Stanford physicians and researchers published an open letter to the Stanford University School of Medicine faculty on Wednesday that criticized Hoover Institution Senior Fellow Dr. Scott Atlas’ controversial views on the COVID-19 pandemic, countering his stances with a list of statements on COVID-19 infection and mitigation supported by a “preponderance of data.” 

Atlas, the former chief of neuroradiology at Stanford Medical Center, was named senior advisor to President Trump and member of the White House Coronavirus Task Force in August. He drew sharp criticism after the Washington Post reported that he advocated for a herd immunity strategy to accelerate reopening, although Atlas denies proposing a herd immunity policy to the president or the task force.

More than 100 Stanford affiliates in areas such as epidemiology, infectious disease, immunology and health policy condemned the “falsehoods and misrepresentations of science recently fostered by Dr. Scott Atlas” in the letter. The authors cited the Hippocratic Oath and their “moral and ethical responsibility” to speak out.

Stanford Medicine spokesperson Julie Greicius told The Daily that Atlas “has no current affiliation with Stanford Medicine” and that “we … strongly support the freedom of our Stanford Medicine faculty to voice their position based on their expertise.” The University and the Hoover Institution declined to comment on Atlas’ views or role in the White House.

Herd immunity controversy

The herd immunity strategy Atlas has previously proposed would allow for transmission of the coronavirus in order to build a certain level of immunity in the population while keeping vulnerable populations isolated. This would accelerate the reopening of businesses and the economy since the vast majority of the population would not need to isolate or practice social distancing measures.

While Atlas denies he suggested a herd immunity policy to the president, he has repeatedly advanced the herd immunity strategy as one of the best ways to “eradicate the threat of the virus” in Hoover Institution virtual policy briefings, in an April op-ed published in The Hill and in his May comments to a United States Senate committee. In a July Fox News Radio interview, Atlas said that “low-risk groups getting the infection is not a problem. In fact, it’s a positive.”

In their open letter, Stanford affiliates wrote that “encouraging herd immunity through unchecked community transmission is not a safe public health strategy” and that it “would do the opposite, causing a significant increase in preventable cases, suffering and deaths, especially among vulnerable populations, such as older individuals and essential workers.”

The authors added that the “safest path” to herd immunity is through the use of effective vaccines. 

Research published in August indicates that individuals infected with COVID-19 may be at risk of being re-infected since immunity may only last several months, which would make herd immunity impossible to achieve.

Dr. Philip Pizzo, professor of pediatrics infectious disease and of microbiology and immunology, former dean of the School of Medicine and one of the letter’s signatories, told The Daily that “sheltering in place and social distancing measures are estimated to have reduced the number of people who may have gotten infected to approximately 5 to 10%.” 

While it is true that the likelihood of virus transmission decreases when people have had prior infection, “it has been projected that the percent of the population that would need to have antibodies to create some degree of protection against COVID-19 is 60 to 65%,” which would cause a significant number of deaths according to Pizzo.

In a statement to The Daily, Atlas wrote that he “never advocated or recommended to the President or the Coronavirus Task Force a policy of herd immunity.” 

“Since my appointment as Special Advisor to the President,” Atlas wrote, “I have used [my] unique background to work with my colleagues on the coronavirus task force and present the President with the broadest possible views on policy, so that he has the best science-based, fact-driven data available to combat this devastating pandemic and make decisions to save lives and best benefit the American people.”

In response to the Stanford experts’ letter, Atlas told The Daily that “I have never advised the President to open schools or society in any fashion other than safely and in accordance with the science. … Instilling fear among Americans based on lies, ignorance, and personal political preference is despicable.”

Although Atlas denies recommending a herd immunity policy to Trump directly, the president discussed herd immunity in a Fox News interview in late August saying, “we use the word ‘herd’ right? Once you get to a certain number, it’s going to go away.”

Dr. David Relman, professor of medicine, microbiology and immunology, and senior fellow at the Freeman Spogli Institute for International Studies, who also signed the letter, told The Daily that there are “fundamental, profound flaws” with Atlas’ strategy for managing the pandemic. 

Relman said that an attempt to achieve herd immunity through rampant community spread of the virus could overwhelm health care systems, “in part because it is hopelessly unrealistic to quarantine all at-risk individuals, and in part because young people can get very sick as well.” The prevalence of underlying conditions such as diabetes and prediabetes place a significant portion of the population at increased risk of adverse outcomes if infected, according to Relman.

Pizzo echoed Relman’s views, adding that completely isolating vulnerable populations is not practical, noting that in the early days of the pandemic, more than 40% of deaths took place in nursing homes where more at-risk individuals were already segregated from the public.

Atlas’ views on asymptomatic testing, masking, infection in children

According to The New York Times, Atlas was involved in a “vigorous debate” that ultimately led to revision of Centers for Disease Control and Prevention guidance, which recommended individuals abstain from COVID-19 testing if they do not have symptoms.

Public health experts assert that asymptomatic testing is crucial in mitigating the spread of the virus, especially since an estimated 40% of COVID-19 infections are asymptomatic. The authors of the Stanford letter wrote that testing asymptomatic individuals “is important to break the chain of ongoing transmission.”

Atlas has also expressed unorthodox views on mask wearing, saying that the science is unsettled. Pizzo disputes any uncertainty regarding the efficacy of masks, saying that “virtually every leadership body, whether it is epidemiological or infectious disease, advocates mask wearing as a way of reducing and containing transmission.”

In addition, Atlas claimed that children have “essentially no risk of dying” from the virus and that concerns surrounding sending children back to school are misguided. 

“It doesn’t matter if children get the disease,” Atlas said in a July 9 interview with Fox News, “they don’t get sick from this and the data shows that they do not significantly transmit to adults.”

While infection in children is less common, “serious short-term and long-term consequences of COVID-19 are increasingly described in children and young people,” the Stanford experts write. 

In addition, a September research letter from Harvard University provides new data on how the coronavirus is causing serious illness and even death in young adults and children. COVID-19 is a “life-threatening disease in people of all ages,” according to Dr. Mitchell Katz, a deputy editor at JAMA Internal Medicine.  

“We all have a responsibility to protect other people as well as ourselves from exposure,” said Dr. Melissa Bondy, who signed the letter and serves as chair of the department of epidemiology and public health. “You cannot just let people get sick since they could still transmit the virus to other individuals and pose a threat to the medical system.”

Relman called Atlas’ statements that children don’t get sick or transmit the virus, that infection in young people may be a good thing and that masks may not be effective, “ignorant and indefensible from an ethical point of view.” 

Experts question Atlas’ qualifications for White House position

Atlas’ calls to reopen the economy and lessen restrictions in frequent Fox News interviews throughout the spring and early summer caught the attention of President Trump and White House advisors who sought out “a doctor with Ivy League or top university credentials who could make the case on television that the virus is a fading danger,” according to The Washington Post.  

In an op-ed for the Los Angeles Times published on Thursday, Bondy and Dr. Steven Goodman, professor of epidemiology and medicine, cast doubt on Atlas’ qualifications to advise the government on matters related to public health, noting that he is a neuroradiologist, not an infectious disease or epidemiological expert. Bondy and Goodman assert that “pseudo-expertise” should not be the driving force behind the U.S. government’s efforts to combat COVID-19. 

Pizzo told The Daily that he and his colleagues wrote the letter to the School of Medicine faculty not to “malign an individual,” but to “raise questions and refute observations or recommendations that we felt were inconsistent with scientific data and where we felt a burden of responsibility to protect our local and global communities, as well as the reputation of our university.”

Relman is calling on University leadership to speak out on this matter, writing that they are “failing to fulfill their responsibilities when they don’t make a statement about a matter like this where the public health is in jeopardy.”

Atlas is not the only Hoover Institution fellow to push controversial ideas related to the pandemic. Richard Epstein, a senior fellow at the Hoover Institution, notably claimed on March 16, when only around 88 Americans had succumbed to the virus, that only about 500 Americans would ultimately die of COVID-19. (Asked about the figure by the New Yorker, Epstein acknowledged an error.) More than 190,000 Americans have since died of COVID-19. Trump administration officials reportedly circulated Epstein’s articles.

Contact Cameron Ehsan at cehsan ‘at’ stanford.edu.