President Trump and 50 governors now face a critical choice. Since March 16, 33 million Americans have filed for unemployment, and more than 83,000 American deaths have been attributed to the COVID-19 virus.
So what to do? How many more weeks, months, or even years should current sheltering-in-place orders continue? When can or should they be lifted?
The administration’s virus taskforce has recommended only a gradual lifting of stay-at-home orders and has established criteria for full re-opening that could take months to satisfy in many states. Yet Trump also insisted that even though “some people [will] be affected badly. . . and there will be more death,” “we have to get our country open and we have to get it open soon.”
Many in the media condemned this statement as “risking more death to save the economy” and a dangerous repudiation of “the science.” Blue-state governors who have refused to reopen have similarly cited “the science” to justify their decisions to extend stay-at-home orders.
“Health outcomes and science — not politics — will guide these decisions,” three West Coast governors insisted in a recent joint statement. “Any plan to reopen society MUST be driven by data and experts, not opinion and politics,” echoed New York Gov. Andrew Cuomo (D). But which experts?
Two Conceptions of Science
The media and official spokespersons for science often depict science primarily as a source of authoritative deliverances. Whether about climate change, the comparative efficacy of embryonic and adult stem cell therapies, or the medical benefits of various diets, science is often portrayed as speaking with one voice.
This has many adverse consequences. Of course, there are many widely accepted and well-supported scientific theories that are properly considered part of the body of established scientific knowledge. But science also involves a deliberative process of testing and evaluating new evidence and competing interpretations of that evidence.
Moreover, scientists often disagree about how to interpret facts and even about what the facts are. As the Italian philosopher of science Marcello Pera has shown, science advances as scientists argue about how to interpret evidence. Premature appeals to an alleged consensus, therefore, can short-circuit this necessary deliberative function and lead to unwarranted conclusions, impeding scientific advance. The false perception of scientific consensus or certainty can, in turn, form the basis of rigidly enforced authoritarian public policy.
Since the COVID-19 outbreak, President Trump has relied on a small group of scientists within the federal health establishment. These experts, led by Dr. Anthony Fauci of the National Institute of Allergy and Infectious Disease, relied on early epidemiological models to craft their policies for quarantining everyone instead of the sick and vulnerable.
In giving way to these experts, Trump and other politicians have tacitly accepted science as a source of authority to the exclusion of science as a deliberative process of testing and evaluation — one that requires the constant refining of models and theories and argument between scientists about how to interpret evidence.
With the formation of his task force on reopening the economy, the president has pitted the advice of economists against the advice of medical scientists. These economists have warned of irreversible economic consequences of continuing the shutdown. Yet the president has not yet recruited skeptical medical scientists who can challenge the advice of his current medical advisors. Consequently, his policy has remained captive to a singular, and quite possibly scientifically flawed, understanding of the epidemic as day by day his signature achievement, the formerly booming U.S. economy, unravels.
Here’s a Way Out
Trump and governors can escape this dilemma by embracing a different concept of science — one that prizes open argumentation and evaluation, and constant reevaluation, of competing hypotheses, models, and evidence. He needs immediately to recruit a new set of medical advisors from outside the federal health bureaucracy to challenge, although not necessarily to replace, his current team.
Many eminent and dissenting medical, scientific and epidemiological experts would make an outstanding scientific “Team B,” perhaps as part of a new task force about how to open the economy. Consider just a few of the experts who have publicly questioned key assumptions or aspects of current policies:
- Professors Jay Bhattacharya, Eran Bendavid, and John Ioannidis of the Stanford University Medical School;
- Scott Atlas, former chief of neuroradiology at Stanford University Medical Center;
- Professor Knut Wittowski, biostatistician and former head of epidemiology, Rockefeller University;
- John Lee, former professor of pathology, Hull York Medical School in the United Kingdom;
- Daniel G. Murphy, chairman of the Department of Emergency Medicine at St. Barnabas Hospital in the Bronx;
- Douglas Axe, Maxwell Professor of Molecular Biology at Biola University and former research scientist at Cambridge University’s Medical Research Council Laboratory;
- Professor Martin Kulldorf, Harvard University Medical School.
Collectively, this group has marshalled many scientific facts and arguments that challenge the wisdom of extending stay-at-home orders. Their scientific arguments, after appropriate evaluation and scrutiny, could provide a stronger and more persuasive basis for Trump’s current calls for rapid reopening.
A Different Narrative From Equally Qualified Experts
For example, these dissenting experts have noted that models justifying the original sheltering-in-place orders have grossly exaggerated: (1) the likely total number of COVID-19 deaths, (2) the death rate among infected people (now steadily dropping to between 0.5 and 0.1 percent from the original 3.4 percent projection) and (3) the strain on the hospital system.
Such experts also note that total number of deaths attributed to COVID-19 will likely not exceed the number from the 1968 Hong Kong flu (100,000), the 1957 flu (116,000), or exceed by much the number (61,000) from 2017-2018 flu season, for which no equivalent economically destructive measures were taken.
Some further argue that the current death count (of roughly 75,000) will shrink dramatically once corrections are made for comorbidity factors, loose Centers for Disease Control coding standards, financial incentives for classifying respiratory deaths as COVID-caused and the distinction between dying with and dying from coronavirus.
Most importantly, some of these dissenting experts have shown that peak or dramatically slowing rates of infection in many places—including China, South Korea, Ohio, California, and New York — occurred well before mandatory shutdown orders could have had any effect, casting doubt on whether extreme mitigation efforts actually made a discernible health difference. Most dissenters think these policies no longer justify their unintended adverse public health consequences such as more suicide, drug addition, child abuse, and increased deaths resulting from limited or delayed access to other medical treatments, surgeries, and testing.
It’s Time to Recruit a ‘Red Team’
Since the outbreak, scientists have learned a lot about the often severe, and admittedly not flu-like, symptoms that can afflict those vulnerable to the virus. At the same time, mounting evidence shows that the early policy recommendations were based upon models that greatly exaggerated the threat to the overwhelming majority of the population.
Recruiting what the military calls a “Red Team” to challenge the received view of an organization from within will enable Trump to weigh the merits of competing medical recommendations. That will help him and governors design and defend a more nuanced policy that balances competing medical insights as well as the competing goods of public health and economic vitality.
Trump may also need such experts to help him put effective pressure on those blue state governors who are unnecessarily extending job-killing stay-at-home orders. Of course, these governors cite “the science, not politics” to justify their orders. A new team of scientific experts, therefore, could help the president marshal evidence — including evidence his current team ignores — to challenge unreasonable lockdown policies in specific states.
In Washington state, for example, home of a formerly robust economy, Gov. Jay Inslee recently extended a mandatory stay-at-home order through the end of May citing, again, “the science.” Yet the state’s Department of Health website shows characteristic bell-shaped epidemiological curves documenting a steady drop in new cases and deaths since both peaked well more than a month ago. It also reports roughly a dozen COVID-related deaths in the last week out of a population of 7.5 million people — hardly a raging epidemic by any measure.
If Trump arms himself with newly available data and recruits a new team of scientific experts to marshal that data in support of a recalibrated policy, he may stave off economic calamity and, quite possibly, save his presidency.