Is trust in public health guidance eroding amid 'mixed messages'?
OTTAWA -- As Canadians grow more tired of the restrictions the nearly eight-month long pandemic has imposed on their lives, experts in health policy say so too has their frustration with the communication around those directives.
David Fisman, a professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health, says conflicting medical guidance in recent months has left room for public doubt.
"The difficulty is, there have been so many backtracks, about-faces, and you know mixed messages," he told CTVNews.ca via phone on Tuesday. "What are people supposed to make of this? It’s just not coherent."
The most recent example of this was the flip-flopping guidance on how to safely celebrate Thanksgiving in Ontario. Confusion mounted when in the same week, the province’s associate medical officer of health ruled out celebrations with people outside one’s household, but then a few days later Premier Doug Ford said he’d be gathering with up to 10 people.
At the same time, officials said restaurants and workout facilities weren’t the major source of transmission, only to announce a few days later that indoor dining and gyms would be closed.
Now, on the eve of Halloween, we’re seeing similar contradictory advice. At one point, it looked promising that all corners of the province could go door-to-door collecting candy, but slowly, as cases climbed, certain hotspots have been told to stay home.
This goes against the advice of Canada’s Chief Public Health Officer Dr. Theresa Tam, who says she doesn’t see trick-or-treating as risky. Neither does CTV News Infectious Disease Specialist Dr. Abdu Sharkawy.
"Let’s remember that this is one of the few occasions that can almost exclusively be experienced in an outdoor setting. We know from the science of transmission of this virus that the risk is incurred by being indoors in poorly ventilated areas, areas in close contact with others for prolonged period of times. I struggle to think how this is something we need to worry about," Sharkawy said on CTV News Channel on Tuesday.
Fisman says unless officials can show there is some evolving science that proves trick-or-treating outdoors is unsafe, it’s bound to cause anger and confusion.
"It comes down to understanding the science and then articulating that to folks who don’t necessarily have that background, or spend their lives studying communicable disease. You have to be able to talk to people and motivate them in a way that resonates and puts them on the team," he said.
He points to B.C.’s provincial health officer, Dr. Bonnie Henry, as an example of an official doing it right.
"[She] can talk to people in plain language and say look, you know, this is what we’re doing, this is why we’re doing it, this is why we have to do it, here’s the end game, here’s what’s in it for you and for all of us," said Fisman.
The U.S. Centers for Disease Control and Prevention outlines seven steps to effective messaging amid an outbreak: Start with empathy, identify and explain the public health threat, explain what is currently known and unknown, explain what public health actions are being taken and why, share dilemmas, foreshadow possibilities, and emphasize a commitment to the situation.
Fisman says some of those steps aren't being met in Ontario.
"I’ve felt for a number of months now, we just don’t have anyone kind of steering the ship who has the ability to communicate."
It’s not because officials have gotten worse at pandemic messaging, he said, but more so because the public has become more informed and thus less passive when regulations arrive at their doorstep without justification.
"You have this broad swath of the population that actually understands a pandemic in quite a sophisticated way. I think it’s becoming a problem, this isn’t armchair epidemiology anymore," he said. "It has to make sense in a connected world where people have access to a lot of information."
Timothy Caulfield, a professor of law at the University of Alberta and Canada Research Chair in Health Law and Policy, says skepticism is bound to rise when medical directives shift to reflect new evidence.
"[Public health authorities] are struggling with a lot of scientific uncertainty. They have to struggle with the context of local conditions being different and that can result in a variation in recommendation from jurisdiction to jurisdiction and that can also result in public health authorities changing their minds as we’ve seen with masks," he said.
Caulfield says it’s up to public health and politicians to be more transparent and frank when information is still unknown to prevent a reversal in positioning.
"It’s a mistake to be dogmatic in your recommendations when you know that the evidence base is less than robust and we’ve seen that at times and we still see it," he said. "They’ve had to revisit their language and I think that’s really problematic."
He says as confusion mounts, the public will often look to alternative, and at times untrusted, sources of information to satisfy personal opinions.
"When you’re frustrated and perhaps have a particular ideological leaning, you are more likely to gravitate to a narrative that fits your personal brand and that’s definitely happening now, you’re seeing that more and more," he said.
Caulfield and Fisman agree the trajectory of the next phase of the pandemic will hinge on strong communication.
"Good communication is every bit as important as a functioning microbiology lab in terms of controlling a pandemic. It’s a key, core, component of this effort. How are you going to motivate people if they don’t find you credible and they don’t like you because you’re shaming them?" said Fisman.