uncertainty and an unstable environment.13, 20 People need information on basic needs, like food, water, and shelter, as well as guidance on how to protect their health and safety and limit morbidity and mortality.21 Accuracy and timeliness are hallmarks of effective emergency communication.22, 23 Effective communication from leadership is crucial in building trust in the response and ensuring compliance with key public health measures; failure to do so can have lasting, far-reaching consequences.
In this article, we apply the CERC framework to examine the COVID-19 response in the United States. We provide illustrative examples as to how each of the 6 core principles were and were not used by various public health authorities and government leaders in the first 10 months of the COVID-19 pandemic, through October 2020, and the consequences of those successful or failed applications. Through this exercise, we aim to rapidly identify and describe lessons learned to strengthen both ongoing and planned COVID-19 communication efforts—particularly in the midst of the fall and winter surge—and future infectious disease epidemics demanding effective crisis and emergency risk communication.
Applying CERC Principles
in the United States
Be First
Early communication about an emerging crisis and the necessary actions for the public—even if details are limited or likely to change—is vital to setting the stage for public trust. CERC highlights that the first source of information frequently becomes the benchmark for future communication; as a crisis evolves and new information emerges, the early voices are often more trusted. We sought to characterize communication from several of these first sources of information.
Failure to “be first” can have lasting consequences. Since COVID-19 was first detected in the United States in January 2020,24 the federal government’s public communication related to the virus has lagged, undermining public trust in the response and elevating the risk to public health.10, 25 More than 2 months after the first reported US cases, officials at the highest levels continued to downplay the urgency and severity of the pandemic and stall on a national response or clear public guidelines to mitigate risk.26–29 This lack of transparency, coupled with a delayed government response and inconsistent messaging, continued for months and generated even greater uncertainty among the public—individuals instead sought out information from a range of sources, many of which were not grounded in science.30–32 In addition to failed risk communication, the delayed federal response and stream of misinformation crippled subnational response capabilities and put federal and state leadership at odds.
Conversely, early action from 2 institutions established themselves as trusted sources of data. These institutions were the Johns Hopkins University Center for Systems Science and Engineering, which created the first comprehensive COVID-19 dashboard,6, 33 and the Institute for Health Metrics and Evaluation at the University of Washington, which released the first long-range projections of global COVID-19 morbidity and mortality under various response scenarios.34 The publicly accessible COVID-19 dashboard continues to provide reliable real-time data on cases, deaths, and other key indicators at the national and subnational levels. Even now, almost 1 year since the earliest reported cases in China, these resources continue to be the primary and preferred information sources for governments, media, and public health institutions. Being the first to generate comprehensive COVID-19 data was key to establishing trust and conferring resilience, which is especially important because projections are notoriously dynamic. That trust and credibility has been maintained and strengthened by continuing to provide consistent, robust analysis even as some authorities use alternate data and calculations that may downplay the pandemic’s severity in their regions.35–37
Be Right
Accuracy and transparency are crucial to building and maintaining credibility; the COVID-19 response has revealed critical failures in this area. Particularly when facing a novel threat with many uncertainties, it is essential that authorities communicate what is currently known, what is unknown, and what steps are being taken to fill those gaps.38 CERC advises leaders to acknowledge areas where they do not yet have information and to articulate the work being done to gather evidence. Contradictory messages from political and scientific leadership can greatly undermine the public’s trust and generate misinformation.
Shifting guidelines on mask use demonstrate the challenges of managing unknowns and the importance of upholding the “be right” principle.39 At the outset of the pandemic, WHO and US public health authorities advised the public not to wear masks, despite limited evidence on their potential benefit or detriment to disease control.40 On February 29, 2020, US Surgeon General Dr. Jerome Adams communicated that masks were not effective in preventing COVID-19 infection among the general public.41 The following week, Dr. Anthony Fauci echoed the statement that face masks were not necessary for the general public and would not offer the level of protection people perceived.42 At the time, studies were underway to assess whether masks—particularly cloth masks, to reduce demand for surgical and N95 masks needed by healthcare workers—could help reduce transmission,43, 44 especially as more evidence emerged about asymptomatic cases. Less than a month later, the CDC issued new guidance advising the public to wear cloth masks to help reduce transmission.
