Testing the Transparency Principle in the Time of Ebola

Submitted By

Meredith Li-Vollmer, Risk Communication Specialist
Public Health—Seattle & King County, Washington
May 29, 2015

“Be open. Be transparent.”

These are principles of risk communication that I frequently discuss when giving risk communication trainings, but in practice, it can be easier said than done. When the trauma center in Seattle decided to consider receiving medical evacuees from West Africa in early October 2014—just a week after officials confirmed a positive case of Ebola in Dallas—I huddled with fellow communicators to decide just how transparent we were ready to be.

At the time, Ebola was raging through Sierra Leone, Liberia, and Guinea and medical volunteers from the United States were desperately needed to contain the transmission and provide humanitarian relief. Leaders at Harborview Medical Center recognized that those who were willing to risk their lives on the front lines in West Africa might need a high level of care in the U.S. if they contracted Ebola. After careful consideration, they notified the State Department that they would consider accepting American medical evacuees if the need arose.

Shortly thereafter, the director of public relations at Harborview and James Apa, Communications Manager at Public Health – Seattle & King County, were weighing how public to make this decision and pulled me into the conversation.

There were compelling reasons to keep it under wraps. There were no imminent plans for anyone to be medically evacuated, and Harborview would only accept an evacuee if they had capacity at that given moment. Public anxiety was extremely high, with news beginning to report that there had been additional exposures in Dallas. Under the glare of upcoming elections, elected officials everywhere were under pressure to ensure that their regions were Ebola-ready. Colleagues asked: Why risk raising levels of public concern locally when there was really very little risk of any Ebola patient in King County, Washington?

But we also felt that we needed to be upfront with local reporters and our community. How much more difficult would it be if the decision was made to accept an Ebola patient in our region and the public had not been told it was even a possibility? How much more outrage would ensue?

What if, instead, they had already started to digest this possibility and had confidence that the public health system was prepared to manage the situation?

Ultimately, transparency reigned. We issued a joint news release with the Washington State Department of Health and held a media briefing to a packed house. We emphasized the readiness at Harborview and the strong coordination of the local healthcare and public health systems. We were also frank in explaining that Harborview would not automatically accept any request to receive Ebola patients—they would first prioritize their responsibilities as a regional trauma center before agreeing to take on a medical evacuee from overseas.

As predicted, it did stir up some anxiety. A small number of patients cancelled their appointments at Harborview. The hospital had to provide additional communications with concerned staff. A handful of people in the community called, emailed, and tweeted to express their strong opinions that Ebola patients should never be admitted to local hospitals.

But in the long-run we made the right decision. We realized this a month later when a low-risk traveler from West Africa to our county developed a slight fever while under the mandatory monitoring period. In this situation, our communicable disease experts felt quite certain that the patient did not have Ebola because the other symptoms were not consistent. But as a precaution, the traveler was tested, and as the first person tested in our region, we felt it was important to alert the media before the information was leaked.

At a short press briefing, we told reporters why it was unlikely that this individual had Ebola. Reporters took our word for it, and in contrast to their jumping at rumors just weeks prior, the reporting was measured and in-line with the lack of risk. I firmly believe that we would have had a much more difficult messaging situation had we not already established that we would be open and forthcoming with information when we shared the first news about the possibility of medical evacuees.

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