I was really looking forward to co-chairing a session at the Society of Toxicology Annual Meeting this year. The organizers wisely canceled the meeting due to the one risk on everyone’s mind these days: coronavirus. My talk? “Communicating Risk in a (Mis)information-filled World,” in which I explore how errors in risk perception lead to public misunderstanding of scientific issues. These errors apply to many decisions that we make about health risks, but coronavirus might just be the perfect case study for understanding how errors in risk perception lead us astray. In short, coronavirus shows that we still suck at assessing risk.

This post was originally published on March 14, 2020 before widespread closures had been implemented in most of the U.S. At that time, many people were minimizing the risks and not following social distancing recommendations for slowing spread, while at the same time panic buying supplies like toilet paper. A month later, the landscape looks a lot different. Schools and non-essential businesses are closed. Many states and cities have stay-at-home orders in place. Based on this, we updated this post on April 19 to reflect the current situation. We have also updated the resources list at the end of the post and the graphics from Information is Beautiful to the April 10, 2020 versions.

Humans are terrible at assessing risk

As I’ve written before, humans are intuitively terrible at assessing risk. Even scientists like me who talk about risk all the time struggle with it in our own lives. These tendencies of ours show up again and again in how people assess risks, leading to confusion and misperceptions of common risks. Now we’re seeing many of these risk misperceptions play out daily with coronavirus. Let me explain.

We are bad at assigning value to long-term risks and benefits

Humans tend to focus on short-term risks and downsides, like the costs of canceling events or missing out on plans. We give less thought to the long-term benefits like “flattening the curve.” Flattening the curve means adopting measures to slow the spread of disease and reduce the number of people sick at the peak of an outbreak.

Our focus on short-term risks has led to irrational decisions, like stockpiling goods, that have nothing to do with stopping the spread of coronavirus, which can lead to shortages of necessary medical supplies. We end up making decisions, both collectively and individually, that do not help “flatten the curve” but instead contribute to spreading the disease. A good example is hoarding toilet paper rather than practicing appropriate social distancing as recommended by public health officials.

A month later, this continues to be a problem. Parks, beaches, and hiking trails are crowded. Governments have made exceptions for religious gatherings and talk about easing restrictions before adequate measures are taken. The types of measures that may be necessary to ease these restrictions are outlined in these articles at NEJM, Vox, and The Atlantic; the WHO recently listed six specific conditions for easing restrictions.

We get it: abiding by stay-at-home orders is difficult and stressful and has other serious downstream consequences. However, the worse we are at following these guidelines, the longer this will go on, and the larger the economic and other downstream consequences will be. In part, this has been caused by people not following directions, but the other causes are inconsistent messaging and slow action from government officials. For example, South Korea and the US had their first cases on the same day but South Korea has largely flattened its curve, whereas the number of cases in the US continues to rise. In other words, our current situation has been caused by a combination of failed leadership and action to contain the spread.

We overestimate the risk of what we don’t understand

Each year, public health officials struggle to get people to adopt effective prevention measures for cold and flu (handwashing, social distancing, and vaccination), but hand sanitizers flew off the shelves when news of COVID-19 hit. Why the difference?

The graphic below compares how contagious and deadly COVID-19 is compared to familiar viruses. I am not saying that the dangers of coronavirus and influenza are comparable—they aren’t as the graph clearly shows. However, individuals frequently ignore effective measures like vaccination and handwashing when it comes to the flu because our familiarity with the flu leads us to underestimate its well-established risks. On the other hand, the novelty of COVID-19 has made people suddenly pay attention to these familiar guidelines now that they’re in a new context. We certainly hope that once there’s a vaccine for COVID-19, people’s pristine handwashing and sanitizing habits will persist because now we’re acutely aware of the risks of not washing out hands properly. We also support initiatives to empower over 2.2 billion people worldwide without access to safe water or soap to wash their hands safely.

How contagious and deadly is coronavirus compared to more familiar viruses (Information is Beautiful)

We worry more about risks that we can’t control and tend to overlook risks that we can control

Our fear that we can’t control contagion also adds to our sense of panic and fear. We end up engaging in behaviors that increase our feeling of control, like buying toilet paper, instead of doing the things that would actually help control the spread of coronavirus and flatten the curve.

Where we see this now is in the popularity of videos like the one instructing people to use soap to clear their groceries, even though this is not recommended and washing with soap poses its own risks (soap is not meant for human consumption). Again, this is something we as individuals can control so it makes us feel like we are managing our exposure even though that’s not the reality. This guide to food safety and COVID-19 provides helpful and accurate advice: Food Safety and Coronavirus: A Comprehensive Guide.

We ignore risks that we can’t see in our everyday lives

On the flipside, coronavirus and its effects were largely invisible to us a month ago. I wrote then:

In the past few days, there has been a sharp increase in coronavirus diagnoses and a rapid escalation in response. Unfortunately, we’re often reluctant to take action when a risk seems to be located elsewhere, and likely to wait to take action until we “see” it for ourselves in our own communities. But that delay in action can end up causing great harm to our collective health.

Weeks later, we see the effects of these delays, yet it’s still hard to adhere to restrictions on our activities when we can’t actually see the effects of the virus. It’s difficult to wrap our heads around the risk of something we can’t see. Until people started to see the direct effects of coronavirus on people close to them, it was difficult to convince them to follow social and physical distancing restrictions. Unfortunately, the more this virus becomes visible, the more people suffer and die, and the more we need to do to manage the outbreak.

One way that coronavirus has been very visible to us is the constant news coverage. Being informed is important but the constant barrage of updates and stories can take a toll on our mental health, as we discussed recently in our Coping with COVID post. The Pew Research Center reports that about half of Americans think they have seen at least some made-up news about coronavirus, which makes it very difficult for people to figure out what is accurate and what is nonsense.

On a daily basis, we’re inundated with countless coronavirus articles, memes, infographics and social media posts from unverified people that start to feel like a tangled web of information, misinformation and even some downright lies and conspiracy theories. The graphic below from Information is Beautiful highlights just how much attention the coronavirus outbreak is getting. Thanks to all that extra social media attention, the risks of coronavirus are at the forefront of our minds, with truth and falsehood shared alongside each other, affecting our ability to tell them apart and make rational decisions.

Media mentions for coronavirus (Information is Beautiful)

Break the chain of exaggeration

The way we consume information in 2020 often increases the impact of our risk misperceptions. Health claims are sometimes exaggerated or misrepresented in the media, and those exaggerations are in turn filtered, simplified, and amplified through social media algorithms. We end up with a chain of exaggeration where the information that we consume is disconnected from science, evidence, and expert advice.

When you add in the way social media hits us with a constant barrage of information, it’s even harder to answer the question: how worried should we be? And what makes all of this even harder is that deliberate misinformation is often shared alongside accurate facts. What makes this particularly challenging during this pandemic is that our knowledge is still developing and we don’t have clear answers to many questions. It’s more important than ever to approach information with good critical thinking skills and follow guidelines for finding reliable health information online.

Luckily, there has also been plenty of good reporting on coronavirus, some of which I have listed at the end of this post.

Motivating without panic and fear is a difficult balance

One of the greatest challenges in risk communication is striking a balance between motivating people to take necessary action and avoiding unwarranted panic and fear. Fear is a great motivator, but it tends to motivate people to do just one thing in the moment. That one thing, unfortunately, is not always the right thing. Fear is not an effective motivator for sustaining long term changes in behavior. That’s why it’s a challenge for anyone speaking publicly about this to instill enough of a sense of urgency to spur people to take action, but also convey the risks clearly enough to avoid inducing panic.

Right now, too many people are either in full panic mode or in some level of denial. Denial can range from ignoring risks because they are not in a high-risk group to thinking the entire thing is a hoax and protesting in the streets. Those in full panic are making decisions that may make them feel better but won’t help “flatten the curve”. Meanwhile, people in denial are taking no action at all and that has consequences too. Either way, refusing to take the recommended actions, like not practicing abiding by stay-at-home orders, ignoring social and physical distancing recommendations or not washing hands often enough, will thwart efforts to impede the spread of coronavirus.

Pay attention to your biases

In the midst of what feels like constant information and misinformation overload, try your best to be a careful consumer of media. An important first step is to be aware of your biases. Note when your mental shortcuts are leading you astray. Our biases can influence us by making us either accept misinformation we might otherwise ignore or ignore reliable information that doesn’t make us feel in control. With the high level of uncertainty and lack of complete information we have in the current situation, our biases are kicking into overdrive right now.

By paying attention to our own biases, we’re far more likely to make informed decisions based on evidence rather than fear.

What are the current recommendations?

As of today, April 18, 2020, social and physical distancing remain the strategy. Many states have implemented shelter in place and stay at home orders, and closed schools and non-essential businesses.

On April 3, the CDC changed its recommendations for the general population to include wearing a face cover when you are in a place where social and physical distancing is difficult. They also provide suggestions for coping with the stress of an outbreak. Additional recommendations include:

Clean your hands often.

Avoid close contact.

Cover your mouth and nose with a cloth face cover when around others.

Cover coughs and sneezes.

Clean and disinfect.

Clean your hands often.

Avoid close contact.

Cover your mouth and nose with a cloth face cover when around others.

Cover coughs and sneezes.

Clean and disinfect.

CDC has also issued special recommendations for people at higher risk for serious illness from COVID-19, including older adults (over 60 years of age) and people with serious chronic medical conditions:

Stay home if possible.

Wash your hands often.

Take everyday precautions to keep space between yourself and others (stay 6 feet away, which is about two arm lengths).

Keep away from people who are sick.

Stock up on supplies.

Clean and disinfect frequently touched services.

Avoid all cruise travel and non-essential air travel.

Call your healthcare professional if you have concerns about COVID-19 and your underlying condition or if you are sick.

More details are available on their website. CDC also has information specifically for pregnant women, children, people staying in homeless shelters, people with HIV, and people with asthma.

Resources

Data visualizations (cool graphics)

Articles