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Taking on COVID-19 False Dichotomies : Experts Urge a More Nuanced Understanding of the Science
By Kelly M . Pyrek
The COVID-19 pandemic revealed not only the significant gaps in healthcare and public health preparedness and supply-chain weaknesses , but also the vulnerability to believing what an international team of scientists is calling false dichotomies about SARS-CoV-2 – claims or positions erroneously presented as just two simplistic and polarized options , without any nuances or shades of grey in between .
In a recent paper , Escandón , et al . ( 2021 ) identify three tradeoffs that exist at the interface of science and policy related to this pandemic : clarity-complexity ( simple messages vs . conveying uncertainty ), speed-quality ( timely responses vs . in-depth quality assessment ), and data-assumption ( data availability vs . required set of assumptions ). When examining contentious topics , these experts make the case for a nuanced understanding of COVID-19 science , identify insights relevant to effective pandemic responses , and highlight important research gaps . ( Editor ’ s note : the authors did not consider vaccination in full due to the timing of the paper ’ s publication ; a second limitation of their work is that most of the information and references preceded the Delta variant ’ s arrival .)
As Escandón , et al . ( 2021 ) emphasize , “ Nuance is critical in risk communication with the public and for policymaking in public health . We must recognize that there are not only two options in our understanding of COVID-19 and the public health response .” They add , “ False dichotomies — statements erroneously posited as two simple , mutually exclusive options — have sparked hot debates stemming from different views on evaluating the content and sufficiency of the evidence on which to draw conclusions . Opponents for either side of these conundrums see whatever data through
There is a need for meaningful public health communication and science-informed policies that recognize shades of gray , uncertainties , local context , and social determinants of health .”
— Kevin Escandón , MD , MSc
the lens of their preconceptions , cherry-pick scientific research , and fit polarizing narratives with the perils of black-or-white messaging and reductionist frameworks . Their rigid views , fueled by misinformation , often polarize alongside the increasing certainty with which they are expressed . Some academics and politicians navigating the public scrutiny of COVID-19 response have been concerned that communicating scientific uncertainty undermines trustworthiness .”
This important paper is a clarion call for considering all the shades of grey that exist between black and white as the healthcare sector continues to grapple with the challenges in understanding the broad clinical presentation of COVID-19 , SARS-CoV-2 transmission , and SARS-CoV-2 re-infection . As Escandón , et al . ( 2021 ) explain , “ These key issues of science and public health policy have been presented as false dichotomies during the pandemic . However , they are hardly binary , simple or uniform , and therefore should not be framed as polar extremes . We urge a nuanced understanding of the science and caution against black-or-white messaging , all-or-nothing guidance , and one-size-fits-all approaches . There is a need for meaningful public health communication and science-informed policies that recognize shades of gray , uncertainties , local context , and social determinants of health .”
Lead author of the paper , Kevin Escandón , MD , MSc , is an HIV physician and infectious diseases researcher currently located in Colombia . He is researcher for a nationwide HIV research group called VIHCOL and for the research group VIREM at the Department of Microbiology of Universidad del Valle . His clinical and research work has focused on one of the first truly stigmatized infectious diseases of the modern era – human immunodeficiency virus ( HIV ) – and so his desire to explore the deeper issues beyond the politicization and weaponization of a misunderstood virus is highly appropriate .
Escandón says the idea for the paper began to percolate in his mind as he noticed the basis for the dichotomies presenting themselves in the mass media and even the medical literature , and then began to detect biases as he dug deeper into the evidence .
“ I started to notice positions exactly reflecting polarization as black and white ,” he explains . “ I had quite an interesting discussion with ( co-author ) Angie Rasmussen about health , economy , lockdowns , and NPIs in the first months of the pandemic . Over time , this binary thinking was pervasive , with symptoms , masks , transmission , reinfection , vaccine , variants , school reopening , etc . So , the mass media were our source of analysis of false dichotomies occurring but the scientific evidence – initially from China and then from everywhere – allowed us to build over that and know how the conversation should be driven . We have been working on emerging viruses and public health related to infectious diseases over several years now , and I thought we had to review thoughtfully and thoroughly the evidence . Bringing up these issues would allow discussing nuance and uncertainty so they can become a thing for the laypeople but also to the average scientist and policymaker .”
Some have said that science has room to embrace uncertainty , but a few seem to disagree . The latter include those who seemingly