How to communicate in a postmodern pandemic

A makeshift memorial for Li Wenliang, a doctor who issued an early warning about the coronavirus outbreak before it was officially recognized, is seen after…
A makeshift memorial for Li Wenliang, a doctor who issued an early warning about the coronavirus outbreak before it was officially recognized, is seen after…
Image: REUTERS/Stringer
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In pandemics, as in war, truth is often the first casualty. 

Throughout history, every outbreak—from the smallpox that claimed Rome’s emperor Marcus Aurelius to Europe’s Black Plague—has spread misinformation along with pathogens. The calamities were attributed to everything from bad air to unbalanced humors. The response was no less misplaced. Beaked masks, bleeding patients, and strapping dead chickens to the sick were all accepted practices. Any theory of germs, let alone viruses, lay centuries away.    

That all changed as medical science advanced. An English doctor named Edward Jenner administered the first rudimentary smallpox vaccine in 1796. Scientists isolated influenza A, the cause of most flu pandemics, in the 1930s, leading to the immunization campaigns that are now our primary line of defense against viruses. But even today it usually takes years to develop and distribute a new vaccine.

So our first line of defense in the early days of an epidemic is accurate, trusted information. It slows the spread of the virus, sparing millions of lives, and buys time to roll out treatments. But that defense is being unevenly deployed against the pandemic of Covid-19.

In January, during the early days of the coronavirus outbreak, the Chinese government pursued secrecy. Health officials were chastised for raising alarms. Internal warnings of human-to-human transmission were not shared with the public. Death tolls were revised downward. Only after the epidemic could no longer be hidden from view was the public warned, two weeks or more after Chinese president Xi Jinping knew about the virus, a delay that likely fueled the spread of the virus at home and abroad

In the United States, the Trump administration has spread its own brand of misinformation. In January, Trump told CNBC  that “we have it totally under control. It’s one person coming in from China,” even as the CDC was scrambling to track the outbreak. As the outbreak worsened, Trump went on to say his administration had “inherited” a faulty coronavirus test, and that any American who wants to can get tested, neither of which was accurate.

The coup de grâce, perhaps, was Trump’s speculation in a press briefing that hitting the “body with a tremendous…ultraviolet or just very powerful light” and injecting disinfectants could treat Covid-19, a potentially lethal move, triggering a flood of calls to emergency hotlines.

It’s not the first time the White House has misled the public about an outbreak. In 1918, as the Spanish flu raged across the planet, the US government and local politicians systematically covered up the disease. And it taught a grave lesson: Lack of reliable information and trusted sources can be as dangerous as the virus itself.

The “Spanish” flu

During World War I, the US and other warring nations strictly controlled information at home and abroad. So as a mysterious new virus began spreading among troops in January 1918, the news was suppressed for fear of threatening morale. Only in non-combatant Spain, where the press operated freely, did reports of a new infection surface, lending the outbreak its name, despite evidence it originated in rural Kansas.

Within months, the new influenza had begun spreading rapidly through the civilian population. Eventually, it erupted into one of the most deadly viral outbreaks in history, killing between 50 to 100 million people, more than 1% of the global population, a toll far exceeding that of WWI itself.  

The journal Nature notes US officials viewed suppressing information about the virus as no different than censoring information about the war itself. A chief architect of the US propaganda effort on the Committee on Public Information summarized the strategy: “Truth and falsehood are arbitrary terms,” stated Arthur Bullard. “The force of an idea lies in its inspirational value. It matters very little if it is true or false.”

The federal bureaucracy and local governments cooperated. US surgeon general Rupert Blue advised the new virus was “no cause for alarm if proper precautions are observed.” Chicago’s public health commissioner insisted “worry kills more people than the epidemic.” President Woodrow Wilson never mentioned the first US cases of influenza in public.

All this had catastrophic consequences. As late as August 1918,  most Americans still assumed the influenza was an overseas phenomenon, a complication of war-time malnutrition (pdf, p. 87). Local officials routinely covered up the toll of the disease to maintain morale.

Eventually, the horrific situation unfolding across America couldn’t be suppressed. Mass graves and trains were needed to handle the dead at stricken army bases and small towns, chronicles John Barry, a historian at Tulane University and author of The Great Influenza. “As the epidemic exploded, officials almost daily assured the public that the worst was over,” writes Barry. “This pattern repeated itself again and again.”

The carnage eventually destroyed the public’s trust in officials, and each other. The Red Cross reported people in rural areas starved to death, not for lack of food but because people were unwilling to go near the sick. People felt they had no one to turn to, no one to rely on, no one to trust,” Barry writes.

Truth can save us

One hundred years on, the motivations to spread misinformation have not changed. But the way we communicate has.

The control authorities once wielded over information is impossible in today’s media. While its power to shape the narrative is considerable, the government is only one of a thousand sources of news and information flooding media channels, from universities to press to elected officials less willing to accept official events than their predecessors.

A hint of this was on display in China when Li Wenliang, a 34-year-old doctor in Wuhan, posted online about being quarantined due to a virus resembling SARS in the hospital. Police summoned him, demanding Li sign a statement that his warning constituted “illegal behavior.” Since Li died from the coronavirus in February, he has become a martyr for many Chinese critical of the government’s response and censorship

For millions of Americans, Dr. Anthony Fauci is fulfilling the role of truth-telling doctor amid mixed messages from government officials. The 79-year-old director of the National Institute of Allergy and Infectious Diseases is a staple of television news briefings. A veteran of six presidential administrations, Fauci has often refuted Trump’s advice and delivered pessimistic news, such as warning about an “inevitable” second wave of the coronavirus this fall while Trump has said it “might not come back at all.”

“I feel I have a moral obligation to give the information I’m giving,” said Fauci on CNN. “I cannot force people…to do what [I] think is best. The only thing I can do is give the information based on evidence and experience.”

Fauci is executing the textbook public health strategy from the US Centers for Disease Control and Prevention (CDC). Since WWII, scientists and public health officials have come to agree on how to combat epidemics, says Amy Fairchild, dean of the public health school at Ohio State University: deliver clear, accurate information, especially amid uncertainty.  

It’s not a perfect antidote to panic and paralysis. But the 1918 epidemic showed how deception only accelerates pandemics, while transparency can contain them. “The false reassurances given by the authorities and the media systematically destroyed trust. That magnified the fear and turned it into panic and terror,” writes Barry. “Where people had accurate information and knew what they faced, they often performed heroically.”

More recent global events have confirmed this. During 2009’s H1N1 swine flu outbreak, Mexico was “a model of rapid and transparent reporting, aggressive control measures, and generous sharing of data and samples,” states the WHO. During this coronavirus pandemic, Taiwan and South Korea have proved remarkably swift and transparent in their response.  

To head off the next pandemic, says Dr. Cheryl Healton, the dean of the School of Global Public Health at New York University, we need a global commitment to combat deception by sharing accurate information between national leaders and local doctors. “There have to be very strong carrots to disclose [information] because there’s a natural inclination to cover up,” she says. “Fear operates in people who think something’s going on and don’t want to be the bearer of bad news.”

Novel viruses will only keep emerging as humans and livestock encroach on wildlands, fueling the rise of new zoonotic diseases. Building a global culture that prizes sharing information over official approval could save millions of lives. “We have to flip the incentives so you get an award and a reward for stopping the virus,” says Healton. “It needs to be done everywhere.”