I’ve had a couple days to digest the #JohnSnowMemo and, as a global citizen, I find the state of public health very troubling.

Though the memo has flaws, it’s concerning that so many experts radically disregard broader, foundational public health goals and principles.

2/ Nowhere in the memo are the substantial risks/harms from indefinite population-wide suppression addressed or adequately acknowledged. There is significant global evidence suggesting lockdowns and prolonged societal disruptions harm overall public health. This is problematic.

3/ The Constitution of the WHO states “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It’s a balance. But the memo focuses exclusively on the desired absence of disease/infirmity by “controlling” Covid.

4/ Furthermore, the first principle underlying the ethics of public health is “first, do no harm” (nonmaleficience). How can the memo purport to advance public health if the authors do not at least address this principle on which the ethics of the profession are based?

5/ The memo explicitly argues for suppression until the arrival of an effective vaccine or therapeutics, both of which are uncertain. This is indicative of something very worrying - many public health experts now believe public health isn’t a balance, it’s just Covid suppression.

6/ Though the memo rightly states that C19 poses significant risk, it does not make a cogent argument why extreme societal disruption by suppression is 1) absolutely necessary, 2) proportional or likely to be effective, and 3) that it won’t cause more harm than it prevents.

7/ The memo also asserts that “prolonged isolation of large swathes of the population is practically impossible and highly unethical.” Yet it’s wholly unclear how the memo can acknowledge this but also claim prolonged population-wide suppression is remotely practical or ethical.

8/ Moreover, it’s very upsetting to see memo signatories express pure contempt when addressing the public they purport to serve. But perhaps this is to be expected when the primary objective becomes “suppress Covid” and the public makes that so difficult. https://mobile.twitter.com/KrutikaKuppalli/status/1317093663479111680

9/ I acknowledge that there are certain to be flaws in any public declaration, and I appreciate the work of public health experts. But I sincerely hope the memo’s authors and those who signed it will consider the public’s wellness in a broader, more thoughtful way going forward.