There follows a statement issued by the Norfolk Group of physicians and scientists outlining the questions that must be asked and answered in public by those who upended life in America during the pandemic.
The group of eight scientists includes Martin Kulldorff of Harvard and Jay Bhattacharya of Stanford, two of the three authors of the Great Barrington Declaration issued early on in the pandemic, that called for a response targeted towards the most vulnerable rather than unnecessary blanket restrictions on every aspect of life.
America’s response to the COVID-19 pandemic failed on many levels of Government and in many aspects. Certainly, deaths are unavoidable during a pandemic. However, too many U.S. policy makers concentrated efforts on ineffective or actively harmful and divisive measures such as school closures that generated enormous societal damage without significantly lowering COVID-19 mortality, while failing to protect high-risk Americans. As a result, Americans were hard hit both by the disease and by collateral damage generated by misguided pandemic strategies and decisions that ignored years of pandemic preparation guidance crafted by numerous public health agencies, nationally and internationally.
Many crucial mistakes were made early on, in January, February, and early March 2020, and not corrected later. Mistakes made during this early critical window at the beginning of the pandemic affected our ability to collect data about COVID-19 and protect those most at risk and laid the groundwork for loss of public trust and confusion. These oversights led to unnecessary morbidity and mortality, particularly in nursing homes, and a lack of much-needed medical supplies, reagents for testing, and required medications. Delays in initiating research on key questions such as effectiveness of therapeutics, modes of transmission, length of infective periods, and other questions, meant that policy decisions were based on assumptions rather than on solid data. To this day, many of these questions have not been adequately addressed through robust trials.
At hospitals, morbidity and mortality (M&Ms) conferences are used to examine errors or omissions in order to improve medical care. Aviation agencies conduct detailed investigations after airplane accidents and incidents. Pandemics are recurring events throughout history, and there will be future pandemics. It is thus critically important that we thoroughly examine federal pandemic responses and decisions so that we can identify and learn from mistakes. Individual states should take on the responsibility of conducting similar processes to analyze their own responses to the pandemic. Other countries have conducted such inquiries (Norway, Sweden, The Netherlands, the United Kingdom, and Denmark) and made results available to the public and to decision makers. The United States is notably absent from this list. These inquiries pose important questions to key decision makers during the pandemic, including (i) politicians, (ii) leaders of the Centers of Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH) and the National Institute of Allergy and Infectious Disease (NIAID), (iii) state health departments, (iv) university presidents, medical school deans, hospital executives, medical journal editors, and leading public health scientists, as well as (iv) news media and technology/media companies.
This document is not a report from such an inquiry. Rather, we present a blueprint containing key public health questions for a COVID-19 commission. In separate chapters we summarise key background information and propose specific questions about failures to protect older high-risk Americans, about school closures, collateral lockdown harms, lack of robust public health data collected or made available, misleading risk communication, downplaying infection-acquired immunity, masks, testing, vaccine efficacy and safety, therapeutics and epidemiological modeling.
We chose not to discuss economic issues, although we recognise that negative effects on the economy have long-term negative effects on public health. We have also chosen not to engage in issues regarding media handling of the pandemic, nor questions of how, when and why the SARS-CoV-2 virus originated. Public health responses to a pandemic are devised and implemented independently of viral origin.
This document was prepared and written solely by its eight authors. No other person discussed its content, or saw a draft or the final version before publication. Seven of us started the work at an in-person meeting in Norfolk, Connecticut, organised by the Brownstone Institute in May of 2022. We wrote and edited the bulk of this document during the subsequent six months. In honor of the place where we met, we call ourselves the Norfolk Group.
The eight of us hold a wide range of political views and are not united by any particular political viewpoints. All the authors have voiced criticisms of how the pandemic was handled by government agencies and individuals appointed by and serving in both Republican and Democratic administrations. This is a public health document, and we write it as scientists with different specific areas of expertise, but sharing the same views regarding the basic principles of public health. Our work on this document was not on behalf of any institution, public or private. Further, the statements written in these articles by the Norfolk Group represent our personal interpretations and do not necessarily represent those of our employers. Last, as data are collected and new studies emerge, some of these documents and statements may become out of date or less accurate. These documents are based on current information as of January 2023 and may not have been updated past that date.
- Jay Bhattacharya, MD, PhD; epidemiologist, health economist, and professor at Stanford University School of Medicine; founding fellow of the Academy of Science and Freedom.
- Leslie Bienen, MFA, DVM; veterinarian, zoonotic disease researcher, and faculty member at Oregon Health & Science University-Portland State University School of Public Health (through December 31st 2022). She left in January 2023 to work in healthcare policy.
- Ram Duriseti, MD, PhD; emergency room physician and computational engineer for medical decision making; associate professor at Stanford School of Medicine.
- Tracy Beth Høeg, MD, PhD; physician and PhD epidemiologist in the Department of Epidemiology & Biostatistics, University of California-San Francisco, clinical researcher in healthcare policy and practicing Physical Medicine & Rehabilitation physician.
- Martin Kulldorff, PhD, FDhc; epidemiologist and biostatistician; professor of medicine at Harvard University (on leave); founding fellow of the Academy of Science and Freedom.
- Marty Makary, MD, MPH; surgeon and healthcare policy scientist; professor at Johns Hopkins University.
- Margery Smelkinson, PhD; infectious disease scientist and microscopist whose research predominantly focuses on host/pathogen interactions.
- Steven Templeton, PhD; immunologist; associate professor at Indiana University School of Medicine.
The Executive Summary
In this document we list specific questions on specific topics related to COVID-19 pandemic responses in the United States. We believe these questions are vital for the nation to ask the White House, the CDC, the FDA, and other Government officials, as well as state health departments, scientists and the media. The public deserves answers to these questions so we can learn from our mistakes. Key issues include:
1. What could have been done to better protect older high-risk Americans, so that fewer of them died or were hospitalised due to COVID-19?
2. Why was there widespread questioning of infection-acquired immunity by Government officials and some prominent scientists? How did this hinder our fight against the virus?
3. Why were schools and universities closed despite early evidence about the enormous age-gradient in COVID-19 mortality, early data showing that schools were not major sources of spread, and early evidence that school closures would cause enormous collateral damage to the education and mental health of children and young adults?
4. Why was there an almost exclusive focus on COVID-19 to the detriment of recognising and mitigating collateral damage on other aspects of public health, including but not limited to cancer screening and treatment, diabetes, cardiovascular diseases, childhood vaccinations and mental health?
5. Why did the CDC fail to collect timely data to properly monitor and understand the pandemic? Why did we have to rely on studies from private initiatives and from other countries to understand the behaviour of the virus and the effects of therapeutics, including vaccines?
6. Why was there so much emphasis and trust in complex epidemiological models, which are by nature unreliable during the middle of an epidemic, with unknown input parameters and questionable assumptions?
7. Could therapeutic trials have been run in a more timely manner? How was information on drug effectiveness and safety disseminated to doctors and clinicians? Were effective therapeutics easily accessible across the population? How did certain drugs become heavily politicised?
8. Why did vaccine randomised trials not evaluate mortality, hospitalisation and transmission as primary endpoints? Why were they terminated early? Why were there so few studies from the highest-quality CDC and FDA vaccine safety systems?
9. Why was the USA slow to approve and roll out critical COVID-19 testing capacity? Why was there more emphasis on testing young asymptomatic individuals than on testing to better protect older high-risk Americans? Why was so much effort spent on contact-tracing efforts?
10. Why was there an emphasis on community masking and mask mandates, which had weak or no data to support them, at the expense of efficient and critical COVID-19 mitigation efforts? Why did the CDC or NIH not fund large randomised trials to evaluate the efficacy and potential harms of mask wearing? Why didn’t policy recommendations change after the publication of randomised trial data from Denmark and Bangladesh which showed no or minimal efficacy of mask wearing by the public?
Stop Press: Steve Templeton, one of the authors, has written for the Brownstone Institute about the statement.