Every day there’s a new headline that makes COVID-19 appear more mysterious and perplexing. Recent reports include Kawasaki’s Disease, COVID toes, and COVID strokes. In rapid succession, these observations are disseminated, each provoking confusion, anxiety and a torrent of new theories. As those of us with medical backgrounds are bombarded with questions and opinions from patients, family and friends, let’s take a moment to reflect on how advances in medicine actually occur.
When people think of science, they often call up images of a pristine laboratory with lots of test tubes, and well organized, methodical efforts. While the diligence and rigor these images provoke is central to the scientific method, the “sausage making” component of science is largely underappreciated by the general public. Careful observation is the critical first step in the process. As one would expect from this pandemic, there are lots of observations being made in patients who are diagnosed with COVID-19. Each observation leads to a variety of questions being raised, and each question inevitably provokes a variety of hypotheses, each of which then needs to undergo testing. Testing drives results, that lead to conclusions, that ultimately must be replicated by other testing before the conclusions gain acceptance. As each observation gets multiplied by the number of questions, the number of hypotheses for each question, and the number of studies to test each hypothesis, the scientific process can begin to appear chaotic. However, from this seeming chaos, valid and meaningful conclusions eventually rise to the surface.
In the context of the COVID-19 pandemic, one of the more recent observations has been the occurrence of “pediatric multi-system inflammatory syndrome” exhibiting similarities to both Kawasaki’s Disease (KD) and toxic shock syndrome. This observation has raised questions such as: Is this syndrome part of the natural history of COVID 19? Is it caused by coronavirus? Are the treatments for KD potentially effective for treating COVID-19? Depending on the questions asked, the hypotheses developed, and the approaches taken to test these hypotheses, we may improve our understanding of KD and COVID-19 as well as identify potential treatments and prevention for both.
People tend to jump to the second half of the scientific method involving the discipline of testing, analyzing and drawing conclusions. However, the much messier first half of observing, questioning, and hypothesizing is just as important. We will get to the answers we need if we make accurate observations and then ask the right questions about them. That is how modern medicine successfully eradicated smallpox, reduced mortality from heart attacks, strokes, and many cancers, developed effective treatments for hepatitis C and HIV/AIDS, and improved the quality of life for people suffering from a multitude of chronic illnesses.
While it may feel frustrating to witness the apparent chaos of all the published observations about COVID -19, they serve as the foundation to medical progress. The current observations and questions being raised will result in years of research and likely culminate in improved treatments for conditions stretching well beyond the bounds of coronavirus, to other viruses, other contagions, epidemiology in general, mental health, and public health. Science is a powerful thing when well applied, and it is reassuring to know that rigorous application of the scientific method to our current situation will help us chart our path out of this crisis, even as it advances our understanding of ourselves and the world.