By Steve Berkowitz
I’m sure by now, you have heard many times the latest buzz phrase “Follow the science” from our politicians.
Dr. Tony Fauci recently said, “Science is truth, and as a scientist, I hold the truth”. Interesting sound bite, but it begs a deeper dive. What is “science”, what is the difference between science and opinion, and what is the role of the subject matter expert during this crisis?
The scientific method is a time-honored and reliable process. It involves observation, proposing a hypothesis, testing that hypothesis through experimentation and research, and then drawing a conclusion based upon that data. The whole process is then vetted and peer-reviewed. Only then does the conclusion merit the status of truth.
Of course, real life and the COVID pandemic are much more complex than any lab experiment, but the fundamentals of that time-tested methodology still apply.
So, if we want to “follow the science”, we must clearly differentiate, what is a known truth versus what are interpretations or opinions regarding that truth.
Scientific facts or principles, such as E=mc2 have passed the tests of time. But opinions by their very nature are subjective and prone to interpretation, conflation, ulterior motives, bias, and can sway with the existing political climate.
Therefore, an opinion, regardless of the credentials of the “expert” behind that opinion, may not rise to the same level of truth as the scientific observations behind it. The science does not necessarily move in a straight line. There are a lot of gray zones. Opinions will change as the data changes, as we have definitely seen from the vacillating recommendations of our experts. Relying on the latest opinions may be akin to watching the stock market go up and down every five minutes.
The problem with consensus: To complicate matters, opinions are often justified through consensus. As social beings, we strive for consensus in our decisions. But there is a conundrum with consensus. Scientific truth is objective and results from the application of the above scientific method. Consensus is subjective, and is the result of a political or social process– “the majority wins”. Truth is not determined by a popularity contest. It was the unanimous consensus of queen Isabella’s court in 1492 that the earth was flat. Consensus, yes. Truth, no. Going from truth to opinion can lead to problems as different people can and will reach different conclusions given the same data based upon their own experiences or biases.
Lawyers deal with this every day. During a trial, for instance, a given set of facts are presented to the jury for their consideration. Each side typically produces their “expert”, who will take those facts and proceed to give their opinion. The trial becomes a spectacle of dueling experts. The experts on each side will take those same facts and advocate opposite conclusions. Which expert is right? The jury then debates which of the expert opinions are the most applicable or credible, and a conclusion is reached based upon their consensus. The facts remain the same, but the conclusions can be very different. Truth should be inviolate. Consensus can be arbitrary and easy to influence.
This begs the question of what is “truth”.
Neil DeGrasse Tyson described three kinds of truth:
1. Objective truth- It is true whether you believe it or not. It’s based upon the scientific method and should be a universal truth that is constant. Examples are F=ma in physics or the laws of thermodynamics which apply throughout the universe.
2. Personal truth- These are beliefs held dearly and are very deeply ingrained within the individual. An example is the belief in God. People who hold that belief will insist on its truth, end of discussion.
3. Political truth- Something becomes true because it’s been incessantly repeated enough to become be perceived as truth. Tell a lie often enough, and it becomes truth.
In the age of COVID, the public is so desperate for facts, opinions can quickly be regarded as fact. The three types of truth, objective, personal and political, can become completely entangled with each other.
The conflating of science with politics: Perhaps some of you saw Dr. Fauci getting grilled by Ohio Representative Jim Jordan who asked Dr. Fauci whether participating in public demonstrations could put people at risk for COVID. If a statute can require that a church congregation size should be limited, for example, shouldn’t it apply to any group, such as a public demonstration. After all, one thing is for sure. The virus is an equal opportunity infector. Fauci did not give a straight response to Mr. Jordan’s persistent questioning, resulting in our medical expert now being perceived as a political expedient.
I believe he missed an opportunity to truly advise us. The virus doesn’t give you a break if you go to a demonstration, nor does it give you a break if you go to a funeral. As our medical expert, he should have emphatically stated that ANY public gathering can increase the risk of transmission. However, he was absolutely correct in not recommending a particular statute. The legislators should be the ones making the laws, not the subject matter expert. But the absence of an opinion is an opinion.
Back to the four COVID dimensions– medical, economic, political and social: As we discussed earlier regarding the current COVID crisis, these four dimensions make the management of this pandemic especially challenging.
The “truth” can be influenced by all four.
Are scientific facts only used when convenient or expedient? Do we selectively only believe the facts that promote a particular non-scientific agenda?
Scientifically driven conclusions are factual whether one chooses to believe them or not.
For example, is wearing a mask a scientific truth or a political imperative or an individual rights infringement? Science, politics and social implications become completely immersed and subject to the ultimate motives of the politician.
Confusion generated by non-experts- ultracrepidarianism: That’s a word you can use to impress your friends. It means giving advice or opinions outside of one’s base of knowledge. Do we really need to hear one more celebrity or athlete opine on social media? They may be superstars in their fields, but what do they know about COVID? Who even cares what they think? “Expert” opinion is on shaky enough ground, we do not need another baseless, extraneous opinion that is published just because someone is famous. Being well known does not make one an expert. Down with ultracrepidarianism!
The ultimate decisions made by our President and elected officials are indeed challenging:
A successful leader relies on the subject matter expert in any given area, but the subject matter expert is rarely the ultimate decision maker. Given the four dimensions, is even more complex. There is no pure medical solution. There is no pure economic solution. There is no pure social solution, and there is no pure political solution. Any effort in one dimension will affect all four. And it will get horrendously spun in an election year.
Bottom line, the leader must take all qualified opinions into consideration, and ultimately make the best decision to best improve the overall outcome.
The subject matter expert weighs in. The leader decides.
It starts by clearly discerning what is fact and what is opinion. Once the expert ventures beyond the scientific facts, that expert now enters the twilight zone of conjecture, regardless of the credentials of the so-called expert. That person has gone from science to speculation.
Remember the old TV show Dragnet? Inspector Joe Friday said many times, “Just the facts”. I hope our President and our elected officials can develop the appropriate discernment between truth and opinion. If we pledge to follow the science, let’s follow the science. Opinions and recommendations, even from the subject matter experts, are still opinions, and not necessarily science.
We need this discernment in order to truly combat the COVID virus. We need it badly!
Planning your virtual event? Get in touch with us at the Capitol City Speakers Bureau today to book your healthcare speaker!
“Flatten the Curve”. We hear it every day. What does it really mean for the average person?
Let’s start by looking at the fundamental two-phased approach for any epidemic or outbreak:
1. Containment- There are two components of containment: secure the perimeter of the infection to prevent any future spread outside of that region, and then eradicate the cases within that region, resulting in eliminating the threat. If there has already been spread that cannot be contained, one must move on to the next step-
2. Mitigation- Limit the spread and reduce the burden of disease. Basic mitigation measures include:
a. Sheltering in place/ quarantine
b. Social distancing
c. Wearing masks, personal protective equipment (PPEs)
d. Frequent hand washing
e. Not touching the face or eyes
f. Isolating and protecting the vulnerable, high risk population
g. Isolating new or possible infections by staying home if one has symptoms or has been exposed
If these mitigation efforts are successful, the new infection rate should be reduced and the overall curve of the infection should be blunted or “flattened”. Hence the term.
In March, the President made the unprecedented move to shut down the economy and impose travel restrictions to and from the affected areas. During this time, it became rapidly clear that the actual spread of COVID was worse than previously thought. Pure containment was not possible, and efforts had to be directed toward mitigation.
As we began to quarantine and shelter in place, we heard the expression “flattening the curve” from our elected officials and medical advisors to the point of now becoming a mantra.
It is important to note that flattening the curve does NOT change the total number of cases that might develop over time (the total area under that curve). It just spreads those cases out over a longer period of time. Successful flattening of the curve will therefore result in reducing the number of active infections at any given point in time. To the negative, by reducing the number of cases at any point in time, it will also prolong and delay the time required to achieve “herd immunity”.
There are three critical reasons to “flatten the curve”. We must decrease the number of active cases at any point in time in order to:
1. Not overwhelm the health care delivery system in terms of hospital beds, medications, ventilators, other supplies and very importantly, health care personnel.
2. Maintain an adequate core healthy work force so that the economic infrastructure can still function.
3. Defer the onset of infection in as many individuals as possible, especially those at high risk, into the future where hopefully “good things” will happen, which will then result in decreased total morbidity and mortality.
The “good things” list that would actually reduce total case morbidity and mortality includes:
1. Natural attenuation of the virus- spontaneous, seasonal or otherwise, it goes away
2. Effective medications for prophylaxis or treatment
3. Immunity is developed either through an effective vaccine or population “herd immunity”
Until one or more of these occur, we must dutifully continue all mitigation measures.
Although to date, none have reached fruition, we have seen some optimistic signs. There is evidence that the virus is intrinsically less deadly than it was earlier in the year. We are protecting the vulnerable so that the average age of infection has decreased, which has reduced morbidity and mortality. Certain medications such as remdesvir and dexamethasone have shown a promise to reduce hospitalizations and mortality with other drugs in the pipeline. Several companies seem to be progressing well on the accelerated development of a vaccine, with availability potentially by the end of the year.
Ultimately, the goal is to achieve a mass immunity in the population, often referred to as “herd immunity”. “Herd immunity” exists when enough of the population has been infected and has become immune so that the virus no can no longer replicate within the population, resulting in the virus either becoming dormant, endemic, or even disappearing. Typically, “herd immunity” requires 60-70% of the population to be exposed and develop antibodies to that virus. Optimistically, one study suggests that COVID immunity could be achieved with as little as 20% infected. We simply do not know the number, except that it is much larger than the present number of people infected. We are just beginning the road to immunity.
The problem with just letting a population spontaneously go toward this herd immunity, like the approach in Sweden, is that in order to get to that point, 60-70% of the population has to suffer the disease.
Until some of the “good things” happen, “herd immunity” is a long way down the road, hopefully months, but perhaps years away.
So, here’s what we know for now:
Mitigation efforts will have to continue indefinitely until those “good things” happen.
The economy must continue to rebound and move forward
We now come back to the four dimensions of decision-making: medical, economic, political, social.
We need to find the sweet spot that balances the need for the virus mitigation with the imperative to sustain and grow the economy. We will need to manage the political and social consequences of this balance as well, especially as the election draws near, and issues will become further politicized.
There has been a great deal of talk about the economy having opened too soon, especially in response to the rapid rise in new cases over the past month. Given the proximity of the elections, opening too soon has become a political hot potato. Medical/economics/politics/social dimensions are at odds with each other as politicians battle back and forth while Americans continue to succumb to this virus.
A more productive way to resolve this discussion of opening too soon is to say that the issue is not necessarily opening too soon per se, but rather, once the society was opened, many thought we returned to pre-pandemic times with “business as usual” prevailing. Part of the responsibility in this resurgence lies in the fact we all dropped our guard a bit after the frustrations of the initial lock down. And the virus fought back mercilessly.
Similarly, masking has devolved from a medical issue into a social/political issue. Should masks be mandated? Where is the balance between public health and individual rights? Who is protecting the public?
As are now in the complicated process of managing this new resurgence of COVID. Here are some thoughts to keep in mind:
1. Mitigation efforts need to proceed with even more urgency as the overall prevalence of COVID in the general population has increased due to this recent surge in cases. Social distancing and wearing a mask are more important now than ever, as the chance of randomly encountering a patient with COVID is higher given the greater prevalence of the disease.
2. There is some reason for optimism on the “good things” list, but until then, we must continue the course of strict mitigation methods. There is a light at the end of the tunnel, but we are still in the beginnings of this ordeal.
3. We must take all efforts to minimize crowds. The virus is an equal-opportunity infector and loves to be in high concentrations of people. The virus does not care if the crowd is demonstrating, worshiping, watching a sports event, being educated or simply riding a crowded bus. If these encounters must occur, major mitigation efforts as described above are a must. Whether mandated or voluntary, it is a public responsibility for which every American must step up to the plate.
4. Even though we are daily tantalized by potential vaccines in record time, we need to take a long-term approach to our present efforts. Everyone wants this to be an old memory, but until then, we all must work together to achieve the goal of eradicating this virus.
Medical, economic, political, social differences and implications—We must stand together.
Planning your virtual event? Get in touch with us at the Capitol City Speakers Bureau today to book your healthcare speaker!