The Omicron surge has triggered a mutation in the conventional wisdom about Covid-19. The virus “is here to stay,” oncologist
and two other experts who advised the Biden transition proclaimed in a Jan. 6 article for the Journal of the American Medical Association, “A National Strategy for the ‘New Normal’ of Life With Covid.” That means no more “perpetual state of emergency”: “The goal for the ‘new normal’ . . . does not include eradication or elimination.”
reached the same conclusion almost two years earlier. “Please don’t believe politicians who say we can control this with a few weeks of shutdown,” Dr. Ladapo, then a professor at UCLA’s medical school and a clinician on Covid’s frontline, wrote in USA Today on March 24, 2020. “To contain a virus with shutdowns, you must either go big, which is what China did, or you don’t go at all. . . . Here is my prescription for local and state leaders: Keep shutdowns short, keep the economy going, keep schools in session, keep jobs intact, and focus single-mindedly on building the capacity we need to survive this into our health care system.”
“That was before it became political,” Dr. Ladapo, 43, says in an interview conducted in person, indoors and unmasked. An orthodoxy soon hardened in the medical establishment and most of the media. He says his UCLA faculty colleagues’ reactions to his commentaries went from “Thanks, Joe, for providing us another perspective” to “How can we make Joe stop writing?” He believes USA Today “would never have published anything along that vein later in the pandemic.” But the Journal would: Since April 2020, I have accepted a dozen of Dr. Ladapo’s articles for these pages. One of them, in September 2020, was headlined “How to Live With Covid, Not for It.”
As policy makers’ views began to converge with Dr. Ladapo’s, he became a policy maker. His writings caught the attention of Florida Gov. Ron DeSantis, who in September 2021 appointed him surgeon general, the state’s top health official. “It’s fun that I’m sitting here because of you,” Dr. Ladapo tells me—though he’s also sitting here because Mr. DeSantis had been quicker than most politicians to see the folly of lockdowns and the necessity of living with Covid.
The governor declared a state of emergency in early March 2020, followed in April by the first in a series of executive orders reopening the state. Restaurants, bars, gyms and movie theaters were back in business by June 2020, and public schools were in session that fall. In May 2021 Mr. DeSantis suspended all local Covid-19 restrictions, including mask mandates, and signed legislation ending them permanently. Last summer’s Delta wave hit Florida hard, but the Sunshine State imposed no new restrictions. The state became a punching bag for journalists and other enthusiasts for harsh Covid policies. The hashtag #DeathSantis periodically trended on
In Florida as elsewhere, Omicron has brought an unprecedented explosion in reported cases but a considerably smaller increase in severe ones. “It’s been really a blessing that the Omicron variant is less virulent,” Dr. Ladapo says, though he cautions: “We don’t know what’s around the corner, because these case counts are still very high.” Florida recorded an average of 65,551 cases a day for the week ending Jan. 12, up 165% from the Delta wave’s August peak. But hospitalizations of Covid-positive patients, at 10,526, were 41% lower than the August high.
One way to bring the case count down is by testing fewer people. “Historically in public health, for respiratory viruses in the general population, we consider ‘cases’ to be people who have symptoms, not a PCR test,” Dr. Ladapo says. “But during the pandemic, you can have a positive PCR and be completely healthy but be considered a case and be required to behave like a case, which is to isolate and those types of things.”
On Jan. 6 Dr. Ladapo issued guidance that only people who have Covid symptoms and a risk factor (old age, certain diseases, or current or recent pregnancy) “should” get tested. Those with symptoms but no risk factors are advised to “consider” a test. For the asymptomatic, the guidance discourages testing, saying it “is unlikely to have any clinical benefits.”
“A test is most valuable when it’s most likely to lead to a change in a decision, a change in management,” he says. “I mean, that’s so basic.” To keep hospitalizations down, he adds, the state has made clear “that we expect clinicians to treat patients with risk factors” using therapies including monoclonal antibodies, new antivirals from
and Merck, and fluvoxamine and inhaled budesonide, two medications that have shown promise in off-label use against Covid-19.
He describes the asymptomatic as “a very special group, because this group—you can’t feel any better than not having symptoms. So this group can only be harmed from treatment”—not to mention the “personal downside to them” of being expected to isolate.
The state isn’t restricting access to tests for anyone who wants one, Dr. Ladapo notes: “We’ve avoided that, because that’s been the spirit of the pandemic actually, which is to order people, to make people do things, to force people to do things, and to not respect people’s personal preferences. . . . I’m really stupefied by it—that so many of my colleagues would think that it’s OK to abdicate the rights of adults to make decisions about a vaccine, or about other public-health measures.”
A liberal writer recently tagged Dr. Ladapo “an anti-vaxx nut,” which means his views on the subject are nuanced and heterodox. He says he’s spoken favorably of vaccination throughout his career, and he acknowledges that Covid shots provide “reasonable protection . . . against hospitalization and serious illness” and that “infection case rates are higher in people who have not received the vaccines.”
But he strongly opposes mandates and thinks authorities are pushing vaccines too hard. For one thing, “there has been this irrational—it really has been irrational—campaign to promote the idea that we know all there is to know about safety.” Example: “One of the things that some women have been saying is that it’s altered their menstrual cycles.” Last week the journal Obstetrics & Gynecology published a study that found “vaccination is associated with a small change in cycle length.” NPR.org titled an article on the finding “COVID vaccines may briefly change your menstrual cycle, but you should still get one.”
“That’s perfectly fine to conclude,” Dr. Ladapo says, though one may question NPR’s authority to dispense medical advice. But “it’s wrong to suppress people’s concerns and complaints, what they report after something happening, and not investigate. . . . This study found that the effects were temporary, which is great. But we don’t understand the mechanism. Like why is that happening? And what else don’t we understand? Those are good scientific questions, and it’s antiscience to not let people explore those questions.”
He’s also uncomfortable with the call for ever more shots. “The CEO of Moderna is already talking about the next booster,” because the effect of the third shot begins waning within weeks. “I think that if someone wants to take the booster every few months,” Dr. Ladapo says, “that’s their decision.” But “the cycle of boosters that wear off after a few months . . . not even as a scientist but just as a human being, that doesn’t feel right to me.” This week an official of the European Medicines Agency confirmed Dr. Ladapo’s intuition by warning that repeated boosters could eventually weaken the immune system.
The justification for mandatory vaccination is that the unvaccinated put others at risk of infection. Dr. Ladapo maintains that rationale doesn’t apply to Covid, especially given Omicron’s infectiousness. So many people have been vaccinated that “if the vaccines stopped spread, this pandemic would be over,” he says. “The argument for the negative externalities does not hold water.”
His main objection, though, is to the infringement of civil liberties: “A lot of people have essentially suffered moral injury by coercion to undergo vaccinations that they felt they didn’t need, maybe because they had prior immunity, or they felt they didn’t want, because there are still uncertainties about the complete safety profile of the vaccines.”
Dr. Ladapo, a native of Nigeria, has an immigrant’s appreciation of American freedom. His parents brought him to the U.S. when he was 5, and he grew up in Louisiana, Georgia and North Carolina while his father, a microbiologist, pursued an academic career. The son studied chemistry at Wake Forest, where he was captain of the track-and-field team, then went to Harvard and earned both a medical degree and a doctorate in health policy.
He followed his father’s path into academia. After a stint at New York University, he landed at UCLA, where he did both research and clinical work. Two years ago he found himself treating Covid patients at the university’s hospital early in the pandemic.
“There was a lot of uncertainty and there was a lot of panic,” he recalls. “We had protocols that were changing daily. . . . My residents were very scared.” He looked at data from Wuhan, the Chinese city where the pandemic originated: “It was very clear that risk was concentrated in people who were older, and the risk was very low among people who were younger.”
He also experienced the pandemic as a father of young children. “Los Angeles has been hard-core in terms of its lockdowns and restrictions,” he says. “The closing of the schools when the data was indicating that kids were at extremely low risk—that just completely looked like a bad decision. . . . We have boys, and they have to go outside. So L.A. shuts down; it becomes almost like a ghost town. We have three kids, and we didn’t stop going out. So we would take them to the park, and there’d almost be no one there.”
When schools prepared to open for the fall 2021 semester, the Ladapos decided their children wouldn’t go: “With masks and testing, my wife and I—it was just full stop. We would never do that to our kids. We think that—our personal beliefs are that children shouldn’t be forced to place something over their faces.” They started working with like-minded parents on joint home-schooling arrangements.
Then came the job offer from Tallahassee. “I didn’t think my wife would go for it,” he says. But “I told her, and she just lit up. She said that she had been waiting for something like that to happen.” He thought his academic work was going well, but she was worried about “the direction of UCLA and my career there.” They settled in the Tampa area.
For the benefit of readers who wonder how the other half lives, I ask him to compare California with Florida. “In Los Angeles during the pandemic, it felt like you lived under a blanket,” he says. “People who didn’t feel that they needed to take certain precautions, but there was—they would feel like they needed to be seen as taking certain precautions, because that was the atmosphere, the expectation. It was a very heavy air, sort of an oppressive atmosphere there. . . .
“Here, in contrast, the thing that you feel you’re under is the sun. . . . Do you have a mask on you, are you ready to put it on when you go outside or go to a store—that whole sort of ambiance is completely absent here.”
That resonates with my experience. At Christmas 2020 my wife and I decided to escape New York’s lockdown and wait out the pandemic near Miami, where we have a second home. We’re still waiting. We were most recently in the Big Apple a month ago, as the Omicron panic was getting under way. We had to show our papers—vaccine cards and photo ID—to eat in restaurants. Our last day there, a renewed state mask mandate took effect. It did all feel oppressive, and although I’ve been a New Yorker for more than 30 years, returning to Florida was like coming home to America.
Is it worth the risk? Miami-Dade County has had a higher per capita Covid case count than New York City for several weeks, but its hospitalization rate is somewhat lower. That sounds like a wash until you flip the question: Is the possible reduction in risk worth the price in freedom?
After the interview, an aide to Dr. Ladapo sends me a graph ranking all 50 states and the District of Columbia by age-adjusted Covid mortality rates throughout the pandemic. Florida comes in at No. 30. California does slightly better at 33rd, while New York ranks seventh.
Florida’s permissive policies didn’t stop Covid, but neither did other states’ restrictive ones. It’s an open question whether lockdowns, masking, forced vaccination and the rest have conferred any benefit at all. As the federal government and states like California and New York search for a “new normal,” they should consider following Florida’s example of simply being normal.
Mr. Taranto is the Journal’s editorial features editor.
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