Lockdowns can lock down endemic infections. For a new pandemic, they have little effect, says Sunetra Gupta

Theoretical epidemiologist and decorated Oxford academic Sunetra Gupta earned international fame in October 2020 after she co-authored the Great Barrington Declara­tion which disfavoured lockdowns as a means to fight the Covid-19 pandemic. She and her collaborators were attacked by people in academia as well as in governments. Kolkata-born Gupta, an alumna of Princeton University and Imperial College, found the response to her studies and forecasts astonishing since it came from people professionally close to her. The vilification campaign, however, couldn’t disguise the reality for long. She soon became a controversial figure, earning the wrath of those who advocated lockdowns.

Gupta, 57, now says many of her predictions have come true, and she believes the least her detractors could do is apologise. “It would be gracious if they said that the tactics they chose were wrong,” she tells Open in an interview conducted in her quiet home at the University of Oxford where she is professor of theoretical epidemiology in the Department of Zoology.

Gupta—who grew up among Kolkata’s intellectuals, including the likes of Satyajit Ray and her own father Dhruba Gupta, a professor of history and a film activist—is also an award-winning writer of fiction and a translator, and says she prefers tough-to-grasp novels to easy reads. “Writing fiction and scientific experiments go hand-in-hand,” notes the Sahitya Akademi Award recipient whose key area of expertise is in mathematical modelling of infectious diseases.

Can you enlighten us about your work?

My primary area of expertise is in mathematical modelling of in­fectious diseases. So, I have been working for the past 35 or so years on different diseases, including HIV, malaria, influenza, some bacterial pathogens, pneumonia. Some of the big killers, if you like. My interest has been basically to use mathematical models to understand how these diseases spread and evolve and how our immune systems respond to these pathogens. I have been really interested in applying mathematical modelling to bring together data—epidemiological, immunological and clinical—to try and build the picture of the basic life cycle of the pathogen and our immune responses against it.

The biggest lead that I have had is to come up with a theory for how all pathogens evolve under immune selection pressures. That is at the theoretical level, but in the last 15 years or so, I have been involved in taking some predictions of the theory to a more translational level and particularly one of our models on influ­enza has now been tested and that forms the basis for a new type of flu vaccine which we are working on with industry—a com­pany called Blue Water Vaccines was set up by an entrepreneur to exploit this technology. He licensed it from the University of Oxford. He has now given us research funding to develop that.

How do you respond to the vilification campaigns against you and your co-authors of the Great Barrington Declaration that advocated ‘shielding’ of the vulnerable as opposed to a ‘complete lockdown’ as the best response to the Covid-19 outbreak? How was it like being addressed in the media as a controversial epidemiologist for telling what you viewed as the truth?

When you said vilified for telling the truth, it wasn’t so much the truth as it was my understanding of what had happened. It is not as if we, or I, were trying to say this is the truth. In fact, what was dis­turbing was that the others were saying they knew what the truth was, and that anything we were saying was misinformation. They came up with all sorts of funny words for it. We gave an alternative viewpoint which, I have to say, has largely proved to be correct, especially many parts of it. Covid has already spread quite widely and in many areas where it is coming down, it is not because of lockdowns but because herd immunity has been established. Herd immunity is often a misunderstood term. It simply means that a sufficient proportion of the population is currently immune to the virus and that is what is causing a downturn in its prevalence.

Now, in the case of coronaviruses, we know that the immunity is not lifelong, unlike measles. But we knew this. I certainly knew it, and if I knew it, a lot of other people also knew it. We knew that coronaviruses cause respiratory infections. The same is true of malaria, which is a canonical example of a pathogen which can re-infect you. The pattern is that you get infected regularly, especially in sub-Saharan Africa. Everybody is carrying the pathogens, but very few people are ill. So, the general rule is that you get infected over and over again, but you don’t get sick. You get ill usually on your first infection, quite severely. But then you have good im­munity against the disease, but not against infection. That is the natural state of living with malaria. That is the natural state of liv­ing with all the seasonal coronaviruses which are closely related to SARS Cov-2. They repeatedly infect you every couple of years and you may get a cold until you’re very old, in which case your immune systems become weak.

This new virus was coming in a background where people hadn’t seen it. People hadn’t had Covid before. So, of course, it meant that some people were not protected from severe illness and those are people who had bad outcomes from infections. But most of us were protected probably because of cross-protection from other coronaviruses. That is something that a lot of people have shown now, including in our lab.

Which parts of your predictions actually came true?

There are studies that we did and there are predictions that I made. They are, in fact, not predictions so much as statements regarding what I thought was the likely cause of the Covid spread. What is true is that it had spread quite considerably and a lot of herd immunity was already in place by the time lockdowns were im­posed in certain parts of the world, not everywhere, not in New Zealand or some places like that.

Parts of the UK, however, I think, had experienced quite a high exposure to Covid. In the northern hemisphere we had the sum­mer. The levels went down anyway because the transmission of a virus is lower in summer—seasonality matters. Where it disap­peared during the summer were parts where it had already had sufficient immunity in the population and we’ve seen that borne out by subsequent waves of Covid where we have been able to monitor what has been happening in the population.

Do you think those who presented their statements as the ulti­mate truth, especially among health policymakers and politi­cians, should be made accountable for what went wrong?

I don’t think making them accountable is important. It would be very good for science—after all, the damage is done—if they merely said they were wrong. It would be gracious of them if they said that the tactics they chose were wrong.

What are the big lessons from the policy of lockdowns?

We had so far been talking about what the virus was going to do. I had my hypothesis and other people had their hypotheses. The question was: What does the virus do anyway and would lock­downs change that? We had some disagreements there, but no one knew until the experiment was done that lockdowns did very little to suppress the spread of Covid-19. Now we know that. Lock­downs can lock down endemic infections. For a new pandemic, they have very little effect. This is very basic science actually, and that is exactly what we saw. There was an insistence every time when the infections were down that it was because of lockdowns. Wearing a mask or not wearing it, their effects on the population were negligible. We know that now, but at the time when the pan­demic hit us, we didn’t know that. And they were very insistent on the benefits of the lockdown. So, they should apologise.

The main reason why I myself and people like Jay Bhattacharya (Stanford University) and Martin Kulldorff (Harvard University) went ahead with a public statement (at Great Barrington) was to highlight the cost of lockdowns. It was not just to say, look, we have got a cool different idea how diseases are going to progress and we think there is herd immunity. What we were saying was whether lockdowns worked or not, and even if they did, what would that achieve? It would suppress the infection, but how long could you suppress it? Okay, maybe, until a vac­cine arrived. What was the endgame? How could you realise that endgame given the enormous cost of the lockdown?

For me, right from the beginning, lock­downs seemed to be the wrong tool. It was because the costs of the lockdown are too great on the poor and you could see that the virus had a specific target: elderly and those with comorbidities.

Now, I am perfectly aware that even do­ing that is almost impossible. What is also true is that lockdowns are also going to kill a lot of people, the poor, of course, and affect children in a very negative way. On March 23, when they went for the lockdown in this country, my thoughts went out to those little children who live in council flats (welfare housing) in a toxic environment, or even a poor child whose only proper meal is the one he or she gets at school. I was worried about the devastating consequences of a complete lockdown.

You have talked about the shaming and intimidation that followed the Great Barrington Declaration (drafted at the American Institute for Economic Research in Great Bar­rington, Massachusetts, and published on October 5, 2020). How did it change you?

It hasn’t changed me at all (laughs). I was astonished by how it happened, particularly involving people I have known and have professional relationships with and people in great positions of power.  That he would be able to engage in that level of opposition was very astonishing to me. There were also accusations of us being pseudo-scientists and I was even called evil.

For a layman, vaccines often used to mean an antidote to stop contraction of a disease. But Covid changes all that. Now a vaccine is at best something that makes the symp­toms less severe. Why so?

That is all we could have expected these vaccines to do because that is all what natural infections do. Natural infections stop you from being re-infected. So, for the vaccine to do better than that is asking for a lot, especially of one that is developed through very conventional methods.

What are your thoughts on long Covid in which infected people end up suffering for many months and perhaps years?

That is a well-characterised phenomenon after any viral disease, including influenza, and it is no different for Covid. Long Covid is being overblown by people who wish to do that. What we should do is raise awareness about post-viral syn­dromes. This is not unusual and people should take it seriously. The observation of so many people getting long Covid because they got Covid at the same time will raise awareness about post-viral complications which, prior to this, used to happen some­times months after the infection—and were not taken seriously by people.

What do you think of advisers sur­rounding the likes of US President Joe Biden who once said Covid “is the pan­demic of the unvaccinated”?

For Joe Biden, all he does is listen. He is told by his advisers what to say. He has Ashish Jha as one of them (as the White House Coronavirus Response Coordinator), and he was one of those guilty of smearing us publicly. He was the dean of the Brown University School of Public Health. Someone like that shouldn’t be calling the authors of the Great Barrington Declaration clowns. All we were saying was that the cost of the lockdown was going to be hard on the poor—as you know about migrant workers in India. Backing up healthcare resources was the thing to do after the first wave. On the other hand, many countries were in a state of panic. People in India died for want of oxygen. Everyone abdicated their responsibility, I think.

There are those who argue that the Covid pandemic ben­efited only the wealthy while others suffered.

We know that there is a massive transfer of wealth upwards. A lot of the wealthy people became wealthier. Even otherwise, lockdowns are the luxury of the laptop classes. For instance, my life was fine during Covid. I did go to the lab, but life was very good. Who were driving the buses, caring for the needy at hospitals, and cleaning roads? They were all at risk if they had certain health problems. There were reports in London that many of those who died doing such jobs were South Asians. No. Covid did not put South Asians at risk. It put at risk the lives of South Asians doing those jobs who had comorbidities and who had fragile health. Many of those who should have been home were doing jobs during the lockdown.

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