Blog: Better pandemic communication and leadership is needed
By Fmr. Gov. Bobby Jindal and Heidi Overton, M.D.
This week, a poll by Scott Rasmussen indicated that only 25% of those surveyed believed the worst of the pandemic is behind us. In a polling series from April 2020 through the present, Mr. Rasmussen’s data reveals that these August 20-22, 2021, findings are the most pessimistic since mid-December 2020—the same time the first COVID-19 vaccine received emergency use authorization from the FDA.
While there are many contributing factors to the decreased confidence that the worst of the pandemic is behind us, including the highly transmissible delta variant of SARS-CoV-2, breakthrough infections, and vaccine booster discussions, ever-changing guidance from public health experts has not helped. Arguably, the result of confusing guidance from public health and elected officials has many Americans simply ignoring this advice. For example, a survey conducted from March 17-18, 2021, found that 66% of Americans reported engaging in at least one civic behavior not recommended by the CDC, including attending large family gatherings and going out in public without a mask. Among individuals surveyed from May 20-22, 2021, just 45% were aware of the CDC’s new guidance that face masks were no longer recommended for those fully vaccinated. A poll conducted from July 29-31, 2021, found that 57% of voters would feel comfortable going to indoor social settings with many people without a mask. Importantly, this survey was conducted 2 days after a significant change in CDC guidance again recommended face mask utilization indoors for those who have been fully vaccinated.
The Mask Example
The timeline of public health guidance on mask-wearing offers a helpful illustration.
On January 31, 2020, the date then HHS Secretary Alex Azar declared COVID-19 a public health emergency, leading CDC physicians stated in a briefing call, “While it is cold and flu season, we don’t routinely recommend the use of face masks by the public to prevent respiratory illness, and we are certainly not recommending that at this time for this novel virus.” This recommendation for the general American public was maintained until April 3, 2020, more than 2 weeks after the U.S. declared a national emergency when the CDC recommended the use of cloth face coverings in public. A CDC research report found that nearly 62% reported adhering to this recommendation within days (April 7-9), and 76% were in adherence one month later (May 11-13). This recommendation persisted for over a year with some interim scientific updates, including one on November 20, 2020, about the effectiveness of source control for the infected and the new prevention element for the uninfected. On February 10, 2021, the CDC released a report on ways to improve mask performance, including wearing a cloth mask over a medical procedure mask. Though out of scope for this review, these recommendations formed the basis for many state and local government mask mandates, which analysis has shown did not prevent county-level case surges.
On May 13, 2021, the CDC made a major announcement that fully vaccinated individuals no longer needed to wear masks. This came just 1 week after the agency published an updated scientific brief on its recommendation for community use of masks without any reference to vaccination status. The timing of the announcement took businesses and public health experts by surprise, with one health expert stating: “Americans are feeling incredible whiplash.”
Little did anyone know how significant that backlash would feel 2 months later when the CDC again abruptly reversed its guidance. On July 27, 2021, the CDC announced that fully vaccinated individuals in substantial or high transmission areas should wear masks indoors due to the increased transmissibility of the delta variant of SARS-CoV-2. This recommendation affects essential parts of daily life, especially workplace and school environments, as many state and local governments have re-implemented broad mask mandates.
Opportunity to Improve
As the scientific understanding of a novel virus evolves, it is expected that public health guidance will also evolve. Recommendations from public health and elected officials, however, should be clear and consistent rather than contributing to confusion and pessimism for Americans. This should include efforts to inform people as much as possible which criteria and benchmarks would necessitate a change in guidance, what such changes might look like and why, and how updates on evolving conditions will be delivered. Increased transparency, improved communication, and consistent leadership are needed now more than ever.
This weekend marks the 58th anniversary of the March on Washington, and thousands are expected to participate in organized marches about voting rights, despite the high transmission rates of the delta variant. Last summer, some leading public health experts supported mass protests in amid the pandemic asserting that public health risks of systemic racism outweighed the risk of the virus. Many experts and media commentators quickly condemned conservative gatherings and worship services as if the virus would distinguish between BLM and pro-life gatherings. This lack of consistency resulted in a loss of credibility for public health recommendations. The mass marches planned this weekend in Washington, D.C. and other large cities in America offer public health and elected officials an opportunity for the kind of transparency, communication, and leadership the country needs—their response should be noted and evaluated for consistency with recommendations for places of work, worship, and learning.
America is fortunate that vaccines are available for all who want them, and they have demonstrated efficacy, particularly against severe COVID-19 infections. A greater understanding is needed about the clinical protection of natural immunity (from previous COVID-19 infection), as well as more targeted discussions on the potential need for vaccine boosters based on clinical risk. Communicating these messages could help address the current concerns of Americans and empower them to make well-informed health decisions.