Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged early in December 2019 and currently affects most of the countries in all continents. As was very well highlighted by Correia, 1 there are a number of major scientific uncertainties underpinning the nature of SARS-CoV-2 that must be addressed; one of which is the degree to which asymptomatic infection occurs and how much it contributes to transmission in different settings. As also well stated by Correia, 1 there has been a remarkable gap between the general acknowledgement of uncertainty in the scientific community and the seeming absolute confidence in the tone of political management of this virus by many countries. The inability or unwillingness of these administrations to acknowledge uncertainty and the need for flexibility in the adoption of different policies does not bode well for the future. Specifically, this is because we are very likely at just the tip of an iceberg of how many have been exposed to this virus, meaning that it is likely already well established in many populations; thus further highlighting the need for different public policy managers to change tone and critically reflect on a number of issues related to SARS-CoV-2 before it is too late. Like other respiratory infections, SARS-CoV-2 is believed to primarily be transmitted by respiratory droplets that could be generated during sneezing, coughing, breathing and even during talking, as well as fomites. 2, 3 Infections are transmitted by inhalation of respiratory droplets of varying sizes, and the time of exposure is another important factor. 2 Maintaining an interpersonal distance of more than 1.5 to 2 m is considered to reduce the risk of contracting the virus, as it is primarily thought to be spread through larger respiratory droplets that are less likely to spread that distance. This among other social distancing policies has proven to be effective in the past; however, reductions in spread can be temporary. For instance, social distancing measures initially reduced spread of virus during the Spanish flu pandemic, but multiple waves of infection were experienced after social distancing measures were relaxed. 4 The same risk exists with the current pandemic for countries that succeeded in flattening the curve, 5 which necessitates continuous community mitigation in these countries for a long time. The situation in most developing countries is likely quite different for a number of reasons. There are a number of cultural and institutional barriers for effectively implementing these policies, and potentially could be major future hotspots of COVID-19 related infections and deaths, especially those with high population density, less healthcare infrastructure, and higher rates of comorbidities. 6

As of June 4, more than six million people worldwide are infected, with more than 382,867 deaths from COVID-19. Unfortunately, this is just the visible tip of the iceberg representing laboratory confirmed cases, as there are likely many more cases that include asymptomatic, presymptomatic and undiagnosed/unconfirmed cases. The epidemiological investigation of this disease should be heavily focused on the latter group of cases. This potentially large hidden portion of the iceberg determines the fate of any disease control program. Wide-scale proactive screening is done for the hidden portion of iceberg whereas reactive diagnosis is done for tip of iceberg. Many other infectious diseases historically also have displayed this iceberg-like pattern, including measles, mumps, hepatitis A and B, diphtheria, other coronavirus infections, tuberculosis, brucellosis and leptospirosis. It is speculated that SARS-CoV-2 infection is also another example …