Tuesday, May 26, 2020

The Science of Covid-19

We continually hear that we are supposed to follow the "science" when it comes to our response to Covid-19.

However, science is continually evolving.

Scientists also often disagree what the "science" is.

For example, consider that on this past Memorial Day weekend New York City allowed people to hang out on the beach but not go in the water.  California said that that you could go in the water but you could not hang out on the beach. Both say they are guided by the "science".

A group of scientists from Brazil recently wrote an open letter on the "science" of the Covid-19 pandemic. They make some wonderful points that more should take into account.

During this pandemic, the term “science” has been used “ad nauseam”, that is, has been repeated to exhaustion: “Science, science, science”, “I’m pro-science”, “For from the science, through the science and to the science I guide my decisions and acts” and “I am, therefore, fully right to do so”. It is clear that the intention here is to lead all of us to the idea of ​​decisions based on something unquestionable and infallible, as scientific as law, as the law of gravity.
But what kind of “science” is that to which they are appealing? And who, in the name of this “science”, would be allowed to speak? Science (I know that there are controversies, as scientists even debate on its meaning) is “the dispassionate search for the truth about the Universe and life”. But ironically, we seek truths that we don’t even know what those truths would be like, or where they would be found. For this reason, sometimes, ironically, even when scientists find a truth that is indeed true, yet they doubt that they have found it. We literally zigzag in the dark, searching for solutions to our problems.
Scientists are human beings, therefore, skeptics and enquirers who can and should speak for themselves, like all scientists have the right to do, but NEVER A SCIENTIST OR A GROUP OF THEM CAN DECLARE TO BE AUTHORIZED TO SPEAK IN THE NAME OF SCIENCE!

If anything, our experience with Covid-19 should have made all of this self-evident.

It seems as if we learn something new every day about the virus. Or we find out what we thought we knew, was wrong. All of this is expected when you are dealing with something that is novel and new like Covid-19.

However, what we should not expect to be told is that we must follow "the science" because someone decided that it is the "science" that supports their views while ignoring the "science" that doesn't support their views.

We see this clearly in views about the use of Hydroxychloriquine ("HCQ") which has become politicized ever since President Trump spoke favorably about it. Despite hundreds of positive examples of its use as a treatment for Covid-19 around the world there are those who want to to say it is not backed by "science". For example, here is an international poll of doctors done in April in which HCQ was deemed the "most effective" treatment for Covid-19. 

Is that science? No. However, it is just as true that we cannot yet say it is not backed by science. We are in period of discovery. We are in a period of doubt and what should be a period of debate in understanding the virology of Covid-19 as well as the best methods to treat it and mitigate its effects on the population.  

Quoting again from the Brazilian letter.

Richard Feynman put it this way: “Science is the culture of doubt”. And I would add, “science is the culture of debate, of divergence of opinions”.

Debate? Doubt? Divergence of opinions? Not in the world of science (and politics) we live in today.

All of this serves as useful context in evaluating the latest CDC pandemic planning scenarios that were released last week. These are designed to help inform the decisions of public heath officials and modelers to evaluate and recommend different community responses to the virus. You could say that it represents the best "science" that is known on the biological and epidemiological characteristics of Covid-19.

Different scenarios are presented by the CDC with Scenario 5 representing what is considered to be the current best estimate of viral transmission and disease severity in the United States of Covid-19.

That best current estimate is below.

The most significant change is that the CDC is now estimating that the Case Fatality Rate for Covid-19 in the United States is .4% overall.

For those age 0-49 it is one-eight of that---.05%.

The seasonal flu is generally believed to have an overall fatality rate of .1%.

Previous fatality estimates for Covid-19 were stated to be, at best, 1% of those infected. That would make Covid-19 ten times more deadly than the seasonal flu.

The CDC is now estimating a 1.3% fatality ratio for those age 65+ who end up with symptomatic cases.

However, according to CDC data, the seasonal flu of 2018/19 had a case mortality rate of .8% for the same age group. That would make it about 50% more deadly for the elderly than the seasonal flu. However, that is a long way from 10 times as deadly.

Those age 65+ are always more vulnerable to respiratory illnesses. The CDC data from the 2018/19 flu season shows that those in this age group made up only 9% of all cases in that flu season but accounted for 75% of all deaths.

Source: https://www.cdc.gov/flu/about/burden/2018-2019.html

We are seeing a similar pattern with Covid-19 with deaths of those age 65+ comprising 81% of deaths according to the most recent CDC data.

This chart from Business Insider using data from about the same time as the lockdowns began (March 18) provides some perspective on what the best estimates of mortality were at that time.

Viewing "the science" at that time it is hard to argue that the social distancing and economic lockdowns were not prudent decisions. I made that point at the time in these pages.

However, since that time I have continued to follow the facts and the data in making judgments about what our responses to Covid-19 should be.

I may alter my views more as additional evidence and information becomes available.

In the end, as the scientists in Brazil stated so well, isn't that what science requires?

Why then do so many take something with so many questions surrounding it and question why anyone would question our response to Covid-19?

As the latest CDC pandemic planning scenarios show, there is nothing settled about the science of Covid-19.

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