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Bloviating and Bungling the COVID-19 Pandemic.

Wegwarth and coauthors1 shed some light into why their country of Germany has fared better than the United States in handling the coronavirus disease 2019 (COVID-19) pandemic.1 As of November 1, 2020, for example, the mortality rate per million was 5 times lower in Germany than in the United States (128 vs 715, respectively).2 Indeed, the mortality rate in Germany was lower than almost every American state, including Hawaii. This difference in mortality, morbidity, and lost quality of life is difficult to attribute to medical technology, drug therapy, underlying genetics, environmental factors, or virus characteristics. One contributing factor may be differences in public health messages intended to guide individual behaviors to mitigate the COVID-19 pandemic. Wegwarth et al1 used a national survey of German adults (N = 2011) to test nuances in public health messaging about the COVID-19 pandemic. The nuances spanned from comprehensive messages (describing the uncertainty in both numbers and adjectives) to limited messages (leaving the uncertainty unmentioned). The results suggested that individuals tend to prefer messages with comprehensive rather than limited expressions of uncertainty (32.3% vs 21.1%; P < .001). Similar findings were replicated in analyses of motivation to adopt and maintain containment efforts. Together, the findings of this thoughtful and rigorous research suggest that disclosing uncertainty can help persuade skeptics and bolster public behaviors to manage the COVID-19 pandemic. This study is not the first to stress the value of expressing uncertainty to promote trust and behavior change. In social psychology science, the strategy is termed “correcting against selfinterest” and can enhance the credibility of the messenger and increase the influence of the message.3 For example, a car mechanic who comments “you have an oil leak that is small and probably not worth correcting” seems a credible professional who merits trust when later suggesting a radiator leak repair. More generally, public health authorities might gain trust by ensuring that the public understands statistical uncertainty (such as in daily trends or replication estimates) and might lose trust by overhyping outlier anomalies (such as single-day spikes in cases or deaths).4 Communication requires tact when relaying information that the future is uncertain. A vague acknowledgment tends to undercut trust, such as the trite declaration “the future is difficult to predict.” An excessive emphasis on uncertainty may be even worse, such as messages promoted by merchants of doubt who minimize public concern by capitalizing on the limitations of science about COVID-19. A better strategy may be to acknowledge risk by explicitly providing a best-case scenario, a worst-case scenario, and a likely case scenario.5 These communication nuances might also help clinicians to better explain uncertainty to patients and families in medical care. The public perception of risk can be further skewed by emotions because most people are not dispassionate about risks.6 One salient emotion reflects feelings of mystery provoked by hazards that are newly arising, relatively unobservable, and delayed in manifestation (eg, radiation exposure). Another salient emotion reflects feelings of dread provoked by hazards that have catastrophic potential, involuntary exposure, and a lack of control (eg, domestic terrorism). The COVID-19 pandemic is frightening, therefore, because it is high in both mystery and dread. These intuitive emotions can also help explain why statistics do not inspire consensus and why the public perception of risk often diverges from numerical analyses of uncertainty. An additional feature in the public’s perception of risk is psychophysical numbing, as depicted in the famous saying, “One death is a tragedy but 1 million deaths is a statistic.” Paradoxically, this means that public interest can decline even when the total number of deaths continues to rise.7 This loss of emotional salience may contribute to everyday shortfalls in physical distancing, mask wearing, + Related article