Ivana Kottasová: Why has the message on coronavirus been so muddled? On masks, airborne transmission, social distancing, the WHO and others have seemingly changed their message several times, leaving people confused. Why is that? Are they failing as crisis communicators? Or is it simply that the message evolves as we find out more about this virus?
Peter Sandman: There is no question that COVID-19 messages have to change as the experts learn more about the SARS-CoV-2 virus. And the changes can lead to audience confusion, or even to charges that the experts don’t know what they’re talking about. Crisis communication experts know teachable strategies for ameliorating these problems. To the extent that publics are confused or skeptical about message changes, that is mostly the messenger’s fault.
The most important way to mitigate the downsides of changing your message is emphatically and loudly warning the audience in advance to expect uncertainties, reversals, and even screw-ups. When he was at the World Health Organization, David Heymann did this elegantly during the 2003 SARS epidemic. “We are building our boat and sailing it at the same time,” he said; in plainer English, we’re going to make some mistakes. Jeff Koplan was Director of the U.S. Centers for Disease Control and Prevention (CDC) during the 2001 anthrax attacks and even more poignantly said: “We will learn things in the coming weeks that we will then wish we had known when we started.” The public came to trust Heymann and Koplan not despite these admissions of uncertainty, but because of them.
Emphatically predicting that you’re going to change your mind about some things reduces the reputational damage of changing your mind. That in turn reduces the temptation to hide new evidence and pretend you haven’t changed your mind. I can’t tell you how many conversations I’ve sat in on in that took this form:
“It looks like what’s really happening is Y, not X like we thought.”
“Yeah, but we already said it’s X. If we say now that it’s Y, we’ll lose credibility. People will say we flip-flopped. They’ll say we don’t know what we’re doing.”
“You’re right. I guess we’d better keep saying it’s X.”
Here’s an example I can share, because I know it only from publicly available information. Early in the 2009 swine flu pandemic, the U.S. CDC said that children and young people were the most vulnerable group, and thus should have first priority when vaccines became available. Pretty soon, the CDC learned it was mistaken; the 50-64-year-old age cohort was far and away the most vulnerable. Nonetheless, the agency decided not to change its messaging. It continued to say that children and young people were most vulnerable and most important to vaccinate.
The ideal crisis communication strategy is to emphatically, vividly, and dramatically predict that you will change your mind about some things as you learn more. Half-credit for at least acknowledging your uncertainty in real time. It would have been nice to hear COVID-19 experts say something like this: “We think droplets are the main way the virus is transmitted. But the evidence isn’t definitive. Some transmission has been reported via surfaces (fomites), and also some airborne (aerosol) transmission. Based on the research so far, though, most but not all experts think those two transmission routes are less important than droplets. We are basing our recommendations on that preliminary conclusion. But we promise to let you know as we learn more.”
Zero credit for sounding overconfident – a crisis communication sin that public health professionals have committed far too often throughout the pandemic. Sometimes they explicitly claim certainty. More often they just adopt a confident tone, deemphasize their doubts, don’t mention other experts with different opinions, and pretend the evidence is stronger than it is.
The accurate-but-ritualistic statement that “we are learning more about this virus every day” is usually voiced in the past tense to explain why the experts previously got something wrong. It would be refreshing to hear it in the present tense, as a reason why what they’re saying now might turn out wrong too.
In fairness to public health experts and officials, uncertainty claims have a tough time getting through the communication process. What you say sounds more confident than you meant it to sound; what reporters write sounds more confident than what you said; what editors publish sounds more confident than what the reporters wrote; what the public remembers sounds more confident than what the editors published. This is even truer when anxiety is high – and it is extremely high right now. Everybody craves certainty in a crisis. I advise my clients that acknowledging uncertainty isn’t enough. If they don’t want to end up sounding overconfident, they have to proclaim uncertainty.
But there are worse crisis communication sins than sounding overconfident about something you’re really not that sure is true. One of the worst: Confidently saying something you’re pretty sure is false. Public health professionals do that too, especially when they think such dishonesty is the best way to get the public to do what they want it to do.
Masks are a good example.
In the early months of the pandemic, as more and more people began to take the risk of COVID-19 seriously, one obvious precaution was to wear a face covering of some kind when out in public – maybe a medical mask, maybe just a bandana. The virtually unanimous messaging from the public health establishment: “The science conclusively demonstrates that masks are useless outside of healthcare settings. They might even be harmful. False sense of security blah blah blah. But for sure they’re completely useless.”
This was a flat-out lie. In fairness, not every public health professional who voiced the lie knew it was a lie. But the experts knew. They knew by early February that a fair number of infected people who didn’t feel very sick, and were therefore out and about in their normal lives, were transmitting the virus in public places. Whether these people were asymptomatic or presymptomatic or mildly symptomatic is irrelevant. They would have transmitted the virus less (we still don’t know how much less) if they’d been wearing face coverings, a fact that most experts at least suspected, even if they couldn’t quite say they “knew” it with full evidence-based confidence. They certainly had no evidence base for claiming they knew it was not the case, which is what they claimed.
Behind the lie lay a false assumption about the audience. The “you” that public health professionals were claiming had no use for masks was a “you” who wants to protect “yourself” from others who might be infected. They were talking about the alleged uselessness of masks as personal protective equipment (PPE) to protect the wearer. Even this claim is debatable and profoundly counterintuitive. It is in obvious conflict with mask guidance for healthcare facilities and for people taking care of COVID-19 patients at home, where there is lots of close contact. Haven’t any of those experts ever been on a jam-packed bus or subway for a forty-minute commute during flu season?
Worse, the claim that face coverings are useless ignores their other use, as “source control” to protect others from a “you” who might be unknowingly infected. That other use is undeniable, unless public health professionals are also lying about “respiratory hygiene.” We’re all endlessly urged to cover our cough with a tissue or an elbow. If I can’t because I’m hanging onto a toddler, a briefcase, a shopping bag, or a subway pole, how can it be useless for me to cover my cough with a mask or bandana instead?
Why did public health experts and officials lie about masks? They worried that people would mistakenly believe masks protected mostly the uninfected mask-wearer, and that might give them a false sense of security that could lead to less compliance with social distancing. They worried that people would prefer medical-grade masks to nonmedical face coverings, and that would exacerbate hospital PPE shortages. So they dishonestly claimed that masks are useless in everyday life. And when they finally did an about-face (the U.S. CDC made the switch on April 3) and began insisting that masks are essential in everyday life, they did so without apology. Instead of apologizing, they pretended that their new recommendation was a response to surprising new data about SARS-CoV-2 transmission from people who didn’t seem sick, data that was actually many months old. With rare exceptions, they’re still pretending.
Public health professionals try to be truthful. But they typically put a higher value on health than on truthfulness. So when they believe the truth will lead people to act in unhealthful ways, they may choose to shade the truth, mislead, or even lie. More often than not, they get away with their dishonesties in ways that corporate or political leaders would not. They don’t get caught as often as they should, and when they’re caught their credibility doesn’t suffer as much as it should.
This time, though, I think their dishonesty about masks did real harm. They got caught, and their credibility suffered. There are other reasons why masks became such a politically loaded controversy in the U.S., like nowhere else I know. President Trump’s disdain for mask-wearing was obviously a paramount reason. But the public health profession’s early disdain for mask-wearing certainly didn’t help. After the profession’s unapologetic about-face, it was harder than it would otherwise have been for public health professionals to criticize people for not wearing a mask.
Copyright © 2020 by Peter M. Sandman
