Discussion about COVID-19 policy rarely seems to go very far before the word “Science” is invoked reverentially.  By implication, further discussion is no longer warranted.

Yet, science is in a constant state of flux. Today’s “settled science” can be reversed tomorrow once new data becomes available.  New data tests old theories and previously “settled” conclusions replaced.

That science is in this state of flux is a “feature,” not a “bug.”

Especially when combatting a novel disease such as COVID-19, a variety of hypotheses need to be first proposed and then tested.  Without such a dynamic response, we would be poorly equipped to respond to the challenge.

The evolving guidance on masks illustrates changing “Science.”  The U.S. Surgeon General Dr. Jerome Adams tweeted at the end of February that masks offered no benefit to the average citizen. [i] The Centers for Disease Control and Prevention (CDC) later recommended that Americans wear “cloth face coverings fashioned from household items or made at home from common materials … as an additional, voluntary public health measure.” [ii]  More specifically, public health officials decided that masks help combat the threat from “asymptomatic spreaders.”

The Center for Scientific Integrity has maintained a website called the Retraction Watch.[iii]  It tracks the long list of papers, that after publication, have been withdrawn or retracted. COVID inquiry has resulted in its own list. The rapid-fire process for proposing new ideas, testing, and then either discarding or adopting them does credit to the scientific community.  By publicly sharing working hypotheses, the investigative process is speeded.   

Hydroxychloroquine’s consideration has morphed into a referendum on President Trump personally. Apparent side effects offset initial encouraging studies about its treatment effectiveness.    

Other coronavirus treatments show considerable progress, though. The grim death rates experienced in New York in April have ended.  Those with new cases are far more likely to experience a full recovery. For example, dexamethasone, a readily available steroid, has been a very effective treatment.[iv]  (One can only guess what the response would have been if the President tweeted about it. Would blue state America have rejected it?)

Public health policy does not address the prevention of individual tragedies.  Success, instead, reflects more general society-wide results.  Last year 8.8 million Americans died. This year’s total will reflect the 183,000 COVID deaths to date. 

More subtly, public health policy often involves trade-offs.  Indeed, the focus on a single problem or factor can have negative consequences.  For example, the COVID “lock-down” has caused many to forgo cancer and other health screenings.  As a result, otherwise, treatable diseases will result in more dire consequences.

The FDA’s benchmark for the effectiveness of a COVID vaccine is 50%, the same standard as used for flu vaccines.[v]   According to the CDC, seasonal flu vaccines’ efficacy has ranged from 19% to 60% since 2010.[vi]  To be clear, then, these vaccines do not eliminate a disease’s threat.   Instead, the flu vaccine reduces the risk of contracting it by 40 to 60%.[vii]

All of which serves as a prelude to the question uppermost in people’s minds – Is it safe to go outside yet?

Public health scientists are unlikely to deliver a definitive “all clear” anytime soon, as was done on May 8, 1980, for smallpox. (And for smallpox, a vaccine had already existed for 200 years.)

Instead, informed choices for relative health risks must be made. Factors for consideration include the possible consequences from COVID for specific populations.  For example, we now understand that the school-age face far lower risks compared with those with a variety of chronic diseases. 

Maintaining a continuing “all or nothing,” complete lock-down until everyone is no longer at risk is not recommended.  It is an approach that could lead to a shutdown measured not just in weeks or months, but for considerably longer.

That Americans, as individuals, have a broad range of personal tolerance to risk is also a “feature” and not a “bug” of our country.  As the national election unfolds, a conversation about the “reopen” decision is worth having.  In fact, it must be a central part of the coming campaign.

[i] https://twitter.com/Surgeon_General/status/1233725785283932160?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1233725785283932160&ref_url=https%3A%2F%2Fwww.inquirer.com%2Fhealth%2Fcoronavirus%2Fface-masks-hand-washing-coronavirus-protection-20200304.html

[ii] https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fcloth-face-cover.html

[iii] https://retractionwatch.com/   ; https://retractionwatch.com/retracted-coronavirus-covid-19-papers/

[iv] https://www.nature.com/articles/d41586-020-01824-5

[v] https://www.wsj.com/articles/fda-to-issue-guidance-on-covid-19-vaccine-approval-11593516090?mod=hp_lead_pos3

[vi] https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm

[vii] https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm