Zealotry and fundamentalism are a problem

From masks, to eradication, to vaccines being a zealot hurts

Many years ago, Cifu and I wrote in our book Ending Medical Reversal, “Fundamentalism in all it's forms is bad”. Our point was simple— being an absolutist was almost always wrong in the messy world of human beings and medicine.

That turned out to be especially true for COVID-19. Recently a wave of bad studies was widely shared, prompting commenters to wonder why? How could smart people not see the flaws? I offer a hypothesis as to how critical thinking become suppressed: fundamentalism clouds reason.

Which covid views are zealot views, and how do they contrast with realistic views? Let me highlight a few e.g.s

1. If we work hard enough, we can push the virus to extinction. The idea that zero COVID was ever possible for a virus that could spread to multiple animals, with a high rate of transmission, with many mildly symptomatic or asymptomatic individuals, in a globally connected world — was always a zealot view. You had to have a sort of fundamentalist way of thinking to believe eradication was possible. Realists believed that insofar as we could control the spread prior to vaccination, with minimal off target harms, we should do so, but we should always think about trade-offs, we should always gather evidence to make sure what we're doing works, and after mass vaccination, the calculus will change significantly.

2. Everyone should wear a mask. Even 2-year-olds. Babies don't need to see faces. There are no downsides. These were always clearly delusional and zealot views. A reasonable person might say, it's totally fine to try masking for 3 months, while we conduct cluster randomized trials. We should focus on adults and elderly people. It's probably reasonable to run some trials in kids of advanced age particularly in school. But masking toddlers probably a bridge too far. The World Health Organization sort of took this position. Although it failed to run any randomized studies. A testament to the organization's limits.

3. Every person of every age, irrespective of prior immunity, should be coercively forced to get a vaccine. If any safety signal arises, it should be discarded. We should never test variations in dose, timing between the doses, and our booster policy must be one size fits all. This is clearly a zealot view. And yet it is very common. Instead the realist view: is that vaccines should be encouraged in adults without prior immunity. Boosters encouraged in the elderly and vulnerable and kids largely left alone, unless a very large RCT can establish net clinical benefit. This is the stance of Denmark.

4. No person of any age should get the vaccine. It's similarly bizarre to witness older, unvaccinated people who do not have natural immunity avoid vaccination. This is also a form of fundamentalism, just in the opposite direction. Fundamentalism in all it's forms is bad.

5. After vaccination, we should continue to abide by the same precautions as before vaccination. This is a zealot view. For a while after vaccination, the circulating strains infrequently resulted in breakthrough, ergo it was irrational to continue precautions as you were already protected. By the late summer and fall of 2021, it was evident that vaccines were incapable of stopping mild infections, though they still had protection against severe infection. Ergo, it was irrational to continue to avoid the virus, because inevitably, eventually, you would get it. You have already done the major risk reducing activity you can do, time to get back to normal. Not changing your behavior after vaccine is irrational

These are just a few examples but for those who cling to absolutism, it is easy to miss the errors in papers. Taking a nuanced and flexible position, going where the data goes, and not anchoring too strongly to any worldview is the hallmark of real science. Hopefully we see it again someday.