COVID 19 an Urgent Call
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COMMENTARY COVID-19: An Urgent Call for Coordinated, Trusted Sources to Tell Everyone What They Need to Know and Do Scott C. Ratzan, MD, MPA, MA, CUNY Graduate School of Public Health and Health Policy; Lawrence O. Gostin, JD, Georgetown University; Najmedin Meshkati, PhD, CPE, University of Southern California; Kenneth Rabin, PhD, Journal of Health Communication: International Perspectives, and Ruth M. Parker, MD, Emory University March 5, 2020 Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Acad- emies of Sciences, Engineering, and Medicine (the National Academies). This paper is intended to inform and stimulate discussion. It is not a report of the NAM or the National Academies. Since 1995, the global community has experienced six market in Wuhan, Hubei Province, China. Many possi- outbreaks that the World Health Organization (WHO), bilities have been discussed since the virus emerged, as authorized in a 2005 revision of the International but the original reservoir species (initially thought to Health Regulations (IHR), designated as a Public Health be a species of bat) has not been confi rmed. Whether Emergency of International Concern (PHEIC): H1N1 In- directly or through an intermediary animal, the virus fl uenza, polio, Ebola in West Africa and in the Demo- “jumped” from this initial reservoir species to humans. cratic Republic of Congo, Zika, and now a novel coro- After this initial transmission, the outbreak appears navirus, which WHO offi cially termed SARS-CoV-2. to be sustained through relatively effi cient human-to- SARS-CoV-2 is the virus responsible for the disease human transmission. Fortunately, from available data, state termed COVID-19. Two other novel coronavi- the fatality rate appears relatively low compared with ruses, severe acute respiratory syndrome (SARS) and SARS and MERS. Middle East respiratory syndrome (MERS), also spread Wuhan is central China’s transportation hub, and internationally. SARS occurred before the major IHR soon after the outbreak began, some 5 million trav- revision in 2005 and thus was not designated a PHEIC. elers left the region for other locations in mainland MERS arose on the Saudi peninsula after the IHR revi- China and global destinations—many traveling in sion, but WHO never offi cially designated it a PHEIC, anticipation of the Lunar New Year. As the outbreak even though it spread internationally, including a ma- progressed, the Chinese government took the unprec- jor outbreak in South Korea. edented step of quarantining the 50 million inhabit- PHEIC is not a color- or numeric-coded system of ants of Wuhan and the wider Hubei province. Further alert levels, but is strictly a technical description de- complicating the global response to the pandemic, a signed to support coordination among the 196 states suddenly symptomatic Chinese passenger caused a that are parties to the IHR—coordination which has so Mediterranean cruise ship, Costa Smeralda, with 6,000 far proven diffi cult to achieve in the case of COVID-19. passengers on board to be placed under quarantine in Italian waters. A second cruise ship, Diamond Prin- COVID-19 Response cess, was also quarantined off Yokohama, Japan, after It is believed that the virus responsible for COVID-19 a passenger became symptomatic. Almost all airline originated from an animal found in an open-air food fl ights to and from China have been grounded (as of Perspectives | Expert Voices in Health & Health Care COMMENTARY the publication of this Commentary), and this extreme can be achieved if the public does not believe what disruption of both traffi c and commerce to and from they are being told. the world’s second largest economy has had a growing and potential seismic eff ect on global production, sup- Need for Reliable and Eff ective Communica- ply chains, and fi nancial markets. tion On January 30, 2020, WHO declared the outbreak COVID-19 is a test of the global health polity’s credibil- of COVID-19 a PHEIC [1]. A day later, the U.S. Depart- ity in addressing a legitimate public health threat with ment of Health and Human Services (HHS) declared an unknown trajectory. This sort of an emergent threat COVID-19 a national public health emergency [2]. requires government, media, technology platforms, The U.S. Centers for Disease Control and Prevention and the private sector to step up. A responsible com- (CDC) implemented enhanced border screening and munication response to the pandemic requires coop- a 2-week quarantine of passengers traveling to the eration and coordination among all sectors. The public United States from the outbreak’s epicenter, including needs reliable and actionable information to help them evacuees from Wuhan; the U.S. Department of State understand their risk of exposure as they go about banned foreign nationals who had recently been to their lives in apartment complexes, airports, schools, Hubei province from entering the United States; and supermarkets, or at health clinics. The public needs U.S. airlines and other foreign carriers indefi nitely sus- clarity and transparency about travel bans, quaran- pended fl ights to China. tines, personal protection eff orts, and social distancing COVID-19 is an especially mysterious PHEIC, and in (e.g., closing mass transit, closing schools, or cancel- today’s 24-hour media environment, is covered con- ling sporting events). Moreover, the public needs the tinually and in real time. All of the developments above assurance that as more is learned about this emerg- were broadcast globally on television, radio, news- ing infection, the information they get from trusted papers, and news sites as they occurred, with sites sources refl ects both accurately and clearly what the sometimes reporting confl icting information simulta- health care establishment does and does not know neously. Social media outlets were also active partici- about COVID-19. Indeed, there are data voids and the pants, and quickly became home to ample misinforma- public health community does not have all of the evi- tion—so much so that Facebook vowed to block all but dence needed to reliably predict the trajectory of this offi cial health pronouncements on COVID-19 posted infection. Unfortunately, this uncertainty creates a ripe to the site, and Pinterest made all of its searches for environment for both fear and misinformation. coronavirus connect to posts created and approved by Policy makers, health workers, and the business WHO, the search displaying a banner stating that all of community need to agree on what information to com- the pins that appear are from verifi ed medical sources. municate, as well as the channels of communication and specifi c, credible spokespeople they use. Messag- COVID-19 Communication Challenges es must be updated as soon as new information is vali- The rapid escalation of the virus has been associated dated by public health authorities, and where there is with confusing and sometimes contradictory commu- little new to report, the opportunity should be utilized nication about its spread and what individuals need to to reiterate basic infection control information consis- know and do about COVID-19. As information becomes tently and often (e.g.: “Protect yourself and your family. available at unpredictable times and in unpredictable Wash your hands frequently. Avoid exposure to people ways, it has been challenging to report on the status of who have fl u-like symptoms. Stay up to date with all the outbreak in a manner that is always consistent with vaccinations”). the reporting that has come before. Health communication professionals have learned These sometimes contradictory messages are con- valuable lessons from previous public health threats, fusing to the general public and may undermine both such as HIV/AIDS, “mad cow disease”, anthrax, H1N1, the public health response and public trust in offi cial SARS, and MERS, and these lessons should also be ap- information sources. Increasingly, people may wonder plied to COVID-19. One of the most important of these how transparent, honest, and up to date the informa- lessons is the use of a trusted, known public health tion they are receiving is—and whether they should source, such as the U.S. Surgeon General or others, to believe it. The authors of this Commentary agree that be the “face” and “voice” of evidence-based, up-to-date, a responsible public health and health communication trustworthy information that everyone can obtain, response to this pandemic is critical, but wonder if it process, and understand in order to make appropri- Page 2 Published March 5, 2020 COVID-19: An Urgent Call for Coordinated, Trusted Sources to Tell Everyone What They Need to Know and Do ate health decisions. A single strong voice at the fed- The authors of this Commentary suggest that a lead- eral level can allow state, county, city, and local health ing governmental medical spokesperson, such as the departments to assume their roles as locally-trusted U.S. Surgeon General or others, should be tasked to sources of the best available information for the public create and lead a credible, public–private, interdisci- to access, understand, and use to protect themselves plinary “COVID-19 News Bureau” to inform the United and their families. Health communication profession- States and serve as an international resource in times als must continue to emphasize the importance of of emerging global health threats. Such a bureau could message repetition, suggesting a potential role for the forge long-term relationships with both traditional and U.S. Ad Council, the creators of Smokey Bear. The pub- social media to deliver sustained, up-to-date, evidence- lic health community must not stop at issuing one set based, health literate communication and serve as a of messages one time.