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CDC won’t teach you about “community spread”

Month: February 2020

CDC won’t teach you about “community spread”

Posted on by Public Linguist
Last night we learned that a California patient is the first person in the US to come down with the coronavirus where the origin is unknown. It’s what public health officials call “community spread.”  This important news hasn’t made it to the CDC website yet.  
But CNN and other news outlets reported it liberally last night. 
I heard it from Chris Hayes. Dr. Sanjay Gupta had a good, clear explanation as well.
It’s not just that they reported the event, they made an effort to explain what was important about this new information. 

(informal transcript done by me from broadcast) 

After explaining that up to now epidemiologists have been able to identify where people contracted the coronavirus, Hayes says:
——– 
“The other way to think about this is what’s called “community spread. ”That is when cases start appearing without a known source of exposure.  So, in Brazil for example, the person who tested positive had just been in Italy where there is a lot of the virus….” 
He goes on to say that in a number of countries they already have “community spread.”
“That means that people are showing up with the virus and it is not clear how they got it.”
———
 As you may know, I study how people understand or misunderstand health and science information.  

It’s so important for the general public to understand basic public health concepts, especially at a time such as this, when hyperbole, pervasive social media warnings and misinformation can contaminate our thinking and our actions.  

We have high profile candidates like Amy Klobuchar in the Democratic Debate on Tuesday advising the public to learn about Coronavirus from the CDC website. 

Amy are you sure you want to advise that? 

Are you sure good, up-to-date, understandable information lives there?

In this post I use the CDC’s failure to explain “community spread” as one of many examples of how the CDC could and must do a waaaaay better job communicating with the public and helping people to understand things such as infection and pandemic.   

Last week I simply asked friends what community spread means. Most didn’t know and many said  it means that “the virus is just hitting certain few communities.” 

And for the correct information – well it is hiding in plain sight deep in the catacombs of CDC information. In this case information about community spread is in the transcript of a  CDC representative speaking to the media on a telebriefing  call yesterday, Feb 14 2020! . 

It was posted all in caps ( much harder to read).
————-

…WE’RE CONTINUING TO HOPE THAT WE WON’T SEE COMMUNITIES SPREAD AND CERTAINLY HOPING THAT OUR MEASURES GIVE US EXTRA TIME TO PREPARE BY GAINING OURSELVES THIS TIME, THE HOPE IS THAT WE’LL HAVE MORE TIME TO PREPARE. 

–>

….MITIGATION, IS WHEN YOU STOP TRYING TO TRACE CLOSE CONTACTS AROUND EVERY CASE TO CONTAIN THE CASE, AND INSTEAD TO FOCUS ON — FOCUS ON THE DISRUPTION AND THE COMMUNITY TRYING TO DECREASE THE BURDEN, TRYING TO DECREASE THE MORBIDITY AND MORTALITY.  DOING EVERYTHING TO HELP AT A SOCIETAL LEVEL.  THE KIND OF THINGS THAT WE’RE TALKING ABOUT ARE COMMUNITY LED LEVEL DECISIONS.  FOR EXAMPLE, IN GENERAL, SOCIAL DISTANCING, SCHOOL CLOSURES, CANCELING MASS GATHERINGS, SORT OF NONPHARMACEUTICAL INTERVENTIONS WE’RE TALKING ABOUT THINGS LIKE TELEMEDICINE, TELESCHOOLING, TELEWORKING SO THAT AT A SOCIETAL LEVEL WE TRY TO DISRUPT THE SPREAD.  IN A SITUATION LIKE THIS WHERE WE DON’T HAVE A VACCINE AND WE DON’T YET HAVE A SPECIFIC COUNTERMEASURE, THOSE KIND OF NONPHARMACEUTICAL INTERVENTIONS AT A COMMUNITY LEVEL ARE REALLY IMPORTANT.  THAT’S WHY IN THIS TIME THAT WE HAVE GAINED OURSELF IS WORKING CLOSELY ACROSS ALL OF GOVERNMENT AND WITH OUR LOCAL AND STATE PARTNERS ON PLANNING FOR THOSE OPERATIONS.  FORTUNATELY IN THE UNITED STATES BECAUSE WE HAVE DONE A LOT OF PLANNING AROUND PANDEMIC INFLUENZA WE HAVE A GOOD HEAD START, BUT WE NEED TO LOOK AT THE PLANS, SEE HOW THE CURRENT SITUATION MIGHT ALTER THEM AND YOU’LL SEE A LOT OF THE GUIDANCE COMING UP ON THE WEBSITE IN THE COMING WEEKS.  NEXT QUESTION.
————————-

A clear explanation of why community spread is important is still not posted anywhere I can find on the CDC website


I ask again, why hasn’t this been posted on the CDC website so that people can become more informed about this pandemic event and to advance their health literacy about how much can and will be done to protect communities if the time arises?

–>

Dear CDC – Should My Mom Go On Her Cruise?

Posted on by Public Linguist

My 91 year old Mother is scheduled to go on a 6 day cruise in the Caribbean with her friends and all their walkers. Clearly, Coronavirus has changed the nature of the small talk from best-buffet-items to “what type of mask should I take.”  
My mom at 90 is the new 75 – active, sharp as a tack, albeit walking on sorely uncooperative knees.

Predictably, as the departure date nears, my internet savvy, text fluent Mom has consumed and shared a barrage of CNN alerts, CDC updates and random blog posts,  sprinkled with a healthy dose of what Edna–at-the-pool’s son told her.
By last Friday Mom had me contacting my colleagues in public health (none working on infectious diseases, mind you) to find out what they thought about going on a cruise right now. No one had more than personal guidance and thought I should check out what CDC was advising. ( You may have noticed I’ve been combing the CDC since the outbreak was reported).  

Ever hopeful, I did. Let’s take a look at what I found and importantly didn’t find. 


is about China.  No help there. 
Resources for Ships – Now we’re getting somewhere.!
But we find info about disinfecting ships and Zika.


Hmmm.  Still nothing. 





So as of now I have no informed, useful  information about whether Mom should go on a cruise or not.  Just my own personal, long standing hyper-vigilence.  

Quarantine
The last few days the talk’s been about “quarantine”.


Over seafood salads at their Florida condo deli, Eva is more than annoyed. “Why would they keep all those people on a ship with sick people.  I’ve never heard anything so stupid in my life.”  

1.  So I go to the CDC again to read about Quarantine  
This first link yields this brief definition: 

2.  Let’s try the next obvious link:  History of Quarantine
Some fascinating stuff here – 
From the Middle Ages
“The practice of quarantine, as we know it, began during the 14th century in an effort to protect coastal cities from plague epidemics.” … and the Italian origins of the word quaranta giorni (which means 40 days).
To Today:
The Division of Global Migration and Quarantine is part of CDC’s National Center for Emerging and Zoonotic Infectious Diseases and is headquartered in Atlanta. Quarantine stations are located in Anchorage, Atlanta, Boston, Chicago, Dallas, Detroit, El Paso, Honolulu, Houston, Los Angeles, Miami, Minneapolis, New York, Newark, Philadelphia, San Diego, San Francisco, San Juan, Seattle, and Washington, D.C. (see contact lists and map).
 ——
It’s Tuesday 2-18-20.  Mom’s cruise is 10 days away.  And this daughter, with her PhD and 40 years of experience working in communicating public health finds herself in this cone of uncertainty and lack of useful information from any trusted sources.
And the ladies who cruise:
 Well I did overhear this when my salad was finished:

“Annie, what’s the big deal.  The media is trying to scare you.  How awful could it be to get a few more days on the ship.  Esther said the Princess Diamond is gorgeous. “
As Mom’s best friend Molly said yesterday, “If that boat leaves, I’ll be on it.”

Mom hasn’t started talking about packing yet. 

What you’re not going to learn from CDC website

Posted on by Public Linguist
Last night we learned that a California patient is the first person in the US to come down with the coronavirus where the origin is unknown. It’s what public health officials call “community spread.”  This important news hasn’t made it to the CDC website yet.  
But CNN and other news outlets reported it liberally last night. 
I heard it from Chris Hayes. Dr. Sanjay Gupta had a good, clear explanation as well. 

As you may know, I study how people understand or misunderstand health and science information.  
It’s so important for the general public to understand basic public health concepts, especially at a time such as this, when hyperbole, pervasive social media warnings and misinformation can contaminate our thinking and our actions.  


We have high profile candidates like Amy Klobuchar in the Democratic Debate on Tuesday advising the public to learn about Coronavirus from the CDC website. 

Amy are you sure you want to advise that? 

Are you sure good, up-to-date, understandable information lives there?

In this post I use the CDC’s failure to explain “community spread” as one of many examples of how the CDC could and must do a waaaaay better job communicating with the public and helping people to understand things such as infection and pandemic.   

Last week I simply asked friends what community spread means. Most didn’t know and many said  it means that “the virus is just hitting certain few communities.” 

And for the correct information – well it is hiding in plain deep in the catacombs of CDC information. In this case information about community spread is in the transcript of a  CDC representative speaking to the media on a telebriefing  call yesterday, Feb 14 2020! . 

It was posted all in caps ( much harder to read).
————-

…WE’RE CONTINUING TO HOPE THAT WE WON’T SEE COMMUNITIES SPREAD AND CERTAINLY HOPING THAT OUR MEASURES GIVE US EXTRA TIME TO PREPARE BY GAINING OURSELVES THIS TIME, THE HOPE IS THAT WE’LL HAVE MORE TIME TO PREPARE. 


–>

….MITIGATION, IS WHEN YOU STOP TRYING TO TRACE CLOSE CONTACTS AROUND EVERY CASE TO CONTAIN THE CASE, AND INSTEAD TO FOCUS ON — FOCUS ON THE DISRUPTION AND THE COMMUNITY TRYING TO DECREASE THE BURDEN, TRYING TO DECREASE THE MORBIDITY AND MORTALITY.  DOING EVERYTHING TO HELP AT A SOCIETAL LEVEL.  THE KIND OF THINGS THAT WE’RE TALKING ABOUT ARE COMMUNITY LED LEVEL DECISIONS.  FOR EXAMPLE, IN GENERAL, SOCIAL DISTANCING, SCHOOL CLOSURES, CANCELING MASS GATHERINGS, SORT OF NONPHARMACEUTICAL INTERVENTIONS WE’RE TALKING ABOUT THINGS LIKE TELEMEDICINE, TELESCHOOLING, TELEWORKING SO THAT AT A SOCIETAL LEVEL WE TRY TO DISRUPT THE SPREAD.  IN A SITUATION LIKE THIS WHERE WE DON’T HAVE A VACCINE AND WE DON’T YET HAVE A SPECIFIC COUNTERMEASURE, THOSE KIND OF NONPHARMACEUTICAL INTERVENTIONS AT A COMMUNITY LEVEL ARE REALLY IMPORTANT.  THAT’S WHY IN THIS TIME THAT WE HAVE GAINED OURSELF IS WORKING CLOSELY ACROSS ALL OF GOVERNMENT AND WITH OUR LOCAL AND STATE PARTNERS ON PLANNING FOR THOSE OPERATIONS.  FORTUNATELY IN THE UNITED STATES BECAUSE WE HAVE DONE A LOT OF PLANNING AROUND PANDEMIC INFLUENZA WE HAVE A GOOD HEAD START, BUT WE NEED TO LOOK AT THE PLANS, SEE HOW THE CURRENT SITUATION MIGHT ALTER THEM AND YOU’LL SEE A LOT OF THE GUIDANCE COMING UP ON THE WEBSITE IN THE COMING WEEKS.  NEXT QUESTION.
————————-

A clear explanation of why community spread is important is still not posted anywhere I can find on the CDC website


I ask again, why hasn’t this been posted on the CDC website so that people can become more informed about this pandemic event and to advance their health literacy about how much can and will be done to protect communities if the time arises?

Coronavirus doesn’t sound so bad!

Posted on by Public Linguist

The thread running through my last few posts about how CDC is communicating (or not,) the Coronavirus is that medical experts are using their familiar medical terms, like “novel virus” that stand for, or signify specific important information (semantics). And, importantly, that there is little reason to assume that the general non-scientific public understands these significances. 

For example again,   “novel” or even “new” isn’t communicating that the virus is “fresh and new”, “something new that needs a name”, or “something that will eventually get old.”  In the epidemiologic world is “novel” stands for or signals a number of important medical/scientific issues: 
  • what is known and not known about the virus; 
  • how likely it is that there is a vaccine for it; 
  • issues of natural immunity; 
  • and importantly, that scientists are in an active period of potential uncertainty.  

You can see another straightforward example of this word vs significance problem in using today’s CNN article by Jacqueline Howard  “CDC director: Novel coronavirus ‘is probablywith us beyond this season, beyond this year.”  
 Dr. Sanjay Gupta is talking to Dr. Robert Redfield, CDC Director explaining that “containment” of the virus is the current goal….
—– 
“The containment phase is really to give us more time. This virus will become a community virus at some point in time, this year or next year,” Redfield said. “We don’t have any evidence that this coronavirus is really embedded in the community at this time, but with that said, we want to intensify our surveillance so that we’re basing those conclusions based on data.”
——– 
So here’s the seemingly simple term- “community virus.”
  • Does that mean it will be limited to certain communities? 
  • So it’s won’t be as bad as a city-wide, or state-wide virus? 
  • Doesn’t sound so bad to me!  They always make it sound so much worse than it is!

What is lost on the average reader/listener is that this term SIGNALS a very important and frightening thing – when it becomes a community virus it will strike otherwise healthy people
At least that’s my understanding of how CDC is using it.

Why can’t we start working to close the gap between experts and the public by unpacking what we say.  Put some thought into what it takes to understand what we say.  And then say it better?

Coronavirus is “novel”: And so that means…………..

Posted on by Public Linguist

–>

Novel Virus
Since every description of the “COVID-19” Coronavirus I’ve found uses the term “novel” I spent the afternoon searching for even one source easily available to the public online that explains what novel means and why it’s important for people to understand it. (This is what happens to a linguist with time on her hands).





Prepare to be underwhelmed. (But, just think of all the time I just saved you!)

From Wikipedia:
“Novel virus refers to a virus not seen before. It can be a virus that is isolated from its reservoir or isolated as the result of spread to an animal or human host where the virus had not been identified before. It can be an emergent virus, one that represents a new strain, but it can also be an extant virus not previously identified. The virus also may come up just as the results of genetic make up mutations under various causative and thus being unnoticed by human it may be lethal.” 
WHO:
“Novel influenza infections are those due to influenza viruses that differ from strains currently circulating among humans. The table below
distinguishes the Asian-origin H5N1 and H7N9 viruses, which have caused fatal human cases outside of the U.S., and highly-pathogenic
avian influenza H5 and H7 viruses (U.S. strains H5N1, H5N2, H5N8, H7N8, H7N9), which are not known to infect humans.”
*But they do have a very cool video explaining the virus.
CDC
“Viruses of Special Concern
A novel influenza A virus is one that has caused human infection, but is different from current seasonal human influenza A viruses that circulate among people. Novel influenza A viruses are usually influenza A viruses that circulate among animals. Some novel influenza A viruses are believed to pose a greater pandemic threat than others and are more concerning to public health officials because they have caused serious human illness and death and also have been able to spread in a limited manner from person-to-person. Novel influenza A viruses are of extra concern because of the potential impact they could have on public health if they gain the ability to spread easily from person to person, which might cause the next influenza pandemic. Human infection with a novel influenza A virus is a nationally notifiable condition reportable to CDC. The text below summarizes the novel influenza A viruses that are currently most concerning to public health officials.”


 You can skip the definition lawyers concoct:


Influenza A, novel virus means infection of a human with an influenza A virus subtype that is different from currently circulating human influenza H1 and H3 viruses. Novel subtypes include H2, H5, H7, and H9 subtypes or influenza H1 and H3 subtypes originating from a nonhuman species.

How about some local health departments?
Texas
Q: What is novel/variant influenza A virus?
A:  A novel/variant influenza A virus is an influenza A virus subtype that is different from currently circulating human influenza H1 and H3 viruses. Novel subtypes include, but are not limited to H2, H5, H7 and H9 subtypes. Influenza H1 and H3 subtypes originating from a non-human species or from genetic reassortment between animal and human viruses are also novel/variant subtypes.
Minnesota
Flu viruses constantly change and mutate. Novel and variant influenza A viruses can infect and cause severe respiratory illness in humans. These influenza viruses are different from currently circulating human influenza A virus subtypes and include influenza viruses from predominantly avian and swine origin.
New York State
The 2019 novel coronavirus is a new virus and shouldn’t be confused with other coronaviruses that have been around for many years causing upper respiratory symptoms, like the common cold.

One source that comes close to explaining the significance of “novel”  uses an easy to read narrative. 




What we do and don’t know about the novel coronavirus:
Experts from the Vet School, Med School, and Center for Public Health Initiatives provide insight into the new disease outbreak.
“Until a month ago, it’s possible to never have heard of coronavirus, despite the fact that science has known about this family of seven viruses since the 1960s. Four are common, causing mild or moderate respiratory symptoms like a runny nose and sore throat, all of which dissipate quickly. 
In the past few decades, however, several new coronaviruses have emerged, originating in animals and jumping to humans. In the early 2000s, it was severe acute respiratory syndrome (SARS), which lead to almost 800 deaths. A decade later Middle East respiratory syndrome (MERS) came about, which, according to the Centers for Disease Control and Prevention, killed approximately three out of every 10 patients with the virus. 
In late December, news started to spread of a new disease originating in Wuhan, China. Since then, at the time of publication, 132 people have died from novel coronavirus (2019-nCoV). China has confirmed 6,061 cases, with many more in other countries. The United States has so far identified five. “



Effective Communication 
RULE #2
Explain Terms
(especially when they’re central to your message)

Coronavirus CDC – Do you know your audience?

Posted on by Public Linguist
Woke up.
No change. 
So I’ll stay on topic – the utter incomprehensibility

 of current CDC communications about Coronavirus.




Today on risk assessment
————————
Risk Assessment
Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications).

The potential public health threat posed by 2019-nCoV virus is high, both globally and to the United States. The fact that this virus has caused illness, including illness resulting in death, and sustained person-to-person spread in China is concerning. These factors meet two of the criteria of a pandemic. It’s unclear how the situation will unfold, but risk is dependent on exposure. At this time, some people will have an increased risk of infection, for example healthcare workers caring for 2019-nCoV patients and other close contacts of 2019-nCoV patients. For the general American public, who are unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low at this time.

———————–


FACTS WIDELY KNOWN FOR DECADES:

  • At least half of the population reads @ 8thgrade level and lower.

                (NALS1993 & NAAL 2003)  

  • More than half the adults in the US havelow health literacy
  • Poorer minorities and seniors are disproportionately low literate.


EFFECTIVE COMMUNICATION
RULE #1 
KNOW YOUR AUDIENCE

CDC Coronavirus Communications: Predictably Complicated

Posted on by Public Linguist

If you’re like me you keep track. And you see something predictable and maddening. Each time we’re faced with the outbreak of a poorly understood or new virus ( H1N1, SARS, Zika, Ebola) you can count on trusted sources of information to be writing/speaking to anyone but the average public. 

Here’s the first descriptive information you encounter on the CDC page regarding Coronavirus.  (Accessed 2/11/20)
——————
2019 Novel Coronavirus (2019-nCoV) is a virus (more specifically, a coronavirus) identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China. Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, indicating person-to-person spread is occurring. At this time, it’s unclear how easily or sustainably this virus is spreading between people.  The latest situation summary updates are available on CDC’s web page 2019 Novel Coronavirus, Wuhan, China.
———————–

And while I’m most often stressing that readability scores can only give you a surface level evaluation of the reading level of a text, take a deep breath and check out the readability of the above paragraph: 



What makes this so unreadable to millions ( certainly the 50% of the US population that reads at 8th grade and lower?

  • long, multiply embedded sentences – sticking relative clauses and phrases into sentences making them complex sentences;
  • passive verb constructions – identified as….
  • generally difficult vocabulary – detected, indicating, reportedly, sustainably…
  • difficult science concepts – a novel virus
“Novel” seems to be a favorite term for the CDC.  They used the same language to explain (to the public?) the H1N1 outbreak in 2009. 



A little help here CDC! ( and the media that pull specific language from CDC).  It wouldn’t take much to write clearer, more understandable sentences, and explain what a “novel” virus is and why being novel is important?



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