Politics of medicine is perhaps nowhere else more prominent than in the case of COVID-19 testing. To stem the new coronavirus pandemic, we ought to address both corona-science and corona-politics.
Politics refers to constitution and contestation of power in society. There is ‘politics’ whenever there is a power asymmetry or a difference between ‘what is said’ and ‘what is actually happening’ in society. Even a smile can be political, if it is intended to exert influence and power on others.
Testing for disease is inherently political: the criteria for who should be tested, choice of the laboratory method, centralized or distributed testing, how the test results are reported, amongst other decisions.
We live in times of authoritarian, anti-intellectual populism. The late Hannah Arendt (1906-1975), an astute political theorist, has said “words can be relied on only if one is sure that their function is to reveal and not to conceal”. That calls for open, independent science, for COVID-19 testing.
Turkey had, astonishingly, no confirmed COVID-19 for weeks in the midst of an international outbreak, as a global travel hub and while numerous cases were reported in neighboring countries such as Iran. The first case in Turkey was identified on March 11th, the day when the World Health Organization (WHO) declared COVID-19 a pandemic. However, the number of confirmed cases is only relevant in proportion to the number of people who have been tested.
Let’s put this into further context with numbers. According to health authorities, by March 2, a total of 940 tests, i.e., only 11 tests per million citizens, were completed for COVID-19 in Turkey.1,2
By contrast, in South Korea, 2,138 tests were performed per million citizens.2 That adds up to a total of 109,591 tests in South Korea, with a 4.4% positive test rate on March 3.
By March 14, the health authorities in Turkey confirmed five COVID-19 cases and more than 4,000 tests having been completed. This is equivalent to 49 tests per million citizens in Turkey, still a fairly low rate of testing compared to other countries that initiated proactive widespread community testing and effective mitigation strategies.
A larger number of COVID-19 cases would likely have been detected, if a larger number of tests were deployed over the past four weeks in Turkey. This might mean, some of the missed, undetected, COVID-19 cases in the last month are in the country and poised to cause human-to-human domestic transmission, independent from the imported cases. This calls for widespread community testing of all suspected cases with clinical findings, regardless of their travel history.
In fact, in Section C of the ‘suspected case’ description, the WHO interim guidance dated February 27 does not ask for travel history.3
Moreover, because COVID-19 can cause death in ways similar to influenza, e.g., pneumonia and multi-organ failure, it is quite possible some of the COVID-19 related deaths were mislabeled in hospitals as influenza related. Indeed, on March 12th, the US CDC has noted that there were emerging case reports of people dying from what appeared to be influenza when in fact it was COVID-19.4
The assumption that the future COVID-19 cases can only come from outside Turkey or through their immediate contacts is, therefore, not well founded. We are currently bleeding precious time to start broad testing. Each passing hour and day add to the risk to move from the linear to the exponential phase of virus spread, as seen in some countries like Italy.
Can we do better for COVID-19 testing?
COVID-19 testing should be broadly available immediately. Still, that is not enough. Independent laboratories should corroborate the methods used for centralized testing. That is how science, including open science, work. The term 'Nullius in verba' that means 'take nobody's word for it' is relevant in a context of open science, as with being aware of the corona-politics.
The virus may potentially mutate in the coming months, and will likely be a moving diagnostic target. We should plan our responses with the long-term view in mind. Hence, test performance metrics such as sensitivity and specificity ought to be shared with the public on a periodic basis.
Patient privacy should be protected during COVID-19 testing, particularly, of minorities, refugees, and those currently in crowded detention or prison conditions, to prevent human rights breaches.
An important political dimension of the coronavirus science is conflation of the concept of ‘nation’ with genes and susceptibility to diseases such as COVID-19. In fact, historically, it is not uncommon in scientific communities to hear the claims of an imagined Turkish gene, Italian gene, and so on, that allegedly confers resistance or susceptibility to a given disease. Such false claims should be rejected because a nation, in the words of the late political scientist Benedict Anderson and many other scholars, is a socially constructed imagined community. Sadly, political science education is sorely absent in life sciences, medicine and engineering which sometimes results in such unfounded, imagined, false linkages between nation, nationality and genes versus disease risks. The world would have been a much better place if the medical and STEM (Science, Technology, Engineering and Mathematics) curricula were informed by critical social science and cultural studies as well.
If the correct policy choices are made in the coming weeks, Turkey can play an exemplary leadership role for planetary health and peace in these unprecedented times.
Conversely, attempting to stem the COVID-19 pandemic without widespread community testing of all suspected cases is like jamming down on the accelerator of a car on a dark night without headlights.5
We are in this for the long haul as planetary society. Our collective futures, and of next generations, are at stake. It is time for solidarity, open science, and rethinking the exploitive systems such as neoliberalism that viewed nature, animals and human beings as infinite material sources to be mindlessly extracted. These have collectively contributed to the rise of infections that jump from animals to humans such as COVID-19.
No doubt, human life will be arduous in the next several years in times of COVID-19. But there is a bright future waiting after COVID-19, one where there is greater solidarity and kindness, with adoption of progressive ideas and economies such as post-growth, provided we are able to learn and face off with human nature and history.
Let's never give up on hope, for hope is an inspiration for life, freedom, responsibility, and ultimately, a form of resistance and agency, be it against pandemics, authoritarian populism or neoliberal extractive regimes.
- Sclove R. (2020). Democracy and Technology: An Interview with Richard Sclove from Beth Simone Noveck. Digit Gov Res Pract 1(1), Article 5 https://dl.acm.org/doi/10.1145/3368273
Vural Özdemir is Editor-in-Chief for OMICS: A Journal of Integrative Biology in New York. Trained in Toronto, Ankara and İzmir. Qualified as full professor in communication, associate professor in medicine. Diplomat, American Board of Clinical Pharmacology. Works published in British Medical Journal, Nature Biotechnology, Project Syndicate, AGOS, Hürriyet Daily News, amongst others. He was an invited speaker at the New England Journal of Medicine Panel on Personalized Medicine at the 50th Annual Meeting of the World Economic Forum in Davos, Switzerland in January 2020. Member, World Association of Medical Editors and the Toronto International Film Festival.