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 We have been well served by infectious disease specialists affiliated to the NIH, major medical schools, and competent medical commentators. Unfortunately disharmony has characterized our leadership despite the establishment of a Coronavirus Taskforce, first under the leadership of the Secretary of Health and Human Services, Alex Azar, and then by the Vice President. Most recently as we approach the November election, political rhetoric and suspicions of undue pressure on both the the FDA and the CDC have detracted from public confidence
For the record, Sweden, unlike its neighbor Denmark, did not shut down their economy, but following the advice of Dr. Anders Tegnell, decided to allow the infection to progress through the population to create “herd immunity”. Recognizing the vulnerability of the elderly and those with predisposing conditions, attempts were made to protect this population. Months after implementation of the program, it is clear that Sweden experienced a 0.5 percent fatality rate among the entire population, posting 5,800 fatalities. Regrettably 80 percent were in the elderly, mostly in rest homes. Essentially Sweden sacrificed its grandparents for an open society and their economy. The development of herd immunity, the prime motivation for the exercise was unsuccessful. By May, four months into the pandemic, 6.7 percent of those aged 20 to 64 showed serological evidence of exposure, with 4.7 percent in those younger than 19 and 2.7 percent of those over 65. In effect many Swedes adopted precautions to prevent infection, confounding the intent of the policy and suggesting that the approach to inducing herd immunity was flawed.
 The figures on Sweden were cited by Dr. Scott Gottlieb, the Commissioner of the Food and Drug Administration from 2017 through 2019 and now a resident fellow at the American Enterprise Institute, in a recent Wall Street Journal commentary. He advocates a more conventional position to suppress COVID-19 contrary to a new advisor to the Administration. Dr. Scott Atlas, formerly Chief of Neuroradiology at the Stanford University Medical Center and a fellow at the Hoover Institution. On numerous appearances on Fox News Atlas commended the Swedish-style approach to controlling COVID-19 in the face of increasing regional incidence rates.
In a number of interviews over the Labor Day weekend, Dr. Atlas appeared to vacillate in his views and his lack of experience and training in the areas of infectious diseases and epidemiology were all too apparent. Under hard questioning he appeared to backtrack from previous assertions concerning COVID-19 in the U.S. and he apparently may be deviating from his earlier pronouncements and advice that lack scientific validation. His views were repudiated on September 10th by a group of 78 physicians on the faculty of the Stanford Medical School citing “falsehoods and misrepresentation of science”. In an open letter, his erstwhile colleagues stated “many of his opinions and statements run counter to established science and by so doing , undermine public health authorities and the credible science that guides public health policy” Dr. Yvonne Maldonado a pediatrician specialized in infectious diseases and a signatory to the letter stated “It is critical that people with expertise stand up against any dissemination of misinformation because it’s dangerous and unsafe”.
 Even if one or more of the candidate vaccines becomes available, it is noted that protection will require two successive injections at one month intervals. The candidate vaccines will require a cold chain that will create challenges in accomplishing mass vaccination. Perhaps the biggest obstacle will be the disinclination of citizens to receive the vaccine. Currently, only 25 percent of those surveyed intend to be vaccinated when the vaccine becomes available and it remains to be seen how many of the recipients are actually protected despite an antibody response. The characterization of vaccine development as a “warp speed” endeavor has created suspicion, especially when viewed against the tarnished credibility of the Administration, the CDC and the FDA concerning their statements and response to COVID-19 including discredited therapeutics. The manufacturers of vaccines issued a joint statement on September 8th declaring that they will not apply for approval from the FDA until appropriate testing is completed. On the same day, AstraZeneca suspended a trial in the UK following a single case of an undiagnosed neurological condition in a recipient. Is this a happenstance or is it analagous to the 1 in 100,000 incidence of Guillain-Barre Syndrome associated with the rapidly developed 1976 “swine flu” vaccine? A phase-3 trial of a COVID-19 vaccine with 30,000 patticipants will not detect a low-incidence adverse reaction caused by a novel biological agent.
As a nation we should be committed to uniform adoption of precautions including masking, social distancing and avoiding crowds. We cannot legislate against the virus, destroy it by bluster or eliminate it by denial. We must be guided by experienced infectious disease specialists and epidemiologists who are politically neutral and function in accordance with the Hippocratic oath. We must continue a program of structured testing with rapid results to detect both symptomatic and asymptomatic carriers who should be quarantined and their contacts traced and evaluated for risk of infection.
Above all we should be realistic and make sacrifices in order that transmission rates can be minimized and to endure preventive measures in harmony as a united society. Our collective hope is a safe and effective vaccine to stimulate a level of immunity in our population that effectively lowers the level of susceptibility to below the outbreak threshold and subsequently the disease threshold.
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