Evolving Evidence and Information Dissemination | Toru Takebayashi, Dean of the Graduate School of Health Management
August 25, 2020
One evening during my summer vacation, I went to an exhibition. The event was held with a reservation system to control the number of people entering the venue, and the elevator to the exhibition hall was limited to a maximum of six people. Moreover, the footprint marks on the floor indicating where to stand were all facing the wall. I found myself wondering if such meticulous attention to detail might be one of the reasons why the infection has not spread explosively in Japan.
Now, with a new infectious disease like COVID-19, information considered correct is constantly being updated. As a result, information disseminated at one point in time may not necessarily be appropriate later. A typical example is the WHO, which in April stated that it did not recommend mask-wearing for the healthy general public, but then reversed its position in June, recommending masks as effective for preventing the spread of infection. A paper titled "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis," published in the June 27 issue of The Lancet, evaluated the effectiveness of three infection prevention measures—physical distancing, mask-wearing, and eye protection—in both healthcare and community settings by narrowing down from 20,013 previously published articles. The paper reported that, along with maintaining a distance of one meter or more, mask-wearing is suggested to be effective in preventing person-to-person transmission not only in healthcare settings but also from a public health perspective. This became the basis for the WHO's change in message. For us Japanese, who have a low hurdle for wearing masks outdoors partly due to hay fever countermeasures, this may feel like old news. However, to send a message to societies where this is not the case and to encourage behavioral changes that require a certain cost, scientific evidence is essential. (Still, the paper's conclusion, stating the need for "evidence from well-conducted randomized controlled trials," cannot help but feel somewhat out of touch with reality, a kind of evidence-supremacism.)
Speaking of which, the guidelines for preventive measures posted at the exhibition venue mentioned "ensuring physical distance." The title of the aforementioned paper also uses "physical distancing." For Japanese people, for whom daily actions like hugging are rare, I had thought "physical distance" felt more appropriate than "social distance." It seems there may be a growing global awareness of the need to properly distinguish between these two terms, which originally have different meanings. This is another example of how messaging changes over time.
As we confront the pandemic, new evidence is added and rewritten, shaping the measures we should take. Under such circumstances, I often feel the difficulty of disseminating information. However, in an age where a vast amount of information circulates instantly through social media and other channels, it is not hesitation while waiting for information to be confirmed, but rather swift dissemination while carefully examining the information, that is necessary to gain public trust. Before I knew it, the fall and winter influenza season has come into view.