About scientific debate and uncertainty

The crystallization of knowledge out of the fog of uncertainty.

A scientific debate does not imply complete uncertainty.

For all of us the coronavirus has brought the scientific process much closer to the surface, exposing it to people who ordinarily wouldn’t give it a second glance. A case in point are the following videos in which you can see the scientific debate playing out. (Feel free to watch them if you’d like to get into the weeds of this post.)

• Covid-19: How the Virus Gets in and How to Block It: Aerosols, Droplets, Masks, Face Shields, & More

  • A long discussion with three scientists on COVID-19 transmission. The researchers have different perspectives and the first and third scientist definitely contrast each other as they debate face masks vs. face shield and as they debate the line between droplet and aerosol.

• YouTube- Atmospheric Chemistry Professor

  • The professor in this video presents the evidence in lay terms for transmission of SARS-CoV-2 (the virus that causes COVID-19) via aerosol. You can tell she’s arguing forcefully and trying to knock back the droplet transmission theory.

The videos above have some vigorous debate about droplet vs aerosol transmission. The videos also expose a debate about the efficacy of face shield vs face masks. To me I watch these videos and see the scientists agreeing on the fact that COVID-19 is largely spread through the air. I also see the fact that some sort of face protection is key to slowing the spread. Unfortunately other people watching these scientific debates might lose the big picture. If you watch these videos and only see disagreement, then you might be paralyzed in your ability to act.

Just because there is disagreement on some points does not mean that there is not agreement on other, perhaps bigger more important, points.

Scientists too can lose sight of the big picture.

Unfortunately scientific debate besides distracting the public from what is crucial can sometime even distract scientists from what is crucial. A scientific debate can turn tragic when scientists get lost in their own internal arguments and miss the really important big picture. Scientists are people too and often get too wedded to their own point of view.

An example of this occurred early on in this pandemic when German scientists got lost in the distinctions between asymptomatic versus pre-symptomatic. The intense debate and posturing between these scientists should have been saved for academic journals post pandemic. The scientists needed to share the information they could agree on, namely that people who have at most extremely mild symptoms can easily spread COVID-19. They got caught up in their own minutia and lives were lost. Listen to the following episode of The New York Times’ The Daily podcast for an in depth discussion of this tragedy: New York Times- Asymptomatic coronavirus spread

Empower yourself and others by knowing the core facts and what is up for debate.

Knowing a core set of facts and what is debatable helps you communicate with those who you care about. It helps you communicate the truly critical information while at the same time allowing for approaches to the pandemic that differ from person to person.

In this pandemic world everyone has their own sense and judgement about what is safe for themselves.  There is wide variation in the approaches my friends and family have to COVID-19. Some around me are doing things that seem foolhardy to me, and others seem overly cautious. Given such a broad range of behavior, most everyone, myself included, is going around judging others actions.

Unfortunately public health messaging is not effective when it is attached to judgement. Public health messaging becomes much more effective when those trying to educate listen to those they are trying to teach.  The following New York Times article discusses effective public health messaging beautifully in the context of AIDS and Ebola: New York Times- Coronavirus health experts.

My best conversations are the ones in which, after listening to someone’s coronavirus concerns, I can introduce one or two of the following core bits of COVID-19 knowledge in a way that is relevant to them. Ideally I can convey a bit of knowledge without being judgy. Here are some facts I consider to be truly critical.

• This disease is incredibly variable hitting people in wildly different ways.

  • Because it can be deadly in (currently) unpredictable ways we must treat it with respect.

• People who do not have symptoms or who have very mild symptoms can spread COVID-19.

• Some sort of face covering or shield helps reduce the spread.

• The probability of outdoor transmission is much lower than indoor transmission.

• We are going to be living with COVID-19 for the rest of this year if not longer.

• Many of the actions we are all being asked to take are not for the care of yourself they are for the care of your broader community.

Example- Gym vs Personal Trainer

I talked over a decision about whether to go to a gym and/or a personal trainer. I listened to descriptions of the protocols in place for both. The gym’s reopening plan seemed not very rigorous or well thought out. People would spend a lot of time in the gym’s indoor space. I would be hard to know whether everyone was wearing masks effectively. In contrast the personal trainer had given much more thought to their protocols. They were operating out of their garage with a lot of ventilation. The personal trainer was only seeing one person at a time. The personal trainer would wear a mask as much as you wanted.

I definitely discouraged the gym and then gave some suggestions about how the interactions with the personal trainer could be made even safer. After reading an article in the SF Chronicle I think I would also ask how much do you need to go to the personal trainer.

Example- Visiting friends

Visiting friends is so fraught these days. I am often asked for advice on whether to visit and how to visit with friends. I almost always lead with the fact that a visit outdoors socially distant with both parties masks presents a very low risk to all involved. The opposite of this would be a long meal indoors. With these two book ends I start feeling out what middle ground I should guide people to.

I would steer more toward the socially distant interaction with friends who I feel have been more lax in their social distancing with others.

On the flip side I could see encouraging two people who live alone and who have a low risk tolerance (ie they are both very concerned about COVID-19) to pod up together. This allows for needed socialization such as dinner with others without a significant increase in risk to either person.

Parting thoughts

I would really like for this pandemic to

• help the public hear scientists

• help teach scientists how to talk to the public

• and even help scientists learn how to talk to each other.

So much more than public health depends on learning good communication - climate change anyone?