New Florida surgeon general often takes contrary positions on COVID policy, treatment

For the first year and a half of the coronavirus pandemic in Florida, it was difficult to heed the advice of Florida’s top health official — Dr. Scott Rivkees — because he rarely publicly shared his views.

That won’t be a problem for Rivkees’ successor. On Tuesday, Gov. Ron DeSantis replaced Rivkees with a new surgeon general, Dr. Joseph Ladapo, a UCLA researcher. Beginning with a column in USA Today in March 2020, Ladapo has widely and frequently shared his opinions on the coronavirus.

In more than a dozen published columns in major newspapers, Ladapo has frequently deviated from the medical establishment consensus. In the USA Today piece at the start of the pandemic, for instance, Ladapo warned that American economic shutdowns would not stop the spread of the virus.

“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,” Ladapo wrote.

That piece published four days after DeSantis issued a series of restrictions via executive order curtailing activities at bars, restaurants and gyms.

Last summer, Ladapo was featured in a viral video where he and a group of other physicians appeared on the steps of the U.S. Supreme Court to promote various COVID-19 talking points, including the benefits of hydroxychloroquine as a treatment. Although the group named itself “America’s Frontline Doctors” and spoke about the mental health dangers associated with lockdowns, none of the physicians had practices “that would place them on the actual front lines of the COVID-19 pandemic,” reported MedPage Today, an online medical news service.

Ladapo researches the cost-effectiveness of diagnostic technology and ways to fight cardiovascular disease, according to his UCLA resume. Although Ladapo wrote two different columns saying that he has experience treating COVID-19 patients, MedPage Today said UCLA Health and Ladapo did not confirm that he had. The Herald/Times reached out to the governor’s office and UCLA Health, but did not immediately hear back.

Ladapo has continued writing as the pandemic — and the politics surrounding it — have evolved. In recent months, his words have closely aligned with the public pronouncements of Florida’s governor. Like DeSantis, Ladapo has expressed doubts about the efficacy of mask mandates — which he made clear with an emergency rule Wednesday affirming the state’s ban on mask mandates in schools. He’s called for an aggressive expansion of the availability of potential pharmaceutical treatments of the virus. And he’s criticized lockdowns as inhumane and ineffective.

Here are four of Ladapo’s most noteworthy COVID-19 takes.

Vaccine risk vs. benefit

1. “The risks of a COVID-19 vaccine may outweigh the benefits for certain low-risk populations, such as children, young adults and people who have recovered from COVID-19.”

Ladapo and a co-author, Yale epidemiologist Harvey A. Risch, wrote those words in a June 22 Wall Street Journal column titled, “Are COVID Vaccines Riskier Than Advertised?” To reach that conclusion, the authors analyzed negative outcomes from the federal Vaccine Adverse Event Reporting System.

The authors noted that “VAERS” doesn’t determine whether a given negative reaction was caused by a vaccine; the system only tracks bad outcomes that happen soon after a jab. The system’s reports are unverified, and anyone can file one. Still, Ladapo and Risch noted that, for example, the government had detected 321 cases of myocarditis — heart inflammation — within five days of vaccination, compared to zero a week and a half out from vaccination.

“The large clustering of certain adverse events immediately after vaccination is concerning, and the silence around these potential signals of harm reflects the politics surrounding COVID-19 vaccines,” the authors wrote.

Yet the government was not silent on the myocarditis risk. According to a webpage accessed via the internet archive, the Centers for Disease Control and Prevention had posted information about myocarditis the week before the experts’ column published.

“The known and potential benefits of COVID-19 vaccination outweigh the known and potential risks, including the possible risk of myocarditis or pericarditis,” the agency wrote.

If it’s not 100% effective, what’s the point?

2. “Vaccine mandates can’t end the spread of the virus as effectiveness declines and new variants emerge. So how can they be a sensible policy?”

Ladapo is no fan of vaccine mandates. In a piece from last week titled “Vaccine Mandates Can’t Stop COVID’s Spread,” Ladapo argues that empirical evidence has shown how vaccine mandates are not capable of stopping the spread of the disease.

DeSantis often makes this same point. To illustrate the shortcomings of a vaccine-only approach, the governor points to Israel, which has seen 64% of its population fully inoculated against the disease. That country also allows vaccine mandates: Businesses can ask customers for proof of vaccination or recovery from COVID-19 to enter some indoor spaces. Despite these efforts, Israel has just seen its worst case spike of the pandemic.

However, according to Johns Hopkins University data, that spike has not yet proven to be as deadly as past jumps. The reason for that could be a point that Ladapo acknowledged in his piece: Vaccines are incredibly effective at preventing death and serious illness from the coronavirus.

Vaccines are not 100% effective at preventing a vaccinated person from spreading the disease. That’s why the Centers for Disease Control and Prevention has recommended that vaccinated people continue to wear masks in crowded indoor areas. However, vaccines are overwhelmingly effective at preventing the worst outcomes from COVID-19. That’s why medical groups such as the American Medical Association, American Nurses Association, American Academy of Pediatrics, Association of American Medical Colleges and National Association for Home Care and Hospice have called for vaccine mandates at healthcare facilities.

Contract COVID, get immunity

3. “People who have recovered from COVID-19 appear to have the most protection of all.”

This statement by Ladapo came from the same column where he questioned vaccine mandates. It’s noteworthy not because it is controversial on its face but because the new surgeon general signed a document last year called the “Great Barrington Declaration.”

The declaration was crafted in October 2020 by medical experts who believed that herd immunity could be reached by allowing the less vulnerable people to be infected, while at the same time shielding the most vulnerable from the virus.

“The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection,” the document reads.

The idea was panned by some leading health authorities. The leader of the World Health Organization, Tedros Adhanom Ghebreyesus, called it “unethical” and “not an option.” The virus came with too many unknowns to allow it to spread unchecked, Tedros said, noting that plenty of younger patients have died from it. (In Florida, nearly 3,200 people younger than 50 had succumbed to the virus as of last week.)

“Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic,” Tedros said, according to The Guardian.

On Tuesday, Ladapo acknowledged that he signed the document, although he added that he did not agree with all of its provisions.

Home remedies

4. “Treating high-risk patients with COVID-19 at home using safe medications is the most promising public-health strategy for preventing hospital overcrowding and death.”

Throughout the pandemic, Ladapo has perhaps emphasized home remedies the most. As early as a November Wall Street Journal column, “Too Much Caution Is Killing COVID Patients,” Ladapo hailed ivermectin as a COVID-19 treatment. The misuse of that anti-parasitic medication led to a spike in calls to Florida poison control centers last month. He’s also argued for hydroxychloroquine, a medication touted by both DeSantis and former President Donald Trump, as a treatment.

Others in the medical community are not as enthusiastic about hydroxychloroquine. An analysis of 28 clinical trials on the effectiveness of the medication published in Nature in April found that “treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine.”

Ivermectin has become even more controversial in recent weeks, as some COVID-positive patients have turned to unhealthy doses meant for farm animals. The Centers for Disease Control and Prevention has warned against off-label use of the medication, which has been used safely by humans for decades.

Some studies have hinted at potential benefits from using ivermectin as a COVID-19 treatment. An analysis of 15 clinical trials in the American Journal of Therapeutics found that “large reductions in COVID-19 deaths are possible using ivermectin.”

But according to Nature, that stark finding could be attributed to that journal including a study in its analysis that was later shown to have been potentially fabricated in part. Other scientists, like Dr. Asim Tarabar, an assistant professor of emergency medicine at the Yale School of Medicine, have said ivermectin’s potential as a COVID-19 treatment is, as of yet, unproven.