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Covid-19: how a virus is turning the world upside down

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1336 (Published 03 April 2020) Cite this as: BMJ 2020;369:m1336

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COVID-19 Pandemic and the politics of the science, facts, research evidence and evidence-based medicine (EBM): The imperative for rekindling the ‘Multiparameter-Based Medicine (MBM)’ in the 21st century

The ‘COVID-19 Pandemic’ is unquestionably a ‘COVID Phenomenon’ of the 21st Century: ‘Unprecedented Roaring Devastation’ on ‘Mankind’/ ‘Plethora of Potentially Sustainable Benefits’ for ‘Our Improved Common Humanity’ [1-10]. With the ‘Rapidly-Dynamically-Transmuting Scourge Variables’, the ‘COVID-19 Pandemic Literature’ MUST become even more ‘Rapidly-Dynamically Replete’ with ‘Evolving-Metamorphosing Informed Conversation’! The ‘COVID-19 Pandemic’, a ‘COVID Phenomenon’, is ‘BAD’ with ‘AVOIDABLE DOOM’ [1-7] but is equally ‘GOOD’ with ‘SUSTAINABLE BOOM’ [4,7-10]!! The ‘Pandemic’ is an ‘Infection’, albeit an ‘Infection with a Novel Coronavirus: ‘SARS-CoV-2’’ and ought to be ‘Approached’-‘Handled’ with the ‘Best Known Scientific Principles-Ethos’!!! The World is embarrassingly and disgustingly enmeshed in ‘AVOIDABLE POLITICS’ which is ‘SUBMERGING and ERODING’ the ‘KNOWN and TIME-TESTED PRINCIPLES-PILLARS’ of the ‘SCIENCE-FACTS-RESEARCH EVIDENCE’ deployed to unravel/ address such ‘Epidemics-Pandemics’; The World has a ‘Rich Armoury of Experience-Learnt Lessons’ [11,12]! Some argue that the World should have embraced ‘EVIDENCE-BASED MEDICINE’ in its ‘APPROACH’ to the ‘COVID-19 Pandemic’!!

‘Evidence-based Medicine’ sought, at the outset, the ‘Best Available Research Evidence (BARE)’ for the ‘Optimal Clinical Decision-making Process’ for the ‘Best Patient Care Outcomes’ virtually to the ‘Complete Exclusion’ of other ‘Equally Determinant Parameters’: ‘Expert Opinion-Clinical Expertise’, ‘Patient Values-Preferences’ etc [13]! Unfortunately, ‘Evidence-based Medicine Movement’ remains ‘Work in Progress’ with ‘Transmuting Concepts and Difficult Realities’ with ‘Robust Critical Conversations’ [14-17]!! The ‘COVID-19 Pandemic’ ignites a ‘Foundational Threat’ to ‘Evidence-based Medicine’ with the ‘Rapidly Ravaging Politics’ which ‘Launch Destructive Missiles’ at the ‘Science-Facts-Research Evidence’ of the ‘Raging Pandemic’!!

A ‘Tantalizing Teaser’ exposes some of the ‘Political Threats’ to the ‘Science-Facts-Research Evidence’ of ‘COVID-19 Pandemic’:

1. Source of the Novel Coronavirus: The ‘Novel Coronavirus’ was originally thought to be from Wuhan, China. Some suggest it was from outside China! Science is about ‘Facts’ and ‘Facts are ‘Sacred’! Not for ‘Politics’!!

2. Name of the Novel Coronavirus: ‘Politics-driven Work in Progress’ and still in a flux; ‘Wuhan Virus’, ‘Wuhan Coronavirus’, ‘China Coronavirus’, ‘China Virus’, ‘Chinese Virus’, ‘American Coronavirus’, ‘Virus of the COVID-19’, ‘COVID-19 Virus’, ‘2019-nCoV’, ‘nCoV-2019’, ‘SARS-CoV-2’, ‘Human Coronavirus 2019 (HCoV-19)’ etc [11, 18-21]!

3. Name of the Novel Coronavirus Disease: Equally still in a flux undermining ‘Best Practices’; ‘Kung-Flu’, ‘Coronavirus Disease 2019 (COVID-19)’ and variously documented as COVID-19, Covid-19, covid-19, Coronavirus (Covid-19), Corona Virus etc!

4. Disease Transmissibility-Modes of Transmission: With the documented ‘Genomic Diversity’-‘Viral Recombination Capacity’, the ‘Protean Transmission Modes’ should have been incontrovertibly addressed to avoid ‘Missed Opportunities’ in ‘Policing the Virus’!

5. Aerosolization/ Mask Use: The ‘Possible Aerosolization’ of ‘SARS-CoV-2’ implied ‘Probable Airborne Transmission’ for which the ‘Potential Role of Mask Use’ needed ‘Consideration-Exploration’ as a ‘Scientific Option’ but this was marred by ‘Politics’ of ‘Mask Production-Supplies-Distribution’ and ‘Critical Shortages’ where most ‘Critically Needed for Frontline Healthcare Staff’! The ‘Science of the Disease’ should hold sway rationally!!

6. Ventilator Production-Distribution: The ‘Politics’ encapsulating ‘Ventilator Production-Stockpiling’ is legion with resistance of the ‘Science-Facts-Logic-Evidence’!

7. Age Susceptibility-Critical Care Prioritization: The ‘Facts-Evidence’ for ‘Age-Susceptibility’ exist but the ‘Politics’ is begetting ‘Ethical Dilemmas’!

8. Mitigation Measures: There are ‘Time-tested Impactful Mitigation Interventions’ re: ‘Non-Pharmaceutical Measures’ including Social Distancing, Social Solidarity, Self-Isolation, Mass-Gatherings Restrictions, Country Lockdowns-Shutdowns, Shelter-in-Place etc! For ‘Political Considerations’, these ‘Impactful Measures Implementation’ defied known ‘Scientific Principles-Approaches’ in terms of Acceptance-Declaration, Extent, Duration, Precocious Relaxation-Reopening etc with implications for the ‘Epidemic Curve-Peak’!!

9. Vaccines Production-Trials: There are ‘Established Scientific Principles-Processes-Procedures’ for ‘Vaccines Production-Trials’ in ‘Phases’ lasting 12-18 months at the fastest! With ‘Politics’, there is intense ‘Performance Pressure’ to ‘Rapidly Conclude’ this ‘Vaccines Production Intervention’ with obvious implications!!

10. Drugs Production-Trials: Several drugs are touted for ‘Treatment Effectiveness’ against ‘COVID-19’ but the ‘Drugs Production-Trials’ are receiving the ‘Baptism of Politics’ with ‘Performance Pressure’ to possibly ‘Deliver without Best Scientific Principles-Practices’!

11. Screening-Test Kits: There has been monumental ‘Performance Pressure’ to flood the ‘Health Systems’ with these ‘Rapidly Developed-Produced-Supplied Screening Kits’ but huge problems of ‘Sensitivity’-‘Specificity’ remain a ‘Difficult Reality’!

12. ‘COVID-19 Pandemic Research’: Like never before, the ‘Scientific Research Process’ risks kowtowing to the ‘Politics Pressure-Manipulation’; The ‘Conceptualization-Conduct-Data Production-Publication-Dissemination’ are expected to ‘Receive Approval’ from ‘Political Authorities’! The ‘Best Available Research Evidence (BARE)’ can obviously not be ‘Sourced and Harvested’ in this ‘Politics-tinted Research Regime’!!

13. Information Communication-Infodemic: The ‘Science-Facts-Evidence’ are known but ‘Politics’ adds to ‘Dangerous Pandemic-Infodemic’!

One obvious ‘Potentially Sustainable Benefit’ of the ‘COVID-19 Pandemic’, ‘Beyond the 17 Integrated SDGs’8,9, is the imperative to have a ‘Critical Rethinking’ on the ‘Evidence-based Medicine Concept’ since what is expectedly considered as the ‘Best Available Research Evidence (BARE)’ can be a ‘Subject of Manipulation’: ‘Political Pressure’-‘Commercial Influence’-‘Conflicts of Interest’ etc! Other ‘Determinants’ that have been critically reported to ‘Alter or Modulate’ the ‘Best Available Research Evidence (BARE)’, most likely from ‘Systematic Reviews-Meta-Analyses (SRMA)’, include in addition to others: ‘Research Question’-‘Research Hypothesis’-‘Selection-Inclusion Criteria for Studies’-‘Forest Plot’ Issues: What are the ‘Evaluated Specifics’ regarding ‘Sensitivity-Heterogeneity-Publication Bias Analyses’ [17,22-24]? This is the imperative to ‘Rekindle’ the ‘Multiparameter-based Medicine (MBM)’ which facilitates the ‘Best Decision-making Process’ to be crystallized through the ‘Composite Consideration’ of ‘ALL Relevant Parameters’ (Previously ‘Circles of Influence’) taking cognizance of the ‘Best Available Research Evidence (BARE)’ but ALSO being aware that there may be ‘Other Compelling and Confounding Influence’ that may ‘Purposely Colour the Research Evidence’ [17]!

The ‘Relevant Parameters’ include: Initially the ‘Research Evidence’-‘Clinical Expertise’-‘Patient’s Preferences and Actions’-‘Clinical State and Circumstances’ and the ‘New Parameters’ of ‘Family Parameter’-‘Societal Parameter’-‘Cultural-Traditional Parameter’-‘Resources Availability Parameter’! With the ‘COVID-19 Pandemic’, an additional ‘Politics Parameter’ may be included in the ‘Multiparameter-based Medicine (MBM) Model’!! The various possible ‘Parameters’ represent ‘Forms of Evidence’!!! The ‘Best Available Research Evidence (BARE)’ can no longer be the ‘SOLE DETERMINANT’ of ‘Critical Decision-making Process’ as it is not ‘Immunized’ against ‘Commercial Influence’-‘Political Considerations-Manipulations’-‘Conflicts of Interest’ etc [25,26]!

With the ‘Evidence-based Medicine (EBM) Movement’ as continued ‘Work in Progress’, the World is in a flux regarding ‘Best Decision-making Process’ but the ‘COVID-19 Pandemic’ brings to the fore, once again, the imperative to embrace the ‘Multiparameter-based Medicine (MBM) [17]!

REFERENCES
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Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria and
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementation.
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.

Competing interests: No competing interests

17 April 2020
CHARLES OSAYANDE EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria. Also, UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementaion. Also a Technical Expert/ Consultant on FMOH-UNICEF-NAFDAC Project on Code Implementation in Nigeria
Institute of Child Health, College of Medical Sciences, University of Benin, Benin City, Nigeria.