John Snow vs. The John Snow Memorandum

Turns out the John Snow Memorandum isn’t trolling or satirizing Game of Thrones or other marquee zombie franchises. Nay, the John Snow in question should not be confused with Jon Snow nee Aegon Targaryen, the Lord Commander of the Night’s Watch cum King in the North and slayer of the Mother of Dragons, returned from the dead. That is too bad as I have been anxiously awaiting a zombie-covid mashup epic enough to put Pride and Prejudice and Zombies to shame.

The John Snow in question was an English physician, born 1813 and deceased 1858, never to rise again. He is considered the father of epidemiology because he traced a cholera outbreak in London in 1854 to a specific water source and convinced the local council to remove the water pump’s handle. More on that a bit later.

The John Snow Memorandum seeks to counter the Great Barrington Declaration, which has made waves globally by suggesting that general lockdowns cause more deaths than they prevent. And yes, Tyler Cowen, much of the world remains locked down due to the perceived threat from the so-called novel coronavirus. Even in America, many schools remain hybrid or even online only; worshippers must meet outside; businesses struggle under arbitrary capacity limits. 

Signers of the Great Barrington Declaration think that people should again be free to live their lives as they see fit and that governments should concentrate their efforts on helping the most vulnerable while the young and healthy develop immunity, which is the only way that everyone can return to normal lives. Herd immunity is already happening — just look at the New York Times stories about covid cases hitting new highs in 17 states — yet many policymakers still insist that they can “control” the virus and save our lives at the slight cost of killing our livelihoods.

The outrage expressed by Dr. Fauci and others regarding the Great Barrington Declaration is probably the best evidence that its policy prescription is right on the mark. Fauci and other critics have been wrong about everything so far, so their disapproval is welcomed the way that the disapproval of Nazis and Flat Earthers is. Recall that Fauci first said we shouldn’t wear masks unless contagious. Then, suddenly, it was all about the masks, unless you went to a baseball game with friends after throwing out a first pitch so bad that you should have worn the mask simply to hide your shame. 

Turns out though that I am as much a “doctor” as Fauci is. After all, I hold a doctorate and study the history of science and Fauci has long been just a bureaucrat whose picture should appear in the Encyclopedia Reagan in the entry Most Terrifying Words In the English Language: “I’m from the government and I’m here to help.” I will debate him any time, anywhere, so long as it is indoors and we sit face-to-face, maskless, two feet apart. No, wait, he is part of the vulnerable population, as are a large percentage of the most adamant lockdowners. That is okay, recusal is just for judges. The rest of us can engage in self-interested advocacy and even try to pretend it is in the public interest.

Lockdowners and critics of herd immunity have missed a couple of important details. The first is that covid [insert obligatory concession to it being a “serious” disease here] is simply NOT as deadly as once thought. Remember John Ioannidis, perhaps the greatest health scientist alive? He was pilloried for assembling studies that showed covid was not as deadly as once feared. Now the WHO, the World Health Organization not the British rock band, has published his now peer-reviewed piece “Infection Fatality Rate of COVID-19 Inferred from Seroprevalence Data” and endorsed its conclusion: “Inferred infection fatality rates tended to be much lower than the estimates made earlier in the pandemic.”

And that research is old in covid terms. You know all those spikes and waves in “cases” that were supposed to frighten everyone into permanent lockdown? Well they haven’t translated into mass deaths. In short, the infection fatality rate will eventually come in much lower than the numbers in this crucial WHO study. Follow that “the” science, Joe!

Once again, however, much of the media is playing the Doomsday card. An additional 640,000 people may die from COVID by February 2023 if we go for herd immunity, headlines scream. Yes, 2023! Well I will make the bold prediction that won’t happen because those people will have already died from other causes — drugs, homicide, suicide, starvation, and other diseases, contagious and not — by then if lockdowns continue. 

Fauci et al think of herd immunity as a single number, a binary switch, because they aren’t cool historians of science like me. So they haven’t read Isaiah Berlin’s “History and Theory: The Concept of Scientific History.” Unlike Berlin, they apparently cannot think probabilistically or marginally so they do not understand that every infection that resolves (through death or immunity) decreases the probability that others will be infected. They do not grasp the concept because they equate herd immunity with vaccination and hence are accustomed to overestimating it. They want to vaccinate as many people as possible because it covers them at no cost to themselves and keeps the drug companies fat and happy. (And please note that I am NOT an anti-vaxxer. I get flu vaccines every year, signed up to be in covid trials, and called for a live vaccine in March. What I don’t like are governments forcing or tricking people into vaccination.) 

Lockdowners also fail to understand that the coronavirus does not bounce around randomly but rather strikes those who are the most socially active, which happily, in this case, corresponds to the people least likely to suffer serious consequences from the disease. (Mandatory buttless chaps would be more effective than masks because only healthy people would go out so attired!) At this stage, no self-respecting scientist would multiply a case or infection fatality rate by the population to predict the number of deaths because everybody knows about the virus and knows their personal risk profile and behaves accordingly where unconstrained by law. 

Where those lawful constraints have been removed, the young and healthy mingled, got infected, and became immune. Instead of holding them up as heroes and facilitating their transition into jobs helping the vulnerable, many governments punished them by reimposing restrictions. Let’s get this straight right now:

• Quarantining the sick: constitutional
• “Quarantining” everyone: language abuse and on thin constitutional ice
• Locking down and masking people who CAN NO LONGER get sick: inexcusable violation of human rights

Marginal analysis suggests that people, if allowed to make decisions for themselves — you know, like adults — will reintegrate into society as community immunity increases. Yes, some people will miscalculate, some will be unlucky, and some will die “with” but not “from” covid. It’s called reality and it is a much less frightening one with individual liberties restored and without power-hungry politicians, pseudo-scientific bureaucrats, and self-serving pundits with platforms dictating who can do what, when, and how. (Eating with a mask on! Really?)

In case my fancy words remain unclear, I am saying that the public health officials who do not understand the correct policy response to covid, represented by the Great Barrington Declaration, fail to do so because they have not studied the history of science or even medicine in sufficient detail to understand the scientific method. They are too ignorant to be humble.

Case in point, John Snow himself would have signed the Great Barrington Declaration, not the John Snow Declaration. Yes, I can indeed channel the dead because, as noted, I am a historian. That is what we do, by reading the words and interpreting the actions of people who can no longer speak for themselves, and doing so in the context of the times in which they lived.

The people who passed for scientists in Snow’s day believed that people got cholera from other people or from “miasmas,” scientific jargon for bad air. So during cholera outbreaks, many governments imposed quarantines and cordon sanitaires that “cramp(s) commerce and cause(s) vast expense.” They were more limited geographically than today’s lockdowns but nonetheless often led to a “state of confusion, bordering on anarchy” where imposed.

Those were the words of James Gillkrest, “a Professional Man of Thirty Years experience, in various parts of the World,” who argued in 1831 that cholera was not readily spread person-to-person and hence that “quarantine regulations, are, as far as regards this disease, not merely useless, but highly injurious to the community.” Gillkrest also noted that “medical men” had not handled cholera research “with due impartiality” and had forgotten that “the safe side” of any issue was not some half-baked consensus but rather “truth.”

Alas Gillkrest was no John Snow, who noticed cholera victims all initially presented with tummy problems, not breathing issues, which suggested that they ingested, rather than inhaled, something untoward. In 1849, he published a paper, “On the Mode of Communication of Cholera,” which argued that bad water, not bad air, caused cholera. 

Thomas Davis had made the same claim in 1832, but nobody in power wanted to hear that London’s sewage system had to be modernized and enlarged. But Snow kept collecting data like any good scientist would. (See also Dana Tulodziecki, 2012. “Principles of Reasoning in Historical Epidemiology.” Journal of Evaluation in Clinical Practice 18 (5): 968–73.) Turned out that the Londoners who got their water from a company that pumped it out from a part of the Thames visibly contaminated with sewage were an order of magnitude more likely to die of cholera (315 vs. 59 per 10,000) than those who got their water elsewhere.

That’s a smoking sewer pipe if there ever was one, right? But no, “the” scientists needed more proof. They got their water from safe sources and had published articles and books that blamed cholera on miasmas and other quackeries and didn’t really care about the poor Londoners drinking dangerous water. Ironically, one major voice of establishment skepticism was The Lancet, the very outlet pushing the John Snow Memorandum. It implied, in the gentlemanly style of the day, that Snow was not a real scientist and that his words bordered on treason! 

Despite opposition, Snow pressed on, discovering during an 1854 outbreak that most of the sick people got their water from a single well while others who lived and worked nearby — and hence breathed the same air — were fine if they drew water from private sources. Snow even mapped it all out but there was nothing wrong with the well that anyone could see. Later, though, a baby with diarrhea was identified as patient zero for that outbreak, which ended soon after the baby died and its mother stopped putting its feces into a cesspool that leaked into the well that Snow had identified and convinced local leaders to shut down. 

Snow contributed to epidemiological thinking by proposing a novel hypothesis for cholera transmission, testing the hypothesis by leveraging heterogeneity regarding water sources and outcomes, providing clear and compelling evidence for his case, and pushing for the lowest cost-effective intervention. Yet Snow conceded that removing the handle from the water pump was only an intermediate stopgap and that only the baby’s death removed the threat from the community. 

Even after this triumph, public health officials and establishment outlets like The Lancet would not accept Snow’s theory, presumably in part because the fecal-to-mouth transmission method was too gross to contemplate. Although a teetotaler and vegetarian who boiled his own water, Snow died of a stroke at age 45. I suspect the stupidity and cupidity of those with whom he had to deal caused him to pop a vessel. Only after additional studies conducted after his death was Snow’s theory finally accepted and widespread sanitary reforms implemented. Snow died but won, while The Lancet lost and lived on, and on, and on.

How does any of Snow’s story translate into support for lockdowns? 

Snow stopped the causal chain the only place he could, at a single pump handle in a city with multiple alternative and safer water sources and in a neighborhood that had already largely spontaneously depopulated. So the cost was very low. Had Snow known about the baby, he would have asked the mother to dispose of the baby’s feces in a safer manner while the cesspool was plugged because, after all, the cause was the choleric baby, not the pump, and certainly not the air. In the meantime, a warning to boil the water thoroughly before use would have provided remaining residents with a choice: expend resources on boiling, or get water elsewhere, or risk getting cholera. 

What the signatories of the John Snow Memorandum want you to think is that they are the John Snows of 2020, bravely following “the” science. But the fact is, The Lancet and signatories like Chelsea Clinton represent The Establishment, hellbent on maintaining current policies regardless of the mounds of evidence that lockdowns do not work to stop the spread and increase other forms of mortality. They gloss over the fact that Snow searched for a targeted intervention, not the lockdown of London. 

Lockdowns can slow the spread of Covid but that is a bad thing at this point because covid doesn’t come from poopy diapers (usually anyway). Thankfully, unlike cholera, it spares the babies. And the toddlers. And the tweens and teens and twenty-somethings. Heck, it spared the old, fat man in the White House. 

Covid stems from a virus spread during socioeconomic interaction, something almost as essential to us as water. We can generate some of that life-sustaining socioeconomic interaction via the safe well called the Internet but digital streaming can’t slake our entire thirst for human intercourse and not everyone has ample access to it. Social distancing is the equivalent of boiling water, something that government need only advise. What government officials really ought to be doing is improving our flawed healthcare system, not trying to micromanage how people boil their water. 

No thinking person today would question John Snow’s methodology or conclusions but every day more and more thinking people are rejecting the self-serving lockdown policies espoused by the signers of the John Snow Memorandum by declaring for Great Barrington instead. That declaration, incidentally, could have been called the William White declaration because in 1838 White attacked cholera quarantines and told her Majesty, Queen Victoria, the following:

“While Ministers are chiefly directing their attention as to how and by what means they shall retain their places and preserve their power, thousands and tens of thousands of human beings, through their neglect, are hourly being consigned to premature graves, under circumstances the most horrid and appalling. Millions upon millions of the human race have already been swept away the victims to a barbarous system of laws, the iniquitous effects of prejudice and ignorance.”

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