In politics, certainty is strength, uncertainty is weakness. In the patriarchal model of medical care, now deemed a relic, bringing certainty to a patient consultation was a proxy for professional competence. Public health doctors were no less convinced of the correctness of their solutions. Modern medicine, even before COVID-19, had moved considerably in the opposite direction. Uncertainty, in the shape of risks and benefits, became essential to any patient interaction. Uncertainty became equally palatable in public health. Over two decades ago, this future might have seemed improbable. The emerging discipline of evidence-based medicine promised answers to every question, at least to the unenlightened. Instead of understanding the uncertainty revealed by a higher quality of evidence, the misguided disciples of evidence-based medicine believed in the certainty of what the evidence revealed. Indeed, uncertainty in clinical practice is an age-old concept overlooked by both the self-deluded patriarchs and the optimistic EBMers. Today, uncertainty is a natural state for clinicians and scientists; a reality that politicians seem unable and unwilling to grasp. This contrast plays out sharply when politicians claim to be ‘following the evidence’ in their response to COVID-19. How can the evidence be so certain that it should be followed? Isn’t it better to accept uncertainty, communicate that uncertainty clearly to the public, but provide a convincing rationale for policy informed by, not following, the best available science and evidence? Perhaps it doesn’t pay for a politician to think so deeply? In times of crisis people tend to crave strong leadership, but one of the lessons of COVID-19 is that some of the countries that have fared the best, New Zealand and Germany for example, are led by women willing to accept uncertainty and the advice of their scientists – and then take decisive action. Meanwhile, the leaders of the USA and UK have parroted ‘following the evidence’ but chosen a path informed less by science and more by their own world view, and ended up dithering. The outcomes speak for themselves. This month’s issue reflects some of the many uncertainties in responding to COVID-19. At what age should we start protecting people? At age 60 years or 70 years? How can we lessen the inequalities exposed by COVID-19? What are some of the clinical effects of loneliness and social isolation? Was lockdown even the right policy option? Either way, what are the conditions now required to exit it? These are difficult questions to answer with certainty and the evidence may be patchy. The solution to how best to move forward may come from an older source, from a closer examination of the experiences of the Spanish Flu of 1918. When our COVID-19 politics and disagreements are done too, history will judge how well we, politicians and clinicians, served the people.

中文翻译：

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COVID-19 的许多不确定性

在政治上，确定就是力量，不确定就是弱点。在现在被视为遗物的父权制医疗模式中，为患者咨询带来确定性是专业能力的代表。公共卫生医生同样坚信他们的解决方案的正确性。甚至在 COVID-19 之前，现代医学已经朝着相反的方向发展。风险和收益形式的不确定性对于任何患者互动都至关重要。不确定性在公共卫生中变得同样可口。二十多年前，这个未来似乎不太可能。新兴的循证医学学科承诺对每一个问题都有答案，至少对未开悟的人来说是这样。与其理解更高质量的证据所揭示的不确定性，循证医学的被误导的门徒相信证据所揭示的确定性。事实上，临床实践中的不确定性是一个古老的概念，被自欺欺人的先祖和乐观的 EBMers 所忽视。今天，不确定性是临床医生和科学家的自然状态。政治家们似乎无法也不愿掌握的现实。当政客们声称在应对 COVID-19 时“遵循证据”时，这种对比就变得非常明显。证据如何如此确定以至于应该遵循？接受不确定性，向公众清楚地传达这种不确定性，但为政策提供令人信服的理由是不是更好？最好的科学和证据？或许政治家思考得如此深入并不值得？在危机时期，人们往往渴望强有力的领导，但 COVID-19 的教训之一是，一些表现最好的国家，例如新西兰和德国，由愿意接受不确定性和建议的女性领导他们的科学家——然后采取果断行动。与此同时，美国和英国的领导人却重复着“循证”，却选择了一条少科学、多世界观的道路，最终犹豫不决。结果不言自明。本月的问题反映了应对 COVID-19 的许多不确定性中的一些。我们应该从几岁开始保护人？60岁还是70岁？我们如何减少 COVID-19 暴露的不平等？孤独和社会孤立有哪些临床影响？封锁甚至是正确的政策选择吗？无论哪种方式，现在退出它需要什么条件？这些都是很难确定地回答的问题，而且证据可能不完整。如何最好地向前迈进的解决方案可能来自更古老的来源，来自对 1918 年西班牙流感经历的仔细研究。当我们的 COVID-19 政治和分歧也结束时，历史将判断我们、政治家和临床医生，为人民服务。现在退出它需要什么条件？这些都是很难确定地回答的问题，而且证据可能不完整。如何最好地前进的解决方案可能来自更古老的来源，来自对 1918 年西班牙流感经历的仔细研究。当我们的 COVID-19 政治和分歧也结束时，历史将判断我们、政治家和临床医生，为人民服务。现在退出它需要什么条件？这些都是很难确定地回答的问题，而且证据可能不完整。如何最好地前进的解决方案可能来自更古老的来源，来自对 1918 年西班牙流感经历的仔细研究。当我们的 COVID-19 政治和分歧也结束时，历史将判断我们、政治家和临床医生，为人民服务。