Day: February 4, 2020

Wuhan Coronavirus/2019-nCoV Update: February 4th, 2020 (and Some Frank Talk About Proper Risk Communication by Governments During a Potential Pandemic by an Expert)

I can tell that a certain amount of “WuFlu fatigue” has already begun to set in among my readers, according to my WordPress viewer stats. That’s probably to be expected; nobody wants to keep reading bad news.

My Twitter feed, which I had taken such pride in ruthlessly pruning to follow only those people in social VR and virtual worlds, has suddenly become a rather bizarre mix of social VR/virtual worlds and various good, authoritative sources of information about the 2019-nCoV outbreak. (By the way, if you want a credible list of people to follow on Twitter, epidemiologist Dr. Ellie Murray has compiled a curated list of coronavirus experts that you can subscribe to.)

One of the people I am following is a brand new account called simply nCoV2019. There is no biography provided, zero information about who this person is, and there’s no way to learn their background or qualifications, but God damn it, whoever they are, I think they have been BANG. ON. THE. MONEY. lately in their coverage of the Wuhan coronavirus.

One of the things this person did yesterday was share several excerpts of a report from the 2009 H1N1 “swine flu” influenza pandemic about risk communication by governments, and a lot of what they are sharing is directly applicable to the current 2019-nCoV situation.

Here’s a quote from the paper by Dr. Peter M. Sandman and Dr. Jody Lanard, titled Containment as Signal: Swine Flu Risk Miscommunication, from the Peter Sandman Risk Communication website. Please note that the following quoted text is **NOT** about 2019-nCoV, but about the H1N1 influenza virus!

How should they explain the goals and endpoints of containment to their publics?

Many governments doing intense swine flu containment are signaling that the purpose of containment is to prevent local spread of the virus – not just slow it or reduce its impact, but actually prevent it. Many of these governments explicitly tell their people that this is the goal; some just signal it without actually saying so. In all cases, these signals and messages are misleading, since containment will eventually fail.

Thus governments are setting themselves up to be blamed, and setting their people up to be shocked and unprepared for imminent domestic epidemics.

The misleading signals and messages about containment violate a very basic risk communication principle for helping people cope with bad news that is likely to worsen: anticipatory guidance, telling people what to expect.

As I have reported in today’s and previous days’ updates, many infectious disease experts are now openly saying that we can expect a pandemic, as nCoV2019 has tweeted:

The message from many infectious disease experts, such as Dr. Michael Osterholm (which I blogged about here), Dr. Anthony Fauci (which I blogged about here) and Dr. Gregory Poland and Dr. Scott Gottlieb (which I blogged about here) could not be clearer:

Despite our best efforts, we here (in countries outside China) will probably NOT be able to successfully contain the 2019-nCoV virus, because it seems to be so easily transmissible. Eventually, it WILL begin to spread widely around the world.

Here’s another pertinent quote from that 2009 Sandman/Lanard swine flu paper (again, please note that the following quoted text is **NOT** about 2019-nCoV, but about the H1N1 influenza virus):

…we believe the combination of the containment strategy itself and the way that strategy is being communicated has had a huge impact on worldwide public understanding of the novel H1N1 pandemic, especially in the developing world. We think the containment signal has:

– led many publics to expect that swine flu will be prevented from entering or at least from spreading in their country;
– led many publics to believe that swine flu is currently more severe than it actually is (so far);
– led many governments to adopt containment measures that experts consider epidemiologically ineffective and economically harmful;
– led many governments to continue initially sensible containment measures long after they were no longer useful; and
– led many governments to beg the World Health Organization to delay declaring swine flu a pandemic, in part because they did not want to tell their people that swine flu’s continuing spread was unstoppable.

And when the swine flu containment strategy is ultimately abandoned, the risk communication signals sent by that strategy – if uncontradicted by explicit government communications – can lead many publics to become more mistrustful of their government and more alarmed about swine flu.

In other words, if governments and institutions do not do a proper job of risk communication in the face of a potential pandemic, they will only amplify public panic and reduce people’s trust in government, if/when things do become worse.

Peter Sandman has posted the text of an email message he shared with Canadian National Post journalist Sharon Kirkey on January 29th, 2020. (Sharon Kirkey later wrote an article on the coronavirus threat for the National Post, quoting part of what Peter wrote to her.)

I am going to quote Peter’s message at length, because I think it is required reading:

My most fervent risk communication complaint at the moment is the tendency of many top officials in the U.S., Canada, and Europe to overemphasize the fact that the risk of the novel Wuhan coronavirus here and now is tiny – as if that meant that people should (or could!) wait to worry until the risk here and now got bigger. “No reason for alarm,” is bad science as well as bad risk communication. Officials and experts are alarmed already – reason enough for the public to gird up its loins as well.

Worry is about the future. Telling people not to worry about an emerging infectious disease because it isn’t a significant risk here and now is foolish. We want people to worry about measles when there’s very little measles around, so they will take the precaution of vaccinating their children before it’s imminently necessary. We want people to worry about retirement when they’re years away from retiring, so they will start saving now.

Given the real possibility that the coronavirus might start spreading locally in North American cities, now is the right time to worry and prepare, at least emotionally and perhaps logistically as well. There’s not much reason to wear masks against the coronavirus in North America now. Masks may or may not turn out to be useful in the months ahead. In case they do turn out useful, buying them now is provident, not panicky.

Even more importantly, telling people they are foolish to worry about an emerging infectious disease is patronizing and contemptuous – when what is needed is empathy. When confronted with a risk that’s new and scary, people naturally go through what some risk communication professionals call an adjustment reaction. We temporarily overreact – feeling and imagining and even behaving as if this possible future threat were here and now. The adjustment reaction is unavoidable and usually pretty brief. It is also useful, an emotional rehearsal. It helps us prepare for the new normal that may be coming.

Instead of deriding people’s fears about the Wuhan coronavirus, I would advise officials and reporters to focus more on the high likelihood that things will get worse and the not-so-small possibility that they will get much worse. I think there is little need to ameliorate public over-reaction now. The bigger need is to reduce public over-reaction later to predictable bad news that will take people by surprise insofar as they weren’t sufficiently forewarned and didn’t get enough chance to rehearse emotionally. My wife and colleague Jody Lanard M.D. says to tell you that adjustment reactions are “like tabletop exercises for regular people.” Officials should help the public rehearse better, not tell people not to rehearse.

Good Sources of Information on 2019-nCoV

Here is my list of good, credible, authoritative resources to learn more about the Wuhan coronoavirus (more formally known as 2019-nCoV):

If you want a quick, up-to-date overview of the current situation, here are three good places to check:

Sources of Fast-Breaking News on 2019-nCoV (WARNING: News You Read Here May Not Be 100% Credible!)

PLEASE READ: In addition to the sources listed in the previous section, there are other places you can check, which might have reports (including translated links to local social media in China) that have not yet made the mainstream news media. Please keep in mind that the situation in China is chaotic, and that some of the information you find in the sources I list below might be gossip, rumours, hoaxes, conspiracy theories, misinformation, or disinformation! 

Please review the information and videos I posted in my blogpost about How to Spot Fake News, BEFORE using any of these links.

Stay healthy!