March 11, 2020.3 Soon after, COVID-19 was declared a national emergency in the United States, resulting in a number of control measures: social distancing; school, bar, cinema, and restaurant closures; cancellation of large gatherings; and a transition to remote work for many businesses4 (see Figure 1 for a timeline of major pandemic-related global and US events). Public health scientists were suddenly at the forefront of an unprecedented crisis, tasked with taming a quickly spreading novel virus.5 More than 10 months later, a safe and effective vaccine is only just becoming available, over 430,000 people have died in the United States,6 millions have lost jobs, and a majority of Americans now live their lives virtually.
These widespread public health measures have been accompanied by a massive flow of COVID-19 information, misinformation, and disinformation. We are concurrently inundated with a global epidemic of misinformation, or an infodemic, primarily being spread through social media platforms; its effects on public health cannot be underestimated.7 Thus, the pandemic provides an opportunity to develop infodemic management approaches.8
In 2002, the US Centers for Disease Control and Prevention (CDC) published the Crisis and Emergency Risk Communication (CERC) manual to inform successful public, partner, and stakeholder communication during crises and emergencies; this manual was updated in 2012, 2014, and 2018.9, 10 The CERC manual integrates elements from risk, crisis, and health communication theories and outlines 6 core communication principles: (1) be first, (2) be right, (3) be credible, (4) express empathy, (5) promote action, and (6) show respect (Figure 2). It posits that trust, adherence to public health recommendations, and support during an emergency can be achieved, partly by providing information to enable the public to make sense of the emergency.11, 12 Many of these principles are intertwined and designed to be employed together; as such, failure to adhere to even 1 principle affects application of the broader framework.
Figure 2. Crisis and Emergency Risk Communication framework principles.
Adapted from the US Center for Disease Control and Prevention Crisis & Emergency Risk Communication (CERC) Manual.10
The novelty of this virus and the constantly changing science around it has led to many communication challenges. Because of the uncertainty around risks related to COVID-19, traditional and social media have inadvertently induced panic and feelings of fear, sadness, and anger.13 Carefully planned crisis communication plays a critical role in preventing and mitigating pandemics, by alleviating fear and anxiety and supporting adherence to public health recommendations.14 The information environment around this pandemic highlights the importance of effective communication. A rise in conspiracy theories, fake news, and misinformation has made it increasingly challenging for the public to distinguish scientific evidence from misinformation.15
Risk communication—“the exchange of information among interested parties about the nature, magnitude, significance, or control of a risk”16—has a long history of research and practice that informs many public health campaigns.17 At its core, risk communication focuses on timely, accurate, effective dissemination of high- or low-hazard information to at-risk populations, aiming to minimize the gap between knowledge and action.16 It also includes communication and advice to the public on behaviors to proactively cope with risk.18 The risks associated with miscommunication during the COVID-19 pandemic are tremendous, especially because of declining trust in and credibility of authorities and governments.16
Effective mobilization in response to a crisis like COVID-19 starts with national leadership.19 Because of their infrequent nature, emergencies create high levels of
