Our coronavirus response requires good risk communication – leave the ghouls out of it
Vincent Lam, The Globe and Mail
January 31, 2020
uring the SARS outbreak of 2003, I was an emergency physician at the Toronto East General Hospital. Now called Michael Garron Hospital, it cared for SARS patients, and the way we delivered care to all of our patients was seriously affected.
Non-essential clinics were closed. We used a large event tent and TTC buses in order to screen staff and patients. A colleague of mine was exposed to SARS and was admitted to hospital. Others were quarantined at home.
It was sobering to have my temperature taken each day before donning a mask and gown, knowing that I could potentially be exposed to a dangerous infection each time I went to work, and that if I became ill, I might expose my family to illness. My fellow physicians, as well as nurses, paramedics and other health-care workers, all worked under this strain.
Patients in our emergency department were also masked and I strained to hear their muffled descriptions of symptoms. In contrast, some panic-tinged voices in the media coverage of SARS were sharp and perhaps too easy to hear.
As now with 2019-nCoV, daily tallies of case and fatality numbers made for easily written and dramatic headlines. Public-health practitioners, then as now, walked a careful line communicating both information and risk in a sensible way, while implementing reasonable precautions. In the best instances, media was a partner in good communication.
The profession of medicine attracted me with the prospect of “doing things” – fixing people and saving lives. It turns out that all of medicine is predicated upon risk assessment and risk communication, which guides intervention where appropriate. Central to the practice of public health is the concept that the public is the patient.
With the emergence of 2019-nCoV, the first crucial task is to assess and communicate risk to that patient. This is difficult to do well. We human beings are not good at processing information around risk.
Our minds are biased toward overestimating the significance of novel risks and nonchalantly accept familiar ones. One may imagine a person who is terrified before boarding a roller coaster, who calms their nerves by smoking a cigarette.
Media is tilted toward generating sensation, rather than communicating nuance or placing issues in perspective. A Jan. 28 New York Times headline regarding 2019-nCoV read, Death Toll Exceeds 100 As Number Of Infections Skyrockets. A hundred human deaths constitutes a great loss, and the number of deaths is higher as you read this.
However, does the number 100 seem different if we place it next to U.S. National Highway Traffic Safety Administration data that 120 pedestrians were killed weekly by drivers of vehicles in the United States in 2018? What if we view the number 100 alongside the 365 Canadians who died each month in apparent opioid-related overdoses during the first nine months of 2019? What if the headline used the word “rises” instead of “skyrockets?” There may be fewer clicks.
On the same day, an opinion piece in the same paper wrote that coronaviruses “evolve as quickly as a nightmare ghoul.” For that claim to be accurate, one would need good data on the evolution of ghouls.
It would be incorrect to suggest that 2019-nCoV is nothing to worry about. The middle truth may sound frustratingly vague, but here it is: There is a legitimate worldwide concern regarding 2019-nCoV. The information that we have, and the situation itself, will change. The recommendations around what to do will change as the situation evolves. When this happens, it will be incorrect to view that as proof of previous public-health error or incompetence. It may be a sign of open communication and timely adaptation to a dynamic situation.
During SARS, I remember the long hours of wearing isolation masks, which grew hot and wet, pressing red welts into my cheeks. My glasses did not sit properly over the nose of the mask, so the hospital always appeared off-kilter.
Work was tiring, but the acuity of fear settled as the situation became a new normal. Important medical services continued. For the most part, good public communication in Canada allayed panic. Lessons were learned that were later applied during the H5N1 influenza outbreak in 2008, and that can be applied now.
I realized during SARS that we relied upon capacities within systems, institutions, culture and people, which need to be in place prior to the emergence of a new virus. It is worth now reminding ourselves of the importance of these strengths.
Our health-care system is universally accessible. This is an advantage in addressing infectious disease risk. Anyone can access required health-care services, which serve to both care for that individual and to protect others who are not ill.
Our hospitals are non-profit, publicly funded institutions, such that in a disease outbreak the motivation is to act in the public interest, and without profit concerns. Our political culture is one that values openness and transparency in public communication. This can lead to a range of opinions on any issue, and meanwhile the potential strength is a public confidence in knowing that nothing is hidden. The professionals who work in health care are highly skilled, compassionate and have a deeply felt sense of duty to the public.
We should understand that these are not strengths that can be pulled out of a closet in the case of emergency. These are strengths that require ongoing commitment, both by the public and by those who work in these systems and institutions. They offer us much when there is no emerging viral illness and when we are grappling with one.
When people ask me how to tell if a doctor is good, I tell them, “Look for a doctor who can explain what they know, who will be open about what they don’t know, who can recommend reasonable actions despite imperfect information, and who is willing to change their advice as knowledge evolves.” As the 2019-nCoV issue evolves, my advice is to listen most closely to the voices that speak in this way.