Why the U.S. needs a reckoning on lockdowns before the next pandemic

The COVID pandemic lockdowns. It was an approach endorsed by many public health experts.

But could there have been a better way?

Today, On Point: Why the U.S. needs a reckoning on lockdowns before the next pandemic.

Ashish Jha, dean, Brown University School of Public Health. Appointed as White House COVID-19 Response Coordinator in March 2022. Faculty director of the Harvard Global Health Institute from 2014 until 2020. Former professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School.

Tracy Høeg, visiting scholar, MIT. Physician epidemiologist. Physician scientist, University of California San Francisco. Associate professor of clinical research, University of Southern Denmark.

Part I

DR. FRANCIS COLLINS: If you're a public health person and you're trying to make a decision, you have this very narrow view of what the right decision is, and that is something that will save a life.

MEGHNA CHAKRABARTI: In July of last year, Dr. Francis Collins, former head of the National Institutes of Health, shared his candid reflections on America's COVID response at an event hosted by Braver Angels, a non profit, nonpartisan group dedicated to bridging political divides.

They were in Gettysburg, Pennsylvania.

COLLINS: Doesn't matter what else happens. So you attach infinite value to stopping the disease and saving a life. You attach a zero value to whether this actually totally disrupts people's lives, ruins the economy, and has many kids kept out of school in a way that they never quite --

Collateral damage.

So, yeah, collateral damage. This is a public health mindset. And I think a lot of us involved in trying to make those recommendations had that mindset. And that was really unfortunate. That's another mistake.

CHAKRABARTI: Collins is honorably admitting that America's imperfect lockdowns beginning in March 2020 didn't exactly work.

And that there is so much to be learned to improve the U.S. response before the next global pandemic, which will certainly come. But before better solutions can be found, it's essential to understand how the world and the U.S., in a matter of weeks, decided that an unprecedented use of widespread lockdown was needed to fight a novel pandemic.

January 23rd, 2020. The Chinese government puts 11 million people on lockdown in the city of Wuhan, origin of a new coronavirus.

NEWS BRIEF: Tonight, the Chinese city of Wuhan and nearby towns locked down, no trains, flights or mass transit. 25 million people effectively quarantined and nervous.

These are drastic measures by authorities here in central China to contain a virus that's fueling fears of a pandemic.

CHAKRABARTI: But the virus had already spread. Cases were reported in 13 countries when Wuhan shut down. By March 10th, Italy was in crisis. 10,000 confirmed cases. It shut down.

POLICE ANNOUNCEMENT: All residents stay at home, orders the police. Public gatherings banned, bars and restaurants closed from 6pm, tables a meter apart, schools, museums and nightclubs shut.

CHAKRABARTI: Just days later, some U.S. cities began shutting down. On March 16, 2020, San Francisco Mayor London Breed announced a, quote, shelter in place order requiring all residents to stay at home, excluding essential workers.

LONDON BREED: These measures will be disruptive to day life, but there is no need to panic.

CHAKRABARTI: California Governor Gavin Newsom followed suit with a statewide stay at home order just three days later, March 19th. The goal, Newsom said, quote, to establish consistency across the state in order to slow the spread of COVID 19, end quote.

The very next day, March 20th, 2020, New York Governor Andrew Cuomo announced New York on PAUSE. The acronym stood for Policies that Assure Uniform Safety for Everyone.

ANDREW CUOMO: Uniform safety for everyone. Why? Because what I do will affect you. And what you do will affect me. Talk about community and interconnection and interdependence.

This is the very realistic embodiment of that. We need everyone to be safe. Otherwise, no one can be safe.

CHAKRABARTI: Cuomo told New Yorkers that he knew this was, quote, the most drastic action he could take. Three days later, March 23rd, nine states had taken the same drastic action. By March 26th, that number went up to 21 states.

On March 26th, 30 states. And by April 3rd, 41 states had issued statewide stay at home orders and 49 states had closed their schools. Though the federal government did not and could not directly shut down the states, on March 13th, President Donald Trump in the Rose Garden with the White House COVID task force behind him, made it clear that he and his administration supported these drastic actions.

DONALD TRUMP: To unleash the full power of the federal government in this effort today, I am officially declaring a national emergency. Two very big words.

CHAKRABARTI: All of this brings us back to what Dr. Francis Collins said this past July. Five also very significant words Collins said. That the lockdowns as carried out in the U.S., quote, may have been a mistake. So how did that happen? And more importantly, how can we do better next time? Dr. Ashish Jha joins us in the studio today. He's currently the Dean at Brown University's School of Public Health. But from March 2022 to mid-June 2023, he served as the COVID White House, excuse me, the White House COVID-19 response coordinator for President Joe Biden.

Dr. Jha, it's great to have you in the studio.

ASHISH JHA: Meghna, thanks for having me back.

CHAKRABARTI: So take us back to March of 2020 or even the January, February period. This was before you were in government, but nevertheless, state leaders and maybe even national leaders were reaching out to you for advice on what to do about whether we should shut down.

What were those conversations like?

JHA: So if we start back in January of '20 we knew there was a novel virus. We knew it was going to spread. It was, we knew it was going to become global. And there was a very straightforward response. Get testing up and running. Get surveillance going. If you do that, you can avoid doing some of the more difficult calamitous things like having to issue stay at home orders.

And I was talking to friends at CDC and etc. And my assumption, turned out to be wrong, was that this was going to happen. The CDC was really good at developing tests. We were going to have testing widely available. We all know how that story played out. And in early March, it dawned on me that we had missed the six weeks critical window to avoid, it essentially became a catastrophe.

Just numbers of people who died in New York and Boston and elsewhere were awful. And what I said, and I think I said it on this show by Zoom, was I said, we need a two-week national pause. And people said why two weeks? And what I was hearing from the White House was, we are going to have testing widely available.

Vice President Pence said, we're going to get 4 million tests out to the states in weeks. The whole idea here was, Put a pause. Put it, use it as a circuit breaker, stop the spread, get testing. Once you have testing, you can reopen safely. And let me just make one last point of why testing and surveillance is the antidote to lockdowns.

If you have testing and surveillance, you know where the virus is spreading. You know who needs to stay at home, people who are infected, who doesn't need to stay at home, people who are not infected. You can manage your way through this crisis with testing and surveillance.

We find ourselves in mid-March, with no testing, no surveillance, flying blind.

CHAKRABARTI: But you were getting indications from the White House that testing was going to be stood up. And presumably, that's what governors were also being told.

JHA: That's what, I mean, Vice President Pence was saying that publicly. And I think President Trump went to the CDC and said, We're going to be getting all these millions of tests out.

So every bit from the White House, I spoke to the testing coordinator at the White House, Brett Giroir. He's, we have plenty of tests, and we're going to have so much more in the upcoming weeks.

CHAKRABARTI: So that was the hope at the time, and yes, you did say that on this very show, and you said that hopefully it'll just be a couple of weeks, but you said without testing, we were flying blind.

JHA: Correct.

CHAKRABARTI: Turns out we ended up flying blind for quite a bit longer than just a couple of weeks, but looking back now, and again, this is not a conversation about casting blame. I am not interested in that at all. We have to do some kind of after-action report so that we know what to do better next time.

As I mentioned, even by the time the Chinese government shut down Wuhan and the province that it was in, we already knew that there were infections elsewhere in the world.

Isn't that one single piece of information indicative enough that lockdowns, it was already too late for lockdowns.

JHA: So let's talk about what was happening at the time. And again, retrospectively, lots of things are much easier. We had hospitals in New York totally overwhelmed. We had refrigerated trucks outside of Amherst Hospital.

And people were running out of refrigerated trucks. That is a calamity at that moment, because of exponential growth, we knew this was happening in New York, we knew this was happening in Boston, we had no idea where else it was happening. Was it also happening in Miami and Mississippi and Montana?

We didn't know. We had no testing, no surveillance. And I have a lot of sympathy for political leaders who make decisions when they have no information. They could have said, we're just going to ride this out. And then we would have had people dying in extraordinary numbers everywhere. And so political leaders made a decision based on information that they were getting from the White House. That this is going to be a couple of weeks and then we'll have testing and then we'll know where the virus is spreading, that we were going to put this pause on.

We were going to do shelter in place. By the way, shelter in place and lockdowns as people like to call them. I look at this as an extreme thing that you do under only the most extraordinary of circumstances. You want to do it rarely and you want to end it as quickly as possible. And unfortunately, we found ourselves having to do this.

I didn't, political leaders, President Trump, 49 states, but they did it because we were flying blind. We had no idea. And then lifting those orders was much, much harder, because testing never showed up. So some states did it. Other states didn't. And then it became a free for all.

CHAKRABARTI: I will be endlessly curious and I'm not sure we can answer this question, cause it's a hypothetical, but because China took that extraordinary step of locking down 11 million people. And the Chinese government can do that instantaneously and not have any pushback given its authoritarian nature.

I always wonder if that sort of paved the way for making it, making shelter in place a palatable option for the rest of the world. And also, at the same time, we weren't getting clear information out of China about how many people were infected, how many people were dying. If that hadn't happened, do you think that the people you were talking to would have even considered shelter in place?

JHA: The way I look at it, first of all, Chinese shelter in place for lockdown was very hard. Like they literally enforce it with the military and people. It was awful. And that we never did here and never would want to do here. The problem for governors was they were looking at their hospitals, they were hearing from their hospital executives, in the places where the virus was spreading, New York, Boston, Atlanta, not Atlanta, sorry, Detroit, New Orleans, a few other places, and they were saying, 'We're running out of beds.

We're running out of personnel.'

They had to do something. There weren't a whole lot of options.

CHAKRABARTI: They had to do something in those places, no doubt. But the fact that governors and states were perhaps, there were lots of areas where there wasn't as much COVID or infections. I want to talk about that in the rest of the show, about maybe a better way.

If we have to institute these extreme measures, what that better way might be. So today we're trying to do some kind of, at least in the context of a radio show, an after-action report on the efficacy or failures of COVID shelter in place slash lockdown decisions that were made in 2020 and into 2021.

Part II

CHAKRABARTI: Today we're trying to conduct an honest reckoning about the efficacy or failures of COVID lockdowns. Our intent is to learn, because like it or not, eventually there will be another global pandemic, and it probably won't take another 100 years.

Now what took place in the Spring of 2020 was unprecedented. Never before had there been such widespread global restrictions on the movement of people. And given the scale, it is understandable that many people believed there was consensus across international public health experts that lockdowns, regardless of age or geography, were the right way to control COVID's spread, at least for a while.

But in fact, no such ubiquitous consensus existed. Here's an example. On October 4th, 2020, seven months after COVID lockdowns began in the United States, three researchers published the so-called Great Barrington Declaration. It was signed by thousands of doctors and scientists. In the declaration, they wrote, quote, "Current lockdown policies are producing devastating effects on short- and long-term public health.

The results include lower childhood vaccination rates, fewer cancer screenings, deteriorating mental health, with the working class and younger members of society carrying the heaviest burden." End quote. Instead, the group proposed what they called focused protection, essentially keeping protections in place for the elderly and groups most vulnerable to COVID.

While the less vulnerable could resume life as normal until communities reach the so-called herd immunity threshold. Now, there was no COVID vaccine at the time of this declaration. Public health leaders dismissed the proposals as radical and Trumpian epidemiology. Co-author Dr. Jay Bhattacharya, health economist and epidemiologist at Stanford Medical School, responded in a Newsnight interview.

DR. JAY BHATTACHARYA: Traditional public health involves thinking about people holistically. We shouldn't just be thinking about infection control in isolation. People need more than just to be not sick with COVID. They need to be healthy in many other ways. And focus protection basically calls for a return to that. If that's Trumpian epidemiology, then so be it.

CHAKRABARTI: Now, that was October 2020, and I'm bringing up the Great Barrington Declaration again now because of what happened next. There is a great deal to be learned about how politics and fear disrupt the normal process of scientific disagreement, and how the public suffers when that disruption is blasted across media and oversimplified and devoid of context.

So we spoke with Dr. Jay Bhattacharya last week, and he told us why he decided to co-author the declaration.

BHATTACHARYA: I initially thought that lockdowns were the biggest public health mistake in history. It was already too late to stop COVID from spreading everywhere.

CHAKRABARTI: The backlash from public health officials came immediately. And Bhattacharya believes that's because he dared to engage in a normal scientific process, offering a dissenting approach, at an acutely abnormal time.

BHATTACHARYA: The attacks on me had to do with the fact that I was criticizing public health at a time when public health thought that it was irresponsible for anyone to criticize them.

CHAKRABARTI: In fact, just four days after the Great Barrington Declaration was released, Dr. Francis Collins, then NIH head, wrote an email to Dr. Anthony Fauci and his colleague, Dr. Cliff Lane. Collins wrote, quote, "This proposal from three fringe epidemiologists seems to be getting a lot of attention and even a co-signature from a Nobel Prize winner," end quote.

Those fringe scientists were Bhattacharya of Stanford, Dr. Martin Kulldorff, an epidemiologist at Harvard Medical School, and Dr. Sunetra Gupta at Oxford University. She'd received honors from two of the UK's top scientific societies, and her research focused on transmission dynamics of infectious diseases.

FRANCIS COLLINS: As somebody who is deeply engaged in the federal effort to try to save lives, I saw this and I was deeply troubled. I regret that I used some terminology that I probably shouldn't.

CHAKRABARTI: Now this is Dr. Francis Collins speaking at that event hosted by the group Braver Angels last summer. And yes, he admitted it was a mistake to call Kulldorff, Bhattacharya, and Gupta fringe scientists.

BHATTACHARYA: Much of the public health community seems to think that anyone that criticizes public health is automatically anti-science or means bad for public health. When in fact what needs to happen is an honest evaluation of the failures of public health.

CHAKRABARTI: Interestingly, Francis Collins also thinks a more robust public discussion about lockdowns should have happened around the declaration.

COLLINS: That declaration would have been a great opportunity for a broad scientific discussion about the pros and cons, but that's not how it was presented. On the day it was presented to the Secretary of Health and Human Services, Alex Azar. It would have been presented the next day to the president, if he wasn't in Walter Reed at the time being treated for COVID, this was an effort to take a very fast track of something which would have potentially been a major change in national policy without the opportunity for any debate or discussion.

CHAKRABARTI: Unsurprisingly, Bhattacharya rejects that characterization. He believes it was Collins who wanted to quash all debate. Because in that same October 8th, 2020 email to Dr. Fauci and Lane, Collins wrote, quote, "There needs to be a quick and devastating takedown of its premises. I don't see anything like that online yet. Is it underway?" Here's Bhattacharya again.

BHATTACHARYA: Public health has tremendous power. And we've seen during the pandemic how easy it is for people in public health and the people that surround it to abuse that power with no check.

CHAKRABARTI: For his part, Collins says he regrets using terminology like quick and devastating takedown.

But he also says he was not wrong.

COLLINS: In a few days, no less than 14 of the public health associations of the United States all together wrote a scathing takedown of the Great Barrington Declaration saying this would probably kill tens of thousands of people.

CHAKRABARTI: For Collins, that joint statement was adequate scientific discussion of the Great Barrington Proposal.

But Bhattacharya sees it as nothing more than the public health associations falling into line.

BHATTACHARYA: When a public health leader, or set of public health leaders or public health institution makes a recommendation, it is very difficult for any leader to say no.

CHAKRABARTI: In truth, that joint open letter wasn't a typical scientific rebuttal.

It was a statement calling the Great Barrington Proposal, quote, not a strategy, but a political statement, one that sells false hope and will predictably backfire, end quote. It didn't contain a lot of data. But by my reading, neither did the original Great Barrington Declaration. In fact, what the public was witnessing was a rare, real time airing of scientists debating not evidence, but values.

Meanwhile, the American people had to make sense of the debacle on their own. What did it mean that there was an alternative lockdown proposal? Who was right? Why wasn't there consensus? And looking back, I would say that essential guidance was not coming from the scientific community. Nor did it come from us in the media.

As for Dr. Jay Bhattacharya, his views have only hardened over time. He now calls public health, quote, an authoritarian exercise in need of reform. But he says nonpartisan analysis of COVID policy successes and failures across both the Trump and Biden presidencies would have to be done first. It has to be done.

But he's not holding his breath.

BHATTACHARYA: The lockdown, school closures, all that entire project was a bipartisan project. Both parties share some blame in it and neither party wants to accept their part in the blame in it. There's a tendency to say, okay, everyone got it wrong. Let's move on. When in fact, that's just not good enough.

We're going to have the same response again and the same disaster again.

CHAKRABARTI: That's Dr. Jay Bhattacharya from Stanford and one of the co-authors of the Great Barrington Declaration. Dr. Ashish Jha, I know you probably have a lot to say about that, but I have two specific questions. First of all, your response to Bhattacharya's sort of assertion about the power of public health officials to shape national conversations around emergencies like shelter in place orders?

JHA: When states, the federal government, faced a crisis that they had not seen before, and I was speaking to a lot of governors, a lot of state health officials. They looked for people, to people for advice, and what I found really interesting in that moment, I remember one Sunday morning, speaking to a governor, there was a really bad outbreak happening in that governor's state and so it was a 7 a.m. Zoom call with the governor and the governor's team. And the governor asked me, he said, what are your recommendations?

I started off, first one, I said, in those areas where the outbreak is bad, you got to shut down the bars. The bars are where the spread is happening. The governor looked at me straight in the eye and said, what else you got for me, Dr. Jha? I was like, okay, that's not interesting. I had a list of five. They ended up doing two. As I walked out of that conversation, I realized, at the end of the day, the governor is accountable to the people of that state. We do need political leaders making these decisions.

Public health officials should be advising, should be guiding, the advice I gave privately was the same advice I gave publicly. The political leaders ultimately were accountable to the people and had to make those decisions. And I think that's right. I think in a democracy, we've got to hold our political leaders accountable here. The decisions that were made in 2020 by Republicans and Democrats, last week we had an event in Washington.

We brought in governors from Republicans and Democrats. There were a lot of Republican governors and Democratic governors who did an extraordinary job managing this. There are people who did this right. Public health is an input into that decision making, a really important input in a public health crisis, but the decision lies with our elected leaders.

CHAKRABARTI: Yeah. Point well taken. And I just want to let listeners know that obviously anything related to COVID is a very multifaceted conversation. And so I could talk about just the failures of the Trump administration for many hours. But today we're just, we're focusing on the public health and science part.

We want to do an informal ongoing series that takes different pieces of this, so the politics will definitely get to, in more detail, down the line. But so with that in mind, there is this question that I raised with the example of the Great Barrington Declaration that under normal circumstances, there's papers and rebuttals and conferences and people share different ideas, debate the evidence. That sort of happens in the scientific community.

By virtue of the emergency, that all burst out into the public during the COVID lockdowns. But I feel like the scientific community or the public health community forgot that the public was listening. Because it does seem that no one knew who to believe.

What, is that not a failure? And how would we avoid that next time?

JHA: That's a great question. So first on the Great Barrington Declaration, just to take a minute on that. There, when that came out, I read it. I read it carefully. My personal view on this was, this sounds great on its surface, I don't think it's going to work.

I don't see how you could make it work. Focus protection sounds exactly right. How on earth do you take all the elderly, put them on an island for six months? Like, how do you do this? We actually, there were a lot of states who thought about how to implement this and really struggled. And I don't think there's a single state that ended up ultimately implementing it.

The bottom line is that in the public space, what you're talking about, Meghna, there was not enough of, I think the temperatures were too high. I think there was too much screaming. I think Dr. Collins's email about a takedown, what are we doing? That is not the way we should have been doing this.

I get it. We were in a crisis, but I absolutely agree with the idea that we needed to have public debates on these things. That was much more reasoned, much more civil. That was not happening.

CHAKRABARTI: In terms of how to do that, we'll talk about that later in the show, but I would say that in the sub genres of shelter in place, one of the places where the temperature was the highest for longest was with schools.

JHA: Yep.

CHAKRABARTI: And with that in mind, I'd like to introduce Dr. Tracy Høeg into the conversation. She's a visiting scholar at MIT. She's a physician and epidemiologist and also at the University of California, San Francisco. Dr. Høeg, welcome back to the show.

TRACY HØEG: Thanks, Meghna. It's so great to be back.

CHAKRABARTI: Okay. You did some studies during that first phase of COVID about whether or not transmission was actually happening in schools, right?

And around masking, as well. And just briefly, if I remember correctly, you didn't seem to find adequate evidence that schools were going to be hotbeds for COVID transmission. Is that correct?

HØEG: Yeah, that's correct. And what we published in January of 2021 in CDC's MMWR where we found minimal transmission in the schools, just 7 cases of transmission over the fall semester among over 5,000 students and staff in Wood County, Wisconsin and 37% lower prevalence in the schools in the community.

What we found was consistent with the reports we had been getting out of Europe, starting in the spring of 2020, that COVID was not spreading to the degree that we thought it was going to in schools, and was not increasing community transmission. And we knew this actually from comparing Sweden to Finland.

Already in June of 2020.

CHAKRABARTI: In fact, I think it was with you. I had a conversation around that time, and it seemed like the trajectory of infection was in districts that had higher rates. It's because the community had already had higher infection rates. It was going from the community into the schools.

HØEG: Correct. And our impression was, and my impression actually for many months, before we did our study, was that children were actually relatively safe in schools compared to out in the community.

CHAKRABARTI: So but during that time and help me remember the details here. I think there was a particular paper or papers that you were getting published that your university didn't want your affiliation to be printed along with that.

HØEG: Yeah, that's correct. And this was really a big surprise to me. And I think an important topic when we look back on the pandemic is I did a number of interviews about our findings in the Wood County, Wisconsin study, including a nature magazine, and was actually asked due to pressure on University of California, Davis to take my take my affiliation off of my interviews when I talked about where I was working.

And this was something, actually, that I faced when talking about mask mandates and also vaccine safety studies, that if you publish findings that went against the dominant narrative, that could be problematic for your university's funding. And unfortunately, I did end up actually losing my position at University of California, Davis to move to, and ended up moving to UCSF and now at MIT, but a lot of researchers and scientists are aware of this and are hesitant to publish findings and studies that might get them in trouble.

CHAKRABARTI: So in the interest of again, understanding what went wrong in order to not repeat the mistakes again, the schools are so important to understand. Because we had domestically, I would say, a pretty strong bifurcation around schools that we know that certain districts stayed, kept kids out of buildings for much, much longer than others.

What do you think went wrong in terms of reassuring people of the latest state of the understanding of whether or not putting kids back in school presented a danger or not?

HØEG: Yeah. I actually think I have a unique perspective in terms of that, because I moved from Denmark to the United States in 2015.

And I did my PhD in epidemiology and public health at the University of Copenhagen and worked as a physician there. And so I was reading their media's perspective of the pandemic, and they were able to reopen schools, they reopened schools six weeks after their initial lockdowns. And gave a very reassuring message to the public, and all along were reassuring parents and the public in general that things were going well in schools.

They were being creative, trying all along, studying what was working in terms of getting schools open again and then reporting to the public when things were going well. And what was working.

Part III

CHAKRABARTI: Dr. Høeg, you were talking about how in Denmark, regarding schools, there was, it seemed like there was a constant flow of information about here's what we know, here's what we don't know. Let us reassure you about this. We still need to figure out about that. The implication being that was not happening here in the United States.

And is that one of the reasons why you feel like there were such entrenched feelings about keeping schools shut in a lot of places?

HØEG: Yeah, definitely. And I think people in general felt like in the United States, the public health officials were more telling them what to do, rather than understanding the problems with the school closures and the lockdowns and the real problems people were facing.

And so I think that the part of the issue was in the United States, we didn't have that sort of holistic look at this, of these closures and these lockdowns are unprecedented. COVID is not the only risk that children and people face, but especially children. And we need to take, as Jay Bhattacharya said, a more holistic view of people's health.

And so as closures, lockdowns, school closures went on. I think, the general person, the typical family got more and more frustrated, especially if they had young kids or they had lost their jobs with, what is the plan here? And why is this happening? And is what we're doing actually working?

And I think that's another question, is we weren't studying that. Were the school closures, were they actually effective? Were the lockdowns actually being effective? And now, all along we were seeing, we're not seeing data that these measures are effective or that their benefits are outweighing the harms.

CHAKRABARTI: And it seems to me that one of the reasons why it was so hard to get those things done, like you said, one of the universities you were affiliated with didn't even want that, their name next to yours when you're presenting research. That's quite, quite striking.

But if I understand it correctly, on schools, this was one point where Dr. Anthony Fauci was very supportive of getting kids back into schools, but he was meeting some resistance from the Biden administration. And one of those, one of the reasons for that is that, as we now know, the American Federation of Teachers, teachers' unions are essentially very proactive.

And in the room when members of the Biden administration were trying to come up with guidance for how to open schools. So here's an example. This is AFT President Randi Weingarten, at the biannual convention of the AFT, was held virtually in July of 2020. And at that time, the Trump administration actually was threatening to pull school funding for schools that did not reopen in the fall.

And here's what Weingarten said.

RANDI WEINGARTEN: Let's be clear, just as we have done with our health care workers, we will fight on all fronts for the safety of students and their educators, but if the authorities don't protect the safety and health of those we represent and those we serve, as our executive council voted last week, nothing is off the table,  advocacy or protests, negotiations, grievances or lawsuits, or if necessary, and authorized by a local union as a last resort, safety strikes.

CHAKRABARTI: Dr. Jha, I am curious about what, if anything, could public health leaders, elected officials have said, or a proactive approach they could have taken that would have brought the temperature down, right? Because here, we were hearing other education leaders saying that if kids go back into school, that local superintendents will have caused the death of children, of teachers, and grandchildren and grandparents.

(Editor's note: this part of the transcript has been edited to correct a misattribution)

Like they would have blood on their hands. How do you step back from that?

JHA: So there has been a lot of confusion about what happened with school. So let's actually just take one minute, Meghna, and remind ourselves. Across Europe, in the United States, schools shut down in the spring of 2020. I think the debate really begins in the summer of 2020.

What are we going to do in the fall? What I saw was some states moved forward and will reopen schools, Florida, Texas, Rhode Island, where I work. Governor Raimondo is schools are reopening, and they're going to stay open. And they did. And the evidence that came out, there was data that started emerging immediately, that schools were not major sources of spread.

And that pushed a lot of us. You can go back and find my tweets from late September, early October, saying, we have got to open up all the schools. Why we were not able to in places like Massachusetts. I live in Massachusetts. Casinos were open and schools were closed. And I had a motto, which I probably said 100 times, which is school should be the last thing to close and the first thing to open.

That should be the philosophy. And you can have casinos and bars open, but schools closed? That's nonsense. That was very clear to many of us. There was a lot of fear. There was a lot of not really taking on the mitigation measures. I love Tracy's paper from Wisconsin. It was one of the ones I often talked about.

In 17, I think it was 17 school districts, kids were masked up, there was very little transmission. With basic mitigation, we could get kids back into school. That was very clear. Her paper came out in January '21, but it was clear by September of 2020 that was the case. I do think that this is a story where some states did fabulously, but other states really failed.

CHAKRABARTI: Dr. Høeg, do you want to add to that?

HØEG: Yeah, I would also add that it's important to point out that Sweden gave us a counterfactual because they actually never closed schools. And they gave us a report very early on comparing Sweden to Finland, which did close schools and there was no community impact.

There was of closing the schools, and there was no detriment to the teachers or students from keeping the schools open. And we did have that data very early. And yeah, that's what I would say about that. And I think when we're talking about what happened in February of 2021 from the CDC, I think it was very difficult to understand why the CDC that far into the pandemic was still recommending six feet of distancing at times of community transmission, in spite of our Wood County, Wisconsin study.

And I think that's definitely a point where public health lost, and the CDC lost a lot of people's trust. And I would also point out about our paper from Wood County, Wisconsin, that our study was not a study of masking children. And we can talk about how the study, these different mitigation strategies, but Norway and Denmark and Sweden had reopened their schools without masking students and without masking the teachers so that the learning could be better.

CHAKRABARTI: And Dr. Jha, I want you to address that, because this, again, and actually gets us back to where the learning phase, because I think a lot of people, there was that time where the CDC, when they said six feet distancing in schools and then they issued a basically, I think other researchers said, if school districts did comply with that, most districts would have to stay closed because they physically could not do that in schools.

And so it's just, I think there's a great deal of confusion and also suspicion, right? This time it's suspicion coming from the left. In the previous examples we were talking about, it's coming from the right. That there was some kind of effort to keep kids out of schools.

Your thought there.

JHA: Yeah, a couple of things. Look, in a pandemic, you're always learning and you're doing it right if you're changing your policies based on that.

CHAKRABARTI: You know what? I'm just jumping here. I agree. But that statement that you just made was never made clearly and repeatedly, I'd say, or often enough from the start of this pandemic.

JHA: Yeah, it's interesting, right? It's funny, I now get people who go back and look at my tweets from 2020 and say, this was a guy who believed in masking. Why isn't he asking people to mask anymore? He has sold out. And then I have other people who look at my tweets today and they say, if only you had come to this conclusion in 2020. I'm like, no, things have changed since 2020.

We've all gotten immunized. The virus is probably not as dangerous as it was four years ago, certainly no longer as dangerous to us. So you want a dynamic policy response as the virus changes and as you learn more. On the school front, the one part I will say, just because I was part of the Biden administration, I try not to be an advocate, but I'll make one important point.

When president Biden came into office, 44% of schools were open full time, five days a week. Four months later, 98% were. That was a major goal of the Biden administration. So you can't take what happened in fall of 2020 and blame that on President Biden. He wasn't president at the time.

There was a major concerted focus from January 20th onwards to get schools reopened. Those are just the facts. Schools reopened basically in the spring, not fast enough. They should have opened in the fall. We can go back and look at it. But what I actually want to do is look forward and say, how do we not do this again?

And in my mind, there are three things. Number one is, if you have good surveillance, good mitigation, you can tell that something is not spreading. This was a virus that was not as dangerous to kids. We learned that. And again, there are states, like Rhode Island was doing this, looking at states that were doing a good job, Florida, other states, and using that as a model to nationalize.

That's what we needed to have been doing. Many of us were advocating for it. It didn't happen.

CHAKRABARTI: So in the last five minutes or so that we have I want to get us back to a place where we're, again, this is a learning space, essentially. And all through the entirety of 2020 and much of 2021, I used a theme whenever we talked about COVID that I borrowed from Anne Applebaum about COVID.

The pandemic was a mirror that held up to societies and reflected back what we truly are. So we learned a lot from that reflection and from that mirror. And with that in mind, we have to be able to do this better next time. And I want to just play a little clip. This is J. Stephen Morrison, Senior Vice President at the Center for Strategic and International Studies.

And he directs its Global Health Policy Center. And this was at an event last week, Dr. Jha, you had mentioned it, that they hosted, called the American Democracy and Health Security Initiative: Lighting a Path Amid Pandemic Polarization.

J. STEPHEN MORRISON: American health security depends on maximizing our ability to live in a free society and manage a public health emergency simultaneously. And likewise, the health of our democracy depends on citizens' faith in their institutions, our schools, our workplaces, and especially our government to protect them in a crisis. Somehow, we now struggle to find a way forward that both respects the individual freedoms that we hold dear and supports the collective good.

And one of the hard lessons is that when we allow these two values to be seen as in opposition to one another, as in collision, we pay a high price for that, and we need to avoid it.

CHAKRABARTI: This is the mirror, right? The United States is not China, politically. The United States, culturally, is not any of the East Asian countries that were able to more successfully get a sense of community, or Australia or many of the European countries, okay?

That just is a fact. So with that in mind, trying to balance the individual freedoms that are so important to Americans, with the necessity of collective action around pandemics, my question is, and I'll start with you Dr. Høeg. Will lockdowns ever be a viable tool for pandemic control in the United States again?

HØEG: So we don't have good evidence that the lockdowns worked for COVID-19. And there was a recent paper that came out in Scientific Advances by Eran Bendavid and Chirag Patel that looks at that. And I think that people need to understand that lockdowns were never part of the normal public health response to a pandemic.

Now, George W. Bush did actually indicate that he would want to make that part of the pandemic strategy. But I think that in terms of mitigating a respiratory virus, in terms of when it's already obviously been spreading and that we don't have evidence that lockdowns worked. And in the future, I think it's very important.

And I also want to mention, we have so much evidence of harms in terms of worldwide poverty, in terms of excess death, especially among young people in the United States.

But moving forward, I think first of all, we didn't, compared to other countries, it was very clear the United States did not prioritize children, did not show that it valued children, but also that we did not show that we valued the scientific process of evaluating scientifically what we were doing as we were doing it. And in a future pandemic I think we need to be ready to quickly study, in preferably a randomized way, our mitigation strategies, what sort of treatments are working, do studies like Jay Bhattacharya did, about the seroprevalence, about how far the disease has already spread, as quickly as possible.

CHAKRABARTI: Yeah. But bringing the public along with that scientific process, I would say is very important. And what I'm wondering about, thinking about that and lockdowns. Their physical efficacy, we can debate in terms of evidence, but I think politically they were doomed to fail in the United States, even before March of 2020. And also, there are still lots of people who, let's say, live in Helena, Montana, who are wondering why they ever needed to be locked down even for a day. The vastness of the United States and our current political polarization, should we not instead in the future focus on getting smarter public health actions at the state and local level, Dr. Jha.

JHA: Yeah. So let me tell you how I thought about this at the White House, as I was leaving the White House and thinking about how do we get better prepared for future pandemics. As I said earlier, Meghna, surveillance, community-based disease surveillance and testing is the antidote to shelter in place, okay?

If we had that in March or February of 2020, if we had not wasted those six weeks, we would have known the virus is spreading in New York but not in Mississippi, and we would not have shut down Mississippi and Montana, but we would have put in restrictions in New York and Boston until the virus spread, slowed down.

The key here is we got to get away from this binary thinking of lockdown, no lockdown. What we want to do is actually say, what do we need to do to manage viruses moving? You want a strong surveillance system. You want good testing. You want to restrict movements as a last resort when everything else has failed and your health care system is overwhelmed.

That should be the strategy, last resort. We went to it first. Because we blew through everything else. We have to make sure we never do it again. I think we're in much better shape. But we've got to stay committed to ensuring we don't have to do that ever again.