Media thrives on click bait—scary headlines to entice you to click and make advertisers happy. This week it is Eastern Equine Encephalitis (EEE); before it was “brain-eating amoeba,” or West Nile, or Zika.
Warning people about risks is well and good—as an infectious disease doc, I’m all about public health and preventing illness.
But we need to get a grip and put threats in a realistic perspective.
This week, a friend in Michigan asked for advice about EEE, after this headline appeared: “State health officials urge cancellation of outdoor events.”
Is that recommendation sound? As is nauseatingly typical these days, the advice is couched as “”out of an abundance of caution to protect the public health.”
Is cancelling outdoor activities really necessary? What are the alternatives?
These stories of specific threats may alert about a (usually rare) infection, but distract from the important picture. What we should be asking why are “rare” infections no longer so rare?
The range of ticks is expanding northward and westward from previous areas. Why? Because regions that were too cold to sustain populations of ticks are now warm and comfy. We are altering habitat, too, by expanding suburbia into the backyards of deer and mice. We plant colorful shrubs like Japanese barberry, that makes a welcoming home for the mice and ticks they nurture, rather than resistant native plants. Nurseries carry what’s popular and easy to grow, and damn the real cost.
Mosquito borne infections have gotten worse. Where do mosquitoes breed? Standing water. Why are there more areas of standing water? A warming climate, more hurricanes, and more flooding. Bonus points if you said, “growing poverty.” As professor Peter Hotez has repeatedly stressed, poor people are at greater risk of these infections. Many of their homes lack screens, let alone central air conditioning. Small pools of water might collect in trash or discarded containers, or simply from a poor infrastructure. For example, inadequate municipal trash pick up and drainage systems will provide mozzie breeding grounds
“Abundance of Caution” is risky behavior
One of the goals of public health and risk communication is to build trust, so people will listen and follow instructions in true emergencies. A prime example are the recent hurricanes and politicization of the NOAA (see “SharpieGate”), long a solid, trustworthy source of information that is as accurate as technically possible.
In a candid and open access journal article on risk communication for public health, Dr. Tara Kirk Sell of Johns Hopkins Center for Health Security notes that use of “abundance of caution” “and the activities that go along with it can undermine messages about risks being based in science and fact, and they could suggest to the public that they shouldn’t trust science and official recommendations.” This unscientific approach also led to economic losses for communities (Florida and Zika) and needless restrictions on civil liberties (Ebola and needless quarantines).
EEE, amoeba, Powassan virus are scary and newsworthy because they are rare. Instead, I would urge public health officials to attend more to the overall or total risk of diseases, both in deaths and DALYs (disability-adjusted life years).
There needs to be more focus on diseases that are far more common and debilitating, like Lyme. Again, the answer shouldn’t be “Don’t play outside.” We should focus on prevention.
Only seven human cases of EEE are usually reported each year, so the Michigan cases are an uptick.
But there are so many better things to lose sleep over than EEE.
Antibiotic resistant bacteria like CRE and MRSA, kill 23,000 people in the U.S. annually, and sicken 2 million.”
Drunk drivers cause one death every 50 minutes. There are often no serious consequences, as the offenders are “good boys” or pillars of the community.
At least 1,300 children are killed by guns each year. Suicide accounts for 38% of those deaths.
There were 22 school shootings Jan-July 2019 in US. Vox has a fine map:
Accidents are the leading cause of death for those aged 1–44. They caused 6% of deaths, or 169,936 deaths in 2017 alone.
Suicide is the second-leading cause of death among people aged 10-34 years.
Homicide is #3.
Still worried about that rare infection from a mosquito bite?
Use common sense and examine the evidence
Officials should use common sense in giving public health advice, and consider the consequences of their advice. What is the downside of cancelling outdoor activities? That increases social isolation. I suspect it increases depression and anger from being cooped up with “cabin fever.” Restrictions certainly will reduce physical activity and contribute to obesity. Is this really necessary?
What could public health officials recommend instead? Education about how to avoid insect bites—and especially about specific reasonable precautions to take. This includes the need for judicious use of insect repellents and posting easy-to-access information about which ones are safe and effective. There needs to be continuing education about how to clean up breeding sites. Similarly, they need to emphasize the need to do “whole-body tick checks” after being outdoors .
It’s critical that our government leaders, public health officials, and the media use appropriate risk communication, common sense, and bolster the public’s understanding of the science behind recommendations.