EDITORIAL NOTE:  The situation regarding COVID-19 continues to evolve. For the most current information, please consult the websites for Centers for Disease Control and Prevention or the World Health Organization.

Undoubtedly, this is an extremely trying time for public health professionals as COVID-19 continues to spread across the globe, including throughout the United States. Public health professionals are working around the clock to achieve the four overarching goals of public health preparedness and response:

• To minimize morbidity and mortality
• To maintain continuity of essential services
• To minimize social disruption
• To minimize economic disruption

In the last post, the four core strategies (surveillance, risk communication, clinical interventions, and non-clinical interventions) to achieve these goals were discussed. Since that time, we have seen significant threats to the first two strategies, surveillance and risk communication. Surveillance has been threatened by inadequate capacity for the testing. Risk communication has been threatened by inconsistent and, at times incorrect, messaging. With respect to clinical interventions, there are ongoing efforts for vaccine and anti-viral development and testing, some of which appear to be promising. With respect to non-clinical interventions, there has been wide-spread employment of the non-clinical interventions including isolation, quarantine, and even cordoning off entire communities in addition to social distancing and the promotion of hand hygiene and respiratory etiquette.

With respect to surveillance, the ability to appropriately identify and isolate people who have COVID-19 and to identify those with whom they have had contact is the cornerstone in accomplishing the above goals. We are now seeing some improvement in our capacity to test. I would like to focus this blog, however, on the second strategy, risk communication. Risk communication impacts each of the other three strategies. I imagine most of us in public health have had to become information ambassadors, fielding countless calls, emails, and texts from worried family, friends, colleagues. I believe that we are all trying our best to respond with consistent and accurate messaging. Just this morning, my sister-in-law, who lives in another state, texted me seeking answers for a friend. Her friend’s school-aged child was home because his school was being cleaned. A student at the school is currently being tested for COVID-19 but test results are not yet available. In the absence of clear guidance, my sister-in-law’s friend, who knows of my background, was seeking advice from a stranger about whether the family needs to self- quarantine. The reality is that these calls, emails, and texts are merely a reflection of our collective failure to adequately meet our communities’ needs with respect to risk communication. I do not know what message the school sent out, nor do I know the level of involvement of the local health department.   What I do know is that there are opportunities to improve communication and to decrease the level of anxiety families across the world are feeling today.

Risk communication is challenging even under good circumstances. We have witnessed, and will continue to witness, examples of excellent risk communication.  We have also witnessed, and will continue to witness, examples of failure in risk communication. We know that even with availability of 24/7 national news on our computers and with social media, the impact of any emergency or disaster is felt locally and that our communities expect a local response to risk communication. With that in mind, what concrete steps can we take to ensure that we are meeting our communities’ needs with respect to risk communication? I believe that there are three key ingredients for our success at optimizing risk communication:

1. Know our communities: In an ideal world, every local public health director has spent significant time cultivating meaningful relationships with leaders in the media, healthcare systems, schools, faith-based community, major employers, and other key stakeholders in their community. If they have not yet, it is not too late. Such relationships allow for effective, consistent, timely information sharing that our communities need, want, and deserve. Investing in these relationships ensures that there is ongoing two-way communication, with the health department being able to trust that key stakeholders will share its messaging, and the key stakeholders being able to trust that the health department will be there to support their communication needs. During a public health emergency, it is critical that local health departments know how and when to reach out and engage local leaders to ensure that everyone is sharing the same message. Based on feedback from stakeholders, local health departments can deploy tool kits to help stakeholders share information with their constituents (see below). Depending on your community’s needs, regularly scheduled conference calls for the duration of the event, including a debriefing once the situation has resolved, can be extremely useful in assuring consistent messaging.
2. Know our messages: There are so many sources of information available at the tip our fingers today. To ensure that public health professionals are sharing the same messages in the same time frame, it is critical that they know where to go for the most accurate, reliable, and up-to-date information. For consistency’s sake, local public health directors typically rely on their state health departments or on the CDC, depending on the structure and functioning of their state’s public health system. Often state health departments may have more flexibility than does the federal government with respect to staying current. A key example of this for COVID-19 is the reporting of case counts for which there is a lag between the time that the states and the CDC post their testing data. Regardless of where local public health leaders feel most comfortable getting their information, ideally, they should be consistent and transparent about their source of information. Please see the below section on risk communication tools for COVID-19 available from the CDC’s website.
3. Know our own capabilities and capacities: Local health departments come in all sorts of shapes and sizes, with varying degrees of resources available to support the risk communication needs. To the extent feasible, engage health communications professionals to assist with messaging. Small local health departments may need to rely on city, county, or state resources for professional assistance with messaging.

The Centers for Disease Control and Prevention (CDC) and the World Health Organization have excellent communication tools for a community audience available on their websites. For example, the CDC has recommendations on how to prepare and take action for COVID-19 at home, at school, at work, and at places of worship. This information provides the foundation for effective, consistent, and timely messaging at the local level. As important and helpful as this information is, it is most impactful when it is communicated through a local, trusted voice — the voice of the local public health director. The CDC also has a webpage on communication resources that local health departments can use for their tool kits to facilitate communication in their communities.

It is never too late to improve on community engagement and risk communication. Public health professionals are so busy right now, coordinating surveillance efforts to improve identification of those residents who may have COVID-19 or who may be under quarantine; working with colleagues in the healthcare system to ensure appropriate triaging and utilization of existing resources; working with colleagues across government to ensure continuity of essential services; and so much more. It may seem, and may in fact be, overwhelming right now to consider ways in which to continue to improve risk communication; however, doing so may very well decrease anxiety, save time, energy, and resources both now and in the future. It may even save lives.

In closing, I share W.H.O.’s Director General Dr. Ghebreyesus recent closing remarks on COVID-19:

Let hope be the antidote to fear.

Let solidarity be the antidote to blame.

Let our shared humanity be the antidote to our shared threat.

Read all columns in this series:

• Coronavirus and Local Health Departments: Where the Rubber Meets the Road
• Tulsa Health Department’s Response to Tulsa County Historic 2019 Flooding
• Summer at a Local Health Department and the Eisenhower Matrix
• Measles in New York: The Outbreak, the Response, and the Potential Unintended Consequences
• Trust: An Essential Ingredient for Becoming a Chief Health Strategist 
• Introducing Boots on the Ground: Narratives from Today’s Local Public Health Workforce

As with community health improvement, we are stronger if we work together. If you are interested in sharing your story, please contact Dr. Cynthia Morrow at cbmorrow@vt.edu.