In the weeks leading up to Labour Day and the annual return to school, Canadian media outlets have provided ample coverage of the unprecedented stresses and challenges the COVID-19 pandemic have created for politicians and educators.
On September 1, 2020, CBC reported that Ontario’s school boards will need to ‘collapse’ some classes, trustees group says. It appears that school boards are coping with a dramatic increase in online learning in response to the pandemic. School boards and media covering Ontario’s education system have focused-on class sizes as a key element of funding agreements with the province.
On August 31, 2020 The Globe and Mail published an article stating that Ontario’s education unions file labour board challenge over school pandemic plans. The upshot is that Ontario’s four education unions are challening the provincial government’s approach to the coming school year….with a focus on smaller class sizes.
Back in July, The Toronto Star reported that Opening Ontario schools safely amid COVID could require up to $3.2 billion funding for staff, cleaning supplies, say Liberals, staff union.
What is absent from all of this discourse? Any evidence that educators, politicians or the media have recognized how fundamentally-flawed, ill-prepared and out-dated the design of Ontario’s education system is.
Who does seem to have recognized this issue? Administrators. CBC reported on September 2, 2020 that Ontario school boards lose 20% of education directors as daunting pandemic year looms, even quoting Alana Murray, a retiring Director in the Bluewater District that “I guess my timing was pretty good.”
The timing to recognize that Ontario’s publicly-funded education system is terribly outdated and badly in need of reform isn’t just “pretty good” – it is critical.
Federal and provincial governments are tripping over themselves, and each other, in hurried efforts to distribute supplies, maintain social distancing, fulfill online learning needs, negotiate with educate unions and sort our their funding agreements. How it will all be paid for is anyone’s guess. Or isn’t it everyone’s certainty that the costs of COVID-19, whether within the domain of education spending or across the whole public sector, will be paid via taxes?
Ontario’s government, whether anybody wants to admit it or not, is faced with a critical problem to redesign and modernize Ontario’s publicly-funded education system. No small part of that will be recognizing and addressing one of Ontario’s most expensive anachronisms – the ongoing public funding of separate Catholic schools. After COVID-19, we can’t afford it any longer.
Over two months have now passed since my first commentary on the Covid –19 pandemic. And in that short time period, a lot has happened. When considering information and evidence regarding a novel new virus like Sars CoV – 2, we must constantly remember our knowledge limitations. And so it is always worth repeating and remembering what we might call Rumsfeld’s Rule:
“There are known knowns. There are things we know that we know. There are known unknowns. That is to say, there are things that we now know we don’t know. But there are also unknown unknowns. There are things we do not know we don’t know.”
So at this point in time, what do we know, and what do we know we don’t know about this particular virus?
In case you’re wondering, there are very specific reasons why this particular novel corona virus is called Covid – 19. According to the Center for Disease Control:
On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease.
In April 16, 2020, Whitehouse counsellor, Kellyanne Conway said: “Some of the scientists and doctors say that there could be other strains later on, that this could come back in the fall in a limited way. This is COVID-19, not COVID-1, folks,” Conway said. “You would think that people charged with the World Health Organization facts and figures would be on top of that.” In response to this startling statement of ignorance, Congressman Bobby Rush stated the following:
Dear Kellyanne, you seem to be confused, so let me break it down for you:
– : that’s a hyphen
19: 2019, the year the virus was discovered (no, there haven’t been 19 corona viruses).
President Trump, on the other hand, has called Covid-19 many different things from the China virus, to the Wuhan virus, and on June 24th:
President Donald Trump seemed confused about the origin of the “19” in COVID-19 during his rally in Phoenix on Tuesday night as he riffed on various names for the novel coronavirus. “I could give you 19 or 20 names for that, right,” Trump told the student attendees, who were gathered for a rally organized by Students for Trump. He went on to give several examples including “kung flu,” a racist term targeting China, where the virus was first identified, that perhaps received the loudest cheer from the crowd. He continued: “I said, ‘What’s the 19?’ COVID-19, some people can’t explain what the 19, give me, COVID-19, I said, ‘That’s an odd name.'”
No, it’s not an odd name. It’s a perfectly rational, sane, and scientifically accurate term for a novel new virus. Enough said; moving on.
From the World Health Organization (WHO) we find that the virus originally developed in Wuhan, China sometime in December, 2019 (perhaps earlier). In their findings, the WHO states the following:
While some of the earliest known cases had a link to a wholesale food market in Wuhan, some did not. Many of the initial patients were either stall owners, market employees, or regular visitors to this market. Environmental samples taken from this market in December 2019 tested positive for SARS-CoV-2, further suggesting that the market in Wuhan City was the source of this outbreak or played a role in the initial amplification of the outbreak. The market was closed on 1 January 2020.
Since then, scientists have determined that the virus has an ecological origin in bat populations which rules out conspiracy theories that it was man-made or intentionally constructed in a laboratory.
Many researchers have been able to look at the genomic features of SARS-CoV-2 and have found that evidence does not support that SARS-CoV-2 is a laboratory construct. If it were a constructed virus, its genomic sequence would show a mix of known elements. This is not the case.
Some readers will remember the Severe Acute Respiratory Syndrome (SARS) outbreak of 2003. This was another coronavirus called SARS-CoV-1, and it too, found its origins in bats. But these viruses did not directly infect humans from bats but first infected other animals.
For example, SARS-CoV-1 infected civet cats and then humans, while the virus causing the Middle East Respiratory Syndrome (MERS-CoV) is found in dromedary camels, and has continued to infect humans since 2012.
Currently, scientists are not sure what animal the bats infected which then transmitted the SARS-CoV-2 virus to humans. Some have proposed that it may be pangolins. For those of you who may have seen the movie Contagion, you will recall that the novel new virus in the movie developed when a bat dropped an uneaten piece of fruit into a pig pen which was then consumed by a young pig which then infected a chef who was Patient Zero who then passed it on throughout much of the human population worldwide.
Ethical Dilemma 1:
For over two decades my colleagues and I have been contacting Chinese and Canadian politicians in an effort to stop or at least curb the way in which such ‘wet markets’ operate in China. Aside from the different types of animals which are being offered at these markets and the manner in which they are treated, we have tried to bring attention to the fact that the history of agriculture in general is the central reason why such viruses are transmitted to humans in the first place.
Aside: In case you’re wondering, it was due to our ancestral domestication of animals around ten thousand years ago that has led to all of our seasonal colds and flus. If we were still nomadic, the rate of such maladies would hardly exist. But once humans and animals are in close contact, the likelihood of novel new viruses crossing over into human populations increases dramatically. Because of our close proximities to domesticated and wild animals, we need to become far
more conscious of what’s called ‘microbial ecology’ – that is, the relationships of multi-species pathogens at the very tiny level of causation i.e. at the level of bacteria and viruses. We must become ‘germ-aware’ not germ-a-phobic of how such pathogens arise and infect the human population. We are constantly in an arms race against mutating pathogens. And if we can understand them better and stay ahead of them, we win. Otherwise, the outcome can be catastrophic.
The ethical question that emerges from our understanding of the origin of this (and other) virus is whether or not one country has the right to tell another what they can and cannot eat – even if such practices pose world-wide catastrophic effects to other countries.
Controlling the Spread of the Disease
As we saw in my first paper, what makes the spread of this virus particularly difficult to contain is that a significantly large percentage of those infected with it, show no symptoms. This characteristic – the fact that carriers can be asymptomatic – is the single greatest reason we are all living under the conditions we now find ourselves.
We also noted that a global viral pandemic will always follow this exact pattern of reaction:
Testing, Isolation, Anti-virals, and Vaccine (or TIAV)
To return to our acronym – TIAV, let’s now look at each element in light of current information:
Basically, there are two types of tests available for Covid19: Molecular and Antibody.
Molecular Tests are also called nucleic acid detection/amplification tests and are also known as genetic, RNA (recombinant nucleic acid), or PCR (polymerase chain reaction) tests.
Antibody Tests – also known as serology (or blood) tests.
In Molecular Testing, nucleic acid amplification (RNA) testing requires respiratory samples from the patient because SARS-CoV-2 is a respiratory virus. And so nasopharyngeal swabs are most commonly used. And for those who have had one, the swab is shoved way – way, up the nose. Just ask Drake: “But yo, that test is uncomfortable though, they put that Q-tip all the way inside your thoughts!” Yes, Mr. Drake is quite right. In order to assure that a sample contains the virus, a swab must reach a person’s nasopharyngeal region (where your respiratory tract meets your throat). This is where the virus first attaches and begins replicating. So there might be some slight discomfort or, as Morpheus told Neo in The Matrix: “This might feel a little weird.” But then it’s over and you can wait a few days for your results.
The next part gets a little complicated:
Samples are then processed and tested for SARS-CoV-2 RNA. The test includes extraction of RNA from the patient specimen, conversion to DNA and PCR amplification with SARS-CoV-2-specific primers.
This ‘nucleic acid amplification’ reveals whether or not a patient is actively infected with SARS-CoV-2 by detecting the presence of characteristic sequences of SARS-CoV-2 genetic material (RNA) in respiratory samples of patients.
Molecular tests can yield a false negative result if the level of viral RNA in a particular sample is too low for detection, and results can be skewed if steps are not taken to ensure that the tests are performing properly in the first place. The American Society for Microbiology has developed step-by-step verification procedures to help labs develop efficient and effective verification protocols for commercial EUA [Emergency Use Authorization] COVID-19 diagnostic tests. These procedures will help ensure that data is accurate.
So if you have been tested for Covid-19, this is the type of test that will tell you if you are currently infected.
However, the antibody test is, in many ways, just as important because it informs scientists about who has been infected by the virus. This type of test allows us to better understand the extent to which a population has been infected.
Antibodies are naturally occurring proteins produced by our immune systems which respond to various types of pathogens or infections. When pathogens (disease causing organisms) enter our bodies, antibodies attach themselves to antigens on their surfaces. When the antibody attaches to or ‘binds’ to an antigen, its sole purpose is to disable, stop, or ‘kill’ the pathogen through various means.
With antibody testing, scientists can determine if SARS-CoV-2-specific antigens are mixed with a person’s blood. If so, the two will bind to one another, resulting in a color change that marks the test positive. In this way, scientists can measure the amount of antibodies produced in response to the SARS-CoV-2 infection and does not test for the presence of the virus itself. Such a test, therefore, does not indicate if a person is currently infected – rather, it measures if they have been infected.
Important Findings and Caveats:
Antibody testing reveals if a patient has been exposed to the virus but does not tell whether an active infection occurred, or whether the antibodies produced are the kind that can prevent another infection. Furthermore, it does not reveal how long protective immunity to SARS-CoV-2 infection will last if developed. If we can determine those things, they will help inform decisions about the safety of returning to normal activities.
There are several concerns regarding antibody testing. For example, such tests may yield a false negative result if the test is conducted too early and antibodies have not yet developed. As well, they can produce false positives if antibodies to coronaviruses other than COVID-19 are present (e.g., SARS-CoV and MERS-CoV). It is vitally important that such serology tests are carefully designed to determine specifically for the SARS-CoV-2 virus.
The value of such serological testing is to provide an understanding of the infection rates of the larger populations. This will assist in surveillance and tracking in an effort to control the spread of the virus.
Here is a good depiction of the two types of tests from the American Society for Microbiology:
Comparison of COVID-19 Molecular and Antibody Tests
Currently, the number one problem with Molecular Tests which diagnose active Covid-19 infections is the time delay in getting results. When the tests first began in March, it took Ontarians up to five days to get their results. Since then, the time to receive results has improved but it still takes anywhere from 2-3 days. And this is problematic for a number of reasons.
First, there is considerable stress produced in waiting for the results while being barricaded away from family members somewhere in a home, apartment, etc. And second, people can be negative during a test, and then contract Covid-19 between the test time and the day they receive their results. If the test comes back negative, but they have since become infected, they may unknowingly infect others. We have to decrease the response time for Covid-19 testing. Luckily, there are plenty of companies working on this right now.
On the Government of Canada’s website page: ‘Testing devices for COVID-19: List of applications under evaluation’, states that there are 43 companies that have developed fast-resulting tests: 16 DNA and 27 Serological. But there is a problem. Before such tests can be used, they need to be examined and approved by Health Canada, the FDA, etc., for Emergency Use Authorization (EUA). So if you go to the website, you will find that the status for all 43 testing devices is largely “Under Review” (or “Awaiting Response from Manufacturer”).
To date, I have contacted 4 of the 16 companies working on DNA or diagnostic tests (3 Canadian, 1 UK): Spartan Bioscience, Precision Biomonitoring, Hyris Global Diagnostics, and the Centre for Biodiversity Genomics (CBD). Spartan Bioscience released their devices over a month ago, but they were recalled due to issues with their swabs and so will be re-releasing their revised units shortly. When I spoke with Federico Baldo (Business Developer) at Hyris Global Diagnostics, he said that they “…expect to be close to getting approved but unfortunately with these matters you can never know for sure.” He also added that he would be pleased to inform me when they received approval from Health Canada. And in speaking with the Director of the Centre for Biodiversity Genomics, Dr. Paul Hebert, I learned that his team has developed a rapid results-producing and inexpensive Covid-19 test. Currently, the average cost for a Covid-19 test is around $40.00/test. Dr. Hebert’s team can produce a better, faster test for $1.00/test. When I spoke to Dr. Hebert recently he told me that his team’s progress has been impeded by university regulations. When I first spoke with the CEO of Precision Biomonitoring, Dr. Mario Thomas told me that his company was simply waiting for approval from Health Canada which he then described as “imminent”. When I questioned him about the device’s accuracy, he stated: “We know our system works very well…in blind testing it had an accuracy rating of over 98%.” During the very last stages of revising this paper, Dr. Thomas contacted me to inform me that his company had received approval from Health Canada. This is extremely encouraging news because, if successful, such devices could drastically reduce the number of infections within a given population. This is exactly the type of testing that is needed at this point in the pandemic. Let’s just hope there are many more such testing units produced to be massively distributed around the world and especially, to those places hardest hit.
Ethical Dilemma 2:
During a pandemic, when perhaps hundreds of thousands of lives are at stake, what should be the protocol for monitoring and considering new technologies? For example, what is the hold up with Health Canada? We all want to be assured that tests are accurate and reliable. But at the same time, we want to save lives. What is the ethical balance between the two? For every day delayed, thousands of lives are lost. But we can’t risk making the situation worse by rushing approval for devices that may be inaccurate.
In my next entry, I will definitely be contacting officials at Health Canada to learn more about their policies and procedures during a pandemic.
What is Still Needed: Rapid Response Testing
As I mentioned in Part I, the Holy Grail of testing for Covid-19 would be a fast and accurate home test that anyone could use. Right now, this doesn’t exist. But there are some companies working on making this a reality. For instance, in South Africa, Canary Health Technologies has produced a proto-type breathalyzer that is currently undergoing test trials.
If such testing units were to become widely available for public/private use, this would be a game-changer in a significant way. Governments could ease travel restrictions considerably; people could meet in larger gatherings; sporting events could return to some semblance of normalcy, etc. However, at this point in time, such devices simply do not exist. And there is a big gamble in developing such testing units. If, for example, these units took longer to perfect than a vaccine, then a lot of money in research and development will be wasted. However, if a vaccine is months or even years away, then such a device would be extremely effective in easing quarantine or travel restrictions.
The single greatest need at this point in the pandemic continues to be rapid, accurate, testing capabilities. Otherwise, isolation alone, would once again become our greatest defense. However, not everyone seems to be onboard with the value of testing. On June 21, 2020, in a less-than-half filled auditorium in Tulsa, Oklahoma, the President of the United States, Donald Trump, said the following:
“When you do testing to that extent, you’re going to find more people, you’re going to find more cases,” Trump said. “So I said to my people, ‘Slow the testing down, please.’ They test and they test.”
In what appears to be a direct flouting of consistency and logic, some members of Trump’s administration claimed it was said tongue-in-cheek while the President followed up by saying: “I don’t kid. Let me just tell you, let me make it clear.” Whether or not he was kidding, it was a ridiculous thing to say and undermines what every health official in the world has been calling for: massive increases in testing.
By using Critical Thinking, we can now state that, as a conditional, if any company could produce millions of fast and accurate devices for use around the world, then it logically follows that we will be better enabled to determine positive and negative cases and track infection rates much more accurately. This, in turn, will allow for the greater mobility of human populations.
Although isolation restrictions have eased in various places around the world, cases continue to rise in places like the US, India, Brazil, and others. Ontario has recently entered Stage II of reopening which allows various businesses to re-open, and gatherings of 10 people or less. Some believe this decision may be premature. Time will tell. What is important to consider at this point is how well people will remain vigilant in physical distancing and wearing masks.
In the US, a movement has begun which identifies the wearing of a mask as an impingement on human rights. As much as the Democrats and Republicans have been polarized on important issues, one more issue which has been added to the list is the wearing of masks for personal and public protection. Many on the left tend to side more with the expertise of scientists, public health doctors, etc., while many on the right tend to be somewhat suspicious of science and view the wearing of a mask as not only unnecessary but as a symbol of oppression. The evidence speaks for itself:
Though masks alone will not completely halt the spread of the virus, recent research has shown that wearing them is the most efficient way to stop its transmission. [Dr. Anthony] Fauci, at a recent talk, said everyone should wear a mask in public and it “should not be a political issue. It is purely a public health issue.”
Although this again appears to be another case of autonomy vs. paternalism i.e. how much freedom should the public have vs. how much control should the government exercise over them, whatever one’s political stripe, remember: Nature always wins. And the greatest defense we have against this virus right now is, and always will be, scientific knowledge.
Ethical Dilemma 3:
With Stage 2 of the Province of Ontario’s ‘Reopening’, what are the legal and moral ramifications for employers asking their employees to return to work? We were all informed at the start of the pandemic that nobody would lose their job as a result of self-isolating at home. But now that travel and activity restrictions have eased, what happens if someone still feels uneasy about returning to work? What measures are being taken to assure their safety? According to the Ontario Government’s report: A Framework for Reopening our Province:
Keeping workplaces, employees and the general public safe as Ontario gradually reopens is essential for making the reopening of the province a success. That is why we are providing people, businesses and communities with the guidelines they need to prepare for Stage 2. The government and its health and safety association partners have released more than 100 health and safety guidance documents for multiple sectors, as well as a guidance document for essential workplaces. These documents, available at Ontario.ca/covidsafety, will cover businesses able to open in Stage 2. More guidance will be available as Ontario continues to move through the next stages of reopening and recovery. To reopen safely, employers must review the workplace health and safety guidance and ensure that appropriate measures are in place. Employers must also meet all existing occupational health and safety requirements.
So these touch on the legal aspects regarding easing restrictions and gradually returning to work. But what about the moral/ethical considerations? What if someone is immuno-compromised? Or suffers from anxiety? Or simply doesn’t feel safe in such a workplace environment? What will be the new set of guidelines or policies and procedures for returning to work as we progress through the rest of this pandemic? Again, there are no easy answers, but just a few of the pressing questions we should start thinking about now.
By this point in the pandemic, I sincerely thought we would have had better, more rapid, and more accurate widespread testing available. I am disappointed that people continue to suffer and lives are being lost because we do not have these services up and running throughout the world. Hopefully, once Health Canada gives the ‘green light’ to some of the proposed testing devices, we can generate the much-needed testing at the facilities which require it the most: hospitals/clinics, retirement communities, prisons/penitentiaries, supply chains, food services, etc. Until then, unfortunately, all we can do is wait.
In my last paper, I had mentioned several developments involving anti-viral medications. Since then, we have discovered that President Trump has been taking the anti-malarial drug: hydroxychloroquine as a prophylactic i.e. preventive measure, to avoid contracting Covid-19. Although studies have indicated that there is no evidence that such a drug has a preventative effect on this particular strain of the coronavirus, when asked why he was taking the drug (along with zinc), Mr. Trump responded with the apparent argument: “I’m not gonna get hurt by it…Here’s my evidence: ‘What do you have to lose?’” All of Mr. Trump’s evidence is based on a rhetorical question regarding harm. In other words, he’s making us infer his conclusion which is: “He has nothing to lose.” Not only is this a false premise, for he could possibly lose his life due to heart or other complications, it is simply a factually false statement. If there was an award for an argument’s failure to satisfy any and all logical criteria, Mr. Trump would be the grand master in this case.
Ethical Dilemma 4:
What if, based on Donald Trump’s beliefs and actions that hydroxychloroquine should be taken because people have “nothing to lose”, some of his followers copied his behaviour and became seriously ill or died? For example, if people believe that hydroxychloroquine should be taken to ward off Covid-19 and as a result of side effects, die, should there be any legal or moral recourse against the President for spreading false and highly dangerous information? To consider this in some context, Trump’s actions were so stunning, that Fox’s own Neil Cavuto put out an Emergency Fox News Alert saying: “If you are in a risky population here, and you are taking this as a preventative treatment … it will kill you. I cannot stress enough. This will kill you.” So if the President’s actions and/or advice e.g. injecting bleach or shining UV radiating into one’s body, harms another person, is he morally blamable? Legally culpable? Both? Neither?
Although there is no compelling evidence that hydroxychloroquine successfully prevents people from contracting the Covid-19 corona virus, a recent major study in support of these findings was pulled from the leading science journal, The Lancet:
The online medical journal The Lancet has apologized to readers after retracting a study that said the anti-malarial drug hydroxychloroquine did not help to curb COVID-19 and might cause death in patients. The study was withdrawn because the company that provided data would not provide full access to the information for a third-party peer review, saying to do so would violate client agreements and confidentiality requirements, The Lancet said in a statement. “Based on this development, we can no longer vouch for the veracity of the primary data sources. Due to this unfortunate development, the authors request that the paper be retracted,” The Lancet said in a statement. The study was published May 22, with researchers from Brigham and Women’s Hospital in Boston using data and analysis provided by Surgisphere Corporation. The study was massive, with information coming from 671 hospitals around the world and the medical records of 96,000 patients.
It was concluded in the study that researchers found that hydroxychloroquine not only didn’t help prevent or ease the effects of Covid-19, it actually caused heart problems and increased the likelihood of death. This led the WHO and other agencies to stop research into its efficacy.
Keep in mind that the results of the study are not in question; simply the protection of private information of those in the study has stopped third parties from confirming or falsifying the findings of the study. In science, this is the responsible thing to do; even if it raises doubts or questions regarding the truthfulness of the study.
There has, however, been some encouraging news in the development of antivirals. In the last paper, I mentioned that the drug, Remdesivir, had passed various randomized placebo controlled trials with 1090 test subjects which demonstrate “…a clear-cut significant, positive effect in diminishing the time to recovery”. Since then, remdesivir has become a much-needed drug in reducing inflammation in patients suffering from Covid-19. Such a drug can reduce a patient’s time in ICU by up to five days and has quickly become a very popular drug world-wide; so popular, that Mr. Trump decided to buy up the world’s entire supply:
The US has bought up virtually all the stocks for the next three months of one of the two drugs proven to work against Covid-19, leaving none for the UK, Europe or most of the rest of the world. Experts and campaigners are alarmed both by the US unilateral action on remdesivir and the wider implications, for instance in the event of a vaccine becoming available. The Trump administration has already shown that it is prepared to outbid and out-manoeuvre all other countries to secure the medical supplies it needs for the US. “They’ve got access to most of the drug supply [of remdesivir], so there’s nothing for Europe,” said Dr. Andrew Hill, senior visiting research fellow at Liverpool University.
The Trump administration has purchased more than 500,000 doses of remdesivir from the manufacturer Gilead, which accounts for all of their production for July and 90% of their production for August and September. The patent for the drug is held by Gilead which means that no other manufacturer in the world can produce it.
Ethical Dilemma 5:
During situations like pandemics, to what extent should a major drug manufacturer prioritize who should receive their product or sell to the highest bidder? It costs billions to develop medications. So why should a company lose money by fairly distributing its product when they stand to make far more money for their stakeholders? And is there any ethical obligation for lessoning restrictions on their patent of the drug so that it may be produced in other countries? On the one hand, a drug company is in business to make money. On the other hand, they are involved in a humanitarian enterprise. There are no easy answers or solutions but when one country buys up an entire supply of a life-saving drug to the exclusion of all other countries, it does trigger our ‘fairness detectors’ and makes us wonder if such an act is ethically justifiable.
At this point in time, we have seen another drug make its way into the antiviral arsenal and it’s called dexamethasone.
Dexamethasone, a cheap, widely-available steroid, is the latest drug touted by experts in the UK as a possible treatment for COVID-19, with evidence suggesting that it can successfully reduce deaths from the virus by up to one third in severely-ill patients. After researchers at the University of Oxford announced the headline results on Tuesday – with the full results to be released later this month – the British government immediately authorised its use in treating coronavirus patients. It’s not the first time during the coronavirus pandemic – which has killed 438,000 people worldwide – that a drug has been touted as a treatment for COVID-19, famously by the U.S. President Donald Trump, who controversially tweeted that he was taking the anti-malarial drug hydroxychloroquine. Interestingly, it was the same researchers at Oxford that proved hydroxychloroquine did not work that suggested that dexamethasone could.
Although it is still fairly early in the pandemic, some scientists have said that this new treatment might be a game-changer in the treatment of those who have been most severely affected by the virus. By my next installment, we should know better as to the efficacy of this particular antiviral treatment.
Since my first paper, there has been quite a bit of research and development of vaccines for Covid-19. Although the re is a rigorous 3-phase procedure for developing and testing vaccines, scientists and healthcare experts are confident that one will be ready within the next six months:
COVID-19 vaccine candidates will enter late-stage clinical studies by the end of the month, with others beginning in August, September and October, the U.S. government’s top infectious diseases expert said on Thursday. The news comes as Moderna Inc, which is at the forefront of the country’s vaccine development efforts, reiterated earlier in the day that a late-stage trial with 30,000 volunteers would begin this month. “We may be able to at least know whether we are dealing with a safe and effective vaccine by the early winter, late winter, (or) beginning of 2021,” Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said in an interview to JAMA Network. Earlier on Thursday, Dr. Francis Collins, the director of the U.S. National Institutes of Health, said the Trump administration’s vaccine-acceleration program could generate a safe and effective COVID-19 vaccine by year-end.
But developing a vaccine for such a novel new virus like SARS-CoV-2 is not an easy task. And it takes time. Because we now live in what I have been calling the Age of Immediacy where information and options are available in seconds, the world has gotten in the habit of expecting medical breakthroughs to function like Amazon i.e. same-day shipping. But scientific research does not work this way. It takes time because we want to do things properly and safely. I am not sure who the above-mentioned 30,000 volunteers will be. But I do know that there is already a movement underway which brings together volunteers who wish to sacrifice their own bodies in an effort to speed up the testing trials of new vaccines. Known as ‘1 Day Sooner’ the movement is comprised of volunteers who want to engage in what’s called Human Challenge Testing which bypasses current ethical standards and safety measures in order to help with the development of a new vaccine. They believe that if they can help develop a vaccine one day sooner than it normally would have been, they will have saved thousands of lives. It is indeed a noble movement. But it leads to some ethical considerations:
Ethical Dilemma 6:
Should people be allowed to offer their bodies as ‘guinea pigs’ to be subjected to vaccination trials for Covid-19? Such trials would involve the injection of vaccines and then the infection of the SARS-CoV-2 virus in an effort to determine efficacy. It raises questions again of paternalism vs. autonomy i.e. who has the right to say what people do with their own bodies? If I could sell some of my organs to make money in some parts of the world, why can’t I offer my body as a trial host to speed up the development of a new vaccine?
Although the WHO does not sanction the wishes of such 1 Day Sooner volunteers, it did make a statement saying that if such testing were to be allowed, subjects would have to be healthy, between the ages of 18 and 30, use a safe dose of the virus i.e. one which causes illness but not severe disease, and test in secure facilities to avoid infecting others. To date, there has been no official approval of such Human Challenge Testing because as the WHO notes, there is no “escape treatment” which could rescue any test subjects if they became severely infected i.e. no one yet knows what a “safe dose” of the virus is.
With 38 vaccine trials currently underway around the world, we have little choice but to wait and hope. Many experts in the field of immunology believe that it’s not so much a matter of ‘if’ but ‘when’ such a vaccine will be available but currently can give no definitive estimated time of arrival. In March, Dr. Anthony Fauci stated that it would take a year to 18 months before a vaccine was available. Although we may see one developed before then, Fauci and Dr. Francis Collins (Director of the National Institutes of Health) recently stated in the journal Science that perhaps multiple vaccines may be needed in order to inoculate billions of people worldwide. We must also anticipate the possibility that even if a vaccine is developed and distributed worldwide, it is unlikely to be 100% effective. To put things into perspective the MMR (measles, mumps and rubella) vaccine is 97% effective in prevention and our seasonal flu shots come in at around 60% effective. Nonetheless, such a vaccine, combined with other protective measures e.g. physical distancing, mask-wearing, hand-washing, etc., should prove largely effective in defeating the virus throughout the world.
Recommendations – What Needs to be Done Now:
What the world needs right now is the development and distribution of hundreds of thousands of portable, fast, and accurate testing devices throughout the world – especially those countries most affected. Within our own province and country, all hospitals, retirement homes, police, ambulance, and fire stations, all supply side and food distributors and processors, migrant workers, borders, airports, bus stations, etc., must be equipped with such devices as soon as they become approved.
REMEMBER: This virus spreads largely because of people who are asymptomatic–which represents anywhere from around 20% to 50% of the population. And the only way to determine who has the virus is through proper testing. People who feel well, but are infected, run the risk of infecting hundreds of others. Until we have the appropriate number and types of testing devices in place, we have no choice but to rigorously practice physical distancing, isolation, and wearing masks.
I am deeply concerned that many countries around the world – especially in the northern hemisphere – are lifting isolation restrictions too much and too quickly. This will invariably lead to the spiking of cases in specific parts of the world. We are unfortunately seeing this occur in many states in America. When the warm weather and sunshine of the summer arrives, many people are naturally drawn to the outdoors. Psychologically, we subconsciously think that the summer is not a time of the year to be sick. And we’ve heard that the Covid-19 virus doesn’t survive as well in warmer weather. Combine this with the fact that many people are facing what has been called ‘quarantine fatigue’ along with the recent #BLM protests, and you have the perfect storm of causalities which will, unfortunately, lead to a considerable spike in cases.
Ethical Dilemma 7:
With the recent death of George Floyd, many people around the world took to the streets to protest against black racism and injustice. While the world applauds the right to assembly and protest, we must also keep in mind that this (or any) virus doesn’t care about human rights. It doesn’t care about anything. It’s simply a small, replicating, machine which needs biological hosts to reproduce. No matter how noble our causes, SARS-CoV-2 doesn’t care one bit about our politics. And so we are left with another ethical consideration regarding the delicate balancing act of allowing massive assemblies of people vs. the avoidance of physical contact. Once again, this is another example of autonomy vs. paternalism. That is, we want people to be free to demonstrate their rights and to be able to assemble and protest. But in so doing, how many more lives might be lost due to the spreading of this virus? How do we balance the right to peaceful assembly with the various pandemic conditions placed on physical distancing?
Let’s never forget that now, more than ever, it is time to use our prefrontal cortexes rather than our limbic systems. During these stressful and difficult times, we need to think critically, not emotionally, about our next steps. And we must be vigilant in using Critical Thinking and Ethical and Scientific Reasoning in meeting and resolving our challenges. For these are the systems of thought that will save lives and get us through this pandemic. Let us not forget this when we get to the other side.
 PCR is a laboratory technique which can make many copies of a specific segment of DNA. It is a very precise technique and can be used to amplify, or copy, a specific DNA target from a mixture of DNA molecules. This helps to determine if specific pathogens (like viruses) are present.
There is perhaps no greater time in history to think critically than during a world crisis. But what is ‘Critical Thinking’? And why is it important; especially now? Many CEOs, politicians, world leaders, and educators champion its importance, but very few know what it actually is. So allow me to be clear: Critical Thinking is comprised of a set of tools or skill set that teaches us how to carefully, reflectively, and analytically interpret, understand, and act on information.
There really are better and worse ways to think about information
Critical Thinking allows us to distinguish between fake news and
information; and then to make valid inferences or conclusions based on that information. Although the Critical Thinking skill set can point us in a direction regarding what to think, it is primarily a set of guidelines initially assisting us in how to think about information.
The ABC’s of Critical Thinking
These guidelines include tools for the responsible collection of data and information which can be stated in the form of convincing arguments. They also include a greater capacity to acknowledge biases – both within ourselves – and within others, which may affect the way in which information is presented or interpreted. As well, Critical Thinking tools train us to understand the context in which information is housed so that it is reflected faithfully and without the omission of important back-story elements. Critical Thinking skills also allow us to better understand how evidence plays a key role in supporting arguments. And finally, one of the most important tools in the Critical Thinking skill set is the ability to recognize and call out errors of reasoning known as fallacies. When political leaders favour personal biases which contradict scientific evidence, we should recognize these fallacies for what they are – irrelevant, unfounded, emotional, self-serving, and often, dangerous.
How to Critically Think About Covid-19
Having acknowledged the importance of the Critical Thinking skill set, how should we be thinking about information regarding Covid-19? First and foremost, we need to start with information that has been attained responsibly and reliably. We need to familiarize ourselves with relevant contextual and background information that is evidence-based rather than simply based on opinion.
Although no news service can be completely free of bias or vested interest, there are many reliable resources available to choose from including:
BBC News, ABC, NPR, The Economist, The Wall Street Journal, Google News, NBC, The Guardian, CNN, PBS, NASA, Scientific American, Popular Science, Real Clear Science, Discovery, Nautilus, and National Geographic.
There are various other online resources that one might find useful to fact-check or further research information regarding a particular issue: Snopes, Pressbook: Web Literacy, Politifact, Factcheck.org, Washington Post Fact Checker, Truth Be Told, NPR Fact-Check, Lie Detector (Univision, Spanish language), Hoax Slayer, Climate Feedback, SciCheck, Quote Investigator, FactsCan (Canada), El Polígrafo (Mexico), The Hound (Mexico), Guardian Reality Check (United Kingdom), BBC Reality Check (United Kingdom), Full Fact (United Kingdom), mediabiasfactcheck.com, civilination.org, domainbigdata.com, and newswise.ca.
This list is not meant to be exhaustive of the resources available; rather, it illustrates some of the helpful and trusted sites that one may access in determining the reliability and truthfulness of information.
When it comes to knowledge – that is knowing what is true from what is mere speculation, our epistemic states of being could not have been summed up better than, believe it or not, Donald Rumsfeld. As Defense Secretary for George W. Bush, Rumsfeld summed up all possible epistemic states regarding any object of knowledge. He said:
“There are known knowns. There are things we know that we know. There are known unknowns. That is to say, there are things that we now know we don’t know. But there are also unknown unknowns. There are things we do not know we don’t know.”
Even though he was wrongly ridiculed for making these statements, his pithy depiction of epistemic brevity captures brilliantly what we should be asking ourselves with every issue we face. We should always begin with what we know, then proceed to consider what we know we are ignorant of i.e. reflective ignorance, and finally, we should be cognizant of the fact that our level of ignorance extends more deeply to the point of oblivion i.e. blind ignorance or not even being aware of what we don’t know. This is a healthy way to approach knowledge acquisition while working through uncertainty.
In regards to the latter epistemic state, David C. Logan pointed out that:
Much scientific research is based on investigating known unknowns. In other words, scientists develop a hypothesis to be tested, and then in an ideal situation experiments are best designed to test the null hypothesis. At the outset the researcher does not know whether or not the results will support the null hypothesis. However, it is common for the researcher to believe that the result that will be obtained will be within a range of known possibilities. Occasionally, however, the result is completely unexpected—it was an unknown unknown.
Sometimes referred to as ‘serendipity’, every now and again, scientists discover something completely novel that they never anticipated. This leads to the discovery of an unknown unknown. But let’s start at the beginning: what do we currently know about this particular virus?
Currently, we now know that Covid-19 is a novel new form of Corona virus which has passed from one animal species (probably bats) to another, and is using human beings as hosts which has unfortunately spread itself around the world due, in large part, to air travel. We first learned of its origins stemming from Wuhan, China. For various reasons – due both to human ignorance and political bureaucracies – the virus was not contained at its point of origin and has spread rapidly through populations causing a global pandemic.
What makes the spread of this virus particularly difficult to contain is that a significantly large percentage of those infected with it, show no symptoms. This characteristic – the fact that carriers can be asymptomatic – is the single greatest reason we are all living under the conditions we now find ourselves.
Now that we are faced with the extremely daunting tasks of avoiding or containing further infections while trying to develop ways to destroy or prevent further spreading of this pathogen, a global viral pandemic will always follow this exact pattern of reaction:
Testing, Isolation, Anti-virals, and Vaccine (or TIAV)
If you can remember the acronym TIAV, you will forever remember the order in which humans will always react to viral pandemics. Let’s look at each element of the acronym.
Due to the fact that we know carriers of Covid-19 can be asymptomatic, it has become vitally important to develop accurate tests which determine infections in real time. In various parts of the world, testing for signs of infection require people to wait for their results over a five day period. It doesn’t take much critical thinking to realize that this is far too long a time period if we wish to know accurate numbers of infections in real time. For example, based on such a system, person A could be tested on one day and produce a negative result, and then contract the virus between the test date and the result date thereby making the results of the test extremely ineffectual and potentially dangerous.
Luckily, there are new tests being developed and used to quicken the results. In Canada, the company Spartan Bioscience is producing millions of units to quicken the diagnosis time of testing. But not all countries have such tests; and some tests may not be as accurate as others. So in case you’re wondering why some countries – like Singapore and South Korea – seem to be ahead of other countries in ‘flattening the curve’ of their outbreaks, it’s because they conduct massive testing which provide results much more quickly. This allows officials to more accurately know and track those who are infected and those who are not. This, in turn, can allow for greater autonomy or social movement within various communities.
At this point in time, we know that Spartan Bioscience has developed portable DNA testing devices which were recently approved by Health Canada. These devices can apparently provide accurate tests for Covid-19 in less than an hour.
By using Critical Thinking, we can now state that, as a conditional, ifSpartan Bioscience (or any similar companies producing fast results) can produce millions of these devices for use around the world, then it logically follows that we will be better enabled to determine positive and negative cases and track infection rates much more accurately. This, in turn, will allow for the greater mobility of human populations. But – and this is a very big but – we can only increase human mobility if we have such accurate testing capabilities. Otherwise, isolation alone becomes our greatest defense.
Without such quick and accurate testing, our greatest defense against such a pathogen is isolation. By keeping populations isolated, we can slow the transmission of the virus and limit the increase of infections which will, in turn, ease the burden on hospitals faced with increasing numbers of advanced or critical cases. Trying to isolate massive populations, however, is not an easy task; and our current world population does not have much experience in doing so. There are many people – from essential services, to the homeless, to those who simply ignore the dangers of infection – who are susceptible to contracting the virus.
Autonomy vs. Paternalism
This raises the very interesting philosophical and political issues of autonomy versus paternalism. In other words, how much freedom should individuals have versus the State’s right to act like a parent and restrict their freedom? In Wuhan, China, and other countries around the world, strict isolation was enforced. However, in the US, individual states have controlled the amount of autonomy individuals have.
The most important inference to make here is that without accurate testing with real time results, isolation is our only tool by which to lower the rate of infection and ‘flatten the curve’. By using Critical Thinking, we can logically infer, then, that once a faster type of testing is available, we will begin to see a lesser need for isolation and a gradual loosening of travel restrictions on citizens.
By using the skill set of Critical Thinking, we can now infer that, at this point in the pandemic, there are three – and only three – reasons for easing isolation restrictions:
Testing: By conducting massive and accurate testing in real time to track infection populations.
Anti-Virals: The development of novel drugs which either cure outright or severely limit the damaging health effects to those who contract the virus.
Vaccine: The development of a novel vaccine which will prevent people from becoming infected by the virus.
It logically follows that the first wave of attack against the virus will be the development of accurate and effective tests. As mentioned above, this will allow epidemiologists to more accurately determined and track rates of infections and where those infections are occurring within a given population. This will then provide a more accurate picture of how and when personal isolation can gradually and strategically be lifted.
The next advancement in the war against Covid-19 will be the development of novel anti-viral medications. Currently, there are hundreds of trials being conducted worldwide to determine which drugs – or combinations of drugs – are effective in fighting this particular strain of Corona virus. Naturally, the world wants a cure as soon as possible. But we must be careful and vigilant in knowing which drugs work and especially, which ones do not. President Trump has been championing Hydroxychloroquine (a malaria drug) to combat the virus. But studies have demonstrated that it is not very effective and can actually have harmful side effects to patients – especially those with underlying heart conditions.
Japan’s Prime Minister, Shinzo Abe, has stated that research is being conducted on Avigan (or favipiravir), an antiviral drug developed by a domestic firm (Fuji Film) that has been effective in treating COVID-19 patients. He has even gone so far as to give Fuji Film the go ahead to produce millions of pills. The problem, however, is that there is no definitive knowledge of its effectiveness and there are some bad side effects – including birth defects.
As much as we emotionally want to bring help to those suffering – and about to suffer – from the virus, the skill set of Critical Thinking trains us to ‘step back’ from our emotions to carefully and more reflectively consider how we should proceed. And this means that, at this point in the battle, any drug or vaccine development must go through stringent testing. In my latest book, I state that there are several phases for determining a drug or vaccine’s effectiveness, or efficacy, which must be carried out before such treatments ever make it to world-wide distribution and use:
Phase I: First of all, studies are initially conducted to learn about the dosages required to produce a response in the human body and about how the human body processes the drug and to learn whether the drug produces toxic or harmful effects and at what dosages.
Phase II: Second, a drug under consideration will be tested on a group of patients who have a specific disease. At this point, the drug is not a treatment per se but rather is the object of study to determine any benefits, side effects, and so on. If there are no benefits, the study stops. If there are benefits, researchers move on to Phase III.
Phase III: Finally, at this point, the intent of the drug experiment is to introduce a lasting beneficial change in the patients participating in the study with the intent to prevent or reverse the progression of the disease. There is a specific strategy involved in treatment experiments with patient participants at this stage.
For vaccine research, there are often Phase IV trials which occur after successful development at the prior three phases. This phase utilizes post-market surveillance studies to consider any and all potential adverse events with regular reports by the manufacturer to the Vaccine Adverse Event Reporting System (VAERS)  to quickly and effectively identify potential problems after use in the population begins.
During the various Phases of drug research, scientists are utilizing the Controlled Clinical Trial. Clinical research on drugs or surgical treatments are undertaken in order to provide answers to specific questions such as these:
Will this treatment prevent or remedy a particular disease?
Will this treatment do more good than harm to patients with this particular disease?
Will this treatment do more good than available alternative treatments?
The central idea behind controlled clinical trials is to reduce bias in order to maintain objective, reliable observations. If scientists are not careful, their own biases can skew their understanding, rendering research useless thereby creating a false belief that ineffective or harmful treatments are therapeutic when in fact, they are not. The purpose for establishing a clinical trial is to determine the effectiveness of a therapeutic treatment. The word ‘trial’ indicates that there is a comparison between two or more potential outcomes.
Sometimes the outcomes compared are null, or to consider the option of having no therapeutic treatment. At other times, trials may involve comparisons between current and newly developed treatments. In the case of the latter, the goal of the trial is to determine which treatment is superior to another in, say, safety or effectiveness. The word ‘controlled’ refers to the comparative null set or group that receives no therapeutic treatment. It is often the case that a control group will receive a placebo rather than the actual treatment in order to compare the outcomes or effects of the study group. So there are often two groups that have a particular ailment. One group will be given a new therapeutic treatment, while the other group will be given either a placebo or competing drug.
The most important aspect of such studies is that they are blinded. This is a creative and novel use of what we might call ‘enforced ignorance’. Researchers deliberately single-blind or double-blind their experiments in order to maintain objectivity when compiling and later reading data.
Controlled clinical trials in which the patients do not know what group they are in are known as single-blinded studies. However, when neither the patients nor the administrators of the test know which group they are in, the study is said to be double-blinded. The purpose of blinding a clinical trial is to limit bias on the part of the administrators. In other words, if neither the administrators of the test nor the subjects know who is in which group, this will ensure greater objectivity in determining the effectiveness of the treatment. Only the lead researcher knows who is in the control group and who is in the test group. By blinding the administrators and the subjects of the trial, the lead researcher can prevent bias on two levels: at the level of the participants and at the level of the administrators.
Currently, throughout the world, there are hundreds of drug and vaccine trials being carried out. The greatest obstacle in determining what potential treatments are safe and effective is time. Right now, the world just wants to get back to normal. However, scientists cannot simply speed up the process of trials because, in so doing, they may approve a drug or vaccine which either doesn’t provide results or perhaps can even make things worse.
Since vaccines take much longer to develop, we can logically infer that an anti-viral treatment will likely be developed sooner than a vaccine. Should a successful antiviral treatment develop over the next few months, it will help to flatten the curve considerably. It will also provide hope for those who suffer most from the harmful effects of the virus. This, in turn, will help buy some time for those front-line staff and ICU hospital workers until a vaccine can be developed.
Unless and Until – The New Normal
One final aspect to consider: unless and until a safe and effective vaccine is developed, the world will be forced to live according to a new ‘normal’. Travel restrictions can conceivably be loosened with proper testing and anti-viral drugs. However, we will not get back to a pre-Covid-19 existence until all humans can be protected from the virus. And Critical Thinking allows us to infer that there are limited ways that this can happen: either the virus will be eradicated naturally from the world – as we saw with SARS and MERS; or there will be global inoculations through vaccinations to prevent the contraction and spread of the virus – or perhaps, a combination of both will occur simultaneously.
Recommendations – What Needs to be Done Now:
Accurate testing and tracking in real time needs to be set up as soon as possible at all of the following locations:
Telecommunications and IT infrastructure/service providers
Agriculture and food production
Resources and Energy
At each one of these facilities (and more), testing must be done consistently so that identification of infection can be accurately determined, tracked, and controlled. Without such testing, easing isolation restrictions will undoubtedly lead to a second or third wave of infection rates.
When you read or watch a media report claiming that a country is taking precautions by taking peoples’ temperatures, red flags and alarms should go off in our heads. And this is because a large percentage of people who are infected with the virus are asymptomatic – they experience and display absolutely no overt effects from virus – like fevers, body aches, tiredness, etc. Therefore, using our Critical Thinking skills, we can logically infer that testing for physical symptoms will only do a partial job of identifying and tracking viral infections. So if we simply let all people without symptoms move about within a given society, we will continue to see a surge or increase of affected cases. This is why accurate testing in real time must be done excessively and redundantly. Without a vaccine, it is literally the only way we can be sure of infection rates. And we should not limit isolation unless and until we can test at this level.
Conclusions and Caveats:
One final aspect to consider is human population behaviour once isolation restrictions have been lifted. Currently, some people – particularly in the US, but there have been some Canadians – who have begun picketing in protest of the ‘lock-down’. They are demanding that the travel bans and home isolation orders be lifted so they can return to their ‘normal’ lives.
There are obvious and great problems with these gatherings. Such gatherings will only worsen the spread of the virus which will inevitably and ironically, lengthen the time people have to self-isolate. Part of the reasoning behind such gatherings is that the virus is no more deadly than the common seasonal flu; and that we should just let it ‘run its course’. This is sadly misguided. What we do know is that Covid-19 kills, on average, ten times as many victims as regular flu strains. So it definitely is more dangerous.
Alone and Isolated
And finally, what many do not realize is the horrific way in which this particular virus takes lives. Because of the nature of the disease – its transmission, the likelihood for contagion, its pathology, etc. – those who suffer worst from the virus, usually die alone and isolation. And because of our current state of world-wide self-isolation, funerals and burials have been restricted which has severely affected the grieving process for millions of people worldwide. The long term effects this will have on loved ones will be felt strongly and for years to come. So we should be preparing our mental health experts to anticipate an increase in therapeutic need when the world emerges eventually and successfully from this pandemic.
Now, more than ever, it is a time to use our prefrontal cortexes rather than our limbic systems. During world crises, we need to think critically, not emotionally, about our next steps. It is my great hope, that when this world, our country, and our neighbourhoods return back to some level of normalcy, we will not forget how this happened or how we overcame it. We must continue to strive to put Critical Thinking at the forefront of our education and political systems at all levels. These are the skills needed at any given time in our lives. But they are most needed when we commonly face a world-wide crisis.