Less fundamentalism and more scientific methods

A survey among Latin American doctors, conducted by the organization FINE (fine-research.com), provides suggestive elements on how doctors view the pandemic. In the case of Argentina, the sample reaches 414 primary care and specialty doctors who attend to at-risk populations (oncologists, rheumatologists, infectious disease specialists, cardiologists, endocrinologists, etc.). The data are not necessarily representative since it is an online survey that is answered by the physician who wishes to do it, therefore not a randomized sample. In any case, they provide very interesting indications.

Among the main results, 87% of doctors think that the measures taken by the national government are fair. 60% think that the population is little or not aware at all in how to face the pandemic. When asked about the effectiveness of different measures, the one with the most votes was “mandatory national quarantine”. Certainly, these impressions may be influenced by their opinion of the state of the health system. It is striking that 90% consider that the infrastructure of intensive care, respirators, personal protective equipment, supplies, etc. is not adequate and will collapse within 1 month.

Against this background, they are asked the following question: “In your expert opinion, in how many days will the situation be under control and will the population be able to resume its activities? The answers were:

• 28% opined that over the 2 months.
• 58% opined than 2 months of which almost half advise more than 4 months.
• 14% said they had no idea or preferred not to respond.

These data suggest that most doctors think that the population should be confined for more than 2 months. This medical opinion clashes with the reality that the majority of the population cannot endure such an extension of the isolation. Many, because they are left without income, and the rest because their mental health will be affected by sadness, depression, worsening addictions, family violence and deteriorating health due to poor diet and lack of routine or recreational physical activity.

The extreme positions are based on the total ignorance of the advance of the virus and the certainty that the hospital infrastructure has limits. That is why the countries that took the pandemic most seriously tend to attenuate ignorance by carrying out mass tests. Without going too far, Chile tests 57 out of every 10,000 inhabitants and Uruguay 34 out of every 10,000. Argentina, on the other hand, tests 7 out of every 10,000. Such a level of darkness exacerbates panic and extremism. In this context, it is very paradoxical that 43% of the doctors surveyed minimize the importance of mass testing. As said, although the survey is not representative, it is worrying that among the responding physicians the rejection of evidence-based medicine prevails.

Health policies need to be interdisciplinary. Epidemiology experts should match strategies with contributions from other disciplines such as engineering, economics, mental health, sociology, political science, communication science, etc. In the short term, extreme actions guided exclusively by medical criteria are tolerable. But not taking advantage of this time to enrich the analysis and the design of the strategies with more information and inputs from other sciences will cause more damage than the pandemic. The most obvious is that, without an orderly flexibilization, deconfinement will be spontaneous and anarchic with risks of greater contagion.

Using health arguments to impose on people over 70 the obligation to ask permission to go out or to advise the population to stop having physical contact in sex, not only borders on the ridiculous, but is a very dangerous precedent to the temptations of restrictions and invasions to people’s freedom and privacy. These approaches can only be explained by the panic generated by ignorance. The alternative is to confront the pandemic with objective information and scientific methods.