Dr. Scott Atlas, a senior fellow at the Hoover Institution, addresses all of those questions and more in his book A Plague Upon Our House. (Disclosure: I am also a Hoover fellow and know Atlas professionally.) But he does so much more than that. He lays out how dysfunctional both the task force and the White House were in dealing with the coronavirus. Based on my own experience at interagency meetings in Ronald Reagan’s administration, I find Atlas’s many reports of people on the task force “going with the flow” completely plausible. It’s true that we have to take his word for what went on, but based on my experiences with him at Hoover, I do.
Beyond making his case with many facts, Atlas is a passionate man, and his book reads as if it were written in anger and frustration. Some readers might find that off‐putting. I like it because he almost never lets his passion override his respect for facts and reasoned argument. Indeed, his passion is largely based on his view that lockdowns led to many deaths, destroyed millions of livelihoods, and caused needless suffering — a case he makes well.
A researcher’s questions / Atlas tells his story largely chronologically, starting in February 2020 and ending in December 2020. In February 2020, while working on a different book, he started paying attention to the pandemic. He thought that the early‐reported 3.4% fatality rate from COVID — which, if true, would have been very scary — didn’t make sense. He noted that the 3.4% was based on a badly biased sample. The people being tested for COVID in the first month or so were largely people who were sick enough that they sought medical care — making them medical “cases.” Based on what infectious disease specialists knew about past viruses, it was virtually certain that many other people had the coronavirus but did not have extreme symptoms. The case fatality rate, in short, was the wrong measure; what mattered was, and is, the infection fatality rate. And if the number of people infected were a huge multiple of the number of reported cases, the 3.4% would turn out to be a huge overestimate of fatality risk.
Seeing this in February and March, Atlas did what good scientists do: read to learn more. He came across a March 2020 article on the respected medical website Stat by his Stanford University colleague, Dr. John Ioannidis, whom Atlas hadn’t known before. In “A Fiasco in the Making? As the Coronavirus Pandemic Takes Hold, We Are Making Decisions Without Reliable Data,” Ioannidis made the point that Atlas had reached on his own.
Early on, Atlas noticed something that many critics of lockdowns had noted in March and April: the almost‐complete focus on ending or slowing the spread of the coronavirus, with virtually no attention to the collateral damage that lockdowns and government‐promoted fear would cause. As he researched further, he learned that half of cancer patients had deferred their chemotherapy, “80 percent of brain surgery cases were skipped,” and about half of acute stroke and heart attack patients “missed their only chances for treatment, some dying and many now facing permanent disability.” A fight against a virus that was a large threat to public health was being carried on as if the virus were the only threat to public health.
Atlas, surrounded by economists at the Hoover Institution, was also aware of the economics literature that finds a strong connection between wealth and health. Shutting down huge sectors of the economy made many people poorer. That alone would cause some reduction in health and increase in deaths.
Examining the early data, he found that the group at least risk from COVID was children. Their probability of dying from it was lower than their probability of dying from the flu in a normal flu season. This is now well known, but also was known as early as April 2020. Hence, it made no sense to close the schools. Later in the book, Atlas points out that opening schools would not have put teachers at risk. Although we didn’t know it at the time, by the summer of 2020, the data showed that children rarely transmitted the virus to their parents. Given that they were typically around their parents in closed rooms more than they were around teachers, this meant that teachers were at little risk.
The politicians call / Atlas started writing and going on TV to talk about why lockdowns were such a bad idea. His increased visibility led to two important phone calls. The first was from Florida Gov. Ron DeSantis, who, like most U.S. governors, had imposed lockdowns. DeSantis, though, started reading the literature and concluded that his initial reaction was a mistake. He asked Atlas a series of questions of the form, “Here’s my understanding; is it correct?” And to virtually every question, writes Atlas, the answer was yes. Probably not coincidentally, DeSantis was the first big‐state governor to end the lockdowns.
The other big phone call was from the White House, specifically from John McEntee of the White House’s Personnel Office. McEntee, Atlas later learned, was “one of President Trump’s closest confidantes.” After asking Atlas a few questions — one of them, disappointingly in my view, was whether he had publicly aired any views “hostile to the president” — McEntee invited him to fly to Washington to meet with Trump. Atlas agreed (and used his frequent‐flyer miles to upgrade to first class). The meeting ended with an offer for Atlas to advise Trump on COVID-19. Atlas made clear that he would not ever go along with anything that didn’t make sense. Later in the book he states, “I would never have remained silent when the president brought up drinking disinfectant at a press conference.” He adds, “Then again, I was not a career bureaucrat.”
At first, Atlas tried to advise from California. He paid close attention to what Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the COVID task force, was saying publicly. Atlas quickly noticed the disconnect between what Fauci and Dr. Deborah Birx, another task force member, were saying and the impression he had from his first meeting with Trump. He writes, “I also sensed, even in this initial conversation, that he [Trump] was frustrated — not just at how the country was still shut down, but that he had allowed it to happen, against his own intuition.” Atlas states his initial view of Fauci: he “kept focusing on what might happen, stressing what we didn’t know with absolute certainty, rather than underscoring what we did know about the virus based on months of evidence, including the most fundamental biology.” And, notes Atlas, the media didn’t help, instead “sensationalizing every new piece of information.”
Advising from California didn’t work well and so, at the end of July 2020, Atlas moved to Washington. Early in his time, he met Birx, whom Trump adviser and son‐in‐law Jared Kushner suggested would feel threatened by Atlas’s presence. Atlas checked her background and found that for much of her 35‐year career in government, she had been involved with HIV/AIDS, not an obvious basis for her role as White House coronavirus response coordinator. Tellingly, Kushner said to Atlas more than once, “Dr. Birx is 100 percent MAGA!” MAGA, of course, stands for “Make America Great Again,” the slogan used by Trump during his 2016 campaign for president and used regularly over his four years in office. That didn’t seem like a strong qualification for Birx’s job.
The task force / One thing that wouldn’t surprise anyone who knows Atlas is that he got into a substantive discussion with Birx the first time he attended a task force meeting. He asked her which study she thought was most important in establishing that masks were effective. She replied that it was a paper on the apparent lack of transmission of the virus in a single Missouri hair salon that required masks. He pointed out some severe methodological problems with the study but, according to Atlas, she showed “no awareness at the meeting about some important flaws in the study she most relied on.”
Though Birx was coordinator of the White House coronavirus response, she did not head the task force; Vice President Mike Pence did. According to Atlas, Pence always opened meetings by giving Birx the floor and she always started by going through tables and charts of the latest data on the pandemic. Atlas noticed right away that, in presenting her charts of each state’s percentage of positive tests, she made an implicit and erroneous assumption that each state used the same criteria for determining who was tested. That resulted in the testing data giving a distorted view of how each state was faring.
Atlas had two major disappointments early on that soured him on the task force. The first was how unwilling the major players were to dig into data and discuss the evolving literature on the coronavirus. He often brought copies of studies to the meetings, but his impression was that few people read them. He noted that Fauci, Birx, and Dr. Robert Redfield, head of the Centers for Disease Control, agreed with each other on everything and never challenged each other. For that reason, he began to think of them as the “Troika.”
The second disappointment, which was related to the first, was about two specific policy issues: testing and schools.
On testing, Atlas pointed out that one of the two types of tests available for the virus, polymerase chain reaction, produced a lot of false positives on current infection because it detects “fragments of dead virus” that can hang around for weeks after the infection has resolved. Atlas writes that he was the only one at the meetings who raised this fact. Nevertheless, he managed to persuade the group — including all the doctors — to sign onto a CDC guidance statement recommending less testing for the general public and more testing for people in high‐risk situations such as nursing homes. Yet, when the document was circulated at a later meeting, virtually all of that material was gone. Atlas pointed that out and had a temporary victory: the new guidance was issued with the material restored. But when the guidance was released, the press and Democratic politicians, both of which had been very positive on the CDC, attacked it. New York Gov. Andrew Cuomo called it “political propaganda.” After two weeks of taking heat, the CDC caved and issued new guidance that reverted to that of a few weeks earlier.
Later, in a discussion of guidance for opening colleges, Atlas pointed out how low a risk college students faced on campus and argued for not testing people who didn’t have serious symptoms. After he challenged Birx’s view that they should increase testing of people, including college students, “Birx, Fauci, and Redfield were silent.” No one else commented either. Pence concluded the meeting with the statement, “So we will make sure we increase the testing.” Pence, as you might have figured by now, does not get good grades in the book.
Atlas’s other major policy disappointment was on schools. What was well known by the summer of 2020 was the harmful effects that school closings and remote learning were having on children, especially those in poorer families. Yet, notes Atlas, no one at the task force meetings, other than him, ever talked about the huge downsides of school closings. As noted above, the data showed clearly how safe young people were in school and, by the summer of 2020, how children rarely passed the virus on to adults. Therefore, argued Atlas at one of the meetings, schools should be opened without testing and masks. He writes that no one at the meeting, including Birx and Fauci, mentioned contrary data. Instead, Birx answered, “There is a bell curve of epidemiologists, and you are on the fringe.” Pence then asked Redfield, whose CDC was responsible for issuing guidance, what he thought about the risks of opening schools. Redfield replied, “Let’s just say, the jury is still out.”
Conclusion / I have two main criticisms of the book, one relatively small and one more important. The small criticism is that Atlas, after driving home throughout the book the principle that correlation does not mean causation, forgets that principle on one particular issue. He notes that he acted, with some other members of the task force such as Seema Verma, then administrator of the Centers for Medicare and Medicaid Services, to increase protections for the vulnerable, especially those in nursing homes. He writes, “The data speaks for itself — as was proven months later.” He then claims that their measures helped reduce nursing home COVID mortality by half. Is he right about this causation? Probably. But correlation is not causation; the data almost never speak for themselves.
On the issue of data, my more important criticism is that this 300‐plus‐page book has zero footnotes and very few references. Atlas sometimes refers to studies that, with a few key words, you might find by googling. But in many cases I was left wondering which studies he was referring to.
Overall, though, this is a very good book by a passionate man. If you were not scared of what unaccountable bureaucrats can do when given a platform to make recommendations for the nation, you will be scared after reading his book. Hopefully, we will never again give governors the power to close whole sectors of the economy. And if we take away that power, one person who will deserve a lot of the credit is Scott Atlas.
