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Why Not Lose Faith in Science in the Fight Against Coronavirus

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 Why Not Lose Faith in Science in the Fight Against Coronavirus

DOI: 10.5455/msm.2020.32.252-257
Received: NOV 19 2020; Accepted: DEC 20, 2020

© 2020 Asim Kurjak1, Olus Api2, Izet Masic3

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

EDITORIAL Mater Sociomed. 2020 Dec; 32(4): 252-257

Why Not Lose Faith in Science in the

Fight Against Coronavirus
Asim Kurjak1, Olus Api2, Izet Masic3

1
International Academy
of Perinatal Medicine, ABSTRACT kidney transplants were made and more knowl-
Zagreb, Croatia Background: One of the most vulnerable group to edge acquired about the immunological mecha-
2
VKV American Hospital, cope with the consequences of COVID-19 pandemic nisms of rejection; brain death was diagnosed;
Istanbul, Perinatal
Medicine Foundation, are women, particularly pregnant ones. Objective: a great deal of progress was made in molecular
Istanbul, Turkey The aim of this article was to make review of the biology; in psychopharmacology, in hormone
3
Academy of Medical scientific literature to show clearly that pandemic is treatments aimed at regulating human procre-
Sciences of Bosnia and
Herzegovina, Sarajevo, not so dangerous neither for mother nor her unborn ation and in pre-natal diagnosis (1).
Bosnia and Herzegovina and newborn children. Results and Discussion: It These biomdical advances in new technolo-
should be stated that most of the scientific papers gies caused such bewilderment not to say fear
Corresponding author.
Professor Emeritus on COVID-19 are currently being conducted in a that doctors and biologists understandably
Asim Kurjak, MD, way that would probably be completely unaccept- became interested in clarifying concepts such
PhD. President of
International Academy able to serious science in any other circumstances. as what is good, who has the authority to de-
of Perinatal Medicine, Taking into account everything we have learned cide what is good and what is not good, and on
Zagreb, Croatia. Address:
Ljubinkovac stube 1,
about the SARS-CoV-2 virus so far it comes as a what this authority is based. They also began
10000 Zagreb, Croatia. surprise that there has not been a more intense searching for ethical decision-making criteria
E-mail: asim.kurjak1@
scientific debate on whether the blind lockdown which could be broadly applicable. Where are we
yahoo.com; asim.
[email protected]. model, implemented by most national govern- now living with corona? COVID-19 has already
ORCID ID: https://orcid. ments, was truly an appropriate response to the changed the world in the magnitude never seen
org/0000-0002-1680-
3030. challenges posed by the pandemic. Conclusion: before. The invisible devil has already affected
Deep analysis what science in perinatal medicine the life of virtually every single human being on
did assess and what it recommended to perinatal the planet. These issues are reviewed in recently
world it may be followed by principles that the published paper on Pandemic corona virus issue
research of the members of the Academy will not – how do we respond? (2-8).
be the first to be published, but we certainly aim
that the scientific evidence published by Academy 2. HOW STRONG COVID-19 IS
is fast, reliable and implementable. DANGEROUS?
Keywords: Corona pandemic, scientific approach, These real numbers of COVID-19 infections
Internation Academy of Perinatal Medicine, global are much higher due to the lack of testing capac-
issue of pandemics. ity and underreporting. COVID-19 is, although
dangerous, very fair one choosing not only poor,
homeless, old people with chronical diseases,
1. BACKGROUND but also Prime Ministers, Crown Princes, celeb-
Significant scientific and technical prog- rities and wealthy people. In an elegant recent
ress has been made in the second half of the editorial Cadmus (9) sent a message.
XX century. We will just mention a few of the The unanticipated consequences of COV-
breakthrough events that took place in the 1960s ID-19 are impacting every sector, field of activity
and 1970s, usually with very positive results and and level of global society today. They are rais-
considerable social impact: the first Intensive ing unemployment and inequality, compelling
Care Units were introduced, patients began to adoption of unconventional economic policies,
be regularly treated with dialysis, which for the polarizing societies, activating political ex-
first time was performed in their own homes; tremism, aggravating competitive nationalism,

252 EDITORIAL • Mater Sociomed. 2020 Dec; 32(4): 252-257

 Why Not Lose Faith in Science in the Fight Against Coronavirus

contesting the veracity of scientific knowledge, undermin- nancy in the epidemic areas is largely unknown. So far,
ing international cooperation and the functioning of the eighteen articles reporting data from only 108 pregnancies
multilateral system. between December 8, 2019 and April 1, 2020 have been
At a more fundamental level, the Pandemic has exposed summarized in the recent systematic review.
a plethora of hidden threats to human wellbeing which There was one neonatal death and six admissions to
challenge prevailing notions of security, laid bare the the intensive care unit. Although it seems that severe
inadequacy of partial theories and siloed disciplines, re- pregnancy and neonatal complications during COVID-19
vealed the limitations of narrowly framed sectoral policies pandemic are due to the premature birth and cesarean de-
and strategies implemented by specialized agencies, and livery complications (as the predominant delivery mode),
highlighted fundamental questions regarding the complex, there are also case-reports on maternal deaths.
interconnected nature of the social reality on which our While most of the reported cases focused specifically on
understanding of the world and ourselves is based. the maternal outcomes and possible vertical transmission,
A new approach to security is urgently needed which less attention has been payed on fetus as a patient in such
relates and synthesizes the multiple dimensions of human pregnancies. It should be stated that most of the scientific
life to present a comprehensive, integrated concept of hu- research on COVID-19 (also during pregnancy) is currently
man security. The Sustainable Development Goals identify being conducted in a way that would probably be completely
all the major components but deal with them separately as unacceptable to serious science in any other circumstances.
independent dimensions. Human Security places people at The research has been published fast-tracked and pos-
the center and views all these elements as inseparable and sibly without proper peer-review process, using small and
interdependent dimensions of an indivisible social whole. often insufficiently representative samples, numerous
The pandemic thus reiterates the need for fundamental imperfections in the research design are being overlooked
changes in theory, intellectual disciplines, educational cur- as well as many other details which are usually taken into
ricula and content, the structure and coordination within account. All of these factors resulted in a flood of superficial
and between different departments and levels of govern- research, all in a desire to get answers as fast as possible.
ment, policy-making institutions, programs for implemen- Unfortunately, rush and wrong answers can cause greated
tation and measures for assessment. damage than an accurate but slow one.
At the international level it has profound implica- It is realistic to expect a whole series of daily reports on
tions for our conception of multilateralism and the type, various „scientific research results” which will in a week
structure and relationship between the complex array of or two turn out to be wrong or unfounded. The number
international institutions established to foster peace and of domestic violence cases reported to a police station in
human security for ‘we the people’. At a still deeper level Jingzhou, a city in Hubei Province, tripled in February 2020,
it points to the need for a fundamental shift from analytic compared to the same period the previous year. Security,
thinking about specialized, compartmentalized subjects to health, and money worries create tensions and strains.
comprehensive perspectives that include all parts of global More than half of the world’s population was under lock-
society and also perceive the deeper forces and process of down conditions by early April. Violence against women
social evolution by which the various fields, sectors, levels, remains a major global public health and women’s health
ideas, values and aspirations are related and integrated with threat during emergencies. One of the solutions may be
one another as dimensions of a single transdisciplinary the extended use of mobile devices and tablets that has
knowledge of the whole. revolutionized healthcare for some of the hardest to reach
COVID-19 is a call for new ways of thinking, knowing, communities across Asia, Africa and the Middle East.
educating, decision-making and practical execution of
measures to promote human security of all for the common 3. CROSS-SECTIONAL STUDIES ABOUT
good. Humanity is called on today to change many things, COVID-19 IN THE SCIENTIFIC LITERATURE
but most of all our understanding of the world we live in, our The second author, Olus Api, did review of literature
place in it, and our relationship to it and to one another (9). which is included in this paper, and made the next de-
One of the most vulnerable group to cope with the con- scription.
sequences of COVID-19 pandemic are women, particularly Vertical transmission is defined as the transmission
pregnant ones. The data about outcome of pregnancies with of the infectious pathogen from the mother to the fetus
COVID-19 infection are scarce and the results of the cur- during the antepartum and intrapartum periods, or to the
rent studies are inconsistent and are obtained mostly from neonate during the postpartum period via the placenta in
mid- or low-income countries with different health care utero, body fluid contact during childbirth, or through di-
systems, non-equal access to pregnancy care low-income rect contact owing to breastfeeding after birth. Although
and pregnancy surveillance. multiple infectious vectors have been shown to be capable
The knowledge gained from previous human coronavirus of vertical transmission, the possibility of vertical trans-
outbreaks, namely the severe acute respiratory syndrome mission of SARS-CoV-2 from the infected mother to the
coronavirus (SARS-CoV) and the Middle East Respiratory fetus or neonate has been a point of a recent debate with
Syndrome Coronavirus (MERS-CoV) and Ebola Virus Dis- previous systematic reviews, albeit with a limited number
ease (EVD), suggests that pregnant women and their fetuses of studies, concluding that there is no evidence of vertical
may be particularly susceptible to poor outcomes. transmission. No known cases of vertical transmission
The prevalence of the COVID-19 infection during preg- have been noted with similar coronaviruses such as SARS

Mater Sociomed. 2020 Dec; 32(4): 252-257 • EDITORIAL 253

Why Not Lose Faith in Science in the Fight Against Coronavirus

and MERS, although the number of cases has been limited. case series, and case reports of pregnant women with CO-
COVID-19 shares 50% and 79% sequence homology with VID-19 that include information regarding fetal or neonatal
SARS and MERS, respectively; despite this homology, a COVID-19 testing.
similar lack of vertical transmission cannot be assumed. A This systematic review included 30 eligible case reports
concern over vertical transmission in the case of COVID-19 describing a total of 44 SARS-CoV-2 positive pregnant
exists for several reasons. women with outcomes available for 43 neonates and 39
First is the known tissue tropism of COVID-19. The cohort or case series studies describing a total of 936 tested
main receptor that COVID-19 binds to enter a cell is the neonates born to SARS-CoV-2 positive pregnant women.
angiotensin-converting enzyme 2 (ACE2) receptor. ACE2 Data in this review were limited to pregnant women who
is expressed in the placenta and is found in the syncytio- had laboratory-confirmed SARS-CoV-2 infection diagnosed
trophoblast, cytotrophoblast, endothelium, and vascular by RT-PCR in an NP swab specimen, which is considered
smooth muscle from both primary and secondary villi. A the gold standard for the diagnosis of COVID-19. Because
recent systematic review also found evidence that ACE2 is of the recent onset of the pandemic, the vast majority of
expressed in gynecologic organs such as the ovary, uterus, data came from pregnant women in their third trimester,
and vagina. Overall, ACE2 expression is seen in numerous whereas the greatest paucity of reports involved patients
tissues that are in direct communication with a developing in the earlier stages of pregnancy.
pregnancy. These data were further bolstered by a recent Of the 30 case re- ports, 29 reports described neonatal
single-cell RNA sequencing analysis that found ACE2 ex- outcomes of women in their third trimester, whereas only 2
pression in stromal, perivascular, placental, and decidual case reports described outcomes of women in their second
cells at the maternal-fetal interface. However, a single-cell trimester. To date, no reports are available describing the
RNA sequencing analysis looking at the coexpression of assessment for the presence of SARS-CoV-2 in products of
ACE2 and the transmembrane serine protein for virus spike conception of a first-trimester pregnancy. The details of
(S) protein priming, transmembrane serine protease 2 (TM- this syudy is as follows:
PRSS2), showed that only a minimal number of placental 936 neonates from mothers with COVID-19, 27 neonates
cells express both proteins in any trimester. had a positive result for severe acute respiratory syndrome
Furthermore, this group showed that chorioamniotic coronavirus 2 viral RNA test using nasopharyngeal swab,
membranes from the third trimester exhibit minimal co- indicating a pooled proportion of 3.2% (95% confidence
expression of both proteins. Nonetheless, the authors sug- interval, 2.2e4.3) for vertical transmission. Of note, the
gested that viral entry into placenta cells may still occur pooled proportion of severe acute respiratory syndrome
using a combination of ACE2 and a noncanonical cell-entry coronavirus 2 positivity in neonates by nasopharyngeal
mediator. In addition, animal data indicated that oronasal swab in studies from China was 2.0% (8/397), which was
inoculation of pregnant mice withmouse hepatitis virus similar to the pooled proportion of 2.7% (14/517) in studies
(MHV), which is part of the Coronaviridae family, led to the from outside of China. Severe acute respiratory syndrome
dissemination of the virus to the fetus in each trimester. coronavirus 2 viral RNA testing in neonatal cord blood was
However, the dissemination was dependent on the strain positive in 2.9% of samples (1/34), 7.7% of placenta samples
of MHV and the strain of mice, with BALB/cByJ mice being (2/26), 0% of amniotic fluid (0/51), 0% of urine samples
the most susceptible. In addition to this biological plausibil- (0/17), and 9.7% of fecal or rectal swabs (3/31). Neonatal
ity, there are several lines of clinical evidence concerning serology was positive in 3 of 82 samples (3.7%) (based on
vertical transmission. Initial reports from China have docu- the presence of immunoglobulin M).
mented immunoglobulin M (IgM) antibodies in neonates
born to mothers who had positive results for COVID-19 4. KEY FINDINGS OF THIS STUDY
raising concerns for in utero transmission because IgM The vertical transmission of COVID-19 in the third
cannot cross the placenta. trimester is approximately 3.2% (22/936) by infant naso-
Moreover, several recent case reports provided evidence pharyngeal swab testing, with severe acute respiratory
that COVID-19 can infect the placenta as confirmed by syndrome coronavirus 2 (SARS-CoV-2) RNA positivity in
the presence of SARS-CoV-2 viral RNA and protein in the other test sites ranging from 0% (0/51) in amniotic fluid
placenta and evidence of virions found within the syncy- and urine (0/17), 3.6% (1/28) in the cord blood, 7.7% (2/26)
tiotrophoblast. by placental sample analysis, 9.7% (3/31) by rectal or anal
Answering the question of vertical transmission is cru- swab, and 3.7% (3/81) by serology.
cial for guiding patient counseling regarding COVID-19
related risks before and during pregnancy and obstetrical 5. WHAT DOES THIS ADD TO WHAT IS
care for women infected with COVID-19. KNOWN?
The most recent meta-analysis published in the latest There is evidence of SARS-CoV-2 vertical transmission
issue of AJOG is able to answer this difficult question. The when the infection occurs in the third trimester of preg-
authors of this meta-anaysis conducted a systematic search nancy. To conclude, vertical transmission of severe acute
of the literature from Cochrane Library, DisasterLit, Ovid, respiratory syndrome coronavirus 2 is possible and seems
Embase, Ovid Medline, Google Scholar, LitCovid, MedRxiv, to occur in a minority of cases of maternal coronavirus
Pubmed, Scopus, and Web of Science Core Collection da- disease 2019 infection in the third trimester. The rates of
tabases to find relevant articles published from inception infection are similar to those of other pathogens that cause
of the database to May 28, 2020, to identify cohort studies, congenital infections. However, given the paucity of early

254 EDITORIAL • Mater Sociomed. 2020 Dec; 32(4): 252-257

 Why Not Lose Faith in Science in the Fight Against Coronavirus

trimester data, no assessment can yet be made regarding exaggerating the expected death rates, and his greatest ‘sin’
the rates of vertical transmission in early pregnancy and was pioneering the attitude that blind lockdown will not
potential risk for consequent fetal morbidity and mortality. save lives but that it will cause dramatic economic conse-
The activities of the International Academy of Perina- quences and indirectly cause more deaths than COVID-19.
tal Medicine had the remarkable impact of perinatal care Until recently, statements like this seemed wildly ex-
worldwide. Naturally, the future depends on role of its mem- travagant. It didn’t help that Levitt was backing everything
bers because no academy can be appreciated by itself but by with mathematical analysis of exact data.
the reputation of each and all its members. Indeed, science Today Levitt is a resentful scientist calling out the entire
is true global activity because its very nature is global. epidemiological profession; he is warning that epidemiolo-
Most of us welcomed positive globalization process but gists are guided by the idea that it is better to implement
with the recent pandemic of corona disease we are introduc- radical epidemiological measures and prevent the pandemic
ing negative part of globalization with many unpredictable from escalating, but that they’re irresponsibly disregarding
developments. In science we do not have good and bad work. the damages caused precisely by those radical epidemio-
By following our principal duties we justifiably expect that logical measures. The biggest problem of the COVID-19
creative and visionary members of the Academy show again pandemic is that it caused economic damage of epic propor-
its intellectual power in order to solve this global pandemic. tions. Levitt is the first one in the scientific community who
Taking into account everything we have learned about is demanding not just that we discuss the data but that we
the SARS-CoV-2 virus so far it comes as a surprise that there assign responsibility for the wrong assessments.
hasn’t been a more intense scientific debate on whether Anyway, it needs reminding that the huge scope of dam-
the blind lockdown model, implemented by most national age caused by the COVID-19 pandemic is actually impos-
governments, was truly an appropriate response to the sible to asses: between GDP losses, the rise of debt, social
challenges posed by the pandemic. problems and death toll caused by other acute and chronic
Today, when we know more about the transmission diseases… We should instead take account of how much has
modes of SARS-CoV-2 (primary mode is by respiratory COVID-19 changed our future.
droplets) as well as how dangerous it truly is (much less than Those who have the nerves and knowledge to read stud-
previously thought), it is time to reassess the first radical ies with complex mathematical models should read „Scar-
epidemiological reactions. This needs to be done not to ac- ring Body and Mind: The Long-Term Belief-Scarring Effects
cuse someone of mistakes, but in order to plan future action. of Covid-19“. The analysis was published by three scientists
It is clear that in the beginning numerous countries opt- employed by American institutions with the best access to
ed for radical epidemiological measures because we didn’t statistical data in the world – the Federal Reserve system
have enough information about the COVID-19 pandemic and the National Bureau of Economic Research
but now the time has come to ask the questions about the The authors of “Scarring Body and Mind” reason that the
weirdly mingled responsibility of politicians and epidemi- greatest economic consequences will be due to changes in
ologists who persist in scaring the populace with threats behavior after the current health crisis is resolved.
of the virus without considering the general consequences. They stipulate that expecting new shocks will become a
Individuals who bravely provoke the world scientific permanent issue and that living in fear will cause greater
community by insisting on a discussion based on data and damage to the long-term growth than this short-term
not assumptions are actually very rare. reduction in output. Which was in itself a frightening ex-
One of the most famous ‘provocateurs’ is Michael Levitt, perience.
the Nobel prize winning biophysicist and structural biology
professor who’s made a name for himself by developing mul- 6. LONG-TERM CONSEQUENCES
tiscale models for complex chemicals. Since the COVID-19 Long-term consequences projections in several scenarios
pandemic started, he has been spending 18 hours a day of the authors are, at the very least, twice as bad – precisely
analyzing all available data, drawing conclusions, making because they’re long-term: the fear and uncertainty rob
prognoses and publicly debating his findings. us of perspective, rob us of a future, rob us of the growth
Levitt’s biggest sin was that he warned, early in the which the future generations should inherit.
pandemic, that the spread of the virus will not be as rapid The coordination of scientific resources on a global scale
or dangerous as it seemed by initial findings from Wuhan. was completely nonexistent, while at the same time two
That was brave. thirds of scientists are boasting of being globalists. The
A Jew born in South Africa with an unquestionable sci- world today would probably be much less different from
entific reputation who bravely and precisely diagnosed the the pre-pandemic time if the global coordination of science
development of the pandemic. His tweets were sensational didn’t fail so miserably.
and far removed from the political-scientific mainstream He believed that his measures would keep the number of
Back in March, he calculated that the growth of the infected below 20 thousand. So, he not only overestimated
death toll in China will slow down. He also announced the the danger of the virus, but also the efficiency of his mea-
reduction of the infection rate and explained why, dealing sures in protecting against a virus which turned out to be
with the SARS-CoV-2 virus, we can’t speak of exponential much less dangerous than he announced.
growth even though that word became a buzzword in media Although Ferguson was called out by other virologists
and scientific reports. for strained assessments on which he based his models (e.g.
He warned the scientific doomsayers that they’re highly that 50 percent of households will not observe quarantine),

Mater Sociomed. 2020 Dec; 32(4): 252-257 • EDITORIAL 255

Why Not Lose Faith in Science in the Fight Against Coronavirus

Ferguson didn’t resign his position in the Scientific Advi- are future challenges (Academy Corner). J Perinat Med. 2016;
sory Group for Emergencies for making wrong projections. 44: 733-735.
He only resigned after it was discovered that he was 4. Kurjak A, Di Renzo GC, Stanojevic M. Globalization and peri-
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that I was immune, having tested positive for coronavirus 5. Kurjak A, Dudenhausen J, Chervenak FA. Editorial: Does glo-
and completely isolated myself for almost two weeks after balization and change demand a different kind of perinatal
developing symptoms.” research. J Perinat Med. 2008; 36: 273-275.
Ferguson didn’t do anything illegal because he didn’t 6. Kurjak A. Global education in perinatal medicine: will the
leave his house. He was only visited by a certain woman. bureaucracy or smartocracy prevail? (Academy Corner). J
Twice. That doesn’t seem like too much. Twice is still twice, Perinat Med. 2014; 42: 269-271.
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quoted list of references (11-25). 9. Editors. Inside this Issue (Preface). Cadmus–New Perspec-
International Academy of Perinatal Medicine and, also, tives on Major Global Issues, 2020: 4(3(: (i) and (ii).
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Mater Sociomed. 2020 Dec; 32(4): 252-257 • EDITORIAL 257

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