It’s already started.
Last week, I ran into a neighbor in the supermarket, and knowing the work I do, her abrupt greeting was, “So now they’re gonna make a big deal of every new thing coming down the pike. I’m not gonna worry about sick birds right now.”
Also, last week (Jan 2, 2025), a headline from WFMZ TV in Lehigh Valley, PA, read, 'Birds falling from the sky': Nonprofit confirms at least 35 snow geese tested positive for bird flu". Echoing a headline in Dec. on KNBC News in Kansas City.
Major news outlets (NYTimes, CNN, NBC, Newsweek) voicing concern, “Key warning signs about bird flu are all going in the wrong direction: This year has been marked by concerning developments in the virus’ spread, including widespread detections in wastewater and mutations observed in the virus .” (Dec 22, 2024)
And not surprisingly, testaments to public confusion, anxiety, and skepticism appear on social media daily: Do I still feed my cat frozen raw chicken? Do I take in my bird feeders? Maybe this was timed to coincide with the start of a new administration? STOP SPRAYING US WITH AEROSOLIZED "PANDEMICS"! "Pandemics" are caused by aerosolized bioweapons, including H5N1.
Referring to the animal-to-human transmission in Louisiana, the CDC posted the following:
(CDC Dec 18, 2024)
"Partial viral genome data of the H5N1 avian influenza virus that infected the patient in Louisiana indicates that the virus belongs to the D1.1 genotype related to other D1.1 viruses recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington state. This H5N1 bird flu genotype is different than the B3.13 genotype detected in dairy cows, sporadic human cases in multiple states, and some poultry outbreaks in the United States. Additional genomic sequencing and efforts to isolate virus from clinical specimens from the patient in Louisiana are underway at CDC".
In another posting CDC proclaims that “ a sporadic case of severe H5N1 bird flu illness in a person is not unexpected.” They reflect that in other countries, this has been happening in recent years. “No person-to-person spread of H5 bird flu has been detected. This case does not change CDC's overall assessment of the immediate risk to the public's health from H5N1 bird flu, which remains low.” (my emphasis)
“No story here, folks. Pay no attention to the man behind the curtain.” foreclosing on any questions.I, for one, am experiencing an unnerving sense of déjà vu.
Looking at how public health experts are talking about bird flu now, I am in disbelief that they seem to be repeating some of the fundamental mistakes made during the COVID pandemic. Basically, they are using communication strategies and techniques that rely on a combination of sophisticated science jargon overlayed by the absolutist tone of the elite.
How could the failed communication strategies employed during COVID-19 be pulled out and used again?
Especially because much research and writing has analyzed and critiqued all key aspects of the COVID response. Regarding public health communication, my field, critiques include analysis of how experts were communicating about COVID from the very start 2020. We’ve analyzed and interrogated how effective the timing and the content of public-facing health information from scientists, experts, the media, and social media were. How linguistically complicated were the messages? What type of science literacy did a person need to understand the avalanche of messages about “novel” viruses, “spike proteins,” “community spread,” “flattening the curve,” and mRNA? What other factors shaped the public’s attitudes and behaviors? Importantly, with future pandemics and complex emergencies in mind, has been much conversation about what needs to change to prevent some of the colossal failures that fostered the mass public confusion, conjecture, disinformation, pseudoscience, and conspiracy theories that predictably fill in gaps when expert communication fails.
I hold unbounded respect for scientists like Dr. Anthony Fauci and the thousands of unnamed microbe hunters who contribute to this country's science greatness. Yet, the challenges in public health communication extend beyond these individuals. They stem from the limited expertise of those crafting public-facing messages, the agendas of most print and broadcast media, and the democratized but flawed information landscape of social media. Without a serious reimagining of how experts convey health and safety post-COVID, the cracks in the social contract between public health and the public will only deepen. This will come at great cost. The long-standing and pernicious economic and social inequities in this country, so evident during COVID-19, will worsen with enormous consequences for personal and community health, policy, politics, economics, and civil society.
For those of us who study public health communication, from the very start in Feb 2020, we found that much of the COVID information and messaging from experts ricocheted from scientifically complex language and concepts for the small minority of the public who are science literate to remedial, science-lite for the rest.
I’ll use two brief examples and then get back to bird flu.
I believe the following is the first information you would have encountered on the CDC website regarding Coronavirus (Feb 13, 2020).
Novel Coronavirus (2019-nCoV) is a virus (more specifically, a coronavirus) identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China. Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, indicating person-to-person spread is occurring. At this time, it’s unclear how easily or sustainably this virus is spreading between people. (A link to a long-ago archived page on the novel Coronavirus, Wuhan, China).
At about the same time in 2020, Dr. Sanjay Gupta was interviewing the then Director of the CDC, Dr. Robert Redfield.
“The containment phase is really to give us more time. This virus will become a community virus at some point in time, this year or next year,” “We don’t have any evidence that this coronavirus is really embedded in the community at this time, but with that said, we want to intensify our surveillance so that we’re basing those conclusions based on data.”
You might recall the almost daily White House briefings broadcast. Here, Dr. Deborah Birx, one of the White House's chief coronavirus response coordinators at the time, in science-speak states, “The antibody piece is critical, as you described, because at this time, we can't - if we have - let's say asymptomatic status is inversely - symptomatic status is inversely related to age, and so the younger you are, the more likely you are to be asymptomatic: We have to know that because we have to know how many people have actually become infected.”
This kind of biology-thick complexity was echoed by much of the media.
Example: Coronavirus variants: Here’s what we know” (11/29/21), CNN
“…genetic sequencing showed it carried a large number of troubling mutations on the spike protein -- the knoblike structure on the surface of the virus that it uses to grapple onto the cells it infects. Some of those mutations were already recognized from other variants and were known to make them more dangerous, including one called E484K that can make the virus less recognizable to some antibodies -- immune system proteins that are a frontline defense against infection and that form the basis of monoclonal antibody treatments.”
In sum, the vast majority of the COVID health communication for the public came down to - either you could decode the scattergrams on the front page of the NYT reporting where Covid was surging in 2021, or you were left with elementary school-like posters telling you to “sneeze into your sleeve and wash your hands often.”
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In my opinion and experience, the most fatal flaw in COVID communication was the failure on the part of experts and their proxies to make skillful and sustained efforts to explain the “why” of information. Why is it important that COVID is a “novel” virus? Do antibiotics work with a virus? What’s the difference between a virus and an antibiotic? What does it mean that viruses mutate? Why are expert recommendations changing?
Exceptions surely existed. For example, Chris Hayes, and MSNBC news anchor,
“Epidemiologists are continuing to track the spread of Coronavirus. We now have the first confirmed cases of the virus in places like Brazil, Norway, Greece, Pakistan, and Georgia. Now, in many of these cases, we can identify how a person got the virus, what their source of exposure was. The other way to think about this is something called Community spread. Now, that is when cases start appearing without a known source of exposure…. So that means people are showing up with the virus, and it is not clear how they got it." (followed up with remarks by, another familiar expert scene throughout the pandemic, Doctor Peter Hotez, the dean for the National School of Tropical Medicine at the Baylor College of Medicine).
Just one simple, human example showing an appreciation of what people want and need to understand – making it possible for more people to be in the room where it happens, to know how the sausage is made…
Public understanding of health and science has been extensively studied. Roughly 20% of people have sophisticated science and health understanding. At least 50% of adults in the US read at 7th grade level or lower and struggle to read and understand health and science information ( NALS,1992; NAALS, 2003). Education strongly correlates with science literacy—71% of those with postgraduate degrees demonstrate high science knowledge, compared to less than 20% of high school graduates. Fundamental and harmful misconceptions persist, with nearly half of adults believing antibiotics kill viruses and bacteria. Only a quarter can describe aspects of a scientific study, and 90% lack a clear understanding of clinical trials. Trust in science and media proxies has declined sharply, further eroding confidence in accurate storytelling (NSF, PEW). So “mutations,” “spike proteins,” and “monoclonal antibodies” beg explanation.
That Déjà Vu Feeling of Mine
From the earliest reports when bird flu sickened a dairy farm worker in the winter of 2024, I kept expecting that public health information about this possible threat to the larger public would be smarter, more strategic, and more trustworthy than what we saw during the COVID-19 pandemic. True, each area of expertise has a specialized language we think in and use with colleagues. But the post-mortem on COVID communication surely would have resulted in public health experts being more linguistically flexible. Specifically, more proficient at a fundamental human language skill – code-switching – the ability and necessity to talk to one person differently than how you would talk to another person. Children learn to code-switch at around 3 years old.
Good communication is dialogic - it anticipates reader/listener questions and addresses them with respect. I had every reason to expect that public health experts wouldn’t continue to use complex scientific evidence as a crutch but would rather employ it as an opportunity to translate key aspects of the evidence, slowly building a foundation of understanding among the public. This strategy is shown to reduce the amount of alternate versions of the truth and pseudo-science. Officials would be very mindful of the residual trauma of living through COVID and that would help them anticipate some of the ways, people would be responding to Bird Flu or any other possible new epidemic.
We’d be so much better off if the dedicated, extremely knowledgeable scientists and public health experts could re-imagine what integrity is - abandon their confining ideological high-ground, leave their comfort zone, and commit to working multi-disciplinarily to explain and educate the public, allowing them, if even just a bit, to be “in the room where it happened.”
But, because I’m a sociolinguist who has studied and taught public understanding of health and science for four decades and spent untold light years analyzing public health messages, I’m not inclined to magical thinking. The reality is that health experts know and trust “the science” even when the path is pothole-filled. Their proxies in the media and social media choose to transmit this without adequate translation. The public understands far less of the sophisticated science and brings the accumulation of decades of inaccessible messages, conflicting guidance, contingent truth and social disparities that cost people their health and lives.
If you haven’t been closely following and analyzing the bird flu messaging, here are some specimens in the unfolding communication hit parade that are dismaying. You will see the unnerving similarities to the COVID-speak I mentioned earlier.
My idiosyncratic timeline
In March 2024, a dairy farm worker in Texas was found to be sick with bird flu. About that time, I asked ChatGPT if cattle can get bird flu, and the answer was confident."Cattle are not typically susceptible to bird flu (avian influenza) because the virus primarily affects birds. However, it is possible for other animals, such as pigs, to become infected with certain strains of avian influenza. In rare cases, these animals can act as intermediate hosts and potentially transmit the virus to humans. Overall, the risk of cattle contracting bird flu is very low. "
By late summer, we saw repeated warnings about raw milk by the CDC, FDA, and numerous prestigious health entities. The FDA formed the Task Force Alectryon. (using the classical Greek word for “rooster” – talk about elite).
By December 2024, H5N1 bird flu had been confirmed in hundreds of dairy cattle in 16 states: More than 60 people were infected, mainly by cows or poultry. Then there was the person in Louisiana.
Currently high-profile news outlets are warning that human cases could skyrocket if the virus evolves to spread efficiently from person to person. In a two-part series on MSN titled “How America Lost Control of Bird Flu, Setting the Stage for Another Pandemic,” reporter Amy Maxmen writes, “Just a few mutations could allow the bird flu to spread between people. Because viruses mutate within human and animal bodies, each infection is like a pull of a slot machine lever.”
But CDC chooses to post this explanation (CDC Dec 18, 2024). (I feel it should come with a label - “only elites need read this.”
"Partial viral genome data of the H5N1 avian influenza virus that infected the patient in Louisiana indicates that the virus belongs to the D1.1 genotype related to other D1.1 viruses recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington state. This H5N1 bird flu genotype is different than the B3.13 genotype detected in dairy cows, sporadic human cases in multiple states, and some poultry outbreaks in the United States. Additional genomic sequencing and efforts to isolate virus from clinical specimens from the patient in Louisiana are underway at CDC."
This past week, the Biden administration doubled the funds the government is committing, $306 million, to prepare for a possible bird flu pandemic. If we are indeed facing a bird flu pandemic and public health officials persist in business as usual, the price we pay may be enormous. USA Today recently made the point that over the past 30 years, about 450 people diagnosed with bird flu around the world have died. Even if the case fatality rate is much lower for this strain of the bird flu, COVID showed how devastating a 1% death rate can be when a virus spreads easily.
In a cautionary and prescient book, physician Reid Wilson, Epidemic: Ebola and the Global Scramble to Prevent the Next Killer Outbreak (2020), reflected on what occurred during the Ebola outbreak and how and how it must inform preparedness and response in future complex health emergencies. He describes how people in West Africa changed their burial habits during the Ebola outbreak. Liberians began cremating their dead, changing a thousands-year-old cultural burial tradition. They did this to protect themselves and their community.
In an interview by NPR (4/9/20), he reflects, "People are intelligent. And if you give them the proper information on how to protect themselves, they will go as far as to change the practices that their culture has used for of a thousand years in order to protect themselves in the short run from a virus. That tells me we have to put a premium on disseminating intelligent, timely and correct information. Giving the people the tools to protect themselves would save a lot of lives."
In conclusion, the social contract between public health experts, their proxies, and the public must be reimagined, re-tooled, and executed now. To achieve the shared goal of healthier, safer people, who rely on scientists and public health experts, we need to rebuild the fundamental relationships between science, the field of public health, and the public.
• Those who communicate science, health, and safety to the public must commit to interrogating and re-conceiving what their role in educating the public is. They should not do this in isolation but involve social scientists and citizens in the process. In multiple ways, show that they are working to regain the public’s trust.
• Good communication is dialogic - it anticipates reader / listen questions and addresses them with respect. They need to become informed about the over 30+ years of research into identifying science and health literacy of the public and see it as part of their mission to advance the public’s engagement and understanding of science and health. Public health experts need to determine how they will re-stock their communication toolboxes.
• They must put the “why” back in all substantive reports and guidance and do it effectively. For example: This is what we’re watching (monitoring) now. If we see this, then it means this. This is what we would do if we see this... All the while communicating that science knowledge (and guidance) changes. Scientists expect this. The public needs to begin to understand why.
• Develop ways to build a knowledge base and shared vocabulary that can be used by media and other proxies.
This is too long a missive. My apologies, dear reader.
I did not have the time to write a shorter one.
Pascal, 17th century. (adopted by Mark Twain)
