My thanks to Dr. Bhattacharya for taking the time to provide such thoughtful answers.

JIMMY LICON: What in your opinion is the biggest single mistake made by policymakers during the Covid-19 pandemic, either in the United States or abroad? Is there a single biggest mistake?

JAY BHATTACHARYA: There are so many mistakes that public health officials and policy makers have made in dealing with the Covid pandemic. There are many candidates to choose among for the single worst -- e.g., using deception and panic as deliberate tools in public health communication, moralizing and stigmatizing an infectious disease so that people feel ashamed to contract it, and the censoring and smearing scientists to silence dissent, and many others.

If I have to pick among the mistakes, though, I think the single biggest one is that public health officials ignored the fact that that there are many public health problems and priorities beyond Covid that are also matters of life and death. It was public health malpractice to put those priorities to one side for a year and counting to address a single problem -- Covid risk. The collateral damage from this catastrophic decision on the health and well-being of the world population, especially the poor, will continue for years to come.

JL: In February 2020, the United States botched the development of rapid Covid-19 testing kits. Do you think if the United States had rapid testing early-on, we would have needed mitigation measures like lockdowns and masks to the same degree? Or would it not have mattered?

JB: It is possible that if the US had closed its international borders and sought to quarantine visitors with symptoms in December 2020, it might have been possible to stop the disease from reaching epidemic status in the US. I am still undecided about that point. The first PCR test for the disease was developed and disseminated in late January 2020, so testing could not have formed a part of the policy at that time.

Given what the earliest seroprevalence studies have shown (mostly conducted in April 2020), it is likely that by February 2020, the disease was already too widespread in some parts of the country (e.g., New York) for a test/trace/isolate strategy to stop the epidemic. We should have adopted a harm reduction / focused protection approach in March 2020. We knew by then which people were the most vulnerable – older people, nursing home residents, people with certain chronic conditions. We should have used that knowledge to inform our response.

JL: The Great Barrington Declaration held a better approach to the pandemic would have been, among other things, targeted mitigation of vulnerable groups in the population like the elderly and those with compromised immune systems. But given how interconnected societies are, wouldn’t we still require some form of lockdowns, social distancing, and masks? (This point was pressed in the book Economics in One Virus: An Introduction to Economic Reasoning Through COVID-19 by Ryan A. Bourne)

JB: The idea that lockdowns were the only effective way to protect the vulnerable is false and should have been seen as false in March 2020. First, there are many essential aspects of human life and human interactions that cannot be put on hold even for short periods of time. The lockdowns necessarily required "essential" workers to continue their activities, for example. Many of these "essential" workers were vulnerable to poor outcomes from Covid infection.

Second, the idea that compliance with the lockdown could extend indefinitely in a free society is (and should have been seen at the time) as nonsense. Lockdown noncompliance is not avoidable and should be seen as a constraint on public health diktats. It should not serve as an impetus to impose additional draconian restrictions, most of which do nothing to reduce disease spread, and to blame the public for a failure to do the impossible, as some public health officials like Dr. Anthony Fauci have shockingly done.

It's now clear that the lockdowns, as a way to protect the vulnerable, have failed. Comparing the outcomes from locked down California versus mostly open Florida is instructive. The Covid mortality per capita in the over-65 population is actually lower in Florida to date than it is in California.

Could focused protection have worked if we had tried it? Probably not perfectly – this is an exceptionally infectious disease we are dealing with after all – but much better than the lockdowns did. The kinds of steps my colleagues and I suggested in the Great Barrington Declaration were not new ideas and were well within the capacity of public health officials to adopt.

Most obviously, protecting nursing homes from Covid, rather than exposing nursing home residents as New York, Pennsylvania and other states did, would have led to much less Covid death. Providing "essential" vulnerable workers with workplace accommodations or paid leave, so they did not have to choose between feeding their families and facing Covid infection was also possible if only public health officials had prioritized it in their recommendations.

The same was true for providing elderly people living in multigenerational homes. For instance, public officials could have provided appropriate protection, such as making available temporary alternate living arrangements to them if someone at home was exposed to the virus. The FDA should have prioritized the rapid approval of rapid antigen tests for use for home settings to empower informed action and decision making by families to reduce the risk of exposure for vulnerable family members. The first such tests were approved for over-the-counter use only this month.

Certainly, good communication with the public about who is at greatest risk and who is at low risk should have been a mainstay of our response. Instead, many public health officials and the media sought to panic the entire public at large and have accomplished their aim.

Public health professionals are usually very creative in thinking of ways to protect vulnerable populations in other settings. It is still shocking to me that most did not approach the Covid problem with their usual creativity and instead decided early on that lockdowns were the only viable approach.

JL: When weighing public policies, it is better think of both the benefits and the costs. Yet the public health professionals in the United States appeared to focus only on the benefits of measures like lockdowns. Should the United States (and others) have done a better job of including economists in the response?

JB: There should be no doubt at this point in the epidemic that public health officials and epidemiologists do not have sufficient expertise to make the sorts of decisions and recommendations that they have made during the epidemic. It is clear, for instance, that many of them cannot perform the most elementary sorts of cost-benefit analyses that come naturally to economists and to many other people. With lockdowns, for instance, many public health officials (including especially Dr. Fauci) seem utterly blind to their costs.

The idea that counting the costs of the lockdowns is somehow immoral, which took hold in the early days of the epidemic, was itself immoral since so many of those costs involve the lives of the poor killed by the lockdowns themselves.

Economists should definitely have been a greater part of the decision-making about the management of the epidemic. But so should have people – experts and non-experts – with every conceivable background, including moral philosophers, priests, rabbis, and imams, psychologists, sociologists, artists, parents, geriatricians, demographers, radiologists, and oncologists, to name just a few.

Given how wide-ranging the effects of the lockdown have been – affecting every person on earth in profound ways – no single set of experts has the expertise to make wise decisions. It was an enormous mistake to cede these decisions to epidemiologists and public health officials. It's not their fault that they do not have the training of the philosopher-king of Plato's Republic. No one has such expertise, and we should never again pretend that there exists such a class of experts who have such wide-ranging knowledge.

JL: You’re trained as both a physician and an economist. And economists are good at looking at not only the short-term and local consequences of policy, but the broader long-term ones too. Do you think your interdisciplinary training allowed you to see mistakes and shortcomings in public health approach to the pandemic? Explain a bit if you would.

JB: My training in medicine and economics and my research interests in infectious disease epidemiology and other topics, which I've always viewed as a bit idiosyncratic before the pandemic, conditioned me to think almost immediately about the collateral harms from the lockdowns from the moment I first heard about them.

I gave an interview with a Reuters reporter in late March 2020, where I shared some of my early thoughts about these harms, which I thought would be horrific at the time. In retrospect, I think I underestimated them. The only question at this point in my mind is whether the collateral damage around the world from the lockdowns will be two or three orders of magnitude worse than the marginal Covid harm averted by them.

That said, I do not think it takes any special training to understand that it is essential to consider both the costs and benefits of a policy over both the long and short term before deciding that the policy is a good idea. That so much of the more vocal parts of the public health and epidemiology communities focused (and continue to focus) on the putative benefits of lockdown, while appearing utterly blind to its harms, remains shocking.

JL: Do you think in the near to long-term public health experts and policymakers will have learned from their mistakes in their response to the pandemic? Or do you think they will likely repeat them if we have another pandemic in the next few decades? (This question is speculative).

JB: It is of utmost importance that we adopt regulations, laws, processes, and organizational structures that make it substantially more difficult for a relatively small group of epidemiologists and public health officials to set in motion a political process that leads to widespread lockdown. At a minimum, a broader set of people should be advising governors and the federal government about these sorts of decisions than participated this time around. The reformed processes should be resistant to distortions in perception that come from panic and fear, which unfortunately characterized decision-making at the highest levels of government everywhere.

When a disaster like the Apollo 13 mission occurred, panic did not rule the day at NASA. Instead, the engineers, scientists, and managers there relied on a broad range of expertise, extensive contingency planning, and a culture that knew how to put panic and fear aside in stressful situations to help bring the astronauts home safely despite a disaster that might otherwise have left them to die in space. We need to bring the same ethos to pandemic response by public health agencies, so as not to repeat the failures we have seen in this pandemic.

JL: If you had to convince someone to rethink lockdowns, but only had a few minutes, what would you say? Is there a data point or argument you could make that conveys why lockdowns aren’t the obvious solution to the pandemic that many think?

JB: The scientific case against lockdowns is amazingly simple, and is based on a very few salient facts. First, there is a thousand-fold difference between the young and the old in the risk of mortality and other severe outcomes after Covid infection. According to seroprevalence data worldwide, people over 70 have a 95% chance of surviving Covid infection, while people under 70 have a 99.95% surviving.

Since the old are much more vulnerable, we should use every ounce of ingenuity we have to protect them against infection, for instance by prioritizing them for vaccination no matter where they live in the world. Protecting the vulnerable is the warp and woof of public health, and there is every reason to think it would have been possible to do so, even before the vaccine was developed.

At the same time, the collateral damage from lockdowns pose a greater risk to most of the younger population than does Covid infection. By relying on failed lockdowns to protect the elderly and eschewing focused protection strategies, we have ended up exposing the elderly with the virus and harming the young with lockdowns.

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