In the UK, the relatively swift availability of vaccines against SARS-CoV-2 – the causative virus of COVID-19 – has prompted a glimmer of hope. But one corollary of the wave of optimism sweeping the country has been the widespread view that those who voice concerns over aspects of the conduct of COVID-19-related science are cynics who somehow deserve moral censure rather than engagement in debate.
So, it is timely that Bramstedt (2020) has drawn attention to what she has termed the ‘carnage of substandard research during the COVID-19 pandemic’, citing over 1200 COVID-19-related studies undertaken worldwide. Significantly, her paper is in a journal devoted to medical ethics. As of 31 July 2020, she notes that 33 papers were retracted, withdrawn, or had elicited expressions of concern, with 29 papers associated with data falsification, methodological issues, concerns about data interpretation, and authorship and participant privacy issues (Bramstedt, 2020). Meanwhile, the concerns of Doshi (2020) are summarised in the title of his piece ‘Will covid-19 vaccines save lives? Current trials aren't designed to tell us’, with Johnson et al (2020) debating whether treatments and vaccines should be recommended in the absence of transparent, publicly available data. And with Godlee (2020) pointing out how ‘poor study designs are exacerbated by a cacophony of endpoints and treatment durations, fuelling confusion and sensationalism …’ her assertion that ‘only new thinking and new leadership will ensure that researchers harmonise outcome measures, share data, and test the treatments with the most clinical (rather than financial) promise’ should give pause for thought.
Some readers may judge that the authors cited above are taking unnecessarily bleak views of the unfolding COVID-19 research landscape, in which case I would disagree with them. On the contrary, science is not above disputation. Indeed, once the experiments are completed and the data generated, meaningful public debate cannot be conducted by equation but in the language of the humanities, where the concept of objectivity does not reign supreme. Teleology – or reasoning from purpose – is commonplace in both science and the humanities. As the philosopher Mary Midgley (1992) observed: ‘Purpose-centred thinking is woven into all our serious attempts to understand anything, and above all into those of science.’
Meanwhile, patiently awaiting our turn in the COVID-19 queue for vaccination gives health professionals an opportunity to ensure that their nutritional health, and that of their patients, is as robust as it can be, given that metabolic health is an important determinant of how successfully a SARS-CoV-2 infection can be overcome. For example, Izzi-Engbeaya et al (2021) not only cite evidence that people with diabetes are over-represented in studies of patients with COVID-19 but they also demonstrate that in a large cohort of COVID-19 patients admitted to three London teaching hospitals, ‘diabetes is associated with increased risk of admission to intensive care unit and/or death within 30 days of diagnosis of COVID-19’.
Birgisdottir (2020) also highlights the importance of good nutrition during this pandemic, singling out vitamin D and advising on the value of ensuring ‘adequate vitamin D status, such as through guideline-directed supplementation, while also taking into account special conditions and common risk variants such as skin colour and even obesity …’. More particularly, following their meta-analysis of 10 articles with 361 934 participants, Liu et al (2020) found that COVID-19-positive patients have a higher incidence of low vitamin D concentrations than COVID-19-negative patients; that COVID-19-positive patients have lower vitamin D concentrations than COVID-19-negative patients; and that vitamin D supplementation may be beneficial in preventing and treating COVID-19, ‘although formal proof for an effect remains to be determined by randomized controlled trials’ (Liu et al, 2020).
Simple measures, like good nutrition, physical exercise and sleep are well-documented immune-boosting factors. And while COVID-19 studies continue apace, I agree with the cautious approach of Dinis-Oliveira (2020), who warns that society will not benefit from early findings if they are weak, widely publicised, and possibly incorrect, yet form the basis of healthcare policy responses to COVID-19. Dinis-Oliveira (2020) further acknowledges that while scientific research has changed the world, it needs to change itself: ‘A pandemic with a “paperdemic” will be even more complicated to manage if it progresses in an uncontrolled manner and is not properly scrutinized.’