Coronavirus, the right to be informed (and worry enough)

In the absence of vaccines and antivirals, risk communication remains the most effective tool for managing uncertainty and curbing infection, but not everything has gone smoothly

(photo: Str / Afp via Getty Images)

So we have to worry or not about this damned coronavirus? It is a legitimate question , which you too will have asked yourself by scanning the news reports or scrutinizing the expressions of the experts in tv looking for some clues. To be honest, however, no one has the answer . To know if behind this demon called 2019 – nCoV yes hides a threat worthy of so much fanfare, we should in fact have clearer ideas about a bunch of things that still elude us: where did it come from? Is it true that it can be transmitted even in the absence of symptoms? How contagious is it? How lethal is it? And how will it change?

The problem is that, as always happens in the face of an emerging risk – that is, at a risk that presents itself for the first time, as a virus that has never circulated before among humans – what we do not know, at least in the beginning, far exceeds what we know. Uncertainty prevails, experts say. And it is with this uncertainty – destabilizing, of course, but unfortunately inevitable – that we have to learn to reckon.

The perceived risk

In the face of a new threat it is normal worry : the studies on the perception of the risk have clarified that an alarm bell rings inside us. The uncertainty about the nature of the danger and what could happen amplifies the feeling of having no control . And this scares us. On the other hand, the emergence of a new virus also worries experts. The World Health Organization (WHO) has defined the risk of coronavirus spreading outside of China “ a cause for serious concern “. Trying to scale down the threat by making comparisons with seasonal flu makes little sense, given that in the case of pandemic – which at the moment no one can rule out – health systems around the world would be forced to face two serious problems instead of one only. “ Of course people are worried, why shouldn't they be worried ?” He said Mike Rya n, executive director of WHO health emergencies. “ There is a new virus, we have neither vaccines nor therapies : if someone worries we should not criticize him . “

So, to appease uncertainty, we seek information . If we didn't find it, it would be a lot of trouble because, faster than any virus, it would spread a feeling of suspicion and paranoia . But nowadays we also have the problem opposite : the ubiquitous omnipresence of information, more or less reliable (WHO speaks of infodemia ). Last Friday I was on the train: I leaf through the newspaper, coronavirus . I look on social media, coronavirus . I read the mail, coronavirus . I listen to the neighbors, coronavirus . I look up exasperated: coronavirus also in the news that flows on the screens of the corridor. At the first cough, a silence fell in the compartment that even in Noon of fire .

Okay, it makes you smile to hear someone blur: “ This story of the virus gives me tremendous anxiety, it makes me you need a cigarette to calm me “. Yet we are like this: in order not to be overwhelmed, we are able to focus on one risk at a time, and the looming threats scare us more . If you think about it, there is a reason. Often there is a tendency to contrast perceptions and rationality, but it is also thanks to our perceptions if we have come this far. Let me explain: perhaps that yellow spot in the thick of the forest is not a tiger, but if we wait to be sure it may be too late. From what world is the world, to save the hide, we learned that we cannot be paralyzed in the face of a risk imminent: better to make a decision quickly , even at the cost of running and shouting for a danger that will not wax.

It is the same dilemma that grips the institutions health calls to manage the pandemic risk, because from the ability to decide in conditions of uncertainty it can depend on the life and death of many people. Recent experience with the epidemics of Sars , H5N1 and ebola taught that if not it is possible to postpone decisions, the uncertainty must be accepted : it is necessary to learn to live with it. And at that point there is only one antidote: “ Communicating what we know, communicating what is still we don't know and communicating what we are doing to get more information, save lives and minimize the damage “. These are the keywords of the guide Risk Communication and Community Engagement (Rcce) distributed by WHO to manage the emergency of the coronavirus 2019 – nCoV . And they are sacrosanct words. “ Effective risk communication and citizen involvement create trust, increase the likelihood that recommendations will be heard, reduce misunderstandings and unfounded rumors that can undermine the success of countermeasures to contain the infection “.

Communicate the risk

Risk communication must be as old as human language . Maybe she was born around a fire when someone told how she managed to save herself from a saber-toothed tiger. The stories of the survivors have always fascinated us because they contain salvific information: next time it could be up to us. Even today the risk communication serves to save lives . In our society it is considered a crucial tool in prevention and in emergency management .

When a new pathogen emerges, all you can do to stem the contagion is sound the alarm , identify and isolate any suspected cases and disseminate information on the behavior to be adopted. The timeliness and the transparency of communication become essential. “ Without vaccines and therapies, risk communication is the most effective tool we have “, admitted Mike Ryan of the WHO.

Research has made it possible to establish some empirical principles for communicating risk effectively. The most important reads: never deny , hide or diminish a risk . Recent history – from Chernobyl to mad cow, up to Sars – has indeed shown that trying to hide information on risk, diminishing the severity of events or delaying the alarm, aggravates the situation : prevents people exposed to danger of taking precautions, and it shatters trust in institutions. And without trust , even the simplest indications to defend yourself from contagion, such as washing your hands frequently, risk being He disregarded. This is what happened with the Sars in the 2003 when, in fear of economic repercussions, the Chinese government hid information about the virus.

Delays and hesitations

This time it definitely went better , but the temptation to hiding unwanted news under the carpet is still a widespread practice and may have also delayed the alarm on the new coronavirus . Some reconstructions pointed the finger at the Wuhan authorities who in mid-January, when the new virus had already been isolated, would have underestimated the seriousness of the situation and hindered the sharing of information. And so another ten days passed before the Beijing government declared the emergency and adopted those unprecedented measures which have isolated Wuhan and a dozen other cities in the province of Hubei. Measures so drastic as to merit the WHO's applause, but not without ethical implications, considering that about 56 millions of people (more or less like the entire Italian population ) were confined to a high risk area . The stable, however, may have been closed after the oxen escaped, epidemiologist W. Ian Lipkin commented to the New York Times . As proof of what the timeliness and the transparency are crucial in risk management.

The WHO international emergency declaration also appeared late, which came after a few days of hesitation , perhaps because of the criticisms received in the past on the management of the Ebola and Zika epidemics, which in retrospect have proved less serious than feared. The fact is that when such a decision is to be made, it can also have relevant consequences economic , nobody can know how it will end. Previously, the WHO had opted for a precautionary attitude , declaring the emergency sufficiently in advance so that all nations could prepare for the scenario worse . In risk communication it is by far the most appropriate choice: better safe than sorry , as the English proverb says, or better to exceed the precautions, even at the cost of being accused of alarmism , rather than having to apologize for not doing enough if the situation worsens.

Anticipating events in situations of great uncertainty is always difficult but crucial in risk management. WHO itself admits that “ proactive risk communication is among the most important and effective interventions to defend public health “. The international emergency declaration obliges all countries to share the information available and to take action to stem the contagion, giving the necessary support to nations with less means to defend themselves.

We must act now to help countries prepare for that possibility.

This is the time for facts, not fear.

This is the time for science, not rumors.

This is the time for solidarity, not stigma. # 2019 nCoV

– Tedros Adhanom Ghebreyesus (@DrTedros) January 30, 2020

Don't panic, it's not the plague

Although the Oms has treasured the lessons learned and is rightly considered a virtuous example in risk communication, in the management of the new coronavirus he made another questionable choice: did not give a name to the threat . An acronym like 2019 – nCoV badly adapts to the needs of mass communication, so that expressions such as “ Chinese virus “or, in the best case scenario, “ Wuhan's coronavirus “, which risk feeding the stigma towards the Chinese community . In the case of Sars a neutral term had been chosen at the table (Sars is the acronym for Severe Acute Respiratory Syndrome ) just to avoid any negative connotation. Why didn't something like this happen in this case?

Words are important : they create worlds, direct thoughts and actions. Therefore, dear Minister Speranza , we appreciate the willingness to reassure the government's maximum commitment to dealing with the epidemic, but get to say, as he did in recent days, that the threat will be faced “ as if it were the plague or cholera “was not a great idea. Because in this country the cholera reminds us of bad risk management and, worse still, the plague evokes hunts for greasers and pyres of corpses. It's not what we should have in mind. Comparisons between risks are always slippery, better to avoid them.

And finally let's be clear: this new coronavirus must be taken seriously, but the bogeyman of panic often referred to in the news these days has nothing to do with what we are experiencing. Panic is a very dangerous collective behavior , capable of making victims, but fortunately it is a rare event because it occurs only in the presence of three conditions: the perception (founded or not) of a serious and imminent risk ; the absence of an authoritative guide that tells people what to do; the feeling of having no escape . It can be triggered by a bomb alarm among a crowd that finds no escape route, not by an epidemic that can be managed over weeks or months. Historical research has revealed that panic did not spread even during the terrible epidemic of Spanish of 1918, which caused 50 – 100 millions of deaths and is considered the worst of the pandemic scenarios.

Risk communication is certainly not intended to alarm, but we have the right to be concerned . A level of concern appropriate to the threat is essential to take the risk seriously and take the necessary countermeasures. Panic, however, is a word that should be put to the ban in the story epidemics.

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