- Charlotte Talks on WFAE (90.7 FM) had the following episode about the “history” of making the COVID-19 vaccine. It’s not required but might be of interest to many of you in healthcare programs:
- A Shot To Save The World Author Details the Successful Race for Safe and Effective COVID-19 Vaccines (10/27/2021)
- Apparently, scientists were researching coronavirus vaccines before this outbreak
- Disease and Medical “Certainty,” a personal story
- Emerging Science
- Politics and politics of Science/Medicine
- We’ll make a distinction between uppercase-P Politics and lowercase-p politics
Watch the short video and read the following short articles below:
- Video: Baller, April. “When and how to wear medical masks to protect against the new coronavirus?” World Health Organization (WHO), 6 March 2020 (YouTube video 2 min 17 secs).
- Casiano, Louis. “WHO guidance: Healthy people should wear masks only when…” Fox News, 28 May 2020.
- Yan, Holly. “Fauci says the WHO’s comment on asymptomatic spread is wrong.” CNN.com, 10 June 2020.
- Morens, David M. and Fauci, Anthony S. “Emerging Pandemic Diseases: How We Got to COVID-19” Cell, 15 Aug. 2020.
Disease and Medical “Certainty,” a personal story
Last week was the 8-year anniversary of my friend’s death due to ALS, or amyotrophic lateral sclerosis. We had been friends from the age of 7, but he’s always on my mind and on the Las Vegas shelf in my house. He’s obviously not a statistic, but his situation is an outlier because he was so young when he succumbed to the disease. Most people develop it between 40-70, and around 5,000 people per year are diagnosed with ALS. I mention this to have us pause for a moment and remember that the facts and figures surrounding our medical discussions are about human beings, and both healthy and unhealthy lives don’t necessarily follow exact predictions. Medicine, as we’ve learned with all science, deals with probabilities and not 100% certainty.
Liver Disease on the Rise
I’m trying to impress upon the class this issue of comorbidity, the presence of two or more diseases. We may be in the midst of a “silent” epidemic of liver disease.
I am not a medical specialist. I specialize in technical communication and discourse surrounding science and technology. The above is in no way an official, medical announcement of an epidemic. It is a cautionary tale based on the evidence so far. Below are readings (not required) that provide more information on liver disease and the growing cases being found in the United States:
- Rapid Rise in Deaths from Liver Disease in the US Over the Last Decade (BMJ: The British Medical Journal)
- “…the worsening trends began after 2008, a year marked by the global financial crisis and a subsequent economic recession in the US, which may explain some of the results.”
- “…the researchers found that deaths due to cirrhosis increased by 65% (from 20,661 in 1999 to 34,174 in 2016) and deaths due to liver cancer doubled (from 5,112 in 1999 to 11,073 in 2016).”
- COVID-19: Issues Related to Liver Disease in Adults
- “Whether patients with chronic liver disease are more susceptible to COVID-19 is uncertain.”
- Although there is limited data to support this, the medical community is paying close attention, and “The Centers for Disease Control and Prevention (CDC) has stated that patients with chronic liver disease or who are immunocompromised may be at higher risk for severe illness from COVID-19…”
- Fatty Liver Disease (Cleveland Clinic)
And guess what happened to our drinking consumption during lockdown?
The materials for today’s lesson are not the last word on COVID-19. As you remember from your reading of Collins & Pinch, this course teaches about science. Specifically, we want to consider the ways in which lay audiences hear about science: lay audiences are the public, non-experts. You’ve no doubt heard that political preferences seem to dictate one’s assumptions regarding mask wearing and the validity of scientists regarding the pandemic. The pandemic is real. Also, early in 2020, scientists weren’t certain about what precautions would be most effective in stopping the spread of COVID-19. As college-educated citizens, you should understand why there were different guidelines early on; you shouldn’t throw your hands up and claim, “it’s just too confusing, so no one’s right.” Emerging science isn’t the same as black boxed science–science that the scientific community has established–so initial reporting might be wrong. However, as experts continue to work on the emerging science, they begin to be able to answer more and more questions.
Collins & Pinch tell us that science can be messy. Their discussion of cold fusion underscores “science as normal,” and “it is our image of science which needs changing, not the way science is conducted” (p. 77). The public needs to have more realistic assumptions about science and not expect perfection. This isn’t a debunking of science. It is having a critical view of science, understanding the process of establishing facts and demonstrating evidence. Collins & Pinch definitely discussed science in relation to what I’ll call little-p “politics” (p. 54), but they didn’t address science and big-P “Politics,” which relates to our two-party system of Democrats vs Republicans. Little-p “politics” exists everywhere–jobs, schools, dating, marriage, discourse communities, academic disciplines, etc.–and establishes how members interact, get rewarded, get censured, and maintain a variety of hierarchies. We sometimes refer to these as the “unwritten rules” of an organization or discipline. No one sits you down and says, “these are our office politics.” As you get acclimated to your field and interact with your colleagues, you absorb the invisible political worldview of your profession.
Unfortunately, we live in a culture where a large portion of the public are anti-intellectual and dismiss science. Researchers found that one’s Political orientation (Democratic or Republican) influences their acceptance of mask mandates and social distancing guidelines. It is shameful and a despicable comment on society that conviction and taste, as opposed to well-reasoned and supported opinions, guide people during a deadly pandemic. Aim to think critically about information you consume; aim to understand why an expert advises us one way or another. Don’t let what you believe blind you from facts.
Ways of knowing or, more accurately, ways of arguing often get supported by the following:
- Tastes and convictions
Truth is often defined as facts, so the above list is ranked from more personal knowledge (1) to most socially accepted knowledge (4).
Where might “statistics” go?
For more on rhetoric, come see me in a future semester or check out the Rhetoric, an Introduction webpage.
The WHO’s Early Mask Guidelines for COVID-19
Full disclosure: In early March 2020 (prior to the 13th), I thought the pandemic was a little over blown. I didn’t think it was a hoax, but I thought it might “just be another flu…” Well, once we returned to classes after Spring Break, I told my class, “it’s not if we’re going 100% online; it’s when are we going 100% online.” I thought it wouldn’t be until April, and we went online by the end of that second week of March. I’m not blaming scientists for giving me false information; instead, I’m blaming myself for allowing assumptions, such as “we’ll be fine” and “it can’t be that bad,” blind me from the reality in which we now live. Friends and colleagues also were unsure this was a pandemic or not. Well, we no longer have any doubt!
Watch the WHO video with Dr. April Baller. Remember, this was published to YouTube on March 9, 2020. Dr. Baller tells the audience that they don’t need masks unless they are interacting with patients. She also claims that if you aren’t experiencing “respiratory symptoms” you don’t need a medical mask, and she holds up a mask (more on that specific mask below). Another claim is that “masks alone can give you a false feeling of protection” (0:0.23). She also makes the argument that sick people should wear masks to keep from infecting others. Although we now know we should always wear effective facial coverings when around others to slow the spread of this coronavirus, the WHO was very worried about a shortage of surgical masks that health care workers needed to treat COVID-19 patients. This was a legitimate fear and shortages did happen in January and February. The following are not required reading but here for more evidence on the initial fear that there’d be “a run on” or panic buying of masks:
- Durbin, D’Innocenzio, and Pisani
- McKenna, Maryn
- Kelly Ng
- The Lancet (The British version of the New England Journal of Medicine)
The last source above is a well-respected peer-reviewed medical journal, and the three prior sources are reporting on this emerging science by interviewing medical professionals. The advice was to save Personal Protective Equipment (PPE) for front-line workers. Notice that medical experts wanting everyday people, who should practice social distancing and be in lockdown, not to make a run on masks (remember the toilet paper shortages…) isn’t bad advice. They–the experts–advise policy makers on the BEST strategies (even if they cramp your style) to keep the public safe. That includes advising the public not to stockpile PPE if the equipment in short supply is needed for the medical professionals treating patients. Also, the WHO* is a world organization and needed to have a consistent policy that applied worldwide for rich countries, poor countries, and all in between.
*Upon re-watching the Dr. Baller video on YouTube, I notice there’s a disclaimer about the organization: “From an international health authority”
The Critique: First, this isn’t a debunking of Dr. Baller’s advice (in March 2020) or a condemnation of the WHO. However, the WHO’s one-size-fits-all advice didn’t take into account a country’s resources. When you’re immersed in a rich society (even if you’re dirt poor, living in the United States makes you aware of what a rich society is), you don’t often deal with shortages or rationing. I was an infant during the 1970s gas shortage when people waited in line for hours at gas stations to fill up, and the gasoline shortage circa 2008 barely had an effect on me (neither did the May 2021 shortage due to that ransomware attack on Colonial Pipeline). Americans don’t have the same experience of shortages of goods as other countries have. This doesn’t mean everyone has everything they need in the United States, but we’re relatively more secure on average than other countries. I think the WHO should have explained that in their March 6th video. A more appropriate discussion would have explained the difference between those coveted N-95 surgical masks, which should be reserved for medical professionals, and the cloth coverings that we used (which they now say aren’t effective for later strains of the virus). Dr. Baller should have said that, in order to avoid a shortage, the public should make or buy non-surgical masks that offer an appropriate level of safety (at that time in the virus’s evolution) for consumer needs: grocery shopping, doctor appointments, vet visits, commuting, etc.
Although this is hindsight, the FDA has a good discussion of the differences between the various types of PPE. Again, I’m not debunking the WHO or claiming they gave bad advice. Looking back, I believe they should have had a fuller discussion on why saving masks for health care workers was the appropriate policy because it was the best policy to make sure front-line medical professionals had the necessary equipment to be safe while they helped the mass public. This nuanced critique doesn’t fall into the absolutist fallacy you might hear in sound-bite media; for instance, they were wrong about mask wearing, so they’re wrong about EVERYTHING. That is immature logic.
The Uncritical View of Early Mask Guidelines for COVID-19
In contrast to those March 2020 WHO guidelines, the Centers for Disease Control and Prevention (CDC) advised us to wear cloth facial coverings (here are their current guidelines). What this did was give fuel to the anti-maskers to claim that no one knows if masks help and the scientists disagree, so I’m out. Instead of discussing this, the Fox News article I asked you to read has this title: “WHO guidance: Healthy people should wear masks only when ‘taking care of’ coronavirus patients.” Now, this is true, but it’s misleading, and I’ll explain why. Rhetorically, titles grab readers’ attention and get them to read the full article. Of course, sometimes people don’t read the full article and re-post a headline on social media, claiming the story is over. I came across the above Fox News article on Facebook. In late May/early June 2020, a relative of mine encouraged people to wear face masks to protect themselves and others through a post. Another relative called masks into doubt in the reply section and linked to the above article. The article does mention that the CDC “urges individuals to wear a mask or face-covering in public settings, regardless of infection or not, to limit the spread of the virus” (para. 3). How could my relative, who applauded Trump’s decision to defund the WHO, not be swayed by the CDC’s recommendation? Politics. This article allows folks to believe what they want to believe. If they want to deny masks are helpful, it’s in there; if they want support that the experts can’t agree and are therefore wrong, it’s in there. I read to the end, and, while it does provide some accurate facts, it’s misleading for these reasons:
- The first sentence begins “The World Health Organization is recommending…,” which implies the recommendation is coming now.
- The article is from May 28, 2020–nearly 3 months after the WHO’s video from Dr. Baller.
- To the article’s credit, it mentions the video is from March.
- However, why use three-month-old advice about an emerging virus when information changes so quickly?
- Again, you need to read the article and not the headline to know that the original advice came in March.
- The article came at a time when people were over the lockdown and wanted to return to normal.
- As mentioned, one’s Politics had much to do with whether one believed the experts or not, and Fox News has an audience less-inclined to believe medical professionals about COVID-19 guidelines.
- The article makes a spurious claim in the final sentence:
The news comes after the CDC recommended last month that people wear nonsurgical face coverings when out in public after previously advising only health care workers and people exhibiting symptoms to do so.
- This observation has no discussion and can only sow more doubt among the public because it points out the CDC once had different advice.
- The article makes no attempt to discuss why there might be competing advice from these two groups.
- Although no article can provide all the details regarding a subject, this 290-word article offers little substantive information on a deadly disease, and the doubt it allows readers to imply is dangerous.
By the way, that relative eventually unfriended me. People don’t like to hear what they don’t like to hear. I’ve never lost any sleep over that.
Fauci says the WHO’s comment on asymptomatic spread is wrong
For this article, Holly Yan interviews or finds public statements from experts in the field in order to explain the reasons behind why wearing masks slows the spread of COVID-19. Specifically, the article defines the following:
- Asymptomatic spread: “transmission of the virus by people who do not have symptoms and will never get symptoms from their infection.”
- Pre-symptomatic spread: “transmission of the virus by people who don’t look or feel sick, but will eventually get symptoms later.”
Here’s what’s interesting about the title. Yan uses “Fauci” in the title, yet she uses quotations from a variety of experts. Fauci, an infectious disease expert who has been in the public’s eye since the beginning of the AIDS epidemic, is very well known and trusted. Rhetorically, having the title “Fauci says…” rather than “Experts say…” conveys a stronger ethos, stronger credibility, because readers know Fauci’s character and expertise. I’m not saying Yan is misleading readers; after all, she does include information from Fauci. Just don’t miss the subtle rhetorical move of putting “Fauci” in the title.
Some key quotations from the article:
- para. 6: the WHO claims “asymptomatic spread ‘appears to be rare,'” but other scientists disagree
- Consensus is being established in the news, but, as an emerging disease, scientists still have questions–not certainty
- para. 8: “Evidence shows that 25% to 45% of infected people likely don’t have symptoms” (paraphrase from Fauci)
- Yan doesn’t ask how Fauci derived that statistic. Doing so wouldn’t be appropriate for the readers who aren’t well versed in how statistics are compiled.
- This doesn’t mean the article is bad; we trust Fauci has done the proper research or understand the research others did to get that 25%-45% range.
- para. 11: Yan points out that pre-symptomatic carriers might be more of a concern to the public than asymptomatic
- She provides us with more research, but she never again mentions Fauci’s name in the rest of the article.
- Then, she cites actual research that found pre-symptomatic spread more likely than asymptomatic.
- para 15: “…studies have found that paucisymptomatic transmission (meaning they have extremely mild symptoms) can occur, and in particular, in the German study, they found that transmission often appeared to occur before or on the day symptoms first appeared.”
Other Experts in Yan’s Article
In the rest of the article, notice how Yan cites reputable and well-known sources. Find comments in the article from the following:
- Anne Rimoin, an epidemiology professor at UCLA’s School of Public Health
- The US Centers for Disease Control and Prevention (CDC)
- The journal Science
- Harvard Medical School
- CNN Chief Medical Correspondent Dr. Sanjay Gupta said, “People tend to be the most contagious before they develop symptoms, if they’re going to develop symptoms” (para. 29)
- Although Dr. Gupta is at CNN and they’re publishing this article, he is a highly respected neurosurgeon and was considered as a choice to be Surgeon General by President Obama.
- In 2003, while reporting on medical conditions in Iraq, he actually saved soldiers and civilians lives by performing emergency surgeries!
Yan, a journalist, cites the experts to explain why wearing masks is helpful. She doesn’t go into enormous detail but provides pretty good evidence for why we ought to wear masks and not rely on whether or not someone’s showing symptoms. She references actual scientific studies that were done: these studies are what build scientific consensus. Scientists do their research and disseminate it via peer-reviewed outlets (mainly through journals and, prior to 2020, conferences*). This vetting process, which you’re read about this semester, is how science gets established. During an emerging issue–such as a pandemic–science might not be as quick to resolve disputes as the public wants. That’s not a failure of science; that’s a failure of citizens who don’t understand the process of science.
Speaking of citizens who fail to understand, compare Yan’s short article to the Fox News article from Casiano that only mentions what the WHO says and what the CDC says without going any further into the science behind transmission. Notice the sources Casiano mentions; notice the studies he references; notice that it’s nearly a useless article.
Yes. All news is not created equal. There is a difference, and, as college-educated readers, you need to be able to recognize the difference.
*Academic conferences have continued during the pandemic, but they’re mostly done remotely. All my conferences in 2020 were canceled, and my 2021 and early 2022 conferences have been all online. In two weeks, I’ll attend my first face-to-face conference since February 2020.
Morens & Fauci “Emerging Pandemic Diseases”
As mentioned above, this article comes from a peer-reviewed source, meaning the authors had reviewers read and verify their findings before publication. This is the difference between journalism that reports on findings (although investigative journalism may approach the rigor of peer review) as opposed to academics who create knowledge. If there are any aspiring academics out there, your goal is to publish peer-reviewed research. Even in the humanities, we have our research vetted by blind reviewers (meaning we don’t know them, and they don’t know us).
This isn’t the longest thing you’ve had to read, but it’s longer than the previous articles. Notice the way it’s written. It’s not written for a general audience the way the other articles are written. There are lots of definitions and several charts that display information visually. I’m going to focus on just some areas. This article is pretty comprehensive and provides context for COVID-19 or SARS-CoV-2. I’d be stunned if you’ve gotten the information on how pandemics emerge from popular sources (newspapers, online news outlets, nightly news, NPR, etc.).
In order to make things easier to locate, I’m using page numbers from the PDF version of the article. You can read either version for the same information.
- p. 1077: “Newly emerging (and re-emerging) infectious diseases have been threatening humans since the neolithic revolution, 12,000 years ago, when human hunter-gatherers settled into villages to domesticate animals and cultivate crops. These beginnings of domestication were the earliest steps in man’s [sic] systematic, widespread manipulation of nature.”
- p. 1077: “Only a century ago, the 1918 influenza pandemic killed 50 million or more people, apparently the deadliest event in recorded human history. The HIV/AIDS pandemic, recognized in 1981, has so far killed at least 37 million.”
- p. 1081: “Also of importance to the infectivity of newly emerging infectious diseases are viral genetic properties associated with pathogenicity and co-pathogenicity, exemplified most clearly with pandemic IAVs. The 1918 H1N1 pandemic virus, which killed an estimated 50 million people (equivalent to 200 million when adjusted to the 2020 population) was particularly lethal.
- Notice what the authors do here by explaining the lethality in today’s population terms. They’re basically saying that in 1918, with a world population at 1.8B (billion), 50M (million) deaths would be around 200M based on today’s world population.
- The math is easy enough for an English professor. Fifty million is 2.7% of the world population in 1918. Today’s world population is 7.7B, and 2.7% is 210M (these are estimates of population, so their “200 million” isn’t an exact calculation but a good estimate).
- You hear this all the time when someone says this amount of USD (dollars) would be $XXXXX.XX today because of inflation.
- p. 1084: “Human beings have many different organ systems, each with many different cell types, and with each cell having arrays of different receptors; therefore, it is not surprising that switching of a pathogen from an animal host to humans results in very different clinical and epidemiologic outcomes, including different disease manifestations and transmission mechanisms.”
- p. 1085: “Preliminary evidence from clinical and pathological studies of both SARS-CoV and SARS-CoV-2, which indicate viral infection of multiple tissues, is consistent with elicitation of robust and hopefully long-lasting protective immunity, providing a potential for control of COVID-19 with vaccines.”
- I take this as a good sign (but the next quote should scare you).
- They cite other researchers and suggest–remember, they can’t prove anything at this point in time–a vaccine for COVID-19 should be very likely because it “looks” and “behaves” similarly to pathogens scientists know about.
- Again, they aren’t certain, but, based on how viruses of this type act, they are confident a vaccine will be developed soon.
- Of course, a vaccine was available within four months of this article being published!
- p. 1085: “More ominously, expression of ACE-2 receptors on endothelial and numerous other cells, and autopsy evidence of significant SARS-CoV-2 endothelial infection, are consistent with systemic viral infection causing both pulmonary and extra-pulmonary pathology, including widespread microthrombus formation, among other outcomes.”
- There are a lot of specialized words here (endothelial, microthrombus, ACE-2, etc.), and the meaning will only be immediately understood by members of this discourse community.
- Now for the scary part and our purpose regarding rhetoric: Scientists try to limit the adjectives they use because they believe it is a more objective way to communicate. They don’t like to “dress up” their language. When they do use an adjective–especially ominously–you ought to pay attention.
- pulmonary pathology: diseases related to the lungs.
- extra-pulmonary pathology: diseases situated outside the lungs.
- Basically, this respiratory disease can spread and affect your other organs: heart, kidneys, liver, brain, and even skin!
- p. 1087: “The discovery that its closest identified viral relatives are enzootic in horseshoe (Rhinolophus) bats indicates that SARS-CoV-2 probably emerged from an as-yet-unidentified bat reservoir either directly or after infection of an intermediate host such as a pangolin.”
- p. 1089: “As human societies grow in size and complexity, we create an endless variety of opportunities for genetically unstable infectious agents to emerge into the unfilled ecologic niches we continue to create. There is nothing new about this situation, except that we now live in a human-dominated world in which our increasingly extreme alterations of the environment induce increasingly extreme backlashes from nature.”
- p. 1089: “The COVID-19 pandemic is yet another reminder, added to the rapidly growing archive of historical reminders, that in a human-dominated world, in which our human activities represent aggressive, damaging, and unbalanced interactions with nature, we will increasingly provoke new disease emergences.”
- The text in red might seem peculiar for academic writing, but we must consider where this text is in the article: the conclusion.
- Academics often use conclusions not to simply summarize their study (which you were probably told was appropriate in 5-paragraph essays…) but to point out where new research should focus.
- In this conclusion, I think the authors are telling us to wake up! The conclusion’s style is much more aligned with expectations for general or lay audiences, and, rhetorically, they’re warning readers that pandemics will return, so we ought to consider what causes them and work to avoid them.
The authors’ conclusion points out that our “meddling” and “aggressive” actions in nature cause these zoonotic diseases to spread to humans. The article never mentions masks, facial coverings, or social distancing. It tells us that COVID-19 is yet another pandemic humans have had to deal with and it won’t be the last. In case it isn’t clear…
COVID-19 isn’t a hoax; it wasn’t created by rogue scientists; it can kill you in painful ways.
After reading this peer-reviewed article that details the pathogenic properties of COVID-19 in relation to other pandemics, you know the authors are very well educated and know viruses. If they suggest I wear a mask for protection, I’m gonna wear the $&%*#@ mask!
Perhaps for a Future Rhetorical Analysis
Some of you are probably done with this topic, but, based on the healthcare majors I see in this course, many of you will be the future professionals communicating medical information and treating patients. You might be interested in further research around this emergence of COVID-19 in order to better prepare for the next pandemic (not required reading). There is a subfield of rhetorical studies that analyzes healthcare communication. My other classes often do rhetorical analyses where they explain how sentence-level techniques and speech acts to create specific rhetorical effects. This isn’t required reading, but it is interesting over two years after the pandemic:
Bring on Science Fiction!!! Read H. G. Wells Time Machine. Ch. 1-5—Read online for free.