In June 1981 I graduated from law school. One month after that an article appeared in the New York Times with the headline “Rare Cancer Seen in 41 Homosexuals” on page A20. These two events would end up pretty much defining the rest of my life. I became the chairperson of a group of lawyers volunteering time to provide legal help to people with this new disease and later became the Director of Legal Services at the Gay Men’s Health Crisis (GMHC) where I provided wills and advocacy on insurance and immigration matters, landlord/tenant issues, and discrimination in jobs and public accommodation. I also emerged as the spokesperson for the agency on important public health policy matters both at GMHC and in the 1990s at AIDS Project Los Angeles. This included commenting on important milestones such as actions by legislatures (or lack thereof), regulatory matters, and high profile developments such as Rock Hudson, Greg Louganis, Brad Davis and Magic Johnson, and more. In short, I got to know media and communications in the face of an emerging pathogen. During past outbreaks of emerging pathogens, I have written postings on this topic. As I watch the media report on the new Wuhan coronavirus, there are some lessons from that time that bear noting and repeating.
- Facts are low; speculation is high – In the earliest reporting on Wuhan, human to human transmission was regarded as a low likelihood though transmission is now regarded as more likely than either SARS or MERS. So little in the earliest stages of an emerging situation that there is necessarily a good deal of speculation, often on which opinion gets based. Early reporting referenced the fact that mortality seemed concentrated in the elderly with co-morbidities, but news outlets also reported the deaths of young medical workers. In short, speculation or casual observation is often presented as fact and policy actions are sometimes based on that. But the only fact is that we don’t know much about this and only time and experience will tell.
- Numbers don’t mean a lot – The number of Wuhan cases reported climbed dramatically within only a few days. In the early days of an epidemic, numbers are frequently subject to change. The number of diagnoses represent only those people infected who are showing symptoms, not the number of people infected who may not be symptomatic but who may be able to transmit. Second, the method and nature of counting (and testing) can change, as it did for COVID-19 when the methodology for counting cases caused a spike in the numbers. Third, there is always under-reporting. A communications focus should rely less on numbers than on solid principles of public health and on the business facts that are at hand. Numbers are indicative, but not certain.
- Points of reference will change – In the earliest days of the AIDS epidemic the disease was referred to as GRIDS (Gay-related Immune Deficiency Syndrome) and then AIDS. When finally discovered, the virus was HTLV-III and then became called HIV. In short, it takes time for the nomenclature and framework to become established, which can add to confusion. The situation can remain very fluid well into an epidemic. The coronavirus became COVID-19. It will be essential to monitor and educate stakeholders, both internally and externally, in any organization.
- Fraud potential is high – Not only will homespun remedies emerge, but on a more unpleasant note, there is a high potential for products to appear accompanied by unapproved claims. There is also a high potential for the emergence of counterfeit products. This is where FDA and FTC have a role to play.
- Policy can ham-fisted – With so few facts in hand, policymakers often react in ways to make it appear that something is being done to address an outbreak when in fact, policies being enacted may not support public health goals, necessitating vigilance in monitoring and considerations for how organizations respond. Some may be benign while others may be truly ill-advised.
Under fast changing circumstances, it is difficult to get a good grasp of the total picture along with all the nuance represented therein. As events unfold, and there is a greater demand for communications from stakeholders such as public officials, companies and health authorities, it is important to keep in mind some truisms during the early days to help us keep our bearings and develop perspectives.
- FDA Web Page – Outlines FDA actions with respect to COVID-19 and other important links
- World Health Organization – Multiple resources and up-to-date situation reports with a focus that is both global and localized
- Centers for Disease Control – Comprehensive overview of resources and information page on COVID-19 in the U.S.
Photo credit – NIAID-RML