Discussion

At the root of the UK’s limited success in controlling transmission of SARS-CoV-2 lay flawed droplet-but-not-airborne and situationally-airborne narratives. By presenting elements of the pandemic as social dramas, we have argued that these narratives, and the false certainty with which they were conveyed, produced ineffective public health measures, contributed to shocking levels of care home deaths, exacerbated toxic discourse on masking, and justified withholding adequate protection from healthcare staff (especially less senior doctors and non-medical personnel).
Why did the flawed narratives prevail? One explanation is psychological. Individuals are unlikely to change their beliefs in light of complex and contravening evidence, because this requires effort and presents an aversive state for most people.98 Policymakers are known to exhibit satisficing— that is, narrowing the parameters within which their decisions must make sense and be accountable, especially when threats are complex and urgent.99
Another explanation is scientific elitism. Scientists in infection control have amassed considerable scientific capital (i.e. influence, status, accolades); their favoured methods (randomised controlled trials) are greatly valued; and they have much to lose if they discard their long-held droplet narrative and concede the importance of other kinds of evidence.13 The inside track for pandemic policymaking in the UK and World Health Organisation was narrow and partisan, enabling an unusual degree of symbolic violence100 to be wielded against outside-track scientific voices and precluding the kind of interdisciplinary deliberation that might have allowed a full and fair consideration of important competing narratives.13 101 102
There are also political explanations. Droplet precautions are, by and large, under the control of individuals and hence resonate with neoliberal and libertarian discourses about individual freedom, personal responsibility and restraint of the state. Airborne precautions require strategic actions from those responsible for public safety, aligning with a more socialist-leaning political discourse.25The World Health Organisation’s tweet (Figure 1) emphasises how to protect yourself rather than what to expect of your employer, your child’s school or your government.
Finally, there is populism, whose modus operandi is cherry-picking evidence that supports the policy drive and valorises anti-science sentiment under the guise of bringing power to people.76 Populism drew on public desires to return to normalcy and further marginalised aerosol science by depicting its recommended measures25 as obscure, unaffordable and an enemy of the public interest.
The narratives and dramas presented in this paper are not exhaustive. The framing of protection as a matter of individual responsibility, for example, also accommodates the current political narrative of “learning to live with Covid-19”,103 in which good citizens stoically accept the endemicity of a—hopefully attenuating—virus in exchange for greater individual freedoms.
The Covid-19 pandemic can be framed as what Marcel Mauss calls a “total social fact”,104 a phenomenon which affects all domains and layers of society (economic, legal, political, religious) and requires us to draw evidence from across multiple scientific and other sub-fields.105 In such circumstances, the combination of policymakers’ cognitive biases and satisficing behaviour, scientists’ desire to protect their interests, and politicians’ alignment with individualist values and populist sentiment proved perilous.
As we approach the second anniversary of the UK’s first case of Covid-19, airborne transmission of SARS-CoV-2 and the mitigations needed to address it (column b in Table 1) remain misunderstood and under-recognised. Extraordinarily, a recent UK inquiry into errors made in the pandemic did not mention masks or ventilation at all.19
Bold action is now needed to ensure that the science of SARS-CoV-2 transmission is freed from the shackles of historical errors, scientific vested interests, ideological manipulation and policy satisficing. Policymakers should actively seek to broaden the scientific inside track to support interdisciplinarity and pluralism as a route to better policies, greater accountability and a reduction in the huge inequities that the pandemic has generated.
Declarations of interest: MO declares no conflicts of interest. In November 2020, DT contacted Public Health England, the Chair of NERVTAG, the Department of Health and Social Care and NHS England to request improved personal protective equipment for healthcare staff. In February 2021, TG added her signature to a letter from the Royal College of Nursing to the UK Prime Minister making a similar request.