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The UK’s public health response to covid-19

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1932 (Published 15 May 2020) Cite this as: BMJ 2020;369:m1932

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Rapid Response:

Complexity: the science for Covid-19, public health and the human story.

Dear Editor

This editorial identifies where the UK plan for COVID that was backed by science went wrong, with ideas on what now needs to be done? (1), which can be extended globally.

The expectation of science is to protect us and make a better world – how it is used is another story. Following the science should be a good thing, until it’s not. As identified, science and public health have been underdeveloped, misunderstood, misused and not used in context.

Science is simple - knowledge that is testable, usable to predict, and refutable, while its use or claims of its use is complex - see - Science evidence and the use of the word scientific, Lancet Letter (2) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)73141-X/fulltext

Science and public health have not failed us in this pandemic – how they are used and managed have. The editorial points out numerous instances, with recommendations for fixing this. In particular, politics, which is very complex, weaves itself into health and public health, making these even more complex.

A complexity thinking can help us understand and use science in context to make a better world (3). The reality is that everything that happened was in the context of the politics, economics, society, etc and is part of the interaction of science and society. We need to FACE this reality and use a complexity thinking to make it better, with Feedback, Adaptation, Change, and Emergence of better, which sometimes works.

A complexity thinking would expand the narrow scientific view beyond the modellers and epidemiologists as decried, to include people who have experience taking the science to society, in an open manner as also identified, with debate and discussion to allow for change and adaptation as necessary. A similar caution re following the science exists with complexity, with contention that it was misapplied by a UK Govt senior adviser, reinforcing the need for open discussion (4).

The editorial argues that “The response to COVID-19 is not about flattening epidemic curves, modeling or epidemiology. It is about protecting lives and communities most obviously at risk in our unequal society. …requires a strong and credible public health of community at the heart its response…a UK govt that prioritizes the health and well being of the public…,” which brings me back to how science is used as another story.

“Complexity: The science for medicine and the human story” Lancet Letter (5) , https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60512-0/fulltext
suggests that “Medicine and its underlying science not only change, but lie in the eye of the beholder. To some they mean absolute truth and validity, to others uncertainty and the contextual nature of reality. This makes medicine a human story, with an ever-changing complex, dynamic, intertwined art and science—and chaos and complexity its science for the 21st century.”

This should then make Complexity the science for Covid, public health and the human story.

1. Scaly G, Jacobson B, Abbasi K. The UK’s public health response to covid-19: too little too late, too flawed.
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1932 (Published 15 May 2020) BMJ 2020;369:m1932 https://www.bmj.com/content/369/bmj.m1932 (accessed May 20, 2020)
2. Rambihar VS. Science evidence and the use of the word scientific
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)73141-X/fulltext
(accessed May 20, 2020). Lancet 2000 May 13;355(9216):1730. doi: 10.1016/s0140-6736(05)73141-x. PMID 10905277
3. Rambihar VS, Rambihar SP, Rambihar VS Jr. Tsunami Chaos and Global Heart: using complexity science to rethink and make a better world. 2005. Vashna Publications. Toronto, Canada. http://femmefractal.com/FinalwebTsunamiBK12207.pdf (accessed April 11, 2020).
4. Taleb N, Bar-Yam Y. The Guardian Opinion. Wed 25 March 2020. The UK's coronavirus policy may sound scientific. It isn't. https://www.theguardian.com/commentisfree/2020/mar/25/uk-coronavirus-pol... (accessed May 22 2020).
5. Rambihar Vivian, Rambihar Vanessa. Complexity: the science for medicine and the human story. Corespondence: Lancet Vol 375, Issue 9721, p 1162, April 03, 2010 DOI:https:/doi.org/10.1016/S0140-6736(10)60512-0 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60512-0/fulltext
(accessed May 20, 2020).

Competing interests: No competing interests

25 May 2020
Vivian Rambihar
Cardiologist
Courtesy Staff - Sunnybrook Health Sciences Centre and The Scarborough Network, Toronto Canada., Adjunct Assistant Professor of Medicine, University of Toronto.
Toronto, Canada