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Original research article, covid-19: scientific arguments, denialism, eugenics, and the construction of the antisocial distancing discourse in brazil.

• 1 Faculty of Public Health's Audioteca Collection, University of São Paulo, São Paulo, Brazil
• 2 School of Arts Science and Humanities, University of São Paulo, São Paulo, Brazil

Since March 11, the world has been experiencing a pandemic of Sars-Cov-2, the new coronavirus, which emerged in China in late December 2019 and causes the COVID-19 disease. Pandemics are characterized by pathogen's ability of emerging or re-emerging across geographical boundaries, simultaneously affecting a large number of people around the world, due to the sustained transmission in humans. In the case of the COVID-19 pandemic, we have witnessed in real time the dissemination of different types of information about it and strategies used to contain the rate of virus contamination. Our main goal in this study is to analyze the discursive production of the Brazilian journalistic media about vertical isolation as a supposed scientific strategy, and to demonstrate how that has been used in the denialist approach adopted by the Brazilian President Jair Bolsonaro. The research was carried out on the Google platform, using the following descriptors: coronavirus and herd immunity; coronavirus and the Imperial College herd immunity strategy; vertical isolation; Bolsonaro and vertical isolation. Thirty-six articles were selected for a qualitative analysis besides the original article by David L. Katz (published in The New York Times), where he claims the creation of the vertical confinement strategy. All documents of the analytical corpus are open and free of charge. The articles were submitted to discursive analysis and the main results shows that Brazilian media highlighted Bolsonaro's proposal of vertical isolation and amplified his pandemic denial and eugenics policies The mass media vehicles play a central role in the dissemination of information and should commit to the publication of reliable and trustworthy information, as well as to objectively situate the areas of knowledge of the specialists whose opinions are being published.

Introduction

The COVID-19 pandemic presents itself as concerning for the majority of people across the planet. This concern is guided by a number of characteristics of Sars-Cov-2 and by the contemporary lifestyle. The virus has a high potential for dissemination in the globalized world—by mid-August 2020, more than 20.7 million people had been contaminated; part of this contingent became seriously ill, requiring hospitalization, and nearly 780 thousand people had died 1 . There is still no treatment available for this disease, nor vaccines that might prevent infection. These factors, together with the lack of knowledge and the uncertainties on the evolution of the infection/disease, as well as the post-infection immunological responses, have led to great investments in scientific research in the several fields of science, while at the same time the population searches incessantly for information in order to make sense of their own experiences.

Within this context of a pandemic, mass media holds a key social role; as a source of information that is historically recognized and trustworthy, the media has been disseminating and modeling the ways in which ordinary people think about and deal with everyday events. It is important to remember that the conditions of truth and of social justification are the pillars that support the belief in journalistic discourse, which becomes trustworthy and credible as long as it manages to prove the veracity of its testimony, by means of the detailing of facts and the citation of specialized sources ( Lisboa and Benetti, 2015 ).

It is important to note, however, that this “proof of veracity” does not make news stories “mirrors” of reality, but instead, simply one of the possible narratives about social occurrences. Transformed into information, these occurrences are shared between members of society and journalists, who in turn claim a monopoly on this knowledge (defining what is news), meaning that, more than passive observers, they are active participants in the construction of reality ( Traquina, 2007 ). Although creative, journalistic activity is submitted to a number of “tyrannies”: of the deadlines and formats of journalistic production; of superior hierarchies (editors-in-chief, news editors, and, frequently, the owners of the platforms); the imperatives of journalism as a business; the extreme competition; and the action/pressure of different social actors searching to highlight their own matters ( Traquina, 2007 ). Thus, newsmaking results in journalism's capacity for producing social facts, in other words, for instituting realities, according to the repertories and contexts that the journalist chooses to use.

We have, in addition, used journalistic discursive practices within the perspective offered by Van Der Haak et al. (2012) , who state that journalism, as a public asset, should produce information and analyses that are useful for democratic societies, based on transparency, independence, the use of reliable sources, and the detailed analysis of events.

In this text we took the journalistic coverage of COVID-19 as a producer of meanings and social facts ( Spink, 2004 ). We also used the perspective of Thompson (2014) , for whom the process of news production, whichever it may be, always occurs within a socio-historical context that allows media outlets to capture and transform a certain number of everyday events into messages (symbolic forms) in detriment of an infinity of others.

We considered the context of exceptionality of the pandemic, where researchers and scientists are being obliged to accelerate their production to a rhythm never seen before, in order to provide clinical responses to the disease and guide public policies and State actions for managing public health around the world. This implies that most of the knowledge produced about Sars-CoV-2 and the disease it causes is being permanently revised, refuted, and discarded.

The problem is that, with this frenetic production, the refuted suppositions have often already reached a level of dissemination and absorption by common sense and even by public authorities which, due to a variety of interests, makes it impossible to revert their use, remaining as valid points of view. In other words, even when these suppositions have been invalidated by science, they continue as a social fact, affecting the lives of people and the manners in which they make their decisions when faced with the epidemic. Thus, it is important for journalists and mass media companies to be vigilant regarding the possible consequences of the content they relay.

We are referring, therefore, to the decisive role played by mass media in structuring the public space. This is a sensitive debate around the world, as it involves controlling the access to the production and circulation of the information that is transformed into messages (symbolic content) by a restricted number of actors, according to private interests or that of the groups that the media represents ( Thompson, 2014 ). This aspect is especially problematic in Brazil. The country has a historical asymmetry in the relationship between mass media and society, establishing what Kucinski (2006) call the “principle of exclusion,” violating the human right to information.

In Brazil, different from that which occurred for the most part in the liberal democracies of the global North, the mediatic market is marked by an ideological, economic, and political homogeneity that is usually pro-establishment. From the start, the media—and particularly the press—has historically reproduced with great fidelity the oligarchic model of land ownership, with a predominance in newspaper management of the “favoritism typical of the command culture of large rural properties” ( Kucinski, 2006 , p. 20).

The business model for national media is amplified by Brazil's complexity. Companies are configurated as oligopolies, with properties that are horizontal, vertical, and crisscrossed by different mediums (newspapers, magazines, AM and FM radio, open access and pay TV, internet provider) within the same market, whether local, regional, or national. This process was accentuated by the privatization of telecommunications during the 1990s ( de Lima, 2001 , 2011 ; Malinverni, 2016 ). Currently, according to the Brazilian section of the MOM (Media Ownership Monitor)/Reporters Sans Frontiéres, eight economic family groups control 26 of the 50 largest media vehicles in the country, according to audience and to scheduling capacity; in other words, in terms of potential to influence public opinion.

Divided into four large sectors (print, radio, TV, and online), the study, which resulted in the report “Who controls the media in Brazil,” released in late 2017, indicates a red alert for the Brazilian mediatic system due to the high concentration of audience and properties, the high geographic concentration, and the lack of transparency, besides economic, political, and religious interference in the production of information 2 . Seven of the twelve vehicles that published the news stories analyzed in this work integrate the control group describe above. The most paradigmatic of these is the Globo group, the largest oligopoly in this sector in Brazil and Latin America, and one of the largest in the world, with more than half of the audience among the first four (36.9%). The concentration of media outlets by a small number of private groups restricts competition and, consequently, the diversity to represent the distinct interests of society. Without the possibility of contradiction, there is a predominance in the mediatic market of what many studies and analysts call “penseé unique” ( de Lima, 2011 ).

Faced with such a complex dynamic—taken here in the sense proposed by Law and Mol (2002) , according to whom innumerable actors, materialities, and sociabilities perform the several facets of a phenomenon—and with the up-to-the-minute scope of the pandemic, which takes place in real time, journalistic coverage is up against enormous difficulties. These range from the immediacy of translating the technical-scientific knowledge of several fields to critical evaluations on what to publish and the possible effects.

Historically, at moments of public health emergency, the population and journalists wait to receive trustworthy information from governmental organizations and political leaderships, whose actions are based on the guidance of health authorities. In Brazil, however, besides this complexity that is inherent to the pandemic, mass media must deal with other challenges. The first, as we will see in the analyses, lies in reporting two distinct official discourses on controlling COVID-19: that of the president of the Republic and his supporters; and that of the scientists in the field of health, technicians from the Ministry of Health (in the first months), and governors and mayors who are favorable to social distancing. This resulted in a politicization of the actions for disease control.

Brazil has a Unified Health System (Sistema Único de Saúde—SUS) that guarantees universal health access to all within the national territory; the System is well-structured and organized in a decentralized manner. Since the promulgation of the 1988 Constitution, it is up to the federal government to establish guidelines and coordinate healthcare actions, allocating a budget for the states and municipalities, who manage resources and actions according to local/regional needs. This system counts on a structure of sanitary surveillance and consolidated data registration that allows the monitoring of healthcare actions throughout the country. The pandemic, however, hit Brazil at a point when SUS has been weakened, since, as stated by Menezes et al. (2019) , from 2016 a policy of defunding healthcare has been implemented, by means of the approval of a constitutional amendment that froze the federal budget in this sector for the next 20 years, with readjustment calculations based only on inflation. This policy of deconstructing SUS has intensified during the Bolsonaro government, with already-perceptible effects upon the population's health: “For example, the loss of 8.5 thousand Cuban doctors from the More Doctors Program, who were treating around 30 million Brazilians, in 2.9 thousand municipalities and indigenous villages” ( Menezes et al., 2019 , p. 67).

Despite this process of scrapping, from January to May the technical team of the Ministry of Health, responsible for managing SUS, carried out assertive actions relating to the pandemic, creating decrees, establishing benchmarks for action, and guiding the population. The president of the Republic, however, who refuses to acknowledge the severity of the pandemic, has been producing and divulging, from the start, counterinformation that contradicts the ministerial discourse. Within this context, on April 16, Bolsonaro dismissed the minister of Health, doctor and politician, and nominated a new leader for the department, an oncologist and business entrepreneur who works in the private sector. With a more technical profile, he remained only 28 days in office, and resigned due to disagreeing with the president's position regarding use of chloroquine to combat COVID-19. Therefore, since May 15, the position of minister of Health has been occupied in an interim manner by a general without any health background, who nominated other members of the military, equally without specialized training, to key roles in the Ministry of Health, furthering the dismantling of SUS 3 .

Brazilian journalism gave plenty of space for this polarization between the president and his supporters and the Ministry of Health, during the first months of the pandemic, as well as to the national and international scientific community on the subject of measures of social distancing. The analysis of articles indicated that the journalistic coverage often considered both discourses as equivalent, even knowing that the president and his supporters had no scientific backing—on the contrary, they often based themselves on false news and unfounded calculations.

For Gelbspan (1998 , p. 57–58), in discussing journalistic coverage of global warning:

The professional canon of journalistic fairness requires reporters who write about a controversy to present competing points of view. When the issue is of a political or social nature, fairness – presenting the most compelling arguments of both sides with equal weight – is a fundamental check on biased reporting. But this canon causes problems when it is applied to issues of science. It seems to demand that journalists present competing points of views on a scientific question as though they had equal scientific weight, when actually they do not.

In this sense, it is crucial that journalists covering themes that involve science know how to translate the concepts and recognize strong evidence so as not to fall into the mistake that Pitts (2018) designates “ both-sideism.” Rosen (2010) , discussing this journalistic strategy, states that it is often adopted in order to seek an “objectivity,” by means of which the journalist would speak from a supposed position of neutrality (a view from nowhere), and could not therefore be accused of favoring one position. For Sousa (2002) , this position is a tributary of two ideological forces that modulate news: that of objectivity and that of professionalism. The first explains the descriptive and factual orientation of news, with its mimetic ambition regarding reality that becomes explicit, and the systematic identification of sources of information in news statements; the second is based on the belief that the production routine and professional experience are sufficient tools for journalistic exemption. Supported by deontological codes constructed throughout history, the journalist acts as a “professional authority,” imbued with the right and the obligation to mediate and simplify information on daily happenings ( Traquina, 2007 ). In other words, under the jargon “interests of society,” the press acts within a discursive safe conduct that “authorizes” the prescription of standards and practices, while at the same time serving as an “argumentative shield” that protects and exempts journalists and owners of communication vehicles from the consequences of their discursive practices ( Malinverni et al., 2012 ). This strategy, however, impedes a deeper analysis and the production of precise information based on the truth.

Another challenge that journalists face is the increasingly precarious nature of work in newsrooms, and a lack of specialization in the area of health ( Malinverni and Cuenca, 2017 ), both of which have become more of an issue over the past decade with the financial crisis that has impacted media companies, especially print journalism, due to the rise of virtual media ( Castilho, 2015 ), affecting directly the quality of the news. Vukasovich and Vukasovich (2016) indicate, additionally, that globalization and the incessant pressures of newsmaking are two more elements that greatly impact the quality of journalistic coverage.

Methodology

In this work we carried out the discursive analysis of journalistic coverage following two key thematic lines: herd immunity and vertical isolation. Using Google search, we researched news articles on the Sars-CoV-2 epidemic in Brazil using four descriptors: 1—Herd immunity and coronavirus; 2—Herd immunity and Imperial College; 3—Vertical isolation; and 4—Bolsonaro and vertical isolation. Criteria for inclusion: the first three pages of results presented by Google; articles published by print media and mass news sites with high visitation numbers and open access links. Criteria for exclusion: blogs with no connection to mass media or governmental and non-governmental organizations; low repercussion media, videos and links that can be exclusively accessed by subscribers; texts reproduced ipsis litteris on other sites.

The time period set for article selection was March 16 to April 30, 2020, starting 5 days before the date on which the Ministry of Health confirmed community transmission of the disease in the country (March 20) and a public health emergency was declared by most state and municipal governments.

In the first phase of systemization, 101 texts were located; of these, after application of the above criteria, 36 were selected for analysis: 8 articles under descriptor 1; 8 under descriptor 2; 11 under descriptor 3; and 9 under descriptor 4. All texts were copied into Word to be later read in full and analyzed. The texts were published on 12 websites, linked to nine media groups: UOL, Folha de S.Paulo and Bol/UOL (Grupo Folha); O Globo (Organizações Globo); Saúde Estadão (Grupo Estado); Saúde Abril and Veja (Grupo Abril); Gazeta do Acre (independent); IstoÉ Dinheiro (Editora Três); BBC News Brasil (a subsidiary of BBC, controlled by the British government); El País Brasil (from the Spanish group PRISA); and CNN Brasil (a subsidiary of the American CNN). The four first, as already mentioned, are among the organizations that control almost 60% of the national audience. Historically, they operate under the establishment logic, with episodic demonstrations of divergences that lend an appearance of plurality. Rarely do they explicitly support a candidate or political party, although the journalistic coverage is always more favorable to agendas that adopt a center or right-wing positioning within the political spectrum. This perspective, shared by IstoÉ Dinheiro and CNN Brasil, has been in effect in the country since mid-March of 2020. The Gazeta do Acre is the only independent vehicle; in other words, that is not connected to a multimedia conglomerate. It was founded by two reporters who worked at an alternative newspaper which, in the 1970s, challenged the censorship imposed by the military regime and reported the daily violence committed by the large landowners against the small-scale rubber tree tappers—among them Acre environmentalist Chico Mendes, murdered by local ranchers in 1988. El País Brasil and BBC News Brasil follow the more liberal line of journalistic coverage set by their parent companies. These characteristics may explain why these three vehicles were the only ones to adopt a more critical approach to Bolsonaro's discourse, as will be discussed.

We adopted the theoretical perspective of discursive practices ( Spink, 2004 ), focusing on the language in use, a social practice analyzed in the intersection between performative aspects of language (when, in which conditions, with what intention, in which manner) and the conditions of production (understood in this case both as social and interactional context, and in the Foucauldian sense of historical constructions).

In this approach, the notion of interpretative repertories of Wetherell and Potter (1988 , p. 172) is central:

Repertoires could be seen as building blocks speakers use for constructing versions of actions, cognitive processes, and other phenomena. Any particular repertoire is constructed out of a restricted range of terms used in a specific stylistic and grammatical fashion. Commonly these terms are derived from one or more key metaphors and the presence of a repertoire will often be signaled by certain tropes or figures of speech.

The circulation dynamic of the interpretative repertories, within the flow of production of meanings, updates contents and processes present in the history of a society.

In this analysis we looked for these standards in the journalistic coverage of the two studied themes, making clear the content of the discussions and marking out the meanings they produce, as well as situating the contexts for production of the articles. Therefore, throughout the text, we introduce episodes and events that contextualize the analysis and help us to understand the scenario for news production, since, as stated by Rosen et al. (1997 , p.3), “[…] the journalism itself, the art of telling our collective story, is never independent of the country and culture in which the story is told.”

Strategies of Social Distancing and Herd Immunity in Brazil

The strategies of social distancing and of herd immunity were already circulating in Brazilian media before the official declaration of sustained transmission of Sars-CoV-2 in the country. We carried out this study associating the descriptor “Herd immunity” to coronavirus and to Imperial College. Next, we introduce the main results of the discursive analysis, discussing the meanings produced by the articles found with these descriptors.

The first article with the descriptor herd immunity (“What is ‘group immunity,' the polemical strategy of the United Kingdom to combat coronavirus” 4 ) dates from March 16, and was published by two large Brazilian news sites; its central theme is the debate surrounding the measures adopted by the United Kingdom. The article discusses the criticism suffered by the British government that, contrary to countries such as Italy, Spain, and France, had decided not to adopt a strategy of social suppression, betting on the free circulation of the virus in order to consequently lead the population toward herd immunity (a mitigation strategy). According to this text, the mitigation measure would help preserve the economy, since all activities would remain operational. The key criticism stemmed from the scientific community, for whom mitigation would lead to an uncontrolled growth in the number of people contaminated by Sars-CoV-2, with an inevitable rise in infections and the overburdening of the National Health Service (NHS) due to hospitalization demands for severe cases. This debate permeated the 16 articles analyzed under the descriptor “Herd immunity,” progressively incorporating references to reports from the Imperial College.

All the articles analyzed, when discussing herd immunity, made reference at some point to the United Kingdom and/or its prime minister and team. The United States and its president were also cited in six articles. Thus, we can say that the debate on social distancing, in Brazil, was closely connected to the measures and pronouncements of British and North American political authorities. Despite herd immunity having been considered and discussed in other cities/countries in Europe, the perspective that dominated the Brazilian news was that of the UK and the USA.

In addition to the positioning of political authorities, the scientific reports of the Imperial College were also widely commented on by the Brazilian media, and for this reason it was included as a descriptor. This institution appears often as being responsible for publishing studies that made the UK and the USA give up on the mitigation strategy. The majority of articles published between March 17 and April 24 refer directly to a specific report by the Imperial College, made public on March 16, which presents calculations regarding the lethality of the disease and the number of sick people according to each behavioral strategy adopted by the two countries. Only one article, from March 26, cites the report that makes estimates regarding the possible effects of the different non-pharmacological strategies in Brazil.

It is interesting to observe that, among the group of articles discussing herd immunity there are explanations on what this strategy entails. But most of these (5 articles) promote a simplification of this strategy, which can be explained by observing the authorship of the analyzed texts: only in three were the authors specialists. The first of these, mentioned above and produced by BBC News Brasil, is signed by a foreign journalist, a specialist in scientific communication. The second—““Coronavirus: must almost everyone catch it to end the pandemic?” 5 , from March 25, published in the health section of the website of Veja magazine—was written by two Brazilian researchers from the field of microbiology who acted as scientific disseminators. In this article there is a clear effort to translate expert knowledge for ordinary non-specialized readers, in a clear and simple manner, focusing on the reasons that herd immunity could not be legitimized by science to guide public policies against Sars-CoV-2. The third article—“Who is immune to coronavirus?” 6 , published on April 14 by the newspaper Folha de S.Paulo and available on the UOL website—was written by Marc Lipsitch, a professor of Epidemiology at Harvard University's School of Public Health. Published originally in the New York Times , it is a direct translation. In these three articles, there is a greater care in explaining herd immunity, based on scientific knowledge.

Another factor that could explain the simplifications and superficial approaches adopted by the Brazilian media for the theme of herd immunity relates to the sources consulted and used in the articles. Historically, the production of news articles in the field of health includes consultation with known specialists who can expound on the theme with authority, productivity, and credibility, conferring legitimacy and reliability to the information presented ( Tuchman, 1983 ; Traquina, 2007 ). However, with regard to the debate on herd immunity, the analyzed articles make little use of consulting epidemiologists, the most appropriate specialists when it comes to this theme. Among the medical sources, the articles prioritized the opinions of virologists, infectious disease specialists, and immunologists; only four epidemiologists were consulted—two Brazilians, one from North America, and one from India. This may have contributed toward the polarization of measures of social distancing, as the guidelines suggested by epidemiology would explain with more clarity the catastrophic effects of the epidemic on the healthcare system and, consequently, on people's lives, if natural herd immunity were to be adopted in the country.

The articles that cite the reports of the Imperial College approach the theme in a manner that presents, together with projections of mathematical models that favor suppression, the arguments contrary to this measure, as well as the “harmful” effects of broad and unrestricted social distancing on the economy.

The concept of herd immunity has a longstanding and legitimate scientific basis, which postulates that the infection of a percentage of the population is enough to block transmission of a virus, and therefore can contain or even eradicate it within a certain territory. Since this debate began, the World Health Organization (WHO) and scientists all over the world have explained that this concept applies to immunization by means of vaccinations, and that investing in natural herd immunity against COVID-19 would overburden the healthcare systems, causing hundreds of thousands of avoidable deaths.

The positioning of some government leaders in favor of this strategy appears to be oriented by Malthusian theories, according to which some populations, such as the elderly, can be considered as weak and surplus ( Mezzadra, 2020 ). In this manner, they could become “naturally” extinct by pandemics, such as the case of COVID-19. Hannah et al. (2020) observe that, by defending herd immunity, governors assume that the biopolitical interests of capital take precedence over the biopolitical interests of life. One of the articles of the corpus emphasizes that matters of economy were decisive in the debate on herd immunity. The text “Specialists recommend herd immunity for poor countries 7 ”—produced by Bloomberg, a news agency of the financial sector, and published in the finance section of UOL on April 22—, presents herd immunity as the only alternative for poor, young countries such as India. The journalist presents arguments from an Indian epidemiologist as well as researchers from the Center for Disease Dynamics, Economics & Policy and Princeton University in defense of this strategy:

[…] allow the virus to circulate in a controlled manner throughout the next seven months would provide immunity to 60% of the country's population by November, and thus, contain the disease. Mortality could be limited while the virus propagates, in comparison to European countries, such as Italy, since 93.5% of the Indian population is under 65 years, it is said, although they have not divulged projections on the number of dead .

The article is overly brief, but points out that this is a risky strategy, concluding that at the moment not much was known regarding immunity to coronavirus.

The possibility of using the strategy of herd immunity to minimize the effects of the pandemic on the economy was discussed hypothetically in many of the articles analyzed, but not indicated as a viable solution. For instance, the texts that mention this discussion in the United Kingdom clarify that the British government refuted that they were seeking herd immunity. This proposal would be morally unacceptable, since the known lethality data indicates that this strategy would imply acceptance and recognition that at least 1% of the population could die, in addition to a high number of hospitalizations, leading to a collapse of the healthcare services.

In the 16 articles analyzed with descriptors 1 and 2, only one has a critical approach and presents the Imperial College projections for Brazil. The article is “Coronavirus pandemic: the best scenario is disastrous 8 ,” published on March 30 on the website of the Gazeta do Acre , a local newspaper of the state of Acre, at the extreme north of the country. The text presents the calculations for the newspaper's hometown, the state capital Rio Branco, informing the amount of people who would get sick and die if suppression were not adopted. The other articles touched generically upon the theme, without taking the trouble to inform about the effects of different measures within the local contexts of Brazilian cities with their inequalities.

Among the articles of this corpus , the only argument in favor of herd immunity that had no economic framing was that of a supposed prevention of a second wave of the disease, since in the countries that adopted restrictive measures only a small portion of the population would have had contact with the virus, and thus the virus would once again strike these populations.

Before we continue the discussion, it is important to present the facts for the Brazilian context. From March 11, some state governors and mayors began to declare non-pharmacological measures to deal with the pandemic, following recommendations from the Ministry of Health and creating scientific committees. Throughout that entire month, several states and municipalities suspended classes at all educational levels, prohibiting events and religious services, and closing commerce and non-essential services, maintaining only healthcare, pharmacies, and grocery stores, in addition to bars, restaurants, and bakeries, although these last could only serve customers by delivery. These measures met with strong resistance from entrepreneurs and politicians, especially the president of the Republic and his social and political support base.

In this manner, from mid-March and throughout the month of April, the media began to include in discussions of the pandemic the financial damage that social distancing measures could provoke, and the effects on people's daily lives. In this context, the news began to construct a narrative around the concept of “two sides”; one favorable to the strategy of seeking herd immunity, and the other, to social distancing. As previously discussed, his false equivalency between scientifically based arguments and fragile arguments supported by hypotheses is damaging to the coverage of scientific themes ( Gelbspan, 1998 ).

With regard to herd immunity, this approach was present in many of the articles analyzed, with only two of the news stories breaking this logic. The first, titled “Epidemiologist opposes Osmar Terra and sees Brazil as far from the end of the epidemic 9 ,” from April 14, published on the UOL website, the journalist presents the arguments of an epidemiologist to deconstruct the reasoning presented by congressman Osmar Terra 10 , an advisor to Bolsonaro and part of his support base. As the central character in the text, and in opposition to Osmar Terra, the epidemiologist, who is also the rector of a federal university, demonstrates with data and scientific evidence that the country was far from reaching herd immunity, and points out the political polarization of the debate on social distancing:

The discussion about social distancing in all the media is based on ideology and not science. There is a group of people who think we must relax and who voted on the same candidate [Bolsonaro], and the other people, who voted against, are in favor of distancing .

The epidemiologist's perception on the role of the media in this polarization is precise. Osmar Terra is a member of Congress who, despite a degree in medicine and an appointment as Health Secretary, is not a specialist in this theme. It is worth noting that, according to the evaluation carried out by the website Radar aos Fatos, which checks and verifies fake news , he was the parliamentary member who most divulged false news on COVID-19 11 . More than that, the fact that there was a link to the video in which the congressman reproduces false news signals that the news site UOL itself contributed toward disseminating an opinion that, based on antiscientific visions, not only encourages the political polarization of the epidemic scenario, but also confuses the population. This polarization indicates a narrative framing typical of political coverage, in which reality is taken as “[…] a field in conflict, a bipolar world of successive hostilities” ( Motta, 2007 , p. 10), feeding the confrontation with successive affirmations that belie the sources, in a dramatic game based on the notion of contradiction. In the case of this coverage, the narrative option for the “two opposite sides” of the phenomenon makes no sense, as by giving equal weight and space to the scientific evidence and positioning of the majority of national and international scientists, and the opinions of a small group of denialist politicians with an anti-science agenda, the media breaks their social commitment of informing the population correctly about phenomena and events that impact daily life, such as the case of the COVID-19 epidemic.

The second article for the descriptor “herd immunity”—the previously mentioned “Coronavirus pandemic: the best scenario is disastrous” of the Gazeta do Acre —was the only one among the 16 news stories analyzed to critically situate the attacks of Bolsonaro and his supporters upon suppression measures. The text, with authorship stated simply as “Newsroom,” classifies Bolsonaro's statements as unfounded and absurd:

At this moment, the majority of countries, the Ministry of Health of Brazil, governors and mayors from all around the country, based on directives given by the WHO, are trying to adopt the measure of suppression to control the epidemic in Brazil .

However, president Bolsonaro and a small group of his counselors and advisors (which includes his children) are the only dissonant voices and are actively advocating the adoption of the mitigation strategy to control dissemination of the virus in Brazil .

This is a noisy minority, incidentally. Thanks to the control that the president and his children have over their thousands of fanatic followers, the social networks are inundated with the most absurd campaigns in favor of this option of control .

From “Vertical Interdiction” to “Vertical Isolation,” The Use of Scientists' Opinions for Denialism

The analysis demonstrated that the use of the terminology “vertical isolation” was imposed by President Bolsonaro himself and naturalized by the media. On March 24, in a pronouncement on the radio and TV network 12 , he urged the population to abandon the social distancing measures that had been recommended by the Ministry of Health and which, as previously mentioned, had been adopted by several governors and mayors. His proposal: keep in confinement only the so-called risk groups. In Brazil, this would be the elderly population over 60 years of age and those with chronic diseases, besides symptomatic cases. In his speech, which shocked the national and international scientific community and those Brazilians who had adhered to social distancing—at least 50% of the population, in several regions, at the start of community transmission—, Bolsonaro stated that COVID-19 was just “a little flu,” a “little cold” that was inoffensive to the majority of the young and the healthy who, like him, had an “athletic history” 13 . The following morning (25), when asked by a reporter how the country would protect these vulnerable groups, he answered: “[…] there is horizontal isolation, that they're doing here, and there's the vertical. It's the vertical [for groups at risk]” 14 .

The term vertical isolation resonated intensely in newspapers and news sites, and, after March 25, it was in the title of the 20 articles analyzed for descriptors 3 and 4 (“Vertical” isolation” and “Bolsonaro and vertical isolation”). When explaining the concept proposed by Bolsonaro, three texts cited the hypotheses of David L. Katz, a doctor who specialized in diet and nutrition 15 , which were published in an article in The New York Times , on March 20, 2020, with one text also bringing up an article by epidemiologist John Ioannidis, statistician, and co-director of the Stanford Prevention Research Center, published on March 17, on the StatNews website. Both were critics of the social suppression measures proposed and adopted in some Asian and European countries.

The analysis also suggested that the terminology “vertical isolation” which circulated in the national media was a translation of the arguments proposed by Katz, which were in turn anchored on the debate about herd immunity and the initial mitigation strategies adopted by the UK and USA to deal with the pandemic. Although quickly rejected by the scientific community, “isolation” as a synonym to distancing continued to resonate in Brazilian newspapers and news sites and is still used today in this sense.

Katz's article (“Is our fight against coronavirus worse than the disease?”) was published 5 days before Bolsonaro's interview. In it, Katz employs classic concepts of epidemiology to make a misleading analysis, based on a still-fragile foundation of data about the pandemic, as we will see in the following analysis. Centered on repertories from epidemiology, he frames social distancing as a potentially harmful “war” strategy, with socioeconomic consequences and effects upon the healthcare systems that could be worse than the disease. From the very start, with the title, Katz makes use of militaristic metaphors—a longstanding and recurring discursive strategy in all dimensions of the dissemination of science and medicine ( Wenner, 2007 )—in order to build his thesis for reducing the costs of the “war” against the new coronavirus.

He supports his arguments by interpreting data from South Korea, which indicated that 99% of COVID-19 cases were light, while the lethality of the disease basically affected those who were more vulnerable. Still employing war metaphors, Katz concludes that the most advisable approach would be a “surgical strike,” naming this a “vertical interdiction,” which would consist in forbidding circulation only for those who are most vulnerable and exposing the majority of the population to the virus, thus attaining herd immunity. In the text, even though the social impact of distancing is mentioned, it is clear that the specialist is preoccupied with the financial aspect:

I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life — schools and businesses closed, gatherings banned — will be long lasting and calamitous, possibly more severe than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order ( Katz, 2020 ).

Likewise, the arguments made by Ioannidis—in the article “We know enough now to act decisively against COVID-19. Social distancing is a good place to start”—focused on the economic effects of distancing measures:

If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It's like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies ( Ioannidis, 2020 ).

The hypotheses of Ioannidis and, mainly, Katz gather elements that are of great use to the interests of the denialists, in the sense used by Hoofnagle and Hoofnagle (2007) and referenced by Diethelm and McKee (2009) , for whom the denialist discourse is constructed around rhetorical arguments,

[…] to give the appearance of argument or legitimate debate, when in actuality there is none. These false arguments are used when one has few or no facts to support one's viewpoint against a scientific consensus or against overwhelming evidence to the contrary. They are effective in distracting from actual useful debate using emotionally appealing, but ultimately empty and illogical assertions ( Hoofnagle and Hoofnagle, 2007 ).

The denial is constructed with basis on five discursive tactics which, together or separately, produce pseudoscientific discourse ( Hoofnagle and Hoofnagle, 2007 ; Diethelm and McKee, 2009 ). Three of these bring to light the manner in which the arguments of the two American specialists help sustain the denialism of President Bolsonaro and his supporters: (1) selectivity in choosing out-of-context scientific data in order to suggest error; (2) the use of specialists whose opinions are inconsistent with the knowledge established by scientific canon; and (3) resorting to isolated articles that challenge the dominant consensus as a means of discrediting the entire field.

In Brazil, the hypotheses of Ioannidis and, above all, Katz were presented by the media as an explanation for the vertical isolation proposed by Bolsonaro. The news stories also included criticism of this strategy by Brazilian and international specialists. This is what can be surmised from the article “What is the vertical isolation that Bolsonaro wants and why do specialists fear it will cause more deaths 16 ” published on the BBC News Brasil website, on March 25. In this news piece, the arguments of the two American specialists are rejected by the scientific community, due to their hypothetical nature, based on fragile data and a partial analysis that does not include the response capacity of the healthcare system; in this case, American healthcare. One of the opposing sources presented in the article is Harry Crane, a statistics professor from Rutgers University, who considered that their mistake was:

[…] to allow themselves to be affected by the desire to negate a situation that can cause despair. “Under severe uncertainty, it's natural instinct and common sense to hope for the best, but prepare for the worst”, wrote Crane, in response to the article by Ioannidis. This is because the mortality rate does not depend only on the clinical picture that the virus itself can produce, but also the capacity for response of societies for treating the sick .

The text makes it clear that, while the hypotheses of the two specialists were refuted by their peers, they were rapidly embraced by neoliberal politicians and economists, becoming “[…] music for the ears of the governmental economy teams who were trying to finish public accounting in midst of the perspective of recession” (BBC News Brasil, 2020). The journalist who authored the text supports this statement by citing part of an editorial from The Wall Street Journal , published in the wake of the Ioannidis article:

“ America urgently needs a pandemic strategy that is more economically and socially sustainable than the current national lockdown”, summarized the editorial from The Wall Street Journal, known for expressing the thoughts of the American economic elite, a week ago .

In the same article, the journalist affirms that the conclusions of Katz and Ioannidis acquired a following in the team of the Brazilian minister of Economy, “[…] in search of a gentler solution for the public health crisis.”

But it was, above all, the political support base of denialist leaders that took on the hypotheses of the two specialists and began using them to contest social distancing measures. In the news piece “Why is vertical isolation seen with skepticism 17 ?” produced by the agency Conteúdo Estadão and published on five news sites, on March 30, there is a clear use of these specialist arguments in the discourse against distancing:

Defended by President Jair Bolsonaro, the so-called “vertical isolation” of the population is a minority theory among scientists and is viewed with skepticism by the medical community. It consists on separating those who are in the risk group from being exposed to the virus, such as those older than 60 and those with chronic diseases (UOL, March 30).

Although the title of the article points to skepticism, the body of text brings a plurality of opinions, under the dichotomy of pros-cons and advantages-disadvantages of this strategy, including the discussion on herd immunity as a strategy and the reasons it was discarded in the United Kingdom. The most interesting point brought up in the article is a comparison of the supporters of Bolsonaro and Donald Trump. After informing that the American president had recommended extreme distancing, following the publication of the Imperial College study on March 16, the article adds that Trump went back to defending a quick return to activities in the United States, projecting a flexibilization in 10 days, which did not end up taking place but still had repercussions among Bolsonaro supporters:

Excerpts of the video with this speech from the American [Trump] were disseminated by supporters of Bolsonaro in Brazil, as a supposed sign that the Americans would relax their measures. After being criticized, Trump pulled back and said that the date to reopen the country was just a suggestion, but that the end of social isolation would not take place without backing from scientists. The day before yesterday, Trump affirmed that he is thinking of establishing an official quarantine for states such as New York (which has the majority of cases), New Jersey and Connecticut .

This text makes it clear how the denialist discourse of Trump and Bolsonaro align and, at the same time, how the largely connected environments of the social networks serve as feedback for both of their support bases. However, by indicating a new retreat by Trump, the text also demonstrates that his denialism was more vulnerable to scientific and medical arguments in favor of social distancing. The impression that we get is that Trump oscillates, either denying the scientific reading of the severity of the pandemic in his discourse and actions, or accepting information from scientists, different in this way from Bolsonaro, who has been unwavering in his denialist positioning from the start of the epidemic in Brazil.

Media Adhesion and Naturalization of “Vertical Isolation”

In the 20 articles analyzed for descriptor 3 (Vertical isolation), vertical isolation appears as a specific type of social distancing, allowing us to infer the media's unrestricted adhesion to the terminology, central to the sum of information circulated in both corpora . Instrumental, 10 of the 11 titles for descriptor 3 were constructed around the notions of functioning/operation of this model, seeking to explain vertical isolation with its advantages, disadvantages, and risks 18 .

We raised several hypotheses on what may have contributed to this: the generalist nature and increasingly precarious state of Brazilian mass journalism and the absence of epidemiologists as sources for news stories, already discussed in this work; the didacticism employed in the framing of texts, announced even in the titles.

This pedagogic concern brings to light the efforts made by journalists to translate to readers, who are always assumed to be laypeople, the technical-scientific jargon employed in the news. This didacticism—which legitimizes journalists as “[…] the place of ‘being able to show', of ‘being able to say' and ‘being able to analyze' (…) as a place of mediation and of revelation of truth” ( Vizeu, 2009 , p. 77)—may have contributed in particular toward the production of the meaning of “vertical isolation” as a scientifically validated consensus strategy that “mirrors” a supposed epidemiological reality, aseptic and neutral.

It is necessary, therefore, to problematize the media's naturalization of “vertical isolation” to express measures of social distancing (quarantine, cordon sanitaire , lockdown). In first place, the terminology confuses two distinct models of attention to epidemics. In the field of health, including Brazil, the established scientific consensus uses the term isolation to designate the care given to an infected and symptomatic patient, and is therefore a model for individual attention, belonging to the field of clinical medicine; distancing, on the other hand, implies collective/populational care, affiliated to epidemiology.

The use of “social isolation” in the place of social distancing is also a sematic error as it is based on a false synonymy. In the Portuguese language, “isolate” means to separate, segregate, and confine a person from all others in their social circle—in Brazilian dictionaries, among examples of isolate, we find medical activity aimed at treating patients with contagious diseases. On the other hand, distancing is the act or effect of separating people/groups, centered on a notion of physical space and not segregation.

By using one term in place of another, naturalizing a theoretical hypothesis that is still under discussion and therefore not validated by the scientific community, the media legitimized the term social isolation as common sense. And this may have contributed to the construction of a derogatory meaning for the strategy of social distancing, amplifying the resistance of the Brazilian population toward this measure.

Vertical Isolation, Denialism, and Eugenics

The denialist discourse throughout the world is not just aligned to anti-science, but also resonates as a more or less homogeneous mark of eugenics. In Brazil, this is no different. The social and scientific movement for improving the human race that emerged at the end of the nineteenth century and was widely experimented with by the German Nazi regime during World War II (1939–1945), arrived in the country in 1918, with the creation of the Eugenics Society of São Paulo. Intellectuals from several areas notably from medicine and the public health services, gathered around this movement, and the triad of sanitation, hygiene, and eugenics supported a broad and generalized project for civilizational progress ( Maciel, 1999 ), with medical knowledge playing a central role.

Racial regeneration would occur by means of three types of eugenics: positive, negative, and preventive. This last, also called prophylactic hygiene by Brazilian eugenists, was mixed with principles of rural and urban sanitation, the suppression of social vices such as alcoholism, control of immigration and of matrimony, and the compulsory sterilization of “degenerates.” In the 1930s, the main activist in Brazilian eugenics, Renato Kehl, openly assumed his favorable position to some of the measures adopted by the German eugenics movement ( Kobayashi et al., 2009 ).

Thus, the world eugenics ideology met the Brazilian positivist-hygienist movement, forming a new and active field, of hygienist-physicians, the protagonists and disseminators of the eugenics elements that would mark the actions of Brazilian public health for the next decades, and which still linger today in many practices, especially in the field of social care. This scientific rationality led to the implementation of “[…] projects of eugenic nature that intended to eliminate disease, separate madness and poverty” ( Schwarcz, 1993 , p. 34), focusing mainly on immigrants, Black people, and the poor ( Diwan, 2007 ). Acting in an intensive manner, the hygienist doctors undertook “[…] what they imagined to be a national regenerative mission, exerting functions, carrying out tasks, occupying positions that were strange to medicine,” and disseminating the certainty “[…] of being able to end the blemishes of the nation, collaborating with Brazil's administrative and social entirety” ( Mota, 2003 , p. 21).

From the start of the community transmission of Sars-CoV-2 in Brazil it is possible to observe this memory of eugenics in Bolsonaro's denialism, especially in his defense of vertical isolation. As governors and mayors began to officially order social distancing, the president's position became more and more radical. This is what can be surmised from the article “Bolsonaro once again minimizes COVID-19 and says that Health is studying vertical isolation 19 ,” published on the financial news site IstoÉ Dinheiro on March 26. In this piece, the president once again says that “ some governors and mayors erred in the dose” of containment measures, demanding the reopening of all sectors of the economy:

“ And do a stay-at-home campaign. Don't let grandpa leave the house, leave him in a corner. When you get home have a shower, wash your hands, wipe your ears with sanitizer gel. That's it”, he declared .

In the excerpt, Bolsonaro dehumanizes the elderly, the main target for his strategy of vertical isolation, turning their existence into objects in face of the epidemic. In his ambition to maintain the capitalist order, the president treats this subject (the elderly) as objects without free will who must be segregated in a “corner,” removing “their individual, malleable, unique characteristics” and transforming them “into empty husks, representations of themselves who, apparently, are no longer covered by the State of right” ( Souza, 2017 , p. 70).

In the same article, when commenting on the critical situations in other countries and on the perspectives of how the disease would manifest in Brazil, Bolsonaro yet again invests in a rhetoric of dehumanization:

“ I don't think it's going to reach that point, even because Brazilians should be studied, they don't catch anything. You see the guy leaping into sewage, coming out, diving in and nothing happens” .

This speech speaks directly of the more vulnerable social classes in Brazil that, due to conditions of extreme poverty, are subject to extremely precarious production relations. In this manner, it is possible to identify in the president's discourse a correlation between men and rats, who are immune to sewers. This perspective, in turn, bears a resemblance to the metaphor of the crab man, created by doctor and geographer Josué de Castro to designate a new species of Brazilians: those excluded from the production processes and who took their subsistence from the mangrove swamps of Recife, mixing them up with the crabs they fed upon 20 . Later, in the 1990s, following on the heels of the crab men, the gabiru men emerged. This hyperbole was used to designate country folk who lost their lands to large-scale farming and ended up in urban shantytowns, carrying with them an old acquaintance, hunger ( Portella et al., 1992 ; de Melo Filho, 2003 ). From the Tupi wa'wiru , gabiru means that which devours supplies, lives off trash, begs for hand-outs, causes repugnance, attacks and steals ( Portella et al., 1992 ).

Besides touching upon this social imaginary of the excluded Brazilian, the speech is evidence of a reading in which the population can be left to their own luck, without needing the actions of a protective State since they are, by their animalistic nature, survivors.

In addition to the theoretical fragility of Bolsonaro's proposal, the news stories analyzed also demonstrate that the strategy was unfeasible due to Brazil's socioeconomic inequalities. In the article “Vertical isolation proposed by Bolsonaro may accelerate contagion by coronavirus and compromise health systems 21 ,” published on March 25 on the El País Brasil website, health specialists and medical authorities alert to the risks of accelerated contagion in Brazil and a rapidly compromised healthcare system:

“ The theoretical idea of vertical isolation is that you can allow young people to circulate. They would become infected and could become immune. But we don't know how this works with COVID-19 and we can't guarantee the exclusive isolation of a specific group”, alerts the doctor Valdes Bollela, professor at the School of Medicine of USP Ribeirão Preto [São Paulo University of Ribeiro Preto] . (…) You think you can separate all the people [in the risk groups] who are young from those who are over 60? (…) People with HIV, diabetes and the elderly who count on their families? I can't imagine that in real life. In a theoretical idea, it's possible. In practice, it's a trap (…) In Brazil, a lot of people depend exactly on the care of their children” .

On the isolation of the elderly, in an article published on March 25 on the CNN Brasil website, along with the previously mentioned press conference video, titled “Bolsonaro vai propor isolamento vertical para conter coronavírus 22 ,” other related opinions are mentioned:

[…] each family must be responsible for their relatives. “The people need to stop pushing things onto the public powers”, he stated. (…) He stressed that the president of the United States, Donald Trump, follows a “similar line” as to measures to contain the disease, referencing yesterday's speech by the North-American in which he intends to end quarantine in the USA “by Easter” .

In these excerpts, it is possible to observe Bolsonaro's contempt for the excluding social characteristics in Brazil, where extreme social inequality would make it impossible to completely isolate the elderly and those with comorbidities from their relatives. Additionally, this also indicates his positioning on two aspects: the first, in prioritizing the economy—what really matters is to keep people working and generating income and taxes; the second, in making the State exempt from the consequences of its omission regarding the risks that the elderly face, in other words, that their life or death is not a problem of the public powers but of their families. Bolsonaro also uses the reference to the president of the United States in order to legitimize and strengthen his arguments and transmit the idea that there is a consensus between them regarding the pandemic, reinforcing the thesis that vertical isolation would be a viable strategy, since it was adopted by a developed country.

The article is short and uses a neutral tone, but it refers to a number of links, informing us, among other things, that Bolsonaro was the target of protests by Brazilians who were maintaining social distancing and of criticism by politicians:

The speech [referring to the press conference video posted at the start of the article and already mentioned in this analysis] — during which there were records of pot-banging protests in several of the country's capitals — gave rise to criticism by health secretaries, authorities and politicians (CNN Brasil, March 25).

The website brings visibility to the president's speeches without the concern of reflecting upon them or of pointing out their damaging effects upon the population's health.

In the article “Bolsonaro defende isolamento vertical e sugere que país pode 'sair da normalidade democrática 23 ,”' produced by international news agency Ansa and published on the website of the O Globo newspaper (March 25), the president also makes what can be considered his first threat of democratic rupture, using the argument that measures of social distancing would provoke an economic crisis of enormous proportions, which could lead to social convulsions.

“ […] what happened in Chile [street movement that left its mark upon the Chilean scenario for months] will be small change next to what could happen in Brazil. We will all pay a price that will take years to pay, that is, if Brazil might not yet leave the democratic normality that you all defend so much, no one knows what can happen in Brazil” (…) “The chaos makes it so the left can seize the moment to come to power.”

By treating a scientifically legitimized event—the existence of an epidemic with planetary proportions—as an “excuse” of the Brazilian left to take his power, Bolsonaro brings up a fourth element that is characteristic of denialism: the identification of conspiracies among the consensuses of science. For conspiracy theorists, the validation of science is not a result of an evidence-based consensus among scientists, but of the involvement of these scientists in a complex and secret conspiracy ( Hoofnagle and Hoofnagle, 2007 ). In this sense, the process of peer revision “[…] is seen as a tool by which the conspirators suppress dissent, rather than as a means of weeding out papers and grant applications unsupported by evidence or lacking logical thought” ( Diethelm and McKee, 2009 ).

“So What?”: Considerations on a Eugenics Discourse

Denialism has different motivations—economic, political, personal, ideological, or religious—, but has as a common point the rejection of any thesis incompatible with the fundamental beliefs of those who hold them. As the analyses demonstrate, a first dimension of the denialism of Jair Bolsonaro on the Sars-Cov-2 epidemic is based on the idea that the effects of an economic crisis would be worse than the severe consequences of the disease itself on people's lives. As seen in this work, this discourse aligns with that of other denialist world leaders, such as President Donald Trump and Prime Minister Boris Johnson —although, different from the Brazilian president, these leaders have oscillated throughout the pandemic between accepting scientific arguments in favor of the population's health and prioritizing the economy.

In terms of the economic argument, however, a second dimension emerges in Bolsonaro's discourse: that of eugenics. Under the terminology of vertical isolation, naturalized and legitimized by the media, the Brazilian president turns the most vulnerable segment of the population into objects, establishing a moral compass according to which, faced with the needs of maintaining the relations of capitalist production, some lives are worth less than others, and that this would be enough to justify the sacrifice.

It is important to point out that this discursive posture is not casual or chaotic. There is a method here that, moreover, helped to elect Bolsonaro 24 , known for his racist, misogynistic, sexist, and xenophobic statements. In 2017, during the electoral campaign for presidency, the then parliamentary member promised to end all demarcation of land for Indigenous Peoples 25 : “You can be certain that, if I get there (…) There will not be a centimeter marked off for indigenous reservations or for quilombola 26 lands.”

At the same event, he made disparaging and fat-shaming comments: “I went to a quilombo. The lightest Afro-descendent there weighed seven arrobas (arroba is a measurement used to weigh cattle; one arroba is equivalent to 15 kg). They do nothing. I think he was of no use even to serve for breeding.” Ironically, this speech, which drew laughter from the audience, was given at Hebraica in Rio de Janeiro, one of the most traditional Jewish associations in the country.

In the wake of the rise of right-wing populism that, in the last years, has benefitted other leaders around the world, Bolsonaro was elected for his antisystem rhetoric, exploiting the fears and prejudices of ordinary voters, undermining the credibility of traditional political parties and democratic institutions, and normalizing discriminatory discourse, thanks to the reach of his social media, which he and his group manage with mastery, and with advisory help from Steve Bannon, former vice-president of Cambridge Analytica ( Ricard and Medeiros, 2020 ). When he took over the presidency of the Republic, in January 2019, he not only radicalized this rhetoric but also, in many cases, transformed it into State policy—in the first days of his government, he ended social and environmental protection structures and programs; under Bolsonaro, for example, the recognition of quilombos fell to the lowest levels in history 27 .

On March 18, in an interview to Fox News 28 during an official visit to the United States, Bolsonaro attacked immigrants by defending Trump's plans to build a wall on the border between the USA and Mexico: “The majority of immigrants do not have good intentions and do not want to do good for Americans.” It is worth remembering that there are over a million Brazilians living in the USA. In this manner, the alignment of Bolsonaro's migratory policies with those of the American president—who in December 2019 called Haiti, El Salvador, and African countries “shitholes”—indicates “a racist slant, since not by chance most immigrants are Black or Indigenous people, from countries with a non-white populational majority. There is a logic that is eugenic, racist, and ethnic in nature,” states Dennis Oliveira in the same article—a journalism professor from the University of São Paulo (USP) and an activist in the Rede Quilombação network.

As the Brazilian health crisis grew in severity, Bolsonaro's eugenics slant became more explicit, until it reached an emblematic declaration: “So what? I'm sorry. What do you want me to do? I'm a Messiah, but I don't do miracles 29 .” Spoken to a group of reporters and supporters in front of the Alvorada Palace, the presidential residence in Brasília, on the night of April 28, when Brazil hit 5,017 official deaths, the phrase was followed by a disturbing statement on the severity of COVID-19 among the elderly: “I regret the situation we are going through with the virus. We sympathize with the families who have lost their loved ones, who were mostly elderly. But such is life. Tomorrow it will be me [to die].”

The numbers for the epidemic in Brazil indicate that the eugenics project is succeeding, since on June 5, CNN informed that 40% more Black than white people die from COVID-19 in Brazil 30 . Although the country did not officially adopt the vertical isolation policy proposed by Bolsonaro, because the Supreme Court decreed that states and municipalities had the autonomy to adopt social distancing measures, Bolsonaro's government continued to boycott the actions of governors and mayors to contain dissemination of the virus. This boycott could be observed in the presidential decrees that increased the list of activities considered essential, in the delays and inefficiency in implementing financial aid to those who were left without income, in the absence of effective programs to subsidize small businesses, and, of course, in Bolsonaro's speeches, which resonated throughout the country both by means of mass media and social networks 31 .

Up until the conclusion of this article, the Ministry of Health was still under the interim command of a general who, like Bolsonaro, also adopted a denialist stance. On May 20, under this administration, the ministry published a protocol 32 with guidelines for prescribing chloroquine and hydroxychloroquine for light, moderate, and severe cases of COVID-19. Although there is no strong scientific evidence on the effectiveness of this medication, the Bolsonaro administration maintains its use as a standard for care in SUS. Since the start of June 33 , the government has been changing the manner and time for divulging the epidemiological reports that update infection cases and deaths by the disease, while also announcing the adoption of a new methodology for sharing the data which will invalidate comparisons with the previous numbers and, consequently, affect monitoring of the evolution of COVID-19 in the country. One of the aims of this strategy is to reduce the visibility of the number of deaths and misinform the population. Following the same direction, the Department of Social Communication created a “life scoreboard,” a report disseminated exclusively on the presidency's social networks that highlights the number of recovery cases while omitting the deaths.

In addition to these actions, the president's denialist speeches that are spread both by mass media and social networks have a direct effect upon the behavior of the population regarding social distancing, as demonstrated by Ajzenman et al. (2020) .

In this scenario, our study demonstrates that the Brazilian mass media is still fixed upon the notion that it is necessary to present both sides of an event, giving each equal weight, even when one has assumed a denialist position toward the science. This positioning, justified normally by the pursuit of neutrality in news coverage, allows for the spreading of false premises posing as science and strengthens the denialist and eugenist project of Bolsonaro. This occurs because, as stated by Happer and Philo (2013) , the media holds a central role in spreading information and in the process of focusing attention on a specific subject, as well as in defining a public agenda.

Another aspect identified in the study relates to the characteristics of the method adopted by Bolsonaro since the elections, which have endured during this past year-and-a-half of his mandate: the discursive verbiage, often grotesque and always of populist appeal, which the Brazilian media appears to have become a hostage of. And, by amplifying the president's speeches, the media symbolically places him at the center of the coordination of control measures for the epidemic in Brazil, a role he has never undertaken. In this sense, we agree with Rosen (2020) and Smith (2020) , who identified the same phenomenon in the media coverage of coronavirus in the United States, pointing to the need of removing President Trump as a protagonist in news about the theme.

Under the guise of conclusion, it is important to highlight an action which indicates that the Brazilian press has gradually taken on a more critical posture. In June, faced with the proposal from the Ministry of Health for presenting incomplete data on COVID-19, the six largest newspapers and news sites in the country united in order to compile and systematize daily the data from the State Departments of Health 34 , ensuring a higher reliability and transparency of the numbers, thus acting as overseers for the public powers and guaranteeing the dissemination of correct information. However, in a health crisis with the magnitude of the present one, much more is necessary than merely making numbers visible. Newspapers and news sites have a key role, since the information they produce and circulate guide collective and individual behaviors ( Stevens and Hornik, 2014 ). Therefore, it is crucial that journalists take on a critical posture, knowing how to identify the multiple faces of denialism and making clear the damaging effects of eugenics policies upon the health of the population.

Data Availability Statement

Publicly available datasets were analyzed in this study. All the articles/data used in the research are listed in the footnotes and are open access.

Author Contributions

CM and JB contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

1. ^ Daily map of Johns Hopkins University and Medicine. Available at https://coronavirus.jhu.edu/map.html .

2. ^ Carried out in partnership between the RSF and the Intervozes collective, MOM-Brasil was the 11th study throughout the world and also the largest—up until 2017, the number of vehicles investigated had reached at the most 40. Available at: http://brazil.mom-rsf.org/br/ .

3. ^ Available at: https://brasil.elpais.com/brasil/2020-06-25/nem-o-pior-ministro-da-saude-fez-o-que-exercito-esta-fazendo-desmontando-a-engrenagem-do-sus.html .

4. ^ “What is ‘group immunity,' the polemical strategy of the United Kingdom to combat coronavirus.” Available at: https://noticias.uol.com.br/saude/ultimas-noticias/bbc/2020/03/16/o-que-e-a-imunidade-de-grupo-a-polemica-estrategia-do-reino-unido-para-combater-coronavirus.htm .

5. ^ “Coronavirus: must almost everyone catch it to end the pandemic?” Available at: https://saude.abril.com.br/blog/cientistas-explicam/coronavirus-quase-todo-mundo-tem-que-pegar-para-a-pandemia-passar/ .

6. ^ “Who is immune to coronavirus?” Available at: https://www1.folha.uol.com.br/equilibrioesaude/2020/04/quem-e-imune-ao-coronavirus.shtml .

7. ^ “Specialists recommend herd immunity for poor countries.” Available at: https://economia.uol.com.br/noticias/bloomberg/2020/04/22/especialistas-recomendam-imunidade-de-rebanho-para-paises-pobres.htm .

8. ^ “Coronavirus pandemic: the best scenario is disastrous.” Available at: https://agazetadoacre.com/2020/03/pandemia-de-coronavirus-o-melhor-cenario-e-desastroso/ .

9. ^ “Epidemiologist opposes Osmar Terra and sees Brazil as far from the end of the epidemic.” Available at: https://www.bol.uol.com.br/noticias/2020/04/14/brasil-esta-longe-do-final-da-epidemia-e-de-imunizacao-diz-epidemiologista.htm .

10. ^ Doctor, former Health Secretary of Rio Grande do Sul and former minister for presidents Michel Temer (who took over the presidency of the Republic in 2016, after the parliamentary coup against president Dilma Rousseff) and for Bolsonaro himself, Terra had participated, the day before, in a debate on the epidemic promoted by UOL, one of the largest news sites in the country. Available at: https://noticias.uol.com.br/politica/ultimas-noticias/2020/04/13/governistas-criticam-isolamento-e-minimizam-briga-bolsonaro-x-mandetta.htm .

11. ^ Available at: https://www1.folha.uol.com.br/poder/2020/05/deputados-divulgam-fake-news-sobre-coronavirus-para-ecoar-discurso-de-bolsonaro.shtml .

12. ^ Available at: https://www.youtube.com/watch?v=Fy9dqEsjkVk .

13. ^ Link to the pronouncement.

14. ^ After 7m14s. Available at: https://www.youtube.com/watch?reload=9&v=vp3A_8vywC0 .

15. ^ The president of the True Health Initiative and director-founder of the Yale-Griffin Prevention Research Center.

16. ^ “What is the vertical isolation that Bolsonaro wants and why do specialists fear it will cause more deaths?” Available at: https://www.bbc.com/portuguese/internacional-52043112 .

17. ^ “Why is vertical isolation seen with skepticism?” Available at: https://saude.estadao.com.br/noticias/geral,por-que-isolamento-vertical-e-visto-com-ceticismo,70003252797 .

18. ^ The titles of the articles (descriptor 3): What is vertical isolation against coronavirus; What is the vertical isolation that Bolsonaro wants and why do specialists fear it will cause more deaths?; Does vertical isolation work? Reality has already answered that question, says doctor; What is vertical isolation and why it may not work; What is vertical isolation [and why this may not be a good idea)?]; What is vertical isolation (and why this is not a good idea)? Horizontal vs. vertical isolation: know the pros and cons of the strategies to contain coronavirus; Health alerts to rash transition, but sees vertical isolation as possible in little-affected locations; and, What are the risks of adopting only vertical isolation, proposed by Bolsonaro; What is the vertical isolation that Bolsonaro wants and why do specialists fear it will cause more deaths?; Specialists: Brazil's characteristics do not permit vertical isolation; Health alerts to rash transition, but sees vertical isolation as possible in little-affected locations; Turkey endures drastic consequences of vertical isolation.

19. ^ Bolsonaro once again minimizes COVID-19 and says that Health is studying vertical isolation. Available at: https://www.istoedinheiro.com.br/bolsonaro-volta-a-minimizar-COVID-19-e-diz-que-saude-estuda-isolamento-vertical/ .

20. ^ The notion of the crab men emerged from the main works of Josué de Castro: Geografia da fome (1948), Geopol í tica da fome (1951), Documentário do Nordeste (1957), Fatores de localização da cidade do Recife (1957), and Homens e caranguejos (1967), the last an autobiographical romance.

21. ^ “Vertical isolation proposed by Bolsonaro may accelerate contagion by coronavirus and compromise health systems.” Available at: https://brasil.elpais.com/brasil/2020-03-25/isolamento-vertical-proposto-por-bolsonaro-pode-acelerar-contagios-por-coronavirus-e-comprometer-sistema-de-saude.html .

22. ^ “Bolsonaro will propose vertical isolation to contain coronavirus.” Available at: https://www.cnnbrasil.com.br/politica/2020/03/25/bolsonaro-nao-estou-preocupado-com-a-minha-popularidade .

23. ^ “Bolsonaro defends vertical isolation and suggests the country may ‘depart from democratic normality.”' Available at: https://oglobo.globo.com/brasil/bolsonaro-defende-isolamento-vertical-sugere-que-pais-pode-sair-da-normalidade-democratica-24327038 .

24. ^ After retiring as a captain of the Brazilian Army at the age of 33, Bolsonaro has been a professional politician for over 30 years. Before becoming president, he was on the Rio de Janeiro city council and, later, was a federal congressman for 27 years. During that period, he presented only two draft bills.

25. ^ Available at: https://veja.abril.com.br/brasil/bolsonaro-e-acusado-de-racismo-por-frase-em-palestra-na-hebraica/ .

26. ^ Quilombo are settlements first established by escaped slaves in Brazil. Quilombolas are the descendants of Afro-Brazilian slaves who escaped from slave plantations that existed in Brazil until abolition in 1888. Since 2003 the Decreto 4.887/2003,recognized Quilombo communities and their claims to the land they inhabited, but only 219 of the 2,926 Quilombos have land titles.

27. ^ Available at: https://www.bol.uol.com.br/noticias/2020/06/23/sob-bolsonaro-reconhecimento-de-quilombolas-cai-ao-menor-patamar-da-historia.htm .

28. ^ Available at: https://ponte.org/eugenia-2-0-a-politica-migratoria-de-bolsonaro/ .

29. ^ Available at: https://veja.abril.com.br/politica/e-dai-nao-faco-milagres-diz-bolsonaro-sobre-mortes-por-COVID-19/ .

30. ^ Available at: https://www.cnnbrasil.com.br/saude/2020/06/05/negros-morrem-40-mais-que-brancos-por-coronavirus-no-brasil .

31. ^ Available at: https://www.huffpostbrasil.com/entry/mortes-COVID-19-25-junho_br_5ef4b64cc5b66c3126832ef9 .

32. ^ Available at: https://www.saude.gov.br/images/pdf/2020/May/20/orientacoes-manuseio-medicamentoso-covid19.pdf .

33. ^ To read further, see: “ https://www.huffpostbrasil.com/entry/mortes-COVID-19-25-junho_br_5ef4b64cc5b66c3126832ef9 .

34. ^ Available at: https://www1.folha.uol.com.br/equilibrioesaude/2020/06/congressistas-e-entidades-elogiam-consorcio-de-imprensa-para-coletar-dados-da-COVID-19.shtml .

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Keywords: novel SARS-coronavirus-2/SARS-CoV-2/COVID-19, digital media, eugenics, denialism, public health communication, journalism

Citation: Malinverni C and Brigagão JIM (2020) COVID-19: Scientific Arguments, Denialism, Eugenics, and the Construction of the Antisocial Distancing Discourse in Brazil. Front. Commun. 5:582963. doi: 10.3389/fcomm.2020.582963

Received: 13 July 2020; Accepted: 30 September 2020; Published: 04 November 2020.

Reviewed by:

Copyright © 2020 Malinverni and Brigagão. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Claudia Malinverni, claudia.malinverni@usp.br ; Jacqueline Isaac Machado Brigagão, jac@usp.br

This article is part of the Research Topic

Strategic Narratives in Political and Crisis Communication: Responses to COVID-19

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The Science of Persuasion Offers Lessons for COVID-19 Prevention

Hand washing, mask wearing, social distancing—experts agree these protective behaviors are key to stemming coronavirus disease 2019 (COVID-19). But how should leaders encourage their uptake?

Look to the science of persuasion, says communications professor Dominique Brossard, PhD. Brossard is part of a new National Academies of Science, Engineering, and Medicine group called the Societal Experts Action Network, or SEAN, whose recent report lays out research-based strategies to encourage COVID-19–mitigating behaviors.

Brossard says the changes must feel easy to do—and to repeat, which helps to form habits. Past public health campaigns also suggest it’s wise to know and understand one’s target audience, and to tailor messages and messengers accordingly.

“It’s difficult to change people’s behavior at the massive level,” Brossard, chair of the life sciences communications department at the University of Wisconsin-Madison, said in a recent interview with JAMA. The following is an edited version of that conversation.

JAMA: You and your coauthors write that simply explaining the science of COVID-19 and its risks will rarely translate to a change in attitudes and behaviors, even if people understand and accept the facts. Why isn’t it enough to explain the science if you want to change health behaviors?

Dr Brossard: Because human beings rely more on the psychological dimensions of the risk than the quantitative aspect of the risk. If experts measure risk in numbers, such as the probability of getting harmed by something, human beings in general—you and me included—look at what we call the qualitative aspect of that risk: the potential magnitude of the effect, the potential dread, how much it may impact people [close] to us, and so on. So, psychological dimensions.

JAMA: How does that translate to people’s unwillingness to change their attitudes and behaviors?

Dr Brossard: If we’re asked to do something new, that will impact our willingness to do it for a variety of reasons. It might be because people around us, our social network, the norms around us tell us that this is something that’s not acceptable. It might be because it’s a little inconvenient. It might be because we forget about it. At the end of the day, when we perform certain behaviors, rarely do we think about the science that tells us why we shouldn’t do it and why this might be dangerous. We do it because, as social animals, we pay attention to cues that our minds tell us to pay attention to and our community and people around us tell us to pay attention to. Therefore, our behavior is really based on the psychological components rather than more quantifiable aspects.

JAMA: Your report recommends 5 habit-promoting strategies: make the behavior easy to start and repeat; make the behavior rewarding to repeat; tie the behavior to an existing habit; alert people to behaviors that conflict with existing habits and provide alternative behaviors; and provide specific descriptions of desired behaviors. How can these strategies be applied today?

Dr Brossard: People are more likely to act in healthy ways when it’s easy for them to perform that behavior. So let’s think in terms of hand washing, for example. It will be very important to have hand washing stations and hand sanitizer easily accessible to people. Making the behavior very easy to start and to repeat is very important. If you put a mask next to your front door, and it’s easy to grab when you go out the door, that’s going to be easy to implement and you may be more likely to actually do it again. If you want to encourage people to physically distance from other people around them, having signs on the floor is actually something that works. They don’t have to calculate in their mind: what does it mean to be physically distanced? How far am I from other people? They simply stand where the mark tells them. It makes the behavior easy to repeat and easy to perform.

JAMA: So you’re trying to take away any barriers to the behaviors?

Dr Brossard: Exactly. The idea is if you take away as many barriers as possible, you encourage people to repeat the behavior. And then you end up creating a habit.

JAMA: In your report you mentioned that having many hand sanitizer stations sets the norm—that it’s normal to hand sanitize.

Dr Brossard: Mask wearing and physically distancing are new habits we’re creating from scratch. As social animals, that’s not something we do, in general. However, hand washing is a habit that we would have hoped the population already had. The problem is it hasn’t been really implemented. People do it very inconsistently. If you have hand sanitizers everywhere, it’s very easy. As a matter of fact, in supermarkets, when you have the hand sanitizer at the door, people line up and do it. So it’s that idea of the social norm and making it sound like, this is something you do, it’s widely available, other people do it as well, and therefore, this is socially acceptable and highly encouraged, and we should just all do it.

JAMA: The report also discusses 10 strategies for communicating risk, like using clear, consistent, and transparent messaging. It feels like that’s the opposite of what we’ve had. What’s your take on the federal government’s messaging around COVID-19 mitigation?

Dr Brossard: I think that in this case what’s really crucial is the messaging at the local level. At the state level vs county level vs town level, having a consistent strategy, consistent messages, is very important. It’s clear that for public health–related issues, really what makes a difference is the action of local leaders. It’s really the community-based action that can change people’s behavior. At the local level people trust the doctors, the public health officials.

JAMA: Masks unfortunately have become politicized. Is it too late for universal masking to be accepted or do you think minds can still be changed?

Dr Brossard: You will always have extremes on both ends. The vast majority of the population will be somewhere in between. People that are extremely set on the attitude not to wear a mask, which is, by the way, a very, very small minority, are unlikely to change their views. However, all the others can change their views. People are reasonable in the sense that they want to protect their own, they want to protect the community, they want to have the economy reopen, and so on. So I would say, yes, there’s still hope. And we see it. Every week, our group at the SEAN Network publishes a summary of all the polls that address [COVID-19–related] behaviors. We see that mask wearing is increasing. It’s not yet at the level that we would like to make sure that we are protected, but it’s indeed increasing.

JAMA: You reported that highlighting crowded beaches or people who aren’t wearing masks can be counterproductive. Why? And what’s a better approach?

Dr Brossard: They end up thinking that it’s a more prevalent behavior than it actually is. Or it may actually prompt them to think, “Oh, I wish I was on the beach.” You want to highlight good behavior and make it sound like this is socially acceptable rather than highlighting undesirable behavior and making it sound like it’s more frequent than it actually is.

JAMA: So local leaders should emphasize that mask wearing is increasing, for example?

Dr Brossard: Exactly. The research on social norms is extremely, extremely important here. We tend to get cues based on the people around us. Human beings have something that we call fear of isolation. We don’t like to be the lonely person that is the only one doing a certain thing when the vast majority around us are doing another thing. So it’s very important to actually show, “Look, this is going in this direction. Political leaders from both sides of the spectrum are doing it.” To show that the desirable behavior is something that’s becoming prevalent and that this is the direction society is taking.

JAMA: One lesson in your report is that it’s important to concede uncertainty. Why should leaders say things like, “Based on what we know today…”?

Dr Brossard: This is a really key message of risk communication. If you highlight something as being certain and then the science changes and suddenly you say, “Well, wait a minute, actually this was wrong, and now it is this,” you destroy trust. Science evolves, particularly in the context of COVID-19. We are all discovering this virus. The social sciences have shown that acknowledging uncertainty will actually increase trust, much more than painting things as certain. So it’s very important to say, “Based on the science of today, this is what we should do.” It’s very important to show that it’s a work in progress.

JAMA: What about the messengers themselves? Have we tapped into social media influencers enough? And who are community influencers that have the power to change our collective behaviors?

Dr Brossard: It makes us think of the AIDS community, where the leaders of the communities were messengers in helping promote protective behaviors. Using messengers that are trusted by the target audiences and relying on social media is extremely important. And as far as influencers in the communities, this will depend from one community to the other. Let’s take Wisconsin, for example. Football is a sport that people enjoy regardless of their political ideology, age, and so on. So the [Green Bay] Packers are messengers that transcend potential barriers there. It’s important to find trusted messengers that can connect with the audience on social media but also face-to-face. That can be a trusted local business leader, for example.

JAMA: What have we learned from past public health campaigns, like antismoking and wearing seatbelts, that can be applied now?

Dr Brossard: In the ’70s, we had social marketing approaches that suggested that we needed to stop trying to educate people and actually adapt a marketing technique to social issues. The antismoking Truth campaign, as it was called, was a successful application of social marketing techniques. The idea that you need to segment your audience and tailor the message specifically to that audience is something that the Truth campaign very well illustrated. A specific audience that needed to be targeted was adolescents and teenagers, and one thing that adolescents do is rebel against authority. They don’t like people to force them to do things. So the Truth campaign tried to appeal to their drive for autonomy by showing them that the tobacco industry was taking advantage of the adolescent population. That was extremely powerful. The problem is that a mass media campaign like that can be extremely, extremely expensive. That’s why it’s very important also to rely on what we think of as organic dissemination of messaging through social media, which we couldn’t do when the Truth campaign was put together.

JAMA: How can physicians apply these strategies of persuasion with patients, in their communities, or on social networks?

Dr Brossard: We are all tempted to correct misinformation. And right now, we see it everywhere, right? However, we need to be careful because by repeating the misinformation itself, we make it more prevalent. When physicians want to communicate about COVID-19, it’s better to actually communicate the right information without repeating the misinformation itself. I think it’s very important to remember that all of us are part of the solution by making sure that those right behaviors get communicated to as many people as we can. I think physicians have a really, really big part to play in this organic dissemination.

JAMA: How will these strategies apply once we have a COVID-19 vaccine?

Dr Brossard: It goes back to that idea of targeting and audience segmentation to understand who has issues with the vaccine—in this case potentially COVID-19—and why. We actually do not know why people think the way they do. What we do know is that there’s no wrong concern. If people are concerned, they’re concerned. We need to listen and try to understand why and then address that.

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Abbasi J. The Science of Persuasion Offers Lessons for COVID-19 Prevention. JAMA. 2020;324(13):1271–1272. doi:10.1001/jama.2020.15139

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The complexity of managing COVID-19: How important is good governance?

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Alaka m. basu , amb alaka m. basu professor, department of global development - cornell university, senior fellow - united nations foundation kaushik basu , and kaushik basu nonresident senior fellow - global economy and development @kaushikcbasu jose maria u. tapia jmut jose maria u. tapia student - cornell university.

November 17, 2020

• 13 min read

This essay is part of “ Reimagining the global economy: Building back better in a post-COVID-19 world ,” a collection of 12 essays presenting new ideas to guide policies and shape debates in a post-COVID-19 world.

The COVID-19 pandemic has exposed the inadequacy of public health systems worldwide, casting a shadow that we could not have imagined even a year ago. As the fog of confusion lifts and we begin to understand the rudiments of how the virus behaves, the end of the pandemic is nowhere in sight. The number of cases and the deaths continue to rise. The latter breached the 1 million mark a few weeks ago and it looks likely now that, in terms of severity, this pandemic will surpass the Asian Flu of 1957-58 and the Hong Kong Flu of 1968-69.

Moreover, a parallel problem may well exceed the direct death toll from the virus. We are referring to the growing economic crises globally, and the prospect that these may hit emerging economies especially hard.

The economic fall-out is not entirely the direct outcome of the COVID-19 pandemic but a result of how we have responded to it—what measures governments took and how ordinary people, workers, and firms reacted to the crisis. The government activism to contain the virus that we saw this time exceeds that in previous such crises, which may have dampened the spread of the COVID-19 but has extracted a toll from the economy.

This essay takes stock of the policies adopted by governments in emerging economies, and what effect these governance strategies may have had, and then speculates about what the future is likely to look like and what we may do here on.

Nations that build walls to keep out goods, people and talent will get out-competed by other nations in the product market.

It is becoming clear that the scramble among several emerging economies to imitate and outdo European and North American countries was a mistake. We get a glimpse of this by considering two nations continents apart, the economies of which have been among the hardest hit in the world, namely, Peru and India. During the second quarter of 2020, Peru saw an annual growth of -30.2 percent and India -23.9 percent. From the global Q2 data that have emerged thus far, Peru and India are among the four slowest growing economies in the world. Along with U.K and Tunisia these are the only nations that lost more than 20 percent of their GDP. 1

COVID-19-related mortality statistics, and, in particular, the Crude Mortality Rate (CMR), however imperfect, are the most telling indicator of the comparative scale of the pandemic in different countries. At first glance, from the end of October 2020, Peru, with 1039 COVID-19 deaths per million population looks bad by any standard and much worse than India with 88. Peru’s CMR is currently among the highest reported globally.

However, both Peru and India need to be placed in regional perspective. For reasons that are likely to do with the history of past diseases, there are striking regional differences in the lethality of the virus (Figure 11.1). South America is worse hit than any other world region, and Asia and Africa seem to have got it relatively lightly, in contrast to Europe and America. The stark regional difference cries out for more epidemiological analysis. But even as we await that, these are differences that cannot be ignored.

To understand the effect of policy interventions, it is therefore important to look at how these countries fare within their own regions, which have had similar histories of illnesses and viruses (Figure 11.2). Both Peru and India do much worse than the neighbors with whom they largely share their social, economic, ecological and demographic features. Peru’s COVID-19 mortality rate per million population, or CMR, of 1039 is ahead of the second highest, Brazil at 749, and almost twice that of Argentina at 679.

Similarly, India at 88 compares well with Europe and the U.S., as does virtually all of Asia and Africa, but is doing much worse than its neighbors, with the second worst country in the region, Afghanistan, experiencing less than half the death rate of India.

The official Indian statement that up to 78,000 deaths 2 were averted by the lockdown has been criticized 3 for its assumptions. A more reasonable exercise is to estimate the excess deaths experienced by a country that breaks away from the pattern of its regional neighbors. So, for example, if India had experienced Afghanistan’s COVID-19 mortality rate, it would by now have had 54,112 deaths. And if it had the rate reported by Bangladesh, it would have had 49,950 deaths from COVID-19 today. In other words, more than half its current toll of some 122,099 COVID-19 deaths would have been avoided if it had experienced the same virus hit as its neighbors.

What might explain this outlier experience of COVID-19 CMRs and economic downslide in India and Peru? If the regional background conditions are broadly similar, one is left to ask if it is in fact the policy response that differed markedly and might account for these relatively poor outcomes.

Peru and India have performed poorly in terms of GDP growth rate in Q2 2020 among the countries displayed in Table 2, and given that both these countries are often treated as case studies of strong governance, this draws attention to the fact that there may be a dissonance between strong governance and good governance.

The turnaround for India has been especially surprising, given that until a few years ago it was among the three fastest growing economies in the world. The slowdown began in 2016, though the sharp downturn, sharper than virtually all other countries, occurred after the lockdown.

On the COVID-19 policy front, both India and Peru have become known for what the Oxford University’s COVID Policy Tracker 4 calls the “stringency” of the government’s response to the epidemic. At 8 pm on March 24, 2020, the Indian government announced, with four hours’ notice, a complete nationwide shutdown. Virtually all movement outside the perimeter of one’s home was officially sought to be brought to a standstill. Naturally, as described in several papers, such as that of Ray and Subramanian, 5 this meant that most economic life also came to a sudden standstill, which in turn meant that hundreds of millions of workers in the informal, as well as more marginally formal sectors, lost their livelihoods.

In addition, tens of millions of these workers, being migrant workers in places far-flung from their original homes, also lost their temporary homes and their savings with these lost livelihoods, so that the only safe space that beckoned them was their place of origin in small towns and villages often hundreds of miles away from their places of work.

After a few weeks of precarious living in their migrant destinations, they set off, on foot since trains and buses had been stopped, for these towns and villages, creating a “lockdown and scatter” that spread the virus from the city to the town and the town to the village. Indeed, “lockdown” is a bit of a misnomer for what happened in India, since over 20 million people did exactly the opposite of what one does in a lockdown. Thus India had a strange combination of lockdown some and scatter the rest, like in no other country. They spilled out and scattered in ways they would otherwise not do. It is not surprising that the infection, which was marginally present in rural areas (23 percent in April), now makes up some 54 percent of all cases in India. 6

In Peru too, the lockdown was sudden, nationwide, long drawn out and stringent. 7 Jobs were lost, financial aid was difficult to disburse, migrant workers were forced to return home, and the virus has now spread to all parts of the country with death rates from it surpassing almost every other part of the world.

As an aside, to think about ways of implementing lockdowns that are less stringent and geographically as well as functionally less total, an example from yet another continent is instructive. Ethiopia, with a COVID-19 death rate of 13 per million population seems to have bettered the already relatively low African rate of 31 in Table 1. 8

We hope that human beings will emerge from this crisis more aware of the problems of sustainability.

The way forward

We next move from the immediate crisis to the medium term. Where is the world headed and how should we deal with the new world? Arguably, that two sectors that will emerge larger and stronger in the post-pandemic world are: digital technology and outsourcing, and healthcare and pharmaceuticals.

The last 9 months of the pandemic have been a huge training ground for people in the use of digital technology—Zoom, WebEx, digital finance, and many others. This learning-by-doing exercise is likely to give a big boost to outsourcing, which has the potential to help countries like India, the Philippines, and South Africa.

Globalization may see a short-run retreat but, we believe, it will come back with a vengeance. Nations that build walls to keep out goods, people and talent will get out-competed by other nations in the product market. This realization will make most countries reverse their knee-jerk anti-globalization; and the ones that do not will cease to be important global players. Either way, globalization will be back on track and with a much greater amount of outsourcing.

To return, more critically this time, to our earlier aside on Ethiopia, its historical and contemporary record on tampering with internet connectivity 9 in an attempt to muzzle inter-ethnic tensions and political dissent will not serve it well in such a post-pandemic scenario. This is a useful reminder for all emerging market economies.

We hope that human beings will emerge from this crisis more aware of the problems of sustainability. This could divert some demand from luxury goods to better health, and what is best described as “creative consumption”: art, music, and culture. 10 The former will mean much larger healthcare and pharmaceutical sectors.

But to take advantage of these new opportunities, nations will need to navigate the current predicament so that they have a viable economy once the pandemic passes. Thus it is important to be able to control the pandemic while keeping the economy open. There is some emerging literature 11 on this, but much more is needed. This is a governance challenge of a kind rarely faced, because the pandemic has disrupted normal markets and there is need, at least in the short run, for governments to step in to fill the caveat.

Emerging economies will have to devise novel governance strategies for doing this double duty of tamping down on new infections without strident controls on economic behavior and without blindly imitating Europe and America.

Here is an example. One interesting opportunity amidst this chaos is to tap into the “resource” of those who have already had COVID-19 and are immune, even if only in the short-term—we still have no definitive evidence on the length of acquired immunity. These people can be offered a high salary to work in sectors that require physical interaction with others. This will help keep supply chains unbroken. Normally, the market would have on its own caused such a salary increase but in this case, the main benefit of marshaling this labor force is on the aggregate economy and GDP and therefore is a classic case of positive externality, which the free market does not adequately reward. It is more a challenge of governance. As with most economic policy, this will need careful research and design before being implemented. We have to be aware that a policy like this will come with its risk of bribery and corruption. There is also the moral hazard challenge of poor people choosing to get COVID-19 in order to qualify for these special jobs. Safeguards will be needed against these risks. But we believe that any government that succeeds in implementing an intelligently-designed intervention to draw on this huge, under-utilized resource can have a big, positive impact on the economy 12 .

This is just one idea. We must innovate in different ways to survive the crisis and then have the ability to navigate the new world that will emerge, hopefully in the not too distant future.

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Note: We are grateful for financial support from Cornell University’s Hatfield Fund for the research associated with this paper. We also wish to express our gratitude to Homi Kharas for many suggestions and David Batcheck for generous editorial help.

• “GDP Annual Growth Rate – Forecast 2020-2022,” Trading Economics, https://tradingeconomics.com/forecast/gdp-annual-growth-rate.
• “Government Cites Various Statistical Models, Says Averted Between 1.4 Million-2.9 Million Cases Due To Lockdown,” Business World, May 23, 2020, www.businessworld.in/article/Government-Cites-Various-Statistical-Models-Says-Averted-Between-1-4-million-2-9-million-Cases-Due-To-Lockdown/23-05-2020-193002/.
• Suvrat Raju, “Did the Indian lockdown avert deaths?” medRxiv , July 5, 2020, https://europepmc.org/article/ppr/ppr183813#A1.
• “COVID Policy Tracker,” Oxford University, https://github.com/OxCGRT/covid-policy-tracker t.
• Debraj Ray and S. Subramanian, “India’s Lockdown: An Interim Report,” NBER Working Paper, May 2020, https://www.nber.org/papers/w27282.
• Gopika Gopakumar and Shayan Ghosh, “Rural recovery could slow down as cases rise, says Ghosh,” Mint, August 19, 2020, https://www.livemint.com/news/india/rural-recovery-could-slow-down-as-cases-rise-says-ghosh-11597801644015.html.
• Pierina Pighi Bel and Jake Horton, “Coronavirus: What’s happening in Peru?,” BBC, July 9, 2020, https://www.bbc.com/news/world-latin-america-53150808.
• “No lockdown, few ventilators, but Ethiopia is beating Covid-19,” Financial Times, May 27, 2020, https://www.ft.com/content/7c6327ca-a00b-11ea-b65d-489c67b0d85d.
• Cara Anna, “Ethiopia enters 3rd week of internet shutdown after unrest,” Washington Post, July 14, 2020, https://www.washingtonpost.com/world/africa/ethiopia-enters-3rd-week-of-internet-shutdown-after-unrest/2020/07/14/4699c400-c5d6-11ea-a825-8722004e4150_story.html.
• Patrick Kabanda, The Creative Wealth of Nations: Can the Arts Advance Development? (Cambridge: Cambridge University Press, 2018).
• Guanlin Li et al, “Disease-dependent interaction policies to support health and economic outcomes during the COVID-19 epidemic,” medRxiv, August 2020, https://www.medrxiv.org/content/10.1101/2020.08.24.20180752v3.
• For helpful discussion concerning this idea, we are grateful to Turab Hussain, Daksh Walia and Mehr-un-Nisa, during a seminar of South Asian Economics Students’ Meet (SAESM).

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Coronavirus: The world has come together to flatten the curve. Can we stay united to tackle other crises?

Watching the world come together gives me hope for the future, writes mira patel, a high school junior..

Mira Patel and her sister Veda. (Courtesy of Dee Patel)

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Before the pandemic, I had often heard adults say that young people would lose the ability to connect in-person with others due to our growing dependence on technology and social media. However, this stay-at-home experience has proven to me that our elders’ worry is unnecessary. Because isolation isn’t in human nature, and no advancement in technology could replace our need to meet in person, especially when it comes to learning.

As the weather gets warmer and we approach summertime, it’s going to be more and more tempting for us teenagers to go out and do what we have always done: hang out and have fun. Even though the decision-makers are adults, everyone has a role to play and we teens can help the world move forward by continuing to self-isolate. It’s incredibly important that in the coming weeks, we respect the government’s effort to contain the spread of the coronavirus.

In the meantime, we can find creative ways to stay connected and continue to do what we love. Personally, I see many 6-feet-apart bike rides and Zoom calls in my future.

If there is anything that this pandemic has made me realize, it’s how connected we all are. At first, the infamous coronavirus seemed to be a problem in China, which is worlds away. But slowly, it steadily made its way through various countries in Europe, and inevitably reached us in America. What was once framed as a foreign virus has now hit home.

Watching the global community come together, gives me hope, as a teenager, that in the future we can use this cooperation to combat climate change and other catastrophes.

As COVID-19 continues to creep its way into each of our communities and impact the way we live and communicate, I find solace in the fact that we face what comes next together, as humanity.

When the day comes that my generation is responsible for dealing with another crisis, I hope we can use this experience to remind us that moving forward requires a joint effort.

Mira Patel is a junior at Strath Haven High School and is an education intern at the Foreign Policy Research Institute in Philadelphia. Follow her on Instagram here.  

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Read these 12 moving essays about life during coronavirus

Artists, novelists, critics, and essayists are writing the first draft of history.

by Alissa Wilkinson

The world is grappling with an invisible, deadly enemy, trying to understand how to live with the threat posed by a virus . For some writers, the only way forward is to put pen to paper, trying to conceptualize and document what it feels like to continue living as countries are under lockdown and regular life seems to have ground to a halt.

So as the coronavirus pandemic has stretched around the world, it’s sparked a crop of diary entries and essays that describe how life has changed. Novelists, critics, artists, and journalists have put words to the feelings many are experiencing. The result is a first draft of how we’ll someday remember this time, filled with uncertainty and pain and fear as well as small moments of hope and humanity.

• The Vox guide to navigating the coronavirus crisis

At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:

Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.

His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.”

Writing from Chattanooga, novelist Jamie Quatro documents the mixed ways her neighbors have been responding to the threat, and the frustration of conflicting direction, or no direction at all, from local, state, and federal leaders:

Whiplash, trying to keep up with who’s ordering what. We’re already experiencing enough chaos without this back-and-forth. Why didn’t the federal government issue a nationwide shelter-in-place at the get-go, the way other countries did? What happens when one state’s shelter-in-place ends, while others continue? Do states still under quarantine close their borders? We  are  still one nation, not fifty individual countries. Right?

• A syllabus for the end of the world

Award-winning photojournalist Alessio Mamo, quarantined with his partner Marta in Sicily after she tested positive for the virus, accompanies his photographs in the Guardian of their confinement with a reflection on being confined :

The doctors asked me to take a second test, but again I tested negative. Perhaps I’m immune? The days dragged on in my apartment, in black and white, like my photos. Sometimes we tried to smile, imagining that I was asymptomatic, because I was the virus. Our smiles seemed to bring good news. My mother left hospital, but I won’t be able to see her for weeks. Marta started breathing well again, and so did I. I would have liked to photograph my country in the midst of this emergency, the battles that the doctors wage on the frontline, the hospitals pushed to their limits, Italy on its knees fighting an invisible enemy. That enemy, a day in March, knocked on my door instead.

In the New York Times Magazine, deputy editor Jessica Lustig writes with devastating clarity about her family’s life in Brooklyn while her husband battled the virus, weeks before most people began taking the threat seriously:

At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him.

Essayist Leslie Jamison writes in the New York Review of Books about being shut away alone in her New York City apartment with her 2-year-old daughter since she became sick:

The virus.  Its sinewy, intimate name. What does it feel like in my body today? Shivering under blankets. A hot itch behind the eyes. Three sweatshirts in the middle of the day. My daughter trying to pull another blanket over my body with her tiny arms. An ache in the muscles that somehow makes it hard to lie still. This loss of taste has become a kind of sensory quarantine. It’s as if the quarantine keeps inching closer and closer to my insides. First I lost the touch of other bodies; then I lost the air; now I’ve lost the taste of bananas. Nothing about any of these losses is particularly unique. I’ve made a schedule so I won’t go insane with the toddler. Five days ago, I wrote  Walk/Adventure!  on it, next to a cut-out illustration of a tiger—as if we’d see tigers on our walks. It was good to keep possibility alive.

At Literary Hub, novelist Heidi Pitlor writes about the elastic nature of time during her family’s quarantine in Massachusetts:

During a shutdown, the things that mark our days—commuting to work, sending our kids to school, having a drink with friends—vanish and time takes on a flat, seamless quality. Without some self-imposed structure, it’s easy to feel a little untethered. A friend recently posted on Facebook: “For those who have lost track, today is Blursday the fortyteenth of Maprilay.” ... Giving shape to time is especially important now, when the future is so shapeless. We do not know whether the virus will continue to rage for weeks or months or, lord help us, on and off for years. We do not know when we will feel safe again. And so many of us, minus those who are gifted at compartmentalization or denial, remain largely captive to fear. We may stay this way if we do not create at least the illusion of movement in our lives, our long days spent with ourselves or partners or families.

• What day is it today?

Novelist Lauren Groff writes at the New York Review of Books about trying to escape the prison of her fears while sequestered at home in Gainesville, Florida:

Some people have imaginations sparked only by what they can see; I blame this blinkered empiricism for the parks overwhelmed with people, the bars, until a few nights ago, thickly thronged. My imagination is the opposite. I fear everything invisible to me. From the enclosure of my house, I am afraid of the suffering that isn’t present before me, the people running out of money and food or drowning in the fluid in their lungs, the deaths of health-care workers now growing ill while performing their duties. I fear the federal government, which the right wing has so—intentionally—weakened that not only is it insufficient to help its people, it is actively standing in help’s way. I fear we won’t sufficiently punish the right. I fear leaving the house and spreading the disease. I fear what this time of fear is doing to my children, their imaginations, and their souls.

At ArtForum , Berlin-based critic and writer Kristian Vistrup Madsen reflects on martinis, melancholia, and Finnish artist Jaakko Pallasvuo’s 2018 graphic novel  Retreat , in which three young people exile themselves in the woods:

In melancholia, the shape of what is ending, and its temporality, is sprawling and incomprehensible. The ambivalence makes it hard to bear. The world of  Retreat  is rendered in lush pink and purple watercolors, which dissolve into wild and messy abstractions. In apocalypse, the divisions established in genesis bleed back out. My own Corona-retreat is similarly soft, color-field like, each day a blurred succession of quarantinis, YouTube–yoga, and televized press conferences. As restrictions mount, so does abstraction. For now, I’m still rooting for love to save the world.

At the Paris Review , Matt Levin writes about reading Virginia Woolf’s novel The Waves during quarantine:

A retreat, a quarantine, a sickness—they simultaneously distort and clarify, curtail and expand. It is an ideal state in which to read literature with a reputation for difficulty and inaccessibility, those hermetic books shorn of the handholds of conventional plot or characterization or description. A novel like Virginia Woolf’s  The Waves  is perfect for the state of interiority induced by quarantine—a story of three men and three women, meeting after the death of a mutual friend, told entirely in the overlapping internal monologues of the six, interspersed only with sections of pure, achingly beautiful descriptions of the natural world, a day’s procession and recession of light and waves. The novel is, in my mind’s eye, a perfectly spherical object. It is translucent and shimmering and infinitely fragile, prone to shatter at the slightest disturbance. It is not a book that can be read in snatches on the subway—it demands total absorption. Though it revels in a stark emotional nakedness, the book remains aloof, remote in its own deep self-absorption.

• Vox is starting a book club. Come read with us!

In an essay for the Financial Times, novelist Arundhati Roy writes with anger about Indian Prime Minister Narendra Modi’s anemic response to the threat, but also offers a glimmer of hope for the future:

Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it. 

From Boston, Nora Caplan-Bricker writes in The Point about the strange contraction of space under quarantine, in which a friend in Beirut is as close as the one around the corner in the same city:

It’s a nice illusion—nice to feel like we’re in it together, even if my real world has shrunk to one person, my husband, who sits with his laptop in the other room. It’s nice in the same way as reading those essays that reframe social distancing as solidarity. “We must begin to see the negative space as clearly as the positive, to know what we  don’t do  is also brilliant and full of love,” the poet Anne Boyer wrote on March 10th, the day that Massachusetts declared a state of emergency. If you squint, you could almost make sense of this quarantine as an effort to flatten, along with the curve, the distinctions we make between our bonds with others. Right now, I care for my neighbor in the same way I demonstrate love for my mother: in all instances, I stay away. And in moments this month, I have loved strangers with an intensity that is new to me. On March 14th, the Saturday night after the end of life as we knew it, I went out with my dog and found the street silent: no lines for restaurants, no children on bicycles, no couples strolling with little cups of ice cream. It had taken the combined will of thousands of people to deliver such a sudden and complete emptiness. I felt so grateful, and so bereft.

And on his own website, musician and artist David Byrne writes about rediscovering the value of working for collective good , saying that “what is happening now is an opportunity to learn how to change our behavior”:

In emergencies, citizens can suddenly cooperate and collaborate. Change can happen. We’re going to need to work together as the effects of climate change ramp up. In order for capitalism to survive in any form, we will have to be a little more socialist. Here is an opportunity for us to see things differently — to see that we really are all connected — and adjust our behavior accordingly.  Are we willing to do this? Is this moment an opportunity to see how truly interdependent we all are? To live in a world that is different and better than the one we live in now? We might be too far down the road to test every asymptomatic person, but a change in our mindsets, in how we view our neighbors, could lay the groundwork for the collective action we’ll need to deal with other global crises. The time to see how connected we all are is now.

The portrait these writers paint of a world under quarantine is multifaceted. Our worlds have contracted to the confines of our homes, and yet in some ways we’re more connected than ever to one another. We feel fear and boredom, anger and gratitude, frustration and strange peace. Uncertainty drives us to find metaphors and images that will let us wrap our minds around what is happening.

Yet there’s no single “what” that is happening. Everyone is contending with the pandemic and its effects from different places and in different ways. Reading others’ experiences — even the most frightening ones — can help alleviate the loneliness and dread, a little, and remind us that what we’re going through is both unique and shared by all.

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Greater Good Science Center • Magazine • In Action • In Education

11 Questions to Ask About COVID-19 Research

Debates have raged on social media, around dinner tables, on TV, and in Congress about the science of COVID-19. Is it really worse than the flu? How necessary are lockdowns? Do masks work to prevent infection? What kinds of masks work best? Is the new vaccine safe?

You might see friends, relatives, and coworkers offer competing answers, often brandishing studies or citing individual doctors and scientists to support their positions. With so much disagreement—and with such high stakes—how can we use science to make the best decisions?

Here at Greater Good , we cover research into social and emotional well-being, and we try to help people apply findings to their personal and professional lives. We are well aware that our business is a tricky one.

Summarizing scientific studies and distilling the key insights that people can apply to their lives isn’t just difficult for the obvious reasons, like understanding and then explaining formal science terms or rigorous empirical and analytic methods to non-specialists. It’s also the case that context gets lost when we translate findings into stories, tips, and tools, especially when we push it all through the nuance-squashing machine of the Internet. Many people rarely read past the headlines, which intrinsically aim to be relatable and provoke interest in as many people as possible. Because our articles can never be as comprehensive as the original studies, they almost always omit some crucial caveats, such as limitations acknowledged by the researchers. To get those, you need access to the studies themselves.

And it’s very common for findings and scientists to seem to contradict each other. For example, there were many contradictory findings and recommendations about the use of masks, especially at the beginning of the pandemic—though as we’ll discuss, it’s important to understand that a scientific consensus did emerge.

Given the complexities and ambiguities of the scientific endeavor, is it possible for a non-scientist to strike a balance between wholesale dismissal and uncritical belief? Are there red flags to look for when you read about a study on a site like Greater Good or hear about one on a Fox News program? If you do read an original source study, how should you, as a non-scientist, gauge its credibility?

Here are 11 questions you might ask when you read about the latest scientific findings about the pandemic, based on our own work here at Greater Good.

1. Did the study appear in a peer-reviewed journal?

In peer review, submitted articles are sent to other experts for detailed critical input that often must be addressed in a revision prior to being accepted and published. This remains one of the best ways we have for ascertaining the rigor of the study and rationale for its conclusions. Many scientists describe peer review as a truly humbling crucible. If a study didn’t go through this process, for whatever reason, it should be taken with a much bigger grain of salt. 

“When thinking about the coronavirus studies, it is important to note that things were happening so fast that in the beginning people were releasing non-peer reviewed, observational studies,” says Dr. Leif Hass, a family medicine doctor and hospitalist at Sutter Health’s Alta Bates Summit Medical Center in Oakland, California. “This is what we typically do as hypothesis-generating but given the crisis, we started acting on them.”

In a confusing, time-pressed, fluid situation like the one COVID-19 presented, people without medical training have often been forced to simply defer to expertise in making individual and collective decisions, turning to culturally vetted institutions like the Centers for Disease Control (CDC). Is that wise? Read on.

2. Who conducted the study, and where did it appear?

“I try to listen to the opinion of people who are deep in the field being addressed and assess their response to the study at hand,” says Hass. “With the MRNA coronavirus vaccines, I heard Paul Offit from UPenn at a UCSF Grand Rounds talk about it. He literally wrote the book on vaccines. He reviewed what we know and gave the vaccine a big thumbs up. I was sold.”

From a scientific perspective, individual expertise and accomplishment matters—but so does institutional affiliation.

Why? Because institutions provide a framework for individual accountability as well as safety guidelines. At UC Berkeley, for example , research involving human subjects during COVID-19 must submit a Human Subjects Proposal Supplement Form , and follow a standard protocol and rigorous guidelines . Is this process perfect? No. It’s run by humans and humans are imperfect. However, the conclusions are far more reliable than opinions offered by someone’s favorite YouTuber .

Recommendations coming from institutions like the CDC should not be accepted uncritically. At the same time, however, all of us—including individuals sporting a “Ph.D.” or “M.D.” after their names—must be humble in the face of them. The CDC represents a formidable concentration of scientific talent and knowledge that dwarfs the perspective of any one individual. In a crisis like COVID-19, we need to defer to that expertise, at least conditionally.

“If we look at social media, things could look frightening,” says Hass. When hundreds of millions of people are vaccinated, millions of them will be afflicted anyway, in the course of life, by conditions like strokes, anaphylaxis, and Bell’s palsy. “We have to have faith that people collecting the data will let us know if we are seeing those things above the baseline rate.”

3. Who was studied, and where?

Animal experiments tell scientists a lot, but their applicability to our daily human lives will be limited. Similarly, if researchers only studied men, the conclusions might not be relevant to women, and vice versa.

Many psychology studies rely on WEIRD (Western, educated, industrialized, rich and democratic) participants, mainly college students, which creates an in-built bias in the discipline’s conclusions. Historically, biomedical studies also bias toward gathering measures from white male study participants, which again, limits generalizability of findings. Does that mean you should dismiss Western science? Of course not. It’s just the equivalent of a “Caution,” “Yield,” or “Roadwork Ahead” sign on the road to understanding.

This applies to the coronavirus vaccines now being distributed and administered around the world. The vaccines will have side effects; all medicines do. Those side effects will be worse for some people than others, depending on their genetic inheritance, medical status, age, upbringing, current living conditions, and other factors.

For Hass, it amounts to this question: Will those side effects be worse, on balance, than COVID-19, for most people?

“When I hear that four in 100,000 [of people in the vaccine trials] had Bell’s palsy, I know that it would have been a heck of a lot worse if 100,000 people had COVID. Three hundred people would have died and many others been stuck with chronic health problems.”

4. How big was the sample?

In general, the more participants in a study, the more valid its results. That said, a large sample is sometimes impossible or even undesirable for certain kinds of studies. During COVID-19, limited time has constrained the sample sizes.

However, that acknowledged, it’s still the case that some studies have been much larger than others—and the sample sizes of the vaccine trials can still provide us with enough information to make informed decisions. Doctors and nurses on the front lines of COVID-19—who are now the very first people being injected with the vaccine—think in terms of “biological plausibility,” as Hass says.

Did the admittedly rushed FDA approval of the Pfizer-BioNTech vaccine make sense, given what we already know? Tens of thousands of doctors who have been grappling with COVID-19 are voting with their arms, in effect volunteering to be a sample for their patients. If they didn’t think the vaccine was safe, you can bet they’d resist it. When the vaccine becomes available to ordinary people, we’ll know a lot more about its effects than we do today, thanks to health care providers paving the way.

5. Did the researchers control for key differences, and do those differences apply to you?

Diversity or gender balance aren’t necessarily virtues in experimental research, though ideally a study sample is as representative of the overall population as possible. However, many studies use intentionally homogenous groups, because this allows the researchers to limit the number of different factors that might affect the result.

While good researchers try to compare apples to apples, and control for as many differences as possible in their analyses, running a study always involves trade-offs between what can be accomplished as a function of study design, and how generalizable the findings can be.

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You also need to ask if the specific population studied even applies to you. For example, when one study found that cloth masks didn’t work in “high-risk situations,” it was sometimes used as evidence against mask mandates.

However, a look beyond the headlines revealed that the study was of health care workers treating COVID-19 patients, which is a vastly more dangerous situation than, say, going to the grocery store. Doctors who must intubate patients can end up being splattered with saliva. In that circumstance, one cloth mask won’t cut it. They also need an N95, a face shield, two layers of gloves, and two layers of gown. For the rest of us in ordinary life, masks do greatly reduce community spread, if as many people as possible are wearing them.

6. Was there a control group?

One of the first things to look for in methodology is whether the population tested was randomly selected, whether there was a control group, and whether people were randomly assigned to either group without knowing which one they were in. This is especially important if a study aims to suggest that a certain experience or treatment might actually cause a specific outcome, rather than just reporting a correlation between two variables (see next point).

For example, were some people randomly assigned a specific meditation practice while others engaged in a comparable activity or exercise? If the sample is large enough, randomized trials can produce solid conclusions. But, sometimes, a study will not have a control group because it’s ethically impossible. We can’t, for example, let sick people go untreated just to see what would happen. Biomedical research often makes use of standard “treatment as usual” or placebos in control groups. They also follow careful ethical guidelines to protect patients from both maltreatment and being deprived necessary treatment. When you’re reading about studies of masks, social distancing, and treatments during the COVID-19, you can partially gauge the reliability and validity of the study by first checking if it had a control group. If it didn’t, the findings should be taken as preliminary.

7. Did the researchers establish causality, correlation, dependence, or some other kind of relationship?

We often hear “Correlation is not causation” shouted as a kind of battle cry, to try to discredit a study. But correlation—the degree to which two or more measurements seem connected—is important, and can be a step toward eventually finding causation—that is, establishing a change in one variable directly triggers a change in another. Until then, however, there is no way to ascertain the direction of a correlational relationship (does A change B, or does B change A), or to eliminate the possibility that a third, unmeasured factor is behind the pattern of both variables without further analysis.

In the end, the important thing is to accurately identify the relationship. This has been crucial in understanding steps to counter the spread of COVID-19 like shelter-in-place orders. Just showing that greater compliance with shelter-in-place mandates was associated with lower hospitalization rates is not as conclusive as showing that one community that enacted shelter-in-place mandates had lower hospitalization rates than a different community of similar size and population density that elected not to do so.

We are not the first people to face an infection without understanding the relationships between factors that would lead to more of it. During the bubonic plague, cities would order rodents killed to control infection. They were onto something: Fleas that lived on rodents were indeed responsible. But then human cases would skyrocket.

Why? Because the fleas would migrate off the rodent corpses onto humans, which would worsen infection. Rodent control only reduces bubonic plague if it’s done proactively; once the outbreak starts, killing rats can actually make it worse. Similarly, we can’t jump to conclusions during the COVID-19 pandemic when we see correlations.

8. Are journalists and politicians, or even scientists, overstating the result?

Language that suggests a fact is “proven” by one study or which promotes one solution for all people is most likely overstating the case. Sweeping generalizations of any kind often indicate a lack of humility that should be a red flag to readers. A study may very well “suggest” a certain conclusion but it rarely, if ever, “proves” it.

This is why we use a lot of cautious, hedging language in Greater Good , like “might” or “implies.” This applies to COVID-19 as well. In fact, this understanding could save your life.

When President Trump touted the advantages of hydroxychloroquine as a way to prevent and treat COVID-19, he was dramatically overstating the results of one observational study. Later studies with control groups showed that it did not work—and, in fact, it didn’t work as a preventative for President Trump and others in the White House who contracted COVID-19. Most survived that outbreak, but hydroxychloroquine was not one of the treatments that saved their lives. This example demonstrates how misleading and even harmful overstated results can be, in a global pandemic.

9. Is there any conflict of interest suggested by the funding or the researchers’ affiliations?

A 2015 study found that you could drink lots of sugary beverages without fear of getting fat, as long as you exercised. The funder? Coca Cola, which eagerly promoted the results. This doesn’t mean the results are wrong. But it does suggest you should seek a second opinion : Has anyone else studied the effects of sugary drinks on obesity? What did they find?

It’s possible to take this insight too far. Conspiracy theorists have suggested that “Big Pharma” invented COVID-19 for the purpose of selling vaccines. Thus, we should not trust their own trials showing that the vaccine is safe and effective.

But, in addition to the fact that there is no compelling investigative evidence that pharmaceutical companies created the virus, we need to bear in mind that their trials didn’t unfold in a vacuum. Clinical trials were rigorously monitored and independently reviewed by third-party entities like the World Health Organization and government organizations around the world, like the FDA in the United States.

Does that completely eliminate any risk? Absolutely not. It does mean, however, that conflicts of interest are being very closely monitored by many, many expert eyes. This greatly reduces the probability and potential corruptive influence of conflicts of interest.

10. Do the authors reference preceding findings and original sources?

The scientific method is based on iterative progress, and grounded in coordinating discoveries over time. Researchers study what others have done and use prior findings to guide their own study approaches; every study builds on generations of precedent, and every scientist expects their own discoveries to be usurped by more sophisticated future work. In the study you are reading, do the researchers adequately describe and acknowledge earlier findings, or other key contributions from other fields or disciplines that inform aspects of the research, or the way that they interpret their results?

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This was crucial for the debates that have raged around mask mandates and social distancing. We already knew quite a bit about the efficacy of both in preventing infections, informed by centuries of practical experience and research.

When COVID-19 hit American shores, researchers and doctors did not question the necessity of masks in clinical settings. Here’s what we didn’t know: What kinds of masks would work best for the general public, who should wear them, when should we wear them, were there enough masks to go around, and could we get enough people to adopt best mask practices to make a difference in the specific context of COVID-19 ?

Over time, after a period of confusion and contradictory evidence, those questions have been answered . The very few studies that have suggested masks don’t work in stopping COVID-19 have almost all failed to account for other work on preventing the disease, and had results that simply didn’t hold up. Some were even retracted .

So, when someone shares a coronavirus study with you, it’s important to check the date. The implications of studies published early in the pandemic might be more limited and less conclusive than those published later, because the later studies could lean on and learn from previously published work. Which leads us to the next question you should ask in hearing about coronavirus research…

11. Do researchers, journalists, and politicians acknowledge limitations and entertain alternative explanations?

Is the study focused on only one side of the story or one interpretation of the data? Has it failed to consider or refute alternative explanations? Do they demonstrate awareness of which questions are answered and which aren’t by their methods? Do the journalists and politicians communicating the study know and understand these limitations?

When the Annals of Internal Medicine published a Danish study last month on the efficacy of cloth masks, some suggested that it showed masks “make no difference” against COVID-19.

The study was a good one by the standards spelled out in this article. The researchers and the journal were both credible, the study was randomized and controlled, and the sample size (4,862 people) was fairly large. Even better, the scientists went out of their way to acknowledge the limits of their work: “Inconclusive results, missing data, variable adherence, patient-reported findings on home tests, no blinding, and no assessment of whether masks could decrease disease transmission from mask wearers to others.”

Unfortunately, their scientific integrity was not reflected in the ways the study was used by some journalists, politicians, and people on social media. The study did not show that masks were useless. What it did show—and what it was designed to find out—was how much protection masks offered to the wearer under the conditions at the time in Denmark. In fact, the amount of protection for the wearer was not large, but that’s not the whole picture: We don’t wear masks mainly to protect ourselves, but to protect others from infection. Public-health recommendations have stressed that everyone needs to wear a mask to slow the spread of infection.

“We get vaccinated for the greater good, not just to protect ourselves ”

As the authors write in the paper, we need to look to other research to understand the context for their narrow results. In an editorial accompanying the paper in Annals of Internal Medicine , the editors argue that the results, together with existing data in support of masks, “should motivate widespread mask wearing to protect our communities and thereby ourselves.”

Something similar can be said of the new vaccine. “We get vaccinated for the greater good, not just to protect ourselves,” says Hass. “Being vaccinated prevents other people from getting sick. We get vaccinated for the more vulnerable in our community in addition for ourselves.”

Ultimately, the approach we should take to all new studies is a curious but skeptical one. We should take it all seriously and we should take it all with a grain of salt. You can judge a study against your experience, but you need to remember that your experience creates bias. You should try to cultivate humility, doubt, and patience. You might not always succeed; when you fail, try to admit fault and forgive yourself.

Above all, we need to try to remember that science is a process, and that conclusions always raise more questions for us to answer. That doesn’t mean we never have answers; we do. As the pandemic rages and the scientific process unfolds, we as individuals need to make the best decisions we can, with the information we have.

This article was revised and updated from a piece published by Greater Good in 2015, “ 10 Questions to Ask About Scientific Studies .”

About the Authors

Jeremy Adam Smith

Uc berkeley.

Jeremy Adam Smith edits the GGSC’s online magazine, Greater Good . He is also the author or coeditor of five books, including The Daddy Shift , Are We Born Racist? , and (most recently) The Gratitude Project: How the Science of Thankfulness Can Rewire Our Brains for Resilience, Optimism, and the Greater Good . Before joining the GGSC, Jeremy was a John S. Knight Journalism Fellow at Stanford University.

Emiliana R. Simon-Thomas

Emiliana R. Simon-Thomas, Ph.D. , is the science director of the Greater Good Science Center, where she directs the GGSC’s research fellowship program and serves as a co-instructor of its Science of Happiness and Science of Happiness at Work online courses.

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Open Access

Peer-reviewed

Research Article

The impact of the COVID-19 pandemic on scientific research in the life sciences

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Affiliation AXES, IMT School for Advanced Studies Lucca, Lucca, Italy

Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Chair of Systems Design D-MTEC, ETH Zürich, Zurich, Switzerland

• Massimo Riccaboni, 
• Luca Verginer

• Published: February 9, 2022
• https://doi.org/10.1371/journal.pone.0263001
• Reader Comments

The COVID-19 outbreak has posed an unprecedented challenge to humanity and science. On the one side, public and private incentives have been put in place to promptly allocate resources toward research areas strictly related to the COVID-19 emergency. However, research in many fields not directly related to the pandemic has been displaced. In this paper, we assess the impact of COVID-19 on world scientific production in the life sciences and find indications that the usage of medical subject headings (MeSH) has changed following the outbreak. We estimate through a difference-in-differences approach the impact of the start of the COVID-19 pandemic on scientific production using the PubMed database (3.6 Million research papers). We find that COVID-19-related MeSH terms have experienced a 6.5 fold increase in output on average, while publications on unrelated MeSH terms dropped by 10 to 12%. The publication weighted impact has an even more pronounced negative effect (-16% to -19%). Moreover, COVID-19 has displaced clinical trial publications (-24%) and diverted grants from research areas not closely related to COVID-19. Note that since COVID-19 publications may have been fast-tracked, the sudden surge in COVID-19 publications might be driven by editorial policy.

Citation: Riccaboni M, Verginer L (2022) The impact of the COVID-19 pandemic on scientific research in the life sciences. PLoS ONE 17(2): e0263001. https://doi.org/10.1371/journal.pone.0263001

Editor: Florian Naudet, University of Rennes 1, FRANCE

Received: April 28, 2021; Accepted: January 10, 2022; Published: February 9, 2022

Copyright: © 2022 Riccaboni, Verginer. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The processed data, instructions on how to process the raw PubMed dataset as well as all code are available via Zenodo at https://doi.org/10.5281/zenodo.5121216 .

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The COVID-19 pandemic has mobilized the world scientific community in 2020, especially in the life sciences [ 1 , 2 ]. In the first three months after the pandemic, the number of scientific papers about COVID-19 was fivefold the number of articles on H1N1 swine influenza [ 3 ]. Similarly, the number of clinical trials related to COVID-19 prophylaxis and treatments skyrocketed [ 4 ]. Thanks to the rapid mobilization of the world scientific community, COVID-19 vaccines have been developed in record time. Despite this undeniable success, there is a rising concern about the negative consequences of COVID-19 on clinical trial research, with many projects being postponed [ 5 – 7 ]. According to Evaluate Pharma, clinical trials were one of the pandemic’s first casualties, with a record number of 160 studies suspended for reasons related to COVID-19 in April 2020 [ 8 , 9 ] reporting a total of 1,200 trials suspended as of July 2020. As a consequence, clinical researchers have been impaired by reduced access to healthcare research infrastructures. Particularly, the COVID-19 outbreak took a tall on women and early-career scientists [ 10 – 13 ]. On a different ground, Shan and colleagues found that non-COVID-19-related articles decreased as COVID-19-related articles increased in top clinical research journals [ 14 ]. Fraser and coworker found that COVID-19 preprints received more attention and citations than non-COVID-19 preprints [ 1 ]. More recently, Hook and Porter have found some early evidence of ‘covidisation’ of academic research, with research grants and output diverted to COVID-19 research in 2020 [ 15 ]. How much should scientists switch their efforts toward SARS-CoV-2 prevention, treatment, or mitigation? There is a growing consensus that the current level of ‘covidisation’ of research can be wasteful [ 4 , 5 , 16 ].

Against this background, in this paper, we investigate if the COVID-19 pandemic has induced a shift in biomedical publications toward COVID-19-related scientific production. The objective of the study is to show that scientific articles listing covid-related Medical Subject Headings (MeSH) when compared against covid-unrelated MeSH have been partially displaced. Specifically, we look at several indicators of scientific production in the life sciences before and after the start of the COVID-19 pandemic: (1) number of papers published, (2) impact factor weighted number of papers, (3) opens access, (4) number of publications related to clinical trials, (5) number of papers listing grants, (6) number of papers listing grants existing before the pandemic. Through a natural experiment approach, we analyze the impact of the pandemic on scientific production in the life sciences. We consider COVID-19 an unexpected and unprecedented exogenous source of variation with heterogeneous effects across biomedical research fields (i.e., MeSH terms).

Based on the difference in difference results, we document the displacement effect that the pandemic has had on several aspects of scientific publishing. The overall picture that emerges from this analysis is that there has been a profound realignment of priorities and research efforts. This shift has displaced biomedical research in fields not related to COVID-19.

The rest of the paper is structured as follows. First, we describe the data and our measure of relatedness to COVID-19. Next, we illustrate the difference-in-differences specification we rely on to identify the impact of the pandemic on scientific output. In the results section, we present the results of the difference-in-differences and network analyses. We document the sudden shift in publications, grants and trials towards COVID-19-related MeSH terms. Finally, we discuss the findings and highlight several policy implications.

Materials and methods

The present analysis is based primarily on PubMed and the Medical Subject Headings (MeSH) terminology. This data is used to estimate the effect of the start of the COVID 19 pandemic via a difference in difference approach. This section is structured as follows. We first introduce the data and then the econometric methodology. This analysis is not based on a pre-registered protocol.

Selection of biomedical publications.

We rely on PubMed, a repository with more than 34 million biomedical citations, for the analysis. Specifically, we analyze the daily updated files up to 31/06/2021, extracting all publications of type ‘Journal Article’. For the principal analysis, we consider 3,638,584 papers published from January 2019 to December 2020. We also analyze 11,122,017 papers published from 2010 onwards to identify the earliest usage of a grant and infer if it was new in 2020. We use the SCImago journal ranking statistics to compute the impact factor weighted number (IFWN) of papers in a given field of research. To assign the publication date, we use the ‘electronically published’ dates and, if missing, the ‘print published’ dates.

Medical subject headings.

We rely on the Medical Subject Headings (MeSH) terminology to approximate narrowly defined biomedical research fields. This terminology is a curated medical vocabulary, which is manually added to papers in the PubMed corpus. The fact that MeSH terms are manually annotated makes this terminology ideal for classification purposes. However, there is a delay between publication and annotation, on the order of several months. To address this delay and have the most recent classification, we search for all 28 425 MeSH terms using PubMed’s ESearch utility and classify paper by the results. The specific API endpoint is https://eutils.ncbi.nlm.nih.gov/entrez/eutils/esearch.fcgi , the relevant scripts are available with the code. For example, we assign the term ‘Ageusia’ (MeSH ID D000370) to all papers listed in the results of the ESearch API. We apply this method to the whole period (January 2019—December 2020) and obtain a mapping from papers to the MeSH terms. For every MeSH term, we keep track of the year they have been established. For instance, COVID-19 terms were established in 2020 (see Table 1 ): in January 2020, the WHO recommended 2019-nCoV and 2019-nCoV acute respiratory disease as provisional names for the virus and disease. The WHO issued the official terms COVID-19 and SARS-CoV-2 at the beginning of February 2020. By manually annotating publications, all publications referring to COVID-19 and SARS-CoV-2 since January 2020 have been labelled with the related MeSH terms. Other MeSH terms related to COVID-19, such as coronavirus, for instance, have been established years before the pandemic (see Table 2 ). We proxy MeSH term usage via search terms using the PubMed EUtilities API; this means that we are not using the hand-labelled MeSH terms but rather the PubMed search results. This means that the accuracy of the MeSH term we assign to a given paper is not perfect. In practice, this means that we have assigned more MeSH terms to a given term than a human annotator would have.

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https://doi.org/10.1371/journal.pone.0263001.t001

The list contains only terms with at least 100 publications in 2020.

https://doi.org/10.1371/journal.pone.0263001.t002

Clinical trials and publication types.

We classify publications using PubMed’s ‘PublicationType’ field in the XML baseline files (There are 187 publication types, see https://www.nlm.nih.gov/mesh/pubtypes.html ). We consider a publication to be related to a clinical trial if it lists any of the following descriptors:

• D016430: Clinical Trial
• D017426: Clinical Trial, Phase I
• D017427: Clinical Trial, Phase II
• D017428: Clinical Trial, Phase III
• D017429: Clinical Trial, Phase IV
• D018848: Controlled Clinical Trial
• D065007: Pragmatic Clinical Trial
• D000076362: Adaptive Clinical Trial
• D000077522: Clinical Trial, Veterinary

In our analysis of the impact of COVID-19 on publications related to clinical trials, we only consider MeSH terms that are associated at least once with a clinical trial publication over the two years. We apply this restriction to filter out MeSH terms that are very unlikely to be relevant for clinical trial types of research.

Open access.

We proxy the availability of a journal article to the public, i.e., open access, if it is available from PubMed Central. PubMed Central archives full-text journal articles and provides free access to the public. Note that the copyright license may vary across participating publishers. However, the text of the paper is for all effects and purposes freely available without requiring subscriptions or special affiliation.

We infer if a publication has been funded by checking if it lists any grants. We classify grants as either ‘old’, i.e. existed before 2019, or ‘new’, i.e. first observed afterwards. To do so, we collect all grant IDs for 11,122,017 papers from 2010 on-wards and record their first appearance. This procedure is an indirect inference of the year the grant has been granted. The basic assumption is that if a grant number has not been listed in any publication since 2010, it is very likely a new grant. Specifically, an old grant is a grant listed since 2019 observed at least once from 2010 to 2018.

Note that this procedure is only approximate and has a few shortcomings. Mistyped grant numbers (e.g. ‘1234-M JPN’ and ‘1234-M-JPN’) could appear as new grants, even though they existed before, or new grants might be classified as old grants if they have a common ID (e.g. ‘Grant 1’). Unfortunately, there is no central repository of grant numbers and the associated metadata; however, there are plans to assign DOI numbers to grants to alleviate this problem (See https://gitlab.com/crossref/open_funder_registry for the project).

Impact factor weighted publication numbers (IFWN).

In our analysis, we consider two measures of scientific output. First, we simply count the number of publications by MeSH term. However, since journals vary considerably in terms of impact factor, we also weigh the number of publications by the impact factor of the venue (e.g., journal) where it was published. Specifically, we use the SCImago journal ranking statistics to weigh a paper by the impact factor of the journal it appears in. We use the ‘citation per document in the past two years’ for 45,230 ISSNs. Note that a journal may and often has more than one ISSN, i.e., one for the printed edition and one for the online edition. SCImago applies the same score for a venue across linked ISSNs.

For the impact factor weighted number (IFWN) of publication per MeSH terms, this means that all publications are replaced by the impact score of the journal they appear in and summed up.

COVID-19-relatedness.

To measure how closely related to COVID-19 is a MeSH term, we introduce an index of relatedness to COVID-19. First, we identify the focal COVID-19 terms, which appeared in the literature in 2020 (see Table 1 ). Next, for all other pre-existing MeSH terms, we measure how closely related to COVID-19 they end up being.

Our aim is to show that MeSH terms that existed before and are related have experienced a sudden increase in the number of (impact factor weighted) papers.

Intuitively we can read this measure as: what is the probability in 2020 that a COVID-19 MeSH term is present given that we chose a paper with MeSH term i ? For example, given that in 2020 we choose a paper dealing with “Ageusia” (i.e., Complete or severe loss of the subjective sense of taste), there is a 96% probability that this paper also lists COVID-19, see Table 1 .

Note that a paper listing a related MeSH term does not imply that that paper is doing COVID-19 research, but it implies that one of the MeSH terms listed is often used in COVID-19 research.

In sum, in our analysis, we use the following variables:

• Papers: Number of papers by MeSH term;
• Impact: Impact factor weighted number of papers by MeSH term;
• PMC: Papers listed in PubMed central by MeSH term, as a measure of Open Access publications;
• Trials: number of publications of type “Clinical Trial” by MeSH term;
• Grants: number of papers with at least one grant by MeSH term;
• Old Grants: number of papers listing a grant that has been observed between 2010 and 2018, by MeSH term;

Difference-in-differences

The difference-in-differences (DiD) method is an econometric technique to imitate an experimental research design from observation data, sometimes referred to as a quasi-experimental setup. In a randomized controlled trial, subjects are randomly assigned either to the treated or the control group. Analogously, in this natural experiment, we assume that medical subject headings (MeSH) have been randomly assigned to be either treated (related) or not treated (unrelated) by the pandemic crisis.

Before the COVID, for a future health crisis, the set of potentially impacted medical knowledge was not predictable since it depended on the specifics of the emergency. For instance, ageusia (loss of taste), a medical concept existing since 1991, became known to be a specific symptom of COVID-19 only after the pandemic.

Specifically, we exploit the COVID-19 as an unpredictable and exogenous shock that has deeply affected the publication priorities for biomedical scientific production, as compared to the situation before the pandemic. In this setting, COVID-19 is the treatment, and the identification of this new human coronavirus is the event. We claim that treated MeSH terms, i.e., MeSH terms related to COVID-19, have experienced a sudden increase in terms of scientific production and attention. In contrast, research on untreated MeSH terms, i.e., MeSH terms not related to COVID-19, has been displaced by COVID-19. Our analysis compares the scientific output of COVID-19 related and unrelated MeSH terms before and after January 2020.

In our case, some of the terms turn out to be related to COVID-19 in 2020, whereas most of the MeSH terms are not closely related to COVID-19.

Thus β 1 identifies the overall effect on the control group after the event, β 2 the difference across treated and control groups before the event (i.e. the first difference in DiD) and finally the effect on the treated group after the event, net of the first difference, β 3 . This last parameter identifies the treatment effect on the treated group netting out the pre-treatment difference.

For the DiD to have a causal interpretation, it must be noted that pre-event, the trends of the two groups should be parallel, i.e., the common trend assumption (CTA) must be satisfied. We will show that the CTA holds in the results section.

To specify the DiD model, we need to define a period before and after the event and assign a treatment status or level of exposure to each term.

Before and after.

The pre-treatment period is defined as January 2019 to December 2019. The post-treatment period is defined as the months from January 2020 to December 2020. We argue that the state of biomedical research was similar in those two years, apart from the effect of the pandemic.

Treatment status and exposure.

The treatment is determined by the COVID-19 relatedness index σ i introduced earlier. Specifically, this number indicates the likelihood that COVID-19 will be a listed MeSH term, given that we observe the focal MeSH term i . To show that the effect becomes even stronger the closer related the subject is, and for ease of interpretation, we also discretize the relatedness value into three levels of treatment. Namely, we group MeSH terms with a σ between, 0% to 20%, 20% to 80% and 80% to 100%. The choice of alternative grouping strategies does not significantly affect our results. Results for alternative thresholds of relatedness can be computed using the available source code. We complement the dichotomized analysis by using the treatment intensity (relatedness measure σ ) to show that the result persists.

Panel regression.

In this work, we estimate a random effects panel regression where the units of analysis are 28 318 biomedical research fields (i.e. MeSH terms) observed over time before and after the COVID-19 pandemic. The time resolution is at the monthly level, meaning that for each MeSH term, we have 24 observations from January 2019 to December 2020.

The outcome variable Y it identifies the outcome at time t (i.e., month), for MeSH term i . As before, P t identifies the period with P t = 0 if the month is before January 2020 and P t = 1 if it is on or after this date. In (3) , the treatment level is measure by the relatedness to COVID-19 ( σ i ), where again the γ 1 identifies pre-trend (constant) differences and δ 1 the overall effect.

In total, we estimate six coefficients. As before, the δ l coefficient identifies the DiD effect.

Verifying the Common Trend Assumption (CTA).

We show that the CTA holds for this model by comparing the pre-event trends of the control group to the treated groups (COVID-19 related MeSH terms). Namely, we show that the pre-event trends of the control group are the same as the pre-event trends of the treated group.

Co-occurrence analysis

To investigate if the pandemic has caused a reconfiguration of research priorities, we look at the MeSH term co-occurrence network. Precisely, we extract the co-occurrence network of all 28,318 MeSH terms as they appear in the 3.3 million papers. We considered the co-occurrence networks of 2018, 2019 and 2020. Each node represents a MeSH term in these networks, and a link between them indicates that they have been observed at least once together. The weight of the edge between the MeSH terms is given by the number of times those terms have been jointly observed in the same publications.

Medical language is hugely complicated, and this simple representation does not capture the intricacies, subtle nuances and, in fact, meaning of the terms. Therefore, we do not claim that we can identify how the actual usage of MeSH terms has changed from this object, but rather that it has. Nevertheless, the co-occurrence graph captures rudimentary relations between concepts. We argue that absent a shock to the system, their basic usage patterns, change in importance (within the network) would essentially be the same from year to year. However, if we find that the importance of terms changes more than expected in 2020, it stands to reason that there have been some significant changes.

To show that that MeSH usage has been affected, we compute for each term in the years 2018, 2019 and 2020 their PageRank centrality [ 17 ]. The PageRank centrality tells us how likely a random walker traversing a network would be found at a given node if she follows the weights of the empirical edges (i.e., co-usage probability). Specifically, for the case of the MeSH co-occurrence network, this number represents how often an annotator at the National Library of Medicine would assign that MeSH term following the observed general usage patterns. It is a simplistic measure to capture the complexities of biomedical research. Nevertheless, it captures far-reaching interdependence across MeSH terms as the measure uses the whole network to determine the centrality of every MeSH term. A sudden change in the rankings and thus the position of MeSH terms in this network suggests that a given research subject has risen as it is used more often with other important MeSH terms (or vice versa).

We then compare the growth for each MeSH i term in g i (2019), i.e. before the the COVID-19 pandemic, with the growth after the event ( g i (2020)).

Publication growth

Changes in output and COVID-19 relatedness

Before we show the regression results, we provide descriptive evidence that publications from 2019 to 2020 have drastically increased. By showing that this growth correlates strongly with a MeSH term’s COVID-19 relatedness ( σ ), we demonstrate that (1) σ captures an essential aspect of the growth dynamics and (2) highlight the meteoric rise of highly related terms.

We look at the year over year growth in the number of the impact weighted number of publications per MeSH term from 2018 to 2019 and 2019 to 2020 as defined in the methods section.

Fig 1 shows the yearly growth of the impact weighted number of publications per MeSH term. By comparing the growth of the number of publications from the years 2018, 2019 and 2020, we find that the impact factor weighted number of publications has increased by up to a factor of 100 compared to the previous year for Betacoronavirus, one of the most closely related to COVID-19 MeSH term.

Each dot represents, a MeSH term. The y axis (growth) is in symmetric log scale. The x axis shows the COVID-19 relatedness, σ . Note that the position of the dots on the x-axis is the same in the two plots. Below: MeSH term importance gain (PageRank) and their COVID-19 relatedness.

https://doi.org/10.1371/journal.pone.0263001.g001

Fig 1 , first row, reveals how strongly correlated the growth in the IFWN of publication is to the term’s COVID-19 relatedness. For instance, we see that the term ‘Betacoronavirus’ skyrocketed from 2019 to 2020, which is expected given that SARS-CoV-2 is a species of the genus. Conversely, the term ‘Alphacoronavirus’ has not experienced any growth given that it is twin a genus of the Coronaviridae family, but SARS-CoV-2 is not one of its species. Note also the fast growth in the number of publications dealing with ‘Quarantine’. Moreover, MeSH terms that grew significantly from 2018 to 2019 and were not closely related to COVID-19, like ‘Vaping’, slowed down in 2020. From the graph, the picture emerges that publication growth is correlated with COVID-19 relatedness σ and that the growth for less related terms slowed down.

To show that the usage pattern of MeSH terms has changed following the pandemic, we compute the PageRank centrality using graph-tool [ 18 ] as discussed in the Methods section.

Fig 1 , second row, shows the change in the PageRank centrality of the MeSH terms after the pandemic (2019 to 2020, right plot) and before (2018 to 2019, left plot). If there were no change in the general usage pattern, we would expect the variance in PageRank changes to be narrow across the two periods, see (left plot). However, PageRank scores changed significantly more from 2019 to 2020 than from 2018 to 2019, suggesting that there has been a reconfiguration of the network.

To further support this argument, we carry out a DiD regression analysis.

Common trends assumption

As discussed in the Methods section, we need to show that the CTA assumption holds for the DiD to be defined appropriately. We do this by estimating for each month the number of publications and comparing it across treatment groups. This exercise also serves the purpose of a placebo test. By assuming that each month could have potentially been the event’s timing (i.e., the outbreak), we show that January 2020 is the most likely timing of the event. The regression table, as noted earlier, contains over 70 estimated coefficients, hence for ease of reading, we will only show the predicted outcome per month by group (see Fig 2 ). The full regression table with all coefficients is available in the S1 Table .

The y axis is in log scale. The dashed vertical line identifies January 2020. The dashed horizontal line shows the publications in January 2019 for the 0–20% group before the event. This line highlights that the drop happens after the event. The bands around the lines indicate the 95% confidence interval of the predicted values. The results are the output of the Stata margins command.

https://doi.org/10.1371/journal.pone.0263001.g002

Fig 2 shows the predicted number per outcome variable obtained from the panel regression model. These predictions correspond to the predicted value per relatedness group using the regression parameters estimated via the linear panel regression. The bands around the curves are the 95% confidence intervals.

All outcome measures depict a similar trend per month. Before the event (i.e., January 2020), there is a common trend across all groups. In contrast, after the event, we observe a sudden rise for the outcomes of the COVID-19 related treated groups (green and red lines) and a decline in the outcomes for the unrelated group (blue line). Therefore, we can conclude that the CTA assumption holds.

Regression results

Table 3 shows the DiD regression results (see Eq (3) ) for the selected outcome measures: number of publications (Papers), impact factor weighted number of publications (Impact), open access (OA) publications, clinical trial related publications, and publications with existing grants.

https://doi.org/10.1371/journal.pone.0263001.t003

Table 3 shows results for the discrete treatment level version of the DiD model (see Eq (4) ).

Note that the outcome variable is in natural log scale; hence to get the effect of the independent variable, we need to exponentiate the coefficient. For values close to 0, the effect is well approximated by the percentage change of that magnitude.

In both specifications we see that the least related group, drops in the number of publications between 10% and 13%, respectively (first row of Tables 3 and 4 , exp(−0.102) ≈ 0.87). In line with our expectations, the increase in the number of papers published by MeSH term is positively affected by the relatedness to COVID-19. In the discrete model (row 2), we note that the number of documents with MeSH terms with a COVID-19 relatedness between 20 and 80% grows by 18% and highly related terms by a factor of approximately 6.6 (exp(1.88)). The same general pattern can be observed for the impact weighted publication number, i.e., Model (2). Note, however, that the drop in the impact factor weighted output is more significant, reaching -19% for COVID-19 unrelated publications, and related publications growing by a factor of 8.7. This difference suggests that there might be a bias to publish papers on COVID-19 related subjects in high impact factor journals.

https://doi.org/10.1371/journal.pone.0263001.t004

By looking at the number of open access publications (PMC), we note that the least related group has not been affected negatively by the pandemic. However, the number of COVID-19 related publications has drastically increased for the most COVID-19 related group by a factor of 6.2. Note that the substantial increase in the number of papers available through open access is in large part due to journal and editorial policies to make preferentially COVID research immediately available to the public.

Regarding the number of clinical trial publications, we note that the least related group has been affected negatively, with the number of publications on clinical trials dropping by a staggering 24%. At the same time, publications on clinical trials for COVID-19-related MeSH have increased by a factor of 2.1. Note, however, that the effect on clinical trials is not significant in the continuous regression. The discrepancy across Tables 3 and 4 highlights that, especially for trials, the effect is not linear, where only the publications on clinical trials closely related to COVID-19 experiencing a boost.

It has been reported [ 19 ] that while the number of clinical trials registered to treat or prevent COVID-19 has surged with 179 new registrations in the second week of April 2020 alone. Only a few of these have led to publishable results in the 12 months since [ 20 ]. On the other hand, we find that clinical trial publications, considering related MeSH (but not COVID-19 directly), have had significant growth from the beginning of the pandemic. These results are not contradictory. Indeed counting the number of clinical trial publications listing the exact COVID-19 MeSH term (D000086382), we find 212 publications. While this might seem like a small number, consider that in 2020 only 8,485 publications were classified as clinical trials; thus, targeted trials still made up 2.5% of all clinical trials in 2020 . So while one might doubt the effectiveness of these research efforts, it is still the case that by sheer number, they represent a significant proportion of all publications on clinical trials in 2020. Moreover, COVID-19 specific Clinical trial publications in 2020, being a delayed signal of the actual trials, are a lower bound estimate on the true number of such clinical trials being conducted. This is because COVID-19 studies could only have commenced in 2020, whereas other studies had a head start. Thus our reported estimates are conservative, meaning that the true effect on actual clinical trials is likely larger, not smaller.

Research funding, as proxied by the number of publications with grants, follows a similar pattern, but notably, COVID-19-related MeSH terms list the same proportion of grants established before 2019 as other unrelated MeSH terms, suggesting that grants which were not designated for COVID-19 research have been used to support COVID-19 related research. Overall, the number of publications listing a grant has dropped. Note that this should be because the number of publications overall in the unrelated group has dropped. However, we note that the drop in publications is 10% while the decline in publications with at least one grant is 15%. This difference suggests that publications listing grants, which should have more funding, are disproportionately COVID-19 related papers. To further investigate this aspect, we look at whether the grant was old (pre-2019) or appeared for the first time in or after 2019. It stands to reason that an old grant (pre-2019) would not have been granted for a project dealing with the pandemic. Hence we would expect that COVID-19 related MeSH terms to have a lower proportion of old grants than the unrelated group. In models (6) in Table 4 we show that the number of old grants for the unrelated group drops by 13%. At the same time, the number of papers listing old grants (i.e., pre-2019) among the most related group increased by a factor of 3.1. Overall, these results suggest that COVID-19 related research has been funded largely by pre-existing grants, even though a specific mandate tied to the grants for this use is unlikely.

The scientific community has swiftly reallocated research efforts to cope with the COVID-19 pandemic, mobilizing knowledge across disciplines to find innovative solutions in record time. We document this both in terms of changing trends in the biomedical scientific output and the usage of MeSH terms by the scientific community. The flip side of this sudden and energetic prioritization of effort to fight COVID-19 has been a sudden contraction of scientific production in other relevant research areas. All in all, we find strong support to the hypotheses that the COVID-19 crisis has induced a sudden increase of research output in COVID-19 related areas of biomedical research. Conversely, research in areas not related to COVID-19 has experienced a significant drop in overall publishing rates and funding.

Our paper contributes to the literature on the impact of COVID-19 on scientific research: we corroborate previous findings about the surge of COVID-19 related publications [ 1 – 3 ], partially displacing research in COVID-19 unrelated fields of research [ 4 , 14 ], particularly research related to clinical trials [ 5 – 7 ]. The drop in trial research might have severe consequences for patients affected by life-threatening diseases since it will delay access to new and better treatments. We also confirm the impact of COVID-19 on open access publication output [ 1 ]; also, this is milder than traditional outlets. On top of this, we provide more robust evidence on the impact weighted effect of COVID-19 and grant financed research, highlighting the strong displacement effect of COVID-19 on the allocation of financial resources [ 15 ]. We document a substantial change in the usage patterns of MeSH terms, suggesting that there has been a reconfiguration in the way research terms are being combined. MeSH terms highly related to COVID-19 were peripheral in the MeSH usage networks before the pandemic but have become central since 2020. We conclude that the usage patterns have changed, with COVID-19 related MeSH terms occupying a much more prominent role in 2020 than they did in the previous years.

We also contribute to the literature by estimating the effect of COVID-19 on biomedical research in a natural experiment framework, isolating the specific effects of the COVID-19 pandemic on the biomedical scientific landscape. This is crucial to identify areas of public intervention to sustain areas of biomedical research which have been neglected during the COVID-19 crisis. Moreover, the exploratory analysis on the changes in usage patterns of MeSH terms, points to an increase in the importance of covid-related topics in the broader biomedical research landscape.

Our results provide compelling evidence that research related to COVID-19 has indeed displaced scientific production in other biomedical fields of research not related to COVID-19, with a significant drop in (impact weighted) scientific output related to non-COVID-19 and a marked reduction of financial support for publications not related to COVID-19 [ 4 , 5 , 16 ]. The displacement effect is persistent to the end of 2020. As vaccination progresses, we highlight the urgent need for science policy to re-balance support for research activity that was put on pause because of the COVID-19 pandemic.

We find that COVID-19 dramatically impacted clinical research. Reactivation of clinical trials activities that have been postponed or suspended for reasons related to COVID-19 is a priority that should be considered in the national vaccination plans. Moreover, since grants have been diverted and financial incentives have been targeted to sustain COVID-19 research leading to an excessive entry in COVID-19-related clinical trials and the ‘covidisation’ of research, there is a need to reorient incentives to basic research and otherwise neglected or temporally abandoned areas of biomedical research. Without dedicated support in the recovery plans for neglected research of the COVID-19 era, there is a risk that more medical needs will be unmet in the future, possibly exacerbating the shortage of scientific research for orphan and neglected diseases, which do not belong to COVID-19-related research areas.

Limitations

Our empirical approach has some limits. First, we proxy MeSH term usage via search terms using the PubMed EUtilities API. This means that the accuracy of the MeSH term we assign to a given paper is not fully validated. More time is needed for the completion of manually annotated MeSH terms. Second, the timing of publication is not the moment the research has been carried out. There is a lead time between inception, analysis, write-up, review, revision, and final publication. This delay varies across disciplines. Nevertheless, given that the surge in publications happens around the alleged event date, January 2020, we are confident that the publication date is a reasonable yet imperfect estimate of the timing of the research. Third, several journals have publicly declared to fast-track COVID-19 research. This discrepancy in the speed of publication of COVID-19 related research and other research could affect our results. Specifically, a surge or displacement could be overestimated due to a lag in the publication of COVID-19 unrelated research. We alleviate this bias by estimating the effect considering a considerable time after the event (January 2020 to December 2020). Forth, on the one hand, clinical Trials may lead to multiple publications. Therefore we might overestimate the impact of COVID-19 on the number of clinical trials. On the other hand, COVID-19 publications on clinical trials lag behind, so the number of papers related COVID-19 trials is likely underestimated. Therefore, we note that the focus of this paper is scientific publications on clinical trials rather than on actual clinical trials. Fifth, regarding grants, unfortunately, there is no unique centralized repository mapping grant numbers to years, so we have to proxy old grants with grants that appeared in publications from 2010 to 2018. Besides, grant numbers are free-form entries, meaning that PubMed has no validation step to disambiguate or verify that the grant number has been entered correctly. This has the effect of classifying a grant as new even though it has appeared under a different name. We mitigate this problem by using a long period to collect grant numbers and catch many spellings of the same grant, thereby reducing the likelihood of miss-identifying a grant as new when it existed before. Still, unless unique identifiers are widely used, there is no way to verify this.

So far, there is no conclusive evidence on whether entry into COVID-19 has been excessive. However, there is a growing consensus that COVID-19 has displaced, at least temporally, scientific research in COVID-19 unrelated biomedical research areas. Even though it is certainly expected that more attention will be devoted to the emergency during a pandemic, the displacement of biomedical research in other fields is concerning. Future research is needed to investigate the long-run structural consequences of the COVID-19 crisis on biomedical research.

Supporting information

S1 table. common trend assumption (cta) regression table..

Full regression table with all controls and interactions.

https://doi.org/10.1371/journal.pone.0263001.s001

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• Published: 01 November 2023

Historical narratives about the COVID-19 pandemic are motivationally biased

• Philipp Sprengholz   ORCID: orcid.org/0000-0002-9925-1920 1 , 2 , 3   na1 ,
• Luca Henkel 4 , 5   na1 ,
• Robert Böhm   ORCID: orcid.org/0000-0001-6806-0374 6 , 7 , 8   na2 &
• Cornelia Betsch   ORCID: orcid.org/0000-0002-2856-7303 2 , 3   na2  

Nature volume  623 ,  pages 588–593 ( 2023 ) Cite this article

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How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation 1 , 2 , 3 , 4 , 5 , 6 . Here, using 4 studies across 11 countries (total n  = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status—whether vaccinated or unvaccinated—tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

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Data availability.

Data are available at https://doi.org/10.17605/OSF.IO/BXG7V . Study 2 ( https://aspredicted.org/uw47f.pdf ) and study 3 ( https://aspredicted.org/kk33k.pdf ) were preregistered.

Code availability

Data analysis scripts are available at https://doi.org/10.17605/OSF.IO/BXG7V .

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Acknowledgements

We thank J. Simmank and J. Schneider for discussions about the ex-post evaluation of the pandemic and for input for the items to assess the appropriateness of political action; S. Columbus, M. Müller and F. Zimmermann for comments and suggestions; and the COSMO teams at the University of Erfurt and the Bernhard Nocht Institute for Tropical Medicine for their continuous work, on which this paper builds. Financial support by the following institutions is acknowledged: Federal Centre for Health Education, Robert Koch Institute, Leibniz Institute of Psychology, Bernhard Nocht Institute for Tropical Medicine, Klaus Tschira Foundation, Thüringer Ministerium für Wirtschaft, Wissenschaft und digitale Gesellschaft, Thüringer Staatskanzlei, University of Erfurt and Deutsche Forschungsgemeinschaft (DFG; German Research Foundation). The project was partly funded by the DFG under Germany’s Excellence Strategy: EXC 2126/1–390838866. Support from the DFG through CRC TR 224 (project A01) is also acknowledged. C.B. was partly funded by the DFG (BE3970/12-1) and the Leibniz Foundation (P106/2020). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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These authors contributed equally: Philipp Sprengholz, Luca Henkel

These authors jointly supervised this work: Robert Böhm, Cornelia Betsch

Authors and Affiliations

Institute of Psychology, University of Bamberg, Bamberg, Germany

Philipp Sprengholz

Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany

Philipp Sprengholz & Cornelia Betsch

Implementation Science, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

Kenneth C. Griffin Department of Economics, University of Chicago, Chicago, IL, USA

Luca Henkel

Department of Economics, University of CEMA, Buenos Aires, Argentina

Faculty of Psychology, University of Vienna, Vienna, Austria

Robert Böhm

Department of Psychology, University of Copenhagen, Copenhagen, Denmark

Copenhagen Center for Social Data Science, University of Copenhagen, Copenhagen, Denmark

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All authors designed and performed the research. P.S. and L.H. performed the data analyses. All authors wrote and revised the manuscript.

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Extended data figures and tables

Extended data fig. 1 predictors of appropriateness of political action in study 1..

Results of a multiple linear regression with vaccination status and vaccination status identification predicting perceived appropriateness of political measures to contain the COVID-19 pandemic. Ribbons visualize 95% confidence intervals; R 2  = 0.482.

Extended Data Fig. 2 Effects of interventions to reduce recall bias in study 2.

a – f , Linear regression predicting individual recall on the basis of past (December 2021) and present (January 2023) ratings and their interactions with vaccination status and experimental condition for infection probability ( a ), infection severity ( b ), trust in government ( c ), trust in science ( d ), mask wearing ( e ) and avoiding contacts ( f ) ( n  = 3,105). Each line visualizes directional bias and how past and present perceptions affect recall (at recall = 4) for a given vaccination status and experimental condition (see the Fig. 1 legend for details on how to read the figure).

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Sprengholz, P., Henkel, L., Böhm, R. et al. Historical narratives about the COVID-19 pandemic are motivationally biased. Nature 623 , 588–593 (2023). https://doi.org/10.1038/s41586-023-06674-5

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Why the Pandemic Probably Started in a Lab, in 5 Key Points

By Alina Chan

Dr. Chan is a molecular biologist at the Broad Institute of M.I.T. and Harvard, and a co-author of “Viral: The Search for the Origin of Covid-19.”

This article has been updated to reflect news developments.

On Monday, Dr. Anthony Fauci returned to the halls of Congress and testified before the House subcommittee investigating the Covid-19 pandemic. He was questioned about several topics related to the government’s handling of Covid-19, including how the National Institute of Allergy and Infectious Diseases, which he directed until retiring in 2022, supported risky virus work at a Chinese institute whose research may have caused the pandemic.

For more than four years, reflexive partisan politics have derailed the search for the truth about a catastrophe that has touched us all. It has been estimated that at least 25 million people around the world have died because of Covid-19, with over a million of those deaths in the United States.

Although how the pandemic started has been hotly debated, a growing volume of evidence — gleaned from public records released under the Freedom of Information Act, digital sleuthing through online databases, scientific papers analyzing the virus and its spread, and leaks from within the U.S. government — suggests that the pandemic most likely occurred because a virus escaped from a research lab in Wuhan, China. If so, it would be the most costly accident in the history of science.

Here’s what we now know:

1 The SARS-like virus that caused the pandemic emerged in Wuhan, the city where the world’s foremost research lab for SARS-like viruses is located.

• At the Wuhan Institute of Virology, a team of scientists had been hunting for SARS-like viruses for over a decade, led by Shi Zhengli.
• Their research showed that the viruses most similar to SARS‑CoV‑2, the virus that caused the pandemic, circulate in bats that live r oughly 1,000 miles away from Wuhan. Scientists from Dr. Shi’s team traveled repeatedly to Yunnan province to collect these viruses and had expanded their search to Southeast Asia. Bats in other parts of China have not been found to carry viruses that are as closely related to SARS-CoV-2.

The closest known relatives to SARS-CoV-2 were found in southwestern China and in Laos.

Large cities

Mine in Yunnan province

Cave in Laos

South China Sea

The closest known relatives to SARS-CoV-2

were found in southwestern China and in Laos.

philippines

The closest known relatives to SARS-CoV-2 were found

in southwestern China and Laos.

Sources: Sarah Temmam et al., Nature; SimpleMaps

Note: Cities shown have a population of at least 200,000.

There are hundreds of large cities in China and Southeast Asia.

There are hundreds of large cities in China

and Southeast Asia.

The pandemic started roughly 1,000 miles away, in Wuhan, home to the world’s foremost SARS-like virus research lab.

The pandemic started roughly 1,000 miles away,

in Wuhan, home to the world’s foremost SARS-like virus research lab.

The pandemic started roughly 1,000 miles away, in Wuhan,

home to the world’s foremost SARS-like virus research lab.

• Even at hot spots where these viruses exist naturally near the cave bats of southwestern China and Southeast Asia, the scientists argued, as recently as 2019 , that bat coronavirus spillover into humans is rare .
• When the Covid-19 outbreak was detected, Dr. Shi initially wondered if the novel coronavirus had come from her laboratory , saying she had never expected such an outbreak to occur in Wuhan.
• The SARS‑CoV‑2 virus is exceptionally contagious and can jump from species to species like wildfire . Yet it left no known trace of infection at its source or anywhere along what would have been a thousand-mile journey before emerging in Wuhan.

2 The year before the outbreak, the Wuhan institute, working with U.S. partners, had proposed creating viruses with SARS‑CoV‑2’s defining feature.

• Dr. Shi’s group was fascinated by how coronaviruses jump from species to species. To find viruses, they took samples from bats and other animals , as well as from sick people living near animals carrying these viruses or associated with the wildlife trade. Much of this work was conducted in partnership with the EcoHealth Alliance, a U.S.-based scientific organization that, since 2002, has been awarded over $80 million in federal funding to research the risks of emerging infectious diseases.
• The laboratory pursued risky research that resulted in viruses becoming more infectious : Coronaviruses were grown from samples from infected animals and genetically reconstructed and recombined to create new viruses unknown in nature. These new viruses were passed through cells from bats, pigs, primates and humans and were used to infect civets and humanized mice (mice modified with human genes). In essence, this process forced these viruses to adapt to new host species, and the viruses with mutations that allowed them to thrive emerged as victors.
• By 2019, Dr. Shi’s group had published a database describing more than 22,000 collected wildlife samples. But external access was shut off in the fall of 2019, and the database was not shared with American collaborators even after the pandemic started , when such a rich virus collection would have been most useful in tracking the origin of SARS‑CoV‑2. It remains unclear whether the Wuhan institute possessed a precursor of the pandemic virus.
• In 2021, The Intercept published a leaked 2018 grant proposal for a research project named Defuse , which had been written as a collaboration between EcoHealth, the Wuhan institute and Ralph Baric at the University of North Carolina, who had been on the cutting edge of coronavirus research for years. The proposal described plans to create viruses strikingly similar to SARS‑CoV‑2.
• Coronaviruses bear their name because their surface is studded with protein spikes, like a spiky crown, which they use to enter animal cells. T he Defuse project proposed to search for and create SARS-like viruses carrying spikes with a unique feature: a furin cleavage site — the same feature that enhances SARS‑CoV‑2’s infectiousness in humans, making it capable of causing a pandemic. Defuse was never funded by the United States . However, in his testimony on Monday, Dr. Fauci explained that the Wuhan institute would not need to rely on U.S. funding to pursue research independently.

The Wuhan lab ran risky experiments to learn about how SARS-like viruses might infect humans.

1. Collect SARS-like viruses from bats and other wild animals, as well as from people exposed to them.

2. Identify high-risk viruses by screening for spike proteins that facilitate infection of human cells.

2. Identify high-risk viruses by screening for spike proteins that facilitate infection of

human cells.

In Defuse, the scientists proposed to add a furin cleavage site to the spike protein.

3. Create new coronaviruses by inserting spike proteins or other features that could make the viruses more infectious in humans.

4. Infect human cells, civets and humanized mice with the new coronaviruses, to determine how dangerous they might be.

• While it’s possible that the furin cleavage site could have evolved naturally (as seen in some distantly related coronaviruses), out of the hundreds of SARS-like viruses cataloged by scientists, SARS‑CoV‑2 is the only one known to possess a furin cleavage site in its spike. And the genetic data suggest that the virus had only recently gained the furin cleavage site before it started the pandemic.
• Ultimately, a never-before-seen SARS-like virus with a newly introduced furin cleavage site, matching the description in the Wuhan institute’s Defuse proposal, caused an outbreak in Wuhan less than two years after the proposal was drafted.
• When the Wuhan scientists published their seminal paper about Covid-19 as the pandemic roared to life in 2020, they did not mention the virus’s furin cleavage site — a feature they should have been on the lookout for, according to their own grant proposal, and a feature quickly recognized by other scientists.
• Worse still, as the pandemic raged, their American collaborators failed to publicly reveal the existence of the Defuse proposal. The president of EcoHealth, Peter Daszak, recently admitted to Congress that he doesn’t know about virus samples collected by the Wuhan institute after 2015 and never asked the lab’s scientists if they had started the work described in Defuse. In May, citing failures in EcoHealth’s monitoring of risky experiments conducted at the Wuhan lab, the Biden administration suspended all federal funding for the organization and Dr. Daszak, and initiated proceedings to bar them from receiving future grants. In his testimony on Monday, Dr. Fauci said that he supported the decision to suspend and bar EcoHealth.
• Separately, Dr. Baric described the competitive dynamic between his research group and the institute when he told Congress that the Wuhan scientists would probably not have shared their most interesting newly discovered viruses with him . Documents and email correspondence between the institute and Dr. Baric are still being withheld from the public while their release is fiercely contested in litigation.
• In the end, American partners very likely knew of only a fraction of the research done in Wuhan. According to U.S. intelligence sources, some of the institute’s virus research was classified or conducted with or on behalf of the Chinese military . In the congressional hearing on Monday, Dr. Fauci repeatedly acknowledged the lack of visibility into experiments conducted at the Wuhan institute, saying, “None of us can know everything that’s going on in China, or in Wuhan, or what have you. And that’s the reason why — I say today, and I’ve said at the T.I.,” referring to his transcribed interview with the subcommittee, “I keep an open mind as to what the origin is.”

3 The Wuhan lab pursued this type of work under low biosafety conditions that could not have contained an airborne virus as infectious as SARS‑CoV‑2.

• Labs working with live viruses generally operate at one of four biosafety levels (known in ascending order of stringency as BSL-1, 2, 3 and 4) that describe the work practices that are considered sufficiently safe depending on the characteristics of each pathogen. The Wuhan institute’s scientists worked with SARS-like viruses under inappropriately low biosafety conditions .

In the United States, virologists generally use stricter Biosafety Level 3 protocols when working with SARS-like viruses.

Biosafety cabinets prevent

viral particles from escaping.

Viral particles

Personal respirators provide

a second layer of defense against breathing in the virus.

DIRECT CONTACT

Gloves prevent skin contact.

Disposable wraparound

gowns cover much of the rest of the body.

Personal respirators provide a second layer of defense against breathing in the virus.

Disposable wraparound gowns

cover much of the rest of the body.

Note: ​​Biosafety levels are not internationally standardized, and some countries use more permissive protocols than others.

The Wuhan lab had been regularly working with SARS-like viruses under Biosafety Level 2 conditions, which could not prevent a highly infectious virus like SARS-CoV-2 from escaping.

Some work is done in the open air, and masks are not required.

Less protective equipment provides more opportunities

for contamination.

Some work is done in the open air,

and masks are not required.

Less protective equipment provides more opportunities for contamination.

• In one experiment, Dr. Shi’s group genetically engineered an unexpectedly deadly SARS-like virus (not closely related to SARS‑CoV‑2) that exhibited a 10,000-fold increase in the quantity of virus in the lungs and brains of humanized mice . Wuhan institute scientists handled these live viruses at low biosafet y levels , including BSL-2.
• Even the much more stringent containment at BSL-3 cannot fully prevent SARS‑CoV‑2 from escaping . Two years into the pandemic, the virus infected a scientist in a BSL-3 laboratory in Taiwan, which was, at the time, a zero-Covid country. The scientist had been vaccinated and was tested only after losing the sense of smell. By then, more than 100 close contacts had been exposed. Human error is a source of exposure even at the highest biosafety levels , and the risks are much greater for scientists working with infectious pathogens at low biosafety.
• An early draft of the Defuse proposal stated that the Wuhan lab would do their virus work at BSL-2 to make it “highly cost-effective.” Dr. Baric added a note to the draft highlighting the importance of using BSL-3 to contain SARS-like viruses that could infect human cells, writing that “U.S. researchers will likely freak out.” Years later, after SARS‑CoV‑2 had killed millions, Dr. Baric wrote to Dr. Daszak : “I have no doubt that they followed state determined rules and did the work under BSL-2. Yes China has the right to set their own policy. You believe this was appropriate containment if you want but don’t expect me to believe it. Moreover, don’t insult my intelligence by trying to feed me this load of BS.”
• SARS‑CoV‑2 is a stealthy virus that transmits effectively through the air, causes a range of symptoms similar to those of other common respiratory diseases and can be spread by infected people before symptoms even appear. If the virus had escaped from a BSL-2 laboratory in 2019, the leak most likely would have gone undetected until too late.
• One alarming detail — leaked to The Wall Street Journal and confirmed by current and former U.S. government officials — is that scientists on Dr. Shi’s team fell ill with Covid-like symptoms in the fall of 2019 . One of the scientists had been named in the Defuse proposal as the person in charge of virus discovery work. The scientists denied having been sick .

4 The hypothesis that Covid-19 came from an animal at the Huanan Seafood Market in Wuhan is not supported by strong evidence.

• In December 2019, Chinese investigators assumed the outbreak had started at a centrally located market frequented by thousands of visitors daily. This bias in their search for early cases meant that cases unlinked to or located far away from the market would very likely have been missed. To make things worse, the Chinese authorities blocked the reporting of early cases not linked to the market and, claiming biosafety precautions, ordered the destruction of patient samples on January 3, 2020, making it nearly impossible to see the complete picture of the earliest Covid-19 cases. Information about dozens of early cases from November and December 2019 remains inaccessible.
• A pair of papers published in Science in 2022 made the best case for SARS‑CoV‑2 having emerged naturally from human-animal contact at the Wuhan market by focusing on a map of the early cases and asserting that the virus had jumped from animals into humans twice at the market in 2019. More recently, the two papers have been countered by other virologists and scientists who convincingly demonstrate that the available market evidence does not distinguish between a human superspreader event and a natural spillover at the market.
• Furthermore, the existing genetic and early case data show that all known Covid-19 cases probably stem from a single introduction of SARS‑CoV‑2 into people, and the outbreak at the Wuhan market probably happened after the virus had already been circulating in humans.

An analysis of SARS-CoV-2’s evolutionary tree shows how the virus evolved as it started to spread through humans.

SARS-COV-2 Viruses closest

to bat coronaviruses

more mutations

Source: Lv et al., Virus Evolution (2024) , as reproduced by Jesse Bloom

The viruses that infected people linked to the market were most likely not the earliest form of the virus that started the pandemic.

• Not a single infected animal has ever been confirmed at the market or in its supply chain. Without good evidence that the pandemic started at the Huanan Seafood Market, the fact that the virus emerged in Wuhan points squarely at its unique SARS-like virus laboratory.

5 Key evidence that would be expected if the virus had emerged from the wildlife trade is still missing.

In previous outbreaks of coronaviruses, scientists were able to demonstrate natural origin by collecting multiple pieces of evidence linking infected humans to infected animals.

Infected animals

Earliest known

cases exposed to

live animals

Antibody evidence

of animals and

animal traders having

been infected

Ancestral variants

of the virus found in

Documented trade

of host animals

between the area

where bats carry

closely related viruses

and the outbreak site

Infected animals found

Earliest known cases exposed to live animals

Antibody evidence of animals and animal

traders having been infected

Ancestral variants of the virus found in animals

Documented trade of host animals

between the area where bats carry closely

related viruses and the outbreak site

For SARS-CoV-2, these same key pieces of evidence are still missing , more than four years after the virus emerged.

For SARS-CoV-2, these same key pieces of evidence are still missing ,

more than four years after the virus emerged.

• Despite the intense search trained on the animal trade and people linked to the market, investigators have not reported finding any animals infected with SARS‑CoV‑2 that had not been infected by humans. Yet, infected animal sources and other connective pieces of evidence were found for the earlier SARS and MERS outbreaks as quickly as within a few days, despite the less advanced viral forensic technologies of two decades ago.
• Even though Wuhan is the home base of virus hunters with world-leading expertise in tracking novel SARS-like viruses, investigators have either failed to collect or report key evidence that would be expected if Covid-19 emerged from the wildlife trade . For example, investigators have not determined that the earliest known cases had exposure to intermediate host animals before falling ill. No antibody evidence shows that animal traders in Wuhan are regularly exposed to SARS-like viruses, as would be expected in such situations.
• With today’s technology, scientists can detect how respiratory viruses — including SARS, MERS and the flu — circulate in animals while making repeated attempts to jump across species . Thankfully, these variants usually fail to transmit well after crossing over to a new species and tend to die off after a small number of infections. In contrast, virologists and other scientists agree that SARS‑CoV‑2 required little to no adaptation to spread rapidly in humans and other animals . The virus appears to have succeeded in causing a pandemic upon its only detected jump into humans.

The pandemic could have been caused by any of hundreds of virus species, at any of tens of thousands of wildlife markets, in any of thousands of cities, and in any year. But it was a SARS-like coronavirus with a unique furin cleavage site that emerged in Wuhan, less than two years after scientists, sometimes working under inadequate biosafety conditions, proposed collecting and creating viruses of that same design.

While several natural spillover scenarios remain plausible, and we still don’t know enough about the full extent of virus research conducted at the Wuhan institute by Dr. Shi’s team and other researchers, a laboratory accident is the most parsimonious explanation of how the pandemic began.

Given what we now know, investigators should follow their strongest leads and subpoena all exchanges between the Wuhan scientists and their international partners, including unpublished research proposals, manuscripts, data and commercial orders. In particular, exchanges from 2018 and 2019 — the critical two years before the emergence of Covid-19 — are very likely to be illuminating (and require no cooperation from the Chinese government to acquire), yet they remain beyond the public’s view more than four years after the pandemic began.

Whether the pandemic started on a lab bench or in a market stall, it is undeniable that U.S. federal funding helped to build an unprecedented collection of SARS-like viruses at the Wuhan institute, as well as contributing to research that enhanced them . Advocates and funders of the institute’s research, including Dr. Fauci, should cooperate with the investigation to help identify and close the loopholes that allowed such dangerous work to occur. The world must not continue to bear the intolerable risks of research with the potential to cause pandemics .

A successful investigation of the pandemic’s root cause would have the power to break a decades-long scientific impasse on pathogen research safety, determining how governments will spend billions of dollars to prevent future pandemics. A credible investigation would also deter future acts of negligence and deceit by demonstrating that it is indeed possible to be held accountable for causing a viral pandemic. Last but not least, people of all nations need to see their leaders — and especially, their scientists — heading the charge to find out what caused this world-shaking event. Restoring public trust in science and government leadership requires it.

A thorough investigation by the U.S. government could unearth more evidence while spurring whistleblowers to find their courage and seek their moment of opportunity. It would also show the world that U.S. leaders and scientists are not afraid of what the truth behind the pandemic may be.

More on how the pandemic may have started

Where Did the Coronavirus Come From? What We Already Know Is Troubling.

Even if the coronavirus did not emerge from a lab, the groundwork for a potential disaster had been laid for years, and learning its lessons is essential to preventing others.

By Zeynep Tufekci

Why Does Bad Science on Covid’s Origin Get Hyped?

If the raccoon dog was a smoking gun, it fired blanks.

By David Wallace-Wells

A Plea for Making Virus Research Safer

A way forward for lab safety.

By Jesse Bloom

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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Alina Chan ( @ayjchan ) is a molecular biologist at the Broad Institute of M.I.T. and Harvard, and a co-author of “ Viral : The Search for the Origin of Covid-19.” She was a member of the Pathogens Project , which the Bulletin of the Atomic Scientists organized to generate new thinking on responsible, high-risk pathogen research.

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SARS-CoV-2 and COVID-19: The most important research questions

Kit-san yuen.

1 School of Biomedical Sciences, The University of Hong Kong, 3/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong

2 Department of Microbiology, The University of Hong Kong, Pokfulam, Hong Kong

Sin-Yee Fung

Chi-ping chan, dong-yan jin, associated data.

Not applicable.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing global health emergency. Here we highlight nine most important research questions concerning virus transmission, asymptomatic and presymptomatic virus shedding, diagnosis, treatment, vaccine development, origin of virus and viral pathogenesis.

The 2019-nCoV causes an ongoing outbreak of lower respiratory tract disease called novel coronavirus pneumonia (NCP) by the Chinese government initially. The disease name was subsequently recommended as COVID-19 by the World Health Organization. Meanwhile, 2019-nCoV was renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses. As of February 24, 2020, more than 80,000 confirmed cases including more than 2,700 deaths have been reported worldwide, affecting at least 37 countries. The WHO has declared this a global health emergency at the end of January 2020. The epicenter of this ongoing outbreak is in the city of Wuhan in Hubei Province of central China and the Huanan seafood wholesale market was thought to be at least one of the places where SARS-CoV-2 from an unknown animal source might have crossed the species barrier to infect humans.

A pioneering study conducted in the city of Shenzhen near Hong Kong by a group of clinicians and scientists from the University of Hong Kong has provided the first concrete evidence for human-to-human transmission of SARS-CoV-2 [ 1 ]. This is an excellent example of how a high-quality clinical study can make a major difference in policy setting. Several important clinical features of COVID-19 have also been documented in this study. First, an attack rate of 83% within the family context is alarmingly high, indicating the high transmissibility of SARS-CoV-2. Second, the clinical manifestations of COVID-19 in this family range from mild to moderate, with more systematic symptoms and more severe radiological abnormalities seen in older patients. Generally, COVID-19 appears to be less severe than SARS. Third, an asymptomatic child was found to have ground-glass opacities in his lung and SARS-CoV-2 RNA in his sputum sample. This finding of asymptomatic virus shedding raises the possibility for transmission of SARS-CoV-2 from asymptomatic carriers to others, which is later confirmed by others [ 2 ]. Finally, the presentation of diarrhea in two young adults from the same family also suggests the possibility for gastrointestinal involvement in SARS-CoV-2 infection and fecal–oral transmission. The study has set the stage for the control and management of COVID-19 [ 1 ]. The work was completed timely and the investigators showed great courage and leadership in a very difficult time when the Chinese authority failed to recognize widespread person-to-person transmission of SARS-CoV-2 before January 20, 2020.

Several interesting papers on SARS-CoV-2 and COVID-19 have been published in the past few weeks to report on the evolutionary reservoir [ 3 ], possible intermediate host [ 4 ] and genomic sequence [ 5 ] of SARS-CoV-2 as well as clinical characteristics of COVID-19 [ 6 , 7 ]. In view of these findings and the urgent needs in the prevention and control of SARS-CoV-2 and COVID-19, in this commentary we highlight the most important research questions in the field from our personal perspectives.

The first question concerns how SARS-CoV-2 is transmitted currently in the epicenter of Wuhan. In order to minimize the spreading of SARS-CoV-2, China has locked down Wuhan and nearby cities since January 23, 2020. The unprecedented control measures including suspension of all urban transportation have apparently been successful in preventing further spreading of SARS-CoV-2 to other cities. However, the number of confirmed cases in Wuhan continued to rise. It is therefore crucial to determine whether the rise is due to a large number of infected individuals before the lock down and/or failure in the prevention of widespread intra-familial, nosocomial or community transmission. Based on the number of exported cases from Wuhan to cities outside of mainland China, it was predicted that there might be more than 70,000 individuals infected with SARS-CoV-2 on January 25, 2020 in Wuhan [ 8 ]. This should be determined experimentally in Wuhan as discussed below and it will reveal whether the real numbers of infected people and asymptomatic carriers are indeed underestimated severely. In addition to viral RNA detection, measurement of IgM and IgG antibodies as well as antigens would be very helpful. Several representative residential areas should be selected for detailed analysis so that a big picture can be deduced. The analysis should include all healthy and diseased individuals within the area with the aim of identifying people who have recovered from an infection or are having an active infection. The ratio of asymptomatic carriers should also be determined. The analysis should also be extended to detect RNA and antigen of influenza viruses. The activity of seasonal flu in Wuhan also reached a peak at the beginning of 2020. It will be of interest to see whether the flu season had ended and how many people having a fever now are actually infected with influenza virus. Precision control measures for SARS-CoV-2 should be tailor-designed for high-risk groups based on the results of this analysis. Differentiating people having a flu and preventing them from infecting with SARS-CoV-2 in a hospital setting might also be critical.

The second question is how transmissible and pathogenic is SARS-CoV-2 in tertiary and quaternary spreading within humans. Continued transmission of SARS-CoV-2 in Wuhan suggests that tertiary and quaternary spreading has occurred. Compared to the primary and secondary spreading during which SARS-CoV-2 was transmitted from animal to human and from human to human, has the transmission rate increased and has the pathogenicity decreased? Alternatively, is the virus less transmissible after several passages in humans? Retrospective analysis of all confirmed cases in Wuhan should be very informative. The answers to the above questions hold the key to the outcome of the outbreak. If the transmission is weakened, the outbreak may ultimately come to an end at which SARS-CoV-2 is eradicated from humans. On the contrary, if effective transmission can be sustained, the chance is increased that SARS-CoV-2 will become another community-acquired human coronavirus just like the other four human coronaviruses (229E, OC43, HKU1 and NL63) causing common cold only. The basic reproductive number (R 0 ) of SARS-CoV-2 has been estimated to be 2.68, resulting in an epidemic doubling time of about 6.4 days [ 8 ]. Other estimates of R 0 could go up to 4, higher than that of SARS-CoV, which is lower than 2. Determining the real R 0 will shed light on whether and to what extent infection control measures are effective.

The third question relates to the importance of asymptomatic and presymptomatic virus shedding in SARS-CoV-2 transmission. Asymptomatic and presymptomatic virus shedding posts a big challenge to infection control [ 1 , 2 ]. In addition, patients with mild and unspecific symptoms are also difficult to identify and quarantine. Notably, the absence of fever in SARS-CoV-2 infection (12.1%) is more frequent than in SARS-CoV (1%) and Middle East respiratory syndrome coronavirus (MERS-CoV; 2%) infection [ 6 ]. In light of this, the effectiveness of using fever detection as the surveillance method should be reviewed. However, based on previous studies of influenza viruses and community-acquired human coronaviruses, the viral loads in asymptomatic carriers are relatively low [ 9 ]. If this is also the case for SARS-CoV-2, the risk should remain low. Studies on the natural history of SARS-CoV-2 infection in humans are urgently needed. Identifying a cohort of asymptomatic carriers in Wuhan and following their viral loads, clinical presentations and antibody titers over a time course will provide clues as to how many of the subjects have symptoms in a later phase, whether virus shedding from the subjects is indeed less robust, and how often they might transmit SARS-CoV-2 to others.

The fourth question relates to the importance of fecal–oral route in SARS-CoV-2 transmission. In addition to transmission via droplets and close contact, fecal–oral transmission of SARS-CoV has been shown to be important in certain circumstances. Gastrointestinal involvement of SARS-CoV-2 infection and isolation of SARS-CoV-2 from fecal samples of patients are in support of the importance of fecal–oral route in SARS-CoV-2 transmission. Although diarrhea was rarely seen in studies with large cohorts [ 6 , 7 ], the possibility of SARS-CoV-2 transmission via sewage, waste, contaminated water, air condition system and aerosols cannot be underestimated, particularly in cases such as the Diamond Princess cruise ship with 3,700 people, among whom at least 742 have been confirmed to be infected with SARS-CoV-2 plausibly as the result of a superspreading event. Further investigations are required to determine the role of fecal–oral transmission in these cases and within the representative residential areas selected for detailed epidemiological studies in Wuhan as discussed earlier.

The fifth question concerns how COVID-19 should be diagnosed and what diagnostic reagents should be made available. RT-PCR-based SARS-CoV-2 RNA detection in respiratory samples provides the only specific diagnostic test at the initial phase of the outbreak. It has played a very critical role in early detection of patients infected with SARS-CoV-2 outside of Wuhan, implicating that widespread infection of the virus had occurred in Wuhan at least as early as the beginning of 2020. This has also pushed the Chinese authority to acknowledge the severity of the situation. Due to difficulties in sampling and other technical issues in this test, at one point in early February clinically diagnosed patients with typical ground glass lung opacities in chest CT were also counted as confirmed cases in order to have the patients identified and quarantined as early as possible. ELISA kits for detection of IgM and IgG antibodies against N and other SARS-CoV-2 proteins have also been available more recently. This has made specific diagnosis of ongoing and past infection possible. Particularly, seroconversion for IgM antibodies normally occurs a few days earlier than that of IgG. ELISA reagents for detection of SARS-CoV-2 antigens such as S and N are still in urgent need, and would provide another test highly complementary to viral RNA detection.

The sixth question concerns how COVID-19 should be treated and what treatment options should be made available. COVID-19 is a self-limiting disease in more than 80% of patients. Severe pneumonia occurred in about 15% of cases as revealed in studies with large cohorts of patients. The gross case fatality is 3.4% worldwide as of February 25, 2020. This rate is 4.4% for patients in Wuhan, 4.0% for patients in Hubei and 0.92% for patients outside of Hubei. The exceedingly high fatality in Wuhan might be explained by the collapse of hospitals, a large number of undiagnosed patients, suboptimal treatment or a combination of these. Up to date, we still do not have any specific anti-SARS-CoV-2 agents but an anti-Ebola drug, remdesivir, may hold the promise. As a nucleotide analog, remdesivir was shown to be effective in preventing MERS-CoV replication in monkeys. Severity of disease, viral replication, and lung damage were reduced when the drug was administered either before or after infection with MERS-CoV [ 10 ]. These results provide the basis for a rapid test of the beneficial effects of remdesivir in COVID-19. Other antiviral agents worthy of further clinical investigations include ribavirin, protease inhibitors lopinavir and ritonavir, interferon α2b, interferon β, chloroquine phosphate, and Arbidol. However, we should also bear in mind the side effects of these antiviral agents. For example, type I interferons including interferon α2b and interferon β are well known for their antiviral activity. Their beneficial effects at an early phase of infection are well expected. However, administration at a later stage carries the risk that they might worsen the cytokine storm and exacerbate inflammation. Notably, steroids have been experimentally used widely in the treatment of SARS and are still preferred by some Chinese physicians in the treatment of COVID-19. It is said to be capable of stopping the cytokine storm and preventing lung fibrosis. However, the window in which steroids might be beneficial to patients with COVID-19 is very narrow. In other words, steroids can only be used when SARS-CoV-2 has already been eliminated by human immune response. Otherwise, SARS-CoV-2 replication will be boosted leading to exacerbation of symptoms, substantial virus shedding, as well as increased risk for nosocomial transmission and secondary infection. In this regard, it will be of interest to determine whether the report of fungal infection in the lungs of some patients in Wuhan might be linked to misuse of steroids. Nevertheless, the screening of new pharmaceuticals, small-molecule compounds and other agents that have potent anti-SARS-CoV-2 effects will successfully derive new and better lead compounds and agents that might prove useful in the treatment of COVID-19.

The seventh question is whether inactivated vaccines are a viable option for SARS-CoV-2. The chance that SARS-CoV-2 will become endemic in some areas or even pandemic has increased in view of its high transmissibility, asymptomatic and presymptomatic virus shedding, high number of patients with mild symptoms, as well as the evidence for superspreading events. Thus, vaccine development becomes necessary for prevention and ultimate eradication of SARS-CoV-2. Inactivated vaccines are one major type of conventional vaccines that could be easily produced and quickly developed. In this approach, SARS-CoV-2 virions can be chemically and/or physically inactivated to elicit neutralizing antibodies. In the case of SARS-CoV and MERS-CoV, neutralizing antibodies were successfully and robustly induced by an inactivated vaccine in all types of animal experiments, but there are concerns about antibody-dependent enhancement of viral infection and other safety issues. While inactivated vaccines should still be tested, alternative approaches include live attenuated vaccines, subunit vaccines and vectored vaccines. All of these merit further investigations and tests in animals.

The eighth question relates to the origins of SARS-CoV-2 and COVID-19. To make a long story short, two parental viruses of SARS-CoV-2 have now been identified. The first one is bat coronavirus RaTG13 found in Rhinolophus affinis from Yunnan Province and it shares 96.2% overall genome sequence identity with SARS-CoV-2 [ 3 ]. However, RaTG13 might not be the immediate ancestor of SARS-CoV-2 because it is not predicted to use the same ACE2 receptor used by SARS-CoV-2 due to sequence divergence in the receptor-binding domain sharing 89% identity in amino acid sequence with that of SARS-CoV-2. The second one is a group of betacoronaviruses found in the endangered species of small mammals known as pangolins [ 4 ], which are often consumed as a source of meat in southern China. They share about 90% overall nucleotide sequence identity with SARS-CoV-2 but carries a receptor-binding domain predicted to interact with ACE2 and sharing 97.4% identity in amino acid sequence with that of SARS-CoV-2. They are closely related to both SARS-CoV-2 and RaTG13, but apparently they are unlikely the immediate ancestor of SARS-CoV-2 in view of the sequence divergence over the whole genome. Many hypotheses involving recombination, convergence and adaptation have been put forward to suggest a probable evolutionary pathway for SARS-CoV-2, but none is supported by direct evidence. The jury is still out as to what animals might serve as reservoir and intermediate hosts of SARS-CoV-2. Although Huanan seafood wholesale market was suggested as the original source of SARS-CoV-2 and COVID-19, there is evidence for the involvement of other wild animal markets in Wuhan. In addition, the possibility for a human superspreader in the Huanan market has not been excluded. Further investigations are required to shed light on the origins of SARS-CoV-2 and COVID-19.

The ninth question concerns why SARS-CoV-2 is less pathogenic. If the reduced pathogenicity of SARS-CoV-2 is the result of adaptation to humans, it will be of great importance to identify the molecular basis of this adaptation. The induction of a cytokine storm is the root cause of pathogenic inflammation both in SARS and COVID-19. SARS-CoV is known to be exceedingly potent in the suppression of antiviral immunity and the activation of proinflammatory response. It is therefore intriguing to see how SARS-CoV-2 might be different from SARS-CoV in interferon-antagonizing and inflammasome-activating properties. It is noteworthy that some interferon antagonists and inflammasome activators encoded by SARS-CoV are not conserved in SARS-CoV-2. Particularly, ORF3 and ORF8 in SARS-CoV-2 are highly divergent from ORF3a and ORF8b in SARS-CoV that are known to induce NLRP3 inflammasome activation. ORF3 of SARS-CoV-2 is also significantly different from the interferon antagonist ORF3b of SARS-CoV. Thus, these viral proteins of SARS-CoV and SARS-CoV-2 should be compared for their abilities to modulate antiviral and proinflammatory responses. The hypothesis that SARS-CoV-2 might be less efficient in the suppression of antiviral response and the activation of NLRP3 inflammasome should be tested experimentally.

Much progress has been made in the surveillance and control of infectious diseases in China after the outbreak of SARS-CoV in 2003. Meanwhile, virological research in the country has also been strengthened. The new disease report and surveillance system did function relatively well during the 2009 pandemic of swine flu. New viral pathogens such as avian influenza virus H7N9 and severe-fever-with-thrombocytopenia syndrome bunyavirus have also been discovered in recent years [ 11 , 12 ], indicating the strength and vigor of Chinese infectious disease surveillance and virological research. However, the ongoing outbreak of SARS-CoV-2 has not only caused significant morbidity and mortality in China, but also revealed major systematic problems in control and prevention of infectious diseases there. Unfortunately, many of the lessons from the 2003 outbreak have not been learned. Importantly, disease control professionals, practicing physicians and scientists are disconnected in the fight against SARS-CoV-2 and COVID-19. In addition, important decisions were not made by experts in the field. Hopefully, these issues will be dealt with swiftly and decisively during and after the outbreak.

Above we have discussed the two possibilities that this outbreak will unfold. If SARS-CoV-2 is not eliminated from humans through quarantine and other measures, it can still be eradicated by vaccination. If it attenuates to become another community-acquired human coronavirus causing mild respiratory tract disease resembling the other four human coronaviruses associated with common cold, it will not be a disaster either. Before SARS-CoV-2 attenuates further to a much less virulent form, early diagnosis and improved treatment of severe cases hold the key to reduce mortality. We should remain vigilant, but there are grounds for guarded optimism. Redoubling our research efforts on SARS-CoV-2 and COVID-19 will solidify the scientific basis on which important decisions are made.

Acknowledgements

We thank Pearl Chan, Hinson Cheung, Terence Lee and Kam-Leung Siu for critical reading of the manuscript.

Authors’ contributions

KSY and DYJ wrote the manuscript with inputs from ZWY, SYF and CPC. All authors read and approved the final manuscript.

Coronavirus research in our laboratory was funded by the Hong Kong Health and Medical Research Fund (HKM-15-M01) and Hong Kong Research Grants Council (T11-707/15-R).

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No potential conflict of interest was reported by the authors.

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