Skolnik: Please Tell It Like It Is – Before It Is Much Too Late

By RICHARD SKOLNIK
Los Alamos

Providing the public with regular, clear, evidence-based, and actionable messages has been key to successfully addressing every major public health problem. Successful messaging has also centered on creating a popular consensus around understanding outbreaks and taking the measures needed to deal with them. This has been true, for example, about messaging in the U.S. on tobacco and seat belts. It was also true for how governments dealt with HIV in Thailand and Uganda and with Ebola in West Africa. Messages in the above manner have also been at the core of the global program to eradicate polio.

Sadly and very dangerously, the messaging from the federal government (and many state governments) around COVID-19 has failed to take account of these critical lessons.

The federal government, for example, has often failed to speak the truth to us about COVID-19. Early on, we were told that COVID-19 was not much of a problem, that the government had it under control, and that it was going to go away quickly. This was despite the warnings of the intelligence and public health communities and evidence of what had occurred in China and was beginning to occur in Europe. Senior officials are now telling us that the increase in positive tests is because of an increase in the number of tests. However, trends in the share of tests which are positive in some places clearly indicates that the outbreak is growing. Some are telling us that the increase in positive tests is a result of recent protests. However, that cannot possibly explain what is happening, for example, in Arizona, Florida, and Texas.

In addition, the President himself has often touted measures to address the virus that were not based on evidence, and could be dangerous, such as the use of hydroxychloroquine. He also raised questions about the possibility of our “disinfecting ourselves”. The President’s recent political rallies did not require the wearing of masks and did not include appropriate social distancing, despite the federal government’s own warnings. The President also suggested that if we test fewer people, we will have less of a COVID-19 problem.  

Moreover, messaging by the President and many governors has turned what should be a war against COVID-19 into a culture war. Among the high-income countries, only in the US has the President called on people to “liberate” some (only Democratic) states from measures taken to address the outbreak. Among the high-income countries, only in the US is wearing a mask an issue of contention. Such messaging has also contributed, only in the US among the rich countries, to vehement attacks on a number of public health officials and on contact tracers.

The words and actions of leaders matter. We need to reopen the economy in line with the nature of the epidemic and with great care. We need everyone to understand the nature of the outbreak and the grave risks that a failure to reopen carefully will lead to more illness, death and economic hardship. We need everyone to understand their part in helping to stem transmission of the virus.

Instead, and very dangerously, we have failed to do this in many states. As a result, we are rapidly losing the gains we made against the virus, COVID-19 is quickly gaining more steam in a number of states, and we are headed in those places to new highs in illness, death, and related economic loss. Our rate of new positive tests is multiples and multiples of those in other high-income countries.  New Zealand, South Korea, and Taiwan suppressed the virus through timely public health measures. By contrast, we are at risk of being buried – literally and figuratively – by COVID-19. Our friends around the world are perplexed by our incompetence in dealing with COVID-19 and frightened of the risks this poses for us and for the health of the rest of the world.

Some governors of both parties have shown in their words and actions that this is a life and death matter, that cannot be made political. They have done well at putting into practice the messaging that is so essential to winning the fight against this dangerous virus. It is now time for leaders at all levels of government to do the same. Their failure to do so is killing people.

Editor’s note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health.