In response to the novel coronavirus pandemic, there have been repeated calls to “trust the science.” The first definition in the Merriam-Webster dictionary for the word “science” is “the state of knowing,” while the third definition is “knowledge or a system of knowledge covering general truths or the operation of general laws especially as obtained and tested through scientific method.” Science is not about trust, but instead about knowledge, as obtained through observation and experimentation.
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Prior to 2019, nothing was known about the SARS-CoV-2 virus, although there was general knowledge of virology. Thus, while science is “the state of knowing,” with regards to the particularities of this virus, the world’s researchers have until the past year been in a state of ignorance. Using the information at their disposal, different governments have taken differing scientific approaches to addressing COVID-19.
Over time, scientific evidence accumulates, and the quality of the evidence available often improves. For instance, when the United States Preventive Services Task Force (USPSTF) makes recommendations, it notes that there can be low, moderate or high certainty regarding the net benefit. While interventions with low certainty of net benefit may be beneficial, such interventions nonetheless are only supported by a limited number of studies, studies with methodological flaws or studies that are not generalizable.
Likewise, there may be inconsistency in findings across the literature. Different professional societies may likewise review the same evidence and offer different, but equally valid, recommendations due to differences in priorities as well as their interpretations of the evidence.
Unsurprisingly, the evidence supporting COVID-19-related interventions has evolved over the course of 2020, and public policy has changed as well. While early public policy efforts included closing large outdoor spaces, such as national and state parks, as the dangers of respiratory spread became better understood, the emphasis instead became on encouraging people to spend time outdoors when possible. The US surgeon general switched from telling people not to wear masks to providing instructions on how people could make their own.
Science itself has reversed course several times during the pandemic as well. There has been a rush to develop scientific evidence, and in many cases, a reliance on findings that have yet to have undergone peer review. Preprint servers have enabled scientists to distribute their work at a rapid pace, but have also removed the safeguards offered by the traditional publication process. That said, even the integrity of peer review has been called into question, with The Lancet and the New England Journal of Medicine both retracting studies regarding the treatment of COVID-19.
As the article retractions demonstrate, science is not about trust, but about a process of inquiry in which even published findings may be questioned. The very novelty of the SARS-CoV-2 virus should lead us to expect there to be changes in our collective knowledge of it over time. Nonetheless, diagnostic, treatment and public policy decisions must be made based upon the information available. As inaction is a decision in itself, leaders must consciously use the evidence available to provide direction.
Proceed With Uncertainty
To proceed in a time of uncertainty, it is essential to move from blindly following scientific findings of varying quality to actively weighing them. Following an approach similar to the United States Preventive Services Task Force, recommendations that are made should consider the quality of the scientific information on which they are based, with the understanding that the evidence may be of uneven quality. Cost-benefit analyses should be performed on policy interventions that are being discussed, with both direct and indirect costs considered as factors.
As we proceed with uncertainty, it is important to remember that the costs associated with errors are sometimes not symmetric. For instance, there has been some debate around the efficacy of mask-wearing. If masks are worn but later proven to be ineffective, the costs society will have borne will likely be the relatively minimal cost associated with their purchase or construction, as well as the physical and social discomfort caused by their utilization. Meanwhile, if masks are not worn, but later further evidence mounts that they are effective, the cost will be the societal losses due to the resulting illness and business closures.
The calculus regarding online versus live education for school children is hazier, as there are clear downsides to either path: Bringing children into schools may lead to increased spread of the virus, while keeping children at home may both hamper their education and their parents’ ability to work. The path that has been widely chosen, hybrid education, may be the most costly of all, as it both fails to shelter families from exposure and fails to provide parents with consistent childcare, in many cases, leading to the children spending increased time with vulnerable retired relatives or additional groups of children from alternative childcare arrangements.
One of the drivers of the decision to move toward the Solomonic judgment represented by the hybrid model has been the belief that students must be able to keep a distance of six feet, or two meters, at all times while in the classroom, a recommendation given by the United States Centers for Disease Control and Prevention but contrary to the guidance of the World Health Organization (WHO), which recommends keeping a distance of three feet, or one meter.
The reason for the discordance between the guidance of the WHO and the United States is because there likely is no single optimum distance but, instead, a gradient of risk. Two meters is likely somewhat safer than one meter, and 20 meters is safer still. As with every decision in health care, the costs and benefits of different safety thresholds must be weighed. If maintaining a six-foot distance forces schools to not operate at full capacity (or at all), it must be weighed against the potential medical and financial harms that come from implementing such a regulation, such as increased potential exposure of the elderly.
Moreover, it must be appreciated that neither distance completely mitigates risk due to the aerosol-based spread of the virus. There may be a right answer regarding the distance that is socially optimal, but such a distance needs further exploration using the scientific process. While doing so, we must appreciate both what we know and what we currently do not know, and increase our comfort with declaring our uncertainty.
The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.
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