Editor’s note: This is the third in a three-part report on the challenges Missouri’s local public health departments are facing during the COVID-19 pandemic.
Drinking vodka isn’t a medically supported COVID-19 prevention tactic — but that doesn’t stop rumors that it is from circulating widely on Facebook and other social media platforms.
It’s the type of COVID-19 misinformation that Cooper County Public Health Administrator Melanie Hutton has gotten used to fighting during the pandemic.
"It’s a stumbling block for people to not take (COVID-19) seriously," she said. "The more they see it, the more it validates these crazy thoughts."
As new reported cases of COVID-19 continue to climb, local public health officials in Missouri find themselves working to explain changing scientific guidelines and combat toxic misinformation.
Part of the issue comes from a basic human tendency to seek out information one already agrees with, said Lynelle Phillips, assistant teaching professor in the University of Missouri’s public health department.
"People get misled by false information, and people hear what they want to hear," Phillips said. "That complicates our job, and it’s hard to convey bad news — and it’s very easy for people to disregard it and believe what they want to believe."
Larry Jones, director of the Missouri Center for Public Health Excellence, credits strong emotions for a willingness to believe questionable information.
"I think it comes from fear. I think it comes from anger," he said. "I think it comes from feeling like you’re not in control of what’s going on around you."
Basic public health measures like handwashing, wearing masks and social distancing are not new. But the scientific understanding of COVID-19 continues to evolve. For a public that is already skeptical, changing messages can be hard to communicate.
Sarah Czech, a health educator with the Cass County Health Department, said discrepancies in case number data between the state and local health departments often occur when patients are tested outside of their home county.
Testing outside a patient’s home county, especially in another state, can slow positive results from reaching a patient’s own health department. And state counts often lag behind local reports. But communicating that message is difficult.
"What the public sees — when they already have some distrust of government — is that ... the state’s numbers and the feds’ numbers and the local numbers are all different," she said. "So we’ve been making sure that we are working very, very hard with our social media to be as upfront and transparent as quickly as possible."
Changing the narrative to reflect new scientific information is a challenge. Public health officials were working with incomplete information when the pandemic began, and they have updated their messaging as new insights about COVID-19 emerge.
"As we got a better picture about what was going on, we were able to pivot a bit," Czech said. "But folks have a tough time with that when the narrative or message changes midstream."
For local health departments, changing guidance from the state and federal level also makes it hard to communicate clear messages.
In April, the Centers for Disease Control and Prevention (CDC) abruptly changed its messaging on face masks: It swapped its original recommendation that masks were not needed by the general public for guidance that strongly encourages their use.
The U.S. Surgeon General also tweeted Feb. 29: "Seriously people —STOP BUYING MASKS! They are NOT effective in preventing general public from catching #coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
"You can say, ‘You don’t need one, you don’t need one’ — and then all of the sudden, come out strong saying, ‘You do need one, and you should have been wearing it all along’ — it kind of attacks your integrity and validity," said Andrew Warlen, director of the Cass County Health Department and president of the Missouri Public Health Association.
Warlen said this inconsistency in messaging increases public distrust.
"It is just ridiculous — the number of people I’ve seen either in real life, or on social media, who all proclaim that this was just some made-up disease," he said. "We’re trying to pass on the information that comes. But different messages are being sent at different levels of government and on social media — even at the highest levels of government."
At the state level, Gov. Mike Parson overstated the availability of tests in mid-May.
"We have our governor telling everyone to go out and get tested, everybody can get tested, there's no shortage of testing," Shelby County Health Director Audrey Gough said. "But the reality is there is a shortage of testing because there aren't enough supplies."
Because there is varying guidance about who is eligible for a test, Gough said she spent most of a recent morning trying to arrange testing for a symptomatic patient in her county who had tried to get a test in a neighboring county. But the patient didn’t meet the county’s criteria so they were denied a test.
"They had to drive all the way to Columbia to get tested (about 85 miles)," she said.
Diane Weber, director of the Missouri Association of Local Public Health Agencies, said state and federal agencies need to do a better job of fighting misinformation.
"We need better guidance from the state and from the federal government as far as what we need to do to stay safe," she said. "I think when it’s done on a local basis, it’s very personal — when the local health department or the local community has to do it."
Several local public health officials also blamed unreliable online sources, like Facebook, for spreading bad information.
One Facebook group, called Reopen Missouri, started as a way to plan an anti-lockdown rally in Jefferson City at the end of April. As of mid-July, it has attracted more than 19,000 members. Members regularly post messages about how the pandemic is a hoax designed by the government to have more control over citizens. The group is anti-mask, anti-vaccine, anti-testing and anti-contact tracing.
"There’s this whole perception that the government is monitoring people, like somehow putting some computer chip or device on the end of a nasal swab and inserting and you’re able to track people — well, people actually believe that," Hutton said.
Hutton said she’s willing to work with skeptics.
"If you’re someone who questions that, we will show you the cotton swabs and we will explain that process," she said.
Misinformation about mask requirements is also proving problematic for local officials.
"People think that they’re going to asphyxiate if they put a mask on, that they’re going to be (carbon dioxide) poisoned," Gough said. "If that were true, then all of our surgeons and nurses and health care workers on the front line would be dead."
Getting people to accept the severity of the outbreak is a challenge as well.
"(Misinformation) has caused major issues, like, ‘Oh, it doesn’t exist, it’ll disappear come Nov. 3,’" Hutton said. "No, it won’t disappear, because it’s not made up."
Phillips has noticed a similar trend and blames political division.
"It’s unfortunate when public health issues get into being politicized because people stop using their own judgement and just align with their tribe instead of thinking for themselves," Phillips said.
Benjamin Warner studies political communications at the University of Missouri. Much of his research focuses on "group thinking" in political polarization.
"I guess initially I was pretty surprised that those things became partisan," he said. "But then it makes sense why they became partisan. Once the president, the most important political voice in the country, took a contrarian point of view on it, it became inevitable that it would become partisan. And once it becomes partisan, it’s going to kind of polarize along partisan lines."
Warner said that recruiting bipartisan political elites to promote public health measures could be helpful.
"Anything you can do to disentangle mask wearing, or social distancing or whatever it is from partisan identities will be really important," he said.
Phillips said that politicization will likely continue to impact public health messaging.
"Whenever you tell people they have to do something, there’s going to be people who don’t like being told what to do," Phillips said. "And I think that’s just the nature of humanity, you’re always going to have opposing viewpoints."
This story was produced by the Missouri Information Corps, a project of the Missouri School of Journalism. Have tips for us? Email: email@example.com.