Crisis Communication in the Pandemic Era

CridCommun

Max R. Lum Ed.D., MPAApril 15, 2021Senior Advisor, e-Communication and Research TranslationNIOSH-CDC, Office of the Director Washington, D.C.

Why is effective communication of risk so important?

• High level of public interest in the problem• Public acceptance of the solution depends

on participation and understanding• Our personal credibility depends on ability

to communicate• Quality of decision-making is improved• The likelihood of finding a solution is

increased

Communication Basics

• Be serious and accurate• Avoid too much information• Strive for clarity• Accommodate the lawyers• Propose a call to action• Understand your audience

Be Serious

Avoid Too Much information

Accommodate the Lawyers

Warning ….Seriously?

Warning Label on a Baby Stroller

Don’t Forget the Call to Action

Strive for Clarity

Communication Basics

• Be serious and accurate• Avoid too much information• Strive for clarity• Accommodate the lawyers• Propose a call to action• Understand your audience

Q. Please explain “variants”

A. The analysis being reference reported on the identification of seven variants in the U.S. that contain a spike protein substitution. Q677P/H. Position 677 is near the furin-clevage site (681-685) and may increase the ability of the virus to replicate

Clarity: Simplify the language • The analysis being reference reported on the

identification of seven variants in the U.S. that contain a spike protein substitution. Q677P/H. Position 677 is near the furin-cleavage site (681-685) and may increase the ability of the virus to replicate

• This study identified seven variants of SARS-COV-2 in the US with specific changes in the spike protein that may increase the ability of the virus to replicate

Clarity: Simplify the Language

Clarity: Using Numbers

Percent With Correct Answers

Germany 28%

USA 25%

Clarity: Using VisualsMore than 25% of Americans will eventually die of cancer” might sound less scary from a different perspective:

“Nearly 75% of Americans will not die of cancer.” The same information might seem clearer described as a ratio:

“More than 1 in 4 Americans will eventually die of cancer.

Clarity: A Good Visual?

Just Plain Stupid?

Clarity: How Do You Rate This Graph?

• Staying sober-fail fail rate:

Communication Basics• Be serious and accurate• Avoid too much information• Strive for clarity• Accommodate the lawyers• Propose a call to actionBe careful with

numbers and visuals• Understand your audience

Know Your Audience:Segmentation

Know Your Audience

A Few Key Points from the Literature & Practice

• Risk is complex concept and difficult to communicate in ways that are convincing and lead to avoidance decisions

• Perceived risk is the same as real risk• Emotions play a major role• Need to know your audience• Concept of risk is a social decision

Segmentation is Key

• Health professionals need detailed pages with technical language and guidance

• Personnel setting up testing need simplified training resources

• The media needs details in plain language• The public needs information that

addresses their concerns

Same Question Different Answers

5 Cardinal Missteps for Crisis Communication

1. Pre-crisis planning is essential 2. Mixed messaging/over-reassurance3. Understanding and harnessing social media is critical4. Must have the right team (by function and by temperament)5. Must learn from our mistakes

Risk Communication Basics

Emotions play a major rolePerceived risk is the same as real riskNeed to know your audienceConcept of risk is a social decision

How Could We Not Foresee the Importance of Pre-crisis Planning?

2001 Anthrax Spores mailed to politicians (US)2002-2004 SARS2009 HINI Influenza pandemic2012 MERS respiratory syndrome outbreak2013-16 Zika epidemic2014-15 Ebola epidemic2019- COVID-19 pandemic

Who Got it Right?Unlike public health responses to Ebola where local communities were essential in taking control Taiwan decided on a whole country approach and implemented a technical communication digital solution

Linked digital databases . Classified travelers’ infectious risks based on flight origin and travel history in the past 14 days

Used SMS (short messaging service) Used QR code scanning Home quarantine Implemented a toll-free number served as a hotline for citizens to report suspicious

symptoms or cases in themselves or others; this hotline reached full capacity quickly, so each major city was asked to create its own hotline as an alternative

The government addressed the issue of disease stigma and compassion for those affected by providing food, frequent health checks, and encouragement

#Masks4all. Everyone must wear a mask when out in public. Taiwan has no bailouts and no new debt or taxes to pay for one.

Taiwan’s Approach

Digital Technology as a Tool for Preparedness and Response

32

Digital Technology as a Tool for Preparedness and Response Lancet 2020

Digital Response to the COVID Crisis

• Hong Kong, location-tracking wristbands are given to those put under quarantine.

• Singapore, the government uses text messages to contact people, who must click on a link to prove they are at home

• Thailand rolled out a mobile app that anyone arriving at an airport must download to help monitor where they have been in the event that they test positive for the virus.

• Vietnam also launched a mobile app to help track cases, and it could be used to enforce quarantines

• South Korea and Israel, are using satellite-based phone tracking for so-called contact tracing to see where infected individuals might have passed SARS-CoV-2 to others.

• China has used a wide range of intrusive personal methods to monitor the health and whereabouts of people and enforce restrictions on movement.

Digital Tracing and Information SystemsMore Centralized

• China• Singapore • Japan• South Korea• Taiwan

Less CentralizedContacts receive notification of their proximity to infected people, but health authorities are notified only if the individual fails to do so

CanadaAustraliaEstoniaGermanySwitzerlandUKUSA?

The public would have to be assured and trust public health personnel to never use the data for any other purpose

How Many People Downloaded the COVID Safe App?

Crisis Communication: The Five Common Missteps

1. Pre-crisis planning, and the use of technology is essential

2. Mixed messaging and a strong tendency to over-reassure must be addressed 3. Understanding and harnessing social media is critical4. Must have the right team (by function and by temperament) 5. Must learn from our mistakes

Mixed Messages: Clarity, Accuracy, Serious?

Sources Statement Correction

US Surgeon General “Begs people to stop buying masks” March 1 CDC: use non-medical masks April 3

WHO Air transmission doubtful and “a problem mostly for medical procedures” March

Virus does linger in the air. July 6

WHO Asymptomatic transmission “very rare” Corrected

Chloroquine and Spurious claims

“ I take it” No evidence of efficacy

Political leaders It’s just like the flu Not really

French Ministry of Health

Warning on using Ibuprofen for fever WHO: “not recommending against the use”

Public outrage “Limiting my freedom of choice, goes against human nature and God’s will

Continues…

The Ultimate Mixed Message

Wearing masks: “You can do it. You don’t have to do it. I’m choosing not to do it, ” It’s only a recommendation.” President Trump

Dangerous Message

“It isn’t a very aggressive virus. You would have to sneeze in someone’s face to pass it on. (Belgium’s Federal Health Minister).” (NYT. August 9, 2020)

Lack of Targeted Communication Messagesand the Consequences

• Sweden: Lack of communication targeting can be harmful. Swedish leaders have admitted that things went wrong in terms of the death toll, specifically in elderly care homes. 48.8% mortality rate

• Belgium: Belgium now has, by some measures, the world’s second highest coronavirus death rate per capita, in part because of nursing homes. More than 5,700 nursing-home residents have died. 66% of morality rate

• Australia and the US: Elderly mortality rate = 40%

Reliance on Local Authorities for Communication Outreach

• Brazil’s reliance on regional governors• U.S. reliance on state governors for purchasing

supplies and messaging• Mexico’s reliance on the mayors for outreach and

messaging

.

1. Planning early enough 2. Limit mixed messaging and a strong tendency to over-reassure

3. Not understanding and harnessing digital media4. Not having the right team (by function and by temperament) to build trust and provide advice.5. Not learning from our mistakes

5 Missteps to Getting it Right

Use of Digital Apps in Selected Countries

GermanyThe Paulaner Brewery Group in Munich published regular health and safety posting on the homepage of its employee app. The focus was on preventive measures to protect employees and the production site, guidelines on travel, videos with hygiene tips and guidelines on the information chain to be followed.

The BVG Berlin’s major transport company with so many of its employees at risk interacting with the public updated its employee app with articles on hand washing techniques, how to avoid panic, advice on how to deal with the threat of the virus, authoritative information on health and safety from the German Institute responsible for disease control and prevention

Business Developed Apps

Business Developed Apps

American and European countries provided company apps in China to better control the risk message and avoid mixed messages coming from government sources

Understandingand Using Social Media

5 Mistakes To Getting it Right

1. Planning early enough 2. Limit mixed messaging and a strong tendency to over-reassure3. Not understanding and harnessing digital media

4. Not having the right team (by function and by temperament) to build trust and provide advice.5. Not learning from our mistakes

Having the Right Team by Function and Temperament

48

49

Watch that Body Language

What Business Can Teach US • The culture comes first (only people can create culture)• Decide early and communicate loudly and consider digital• Think about the impact on the wider community• Lockdowns create hidden problems. How to plan for these?• Make remote work part of your talent strategy, Wi-Fi is not

remote work. Establish criteria for remote work• Give people tools and support they need to connect• People need accurate information …..often • Make company communications more engaging• Be prepared for hard conversations• Train managers to handle and manage remote work

Crisis Communication: The Five Common Missteps

1. Pre-crisis planning is essential 2. Mixed messaging and a strong tendency to over-reassure

must be addressed 3. Understanding and harnessing social media is critical 4. Must have the right team (by function and by temperament)

5. Must learn from our mistakes

Tapping into Human Behavior Theory

My Mask

My Handwashing Study n=2

55

Crisis Communication in the Pandemic Era, Pelly’s Industrial Hygiene New Edition, May 2021.