QUESTIONS FOR A COVID-19 COMMISSION

Introduction

America’s response to the COVID-19 pandemic failed on many levels of government and in many aspects. Certainly, deaths are unavoidable during a pandemic. However, too many U.S. policy makers concentrated efforts on ineffective or actively harmful and divisive measures such as school closures that generated enormous societal damage without significantly lowering COVID-19 mortality, while failing to protect high-risk Americans. As a result, Americans were hard hit both by the disease and by collateral damage generated by misguided pandemic strategies and decisions that ignored years of pandemic preparation guidance crafted by numerous public health agencies, nationally and internationally.

Many crucial mistakes were made early on, in January, February, and early March 2020, and not corrected later. Mistakes made during this early critical window at the beginning of the pandemic affected our ability to collect data about COVID-19 and protect those most at risk and laid the groundwork for loss of public trust and confusion. These oversights led to unnecessary morbidity and mortality, particularly in nursing homes, and a lack of much-needed medical supplies, reagents for testing, and required medications. Delays in initiating research on key questions such as effectiveness of therapeutics, modes of transmission, length of infective periods, and other questions, meant that policy decisions were based on assumptions rather than on solid data. To this day, many of these questions have not been adequately addressed through robust trials.

At hospitals, morbidity and mortality (M&Ms) conferences are used to examine errors or omissions in order to improve medical care. Aviation agencies conduct detailed investigations after airplane accidents and incidents. Pandemics are recurring events throughout history, and there will be future pandemics. It is thus critically important that we thoroughly examine federal pandemic responses and decisions so that we can identify and learn from mistakes. Individual states should take on the responsibility of conducting similar processes to analyze their own responses to the pandemic. Other countries have conducted such inquiries (Norway, Sweden, The Netherlands, the United Kingdom, and Denmark) and made results available to the public and to decision makers. The United States is notably absent from this list. These inquiries pose important questions to key decision makers during the pandemic, including (i) politicians, (ii) leaders of the Centers of Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH) and the National Institute of Allergy and Infectious Disease (NIAID), (iii) state health departments, (iv) university presidents, medical school deans, hospital executives, medical journal editors, and leading public health scientists, as well as (iv) news media and technology/media companies.

This document is not a report from such an inquiry. Rather, we present a blueprint containing key public health questions for a COVID-19 commission. In separate chapters we summarize key background information and propose specific questions about failures to protect older high-risk Americans, about school closures, collateral lockdown harms, lack of robust public health data collected and/or made available, misleading risk communication, downplaying infection-acquired immunity, masks, testing, vaccine efficacy and safety, therapeutics, and epidemiological modeling.

We chose not to discuss economic issues, although we recognize that negative effects on the economy have long-term negative effects on public health. We have also chosen not to engage in issues regarding media handling of the pandemic, nor questions of how, when and why the SARS-CoV-2 virus originated. Public health responses to a pandemic are devised and implemented independently of viral origin.

This document was prepared and written solely by its eight authors. No other person discussed its content, or saw a draft or the final version before publication. Seven of us started the work at an in-person meeting in Norfolk, Connecticut, organized by the Brownstone Institute in May of 2022. We wrote and edited the bulk of this document during the subsequent six months. In honor of the place where we met, we call ourselves the Norfolk Group.

The eight of us hold a wide range of political views and are not united by any particular political viewpoints. All the authors have voiced criticisms of how the pandemic was handled by government agencies and individuals appointed by and serving in both Republican and Democratic administrations.  This is a public-health document, and we write it as scientists with different specific areas of expertise, but sharing the same views regarding the basic principles of public health. Our work on this document was not on behalf of any institution, public or private. Further, the statements written in these articles by the Norfolk Group represent their personal interpretations and do not necessarily represent those of their employers. Last, as data are collected and new studies emerge, some of these documents and statements may become out of date or less accurate. These documents are based on current information as of January 2023 and may not have not been updated past that date.

The eight members of the Norfolk Group are:

Jay Bhattacharya, MD, PhD; epidemiologist, health economist, and professor at Stanford University School of Medicine; founding fellow of the Academy of Science and Freedom.

Leslie Bienen, MFA, DVM; veterinarian, zoonotic disease researcher, and faculty member at Oregon Health & Science University-Portland State University School of Public Health (through December 31st 2022). She left in January 2023 to work in healthcare policy.

Ram Duriseti, MD, PhD; emergency room physician and computational engineer for medical decision making; associate professor at Stanford School of Medicine.

Tracy Beth Høeg, MD, PhD; physician and PhD epidemiologist in the Department of Epidemiology & Biostatistics, University of California-San Francisco, clinical researcher in healthcare policy and practicing Physical Medicine & Rehabilitation physician.

Martin Kulldorff, PhD, FDhc; epidemiologist and biostatistician; professor of medicine at Harvard University (on leave); founding fellow of the Academy of Science and Freedom.

Marty Makary, MD, MPH; Physician, public policy researcher, professor at the Johns Hopkins University School of Medicine and member of the National Academy of Medicine. 

Margery Smelkinson, PhD; infectious disease scientist and microscopist whose research predominantly focuses on host/pathogen interactions.

Steven Templeton, PhD; immunologist; associate professor at Indiana University School of Medicine.

This report may be freely republished, in whole or in part, with a clear reference to its original publication by the Norfolk Group at www.NorfolkGroup.org. Throughout the document, references are provided as hyperlinks.