Here are two science-related pieces for today’s reading. The first, by a group of people writing in the journal Science, is a fairly concise summary of what coronavirus does to our bodies, emphasizing how much we don’t know about how it wreaks havoc on us. It’s free, so click on the screenshot to read it. Warning: if you don’t like medical details about a deadly virus and how if affects our bodies, don’t read it. But I think you should.
Beginning with the depressing statement, “. . a clear picture is elusive, as the virus acts like no pathogen humanity has ever seen,” it gets even more depressing as it lists all the organ systems the coronavirus can attack. In many cases we don’t know exactly how it works, though we do know that the virus hooks onto ACE2, a cell-surface receptor especially prevalent in the nasal passages, and thereby gets itself into the body. After that, it can latch onto any cell with the same receptor, inject its RNA into that cell, and make more copies of itself.
Much of what happens then is mysterious. The famous “cytokine storm” caused by some viruses, in which the body’s immune system overreacts, possibly severely damaging many organ systems, has been frequently mentioned as a cause of COVID-19 mortality. But, as the authors note, there’s doubt about even this.
But there’s no doubt that the damage to the body extends far beyond the lower respiratory tract. Here are some other areas liable to failure or destruction:
- damage to the heart and blood vessels, including production of blood clots
- kidney failure: why dialysis machines may be as important as respirators
- damage to the brain and possibly the central nervous system
- damage to the lower gastrointestinal tract (diarrhea is a common symptom). This raises the frightening possibility of viral transmission via fecal contamination, though there’s no evidence for this and the probability seems low.
- liver damage
- inflammation of the eye (conjunctivitis)
Understanding the various ways the virus damages the body will be immensely useful in palliative care and in the design of medicine. But of course a successful vaccine, which requires only using part of the virus’s protein coat to activate the immune system, requires little knowledge of what the virus does to the body. All it requires is knowing what part of the viral proteins can provoke an antibody reaction that can successfully immunize one against future infections. But, depressingly, an effective vaccine might be impossible to design, and even a good one may be countered by mutations in the virus.
After you’ve read that bit, buck yourself up by reading a Guardian paean to science by Jim Al-Khalili, a physicist best known in the UK as a writer of popular science (click on the screenshot):
Although you might be put off, as I was, by Al-Khalili’s first sentence (“As a regular Twitter user, I choose the people and organisations I follow online carefully”), do persist. You may already know these lessons about how science works (I cover them in Faith Versus Fact), but you can always send the piece to your conspiracy-minded friends who think that the Chinese government designed the virus as a bioweapon.
A few excerpts. The first is a pet peeve of mine: the “expertise” of non experts. I, no expert either, have stopped discussing the best way to attack this pandemic, or even how to protect myself against it—save staying away from people and keeping my hands clean:
During the coronavirus crisis, everyone online seems to have a “scientific” opinion. We are all discussing modelling, exponential curves, infection rates and antibody tests; suddenly, we’re all experts on epidemiology, immunology and virology. When the public hears that new scientific evidence has informed a sudden change in government policy, the tendency is to conclude that the scientists don’t know what they’re doing, and therefore can’t be trusted. It doesn’t help that politicians are remarkably bad at communicating scientific information clearly and transparently, while journalists are often more adept at asking questions of politicians than they are of scientists.
Remember when Trump mentioned antibiotics in connection with the virus, apparently unaware of the fact that antibiotics attack bacteria, not viruses? But al-Khalili’s point is to draw a distinction between the doubt and questioning inherent in science and the unwarranted certainty expressed by conspiracy theorists (and, of course, by religionists, who claim to be “immunized by Jesus”).
A second important feature of the scientific method is valuing doubt over certainty. . .
This approach still informs how we do science today. Indeed, this is how the scientific method differs from the stance of conspiracy theorists. Conspiracists will argue that, like scientists, they too are sceptics who question everything and value the importance of evidence. But in science, while we can be confident that our theories and descriptions of the world are correct, we can never be completely certain. After all, if an observation or new experimental result comes along and conflicts with an existing theory, we have to abandon our old presuppositions. In a very real sense, conspiracy theorists are the polar opposite of scientists; they assimilate evidence that contradicts their core beliefs, and interpret this evidence in a way that confirms, rather than repudiates, these beliefs.
Often, in the case of such ideological beliefs, we hear the term “cognitive dissonance”, whereby someone feels genuine mental discomfort when confronted with evidence that contradicts a view they hold. This can work to reinforce pre-existing beliefs. Ask a conspiracy theorist this: what would it take for them to change their minds? Their answer, because they are so utterly committed to their view, is likely to be that nothing would. In science, however, we learn to admit our mistakes and to change our minds to account for new evidence about the world.
This is crucial in the current pandemic. Clearly, the world cannot wait to learn everything about the virus before taking action; at the same time, stubborn adherence to a particular strategy despite new evidence to the contrary can be catastrophic. We must be prepared to shift our approach as more data is accumulated and our model predictions become more reliable. That is a strength, not a weakness of the scientific method.
This is what has apparently happened with hydroxychloroquine, touted by some (including Trump) as a panacea. Tests are showing that it’s almost certainly not that useful, and may even be harmful—one reason that you must do double-blind studies to have good confidence in a new drug.
Al-Khalili’s final paragraph:
I have spent my career stressing the importance of having a scientifically literate society. I don’t mean that everyone should be well-versed in cosmology or quantum physics, or understand the difference between RNA and DNA. But we should certainly all know the difference between bacteria and viruses. Even more importantly, if we are to get through this crisis, we must all have a basic understanding of how science works – and an acknowledgement that during a crisis like this, admitting doubt, rather than pretending certainty, can be a source of strength.
Although I like the rhetoric of that ending, I’m not as certain as he that to get through this crisis, all of us must understand how science works. Yes, it would help us make sense of the confusing back-and-forth recommendations we hear on the news, but to get through an airplane flight, we needn’t know the principles of aerodynamics nor the way airplanes work. We simply must have confidence in the engineers and pilots.
Likewise, if we have trust in the doctors, scientists, and epidemiologists, we’ll get through this crisis. We needn’t know how their fields work, or even that doubt is an important part of their work. Of course, as a superannuated scientist, science lover, and popularizer of science, I would be delighted if people would understand how scientists work, at least in rough outline. And if they’ve had a decent education, they should.
But many people can’t be arsed to care about science, and in that case I’d just tell them, “Eventually the scientists and doctors will work it out. Just heed the latest advice.” And when that advice is conflicting, like about when to wear masks, play on the safe side. Or, you can heed the ubiquitous but unrealistic television advice: “Ask your doctor.” Of course you have to have a doctor who responds, and also one who’s up on the latest science.
h/t: Paul (for second piece) and several readers (for the first)
Much depends on what it means to do this. To me it means everyone needs to understand enough about science to trust scientific expertise enough to recognize it as our best bet. One needs to understand it well enough to distinguish the recommendations of epidemiologists from those of charlatans and grifters. Many, many Americans lack that level of understanding. (True for much of the rest of the world, too, I suppose.)
I remember explaining to my aunt why Suzanne Somer’s hormone treatment and her approach to cancer was bullshit by explaining how science works as in how scientists conduct research, studies, tests, and then repeat the same things independently.
I hope she was interested and her eyes didn’t glaze over. I can’t seem to discuss much with anyone about history without their eyes doing it. I can just imagine the same with science, though since I’ve bumped into a few biblical literalists in my time, the usual response to the word “science” is defensiveness.
In truth, I adore science, but I don’t understand it as well as I’d like. Hence the reason I read all the articles I can when I can… and these two were great, helpful ones.
She did listen to me. It was a phone conversation and I had the same cancer as Suzanne Somers at the time and couldn’t take any more weird ass opinions about non science based treatments.
Yes for goodness sake have a basic level of scientific understanding. We need to educate better in this regard – know what virus vs a bacteria is, understand the difference between ionizing and non-ionizing radiation, know how evolution works, have a basic understanding of genetics.
“the body’s immune system overreacts”
An important of the approaches to treating this is to suppress the immune system – using anti-inflamatories. Several antibiotics and hydroxychloroquine, for example have this suppression effect. I just read the other day about an arthritis med having some good effect. I’m sure progress will be made here long before a vaccine is available.
It’s risky to suppress an immune response when one is infected with a virus. That’s a Catch-22 in treating these patients.
This is what worries me. I’ve taken hydroxychloroquine for several years (arthritis) and I think that may put me at higher risk for COVID19
If may not have to worry for long since it is getting extremely hard to refill a prescription.
Dosage is the key, according to my sources. Overdoses have occurred killing the patient.
Re: Suppressing the immune system. Currently, doctors tend not to give the drug in the earliest stage, where it is important to stop the virus. In the latter stage, where the immune system may be doing more harm than good, that is when those kind of drugs may be useful.
A different view I’ve heard is that it’s important to start some of these drugs early (not sure which ones) because they take a few days to begin there benefit. In some cases starting them late does little to help. I think this will be sorted out with more testing.
True, antibiotics treat bacteria and not viruses. Secondary bacterial lung infections can result from viral infections, hence, Trump’s comment on azithromycin.
Several antibiotics are interesting in their anti-inflammatory roll. I think azithromycin was one of those, although I wouldn’t expect tRump to have a clue what he’s talking about.
No, Drumpf was not talking about secondary infections. He was talking about Covid and how it was brilliant. Here is what he said. “This is a very brilliant enemy. You know, it’s a brilliant enemy. They develop drugs like the antibiotics. You see it. Antibiotics used to solve every problem. Now one of the biggest problems the world has is the germ has gotten so brilliant that the antibiotic can’t keep up with it.”
hydroxychloroquine as some sort of thing to consume because of covid-19 was conjured by an entertainer on Fox. Within hours of this program, you-know-who began his obsession with it. I saw this in John Oliver : https://youtu.be/dRFbwjwQ4VE
That was interesting.
I am across the world and thought I knew something of Trump’s shallowness but if any of that is true it is breathtaking and troubling.
And the worst of the right really are quite awful.
Sub
I doubt either myself or my wife would survive this thing. Too many problems already there besides old age. I saw where one patient had a leg removed due to the virus. Maybe clotting caused that?
The immune system can mess up blood clotting, too.
While I agree that we don’t have to understand aerodynamics and so on to get through an airplane flight, I honestly simply CANNOT UNDERSTAND why someone would not WANT to understand at least something about how this amazing, gigantic thing soars through the air. Similar sentiments apply for cars and computers and medicine and television and even space travel, etc. I don’t understand someone having a lack of curiosity about things that can have impact on their own health, wealth, safety, sanity, enjoyment, and so on. Certainly there are people in many places who simply have too much going on in their lives to be able to learn much, or don’t have access to knowledge about such things. But for most people in “the west,” I just don’t get it.
The word for that is “incurious”
Wicked good word.
I know what you’re saying but I do “get it”. Many people view science and technology as a huge edifice that they can’t begin to climb. In such cases, it’s a natural human reaction to not even bother trying. It’s actually quite rational.
Think about areas of knowledge that you know little about. For example, I know virtually nothing about opera or dance. Sure, I know what they are but not enough to begin to appreciate them as true aficionados do. When I do happen to rub up against them, I appreciate them at some level but the experience doesn’t impel me to learn more.
As I see it, the real problem is that the decision to stay relatively ignorant of science and technology ought to come with a commitment to accept the judgement of experts in those fields. I’m not suggesting that such faith be absolute — there are true controversies in science and tech. Instead, what we find are ignorant people who seem empowered to pick whichever “truth” fits their ideological identity or to simply make shit up.
In short, it’s the combination of ignorance and freedom that’s so deadly.
One difficulty is that the western public is inundated by pseudoscience. One form this takes, in the USA particularly, is through advertising: the fake doctors in white coats,
the fictional statistics, the use of the meme
“studies show…”, and so forth. Then, we
have syndicated radio programs which pretend to the authority of science or scholarship on such subjects as communication with the dead, reincarnation, UFOs, the activities of extra-terrestrial visitors on earth, etc.etc. Most
viewers/listeners cannot distinguish these frauds from science anymore than they can distinguish bacteria from viruses.
“Remember when Trump mentioned antibiotics in connection with the virus, apparently unaware of the fact that antibiotics attack bacteria, not viruses?”
Some of the blame for this mistake should rest with scientists. Arguably, all of it. The “bio” in antibiotics leads one to believe that they are a category of remedies that include antibacterials, antivirals, fungicides, and who knows what else. In fact, WebMD says:
“Antibiotics are medicines that help stop infections caused by bacteria. They do this by killing the bacteria or by keeping them from copying themselves or reproducing. The word antibiotic means ‘against life.’ Any drug that kills germs in your body is technically an antibiotic.“
But if you understand that viruses aren’t alive you also understand that antibiotics won’t disarm them….antivirals will though….sometimes.
Even if viruses aren’t alive, they come from the world of biology from a human perspective. Epidemiologists, doctors, pharmacies, hospitals, the CDC, all deal with viruses AND non-viruses. That viruses aren’t alive is a distinction without a difference as far as the layperson is concerned.
Precisely my point. The layperson needs a basic science education.
Sure, but I’m sticking to my guns. “Antibiotic” is a poorly chosen word if it only applies to bacteria. How can it be justified in the presence of a much better word: antibacterial? Science needs to meet the layperson halfway if they want them to learn.
IMO, you’re railing against the wind. If you insist that “antibiotic” applies to all living things then you must also insist that it kill off multi-cellular parasites. And why stop there? Antibiotics should also work against locust plagues and rodents in my kitchen.
I’m with Diana. Your average person should know the difference between a virus and a bacterium. If they don’t it isn’t because of the word “antibiotic”.
These terms are essentially fixed in the language. “Antibiotic” probably arose ( I might look into this) out of basic science. Doctors prescribe “antibiotics”. I think they just used them to get on with their work – they simply don’t have time to put nomenclature on hold because it might mislead people without the background for it. Actually, that’s what doctors should help with. Scientists could too – but that depends a lot on someone saying they don’t understand or know something. There’s a high barrier to that – being embarrassed, for one thing.
Yes, we can’t easily change these words now. Instead, we should be like WebMD and cut people some slack if they use “antibiotic” in a viral context. If we are going to remind them that it only applies to bacteria, let’s do it gently instead of using it as a scientific virtue signalling device. </soapbox>
I agree with that.
Something in “plain English”, as the phrase goes – not easy to do – but perhaps I could imagine Azar or Fauci saying something like “drugs to get rid bacteria” or “drugs to eliminate a viral infection”… that could lead to more problems though…
OTOH The populace must be compelled by such opportunities to learn the value of studying the e.g. biology of it – uh oh – I think viruses are included in “biology”… but the incurious minds will still be out there…
The question is whether to cut them some slack for not knowing the difference between viruses and bacteria and the fact that antibiotics don’t apply to the former. That’s basic health information, IMO, and blaming ignorance of it on biologists and the history of language doesn’t work, at least not for me. The reason we’ve got a problem with reduced efficacy of antibiotics is due to the failure to know the basic biology (and too many doctors going along with patient demands regardless), not to a failure of language.
Yep.
I think achievement of basic scientific literacy is non trivial.
In some ways, I think to reach scientific literacy, one would need to go through a degree program. Modern science stands on the shoulders of so many that we can’t reduce everything into a single course, even if that were meaningful to do.
And at some point, I personally think one needs *care* about knowing and understanding things on a regular basis, so when familiar material comes up (viruses) in unfamiliar and new settings (no cure or vaccine in a pandemic), one’s mind is already trained to handle it. That isn’t easy either because one’s job probably requires all their attention on other things.
Nah. You don’t need to get a degree in science to be scientifically literate. I consider myself scientifically literate and I have two arts degrees. I’ve even said to friends (with science degrees), “let the arts grad educate you on how this science works”. They hate that but I was right, they were ignorant now they know.
Sure, I’m with you on the fact that you have to show some interest but don’t you have to show some interest in anything you want to know? There will always be some that will resist it but we’ve managed to get people to know how to add and write so we should be able to get them to at least remember what ionizing radiation is and why it’s bad, what kinds of things put out ionizing radiation. Yes, I’m concentrating on that right now because of 5G. I’m so tired of every step in the availability of technology being greeted with lug headed ideas because people don’t know how things work and because they don’t know how things work, they are willing to accept wrong headed conclusions. If they know how one does science, they’d trust scientific conclusions and identify pseudoscience immediately and there’d be less of this foolishness. If they understood some basic concepts, they wouldn’t reject them and waste all of our time with foolishness.
Well put
“don’t you have to show some interest in anything you want to know?”
That’s what I think. However, there’s plenty of things I have to “black box”, or otherwise let someone else do and I just use them as a guide – even though in an ideal world, I’d like to know it….
But we have people saying covid-19 is the nineteenth version…. I’m reminded of This Is Spinal Tap : “But this one goes to 11.”
“they come from the world of biology”
Give it a rest Paul, so does bullsh*t. Trump [and other US politicians can be as bad–] simply didn’t grasp the argument he was mouthing, or care to.
I don’t think tRump was necessarily wrong. I understand some antibiotics have anti-inflammatory side effects and are being used to treat CV-19 patients. I think he must have picked that up in a presentation by his medical advisors and passed it on in complete ignorance of what he was saying.
But if you understand that viruses aren’t alive you also understand that antibiotics won’t disarm them….antivirals will though….sometimes.
+2 It’s worth repeating.
Many of the most successful antibiotics inhibit the enzymes in cell wall biosynthesis. Of course there is more to that story.
Viruses have a membrane with perhaps glycoproteins stuck in it. it’s not a complex cell wall, with multiple layers. They have no enzymes *building and maintaining* anything at all – they use *the host* for that. The virus itself just has nucleic acid inside that has a code for e.g. reverse transcriptase, etc but *the host* is tricked into making that.
Antibiotics are usually reacting in enzyme active sites. Since there’s no enzymes in viruses, … pretty sure there isn’t…. the antibiotics will not have the same effect.
It’s interesting! I’ll have to read some more about it!
This, in the NYT, on the etiology of the disease, and from a physician, too, is exceptionally good.
And, it also seems that the Times gives free access to COVID-related pieces.
I don’t know if Jim meant it in this way but I interpreted this passage to mean that if people had an understanding of how science works in general then that would lead them to have confidence in the experts. Shorter, I think you are both on the same track.
I also interpret Al-Khalili’s statement charitably, which of course means that he agrees with me 😉 . So not only would people typically have more confidence in scientific experts, but they would have less when someone (usually the press, not the scientists themselves) presents initial indications as established facts. People should at least understand that in early stages, only a few plausible alternative hypotheses have been ruled out, while many hypotheses are still in the running.
Jim Al-Khalili:
How am I supposed to “buck myself up” with this? It’s totally true, which is totally depressing.
“conspiracy-minded friends who think that the Chinese government designed the virus as a bioweapon”
People who know about viral RNA genomes claim there is no evidence this cronavirus had been genetically engineered. BUT: since it is unknown how the virus got from bats to humans, no intermediate animal has been identified, the hypothesis that it may have escaped from the Wuhan Institute of Virology (WIV) seems a legitimate one to explore.
LiveScience does a pretty decent reporting job (with links) “Wuhan lab says there’s no way coronavirus originated there. Here’s the science.” And it is far from clear.
http://www.livescience.com/coronavirus-wuhan-lab-complicated-origins.html#xenforo-comments-2085
The comment has a link to The Sun, an unreliable tabloid. As you say, virologists say that it is a naturally occuring coronavirus that spilled over to humans.
Could it have been an escaped lab virus? That is one of a thousand possibilities. All the previous coronaviruses causing disease (4 cause colds, SARS-1, MERS) have been natural spillovers from animals and originating with bats. The only way to prove that would be to have the RNA genomes of the ones in the lab and those that are in the wild and make a phylogenetic tree.
Speaking of denying science, it will be interesting to see what happens in the South. Arkansas has no restrictions, and Georgia is opening up next week as well as Florida, which already opened their beaches. South Carolina is also opening. And I haven’t seen they are recommending masks or social distancing. Many Republican governors are also not enthusiastic about mass testing…I think it’s ironic that they think “what I can’t see can’t hurt me.” Glad I don’t live in a state that heeds our demented “president”.
The possibility occurred to me, which means that it surely occurred to someone else much earlier, that polymorphisms might exist in the ACE-2 (protease) receptor that just might have some effect on SARS spike protein binding. In the best case, there might be some that would confer effective immunity.
Unsurprisingly, someone has already looked into that, and they did indeed find some 32 allelic variants of the gene. Sadly, none of those variants are close to the known amino acid residues involved with binding the spike protein, so this is basically just to note the existence of the study.
There are a couple of rare (~0.00001 allele frequency) coding changes that might influence binding, based on in silico modelling.
I think people are often right to doubt experts. Experts often have a peculiarly narrow viewpoint. The early expert advice about not prioritizing gloves and masks are two examples that were obviously wrong.
“I’m not as certain as he that … all of us must understand how science works. … [T]o get through an airplane flight, we needn’t know the principles of aerodynamics nor the way airplanes work. We simply must have confidence in the engineers and pilots.”
Disagree: We all need to understand how science works and we should not simply have confidence in engineers/pilots/doctors/scientists. We can have more confidence in experts than in non-experts on subjects under study, but not total – remember that doubt is part of scientific method. One of my best remembered subjects in college was Sci 105, which taught freshmen scientific method and how it was developed. I thought then that it should have been taught in 6th grade and up. Not having this grounding is part of the reason Americans can act so foolishly and accept so much nonsense.