How hiring the wrong medical “expert” derailed US pandemic response

Image of a man speaking from behind a podium.
Enlarge / Scott Atlas, a White House adviser, used his position to advocate for allowing the SARS-CoV-2 virus to spread and tried to block testing for it, which would further that goal.

While one congressional committee seems to be grabbing all the headlines recently, other investigations of the Trump administration have continued in the background. One of them is trying to determine how the US’s response to the coronavirus pandemic went so wrong that the country ended up with over a million deaths and one of the worst per-capita death rates in the world. In its own words, the committee’s goal is “to ensure the American people receive a full accounting of what went wrong and to determine what corrective steps are necessary to ensure our nation is better prepared for any future public health crisis.”

In its latest report, released on Tuesday, the committee details the White House career of Scott Atlas, a neuroradiologist with no infectious disease experience. Atlas’ hiring by the White House was expected to be so controversial that he was initially instructed to hide his staff ID from the actual government public health experts. Yet he quickly became a driving force for the adoption of policies that would achieve herd immunity by allowing most of the US population to be infected—even as other officials denied that this was the policy.

How’d this guy get here?

Atlas’ lack of relevant expertise raises questions as to why he was hired in the first place. The new report details that he wasn’t shy about voicing his opinions about the pandemic response, making multiple TV appearances to complain about the policies advocated by actual public health experts. He also directly reached out to a senior government official, calling the US’s response “a massive overreaction” to a virus he estimated “would cause about 10,000 deaths.”

This eventually got him meetings with a number of White House officials, including Trump and his son-in-law, Jared Kushner. After that meeting, Kushner hired Atlas as pandemic adviser but knew that the hiring would not go over well with the government’s public health experts. As a result, Atlas was told to continue working remotely from California, not to introduce himself on conference calls, and to hide his White House ID card when he met with Coronavirus Response Coordinator Deborah Birx. Atlas exited stealth mode when he switched to working in the White House.

Once there, Atlas began participating in the activities of the White House Coronavirus Task Force, meant to formally coordinate the government’s pandemic activities. But Atlas also sat in on less formal meetings with mostly political figures within the Trump administration, such as Kellyanne Conway and Hope Hicks. These meetings were referred to as “China Virus Huddles,” and provided Atlas with a route to influence policy that avoided disagreements with public health specialists. Birx suspected that this allowed Atlas to craft what she called “parallel data streams” for the president that didn’t reflect official government pandemic figures.

According to testimony and documents received by the committee, Atlas used this to promote the idea of reaching herd immunity prior to the availability of vaccines—a route that would see most of the US population infected at a time when there was little in the way of effective treatments. This approach received some backing from political figures in the Trump administration but was vigorously opposed by public health experts. The net result was a set of contradictory public statements and some rapid reversals of official government policy.

Don’t follow the herd

The idea behind herd immunity as promoted by Atlas is to allow most individuals to go about their normal lives, while steps are taken to avoid infections of vulnerable populations such as the elderly and immunocompromised. Almost all public health experts dismissed this idea, recognizing both the risks COVID-19 posed to the otherwise healthy, and the near impossibility of keeping the at-risk populations from being exposed.

To get his ideas adopted over these objections, Atlas took a two-track approach: bring in other herd immunity advocates to influence political figures and sideline public health experts on policy decisions.

Advocates for herd immunity made their arguments in favor of it public through a document called the Great Barrington Declaration, named after the town that hosts the libertarian think tank where it was drafted. Atlas invited many of the documents’ signatories to brief White House figures, including Joseph Ladapo, who went on to play a key role in limiting public health efforts in Florida.

Birx, supposedly in charge of the coronavirus response, dismissed these figures as “a fringe group without grounding in epidemics, public health, or on-the-ground common sense experience.” But the committee found that Atlas began sending ‘opposite opinions’ that contradicted Birx’s daily coronavirus reports to members of the White House staff. He also issued a public statement indicating that the herd immunity approach was formal policy, saying, “targeted protection of the vulnerable and opening schools and society policy matches the policy of the President and what I have advised.” And two White House officials gave an anonymous background briefing to the press that indicated the Trump administration had adopted herd immunity as a policy.

Faced with this, at one point, Birx sent an email to then-Centers for Disease Control and Prevention director Robert Redfield and Anthony Fauci that simply said “I just can’t.”

Despite team herd’s apparent success, when questioned directly, Atlas denied he ever suggested the idea. Alex Azar, who served as secretary of Health and Human Services, also appeared to promote herd immunity publicly but denied it when questioned. (The committee suggests this contradiction “raises serious questions about the veracity of Secretary Azar’s representations to Congress.”)

Targeting testing

Although there was obvious confusion about whether Atlas had gotten herd immunity adopted as official policy, the committee uncovered evidence that he managed to get policies enacted that were consistent with it—at least temporarily. This included undercutting efforts to limit infections through public health measures like testing and mask use.

The committee heard evidence that Atlas blocked a public message that would have encouraged using masks to limit the spread of infections. Atlas also produced a document in which he falsely claimed that data indicated that masks weren’t helpful and suggested they could actually promote infection—language that was echoed by Trump.

But his most significant role was in turning CDC testing guidance into a mess. The CDC testing guidelines initially suggested that people who have been exposed get tested and isolate until they receive a negative test result—actions that, if followed, could significantly reduce the spread of the virus. That, obviously, goes against the idea of establishing herd immunity through infection, and Birx testified that “changing CDC’s testing guidance to reduce the amount of testing being conducted ‘was an intent of Scott Atlas when he came to the White House.'”

And he ultimately succeeded. Redfield allowed language suggesting that people exposed to the virus “do not necessarily need a test” after ensuring that the guidance also included the advice that people should get tested if their doctor suggested they do so—his reasoning being that any sane doctor would obviously suggest a test. (Atlas, it would seem, was evidence to the contrary.) But, after the language had been approved by the CDC, the recommendation that anyone exposed should isolate for two weeks was deleted, although the committee has not determined how that happened.

Documents received by the committee indicate that Atlas also suggested that the PCR testing protocol be revised so it was less likely to return a positive result if the virus were present in low levels. This would ensure that, even if testing were done, fewer tests would return positive results.

The new guidance set off a firestorm of criticism, including by public health figures within the government. Less than a month later, the original guidance was largely restored, thanks to the efforts of Birx and Redfield, among others. According to Redfield’s testimony, the restoration left Atlas incensed.

Assessing the damage

It’s important to remember that all of this was taking place before we had any targeted or especially effective therapies for COVID-19 and prior to the availability of vaccines. At that point, the only means we had of limiting deaths and the evolution of new variants was limiting infections. As the new report details, Atlas worked in this period both to sideline real public health experts and to work with political appointees to increase infection numbers.

But if the committee’s goal is to ensure we do better next time, it’s not clear that this report provides much guidance. Given the large number of degrees our universities hand out, it’s always going to be possible to find someone like Atlas: a person with seemingly relevant credentials who believes things that contradict the views of actual experts, yet maintains an unshakeable certainty in their own beliefs. The only way to ensure that such people don’t become threats is to ensure that nobody on the political side of policymaking takes them seriously.

Unfortunately, the pandemic has made it clear that we can’t trust policymakers to exercise that judgment.

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