Friends, This is a virus update. I’ll also have a few comments regarding the recent Bob Woodward book. New confirmed cases continue to drop for the US, California, and San Diego. California new case numbers are back down to what they were before the 2nd Wave hit in mid June.
San Diego had a moderate sized outbreak at SDSU in the last few weeks which created a spike in new confirmed cases for the County, but those numbers are coming down as well.
Endcoronavirus.org’s county view map now shows mostly yellow across much of the South, including California, Arizona, Texas, Louisiana, and Florida, which was perhaps hardest hit by the 2nd Wave. It looks like that region is now recovering, and the Mid-West is now the region of greatest concern, with increasing numbers in many Mid-Western states.
Bob Woodward comments: If you’ve been reading my posts for long, you know that I try to keep these posts as politics free as possible, referring to policies, but not to people. You also know that my recommendations sometimes support those commonly from the “left” and sometimes from the “right”. I do my best to pass along the science as I see it, since I believe politics and science are terrible together.
If you’ve read my July 7th post, you know that a major concern of mine is Antibody Dependent Enhancement. This phenomena is still not discussed openly in the media, and the only other commentator I hear discussing it is Chris Martenson of the Peak Prosperity YouTube channel. Tony Fauci has mentioned it only in passing. I have been concerned about this phenomena since February when I started studying the SARS-2 virus.
Why did I wait until July to post about it? In any crisis, there are people who are anxious about it, they are the first to react, and some overreact. There are others who are unconcerned, and react slowly if at all. Many are somewhere in between. Anyone who communicates to the public has to aim somewhere in the middle of these perspectives. My goal from the beginning has been to communicate adequate concern while being as positive as possible and not cause the anxious to over-react. As I’m sure you’ve heard, there have been many mental health issues attached to recent events, and I have friends in the mental health field for whom this is a great concern. I struggled for a long time before my July 7th post. I wanted people to be adequately concerned, but I didn’t want to cause needless anxiety. The ADE phenomena is still poorly understood, and it’s not certain if it will play a roll in this crisis. I finally decided to discuss it because I had a lot of friends who I felt were not taking the virus seriously enough, and I began to feel it was wrong of me to not inform them. To this day, I wonder if I waited too long, or maybe shouldn’t have mentioned it when I did.
All this to say, Bob Woodward’s discussion with the President was in February, if my understanding is correct. In February, the virus had still not come to the US, except for a few small clusters. Little was still known about how it would behave in the US, and the opinion of medical professionals regarding how to deal with it has changed many times since then. If President Trump was wrong to downplay the virus in February, then I was wrong too. I hope you will have some understanding for the difficult decisions to be made.
The CDC continued to treat the virus like it has always treated epidemics somewhere else, deep into March. Only in Mid-March did they allow other entities to do SARS-2 testing in the US, responding to the President’s request. Large scale testing did not start until early April. In my opinion, the CDC is most responsible for reacting too slowly to the virus.
A quick note, I posted an update yesterday, but I accidentally only sent it to one person, so for the weekly update, check your feed for yesterday morning, or check my timeline.
Many people have asked me about a video that was posted yesterday by a group called “America’s Frontline Doctors”. The original video has since been removed from Facebook, YouTube and the group’s website has even been dropped by the host, Squarespace. All this to say, you may have a hard time watching it if you want to. I found a different version.
As I’ve said before, politics and science should never go together. Whenever a scientific issue becomes political, it becomes very difficult for free scientific inquiry to move forward, and nearly impossible for non-scientists to figure out what the truth is. So I’m sorry to those of you who are confused and are trying to pursue the truth. The video was put together by the Tea Party Patriots and Breitbart News, 2 right leaning organizations. This is a red flag for me because I know that the message will have a political angle, and that I’ll need to watch with extra care. As I said in my July 14th post, however, just because you disagree with someone in general doesn’t mean they have nothing good to contribute to the discussion. Especially with politically charged issues, we need to get information from a variety of sources in order to be as informed as we can. I know for many of us, it’s nearly impossible to have time for that, so we often just pick someone we trust to get our information from. I definitely have political opinions, but whenever a scientific issue comes up, I do my best to set those aside and look at the evidence. I hope this has been valuable to you. You may have noticed that some of my thoughts about the Coronavirus have been “left-wing” and others have been “right-wing.” I’m doing my best to be objective. And yes, I consider it a tragedy that opinions on scientific issues can be categorized as either left or right.
I want to discuss some of the main points of the video and offer my informed but not expert opinion. I am a Ph.D. molecular biologist specializing in infectious disease testing. I am not a physician or an epidemiologist. I will give my opinion and also why I think that way.
Hydroxychloroquine (HCQ): The video focuses to a great degree on HCQ as a potential “cure” for the Coronavirus. As soon as President Trump mentioned it as being potentially helpful for treating Coronavirus, it became a subject of immediate and hot controversy. Democrats seemed to reflexively dismiss HCQ, and Republicans seemed to reflexively support it. President Trump dug in his heels and seemed to support its use before all the evidence was in. Obviously, this is not how science should be done. Careful and well-reasoned studies should be done, and conclusions made based on evidence. Early studies seemed to support both conclusions. Opponents claim that HCQ doesn’t work and is even harmful to patients, causing heart problems in some. Supporters claim that HCQ works when given early in the disease, and with Zinc and perhaps azithromycin.
Dr. Immanuel made an impassioned case for the use of HCQ, having successfully used it to treat over 300 patients. This kind of evidence is what scientists call “anecdotal”. Anecdotal evidence, basically stories, is often not considered scientific because in a large pool of people, you can find stories supporting all kinds of claims. Anecdotal evidence also usually does not carefully consider other factors that may contribute to a conclusion. An example would be “I ate ice cream and then I got attacked by a shark, so eating ice cream leads to shark attacks.” This is obviously a silly example, but many pieces of anecdotal evidence you hear suffer from the same lack of critical thinking. However, this is not at all to say that anecdotal evidence is not useful! These kinds of stories may not be scientific per se, but can often trigger more rigorous studies that prove the claims of a story.
Several scientists I’ve heard from will point out that HCQ is useful when given early and given in combination with Zinc, and also in appropriate dosages. I actually agree that some of the studies arguing against HCQ use have given it too late or in inappropriately high dosages. I would like more rigorous studies to be done, however at the moment, I think HCQ is well worth consideration by the medical community. Other treatments also exist and may actually be better, such as the MATH+ protocol I described in my summary post on June 22nd, Dexamethasone, Remdesivir, and perhaps Budesonide. For the HCQ protocol, it appears that Zinc is actually most responsible for anti-viral activity, with HCQ mostly helping Zinc enter cells to interact with the virus.
Some have pointed out that Dr. Immanuel has some beliefs that are well outside accepted scientific views. As I pointed out before, even folks who you generally disagree with can bring helpful information to the table. Her HCQ experience may be true despite her unorthodox beliefs. So even if you justifiably don’t consider a person reliable, you should resist the urge to dismiss them outright.
Lastly on the issue of HCQ, physicians have the right to use drugs “off-label” meaning they are granted by their medical degree the right to try medications in ways that are not necessarily supported by the literature or guidelines. This right is granted in the interest of patients, because careful studies can take a prohibitively long time to be published, and to encourage the development of helpful new protocols. In my opinion, government agencies should not be restricting the use of HCQ by doctors at this time.
School reopening: In some ways, there is reason to re-open schools in the Fall. It appears to be true that children under 10 do not get infected at high rates, do not carry a high viral load when infected, do not get severe disease, and do not seem to spread virus to others. So there is a case to be made for reopening schools for young children. However, because of the ADE issue I’ve written about before, I am not currently in support of re-opening schools in the Fall. Just to recap, ADE (Antibody Dependent Enhancement) is the phenomena in which some viruses can use antibodies presented on immune cells to infect those cells and cause more severe disease. So a second infection with a similar strain can lead to much worse symptoms. SARS-1 and MERS, cousins of SARS-2, can both use this pathway, so with current evidence, it seems likely that SARS-2 will as well. But we won’t know for sure until another SARS strain develops and we see how people respond to it. I will point out in full disclosure, that almost no-one is talking publicly about ADE. Dr. Fauci has mentioned it, but just in passing. So I could be out to lunch about this, but it is a major concern of mine. I have had a few epidemiologists mention in private conversations that they think ADE is a real issue, but they aren’t comfortable talking publicly about it either.
Sweden and Herd Immunity: Dr. Dan Erickson, who made a video back in April, also spoke. I was critical of his original video because his analysis of the death rate used the wrong number for total cases. This time he spoke mostly about the lock-downs, and most of his comments were more measured. He argued against lock-downs and suggested Sweden as a model.
I am also critical of lock-downs as they were done in much of the US, with people asked to stay home at all times. However, I am not supportive of the Swedish model either, in which few precautions are taken. While I am not for people staying at home, and I think people should find ways to get back to work, I also think people should wear masks while indoors in public. Small outdoor meetings are fine, even without masks, but large outdoor gatherings with closely packed people are dangerous in my opinion. Again because of the ADE issue, I am not in support of the idea of obtaining herd immunity as a way out of the crisis.
Masks: Some have taken away from the video the idea that we should not wear masks. I didn’t get this from the video. Dr. Gold explicitly said she thinks masks should be worn indoors, but not necessarily outside. I agree with this approach.
As you can see, I agree with some aspects of the video, and disagree with others. When possible, study all sides of the issues, and make the best most reasoned choices for you and your family.
My basic rules are as follows:
1) Wear a mask or face covering in public. Avoid places with unmasked people. 2) Keep 6 ft away from others. 3) Avoid indoor gatherings, especially ones in which singing or shouting is likely. 4) Small outdoor gatherings are fine, even without masks, if everyone maintains a distance. Have guests bring their own food. 5) While many restaurants are open for limited indoor seating, I personally am still not comfortable eating indoors at a restaurant. I enjoy eating outdoors at restaurants, however.
Don’t fear, but be smart!
A version of the America’s Frontline Doctors video: NOTE: The below video was removed by YouTube a day after this blog posted.
This is a case update. For the US and California, cases continue to rise. The number of daily deaths have begun to rise as well in the last week, running about 3 weeks behind the rise in daily confirmed cases.
The news is better in San Diego. Daily new cases has flattened and may even be going down. A caution is always that Sunday and Monday are always low days of the week in terms of new cases, so you have to be careful about saying things are getting better on a Tuesday! The number of active cases in San Diego may be flattening as well.
After a spike in cases in Imperial County, east of San Diego, hospitals in El Centro have become overwhelmed and COVID patients are being sent to San Diego, Orange and other counties. This stresses the importance of keeping case loads low so as not to overwhelm hospitals and ICU deparments.
If you’ve reading my posts, you won’t be very surprised by the entries, they are pretty consistent with what I’ve thought myself.
The information was obtained by polling Texas doctors, so the data probably reflects what they know about their own patient’s histories, and also probably some opinion.
Budesonide: A very interesting video was posted last week featuring Dr. Richard Bartlett. He claims to have a very effective new treatment, using a nebulized anti-inflammatory normally for asthma, Budesonide. It will be very interesting to watch if others have success with this method.
The video introduces another topic that is very timely. If you watch the whole video, you’ll notice that Dr. Bartlett has some views about the virus that I don’t share. However, I think the video is still worth watching. Often these days, people dismiss people with whom they disagree on any topic. In reality, it’s very common to be able to take at least some truth from those with whom we disagree. In fact, on complicated topics, I find that with almost anyone I read or watch, even people I respect highly, there is often some topic that I think they’re wrong about. If I refuse to learn from people that I disagree with, I’d have to quit listening to most of the people I respect! With all that’s going on in the US right now, we will need to listen to and learn from all kinds of people to move forward. Even if you disagree, learning a person’s position will help you understand the topic better.
Here’s the weekly update on the virus. As I predicted in my June 2nd post, we’ve started to see an increase in cases, at least for areas that I closely monitor. For the United States as a whole, the increase has been subtle, really just a flattening of a steady downward trend. For California and especially San Diego County, there has been a pronounced uptick in cases during the last week. The City of San Diego had some protests last weekend, but not nearly as much as in other cities like Minneapolis, NYC and LA. If the pattern for San Diego holds for other cities, they will experience more severe increases in cases. Oddly, many in the media strongly discouraged protests in favor of re-opening, but are seemingly promoting protests about police brutality without regard to precautions like mask wearing. Even the WHO is encouraging mass protests. Of course there are good reasons to attend a peaceful protest. If you go to a protest, please wear a mask. Of course, I have to discourage you from attending a riot.
I do have to point out that there are many factors that contribute to these increases, such as the ongoing re-opening, and no single factor can be blamed.
Endcoronavirus.org has introduced a new feature in the last week, a county level map showing the recent change in new cases. Clicking on a county will give you a plot of new cases for that county. High caseloads for urban areas is a well known pattern, but I’ve also noticed hot-spots of cases in certain rural areas. A new article in the Wall Street Journal may suggest a reason. Large families living in the same house may present an opportunity for rapid spread should someone be infected who lives there. As we discussed on May 27th, the virus spreads much more quickly in indoor venues than it does outside. This suggests that if you have a large family, members will need to be extra cautious to not bring virus in from the outside.
Today I’m going to discuss the JP Morgan study on transmission (among other things), how the Moral Matrix effects how people see the fight against the virus, and the boom stage in many Southern Hemisphere countries.
Frankly, when I think about anti-coronavirus efforts, I have tended to lump lockdowns and social distancing together, especially since many use these terms interchangeably. Notably, the study separates these 2 concepts and suggests that will social distancing (staying a distance away from people in public) may be valuable, lockdowns (staying in your home) is not.
You might say there have been 2 primary models for dealing with the pandemic in the last month after we’ve flattened the curve, but have not brought the numbers down, at least not in the US. I’ll call those models the Lockdown and the Re-opening models. Some want to continue the lockdowns to keep everyone safe from the virus, others want to re-open right away without restrictions. For several weeks, I have been gravitating toward a third Adaptive model. Of course, there can be many flavors of this model. Personally, I think masks, even bad ones, are far better than nothing, especially when worn by everyone, and can help us get back out of our houses and help us re-start the economy with reasonable safety. So I’m very open to the idea that the lockdowns have not been beneficial. Some of you will disagree.
The JP Morgan study is at odds with the endcoronavirus.org study, which recommends brief, very strict lockdowns. It could actually be that these 2 studies actually agree, depending on the time frame you’re talking about. I do think the lockdown was very helpful in the initial “boom” stage of the epidemic here in the US, but may have lost its usefulness later.
The Moral Matrix: ZDoggMD is a physician and medical YouTuber with a very silly screen name, but who posted VERY interesting video on how different people see the pandemic we are all facing. Using Jonathan Haidt’s work on the Moral Matrix, he talks about how different people’s moral framework shapes how we are viewing different efforts to address the issue. I was aware of Haidt’s work, but not had yet applied it to the pandemic in my mind. As someone who is sometimes exasperated with people who disagree with me (as they are with me I’m sure), this video is helping me remember to see their point of view. If you’re exasperated with your friends or family, I HIGHLY recommend you watch this video.
Upsurge in the Southern Hemisphere: Lastly, I just want to mention that many countries which have been relatively little effected until now, are now experiencing a big upsurge in cases. These countries include Russia, Brazil, and Mexico, and many are in the Southern Hemisphere, which is in the late Autumn months right now. Let’s hope they are able to get things under control quickly.
Don’t fear, but be smart!
PS. We went hiking in nearby Calaveras Park today for the first time in months, without our masks. There were a lot of people on the trail, and most were well behaved. When I can’t avoid someone on a narrow trail, I use an old SCUBA diving trick for ascending without getting the bends. Just close your mouth and blow slowly out of your nose as you pass someone. You’ll gently move any virus away from your nose! To maintain my friendliness, I greet people early, with plenty of time to start this little maneuver!
I have a variety of resources to share with you today.
Re-opening: First, after many states have started to re-open, Rt Live is showing that all but 3 states have an Rt value below 1. This means that for most states, each infected person is passing the virus to less than 1 other person, and the virus is slowly disappearing in that state. The states with an Rt above 1 are Minnesota, Maine, and Nebraska. After a poor initial response, I’m happy to say that New York State is doing very well now, and daily new cases are low in New York. In California, my home state, the number of new cases is flat, approximately 1700 cases per day since the middle of April.
How many real new cases? This is going to be a little mathy! I told you I was going to start tracking the number of tests, and I have been doing that since April 27th. This will help us know how many of the new cases are just because of more testing, and how many are actual new cases. I’ve plotted the new cases against the new tests. For each day, a point comparing the new cases and new tests is shown. If new testing matters, then a day with a high number of tests will also have a high number of new cases. To find out if this pairing exists, we can do a statistical test called the R2 test (pronounced “R squared”, also called the correlation coefficient). This test creates a best fit line with the data and that creates an R2 value. This value is a measure of how well the 2 parameters (new tests and new cases) are correlated. I show a hypothetical graph in which the 2 sets of data are well correlated. A perfect correlation will have a score of 1.0, while a set of data with no correlation at all will get a score of 0.0. For scientists (at least the ones in diagnostics, like me) a correlation is considered “true” if the R2 value is above 0.95. You could also say that the correlation is 95% likely to be true.
Now on to our data. I started plotting on April 27th. 5 days later, the graph for the United States got an R2 value of 0.6559. This suggests that new cases and new tests are 66% likely to be correlated for this time period. In real world terms, this probably means that some new cases are because of new testing, but some aren’t.
Interestingly, as of yesterday, a graph like this for the US gets an R2 value of just 0.0117. This is very low and suggests that there is now no correlation between new testing, and new cases. This means that new cases we see now are probably “real” new cases, and not just pre-existing ones that are just being found because of new testing. For California, the correlation between new cases and new testing was never very high. Right now, the R2 value is only 0.0039 for California, suggesting that most new cases discovered are “real” new cases. What this means going forward is that we probably have enough testing now to locate new cases. As we go forward, I expect we will start to see a steeper decline is new cases.
Good news! This good news comes with a warning, however! Those living in the West will easily understand a comparison to a brush fire. Right now, we are in the “containment” stage. We have the fire surrounded, and were at the beginning of the end, but if we walk away now, the fire will start to spread again. We need to stay on task and keep fighting the fire! I am all for re-opening, but we need to remain diligent. Wear a mask when you go out into public, and continue to keep your distance from others! If your workplace re-opens, you will probably want to wear a mask, wash your hands frequently, and sterilize your workspace often. I am probably going to start traveling for work again soon, and I’m very glad that everyone will be wearing a mask on the plane!
Endcorona.org compares responses: I discovered a new website the other day, endcorona.org, from the New England Complex Systems Institute. The group compares the responses and results from different countries. First, “green” countries responded very well, and were able to get the virus under control quickly. Aside from the good response, I also notice that most of these countries have relatively small populations. You may notice that China also appears on this list. Most experts agree that the data coming from China is not reliable, and they probably have many more cases than they are reporting. After intermediate cases in yellow are countries in red that need more action. This includes the US. If you’ve been reading my posts, you’ll recognize the “flat” curve of the US. Yes, we’ve flattened the curve, but we haven’t been able to knock down our case load yet. Other countries with similar flat curves include Canada, Finland, Indonesia, Panama, Poland, Sweden, and the UK. Other countries had low cases at first, but are now experiencing explosive growth in new cases, including Brazil, Mexico, and Russia.
Isolating infected individuals, even from family members!
Strict lockdowns. The stricter the lockdown, the shorter it will be.
Travel restrictions, even within the same country.
Adequate health care capacity.
Safe practices for essential services.
Masks in public for everyone.
Viral spread: Erin Bromage, an Associate Professor of Biology at U Mass Dartmouth, has a very nice article on his blog describing how the virus spreads. It is well written for non-scientists and has lots of links to original research. The take home lesson is that the virus spreads particularly well in-doors. In addition, cough, sneezing, and to a lesser degree shouting, singing, and even talking are all risk factors in spreading virus.
The number of news cases has been erratic in the last week, but at least in the US, it continues to trend downward. I’ve started collecting the number of new cases in the US and California, and while I’m not sure how to integrate that data into my Excel spreadsheet yet, I can tell you that more tests definitely mean more new confirmed cases. So some of the erratic graphs were seen are definitely because of more testing. In the long run, I expect to see new cases come down drastically as we continue to increase testing.
Rt.live is showing that 45 of 50 states have an Rt value below 1 yesterday. This is great news, as it shows that in most states, the virus is slowly disappearing. I’m watching with great interest to see how the states that have started re-opening do. Keep up the great work! We are having an impact!
Also included is a very interesting video I ran across, Simulating an Epidemic, showing a non-scientific computer model of possible epidemic outcomes given different approaches. Keep in mind, this model is NOT attempting to show what will happen in the COVID epidemic, just some theoretical things that might happen given different approaches. He does NOT attempt to prove that any of these things are what’s happening.
The most interesting parts for me were when he compared 2 methods that have been used in different places. At 6:00 minutes, he talks about the Detect and Isolate method, which I favor. This is were you find an infected person and quickly quarantine them until they have recovered. He argues that this is the most effective method in an epidemic like the current one. We haven’t been able to do this, really, because of our lack of testing in the beginning. My fervent hope is that if we get a second wave in the Fall or Winter, we will be ready for this approach.
At 16:50, he talks about a method that I think we are kind of using, the shelter in place, but with trips to central locations. He says that without other measures, these locations become a source of new infections. This is probably not happening as badly in real life because so many are wearing masks to the store!
Friends, For those of you living in San Diego County, there is a lot of news on the evolving situation in San Diego and California.
First, San Diego County reports that the county has met 4 of the 5 criteria for entering Phase 1 of re-opening. We have had down-trending new symptoms and cases for the last 14 days. However, to meet the last criterion, the County needs to have more testing, PPE, and hospital capacity available in the county. Let’s hope this happens soon!
Also, after a brief beach opening for walking, swimming, and surfing, Gavin Newsome has closed all beaches and state parks effective today, May 1st.
Friends, This post doesn’t have much science in it, it’s about why I started posting about the virus, and something about my philosophy on communication. If you’re not interested in that, feel free to skip it.
Much of the reason stems from how scientific information is often communicated to the public. So often a scientist or public official shows up on a news show, and basically gives a conclusion, but no real data. Instead of giving a persuasive case, they just make a claim without much support. Because of this, many in the public have been confused or lost trust in what they learn from the media.
On March 9th, I started posting to Facebook, since I don’t yet have a blog. If you’ve been one of my Facebook friends for a long time, you know that I rarely post, really only to change my profile picture for Talk Like a Pirate Day! I felt it was important to give some data in a digestible way, so people would have some understanding of what was going on. A few days later, I gave a talk at my church (posted here on March 18th). I just wanted to show some data so people could understand why SARS-2 was not like the typical flu.
I started out by giving my credentials, since many of you, especially my high school friends, may not have even known I was a scientist. And yes, it might have helped me get my foot in the door with some of you. However, one of the things I don’t like about our public discourse, is how many scientists expect that their credentials means that they must be believed by the public. Being an expert isn’t enough to automatically be believed. You still have to show your data and show why it supports your conclusion. Anyone who has been to a scientific conference or even a journal club knows that experts often disagree. You can’t just say “I have a PhD” to a room full of PhDs. So when experts try to make a case to the public, they still need to show data, and how they came to their conclusion. Unfortunately, because they often just have 60 seconds on a news show, they don’t have time for that. What too often happens, is that they just make a claim without support, and say that if you don’t believe them, you’re just a <news anchor, YouTuber, insurance salesman> or you’re just anti-science or racist or whatever. This is just lazy, and ironically, is anti-science. Scientists must make observations, show data, and be persuasive. Taking short cuts like name-calling isn’t persuasive, and it just makes your opponent irritated and unwilling to listen. In fact, if your opponent knows how to argue, you’ve just clearly told them that you can’t make your case. You lose.
Here’s what I do: I show a piece of data, then say what it means. I’m prepared to tell you where the data come from, and how I manipulated it if I did. If I quote a source, I give a reference. This shows I have reliable information, and also relieves me of some of the burden, since I’m just reporting what someone else said. I also think graphs are much easier to digest than tables, and tables are much easier than numbers in a paragraph, so I make content visual when I can.
If a news story makes a scientific claim, I try to find the original source, since journalists often oversimplify, misunderstand, or misrepresent scientific information. Politics and science make a terrible combination. As soon as a scientific issue gets politicized, it becomes difficult for scientists to figure out the truth, and nearly impossible for the public to. If you want to understand a scientific issue that has become political, you’ll have to read widely on all sides of the argument. Most people just don’t have time for that.
Here are a few of my rules for being persuasive. If you’re one of my lunch buddies from Quest, you know I did this well sometimes, and also failed sometimes!
If you can’t support a claim, don’t talk until you can. Go study and come back.
If you do speak, don’t just lean on your credentials or criticize someone else for not having any. You both need to be persuasive. And if you have data and can support your claim, you don’t need a degree, although training certainly helps to develop these skills. I am a molecular biologist, specializing in medical testing. I am not an epidemiologist or a physician*.
If someone asks you to support your claim, and you find that you can’t, you may need to change your position!
Ask clarifying questions. This may give you time to think, and also helps you learn their position. It’s OK to have an entire discussion in which you only learn their position.
Don’t accept the burden of proof. When someone makes a claim, many will just offer an opposing claim. When you do that, you’re accepting the burden of proof! Don’t do that! Just ask them where they heard it, or why they believe it. A lot of people can’t tell you either of these things.
If you don’t know something, say you don’t know. Making something up undermines your credibility! You may lose a discussion in the short term, but you’ll build trust.
Don’t hide important information. This of course is a favorite trick of media and politicians. It’s a handy way to deceive your audience without technically lying. However, if you’re caught doing this, you completely undermine your credibility. Plus, you can’t really hide the opposing facts, you just bury them alive. They’ll eventually come out like a zombie and eat your brain.
Your job is not to “win”, it’s to be persuasive. Jerks aren’t persuasive. Play the long game! It’s OK to lose a discussion if you can earn another discussion by being respectful.
Find common ground and build from there. If you can show your opponent that you’re on the same team, you have a head start.
If you find that someone is more interested in being insulting than seeking truth, it’s OK to disengage. Some also give you a burden of proof so great, it’s impossible to meet it. They may not be seeking the truth, and there are some people that you will never convince. Relax! It’s not your job to convince everyone!
Don’t post angry! Take a walk, have lunch, maybe even sleep on it, and think before you respond to something obnoxious. You will lose credibility if you say something destructive. While live conversations are always better, social media allows you to think before you post!
Don’t fear, but be smart! Erik
*A medical license grants the legal right to order tests, interpret results, prescribe medication, and give medical advice. Also, your doctor knows your medical history, and the particular tests and medication you’ve taken. So always consult with your doctor when making medical decisions!