Fraught Language on Controlling Virus Carries Risk for Compliance

(CN) — Stay at home. Safer at home. Shelter in place. On pause. Lockdown. Shutdown.

The novel coronavirus pandemic has forced a recalibration of familiar language and raised questions of how leaders should communicate with their constituents in a public health crisis.

As the Covid-19 wave hits the United States, state and municipal leaders across the country have issued their constituents catchy recommendations, if not full-on orders, with the same basic message: Stay home as much as possible to slow the spread of the virus.

“There’s no consensus on things,” said Wendy Mariner, a professor at Boston University with degrees in public health and law, on the phrasing used by politicians to keep people at home during the outbreak.

“There’s no legal term, you know,” Mariner continued in a phone interview. “Physical distancing is not a legal term. It’s just descriptive of what they want people to do.”

In terms of descriptiveness, she added, “physical distancing” gets to the point a bit better than “social distancing.”

As the world grapples with a pandemic unprecedented in most people’s lifetimes, the inclination is repurpose language they understand for concepts that are entirely new.

Mariner noted, for example, that the term “shelter in place” was used after the Sept. 11, 2001, and Boston Marathon terrorist attacks when leaders were concerned other attacks might be coming and had not tracked down the perpetrators. It is also used in active-shooter situations.

New York City Mayor Bill de Blasio, left, discusses the arrival of a shipment of 400 ventilators with Dr. Steven Pulitzer, the chief medical officer of NYC Health and Hospitals, at the city’s Emergency Management Warehouse on Tuesday. (AP Photo/Mark Lennihan)

San Francisco Mayor London Breed was among those who leaned on the terminology earlier this month as she ordered 6.7 million people in six counties to “shelter in place” to slow the spread of Covid-19.

Later Breed shifted her language, calling it a “public health order” that required San Franciscans “to remain at home with exceptions only for essential outings.”

Mariner said that and other phrases, like “lockdown” and “shutdown,” are “generic terms that can describe a general set of practices.” But exactly what those practices include is up to the states and may not be encapsulated in a pithy declaration.

Experts agree the need for clear, consistent messaging is paramount.

“It is critically important in a pandemic, as in every public health emergency, to have clear and consistent messages repeated through multiple channels from credible sources,” said Jay Bernhardt, who was director of the National Center for Health Marketing at the Centers for Disease Control and Prevention from 2005-10, a tenure during which the H1N1 pandemic caused 12,469 deaths in the United States.

Now the dean of the Moody College of Communication at The University of Texas at Austin, Bernhardt recommended that all government leaders, regardless of their office, “listen to the CDC subject matter experts and follow their guidance without variation.”

“They are the best in the world at what they do and it is extremely dangerous, for all of us, for government officials to ignore their advice,” Bernhardt said in an email.

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Confusion Abounds

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None of the rules imposed so far in the United States are so strict as to literally force people to remain in their homes. In addition to those whose jobs are deemed “essential” — health care workers or those who work in food distribution or transportation, to name a few — Americans are free to carry out relatively solitary activities such as outdoor exercise, buying food and dog-walking.

A woman wears a mask and gloves while carrying toilet paper across the street in San Francisco on March 17, 2020.  (AP Photo/Jeff Chiu)

But the terms used by local leaders to describe these edicts, many of which are essentially the same, vary widely and have caused some confusion.

“What we’re asking everyone to do is remain at home for all but the most essential outings for your safety and the safety of those around you,” San Francisco’s Breed told the public last week. “This is not a time to panic. We are not closing grocery stores.”

In Southern California, the city and county of Los Angeles volleyed back and forth between two catchphrases: “Safe at Home” and “Safer at Home.”

“Nobody is locked down,” Los Angeles Mayor Eric Garcetti said at a press conference last week. “This is stay at home, because you’re safer at home.”

On the opposite coast, in the hardest-hit area of the nation, New York City Mayor Bill de Blasio called for a similar order while recognizing that any such demand had to come from the state. Governor Andrew Cuomo for days resisted giving the order, explaining that he didn’t want to panic people by calling it “shelter in place.”

When Cuomo did issue an order for all New Yorkers to stay at home except when performing essential work or tasks, he coined his own phrasing, calling it “New York on PAUSE: Policies that Assure Uniform Safety for Everyone.”

The phrase “lockdown” has brought consternation from some community leaders. Taking to Twitter on March 20, Houston Mayor Sylvester Turner swatted down social media rumors that government officials confirmed there would be a “city lockdown” that weekend.

“All of this is false,” he wrote. “I am asking HPD and Harris County DAs Office to investigate for possible prosecution.”

Just days later, however, the city put out a “Stay Home, Work Safe” order that allows people to leave their homes only for essential work, necessary supplies or socially distanced exercise.

According to local news source KHOU, Harris County Judge Lina Hidalgo explained that, to Houstonians, “shelter in place” means there’s a hurricane or plant explosion.

In Pennsylvania, instead of designating essential and nonessential services and jobs, Governor Tom Wolf uses the more specific phrase “life-sustaining.”

“On March 19, Governor Wolf ordered the closure of the physical locations of businesses that are not critical to sustaining life in a pandemic,” his website says, sharing a list of businesses that could and could not stay open.

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Clarity and Empathy

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Mariner, at Boston University, emphasized that if leaders want people to comply with their orders to stay home, they also have to back up their language with actions to support those out of work or struggling to pay rent and get food. Without corresponding government support, language rings hollow.

“If you want people to voluntarily comply, you have to make it possible for them to comply,” she said.

Members of a Chinese honor guard wear face masks as they march in formation near the Great Hall of the People on Tiananmen Square in Beijing on Feb. 4, 2020. (AP Photo/Mark Schiefelbein, File)

Susmita Pati, chief medical program adviser at the Alan Alda Center for Communicating Science, said lessons from doctors communicating with patients can also apply to leaders talking to their communities about a public health crisis.

“Active listening, empathy and clarity” are important, as is frequent communication, said Pati, who has degrees in medicine and in public health.

“And you do need to know your audience,” Pati added in a phone interview, “so what works with one audience may not work well with a different audience.”

For weeks that adage has been put to the test at the daily briefings of the White House coronavirus task force. Though President Donald Trump insists his branding of Covid-19 as “the Chinese virus” is descriptively accurate since the disease originated there, critics say such language is stigmatizing for Asian-Americans.

Some Republicans have followed the president’s lead, though CDC director Robert Redfield condemned the language, calling it “absolutely wrong and inappropriate.”

The pithy labeling of viruses by region is not unprecedented.

What we know today as Spanish flu got its name because reporting on the pandemic in the Allied and Central powers nations was limited during World War I. The influenza did not originate in Spain, but Spanish news sources free of the wartime censorship quickly became the public’s first source on the 1918 pandemic .

The Spanish, for their part, called it the French flu.

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Courthouse News reporters Maria Dinzeo, Nathan Solis and James Palmer contributed reporting. 

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