Part of the ‘ infodemic ’ related to COVID-19 is due in no small part to abundant research on SARS-CoV-2 and masks , but it is important to understand that mask science is different in healthcare settings than it is in community settings .
of SARS-CoV-2 transmission , without addressing terminology , practical implications , and critical aspects in public health risk communication and community engagement . Miscommunication of transmission modes precludes harm-reduction approaches by failing to acknowledge that outdoor airborne transmission is low , particularly if the setting is uncrowded .”
Escandón , et al . ( 2021 ) advocate a multi-disciplinary agreement on actionable terminology that respects different fields ’ contributions to the ongoing dialogue : “ The pandemic has underscored the continuum and spectrum that is viral transmission . Such complexities should be addressed with collaborative efforts to communicate in a way that meets the needs of all parties . Nuance and complexity can be understood by the public if communicated clearly and transparently . Public health messaging and risk communication should mention that respiratory pathogens may transmit over long distances via the air under specific conditions , while making clear recommendations about effective mitigation measures . Central to the use of accurate terminology is the risk assessment of indoor vs . outdoor spaces and banishing the thinking of viral transmission as miasma or an insidious trail containing endless infectious virions .”
They emphasize , “ Rather than droplet
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vs . aerosol or airborne vs . non-airborne dichotomies , evolving terminology and science communication for respiratory pathogens should move toward reflecting the nuance of transmission and effective interventions . Broadening the ‘ airborne ’ definition to inhalable aerosol / droplet exposure or respiratory transmission allows new avenues to be explored and reconciles seemingly contradictory data and disciplines . Furthermore , discussing enhanced respiratory precautions and differences between long- and short-range , as well as risk in terms of types of exposure and activities can effectively inform subsequent public health interventions . As long-range aerosol transmission is situational , these circumstances can be explained through an increase in risk factors as dimmers rather than on / off switches . Both the WHO and the CDC have utilized this approach with communicating risk , with an emphasis on proximity , activity , environment , ventilation , NPIs , and vaccination status .”
In the end , the unresolved semantic dilemma warrants interdisciplinary efforts from the full range of experts , including medicine , epidemiology , occupational hygiene , engineering , and fluid physics , seeking a classification framework that recognizes both technical knowledge and practical implications in the context of public health and reconciles with real-life evidence without drawing inaccurate or unduly alarmist conclusions from available studies . Nuanced and transparent communication efforts , coming from those actively working to advance health and research amid the pandemic and facing the challenges of media representation of terminology , are valuable endeavors .
Masks for All Versus No Masking
The fifth false dichotomy might be the most controversial of all . As Escandón , et al . ( 2021 ) characterize it , “ Preponderantly framed as a medical intervention in the past , face masks have become embedded as a social practice informed by expectations and norms amid the COVID-19 pandemic . Masks have provoked a culture war and vigorous debates in many regions , with a volte-face in attitudes from mocking mask wearers earlier in the pandemic to shaming mask abstainers later . On one side of the politically charged false dilemma about community masking , some ‘ pro-mask ’ academics and armchair epidemiologists have hyped masks with overconfident slogans ( e . g ., ‘ Just wear a mask , it ’ s common sense ,’ ‘ The science behind masks is simple and clear ,’ ‘ Masks increase rate of asymptomatic cases ’) , stigmatizing terminology to refer to people not wearing masks (‘ deviants ’), and inaccurate analogies with parachutes and other accessories . Also , some modeling / simulation studies , quasi-experimental studies , and ecological studies were overinterpreted in social and mass media without due acknowledgment of their limitations , including confounding . With well-meaning but incendiary rhetoric , some mask proponents overstated the benefit of masks in preventing SARS-CoV-2 transmission and downplayed many considerations needed for community masking uptake and public trust . Likewise , existing evidence was misinterpreted to advocate further benefits of mask wearing related to reduced COVID-19 severity ( or increased ASI rates ), and protective immunity via reducing the viral inoculum . On the other hand , there have been two ‘ anti-mask ’ groups or counter-publics shaped by their hostile stance toward masking . One seems to ignore the need for and utility of complex systems methodologies , plausibility designs , and diverse evidence approaches to study population-level interventions while staunchly upholding evidence-based medicine tenets ( extended from biomedicine traditions and philosophies ) and awaiting ‘ definitive ’ randomized controlled trials ( RCTs ). The other has vociferously disparaged the use of ‘ muzzles ’ or ‘ face nappies ’ based on unwarranted or negligible physiological concerns , infringement on libertarian values , toxic masculinity , or plain mask denialism . Unsurprisingly , deep-seated conspiracy theories , scientific illiteracy , strong political views , and counter-visualizations have stoked the anti-mask sentiment of the latter group , aiming to overturn mask recommendations and mandates .”
Applying binary thinking to an issue such as masking is dangerous because it has established a culture war among mask absolutists and mask abstainers , the authors say , that undermines scientific pursuit and perpetuates public mistrust .
Which leads to the critical truth that the science of masks is neither straightforward nor simple .
As Escandón , et al . ( 2021 ) explain , “ Evidence on masks varies across study designs , settings , and populations ; mask types and designs ; mask-wearing purposes ; and clinical and microbiological outcomes assessed . Medical masks and FFRs have been shown to prevent respiratory viral infections in healthcare settings .” They point out that “ Direct evidence of mask use related to infections caused by coronaviruses ( not SARS-CoV-2 ) is relatively sparse .”