The Scientific Controversies Around COVID-19

Like much else in life these days, the medical science surrounding the coronavirus pandemic has been controversial and disputed.

COVID-19 is caused by severe acute respiratory syndrome (SARS-CoV-2), a highly contagious virus that has infected almost 110 million people worldwide in some 220 countries.

The good news is that while the infection rate is high, the death rate is relatively low compared to other past untreated epidemics like smallpox, plague, malaria, tuberculosis, cholera and Ebola.

However, several factors from the start have led to an unusual amount of polarization surrounding this disease, including China’s lack of transparency regarding the origin and nature of the virus, which was first detected in Wuhan. We still don’t know if the zoonotic virus jumped from animals to humans or was a biodisease that escaped the Wuhan Institute of Virology, as claimed by scientist Dr. Li-Meng Yan and disputed by the World Health Organization.

It’s true that we wish to follow “good” science. But when it comes to COVID-19, we don’t seem to have a shared understanding of what “good” science is. Here are a few areas of controversy and disagreement.

Uneven Advice

Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization and public health expert, got the fight against COVID-19 off to a poor start. In the critical early weeks of the virus’s spread, Tedros promoted Chinese propaganda, advising a complacent world that there was not human transmission outside of China. He also opposed travel bans.

Dr. Ezekiel Emanuel, an oncologist who advocated for the Obama administration’s Affordable Care Act and has advised President Joe Biden, suggested in 2014 that he would reject curative medical care as a 75-year-old, a statement that may disturb the elderly today who are the most vulnerable to COVID-19.

And Dr. Anthony Fauci, longtime director of the National Institute of Allergy and Infectious Diseases, initially provided admittedly conflicting advice on the use of masks, quarantining and the methods of viral transmission.

Although these doctors have received much media attention, they have generally avoided severe critique. This was not the case for Dr. Scott Atlas, a Stanford neuroradiologist, analyst of government health policy and former special coronavirus adviser to President Trump, who was critiqued for arguing that those under the age of 65 rarely die from COVID-19 and that children rarely exhibit serious illness and should return to school. He also suggested that Americans re-enter the workforce to avoid the quarantine-related development of rising mental illness, substance abuse and child abuse from lost jobs.

Many of these policies were crafted before officials fully understood the virus and its transmission. But the fact remains that pandemics are nothing new, and the consequences for learning on the fly are significant. History and hindsight will be better judges of our performance.

Pandemics are nothing new, and the consequences for learning on the fly are significant.

Disputed cause of death

The Centers for Disease Control and Prevention, along with the COVID Tracking Project and Johns Hopkins University, gathers data on deaths from state-generated reports. Most rely on death certificates, which list the cause of death and, often, other contributing factors.

The key question is which mortalities are actually a result of COVID-19: who died with COVID-19 and who died due to COVID-19. Pre-and-post mortem classification of cases varies among local hospitals and coroners.

Dr. Susan Bailey, the president of the American Medical Association, addressed the debate on under-counting vs. over-counting pandemic deaths, asserting, “The suggestion that doctors — in the midst of a public health crisis — are overcounting COVID-19 patients or lying to line their pockets is a malicious, outrageous and completely misguided charge.”

It is true that hospitals are paid the same for COVID-19 treatment as for any other care, although the more serious the problem, the more hospitals are paid. So, treating a ventilator patient does result in a higher payment to a hospital. However, Medicare, the government health program for the elderly and disabled, pays 20% on top of its ordinary reimbursement for COVID-19 patients — a result of the CARES Act, the federal stimulus bill that passed in spring 2020.

Social distancing 

The World Health Organization has called for the separation of people by at least one meter (just over three feet). The Centers for Disease Control and Prevention has recommended six feet.

When you cough or sneeze, or even sing or speak, droplets are released and quickly fall within a few feet due to gravity. But smaller aerosols may float in the air for fairly long distances and remain there for longer periods of time. Some scientists have warned that aerosols can travel up to some 27 feet. Definitive studies of living patients for viral transmission have encountered ethical challenges due to the lethality of the virus.

This lack of clarity on appropriate social distancing has resulted in confusion about school and business closures and the safety of shopping, religious services, athletic events and even walking around the neighborhood. It is sobering to note the studies that indicate that many COVID-19 infections result from in-home exposure to infected friends and family. 

Mask wearing 

Surgeons wear properly fitted and specialized medical masks to protect patients. And health experts claim that masks are a key factor, along with social distancing and hand washing, in reducing viral community spread. In fact, the CDC recently announced that wearing two masks or a tightly-fitted mask can reduce transmission of COVID-19 by 96.4%. As recommended and often mandated at work and in public, mask-wearing by the American public has generally been highly observed.

But how much a thin or poorly fitting mask alters its efficacy is still being researched. Pathogenic microbes are very small and can enter through or around the side of masks. Furthermore, mask-wearing may provide a false sense of security and even have its own potential health risks, such as touching the face with contaminated hands.

Contact tracing

The emergent epidemic of COVID-19 inspired a new generation of digital systems to identify, track and monitor the movement of individuals by government authorities. There are almost four billion smartphones around the globe, and apps that track our movements risk expanded surveillance, lockdowns and a potential violation of individual rights.

There are reports that in Syria, the government has disguised malware as a contact-tracing app. Several countries in Africa have been accused of brutal lockdowns. In Israel, citizens have complained about the involvement of the Shin Bet security service in case tracing. In Australia, authorities have promised that health data collected after the pandemic won’t be retained.

After the initial lockdowns, Chile was considering — and rejected — a “release certificate” identifying those who have been infected and recovered. South Korea tested electronic trackers on individuals violating quarantine, and Germany promoted a smartphone-based tracker.

Closures and economic costs   

In the spring of 2020, the Trump administration desired that public schools re-open by the fall. It is now a year later, and the Biden administration has disappointed many by announcing it hopes to have more than 50% of American schools open for teaching “at least one day a week” by April 30, 2021.

The costs to children from school closures are incalculable, ranging from learning loss and socialization effects to mental illness. Families have been impacted, and parents have struggled.

Schools are not the only institutions to have suffered from closures. While the stock market has soared as large public companies have reaped the benefits of reduced competition, soaring numbers of small businesses and individuals face bankruptcy from COVID-19 related closures.

Federal relief spending during the crisis has pushed the already-rising national debt toward $30 trillion. Our debt-to-GDP ratio has now risen well past 100%, which some economists assert risks severe future economic slowdown and inflation.

Debates Over Treatments

One debate over treatment focused on the virological cure effects of hydroxychloroquine (with Zinc), especially in combination with the antibiotic azithromycin. In June 2020, The FDA withdrew authorized emergency use of hydroxychloroquine as unlikely to be effective and a heart risk. When physicians representing a group called “America’s Frontline Doctors” touted HCQ on the front steps of the U.S. Capitol in July 2020, they were met with fierce denunciation from public health officials arguing that personal observations have not been matched by scientific studies.

The FDA has approved the antiviral drug Remdesivir, and some doctors are also using anti-inflammatory corticosteroids like dexamethasone to treat COVID-19 pneumonia. The FDA has issued and updated emergency use authorization of an immune-based therapy called convalescent plasma for hospitalized COVID-19 patients.

Fortunately, the rapid development of several vaccines, with more to come, offers hope for an ailing world. Monitoring of any adverse events is advised by former New York Times reporter Alex Berenson, author of “Unreported Truths About COVID-19 and Lockdown,” who has clarified that the mRNA vaccine differs from the vaccines we have used in the past. Other public health experts claim that mRNA vaccines have been used in studies for decades and have been tweaked for COVID-19.

Clinical trials have strongly indicated vaccines may reduce the risk of infection. We await studies on the efficacy of the vaccine for the most vulnerable populations, who were not a statistically significant part of the vaccine development testing protocols. It also remains to be seen for how long one may be immune once vaccinated and how well vaccines will protect against the spread of recent variants of the coronavirus from the United Kingdom, South Africa, and Brazil.

A year into this pandemic, it is startling how much confusion remains about the elusive virus. The science, it seems, is not at all yet settled.

Larry Greenfield is a Fellow of The Claremont Institute for the Study of Statesmanship & Political Philosophy.