editorial

PUBLIC HEALTH Language matters in a pandemic Do you ‘beat’ or ‘treat’ a virus infection? Are you strong if you survive SARS-CoV-2 but weak if you don’t? Language matters if we are to galvanize people to follow public health guidance during the COVID-19 pandemic.

t the end of January 2020, the World tests were in fact unavailable for many days lauds those who recover as ‘the strong’. Health Organization (WHO) issued owing to systematic failures to cope with SARS-CoV-2 infection results in a wide Aa statement1 that the SARS-CoV-2 demand. Further, to offset the unfair use range of symptoms that are more severe outbreak was a public health emergency of of an algorithm that moderated teachers’ in the elderly, in those with underlying international concern. In early March 2020, predictions and awarded pupils with vital conditions, in the poor, in those living when the global caseload stood at 100,000, exam results largely based on which school in deprived areas and in specific Black, guidance2 from the WHO was clear: they attended, Boris Johnson trumpeted Asian and minority ethnic communities. countries should stop, contain, control, delay that a ‘mutant algorithm’ was the problem. SARS-CoV-2 can also result in long-term and reduce the impact of SARS-CoV-2. So-named to imply that the algorithm itself chronic symptoms in around 20% of cases. But not all countries heeded this advice. had changed in some way, this detracted Stigmatizing all of these people as weak is Amid growing consternation at the from the reality that the algorithm approved patently divisive and wrong. spread of the virus and the severity of by his government was not fit for purpose This misuse of language has recently the symptoms, the language changed. A and was unjust. escalated. To be precise, the language and pandemic3 was declared by the WHO in Language matters in public health. imagery that some global leaders are using mid-March 2020. The use of this word It matters because the goals of any public during this pandemic is boding ill for global was important. A previously unknown health campaign must be clearly defined, efforts to control it. Political interests of virus was being transmitted in multiple especially when the campaigns include leaders who have enormous global reach are countries simultaneously, and this was the measures that limit liberty, damage the poised to confuse and dilute crucial public first pandemic caused by a coronavirus. economy and change our way of life. health messages. The word ‘pandemic’ conveys a sense of Powerful language can be used to motivate We live in an age of rolling news and danger that should have garnered action action, and war analogies have somewhat social media, where language matters more from all countries at every level. At that inevitably come to the fore during this than ever. A single statement by a powerful point, Dr Tedros Adhanom Ghebreyesus, pandemic. Leaders around the globe have politician can be viewed by millions upon the Director-General of the WHO, pointed identified SARS-CoV-2 as a common enemy millions of people in every country around out that “all countries can still change the that we can beat. President Emmanuel the world. One powerful politician who course of this pandemic” if they “detect, test, Macron of France, for example, said that understands very well how to use language is treat, isolate, trace, and mobilize their people his nation “was at war with an invisible, President Donald Trump. Having eschewed in the response”. The WHO’s language was elusive enemy.” mask use and repeatedly played down the stepped up to be much more specific about Whilst there is little doubt that war pandemic during a pivotal re-election year, the country-level actions required to alter analogies can be helpful in explaining why President Trump became infected with the progression of the pandemic. extreme measures such as isolation and SARS-CoV-2. He was whisked off to receive There remains a set of simple measures social distancing are needed, wars drag on the best care available but chose to leave that each of us can adopt in our daily lives to over time and the analogies wear thin. A hospital after just three days, and returned help control infection rates: social distancing, cancer diagnosis often results in the use of to the White House under the gaze of the social isolation for the vulnerable, mask battle metaphors that are similar to those world’s media. wearing and hand washing. Increasingly now being espoused about SARS-CoV-2. The stage-managed return to work these simple actions have been blurred by One study found that the use of battle included imagery of him saluting Marine muddled messaging as governments try to analogies undermines cancer treatment One and whipping off his mask despite still navigate towards a ‘new normal’. and can deter those without cancer from being infectious. “Don’t let it dominate you, The clarity of messaging has stuttered as adopting health behaviours that could don’t be afraid of it, you’re going to beat it,”6 the pandemic has progressed. For example, reduce their risk of cancer5. Importantly, he declared. “I know there’s a risk, there’s in the United Kingdom, should we stay two the authors found that using war metaphors a danger, but that’s OK... I stood out front. metres apart or one? Should we work from can produce fatalistic responses and can I led.”7 Since then, he has described his home or go to work? Should we follow the result in surrendering behaviours. These infection as “a blessing from God”, ‘rule of six’, stay in a bubble or ‘eat out to types of analogies might conceivably lead to failed to isolate and returned to work help out’? Not to mention the stunningly individuals feeling that death is inevitable in the Oval office in a show of strength. vague slogans ‘stay alert’ and ‘hands, face, no matter what they do, and so perhaps This combative language and defiant space’ — which should, of course, be ‘space, they should do what they want. This is most behaviour serve to promote the view face, hands’. These ever-changing messages, certainly not what is needed in a pandemic, that the COVID-19 pandemic can be slogans, buzzwords and clickbait continue when the actions of individuals are of readily overcome with available measures. to deflect attention from failures at a basic paramount importance to infection control. The image of strength seems designed level to control infection rates. These Using the language of war in a to undermine the simple public health include announcements of ‘moonshot’4 and pandemic also reduces those who measures he could instead have chosen ‘world-beating’ plans for mass testing, when succumb to infection as ‘the weak’ and to support.

Nature Microbiology | VOL 5 | November 2020 | 1309–1310 | www.nature.com/naturemicrobiology 1309 editorial

In a Perspective8 by Habersaat et al., a set simple and accurate, saying recently10 Organization https://go.nature.com/2SFj3Bv (2020). 2. WHO statement on cases of COVID-19 surpassing 100,000. of behavioural experts convened to delineate “it is serious. As serious as it ever was.” World Health Organization https://go.nature.com/2GNvB7k ten considerations for effectively managing Effective communication is crucial for (2020). the COVID-19 transition towards a new the success of public health measures to 3. WHO Director-General’s opening remarks at the media briefng on COVID-19 - 11 March 2020. World Health Organization normal. With regards to language, they tackle COVID-19. Politicians, celebrities https://go.nature.com/3dfOaNi (2020). assert that “the aim should be to highlight and influencers who use inflammatory 4. Shearing, H., Nevett, J., Scott, J. & Collerton, S. UK PM sets the gains that can be made from engaging language for personal gain are impeding out ‘moonshot’ plan for mass testing. BBC https://go.nature. com/2SFjfd (2020). in target behaviours and activate the preventive measures against COVID-19. 5. Hauser, D. J. & Schwarz, N. Health Commun. 35, internal moral compass that renders We call on all of our authors and readers to 1698–1704 (2020). personal rewards less important than call out misinformation and challenge the 6. Trump says not to fear Covid-19. Do Americans agree? BBC benefits to others”. misuses of language that stand in the way https://go.nature.com/2SSlkcw (2020). 7. Cathey, L. ‘I had to do it': Trump suggests he got virus as act of Many leaders understand the importance of pandemic control. ❐ political courage. ABC News https://go.nature.com/3jWbWkd of imagery and language that supports (2020). public health directives. Marcelo Rebelo 8. Habersaat, K. B. et al. Nat. Hum. Behav. 4, 677–687 (2020). de Sousa, the President of Portugal, was Published online: 21 October 2020 https://doi.org/10.1038/s41564-020-00812-9 9. Mitchell, D. Portugal’s President de Sousa pictured shopping in pictured9 out shopping in a mall, in a mask, a local supermarket, during Coronavirus crisis, like any normal on his own. The pictures went viral and citizen and it has gone viral. EuroWeekly https://go.nature. References com/34Fhzg3 (2020). reinforced the public health message to wear 1. WHO Director-General’s statement on IHR Emergency 10. Coronavirus: Germany’s Angela Merkel warns of hard months to a mask. Angela Merkel kept her messaging Committee on Novel Coronavirus (2019-nCoV). World Health come. DW https://go.nature.com/34JTJQi (2020).

1310 Nature Microbiology | VOL 5 | November 2020 | 1309–1310 | www.nature.com/naturemicrobiology