Fear is a protective response but it can also breed irrationality and therefore become counterproductive. Fear is also a blunt evolutionary tool that does not work well in complex situations that require nuance and calculation. We are seeing this play out in many forms throughout the world in the face of the COVID-19 pandemic.
The pandemic has brought into focus the very thing we discuss the most at SBM – the relationship between scientific evidence and delivering the best medical possible care. The cooler, more professional heads have been saying from the beginning – there is good reason for concern, but not panic. Let’s take steps that are evidence-based and prudent based on our best predictions about what is likely to happen, but there is no need to lose our heads. The actual response around the world has been variable. We are seeing pretty much every possible response and outcome. As is often the case with any time of instability and fear, pseudoscience oozes out of the gutter to exploit the situation, or perhaps out of sincere but misplaced hope.
The biggest pseudoscience is the denial of epidemiology itself, and by extension of experts and the very notion of expertise. One form this took (and still does) was a denial of the pandemic or its seriousness. One common tactic of denial was to falsely compare COVID-19 to the flu. This is not the flu. The mortality rate, while still unknown, is at least two orders of magnitude greater than the flu and perhaps more. The 2018-2019 season flu caused 35.5 million cases and 34,000 deaths in the US, with a mortality rate of around 0.01%. Currently COVID-19 in the US has caused 374,329 cases and 12,064 deaths. The mortality rate of COVID-19 is hard to say, because those are not all completed cases.
If you look at all completed cases worldwide the mortality rate is currently 21%. But this is unlikely to be accurate, partly because there are many cases unreported and many people who are asymptomatic or minimally symptomatic who are not being counted. At the same time, early reporting in NYC shows an increase in deaths at home (not tested and therefore not counted) which would mean the number of deaths from COVID-19 may be underestimated by as much as 40%. So the mortality rate is somewhere between 2 and 3 orders of magnitude greater than the flu, and this is a very contagious disease. By now everyone should know the goal of physical distancing is to flatten the curve, to limit the pulse of cases that threaten to overwhelm our hospitals and ICUs (which is already happening in places like NYC).
At the other end of the spectrum are those offering false or premature treatments for COVID-19. We have already discussed TCM, chiropractic, and false naturopathic claims. These are pure pseudosciences exploiting the crisis. But also there are semi-legitimate potential treatments that are simply untested or not adequately tested, most famously hydroxychloroquine which David has discussed twice now. This is an already-approved drug with potential serious side effects and very preliminary and contradictory early testing.
This is also a great case to illustrate exactly why we recommend a science-based approach. The probability that hydroxychloroquine will turn out to be an effective treatment for COVID-19 is not zero as there is some encouraging pre-clinical data. But the probability, based just on pre-clinical data, is extremely low. Most treatments that look encouraging don’t pan out, for a variety of reasons. It is perhaps more likely that this drug will cause more deaths and harm from side effects and other unintended consequences (like depriving people who actually need the drug) than it will help with the pandemic. At this point all we can say is that rigorous clinical trials are needed. But this requires patience, and that is in short supply during a crisis.
There are also some other pure pseudosciences rearing their heads. I was waiting for homeopathy to make an appearance, and it has, in Cuba. The Cuban government is dispensing a homeopathic potion for primary prevention of COVID-19. The product is PrevengHo-Vir, which seems to have come into existence just recently, and is produced by a Cuban pharmaceutical company. Homeopathy is nothing but magic water, with effectively zero probability of working. Offering this as a preventive treatment for COVID-19 is malfeasance.
What this will accomplish is giving official backing to witchcraft, and also has the potential to create a false sense of security among those treated. Perhaps they will loosen their physical distancing because they believe they are protected. This is a well-documented backfire effect. The Cuban government, in turn, justifies their position by citing the inclusion by the World Health Organization of homeopathy in its list of recognized traditional treatments. This is exactly what we warned about at the time – giving false legitimacy to pseudoscience.
Meanwhile the FDA and FTC are trying to do their job by issuing strongly worded warning letters (yeah, I know) to 7 companies selling pseudoscience for COVID-19:
The FDA and FTC jointly issued warning letters to Vital Silver, Quinessence Aromatherapy Ltd., Xephyr, LLC doing business as N-Ergetics, GuruNanda, LLC, Vivify Holistic Clinic, Herbal Amy LLC, and The Jim Bakker Show. The products cited in these warning letters are teas, essential oils, tinctures and colloidal silver.
At the very least, I hope the pandemic serves to focus attention on the need for science and expertise and the risks of relying on snake-oil, hype, and magic. This is an opportunity to see all this play out in real time around the world, and we have the ability to gather the numbers and see the results. Also, the effects of the pandemic are fairly rapid – rapid enough that even non-experts can draw the line of causation. Rely on pseudoscience at your own peril.