My most fervent risk communication complaint at the moment is the tendency of many top officials in the U.S., Canada, and Europe to overemphasize the fact that the risk of the novel Wuhan coronavirus here and now is tiny – as if that meant that people should (or could!) wait to worry until the risk here and now got bigger. “No reason for alarm,” is bad science as well as bad risk communication. Officials and experts are alarmed already – reason enough for the public to gird up its loins as well.
Worry is about the future. Telling people not to worry about an emerging infectious disease because it isn’t a significant risk here and now is foolish. We want people to worry about measles when there’s very little measles around, so they will take the precaution of vaccinating their children before it’s imminently necessary. We want people to worry about retirement when they’re years away from retiring, so they will start saving now.
Given the real possibility that the coronavirus might start spreading locally in North American cities, now is the right time to worry and prepare, at least emotionally and perhaps logistically as well. There’s not much reason to wear masks against the coronavirus in North America now. Masks may or may not turn out to be useful in the months ahead. In case they do turn out useful, buying them now is provident, not panicky.
Even more importantly, telling people they are foolish to worry about an emerging infectious disease is patronizing and contemptuous – when what is needed is empathy. When confronted with a risk that’s new and scary, people naturally go through what some risk communication professionals call an adjustment reaction. We temporarily overreact – feeling and imagining and even behaving as if this possible future threat were here and now. The adjustment reaction is unavoidable and usually pretty brief. It is also useful, an emotional rehearsal. It helps us prepare for the new normal that may be coming.
Instead of deriding people’s fears about the Wuhan coronavirus, I would advise officials and reporters to focus more on the high likelihood that things will get worse and the not-so-small possibility that they will get much worse. I think there is little need to ameliorate public over-reaction now. The bigger need is to reduce public over-reaction later to predictable bad news that will take people by surprise insofar as they weren’t sufficiently forewarned and didn’t get enough chance to rehearse emotionally. My wife and colleague Jody Lanard MD says to tell you that adjustment reactions are “like tabletop exercises for regular people.” Officials should help the public rehearse better, not tell people not to rehearse.
I’m particularly put off when officials deride the public for worrying more about Wuhan coronavirus than influenza. They say that people are fools if they’re freaking out about the coronavirus but not getting a flu shot. But that doesn’t stop them from freaking out about the coronavirus and it doesn’t make them want to get a flu shot. I’d much rather see officials warn that “One flu is bad enough. A second flu would be awful. One of our fears is that this new coronavirus could possibly become as widespread and dangerous as flu – and at least at first, with no vaccine to help ameliorate the threat!”
A great Canadian example: Allison McGeer in a January 26 STAT article by Helen Branswell:
“The more we learn about it, the greater the possibility is that transmission will not be able to be controlled with public health measures,” said Dr. Allison McGeer, a Toronto-based infectious disease specialist who contracted SARS in 2003 and who helped Saudi Arabia control several hospital-based outbreaks of MERS.
If that’s the case, she said, “we’re living with a new human virus, and we’re going to find out if it will spread around the globe.” McGeer cautioned that because the true severity of the outbreak isn’t yet known, it’s impossible to predict what the impact of that spread would be, though she noted it would likely pose significant challenges to health care facilities.
A bad Canadian example: Patty Hadju in a January 26 Star article by Sandro Contenta:
Hajdu stressed that “the risk is extremely low for Canadians,” noting the virus is spread only through close contact. “There is no need for Canadians to be alarmed,” she said, adding health authorities have learned much since SARS killed 44 people in Toronto.
(You can probably find better Canadian examples – maybe in the National Post.)
One of my favorite good examples comes from the 2009–2010 swine flu pandemic. Swine flu turned out quite mild. But when it first emerged in April 2009 it was scary – as Wuhan Coronavirus is now. Acting Director Richard Besser of the U.S. Centers for Disease Control and Prevention responded superbly in a press briefing:
First I want to recognize that people are concerned about this situation. We hear from the public and from others about their concern, and we are worried, as well. Our concern has grown since yesterday in light of what we’ve learned since then.
I want to acknowledge the importance of uncertainty. At the early stages of an outbreak, there’s much uncertainty, and probably more than everyone would like. Our guidelines and advice are likely to be interim and fluid, subject to change as we learn more….
We do not know whether this swine flu virus or some other influenza virus will lead to the next pandemic; however, scientists around the world continue to monitor the virus and take its threat seriously.
Feel free to use any of the above if it’s useful.
Copyright © 2020 by Peter M. Sandman
