We have now entered the phase of the #COVIDー19 epidemic in which our recommendations may be doing more harm than good.

This new study making the rounds is a perfect example of what I think is a dangerous slippery slope.

Thread on harm reduction: 1/ https://link.medium.com/bf5WgGhAv5 
First, let’s acknowledge that the authors published results without any methods. The paper hasn’t even been written as a pre-print, much less peer-reviewed, so we can’t evaluate the science. Big red flag & a consistent problem these past few months. 2/
Unfortunately, the recommendation here is to maintain a distance of 10-20 meters when running or biking. That is virtually impossible on the average city street, so the de facto recommendation becomes “no running/biking.” 3/
Let’s assume the science is good. This is still only a simulation (by engineers) and does not appear to say anything about the probability of transmission (what we actually care about). There’s a major gap between leaving a trail of particles & actual disease transmission. 4/
Current research suggests close contact (households, workplace) accounts for most transmission.

Are we going to ban outdoor exercise based on a small, theoretical chance of transmission?

Prominent voices in public heath are sharing this article, so the idea is circulating. 5/
The argument (I think) is that we should be conservative & cautious in the face of uncertainty.

I disagree with this approach.

If we begin to police more and more activities which people can do currently, we risk losing progress in the areas that are most important. 6/
We are already seeing signs of fatigue. Morale is low. As time goes on, people will be looking for ways to cheat (they already are). If we don’t provide low-risk options, people may choose activities which are less ideal (e.g. having a few friends over for a glass of wine). 7/
It is imperative that we continue to focus our messaging on preventing the major modes of transmission; primarily, maintaining standard social distancing (6 feet) & closing nonessential business. 8/
As we enter the next phase of the epidemic, we should pivot toward telling people what they *can* do. We should prioritize finding low-risk activities (like outdoor exercise) which can help keep morale up so folks don’t give up on social distancing entirely. 9/
We’ve been down this road before in public health (i.e. abstinence-only sex education) and we know it doesn’t work. We need to focus on harm reduction or we may find ourselves losing any remaining public trust and patience. 10/end
Btw, I still think we should keep a healthy distance! But we should rethink communication.

Yesterday I ran with a friend & our mutual friend spotted us and just texted me this photo.

Keep as much distance as possible but realize 10 meters is unrealistic as a rule.
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