Published last week in the The Lancet, the document is named for John Snow, considered the father of modern epidemiology for mapping out the 1854 London cholera epidemic to pinpoint its source and cause, deadly water contaminated by sewage that was managed by a particular water company. The John Snow Memorandum, signed by the Union of Concerned Scientists (and individually by my wife, a physician and epidemiologist at the Harvard School of Public Health), warns that many factors render herd immunity a "dangerous fallacy unsupported by scientific evidence."

Chief among them are that the coronavirus is much deadlier than the seasonal flu, and it remains unclear how long any immunity lasts after one recovers from an infection. That makes it likely that a herd immunity strategy, according to the memo, will surely cause a huge number of preventable deaths, run the risk of triggering recurrent epidemics, and potentially "overwhelm the ability of healthcare systems to provide acute and routine care."

The upwelling of concern behind the memorandum is the legitimacy being given in key corners of the White House to herd immunity, as represented in a new, high-profile document called The Great Barrington Declaration. It was written by three scientists with fringe views and concocted in a gathering hosted by a libertarian think tank with ties to the climate-denying Koch Industries. The declaration's top authors were invited earlier this month to meet with Scott Atlas, a member of the Coronavirus Task Force and an open advocate of herd immunity, and Health and Human Services Secretary Alex Azar.

The declaration claims, with not a single fact or scientific study to back it up, that "current lockdown policies are producing devastating effects on short and long-term public health." Paternalistically oblivious to systemic and political reasons why Black, Latinx, and Indigenous people die from COVID-19 at higher rates than White people, the declaration says lockdowns are a "grave injustice" to the working class and school children and that keeping lockdowns in place until there is a vaccine "will cause irreparable damage, with the underprivileged disproportionately harmed."

Given all that so-called injustice, the authors say everyone who is "not vulnerable" should be free to move about the country and dance, sing, and play with the virus. They slyly skirt the notion that herd immunity is really about reopening the economy at all costs—which many governors did with catastrophic spikes in coronavirus cases. Instead, they say:

"Schools and universities should be open for in-person teaching;"

"Extracurricular activities, such as sports, should be resumed;"

"Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume."

Herd Immunity’s Unacceptable Toll

Resumption of normal life in the United States under a herd immunity approach would result in an enormous death toll by all estimates. Former CDC director Tom Frieden estimates that another 500,000 people would have to die to achieve 60 percent herd immunity. "And that's the best-case scenario," Frieden wrote in a Washington Post op-ed. "The number of deaths to get there could be twice as high."

Frieden said that is the best-case scenario because no one really knows if the actual percentage needed to see the virus peter out is to have it infect more like 65, 70, or even 75 percent of the population. Even if immunity could be miraculously achieved at 50 percent, an estimate published in Nature Reviews Immunology places the range of sacrifice somewhere between 500,000 and 2.1 million deaths.

That makes it little wonder that Anthony Fauci, the most respected scientist advising the Trump administration on the pandemic, called herd immunity for the coronavirus "total nonsense." Fauci is backed up by the likes of National Institutes of Health Director Francis Collins, who said herd immunity is a "dangerous" and "fringe" component of epidemiology. Ashish Jha, dean of the Brown University School of Health called herd immunity "junk science."

The head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, said this month that the only acceptable form of "herd immunity" is achieved through vaccination. "Herd immunity is achieved by protecting people from a virus, not by exposing them to it," the secretary general said. "Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic... Allowing a dangerous virus that we don't fully understand to run free is simply unethical. It's not an option."

Nowhere does the Great Barington Declaration acknowledge that 60 percent of adults in the United States have at least one chronic medical condition that makes them more vulnerable for worse outcomes from COVID. That means that only 40 percent of adults would have the privilege of resuming normal breathing among work colleagues and shouting and singing in sports and worship.

Nor does the declaration acknowledge a study in The Lancet that finds that less than 10 percent of people in the United States currently have the antibodies for the coronavirus. As proponents of herd immunity wax poetically about letting the virus loose among children and young adults, a grim reality is that one out of every five COVID deaths has occurred among people under the age of 65.

The herd immunity approach is also inherently racist, given the context of the systemic health, employment, residential, and environmental injustice inequities that make people of color more susceptible to the virus. Even though the virus is raging throughout nearly the entire nation, with cases increasing in 42 states and Guam, according to the October 22 tracking by the New York Times, any public health response to the virus must factor in the impact on people of color.

According to the Centers for Disease Control and Prevention (CDC), the COVID hospitalization rate for Latinx, Indigenous Americans, and African Americans, when adjusted for age, were all more than four times higher the hospitalization rate for white Americans, and the age-adjusted death rate for all three groups are triple the rate for white Americans, according to the APM Research Lab. The lab says that if racial death rates were equal, nearly 22,000 Black people and about 11,400 Latinx would still be alive today.

And while proponents of rushing children back into classrooms say we can do so because young kids rarely get sick from coronavirus, nearly four out of every five children who do die are African American, Latinx, or Indigenous, according to the CDC, double their combined share of the U.S. population.

Herd Immunity Is the National De Facto Strategy

Somehow, none of that has culled herd immunity from being considered as a legitimate approach for fighting COVID-19. Rather, the Great Barrington Declaration has much in common with the Trump administration's approach to the coronavirus, which has led to more people dying from COVID-19 in the United States than in any other nation on Earth.

A de facto herd immunity approach is the only thing that can explain the push by governors of so many states to reopen bars, restaurants, beaches, bowling alleys, and gyms in states even as the virus has raged and case numbers have been increasing. It is the only thing that can explain the federal designation of meatpackers as essential workers and state demands that teachers go back into classrooms despite outbreaks and deaths related to those professions.

It also explains how so many of the nation's most respected scientific voices have been silenced. Despite the virus's current "uncontrolled spread" in 34 states and Puerto Rico, according to October 21 tracking by CovidExistStrategy.org, the White House has pushed aside Fauci, Coronavirus Task Force Coordinator Deborah Birx, Surgeon General Jerome Adams, and Robert Redfield, the head of the Centers for Disease Prevention and Control.

In their place, the administration has handed the pandemic podium to Scott Atlas, a radiologist and conservative pundit with no background in infectious disease science or epidemiology in measuring disease prevalence. Inhumanely ignoring the more than half of U.S. adults having a pre-existing condition that could compromise them for COVID-19, he blithely praises herd immunity, saying, "We can allow a lot of people to get infected. Those who are not at risk to die or have a serious hospital-requiring illness, we should be fine with letting them get infected."

He pooh-poohs expanded testing, saying, "you are destroying the workforce." Twitter recently took down one of Atlas's tweets for falsely claiming, "Masks work? NO" and then lying that the WHO says widespread mask use is "not supported." The first sentence of the WHO's webpage on masks says, "Masks are a key measure to suppress the spread of COVID-19 and save lives."

Atlas denies that the White House has a "wide-open strategy of achieving herd immunity." But there's little doubt that the White House is wide open to the idea. Last week, Atlas appeared on Fox News to say the thrust of the Great Barrington Declaration "is exactly aligned with the president." That was seconded by a senior administration official who told reporters in a conference call that the Great Barrington Declaration "is endorsing what the president's policy has been for months."

The freezing out of scientists on the Coronavirus Task Force reached deep space levels this week (a metaphoric minus 455 degrees Fahrenheit), with multiple buckets of ice dumped on Fauci. Atlas diminished Fauci as "just one person" on the force, offering only a "limited approach." President Trump called Fauci a "disaster," claiming, "People are tired of hearing Fauci and these idiots, all these idiots who got it wrong."

Many Thousands of Lives Can Still Be Saved

Atlas's malpractice already merits his dismissal. He should be forced to step down because his disregard for science will surely lead to incalculable disaster if a herd immunity approach becomes official government policy. Calls for his ouster have already begun even from inside the task force. According to the Washington Post, Birx went to Vice President Mike Pence to suggest removing Atlas. All Pence reportedly did was ask Birx and Atlas to work out their problems on their own.

There is no time left for such discord within the task force and for discordant messages to come from the White House on how people should protect themselves from COVID-19. The thousands of scientists and public health professionals who signed the John Snow Memorandum say "it is critical to act decisively and urgently," to launch a "robust" response on the level of New Zealand, Vietnam, or Japan—all of which have shown success in containing the virus and keeping the numbers of cases and deaths relatively low.

The approach that has been proven effective starts with face coverings and social distancing and reducing the temptation we all will feel during the oncoming winter holidays to have extended family gatherings. Researchers from MIT and the Vancouver School of Economics estimate in a working paper that, if the United States had established a national mask mandate in mid-March, between 19,000 and 47,000 lives could have been saved by the end of May. Now that the nation's death toll approaches a quarter million lives lost, and is projected to reach nearly 400,000 by February 1, according to the Institutes for Health Metrics and Evaluation at the University of Washington, the institute estimates we could avoid 74,000 new deaths with universal mask use.

Importantly, masks protect others, including the most vulnerable among us. This week, the Washington Post reported how coronavirus outbreaks among college students partying in unmasked packs in LaCrosse, Wisconsin was found to have led to 19 deaths so far of people over the age of 60. Before that, the city had gone without a single pandemic death in its nursing homes.

That is on the heels of the wedding in Millinocket, Maine that resulted in an outbreak that killed eight elderly people, none of whom attended the event, and the 500,000-person Sturgis, South Dakota motorcycle rally that is now tied to the massive coronavirus outbreak in the Upper Midwest and Mountain States. The Germain IZA Institute of Labor Economics estimates that the illness generated from the rally will cost the nation $12.2 billion in health care costs.

Atlas and the proponents of the Great Barrington Declaration have not yet said why this is just fine. That is why they must be unmasked for the charlatans that they are.