The rapid spread of COVID-19 has forced scientists and doctors to move quickly in order to minimize and mitigate the pandemic’s health effects upon the world’s population. Health professionals from various disciplines have adapted rapidly to the challenges presented by this novel and devastating disease to help keep the world as safe as possible. In particular, with hospitals overwhelmed with patients, ethical and practical concerns precluding clinical trials, and a paucity of knowledge about a novel disease’s pathology and behaviour, basic science has been key to our response.
Why do we need basic science?
Advancements in molecular biology have made it increasingly possible for scientists to look inside cells and virions and understand the fundamental, basic molecular processes—the mechanisms—driving the emergent disease. As they have become available, the new lines of evidence allowed by this basic molecular investigation have become increasingly vital to higher-level medical and policy responses.
Under normal circumstances, the basic scientific understanding of a disease is generally considered low-quality, used only as a starting point for further investigation. In a disease outbreak, however, when traditionally higher-ranked evidence is unavailable and interventions must be made quickly, this evidence is a much more important player. Basic mechanistic evidence of a disease includes information about its structure, transmission dynamics, and pathophysiology, all of which inform higher-level responses; furthermore, molecular work founded on this evidence can lead to crucial drug development and diagnostic testing.
Mechanisms and COVID-19
A disease’s mechanism of transmission is one important line of evidence that can be put into practice. Experimental evidence to support handwashing was infeasible early in the COVID-19 pandemic, but we could reason that simple handwashing was a good idea because we knew that: 1) the virus may be transmitted through fomites, and 2) its lipid membrane is easily disrupted by soaps and alcohols. Mask use is another good example; anecdotes told us at the beginning of the COVID-19 pandemic that masks could prevent spread, but knowledge about the size of the viral agent and its particle transmission dynamics defended the mandate of masks, especially amidst mask-wearing controversy in the first few months.
Furthermore, understanding a disease’s pathophysiology allows us to identify its clinical manifestations and risk factors, and then come up with effective medical interventions. From observation, we can put together a pattern of symptoms, but uncovering biologically plausible mechanisms behind these symptoms increases our confidence in their correlation and sheds light on treatment possibilities. Understanding pathophysiology allows us to predict, for example, that people who have underlying conditions like diabetes are at higher risk of dangerous infection and should take stricter measures to protect themselves.
The molecular study of pathology also predicts effective therapeutics and vaccination candidates, since modern drug discovery targets known molecular mechanisms of infection, reproduction, and cellular attack. As one example among many: due to the observation of increased interleukin-6 levels in COVID-19, antagonists of interleukin-6 have been suggested as possible drugs.
Diagnostic testing also builds on pathophysiological principles and molecular knowledge of the virus. University of Texas researchers favoured certain biochemical markers as “useful indicators to aid in the diagnosis, management, and the risk of progression to a severe condition of COVID-19.” Diagnostic testing based on these molecular markers is important, not only for medical treatment but also to determine case numbers, which inform the strictness of population measures.
The validity of basic science
In a basic scientific study, molecular mechanisms are indirectly observed or predicted in non-human models, under very controlled circumstances—can they be assumed to behave identically in humans, in normal life? It seems like the answer is no:non-human models may not experience the same physiology as humans; many processes depend heavily on the context in which they are observed; molecular clues may not always translate to effects that we can see in real life; and so on.
Though this “problem of extrapolation” is a valid concern, it makes more sense to ask whether basic scientific conclusions are similar enough to the real world to justify not only medical investigation but intervention during emergencies. COVID-19 has shown us that the answer to that question is a resounding yes.Besides, some level of inference is always necessary in medicine; even randomized control trials are not necessarily always reflective of “real life.”
The significance of mechanistic reasoning in a disease outbreak response is part of the larger translational potential of basic scientific evidence in higher-level medicine and policy. Conclusions drawn from that evidence are often the conceptualfoundations of policy, medicine, and even bioethics under normal circumstances—and rise to even more importance in outbreaks. Though it has limitations, a standard of molecular evidence that was unattainable in 1918 or 1957 must underpin increasingly sophisticated and refined disease responses today. COVID-19 has shown the world that in response to disease, modern policy and medical practice must be grounded in basic science.
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