David Farmer knew health misinformation would be a problem when the Centers for Disease Control and Prevention shifted its guidance on masks. 

“We saw a lot of confusion,” said Farmer, a licensed professional counselor who teaches at the Texas College of Osteopathic Medicine. “OK, should we wear masks? Should we not wear masks?”

In March 2020, the CDC said only people who were sick or caregivers needed to wear a mask. On April 3, 2020, however, the messaging changed: “Everyone should wear a cloth face cover when they have to go out in public, for example to the grocery store or to pick up other necessities.” 

That same day, former President Donald Trump announced he wouldn’t personally be wearing a mask.

“When there is that lack of coordinated message that’s going out, it creates a lot of confusion,” Farmer said. “Plus, it creates a lot of mistrust.”

By this point, the World Health Organization had already dubbed the deluge of information — some coordinated, some not, some accurate, some not — an “infodemic.” More than a year later, the U.S. surgeon general, Dr. Vivek Murthy, would issue an advisory urging Americans to help slow the spread of health misinformation during the pandemic.

“When there is that lack of coordinated message that’s going out, it creates a lot of confusion. Plus, it creates a lot of mistrust.”

– David Farmer, licensed professional counselor

Health misinformation is “information that is false, inaccurate, or misleading according to the best available evidence at the time,” according to the advisory. Although it’s not a new phenomenon, local experts like Farmer say misinformation has thrived during the pandemic in part because of the scientific community’s evolving understanding of COVID-19 — which doesn’t always translate to unified guidance for the public — and the politicization of the virus. “You’re left with, ‘Whom should I believe?’” he said.

The consequences of health misinformation can be dire. Not only can it lead to mistrust in health authorities, but also “intensify or lengthen outbreaks when people are unsure about what they need to do to protect their health and the health of people around them,” according to the World Health Organization. 

“We’re treading in really dangerous territory,” said Daniel Sledge, an associate professor of political science at The University of Texas at Arlington. “We’re dealing with people’s lives here.”

As the virus evolves, so does public understanding 

The virus itself plays a part: It’s novel, invisible and highly transmissible. 

“This is an evolving science. I think we’re continuing to discover new things,” Farmer said. “As new variants occur, we’ll discover more. But I think for the common person, it certainly creates this sense of ‘OK, I’m not sure what I should do.’”

For comparison, he pointed to the relative unity of messaging around smoking in the U.S. But, unlike for COVID-19, data about the negative effects of smoking has existed for decades

“People are smart,” Farmer said. “And so people start to say, “‘Well, wait a minute, how much do you really know about this? And do we need to know more?’”

If people delivering the message about COVID-19 — scientists, politicians and journalists — aren’t transparent in the limitations of the information or how it might shift as new data emerges, “people feel slighted,” according to Dr. Amy Faith Ho, a clinical informaticist and physician at John Peter Smith Hospital. 

So, when messaging shifts around masks, for example, public trust erodes. 

“They thought they were told the truth,” she said. “And they were told the truth, but they just needed to understand the limitations and expectations” of the information. But, she added, doing so can be hard. 

Not only does that understanding require transparency from the scientific community, it requires a certain level of literacy from the public. 

Sledge spends much of his time reading peer-reviewed articles or peer-reviewing them. His work requires it. But, he said, most people understandably “have a difficult time following an iterative scientific process.” It takes some scientific literacy to understand why guidance from public health officials shifts over time. 

“Things change, right? And we get new information, and we try to adapt to that new information,” he said. “And I think that’s something that’s proven really difficult to get across to the public.”

The inevitable politicization of COVID-19

This evolving science, coupled with public uncertainty, creates a vacuum in which politicians can “carve out messaging that is going to be appealing to their constituents,” Sledge said. 

Not only do a person’s political beliefs often predict — more than demographic factors — how they think about and approach COVID-19, a state’s political leaning explains its public health policies in the pandemic, according to a preprint paper from 2020. The paper has yet to be peer-reviewed.

Over time, people have become more politically divided. That matters, Sledge said, because to achieve collective goals like reducing the spread of COVID-19, communities need either high levels of solidarity or a willingness to implement regulations that will help further those goals. And the longer the pandemic endures, Sledge said, the more opportunity exists for disunity.

“When you’re dealing with a crisis and you can point to an immediate threat, it can be really easy to mobilize large groups of people,” he said. “When you are dealing with something that is moving very slowly, something that has a gradual impact, people can become accustomed to the situation that they’re living in.”

The invisibility of the virus further complicates the story, he said. 

“If people were bleeding out of their eyes, I think we would be responding really differently,” he said. 

People can’t see the virus, but they can see how it’s disrupted their lives. “The costs of the interventions are obvious and all around,” Sledge said. And those costs aren’t small: Health consequences aside, people are losing their jobs, students are losing their education. 

“There’s a lot of mental strain around this pandemic,” he said. “And a lot of people would like it to be over.”

Sledge is unsurprised the pandemic became political. “Public health is always political when we’re talking about government intervention in people’s lives and in their bodies,” he said.

Empathy and one-on-one conversations may help, as well as community-wide education efforts

Recognizing the universality of suffering in the pandemic may help ease misinformation, according to Farmer and Ho.

“This is the first time that we’ve had a worldwide health issue that impacted every facet of life,” said Ho, who’s also an assistant professor at TCU and UNTHSC School of Medicine. 

Farmer hopes people communicate with each other about how they make decisions when it comes COVID-19. That means listening more and arguing less. It’s a strategy recommended in the U.S. surgeon general’s advisory as well: harnessing a person’s care for someone to “make inroads” by hearing without judgment.

“Other than being dominated by fear, we need to have some compassion as well,” Farmer said. “And we need to understand that we’re all struggling with this. We’re all trying to figure out what’s the right thing to do.”

“We need to understand that we’re all struggling with this. We’re all trying to figure out what’s the right thing to do.”

– David Farmer, licensed professional counselor

That collective engagement is a good thing, Ho said. She’s never seen so many people invested in learning about data.

“I think we should harness that to encourage a more educated public,” she said. 

On a community level, that can look like school districts emphasizing media, health and other literacies in class, according to the surgeon general’s advisory. In July, Illinois became the first state to require media literacy instruction at every public high school. The law will take effect in the 2022-2023 school year.

How can we decrease misinformation?

Tips from the U.S. surgeon general’s advisory

  1. Educators: Teach students to recognize elements of misinformation, like the use of unqualified people as experts or logical fallacies.
  2. Health professionals: Use minimal jargon when chatting with patients about their health concerns.
  3. Journalists: Beware of headlines or images that shock rather than inform.
  4. Researchers: Invite members of the community to help with research design.
  5. Elected officials: Release public health information online and in person, and take care to connect with “hard-to-reach” communities.
  6. Everyone: Engage in conversations about misinformation in “new ways” — ask questions, find common ground and remember it’s a process.

For more tips from the advisory, click here.

For the public’s own learning, Farmer recommends people ask their health care providers where they get their COVID-19 data: “‘Where would be reputable sources? Where are you going for your information?’”

The responsibility lies in part with physicians like her, Ho said. Americans trust medical doctors to look out for people’s best interest more than they trust elected officials, business leaders and the news media, according to a 2019 survey by the Pew Research Center. The surgeon general’s advisory recommends health professionals “proactively” engage with patients and their communities about misinformation. 

For Ho, that means meeting the patient “where they are” and pursuing solutions in incremental steps. And when people don’t know which information to trust, she organizes her conversations with them like a scientific paper. 

“I like to start with a topline summary,” she said. “Then I like to go into the methods of how we arrived there. I like to address the caveats…then I like to open up questions.”

She thinks change will come through conversations like these, one person at a time, on a “microscopic level.” The process will require patience, empathy and the patient’s informed consent: 

“It’s still their health, and it’s still their life,” she said. “So we can offer advice and be experts, but I think it’s more important to be on that journey with them.” 

Editor’s note: This story was updated to include Dr. Amy Faith Ho’s position at TCU and UNTHSC School of Medicine.

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here

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Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....

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