Huh? COVID-19 science and the uncertainty dance

My friend Tim Caufield, professor of law at the University of Alberta, the Research Director of its Health Law Institute, and current Canada Research Chair in Health Law and Policy, writes in an op-ed for the Globe and Mail that COVID public health policies have been with us for a year. So has uncertainty. We’ve all lived through twelve months of “huh”? And this has added to the public’s frustration, fatigue, and stress.

In the early weeks and months of the pandemic, there was uncertainty about masks and asymptomatic spread. There was uncertainty about if and when we’d get a vaccine. There was uncertainty about what type of public health policies worked best and were most needed. We have all had to tolerate a lot of ambiguity. And as the vaccines roll out, we are being asked to tolerate even more. (When will I get a vaccine? Which one will I get? And what about the variants?)

For public health communications to be effective, the public must have confidence in the message. And, unfortunately, for some, that confidence isn’t there. A recent study from the University of Calgary explored pandemic communication and found, not surprisingly, that “participants felt that public health messaging to date has been conflicting and at times unclear.”

This perception is understandable. An atmosphere of seemingly relentless uncertainty and confusion has been created by a combination of scientific realities, media practices, some less-than-ideal communication from policy makers, and the spread of misinformation and conspiracy theories.

The science surrounding COVID was – and, for some topics, continues to be – highly uncertain. While a growing body of evidence has emerged around the most contested issues (such as the value of masks and physical distancing strategies), early in the pandemic there wasn’t much that was unequivocal. The science evolved and, as you would hope with any evidence-informed approach, the resulting science advice and recommendations evolved too. But for some, shifting policies, even if appropriate, just added to a sense, rightly or not, of chaos.

In addition, the media has been reporting on the research as it unfolds, including referencing studies that have not yet been peer reviewed. Often the preliminary or uncertain nature of the relevant research is not reported in the media, thus creating a false impression about the actual state of the science – as exemplified by the “hydroxychloroquine works!” debacle (PS, it doesn’t). Perhaps worse, relatively fringe perspectives – such as those pushing the value of “natural herd immunity” – have been given a relatively high profile in both the conventional press and on social media. This can create a false balance (fringe idea vs. broad scientific consensus) that we know can be detrimental to both public discourse and health behaviours.

Despite the frustration that uncertainty can create, the public has a demonstrated preference for honesty about the limits of our knowledge. A recent study from Germany found that “a majority of respondents indicated a preference for open communication of scientific uncertainty in the context of the COVID-19 pandemic.” This finding agrees with other research that has found that when uncertainty is relevant to their lives, the public wants to know about it.

People may want to hear about uncertainty, but will communicating it do more harm than good? Will it just add to an already confused information environment? The data on this point are actually fairly mixed, but recent research exploring the impact of communicating scientific uncertainty found that it either increased perceptions of trust in science or had almost no impact. This is good news. As the authors of one of the studies notes, “this should allow academics and science communicators to be more transparent about the limits of human knowledge.” Other studies have found that being honest about uncertainties in media reports about research can actually boost the perceived credibility of journalists.

And over the long term, honesty about the uncertainties of the evidence used to inform policy seems essential to the maintenance of public trust. For example, being overly dogmatic about a policy or predictive model could hurt the credibility of decision makers if new evidence requires a revision of a past positions.

When possible, public health authorities (or anyone seeking to communicate science) should start with well-defined and well-supported takeaway messages (e.g., please get vaccinated with whatever vaccine is available to and recommended for you!).But then be honest about what is not known (e.g., while vaccines are our best defense, we aren’t sure how long immunity will last).

Depending on the medium used (a social media post, for example, may not be the best venue for a long discourse on methodological challenges), it may also be wise to explain the limits of the research approach (e.g., observational studies can’t prove causation). If there are areas of scientific disagreement, be honest about that too – but be specific about what is being disputed. Often there is broad agreement about the big stuff (e.g., vaccines work!), but academic debate about some details. Often those trying to sow doubt – like those in the anti-vaccine community – will try to weaponize and over-emphasize small academic disagreements. Don’t give them that room.

When communicating about uncertainty it is also important to highlight what is being done to reduce it, such as forthcoming research or new data analysis. This provides a road map forward and invites the public to follow the science as it unfolds. It is also a way to stress that uncertainty is a natural part of the scientific process.

For the public, try not to let the uncertainty kerfuffle distract you from the big picture. Remember that there are many clear knowns. Vaccines, physical distancing, hand washing, masks, and being responsible when symptoms emerge will get us through this pandemic.

Finally, it is also important to take a break from all the uncertainty noise. Studies have shown that the constant consumption of conflicting COVID news can (no surprise here) add to our stress. Put down the phone, back away from the screen, and take ten from “huh?”

Listeriosis in England and Wales: Summary for 2019

This report summarises the number and characteristics of confirmed cases of listeriosis in England and Wales in 2019:

  • 142 cases of listeriosis were reported in England and Wales;
  • incidence rates of listeriosis were highest in people aged 80 years and over;
  • the crude incidence of listeriosis was lower in men than women, but reported cases among men aged 60 to 69 were 7 times higher than in women aged 60 to 69;
  • pregnancy-associated infections accounted for 17.6% of all reported cases and, a third of pregnancy-associated cases resulted in stillbirth or miscarriage;
  • among non-pregnancy associated cases of listeriosis, death was reported for 23 cases (19.7%), of whom 15 (12.8%) were known to have listeriosis recorded as a cause of death on the death certificate
  • incidence of listeriosis varied geographically, with the lowest incidence in East of England (0.14 per 100,000 population) and the highest in London (0.39 per 100,0000 population); and,
  • there were 4 listeriosis outbreaks investigated in England, including a national outbreak associated with the consumption of prepacked hospital sandwiches.

The art of persuasion hasn’t changed in 2,000 years and applies to coronavirus

Carmine Galloof wrote in the Harvard Business Review last year that ideas are the currency of the twenty-first century. The ability to persuade, to change hearts and minds, is perhaps the single greatest skill that will give you a competitive edge in the knowledge economy — an age where ideas matter more than ever.

More than 2,000 years ago Aristotle outlined a formula on how to master the art of persuasion in his work Rhetoric. A summary of Galloof’s article appears below.

1) Ethos or “Character”

Aristotle believed that if a speaker’s actions didn’t back their words, they would lose credibility, and ultimately, weaken their argument.

2) Logos or “Reason”

Once ethos is established, it’s time to make a logical appeal to reason. Use data, evidence, and facts to form a rational argument.

3) Pathos or “Emotion”

According to Aristotle, persuasion cannot occur in the absence of emotion. People are moved to action by how a speaker makes them feel. Aristotle believed the best way to transfer emotion from one person to another is through the rhetorical device of storytelling. More than 2,000 years later, neuroscientists have found  his thesis accurate. Studies have found that narratives trigger a rush of neurochemicals in the brain, notably oxytocin, the “moral molecule” that connects people on a deeper, emotional level.

4) Metaphor

Aristotle believed that metaphor gives language its verbal beauty. “To be a master of metaphor is the greatest thing by far,” he wrote. When you use a metaphor or analogy to compare a new idea to something that is familiar to your audience, it clarifies your idea by turning the abstract into something concrete.

Those who master the metaphor have the ability to turn words into images that help others gain a clearer understanding of  their ideas — but more importantly, remember and share them. It is a powerful tool to have.

5) Brevity

Here again, Aristotle was ahead of his time. “Aristotle had discovered that there are fairly universal limits to the amount of information which any human can absorb and retain,” writes Kings College professor Edith Hall in Aristotle’s Way. “When it comes to persuasion, less is always more.”

Brevity is a crucial element in making a persuasive speech. An argument, Aristotle said, should be expressed “as compactly and in as few words as possible.” He also observed that the opening of a person’s speech is the most important since “attention slackens everywhere else rather than at the beginning.” The lesson here is: start with your strongest point.

Sorta like journalism.

What’s so funny ‘bout peace, love and understanding? CDC could further strengthen efforts to identify and respond to foodborne illnesses

The U.S. Government Accountability Office writes the Centers for Disease Control and Prevention estimates that 1 in 6 people in the U.S. get food poisoning each year—leading to 128,000 hospital stays and 3,000 deaths. CDC has seen an increase in foodborne illness outbreaks that span multiple states in recent years.

CDC has developed tools to identify possible multistate outbreaks, investigate their cause, and communicate about them to the public. But it needs to balance the need to communicate quickly against the need to provide accurate and specific information.

Our recommendations include that CDC publicize its decision-making process for communicating about multistate outbreaks.

Disgusting face, disease-ridden place? Emoji influence on the interpretation of restaurant inspection reports

Every year, millions of Americans get sick from foodborne illness and it is estimated half of all reported instances occur at restaurants. To protect the public, regulators are encouraged to conduct restaurant inspections and disclose reports to consumers. However, inspection reporting format is inconsistent and typically contains information unclear to most consumers who often misinterpret the inspection results. Additionally, consumers are increasingly searching for this information in a digital context. Limited research explores inspection reports as communication tools.

Using affect-as-information and ELM as theoretical frameworks, this experiment investigated how discrete emotions (e.g., disgust) conveyed through pictorial cues (i.e., emojis) influenced consumers’ processing of inspection reports. Participants, recruited from Amazon’s MTurk, were randomly assigned to one of six experimental conditions in a 3 (emoji: smiling vs. disgusted vs. none) x 2 (violation level: low vs. high) between-subjects design. Then, participants completed a questionnaire regarding perceptions and cognitive processing of the message.

Results revealed that, compared to text, disgusted face emoji increased risk perceptions and avoidance behavior. In terms of emotion, smiling face emoji motivated participants to feel more emotions related to sanitation. In turn, positive feelings decreased elaboration likelihood. As predicted by ELM, involvement also predicted elaboration, such that participants who were highly involved with inspection reports elaborated more than those less involved. Involvement also moderated the relationship between emoji presented and elaboration. Practical implications are also discussed.

Disgusting face, disease-ridden place?: Emoji influence on the interpretation of restaurant inspection reports

Health Communication, 18 August 2020

Elizabeth Ray and Patrick Merle

https://doi.org/10.1080/10410236.2020.1802867

https://www.tandfonline.com/doi/full/10.1080/10410236.2020.1802867

75% of pregnant women in NZ aren’t aware of dangerous foods

New research from New Zealand has found that 75% of pregnant women aren’t aware of what foods are potentially dangerous.

Researchers took a survey of 205 pregnant women, both those in a hospital and online, between December 2017 and January 2018. The results, according to BabyGaga, can be read in two ways. The good news is that the average woman scored 95% correct. The troubling news? Only 25% scored a perfect score. With things like deadly foods for fetuses, you need 100% in order to be completely protected from the dangers.

What danger foods weren’t readily known by expectant mothers? Baked goods with added cream or custard, hummus, certain salads, and soft/semi-soft Cheese all were among the most missed.

Hummus typically purchased in packages run the risk of listeria. This bacteria poses a danger to an unborn baby as it can cause the immune system to weaken. This, in turn, leads to listeriosis. Pregnant women are told to prepare any hummus at home and make sure to eat it while it is still fresh.

Refrigerated, ready-to-eat foods are generally a no-no. Two recent recalls highlight the risk.

The Canadian Food Inspection Agency (CFIA) has issued a recall for a popular brand of lunch meat.

Levitts Foods (Canada) Inc. is recalling Compliments Smoked Beef Pastrami 175 g with a best before date of Dec 25th, 2020 

The CFIA said people should not consume the recalled product and instead throw it out or return it to the store they purchased it from. 

The recalled Pastrami was sold at stores in Alberta, Nova Scotia, Ontario and possibly across the country. 

Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still make you and your family sick. 

The CFIA said there have been no illnesses reported. 

This recall was triggered by the Canadian Food Inspection Agency (CFIA) test results. The CFIA is conducting a food safety investigation, which may lead to the recall of other products. If other high-risk products are recalled, the CFIA will notify the public through updated Food Recall Warnings. 

The CFIA is verifying that the industry is removing the recalled product from the marketplace. 

In the UK, Tesco has issued a recall of 80G packets of its own-brand spicy chorizo slices.

Food standards officials reported a detection of Listeria monocytogenes inside some packs of 16.

Packets with the best before end date of 19/12/20 should return the product immediately.

‘My five-year-old son died with E. coli after eating infected meat at school. He would have been 21 this year’

I’m sorry I missed this story in Wales Online from Sept. 13, 2020, as I was doing my own recovering.

Cathy Owen writes that Sharon Jeffreys dreads this time of year.

As children return for the start of the school year, she relives what happened to her family 15 years ago over and over, and over again.

It was only two weeks into the start of the school year at Deri Primary in 2005 when her eldest son Chandler came home with stomach pains and the beginning of a nightmare for the young family.

Chandler had contracted E. coli O157 after eating contaminated food that had been supplied to the school by a local butcher.

But worse was to come after his younger brother Mason also became ill with the food poisoning.

The five-year-old had only just switched from taking packed lunches to having school dinners because he was so fond of chips and sausages.

“It was the worse decision I ever made,” says Sharon. “Mason loved his food. He was taking sausages and chips off the plates of children, so we decided to switch him to school dinners and he was really happy.”

Mason and eight-year-old Chandler were one of more than 150 schoolchildren and adults struck down in the south Wales outbreak. Thirty-one people were admitted to hospital, but Mason was the only one to die.

He had suffered high temperatures, stomach pains and had hallucinations and was admitted to Bristol children’s hospital, but died of kidney failure.

Today, his mum Sharon remembers every moment of those terrifying days.

“It will be 15 years on September 13 when Chandler first became ill,” she remembers. “When Mason started to be sick I tried to do everything I possibly could. Mason’s condition deteriorated considerably and he started to hallucinate saying he could see slugs and frogs.

“He went a yellow colour and started sweating like he’d just come out of a shower. Mason died two weeks later in unbearable pain.”

Reflecting on the amount of time that has passed, Sharon says: “I just can’t believe how long it has been, it feels like such a long time since I last saw him.

“It is still very difficult to think about, but at this time of year I always relive that awful time. I always dread September coming along because it takes me back there.

“I will never get over it, but I have had to learn how to live with it, but little things can take me back there. Like I see a blade of grass, or hear something and it takes me back with a jolt.

“After Mason died it was really busy, there was the inquest and then the legal proceedings, so I didn’t actually face what had happened for a long time, and then it went quiet and it was like trying to scramble out of a big black hole.

“Mason would have been 21 in December. He should have been looking forward to celebrating that milestone in his life.

“Chandler is 23 now, but he is not the same person. He and Mason were so close, it has left a big hole in his life.

“My younger son is 16 and it has affected his life too. He can’t remember Mason because he wasn’t even one at the time, and that upsets him.”

Fifteen years on and Sharon and her family still feel that they have been denied justice.

Bridgend butcher William Tudor, 56, was jailed for breaching hygiene laws by allowing raw meat to come into contact with cooked ham and turkey.

public inquest in 2010 heard how Tudor put cash before hygiene for years and may have caused other food poisoning outbreaks.

Butcher William Tudor was jailed for 12 months

It was claimed he bought cheap frozen New Zealand mutton and passed it off as prime Welsh lamb and staff who brought him rotten meat unfit for consumption were told to “mince it up” and use it in faggots.

Sharon went  on to immerse herself in other food safety issues, including a push to make restaurant inspection disclosure – scores on doors – mandatory in Wales. Voluntary disclosure misses the point and if large cities like Toronto, New York and Los Angeles can figure out how to make it mandatory so can Wales.

Disclosure became mandatory in Wales and Northern Ireland in Nov. 2013, thanks in part – or largely — to Sharon’s efforts.

The rest of the UK, and Australia, wallows in a voluntary system: lousy score, don’t post it.

“The food hygiene rating scheme is very important and it is good that more people are more aware after what happened,” says Sharon.

“It is a bit concerning to hear that Covid might have an impact on some council environmental services, but we need to make sure there are more officers carrying out inspections and making sure that best practice is being followed.

“I have heard back from people that they have used our story as part of their training for cooks and kitchen staff.

“Before Mason’s death I had never really heard of E. coli. I had heard the name, but didn’t know much about it.

“Now, I think people are definitely more aware. That is good to know, good to know that people haven’t forgotten, even after all these years.”

Whistling in the dark: Media and science citations

I was talking to an emergency room doc for a few hours a couple of  Saturdays ago – about two of those hours involved him stitching up my sliced ear from another fall – and he told me his hobbies were macro may and needlework.

I told him it’s good to be good at what you do.

The association between mention of scientific research in popular media (e.g., the mainstream media or social media platforms) and scientific impact (e.g., citations) has yet to be fully explored. The purpose of this study was to clarify this relationship, while accounting for some other factors that likely influence scientific impact (e.g., the reputations of the scientists conducting the research and academic journal in which the research was published). To accomplish this purpose, approximately 800 peer-reviewed articles describing original research were evaluated for scientific impact, popular media attention, and reputations of the scientists/authors and publication venue. A structural equation model was produced describing the relationship between non-scientific impact (popular media) and scientific impact (citations), while accounting for author/scientist and journal reputation.

The resulting model revealed a strong association between the amount of popular media attention given to a scientific research project and corresponding publication and the number of times that publication is cited in peer-reviewed scientific literature. These results indicate that (1) peer-reviewed scientific publications receiving more attention in non-scientific media are more likely to be cited than scientific publications receiving less popular media attention, and (2) the non-scientific media is associated with the scientific agenda.

These results may inform scientists who increasingly use popular media to inform the general public and scientists concerning their scientific work. These results might also inform administrators of higher education and research funding mechanisms, who base decisions partly on scientific impact.

A case study exploring associations between popular media attention of scientific research and scientific citations, 01 July 2020

PLOS One

Sage Anderson, Aubrey R. Odom, Hunter M. Gray, Jordan B. Jones, William F. Christensen, Todd Hollingshead, Joseph G. Hadfield, Alyssa Evans-Pickett, Megan Frost, Christopher Wilson, Lance E. Davidson, Matthew K. Seeley

https://doi.org/10.1371/journal.pone.0234912

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234912

US to miss foodborne disease reduction goals

I’ve said this for years.

Need new messages, new strategy.

The American Veterinary Medical Association newsletter reports numbers of confirmed illnesses in humans resulting from common foodborne pathogens have risen or remained level for several years, putting the U.S. on track to miss 2020 reduction targets.

Better tests and more testing may help explain why the numbers have not fallen, but to reach its goals, the U.S. needs more work to reduce food contamination, according to authors of an article published this spring in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Among the findings, the authors wrote that preliminary 2019 data show confirmed illness counts for Listeria, Salmonella, and Shigella have remained unchanged over several years, and confirmed illness counts for the other five pathogens tracked by the CDC’s Foodborne Diseases Active Surveillance Network increased.
“FoodNet surveillance data indicate that progress in controlling major foodborne pathogens in the United States has stalled,” the article states. “To better protect the public and achieve forthcoming Healthy People 2030 foodborne disease reduction goals, more widespread implementation of known prevention measures and new strategies that target particular pathogens and serotypes are needed.”

I saw the Hip at a bar in Waterloo, Ontario, Canada on this tour with my 6-month pregnant ex-wife.

Great show.

Bureaucratic bullshit: Communication inside risk assessment and risk management (COMRISK): Final report, 08 July 2020

For those who care about how risk information is provided – I despise the words educate and communicate – welcome to the world of the European Food Safety Authority.

How hard is it to tell a story, one that is backed with credible information?

That’s how people learn.

A key feature of risk analysis is that risk assessment and risk management should be functionally separated (bullshit). However, the usefulness of a risk assessment may be limited if the output is not designed to help with risk management decisions. The COMRISK project investigated the communication between risk assessors and risk managers. The overall goal of the project was to identify current practices and challenges in communication between risk assessors and risk managers during the risk analysis process, and thus increase and improve the understanding and the quality of the communication between them.

Specific actions to achieve this aim included reviewing of historical food safety cases, analysing risk assessment requests, identifying communication guiding documents, including legislation and agreements, conducting semi‐structured interviews with risk assessors and risk managers, and identifying tools for facilitating the communication between risk assessors and risk managers.

It was concluded that the usefulness of a risk assessment is strongly dependent on well‐defined and mutually recognised risk questions and that scarce or poor communication between risk assessors and risk managers is one of the major reasons when an output from risk assessment fails to support risk management. The communication between risk assessors and risk managers preceding the onset of the risk assessment, when the risk assessment requests with its risk questions are defined, is especially identified as one of the critical points to ensure a risk assessment that is fit for purpose. However, difficulties in understanding were also reported for the communication between risk assessors and risk managers during and after the risk assessment. Lack of communication is seldom a result of formal constraints or agreements nor can it be explained by a wish of the risk assessors or risk managers. Instead, perceived constraints or traditions appear to be possible underlying factors leading to scarce or poor communication between risk assessors and risk managers. It is essential that both risk assessors and risk managers acknowledge the crucial importance of communication between them while at the same time respect their different roles in a risk analysis.

According to respondents, the best solution to facilitate the framing of the risk assessment questions is an open dialogue between risk assessors and risk managers to agree on the goal of the assessment and to build trust. Further, the interview results indicate that a formal systematic process may facilitate communication during the risk analysis. Where there is uncertainty, e.g due to data gaps or issues related to the methodology and models, it should be acknowledged and described properly by risk assessors to risk managers. Training of risk assessors and risk managers may improve the possibility of a timely and fit‐for‐purpose output. Such a training should give a deeper insight in the risk management process, give a better understanding of the risk managers role, and especially raise the awareness of the importance of the communication between risk assessors and risk managers.

To improve the risk analysis process, it is also important that the risk assessor gets feedback regarding how risk assessments have met the needs of the risk managers. The present study also found that aspects of risk communication studied in this project are not extensively discussed in the guidance documents for risk analysis. More research is needed to identify the barriers for a fit for purpose communication.