Arq. Bras. Cardiol. 2020; 115(2): 149-151
COVID-19 and Uncertainty: Lessons from the Frontline for Promoting Shared Decision Making
José Augusto Soares Barreto-Filho
, André Veiga, Luis Claudio Correia
COVID-19 has already become the largest and deadliest epidemic of the past hundred years. On a daily basis, healthcare professionals in the frontline are called upon to give answers and make decisions that directly affect the lives of infected patients, and scientists are summoned to the Herculean task of providing “effective medications” in record time for a recently discovered virus with devastating potential mortality. With a hitherto unseen avalanche of information, the debate on how to treat patients with COVID-19 has gone beyond the limits of the technical arena, taking on ideological and political aspects as well.
Science is based on facts. The fact is that we do not currently have an etiological treatment with proven efficacy and safety to combat SARS-CoV-2. At the moment, there are only promises in the pipeline. To exemplify, the most emblematic case of lack of rationality and scientific thinking is the polemic regarding chloroquine/hydroxychloroquine (CQ/HCQ) for treatment of COVID-19. CQ/HCQ is a drug that has been widely and successfully used in patients with malaria and systemic lupus erythematosus. Against COVID-19, the drug inhibits replication of SARS-CoV-2 in vitro , and it modulates the inflammatory cascade triggered by the virus. In vitro data demonstrate biological plausibility, but plausibility does not mean likelihood that a hypothesis is true. CQ/HCQ was, nevertheless, promoted to the category of “magic bullet” by a publication from France, whose methodology was characterized by high risk of bias and random error, meaning that it could not be defined as “scientific evidence.” This notwithstanding, the publication was overestimated, in an ideological manner, by the individuals who were least faithful to the precepts of the liturgy of science. Contaminated by this fallacy, feeling obligated to solve the pandemic magically, even presidents took on the role of drug advertisers, thus helping to viralize pseudoscience and amplify the false information problem.
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