A little misinformation is a dangerous thing, writes Terry Maguire
One aspect of the Covid-19 pandemic is the steep rise in associated myths. This is not unusual. In time of crisis, we all cling to what we believe and we believe new things more easily; these certainties give us security and hope. Indeed, government in its Covid-19 messaging is itself controlling our behaviour in what I believe to be a more or less responsible manner. Scaring us into staying home and normalising this behaviour is key to their public health strategy that will assure that the virus finds it very difficult to spread within the population.
Science is most reliable when all the data are known. In this fast-moving pandemic, it is not possible to know all the data, so estimates are made for the models used to extrapolate and from these extrapolations, we get best-case and worst-case scenarios, which can seem very scary indeed. Minister Swann announced last week the likelihood of 14,000 deaths in NI, while at more or less the same time in the RoI, Leo Varadkar was quoting 1,000 deaths for his population. Minister Swann this week revised his mythical figure down to a maximum of 3,000; still high by most models. Controlling the message in a period of social crisis is clearly very important as the myths created, and the behaviours they stimulate, can be more dangerous than the infection itself.
What is less acceptable are the myths emerging mainly from social media, but also from mainstream media, based on flimsy data and poor science and which cause people to behave in potentially dangerous ways. These myths have their origins in pseudoscience and stem from abuse of existing scientific data or speculation on half-baked ideas.
Iran has suffered particularly severely from Covid-19. It is also now dealing with a nationwide ethanol poisoning epidemic. High-strength alcohol (ethanol) is widely reported in Iran to be a cure for Covid-19. Ironically, in a Muslim country where alcohol is of course banned, they had more alcohol deaths than Covid-19 deaths in one week.
Donal Trump, in one of his extraordinary — they are never ordinary — press conferences extolled the potential efficacy of the antimalarial drug chloroquine in treating Covid-19. Based on this, a couple in Arizona overdosed attempting to use the drug prophylactically against the disease, with one of them dying.
Less worrying perhaps are the myths that drinking cow urine, lemon juice and hot water frequently are sure-fire ways of avoiding this viral infection. It should be noted that these are three separate myths and not the recipe for a pandemic smoothie.
And the myths can get very complex and appear to be plausible science. If we get further data, they might be shown to be correct but in the absence of data, these are potentially the most pernicious myths.
A few weeks ago Olivier Véran, the French Health Minister, who is also a GP, claimed that ibuprofen, which pharmacists and GPs were promoting to alleviate symptoms of Covid-19, may aggravate the infection.
The origin of this was a report from a French doctor who found four Covid-19 deaths where there was no apparent underlying medical cause and the patients were not elderly — one was 20 years of age. The only common association for these atypical patients was an unspecified use of non-steroidal anti-inflammatory medicines, of which ibuprofen is one. With a health minister making this claim, it has been taken seriously. Other doctors have commented that anti-inflammatory drugs may dampen the body’s response to infection, slowing recovery. This is purely speculative and is not supported by evidence. There was further speculation that ibuprofen causes a process in the body that leads to pneumonia, a severe result of Covid-19 which can lead to death. Public Health England admitted there is “not currently enough information on ibuprofen use and Covid-19”, but that patients should not be put off using it. The real worry was that this warning extended to cortisone, which of course we used to manage asthma. There was a need to tell patients not to stop using their preventor ‘steroid’ inhalers.
Sir Patrick Vallance, the UK chief scientific advisor, when asked about the risk of ibuprofen use in cases of Covid-19 was blunt, saying that there was no evidence ibuprofen aggravated Covid-19 but then went on to invoke the precautionary principle, saying that since paracetamol is available, then why risk taking ibuprofen. Ibuprofen, which was going to be a major symptom treatment for uncomplicated Covid-19, was dead.
Another part of this story was more worrying still. For years there had been speculation that certain drugs used to manage chronic diseases stimulate the production of ACE2 receptors on cells, particularly cells lining the nose and throat. SARS-CoV-2, the virus that causes Covid-19, appears to enter cells using this receptor. Myriad drugs increase ACE2 receptors; lisinopril, a commonly used antihypertensive drug, some antidiabetic medicines and anti-inflammatories such as cortisone and ibuprofen.
Looking at excess deaths from China and the association between comorbidities and death rates, it is clear that the ‘underlying health condition’ association is real. Some are already speculating that this may not be a problem of advanced age and disease in patients succumbing to Covid-19, but rather a problem of the drugs patients have been taking for years to manage their chronic conditions. Have people taking these drugs got cells with more ACE2 receptors which are now allowing this, on average not a very dangerous virus, to behave very dangerously indeed? This is an important question but in the current crisis, it risks becoming a myth that may stop people using the medicines essential to their long-term health.
Ironically, that would potentially kill many more than this tetchy virus will do over the next few weeks.