Scott Eagon is an Associate Professor of Medicinal Chemistry in the Department of Chemistry & Biochemistry. The views expressed in this letter do not necessarily reflect those of Mustang News.
I’m writing this letter to the editor as a response to several public claims made by my colleague in the Biological Sciences Department, Dr. Pat Fidopiastis. I believe that students deserve the right to accurate information so that they can make informed decisions regarding their personal health, especially during a pandemic which has killed more than 578,000 Americans.
Before I begin, I want to note that some of my faculty colleagues have expressed reservations about my intention to criticize a fellow faculty member in public, and they have raised concerns about academic freedom. To those colleagues I would say this—I would agree that academic freedom gives all faculty the right to their opinion, and the right to express that opinion in public and in the classroom. However, it does not give faculty the right to be free from criticism, nor to misrepresent the scientific body of evidence in the classroom, nor the right to teach a course for which you are unqualified. I also want to acknowledge the recent positive statement made by several of my colleagues in Biology. However, I and many students and colleagues of mine (including some in Biology) continue to feel that several points were not fully addressed. With these ideas in mind, I’d like to debunk the most egregious claims made by Fidopiastis.
1) Claims that cloth and medical masks are ineffective in blocking transmission of SARS-CoV-2 (the virus responsible for causing COVID-19)
In his letter to the editor, Fidopiastis cited two studies that he says, “showed lack of efficacy for cloth and medical masks in blocking transmission of SARS CoV2”. One of these studies was conducted with only 4 patients and was retracted in April 2020. While Fidopiastis claims “suspicious” political motivations for the retraction (despite providing no evidence), the study authors themselves state that their reported values were lower than they could accurately detect, and thus their data “are unreliable and our findings are uninterpretable.”
The other study Fidopiastis cited was conducted on seven patients claiming that the authors found “medical masks were ineffective at blocking CoV2 transmission from coughing patients.” This is quite different than what the authors of the papers actually state in their conclusion, namely that “N95 and its equivalents efficiently blocked SARS-CoV-2 particles from coughing patents” and that medical masks were “less effective” than N95 masks because some aerosols were able to penetrate the thinner fibers. Table 1 in the manuscript also shows that viral particles were most often detected when the patients wore no mask at all. The authors also explicitly state in their article that “we do not intend to suggest that surgical masks do not have any role in quantitatively reducing the spread of SARS-CoV-2 from coughing patients.” Either Fidopiastis is being dishonest and deliberately misrepresenting the conclusions made by the authors of the paper, or he didn’t bother to thoroughly read the paper he himself cited.
A larger issue here is that Fidopiastis has only cited studies with a tiny number of individuals. An intellectually honest scientist makes decisions on these kinds of issues not by looking at small individual studies, but by looking at a systematic review or meta-analyses—collections of multiple studies covering thousands to tens of thousands of individuals. As early as June 2020, a meta-analysis in the The Lancet found that “face mask use could result in a large reduction in risk of infection” among a combined study group of 2,647 individuals. A cursory review of the medical literature will readily yield several meta-study analyses with similar findings. Moreover, a large scale review published in PNAS on January 2021 found that “the preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts” and that “public mask wearing is most effective at reducing the spread of the virus when compliance is high.”
Finally, Fidopiastis references a 2015 paper looking at cloth masks (versus a control group which included individuals who wore surgical masks) used by hospital staff in Vietnam claiming that “concentrated microbes on a mask surface can make masks amplifiers of transmission.” This is not the conclusion of the authors, who in 2020 made an addendum to their article stating, “our research does not condone health workers working unprotected” and that “the physical barrier provided by a cloth mask may afford some protection, but likely much less than a surgical mask or respirator.” It is also important to emphasize that this study was done long before the emergence of COVID-19, so to reference now while ignoring all the studies that have since been conducted is sloppy at best, and intellectually dishonest at worst. Many recent reviews, such as one published in early 2021, state that cloth masks “are somewhat efficacious in filtering particulate matter and aerosols but provide a worse fit and inferior protection compared to medical masks in clinical environments” likely due to the fact there are many different types of cloth masks with variable thickness and number of layers. However, the overwhelming body of evidence is clear—N95 and surgical masks are better than cloth masks, but any kind of mask is better than no mask at all.
2) Claims that hydroxychloroquine is a potential treatment for SARS-CoV-2 and that officials “ignored a large low-dose study that was successful.”
A cursory search of the medical literature will yield several well-designed clinical trials that repeatedly demonstrate that hydroxychloroquine has no benefit when used to treat COVID-19 and has a higher rate of negative outcomes and side effects when compared to a placebo. A randomized, controlled study of 150 patients in May 2020 concluded that “administration of hydroxychloroquine did not result in a significantly high probability of negative conversion than standard of care alone in patients” and that “adverse effects were higher in hydroxychloroquine recipients than in non-recipients.” A randomized, double-blind, placebo controlled trial in the US of 821 individuals published in June 2020 found that “hydroxychloroquine did not prevent illness compatible with COVID-19 or confirmed infection when used as postexposure prophylaxis within four days after exposure” and that “side effects were more common with hydroxychloroquine than with a placebo.” A randomized, controlled trial of 293 patients published in July 2020 found that “in patients with mild COVID-19, no benefit was observed with hydroxychloroquine beyond the usual care” and also “no differences were found in the mean reduction of viral load at day 3 or at day 7.” Yet another randomized and controlled study in July 2020 of 504 patients found that “the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care.” Another randomized, double-blind, placebo-controlled trial of 423 patients published in October 2020 found that “hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19” and that more side effects were noted in patients who took hydroxychloroquine. By early 2021, a number of meta-studies had been published, including one in January 2021 that concluded “hydroxychloroquine alone was not associated with reduced mortality in hospitalized COVID-19 patients.”
Rather than referencing the ever-growing list of rigorous trials demonstrating that hydroxychloroquine is ineffective at treating COVID-19 and instead associated with a higher risk of side effects, Fidopiastis references an October 2020 retrospective analysis that claims hydroxychloroquine is associated with lower mortality after infection by COVID-19. Fidopiastis goes on to say “I questioned why officials emphasized toxic high-dose studies but ignored [this] low-dose study.” This study is not “ignored,” rather it is considered a less rigorous study because the authors obtained their data by email questionnaires, not by closely monitoring patients in a clinical trial. This has a number of shortcomings, the most glaring being that people do not always follow the treatment regimen that they are prescribed (called patient adherence) and they will often claim to have followed a dosing regimen when in fact they have not (a recent example of such non-adherence can be seen in an anticoagulant review where it was reported that 30% of patients were non-adherent). Moreover, if Fidopiastis had bothered to look for the same studies cited earlier, he would have noticed that the patients in the randomized, controlled July 2020 study had been administered the same amount of hydroxychloroquine over the five days in his “low dose” study (2,400 mg). Either Fidopiastis didn’t bother to read any rigorously controlled studies on hydroxychloroquine, or he just cherry-picked a weak study to justify his pre-existing beliefs.
To compound this intellectual dishonesty, Fidopiastis also comments in his letter to the editor that “African malaria deaths set to dwarf COVID-19 fatalities as pandemic hits control efforts, WHO warns.” If Fidopiastis had actually read the WHO World Malaria report his link cites, he would have noted that the report identifies one of the drivers of this increase in malaria-related deaths to be the stockpiling of hydroxychloroquine and that “sales of a key starting material (4,7-dichloroquinoline) increased up to sixfold from April to June 2020. This key starting material is essential for producing other antimalarial drugs, such as piperaquine and amodiaquine; thus, the supply of other crucial artemisinin-combination treatments was also constrained.” The United States itself stockpiled more than 63 million doses. The very fact that people like Fidopiastis have promoted hydroxychloroquine in the face of all of the evidence to the contrary is one of the factors that is increasing the death rate due to malaria.
3) Claims that lockdowns do not lower COVID-19 mortality rates and the associated risk of mental illness
There is certainly room for thoughtful discussion on risks and benefits of restricted movements (“lockdowns”) and infringement of civil liberties versus the mental illness toll from prolonged separation from individuals and economic harm caused by loss of income. But it is not thoughtful to misrepresent the scientific consensus, which is what’s happening here. What’s happening here is another example of cherry-picking and whataboutism.
Fidopiastis cites an August 2020 paper that full lockdowns were not associated with a lower mortality rate. This claim, however, demonstrates a fundamental misunderstanding of the purpose of a lockdown, which is to slow the rate of infection. There are many reasons why slowing the rate of infections is important. Namely, (a) to prevent a large number of patients from overwhelming available space in hospitals, (b) available treatments improve over time, so the more you can delay getting infected, the better the chance you’ll get a more effective treatment, and (c) buying time to get people vaccinated once it becomes available. A number of scientific papers have concluded that lockdowns are successful in slowing the infection rate and that the more severe the lockdown, the greater the effect. For examples, see:
Fidopiastis also states in his letter that “Sweden has a much lower death rate than countries with tight restrictions and comparable population density in their largest city.” The difference with Sweden is that it didn’t mandate lockdown and mask-wearing because a much larger proportion of their population voluntarily followed recommendations by their public health officials. Sweden also passed a law mandating a number of curtailments to civil liberties, with penalties that include fines and/or imprisonment for violating these mandates. In a September 2020 interview, Dr. Anders Tegnel (the epidemiologist in charge of the national COVID-19 policy in Sweden) discussed how domestic airlines were “slowed down to basically nothing” and how “society really slowed down” not because of a federal mandate, but because a large percentage of the population willingly followed the advice given by their government. Dr. Tegnel also states at the end of his interview that “you make a mistake if you think that the Swedish lockdown was less in place and less effective than many other places just because it was a voluntary lockdown.”
Comparing death rates between cities of comparable density in Sweden and other countries like the U.K. is also a flawed argument, as Swedes have lower rates of obesity (20.6% in Sweden versus 27.8% in the U.K.), which is a known risk factor. Sweden also has a country-wide population density of 60 people per sq. mile, while the U.K. has a country wide population density of 725 people per sq. mile. It makes no sense as to why Fidopiastis wants to only compare the density of the largest city and ignore the fact that there are huge differences in the average distribution of people across the country. If you want to make an epidemiologically competent comparison of countries with similar cultures, health care systems, obesity rates and population densities, then look no farther than Sweden’s neighbors—Norway and Finland. The only large difference between Sweden and its neighbors was that they imposed mandatory lockdowns and mask mandates. As of writing this article, Sweden has a death rate by population more than eight times that of Finland and nearly 10 times that of Norway.
Finally, Fidopiastis cites a claim about Texas and Malawi, without providing any references. These appear to come from two different opinion articles from NBC News and Medium. Everyone is certainly entitled to have an opinion, but opinion pieces are not equivalent to peer-reviewed scientific studies on the effectiveness of lockdowns.
4) But what about the flu?
In a public Facebook post, Fidopiastis posted that “I wonder how many of us couldn’t be bothered to get a flu shot to help save one of those 63,000 people that died of the flu in 2019-2020? Do lives affected by COVID-19 matter more or do all lives matter?”
The answer is very simple. You present the scientific evidence that getting the flu shot saves lives and how following science-based recommendations to prevent the spread of COVID-19 also saves lives at the same time. Fidopiastis could have chosen to give a lecture in his class encouraging students to get a flu shot and presented the scientific evidence demonstrating the benefits associated with doing so. Instead, he decided to either purposely misrepresent the science on COVID-19 or he performed an incompetent review of the literature. Moreover, the number of flu deaths cited by Fidopiastis is wrong, as the total number of flu deaths in 2019-2020 is currently estimated to be 22,000, which is one of the lowest annual numbers we’ve seen in the last 10 years, likely due to social distancing and use the of face masks.
5) Purposely infecting family with a “COVID party”
A number of students have confided to me that during a recorded lecture Fidopiastis stated that he purposely infected his family when we knew he had COVID-19. To confirm this, I reached out to Fidopiastis and asked to see a copy of his original video so that I could listen to his exact words. In an email response, he said that he had taken down the videos and would not share them. However, in response to an individual on Facebook in July 2020 claiming that they were “gonna find a Covid party (sic),” Fidopiastis responded, “I already had one…it was in my living room when I had COVID and I made sure my family got it too.” By that point in the pandemic, more than 140,000 Americans had died, and no one knew the possible long-term consequences of a COVID-19 infection. If you are a parent and you drive your children to school without their seatbelts and you arrive safely—you have still recklessly endangered your family. Any competent researcher in the infectious disease world knows that you don’t needlessly infect people during a pandemic when you can’t possibly know the long-term consequences. In fact, multiple studies have shown that many people suffer persistent symptoms long after infection, including upper-respiratory and gastrointestinal symptoms. Post-COVID young males have also displayed a six-times increased risk of permanent erectile dysfunction. While these studies are preliminary, they demonstrate that we have a limited understanding of the long-term effects that SARS-CoV-2 can cause. There is simply no good reason to recklessly endanger your family in such a manner.
To students I would say that you are your own best advocate for a quality education. If you feel that you are getting taught by someone that is purposely misrepresenting the science and advocating policies that cause harm, then say so. You can express your feelings to both the Chair of Biology (Ken Hillers) and the Dean of COSAM (Dean Wendt). If you are not comfortable directly emailing these individuals, then speak to a professor that you trust and ask them to be an advocate on your behalf. If you have alumni in the family, let them know your thoughts about the quality of material you are being taught. We professors have the right to our opinions and to teach any material in our classes, but you also have a right to a quality science education.