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Risk And COVID-19: Are We Talking About It All Wrong?47:30
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A server brings beverages to a group of people dining for lunch at Mother Anna’s in the North End. (Jesse Costa/WBUR)
A server brings beverages to a group of people dining for lunch at Mother Anna’s in the North End. (Jesse Costa/WBUR)

Communicating the risks of a disease like COVID is a huge challenge, especially when information is new and changing, and the media is tilted toward emphasizing negative risks. Did experts and leaders get the message right when the pandemic began? Are they getting it right now?  

Guests

David Ropeik, expert on risk communication and the psychology of risk perception. Author of “How Risky Is It, Really? Why Our Fears Don't Always Match the Facts.” (@dropeik)

Zeynep Tufekci, associate professor at the UNC School of Information and Library Science. Author of the Insight newsletter. (@zeynep)

Jennifer Nuzzo, epidemiologist and global health security policy scholar at the Johns Hopkins Center for Health Security. (@JenniferNuzzo)

Interview Highlights

At the beginning of the pandemic, were people getting information that would help them make good decisions?

Jennifer Nuzzo: “I think it was largely the best that could be done at the time. I think the thing that I feel sort of regret about is that we didn't do a better job in March of communicating the protracted nature of this crisis. And the fact that it was not going to be something that would disappear in a couple of weeks.

"I know when they closed our schools here, they initially announced it for two weeks and many parents were up in arms and they thought, ‘Oh, gosh, how can we survive two weeks?’ And I would tell other parents it's not going to be two weeks. This is a long-term situation that we're going to have to deal with. And I don't feel like that aspect was communicated as clearly as it should have been.”

Do you think that it was ever clear to the public what early preventative goals should be?

Zeynep Tufekci: “I think it was and was not. It wasn't clear enough for sure. And the ‘flatten the curve’ message was absolutely important because at the time we were facing a crisis. So we could have communicated better. But I'm just looking at ... anniversaries. I've been looking at the outdoor situation, because we're still closing parks and just sort of to refresh my memory.

"I look back at an article I wrote the first week of April for The Atlantic, where I try to say we can't keep closing parks and outdoors because this pandemic isn't going away in a few weeks. We'll be maybe social distancing on and off for another year. And we need to figure out how to maintain compliance with better targeting of these measures. And I remember at the time the idea that we'd be doing this for another year, people just came to me and said, ‘What are you talking about?’

“And I said, ‘It's a pandemic. It's not going away tomorrow.’ So there was this feeling … that two weeks to flatten the curve. And then what? I think we didn't get that ‘then what?’ message properly targeted. But it's understandable. You know, you're kind of in a panic. You don't really have clarity. But what I think we fail to do to this day, unfortunately, is to adjust our messaging to our understanding of the risk.

"For example, you just talked about the Los Angeles mayor talking about staying home. For one thing, it's not clear that it's the people who can choose to stay home that's the problem. A lot of the spread is in workplaces. So just stay home, stay home, doesn't really help with it. Something like better masks for people who can't stay at home would be better targeted.

“And we're still seeing a year into this doing things like stay home and closing the parks when in fact outdoors is crucial. This is a pandemic driven by superspreading and over dispersion, and those always occur indoors. So that's another thing, telling people to stay home if they live in a crowded apartment with bad ventilation, that's probably not good.

"In fact, we have new polling that shows that people who live in multigenerational housing where they're crowded are more likely to catch COVID. So maybe staying home really wasn't the good message. Not everybody can stay home. Outdoors is good for us. And there's all these other ways in which we haven't really evolved our messaging. And we're just saying wear a mask, still wear a mask, stay home. It's not what we should be doing this late in the pandemic.”

On beach shaming at the beginning of the pandemic

Zeynep Tufekci: “Give people an inch and they'll take a mile. It’s absolutely going to backfire. I know you're not claiming this but what you need to do is exactly the opposite, because if you do that, you don't trust people with the correct information. They won't trust you back. And there's nothing more important in public health communication than having people's trust.

"The problem with the beach communication was it was full of pictures of people in breezy beaches, clearly probably the safest place you could be in a pandemic. And nobody in a bikini goes right next to a stranger and just coughs in their face. Like I couldn't even understand what the threat was. If they mean to say stay away from the indoor restaurants that may accompany a beach trip, that's what we should say. Because then we really lose trust because we act like we're just trying to sort of get compliance by scaring people.

“And we're not talking about toddlers. We're talking about adults. So this kind of give an inch, they'll take a mile. Not only does it not work because it's not properly targeted, it backfires because then when we do say something, 'Don't do this.' They're kind of like, 'Can we trust you? Are you just trying to scare me or are you telling me the correct information?' So what we needed to do from the beginning was to be more precise and more targeted. I don't mean false hope. I don't mean false certainty. I don't mean fear either. Just like, 'This is what we know is risky. And this is why.' Which empowers people. If they're in a new environment and they're looking and thinking, 'Should I go into that store?' They should be able to think, 'It's crowded. Maybe not right now.'”

On how the media shapes the coronavirus narrative

Jennifer Nuzzo: “The media is the deliverer of the message. I think the problem is that we didn't actually craft the right messages to deliver. I've been involved in so many conversations with media where I really have felt that they've been kind of active partners in getting the message out and also pushing back on perhaps some of the misleading messaging that government officials were doing. You know, I think they really helped to try to get some truth out there, given the fact that there were leaders who are kind of openly questioning the existence of the virus and the need to take it seriously. The problem is it is hard to message about what things people should do.

“And I think your whole point earlier about the pushback that you got from the harm reduction show, this idea that you're going to acknowledge that some people may not fully follow public health guidance. And if that's going to happen, what can they do to make it safer, given what they're about to do anyway? I think that's a very reasonable approach and that's one that, you know, certain fields in public health have learned as a result of decades of experience in terms of dealing with things like drug use and sexually transmitted infections.

"And we should very much incorporate that into other public health messaging. Unfortunately, I just don't feel like a lot of the messages that have come out from governments — they've been slow to take that harm reduction approach in how they talk about this virus and what we should be doing about it to protect ourselves.”

On how to build trust

David Ropeik: “When we're looking to our leaders, we need to trust that they're on our side. When we look to our friends, we need to trust that they're on our side to help keep us safe. That's an instinct for the social human animal. And when we sense that we can't trust them, that blows everything apart. But let me step way back. Risk communication, not just the media, if I may. Risk communication is a specific tool. Of risk and public health, safety management.

"When people's behaviors are part of what is going to make a risk worse or better, whether it's an epidemic or after 911, or anything, crisis or not crisis, drunk driving, cigarette smoking. When people's behaviors are part of what makes the risk better or worse. It is part of what public health needs to — and this sounds crude — but manage, you're trying to encourage healthier choices. Risk communication is a specific practice. It's not PR, it's not just the messages.

“In fact, it's much more what you do than what you say. It is what you do and say that demonstrates an understanding of and a true, sincere respect for how people feel, because they're going to make their own choices, no matter how good your information is in the context of their own lives. And its goal is to increase trust, which will increase the influence of the communicator to encourage healthy choices.

“Now, we had epidemics, pandemics in the last decade, nothing like this, but we knew it was coming. Did we have a risk communication plan for this? Did we have an infrastructure? Did we have messaging? Did we have actions? Did we have websites? Did we have misinformation, knocked down sorts of things? To the best I can tell, no. That's a super big failing and continues to be, in my opinion.

"Risk communication as a specific practice, I'm not talking just PR. I'm talking about understanding the underlying psychology of why people make the choices they do and demonstrating a respect for that. The way Andrew Cuomo did and Amy Acton did in Ohio, the director of public health and others. That will influence people's choices and manage the public health crisis better.”

On how we can move forward in risk management of the pandemic

Zeynep Tufekci: “We need daily briefings from the public health authorities and they need to sort of give us the picture. So what I look at right now is that there is this tension between the current kind of grim moment, right? We have these new variants that are more transmissible. We had a surge that we're just barely starting to get under control. And it's still very high.

“Seasonality is working against us. So we do need people to be more strict for the moment. So that's definitely part of the problem. But that needs to be balanced with the realization, One, people are tired, quarantine fatigue is real, and they need to understand what's the end game. And then this is just very honest. The end game is looking better and better. We have amazing vaccines. Their efficacy is very high. They're very effective against the outcomes we care about, like hospitalization and death. We're already planning for boosters for these variants. There's all these really, really hopeful things that we're nearing the end of this. We're going to have better things happen soon.

“We're slowly going to come out. And I think that needs to be communicated. And I feel like there's the fear that if we focus on that part, we will lose the message that we do need to be more strict for the moment. I think, in fact, the hope, the end game, the positive stuff and realistically, I'm not talking at all ever about exaggerating or kind of misleading the public with things we are not sure about. It's just what we do know and what we think will happen. We can communicate that just explicitly. And I think that will help with compliance, because if we know what's happening, we can better bear the moment.

“The second thing I would really like is to stop giving these, like, binary instructions. We've been doing like six feet, this, that and the other. Explain the mechanisms. Aerosol and airborne transmission. Fomites are not that big a deal, but it makes sense to wash your hands. It makes sense to disinfect high touch surfaces. But you don't need to really make a big show out of it. It's indoors.

"That's the problem. It's ventilation that really helps. So giving people that kind of intuition about transmission mechanisms rather than rules that never work, like six feet or not. Distinguishing indoors and outdoors, this empowers people. Like we explain better masks and why and when. Like, if you're walking your dog, no, you don't need an N-95. If you're in a high risk environment, this is why it makes sense and how to get it. … People are looking to be safe. We need to empower them.”

From The Reading List

The Atlantic: "Iowans Were Scared Into Taking the Virus Seriously" — "Public-health experts predicted a tsunami of COVID-19 infections in Iowa this winter. Doctors and researchers told me in November that they expected thousands of Iowans to travel to visit family over Thanksgiving and Christmas."

Palm Beach Post: "Coronavirus Florida: Why do some people engage in risky behavior?" — "These long days of social isolation have opened a fascinating personal window within our shut-down lives."

New York Times: "We Have to Focus on Opening Schools, Not Bars" — "The way states lifted social distancing restrictions imposed to fight the coronavirus sadly demonstrates our priorities. Officials let bars, restaurants and gyms open, despite warnings from public health experts that these environments pose the greatest risk for spreading the disease."

The New Yorker: "The Indoor-Dining Debate Isn’t a Debate at All" — "Last Friday, Governor Andrew Cuomo announced that New York City restaurants would be allowed to resume partial-capacity indoor dining on Valentine’s Day—in a non-pandemic year, one of the hospitality industry’s busiest nights."

This program aired on February 10, 2021.

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