I've closely followed COVID-19 coverage for more than 1 year. Here are my key takeaways. (Part 1)

In January of 2020, I started seeing news of a novel illness in China. At that time, I didn't give it much attention because of the then ongoing impeachment trial of Donald Trump. One of my favourite pastimes is following up on current news and topical issues. So, it was towards the end of the impeachment trial that the news of this new infectious disease in China started picking steam in the traditional and social media. The possibility of a new transmissible infection reaching the shores of Africa, for me, was a dreadful thing to think about because it brings back the memories of the 2014 Ebola crisis in West Africa. As a practicing health care worker in Nigeria, I remember how it felt seeing febrile patients with history of travel to regions with confirmed Ebola cases. The last thing I wanted was to relive that experience. Hence, out of fear, anxiety and much trepidation, I closely followed every key event related to this novel viral illness that later came to be named COVID-19 (Coronavirus Disease 2019) by the WHO (World Health Organization). I just wanted to know as much as I could about COVID-19. Eventually, on the 27th February, 2020, I got the news that I dreaded the most: the first case of COVID-19 in Nigeria was confirmed.

To my surprise and great anguish, the news of the first case of confirmed COVID-19 disease in an Italian man who travelled to Nigeria on a business trip was received with so much skepticism, denial, and unfounded speculations in many parts of the country. Many in Nigeria did not agree that there was any new disease in the first place. Some said that even if there was COVID-19 in other countries, that it was not in Nigeria. Others said without proof that "COVID-19 in Nigeria" was a scam perpetuated by the political elites as a means to steal public funds. These false narratives was not just held by laymen in the streets, even some medical/health professionals and well-educated individuals held such views and they were willingly sharing such misinformation on social media and other media platforms. This was unlike the Ebola outbreak in 2014. When the news broke of a patient with Ebola, Patrick Sawyer, who traveled from Liberia to Lagos, many Nigerians believed that Ebola was in Nigeria. And that belief led many to take steps to maintain hand hygiene and partake in other preventive measures. Some even took the extraordinary steps (although with unproven efficacy) of drinking and/or bathing with salty water to prevent them from contracting Ebola. But, in the case of COVID-19, doubts, cynicism, distrust of authorities, and the likes, prevented many from taking the disease seriously.

Faced with the challenge of having doubters, naysayers, conspiracy theorists, even amongst health professionals, promoting misinformation of COVID-19 to people around me, I knew I had to do something. First, I had to know as much as I possibly could about the disease, and then use that knowledge to promote and disseminate reliable information on COVID-19. So, for over a year, I was actively involved in getting factual information on COVID-19 and sharing that information on all my social media handles. In that way, I felt, albeit naively, that I could help counter the misinformation been shared to those who had access to the information I was passing along. I hope I made a difference in my own little way. Even though the threat of COVID-19 is still looming and the COVID-19 fight is not over, I felt I should take some time to write about the things I have observed in the course of following the COVID-19 pandemic. As a health practitioner with interest in creative writing and critical thinking, I think I can offer some perspectives on the COVID-19 struggle. What were/are the challenges? What lessons can we learn from COVID-19 and how do we prepare for a future COVID-19 wave or a future global/regional pandemics/outbreaks? Let's discuss:

1. Build trust in institutions responsible for Public Health.

Challenges

One of the key challenges with the COVID-19 fight was erosion of trust in institutions like the WHO, CDC (the US Centre for Disease Control and Prevention), and other organizations and institutions that many look up to provide guidance and assistance in the face of a public health crisis like COVID-19. Some of the information shared by and actions taken by these organization made some/many to lose faith in these institutions. WHO, for example, gave out some information that were later proven inaccurate. WHO said in January, 2020, that there was no evidence of human-to-human transmission of the novel disease, at a time when such information seem implausible, some experts argue. Yes, WHO is an evidence and fact-based organization, and they weigh the available information before proving guidance. Yet, the benefit of hindsight has led some experts to question why the WHO came out with such statements at that time. Even though they self-corrected and later said there is evidence of human-to-human transmission of the SARS-CoV-2 (name of the virus causing COVID-19) virus, there was some damage to their credibility. The US CDC, earlier in the outbreak of COVID-19 in the US, rolled out test kits that were found to be giving inaccurate results, and it took some time for them to roll out accurate test kits. Even though they had a politically challenging situation at the time, the CDC did not earn much credit with the botched roll out of COVID-19 testing in the US.

In Nigeria, the FMOH (Federal Ministry of Health) did not give accurate information about what some Chinese nationals were coming to do in Nigeria at the early stages of the outbreak in Nigeria, when the ban on international travel was in place in Nigeria. Initially the Minister of Health, Dr. Osagie Ehanire, said the Chinese nationals were medical personnel who were coming to provide equipment and expertise to fight COVID-19 in Nigeria. Later, after these Chinese individuals had arrived in Nigeria, it was discovered some were not medical personnel, and that some were workers for a private Chinese company operating in Nigeria. Now, it's not true that these Chinese nationals were in the country to kill Nigerians, as many speculated at the time. It's not true that they came to Nigeria to help spread COVID-19 in Nigeria. All that was mere speculation that lacked merit. However, it seems the Minister of Health did not really know what those Chinese were coming to do in the country, and the information he gave was inaccurate. And when challenged with keen questions from the press, he did not admit to his mistake, rather, he said he was not going to answer questions on the issue anymore. Faith in public institutions can be lost when accurate information is not shared; and when mistakes are made, it doesn't help to double down on it, instead of correcting it forthright.

Other institutions like the US FDA ( Food and Drug Administration) made mistakes in giving an EUA (Emergency Use Authorization) to drugs with yet to be proven efficacy in the treatment of COVID-19 like the case of hydroxychloroquine. There was the impression that the FDA was unduly influenced by the political leadership at the time. For an organization that prides itself in rigorous scientific work in approving drugs, that experience did not earn them much credit. Those are some examples of the missteps made by some public institutions tasked with providing reliable guidance and information on health crisis issues like COVID-19, but what is the way forward? How can these institutions rebuild the trust and faith that many have on them?

Solutions

Accuracy is better than speed. In the face of a growing threat of a highly transmissible infectious disease, haste could overrun correctness. When one is not sure, like the case of the WHO and the human-to-human transmission, it is better to say that you don't know or that you are not sure. Take the time to get it right. It is far better to get it right the first time. Giving out an inaccurate information and coming around to correct it latter does not endear trust.

Quickly correct mistakes and errors. In the case of the Minister of Health in Nigeria, coming out early to correct an information that was given in error, is far better than grandstanding. Humans are imperfect and are bound to make mistakes. When mistakes/missteps occur, coming out to apologize and set the record straight helps to build trust and faith in that institution or public figure.

Autonomy and independence of institutions of public health. Prior to COVID-19, some institutions had a reputation of been independent, and autonomous: meaning they can make their own decisions devoid of interference from political office holders or outside interests. COVID-19 has unraveled problems of political interference in the affairs of such institutions like the WHO, CDC, FDA, and others. These institutions rely on funding provided by those in political offices and the saying that he who pays the piper calls the tune applies in this case. A comprehensive review of the funding mechanism for these institutions need to be carried out with a view to strengthening the autonomy and financial independence of these organizations.

Transparency and Accountability. While autonomy and independence are critical, building the trust and confidence people have in these institutions also require transparency and accountability. There is need for clear and precise information flow from these organizations. Mistakes need to be owned and corrections promptly made. These institutions also need actively engaged oversight bodies that can hold them to account. These organizations  should also be accountable to the people they serve and to those who rely on them for clear information and guidance. Actions, inactions, missteps, should have corresponding and proportional rewards or consequences. Every one and every institutions need to be accountable to others. This will prevent people/institutions from acting with impunity. Also, this will engender public trust in the system and in those institutions.

2. Communication is key. Good science needs good PR.

Challenges

One of the key problems in this COVID-19 fight is poor communication and bad PR. Sometimes, scientists and researchers do diligent work to gather the facts and evidence, but then do a poor job of communicating it to people. The way an information is presented or shared can be as important as the content of the information itself. The COVID-19 pandemic threw some scientists and public figures into the limelight overnight. So, some persons with no good expertise in communication suddenly found themselves giving press conferences everyday. That generated some bad press. Even persons who have had years of experience in communicating with wide audiences can make mistakes. While some who are new to giving press conferences can become quick learners and learn the ropes pretty quickly, others suffer along. Some of the problems WHO had in the COVID-19 fight is poor communication. The leaders at the helm of WHO made a decision to give daily press briefings on COVID-19. While that may be a good idea on paper, the problem with that is mistakes can easily be made. There was a deluge of research work on COVID-19 published daily, and sometimes those giving the press conferences may be asked questions about things that they've not had much time to digest. A case in point is the issue of asymptomatic transmission of COVID-19. The answer given by the WHO technical lead on COVID-19, Dr. Maria Van Kerkhove, generated a lot of controversy and bad press. She had to give another press availability to clear things up. Please, don't get me wrong. Dr. Maria Van Kerkhove did a great job and is still doing a great job on COVID-19. I learnt a lot from her, Dr Mike Ryan (Head of WHO Emergency Programme), and Dr Soumya Swaminathan (WHO Chief Scientist) in the press conferences I listened to. And they are still doing great work under the leadership of WHO DG, Dr Tedros Adhanom.

Another example of communication missteps was with the Nigerian Minister of Health. Again, Dr. Osagie Ehanire has worked tirelessly in the COVID-19 fight, and this is not to put him in bad light. That said, the Minister made a mistake of saying at a press conference that he would not answer anymore questions on those Chinese nationals that came to Nigeria (mentioned earlier). Clearly, the role those Chinese nationals came to play in Nigeria was different from the picture that the Minister painted before their arrival. The Minister's comments added fuel to the the already heated topic at that time. For me, the Minister was not a very effective communicator on that issue. I've seen some excellent communicators in this COVID-19 fight in Nigeria. The DG of the NCDC (Nigeria Centre for Disease Control), Dr. Chikwe Ihekweazu, and the National Coordinator of the Presidential Task Force on COVID-19 (the PTF is now a Presidential Steering Committee - PSC), Dr. Sani Aliyu, both did a great job of communicating well during the regular press briefings given by the PTF. Maybe, the prior engagement of Drs. Chikwe and Sani before joining the PTF prepared them with such great communication skills.

Solution

Successful companies and institutions have long learnt the importance of having a good public image and that requires a good communication and public relations team. Government agencies, celebrities, sport/music stars, etc., all know the need to have a spokesperson and/or a PR team. Many health organizations, including the WHO, have spokespersons. But when it comes to addressing the public in times of a global pandemic, the heads of these organizations like doing it in person. It's not a bad idea; it may show how serious they take the issue. The problem with that is that not all persons are cut out for addressing the media on a regular basis, so mistakes, missteps, are bound to happen. The US Presidency has a spokesperson who give regular press briefings, and those spokespersons have a communication team that work exclusively on communication. Imagine the US President giving daily press briefings; surely we should expect a lot of gaffes. Before a US President gives a press conference, he receives detailed briefs from the White House team. He gets prepared to answer questions on a range of issues. Even with such preparations, the President can still be found wanting. But, imagine what could happen if he didn't have adequate preparation.

While some health experts, like Dr. Anthony Fauci, have had decades of experience in giving press conferences, testifying in congressional hearings, and addressing the media on emerging and serious public health crisis, not everyone have that experience and skills. And then, even Fauci has had to walk back some comments he made. Like when he criticized the British authorities for expediting a vaccine approval process. So, then, imagine someone, albeit an astute scientist or researcher, who lacks the skills to communicate clearly and precisely, suddenly finding himself/herself playing that role. That's a disaster waiting to happen.

In my opinion, public health institutions, medical experts, researchers, scientists need to work on communication. In any public health crisis, such as the COVID-19 pandemic, communication to the public is very crucial. The diligent work of researchers or scientists can be rubbished by poor communication skills or tactics. If public officials need to give press conferences, it need not be on a daily basis. They should take the time to prepare what to say, and how to say it. It takes a lot more to walk back misstatements. It's always better to get it right in the first instance. No human is infallible, and mistakes can happen, and when mistakes occur those involved should have the strength of character and the humility to walk back or correct such mistakes in a timely fashion. They should be ready and willing to say, 'I don't know', 'I'm not sure', 'Let me get back to you on that question'.

3. Actively combat misinformation on social media or traditional media

Challenges

The WHO has defined information as "What we call things that are accurate to the best of our current knowledge". Misinformation, on the other hand, according to the WHO, "is false information". WHO explained that misinformation "is false information that was not created with the intention of hurting others". Misinformation can be shared by persons who genuinely feel they are "sharing good information", only to find out that that information was false. In contrast, disinformation is "false information created with the intention of profiting from it or causing harm". It is a deliberate act to deceive others. Oftentimes, false information is spread innocently by people who really don't know that what they are sharing is false (that is misinformation). However, the more effective disinformation tactics is using half-truths, taking information out of context, exaggerating things out of proportion, and things of that sort. Those who engage in such devious acts count on the fact that many of the consumers of such false information will not bother to crosscheck or verify.

In the course of my following the COVID-19 coverage, I have come across several false information on COVID-19. Here are some examples. In the early days of the pandemic, an image of one hospitalized black man smiling with a health worker in a Chinese hospital was shared and the message was that Black people were immune to COVID-19. In addition to that, when COVID-19 hit Europe and the US, there were talks of COVID-19 been a 'White man disease'. Now, because of economic disparities, the Whites (Caucasians) were often more traveled, and were more affected by the initial outbreak of COVID-19 in the US, and other countries. But, at the time COVID-19 started spreading in the communities, it quickly became obvious in places like the US, that minority populations like Blacks and Hispanics (people of Latin American descent) were disproportionately more afflicted with COVID-19. In many communities in the US, more Black people were hospitalized and died from COVID-19 when compared to the White population. So, the talk of COVID-19 been a 'White man disease' was not only false but dangerously so.

Another example. In Nigeria, there were misinformation about COVID-19 been a scam perpetuated by the rich and well-connected as a ruse to steal public funds. While corruption is a deeply pervasive and systemic problem in Nigeria, there is no truth to COVID-19 been entirely a money scam. Before COVID-19 was confirmed in Nigeria, there were well documented clinical features of the disease. While the initial confirmed cases in Nigeria had mild illness, soon thereafter, there were cases with severe COVID-19 disease, and they manifested the then classic symptoms of fever, cough and difficulty in breathing. Those early cases had history of travel to countries with COVID-19 outbreaks or had contact with persons with such history of travel. Nigeria, with the aid of WHO had the capacity to do confirmatory laboratory diagnosis of the SARS-CoV-2 virus. Many Nigerians, including the Chief of Staff to the President, Mallam Abba Kyari, died from the disease. So, saying that COVID-19 in Nigeria was a scam was misleadingly mischievous and callous. If you say that some individuals took advantage of the very real COVID-19 disease situation in Nigeria to make some money, you may have a point. Think about this: there are security challenges in Nigeria, and sadly some profit from that situation. Will you then say that because some persons make money from the insecurity in Nigeria, so therefore the insecurity in Nigeria is a scam and that there is nothing like insecurity? There is no situation that corrupt individuals won't take advantage of. That does not preclude the fact that that situation exist.

Solutions

One of the problem I observed with efforts to deal with misinformation, especially on social media, is the slow and weak response from the relevant agencies tasked with providing reliable information on that matter. When there is false information spreading online, there is a need to counter it forcefully and aggressively with the facts. It's like a cancerous growth in the body, you need to address it quickly and aggressively before the cancer spreads and metastasize. An American vaccine expert, Dr. Peter Hotez, recently said that part of the reason why the antivaxxer (those who are opposed to vaccines and vaccination) movement has gained much momentum, especially in this COVID-19 pandemic, is that those in position of decision making in the US years ago decided not to counter the narratives of the anti-vaxxers. The thinking, according to Dr. Hotez, was that publicly addressing the antivaccination propaganda will give much oxygen or undue publicity to the antivaxxers. Regrettably, that inertia left a vacuum that was well-filled by those who spread false information on vaccines, and on COVID-19.

I've seen that slow response in this COVID-19 fight. When certain misinformation were spreading on social media in Nigeria, the NCDC (Nigeria Centre for Disease Control) was too slow to respond. Some State authorities were actively leading disinformation campaigns, with no effective counter response from the NCDC and other agencies/committee tasked with fighting COVID-19 in Nigeria. In my view, that was a mistake. There was and there is need to actively and aggressively counter misinformation or disinformation on COVID-19. Those who create misleading information use creative media, slick videos, and attractive imagery to cajole its consumers to supporting their point of view. The relevant Government agencies or NGOs ( Non-Governmental Agencies) need to have a good social media presence and they should employ tech-savvy individuals who use the facts and truth to counter those false narratives. Don't wait for false information to fester in the news, counter it in a very timely manner.

To be continued...

Written by

DR EUGENE AKPONOJIVI OJIRIGHO

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