Communication Breakdown:

10 Communication Lessons Learned from

Dr. Tom Frieden’s Handling of the Ebola Crisis

R. Alan Martín

November 2014

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16 November 2014

“Be first. Be Right. Be Credible.”*

*CDC’s Crisis and Emergency Risk Communication (CERC) message.

1. No Empathy in the First 30 Seconds

CDC Ebola media briefing, 30 September 2014, 5:30 p.m. EDT, confirming first Ebola case in U.S. First 30+ seconds of briefing by Dr. Tom Frieden: Good afternoon, everybody. Thanks for joining us. As you have been hearing us, Ebola is a serious disease. It's only spread by direct contact with someone who's sick with the virus. It's only spread through body fluids. The incubation period is 8 to 10 days after exposure. Can be as short as two days or as long as 21days. It's a severe disease which has a high case fatality rate, even with the best of care. But there are core tried and true public health interventions that stop it.

2. Blaming the Victim

CDC update on Dallas Ebola Response,12 October 2014,

11 a.m. EDT:

At some point, there was a breach in protocol and that

breach in protocol resulted in this infection.

The protocols work. ... But we know that even a single

lapse or breach can result in infection.

3. Do as I say, not as I do.

Dr. Frieden’s Interview with Megyn Kelly, The Kelly Files, Fox News Network15 October 2014

Segement of Dr. Frieden’s Interview with Megyn Kelly, The Kelly Files, Fox News Network15 October 2014:

KELLY: How do you account for the fact that you called it a breach in protocol, the fact that this nurse has Ebola, this nurse who was wearing protective gear has Ebola now. How do you know it was a breach in protocol and not simply that the protocol itself was insufficient?

FRIEDEN: We know how Ebola spreads. We know how to stop it from spreading. But clearly, what happened at the hospital shouldn't have happened. So we're now looking at that and saying, OK, what's everything we can do to make sure that any time someone's caring for Ebola, their risk is kept to an absolute minimum.

KELLY: OK. But when I look at the CDC's website, it says that when you're putting on the protective gear as the medical personnel, and you know that the nurses have come out and complained that in some of these hospitals, they're just posting it on the bulletin board. "Hey, check the CDC's website to figure out how to deal with Ebola." And the nurses are saying, "Really? A life and death matter for me? This is insufficient."

But I looked at the website and it says, you are only supposed to wear one pair of gloves. And it says, you don't have to cover your head, you know, head gear, head cover, and you don't have to cover your feet. Now, wouldn't you admit that that is insufficient?

FRIEDEN: No. We know how Ebola spreads. It spreads by direct contact. And you know, sometimes more isn't better. You put on more layers, you put on more things, they're harder to get on. They're harder to get off.

KELLY: Really?

FRIEDEN: Yes, really.

Dr. Frieden in Monrovia, Liberia with Personal

Protective Devices (PPD), 28 August 2014

4. Public is Not Empowered—Paternalistic

Interview with Megyn Kelly, The Kelly Files, Fox News

Network, 15 October 2014:

And third, we're reminding doctors everywhere to think

Ebola. Because whatever you may think, we are an

interconnected world.

Ultimately, the only way—and you may not like this—but

the only way we'll get our risk to zero here is to stop the

outbreak in Africa.

5. Adding to the Fear Ebola may be Airborne

CDC Ebola Media Briefing 30 September 2014, 5:30 p.m.

EDT, confirming first Ebola case in U.S.:

We are working with U.S. Aid and other parts of the

government as well as with a broad global coalition to

confront the epidemic there. Ultimately, we are all

connected by the air we breathe.

6. Forgetting Your Audience

CDC Ebola Media Briefing 7 October 2014, 3:00 p.m. EDT. Confusing

geography lesson to an American audience on West Africa:

Now, we've been talking about West Africa, but the fact is, these are

three different countries and they have three different patterns of

disease. Even within each country, there are different patterns of

disease so in Liberia there are 15 districts, and in those different

districts, there are different patterns of disease. In some, they’ve had

very few cases of Ebola. In others, they are just beginning to have a big

increase in cases. I'll mention one particular district, which is in a

remote rural area, the capital city known as Lofa. In that district, that

was the forested district that is bordering both Sierra Leone and Guinea

and that three country border district is what has been the epicenter of

the outbreak.

7. Going Off-Topic

CDC Ebola Media Briefing 7 October 2014, 3:00 p.m. EDT. Changing the subject to the Marburg virus:

One other sign of progress that hasn’t been in the papers recently or until now is a single case in Uganda of a disease caused by the Marburg virus. Now Marburg is a lot like Ebola, except it didn’t have a movie made about it. Marburg has a similar case fatality rate. It’s spread in just about the same way, and it’s controlled in the same one. One individual died from Marburg. Their cause of death not immediately identified, but we've done important work in Uganda to help the Ugandans...

8. Wordy Message

Interview with Megyn Kelly, The Kelly Files, Fox News Network,

15 October 2014—almost 100 words in message:

First, making sure that the care of that nurse is safe and effective. We

have more than 20 staff on the ground who are working around the

clock making sure that those who care for her do it safely and that she

get the best possible care.

Second, we're making sure that if Ebola is found anywhere else in the

country, we will put on to the ground immediately staff who can help the

hospital do it right there.

And third, we're reminding doctors everywhere to think Ebola. Because

whatever you may think, we are an interconnected world.

9. Repeating a Negative

Interview with Megyn Kelly, The Kelly Files, Fox News Network,

15 October 2014. Caught with the word “outbreak”:

KELLY: Do you still believe, as the president said, that the

chances of an Ebola outbreak in the United States are extremely

low?

FRIEDEN: It's hard to stop Ebola, but there's no doubt in my

mind we will not have -- there's no doubt in my mind we will not

have a large outbreak of Ebola in the U.S.

KELLY: We won't have a large outbreak, but I mean, do you

admit we already have an outbreak?

10. Visual Communication

CDC Ebola Media Briefing 7 October 2014, 3:00 p.m. EDT.

Some stations cut-away soon after this “visual” during the

briefing:

References

Centers for Disease Control and Prevention (U.S.) (2014, September 30). CDC Press Conference: CDC Confirms

First Ebola Case Diagnosed in the United States| CDC Online Newsroom | CDC. Retrieved from

http://www.cdc.gov/media/releases/2014/t0930-ebola-confirmed-case.html

Centers for Disease Control and Prevention (U.S.) (2014, October 7). CDC Telebriefing: CDC update on first Ebola

case diagnosed in the United States, 10-07-2014| CDC Online Newsroom | CDC. Retrieved from

http://www.cdc.gov/media/releases/2014/t1007-ebola-confirmed-case.html

Centers for Disease Control and Prevention (U.S.) (2014, October 12). CDC update on Dallas Ebola Response,

10-12-2014| CDC Online Newsroom | CDC. Retrieved from http://www.cdc.gov/media/releases/2014/t1012-

ebola-reponse-update.html

Centers for Disease Control and Prevention (U.S.) (2014, October 15). CDC Tightened Guidance for U.S.

Healthcare Workers on Personal Protective Equipment for Ebola| CDC Online Newsroom | CDC. Retrieved

from http://www.cdc.gov/media/releases/2014/fs1020-ebola-personal-protective-equipment.html

Fox News Network (2014, October 15). CDC director defends Ebola response: 'Our information is clear and

correct' | Fox News. Retrieved from http://www.foxnews.com/transcript/2014/10/15/cdc-director-defends-

ebola-response-our-information-is-clear-and-correct/

Additional Resources on CERC and Ebola

Centers for Disease Control and Prevention (U.S.) (2014, June 25). Crisis & Emergency Risk Communication

(CERC)|CDC. Retrieved November 15, 2014, from http://www.bt.cdc.gov/cerc/

Centers for Disease Control and Prevention (U.S.). (2014). Crisis and Emergency Risk Communication – 2014

Edition (CS249215A). Retrieved from http://www.bt.cdc.gov/cerc/resources/pdf/cerc_2014edition.pdf

Centers for Disease Control and Prevention (U.S.) (2014, October 23). Ebola CARE Kit| CDC Online Newsroom |

CDC. Retrieved November 15, 2014, from http://www.cdc.gov/media/dpk/2014/Ebola-Care-Kit.html

[English and French]

Centers for Disease Control and Prevention (U.S.) (2014, November 14). Ebola Outbreak - 2014| CDC Online

Newsroom | CDC. Retrieved November 15, 2014, from http://www.cdc.gov/media/dpk/2014/dpk-ebola-

outbreak.html

World Health Organization (2014, November 14). WHO | Ebola response roadmap - Situation report. Retrieved

November 15, 2014, from http://www.who.int/csr/disease/ebola/situation-reports/en/