Are number-crunching epidemiologists handing out good medical advice?

Everyone sees the world through a particular lens.  As you go to school and then college and then more school, you sharpen that lens.  That's called expertise.  The greatest experts have the sharpest lenses.  But there is a danger.  When you look outside your area of expertise, you are no longer an expert.  Even with all your years of schooling and all your degrees, you aren't more knowledgeable than the average bloke.  So you hunker down.  You become myopic.  And you try to filter everything through your expertise even if it doesn't belong there.  

For example, say you have a stomachache.  You ask a pharmacist what to do.  The pharmacist recommends a bottle of Pepto-Bismol.  Fine.  Now imagine that you ask that same question to a surgeon.  The surgeon recommends a surgery.  Why?  Because that is what surgeons do.  Take your stomachache to a psychologist, and he will put you on a couch and ask you questions about your relationship with your daddy.  Ask a sociologist, and it turns out that institutional social injustice caused your stomachache.  Ask an epidemiologist, and you'll find yourself in complete social isolation and quarantine.  The moral is, be careful whom you ask!

Epidemiologists are now in control of the world.  We are all stuck in their world.  And their recommendation is to load the shotgun with buckshot — i.e., close down, isolate, move away, jump into the street if someone else is coming, wear a mask, be scared, be very scared, stay home, panic.

In advocating a buckshot approach, epidemiologists are not just destroying our economy, but likely giving us terrible medical advice.

The COVID-19 virus is brand-new, so much is still not known.  But we know in broad brush strokes that our body fights a virus in two basic steps.  First, as our bodies become aware of the infection, innate responses are triggered that try to stop the spread of the virus.  If those fail, our immune response kicks in.  Our innate response is much faster but not as powerful.  Our immune response can take a couple of weeks to fully develop, but it also has tools like antibodies — the antigen-seeking missiles of our immune system.  The danger is when the virus is not slowed enough by our innate response to give the immune response sufficient time to kick in. 

Typically, it is hundreds of thousands or tens of thousands of microscopic particles invading at once that causes illness.  The more particles, the faster and stronger the infection.  The fewer the particles, the more likely that no illness will develop because our innate defense will protect us.  There are many articles supporting this commonsense idea.  As one example, researchers at the NIH (Memoli et al., 2015, Clinical Infectious Diseases) exposed healthy volunteers to different doses of the influenza virus.  Low doses rarely produced illness, whereas greater doses produced more symptoms.

One might be tempted to conclude that small exposure is just benign, whereas larger doses could be dangerous.  However, I suspect that small exposure is not simply benign, but actually a warning to our bodies of the presence of an epidemic in our environment and a priming of our innate defense.  Could, therefore, a low-dose exposure actually be helpful in priming our bodies to defend us against COVID-19? 

In the summer of 1988 — some 32 years ago now — I was traveling out west with my family, visiting the national parks.  We visited Yellowstone during a catastrophic fire that year.  Ashes were falling on us everywhere we went.  The rangers told us they had been operating under a faulty fire management policy of putting out all fires, no matter how small.  It turned out that small fires provide protection against catastrophic fires.  The small fires clear out the dead wood and make the forest more resilient.  Putting out these small fires over the years enabled that great fire.

Epidemiologists talk a lot about herd immunity.  This involves contraction of the disease and the body's immune response with production of antibodies.  Here I am suggesting that small exposures to the virus — too small to produce sickness or antibodies — prime our body's innate defense systems.  Our innate response involves a series of chemical signals, including cytokines secreted by specific cells that in effect advertise the presence of an invader within our bodies or within our environment.  If you cut out these small exposures — these small fires — do you disarm this priming system?

Until this thing passes, no to big crowds.  No to large indoor gatherings.  No to parties.  No to live music venues.  But what about the very small-scale exposure from shopping in stores without masks and saying hi to people from within six feet?  When someone is approaching you on the sidewalk and you jump into the bushes to avoid him, we can all agree that that behavior is rude.  It is very likely a poor medical choice as well.

Epidemiologists track infections and trends and study numbers.  They know that viruses spread by proximity.  They will do great in the aftermath looking back at the statistics.  But their advice to avoid all contact with all people is not likely the right decision medically.  If you have a stomachache you will be advised not to go to an epidemiologist for advice (or a sociologist).  Were we wrong to have asked these same experts for medical advice during this epidemic?  It's past time we take control and push back.