Abu Dhabi, UAESaturday 8 August 2020

CORONAVIRUS

Coronavirus: finding the weaponry to fight back

Evidence-based research is critical to establishing fact from fiction

As the Covid-19 pandemic tightens its grip, more and more countries are looking to the scientific community for answers.

But among researchers themselves, there is a growing concern about the potential countermeasures for combating the virus, and the evidence backing them.

At the same time, ironies and contradictions are starting to emerge in what has become an increasingly complex debate.

These include the possibility that some, relatively simple, measures currently dismissed as “myths” may in fact have some basis in science.

Many countries have adopted draconian measures to halt the spread of Covid-19, with governments talking of the need to “flatten the curve” and keep the growth of the epidemic low enough for hospitals to cope.

That is the rationale behind the lockdowns and social distancing practices now being imposed around the world.

But it’s an approach that actually reflects the lack of scientific evidence about the real levels of infections.

Too few testing kits in some countries and different policies on when to use them are creating a chaotic picture of the development of the pandemic world-wide.

Japan and Germany both appear to have relatively manageable outbreaks. Yet Japan has a policy of only testing those with advanced symptoms, and so may just be failing to identify many of those infected.

Where the truth really lies is anyone’s guess, making it impossible to draw reliable lessons from what either country is doing.

Ideally, all nations would be carrying out regular, large-scale random testing of the population to check for infection levels – and thus monitor the progress of Covid-19. But that isn’t going to happen any time soon.

In truth, it is this absence of scientific evidence that is driving the controversial policies of lockdowns.

And now the wisdom of these measures is coming under attack – again, because of the lack of scientific evidence that they will work.

In a widely-read critique, the leading epidemiologist Professor John Ioannidis of Stanford University, describes the current pandemic as potentially “a once-in-a-century evidence fiasco”.

He points out that no-one knows if policies such as shutting schools make any sense.

On the face of it, they may help cut viral transmission, but they may also lead to children being looked after by more vulnerable adults, putting more strain on the health services.

Prof Ioannidis also points out that the very idea of “flattening the curve” could lengthen the duration of the epidemic - with disastrous consequences for those who never become infected.

“[The] majority of the extra deaths many not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding and the like that are not adequately treated," he writes.

“[We] don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health”.

So what can we do? Is the world condemned to be in lockdown until antivirals or a vaccine becomes available – which we have already been warned is at least a year away?

Many world leaders have talked about our being “at war” with SARS-Cov-2, the virus responsible for Covid-19.

In times of war, no resource is left untapped for its potential.

And the fact is that the scientific literature contains a wealth of research of potential benefit in dealing with the pandemic.

Yet, astonishingly, much of it is being ignored or dismissed out of hand.

Over recent weeks, mainstream media - including this newspaper - has being fighting against a host of quack remedies appearing on social media.

Often the debunking is backed by statements that “there is no evidence” the supposed miracle cure will work. But these debunkings are themselves sometimes questionable.

Take the case of gargling as a means of reducing the risk of infection.

Like so many suggestions, this is routinely dismissed as “unproven” against SARS-Cov-2.

While true, the same argument could be levelled against all the putative therapies now being developed to combat the virus – simply because there has been no time to carry out such tests.

The real question is: might it be worth taking seriously? In the case of gargling, the answer is a very guarded yes.

In Japan, official health guidelines have long recommended the practice as a means of warding off colds and influenza. But – as so often – only recently has any attempt been made to test its efficacy scientifically.

A 2005 study by Japanese researchers compared the benefits of gargling with water or antiseptic on the risk of contracting a respiratory tract infection. The results showed that water alone may cut the incidence by 35 per cent.

But in 2007, the same team looked at the effect of gargling on influenza-like symptoms, and failed to find any benefit.

At least, that is what they concluded. In fact, they found a roughly 25 per cent reduction in risk. That sounds impressive, but the researchers rejected it because the the finding was "statistically non-significant".

In doing so, they fell into a trap statisticians have been warning about for decades (and reported by The National ): interpreting statistical non-significance as proof that a finding is false.

The danger of dismissing a claim on the basis of just one study has since been confirmed by the emergence of further evidence for the effectiveness of gargling. The most impressive involves so-called catechins – anti-viral compounds found in tea.

A review of the evidence published by Japanese researchers in 2016 showed that gargling several times a day with green tea may reduce the risk of influenza infection by around 30 per cent.

Encouraged by the findings, the researchers called for further large-scale studies. Yet despite influenza routinely killing hundreds of thousands of people each year, no such studies have been carried out – despite the practice being simple, cheap and having no obvious side-effects.

Could the practice explain Japan’s low infection rate? It’s an intriguing idea, but impossible to confirm without far more evidence.

Sceptics will rightly point out that SARS-Cov-2 is not influenza, and that gargling is no cure. They will also stress the need not to abandon other measures proven to be effective, such as regular hand-washing.

Yet as the death-toll continues to mount, it is surely time to use science not preconceptions to identify new weaponry to help fight this global war.

Robert Matthews is Visiting Professor and researcher in statistical methods at Aston University, UK

Updated: March 26, 2020 11:39 AM

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