During infectious disease outbreaks, public trust in the government and health agencies becomes critical. Officials need to convince millions of people that they are telling the whole truth, and that their guidance on what to do — and not do — should be followed.
How's that going as coronavirus has begun spreading in some parts of the U.S.?
According to a Gallup poll last month, 77% of people felt confident "the federal government will be able to handle an outbreak of the coronavirus in this country." However, that poll was done before instances of community spread began to appear and before the first U.S. death was announced. It was also before the Trump administration ramped up its coronavirus response, announcing new leaders, apparently trying to get ahold of what has been, at times, a muddled message.
"If people don't trust that the government is telling them the truth about the risk to themselves and their families, people start to make decisions that are not rational, and that puts our medical system at greater risk," says Beth Cameron, who works on global biological policy for the Nuclear Threat Initiative. Previously, she served as senior director for Global Health, Security and Biodefense on the White House's National Security Council, a position that was eliminated by the Trump administration in 2018.
"You really want to make sure that people understand when it makes sense to stay at home, when it makes sense to come to work, and how they can get the care that they and their families need," Cameron says. "When people don't have information, they tend to panic."
The American public seems to be nursing some level of anxiety, if not panic. There's the price gouging on hand sanitizer, runs on face masks (which are unnecessary if you're not a health care worker), and racist incidents towards Asian people.
Some early apparent missteps by the Centers for Disease Control and Prevention in creating and deploying effective coronavirus test kits around the country may not be helping to quell that anxiety.
"I think there is right now a little bit of a deficit of public trust because there has been a lot of confusion about the test kits," Cameron says.
She thinks the administration likely lost time in its response to the virus by getting rid of her old job, which was a position on the National Security Council — instead it had to form a task force specific to coronavirus.
"One of the advantages to having a standing group constantly monitoring outbreaks is that you have existing glue already put together between the different interagency pieces," she says. "You're constantly exercising and talking about what could be happening — I do think that that kind of a structure can really save time in a crisis."
Cameron says she thinks the current deficit in public trust is reversible, and that it "can be easily and quickly rectified if the administration continues to provide clear scientific, fact-based communication on a regular basis," she says.
Howard Markel, a physician and University of Michigan medical historian, agrees that complete and clear communication from officials is what establishes public trust during an epidemic. He says whenever a country announces there's an epidemic, it stands to lose a lot of money, so there's always an urge to wish it away.
"Concealment is one of the big no-nos in the history of pandemics, and it happens again and again and again, sometimes for political reasons, sometimes for commercial reasons," he says.
Some of the ugly responses to coronavirus are familiar, he says, when you look to epidemics past — especially the scapegoating and racism. "During the early 20th century, when we had 1 to 1.5 million immigrants coming in a year — mostly through the gates of Ellis Island — and epidemics broke out, they were often blamed on East European Jewish immigrants," he says. "There was a bubonic plague epidemic in Chinatown in San Francisco in 1900, and the public health officers literally did a jagged quarantine — almost like a gerrymandered congressional district — that was just around the Chinese neighborhood."
What's new — and dangerous — in the year 2020 with coronavirus, Markel says, is a much more "atomized" information landscape. It's an era where "everybody feels they are entitled to their own set of facts, which is absolute rubbish," he says. "There really are a set of scientific facts."
It's important that government officials work "to coalesce the population — to make sure that we're all on the same page of what we need to do to keep ourselves and our children and our families safe — our communities safe," he says.
Public trust is needed when officials say that your risk is low, and you should go about your normal life — which is what they're currently saying is true for most Americans — and when things suddenly change, and officials need cooperation in closing schools or canceling public events.
Markel thinks so far the coronavirus response from officials at the CDC and other agencies has gone quite well. "Look, they're human," he says. "They may make mistakes, it is not going to go perfectly, but an A-minus grade that this professor would give right now is pretty darn good."
He adds, we're well positioned to manage whatever coronavirus might bring going forward. "There's never been a better time to have an epidemic in human history than today," he says. "We have the means, the will, the money and the technology to handle this problem."
Now officials just need to earn — and keep — the public's trust.