Science Is Needed to Rescue the Nation From COVID-19, but Not Just Traditional Biomedical Science | Infectious Diseases | JAMA Health Forum | JAMA Network
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Science Is Needed to Rescue the Nation From COVID-19, but Not Just Traditional Biomedical Science

  • 1United States of Care, Washington, DC
  • 2Distinguished Health Policy Fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia

As the US pushes rigorous education in STEM (science, technology, engineering, and mathematics), it is worth reflecting on this global pandemic and what kind of science society is not effectively using. So far, the greatest unmet need in successfully fighting coronavirus disease 2019 (COVID-19) in the US relates to the insights provided by the social sciences rather than by the traditional biomedical sciences. Sociologists and psychologists are as important in this crisis as virologists and epidemiologists.

In the US, people are comfortable with and accustomed to scientists rescuing them or helping them avoid disaster. But when that does not work perfectly, or leaves temporary gaps, people are left to rely on something less predictable—the human psyche and human interaction—to prevent the spread of the virus.

COVID-19 has the characteristics of a classic sociological challenge. One group of people who feel reasonably safe are being asked to make sacrifices on behalf of another group that is at higher risk. With a contagious disease that has many asymptomatic and unknowing spreaders, it is necessary to rely on a scientific phenomenon called empathy, including empathy toward people we do not know, who may have a different skin color, and who may live in a different community.

Here is one example. One of the hardest hit communities is farm laborers, who are largely Hispanic adults, have lower incomes, and live in housing and have working conditions that make them susceptible to getting sick and dying of COVID-19. They are the very people who put fruits and vegetables on the table. Hundreds of years ago, individuals likely would have known the names of the those who grew the food—but not today.

The more adherence to physical distancing measures, such as avoiding hot spots like bars and wearing a mask in public, the quicker society will reduce community spread and the safer many people who we do not know will be. That includes not only the people who grow food and those who transport it, but also people in jails and prisons, in homeless shelters, and in veterans’ homes. These protective measures may sound like relatively small sacrifices (and they are) but for people who believe their own safety is not at risk, it means addressing what an individual’s role in society is and what kind of society we want to have.

Some will say—and are quite vocal about it—that requiring the wearing of masks or physical distancing is a violation of their rights and that the government should not tell people what to do. There is indeed a strong strand of US history borne out of distrust of the government. Kentucky Governor Andy Beshear, for example, told me that the most important strategy against COVID-19 is kindness. Ed Yong, the science writer for The Atlantic who has received much attention for his work on COVID-19, has switched almost entirely from covering COVID-19 as a scientific matter to covering it as a sociological one. He tells me that the invisible nature of the virus and the fact that it grows exponentially make it harder for people to weigh taking an action that may or may not work, the effects of which they will not know, against their perception of being able to live their lives the way they want.

Civilization has the know-how to severely reduce the spread of COVID-19. It comes down to something as simple and low-tech as not breathing too close to someone or in a crowded place, wearing a mask around others, and other straightforward measures. These measures require adjustment but are rather modest actions. Countries outside the US seem to be better able to adopt these protective strategies, including other high-income countries like Japan, Germany, and Canada, but also the entire continent of Africa where there have been fewer than 35 000 deaths within a population of more than 1.3 billion.

What kind of society people in the US want to have is an especially well-timed question and not simply because of the election in November, but also because of the growing awareness of systemic racism and how it affects the US in every way, from policing and education to its health care system and COVID-19 outcomes. Individual liberties and freedoms have been a beacon for the US, but so have responsibility to others and recognizing the price of that freedom. The COVID-19 pandemic raises questions about whether the US can be a great country when inequality, suffering, and death disproportionately affect those in society who are older and poorer.

Many in the US come from generations for whom sacrifice was not a choice, whether they landed on Ellis Island, were brought to US shores in chains, or fought and died in world wars on behalf of people across oceans. The truth is that as a nation, the US has become a more comfortable but less equal society, and many in it have lost touch with the idea of sacrifice and of asking what the price of freedom is.

If people in the US wait for a vaccine or other miracle to come to the rescue, the desperate need for a deeper examination of society will be further prolonged. And that is a waste of what this crisis has to teach society.

Article Information

Corresponding Author: Andy Slavitt, MBA, United States of Care, 1110 Vermont Avenue NW, Suite 950, Washington, DC 20005 (andy.slavitt@gmail.com).

Conflict of Interest Disclosures: Mr Slavitt reported being a general partner for Town Hall Ventures; being the board chair for United States of Care; being a contributor on health policy topics for USA Today; being a speaker on health policy topics for the Washington Speakers Bureau; serving as host of “In the Bubble with Andy Slavitt” podcast; being a board member for Somatus, Exact Sciences, and Cityblock; serving on an advisory board for Verily Life Sciences; serving as senior advisor for the Bipartisan Policy Center; being a distinguished health policy fellow for Penn LDI; serving as special advisor on health care for General Atlantic; serving as special advisor on health care policy for Wilmer Hale; and being the president of the Slavitt Group Inc (a health policy consultancy).

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    1 Comment for this article
    EXPAND ALL
    Expanding Your Definition of Science Important to COVID
    Lisa Simpson, MB, BCh, MPH, FAAP | AcademyHealth
    Andy Slavitt is correct to urge a broad conception of science to inform our response and recovery from the COVID-19 pandemic . However, I would expand his description to include health services research (HSR), a field originally focused on the study of the quality, outcomes and costs of healthcare. Today, its definition has expanded to include population health, health disparities, and the performance of health systems.

    Just as biomedical science leads to effective preventive and therapeutic responses to COVID-19 and social science informs our understanding of human behavior, HSR helps us understand which clinical, system, and policy
    actions lead to which outcomes, and for whom. For example, HSR reveals the degree of telehealth uptake and satisfaction while also revealing the cost and outcomes impact.

    As our knowledge of the virus, its impact, and the clinical effectiveness of our interventions changes, health system leaders and policymakers face a range of daunting and dynamic questions for which HSR is well suited.

    At the same time, HSR is grappling with fundamental challenges that have been both underscored and exacerbated during the pandemic. These include the need for greater diversity of the HSR workforce, the exploding availability of new data from electronic health records and other sources, and the ability to deliver timely and relevant findings. The pandemic also highlights necessary changes to the way science is financed, organized and incentivized, and funding agencies should support innovative HSR that addresses these challenges.

    AcademyHealth is responding with collaborative work to “reinvent HSR” in partnership with leaders from across the disciplinary and practice spectrum . HSR must be part of the solution. It needs the support of funding agencies to achieve that.

    Lisa Simpson, M.B., B.Ch., M.P.H., FAAP
    AcademyHealth
    Lisa.Simpson@academyhealth.org
    CONFLICT OF INTEREST: I am the CEO of AcademyHealth, the national membership organization for health services research
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