Guidelines for communicating

about coronavirus disease 2019

A guide for leaders

A guide for leaders

Washington, DC
February 2020
Introduction
The outbreak of coronavirus 2019 disease (COVID-19) in Hubei, China, and the introduction of
the virus into the Region of the Americas highlight the urgent need for clear, concise and con-
sistent communication.

Risk communication encompasses all the basics of health communication but differs in the
need for speed and reliance on trust. At times of crisis, leaders are called on to provide a quick,
sensitive and trustworthy response. The public wants to know what you know, what you are
doing about it and what they can or should do.

COVID-19, a disease similar to other coronavirus infections like MERS and SARS and to influen-
za, is causing global concern and has been declared a public health emergency of international
concern by the Director-General of the World Health Organization (WHO). There are many un-
knowns, and this leads to fear, mostly about what could happen. This makes effective risk com-
munication a strategic resource that can contribute to the success of the public health response
in countries of the Americas.

In an ideal situation, there would be time to plan, setting up a communication strategy and an
action guide. But times such as these require immediate skills to communicate with the public.
Risk communication is an integral component of public health risk management and a core
capacity under the International Health Regulations. What follows are some suggestions, prin-
ciples and templates to guide you through.

Protecting health and averting preventable deaths is the mission that we all share. We must en-
sure that public health communication is timely, transparent, based on correct information and
science, but also honest and frank, showing empathy and understanding about the public’s con-
cerns. This type of communication will be essential to ensure that people understand the risks
of COVID-19 and follow authorities’ recommendations to protect their health and the health of
their loved ones.
 I. Key Concepts of
Risk Communication

TRUST it. That shows your human side and creates trust
because you have not tried to hide information.
Trust is the key principle in risk communication.
Without this trust, the public will not believe or act ANNOUNCING EARLY
on information provided by the health minister or
other officials. Ways to maintain trust include: Announcing early shows leadership, leads to trust,
reduces the rumors and can save lives. The so-called
• Don’t over-reassure. You can’t say everything “first announcement” should say what is known,
will be OK if, in fact, you don’t know that. Say what it means, what is being done (e.g., “Today the
what you know and what the government is first laboratory-confirmed case of COVID-19 was
doing about it. Tell the public what they can do diagnosed. We are conducting contact tracing.
(e.g., Wash your hands, sneeze or cough into the This in an imported case, and the patient is now in
inside of your elbow) isolation to prevent disease spread…”)
• Don’t minimize people’s concern. People are
fearful. That’s a healthy reaction. • Delayed announcements create speculation,
• COVID-19 is a scary disease. which leads people to wonder how really bad
• Don’t suggest that the public shouldn’t worry. the situation must be.
• Acknowledge the uncertainty. • Avoid stigmatization. Many people of Chinese
• Don’t say that the government has the situation or Asian origin are suffering unwarranted dis-
under control; instead say what the govern- crimination. As leaders, you need to make sure
ment is doing. stigmatization is minimized, or it can lead pa-
• Express empathy, sometimes referred to as tients to deny they have the disease or to hide
speaking from the heart. For example, don’t say, and fail to seek the care they need.
“I know how you feel.” Instead say, “It’s natural • In this ever-connected world we cannot hide
to feel anxiety. This is a worrisome situation for outbreaks.
all of us.” • If you don’t know an answer to a question, say
• Be the first out with the information. Tell the pub- so. And then get the response later.
lic that there is a case or suspected case of COVID- • Fear and concern are initial reactions to crises.
19 as soon as you know it. Don’t wait to release What’s often described as panic is an adjustment
what already has become rumor. reaction to uncertainty and unknown risk. Peo-
• Acknowledge mistakes. If there is an error, correct ple rarely panic although officials think they do.

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• Don’t use technical jargon when communicat- INVOLVE THE COMMUNITY
ing with the public or the news media.
• Give people steps to protect their own health • The public is entitled to information that affects
and the health of others. their health and the health of their families and
• Set expectations, e.g., “We expect things to get therefore should be involved in the process of mes-
worse before they get better.” sage creation based on their reactions and feedback.
• Acknowledge that the situation will change • Public perception of risk often does not match
and explain that you will provide updates when the science-based reality. If the public does not
there is more information. (e.g., “This is an perceive a risk, they won’t respond adequately
evolving situation and we will update you later to prevent it.
with more details.”) • Gauging public perceptions can be done
through polling, hotlines or social media.
TRANSPARENCY LEADS TO TRUST • Find out the beliefs of the community and in-
clude them in your messages and actions.
There are limits. but the goal is to aim for total candor.
• Be transparent. Ensure that the criteria for tak- PLANNING
ing different actions are clear and available (e.g.,
“We are vaccinating this group first because Risk communication works best when it is part of
they are at greater risk” or “they are healthcare a larger plan or strategy outlined long before it is
workers who are taking care of others.”) needed. That may not be the case with COVID-19,
• Provide timely and transparent information so what follows are checklists and templates.
that is technically correct and based on science.
• Explain the decision-making process (e.g. “We
felt that by naming the individual we would
stigmatize his family.”)
• Other limits to transparency include — but are
not limited to — national security.
• Detail what still needs to be learned and where
the gaps lie.
• Speak about the risks, benefits and challenges.
• When guidance changes explain the reasons why.

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 II. Overall
Communication
Goals for a COVID-19
Outbreak
• Immediately communicate accurate, timely in- • Respond rapidly to the specific concerns and in-
formation and address public health concerns formation needs of the public, healthcare work-
about the first laboratory-confirmed case of ers, and the public health community.
COVID-19.
• Employ a unified and consistent government ap-
• Instill and maintain public confidence in the proach to strategic and operational communication.
government’s public health system to effective-
ly respond to and manage the situation. • Stay connected with the local hospital and local
health departments, not just for the initial an-
• Keep the public fully informed — explain what nouncement but also in the days following. Keep
we know and what we don’t know — so that the messaging alignment between government , hospi-
public understands their personal level of risk tal, and local health authorities.
of COVID-19 infection and behaves accordingly.
• Proactively share public information about the
• Maintain credibility and public trust by provid- first case with local, national and international
ing accurate, science-based information but counterparts to maximize public awareness and
also recognizing the uncertainty with honesty, interagency consistency of COVID-19 messaging.
knowledge and commitment.
• Tell people what they can do to reduce their
• Avoid speculation and conjecture. Dispel ru- exposure to the virus and protect the health of
mors, misinformation, and misperceptions as their loved ones, according to their risk, level of
quickly as possible. concern, and the available recommendations
and options. This provides a sense of motiva-
• Protect the privacy of the patients and contacts tion and greater control.
to the extent possible.

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III. Key
Assumptions and
Considerations
• As more cases of COVID-19 develop internation- • There will be high demand for information
ally, it is possible that one or more cases will be from the public and from domestic and interna-
diagnosed in countries of Latin America and tional media.
the Caribbean.
• Social media will exponentially compound the
• The news media or social media may be the first pressure and demand for information as well
to unofficially announce or speculate that a sus- as greatly expand the potential for misinforma-
pected or confirmed case of COVID-19 has been tion and rumors to spread rapidly.
identified in your country. There may be several
suspected cases that turn out not to be COVID-19. • There will be incomplete information, misin-
formation, rumors, and misconceptions among
• There will be a delay between the reports of the the public. People may take actions based on
first suspected and confirmed case(s); the lon- this information.
ger this period of time, the greater the degree of
media and public speculation. • There could be delays in obtaining and releas-
ing verified information to the public; the lon-
• Travelers may not have had symptoms while ger the delay, the greater the degree of news
traveling but may have exhibited symptoms media and public speculation.
after being in another country for a while and
traversing through several places. Assessing • There will be immediate and ongoing demands
the traveler’s movements and potential con- for information and products from health au-
tacts with others will be necessary to anticipate thorities, partners, news media, policy makers,
public fear in the case that the person interacted the general public, and other audiences. This
with others (e.g., in businesses, schools). demand will place significant pressure on the
government to provide facts quickly.
• The time from positive confirmation of the first
case to public announcement should be very • Health guidance and recommendations may
short. change as we learn more about COVID-19. But
officials need to immediately inform the public
• The patient(s) in question will have been isolat- and other stakeholders of new recommenda-
ed, and active contact tracing will have begun/ tions as they are developed.
will begin immediately.

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COVID-19
Coronavirus Disease 2019
BE AWARE.
COVID-19 is a new respiratory illness that was first discovered in Wuhan, China. It is
transmitted from person to person.

common
symptoms
Runny nose cough Sore Throat

severe
cases
Symptoms* High fever Pneumonia severe respiratory disease

*Symptoms may appear 1 to 12 days following exposure to the virus

Who is most at risk of becoming seriously ill?

How is it transmitted?
• Through close contact with an infected person
• By an infected person coughing or sneezing
• By touching contaminated objects or surfaces and then touching your mouth, nose or eyes

Currently there is no vaccine or specific treatment. We can only treat the symptoms.
Serious cases may require oxygen and ventilatory support.

PREPARE. ACT.
Make sure you get your information from a Avoid close contact with people who
reliable source. have flu-like symptoms.

Wash your hands regularly with soap and water or Avoid touching your eyes, nose or mouth with
use an alcohol-based gel. unwashed hands.

Avoid sharing cups, plates or other personal items

Cover your mouth with the inside of your elbow when you
If you have traveled to areas where COVID-19 is
cough or sneeze or use a tissue and dispose of used tissue
circulating or have been in contact with someone
immediately and wash your hands.
who has it and you experience fever, cough or
difficulty breathing, seek medical attention
immediately. Do not self-medicate.

Note: Information may change when more is known about the disease. February 2020.

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IV. Messages

To avoid confusion about the initial appearance of cases, prevent disease spread and create trust in author-
ities’ response to the virus, messages should be timely, accurate, actionable, and relevant to the audience.
Messages should be updated as soon as new information is verified.

Specific questions about the first diagnosed case of COVID-19 that might come up are below. Health authori-
ties should consider beforehand how they will answer these questions if/when a first case is diagnosed.

1. Who is in charge and what are they doing to 8. Who will notify patients and families of
investigate and control the situation? possible exposures and risks? How?

2. What are health authorities doing to address 9. What is the hospital doing to prevent spread
this situation? Health departments? Hospital? within the hospital and to other patients?
Airline? Border protection?
10. What if COVID-19 spreads and causes an
3. Where and how did the patient get COVID-19? outbreak in (name of your country)?

4. Did the infected patient spread COVID-19 to 11. What should I do if I had close contact with
other people? How? the patient?

5. What are the risks to people who had close 12. Did (or is) the hospital follow(ing) infection
contact with the patient? control practices?

6. What are the risks to other passengers on the 13. Did (or is) the airline crew and border control
airplane (if patient arrived by plane)? officers follow(ing) the appropriate steps?

7. What are the risks to healthcare workers and 14. From what country did the patient come?
other patients in the hospital? What is the risk What steps did the country take, if any, to
to the community? prevent the first case from traveling?

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15. Was the infected patient isolated? 24. Was there adequate warning that this could
happen?
16. Are the patient’s contacts being isolated?
Why? 25. What is being done at the airports and other
points of entry to screen arriving travelers?
17. Are there likely to be more cases? What can be
done to prevent them? 26. Will borders be closed?

18. Is the virus circulating in (name of your 27. What are the symptoms of COVID-19? When
country)? should I see a doctor?

19. Are we prepared for an outbreak? 28. Are there antiviral treatments or other
treatments? Is there a vaccine? Will it be
20. Are hospitals prepared to respond? available for everyone?

21. Do hospital staff have enough personal 29. Should we ban incoming flights or travelers
protective equipment? from affected countries?

22. How can I protect myself and my family from 30. Should we be worried?
COVID-19?

23. Was the airplane quarantined?

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V. Draft Key
Points for First
Case of Imported
COVID-19
Examples of main key points: • The Ministry of Health is working closely with
other ministries to rapidly investigate this situ-
• The first diagnosed case of COVID-19 has been ation and to help prevent the spread of COVID-
reported in your country. 19. We are currently:
» Making sure the patient is receiving treat-
• The Ministry of Health knows that people are ment and is isolated
concerned. We understand these concerns and » Interviewing the patient and close contacts,
are taking this very seriously. We will share the such as family members, to obtain detailed
information we have now and additional infor- information on their travel history and ex-
mation as soon as we have it. posures
» Ensuring the hospital uses appropriate infec-
• Right now, we know that one person was con- tion control measures
firmed to have COVID-19 virus infection. » Identifying people who had close contact
» The patient developed COVID-19 symptoms with the patient and
and was hospitalized in [insert place] on [in- • interviewing them
sert date]. • monitoring them to see if they become ill
» The patient had recently traveled from [insert • collecting and testing specimens from
country] and became ill approximately [insert them, if needed
date relative to arrival in your country]. • requesting that they monitor their health
and seek care if they develop symptoms
• This situation is still evolving. [Names of minis- » Monitoring the health status of healthcare
tries] are investigating— workers who cared for the patient.
» How the patient became infected with
COVID-19 virus • Currently, there is no vaccine to protect against
» How many people had close contact with the COVID-19 infection. Standard treatment for
patient once symptoms developed and their COVID-19 is limited to treating the symptoms as
current health status they appear and supportive care.

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• The government has been preparing for an monia up to 14 days after traveling to any place
event like this as part of the International where the virus is circulating or if the patient
Health Regulations. We have been: may have had contact with an infected person.
» Enhancing surveillance and laboratory test- They should immediately implement appropri-
ing to detect cases ate infection control precautions and contact
» Providing recommendations for healthcare the Health Ministry if they have any questions.
infection control and other measures to pre-
vent disease spread • The Ministry of Health will post new informa-
» Working to inform healthcare providers tion about COVID-19 on the website: www.
about proper response protocols
» Disseminating up-to-date information to the • When health risks are uncertain, people need
general public, international travelers, and information about what is known and un-
public health partners known, and interim guidance to make deci-
sions to help protect their health and the health
• Travelers who have visited countries where of others.
the virus is currently circulating or who were
in contact with anyone with the virus should • Even one case of COVID-19 will generate imme-
monitor their health for symptoms such as diate, intense, and sustained demand for infor-
fever, cough or pneumonia for 14 days after re- mation from the public, healthcare providers,
turning home. If symptoms appear, they should policymakers, and the news media. It can also
take recommended measures to prevent spread create demand for healthcare services.
of the virus and seek medical care, informing
their healthcare provider of their travel history. • Timely and transparent dissemination of accu-
rate, science-based information can build pub-
• Healthcare workers should consider COVID-19 lic trust and confidence.
in patients who develop fever, cough or pneu-

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Guiding Risk
Communication
Principles

This guidance employs basic risk communica- Timely and transparent dissemination of accurate
tion principles in order to establish and main- and accessible science-based information about
tain public trust and manage the expectations of COVID-19 can build public trust and confidence,
citizens during an extremely adverse situation particularly when such communication efforts are
over an extended duration. guided by established principles of risk communi-
cation.
These principles are based on and complement
the WHO Outbreak Communication Guidelines Coordination of message development and release
([Link] of information among all responding organiza-
WHO_CDS_2005_28/en/). tions, international partners and health officials
is critical to help avoid confusion that can under-
When health risks are uncertain, as likely will be mine public trust, raise fear and anxiety, and im-
the case following the first case(s) of COVID-19 di- pede response measures.
agnosed in your country, people need information
about what is known and unknown about the virus, Information to public audiences should be acces-
their actual degree of risk, and interim guidance to sible, technically correct, honest, transparent, and
formulate decisions to help protect their health and sufficiently complete to encourage support of poli-
the health of others. To the extent possible, provid- cies and official actions without seeming patroniz-
ing this information in advance of the first diag- ing to the public.
nosed case will help mitigate initial concerns.
Information presented should minimize specula-
The first diagnosis of COVID-19 in your country tion and avoid overinterpretation of data as well
will likely generate immediate, intense, and sus- as overly confident assessments of public health
tained demand for information from the public, investigations and control measures.
healthcare providers, policymakers, and news
media. Healthcare workers and public health staff It will be important to make clear that our guid-
may need training in media relations and public ance and recommendations may change as we
health and risk communication. learn more about this new disease.

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