminds us in her latest post), the cry from school parents is no different than that from the public at large about who they want at the helm of our pandemic response to navigate us safely back into schools. They want direction from epidemiologists, infectious disease experts and front-line doctors and nurses. They want a course charted by people whose fealty is to science, not to politics.

Leading with science

In a Washington Postpoll in August, 79 percent of parents said they feared an increase in the spread of the coronavirus with a return to in-person classes. Similarly, an Axios/Ipsos survey found that 73 percent of were concerned about schools reopening too soon and 80 percent of parents were concerned about their children getting sick. A Kaiser Family Foundation poll found that two-thirds of the public think schools should open later to reduce virus risk even if it meant youth falling behind in class.

The fear of sending children back to school is highest among African American and Latinx parents. That should come as no surprise given that they are much more likely to have known someone who died from COVID than a white parent. Because of residential segregation, those parents are more likely than white families to live in polluted neighborhoods and to send their child to crumbling schools with questionable ventilation. Such schools are also too often sited closer to toxic industrial sites and waste dumps.

Years of exposure to pollution likely increases the risk of worse outcomes for Black and Latinx children as well as adults. The evidence shows that African American and Latinx children are far more likely to be hospitalized for COVID complications than white children.

A study published last week in the Journal of the American Medical Association found that the school closures of the spring may have spared the nation nearly 1.4 million coronavirus cases over a 26-day period and saved nearly 41,000 lives. In an accompanying editorial, two researchers from the University of Pittsburgh said the findings--which come at a time of murky evidence on the question of how contagious asymptomatic school children might be--amplify the immediate need for robust science to help better understand the disease's transmission, and for schools to receive financial support to make in-school instruction as safe as possible, as the social and educational damage for children not being in school is also severe.

"Without a significant advance in evidence on these points, school administrators will be left to make high-stakes decisions without certainty," the editorial said.

Those stakes are soaring as the federal government has all but abdicated its role in leading with science, instead employing Scott Atlas who has repeatedly accused people concerned with reopening schools as being gripped with hysteria, claiming, in the absence of evidence, that "Children almost never transmit the disease."

Atlas has also made statements that could be construed as racial code, given the disproportionate death toll among African Americans, Latinx and the Indigenous, in arguing to keep businesses open. Atlas said the country should, "not go crazy and just simply shut down the economy. We know who dies. We know who gets hospitalized."

Thankfully, this is not the response to the coronavirus that the US public desires. They want the government to shut down its fatal nonsense. While trust in coronavirus information coming from the Trump administration plummeted to 31 percent in a NPR/PBS News Hour/Marist poll last month, 75 percent still say they trust public health experts. Any true hope in ending despair and the unchecked spread of the coronavirus must begin by following the public's clearly documented trust in science.