John P. A. Ioannidis, Professor of Medicine and Health Research at Stanford University, is among the ten most quoted scientists in the world, according to the Einstein Foundation. A Professor of Epidemiology at Stanford University and a regular lead speaker at conferences on research integrity and evidence-informed policy and practice, he has just published a notable paper in the European Journal of Clinical Investigation. Citation, abstract, problems, and conclusion below.
CITATION: Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based measures
John P.A. Ioannidis. Eur J Clin Invest. 2020 Mar 23:e13223. doi: 10.1111/eci.13223
https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222 (note this article has been accepted for publication and undergone full peer review but has not yet been through the copyediting, typesetting, pagination and proofreading process)
The evolving coronavirus disease 2019 (COVID‐19) pandemic1 is certainly cause for concern. Proper communication and optimal decision‐making is an ongoing challenge, as data evolve. The challenge is compounded, however, by exaggerated information. This can lead to inappropriate actions. It is important to differentiate promptly the true epidemic from an epidemic of false claims and potentially harmful actions.
Problems with early estimates and responses to the COVID-19 epidemic
- A highly flawed non-peer-reviewed preprint claiming similarity with HIV-1 drew tremendous attention; it was withdrawn, but conspiracy theories about the new virus became entrenched
- Even major peer-reviewed journals have already published wrong, sensationalist items
- Early estimates of the projected proportion of global population that will be infected seem markedly exaggerated
- Early estimates of case fatality rate may be markedly exaggerated
- The proportion of undetected infections is unknown but probably varies across countries and may be very large overall
- Reported epidemic curves are largely affected by the change in availability of test kits and the willingness to test for the virus over time
- Of the multiple measures adopted, few have strong evidence, and many may have obvious harms
- Panic shopping of masks and protective gear and excess hospital admissions may be highly detrimental to health systems without offering any concomitant benefit
- Extreme measures such as lockdowns may have major impact on social life and the economy; estimates of this impact are entirely speculative
- Comparisons with and extrapolations from the 1918 influenza pandemic are precarious, if not outright misleading and harmful
If COVID-19 is indeed the pandemic of the century, we need the most accurate evidence to handle it. Open data sharing of scientific information is a minimum requirement. This should include data on the number and demographics of tested individuals per day in each country. Proper prevalence studies and trials are also indispensable.
If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future.
Best wishes, Neil
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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG firstname.lastname@example.org