COVID-19: Time to 'Take the Risk of
Scaring People'

Kate Johnson

February 25, 2020

It's past time to call the novel coronavirus, COVID-19, a pandemic and "time to push people to prepare, and guide their prep," according to risk communication experts.

Medical messaging about containing or stopping the spread of the virus is doing more harm than good, write Peter Sandman, PhD, and Jody Lanard, MD, both based in New York City, in a recent blog post.

"We are near-certain that the desperate-sounding last-ditch containment messaging of recent days is contributing to a massive global misperception," they warn.

"The most crucial (and overdue) risk communication task…is to help people visualize their communities when 'keeping it out' – containment – is no longer relevant."

That message is embraced by several experts who spoke to Medscape Medical News.

"I'm jealous of what [they] have written: it is so clear, so correct, and so practical," said David Fisman, MD, MPH, professor of epidemiology at the University of Toronto, Canada. "I think WHO [World Health Organization] is shying away from the P word," he continued, referring to the organization's continuing decision not to call the outbreak a pandemic.

"I fully support exactly what [Sandman and Lanard] are saying," said Michael Osterholm, PhD, MPH, professor of environmental health sciences and director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota in Minneapolis.

Healthcare professionals should now be advising people how to prepare  – yet this is the most neglected message, Sandman and Lanard write. "Hardly any officials are telling civil society and the general public how to get ready for this pandemic."

Effective communication should inform people of what to expect now, they continue: "[T]he end of most quarantines, travel restrictions, contact tracing, and other measures designed to keep 'them' from infecting 'us,' and the switch to measures like canceling mass events designed to keep us from infecting each other."

Among the new messages that should be delivered are things like:

  • Stockpiling nonperishable food and prescription meds

  • Considering care of sick family members

  • Cross-training work personnel so one person's absence won't derail an organization's ability to function

We hope that governments and healthcare institutions are using this time wisely. Peter Sandman and Jody Lanard

"We hope that governments and healthcare institutions are using this time wisely," Sandman and Lanard continue. "We know that ordinary citizens are not being asked to do so. In most countries…ordinary citizens have not been asked to prepare. Instead, they have been led to expect that their governments will keep the virus from their doors."

For Osterholm, the official WHO designation of pandemic is irrelevant at this point — it's a pandemic mindset that health professionals need to nurture. "I recognized weeks ago we weren't going to contain this thing," said Osterholm, who coauthored a recent opinion piece in the New York Times.

"When you realize, oh my with influenza-like transmission in a disease that might have over 2% fatality rate, this is a very serious situation," Osterholm told Medscape Medical News. "Trying to contain [a virus] like that is like trying to stop the wind. It's not going to happen."

Trying to contain [a virus] like that is like trying to stop the wind. Michael Osterholm

And he said previous comparisons of COVID-19 to seasonal influenza created a false sense of security.

"What we're talking about is a disease that could have a much bigger impact than flu on any one given year," he stressed "When's the last time you saw influenza, even as a pandemic strain in 2009, shut down supply chains like this? Or cause the kind of international issues like this. This is a really a very different situation. The mortality rate is 20 to 30 times higher."

Osterholm added, "I want people to start preparing today. We need to shore up our healthcare facilities and providers. We have to protect healthcare workers at all costs. What does that mean to you and your family? How are you going to stay together? How are you going to keep track of each other? Who is going to be there to take care of you if you're a single mom and you get sick? Who is going to ensure that grandma has her medication? What kind of plans do you have for your food? Do you just assume your grocery store will be open in the normal way? Maybe you should start stockpiling goods.

"There's a lot of these issues we take for granted and don't necessarily think about."

Public health and other healthcare personnel have an opportunity to explain to the public what to expect, agreed Toronto epidemiologist Fisman.

"I don't think this is the apocalypse, but it will look like a terrible flu season on steroids," he cautioned. "People need guidance on how to prepare: Do I need an emergency kit? Should I have a food supply if my neighborhood is going to be on lockdown? Should I be planning family gatherings or events that will involve lots of travel? I don't have answers to those questions: I think people need to look to public health agencies for guidance and I think public health agencies should be forthcoming."

Sandman and Lanard say healthcare professionals are wary of fear-mongering, but "over-alarming risk messages are far more forgivable than over-reassuring ones," they write. "You're only darned if you warn about something that turns out minor. But you're damned, and rightly so, if you fail to warn about something that turns out serious."

It's time to "take the risk of scaring people," they write.

"Every single official we know is having multiple 'Oh my God' moments, as new COVID-19 developments occur and new findings emerge," say Sandman and Lanard. "And then what do they tell the public? That they understand that 'people are concerned' (as if they themselves weren't alarmed), but 'the risk is low and there's nothing you need to do now.' "

Fisman said the most concerning news about the spread of the virus is coming out of Iran "where there must be massive numbers of cases but very few are reported. You can't fight an enemy you can't see. This is likely across the Middle East, into Syria and Iraq, and I think that effectively ends the hope of containment."

He says estimates of the number of actual cases in Iran exceed 20,000, given the number of  "exported" cases registered in Canada, Lebanon, and United Arab Emirates. With further Iran-linked cases identified in Afghanistan, Iraq, Oman, Bahrain and Kuwait [on February 24], "the underlying epidemic in Iran needs to be massive," he said.

And healthcare professionals should not trick themselves into thinking the virus' impact will be any lighter outside of China, said Osterholm. "When's the last time you ever saw a virus change how it acts or operates when it crosses a political border? Next time you're on a New York subway just think about what's different between Wuhan and New York subways?"

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