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Funder: Marie Curie; Id: http://dx.doi.org/10.13039/501100000654, Funder: Wellcome; Id: http://dx.doi.org/10.13039/100010269, Funder: MRC: Medical Research Council, Funder: NIHR: National Institute For Health Research, Rationale: Evidence‐based medicine (EBM), the dominant approach to assessing the effectiveness of clinical and public health interventions, focuses on the results of association studies. EBM+ is a development of EBM that systematically considers mechanistic studies alongside association studies. Aims and objectives: To explore examples of the importance of mechanistic evidence to coronavirus research. Methods: We have reviewed the mechanistic evidence in four major areas that are relevant to the management of COVID‐19. Results and conclusions: (a) Assessment of combination therapy for MERS highlights the need for systematic assessment of mechanistic evidence. (b) That hypertension is a risk factor for severe disease in the case of SARS‐CoV‐2 suggests that altering hypertension treatment might alleviate disease, but the mechanisms are complex, and it is essential to consider and evaluate multiple mechanistic hypotheses. (c) Confidence that public health interventions will be effective requires a detailed assessment of social and psychological components of the mechanisms of their action, in addition to mechanisms of disease. (d) In particular, if vaccination programmes are to be effective, they must be carefully tailored to the social context; again, mechanistic evidence is crucial. We conclude that coronavirus research is best situated within the EBM+ evaluation framework.

Some philosophers have argued that evidence of underlying mechanisms does not provide evidence for the effectiveness of a medical intervention. One such argument appeals to the unreliability of mechanistic reasoning. However, mechanistic reasoning is not the only way that evidence of mechanisms might provide evidence of effectiveness. A more reliable type of reasoning may be distinguished by appealing to recent work on evidential pluralism in the epistemology of medicine. A case study from virology provides an example of this so‐called reinforced reasoning in medicine. It is argued that in this case study, the available evidence of underlying mechanisms did in fact play a role in providing evidence in favour of a medical intervention. This paper therefore adds a novel and recent case study to the literature in support of evidential pluralism in medicine.

Because reasoning about mechanism is critical to disciplined inquiry in science, technology, engineering, and mathematics (STEM) domains, this study focuses on ways to support the development of this form of reasoning. This study attends to how mechanistic reasoning is constituted through mathematical description. This study draws upon Smith’s (2007) characterization of mathematical description of scientific phenomena as ‘‘bootstrapping,’’ where negotiating the relationship between target phenomena and represented relations is fundamental to learning. In addition, the development of mathematical representation presents a viable pathway towards STEM integration. In this study, participants responded to an assessment of mechanistic reasoning while cognitive interviews were conducted to characterize their reasoning about mechanism and mathematical description of the systems of levers represented in the items. Participant item responses were modeled using item response theory and participant talk and gesture were coded according to developed analytic frameworks. Participants were elementary, middle, and high school students as well as college undergraduates, and adults without college education. The results suggest a relationship between participants’ tendencies to describe these systems mathematically and their mechanistic reasoning ability. Moreover, there are specific elements of mechanistic reasoning that are more highly associated with mathematical description. In addition, there is a relationship between a participant’s propensity to both mathematically describe and mechanistically trace mechanical systems.