Chatting with Jay

Before making this essay publicly available, I had a quick chat with Dr. Jay Bhattacharya where he relayed a few initial disagreements. I am grateful to him for being open to criticism and so wanted to list those points here and give my thoughts.

The first thing he pointed out was that his notion of public health not being creative enough was to a large extent about failure to adapt to local circumstances. There didn’t have to be some masterful grand plan from on high, and to be fair many people do criticize the GBD as a sort of monolithic plan. Jay is right in pointing out that the notion of focused protection seems more feasible when considered in each locale.

I still don’t think it was feasible enough. And my reasoning is rooted in a simple fact: the United States lacks social capital and cohesion (at least for the time being). You’ll recall that 2020 saw unprecedented social and political unrest. Gun sales at the beginning of the pandemic skyrocketed and stayed high, with one potential reason being: “a breakdown in trust and a breakdown in a shared, common reality.” I know my local experience with political division over basic protective measures was not unique. For instance, Dr. Ying-Ying Goh who was the public health director for Pasadena details how she and her staff had to basically go out and police behavior every weekend because people were so prone to shirk NPIs. I ultimately think creativity in a public health plan requires a relatively united public if said plan has to last half a year or more. And as detailed in Part Two, Americans often showed little willingness as it were to mitigate COVID.

The second thing Jay pointed out was that the Trump White House wasn’t necessarily receptive to his ideas. It may look impressive to be meeting with the president, but these sorts of meetings are short and the administration can take what it wants from your presentation (or nothing at all).

This makes sense to me. And frankly, I’m actually not too focused on whatever Trump or his staff were doing. I don’t see him as a super consistent actor and would imagine that trying to get him to stick to a national plan during the pandemic would be well-nigh impossible. What I still would emphasize is the connection to Scott Atlas, who seems by all accounts to be a very close collaborator with Jay at the very least. This is Atlas in his recent book describing his path to Washington:

“At that point, I was also having near-daily discussions about the existing evidence with top epidemiologists and infectious disease scientists, including Stanford’s Jay Bhattacharya and John Ioannidis. They both kept reassuring me that my interpretation of the data was accurate, and insisted that I persevere. We believed—and have since been proved right—that COVID-19 proved very little risk to the overwhelming majority of the population. So the focus should have been on protecting the known high-risk groups, instead of quarantining everyone.”

If Atlas had similar ideas to the authors of the GBD, and he was the White House COVID lead during the time when lockdowns were most relevant, I still see the plan as being highly influential. And mind you both Atlas and Jay were top 10 medical contributors on Fox News (the largest cable news network in the US).

The third thing Jay pointed out was that my commentary on young people wasn’t quite fair. And specifically, it left out the harms of lockdowns on the young whose mental health tanked during the early months of COVID (a major reason he and his co-authors wrote the GBD). For instance, the CDC found in August 2020 that 1 in 4 members of Gen Z expressed suicidal ideation based on a survey of ~1,400 people in May and June.

I think this is a sound criticism. I unfortunately don’t think it is based on the best data, and in fact the debate over mental health has often been more a matter of bludgeoning others with CNN headlines than actual analysis (I don’t mean Jay here). For example, that 1 in 4 number neglects to tell you that Gen Z already has a vastly disproportionate ideation rate. According to a McKinsey survey: “Gen Z respondents were also two to three times more likely than other generations to report thinking about, planning, or attempting suicide in the 12-month period spanning late 2019 to late 2020.” It also neglects two significant confounders: COVID’s risk to loved ones and that year’s conflict.

Mental health data is—in my view, having written about mental health quite a bit (1, 2, 3)—very often low quality, and popular analysis of that data even more so. I wish we could have done more but that would have required people acting on data to deliver targeted services or interventions. To this day, discourse is still limited to citing every next mental health statistic to attack lockdowns and lockdown harms. So I’ll reiterate my point from Part Three: “supporters of The Great Barrington Declaration tend only to focus on the harms of lockdowns and not to explore feasible solutions. This is harmful in that public awareness, funding, and volunteer support is a direct and primary determinant of whether social issues get solved.”

I’ll add this incredible analysis by Doctor Tyler Black who studies pediatric mental health. He finds, for example, that a huge proportion of the drop in mental health during the pandemic was attributable more so to modifiable social factors than lockdowns as a brute fact. And then I’ll add my own analysis which points out that mental health rebounded after the actual lockdowns much more quickly than you would expect.

The last thing Jay pointed out to me was about how closure of the US economy affected other countries, primarily with respect to hunger. I would be amenable to this argument if someone could draw a clear line from one thing to the other. But from my understanding 1) United States agricultural exports actually held up during the pandemic (dropped <4% vs close to 20% overall drop in exports) and 2) the vast majority of US agricultural exports actually go to other wealthy countries. It is true that having the US in the global market brings prices down but imo the evidence isn’t too strong that our short, initial lockdown would have had a huge affect on the food supply elsewhere. And someone pointed out to me that certain US food manufacturers fought hard to remain open (with White House support).