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December 10, 2020

Is it time for 'terrifying realism' about Covid-19?

Daily Briefing

    Writing for the New York Times, Elisabeth Rosenthal, a former ED physician, calls on officials to replace ineffective "Mister Rogers-type" public health announcements about the novel coronavirus—which do little to overcome the public's "natural denial" of the virus' effects—with "some sharp, focused terrifying realism."

    How to communicate with patients amid Covid-19

    For inspiration, look to antismoking PSAs

    Rosenthal shares how, when she was a student, she was required to watch a short anti-smoking PSA in class, one featuring "a woman talking mechanically, raspily through a hole in her throat, pausing occasionally to gasp for air." While Rosenthal had "nightmares about that ad," she said, "it was supremely effective: I never started smoking and doubt that few if any of my horrified classmates did either."

    And the evidence, she writes, isn't just anecdotal. Smoking rates plummeted when the government mandated that television and radio stations run antismoking ads between 1967 and 1970—"many of them terrifyingly graphic"—and, since that time, "numerous smoking 'scare' campaigns have proved successful."

    'Mister Rogers-type" PSAs aren't sufficient

    In comparison, however, the United States is now relying on anodyne PSAs about the novel coronavirus that "are virtuous and profoundly dull." For instance, she cites "videos that feature scientists and doctors talking about wanting to send kids safely to school or protecting freedom," or Michigan's videos urging state residents "to put on a mask 'for your community and country.'"

    "Forget that," Rosenthal writes. As Jay Van Bavel, associate professor of psychology at New York University and co-author of a Nature paper on how social science can support Covid-19 response efforts, said, "Fear appeals can be very effective." 

    While Rosenthal writes that she has no interest in promoting "fear-mongering," she believes we should be spotlighting "in a straightforward and graphic way what can happen with the virus." For instance, she writes, run a PSA "featuring someone actually on a ventilator in [a] hospital," perhaps even someone who is "'bucking the vent,'" a reaction bodies have "against the machine forcing pressurized oxygen into the lungs, which is why patients are typically sedated."

    Alternatively, she continues, a PSA "could feature a patient lying in an ICU bed, immobile, tubes in the groin, with a mask delivering 100 percent oxygen over the mouth and nose—eyes wide with fear, watching the saturation numbers rise and dip on the monitor over the bed." Or perhaps, she adds, create a PSA featuring a "Covid long hauler," such as the professional football player Ryquell Armstead, who at 24 "has been in and out of the hospital with serious lung issues and missed the season."

    Rosenthal writes that such PSAs may "sound harsh," but they can also overcome people's tendency to underestimate the risks of the virus and disease to themselves—even when they see and understand the risks as spelled out in graphs, statistics, and explanations. And while such unflinching PSAs will likely "seem hard to watch," she writes, "studies have shown that emotional ads featuring personal stories about the effects of smoking were the most effective at persuading folks to quit. And quitting smoking is much harder than social-distancing and mask-wearing."

    Rosenthal concludes, "Once a vaccine has proved successful and enough people are vaccinated, the pandemic may well be in the rearview mirror. In the meantime, the creators of public health messaging should stop favoring the cute, warm and dull. And—at least sometimes—scare you" (Rosenthal, New York Times, 12/7).

    How to communicate with patients amid Covid-19


    Consumers are eager for credible information about Covid-19, when and how to seek various types of health care services, and what to expect if they do require in-person care. Yet many health systems are providing less frequent information or less detailed safety information than companies and service providers in other industries.

    The attached guide includes details to consider when crafting messages for consumers, example communications from health care providers and companies in other industries, and insight into what makes a message effective.

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