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.