by Craig Klugman, Ph.D.
COVID-19 (formerly known as “coronavirus”) remains at the top of the health-related news feeds. As of February 27, the CDC reports 14 native U.S. cases (2 the result of person-to-person transmission) and 42 cases from people repatriated from the Diamond Princess cruise ship. The World Health Organization reports cases in 82,294 in 46 countries.
On Wednesday, February 26, Trump held a press conference where he outlined his plans for dealing with COVID-19 in the U.S. Trump announced that the U.S. is “very, very ready” for an epidemic and he placed Vice-President Pence in charge of the U.S. response. Pence is famous for botching an epidemic of HIV while he was governor in Indiana. His actions to close down needle exchanges, close testing centers, and remove the availability of condoms is credited for creating the outbreak there. The short story is that Trump does not have a plan and seems to be in denial.
As has become a norm when facing novel technologies or new health crises, bioethicists have willingly stepped up to be interviewed by the media. In some cases, we are egarely sought (I am sitting on some questions from my campus student newspaper). Consider Zeke Emmanuel appearing on MSNBC speaking of the Trump press conference; “I found most of what he said incoherent.” Emmanuel served as a special advisor to health policy under the Obama administration and is considered an architect of the Affordable Care Act. He is currently on leave from the Penn Department of Medical Ethics while he serves as Senior Advisor to the Director General of the World Health Organization. Emmanuel is concerned about Trump’s “ignorance about the situation” and lack of knowledge on public health. He emphasized the importance of handwashing and a growing concern over the break down in the supply chain from China where many medical supplies (i.e. masks) and medications come from.
Art Caplan took to the radio waves with Boston Public Radio to counter Rush Limbaugh’s assertion that COVID-19 is “the common cold folks” and is being used by the left to “bring down Donald Trump”. Caplan directs the NYU Langone Division of Medical Ethics and has experience in global health issues. Caplan questions whether a president who denigrates science and has cut funding for disease surveillance and response is the right person to lead the country through this upcoming crisis. He asks, why a potential pandemic is being viewed not in terms of morbidity and mortality but in terms of political costs? Caplan also has a history of commenting on Limbaugh’s health statements.
Kelly Hills wrote in NBC News’ Think that “Quarantine is an out-of-date concept to treat disease, and a cruise ship is the last place you want to hold an impromptu one”. She instead suggests social distancing, encouraging the sick to stay at home, and washing hands frequently. Hills is an independent bioethicist who founded a consulting firm and was formerly a “software test engineer” who works on “self-driving vehicles and other forms of impending robotic doom, synthetic biology, conflicts of interest, and biosecurity.” However, her examples of where quarantine fails are all examples where people ignore the quarantine. Quarantine is effective when people follow it and/or it is enforced equally. It fails when some people are exempted from it or when people try to get around it. Those actions do not mean that quarantine is no good—in fact, it is very good at what it does—but that it needs to be enacted better and more humanely. “Social distancing” is simply a variation of quarantine.
Two Chinese bioethicists, Ruipeng Lei and Renzong Qiu, write in the Hastings Center Forum about their countries’ unethical reaction to the original whistleblower, Dr Li Wenliang, on this current outbreak. Dr. Li recently died of COVID-19 after being arrested and admonished by the police. Li was silenced for speaking on the growing number of cases that indicated an epidemic. The authors are Hastings Center Fellows and directors of bioethics programs at two universities in China.
Working with the media is one of the threads that distinguished bioethics as a field from its early years. Having on-going relationships with writers, editors, and producers is one way to create trust between academics and the media. However, when one works with the media, it is important to always be speaking from one’s own expertise. Ruipeng and Renzong write out of their knowledge of China and bioethics. Caplan, a long-time media collaborator, provides commentary on an extreme media personality’s false and dangerous words. Caplan draws on his experience of working with the media as well as his work on global health issues. Emmanuel has a long history of crafting and studying health policy and his work with the WHO is clearly relevant. Thus, the first rule of bioethicists talking to the media is to know your facts and have expertise in the topic.
The second rule is not to create panic. Hills comment that quarantine is out-dated and a poor solution undermines a major tool in the public health arsenal. When most governments are responding with scientifically proven techniques and then an “expert” suggests that its not helpful, people can feel greater anxiety and helplessness. Even when offering expert opinions, it is useful to think about the repercussions of what we say and how we say it. One is responsible for yelling fire in a crowded theater; we are responsible for the panic our words might create.
The third rule is to manage the message as best as you can. Few journalists will allow you to read the copy or suggest edits before going to press. And yes, once you say something, you lose control over how it is used. This is where the good relationships are important. One must also speak in ways that get across a message simply, understandably and interestingly. Notice that neither Caplan nor Emmanuel are not offering bioethics or medical analysis. They are using their public pulpit to call out incorrect information and a lack of actual response. Thinking COVID-19 is just the common cold diminishes the effect it is having and could continue to have on our world. Calling out the federal government for a lack of a real response is an important task for someone who has been a government official. They are commenting on the comments: Are the messages useful and helpful? Are the Trump administration and Limbaugh being effective and accurate communicators to deal with an epidemic?
Although both Caplan and Emmanuel speaks at some length (in media terms), notice that both have short, quippy phrases as well that capture and deliver the message. Such wit is what the media usually grabs onto. The reporting on this reporting echoes this idea—Emmanuel’s “incoherent” and Caplan’s “Is that the right person to lead us through the epidemic?” You can have a more nuanced explanation, but you also need the catchy phrase that brings home the important message.
The media has a far reach whether it is a politically biased source or one that aims for neutrality. As bioethicists, we have an ethical responsibility to use our access to the media and their interest in our ideas for the good rather than just for our own promotion. People are scared and anxious over this disease. Providing reasoned, calm discourse that corrects wrong information is important. Helping people find perspective to understand this moment in health history is vital. And providing analysis that can lend to a proportional response is essential. Speaking merely to see your own lips move and your own words in print is detrimental. Deserved or not, bioethicists have an expert status in the media for the public. We must rise to the occasion and help governments and individuals be rational in dealing with COVID-19. This moment is about what we can do to help others and to assist the world in dealing with this situation. This is not the first infectious disease crisis (think SARS, Ebola, and more) and it most certainly will not be the last. Let’s help make the world better and safer while preserving human rights rather than adding to the moral panic.