A new bill introduced in Congress calls on the U.S government to focus on combating misinformation. The “zero draft” of a proposed international pandemic treaty calls on member states to do the same. The FDA is zeroing in on misinformation. Webinars galore are focusing on fighting misinformation to build trust. Even public libraries and schools are entering the fight against fake news.
I hate politics in public health matters but if we're to be honest, it is the Fox News information ecosystem that's been the source of probably 90% of the bad info out there. Get rid of that info ecosystem and things clear up. But they are too powerful to wish away unfortunately! Tie them up in unending litigation says I.
More power to them and their legal team. As you know News Corp.can bring in battalions of experts, who will all be reading off the same script. Like rubber squeeze dolls they will all be saying "Dominion isn't worth that much.". "Dominion hasn't proved losses". It's gonna be monotonous.
A necessary part of achieving this goal is to learn how to effectively communicate risk.
When I am talking to patients about serious diseases and treatments with a reasonable probability of harm, I try and find language that is intelligible to them. Using percentages with four significant digits is not helpful.
Depending on the particulars of the case helpful phrases include the following:
- “Unfortunately you do not have any completely safe options“
- “A few people will be harmed by this therapy but most people will live longer with it”
- “We are all working together to help you live as long and as comfortably as possible“
- “The treatment we are discussing has quite a bit of burden and most patients your age and with this disese complete their lives within 6 months even with the treatment so we also want to discuss the option of focusing on comfort care and hospice."
Really appreciate the clarity of your insights and experience. Communicating risk has to be one of the hardest things to do, and at the same time the most necessary.
Nicely done, but not surprised the WaPo, home of Leana Wen, rejected it.
Thing is, I have in-laws who believe in a flat earth, love Trump. I’ve had a friend tell me that Covid was both a Chinese bioweapon and a hoax—both. At the same time.
So sorry Doug! I have family who supports that mentally ill asswipe! I moved far away from my 6 brothers and 2 sisters! Of the 9, 3 are human and 6 are mentally ill monsters! Shithole America I dumbass whiny white guy at a time!
Honesty about what we do and do not know, without spin, is critical. Spinning information by emphasizing the positive and omitting the negative erodes trust just as much as, if not more than, an outright lie.
Having worked at FDA during the HIV crisis (1990-93) and again from 1999 to 2016, one observed the increasing LAYERS of lawyers and non-scientists who had to clear any public statement. All the Centers, even though the product had no direct relation to their work, had to clear public statements. Not just be informed but to clear. For any public health crisis there should be a SMALL crisis team with scientists as the final clearance in place in public institutions. Yes, include a lawyer and a PR person but the core of the team needs to be the scientific experts and they should have the final say.
IN response to the comment re mis-information = you are NOT informed if you only listen to the major TV news. I have challenged my scientist friends to commit to listening, during a crisis, to the following: news on 2 major channels like ABC, NBC, CBS & PBS AND then Tucker Carlson. If you are not willing to at least LISTEN to an alternative belief system then you are just as ignorant of what is happening as those who refuse to hear any other perspectives. Yes, I wish he were less snarky and wore socks but that is not the point. Closed minds do not bother to even hear what others have to say, whether you like it or not. Though I have been a life long Democrat, I now find my Democratic friends much more closed-minded, & unwilling to listen or try to understand my Republican friends' opinions. They have become self-righteous and that is dangerous. D. Murphy, MD, FAAP
Completely concur that communication from the Agencies should be via a Crisis Communications Team. And your recommended makeup sounds very reasonable to me. It sorta mirrors the FEMA/NIMS PAO process: Bring in the experts to explain their little piece, the Incident Commander to explain the overall response, and the PAO to maintain control in the presser, and serve as advisor in the preparatory phase to make sure it can be understood. PA shouldn't dictate what can be said, and Legal should make sure the mandatory "i's" are dotted and "T's" are crossed.
Pre-pandemic, I tried to scan news from about 5 or six sources daily, including Fox... and Al Jazeera... to gain a cross-section of presentation for what was being reported. Gave me some idea of what most of my friends might be thinking, and the ability to discuss things with almost all of them, as well as other people I might encounter. It also allowed me to analyze the various streams, almost as if they're disparate intelligence sources and form several opinions or positions of Best Case, Middle Case and Worst Case when trying to understand a situation.
When I started doing significant epidemiology and attempting to understand and produce material for the group I support, I intentionally stopped looking at the media reports on COVID because I was initially told that I'd gotten my information from this outlet or that, even though I was citing papers or personal communications. Me? I started literally leaving the room during the news to preclude being "contaminated" by even a network's experts. Any network. I immersed myself into published reports, and there were certainly enough of them, and was active online with several chat groups of clinicians working in ER and critical care. I had a direct line to my State Epidemiologist (until he resigned in disgust), and staff epi's at the State Health Dept., but couldn't make inroads into real people at CDC and FDA. My statements and interpretations were evidence based and included citations to the extent possible (didn't name the clinicians I was talking with). And because I eliminated the media from my data sources, I was, at the same time, not following an agenda from a larger group, but still accused of doing the same. I didn't consider how to best approach the different groups and that meant I was often considered wrong by both Democrats and Republicans. My wife, with decades of clinical experience, DID watch the news, and she often disagreed with what I'd say until she saw the literature I was following. She was my biggest critic for not communicating well with "the masses".
I've started easing back into my old ways of scanning a number of sites. but to be honest, I fully understand why people get comfortable in their echo chambers. We live in a "Conservative" area and just last night, out for dinner, I got my dose of OAN for the week. But for them, the pandemic is well and truly over, so there was no news on that.
I was working in Houston in the 1980s when AIDS, then an ill-understood phenomenon, kicked into high gear. Spent a lot of time in ICUs in the Texas Medical Center.
A timely set of comments with which nobody should disagree! One suggestion I have been making for only three years now is that Persons In Authority must work around the clock to eliminate from the Public Health patois all uses of weasel words or weasel phrases from official spokespersons in the Gubment --- I am talking about folks who, despite MD and or MPH after their names, have serially attempted (with just lousy skills) to tip-toe around, technically "tell the truth", but all the while not totally tell the truth with a crispness befitting the nature of the COVID-19 pandemic situation. There have been hundreds of televised instances of this nonsense to date, going all the way back to the very first month of the pandemic. Oddly -- and I mean *really oddly* -- the release of noxious nattering as continued all the way into the current reign of folks like Jha, Walensky, et al. The uses of cute jingles, catchy jargon, business-world buzzwords, oily weasel phrases, hand-waving gestures while speaking, saying "you know" in every other sentence like some junior high kid hanging out in a mall, and the deployment of just truly dumbed-down metaphors ---- taken in total all of this has comprised nothing less than a very calculated dispersal of bullshit. This must stop. Seriously. Period. Not negotiable.
Birx was the originator of things like "15 Days to Slow the Spread", something she learned in her years of making inroads into HIV prevention and treatment overseas. That it was misused and subsequently abandoned didn't make its initial use less useful overall. And for the record, that junior high kid probably reads at ab bit above the 6th grade level. MOST of our targeting is for people who read in the 6th to 8th grade levels. Those of us who've spent a bit more time in science can interpret what was said; those with less rigorous training can usually catch things on the first pass.
But I've got to, overall, agree with your sentiment: We have to be truthful (that means not silencing folks like Nancy Messonnier for her comments at a CDC presser) and accurate. Sometimes the more trite expressions should be used (note my comment about 6th grade reading levels) to achieve the broadest understanding.
I do know that one problem I encountered was the speed with which new data came out. I don't want to think about the number of articles I've read in the last 3 years, but one issue I continually encountered was the speed with which the information was changing. We might see a completely new paradigm daily, or see a proposal for new therapeutics with some anecdotal result completely obliterated 3 days later by another report where the anecdotal or uncontrolled (we weren't at the point where RCTs were practical) study brought the original article into question.
A lot of the public needs a secret decoder ring, and as much as they think they have it in "The Internet", What we've seen has been people attempting to interpret high-level discussions among scientists, available in the open on, e.g., Twitter, and because the words and phrases sounded like something they were familiar with, felt they understood the nuance. In those discussions, among experts, a lot of jargon and shorthand were used, masquerading as "English" and that secret decoder (education and experience) was a hard requirement to get all (or most) of the information. To borrow a phrase, "These words, I don't think they mean what you think they say."
One significant issue during the previous administration was who was writing the press releases. Rarely did CDC or FDA write their own releases: They had politically responsive teams in place to do that. Said team at CDC even got to be too much for Redfield. They took proposed CDC material and made it into something more politically acceptable. Mask guidance? Let's water that down to nothing. And then we had media outlets (on both sides, unfortunately) that tried to spin pandemic news to some agenda I never really understood (note that I almost withdrew completely from media reports on COVID for 3 years so I could honestly say I wasn't getting my material from a media source, but from scientific data and reported statistics.
I've said since about June 2020 that we were not communicating well and that we needed to do better. I'm a very small voice, but people like YLE, who did a stellar job of communicating the material, DID gain traction and were listened to.
Are there any instances of “misinformation” during the pandemic that later were proven true?
Remember when it was misinformation to question whether natural immunity protected as well as vaccines? Or to question vaccine mandates (that have silently faded without apology or explanation)?
That seems like a bit of a straw man. It's not that anyone questioned whether immunity from infection was protective - immunity is immunity, regardless of the source. In fact - it was precisely the observed immunity after infection that gave scientists the "search warrant" to develop vaccines.
The issues with relying on infections versus vaccines are that infections themselves are (1) infections are way likelier to inconvenience, disable, or kill you (2) infections are contagious.
- anything short of n95 fit tested, single use, on clean shaven face, with surgical tape around perimeter likely useless
- decent odds it accidentally came from WIV, the several lies exposed from zoonotic proponents (specifically Daszak, Fauci) hasn’t helped our confidence
- several approved drugs later rescinded turned out to be useless (I don’t mind this, they were trying and I appreciate when they admit something doesn’t work and pull)
- vaccine had zero impact on transmission, we only got briefly fooled by dosing people as seasonal wave was ending at end of 2020
- it’s possible vaccine causes you to be more likely to get future infections-need honest research on this. This was well documented risk pre2020 (literally out of the mouth of Covid “Titan” Ralph avarice).
- Closing schools was good idea
- locking up playgrounds, closing parks, beaches
- Sweden model wouldn’t work
- China “zero Covid” could work
- lots of sensational reporting no one resigned over “Welcome to Iowa, the state that doesn’t care if you live or die” (WaPo); “Georgias experiment with human sacrifice” (The Atlantic)
- over counting child deaths (CDC) - for the record there’s been zero excess deaths in children anywhere in the world, though the US had a spike in accidental deaths (homicide, drowning, poison, vehicle). Still small increase thankfully
- it’s hard to argue vaccine lowered excess deaths considering countries with low excess deaths pre vaccine had spikes post vaccine and vice a versa, and countries with low vaccine uptake have little consequence
- little to no evidence contract tracing did anything beneficial, just randomly forced quarantines. Can anyone show me where this worked?
- testing could slow/end the pandemic. The more a country tested, the more if found. We gave platform to Michael Mina who profited from testing to make demonstrably false claims in Time Magazine and no one held him accountable
- “2 weeks to flatten the curve”
On the other hand, Covid minalmalists got wrong
- child suicide increase
- vaccine dangerous (I mean, I didn’t take it, but only because I don’t feel like feeling like shit a day or two like 1/3 the people know who later got Covid and felt like shit anyway).
I think a big part of the problem with public health messaging/communication is the lack of nuance, and an unwillingness to express uncertainty. We saw this play out over and over during the Covid crisis. First, masks were definitely not needed, because, Fauci now admits, they didn't want people taking them away from first responders. Then, they were required and nearly 100% effective, which is nonsense--only N95s, worn properly, are effective--forcing people to wear cloth masks even *outside* was absurd. There was lack of nuance around so many other things: school attendance (no one was allowed to question whether kids should in fact not just go to school for educational reasons, but also because they actually benefit from exposure to viruses!); vaccines (timing, efficacy/intent); the value of testing, which types to use and when; the actual risk to different populations...
Part of the reason for this is political, absolutely. But much of it is a sense that people are just not that smart, and if you tell them, say, that N95 masks will help prevent spread but please don't use them right now because we need them for our docs and nurses, they'll all run out and hoard the PPE. Or, if you say that most kids can and should attend school, but that if yours are at risk of infection or of infecting an at-risk adult, they should do school online, most people will freak out. Etc.
Not sure how to handle that problem, but it's HUGE. Public health messaging is designed for the lowest-common denominator mind, with the intent of directing behavior, and often is intentionally false as a result.
This is an extremely good point. We have generally been treated as if we are all little children who can’t possibly grasp nuance, let alone accept that “I don’t know” is quite often the appropriate answer. Honesty, humility, and respect in communications are all key to this. It all goes back to that old saying, “Give a person a fish, and you feed the person for a day. Teach a person to fish, and you feed that person for a lifetime.” One of the biggest unmet needs, which still remains, is offering us all, and particularly those of us who remain at higher risk, information that enables us to assess risk for ourselves and make choices about our behavior based on those assessments.
Dr Nirav Shaw, head of the Maine CDC, is a tremendous communicator. He exemplifies all the skills you mentioned. Mainers all across the State looked forward to his radio appearances that happened up to three times per week during the pandemic. He took questions from the press after each report and was patient and approachable. He began each report with condolences to families who had lost a person to COVID. He explained the science in a way that was easy to understand. I think he has now left Maine and is at the National CDC .
Thank you both so much for this brilliant clarion call, which is in itself a paragon of clear communications. To me, this is the money quote (though there are many contenders in this post): “The proper goal of communication is to tell people honestly and clearly what the situation is, what risks they face, and what they should do to keep themselves and their families safe. Missteps can be avoided by properly acknowledging uncertainty: What do we know? What do we not know? And how are we trying to find answers?”
This seems like the sort of editorial which The Hill might find interesting. Although it is not known widely by the general public, The Hill is known and read by a number of important people in DC and is widely quoted by other news sources. It also tends to appreciate material from people who are expert in those fields. I will be exceedingly disappointed in them if you submitted this and they did not carry it. Frankly, I am very disappointed in any publication which did not honor such common sense.
The most successful vaccine communication I had was when I reminded folks that "The Human Genome Project" started when I was in medical school, and took almost 10 years and millions of dollars to produce the code for one person. Since Crisper (which they have heard of) anyone can get most of their genome in a week for only a few dollars. Science has advanced dramatically in the last 15 years. Since almost everyone has heard or 23 and me or Ancestry.com, it makes sense.
We then review that DNA is code for making something like protein, antibodies, or cell structures. Proteins don't create DNA, its the other way around. mRNA is "just the messenger" Don't kill (or discredit) the messenger, just doing its job. If DNA is the cookbook, mRNA is a snippet instruction from one part of one recipe. The mRNA then leaves the cell nucleus to find a ribosome (cook?) to get the protein actually assembled.
I then remind them that their DNA is absolutely unique to them, no one ever has or ever will have their sequence. However, their ribosomes are identical to mine, to my dog's, and identical to every vertebrate on this planet. Ribosomes see an appropriate mRNA, and they get to work. It's what they do.
So, scientists studying and using CRISPER, and studying errors in DNA (cancer), have been preparing for pandemics for decades. The plan was ready, just waiting for the fateful virus code. It was awesome to watch the international cooperation in getting this new type of vaccine out in record speed. mRNA has the potential to be used in more than just vaccines, and I tell them to be prepared to see it used in many other fields of medicine.
I also expressed frustration over the ridiculous lack of science education offered by the government, treating all of us as if we were too dumb to understand. There is nothing political about DNA translation, and now there are fantastic youtube illustrations to help explain things. Most people love learning these things, because it matters.
At least the folks who still declined the vaccine after my efforts are now aware that ribosomes are amazing, dependable, and underappreciated.
Sorry this was so long! Your postings have been a tonic these long, dark years!
Absolutely stellar description of the mRNA encoding (cooking) process. Thank you! Unfortunately, CRISPER and DNA editing have been politicized already. There are concerns about creating "the perfect human" that have been voiced. Still, CRISPER was the basis for being able to respond so fast.
Communication is always the sticking point. I had, in the past, been pretty good at communicating with patients and family (usually at bedside) in a manner they could understand, adapting my approach to their degree of understanding. During the pandemic, and working for a non-profit essentially as one of their few epidemiologists, I was overwhelmed with data and didn't communicate well. Sometimes I gave too much information, sometimes I dumbed it down to the point people felt insulted. I failed, with many others, at the communication game although I had succeeded in the past. For that matter, I've been accused of the same thing on Substack.
I concur: These two scientists have done a stellar job of communicating throughout this pandemic. And I thank them.
Thanks for taking this on! I agree with all you say, and also think that we need to take a long term approach to this problem. It is great to ask those in positions of authority to focus on clear, truthful communication, but we also need to include communication training as a mandatory part of all graduate training in the sciences! This does not mean that all graduate students need to be trained to speak to the public. It does mean that all graduate students should be able to speak clearly and intelligibly to a scientist outside of their specialty. This is the bread and butter of scientific communication. There is no excuse for why most scientists are so poor at it. If we can get scientists talking clearly to each other we will have taken a big step in solving the problem of communication to the public.
Bazinga! Thank you, Dr. Rivers! I think you and Dr. Jetelina are doing great with this newsletter. This line says it all: "...we must focus instead on getting our own house in order by improving core communications." I live in greater Kansas City, and we had a pandemic team from KU Med Center that has a 2-4 minute segment on the local news, that go over the local COVID stats, treatments, and other breaking news about the virus. I don't think they're doing it anymore, but, it was the 'familiar faces we know and trust' that you wrote about.
Honestly, the CDC has promoted misinformation themselves by not taking clearer stances on masking, aerosol transmission, and long covid prevention. This isn't just about how public health communicates, but WHAT they are communicating and why. Whose interests are they protecting? How do they decide whose lives are important? Immune-compromised people are being actively harmed by public health policies right now, such as ending masking requirements in healthcare all over the country--which tells many people that covid is over now, even though it's not. It's hard to look at public health as a whole and see their communication as their biggest failure in fighting misinformtation. They are actively contributing to some of the misinformation out there.
Yes! 100%. Everytime I see something from Who or CDC that encourages handwashing, but not clean air (aka masking, ventilation etc). I cringe and trust them a little less. Who are we to listen to trust?
I hate politics in public health matters but if we're to be honest, it is the Fox News information ecosystem that's been the source of probably 90% of the bad info out there. Get rid of that info ecosystem and things clear up. But they are too powerful to wish away unfortunately! Tie them up in unending litigation says I.
Dominion is working on it to the tune of $1.6 billion. Go Dominion.
More power to them and their legal team. As you know News Corp.can bring in battalions of experts, who will all be reading off the same script. Like rubber squeeze dolls they will all be saying "Dominion isn't worth that much.". "Dominion hasn't proved losses". It's gonna be monotonous.
A necessary part of achieving this goal is to learn how to effectively communicate risk.
When I am talking to patients about serious diseases and treatments with a reasonable probability of harm, I try and find language that is intelligible to them. Using percentages with four significant digits is not helpful.
Depending on the particulars of the case helpful phrases include the following:
- “Unfortunately you do not have any completely safe options“
- “A few people will be harmed by this therapy but most people will live longer with it”
- “We are all working together to help you live as long and as comfortably as possible“
- “The treatment we are discussing has quite a bit of burden and most patients your age and with this disese complete their lives within 6 months even with the treatment so we also want to discuss the option of focusing on comfort care and hospice."
- "What are your goals?"
Really appreciate the clarity of your insights and experience. Communicating risk has to be one of the hardest things to do, and at the same time the most necessary.
Nicely done, but not surprised the WaPo, home of Leana Wen, rejected it.
Thing is, I have in-laws who believe in a flat earth, love Trump. I’ve had a friend tell me that Covid was both a Chinese bioweapon and a hoax—both. At the same time.
Not sure what you do with that.
Hard to fight "stupid".
I must have the same friend. I've heard that claim recently.
So sorry Doug! I have family who supports that mentally ill asswipe! I moved far away from my 6 brothers and 2 sisters! Of the 9, 3 are human and 6 are mentally ill monsters! Shithole America I dumbass whiny white guy at a time!
Honesty about what we do and do not know, without spin, is critical. Spinning information by emphasizing the positive and omitting the negative erodes trust just as much as, if not more than, an outright lie.
"Half the truth is often a great lie." - Benjamin Franklin
Having worked at FDA during the HIV crisis (1990-93) and again from 1999 to 2016, one observed the increasing LAYERS of lawyers and non-scientists who had to clear any public statement. All the Centers, even though the product had no direct relation to their work, had to clear public statements. Not just be informed but to clear. For any public health crisis there should be a SMALL crisis team with scientists as the final clearance in place in public institutions. Yes, include a lawyer and a PR person but the core of the team needs to be the scientific experts and they should have the final say.
IN response to the comment re mis-information = you are NOT informed if you only listen to the major TV news. I have challenged my scientist friends to commit to listening, during a crisis, to the following: news on 2 major channels like ABC, NBC, CBS & PBS AND then Tucker Carlson. If you are not willing to at least LISTEN to an alternative belief system then you are just as ignorant of what is happening as those who refuse to hear any other perspectives. Yes, I wish he were less snarky and wore socks but that is not the point. Closed minds do not bother to even hear what others have to say, whether you like it or not. Though I have been a life long Democrat, I now find my Democratic friends much more closed-minded, & unwilling to listen or try to understand my Republican friends' opinions. They have become self-righteous and that is dangerous. D. Murphy, MD, FAAP
Completely concur that communication from the Agencies should be via a Crisis Communications Team. And your recommended makeup sounds very reasonable to me. It sorta mirrors the FEMA/NIMS PAO process: Bring in the experts to explain their little piece, the Incident Commander to explain the overall response, and the PAO to maintain control in the presser, and serve as advisor in the preparatory phase to make sure it can be understood. PA shouldn't dictate what can be said, and Legal should make sure the mandatory "i's" are dotted and "T's" are crossed.
Pre-pandemic, I tried to scan news from about 5 or six sources daily, including Fox... and Al Jazeera... to gain a cross-section of presentation for what was being reported. Gave me some idea of what most of my friends might be thinking, and the ability to discuss things with almost all of them, as well as other people I might encounter. It also allowed me to analyze the various streams, almost as if they're disparate intelligence sources and form several opinions or positions of Best Case, Middle Case and Worst Case when trying to understand a situation.
When I started doing significant epidemiology and attempting to understand and produce material for the group I support, I intentionally stopped looking at the media reports on COVID because I was initially told that I'd gotten my information from this outlet or that, even though I was citing papers or personal communications. Me? I started literally leaving the room during the news to preclude being "contaminated" by even a network's experts. Any network. I immersed myself into published reports, and there were certainly enough of them, and was active online with several chat groups of clinicians working in ER and critical care. I had a direct line to my State Epidemiologist (until he resigned in disgust), and staff epi's at the State Health Dept., but couldn't make inroads into real people at CDC and FDA. My statements and interpretations were evidence based and included citations to the extent possible (didn't name the clinicians I was talking with). And because I eliminated the media from my data sources, I was, at the same time, not following an agenda from a larger group, but still accused of doing the same. I didn't consider how to best approach the different groups and that meant I was often considered wrong by both Democrats and Republicans. My wife, with decades of clinical experience, DID watch the news, and she often disagreed with what I'd say until she saw the literature I was following. She was my biggest critic for not communicating well with "the masses".
I've started easing back into my old ways of scanning a number of sites. but to be honest, I fully understand why people get comfortable in their echo chambers. We live in a "Conservative" area and just last night, out for dinner, I got my dose of OAN for the week. But for them, the pandemic is well and truly over, so there was no news on that.
I was working in Houston in the 1980s when AIDS, then an ill-understood phenomenon, kicked into high gear. Spent a lot of time in ICUs in the Texas Medical Center.
Bingo. The arrogance, overconfidence, and inability to weigh competing hypotheses by US democrats is astounding
A timely set of comments with which nobody should disagree! One suggestion I have been making for only three years now is that Persons In Authority must work around the clock to eliminate from the Public Health patois all uses of weasel words or weasel phrases from official spokespersons in the Gubment --- I am talking about folks who, despite MD and or MPH after their names, have serially attempted (with just lousy skills) to tip-toe around, technically "tell the truth", but all the while not totally tell the truth with a crispness befitting the nature of the COVID-19 pandemic situation. There have been hundreds of televised instances of this nonsense to date, going all the way back to the very first month of the pandemic. Oddly -- and I mean *really oddly* -- the release of noxious nattering as continued all the way into the current reign of folks like Jha, Walensky, et al. The uses of cute jingles, catchy jargon, business-world buzzwords, oily weasel phrases, hand-waving gestures while speaking, saying "you know" in every other sentence like some junior high kid hanging out in a mall, and the deployment of just truly dumbed-down metaphors ---- taken in total all of this has comprised nothing less than a very calculated dispersal of bullshit. This must stop. Seriously. Period. Not negotiable.
Birx was the originator of things like "15 Days to Slow the Spread", something she learned in her years of making inroads into HIV prevention and treatment overseas. That it was misused and subsequently abandoned didn't make its initial use less useful overall. And for the record, that junior high kid probably reads at ab bit above the 6th grade level. MOST of our targeting is for people who read in the 6th to 8th grade levels. Those of us who've spent a bit more time in science can interpret what was said; those with less rigorous training can usually catch things on the first pass.
But I've got to, overall, agree with your sentiment: We have to be truthful (that means not silencing folks like Nancy Messonnier for her comments at a CDC presser) and accurate. Sometimes the more trite expressions should be used (note my comment about 6th grade reading levels) to achieve the broadest understanding.
I do know that one problem I encountered was the speed with which new data came out. I don't want to think about the number of articles I've read in the last 3 years, but one issue I continually encountered was the speed with which the information was changing. We might see a completely new paradigm daily, or see a proposal for new therapeutics with some anecdotal result completely obliterated 3 days later by another report where the anecdotal or uncontrolled (we weren't at the point where RCTs were practical) study brought the original article into question.
A lot of the public needs a secret decoder ring, and as much as they think they have it in "The Internet", What we've seen has been people attempting to interpret high-level discussions among scientists, available in the open on, e.g., Twitter, and because the words and phrases sounded like something they were familiar with, felt they understood the nuance. In those discussions, among experts, a lot of jargon and shorthand were used, masquerading as "English" and that secret decoder (education and experience) was a hard requirement to get all (or most) of the information. To borrow a phrase, "These words, I don't think they mean what you think they say."
One significant issue during the previous administration was who was writing the press releases. Rarely did CDC or FDA write their own releases: They had politically responsive teams in place to do that. Said team at CDC even got to be too much for Redfield. They took proposed CDC material and made it into something more politically acceptable. Mask guidance? Let's water that down to nothing. And then we had media outlets (on both sides, unfortunately) that tried to spin pandemic news to some agenda I never really understood (note that I almost withdrew completely from media reports on COVID for 3 years so I could honestly say I wasn't getting my material from a media source, but from scientific data and reported statistics.
I've said since about June 2020 that we were not communicating well and that we needed to do better. I'm a very small voice, but people like YLE, who did a stellar job of communicating the material, DID gain traction and were listened to.
Are there any instances of “misinformation” during the pandemic that later were proven true?
Remember when it was misinformation to question whether natural immunity protected as well as vaccines? Or to question vaccine mandates (that have silently faded without apology or explanation)?
That seems like a bit of a straw man. It's not that anyone questioned whether immunity from infection was protective - immunity is immunity, regardless of the source. In fact - it was precisely the observed immunity after infection that gave scientists the "search warrant" to develop vaccines.
The issues with relying on infections versus vaccines are that infections themselves are (1) infections are way likelier to inconvenience, disable, or kill you (2) infections are contagious.
- cloth masks useless
- anything short of n95 fit tested, single use, on clean shaven face, with surgical tape around perimeter likely useless
- decent odds it accidentally came from WIV, the several lies exposed from zoonotic proponents (specifically Daszak, Fauci) hasn’t helped our confidence
- several approved drugs later rescinded turned out to be useless (I don’t mind this, they were trying and I appreciate when they admit something doesn’t work and pull)
- vaccine had zero impact on transmission, we only got briefly fooled by dosing people as seasonal wave was ending at end of 2020
- it’s possible vaccine causes you to be more likely to get future infections-need honest research on this. This was well documented risk pre2020 (literally out of the mouth of Covid “Titan” Ralph avarice).
- Closing schools was good idea
- locking up playgrounds, closing parks, beaches
- Sweden model wouldn’t work
- China “zero Covid” could work
- lots of sensational reporting no one resigned over “Welcome to Iowa, the state that doesn’t care if you live or die” (WaPo); “Georgias experiment with human sacrifice” (The Atlantic)
- over counting child deaths (CDC) - for the record there’s been zero excess deaths in children anywhere in the world, though the US had a spike in accidental deaths (homicide, drowning, poison, vehicle). Still small increase thankfully
- it’s hard to argue vaccine lowered excess deaths considering countries with low excess deaths pre vaccine had spikes post vaccine and vice a versa, and countries with low vaccine uptake have little consequence
- little to no evidence contract tracing did anything beneficial, just randomly forced quarantines. Can anyone show me where this worked?
- testing could slow/end the pandemic. The more a country tested, the more if found. We gave platform to Michael Mina who profited from testing to make demonstrably false claims in Time Magazine and no one held him accountable
- “2 weeks to flatten the curve”
On the other hand, Covid minalmalists got wrong
- child suicide increase
- vaccine dangerous (I mean, I didn’t take it, but only because I don’t feel like feeling like shit a day or two like 1/3 the people know who later got Covid and felt like shit anyway).
- WEF,NWO,Gates conspiracy to control the world
I think a big part of the problem with public health messaging/communication is the lack of nuance, and an unwillingness to express uncertainty. We saw this play out over and over during the Covid crisis. First, masks were definitely not needed, because, Fauci now admits, they didn't want people taking them away from first responders. Then, they were required and nearly 100% effective, which is nonsense--only N95s, worn properly, are effective--forcing people to wear cloth masks even *outside* was absurd. There was lack of nuance around so many other things: school attendance (no one was allowed to question whether kids should in fact not just go to school for educational reasons, but also because they actually benefit from exposure to viruses!); vaccines (timing, efficacy/intent); the value of testing, which types to use and when; the actual risk to different populations...
Part of the reason for this is political, absolutely. But much of it is a sense that people are just not that smart, and if you tell them, say, that N95 masks will help prevent spread but please don't use them right now because we need them for our docs and nurses, they'll all run out and hoard the PPE. Or, if you say that most kids can and should attend school, but that if yours are at risk of infection or of infecting an at-risk adult, they should do school online, most people will freak out. Etc.
Not sure how to handle that problem, but it's HUGE. Public health messaging is designed for the lowest-common denominator mind, with the intent of directing behavior, and often is intentionally false as a result.
This is an extremely good point. We have generally been treated as if we are all little children who can’t possibly grasp nuance, let alone accept that “I don’t know” is quite often the appropriate answer. Honesty, humility, and respect in communications are all key to this. It all goes back to that old saying, “Give a person a fish, and you feed the person for a day. Teach a person to fish, and you feed that person for a lifetime.” One of the biggest unmet needs, which still remains, is offering us all, and particularly those of us who remain at higher risk, information that enables us to assess risk for ourselves and make choices about our behavior based on those assessments.
Dr Nirav Shaw, head of the Maine CDC, is a tremendous communicator. He exemplifies all the skills you mentioned. Mainers all across the State looked forward to his radio appearances that happened up to three times per week during the pandemic. He took questions from the press after each report and was patient and approachable. He began each report with condolences to families who had lost a person to COVID. He explained the science in a way that was easy to understand. I think he has now left Maine and is at the National CDC .
I agree with you. I live in NH, but listened to him on Maine Public Radio and channels 6, and 8. Maine was fortunate to have him.
Thank you both so much for this brilliant clarion call, which is in itself a paragon of clear communications. To me, this is the money quote (though there are many contenders in this post): “The proper goal of communication is to tell people honestly and clearly what the situation is, what risks they face, and what they should do to keep themselves and their families safe. Missteps can be avoided by properly acknowledging uncertainty: What do we know? What do we not know? And how are we trying to find answers?”
This seems like the sort of editorial which The Hill might find interesting. Although it is not known widely by the general public, The Hill is known and read by a number of important people in DC and is widely quoted by other news sources. It also tends to appreciate material from people who are expert in those fields. I will be exceedingly disappointed in them if you submitted this and they did not carry it. Frankly, I am very disappointed in any publication which did not honor such common sense.
The most successful vaccine communication I had was when I reminded folks that "The Human Genome Project" started when I was in medical school, and took almost 10 years and millions of dollars to produce the code for one person. Since Crisper (which they have heard of) anyone can get most of their genome in a week for only a few dollars. Science has advanced dramatically in the last 15 years. Since almost everyone has heard or 23 and me or Ancestry.com, it makes sense.
We then review that DNA is code for making something like protein, antibodies, or cell structures. Proteins don't create DNA, its the other way around. mRNA is "just the messenger" Don't kill (or discredit) the messenger, just doing its job. If DNA is the cookbook, mRNA is a snippet instruction from one part of one recipe. The mRNA then leaves the cell nucleus to find a ribosome (cook?) to get the protein actually assembled.
I then remind them that their DNA is absolutely unique to them, no one ever has or ever will have their sequence. However, their ribosomes are identical to mine, to my dog's, and identical to every vertebrate on this planet. Ribosomes see an appropriate mRNA, and they get to work. It's what they do.
So, scientists studying and using CRISPER, and studying errors in DNA (cancer), have been preparing for pandemics for decades. The plan was ready, just waiting for the fateful virus code. It was awesome to watch the international cooperation in getting this new type of vaccine out in record speed. mRNA has the potential to be used in more than just vaccines, and I tell them to be prepared to see it used in many other fields of medicine.
I also expressed frustration over the ridiculous lack of science education offered by the government, treating all of us as if we were too dumb to understand. There is nothing political about DNA translation, and now there are fantastic youtube illustrations to help explain things. Most people love learning these things, because it matters.
At least the folks who still declined the vaccine after my efforts are now aware that ribosomes are amazing, dependable, and underappreciated.
Sorry this was so long! Your postings have been a tonic these long, dark years!
Absolutely stellar description of the mRNA encoding (cooking) process. Thank you! Unfortunately, CRISPER and DNA editing have been politicized already. There are concerns about creating "the perfect human" that have been voiced. Still, CRISPER was the basis for being able to respond so fast.
Communication is always the sticking point. I had, in the past, been pretty good at communicating with patients and family (usually at bedside) in a manner they could understand, adapting my approach to their degree of understanding. During the pandemic, and working for a non-profit essentially as one of their few epidemiologists, I was overwhelmed with data and didn't communicate well. Sometimes I gave too much information, sometimes I dumbed it down to the point people felt insulted. I failed, with many others, at the communication game although I had succeeded in the past. For that matter, I've been accused of the same thing on Substack.
I concur: These two scientists have done a stellar job of communicating throughout this pandemic. And I thank them.
Thank you to both of you for all you are doing.
Thanks for taking this on! I agree with all you say, and also think that we need to take a long term approach to this problem. It is great to ask those in positions of authority to focus on clear, truthful communication, but we also need to include communication training as a mandatory part of all graduate training in the sciences! This does not mean that all graduate students need to be trained to speak to the public. It does mean that all graduate students should be able to speak clearly and intelligibly to a scientist outside of their specialty. This is the bread and butter of scientific communication. There is no excuse for why most scientists are so poor at it. If we can get scientists talking clearly to each other we will have taken a big step in solving the problem of communication to the public.
Bazinga! Thank you, Dr. Rivers! I think you and Dr. Jetelina are doing great with this newsletter. This line says it all: "...we must focus instead on getting our own house in order by improving core communications." I live in greater Kansas City, and we had a pandemic team from KU Med Center that has a 2-4 minute segment on the local news, that go over the local COVID stats, treatments, and other breaking news about the virus. I don't think they're doing it anymore, but, it was the 'familiar faces we know and trust' that you wrote about.
Honestly, the CDC has promoted misinformation themselves by not taking clearer stances on masking, aerosol transmission, and long covid prevention. This isn't just about how public health communicates, but WHAT they are communicating and why. Whose interests are they protecting? How do they decide whose lives are important? Immune-compromised people are being actively harmed by public health policies right now, such as ending masking requirements in healthcare all over the country--which tells many people that covid is over now, even though it's not. It's hard to look at public health as a whole and see their communication as their biggest failure in fighting misinformtation. They are actively contributing to some of the misinformation out there.
Yes! 100%. Everytime I see something from Who or CDC that encourages handwashing, but not clean air (aka masking, ventilation etc). I cringe and trust them a little less. Who are we to listen to trust?