








key: cord-332142-lk95akg5
authors: Skovdal, Morten; Pickles, Michael R.; Hallett, Timothy B.; Nyamukapa, Constance; Gregson, Simon
title: Complexities to consider when communicating risk of COVID-19
date: 2020-07-23
journal: Public Health
DOI: 10.1016/j.puhe.2020.07.015
sha: 
doc_id: 332142
cord_uid: lk95akg5

nan

The response to the spread of SARS-CoV-2 around the world has so far been characterised 28 by Governments issuing instructions about the action to take. However, as Governments 29 begin to ease restrictions, the potential for COVID-19 to spread is increased. We argue that 30 correct understanding of individuals' risks of becoming infected and dying is a prerequisite 31 for people and communities to take responsibility and engage in prevention practices, both 32 for self and others; and also to reduce unnecessary anxieties and other unintended negative 33 outcomes. At the same time, effective communication of these risks is fraught with difficulty 34 and there are important complexities that must be recognised and addressed. In our view, 35 there has been little scientific discussion on the complexities, determinants and impacts of 36 COVID-19 risk communication. Here, we highlight seven major complexities in 37 communicating risk and suggest directions for addressing these (see panel). They serve as a 38 framework for Governments, researchers, policy and public health workers to critically 39 appraise COVID-19 risk messaging efforts. As we are trying to highlight complexities that 40 are widely applicable (rather than specific to certain countries or regions), their relevance will 41 differ from context to context. One: the risks of acquiring SARS-CoV-2 infection and of dying from COVID-19 disease 45 once infected vary considerably by epidemic context and between individuals 1 . Nevertheless, 46 it is apparent that the risk of infection varies with the stage of the epidemic, which varies by micro-region, and an individual's exposure, which is often much higher for healthcare 48 workers and carers, and elevated for those with jobs that cannot be done from home, amongst 49 whom ethnic minority groups and people living in greater depravation may be over-50 represented 2 . The risk of death from COVID-19, given infection, varies substantially 51 according to age, male-sex, obesity and other factors 3 . Thus, there is no "one number" to 52 quote to people for their risk; but, at the same time, everyone should know the range in which 53 their risk is likely to fall. Finding ways to provide clear and targeted information about who is 54 at increased risk whilst also recognising the intersectionality of these factors is essential.

Two: Unintended outcomes -such as anxiety, avoiding going to work, and limited healthcare 56 seeking -can result for some people. Thus, over-estimating one's own risk could be as 57 unhelpful to economic wellbeing and health overall as under-stating one's own risk. 58 Moreover, some people aware of their individual risk may (un)willingly take risks, for 59 instance by doing a trade-off between risk and maintaining a livelihood. Communicating risk 60 of SARS-CoV-2 infection must be considered in the broader context of a group of risks as 61 great or greater than that from COVID-19. Therefore, developing strategies to mitigate these 62 risks is important too. 

• Avoid over-simplified 'one-size-fits-all' risk messages • Distinguish between risk of SARS-CoV-2 infection and risk of severe COVID-19 disease • Target risk messages to people according to their levels of risk and capacity to adopt alternative prevention methods • Communicate the uncertainty of risk estimates and that new data may lead to changes

• Develop risk messaging that reflects the broader socio-economic and health context and is actionable by local people. • Include messaging to mitigate other forms of risk (e.g. young women should still adhere to government advice but not put off trips to hospital for breast cancer screening)

• Avoid using unhelpful metaphors (e.g. war, enemy) in risk messaging.

• Avoid using language that can cast shame or blame to people

• Monitor the emergence and spread of myths and misinformation on social media and within the community • Utilize locally trusted institutions and individuals to address misinformation and channels that are widely used by the relevant population • Promote trust in official sources by ensuring that messaging from all such sources is consistent

Reflect changes in the nature of risk and risk perception as the epidemic evolves • Review, revise and explain changes in risk messages as the epidemic evolves • Develop risk messages that counteract innate tendencies for message 'fatigue'

• Use data on risk to stimulate and strengthen motivation to follow Government guidance • Encourage people to think creatively and tailor prevention methods to their own circumstances (e.g. to find effective ways to shield vulnerable family members) • Foster a sense of collective responsibility (e.g., risk messaging that emphasises that your actions benefit others)

• Recognise and address social and health inequities, discrimination, and political agendas, which put some people at greater risk, or prevent them from engaging with risk-reducing practices. • Freely avail health services and equipment to assist risk-reducing practices Panel: Considerations and recommendations to communicate risk in the COVID-19 response

• Avoid over-simplified 'one-size-fits-all' risk messages • Distinguish between risk of SARS-CoV-2 infection and risk of severe COVID-19 disease • Target risk messages to people according to their levels of risk and capacity to adopt alternative prevention methods • Communicate the uncertainty of risk estimates and that new data may lead to changes

• Develop risk messaging that reflects the broader socio-economic and health context and is actionable by local people. • Include messaging to mitigate other forms of risk (e.g. young women should still adhere to government advice but not put off trips to hospital for breast cancer screening)

Avoid negative social consequences of risk messaging • Avoid using unhelpful metaphors (e.g. war, enemy) in risk messaging.

• Avoid using language that can cast shame or blame to people

• Monitor the emergence and spread of myths and misinformation on social media and within the community • Utilize locally trusted institutions and individuals to address misinformation and channels that are widely used by the relevant population • Promote trust in official sources by ensuring that messaging from all such sources is consistent

Reflect changes in the nature of risk and risk perception as the epidemic evolves • Review, revise and explain changes in risk messages as the epidemic evolves • Develop risk messages that counteract innate tendencies for message 'fatigue'

• Use data on risk to stimulate and strengthen motivation to follow Government guidance • Encourage people to think creatively and tailor prevention methods to their own circumstances (e.g. to find effective ways to shield vulnerable family members) • Foster a sense of collective responsibility (e.g., risk messaging that emphasises that your actions benefit others)

• Recognise and address social and health inequities, discrimination, and political agendas, which put some people at greater risk, or prevent them from engaging with risk-reducing practices. • Freely avail health services and equipment to assist risk-reducing practices

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