The recent nature editorial (1) is certainly right that medicine’s evidence pipeline need to be fixed. The COVID-19 pandemic resulted in many wasteful clinical trials that were too small to produce useful results. Also highly ranked journals damaged their reputation while we have never seen before such a wave of corrections and retractions (2). 

Evidence based medicine itself failed as we needed to act fast without having any randomized clinical trial of virus spreading. The absence of evidence is not the evidence of absence. Unfortunately highly respected scientists turned out to fuel the infodemic and provided some politicians the arguments that they wanted to hear. The fundamental principles of evidence-based medicine has now some cracks as we could not decide based on studies (as we also do not have any study on the efficacy of parachutes).

We had millions of data points during the COVID-19 pandemic but we are still missing accurate surveillance. Epidemiological data from representative cohorts had the lowest funding priority, mobile communication networks were not sufficiently analysed, sequencing efforts came in only recently. Future science historians will have to decide if the pandemic could have been avoided; the extent it could have been mitigated or how treatment studies could have been better coordinated. 

We are now being rescued by the progress of vaccination programs and not by a dogmatic belief system. Maybe the package insert of evidence based medicine should include a warning – not to be applied during a worldwide pandemic. It looks like we need bold changes (3).

References

1. NN. Fix medicine’s evidence pipeline. nature. 2021;593:168.

2. Abritis A, Marcus A, Oransky I. An “alarming” and “exceptionally high” rate of COVID-19 retractions. Account Res. 2021 https://doi.org/10.1080/08989621.2020.1793675

3. Morgan OW, Aguilera X, Ammon A et al. Disease surveillance for the COVID-19 era: time for bold changes. The Lancet. 2021; in press 

Coming from asthma and air pollution research I have supported aerosol research and mask wearing during the COVID-19 pandemic long before the WHO.

Thread. Wenn auch noch nicht bei der WHO, so setzt sich doch beim CDC die Meinung durch, dass Mund-Nasenschutz zusammen mit anderen Massnahmen die Pandemie stoppen könnten https://t.co/GzBe0eXdDL

— Matthias Wjst (@science_surf) July 16, 2020

But wait there is an historical background for the dumb hand washing videos promoted by Maria Van Kerkhove during the first months of the pandemic.

WIRED has the interesting story that goes far back into history.

Part of medical rhetoric is understanding why certain ideas take hold and others don’t. So as spring turned to summer, Randall started to investigate how Wells’ contemporaries perceived him. That’s how she found the writings of Alexander Langmuir, the influential chief epidemiologist of the newly established CDC. Like his peers, Langmuir had been brought up in the Gospel of Personal Cleanliness, an obsession that made handwashing the bedrock of US public health policy. He seemed to view Wells’ ideas about airborne transmission as retrograde, seeing in them a slide back toward an ancient, irrational terror of bad air—the “miasma theory” that had prevailed for centuries. Langmuir dismissed them as little more than “interesting theoretical points.”

Addendum 24 Nov 2022

two years later…