White Coat, Black Art

Confusing COVID-19 advice is undermining public trust; here's how to restore it

Public health officials would be wise to access the help of experts in communication and human behaviour, doctors say.

Public health officials would be wise to access help of experts in communication, human behaviour, doctors say

A medical worker wears a surgical mask, face shield, and gloves, conducting a COVID-19 test on an unidentified man in Montreal, Que. With cases surging in many parts of the country, experts say it's time to address declining trust in public health leaders. (Ivanoh Demers/CBC)

Confusion over COVID-19 restrictions is undermining trust in health leaders, experts say.

"It's actually getting harder and harder to really understand why we're asking for certain measures, and how it differs from province to province, and sometimes even from one school to the next," said Dr. Caroline Quach, a pediatric infectious disease specialist and medical microbiologist from Chu Sainte-Justine in Montreal.

"I find that there's less trust in institutions than there was at the beginning of the pandemic."

The anti-mask movement is just one example of lack of trust in public health advice, said Quach.

During the first wave in the spring, when Canadians were in lockdown, the rules on infection control may have been painful, but they were fairly straightforward. 

In the summer, COVID-19 cases lowered and lockdown measures were eased. Now, in much of Canada, cases are rising quickly again.

But the rules on how to keep safe from COVID-19 aren't consistent from one place to another — and nor should they be, given the virus is relatively contained in regions like Atlantic Canada.

Dr. Caroline Quach, a pediatric infectious disease specialist and medical microbiologist from Chu Sainte-Justine in Montreal, said public health experts could do better at explaining the reasons why advice changes at different stages of the pandemic. (Amélie Philibert/Université de Montréal)

Smarter communication could go a long way in dispelling confusion as scientists learn more about the virus and adjust their guidance, Quach told Dr. Brian Goldman, host of CBC's White Coat, Black Art

"What has happened over time is that the messaging from public health has changed because of evolving knowledge," she said. "We started off by saying that masks were not necessary and … everything changed within a matter of weeks."

"I don't know that we are that good at explaining it from the beginning to the end, to explain that evolving story," said Quach, who is also the Canada Research Chair in infection prevention and control and a professor at Université de Montréal.

The situation requires "being quite ruthlessly honest about what we're learning," said Dr. Prabhat Jha, director of the Centre for Global Health Research at St. Michael's Hospital and professor of epidemiology at the Dalla Lana School of Public Health at the University of Toronto.

Jha points to the concern early on about surface transmission. "You could watch [Dr.] Sanjay Gupta on CNN teach you how you take Lysol wipes and clean your groceries when you come home. And now more careful reviews, including by CDC and WHO and others, have basically said they haven't found, as best they can document, a single case that's been picked up [after touching] a surface."

Dr. Prabhat Jha, director of the Centre for Global Health Research at St. Michael’s Hospital, and professor of epidemiology at University of Toronto’s Dalla Lana School of Public Health, said the situation requires 'being quite ruthlessly honest about what we're learning.' (Unity Health Toronto)

Missteps in communication

Behavioural scientist Gordon Pennycook, an assistant professor in the department of psychology at the University of Regina whose research focus is on reasoning and decision-making, said people should actually take it as a positive sign that public health recommendations have changed as knowledge is gained on the virus.

"If they just immediately said, 'Here we go. Here are all the things that you need to know, and we put it out within a month,' and they don't change anything, then they aren't doing any research and that's not how science works." 

That said, there have been missteps in communication along the way, said Pennycook, who holds a PhD in psychology.

"Probably the biggest mass messaging mistake so far has been, 'don't bother with masks' at the start," he said. Part of that was about preserving PPE for medical professionals, but health leaders missed an opportunity to acknowledge, at minimum, that wearing a homemade face covering "probably wouldn't have hurt."

Gordon Pennycook, an assistant professor of behavioral psychology at the University of Regina, said people are more likely to follow public health advice if the messages are tested to see which resonate more with people. (University of Regina Photography Dept)

"That was an overly conservative and kind of misfocused messaging campaign," said Pennycook.

More recently it's been mixed signals around social bubbles that have created frustration for the public, who have found disconnects between advice to restrict private gatherings — including on Thanksgiving — while bars and nightclubs remain open in many places. 

(Only Friday afternoon did the Ontario government introduce new restrictions in hard-hit Toronto, Ottawa and Peel Region, prohibiting indoor dining at restaurants and bars, and closing gyms, movie theatres and casinos.)

Honing the message

Part of the problem is a failure on behalf of public health authorities to engage with experts who can help hone messages, said Quach.

"I think we need more social scientists working with us. I find that when you have an anthropologist or professionals and doctors who actually understand the behaviour of people and how to communicate risk, it usually goes through better."

That's especially important, said Jha, given the advice of public health experts can get lost in the noise from social media, which "just tends to amplify the extreme voices."

"It's either the alarmists that say, 'Well, we have to go back to complete shutdown and lockdown,' or it's the deniers that are loudest on social media. The voices of science, of reason … really need to figure out other ways of communicating." 

Prime Minister Justin Trudeau spoke with reporters during a pandemic briefing on Friday in Ottawa. 2:33

If it were up to Pennycook to help public health authorities connect with the public, he'd start by applying science to the messages themselves.

"You have to, like, come up with 20 different types of ways to message something and then actually run experiments to see which one is the most effective for which groups, and then do it as evidence-based strategy," he said.

Of course, in a pandemic, authorities often have to communicate on the fly. But tools like A/B testing online ad campaigns or recruiting members of the public to evaluate public health marketing messages would make them much more effective.

"That's what's missing."

Getting buy-in for COVID-19 vaccine

Public health messaging is going to be particularly vital for getting people on board to receive a COVID-19 vaccine when it becomes available, he said.

A recent Angus Reid survey found that 32 per cent of Canadians will likely refrain from getting the vaccine when it first becomes available.

"Think about how much money is rightfully going to getting vaccines developed. How much money is going towards developing ways that will make people want to get vaccinated? If you have a vaccine, that's fine, but if people won't take it, then you aren't going to achieve herd community." 

Pennycook has just completed research — yet to be peer-reviewed and published — on people's attitudes toward a potential COVID-19 vaccine. He found that the question has become highly politicized, and that misinformation from U.S. President Donald Trump has affected attitudes on this side of the border as well.

Canadians are trying to decipher confusing advice from public health officials about what kind of gathering, if any, is appropriate and safe for Thanksgiving. 1:57

"In Canada, among Canadians, being hesitant about getting vaccinated is more strongly related to your approval of Trump than it is your disapproval of Trudeau."

But previous research has found that vaccine hesitancy is also correlated to lower levels of what's known as cognitive sophistication, he said, a set of measures that relate to the kind of quality of thought around scientific issues, ability to tell the difference between true and false information, and also how reflective you are.

"So that basically means that all is not lost. If people got better information, they probably would have fewer misperceptions." 


Written by Brandie Weikle. Produced by Jeff Goodes.

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