feminist political theory researcher Carol Bacchi is well known for her analytic strategy for policy theory.

Context: audience, date (timeline in adoption?); purpose, discussion, relevance, influence over implementation (associated revisions based on feedback?)

The takeaway: While minimal protection occurs when a mask is worn in a place where many others are not wearing a mask, community masking is associated with a reduction in COVID cases.

The claim: In a community with modest infection rates, some social distancing, and most people not wearing masks, wearing a surgical mask did not reduce the SARS-CoV-2 infection rate by more than 50%.

The evidence: This study showed that wearing a mask in a community where most people did not wear a mask, did not reduce the risk of getting infected by 50%. Fewer COVID infections were reported in the mask group than in the unmasked group. This study agrees with a meta analysis which showed that masks resulted in a decrease in infections but did not prevent all infections (1) According to the CDC, seven studies have shown community level benefit when masking recommendations were made (2).

When most in the community are not wearing masks, social distancing, and washing hands, wearing a mask alone provides minimal protection to the mask wearer. Community wide masking is associated with a reduction in COVID cases (2).

Sources:

1) https://pubmed.ncbi.nlm.nih.gov/29140516/

2) https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html

Take away: Though the number of COVID deaths prevented and the exact number of years lost due directly to decreases in mental health from lockdowns is at best a rough estimate, several facts are known. Lockdowns decrease mental health, and a decrease in mental health shortens lives too.

The claim: Anxiety from reactions to COVID-19 will destroy at least seven times more years of life than can be saved by lockdowns.

The evidence: This article references many studies detailing the anxiety surrounding COVID-19 (1-4). These studies indicate that many people have increased stress due to COVID. Nature Public Health Emergency Collection reports that the mental health cost of widespread lockdowns may negate the lives saved by this policy (5). This article lists many articles which describe the effect of stay-at-home orders on mental health. Additionally, the effect of poor mental health on physical outcomes is well-defined. Poor mental health shortens lives. Other factors with COVID such as negative media coverage and dealing with job loss and death are also described as negatively affecting mental health. It is unclear how much of the negative mental health outcomes is directly related to lockdowns and what is contributed to the disease, job loss, future uncertainty, and continuous media coverage.

Several supporting facts used in this article are now outdated or could use clarification. Many assumptions are detailed in this article to estimate the number of years lost due to mental harm caused by lockdowns. One example is the authors used a survey of 1,266 patients to estimate the number of people in the United States who have suffered mental harm from lockdowns. These estimates are challenging to conclusively verify. The authors did choose the conservative estimate for each of their numbers. One example of an outdated number is the predicted number of deaths was 114,228 by August 4th. The actual number of deaths per Johns Hopkins was 157,500 (6).

Based on the facts, anxiety and mental disorders can be deadly. Lockdowns result in an increase in poor mental health. The exact number of years lost due to poor mental health directly resulting from lockdowns is less clear. Poor mental health may also result from constant media coverage, loss of loved ones and fear of the future.

The sources:

1) https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious

2) https://www.kff.org/health-reform/report/kff-health-tracking-poll-early-april-2020/

3) https://www.bsgco.com/post/coronavirus-and-americans-mental-health-insights-from-bsg-s-pulse-of-america-poll

4) https://www.kff.org/report-section/kff-health-tracking-poll-late-april-2020-economic-and-mental-health-impacts-of-coronavirus/

5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431738/#

6) https://coronavirus.jhu.edu/us-map

Take Away: The new scientific paper confirms earlier modeling work and should not be interpreted as a detailed prediction for future deaths due to the ongoing pandemic.

The Claim: "A scientific review of the science behind lockdown concludes the policy was a MISTAKE & will have caused MORE deaths from Covid-19"

The Evidence: The scientific process involves replication and confirmation of experiments and studies. A new paper replicates and expands on an early modeling study of the COVID-19 pandemic in England (1). Their findings support the earlier results. However, there are limitations to the replication paper, which does not accurately reflect the current state of the pandemic response and does not make detailed predictions for a second wave of infections and deaths.

A recent expert response to the paper further explains (2):

"It needs to be stressed that all the simulations assume that interventions are only in place for 3 months (18th April – 18th July) and then completely relaxed. This gives rise to a strange set of scenarios where a second wave is allowed to progress in an uncontrolled manner."

“It is this that leads to the counter-intuitive headline finding “that school closures would result in more overall covid-19 deaths than no school closures” – actually what the authors find is that a short period of intense lock-down (including the closure of schools) leads to a large second wave if it is allowed to run with no controls. To be fair the authors do highlight this in the paper, but it is not in the reported press release." -Prof Matt Keeling, Professor of Populations and Disease, University of Warwick

Sources:

(1) https://www.bmj.com/content/371/bmj.m3588

(2) https://www.sciencemediacentre.org/expert-reaction-to-reanalysis-of-model-used-for-imperial-report-9-and-impact-of-school-closures/

Take away: This model excludes the possibility of vaccination. As many vaccines are in stage three clinical trials, the conclusion that more people will die from closing schools, etc. will most likely not be realized.

The claim: School closures and isolation of younger people will increase total number of deaths from second and subsequent waves of COVID-19 when restrictions are lifted.

The evidence: This model predicts more deaths from the combination of place closures such as schools, case isolations, household quarantine, and social distancing of over 70s than for the combination of case isolation, household quarantine, and social distancing for over 70s. The majority of the deaths for the combination of place closures, case isolations, household quarantine, and social distancing of over 70s occur once the restrictions are lifted. This model excludes the possibility of a vaccine reducing the size of the second wave.

At least ten companies have a COVID-19 vaccine in the final stage (Phase III) of clinical trials (1). Therefore a model which excludes vaccination will most likely not be accurate to reality once a vaccine is widely administered.

Source:

1 https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

Take away: People are infectious for only part of the time they test positive. The tests for COVID-19 were granted emergency status by the FDA so some debate concerning the most ideal number of cycles is to be expected. It is worth noting that the FDA has the disclaimer "Negative results do not preclude 2019-nCoV infection and should not be used as the sole basis for treatment or other patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information (2)."

The claim: Up to 90 percent of people diagnosed with coronavirus may not be carrying enough of it to infect anyone else

The evidence: Per Walsh et al. (1), SARS-CoV-2 virus (COVID-19) is most likely infectious if the number of PCR cycles is <24 and the symptom onset to test is <8 days. RT-PCR detects the RNA, not the infectious virus. Therefore, setting the cycle threshold at 37-40 cycles will most likely result in detecting some samples with virus which is not infectious. As the PCR tests were granted emergency use by the FDA (samples include 2-9), it is not surprising that some debate exists currently about where the cycle threshold should be. Thresholds need to be set and validated for dozens of PCR tests currently in use. If identifying only infectious individuals is the goal, a lower cycle number may be justified. If detection of as many cases as possible to get closer to the most accurate death rate is the goal, setting the cycle threshold at 37-40 makes sense. A lower threshold will result in fewer COVID-19 positive samples being identified. It is worth noting that the emergency use approval granted by the FDA includes the disclaimer that a negative test does not guarantee that a person is not infected with COVID-19. RNA degrades easily. If samples are not kept cold or properly processed, the virus can degrade and result in a false negative result.

Source: 1 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa638/5842165

2 https://www.fda.gov/media/134922/download

3 https://www.fda.gov/media/138150/download

4 https://www.fda.gov/media/137120/download

5 https://www.fda.gov/media/136231/download

6 https://www.fda.gov/media/136472/download

7 https://www.fda.gov/media/139279/download

8 https://www.fda.gov/media/136314/download

9 https://www.fda.gov/media/140776/download

Take away: As with most things in nature, there are always exceptions – transmission occurring at greater distances than 3 ft and evidence of aerosolization have been reported.

Discussion: In scientific terms, this virus is still very new so the data supporting an optimal physical distance to prevent transmission remains scarce. In the absence of data, public health agencies have used what they understand about this virus and similar viruses to infer a “best” answer. Public health agencies try to simplify the recommendation to a single answer, but the reality is much more complex.

According to reports the WHO bases their recommendation for 1 meter (~3 ft) distancing off of an understanding that SARS-CoV-2 behaves like similar respiratory viruses that are primarily transmitted via larger droplets (as opposed to smaller aerosols). Assuming most spread is via droplets, the WHO reportedly follows the results of a 1934 study indicating most respiratory droplets fall to the ground within 3 feet.

However, as with most things in nature, there are always exceptions – transmission occurring at greater distances than 3 ft and evidence of aerosolization have been reported.

The evidence basis for the CDCs guidance for 6 feet of separation is less clear, but probably reflects lower risk tolerance, or greater weight to evidence of aerosolization or wider droplet spread.

Even with further study, there may never be a clear answer for optimal physical distancing. This is because, (1) the area of high risk for transmission is probably dependent on the specific conditions of the interaction (e.g. loud talking, windy environment), and (2) the “optimal” distance is based on risk tolerance. There is no single distance between individuals where risk of transmission drops off precipitously to zero.

All evidence indicates that greater distances are safer but, for example, consider how restrictive a physical distancing recommendation of >50 ft would be. In the end, because we can’t control how far others stand away from us, we ask governments to consider these tradeoffs and deliver a “best” answer to guide their citizenry.