The Covid-2019 outbreak due to the SARS-CoV-2 virus in China which, as at 19 February 2019, also affected 25 other countries, resulted in behaviour which reflected global anxiety and fear.
Masks and hand sanitisers disappeared from the shelves of many outlets. Large organisations implemented crises and continuity plans with specific instructions for their staff. Health care delivery systems instituted measures in accordance with their health emergency and disaster plans.
All these responses had its genesis in the perception of the risk of harm from the novel SARS-CoV-2 virus.
What is risk?
There are multiple conceptions of risk, a term which is commonly used to describe a hazard, probability, consequence or a potential threat.
Life is not without risks as there are associated risks with every human activity. Everyone generally take risks if the benefits are perceived to outweigh the risks by a margin, which may or may not be significant. There is no such thing as zero risk.
There were two aspects on everyone’s mind with regard to the outbreak i.e. the frequency of harm from the SARS-CoV-2 virus and the amount of harm from Covid-2019.
Scientists usually describe risk as a mathematical term in terms of numerical odds or probabilities, an approach which is objective, impersonal and applied to populations instead of individuals.
Perception of risk
On the other hand, the public are concerned with qualitative aspects like the origin of the risk (natural or technological), whether the risk is short-term (temporary) or long-term, the distribution of risk in the population, and the ability of individuals to influence or control the risk.
Most people, including health care professionals or patients, do not find it easy to understand risk in terms of numerical odds and probabilities. In addition, patients and their carers may not understand some terms used by health care professionals to explain risk.
In general, patients and their carers approach risk within the context of the individual’s concerns, anxieties and fears about the present and the future. This approach is very personal and is influenced by individual issues and priorities rather than by statistical odds and probabilities.
Individual actions are not based on “actual” risk but on the basis of their perception of risk i.e. risk perception is subjective. The assessment of the importance of risk can vary even if the actual risk does not.
Individuals place different weightages on different risks, depending on risk attributes, even if the numerical magnitude is the same. Risk attributes include the potential for catastrophic or chronic harm, the degree of familiarity of the situation, the degree of uncontrollability of the risks and above all, trust.
As a result of individuals’ perception of risk, their estimates of risk may differ from those of health care professionals and policymakers.
An example can be found in behaviour towards road safety, with road traffic accidents the fourth most common cause of death in Malaysia. The Global Status Report on Road Safety published by the World Health Organization (WHO) and the World Bank in December 2018 reported 7,152 deaths in 2016, which is the third highest in Asia.
Malaysian road traffic fatality rates are similar to that of some African countries with no change since 2007. Compare that to the behaviour towards Covid-2019.
Good communication helps in the building of trusting relationships between the public, health care professionals and policymakers. It also helps the public to take more responsibility for their health. Just like the patient-doctor relationship, the closer the relationship between the public and the government, public cooperation in addressing health care issues, particularly in an outbreak, will be enhanced.
Some general principles on how best to communicate risk include the acceptance and involvement of the public as partners by informing them of the risk; planning the substance of the message; ensuring information and advice is current; evaluating the public’s understanding of the messages; and above all, maintain trust and credibility by being honest, frank and open.
Risk communication in an outbreak
The opening two paragraphs in the World Health Organization (“WHO”) document, “Communicating risk in public health emergencies 2017“, state: “During public health emergencies, people need to know what health risks they face, and what actions they can take to protect their health and lives.
“Accurate information provided early, often, and in languages and channels that people understand, trust and use, enables individuals to make choices and take actions to protect themselves, their families and communities from threatening health hazards.
“Risk communication is an integral part of any emergency response. It is the real-time exchange of information, advice and opinions between experts, community leaders, or officials and the people who are at risk. During epidemics and pandemics, and humanitarian crises and natural disasters, effective risk communication allows people most at risk to understand and adopt protective behaviours.
“It allows authorities and experts to listen to and address people’s concerns and needs so that the advice they provide is relevant, trusted and acceptable.”
The significant principles stated in the WHO document include:
• Building trust and engaging with affected populations – trust, communicating uncertainty, community engagement
• Integrating emergency risk communication into health and emergency response systems – governance and leadership, information systems and co-ordination, capacity building and finance
• Emergency risk communication practice – strategic communication planning, monitoring and evaluation tools, social media and messaging.
The vignettes in the WHO document include:
• “To build trust, risk communication interventions should be linked to functioning and accessible services, be transparent, timely, easy-to-understand, acknowledge uncertainty, address affected populations, link to self-efficacy, and be disseminated using multiple platforms, methods and channels.
• Communication by authorities to the public should include explicit information about uncertainties associated with risks, events and interventions, and indicate what is known and not known at a given time.
• Identify people that the community trusts and build relationships with them. Involve them in decision-making to ensure interventions are collaborative, contextually appropriate and that communication is community-owned.
• Risk should not be explained in technical terms, as this is not helpful for promoting risk mitigation behaviours. Consistent messages should come from different information sources and emerge early in the outbreak. Messages should promote specific actions people can realistically take to protect their health.
• Social media may be used to engage the public, facilitate peer-to-peer communication, create situational awareness, monitor and respond to rumours, public reactions and concerns during an emergency, and to facilitate local-level responses.”
Non-verbal communication and the choice of words are critical in risk perception. The use of face masks by government officials in media conferences conveys a different perception from one in which face masks are not used.
Similarly, the use of the word “cured” conveys a different meaning from the words “discharged or recovered”, with the latter being more appropriate in the light of significant gaps in knowledge about the SARS-CoV-2 virus and Covid-2019.
As usual, the performance of the Health Ministry will be evaluated by the public during the course of the outbreak and afterwards.
The Covid-2019 situation is still constantly evolving. With the abundance of fake news, it is advisable to obtain updated information and guidance from the following dedicated websites, among others i.e.
• World Health Organization: Protect yourself; Question and answer; Travel advice; Situations report; Technical guidance; Global research.
• Ministry of Health, Malaysia: Current information; Guidelines; Media Centre; Infographics; Video; Ask Doctor.
• United States Centers for Disease Control and Prevention: What you should know about COVID-19; Situation updates; Information for specific audiences; What’s new; Communication resources.
• Ministry of Health, Singapore: Case summary in Singapore; Disease outbreak response system condition; Find a PHPC [public health preparedness clinic] near you; COVID-19 situation dashboard; Precautions that you can take; Health advisory; Where to collect your mask; Queries call; Resources; Videos; Infographics and Posters.
• Hong Kong Centre for Health Protection: Latest local situation of Covid-19; Countries/areas with Covid-19; List of buildings with confirmed Covid-19 in the past 14 days; List of flights/trains/ships taken by confirmed cases of Covid-19 during the symptomatic phase in the past 14 days; List of buildings of the home confines under mandatory home quarantine; Novel coronavirus infection-Local situation-Interactive map dashboard; Prevention of pneumonia and respiratory tract infection; Hotline; Preparedness and response plan; Press releases; Letters; Guidelines; Health education materials; News video.
• China National Health Commission: Latest; Measures; Policies; Front-line workers; Tips.
• European Centre for Disease Prevention and Control: Overview; Latest updates; Situation update worldwide and for the EU/EEA and the UK; Facts; What is the risk of infection for the EU/EEA and UK population; Preparedness resources; Guidance and technical reports; Sources of updated information on Covid-19 in the EU/EEA countries; Advice for travellers; Event background; Advice to healthcare workers; Laboratory support; Case definition and European surveillance.
Dr Milton Lum is a past President of the Federation of Private Medical Practitioners Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organization the writer is associated with.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.