In addition to the rapidly spreading coronavirus disease (COVID-19) pandemic, misinformation, fear, and sensationalism is spreading simultaneously in a global infodemic (1). By nature, science is rapidly evolving and full of contradictions. As scientists, we understand this fundamental truth, however, a 2019 survey conducted by the PEW Research Center found that one-third of Americans were either not sure or believed that the scientific method is “unchanging” and are core principles and truth. (2) In times of a pandemic, it is essential to rapidly disseminate information and evidence related to the threat at hand. However, it is also fundamental to remember the need to also educate the public on the key building-blocks of science and the scientific method.
While the media is discussing “flattening the curve”, hydroxychloroquine, and ventilators and aerosol-producing procedures, oftentimes we are failing to effectively communicate the fundamentals behind these concepts. The hot-topic debates surrounding hydroxychloroquine has highlighted some of the public’s misunderstandings regarding the scientific methods needed for assessing a drug’s efficacy and safety. Forthcoming results from trials of remdesivir will most likely emphasize this knowledge gap again. We must step out of our comfort zone and help explain the basics first. For example, more efforts should be made at describing the general structure (control groups and experimental arms) and stages (i.e., phases and timeline) of a clinical trials. Alongside this, we should honestly present failure rates, challenges, and timelines for treatment and vaccine development.
Clinical researchers are specialized experts skilled in jargon and acronyms of their field. As Brand and Botelho recently pointed out, the language that we use to describe epidemics, such as “a perfect storm”, “profoundly shape our experience of illness; our cultural discourse.” (4) We need to work towards creating a culture that is comfortable with estimating and discussing uncertainty. We must better prepare the public for contradiction and to avoid claims expressing strong (un)certainties without a shadow of a doubt. Furthermore, when we do encounter an absence of evidence we must question whether this is a valid justification for inaction. (5) This is especially important as inaction and delayed action are currently some of the main factors influencing the trajectories of COVID-19 globally.
In the absence of evidence, we also must ensure that we are not claiming that there is evidence of absence. A stark example of a miscommunication along these lines was highlighted in the recent and ongoing debates regarding the use of masks. The seeds of distrust were planted with the Centers for Disease Control’s (CDC) recent change to promote the public use of homemade masks and the tweet from the US Surgeon General Jerome Adams claiming that masks were “NOT effective in preventing the general public from catching #Coronavirus.” Clear and consistent communication is one of the most important parts of pandemic response. Claims of no effect should be infrequent and when they are made, we should help others learn to be skeptical. Furthermore, we should recognize and address our projected fears (e.g., that masks promote a false sense of security) and emphasize the psychological and behavior changes needed to make interventions successful.
In the face of (in)action and uncertain evidence, the public may be hungry for information to help them understand the local and global situation and perhaps regain some sense of control. This can be especially relevant for those with chronic or pre-existing health conditions, who may be delaying care or uneasy about how to continue treatment given the current situation. (6) With rapidly developing research being published quickly, often not through traditional academic peer-review, it is essential to help people digest this new information, which can often be twisted through the 24-hour news culture.
Now more than ever, scientists must embrace also open science and ensure that our work more accessible to the public. Currently, sites like arxiv.org which promote open-access medical pre-prints, are being used to accelerate access to late-breaking research. Going forward, we should continue to promote access to research not only through “inreach” mechanisms to own scientific community but also to the general public. (7) Medical journal editors can promote public outreach by requiring plain language summaries for research articles or promote alternative communication styles such as visual or video abstracts. This can help with both the general public and journalist’s understanding of the work. Scientists can also participate in “ask me anything” live blogging session on sites such as Reddit, create informative TikTok videos, and engage with the public and their colleagues on Twitter using general (#coronavirus, #COVID19) or specific (#medtwitter, #epitwitter) hashtags. Furthermore, we can also highlight all of the ongoing coronavirus trials which are registered on clinicaltrials.gov or the systematic reviews which are registered on PROSPERO. Rather than simply stating, we are not yet sure of the evidence and are “working on it”, we can show them the how, who, and where to offer more tangible reassurance.
In times of frustration with delayed or restrictive policies, we must reassure the public but also empower and engage them. COVID-19 can have far reaching consequences for mental health (8), employment instability, and feelings of security and freedom. We should acknowledge their fears and promote positive information to balance the “negative” information that dominates news cycles. Several world and political leaders have had “virtual town halls” to help address the public and children’s questions and concerns. We can help direct individuals to connect with their communities and promote civic engagement by highlighting local resources for food assistance, telehealth, selfcare, and activities to do at home. We should emphasize things they can do in their everyday life to protect themselves and minimize risk. For example, the WHO campaign for hand-washing has been largely successful and similar efforts focused on how to put on, remove, and dispose of masks (and gloves) should also be promoted.
While scientists frequently state that “more research is needed,” we must also promote the idea that more outreach is needed. We must make our work more accessible to the public through more accessible publications, both in terms of language and paywalls. We should also make efforts to better explain the fundamentals of the scientific method and encourage engagement throughout the research cycle. We must better convey not only the content of science, but also our passion for it. Passion is contagious and we have a quite literally captive audience who are yearning or more information. In times of crisis, we learn painful truths and hard lessons but we also find our humanity and spark passion. We can ignite the passion for science and create the next generation of citizen scientists.
1. Zarocostas J. How to fight an infodemic. The Lancet. 2020;395(10225):676. doi:10.1016/S0140–6736(20)30461-X
2. Pew Research Center. What Americans Know About Science | Pew Research Center. Washington, D.C.; 2019. https://www.pewresearch.org/science/2019/03/28/what-americans-know-about-science/. Accessed April 4, 2020.
3. Harrer S, Shah P, Antony B, Hu J. Artificial Intelligence for Clinical Trial Design. Trends in Pharmacological Sciences. 2019;40(8):577–591. doi:10.1016/j.tips.2019.05.005
4. Brandt AM, Botelho A. Not a Perfect Storm — Covid-19 and the Importance of Language. New England Journal of Medicine. 2020;382(16):1493–1495. doi:10.1056/NEJMp2005032
5. Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ. 1995;311(7003):485. doi:10.1136/bmj.311.7003.485
6. Rosenbaum L. The Untold Toll — The Pandemic’s Effects on Patients without Covid-19. New England Journal of Medicine. April 2020. doi:10.1056/NEJMms2009984
7. Bik HM, Dove ADM, Goldstein MC, et al. Ten Simple Rules for Effective Online Outreach. PLOS Computational Biology. 2015;11(4):e1003906. doi:10.1371/journal.pcbi.1003906
8. Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. New England Journal of Medicine. April 2020. doi:10.1056/NEJMp2008017