Coronavirus ‑ Building and maintaining the public’s trust

By Edel Fitzgerald

At the time of writing, we are in the grips of a pandemic. Countries across the world are grappling with their response to this once in a century public health issue.

Unprecedented measures have been taken by different countries to try to protect its citizens, from the closure of schools and crèches to military personnel patrolling the streets limiting people movement. The action taken is time-sensitive and ideally evidence-based, and the difference in approaches by states can be dramatic, from the UK’s reliance on herd immunity (or according to some experts, “letting the fire burn”) to the full-on panic-driven lockdown in Spain and Italy as cases hit extraordinary levels.

But whether the UK’s gamble that behavioural fatigue will set in if they bring in stringent measures too early is correct, what is clear is that the UK’s communications to date to the public has been confusing, with some events taking place and some cancelled, some businesses opening and some closing. The public continue to be baffled as the UK government gives mixed messages: schools are finally to shut but from next Monday, and despite the government repeating that such closures would make little difference in curbing infection.

Each country is taking a different approach to tackle this global crisis; the question is, who is best managing the communications to its most important stakeholders?

The WHO’s sustained call for action: did it fall on deaf ears?

“One of the most important and effective interventions in a public health response to any event is to proactively communicate what is known, what is unknown and what is being done to get more information, with the objective of saving lives and minimizing adverse consequences.“

The above was issued as part of a statement from the World Health Organisation as early as 26th January 2020, as part of their Risk Communication and Community Engagement (RCCE) readiness and initial responses to the coronavirus.

The WHO continued to communicate clearly, consistently and coherently in the following weeks, providing daily updates and advice to countries to take precautionary measures and urgent action.

While they couldn’t forecast the outbreak that now faces over 170 countries worldwide, they held back from announcing it as a ‘pandemic’ for several weeks, despite mounting pressure to label it as such. In daily updates they called upon countries to act and rang “the alarm bell loud and clear. And while the crisis ,which is now labelled as a ‘pandemic’, does not alter anything practically, it became a turning point: it was the final wake-up call for countries who did not heed the WHO warnings, finally signaling for policymakers to work together urgently to bring the virus under control.

Ireland’s Call

Interestingly, Ireland has been called out positively by the WHO for its action in containing the spread of the virus. Executive Director of the WHO Dr Michael Ryan commended Ireland for its action-oriented, evidence-based, and assured approach to managing the crisis.

Importantly, the initial reaction from Ireland, in terms of the government, healthcare experts and state bodies, has been calm, measured and strategic. There was no kneejerk reaction and careful consideration appears to have been afforded to the situation with lessons learned from other regions carefully factored in.

Effectively cascading communications

The HSE High Consequences Infectious Diseases Planning and Coordination Group (HCID) has been working on communications since early January and even at that early stage had been putting in place detailed plans, guidance and information.

Despite events unfolding at astounding speed, the group has cascaded messaging that has been effective in terms of guiding the general public on keeping well and keeping vigilant. Daily notifications and regular updates, published since 27th January via www.gov.ie, as well as updates throughout the day on www.hse.ie, have been reassuring in terms of explaining to stakeholders that things are under control, while also pointedly calling on everyone to ‘play their role’ in deterring the spread of the disease. The narrative, while consistent, also considers the latest knowledge about the virus as it came through in real-time.

For its part, the National Public Health Emergency Team, chaired by Chief Medical Officer Tony Holohan, has taken a strong lead from the ECDC and the WHO in dealing with the outbreak, with regular reviews of communications and data relating to Ireland’s preparedness. Dr. Holohan has provided regular updates on how perspectives and actions are being reframed in order to continue to manage the outbreak, and his confident, calm and informed daily update with his team to the media has been a reassuring voice throughout the entire crisis.

Numerous bodies have been working closely together to ensure all measures and actions taken are aligned and communications are consistent. The HSE Public Health and HSE Health Protection Surveillance Centre who have been monitoring the COVID-19 (Coronavirus) situation since it was first notified by the WHO and the multidisciplinary ‘Expert Advisory Group’, chaired by Cillian De Gascun, Laboratory Director at the National Virus Reference Laboratory, have been key in providing strategic and tailored advice to the National Public Health Emergency Team, the HSE and others on an ongoing basis. This group of experts ensures that a holistic approach is taken in terms of decision-making and allows Ireland to adapt quickly where possible, with the group being on-hand monitoring events as they unfold and providing expert input.

Beyond the informative daily updates by the Emergency Team and the government on the latest state-of-play, possibly the master stroke from the outset was the insistence of the Irish government not to name individuals who contracted the virus, and their use of only vague descriptors in terms of the regions affected. Despite initial pressure from media and social platforms, the government and experts remained confident that by sustaining the principle of confidentiality, a sense of trust would be created and people will be more willing to disclose that they have contracted the virus, in turn enabling quick diagnosis and tracing.

This commitment to building and maintaining trust with the public through detailed, structured communications and actions, was summed up in the empathetic address to the nation by An Taoiseach Leo Varadkar on Tuesday night. Conveying the seriousness of the environment we are living in, he showed great leadership in outlining the challenges ahead and pulling no punches, but also offered reassurance and comfort that together we will prevail.

Indeed, his speech, and the government’s position in relation to this crisis overall, has consistently been about the Irish people, something that perhaps was missing in their election strategy. Protecting Irish people and underlining that this needs to be a community effort, is coming across loud and clear. Thousands of people have been signing up to indicate that they would like to help in the HSE fight against the virus, and thus far the Irish public have been keenly following the HSE guidelines.

The challenge moving forward, as the UK government has already indicated, will be to ensure fatigue does not set in. As An Taoiseach reminded everyone, “This is the calm before the storm, before the surge – and it will come.” As cabin fever sets in, maintaining the public’s trust, that the leaders continue to make the right decisions, will be crucial.

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