Science, public health, policy, uncertainty, and communication aspects of COVID-19 Recommended bibliography: [5, 9, 11, 16, 17, 24] | |
• The COVID-19 pandemic is a stark reminder of ignored yet important gaps, challenges, and opportunities in scientific communication, health education, and policy implementation. | |
• We need to go beyond “following the science.” The need for and interest in science provides opportunities to create better dialogue between scientists and society. | |
• Conveying uncertainty does not harm public trust. | |
• False dichotomies are pervasive and attractive—they offer an escape from the unsettling complexity and enduring uncertainty. | |
• Debunking misinformation and discouraging black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches are valuable endeavors. | |
• Public health agencies can track COVID-19 misinformation in real time and engage communities and governments to dispel misinformation. | |
1. Health and lives vs. economy and livelihoods | |
• Widespread infectious disease transmission negatively impacts both health and the economy. | |
• Appropriate public health strategies that reduce SARS-CoV-2 transmission safeguard both health and the economy. | |
• The pandemic response must involve economic, psychological, and sociological views to ensure that lives and livelihoods are protected. | |
• Public health experts, economists, social scientists, and bioethicists must work jointly to assist governments in shaping the best policies that protect the overall societal well-being. | |
2. Indefinite lockdown vs. unlimited reopening | |
• Lockdowns and other stringent public health measures bring social, psychological, and economic harm and competing health risks. | |
• Regions with widespread transmission should not reopen prematurely in the absence of coordinated and robust countermeasures. | |
• Multilayered NPIs are needed as part of the road maps for navigating the COVID-19 pandemic. | |
• Transmission dynamics should inform policy decisions about mitigation strategies and recommendations for reopening. | |
• Tailored strategies and context-sensitive policymaking fall squarely within the purview of public health and aid in honing our response to COVID-19. | |
• Harm reduction, continued education, and incentivized messaging work better than shaming and blaming people for violating public health measures. | |
• Encouraging outdoor activities helps mental and physical welfare, decreases the pandemic and response fatigue, and avoids risk-prone activities from going underground. | |
• Policies should be constantly reassessed in the name of safety, so that their benefits always outweigh the harms. | |
• Increasing vaccination rates followed by decreasing numbers of cases may allow gradual relaxation of restrictions. | |
3. Symptomatic vs. asymptomatic SARS-CoV-2 infection | |
• SARS-CoV-2 infection ranges from a complete lack of symptoms to critical disease. | |
• Mild COVID-19 is the most common disease presentation. | |
• Broadly, there are two types of infected individuals: symptomatic and asymptomatic. The former individuals undergo three distinct stages (usually communicated as if they were different individuals): presymptomatic, symptomatic, and postsymptomatic. | |
• COVID-19 encompasses a broad clinical spectrum. Fever, cough, fatigue, and anosmia/hyposmia are the most common manifestations. | |
• Testing (serial if possible), follow-up (ideally 14 days), and a thorough symptom assessment are required to avoid misclassification and truly differentiate asymptomatic individuals from presymptomatic, paucisymptomatic, and postsymptomatic individuals. | |
• Differential secondary attack rates, viral shedding dynamics, and modeling estimates of contribution to transmission support greater transmission risk from symptomatic and presymptomatic individuals compared with asymptomatic individuals. | |
4. Droplet vs. aerosol transmission of SARS-CoV-2 | |
• Close-contact transmission, via short-range aerosols and droplets, is the primary transmission mode of SARS-CoV-2. | |
• Direct (physical) and indirect (via fomites) contact transmission play a minor role in propagating SARS-CoV-2. | |
• Long-range aerosol transmission occurs under certain conditions: prolonged exposure in enclosed spaces with inadequate ventilation. | |
• Epidemiological data help determine SARS-CoV-2 transmission mechanisms in real-world conditions. | |
• Minimum infectious dose, particle size distribution of virus concentrations, and virus viability in particles are unknowns germane to elucidating transmission modes. | |
• The term “airborne” offers no clear guidance on how to reduce exposure risk and may lead to misunderstandings of transmission or panic. | |
• Public health messaging on transmission needs nuance and to be accompanied by indications on effective preventive measures. | |
• Disagreement between different disciplines over SARS-CoV-2 transmission is largely related to semantics. | |
5. Masks for all vs. no masking | |
• “Smart masking” is a more accurate term than “universal masking.” | |
• The case for mask wearing is strongest in high-risk scenarios such as crowded spaces, indoor venues, and unventilated places. | |
• The case for mask wearing is weakest in marginal-risk scenarios such as outdoor and uncrowded environments where distancing and ventilation are possible. | |
• In addition to filtration efficiency, fit, and breathability, proper and consistent wearing of masks influences their effectiveness. | |
• Mask adherence is multifactorial, mediated by sociocultural and psychological factors. | |
• A social norm of masking is built through well-crafted messaging plus permanent education campaigns on proper mask wearing, the right settings and times to wear a mask, and safe and legitimate exceptions to masking. | |
• To encourage mask adherence and gain public acceptability, society must be transparently informed about the real-world benefits, potential downsides, and uncertainties. | |
6. SARS-CoV-2 reinfection vs. no reinfection | |
• SARS-CoV-2 reinfection remains an overall infrequent event. | |
• Publication of reinfections is biased toward symptomatic cases. Asymptomatic cases are underreported. | |
• Existing studies suggest that immune protection following SARS-CoV-2 infection is generally in the range of 5–12 months, though the heterogeneity of induction and durability of immune responses across individuals is acknowledged. | |
• Epidemiological analyses (including clinical case history assessment) and virological data (nucleic acid amplification testing and comparative genome analysis) are needed to distinguish between reinfection, persistent viral RNA shedding, and recrudescence. | |
• Additional investigations of SARS-CoV-2 damage to reproductive tissue and potential for persistence need to be determined. |