Watch out!” “Be Careful!” Such words were once commonly shouted by parents at kids rushing out for what today would be called “unsupervised play.” The warnings usually coincided with the slam of a screen door and a kicked-up cloud of summer dust.
Only later did parents realize that something a tad more specific might be better, lest we kids begin to worry about being hit by an asteroid or having our eyes pecked out by maniacal seagulls (qv: Alfred Hitchcock’s The Birds). As a result, “Look both ways when you cross the street!”, “Don’t talk to strangers!”, or “Keep away from that neighbour’s dog!” made more sense as parental PSAs.
Today’s admonitions from the government over Covid-19 have a familiar ring to those older warnings of “Watch out!” or “Be careful!” They are urgent and hectoring, but typically generalized. The audience is apparently assumed to have the thinking capacity and emotional range of young children. (That said, New Zealand actually tried a “Don’t talk to strangers (or neighbours)” policy, even if you happened to be outdoors and masked. No mention of the neighbour’s dog.)
Why do governments and public health officials treat people like little kids? Why do they lean so heavily on monosyllabic commands – “Masks here and here!!!” “Clean your hands!!!” – without supporting information? Apparently our governments and health organizations have all concluded, to paraphrase the immortal line of Jack Nicholson in A Few Good Men, that “We can’t handle the facts!”
This approach might have achieved its immediate goal of keeping people indoors and obedient during the pandemic’s early days, but it also robbed the citizenry of the opportunity to conduct rational risk assessments of their own. This surely contributed to the population’s bifurcation into “the compliant” – no doubt the majority – and a smaller group who are angry, alienated and have come to believe that virtually everything they hear from officialdom are lies. “Healthy skeptics” appear few and far between.
Early in the pandemic, intriguing data started to emerge amidst all the confusion concerning the nature of the virus. It became clear that those most vulnerable were the elderly and people with underlying health conditions (“comorbidities”), while younger, fitter people were at low risk from bad outcomes. Graphs could be found showing the percentage risk profile for different age groups. Airborne transmission appeared to be most prevalent, while risk from infected surfaces was loudly trumpeted but not easily quantified.
The data seemed to underpin public health measures, which provided some reassurance. It also began to quell the acute fears that nearly everyone had felt early on, when new horror stories about the disease’s exponential transmission and fearsome virulence (along with horrifying images from northern Italy) had emerged daily. But this only applied to those who actually read and evaluated the information. Among huge segments of the population, the fears appeared locked in.
Unfortunately, today we appear no further ahead. Despite the collection of vast amounts of data, including from jurisdictions with quite different public health approaches, public discourse seems to have become stuck. Reactions to Covid-19 still range from denial to panic and government policy remains erratic and mostly disappointing.
Health Canada’s website, for example, reports the following about the virus’s transmission, in typically anodyne bureaucratese: “[Covid-19] spreads from an infected person to others through respiratory droplets and aerosols when an infected person breathes, coughs, sneezes, sings, shouts, or talks. The droplets vary in size, from large droplets that fall to the ground rapidly (within seconds or minutes) near the infected person, to smaller droplets, sometimes called aerosols, which linger in the air, especially in indoor spaces.”
Fair enough. However, at this point it might be helpful to confirm that walking outside on a sunny day, in a stiff breeze, poses effectively zero risk to anyone. Instead, outdoor mask mandates, not to mention voluntarily masked pedestrians, are still a thing. And many walkers appear to leap from the sidewalk when approached by another human. Why is that?
What follows from Health Canada is thinner gruel: “The virus may also spread when a person touches another person (i.e.,a handshake) or a surface or an object (also referred to as a fomite) that has the virus on it, and then touches their mouth, nose or eyes with unwashed hands.” And, “It is still unclear how easily the virus spreads through contact with surfaces or objects.”
How can it be, after more than a year and a half, that it still remains “unclear” how infectious various surfaces may be? Do they mean all surfaces or just indoor surfaces? Does UV radiation kill the virus, or doesn’t it? The lingering uncertainty has been a boon for hand sanitizer companies, but we need more specific information. And what does “linger” mean? Five minutes or five hours? Surely there must be old studies of other airborne viruses that would give us some clue.
A Failure to Communicate
In the classic 1950s cartoon “Rabbit Seasoning” Daffy Duck has his beak blown off repeatedly by Elmer Fudd’s shotgun, as a result of Bugs Bunny’s clever word play. Daffy finally deduced he’s suffering from “pronoun trouble.”
What fuels Covid-19 stress derives less from pronouns than from verbs and adjectives. When people read media reports and health advisories – if they actually do so – how should they interpret words like “may,” “could” and, as we’ve seen, “linger” or “unclear”? Risk will be in the mind of the beholder.
Following 20 months of relentlessly bad news, it is small wonder that many people will choose to err on the side of concluding the risks remain great. Being non-specific, they probably seem scarier still. The risk-averse will probably interpret “may” as an unacceptable likelihood, while the risk-tolerant might dismiss it as unlikely. And what to do with the sinister adjective “linger”?
Media reports are of little help. Consider the Calgary Herald’s recent coverage of the increase in Alberta cases – “surpassing 1,000 daily” – that centred on an interview with a professor at the University of Calgary’s medical school. He reported that pediatricians were “advising families to continue masking and take their own precautions with back-to-school just days away.”
The article concedes that “while severe health outcomes for young people are still rare, the lack of province-wide mask mandates in schools and indoor settings are (sic)raising concerns that COVID cases will only continue to rise.” The article quoted pediatrician Joseph Vayalumkal warning that “a runny nose or mild cold for a child can mean an ICU stay or death for others with risk factors,” like an elderly or unvaccinated family member.
The doctor’s statement is true but, framed as it is, how can it do anything but induce panic among those who take the words of experts at face value? His words conjure up a direct connection between innocent play at recess and grandpa clinging to life on a ventilator. He could have said instead, “Parents, your kids are going to be OK, but because there’s a small but not negligible risk of them infecting someone more vulnerable, please make sure they stay away from unvaccinated adults and/or family members with serious health conditions.”
Which would be the more reasonable communications option? The more fear- and stress-inducing? Which might better facilitate a rational risk assessment by the target audience?
Actual Risks – Some Hard Numbers
Clearly our officials and experts are not doing any such soul-searching, for the “threat” to children and their unwitting-but-potentially-deadly role as transmission “vectors” continues to be ceaselessly repeated. This despite compelling statistics to the contrary. As the accompanying chart of U.S. data shows, actual mortality numbers for very young children are surprising in a couple of ways.
First, only a very small number of young children die annually in the U.S. – fewer than 2,400. This is in stark contrast to the staggering rates of child mortality throughout history up to very recent times. My grandfather, born in 1895, was the sole survivor of six children. Former Canadian prime minister Jean Chrétien, born in 1934, was one of 19 children – of whom 10 died in infancy. That should offer some perspective. But for those fixated on the utopian idea that “even one death is too many,” today’s vanishingly low numbers are, by definition, unacceptable.
Second, and even more remarkable, is evidence from the chart of the extremely low mortality due to Covid-19. By any rational and reasonable measure, the death of 25 young children – representing 1 percent of all deaths among kids aged 1-4 – in a country of 330 million people, is extremely low. And might some of the enormous resources poured into Covid-19 perhaps not be better deployed against larger and more easily preventable categories? How must the parents of the almost 400 drowned toddlers feel?
Looking at young people in general, the numbers are still small. As of September 24, 2021 just 16 Canadians under age 20 have died of Covid-19. And even so, the federal government’s data does not indicate what, if any, underlying conditions might have contributed to those deaths.
Physicians and even government health officials undoubtedly mean well by their public comments. But they also fuel suspicions that risk is being communicated so as to encourage certain types of behaviour and forestall others. The media, meanwhile, seem to have written the same story since March 2020 – focusing on whatever number seems the biggest and scariest. With few exceptions, there has been little contextualization of the numbers, let alone communication of real levels of risk.
Rolling the Dice
“What’re the odds, Doc?” Those of a certain age might remember such a line whispered by a wounded GI or other dying character in classic cinema, the grey shades of black-and-white film heightening the drama. Such questions, if not in those words, are certainly spoken by scores of Canadians every day when asking their doctor about the severity of a diagnosis. But if doctors routinely judge such risk, why they aren’t treating Covid-19 the same way in their public statements?
It is well known that, with their approximately 14-million-to-one odds against hitting the jackpot, lottery tickets are not part of any sound retirement portfolio. Despite this, 34 percent of Canadians in a 2014 poll reported that they played the lotto in the hopes of supplementing their future retirement income. If judging the likelihood of a lottery win stretches the abilities of many people, how easy is it for them to judge their relative risk of getting Covid-19 and, more important, of suffering an adverse outcome?
There’s a voluminous literature long predating Covid-19 that morbidly catalogues the many failures of human risk perception. And we’re not talking about extreme cases like those who end up mocked by the Darwin Awards. Psychologists such as the University of Oregon’s Paul Slovic have tried to determine how people judge personal risk and how it aligns with statistical risk, if at all.
In his paper The Psychology of Risk, Slovic describes how, despite life in rich countries becoming better and better, many people have grown more rather than less concerned about risk. This work, predating Covid-19, illuminates several aspects of risk perception which have dominated our recent experience. The elements include how we make intuitive risk assessments, which often differ substantially from the statistics or arguments made by experts, and how risk perception develops in general.
People tend to regard familiar or well-understood things as less risky. Everyday technology like cars is judged less risky than, say, pesticides, nuclear energy or magnetic fields from high tension wires. This despite the fact that each category has its own “scientifically” definable risk. Secondly, demographic factors also play a role. Women – even women scientists – appear more risk-averse than men.
Also, significant mishaps such as the Three Mile Island and Chernobyl nuclear accidents or the Exxon Valdez oil spill serve to amplify risk perception in the public beyond statistical validity and lock such perceptions in place. Perhaps coverage of the death toll in northern Italy early in the pandemic or Chinese officials famously welding people into their apartments triggered the acute fear of Covid-19 that we continue to live with.
The job of public health officials and politicians in an emergency like Covid-19 is complicated by each individual’s complex, highly personal and rarely math-driven formulation of risk. This drastically complicates the job of communicating risk.
In effective communication, trust is essential. Slovic notes that, without trust, “No form or process of communication is effective.” And trust is fragile. Slovic specifically points the finger at the media, stating that they disproportionately report bad, trust-destroying news. Human nature also tends to amplify these negative events. Once mistrust sets in, it tends to be self-reinforcing. Mistrusted officials are ignored and addressing risk-related controversies with more science may actually exacerbate conflict. Sound familiar? But even as the public grows ever-more averse to taking on risks, it still seems exciting to talk about risk – and so risk perceptions continually ratchet upward.
In what could be described as “early lock-in,” Slovic’s work shows how initial depictions of risk – such as the mortality categories he illustrates (see accompanying table) can create dominant, lasting narratives. Defining risk in a certain way early on, will favour one option for dealing with it – say, lockdowns – and that option will rise to the top. Slovic presciently describes such early depictions of risk as “an exercise in power.”
How this relates to Covid-19 is interesting. Despite quite good early data for risk by age group and probability of transmission, public policy in Canada and elsewhere quickly locked into a universalist approach. The generalized risk to everyone was emphasized rather than specific risks to certain groups. This favoured widespread lockdowns and other restrictions. Yet some jurisdictions took a different approach, without catastrophic results. Denmark for example left schools open based on lower risk to children.
Slovic concluded that “polarized views, controversy, and overt conflict,” are pervasive in risk management and that governments have been in a decades-long, “desperate search” for effective ways to communicate risk. Considering our experience with Covid-19, and government’s habitual use of vague but menacing adjectives and adverbs, plus the lack of contextualized hard statistics, one is tempted to complain that they don’t seem to have tried that hard.
Can Narratives be Undone?
Now that we’ve fallen into several fixed narratives regarding Covid-19, it appears increasingly difficult to dislodge them. Besides the unvarying daily media-reported metrics, there is the fixation on vaccines as the only viable “therapy.” Deviation from these accepted narratives risks swift and furious retribution.
Politicians and doctors alike have been excoriated for attempting to put the data and the virus in context. Alberta Premier Jason Kenney was widely rebuked earlier this year for correctly noting that the average age of Covid-19 deaths was 82 and explaining why outdoor dining was less risky. Similarly, Deena Hinshaw, the province’s Chief Medical Officer of Health, was pilloried for lifting Covid-19 restrictions in early summer based on her best evaluation of “the science.” Now, with cases on the rise, her critics cry “I told you so” and have compelled her to apologize. Asserting that society faces other serious health concerns that require attention, and from which our Covid-19 fixation diverts critical resources, is apparently forbidden.
Similarly, discussing options for possible drug therapies or making lifestyle recommendations related to diet, exercise or vitamin supplements that might help with Covid-19 are enough to get you booted off YouTube and other social media. Despite the clear significance of other risk factors like underlying health conditions or comorbidities, these have gone almost unreported – in fact the reporting of them has worsened over the course of the pandemic. As some wags put it, we avoid discussing the connection between lifestyle choices and Covid-19 because we don’t want to offend overweight, sedentary chain-smokers. Then again, it’s no joke, as Jonathan Neman, CEO of the chain of salad eateries, Sweet Green, recently discovered. He was widely accused of “fat-shaming” simply for quoting CDC statistics revealing that 78% of Covid-19 hospitalizations are obese and overweight people. As a result, concrete measures available to individuals to decrease their risk are off the table.
Hinshaw’s allusion to numerous other public health risks have been largely dismissed despite the explosion, in many jurisdictions, of problems like opioid deaths. In the first six months of this year, for example, B.C. suffered more than 1,000 opiod fatalities. A shockingly high share of these victims were young and Indigenous. By comparison, there have been fewer than 1,900 total Covid-19 deaths in British Columbia. Needless to say, there are no calls to lock down the province until the opioid scourge is defeated.
Ironically, there is no shortage of “dashboards” illustrating reams of available data on Covid-19. Most jurisdictions have densely-written, Byzantine websites compiling a wealth of poorly-organized statistical data. While their existence is potentially useful, we are tempted to imagine an alternative universe in which governments present the public with a suite of clearly-illustrated Covid-19-related data and the media report on it straight-up.
Regardless of our own ingrained and well-documented difficulties in risk perception and the challenges associated with communicating statistics, that doesn’t mean public health officials and the media should not communicate numbers and stats. One dataset that is currently in favour, and thereby frequently reported, relates to vaccines. CBC Radio has reported that the unvaccinated are “36 times more likely” to end up in hospital than their more dutiful neighbours. The intention of such reports is clearly to encourage public vaccinations, which is certainly defensible. Data from the Public Health Agency of Canada, reproduced below, illustrates the relative risks compared tovaccination status. (See Figure 5 on the website.) We could use a lot more of this clarity. And on a much wider range of Covid-19 topics beyond the officially-sanctioned topic of vaccines.
Learning From History
The Spanish Influenza pandemic of 1918 to 1920 provides an alternative example of government communication of risk, with a number of insightful analyses presented at a 2018 conference organized by the Virginia Historical Society to mark the centenary of the contagion. The conference proceedings are worth a review, particularly since these expert opinions were released prior to the solidification of Covid-19 narratives.
In sharp contrast to today, the U.S. government of the day preached a “sunny ways” message about the flu. In order to maintain public commitment to fighting the First World War and overseas troop deployments, PSAs from President Woodrow Wilson’s administration argued that this flu was no more serious than the seasonal grippe, and that the country should simply “soldier through.”
Regardless, the public soon made its own assessment of the risk, based on the visibly high death toll and preponderance of healthy young people laid low by the illness. This led to several localized public health ordinances, such as temporary mask mandates and social distancing requirements. Perhaps there was wisdom in those older crowds. And if so, there are lessons for today – governments should have a duty to be honest to their people.
Other lessons from a century ago derive from DNA analysis of Spanish flu victims. It appears that older people – those born before 1890 – had been exposed to similar viruses during their childhood, making them more resistant. Otherwise healthy young people had not been so exposed and, consequently, died in large numbers. This proposes what is currently unthinkable, that actually exposing children to Covid-19 might bolster their immunity to not only this virus, but future Covid-19-like viruses as well.
What the Public Needs, and what Citizens Deserve
Let us now return to our imaginary world where data is presented in ways meant to answer our questions about Covid-19, rather than guide us to pre-determined collective actions. We all know it is difficult for individuals to judge risk, and there is ample mistrust of what governments are telling us and why. But at its core, a free society should err on the side of providing necessary and truthful data to the public so they can make up their own minds about the situation.
The current push to separate the vaccinated sheep from the unvaccinated goats involves some useful sharing of numbers, as per the CBC’s “36 times” statistic cited above. As mentioned previously, we could use a lot more of this sort of information as we ride through Covid-19’s chaotic Fourth Wave.
At a minimum, the risk by age group and behaviour needs to be better understood and more widely communicated so everyone can grasp its significance. This will allow individuals, parents and organizations to make rational choices. Similarly if, as a UK report suggests, teenage boys are more at risk from vaccine-induced pericarditis than from Covid-19 itself, government should let parents know.
It should also be possible to clearly state which surfaces hold the greatest risk of being infectious. That would allow us to clean and sanitize in ways that actually reduce risk. There is no good reason to waste enormous social resources on unnecessary fastidiousness. It might also allow us to share the sidewalks once more. And it is unfortunate that we will likely never see clear data on comorbidities or Covid-related risks in comparison to other risky things we choose to do every day, like bicycling in traffic or playing contact sports. Of course, such revelations would complicate efforts to impose broad public health measures.
Other areas in need of public elucidation include better information on the likelihood of healthy, double-vaccinated people having adverse outcomes and the potential value of promoting vitamin D, exercise, sleep and better diet as alternatives to staying inside, alone and fearful. The list goes on.
Just let us know. We can handle the truth.
Martin Grünn is a writer with a Ph.D. in natural sciences. He lives in British Columbia.