In a best-case scenario, just half of Americans would participate in a voluntary coronavirus “contact tracing” program tracked with cell phones, according to the latest installment of the Axios-Ipsos Coronavirus Index.
Why it matters: A strong contact tracing program — identifying people who have the virus and isolating those who have come into contact with them — is the key to letting other people get back to their lives, according to public health experts.
The findings underscore deep resistance to turning over sensitive health information, and mistrust about how it could be used.
The only way to get even half of Americans to participate would be for public health officials to run the program, not the White House or tech or phone companies.
What they’re saying: “The whole concept of American democracy is about local control and civil liberties, individual liberties,” said Cliff Young, president of Ipsos U.S. Public Affairs.
“At the end of the day, I think there will be an American solution to contact tracing,” but if the survey results are any guide, “it’s not going to be a centralized authority saying, ‘And now we’re going to have contact tracing.'”
These findings come as tech companies develop software to try to halt the spread, and public health officials train thousands to conduct the tracing.
The big picture: Even as the death toll rises and infections breach the White House firewall, Week 9 of our national survey also finds more people itching to return to work as they used to know it — and bending guidelines to see family and friends.
64% say returning to their pre-coronavirus lives would be a large or moderate risk. Just 30% say that’s worth the risk right now.
But four in 10 say they think returning to their normal place of employment would post only a small risk, or no risk.
63% consider airplane travel or mass transit to be a large risk, down from 73% a month ago.
Nine in 10 say they’re still practicing social distancing, but just 36% say they’re self quarantining, down from a peak of 55% in Week 4.
32% say they’ve visited family or friends in the past week, the highest share in seven weeks.
These shifts in behavior come even as growing shares of Americans know people in their own communities who have tested positive and the number of confirmed cases in the U.S. has topped 1.3 million, with roughly 80,000 deaths.
About a third know someone who has tested positive — and of those, nearly half say they know a person in their own community who has tested positive.
“People are getting antsy,” Young said. “They know there’s this risk, but … people’s mental health and social health are challenged and they’re just feeling restless.”
“You can only keep cooped up for so long.”
Between the lines: Most don’t see the virus as an immediate existential threat to themselves. This week, we asked whether people had prepared or updated their wills or living wills since the pandemic began. More than nine in 10 said no.
For contact tracing involving cell phone tracking, Democrats surveyed are more open than Republicans to the notion of opt-in reporting.
68% of Democrats say they’d participate if the Centers for Disease Control and Prevention (CDC) was in charge, compared with 58% of independents and 32% of Republicans.
Those numbers plunged if the federal government more broadly were in charge, but Democrats remained the most likely to participate — 39% compared with 34% of independents and 23% of Republicans.
That’s despite the fact that Democrats are less trusting than others of the Trump administration to protect their families.
Men are slightly more likely than women to trust tech companies with the information.
Be smart: Some reporting initiatives may need to be mandatory or person-to-person to get high enough levels of participation to be worthwhile.
President Trump claimed at a press briefing Monday that any American who “wants” a coronavirus test can get one — contradicting his testing coordinator Adm. Brett Giroir, who just moments earlier said that tests are mostly reserved for people who “need” one because they present symptoms or are participating in contact tracing.
Why it matters: Trump used the briefing largely to celebrate the country’s success in ramping up testing capacity, at one point boasting that “we have met the moment and we have prevailed” in regards to testing. But questions still remain about how Americans will be able to safely return to work if asymptomatic people don’t have access to testing.
Between the lines: The White House, meanwhile, has proven to be a microcosm of what a country with high-quality testing, surveillance and isolation capability can look like.
Giroir explained that people who are in close contact with the president are tested regularly using the 15-minute Abbotts lab device, even if they’re asymptomatic.
This is how the White House was able to diagnose Pence press secretary Katie Miller and isolate officials like Anthony Fauci who came into contact with her.
What they’re saying: “Right now in America, anybody who needs a test gets a test in America, with the numbers we have,” Giroir said. “If you’re symptomatic with a respiratory illness, that is an indication for a test and you can get a test. If you need to be contact traced, you can get a test.”
“And we hope — not hope — we are starting to have asymptomatic surveillance, which is very important. Again, that’s over 3 million tests per week. That is sufficient for everyone who needs a test — symptomatic, contact tracing and, to our best projections, the asymptomatic surveillance we need.”
“I think we have been clear all along that we believe and the data indicate we have enough testing to do the phase one gradual reopening that has been supported in the president’s plan and the task force’s plan. It has to be a phased reopening.”
Earlier in the briefing, when asked when Americans can get tested every day like White House senior staff can, Trump responded: “Very soon.”
He later said: “If people want to get tested, they get tested. We have the greatest capacity in the world, not even close. If people want to get tested they get tested, but for the most part, they shouldn’t want to get tested.”
“There is no reason. They feel good. They don’t have sniffles. They don’t have sore throats. They don’t have any problem.”
The bottom line: Trump and Giroir’s statements blurred the line between two different concepts, as The Daily Beast’s Sam Stein points out. People who “need” a test because they have symptoms or were in contact with an infected person can get one, but the number of tests “needed” to safely reopen the country is not yet sufficient.
Ubiquity of social media has made it easier to spread or even create COVID-19 falsehoods, making the work of public health officials harder.
This is part of our Coronavirus Update series in which Harvard specialists in epidemiology, infectious disease, economics, politics, and other disciplines offer insights into what the latest developments in the COVID-19 outbreak may bring.
When a disease outbreak grabs the public’s attention, formal recommendations from medical experts are often muffled by a barrage of half-baked advice, sketchy remedies, and misguided theories that circulate as anxious people rush to understand a new health risk.
The current crisis is no exception. The sudden onset of a new, highly contagious coronavirus has unleashed what U.N. Secretary-General António Guterres last week called a “pandemic of misinformation,” a phenomenon that has not gone unnoticed as nearly two-thirds of Americans said they have seen news and information about the disease that seemed completely made up, according to a recent Pew Research Center study.
What distinguishes the proliferation of bad information surrounding the current crisis, though, is social media. Kasisomayajula “Vish” Viswanath, Lee Kum Kee Professor of Health Communication at the Harvard T.H. Chan School of Public Health, said the popularity and ubiquity of the various platforms means the public is no longer merely passively consuming inaccuracies and falsehoods. It’s disseminating and even creating them, which is a “very different” dynamic than what took place during prior pandemics MERS and H1N1.
The sheer volume of COVID-19 misinformation and disinformation online is “crowding out” the accurate public health guidance, “making our work a bit more difficult,” he said.
“Misinformation could be an honest mistake or the intentions are not to blatantly mislead people,” like advising others to eat garlic or gargle with salt water as protection against COVID-19, he said. Disinformation campaigns, usually propagated for political gain by state actors, party operatives, or activists, deliberately spread falsehoods or create fake content, like a video purporting to show the Chinese government executing residents in Wuhan with COVID-19 or “Plandemic,” a film claiming the pandemic is a ruse to coerce mass vaccinations, which most major social media platforms recently banned.
In order to be effective, especially during a crisis, public health communicators have to be seen as credible, transparent, and trustworthy. And there, officials are falling short, said Viswanath.
“People are hungry for information, hungry for certitude, and when there is a lack of consensus-oriented information and when everything is being contested in public, that creates confusion among people,” he said.
“When the president says disinfectants … or anti-malaria drugs are one way to treat COVID-19, and other people say, ‘No, that’s not the case,’ the public is hard-pressed to start wondering, ‘If the authorities cannot agree, cannot make up their minds, why should I trust anybody?’”
Mainstream media coverage has added to the problem, analysts say. At many major news outlets, reporters and editors with no medical or public health training were reassigned to cover the unfolding pandemic and are scrambling to get up to speed with complex scientific terminology, methodologies, and research, and then identify, as well as vet, a roster of credible sources. Because many are not yet knowledgeable enough to report critically and authoritatively on the science, they can sometimes lean too heavily on traditional journalism values like balance, novelty, and conflict. In doing so, they lift up outlier and inaccurate counterarguments and hypotheses, unnecessarily muddying the water.
“People are hungry for information, hungry for certitude, and when there is a lack of consensus-oriented information and when everything is being contested in public, that creates confusion among people.”
— Kasisomayajula Viswanath
“What I have found is a remarkable degree of consensus among people who understand the science of this disease around what the fundamental issues are and then disagreements about trade-offs and policies,” said Jha, who is a frequent commentator on news programs. “The idea of covering the science in a two-sided way on areas where there really isn’t any disagreement has struck me as very, very odd, and it keeps coming up over and over again.”
Then there is the problem of political bias. This has been especially true at right-leaning media outlets, which have largely repeated news angles and viewpoints promoted by the White House and the president on the progress of the pandemic and the efficacy of the administration’s response, boosting unproven COVID-19 treatments and exaggerating the availability of testing and safety equipment and prospects for speedy vaccine development.
Tara Setmayer, a spring 2020 Resident Fellow at the Institute of Politics and former Republican Party communications director, said what’s coming from Fox News and other pro-Trump media goes well beyond misinformation. Whether downplaying the views of government experts on COVID-19’s lethality, blaming China or philanthropist Bill Gates for its spread, or cheering shutdown protests funded by Republican political groups, it’s all part of “an active disinformation campaign,” she said, aimed at deflecting the president’s responsibility as he wages a reelection campaign.
But turning around those who buy into false information is not as simple as piercing epistemic bubbles with facts, said Christopher Robichaud, senior lecturer in ethics and public policy at Harvard Kennedy School (HKS) who teaches the Gen Ed course “Ignorance, Lies, Hogwash and Humbug: The Value of Truth and Knowledge in Democracies.”
Over time, bubble dwellers can become cocooned in a media echo chamber that not only feeds faulty information to audiences, but anticipates criticisms in order to “prebut” potential counterarguments that audience members may encounter from outsiders, much the way cult leaders do.
“It’s not enough to introduce new pieces of evidence. You have to break through their strategies to diminish that counterevidence, and that’s a much harder thing to do than merely exposing people to different perspectives,” he said.
While Facebook, Twitter, and YouTube have all recently ramped up efforts to take down COVID-19 misinformation following public outcry, social media platforms “fall short” when it comes to curbing the flow, said Joan Donovan, who leads the Technology and Social Change Project at HKS.
Since the national shift to remote work, many social media firms are relying more heavily on artificial intelligence to patrol misinformation on their platforms, instead of human moderators, who tend to be more effective, said Donovan. So many users suddenly searching and posting about one specific topic can “signal jam search algorithms, which cannot tell the difference usually between truth and lies.”
These firms are reluctant to spark a regulatory backlash by policing their platforms too tightly and angering one or both political parties.
“So they are careful to take action on content that is deemed immediately harmful (like posts that say to drink chemicals), but are reticent to enforce moderation on calls for people to break the stay-at-home orders,” said Donovan.
Viswanath said public health officials cannot, and should not, chase down and debunk every bit of misinformation or conspiracy theory, lest the attention lends them some credence. The public needs to more closely scrutinize and be “much more skeptical” about what they’re reading and hearing, particularly online, and not try to keep up with the very latest COVID-19 research. “You don’t need to know everything,” he said.
Putting the onus entirely on the public, however, is “unfair and it won’t work,” said Viswanath. Institutions, like social media platforms, have to take more responsibility for what’s out there.
Public health organizations should be running effective communication surveillance of social media to monitor which rumors, ideas, and issues most worry the public, what is understood and misunderstood about various diseases and treatments, and what myths are circulating or being actively promoted in the community. And they need to have a strategy in place to counter what they’re picking up. “You cannot control this, but you can at least manage some of this,” Viswanath said.
Though some COVID-19 misinformation and conspiracy theories are outlandish or even dangerously inaccurate, Robichaud said it’s a mistake to dismiss those who believe them as people who don’t care about the truth.
Many cognitive biases get in the way of even the best truth-seeking strategies, so perhaps we could all benefit from a little more intellectual humility in this time of such great uncertainty, he said.
“Most of us are, at best, experts in a tiny, tiny area. But we don’t navigate the world as if that were true. We navigate the world as if we’re experts about a whole bunch of things that we’re not,” he said. “A little intellectual humility can go a long way. And I say that as a professor: It’s true of us, and it’s also true of the public at large.”
Damage to the kidneys, heart, brain — even ‘covid toes’ — prompts reassessment of the disease and how to treat it
Deborah Coughlin was neither short of breath nor coughing. In those first days after she became infected by the novel coronavirus, her fever never spiked above 100 degrees. It was vomiting and diarrhea that brought her to a Hartford, Conn., emergency room on May 1.
“You would have thought it was a stomach virus,” said her daughter, Catherina Coleman. “She was talking and walking and completely coherent.”
But even as Coughlin, 67, chatted with her daughters on her cellphone, the oxygen level in her blood dropped so low that most patients would be near death. She is on a ventilator and in critical condition at St. Francis Hospital, one more patient with a strange constellation of symptoms that physicians are racing to recognize, explain and treat.
“At the beginning, we didn’t know what we were dealing with,” said Valentin Fuster, physician-in-chief at Mount Sinai Hospital in New York City, the epicenter of the U.S. outbreak. “We were seeing patients dying in front of us. It was all of a sudden, you’re in a different ballgame, and you don’t know why.”
Today, there is widespread recognition the novel coronavirus is far more unpredictable than a simple respiratory virus. Often it attacks the lungs, but it can also strike anywhere from the brain to the toes. Many doctors are focused on treating the inflammatory reactions it triggers and its capacity to cause blood clots, even as they struggle to help patients breathe.
Learning about a new disease on the fly, with more than 78,000 U.S. deaths attributed to the pandemic, they have little solid research to guide them. The World Health Organization’s database already lists more than 14,600 papers on covid-19. Even the world’s premier public health agencies, including the Centers for Disease Control and Prevention, have constantly altered their advice to keep pace with new developments.
“We don’t know why there are so many disease presentations,” said Angela Rasmussen, a virologist at the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health. “Bottom line, this is just so new that there’s a lot we don’t know.”
More than four months of clinical experience across Asia, Europe and North America has shown the pathogen does much more than invade the lungs. “No one was expecting a disease that would not fit the pattern of pneumonia and respiratory illness,” said David Reich, a cardiac anesthesiologist and president of Mount Sinai Hospital in New York City.
Like a lot of major health systems, CommonSpirit Health is making strides to reopen elective procedures canceled due to COVID-19.
Some facilities have already resumed some surgical procedures, and others are going to start scheduling such procedures as soon as Monday.
To get started, officials say, the health system giant recently created a toolkit that they sent to its 137 hospitals that stretch across more than 20 states outlining testing, screening and supply protocols. CommonSpirit’s toolkit builds on a framework put out in recent weeks by the American Hospital Association, the American College of Surgeons and other provider groups.
A key message: Hospitals must also make sure to keep one eye on the virus and its ongoing spread in the community on a daily basis and be ready to respond accordingly. CommonSpirit says that facilities need to coordinate with local and state authorities.
“The virus isn’t going away because we reopened,” Barbara Pelletreau, senior vice president for patient safety at CommonSpirit, told FierceHealthcare.
Here’s a look at what else the health system’s new toolkit advises:
1. Assess: The toolkit offers five phases of surgical care, Pelletreau said. In the first phase, a facility must look at how to reassess the health status of patients since the cancellation of their procedure, she said.
Hospitals must adhere to the Centers for Medicare & Medicaid Services’ requirement that there is a physical examination and history of a patient within 30 days of any procedure. “This will verify if there has been no significant interim change in patient’s health status,” the toolkit said.
Hospitals can rely on telehealth for part of this evaluation.
Testing is also a critical part of the restart. Facilities should test patients before surgical procedures and tell patients to remain at home before the results come in to limit any new potential exposure.
A hospital must also create a process to determine next steps if patient testing is not available or results haven’t come back in time for the surgery.
2. Designate leadership and coordinate: As they prepare to get going again, facilities should establish a prioritization policy committee that has members from surgery, anesthesia and nursing.
The committee should examine which types of procedures should get priority to resume.
3. Ensure they have enough PPE: They also need to make sure they have enough personal protective equipment (PPE) to handle not just any new procedures but also another wave of COVID-19 cases.
For instance, one part of the toolkit recommends a facility to have a minimum of four days of PPE on hand and projection of new inventory arriving for the next two weeks.
As facilities ramp up, they must ensure they have enough primary and adjunct personnel. A hospital must also put out guidelines for who is present during intubation and extubation of the patient and how to use PPE.
Communication
However, a key element is harder to address: confidence among patients.
“In the end, you can have all the clinical facts. But it is, ‘How do you feel about your safety?’” Pelletreau said. “How do you feel about going to the grocery store or a hospital that delivers amazing medical care?”
Pelletreau said that CommonSpirit is now also working on messaging to its own employees and to the community to assure patients it is safe to return to the hospital for needed medical care. That includes several communication resources to show examples of the work it is doing, from ramped-up testing to more stringent cleaning protocols, to ensure surgical procedures can be performed safely.
“Consider a proactive approach to communicating with staff, patients, physicians and the community,” the toolkit said. “Recognize the significant interest and questions from our key audiences.”
The president of the Federal Reserve Bank of Minneapolis said Sunday that the “worst is yet to come” after a record of 20 million people lost their jobs amid furloughs and layoffs sparked by the coronavirus pandemic in April.
“I mean the worst is yet to come on the job front, unfortunately,” Neel Kashkari said on ABC’s “This Week.”
“We may be in an environment of gradual relaxing and then having to clamp back down again around the country as the virus continues to spread,” he added. “To solve the economy, we must solve the virus. Let’s never lose sight of that fact.”
Kashkari also contradicted White House economic adviser Larry Kudlow’s prediction for a financially strong half of 2020 and full 2021 when ABC’s George Stephanopoulos asked if that was realistic.
“You know, I wish it were,” he responded. “What I’ve learned in the last few months, unfortunately, this is more likely to be a slow, more gradual recovery.”
President of Minneapolis Federal Reserve Neel Kashkari says economic recovery in the U.S. "is more likely to be a slow, more gradual recovery."
The Minneapolis Fed president said a “robust economy” would require a breakthrough in vaccines, testing and therapies.
“I don’t know when we’re going to have that confidence,” he said, adding, “and ultimately, the American people are going to decide how long the shutdown is.”
The Department of Labor reported last week that the unemployment rate had reached 14.7 percent, which is the highest since the U.S. began tracking in 1948. More than 33 million people have applied for unemployment claims since mid-March.
Speaking earlier Sunday on “This Week,” Kudlow acknowledged that “very difficult” unemployment numbers could likely be reported in May. But he added that there is a “glimmer of hope” within the unemployment data, with 80 percent of the claims involving those who were furloughed or going through temporary layoffs.
HENRY KOTULA 