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I realize that, since the COVID-19 pandemic began, I’ve written about little or nothing else besides COVID-19 and associated conspiracy theories. I suppose that at some point I will need to write about something else, but nothing going on in the world of medicine compels me as much as the pandemic right now; so I’m going to ride with it at least this week. Maybe by next week, I’ll be so sick of writing about the pandemic that I’ll write about something that almost seems quaint, like homeopathy. (Oh, crap, the homeopaths are recommending their quackery to prevent and treat COVID-19. I just can’t escape!)

One aspect of the COVID-19 pandemic that I haven’t really written much about much yet is the developing unholy alliance between COVID-19 deniers (who peddle in conspiracy theories and falsely claim that the disease isn’t that bad and/or that the lockdowns and social distancing are not—or no longer—necessary and should be lifted to alleviate the catastrophic damage to our economy that mitigation efforts have unavoidably caused), and the antivaccine movement (which predictably peddles misinformation and conspiracy theories about how COVID-19 is being weaponized as a plot to impose forced universal vaccination—or even that the disease was created by Bill Gates for that very purpose, along with H1N1 influenza and Ebola!—or how the influenza vaccine supposedly makes one more susceptible to coronavirus; spoiler alert: It doesn’t). Although it might seem odd, those of us who’ve studied conspiracy theories for a long time almost immediately realized that an alliance between the antivaccine movement and COVID-19 deniers would entirely natural and expected it. Both groups of conspiracy theorist share an intense distrust of government, particularly the CDC and FDA. Both share an equally intense distrust of big pharma, while fetishizing individual freedom above all else, with antivaxxers invoking “health freedom” and “parental rights” and COVID-19 deniers invoking absolute bodily autonomy and the “right” to do whatever they want, including violating social distancing. Both groups’ beliefs are rooted in conspiracy theories, with the central conspiracy theory of the antivaccine movement being that the government, big pharma, and the medical profession have evidence that vaccines cause autism and harm but are covering it up, and COVID-19 deniers’s beliefs based in one or more of several conspiracy theories (e.g., the virus is an escaped bioweapon; was created by Bill Gates to impose universal forced vaccination; isn’t nearly as bad as seasonal flu; and several more). Both have a tendency towards germ theory denial, laboring blissfully under the delusion that, because they are so “healthy,” because they live such exemplary lifestyles, exercise, and eat the “right” foods, it makes sense that COVID-19 deniers don’t think that COVID-19 is a threat to them or their loved ones, just as antivaxxers don’t think vaccine-preventable diseases are a threat to them and their loved ones either.

Finally, both groups share zero, or close to zero, sense of shared social responsibility for public health and selfishly emphasize their “rights” über alles. For example, take a look at this Tweet:

COVID-19 deniers have also appropriated the offensive analogies of antivaxxers who now like to compare themselves to the “new civil rights movement,” with White House advisor Stephen Moore comparing protestors against lockdowns and social distancing to Rosa Parks.

COVID-19 deniers are also, in addition to their other conspiracy theories, appropriating the language of the antivaccine movement (“I do not consent”; “I do not comply”) in their message:

This is exactly the same attitude that antivaxxers often express, denying herd immunity, saying that it’s not their responsibility to protect others, asking why those who vaccinated worry about the unvaccinated if vaccines are so great? Both groups also minimize the danger by claiming that only the elderly and chronically ill are at risk for severe illness and death, which is not true. It is true that the elderly and chronically ill are at considerably higher risk of severe disease and death than the young, but the COVID-19 is nonetheless hospitalizing and claiming the lives of younger people at an alarming rate, including health care workers.

Meanwhile, this video shows antivaxxers using standard “V Is For Vaccines” signs sold by antivaccine organizer Josh Coleman:

I’ve been noticing this in more and more of these “Reopen America” protests.

So it should come as no surprise that antivaxxers are all-in with COVID-19 denial, as this article published last week in Undark by Catherine Gammon indicates:

In early March, Melissa Floyd, a self-described health freedom educator who co-hosts “The Vaccine Conversation” podcast, was forced to abruptly change plans. She and her co-host were supposed to pack up for a live multi-city tour. But the public health crisis borne from Covid-19 delayed the start of their tour for months.

Floyd and her co-host, Bob Sears, a California-based pediatrician who advocates a delayed vaccine schedule and skipping some vaccines, addressed the cancellation in a podcast episode, noting that they don’t have any personal fear of the virus. Our government agencies, Floyd said, “are talking about washing your hands, but why aren’t they talking about things you can do to boost your immune system like vitamin D? Why aren’t they talking about reducing sugar? Why aren’t they talking about eating fruits and vegetables and staying away from processed foods?

“I’ve not heard any footage,” Floyd continued, “that talks about how to make your body strong — it’s just wash your hands, use a mask and hopefully that vaccine will come out sooner rather than later.” (Floyd did not respond to an interview request from Undark.)

We’ve written about “Dr. Bob” Sears more times than I can remember on this blog, and I’ve written about him many times on my not-so-secret other blog. Basically, Dr. Bob has been prominent in opposing SB276 and any effort to tighten school vaccine mandates and clamp down on dubious personal belief exemptions and bogus medical exemptions, while having been sanctioned by the Medical Board of California. After SB276 passed, he was an early grifter selling his advice on the seminar circuit to antivaxxers on how to avoid the newly stringent school vaccine mandates and then later, or so it appeared to me, selling such mandates himself.

There’s also another commonality between COVID-19 deniers and antivaxxers:

“It’s not as deadly as we’ve been told,” he said, adding later in the show: “This is really only a tragic situation for a small group of people that are immune-suppressed or elderly.” Similarly, on March 28, Sears posted on Facebook: “Elderly are vulnerable and need protection AND Covid is harmless to almost everyone else.”

Both statements are incorrect — there are numerous reports of young, healthy people in intensive care and on ventilators. But it’s a common tactic, says Reiss. “They focus on death, and they ignore hospitalization, and they’re going to say: look, it’s not going to kill you, you shouldn’t get the vaccine,” she says. “They do that with other diseases as well.” A recent Washington Post analysis found that hundreds of people under the age of 50 have also died from the coronavirus.

This is an apt observation. Just as antivaxxers focus on mortality and ignore morbidity from vaccine-preventable diseases to make disingenuous arguments claiming that “vaccines didn’t save us,” COVID-19 deniers focus on mortality and ignore the suffering caused. More importantly they ignore the possibility that, with no mitigation, hospitals will be overwhelmed with COVID-19 patients, leading to the inability to treat all patients optimally and thus triage, as well as deaths from other causes of people whose treatment suffers because hospitals are overwhelmed. Finally, the claim that COVID-19 is not dangerous to most people, other than the immunosuppressed or the chronically ill, is exactly the same thing antivaxxers say about vaccine-preventable diseases, like the measles or chickenpox, that they’re not serious diseases, that their “healthy children” don’t have to worry about them as more than an inconvenience, when such is certainly not the case.

Dr. Bob has also been peddling false dichotomies, a choice between a “ruined society” and more deaths:

The media label those who go out as Covidiots. Will they also label those who prefer we all die from a ruined society instead? Just to be fair.

Posted by Dr. Bob Sears on Wednesday, March 25, 2020

Of course, millions of deaths, which would be likely without mitigation, would ruin the economy even more thoroughly. Indeed, the very question of “opening the economy” safely is incredibly complex, and it’s doubtful that most people will feel safe going to, for example, movie theaters or anywhere with large numbers of people any time soon. Even more offensively, Dr. Bob is now accusing those supporting the current lockdown of hoping that nations using other approaches to fail “so we can prove we were right”:

Question: we are all waiting with baited breath to see if things work out for Sweden. I wonder, do our leaders hope…

Posted by Dr. Bob Sears on Wednesday, April 15, 2020

Sweden, as many know, is not under total lockdown. Its approach of making social distancing (mostly) voluntary rather than mandated and enforced is, to put it mildly, very controversial, and recent modeling has provided cause for concern, with one study (still on preprint) estimating that Sweden’s approach is likely to “result in a peak intensive-care load in May that exceeds pre-pandemic capacity by over 40-fold, with a median mortality of 96,000 (95% CI 52,000 to 183,000).” Whether that model will turn out to be accurate or if Sweden will manage to do far better than dire predictions like this remains to be seen. Although there are indications that its strategy could backfire, it might also work because 40% of Swedish households are single-person households without children. Of course, invoking Sweden demonstrates commonalities between COVID-19 deniers and antivaxxers, namely cherry picking examples and oversimplifying and misrepresenting legitimate scientific controversies.

Yet another argument used by COVID-19 deniers “pioneered” by the antivaccine movement is that “natural” immunity or “natural herd immunity” is better than immunity from a vaccine:

And another common thread in anti-vaccine groups focuses on the belief that natural immunity — the kind you get from actually having a disease — is better than immunity from a vaccine. The logic, they argue, is that if natural disease is a healthy and normal process, people should just go ahead and get infected with a disease, which will eventually give them immunity and protect more people. “It’s an inferior immunity that vaccines provide, which is why we’ve seen second, third, fourth, fifth doses of vaccines, why everyone has to get a flu shot every single year,” Bigtree said on his March 26 show.

And:

In an interview, Bigtree elaborated, saying he’s not anti-vaccine for the right people. “I would never have a problem with any product if it was designed for the people that need it,” he said. “I do not agree with the principle that perfectly healthy people need to take a product to protect a very small percentage of sick people.”

This is of a piece with Andrew Wakefield’s profoundly deceptive argument showing his utter ignorance of evolutionary theory that “natural herd immunity” to measles led to the disease becoming less virulent as he predicted that there could be a “mass extinction” due to virulent measles strains evolving as a result of mass MMR vaccination. Of course, what COVID-19 deniers and antivaxxers also share in common is a failure to realize that the price of “natural herd immunity” is mass suffering and way more death than herd immunity achieved with mass vaccination. Moreover, again, without mitigation, COVID-19 would likely cause death on a much more massive scale than it is causing now, a fact that neither COVID-19 deniers nor antivaxxers appear overly concerned about:

And it’s not just anti-vaccine groups promoting the idea that people should get sick. The Federalist, an American conservative online magazine, published a story on March 25 advocating a voluntary infection approach for Covid-19.

While it’s true that, in most cases, natural immunity can last longer than vaccine-induced immunity, public health experts say the risks of the former outweigh the risks of the latter for every recommended vaccine. Natural immunity, Ernst says, “protects people after a whole bunch of people get sick, and that’s not good.” Reiss adds that none of these denials or conspiracy theories are new — they’re classic beats in the anti-vaccination world: “They’ve been circulating around, but they’re just applying old beliefs to new contexts.” The new context matters, though — Covid-19 is a public health crisis on a level that hasn’t been seen in 100 years.

Precisely.

It’s not just the US either. Antivaxxers in Italy are peddling COVID-19 denial, for much the same reasons, as this Slate article notes:

One of the cornerstones of the anti-vaccine movement is the assumption that potential negative consequences of vaccinations could be greater than the risks of diseases they prevent. Mario Small, a professor of sociology at Harvard, also believes that one of the reasons why COVID-19 is unlikely to shake this conviction is the perception of the magnitude of the coronavirus, which cannot be compared to other diseases. “You can’t ignore the coffins and the deaths,” Small says, but it is likely that the anti-vaccine movement will approach this disease as different. “Part of the mentality for which you’ve made such strong commitment would be to find reasons why your beliefs are still consistent with reality.”

Giovanni—he has asked Slate to use only his first name—is a father of two in his mid-30s from the Emilia Romagna region. He is a strong opponent of mandatory vaccination, and his two small children were excluded from preschool when he and his partner refused to vaccinate them. He says he might be open to a coronavirus vaccine for himself when one become available. “There are different types of vaccines and different types of diseases. We don’t know enough about COVID-19 yet, but if one day a vaccine became mandatory I might do it to be able to work and travel. It’s soon to say.” What he is sure about is that the coronavirus has not made him change his mind about other vaccines. Giovanni also says that he is afraid this public health crisis will lead to a tightening of vaccination policies.

Meanwhile, there has been an interesting shift among antivaxxers teaming with COVID-19 deniers. Specifically, they’ve both embraced the promotion of the antimalarial and immunomodulatory drug hydroxychloroquine ± the antibiotic azithromycin as miracle cures for COVID-19 by French “brave maverick doctor” Didier Raoult, Donald Trump, Dr. Mehmet Oz, and Trump’s allies in the press. Del Bigtree has promoted hydroxychloroquine on his show, most recently last week:

Never mind that the evidence is most definitely trending in the direction of the conclusion that hydroxychloroquine ± azithromycin doesn’t work against COVID-19 but does cause significant side effects, “miracle cure” testimonials aside.

So have many other antivaxxers. Embracing drugs like this, which are not entirely benign drugs, producing serious side effects in some patients, seems to go against the hostility towards pharma that antivaxxers routinely exhibit. So why are they embracing these drugs? First, no one ever said that conspiracy theories had to be self-consistent. Second, if there’s an effective treatment, antivaxxers likely “reason”, then there will be less focus on a vaccine. It’s an angle that RFK Jr. has also taken. Third, these drugs are off-patent, making it possible for antivaxxers to use one of their favorite arguments in favor of “natural treatments,” namely that big pharma can’t make much money off of these drugs. Finally, as you can see above, Bigtree modified the central conspiracy theory of the antivaccine movement (that the CDC “knew” vaccines cause autism but covered it up) to saying that the CDC “knew” that hydroxychloroquine is highly effective against COVID-19 but didn’t reveal it. I sense a theme here.

Finally, the propaganda and disinformation about COVID-19, whether it comes from antivaxxers, COVID-19 deniers, politicians, or celebrities, have had real world consequences. Last Wednesday, in Michigan, there was a large protest against Gov. Whitmer’s executive order to shelter in place in which thousands of people drove in front of the State Capitol Building in order to call for loosening of the restrictions. Dubbed “Operation Gridlock”, Operation Gridlock was organized by right wing groups funded by the DeVos family:

Notice how the protesters who got out of their cars were not social distancing much. Basically, this protest was a large COVID-19 incubator in which people from parts of Michigan not yet affected much by COVID-19 mingling with people from the hardest hit part of the state (the Detroit area) for several hours and then headed home to take coronavirus with them to every corner of the state. Areas of the state that have so far had few COVID-19 cases could well start to see their numbers climb dramatically in 2-4 weeks, as protestors return home and, likely, fail to social distance adequately once there.

Last week, there were similar protests in other states, such as Maryland, Texas, Ohio, Kentucky, Minnesota, Virginia, Utah, North Carolina, Idaho, and California, with a planned protest in Sacramento today. (Note added: Since I wrote this, I’ve learned that there were protests in several other states on Sunday.) Perusing news reports and photos in social media posts, I have identified antivaxxers in nearly every one of these protests, and antivaxxers heavily promoted the planned protest in Sacramento today on Facebook. Here’s an example:

I fear that this alliance between COVID-19 cranks with the antivaccine movement, with its cross-fertilization of rhetoric and tactics, particularly when fueled by funding and support from various political groups pushing to “reopen America”, has the potential to make the pandemic so much worse than it had to be. The only bright side I can see is this. Although all but a handful of hard core antivaxxers will never change their opposition to vaccines, the pandemic might make the public less forgiving of these cranks:

Catherine Flores Martin, executive director for the California Immunization Coalition, says she is seeing a shift in people reacting to anti-vaccine posts on social media. And she thinks people are going to be a lot less forgiving of anti-vaccination beliefs in the future. “There will still be the believers, but I think other people are going to be a lot less tolerant of it now that people have seen how disease can impact their life. We have their attention.”

I hope that that’s one outcome, when this pandemic finally abates. There’s no guarantee, though, and I fear that it might not be.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.