Opinion: Hold a morbidity and mortality conference on our COVID-19 response

Hospitals hold Morbidity and Mortality (M&M) conferences to discuss patients’ deaths or complications. As a surgery chief resident, I presented problems or complications from our surgery service to the senior surgical and medical staff at a monthly conference. The idea wasn’t to point fingers but to honestly find out what went wrong and how to prevent it from happening again. These sessions could be painful, total honesty was expected, and excuses were not allowed.

As COVID-19 passes from a pandemic stage to an influenza-like endemic, let's examine our nation’s responses to the epidemic, look at what went right, what went wrong, and find ways to do better. The winter approaches and, as Dr. Anthony Fauci warns, “we should not be surprised” if a new COVID-19 variant arises.

At the beginning of COVID-19, as a former member of the congressional committee with oversight over the Centers for Disease Control and Prevention, I sent an email to Fauci. I cautioned him to be aware that a president has to consider many ramifications of public policy concerning the effects of policy on the economy, education, broad aspects of health in other areas and that this involves cost-benefit estimates. In a previous essay in the Register, I cautioned that mistakes would be made in dealing with this new disease and that the public should treat those making decisions with some grace because mistakes would be made. People were trying to do their best in a scary scenario. (I never received a reply from Fauci, nor did I expect one.)

And mistakes were made.

Lacking information, many imposed damaging lockdowns

China’s lack of transparency was at the root of our failures. We were never able to get verifiable data from the source of this pandemic as it relates to the risk of mortality and the ultimate effect of China’s extreme measures to contain the virus. China’s lack of transparency about this illness, its source, and how it was acting really slowed down our understanding of the disease.

China locked down entire cities, and even held people prisoners in their apartments, boarding up their doors. The World Health Organization paid a superficial visit and said China locked down and got rid of the disease. Then Italy, because of its demographics and the inadequate state of its health system, nearly had a health care breakdown. Were we dealing with something like an aerosolized Ebola? There were early estimates of mortality in the 3% to 4% range. Public health officials were scared, maybe even panicked.

Not unsurprisingly, as we have learned more, we can see that the public health response in most countries around the world was flawed. First of all, the current mortality rate is more like 0.1%, which is still higher than the flu but nowhere near early catastrophic predictions. We learned that the main risk factor is age. According to the New York Times, the risk of dying for a vaccinated 55-year-old is 0.03% but is more than 10 times that for a 75-year-old, while the risk for a 25-year-old man is close to 0.00%. COVID-19 is roughly five to 10 times more deadly than influenza but a long way from Ebola or smallpox.

US leaders worked to suppress dissenting views, and evidence

The public health overreaction precipitated national, state, and local governments to impose lockdowns and other restrictions, which caused huge effects on the economy and catastrophic effects on children's education. Test scores have plummeted, and isolation fueled mental illness. Restrictions caused serious delays in doctor and hospital visits and delayed diagnoses and treatments that might have prevented serious morbidity and mortality from other diseases. Maybe this was justified early in the course of the epidemic to “lower the curve” in order to prevent overwhelming the health care system, but then the goal morphed into eliminating the disease.

Sweden’s approach and the Great Barrington Declaration explored alternatives to the “science" preached by the government public health authorities. Thousands of doctors and scientists who thought that we should protect those most at risk but not lock down the rest of the economy were demonized. They were falsely accused of promoting just letting the virus run rampant. Instead they proposed that those most at risk be protected until we had a vaccine and achieved herd immunity. To combat this heresy, Fauci and Dr. Francis Collins at the National Institute of Allergy and Infectious Disease and the CDC corralled a group of virologists — virologists dependent on the NIAID and the CDC for funding their research grants — to issue a statement condemning this approach.

Harms from prolonged restrictions grow even as benefits shrink

What is the track record of lockdowns? For those who could sequester and work at home, it probably delayed their own illness. However, in comparing countries that rigorously locked down to those that didn’t, it is hard to find evidence that it saved lives. Sweden took the targeted approach in line with the Great Barrington Declaration. The Swedes gave resources to older people to protect themselves, groceries were delivered to the elderly, they protected nursing homes, and they advised against mass gatherings. They made recommendations to the public instead of issuing top-down lockdowns. The virus took its course in the general population, and immunity built up in people who were less at risk.

The result? Sweden had fewer excess deaths throughout the entire pandemic compared with many countries that locked down harder. It had fewer deaths than expected given its population age and structure than it had from 2015 to 2019. Sweden imposed no mandatory closures and kept its schools open. This is despite the fact that Sweden made mistakes early on in not protecting nursing homes as stringently as it later did.

Florida, too, closed some schools early in the pandemic but mostly followed a more focused protection, kept schools open, and has avoided some of the effects of harder lockdowns.

Compare this with Australia and New Zealand or New York, which locked down and then perversely sent nursing home residents with COVID-19 back to their nursing homes to infect the other elderly residents. Australia and New Zealand literally locked down for 2½ years. Once these countries reopened, however, the number of cases exploded. Now New Zealand has more cases per capita than the United States.

Interventions are highly effective in specific circumstances

Underlying these lockdowns was the implicit promise was that we could get rid of the disease. This was false; Fauci acknowledged from early 2020 on that "the cat was out of the bag" and that lockdowns were never going to eradicate the disease.

We've found out that vaccines are effective in protecting people from getting really sick and dying. However, we now know that vaccines have not been able to prevent the spread of the disease and were oversold. Pfizer's CEO noted that the trials did not show the vaccines prevented transmission, only that they decreased symptomatic disease.

Also, we have learned that the vaccines' efficacy wears off after a few months. That is why people who are elderly or have underlying conditions should strongly consider getting boosters again for this winter. Children and younger people, however, are not going to benefit much from boosters, Many countries have chosen other policies.

John Tierney wrote in Healthcare, Politics and Law for October 2022 that "The European Union has not yet approved COVI vaccines for children under 5. Except for Austria, European countries have not followed the U.S. in recommending a booster shot for healthy children under 12, and most don’t recommend it for healthy adolescents, either. Some countries have decided to stop even offering vaccines or boosters to young people outside the high-risk groups."

We have learned that if you want real protection you have to wear tightly fitting N95 masks like those worn by hospital personnel. But people who are not trained to wear them properly, those who use inadequate masks like cloth ones, or surgical masks with gaps, dirty reused masks, or even N95 masks with gaps are not going to be protected. For whatever reason, Fauci initially said that masks weren’t necessary for the general population. He was right.

A dozen studies before COVID showed face masks did not protect from past flu virus epidemics in general populations.This doesn’t mean that N95 masks properly worn and so tightly fitting that they don’t let air in around the edges aren’t effective for health personnel trained in their use. It does mean that the general population won’t tolerate those types of masks. They are hot and restrict airflow. In fact, the use of ineffective masks may have given those with risk factors a false sense of security.

Lost trust in public health requires intense reflection

The biggest mistake our health authorities made was to politicize “science.” This has harmed trust in public health leaders. Science works best when there is an open discussion of ideas. Our leaders actively worked to suppress scientific dissent, which silences scientists who are afraid to risk their careers. We had a public health bureaucracy that told social media what was allowed to be discussed and what wasn’t. Public health officials have a narrow range of expertise, but they are not good at thinking about social trade-offs.

Our political leaders are supposed to consider broadly what a policy will do, which is why I sent Fauci my email. A little humility from our public health officials would have been helpful. When public health officials were asked what they knew and they didn’t really have good evidence, they should have just admitted that the data wasn’t in.

The unintended costs of lockdown policies are only now becoming more obvious. We will learn of broader health harms they caused, such as the United Nations estimate in March 2021 that nearly 230,000 Asian children died of starvation as a consequence of the economic dislocation caused by lockdowns.

It is time for a national M&M conference on the successes and failures made in dealing with the COVID-19 crisis where voices of dissent aren’t intimidated or shut down and people aren’t afraid to suggest alternatives based on better information.

Dr. Greg Ganske is a retired surgeon and was a member of Congress from Iowa from 1995 to 2002.

This article originally appeared on Des Moines Register: Opinion: Hold a morbidity and mortality conference on COVID response