>So grateful for all you do to help not only public health folks, but all with specific areas of expertise to do a MUCH better job of public-facing communications.
>Every line of this is excellent, though I do have a personal favorite😎: “Under 1000 words. Bullet points. Bold. Headings. (The book Smart Brevity changed my perspective dramatically).”
Oh, I agree! Dr. Jetelina does a great job, also, laying out more detail and nuance in an organized format. I always find these articles a pleasure to read, along with being highly informative.
Couldn’t agree more (I’m a retired editor/proofreader). I used to work with mechanical and electrical engineers, translating their work into a form the average person could understand. During the pandemic I was just going crazy because I could see what was happening: the scientists were speaking their language, politicians were speaking their language and their target audience couldn’t understand any of it. Remember the story of the Tower of Babel? Things were great until everyone suddenly started speaking different languages, then what they created fell into ruin. I believe all stakeholders (politicians, scientists, and average Americans) need to work together to create messaging that’s accurate, easy to understand, and accessible.
As a long time Med device marketer my opinion is that the scientific community does some amazing research and some horrible communications. They need some Marketing Communications experts who can help with proper messaging for the community as a whole.
Thank you for your important comment Darren. Dr Jeremy Faust is an ER Doc who does a very good job now ... in real time Jeremy is the Author of Substack's "Inside Medicine" 🚑. Not quite as good as Your Local Epidemiologist ... :)
As a public relations practitioner specializing in public health and health communications, THANK YOU! Thank you for recognizing this and sharing it. I assure you none of us are laughing at your post, but forwarding it to our colleagues and saying "Look! Someone else gets it!”
A bunch of us get it. I knew I wasn't communicating well, early in the pandemic. I was simply overwhelmed and trying to keep up my reading/interpreting, and put out appropriate information. I was moving too fast, but couldn't make myself slow down.
Misinformation (wrong information that's accidentally spread as truth) and disinformation (intentional spread of incorrect and misleading information) are different and when they occur we should call it what it is. I can understand not using the term 'conspiracy theory' but if we aren't calling attention to what is misinformation and disinformation, we aren't helping anyone. If everyone is saying X is true when the reality is that y is true and X is misinformation we need to say so. How else to we combat it if we don't call it what it is?
You wrote: "Misinformation is a huge challenge, but proactive communication is even more critical. We can’t just put out fires but need to prevent them." So are you advocating for more of the censorship that was done on social media regarding COVID 19 issues? The kind of censorship that was done to factual statements which were censored merely because they cast doubt on public health policies and goals? That happened. And many of us don't like it. I don't think factual statements can be considered misinformation.
"Trusted messengers are everything." and then the next bullet point: "You will get things wrong. Own it." CDC director Walensky said if you get COVID shots you will not get COVID. A long time later we found out she knew that was not true when she said it. When questioned by a congressional committee about this she said something like "well, it was mostly true at the time." That's not owning it. That's lying. It's a good thing she resigned. As you know by now, the public want's the whole truth, not something that is "mostly" true.
What about the continued mandates for COVID shots? Some colleges require them, some don't. Some health care workers have mandates, some don't. I don't see you writing anything about COVID shot mandates and if they should continue. These mandates are public health policies that have a great effect on people's lives.
"CDC director Walensky said if you get COVID shots you will not get COVID" Actually the full quote is this: "And we have -- we can kind of almost see the end. We`re vaccinating so very fast, our data from the CDC today suggests, you know, that vaccinated people do not carry the virus, don't get sick, and that it's not just in the clinical trials but it`s also in real world data."
The CDC pointed out three days later that this was a oversimplification and did not, in fact, reflect the CDCs official position based on the available data.
Personally, I'm more inclined to pay attention to statements based on facts collected by actual scientists and epidemiologists who have made it their lives' work to study medicine as opposed to the kind of quackery practiced by your boy Joseph Mercola, your crystal-gazer Ana Maria "Do you know that your spirit and physical body are light?" Mihalcea, former physician Meryl Nass (license pulled for pushing loony anti-vax conspiracies) and the other snake-oil peddlers in whom you place so much faith.
Yeah, one thing that would really help would be if during press conferences and interviews, public officials would be more disciplined about answering questions by doing one of the following:
1. Giving a phone number.
2. Stating that they already answered that question
3. Delegating
4. Ending the press conference/interview
5. In the case of anything where health is involved, it's OK to tell people to talk to their doctors
Something I encountered was the number of practicing primary care docs who were not up-to-date on COVID-19. Case in point, my own PCP. Early on he listened patiently when I rattled on the topic. Within 2 months, I was getting email requests for information on pandemic topics from him, and I know now that he shared a fair bit of what I sent with colleagues and internal medicine residents in his program. Educating the docs is a team sport. It's unlikely a busy provider will have/take the time to gather the latest Public Health info and be able to immediately integrate them into practice. They need to cultivate their info sources (and he found the university's info sources tainted by state politics; 'nother story) for factual information they can use.
Of note, sending him info didn't require the translation I should have employed for the public. I could use jargon and if he didn't get it, he'd call or email a question.
They do, but the time necessary to read the volume of data available is the problem. I've not looked in a couple months, but last time I did look, I'd archived over 3000 articles and read over 10k. But that's a trivial amount of the over 350k articles out on the subject.
Can I give this 42 Likes so we do get this important topic addressed? (If it has been please let us know). What is our current understanding of the impact of (a) Covid vaccines and (b) Natural infection on reducing transmission? (with the various key nuances in that question) If (a) is negligible, what's the rationale for *requiring* vaccination for work or school?
Oy. First, vaccines represent probably the best way to avoid serious disease and death. The first vaccines, and I'm primarily talking about the mRNA vaccines, were focused on ancestral-strain SARS-CoV-2. Since then, however, we've seen significant variation in the virus' RNA sequences, and evasion of initial immunity. The bivalent boosters were found to be effective and some research has suggested they provide protection for up to 6 months. The next round of boosters will be monovalent (against a single variant) and targeted toward the prevalent variant of Omicron at the time they lock in vaccine composition. This should, again, provide some degree of preventive immunity for a short period, and a longer period of prevention of serious disease and death.
Naturally or disease acquired immunity is also likely to reduce the incidence of serious disease and death. Studies on the duration of said immunity are all over the timescale, but most I've seen of late suggest protection for at least 6 months.
Neither vaccine-acquired nor naturally-acquired immunity is sterilizing at this stage, meaning it will not stop the virus completely, and thus, while it may reduce transmission by decreasing viral load that can expose someone else, neither will eliminate transmission.
COVID-19 still has the potential for infecting, and reinfecting people. Each subsequent infection carries an increased risk of death or serious disease. Also, there are indications that multiple infections can predispose someone to acquiring Long COVID, something we're still sorting out but which has affected a sufficiently large group to be considered real, if somewhat diverse. Studies world-wide suggest that 5-40% of the population (depends on country statistics) suffer Long COVID after infection. This results in often debilitating symptoms, and can have an adverse effect on work/school. A review of the literature suggests vaccinated people are less likely to acquire Long COVID than those who were not vaccinated. So arguments can be made to reduce severity of the disease and to reduce the incidence Long COVID, mandating vaccination is still a reasonable idea.
An excellent summary on the importance of communication in a public health crisis and how to do it right. One of your points that I'd like to emphasize is this: "Communicating uncertainty is a must. What do you know? But more importantly, what do you not know?" Speaking as someone who studied COVID-related messaging across the political spectrum, I believe that the relative lack of clear and repeated explanations by the most prominent US public health spokespersons of the extent to which the government's well-intended actions and guidance was based on hypotheses (as opposed to sound facts) was perhaps the single largest factor in the wave of distrust of authorities that has swept over the American sociopolitical landscape since 2020, and that will continue to undermine public health for years to come.
I'm a mostly retired state public health agency bureau chief, brought back during the pandemic. I like this post a lot but it leaves important points out! You're wrong about a couple of things, Dr Jetelina: a) Good public health local leaders spend as much time as they have available working on communication, to their agency and the public, but a good deal of that effort is finding channels of communication. We communicate with the people we serve most effectively via news media, at least in my state, and to do that we must cultivate the science and health reporters who decide what gets on the air or (in the old days) printed. I worked at that. What you say is certainly true: we didn't communicate nearly enough, and left out important elements. But we need more communication channels.
b) We are often trained in "crisis communication" and how to talk with reporters - there are at least two very good researchers/experts in this field whose training I found very helpful. You might talk about that field in a future post.
c) The communication that must be done cannot be only done by communication professionals - it's often best done by the local public health practitioners and scientists themselves. This is because they are the potential "trusted sources" and know the whole detailed story, thus how to best put it into words that are both understandable and correct....if they have that skill, which is trainable.
Thank you for these wonderful translations of the science. They are widely read in my agency.
I think your points are well taken. That said, a couple of quibbles. We often had people communicating who didn't have the right messaging. That could have been because we didn't have the right channels (science and health reporters who could translate the material appropriately) or because we gave garbled messages. A lot of the communication this time was via social media. I started in that realm because I felt obligated to counter misinformation and occasionally call out disinformation. That meant I had to handle my own content, and that sometimes didn't work well. That said, we need to plan to add trusted source social media channels to the mix. To become a trusted source, we need to routinely post and have authoritative and factual data available regularly. We can no longer solely depend on print and television media pathways as our outlets.
I believe we also need to start now, putting people of your calibre into the spotlight in the traditional channels, so you, and/or your successors, are recognized and considered go-to sources by the media. It's time for public health to have dedicated personnel to post authoritative information on social media.
During the course of the pandemic I found the torrent of information caused me to lapse into poor communications performance. I've long been able to speak, one-on-one with patients and families and explain what's happening clinically. In the case of the pandemic, the information flow I tried to keep up with, all of which was pertinent to what we're discussing, was such that I certainly couldn't read every article but still such that I often spent 30 or more hours per week (my wife once claimed "per day") critically reading the articles. I had to spend more time after several articles proved to have questionable methods, data or statistics and were highlighted as fraud after publication. Thus, I read EVERY article as if I were a reviewer. Which takes more time. And then translate the material into something useful which can add or change the understanding of the material overall.
I'd LOVE to know who your crisis communications experts are.
A lesson learned after graduation from one of the giants in my field, Dentistry, was "The challenge for the dentist is to motivate patients to want what they need". It's different from "sales" which focuses on the needs of the provider rather than the patient. A skill not taught.
The challenge is to educate the patient, and clearly explain relevant risks, benefits and alternatives. Then the patient has to choose. A big issue in the current practice of dentistry is that insurance coverage seems to matter most to the patient, rather than what treatment would give them the best outcome. The other issue is that patients who go to an in-network provider don't realize that appointments are timed tightly and some offices are more concerned with keeping to the allotted time than providing full disclosure to the patient. It is so different now than it was 30-35 years ago, when it was all about relationships and trust between the provider and patient. Communication seemed so much more important then, but now it's all about expediency and production aka "sales."
Good list. I would add something learned from another Substack author, Jim Fallows, who is also a pilot and writes frequently about near-miss air disasters--controllers and pilots succeed in getting planes down safely by speaking exactly the same language to each other. When one or the other is off, even by a bit, they will self-correct and clarify.
I communicate with about 60 people a day between visits, phone calls, and messages through the EMR. A lot of these points apply well to individual communication, too.
Particularly like this: “Always furnish solutions. Include a call to action.”
I can't agree more. We need to go a step further when it comes to this communication. We need retired volunteer scientists and people who understand these communications to join under a non-profit. I do not understand why there isn't an organization or group dedicated to that. Well, there is your group, but you are also busy with yoir "day jobs." Misinformation was used to create chaos effectively, and people died because of it. It can't get more serious than that.
The last thing that I want to say is that unfortunately few people can be trusted to stay fully informed. Few people have kept up with developments over the last few years. I have done my best to share new developments, but it gets frustrating because people moved on, and they want to pretend the pandemic is over.
I would happily donate to a non-profit for scientific comms. Now is the time to capture lessons learned, plan and build networks and make concrete plans for next time. We all know it’s coming...
Excellent insight and list. For the past 50 years I have been doing analytics without borders, for 37 years with IBM. I have been a member of INFORMS for most of those years. This community refers to communication as a critical soft skill. When we do an applied project in analytics, we have customers who we have to successfully communicate with - the approach - I am the expert just believe me is a one way tickets out the door. I would listen to public health officials and cringe when they conveyed that attitude in communication - especially given the uncertainty of the knowledge we had. Once arrogance is conveyed, trust is lost the first time a mistake is made. With all respect, these are rookie mistakes in the private sector. It isn't just training in how to communicate, it is developing a humbleness on what one doesn't know - which isn't part of the culture. The phrase follow the "data and the science" backed everyone into a corner. Regular people still remember the recommendation to handle packages with gloves and wash your groceries.
A lesson I've learned is that a large fraction of the American people do not believe that "saving lives" automatically wins an argument. e.g. reopening schools. The Right was cold-hearted towards those more at risk to the virus. But the Left precluded legitimate conversations about the trade-offs. I think this helped deepen the schism and increased distrust by the Right of the medical establishment.
So perhaps a willingness to be honest about trade-offs should also be on the list.
I completely agree that honesty about trade-offs is necessary. However it's a mistake to draw political lines. It's also a mistake to condemn a large swath of the population for being cold-hearted.
I am curious to know how and why you have concluded that those who argued for schools to remain open were all or mostly on the "Right". I have many friends on both sides of the political spectrum that overturn your generalizations here.
There were models, that started in the George W. Bush era, looking at the next respiratory pandemic. Because coronavirus wasn't on their list, they were thinking in terms of pandemic influenza (H5N1) . One of the ways the model data suggested would markedly reduce transmission of a respiratory virus was to close schools. Closing schools wasn't due to mass hysteria but rather, by implementing a portion of the best prior planning we had at the time. I'll note that the incumbent administration had scattered the people responsible for pandemic planning to various departments and agencies, eliminating a cohesive working group, or had simply eliminated those positions.
And lest you attempt to cherry-pick the conclusion, as a long-time numerical modeler, I can tell you models are not real-world, but are often the best tool we have to determine what is likely to happen. Models are often incorrect but are also often very useful.
Brilliant-- you are so wonderful! I’m a physician and I took faculty development courses about medical education and the absolute best was from a dynamic palliative care pediatrician who taught us to keep it simple and no more “ death by PowerPoint”-- one hour and it made a huge difference-- to this day.
I have to comment, that when this all started, as a physician, as a scientist, I was baffled about what felt so obvious to me, a layperson in the world of pandemics and complex diseases like Covid.
That a virus could spread so quickly and effectively, and mysteriously at times, was so clearly airborne. That masks were important. I fully appreciated the need to spare the supply for us on the front line, even I struggled. Someone from the West Coast had n95s from the wild fires and overnighted me their small supply. The only real n95s I had for 6 weeks. I had 4 masks. I had to see patients. It was terrifying. People interpreted that lack of consistency as a lack of transparency.
I still don’t get it. That was more than just poor communication. I still really don’t understand the heck that was about. I find it hard to believe that it was not obvious at that time to the experts. It still baffles me.
Dr. Jetelina:
>YOU are a national treasure.
>So grateful for all you do to help not only public health folks, but all with specific areas of expertise to do a MUCH better job of public-facing communications.
>Every line of this is excellent, though I do have a personal favorite😎: “Under 1000 words. Bullet points. Bold. Headings. (The book Smart Brevity changed my perspective dramatically).”
I understand the bullet point thing for general messages, but I also love this blog because it really explains thing beyond the bullet points.
Oh, I agree! Dr. Jetelina does a great job, also, laying out more detail and nuance in an organized format. I always find these articles a pleasure to read, along with being highly informative.
Couldn’t agree more (I’m a retired editor/proofreader). I used to work with mechanical and electrical engineers, translating their work into a form the average person could understand. During the pandemic I was just going crazy because I could see what was happening: the scientists were speaking their language, politicians were speaking their language and their target audience couldn’t understand any of it. Remember the story of the Tower of Babel? Things were great until everyone suddenly started speaking different languages, then what they created fell into ruin. I believe all stakeholders (politicians, scientists, and average Americans) need to work together to create messaging that’s accurate, easy to understand, and accessible.
As a long time Med device marketer my opinion is that the scientific community does some amazing research and some horrible communications. They need some Marketing Communications experts who can help with proper messaging for the community as a whole.
Thank you for your important comment Darren. Dr Jeremy Faust is an ER Doc who does a very good job now ... in real time Jeremy is the Author of Substack's "Inside Medicine" 🚑. Not quite as good as Your Local Epidemiologist ... :)
As a public relations practitioner specializing in public health and health communications, THANK YOU! Thank you for recognizing this and sharing it. I assure you none of us are laughing at your post, but forwarding it to our colleagues and saying "Look! Someone else gets it!”
A bunch of us get it. I knew I wasn't communicating well, early in the pandemic. I was simply overwhelmed and trying to keep up my reading/interpreting, and put out appropriate information. I was moving too fast, but couldn't make myself slow down.
Misinformation (wrong information that's accidentally spread as truth) and disinformation (intentional spread of incorrect and misleading information) are different and when they occur we should call it what it is. I can understand not using the term 'conspiracy theory' but if we aren't calling attention to what is misinformation and disinformation, we aren't helping anyone. If everyone is saying X is true when the reality is that y is true and X is misinformation we need to say so. How else to we combat it if we don't call it what it is?
You wrote: "Misinformation is a huge challenge, but proactive communication is even more critical. We can’t just put out fires but need to prevent them." So are you advocating for more of the censorship that was done on social media regarding COVID 19 issues? The kind of censorship that was done to factual statements which were censored merely because they cast doubt on public health policies and goals? That happened. And many of us don't like it. I don't think factual statements can be considered misinformation.
"Trusted messengers are everything." and then the next bullet point: "You will get things wrong. Own it." CDC director Walensky said if you get COVID shots you will not get COVID. A long time later we found out she knew that was not true when she said it. When questioned by a congressional committee about this she said something like "well, it was mostly true at the time." That's not owning it. That's lying. It's a good thing she resigned. As you know by now, the public want's the whole truth, not something that is "mostly" true.
What about the continued mandates for COVID shots? Some colleges require them, some don't. Some health care workers have mandates, some don't. I don't see you writing anything about COVID shot mandates and if they should continue. These mandates are public health policies that have a great effect on people's lives.
"CDC director Walensky said if you get COVID shots you will not get COVID" Actually the full quote is this: "And we have -- we can kind of almost see the end. We`re vaccinating so very fast, our data from the CDC today suggests, you know, that vaccinated people do not carry the virus, don't get sick, and that it's not just in the clinical trials but it`s also in real world data."
This was said off the cuff on the Rachel Maddow show. Full transcript here: https://www.msnbc.com/transcripts/transcript-rachel-maddow-show-3-29-21-n1262442
The CDC pointed out three days later that this was a oversimplification and did not, in fact, reflect the CDCs official position based on the available data.
Personally, I'm more inclined to pay attention to statements based on facts collected by actual scientists and epidemiologists who have made it their lives' work to study medicine as opposed to the kind of quackery practiced by your boy Joseph Mercola, your crystal-gazer Ana Maria "Do you know that your spirit and physical body are light?" Mihalcea, former physician Meryl Nass (license pulled for pushing loony anti-vax conspiracies) and the other snake-oil peddlers in whom you place so much faith.
Yeah, one thing that would really help would be if during press conferences and interviews, public officials would be more disciplined about answering questions by doing one of the following:
1. Giving a phone number.
2. Stating that they already answered that question
3. Delegating
4. Ending the press conference/interview
5. In the case of anything where health is involved, it's OK to tell people to talk to their doctors
Something I encountered was the number of practicing primary care docs who were not up-to-date on COVID-19. Case in point, my own PCP. Early on he listened patiently when I rattled on the topic. Within 2 months, I was getting email requests for information on pandemic topics from him, and I know now that he shared a fair bit of what I sent with colleagues and internal medicine residents in his program. Educating the docs is a team sport. It's unlikely a busy provider will have/take the time to gather the latest Public Health info and be able to immediately integrate them into practice. They need to cultivate their info sources (and he found the university's info sources tainted by state politics; 'nother story) for factual information they can use.
Of note, sending him info didn't require the translation I should have employed for the public. I could use jargon and if he didn't get it, he'd call or email a question.
A lot of state libraries offer access to databases and electronic resources/journals to physicians licensed by their state
They do, but the time necessary to read the volume of data available is the problem. I've not looked in a couple months, but last time I did look, I'd archived over 3000 articles and read over 10k. But that's a trivial amount of the over 350k articles out on the subject.
They're lucky to have you as a patient. I think my takeaway is to have a doctor whose patients are doctors
Can I give this 42 Likes so we do get this important topic addressed? (If it has been please let us know). What is our current understanding of the impact of (a) Covid vaccines and (b) Natural infection on reducing transmission? (with the various key nuances in that question) If (a) is negligible, what's the rationale for *requiring* vaccination for work or school?
Oy. First, vaccines represent probably the best way to avoid serious disease and death. The first vaccines, and I'm primarily talking about the mRNA vaccines, were focused on ancestral-strain SARS-CoV-2. Since then, however, we've seen significant variation in the virus' RNA sequences, and evasion of initial immunity. The bivalent boosters were found to be effective and some research has suggested they provide protection for up to 6 months. The next round of boosters will be monovalent (against a single variant) and targeted toward the prevalent variant of Omicron at the time they lock in vaccine composition. This should, again, provide some degree of preventive immunity for a short period, and a longer period of prevention of serious disease and death.
Naturally or disease acquired immunity is also likely to reduce the incidence of serious disease and death. Studies on the duration of said immunity are all over the timescale, but most I've seen of late suggest protection for at least 6 months.
Neither vaccine-acquired nor naturally-acquired immunity is sterilizing at this stage, meaning it will not stop the virus completely, and thus, while it may reduce transmission by decreasing viral load that can expose someone else, neither will eliminate transmission.
COVID-19 still has the potential for infecting, and reinfecting people. Each subsequent infection carries an increased risk of death or serious disease. Also, there are indications that multiple infections can predispose someone to acquiring Long COVID, something we're still sorting out but which has affected a sufficiently large group to be considered real, if somewhat diverse. Studies world-wide suggest that 5-40% of the population (depends on country statistics) suffer Long COVID after infection. This results in often debilitating symptoms, and can have an adverse effect on work/school. A review of the literature suggests vaccinated people are less likely to acquire Long COVID than those who were not vaccinated. So arguments can be made to reduce severity of the disease and to reduce the incidence Long COVID, mandating vaccination is still a reasonable idea.
An excellent summary on the importance of communication in a public health crisis and how to do it right. One of your points that I'd like to emphasize is this: "Communicating uncertainty is a must. What do you know? But more importantly, what do you not know?" Speaking as someone who studied COVID-related messaging across the political spectrum, I believe that the relative lack of clear and repeated explanations by the most prominent US public health spokespersons of the extent to which the government's well-intended actions and guidance was based on hypotheses (as opposed to sound facts) was perhaps the single largest factor in the wave of distrust of authorities that has swept over the American sociopolitical landscape since 2020, and that will continue to undermine public health for years to come.
I'm a mostly retired state public health agency bureau chief, brought back during the pandemic. I like this post a lot but it leaves important points out! You're wrong about a couple of things, Dr Jetelina: a) Good public health local leaders spend as much time as they have available working on communication, to their agency and the public, but a good deal of that effort is finding channels of communication. We communicate with the people we serve most effectively via news media, at least in my state, and to do that we must cultivate the science and health reporters who decide what gets on the air or (in the old days) printed. I worked at that. What you say is certainly true: we didn't communicate nearly enough, and left out important elements. But we need more communication channels.
b) We are often trained in "crisis communication" and how to talk with reporters - there are at least two very good researchers/experts in this field whose training I found very helpful. You might talk about that field in a future post.
c) The communication that must be done cannot be only done by communication professionals - it's often best done by the local public health practitioners and scientists themselves. This is because they are the potential "trusted sources" and know the whole detailed story, thus how to best put it into words that are both understandable and correct....if they have that skill, which is trainable.
Thank you for these wonderful translations of the science. They are widely read in my agency.
jerry.gibson.sc@gmail.com
I think your points are well taken. That said, a couple of quibbles. We often had people communicating who didn't have the right messaging. That could have been because we didn't have the right channels (science and health reporters who could translate the material appropriately) or because we gave garbled messages. A lot of the communication this time was via social media. I started in that realm because I felt obligated to counter misinformation and occasionally call out disinformation. That meant I had to handle my own content, and that sometimes didn't work well. That said, we need to plan to add trusted source social media channels to the mix. To become a trusted source, we need to routinely post and have authoritative and factual data available regularly. We can no longer solely depend on print and television media pathways as our outlets.
I believe we also need to start now, putting people of your calibre into the spotlight in the traditional channels, so you, and/or your successors, are recognized and considered go-to sources by the media. It's time for public health to have dedicated personnel to post authoritative information on social media.
During the course of the pandemic I found the torrent of information caused me to lapse into poor communications performance. I've long been able to speak, one-on-one with patients and families and explain what's happening clinically. In the case of the pandemic, the information flow I tried to keep up with, all of which was pertinent to what we're discussing, was such that I certainly couldn't read every article but still such that I often spent 30 or more hours per week (my wife once claimed "per day") critically reading the articles. I had to spend more time after several articles proved to have questionable methods, data or statistics and were highlighted as fraud after publication. Thus, I read EVERY article as if I were a reviewer. Which takes more time. And then translate the material into something useful which can add or change the understanding of the material overall.
I'd LOVE to know who your crisis communications experts are.
Thank you for your detailed comments.
Gerry
A lesson learned after graduation from one of the giants in my field, Dentistry, was "The challenge for the dentist is to motivate patients to want what they need". It's different from "sales" which focuses on the needs of the provider rather than the patient. A skill not taught.
The challenge is to educate the patient, and clearly explain relevant risks, benefits and alternatives. Then the patient has to choose. A big issue in the current practice of dentistry is that insurance coverage seems to matter most to the patient, rather than what treatment would give them the best outcome. The other issue is that patients who go to an in-network provider don't realize that appointments are timed tightly and some offices are more concerned with keeping to the allotted time than providing full disclosure to the patient. It is so different now than it was 30-35 years ago, when it was all about relationships and trust between the provider and patient. Communication seemed so much more important then, but now it's all about expediency and production aka "sales."
Good list. I would add something learned from another Substack author, Jim Fallows, who is also a pilot and writes frequently about near-miss air disasters--controllers and pilots succeed in getting planes down safely by speaking exactly the same language to each other. When one or the other is off, even by a bit, they will self-correct and clarify.
Well communicated communique about communication!
I communicate with about 60 people a day between visits, phone calls, and messages through the EMR. A lot of these points apply well to individual communication, too.
Particularly like this: “Always furnish solutions. Include a call to action.”
I can't agree more. We need to go a step further when it comes to this communication. We need retired volunteer scientists and people who understand these communications to join under a non-profit. I do not understand why there isn't an organization or group dedicated to that. Well, there is your group, but you are also busy with yoir "day jobs." Misinformation was used to create chaos effectively, and people died because of it. It can't get more serious than that.
The last thing that I want to say is that unfortunately few people can be trusted to stay fully informed. Few people have kept up with developments over the last few years. I have done my best to share new developments, but it gets frustrating because people moved on, and they want to pretend the pandemic is over.
I would happily donate to a non-profit for scientific comms. Now is the time to capture lessons learned, plan and build networks and make concrete plans for next time. We all know it’s coming...
Excellent insight and list. For the past 50 years I have been doing analytics without borders, for 37 years with IBM. I have been a member of INFORMS for most of those years. This community refers to communication as a critical soft skill. When we do an applied project in analytics, we have customers who we have to successfully communicate with - the approach - I am the expert just believe me is a one way tickets out the door. I would listen to public health officials and cringe when they conveyed that attitude in communication - especially given the uncertainty of the knowledge we had. Once arrogance is conveyed, trust is lost the first time a mistake is made. With all respect, these are rookie mistakes in the private sector. It isn't just training in how to communicate, it is developing a humbleness on what one doesn't know - which isn't part of the culture. The phrase follow the "data and the science" backed everyone into a corner. Regular people still remember the recommendation to handle packages with gloves and wash your groceries.
A lesson I've learned is that a large fraction of the American people do not believe that "saving lives" automatically wins an argument. e.g. reopening schools. The Right was cold-hearted towards those more at risk to the virus. But the Left precluded legitimate conversations about the trade-offs. I think this helped deepen the schism and increased distrust by the Right of the medical establishment.
So perhaps a willingness to be honest about trade-offs should also be on the list.
I completely agree that honesty about trade-offs is necessary. However it's a mistake to draw political lines. It's also a mistake to condemn a large swath of the population for being cold-hearted.
I am curious to know how and why you have concluded that those who argued for schools to remain open were all or mostly on the "Right". I have many friends on both sides of the political spectrum that overturn your generalizations here.
There were models, that started in the George W. Bush era, looking at the next respiratory pandemic. Because coronavirus wasn't on their list, they were thinking in terms of pandemic influenza (H5N1) . One of the ways the model data suggested would markedly reduce transmission of a respiratory virus was to close schools. Closing schools wasn't due to mass hysteria but rather, by implementing a portion of the best prior planning we had at the time. I'll note that the incumbent administration had scattered the people responsible for pandemic planning to various departments and agencies, eliminating a cohesive working group, or had simply eliminated those positions.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022492/pdf/pone.0097297.pdf
This work was done in the White House, but was claimed en masse by HHS.
And lest you attempt to cherry-pick the conclusion, as a long-time numerical modeler, I can tell you models are not real-world, but are often the best tool we have to determine what is likely to happen. Models are often incorrect but are also often very useful.
Brilliant-- you are so wonderful! I’m a physician and I took faculty development courses about medical education and the absolute best was from a dynamic palliative care pediatrician who taught us to keep it simple and no more “ death by PowerPoint”-- one hour and it made a huge difference-- to this day.
Thank you.
I have to comment, that when this all started, as a physician, as a scientist, I was baffled about what felt so obvious to me, a layperson in the world of pandemics and complex diseases like Covid.
That a virus could spread so quickly and effectively, and mysteriously at times, was so clearly airborne. That masks were important. I fully appreciated the need to spare the supply for us on the front line, even I struggled. Someone from the West Coast had n95s from the wild fires and overnighted me their small supply. The only real n95s I had for 6 weeks. I had 4 masks. I had to see patients. It was terrifying. People interpreted that lack of consistency as a lack of transparency.
I still don’t get it. That was more than just poor communication. I still really don’t understand the heck that was about. I find it hard to believe that it was not obvious at that time to the experts. It still baffles me.