How to Hide a Pandemic

A closer look at the techniques used by the Public Relations exercise that passes for Public Health strategy these days

No one could have predicted this. No, really.

In the years before Covid, the word “pandemic” would have conjured visions of bodies in the street and rioting, maybe. Or maybe it would have been more like the movie “Contagion” or “Outbreak”, with soldiers in full hazmat suits helicoptering in to isolate towns, and a heroic race to find a cure (all within the neat confines of a two-hour runtime, of course).

Not gonna lie, the notion that a raging global pandemic would be met with apathy and a global, Public Health-led effort to downplay its severity- while doing almost nothing to deal with the crisis- was not on our pre-pandemic bingo cards.

And yet, here we are now. Four years in, the pandemic response (such as it is) has devolved into propaganda. Public Health agencies have emphasized Public Relations as the primary tool for crisis management, and a crop of “science communicators” has sprung up out of obscurity to help shepherd public opinion and guide it to a happy place. Reflections on the failure of the CDC, for example, have focused on a need to revamp scientific communication rather than do anything of substance.

But four years is a long time to hone the art of “nothing to see here” propaganda. And the pandemic’s never-ending new waves of viral variants have had a repetitive cadence to them- a predictable sequence of rises in case counts (but low hospitalizations), followed by rises in hospitalizations (but low levels of death), followed by rises in deaths (but falling case counts). That repetitive quality has allowed for a certain eco-friendly reusability when it comes to propaganda messages. Every six months or so, some part of the news cycle gets devoted to the idea that we are finally out of this, that cases are lower than ever before and it’s milder than ever before. Experts come out of the woodwork to confidently predict (again) that this means that we have herd immunity now, or hybrid immunity, or that it’s endemic (thank goodness!), or maybe all three. Of course, this has been going on from the beginning of the pandemic, but no one seems to notice.

In this post, we will explore some of the tools and tricks of the sorry public relations exercise that passes for public health these days. It helps to know what they are- once you start seeing them, you can’t stop!

Grounded and down-to-earth public health messaging. Sort of.

1. Green-mapping

If you can redefine a term enough times, you can make it say anything you want!

The handling of the COVID-19 pandemic by public health authorities, particularly the CDC, and its portrayal in the media, have often been marked by an underplaying of the virus's true risks. A prime example is the CDC's February 2022 revision of its COVID-19 community levels map. The original map, based on transmission levels was almost uniformly red at the time- a well-timed switch to new criteria (based, in part on hospital bed availability) suddenly switched the entire country to a soothing shade of teal green. This visual and metric shift created an illusion of reduced transmission risk, leading to public complacency and a relaxation of compliance with measures.

The alchemy that the CDC practiced with its infamous green map is just one example of a tactic that has been used repeatedly in pandemic communication. Quietly redefining terms in day-to-day conversation by switching the metric that it is being used to describe. “Vaccine efficacy” is another term that got ‘green-mapped’ early on- the word went from meaning “protection against infection” to “protection against severe outcomes” to, finally, “protection against death”. “Learning to live with the virus” underwent a quiet linguistic shift, as did “herd immunity”.

‘Green mapping’ is a particularly pernicious “scicomms” technique, because it undercuts our shared understanding of reality, and lends itself to an Orwellian we-have-always-been-at-war-with-Eastasia retconning of reality.

2. Calm-mongering

The only thing we have to fear during an ongoing pandemic is fear itself, apparently.

From the beginning of the pandemic, a pernicious thread in the public health and media reaction to the pandemic has been to downplay bad news and slow-walk a public discussion of the risks by accusing those pushing for risk mitigation of “fearmongering”, “doom-and-gloom” and “over-reaction”. In fact, panic has not been a hallmark of the public reaction to covid, and the worst of the panic (in March 2020) led to no consequence more dire than an inability to restock on Charmin toilet paper rolls for a few weeks. On the other hand, we would have benefited from reacting in a timely manner to specific pieces of information that were unquestionably bad news for the trajectory of the pandemic. For example the recognition of aerosol spread, the possibility of reinfection, the rapid evolution of the virus, the possibility that vaccine-only strategy would fail to bring the pandemic to an end, the accumulation of long COVID within the population, and widespread infections of children leading to long-term health risks. These were all crucial pieces of information that painted a dire picture for the trajectory of the pandemic, yet they were not given the urgent attention they deserved. Worse still, each one of these risks was pointed out, months and years before they were acknowledged by public health (click those links if you have time to spare- note the dates on the papers, the preprints in most cases were in the public domain at least six months prior).

This trend of "calm-mongering" has been detrimental to the public health response, effectively blinding the public and hindering them from adapting their strategies to the evolving realities of the pandemic. The techniques and tropes used in calm-mongering keep cropping up, so they’re easy to spot — dismissing concerns as “it’s complicated” (the Russell's Teapot fallacy), pushing for inaction until more definitive information is available (often referred to as “milling”), and temporizing by overlooking important findings in preprint studies on the premise that peer-review is the only way to gauge the veracity of a scientific claim. (Spoiler alert: it’s not, and it’s not foolproof either).

Ultimately, the predominant outcome of calm-mongering is a narrative that it’s “too late to do anything now.” It’s a form of defeatism, and it feeds into the narrative that we are powerless to do anything about this, and that no one should be held responsible for failures of public health. Calm-mongering is the peanut butter to the jelly of “no one could have predicted this”- anything can be a surprise if you insist on ignoring warnings.

3. DARVO

Forced infection is freedom of choice, and freedom from disease is oppression.

Public figures who were consistently incorrect in their assessments and predictions about COVID-19 have since attempted to rewrite their role, portraying it as radically different from what actually transpired. If you’re paying attention to the situation, you’ve probably seen them use a strategy known as DARVO – Deny, Attack, and Reverse Victim and Offender. This tactic involves denying their errors, attacking those who point out these inaccuracies, and reversing the roles of victim and offender to deflect responsibility. Two key pieces of this strategy are the propagation of false narratives, and a retconning of recent history.

As evidence continues to mount of the harms associated with repeated COVID infections, a significant DARVO effort has been under way, focusing on the alleged harms of lockdowns and the impact on education. To wit, the claim has been that lockdowns harmed children so badly that they are still suffering, years later. To take the effort seriously requires some serious mental gymnastics- let’s forget for a second about the death toll of the pandemic during the ‘lockdown’ era, or the risk of delayed acute serious health events and long-term disability following COVID. But even if we cast all that aside for a minute, the claims don’t really add up:

1. Harms of Lockdowns: While lockdowns did have economic and social costs, the narrative that they were more harmful than beneficial has been really light on supporting data, and it ignores the context in which they were implemented in the first place. Lockdowns were often a last resort to prevent healthcare systems from being overwhelmed and to reduce mortality rates. In reality, countries like the US and Canada experienced very limited legal restrictions on mobility, and Google Mobility data shows that the impact on people’s day-to-day lives was short and shallow. To hear the retconning, you may be forgiven for thinking that the government stapled masks to our faces and chained us to our toilets for a year. The reality was quite a bit different.

2. Learning Loss: There is no denying that the pandemic disrupted education systems worldwide. The facts of the matter show that most schools in the United States, for example, were fully remote for 8-13 weeks (during which period, 91% offered distance learning), followed by a year of remote learning (for about half the population). Both the magnitude and impact of school closures have been wildly exaggerated, and rely on ignoring the harms to children that result from COVID. The notion that the current free-fall in test scores is related to these events from three years ago is risible. Other explanations — including the rather obvious one that repeatedly infecting children repeatedly with a virus that has been proven to penetrate and inflame brain tissue might possibly harm their cognitive abilities — are ignored in this narrative.

The DARVO framing of an overreaction to the pandemic is often based on the assertion that the number of deaths and the severity of COVID-19 did not justify the measures taken. This viewpoint fails to recognize that successful public health measures, by their very nature, are invisible; they prevent crises from occurring, making their necessity less apparent in hindsight. (Do we complain after evacuations that the lack of deaths from the hurricane proves that the evacuation was unnecessary?) Another common DARVO framing is the portrayal of lockdowns as a method of social control rather than a public health measure. This conspiracy-theory-tinged narrative distracts from the primary objective of lockdowns, which was to save lives and prevent the spread of the virus. In particular, focusing on the historical expedient of lockdowns during the early pandemic is an effective DARVO tactic, because it allows for the conflation of all forms of mitigation as being synonymous with “lockdowns”.

DARVO is particularly effective for the minimizers, because it allows them to go on the offensive and showcase their science-free concerns in theater-of-the-absurd fashion. Using schools as an example, the consequences of repeatedly exposing children to this virus are likely to be severe and will play out for years to come. That discussion —both important and urgent — gets swept aside while we’re all distracted by the DARVO efforts of those very people whose efforts led us to this situation.

4. Myth-making

Why not manifest our way to a better reality, then?

The COVID-19 pandemic has been clouded by numerous myths, which have significantly skewed public perception and response. One major myth is the belief that the pandemic is over, a notion driven by the desire for normalcy but overlooking ongoing infection rates and the emergence of new variants. Another myth that is shockingly prevalent, four years in, is the notion that COVID-19 is only a concern for the vulnerable; in reality, it can have severe outcomes in anyone, including healthy individuals. The myth that the virus has become milder or will inevitably do so continues to gain currency. We’ve seen ebbs and flows in disease severity in the past- Delta was more severe than the original strain on a per-infection basis, and Omicron (while equivalent in severity to the original strain) caused the single largest mortality event in the US’s history, after having been billed as ‘mild’ on the basis of a single study.

Myth-making about immunity has been a cottage industry during the pandemic. There has been no shortage of experts willing to put their credibility on the line by promising herd immunity at a population level or long-lasting immunity at an individual level (both because muh T-cells), improved health through repeated infections or lifelong vaccine protection without boosters. These myths follow a similar set of kinetics in their emergence. Usually, they’re promulgated by an expert whose expertise lies specifically in being repeatedly wrong. The message is then picked up and amplified by others, usually for the length of an entire news cycle. Debunking of the myth happens in a delayed and uncoordinated way, if at all- indeed, it’s sometimes left up to the virus to give the lie to the claims. (“Reality is that which, when you cease to believe it, still exists”).

The myth of asymptomatic transmission being rare has been debunked by studies showing that individuals without symptoms can indeed spread the virus, emphasizing the need for widespread testing and preventive measures. The myth of hand hygiene in preventing COVID-19 was debunked by the mounting evidence of aerosol spread. The myth of rare breakthrough infections was similarly debunked by the Delta and Omicron variants. The myth of Long COVID as a psychosomatic condition was debunked by the pileup of biological studies showing direct physical evidence of changes in the body and viral persistence in patient tissues.

These myths are dangerous as they oversimplify the pandemic, promote a false sense of security, and undermine public health measures. They spread quickly among a public that’s hungry for good news. Dispelling these myths takes an order of magnitude more work than creating them, so it’s important to keep up a healthy level of skepticism about “good news”. It’s generally true at this point that good news is much more likely to flow from concrete actions taken by governments to limit viral spread and evolution than it is from some deus ex machina twist in the plot flowing from changes in viral biology.

5. False framing

You’re either with the virus or you’re against us!

A hallmark of the public health messaging around covid has been its tendency to sound reasonable, or true, even when it’s not. False dilemmas, false assumptions and false baselines have abounded, and have helped create resistance to public health measures. The key to each of these cognitive sleight-of-hand tricks is to lull the public into not thinking too closely about the risks:

1. False Dilemmas: A common false dilemma presented is the choice between complete elimination of the virus and unrestrained spread, suggesting that any attempt to control the virus is futile or economically devastating. Other examples include framing the debate as vaccines versus non-pharmaceutical interventions (NPIs), or masks versus improving indoor air quality. These false dichotomies stem from the plainly false narrative that measures to limit COVID-19 spread are either impossibly difficult or financially ruinous, and ignore the obvious economic costs of repeated reinfections in the population.

2. False Assumptions: Several assumptions have been widely circulated despite lacking evidence. For instance, the belief that the disease will inevitably become milder over time, or the idea that COVID-19 is only a significant risk for those with existing comorbidities. Another false assumption is that a mild acute course of the disease means there are no long-term health concerns, ignoring the possibility of long COVID and the severity of reinfections, which are not always milder.

3. False Baseline: The messaging often sets a false baseline to downplay the severity of the current situation. An example is the claim that the situation is better than it was during the height of the Omicron wave, despite it being the deadliest month in the history of the republic. Drops in life expectancy and test scores are portrayed as part of a long-term trend, rather than as direct impacts of the pandemic. There is also a tendency to manipulate data around excess mortality to create a less alarming picture.

Each of these cognitive tricks serves a purpose: to lull the public into a false sense of security and prevent them from scrutinizing the real risks associated with COVID-19. By simplifying complex situations into binary choices, underestimating the virus's impact, and manipulating baselines, these tactics effectively distract from the need for sustained vigilance and meaningful public health action.

6. Othering

“It’s a pandemic of the ______”.

In reporting on COVID-19 , a common focus for media coverage has been to emphasize that the disease is a concern for the vulnerable and marginalized.

When media reporting highlights the presence of comorbidities, it does so to make COVID Someone Else’s Problem, tapping into the "Just World" fallacy, the cognitive bias that bad things happen to people because of their own actions or flaws. Of course, a significant portion of the population, around 60% in the United States, has comorbidities. Comorbidities, such as hypertension, diabetes, and obesity, are widespread and can affect anyone, regardless of their lifestyle or personal choices. By emphasizing comorbidities in COVID-19 deaths, the narrative subtly shifts the blame onto the victims, implying that their health conditions were a result of personal failings. In fact, the risk of death from COVID-19 increases with age, mirroring the pattern observed in the risk of death from all other causes. This pattern is a natural phenomenon and not something that can be easily controlled by individual behavior. However, the emphasis on "personal responsibility" in media narratives around COVID-19 deaths often downplays these unavoidable risk factors. Questions such as "Was he vaccinated?" or "Wasn’t he overweight?" focus on individual choices, suggesting that the person might have avoided a severe outcome if they had made 'better' decisions. The ugly truth is this — regardless of age, COVID-19 is a significant (Top 10) cause of death in every age group, anyone can get long COVID after an infection, and repeated reinfections are what you can expect once or twice a year if you don’t take precautions. You’re much more likely to die or disabled if you get COVID repeatedly. It’s that simple.

A similar effect is in play when the media emphasizes the risk of COVID-19 for minorities. While it’s unquestionably true that minority communities have been hard hit by the pandemic, emphasizing that fact has been shown to reduce support for mitigation measures. Appeals to altruism and collective responsibility undermine disease mitigation efforts, much as we [A.C. and collaborators] predicted years ago.

The weaponization of narratives around equity in the service of inequitable outcomes is particularly pernicious, as it allows the public to wave the problem away in their own minds.

7. Data Manipulation

Slow the testing down, please!

The COVID-19 pandemic has seen various 'data massaging' techniques used by public health authorities that can paint a misleading picture of the crisis. Understanding these methods is crucial to grasp the true extent of the pandemic- these details matter, and we will dive into some of these techniques in subsequent blog posts.

Manipulating Excess Death Statistics

One technique involves manipulating excess death statistics. Authorities might leverage the kinetics of death reporting, or alter the window for the baseline, to make recent excess death numbers appear favorable. This tactic is intellectually deceptive because it sounds credible, or 'truthy', but skews the real impact of the pandemic.

Hospitalizations and Reporting Issues

The reporting of hospitalization data is another area where manipulation occurs. Since this data is voluntarily reported by hospitals, there is often no incentive for these institutions to provide comprehensive information. As a result, lags and under-reporting are inherent in the system. Additionally, the cause of hospitalization is often unclear, with distinctions between hospitalizations “with” COVID-19 versus “for” COVID-19 being murky. The low standards of data hygiene in the healthcare industry exacerbate these issues, making hospital data less reliable.

Manipulating Counts, Reporting & Visualization for COVID Cases

The voluntary nature of COVID-19 testing and reporting delays contribute to inconsistencies in case counts, rendering them unreliable for comparison across different areas. Typically, these counts are based on symptomatic clinical presentations, which are less reliable than model-based prevalence estimates used for other diseases like influenza and HIV. The lack of model-based estimates for COVID-19 from authorities like the CDC feeds into a narrative that minimizes the virus's severity. An example of this was when the CDC used its influenza model to predict COVID-19 cases, leading to misleading interpretations. The infamous “green map” that we talked about earlier, which conflates case counts with hospital availability, is a prime example of this manipulation.

Reframing Perceptions About Long COVID

The scope and intensity of long COVID are also being reframed in public discourse. There's a persistent myth that long COVID is rare or mainly a concern for those with existing health issues. This misrepresentation diminishes the broader and more severe impacts of long COVID, which can affect a wide range of individuals, including those who had mild initial infections.

We’re four years into this thing, and if you sometimes wake up feeling that the world has plunged into some dystopian hellscape out of the novel Nineteen Eighty-Four, you’re not alone. The Public Health (sorry, Public Relations) strategy for the current pandemic is in full-blown propaganda mode at present, leaning hard into the teachings of Joseph Goebbels: “If you tell a lie big enough and keep repeating it, people will eventually come to believe it”. Giving names to the propaganda techniques that have been used to lull us all into a sense of false security robs them of their power a little bit.

In the end, all propaganda is subject to reality. As we learned from the Parable of Baghdad Bob, the ability of false messaging to warp public perception can only go so far. To return to Goebbels, that quote has a second part to it: “The lie can be maintained only for such time as the State can shield the people from the political, [and/or] economic… consequences of the lie.” It’s the second half of that quote that should give us all hope as we continue to hang in there!