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September 14, 2017
Urging Vigilance Without Inciting Panic
When health information may seem alarming
Walk, do not run, to the nearest exit. We hear this line often as a warning for what to do in the case of an emergency, be it in a crowded movie theater or airplane. It’s prudent advice, because hysteria only escalates the danger.
More recently, we have seen the rise of the “stay calm” meme, which dates back to a motivational poster created by the British government in the face of an emerging war in 1939 but actually never used, with the words “keep calm and carry on.”
In both cases, we see the core message that we need to take action but not panic.
Health officials, and their communicators, often walk a fine line between urging vigilance yet not inciting panic when faced with a public health threat. The Ebola outbreak of 2013–2016 provides an instructive example. This was the most widespread outbreak of Ebola virus disease since it was first detected in 1976. From December 2013 to January 2016, there were more than 28,000 cases and 11,000 deaths1, almost entirely in western Africa, and this is likely an underestimate.
Serious stuff. However, the risk of contracting the disease outside of the three African countries most affected by the outbreak—Guinea, Liberia, and Sierra Leone—was extremely low. Human-to-human transmission occurs only through direct contact with blood or other bodily fluids from an infected person, most commonly when directly caring for a person sick or deceased as a result of the Ebola virus. Nevertheless, worldwide panic set in, fueled in part by inaccurate news reports overestimating the risk or sensationalizing the outbreak. In some cases, people who had visited parts of the vast continent of Africa thousands of miles from the outbreak were barred from school or work upon their return to the United States or Europe.
As health communicators, we have a responsibility to understand the facts and relay them accurately and in a timely manner to the public so that people can make decisions based on facts and not hearsay. Part of this is to be aware of any inaccurate information that people might be sharing, on social media or elsewhere.
The situation becomes more complicated when the facts are evolving. Such is the case for the Zika virus, a pathogen that mostly causes no symptoms, or only mild and manageable symptoms in the infected but can, in pregnant women, result in severe brain malformations for the developing fetus. As we saw with Ebola virus, many people in the United States panicked when Zika virus began dominating the news in the run-up to the 2016 Summer Olympics in Brazil.
But here, we are dealing with a virus transmitted by a mosquito, and facts have been emerging in a stream as nonlinear as a mosquito's flight. Years ago, we thought Zika virus would be endemic only to tropical and subtropical areas. But, to the surprise of most experts, the virus spread more rapidly than expected. We have since learned that Zika can be transmitted human to human through sex2. Zika can also be spread through blood transfusion and exposure in laboratory and healthcare settings.
And the situation may continue to evolve. There is now evidence that, in addition to the warmth-loving female Aedes aegypti, mosquito species capable of living in northern climes might be able to spread the disease3. Changes in climate may also help much of the continental United States to one day harbor mosquitos that carry the Zika virus.
So, what can health communicators do to help inform the public without inciting a panic? We can report the facts as we know them and take care not to overhype them: who is at the greatest health risk, what they need to know, and what actions they can take.
Check sites like NIH’s and CDC’s for the latest information. For Zika, for example, NIH created a page that collects the latest information about Zika from across government agencies. CDC offers tools for helping health communicators draft key messages, gather supporting facts, identify audiences, and select communication channels, including social media, in times of public health emergencies.
A populace armed with the facts is better equipped to address serious problems with diligence and resolve, and without the panic. So keep calm and write well.
2Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Virus Exposure — United States, September 2016. Morbidity and Mortality Weekly Report (MMWR) Weekly. October 7, 2016. 65(39);1077-1081.
3Evidence of Zika Virus RNA Fragments in Aedes albopictus (Diptera: Culicidae) Field-Collected Eggs From Camaçari, Bahia, Brazil. Smartt CT, Stenn TMS, Chen TY, Teixeira MG, Queiroz EP, Souza Dos Santos L, Queiroz GAN, Ribeiro Souza K, Kalabric Silva L, Shin D, Tabachnick WJ. J Med Entomol. 2017 Apr 14. doi: 10.1093/jme/tjx058. [Epub ahead of print] PMID: 28419254.