Violence has been an ongoing threat to healthcare workers, but it is manifesting again as social tensions rise amid the COVID-19 pandemic. This became evident during the politicization of wearing face masks and threats against public health officials trying to enforce their use or mandate other pandemic control methods.

Pandemics historically have proven divisive, with certain groups scapegoated as the source of origin and spread. “But it doesn’t have to be so mean-spirited, aggressive, and even violent. I think that is more a product of our times,” says Joshua M. Sharfstein, MD, vice dean for public health practice and community engagement at Johns Hopkins Bloomberg School of Public Health.

Sharfstein and colleagues recently wrote an editorial outlining the situation. “The present harassment of health officials for proposing or taking steps to protect communities from COVID-19 is extraordinary in its scope and nature, use of social media, and danger to the ongoing pandemic response,” the authors noted. “It reflects misunderstanding of the pandemic, biases in human risk perception, and a general decline in public civility. Some of these causes resist easy fixes, but elected officials and health officials can take certain actions to help address the problem.”1

To some degree, the antivaccine movement that has undermined childhood vaccinations for years has expanded to be anti-public health in general. “There is a lot of crossover,” Sharfstein explains. “There are a lot of people who are active against vaccines who now are active against masks. There are conspiracy theories about flu vaccinations, and [false fears] have led to measles outbreaks. If they don’t vaccinate against flu, it increases the chance of dying of flu. Now, we have a pandemic.”

Across the United States, private information of health officials has been revealed for the purposes of harassment, protesters showing up at their homes, and threats warranting private security personnel. “I think it is very important that public officials support health officials — and, when necessary, it’s important to protect them,” Sharfstein says.

The pandemic is a global outbreak and clearly causes death and disease, but there are several reasons people may be blind to personal risk. The ability to perceive such harms can be undermined by decisional biases known to affect human thinking. A contributing factor is “omission bias,” which is a preference for risks associated with doing nothing over those linked to following public health orders, Sharfstein explains.

“Distance bias and optimism bias may be operating for those who believe COVID-19 will not seriously affect them or their loved ones,” the authors noted. “In an information space flooded with conflicting information, confirmation bias allows some people to dismiss evidence that does not comport with their pre-existing beliefs.”

Such beliefs can be expressed on social media and in attack campaigns against public health experts like Anthony Fauci, MD, director of the National Institute for Allergy and Infectious Diseases.

“The environment deteriorates further when elected leaders attack their own public health officials,” Sharfstein and colleagues noted. “Members of the current presidential administration, and various members of Congress, have displayed hostility toward experts inside and outside of government. … Instead of attacking their health officials, elected leaders should provide them with protection from illegal harassment, assault, and violence.”

Thus far, violence against hospital workers related to the pandemic has not been reported widely.

“Anecdotally, on emergency department violence, there have been some incidents,” says Steven Arnoff, spokesman for the American College of Emergency Physicians. “For example, confrontations with patients’ family upset about visitation restrictions.”

Are Laws the Answer?

Although many states are requiring masks in public settings, others are not, and there are varying degrees of enforcement across the board. A national law could be more effective in ensuring compliance with this key measure against viral spread, but would likely face states’ rights legal challenges, says Lawrence O. Gostin, JD, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University in Washington, DC. For now, laws by states may be more effective. Over time, such laws typically become more accepted, he notes.

“Laws not only require people to engage in healthy behavior, but also can change personal beliefs and practices over time,” Gostin says. “Even if a law is initially controversial, often it ingrains behavior in the population. A good example is seat belts. Seat belt laws were controversial when first implemented, but the public came to regard the use of seat belts as just common sense. I see mask mandates working in the same way.”

Gostin recently co-authored an article looking at the mask issue and the role of the Centers for Disease Control and Prevention (CDC) during the pandemic.

“Historically, states and localities have assured the public’s health, with the CDC providing funding, technical guidance, and coordination,” the authors reported. “National coordination is achieved as states adopt evidence-based recommendations from the CDC. This model, however, breaks down if the federal government does not consistently support the CDC and the science undergirding its guidelines.”2

Among the lessons of COVID-19 is that the CDC should be better insulated from political influence and given greater autonomy in responding to a public health crisis while “preserving the integrity of science,” Gostin and colleagues wrote. Funding sources should come from Congress.

“The CDC was marginalized because the president and the White House contradicted CDC’s science-based advice and even refused to allow CDC to issue certain guidelines, like school opening guidelines,” Gostin tells Hospital Employee Health. “We need to return to a political landscape where political officials support science and key public health agencies like CDC. COVID shows that we need national, uniform legal standards, and CDC is best positioned to use science as the basis for new powers.”

REFERENCES

  1. Mello MM, Greene JA, Sharfstein, JM. Attacks on public health officials during COVID-19. JAMA 2020;324:741-742.
  2. Gostin LO, Cohen IG, Koplan JP. Universal masking in the United States: The role of mandates, health education, and the CDC. JAMA 2020;324:837-838.