How lessons learned from past health outbreaks can help doctors now
Tara Kirk Sell, Ph.D., M.A., is a senior scholar at the Johns Hopkins Center for Health Security and an assistant professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health. Dr. Sell’s research focuses on pandemic preparedness and public health communications and policy responses to public health emergencies, such as the Zika virus and Ebola outbreaks, to discover ways to improve future preparedness and response. We spoke with her to get her thoughts on what we are facing now during the COVID-19 crisis in the U.S.
The most dangerous threat, and what we learned from Ebola
Much of Dr. Sell’s research looks at public health communication around large-scale health events: the messaging from public health organizations, how those messages are mediated by the news media, how those messages are received by the public, and what kind of messages resonate the most with the public when it comes to an outbreak. “Most often, people don’t want to hear as much about the threat, which they seem to be generally fairly familiar with, but they do want to know a lot about protective actions,” she said.
Dr. Sell’s work also encompasses the mis- and disinformation that spreads during these crises—misinformation meaning inaccuracies stemming from errors, while disinformation refers to false statistics, claims, etc., deliberately intended to cause harm. Her research examines how public health can communicate effectively to get people to take appropriate action in the midst of these unhelpful and potentially harmful messages, such as suggestions to inject disinfectants or ingest chlorine dioxide.
We asked Dr. Sell how big she considers the problem of misinformation with COVID-19 compared to prior epidemics such as Zika and Ebola. “I think it’s a big problem. Each one has its own unique challenges, but at the same time, there does seem to be a lot of carryover when it comes to the misinformation topics. We see a lot of conspiracies, we see a lot of false cures,” she said.
‘Misinformation causes deterioration of trust. And in losing trust, public health care will lose the battle against disease.’ – Dr. Sell
Dr. Sell says there’s a larger problem that’s even more dangerous than potential adverse health effects from false cures, however. “Misinformation and disinformation really have the potential to—and may be designed to—cause deterioration of trust. And when we don’t have trust in our communication we can’t get people to do the things they need to do. They don’t support public health or doctors or other health care workers in the work that they’re doing. And in losing trust, public health care will lose the battle against disease.”
She gives the example of the Ebola outbreak in Africa. Widespread community buy-in was necessary to manage the epidemic. People needed to trust that if they or their family members went to an Ebola treatment center they would receive care and weren’t just being sent there to die. And they had to agree to follow safe burial practices, even if they went against cultural norms.
“If you don’t have community buy-in when you’re trying to respond to an outbreak you’ll never be able to win,” said Dr. Sell. “You might have the best plan, you might have a vaccine that works, but if people don’t do what you ask them to do, you’re back at the beginning.”
‘Rightsizing’ our understanding of COVID-19 risks
What we’re seeing play out in the U.S. are the effects of the mis- and disinformation on social media and in the news that push us towards the extremes, said Dr. Sell. On one side you have people who view COVID-19 as terrifying and impossible to control, and feel that the risks are out of their hands. On the other end of the spectrum are the people who think this is all a hoax and there’s no risk at all.
“I think that people really need to rightsize their understanding of the severity of this outbreak,” she said. There is a middle ground where we can recognize the risks while also doing our part to mitigate them by social distancing, proper hand washing, and other protective measures.
Gather news from a variety of sources, and let patients know why you are making certain decisions and how your policy might change as information does.
For her part, Dr. Sell makes a point to get her information from a variety of sources to understand what’s out there and to consider a range of perspectives. She also recommends the CDC’s Crisis & Emergency Risk Communication (CERC) resources. For doctors communicating with patients, be clear about what you do know and what you don’t know, and what you’re doing to try to figure it out. Share what information is causing you to make certain decisions and how your policy might change with changing information.
The critical role all doctors must serve now
Even though everyone’s attention is currently on COVID-19 and many practices are temporarily closed except for urgent care, all healthcare providers are serving a critical purpose right now, said Dr. Sell.
“Doctors, not just the ones on the front lines, have a really important role in communicating true information to their patients and other members of the public because time after time, the research tells us the person patients trust the most is their doctor.”
Research shows that doctors are trusted sources of information for patients and the general public.
Especially during times like we’re currently experiencing, “the best way to get information to members of the public is through trusted communication channels, and doctors are critical parts of that,” said Dr. Sell. “Information coming from someone people trust is one of the most powerful things that we have to combat misinformation.”
As the U.S. moves towards reopening, all healthcare professionals will play a role in setting the tone for what’s safe, necessary, and appropriate. “It’s important to do things based on the science and based on thoughtful considerations of the risks,” said Dr. Sell.
We all need to balance the risk of COVID-19 against the risks of other health consequences that might result from lapses in routine, preventative care. “We don’t know if we’ll ever get a vaccine, and certainly if we do it’s a long way off,” said Dr. Sell. Until then, doctors will need to establish safe and thoughtful ways to move forward and make sure that their patients continue to get necessary care to detect, prevent, and treat all conditions that affect their health.
We’re continually producing new content to support your patient communication efforts throughout the pandemic and beyond. We’ll help you reassure patients that you are prioritizing their health and safety as you reopen.
Photo credit: House Science Committee
Dr. Sell giving Congressional testimony on March 5, 2020