On Saturday afternoon, U.S. Sen. Ted Cruz took to Twitter to ask his followers to heed the advice of public health officials and politicians on the other side of the aisle:

“If you can stay home, stay home,” the Texas Republican wrote. “And wash your hands.”

Good advice — not just for NYC, but everywhere.

If you can stay home, stay home.

And wash your hands. https://t.co/WOcTclI7Ki

— Ted Cruz (@tedcruz) March 14, 2020

Hours later, the Republican governor of Oklahoma tweeted from a packed restaurant in Oklahoma City showing that he is performatively not doing this. “Eating with my ***** and all my fellow Oklahomans at the @CollectiveOKC. It’s packed tonight! #supportlocal #OklaProud”

He deleted the tweet an hour later.

On Sunday morning, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told CBS’ “Face the Nation,” “Right now, personally, myself, I wouldn’t go to a restaurant.”

Meanwhile, U.S. Rep. Devin Nunes, a California Republican, spoke on Fox News and said, “If you’re healthy, you and your family, it’s a great time to just go out, go to a local restaurant, likely you can get in easy. Let’s not hurt the working people in this country ... go to your local pub.”

“If you’re healthy, you and your family, it’s a great time to go out and go to a local restaurant, likely you can get in easy. Let’s not hurt the working people in this country...go to your local pub” pic.twitter.com/jXdhOfwe9R

— Acyn Torabi (@Acyn) March 15, 2020

Stay Home, Even if You Feel Fine

The discordant messages underscore the immense challenges conveying common messages during a public health crisis, one that has happened time and again as the novel coronavirus that causes COVID-19 has swept across the country.

“The most important thing is for people to change their daily routines and really reduce their social interactions,” said Dr. Joshua Sharfstein, a former federal and state health official who is now vice dean for public health practice and community engagement for the Bloomberg School of Public Health at Johns Hopkins University.

“I don’t think it is the consistent message from all health and political officials. If people are going to change the way they live their lives, they need to hear about the need to do that from every credible source of information they have because if they get mixed messages it’s easy to lapse back to not changing.”

From the availability of testing to the need to avoid handshakes, from where patients should go if they develop symptoms to whether to touch your face, the messages — and the actions by the public officials and even sometimes the doctors delivering those messages — have been contradictory.

Go to the ER; Don’t Go to the ER

One day last week, for example, a New York City allergy practice sent patients an email telling them what to do if they suspect they have symptoms consistent with infection with COVID-19.

“As you may be aware, there is a shockingly low number of available tests, and all testing now is done through local emergency departments in the area,” the note read.

Hours later, the advice was retracted: “It has been brought to our attention that the recommendation to visit the ED if one suspects COVID19 is incorrect. One should call their primary care provider to be screened and whether a visit to a lab or emergency department is necessary. … We are sorry for the confusion.”

While the government’s inability to get coronavirus tests in the hands of doctors and local health departments has been roundly criticized for preventing leaders from understanding how the virus is spreading, the mixed messages being given by leaders and others throughout this outbreak threatens to have a continuing effect.

“In some places, at least, there’s an advice vacuum and that leaves a lot of people trying to figure out what’s available and what to do,” Sharfstein said.

Conflicting Information Causes Real Harm

Accurate information is the coin of the realm in public health emergencies such as this one. Setting expectations and sharing accurate information is vital, experts say.

At all levels of government and medicine, that hasn’t happened.

During a visit to the Centers for Disease Control and Prevention this month, President Donald Trump said: “Anybody that wants a test can get a test. That’s what the bottom line is.” In fact, tests were not available. And public health officials told doctors and patients seeking them that they didn’t qualify.

The failure to provide clear answers has continued regarding the availability of ventilators in the event hospitals are overloaded. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, was asked on Fox News whether hospitals could run out in a crisis. Several times, she didn’t answer the question. “Well, that’s why we have an emergency preparedness system,” Verma responded. “We’re used to dealing with disasters.”

On ABC’s “This Week” on Sunday morning, Fauci was more direct when asked whether the federal ventilator stockpile would be enough: “That may not be enough if we have a situation where we really have a lot of cases.”

“That may not be enough if we have a situation where we really have a lot of cases,” Dr. Anthony Fauci tells @jonkarl when asked if the U.S. healthcare system is prepared in terms of the number of ventilators available for coronavirus patients. https://t.co/2siLTcOUzz pic.twitter.com/buv5NiV1sR

— ABC News (@ABC) March 15, 2020

The gap between government messages and reality applies to travel as well. Trump restricted travel from Europe and imposed additional health checks on Americans returning from European countries to protect Americans from the virus. “This president is going to continue to take every step necessary to protect the American people and put the health of the American people first,” Vice President Mike Pence said Saturday.

Yet, hours later, airports in Dallas, Chicago and Washington, D.C., were teeming with crowds waiting to get through the immigration checks. Some lamented that they were being exposed to others who may have the virus, the exact opposite of the stated reason for the additional checks.

This is the scene at O’Hare airport. The traveler who took the photo said it’s a 6-hour wait for bags then on to customs for 2-4 more of waiting in shoulder-to-shoulder crowds. Police are handing out water and disinfectant wipes. @fly2ohare #ord #coronavirus #COVID19 pic.twitter.com/UTx9E0nj1s

— Brooke Geiger McDonald (@BrookeGMcDonald) March 15, 2020

Huge CDC line at Dulles pic.twitter.com/X9wN8znxct

— Zach Graves 🍞🎪 (@ZacharyGraves) March 14, 2020

Mark Morgan, acting commissioner of U.S. Customs and Border Protection, tweeted on Sunday morning that his agency is “aware of the reports of increased wait times at some airports across the nation. CBP along with medical personnel are working diligently to address the longer than usual delays. Nothing is more important than the safety, health and security of our citizens.”

Hours later, Morgan wrote another tweet, calling the waits at some airports “unacceptable.”

Do as I Say, Not as I Do

It goes beyond that. Public health officials have repeatedly called for members of the public to stop shaking hands, but the president has been resisting that advice, at least so far. “Shaking hands is not a great thing to be doing right now, I agree,” Trump said Saturday. “But people put their hand out. Sometimes I’ll put the hand out. You don’t think about it. People are thinking about it more and more. We have to think about it; it’s important.”

Public health officials also have told the public to avoid touching their faces, but sometimes those same officials have touched their faces. A public health official in California held a press conference to tell the public to avoid touching their faces, during which she licked a finger to turn a page in her remarks. (As this reporter has learned, it’s nearly impossible to stop touching your face.)

In a column in The Washington Post, two experts say communication is key, and sports and cultural icons should be brought in to reinforce important messages.

“A communications failure in the face of a pandemic amounts to not just a political problem; it is a public health problem,” wrote Lorien Abroms, a professor and associate dean at the Milken Institute School of Public Health at George Washington University, and Kenneth Baer, a communications consultant and former associate director of communications at the White House Office of Management and Budget.

“Communications can also be the solution: What is needed to help mitigate the severity of the coronavirus epidemic is a few, simple messages delivered by the right messengers. We need a whole-of-culture response — not just political leaders, but also the most influential athletes, actors, social media influencers, singers and personalities using every medium at our disposal to encourage Americans to change their behavior and inspire us to stick with it.”

The Tough Days Ahead

In the days ahead, consistent public health messages will be crucial, Sharfstein said, particularly if the virus continues spreading and places a burden on hospitals. Patients will need to know who to call if they get sick and when and where to seek medical care. Doctors will need to know where to send their patients.

In most cases, the answer is to avoid sending patients to the emergency room if they are showing mild or moderate symptoms of the virus. Those who become sicker or develop trouble breathing should follow up immediately with doctors or seek emergency care.

“A test itself is not treatment,” Sharfstein said. “A test illuminates what’s going on a little bit better. The response may just be to stay at home and monitor yourself. While it’s better to have more testing capability, we’re not powerless because the major response is just going to be to stay at home.”

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