One of the most contested aspects of the lockdowns was the insistence on individuals wearing masks while engaging in outdoor activities , despite the exceedingly low risk of outdoor transmission as well as the “ mask monitors ” in communities who attempted to enforce this damaging practice . As Escandón , et al . ( 2021 ) observe , “ Scolding and moral outrage are counterproductive to the COVID-19 response and can perpetuate stigma . Casting shame and blame on people violating public health measures should be avoided .”
They add , “ Outdoor activities are arguably one of the mainstays of COVID-19 harm reduction by supporting mental and physical welfare and alleviating the pandemic response fatigueFootnote11 , while curtailing infection risk . The costs of not encouraging outdoor activities should not be overlooked . Policies that prohibit outdoor activities may result in the movement of behaviors that are objectively safe outdoors to less-safe indoor settings . Outdoor activities are unlikely to drive SARS-CoV-2 transmission substantially because of the higher viral particle dispersion , reduced person-to-person contact , and external environmental factors . The scarce instances of outdoor SARS-CoV-2 transmission suggest an extremely low risk of transmission .”
The authors advocate for a harm-reduction approach instead of a social abstinence-only policy , noting that “ Long-term restrictive measures come with enormous collateral damage and real-world conditions ( that ) lead individuals to take some risks . Applied to COVID-19 , harm reduction entails enhancing awareness about SARS-CoV-2 transmission and infection risk mitigation , self-assessment of risk related to personal activities , and engagement through alternatives of safer socializing . Although finding balance in the response plans is not an easy task , harm reduction is a sustainable and realistic strategy and a way of negotiating a middle ground . Allowing people to make their own compromises and informed judgments make harm reduction an ethically correct approach that enhances community engagement and trust . In contrast , COVID-19 absolutism is not a viable or reasonable strategy .”
Key Insights
Key perspectives of the COVID-19 topics addressed in the review by Escandón , et al . ( 2021 ) include :
• 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 must 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-orwhite messaging , all-or-nothing guidance , and one-size-fitsall approaches are valuable endeavors .
• Public health agencies can track COVID-19 misinformation in real time and engage communities and governments to dispel misinformation .
Symptomatic vs . Asymptomatic SARS-CoV-2 Infection
The third false dichotomy identified by Escandón , et al . ( 2021 ) is symptomatic vs . asymptomatic SARS-CoV-2 infection , specifically the confusion and debate over the clinical presentation of COVID-19 and asymptomatic SARS-CoV-2 infection ( ASI ). As the authors note , “ It is necessary to look beyond readily observable symptomatic individuals and those completely asymptomatic yet presumed to be infected . Reviewing the terminology needed to differentiate infected individuals and the infection stages is therefore the right first step before diving into the complexities between the poles of this false dichotomy .”
As the authors explain , asymptomatic individuals experience no symptoms throughout the entire course of infection . Symptomatic individuals initially demonstrate no symptoms during the incubation period , then develop symptoms , and later become symptomless again during convalescence . The terms pre-symptomatic , symptomatic , and post-symptomatic refer to different stages of infection in the same infected individual rather than to different infected individuals .
The debate is centered on ASI , and confounding factors are multiple : “ First , many studies reporting on ASI were cross-sectional surveys , often with convenience sampling and different testing eligibility criteria and settings and were not designed to estimate the prevalence of ASI . Therefore , they are prone to significant selection biases . Second , the paucity of adequate follow-up hampers distinguishing between pre-symptomatic and asymptomatic individuals in many of these studies . It is crucial to account for the development of symptoms not only at the time of virological testing since it is well established that symptoms can occur days after testing positive . Based on the incubation period of SARS-CoV-2 , a follow-up of 14 days from the last possible exposure to an index case ( or first positive test if exposure is unknown ) is recommended to exclude most pre-symptomatic cases … Third , some studies reporting a high prevalence of ASI only evaluated a narrow range of symptoms , leading to information biases . This usually happened in early 2020 when smell and taste disturbances and gastrointestinal symptoms were not widely documented . Not only are symptoms subjective and variably ascertained by screening questionnaires or self-reported symptom tracking , but patients may also be unaware of atypical , mild , and prodromal symptoms , may not recall symptoms upon retrospective assessment ( recall bias ), or may recount symptoms caused by other conditions … Both an inadequate follow-up and information biases in estimating exposure and symptom onset times lead to misclassification of some pre-symptomatic , pauci-symptomatic , and post-symptomatic individuals as asymptomatic , likely resulting in an overestimation of the ASI prevalence . Fourth , ASI estimates from serosurveys with uncertain timing of suspected exposure and antibody testing , and coupled with insufficient retrospective symptom assessment deserve caution , given concerns with recall bias and the duration of detectable antibodies . Fifth , confusing methodological definitions , different settings , and language barriers during international