This year, politicians, public health officials, journalists, and even our Facebook friends are urging us to listen to “the” data, trust “the” evidence, and follow “the” science with respect to COVID-19. Yet, each of these groups feel entitled to select which data, evidence, and science they elevate to the royal rank of “the” data, evidence, and science. A quick reflection or a look at an encyclopedia (online or otherwise!) will reveal that science is a never-ending process of asking questions, making observations, structuring ideas, hypothesizing explanations, conducting experiments, and drawing preliminary conclusions that inevitably raise more questions to be researched. In complex systems and processes such as infectious disease spread, the data and evidence resulting from the scientific method, and the underlying models and theories, may never be conclusive, and as such it is foolish and misleading to speak of “the” one science guiding us through the corona crisis.
At the time of writing, the November 2020 United States presidential election is less than 10 days away. The televised debates between the incumbent Donald Trump and main challenger Joe Biden was seen by many observers as a demonstration of a post-truth era, in which anyone can make any claims to scientific evidence, and facts be countered with “alternative facts” in the words of Trump’s former counsellor Kellyanne Conway. Extending the presidential face-off, a proxy debate is shaping up in the media between Trump’s newly appointed coronavirus advisor Dr. Scott Atlas and the director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci. In response to accusations of promoting falsehoods, Atlas has been referring explicitly to “the” (other) science, for example with respect to keeping schools open during the COVID-19 pandemic.
Fact is, there are good reasons to close schools, and better reasons yet to open them. As places of congregation of individuals from numerous families, it is logical to worry that schools could contribute to the spread of Sars-CoV-2 in a population. While the risk of serious disease from this virus has been known to be minimal for young ages, the concern was that children may infect more vulnerable persons among their teachers and family members at home. To my knowledge, recent studies like the Yale University research cited by the Wall Street Journal in Dr. Atlas’s tweet showed little risk for education or child care services to be sources of transmission. After reopening with strict testing protocols, there have been numerous positive Sars-CoV-2 tests among American college students, yet there were virtually no serious illness or deaths reported. Common sense thus suggests that letting the virus spread among healthy young individuals, as we have done every year before 2020, contributes to building herd immunity in a population.
With respect to acquiring immunity, some pundits doubt that a first infection with Sars-CoV-2 actually conveys immunity towards future infections. This seem silly to me – it’s just a coronavirus after all! However, like with all respiratory viruses we should expect Sars-CoV-2 to mutate, so future (re-)infections will be a matter of what the our tests will detect, or how (even, whether?) we want to monitor respiratory diseases as closely as in 2020 going forward.
Another ongoing example of the ever-changing science, 2020 edition, applies to protective masks and other face coverings. In an October 21st public TV talk show, moderator Markus Lanz could not believe his ears, when the president of the German Medical Association noted concerns with the effectiveness and side effects of wide-spread use of face masks (a statement recanted the following day under pressure from politicians and the media). In response, the moderator contrasted scientific evidence with personal opinion, and thereby ignored the essential step of an individual’s interpretation of evidence that may lead to diverging conclusions. When another show participant defended the principle of open discussion of a topic such as mask effectiveness, the Mr. Lanz argued that masks appeared to him as a topic that we should not be discussing any more as a society. The debate also touched on the point that evidence of effectiveness from lab-based studies may not directly translate to the everyday use of make-shift face coverings, which illustrates the vast range of possible conclusions that can be drawn from the same piece of scientific evidence.
The contentious issue of masks provides another example of science vs science. The story of the “Danish mask study” currently makes the rounds in alternative and some mainstream media, after investigators suggested that major medical journals are afraid of publishing their results, and the community suspects that it is because the results put the effectiveness of masks into question. The study with the full title “Reduction in COVID-19 Infection Using Surgical Facial Masks Outside the Healthcare System” is listed in the US National Library of Medicine’s clinical trial database (clinicaltrials.gov). In an extensive randomized trial, it examined COVID-19 outcomes in a group of healthy, working adults who wore face masks whenever they left their home, in comparison with a control group who also followed public health guidelines but did not wear masks where not required. At present, it is not clear whether the rejections from the Journal of the American Medical Association, Lancet, and New England Journal of Medicine were based on the normal peer review process and/or an editorial decision. But the suspicion alone that leading academic journals could reject important, timely research based on its controversial results is damaging to the very foundation of science.
We shall conclude today’s exposé with a look at a thought-provoking tweet from Ontario doctor and lockdown critic, Dr. Kulvinder Kaur Gill. As Sweden’s response to COVID-19, which avoided most lockdown measures and let residents continue to live a mostly normal life, has come under fire again as a “failed experiment”, Dr. Gill reminds us that the experiment is what was done in all other countries but not Sweden. Isolating the infected and the vulnerable was long-established public health practice at times of infectious disease epidemics. By contrast, restricting or locking down the healthy has never been tested in the history of humankind, and it is more and more clear that lockdowns generate much unanticipated side effects in the form of missed medical examinations and treatments, mental illness, poverty, and hunger around the globe.
As a specialist in decision support systems, I am pleased to see increasing public acknowledgements of science as a foundation for important societal decisions to be made. However, decision-makers and the public need to be aware of the process and limitations of science as well. Scientist have an important role to play here, in particular by remaining cautious and restrained with communicating their own findings and interpreting other research results. One might also wish for scientists to hold a good portion of common sense and take a broader perspective on the possible implications of “their” science.