Over the past week, we have been tracking what was originally reported as an undiagnosed outbreak in Venezuela, that now appears to be due to multiple causes:
http://www.flutrackers.com/forum/showthread.php?t=227561
It dawns on me that the initial official messages from public health authorities in this outbreak were just about as wretched as can be, and actually increased the public's fear instead of calming it. I wanted to open this thread to discuss the errors they made, so that we can all learn from them for next time.
1. Never state that an illness is excluded, unless you are sure of it. Orignally, they announced that they ruled out Ebola, meningitis, dengue, chikungunya, and MRSA. Three of those have now been confirmed in at least one patient. It is possible that Ebola is the only one they got right. When you give the public a long list of excluded common diagnoses, you tend to reinforce the opinion that something exotic is going on. And worse yet, if you turn out wrong, you look like a fool.
2. Don't accuse reporters or doctors of terrorism. Unless you have a specific political view that you think they are trying to accomplish, all you do is appear to be covering something up.
3. Report lab results as soon as you have them. The sooner you get the outbreak out of the undiagnosed category, the faster the fear goes away.
4. If any diagnoses are under investigation that seem credible, tell the public what they are and how to prevent them. I haven't seen a single warning about mosquito avoidance or antibiotic treatment. Ideally, give the public at least two credible diagnoses so that if one gets excluded, the mentality shifts to a different one, not to "unknown virus". Nothing causes fear like "unknown virus".
5. Get the public as specific and accurate a symptom list as possible, without violating the patient's privacy. That will keep unrelated illnesses from being lumped into the outbreak by the media, making the situation appear worse.
6. Feel free to speculate about something rare or exotic, as long as it fits the symptoms and nothing more common fits them better. There was a point in this outbreak where plague seemed like a legitimate possibility. It wouldn't have hurt for authorities to remind the public that plague is treatable with antibiotics and to avoid rat exposures, something that also would have helped had something like hantavirus or leptospirosis been confirmed.
7. If you really get stumped, send samples overseas, and tell the public you did it. At least you will be seen as trying to solve the problem, not cover it up.
The reason Dr. Orihuela, who retired 20 years ago, has become the leading voice on this outbreak (via Twitter) is because the current officials have totally botched their handling of media relations.
http://www.flutrackers.com/forum/showthread.php?t=227561
It dawns on me that the initial official messages from public health authorities in this outbreak were just about as wretched as can be, and actually increased the public's fear instead of calming it. I wanted to open this thread to discuss the errors they made, so that we can all learn from them for next time.
1. Never state that an illness is excluded, unless you are sure of it. Orignally, they announced that they ruled out Ebola, meningitis, dengue, chikungunya, and MRSA. Three of those have now been confirmed in at least one patient. It is possible that Ebola is the only one they got right. When you give the public a long list of excluded common diagnoses, you tend to reinforce the opinion that something exotic is going on. And worse yet, if you turn out wrong, you look like a fool.
2. Don't accuse reporters or doctors of terrorism. Unless you have a specific political view that you think they are trying to accomplish, all you do is appear to be covering something up.
3. Report lab results as soon as you have them. The sooner you get the outbreak out of the undiagnosed category, the faster the fear goes away.
4. If any diagnoses are under investigation that seem credible, tell the public what they are and how to prevent them. I haven't seen a single warning about mosquito avoidance or antibiotic treatment. Ideally, give the public at least two credible diagnoses so that if one gets excluded, the mentality shifts to a different one, not to "unknown virus". Nothing causes fear like "unknown virus".
5. Get the public as specific and accurate a symptom list as possible, without violating the patient's privacy. That will keep unrelated illnesses from being lumped into the outbreak by the media, making the situation appear worse.
6. Feel free to speculate about something rare or exotic, as long as it fits the symptoms and nothing more common fits them better. There was a point in this outbreak where plague seemed like a legitimate possibility. It wouldn't have hurt for authorities to remind the public that plague is treatable with antibiotics and to avoid rat exposures, something that also would have helped had something like hantavirus or leptospirosis been confirmed.
7. If you really get stumped, send samples overseas, and tell the public you did it. At least you will be seen as trying to solve the problem, not cover it up.
The reason Dr. Orihuela, who retired 20 years ago, has become the leading voice on this outbreak (via Twitter) is because the current officials have totally botched their handling of media relations.
