As the pandemic raged in 2020, the White House Coronavirus Task Force scheduled frequent news briefings, some at the White House and others at the CDC or the National Institutes of Health.
When the briefings were at the White House, where then-President Donald Trump was more likely to be present, reporters often asked questions about politics rather than health, remembers Jerome Adams, MD, who served as surgeon general and was a task force member.
"People complained when Trump didn't show up, but when he was there, we never got to talk about COVID," said Adams, now executive director of health equity at Purdue University.
Politicization and polarization -- along with dangerous misinformation about COVID-19 -- have been called ''the virus within." This spread of misinformation and disinformation -- a global phenomenon -- has continued to impede efforts to get the pandemic under control and to rally the public around health and safety measures recommended by scientists.
When health experts tried to discuss the reasons behind safety measures, the narrative about COVID-19 often digressed into people simply blaming politics, Adams said. "It literally shut down the conversation," he told Medscape Medical News.
"Every recommended public health step has been contested [by some group] every step of the way," said Kasisomayajula "Vish" Viswanath, PhD, a professor of health communication at the Harvard T.H. Chan School of Public Health and the Dana-Farber Cancer Institute. "There have always been pockets of challenges" to public health recommendations. "But nothing that I know of has been challenged at the scale we are seeing today."
Still, with more than 850,000 U.S. lives lost to COVID and over 68 million reported cases as of Jan. 19, the effort continues to tamp down ''the virus within" because the stakes remain so high.
Politics Driving Behaviors
In one of many similar studies early in the pandemic, Brookings Institution researchers polled nearly 50,000 adults and found that partisan affiliation was more powerful in determining individual attitudes and behaviors about COVID-19 than local infection rates or demographics.
The nonprofit public policy organization reported the study's findings with this headline: "Politics is wrecking America's pandemic response."
Another poll in March 2020 found that people who identified as liberals perceived the pandemic as being of higher risk than did conservatives, placed less trust in politicians to handle the pandemic, and were more trusting of medical experts.
The polarization wasn't only evident in attitudes, they concluded, but in actual behaviors. Liberals consistently reported practicing significantly more protective behaviors, such as wearing face masks.
The Fake News Problem
Researchers from the U.S. and Italy looked at how a variety of things, including the level of fear, affected the tendency of Italians and Americans to believe fake COVID-19 news. The surveys of 560 people were done in April 2020, at an early peak in the pandemic, and were published in Frontiers in Communication/Health Communication.
"We timed it when people were most affected by fear. Every emotion we have in life affects our reasoning ability, whether [we are] in fear or in love. We get less rational with fear," said Carola Salvi, PhD, a research fellow in psychiatry and behavioral sciences at the University of Texas at Austin.
Beside fear, Salvi's team evaluated the participants' "bullshit receptivity" (the ability to accurately assess certain statements), problem-solving ability, and a measure they call "socio-cognitive polarization."
Those who exhibit socio-cognitive polarization are intolerant of ambiguity and are more xenophobic and politically conservative. They looked at how each measure affected the ability to identify fake news.
Those who fit the socio-cognitive polarization profile were most likely to believe in fake news, Salvi told Medscape Medical News. They were also more likely to have high levels of fear.
In addition, the better someone's problem-solving ability, the more likely they were to not believe fake news. She found that those with conservative viewpoints were more likely than others to believe fake news, as were those who were more rigid in their way of thinking.
Respondents who trust network and local television, CNN, MSNBC, and NPR on COVID-19 issues believed little or no COVID-19-related misinformation, while those who trusted Newsmax, One American News, and Fox News believed many misconceptions about the pandemic.
But overall, the researchers said that misinformation was widespread, with 78% of all respondents either believing or unsure about the accuracy of at least one of the false statements presented.
Beyond Misinformation: The Mass of Information
The sheer volume of scientific information during the pandemic has made it difficult even for health experts -- let alone the public and journalists -- to keep up.
About 6 months ago, Harvard's Viswanath asked a colleague to help him do a simple search to calculate the volume of information on COVID-19. Doing a crude search of the term "COVID-19," they quickly came up with an astronomical number of hits.
"I can't read 1% of this," he said.
Fueling a lot of that information is a surge in research. Many researchers have posted their studies on preprint servers such as bioRxiv and medRxiv, which lack peer review but speed up the spread of important information during the pandemic. As of Jan. 7, Cold Spring Harbor Laboratory, the site operator for both servers, had posted more than 21,000 COVID preprints.
The Toll of Misinformation
Quantifying the toll of misinformation, partisan attitudes, and politics on COVID deaths and illness is difficult.
Researchers for the Commonwealth Fund published a study in late December that found there would have been about 1.1 million more COVID-19 deaths without the vaccination program. They also found there would have been more than 10.3 million additional COVID-19 hospitalizations by November 2021.
If no one had been vaccinated, according to this computation, daily deaths from COVID-19 could have reached 21,000. As of January 19, the daily average death count from COVID in the U.S. was approaching 2,000.
Getting Past the Misinformation
In interviews with experts, several approaches were mentioned to ease the misinformation and disinformation problem in an effort to improve public health communication.
Local messaging: Communicating messages about the pandemic locally, not nationally, could go a long way to persuade people to follow preventive measures, said Adams, the former surgeon general.
He believes local outreach can make a difference in convincing more people, if not everyone, about the seriousness of the pandemic. When New York was getting ''slammed" early in the pandemic, he recalled, ''people in Wyoming were saying, 'I don't know a single person who died of COVID.' ''
Viswanath agrees that building trust at a local level and using local leaders and health officials is an effective way to inform the public about vaccines and preventive measures.
"You can't expect them to go to the CDC site every day," he said.
Focus on the present: Less speculation about the pandemic and where it's going or might be going would be another step in the right direction, Viswanath said. "There's no point in speculating and scaring people."
The government also needs a clear consensus about how to communicate a consistent message -- and probably a consistent messenger, he said
Stop finger-pointing: While the political divide won't disappear, it's important to point out that ''there are people in both parties who agree on some topics," Vishwanath said. There is often a lot of focus on those who are opposing something, but shifting more attention to areas where there is agreement, regardless of political affiliation, would help.
Stop blaming the unvaccinated, Adams said. Some people who are vaccine-hesitant have legitimate concerns. He cites a young woman who honestly wonders if she needs to get vaccinated after she has had COVID twice.
"When we say, 'You are an idiot,' that causes them to shut down," he said.
Social media responsibility: Holding social media platforms responsible for misinformation has improved, but not enough, Viswanath said. "They can minimize this misinformation. They are already doing it. They can do more."
Reducing mistrust: "Misinformation is a big deal, but it's not the root problem," Adams said.
"The root problem is mistrust" of both the health care system and the government, he said. Before people will listen to you, he said, they must know you care.
Talk to the other side: "Only talking to those who have the same perception as you is not helping," said Salvi, of the University of Texas. When people confine their conversations only to those with the same views, "We also become rigid in our own position."