When a definitive statement is made without sufficient evidence by someone in a responsible position where people view the person as a scientist, it certainly amounts to pseudoscience. In science it is often inevitable that you go ahead with hypotheses that have not been rigorously tested as yet. Having uncertainty does not make it pseudoscience, but projecting it to the public as an established truth and hiding the uncertainty is what I call pseudoscience. During the Covid 19 pandemic we have witnessed umpteen examples of it.
The early assertion that the virus is not a lab leak, when there was no definitive evidence either way is not the only example. For a number of other things that are being projected as scientific truths, the evidence is actually quite questionable. Projecting them as truth has possibly led to devastating consequences.
The so called non-pharmaceutical interventions (NPIs) such as mass use of masks, social distancing, school closures, lockdowns have been projected as scientific ways of combating the infection and raising any questions about them is trolled as anti-science. But what is the evidence that they prevent spread of the infection, and to what extent?
In 2019, just a few months prior to the beginning of the pandemic, WHO published an official report on the evidence and recommendations for NPIs for respiratory diseases. Since Covid 19 was not yet on the horizon, the focus is on influenza. But it is important to see what the report says (https://apps.who.int/iris/handle/10665/329439). The team writing the report undertook a detailed systematic review of literature on all the NPIs, available at that time and their conclusions are based on a meta-analysis of all relevant literature. They say, “The evidence base on the effectiveness of NPIs in community settings is limited, and the overall quality of evidence was very low for most interventions. There have been a number of high-quality randomized controlled trials (RCTs) demonstrating that personal protective measures such as hand hygiene and face masks have, at best, a small effect…”
Specifically they have to say this regarding individual NPI components:
Hand hygiene: However, there is insufficient scientific evidence from RCTs to support the efficacy of hand hygiene alone to reduce influenza transmission in influenza epidemics and pandemics.
Entry exit screening and border closure: There is sufficient evidence on the lack of effectiveness of entry and exit screening to justify not recommending these measures in influenza pandemics and epidemics. Border closures may be considered only by small island nations in severe pandemics and epidemics, but must be weighed against potentially serious economic consequences.
Face maks: There is a moderate overall quality of evidence that face masks do not have a substantial effect on transmission of influenza.
Surface cleaning: There is a low overall quality of evidence that cleaning of surfaces and objects does not have a substantial effect on transmission of respiratory disease.
Contact tracing: There is a very low overall quality of evidence that contact tracing has an unknown effect on the transmission of influenza.
Isolation of patients: There is a very low overall quality of evidence that isolation of sick individuals has a substantial effect on transmission of influenza except in closed settings.
Quarantine of exposed individuals: There is a very low overall quality of evidence that quarantine of exposed individuals has an effect on transmission…
School and work place closure: There is a very low overall quality of evidence, and the studies that have been published reported or predicted that school measures and closures have a variable effect on transmission of influenza…… There is a very low overall quality of evidence that workplace measures and closures reduce influenza transmission.
Avoiding crowding: There is a very low overall quality of evidence on whether avoiding crowding can reduce transmission…
Travel restrictions: The quality of evidence cannot be judged because no study was identified.
All the above are copy pasted verbatim from the 2019 WHO official report. The report also recognizes that many of the NPIs can be highly disruptive and can cause substantial losses to the society. Therefore the report very sensibly recommends the measures with low costs but does not recommend the ones with high social and economic costs. Accordingly it clearly states in section 2 of the report that contact tracing, quarantine of exposed individuals, entry-exit screening and border closure are NOT recommended. Face masks, school closure or avoiding crowding is only conditionally recommended. Imposing these measures without studying the relevant conditions in the local context amounts to pseudoscience in my view.
The report has further wisdom: It says in settings where multiple exposures occur, removing one mode of transmission may not be sufficient to reduce overall transmission. This makes sense in the current scenario where we know that it is impossible to close all modes of transmission. We have a set of rather arbitrary restrictions which may at the most reduce some of the modes of transmission, but certainly not all. It is common sense that that this cannot “break the chain” that it is supposed to do.
This report has made very honest, logical and sensible statements and has weighed evidence very carefully. However, as the paranoia of the pandemic set in, all this wisdom was forgotten in moments. It looks like this report saw the dustbin immediately and all the ineffective measures were imposed as if they were well proven miracle solutions to save the earth. Were there any studies in between publication of this report and the global NPI recommendations with the beginning of the pandemic? The answer is no. After the NPIs were recommended, within the next few months there was a mushrooming of studies, published by all high impact journals, most of which said that the NPIs are effective. How is it that what was ineffective, doubtful or marginally effective for respiratory infections just a few months ago suddenly became effective? No comparative study and justification for the miracle has been given. A careful look at those studies reveals that they have all kinds of typical well known flaws that a clinical study can but should not have. Most of them compare a set of arbitrarily chosen countries with no justification of why they chose only these countries. If comparison across countries is a valid method, we will also have to agree that healthcare kills, because countries with better health care have greater death rates. The need for consideration of other confounding variables is apparently not felt by these studies. Most important, it is long known that epidemics take wave forms, which is true for the current pandemic as well. In a wave form, the rate of transmission changes on its own, even without any intervention. This natural change in the rate should make the null hypothesis for examining the effect of an intervention. Surprisingly not a single study has an appropriate null hypothesis incorporating natural changes in the transmission rates. The only study that tries to incorporate a null hypothesis is ours and that finds little effect of NPIs during the pandemic (https://www.preprints.org/manuscript/202104.0286/v1). Therefore even after over a year of data on the pandemic, we do not have any agreement along with sound evidence on the effectiveness of the NPIs. But still the NPIs are being promoted with definitive statements. For example, at the peak of the second wave in India Anthony Fauci said that India needs a lockdown. This is nothing else but pseudoscience.
Contextuality being ignored in a pseudoscience regime is no surprise. The Mumbai slums, for example, have a population density of 270,000 per square Km. If everyone stays at home the mean neighboring individual distance turns out to be less than the recommended social distancing. In normal life a substantial part of the population is out for livelihood activities. Many have night duties as well. So on working days, the slums have a moderate density. By lockdowns the density of people in an indoor congested environment actually increases. The nature of housing is such that a table fan in one house quickly carries aerosols to neighboring houses. Would ‘stay at home’ advice work in such a setting? But details like this matter only for reality based genuine science. Why should they matter for pseudoscience? Only pseudoscience can recommend context independent magical solutions.
There are other examples too.
- Why were play grounds, jogging parks and swimming pools closed during the lockdown? WHO has an official statement saying the virus does not spread in swimming pools (https://www.who.int/…/advice-for-public/myth-busters). There is substantial evidence on the other hand that exercise and fitness has protective effects against the complications of Covid (https://bjsm.bmj.com/content/early/2021/04/07/bjsports-2021-104080). The decision of closure of swimming pool and other fitness activities was taken by someone without looking at evidence on the contrary. This is certainly anti-science.
- More and more studies are now revealing that after recovering from infection, immunity lasts long. However, for travel and many other purposes, having recovered from Covid is not taken to be equivalent to vaccination. There is no justification given. For a recovered person why two doses of vaccination are still required? There is no science behind such a recommendation.
- The virus is supposed to spread through coughing, sneezing and may even by talking and breathing out. A dead body doesn’t do any of these. So how does dead body spread a respiratory virus? But funerals of Covid deaths are done by selected people with PPE (salute to their dedicated service, but was it really essential?) and the relatives and friends are strictly kept away (of course with the exception of political leaders).
This is likely to have an unintended but expected effect on people, particularly from villages and remote areas. For them, often a person admitted to a hospital is never seen again. This is comparable to the Baloch agitation where they say so many people just disappeared in state supported terrorism. What do we do if people compare the two situations? Spending the last moments in the company of relatives and friends is of important cultural and emotional value. Since people started missing this, there was a growing reluctance to admit a sick person, even test for Covid in rural areas. I believe this is one of the main reasons why in the second wave, a large proportion of cases as well as deaths remained unreported. People just preferred deaths over pseudoscience supported terrorism. But this is a social and psychological issue, which health researchers will not cover. In my view it is the unnecessary isolation of the dead without any evidence for transmission from the dead, and the natural social response to it fueled the second wave to a substantial extent. At present this is only anecdotal. This needs to be studied as a hypothesis. Reluctant to even consider alternative possibilities as testable hypotheses is another marker of pseudoscience.
- The scanty literature including experiments on the benefits of mask are all short term experiments. Something that is useful in the short run can become counterproductive in the long run. It was said in the first phase of the epidemic that the surprisingly low death rate in India and other crowded south Asian countries was owing to cross immunity through other corona-viruses. Such short term cross immunity along with the possible mechanisms has been demonstrated as well (https://pubmed.ncbi.nlm.nih.gov/33754149/). A possible cause for the rapid onset and higher deaths in the second wave is that owing to masks and social distancing the incidence of other milder respiratory viruses could have come down. Since such immunity is short lived, the population lost this protection on long term use of masks. The only strength that India had in the first wave could have been lost by masks and social distancing. Is this causality proved? The answer is no, but that is because nobody studied it. This hypothesis can make testable predictions. It is possible to take it up as a retrospective study and test it. Such a study would be highly relevant for future policy. Science is certainly interested in alternative hypotheses and testable predictions. Pseudoscience will only ignore alternatives.
We had enough of pseudoscience by now. People should demand science over pseudoscience. Question the rhetoric, cross question the authorities, demand evidence. Good science is also being done no doubt. But it suffocates under heaps of pseudoscience. It is quite possible that this pseudoscience is actually killing more people than the disease itself. Therefore, not being open to evidence and to alternative possibilities, needs to be considered as criminal.