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How Covid-19 spreads: narratives, counter-narratives and social dramas
  • Trisha Greenhalgh,
  • M Ozbilgin,
  • D Tomlinson
Trisha Greenhalgh
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK

Corresponding Author:[email protected]

Author Profile
M Ozbilgin
Brunel University London, Kingston Lane, Uxbridge UB8 3PH, London, UK
D Tomlinson
University Hospitals Plymouth NHS Trust, South West Cardiothoracic Centre, Derriford Hospital, Plymouth, PL6 8DH, UK


This paper offers a critique of UK government policy based on mode of transmission of SARS-CoV-2 (which in turn followed misleading advice from the World Health Organisation) through the lens of policymaking as narrative. Two flawed narratives—“Covid is droplet- not airborne-spread” and “Covid is situationally airborne” (that is, airborne transmission is unusual but may occur during aerosol-generating medical procedures and severe indoor crowding)—quickly became dominant despite no evidence to support them. Two important counter-narratives—“Covid is unequivocally airborne” and “Everyone generates aerosols; everyone is vulnerable”— were sidelined despite strong evidence to support them. Tragic consequences of the flawed policy narrative unfolded as social dramas. For example, droplet precautions became ritualised; care home residents died in their thousands; public masking became a libertarian lightning rod; and healthcare settings became occupational health battlegrounds. In a discussion, we call for bold action 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.
31 Aug 2022Published in BMJ on pages e069940. 10.1136/bmj-2022-069940