The U.S. has formal and informal coronavirus guidance — and it’s confusing and dangerous

Credit: AHMAD AL-RUBAYE / Getty Images

If trust is the currency of leadership, then the United States is running on overdraft — and it’s costing American lives.

Countries that have successfully suppressed Covid-19 have done so in different ways, but there’s one thing they tend to have in common: high levels of trust between citizens and the government officials in charge of combating the virus.

South Korea’s success, for example, has been largely credited to the work the country has done to build a culture of political accountability after past pandemics, which has been important for getting public buy-in for lockdown and distancing measures. In Greece, Sotiris Tsiodras, the Greek Health Ministry’s spokesperson and an infectious disease expert, gives daily briefings and, through empathy and data-sharing, has gained widespread trust and affection. A recent poll declared him the most popular Greek today.

President Donald Trump, on the other hand, contradicts and outright criticizes American scientists who have experience in responding to pandemics. He recently lambasted the guidelines to reopen schools developed by the Centers for Disease Control and Prevention (CDC), and he rarely allows scientists at the organization to speak to the public. The U.S. is also pulling its funding of the World Health Organization, the implication being that the U.S. believes the organization has mishandled the response. For those who like President Trump, these moves might be considered accountability for scientists that mishandled the epidemic and have put Trump’s presidency at risk. For critics, it’s yet another sign of the White House’s incompetence and blame-shifting in responding to the pandemic. Data shows that over 56% of Americans disapprove of Trump’s response to the pandemic — neatly tracking overall disapproval of his presidency as a whole. Taken together, there’s a deep mistrust that leaders at the highest levels of the U.S. government can keep people safe.

Such contradictions pop up locally as well, where political leaders allow for — and implicitly encourage — public behavior that they personally avoid or outright condemn as irresponsible. This week, New Hampshire Governor Chris Sununu said he is supporting Trump’s upcoming rally in his state — and not requiring mask-wearing — but Sununu himself will not be attending. “I will not be in the crowd of thousands of people, I’m not going to put myself in the middle of a crowd of thousands of people, if that’s your question specifically,” he told CNN. “Unfortunately, you know, I have to be extra cautious as the governor, I try to be extra cautious for myself, my family.”

In the absence of accurate health information — and in some cases, the active sharing of disinformation — Americans are forced to find advice about the virus elsewhere. This (hopefully) means more Americans reading science journalism. It also means more people are reading research, including preprints, which are not yet peer-reviewed. It means following more scientists and medical experts on social media. And while following experts on social media can be beneficial for this purpose, there’s the risk of misunderstanding experts, or getting duped by armchair experts or inaccurate stories. Overall, it is unusual that people must so regularly seek new sources because the information they are getting from the federal or state government is inaccurate, incomplete, or inconsistent — and could put their lives at risk.

“Given the challenge with communications during this pandemic, and given that certain institutions have significant political limitations that impact the scope of their communications, such as CDC, the role of scientists and doctors to help fill that gap is immense,” says Abraar Karan, MD, an internal medicine doctor at the Brigham and Women’s Hospital. “In that way, I feel like my relationship with social media has changed because there is a lot more weight and consequence to everything I write or tweet, and I take that very seriously.”

What’s happening is that, in a time where accurate and timely information has never been more sought after, we’re dealing with a fractured set of recommendations: One set of guidance that’s technically “formal” because it comes from the federal government. And one that’s informal, because while it might be more in line with the science, it contradicts the official American policy. And while the availability of good information is always desired, the fact that it has to fight with the official line for attention impairs our ability to respond to the pandemic.

Take the inconsistent reopening plans across the nation. Technically, a person eating inside a restaurant, visiting a nail salon, or having a party of 10 or more people may be following the rules depending on where they live. They are not, according to official policies of their city, doing anything wrong. And yet, if you frequent Twitter or read sources beyond government recommendations, you might be aware that there’s disagreement around reopening policies, and that just because a bar is open doesn’t actually mean you’re safe from the virus if you venture inside.

But should a person be blamed for going to a bar when the bar is open for their business? The implication being that it’s safe for them to go to the bar… because it’s open? Blaming and shaming individuals may feel like the right thing in these situations, but as my colleague Yasmin Tayag writes, it’s rarely effective. Moreover, it’s confusing to have a policy where people are told it is okay and safe to go to restaurants or bars while there’s also an informal policy, shared by their peers or other science experts, that they should not go to these establishments because it’s unsafe or morally reprehensible to do so.

The trouble remains that even six months into the pandemic, there are many unknowns. And while that’s not ideal, it’s normal that recommendations change based on new data (take the early back-and-forth on mask-wearing). But that kind of whiplash is easier to navigate if people trust that their leaders are giving them the most accurate information available, or that they have their lives — and not just the economy — top of mind. It’s easier to navigate if you think you can trust that the recommendations and decisions by leaders are based in science. When the president of the United States says hydroxychloroquine will help Covid-19, you shouldn’t have to go to alternative sources to find out if that’s actually true. But you do (FYI, it’s not safe).

The United States has lost over 132,300 Americans to Covid-19. The shame of the nation is that thousands of these deaths were avoidable, and we’ve known the basics of how to avoid them the entire time.



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