Thread by @MarionKoopmans

@DrJBhattacharya thanks for responding. Few more points. Happy to agree to disagree. You mention topics that I consider to be part of the science advise process, and topics more related to the policy arena and how that works. Sorry, long thread, lost the blue button

I read that your criticism focusses a lot on the second argument and agree evaluation is important. Now there, I think this is very different in different countries, although the same trend (scientists that felt left out) is clear in many places.

I personally believe in the process of evidence synthesis from multiple sources, while maintaining the need for speed. That is how I saw this done in several countries in Europe, with often a key spokesperson conveying the conclusions to policy makers.

That may seem burocratic, but it does not need to be, and it makes debate and weighing of (partial) evidence, adding in local context and uncertainties inherent to the advisory process, which is what I consider to be important.

As for the science, you mention a list of topics, that each could be the subject of a full study on what exactly it is, how it is measured, what it contributes, etc. As an example: the “covid is airborne” topic – certainly on popular platforms- has become overly simplified,

presented as a “yes or no” answer, leaving the more difficult questions out: what is the contribution of different modes of transmission and how does that translate to interventions. That is what the advise needs were about.

SARS COV 2 is expelled by different activities, in particles of different sizes, behaving differently depending on environmental conditions, with virus infectivity decay rates that are context dependent, impacting the effect of interventions.

I do not want to go into individual studies on this platform, because that will trigger back and forth of papers that “show me wrong”, but do like this one that used methods from QMRA (common in the food safety field) to put this complexity together. pmc.ncbi.nlm.nih.gov/articles/PMC80…

the airborne topic also showed a clash between science field that had not interacted before, with different methods and debate leading to different conclusions. That's fine, how science works. But taking that mix of views in for providing advise on how to act is a different task

Take also the issue of who is most at risk. Clinical impact clearly increased with age, and with underlying health condition. The debate also was triggered in our country, with suggestions to protect the high risk individuals and let everyone else go about their own business.

When looking at how to implement that, it was clear that it was not very realistic, at least not in our country. Mmany families and households and businesses have members belonging to a risk group or taking care of someone from a risk group.

Separating those was a theoretical concept, not an actionable one, not in our society. For instance, while the science advise was against school closures, they happened at the explicit wish from specialists worried about high risk children, and school- and teacher boards.

Now those are not scientific decisions, they are societal choices and therefore political choices. Those debates need to happen now: if we were to face a new pandemic, what would we do differently? I do not see much of that happening, unfortunately

In our country, we are testing doing simulation exercises with much wider representation, bringing together some of the science actors that had quite opposed views.
That has required many meetings to even only understand the common grounds at baseline

what are the key questions that science can provide evidence for, what data is needed, where is that data, how good is it and is it actionable (available in real time etc). I agree evaluation is important.

I think we need to get better, particularly in explain the level of (un)certainty and how that translates into a specific recommendation. I would love to see such studies funded.

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