One intriguing aspect of the scientific discussion about #COVID19 measures is how entirely unscientific it feels to me. "Letting young people get infected by the virus is immoral" or "lockdowns are evil" are not scientific statements.
1/
Science can inform on the current situation (e.g. number of undetected #COVID19 cases) and provide plausible projections under different interventions, or absence thereof. Though, science does generally not, in itself, inform on the morality of any such intervention.
2/
Thus, when a scientist expresses their views on what #COVID19 measures the population should adopt, they do not tend to follow the science or go against it, but make a subjective, emotional statement about what they believe is morally/ethically right or wrong.
3/
There is a scientific approach to decide on the merit of #COVID19 measures, based on 'scientific utilitarianism'. Scientists can estimate the cost of measures in terms of gain/loss of lives, years of life, or more complex indices including e.g. wellbeing and education.
4/
A utilitarian approach to #COVID19 may seem appealing to some, but it is not without its challenges. While the calculations are based on science, the choice of which metric to maximise/minimise is not. This becomes particularly difficult when qualitative factors are included.
5/
For example, a #COVID19 model minimising deaths in the short term is likely to give a very different answer about what public health measures perform 'best', relative to one maximising years of life over the next decades and even more so from one including wellbeing/education.
6/
The choice of the metric to minimise/maximise (e.g. deaths, years of life or anything more inclusive of general health) falls outside the realms of science. It is a moral/ethical problem that should not be left to decide by scientists alone.
7/
It feels somewhat unlikely to me that a societal consensus could emerge about what metric #COVID19 public health measures should aim to minimise/maximise (e.g. deaths or years of life), over what timescale and at what geographical scale (country level or more globally).
8/
In the unlikely event a societal consensus emerged on what metric to minimise/maximise, one problem remains. Long-term projections from complex mathematical models tend to be imperfect, because the models are flawed, poorly parameterised or the situation changed unexpectedly.
9/
That said, despite the limitations of an utilitarian approach to #COVID19, injecting a bit more science in the scientific debate on #COVID19 should be beneficial to everyone.
10/

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More from @BallouxFrancois

12 Oct
Reconstruction of transmission chains (i.e. who infected whom) is a sophisticated subfield in infection disease epidemiology. This atrocious drivel masquerading as science, with no stats, no genomic sequencing, no nothing ... besides a childish diagram is not sophisticated.
1/
29 people got infected, including 8 children, that's it. The authors conclude "The high infection attack rate among children in our cluster *could* be explained by prolonged close contact between very young children, who are less able to adjust to control measures."
2/
Indeed, children *could* have infected other children/adults, or not, the data doesn't allow to tell. Pretending otherwise is just speculation. The only saving grace of the paper, is that the authors are at least upfront about having failed to collect meaningful information.
3/
Read 4 tweets
10 Oct
One intriguing aspect about the 'shielding the vulnerable' discussion is how disconnected it feels from reality. People most at risk from #COVID19 have been taking precautions for months. Also, those in elderly care homes are currently being shielded to extreme extents.
1/
For example, I'm aware of at last one situation where residents In an elderly care homes have been denied contacts with anyone, including other residents, this against their will, and had their windows sealed and doors locked for several months.
2/
Whether those most at risk from #COVID19 should be taking extra precaution, willingly or not, is not even worth discussing. This has been the situation for months, and no one in their right mind should argue against it.
3/
Read 4 tweets
8 Oct
New preprint on the origin and spread of drug resistance to the 'wonder drug' bedaquiline in Mycobaterium tuberculosis (Mtb), the agent of tuberculosis (TB), with @LucyvanDorp, @JuanitaPang, @misac42, @CedricCSTan1, @Vehuardo, @XavierDidelot and others.
1/
biorxiv.org/content/10.110…
Around 10M people developed TB in 2019, with ~500k infected with hard-to-treat drug resistant Mtb strains. As a result, ~1.5M people died from TB in 2019. Both drug resistance and deaths are expected to increase significantly with the #COVID19 pandemic.
2/
biorxiv.org/content/10.110…
The recent inclusion of the new drug bedaquiline into TB treatment regimens improved patient survival by ~20%, and might be the biggest public health success in the last decade. It is now under threat due to emergence of bedaquiline resistance.
3/
biorxiv.org/content/10.110…
Read 5 tweets
7 Oct
One intriguing aspect of the #COVID19 pandemic is the extent to which it has exposed current ideologies such as the current left-right divide for their hollow tribalism, rather than carriers of shared moral values.
1/
The dissonance and internal inconstencies on all sides of the political spectrum within our societies may have become too strong for current tribalisms to survive much beyond the pandemic.
2/
It feels interesting to speculate along what axis our societies may become polarised in the future. I would predict the major new divide in society will crystallise along the 'existentialist vs. essentialist' axis that currently divides society on how to respond to #COVID19.
3/
Read 6 tweets
6 Oct
"Herd immunity is back" may sound grand but I feel it is unnecessarily provocative and such sentiments won't help to engage in a much needed societal discussion. Incidentally, it is inaccurate.
1/
'Herd immunity' is neither a strategy nor a policy. It simply describes the mechanism by which an epidemic wanes before everyone in a population has been immunised through vaccination or infection. As such, 'herd immunity' is part and parcel of any vaccination campaign.
2/
It is fairly unlikely we'll have 'infection blocking' vaccines available for everyone in the near future. This is even true for the richest nations on earth. This has been acknowledged by the UK government, which doesn't plan to vaccinate most of its population.
3/
Read 5 tweets
6 Oct
In this video Raoult claims there was a nasty #SARSCoV2 strain circulating in spring, a nice strain in the summer, and now a nasty strain emerging again. He goes on stating that all transmission is through fomites (?!), which I won't even address, life's too short.
1/
I cannot see any merit in the idea there are spring, summer, or whatnot #SARSCoV2 strains. #SARSCoV2 has a big genome (~27.5k) for an RNA virus but all >100k available genomes are on average about ~12.8 mutations apart at this stage, which is tiny.
biorxiv.org/content/10.110…
2/
Moreover, #SARSCoV2 has been introduced many times in most regions of the world. As such, there is also no Asian, European, American or whatnot lineage. Essentially the entire genetic diversity of #SARSCoV2 is recapitulated in most places.
Credit: @LucyvanDorp
3/
Read 4 tweets

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