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      Trust in experts, not trust in national leadership, leads to greater uptake of recommended actions during the COVID‐19 pandemic

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          Abstract

          Evidence suggests that people vary in their desire to undertake protective actions during a health emergency, and that trust in authorities may influence decision making. We sought to examine how the trust in health experts and trust in White House leadership during the COVID‐19 pandemic impacts individuals' decisions to adopt recommended protective actions such as mask‐wearing. A mediation analysis was conducted using cross‐sectional U.S. survey data collected between March 27 and 30, 2020, to elucidate how individuals' trust in health experts and White House leadership, their perceptions of susceptibility and severity to COVID‐19, and perceived benefits of protecting against COVID‐19, influenced their uptake of recommended protective actions. Trust in health experts was associated with greater perceived severity of COVID‐19 and benefits of taking action, which led to greater uptake of recommended actions. Trust in White House leadership was associated with lower perceived susceptibility to COVID‐19 and was not associated with taking recommended actions. Having trust in health experts is a greater predictor of individuals' uptake of protective actions than having trust in White House leadership. Public health messaging should emphasize the severity of COVID‐19 and the benefits of protecting oneself while ensuring consistency and transparency to regain trust in health experts.

          摘要

          证据显示，人们在一场卫生紧急事件中就采取防护行动所具备的意愿有所差异，并且对政府机构的信任可能会影响决策。我们试图分析新冠肺炎（COVID‐19）大流行期间对卫生专家的信任和对白宫领导力的信任如何影响个体在采纳例如佩戴口罩等推荐的防护行动方面的决策。对2020年3月27‐30日收集的美国调查的截面数据进行中介分析，以期阐明个体对卫生专家和对白宫领导力的信任、他们对新冠肺炎的易感染性和严重性的感知、以及对采取新冠肺炎防护措施的利益感知，如何影响他们对推荐防护行动的采纳。对卫生专家的信任与“新冠肺炎严重性感知的增强，和关于采取防护行动的利益感知的增强”相关，导致更高的推荐防护行动采取率。对白宫领导力的信任与新冠肺炎易感染性的较低感知相关，并且与采取推荐防护行动一事不相关。比起信任白宫领导力，信任卫生专家更能预测个体的防护行动采取率。公共卫生信息应强调新冠肺炎的严重性和保护自身的益处，同时确保一致性和透明性，以重获对卫生专家的信任。

          Resumen

          La evidencia sugiere que las personas varían en su deseo de emprender acciones de protección durante una emergencia de salud y que la confianza en las autoridades puede influir en la toma de decisiones. Buscamos examinar cómo la confianza en los expertos en salud y la confianza en el liderazgo de la Casa Blanca durante la pandemia de COVID‐19 impactan las decisiones de las personas para adoptar las acciones de protección recomendadas, como el uso de máscaras. Se realizó un análisis de mediación utilizando datos de encuestas transversales de EE. UU. Recopilados entre el 27 y el 30 de marzo de 2020 para dilucidar cómo la confianza de las personas en los expertos en salud y el liderazgo de la Casa Blanca, sus percepciones de susceptibilidad y gravedad al COVID‐19, y los beneficios percibidos de protegerse contra COVID‐19, influyó en su adopción de las acciones de protección recomendadas. La confianza en los expertos en salud se asoció con una mayor gravedad percibida de COVID‐19 y los beneficios de tomar medidas, lo que llevó a una mayor aceptación de las acciones recomendadas. La confianza en el liderazgo de la Casa Blanca se asoció con una menor susceptibilidad percibida al COVID‐19 y no con la adopción de las acciones recomendadas. Tener confianza en los expertos en salud es un factor de predicción mayor de la adopción de acciones de protección por parte de los individuos que tener confianza en el liderazgo de la Casa Blanca. Los mensajes de salud pública deben enfatizar la gravedad de COVID‐19 y los beneficios de protegerse a sí mismo, al tiempo que se garantiza la coherencia y la transparencia para recuperar la confianza en los expertos en salud.

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          Most cited references87

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          Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

          Derek K. Chu, Elie A. Akl, Stephanie Duda … (2020)
          Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. Findings Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; p interaction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; p interaction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. Funding World Health Organization.
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            Respiratory virus shedding in exhaled breath and efficacy of face masks

            Nancy Leung, Daniel Chu, Eunice Shiu … (2020)
            We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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              Rational use of face masks in the COVID-19 pandemic

              Shuo Feng, Chen Shen, Nan Xia … (2020)
              Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that caused coronavirus disease 2019 (COVID-19), the use of face masks has become ubiquitous in China and other Asian countries such as South Korea and Japan. Some provinces and municipalities in China have enforced compulsory face mask policies in public areas; however, China's national guideline has adopted a risk-based approach in offering recommendations for using face masks among health-care workers and the general public. We compared face mask use recommendations by different health authorities (panel ). Despite the consistency in the recommendation that symptomatic individuals and those in health-care settings should use face masks, discrepancies were observed in the general public and community settings.1, 2, 3, 4, 5, 6, 7, 8 For example, the US Surgeon General advised against buying masks for use by healthy people. One important reason to discourage widespread use of face masks is to preserve limited supplies for professional use in health-care settings. Universal face mask use in the community has also been discouraged with the argument that face masks provide no effective protection against coronavirus infection. Panel Recommendations on face mask use in community settings WHO 1 • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected SARS-CoV-2 infection. China 2 • People at moderate risk* of infection: surgical or disposable mask for medical use. • People at low risk† of infection: disposable mask for medical use. • People at very low risk‡ of infection: do not have to wear a mask or can wear non-medical mask (such as cloth mask). Hong Kong 3 • Surgical masks can prevent transmission of respiratory viruses from people who are ill. It is essential for people who are symptomatic (even if they have mild symptoms) to wear a surgical mask. • Wear a surgical mask when taking public transport or staying in crowded places. It is important to wear a mask properly and practice good hand hygiene before wearing and after removing a mask. Singapore 4 • Wear a mask if you have respiratory symptoms, such as a cough or runny nose. Japan 5 • The effectiveness of wearing a face mask to protect yourself from contracting viruses is thought to be limited. If you wear a face mask in confined, badly ventilated spaces, it might help avoid catching droplets emitted from others but if you are in an open-air environment, the use of face mask is not very efficient. USA 6 • Centers for Disease Control and Prevention does not recommend that people who are well wear a face mask (including respirators) to protect themselves from respiratory diseases, including COVID-19. • US Surgeon General urged people on Twitter to stop buying face masks. UK 7 • Face masks play a very important role in places such as hospitals, but there is very little evidence of widespread benefit for members of the public. Germany 8 • There is not enough evidence to prove that wearing a surgical mask significantly reduces a healthy person's risk of becoming infected while wearing it. According to WHO, wearing a mask in situations where it is not recommended to do so can create a false sense of security because it might lead to neglecting fundamental hygiene measures, such as proper hand hygiene. However, there is an essential distinction between absence of evidence and evidence of absence. Evidence that face masks can provide effective protection against respiratory infections in the community is scarce, as acknowledged in recommendations from the UK and Germany.7, 8 However, face masks are widely used by medical workers as part of droplet precautions when caring for patients with respiratory infections. It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas. As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks. Recommendations on face masks vary across countries and we have seen that the use of masks increases substantially once local epidemics begin, including the use of N95 respirators (without any other protective equipment) in community settings. This increase in use of face masks by the general public exacerbates the global supply shortage of face masks, with prices soaring, 9 and risks supply constraints to frontline health-care professionals. As a response, a few countries (eg, Germany and South Korea) banned exportation of face masks to prioritise local demand. 10 WHO called for a 40% increase in the production of protective equipment, including face masks. 9 Meanwhile, health authorities should optimise face mask distribution to prioritise the needs of frontline health-care workers and the most vulnerable populations in communities who are more susceptible to infection and mortality if infected, including older adults (particularly those older than 65 years) and people with underlying health conditions. People in some regions (eg, Thailand, China, and Japan) opted for makeshift alternatives or repeated usage of disposable surgical masks. Notably, improper use of face masks, such as not changing disposable masks, could jeopardise the protective effect and even increase the risk of infection. Consideration should also be given to variations in societal and cultural paradigms of mask usage. The contrast between face mask use as hygienic practice (ie, in many Asian countries) or as something only people who are unwell do (ie, in European and North American countries) has induced stigmatisation and racial aggravations, for which further public education is needed. One advantage of universal use of face masks is that it prevents discrimination of individuals who wear masks when unwell because everybody is wearing a mask. It is time for governments and public health agencies to make rational recommendations on appropriate face mask use to complement their recommendations on other preventive measures, such as hand hygiene. WHO currently recommends that people should wear face masks if they have respiratory symptoms or if they are caring for somebody with symptoms. Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission. In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available. Universal use of face masks could be considered if supplies permit. In parallel, urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged. Taiwan had the foresight to create a large stockpile of face masks; other countries or regions might now consider this as part of future pandemic plans. © 2020 Sputnik/Science Photo Library 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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                Author and article information

                Contributors
                Sangeeta C. Ahluwalia:
                ORCID: http://orcid.org/0000-0003-0152-0369
                sahluwal@rand.org
                Journal
                Journal ID (nlm-ta): Risk Hazards Crisis Public Policy
                Journal ID (iso-abbrev): Risk Hazards Crisis Public Policy
                Journal ID (doi): 10.1002/(ISSN)1944-4079
                Journal ID (publisher-id): RHC3
                Title: Risk, Hazards & Crisis in Public Policy
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 1944-4079
                Publication date (Electronic): 27 April 2021
                Electronic Location Identifier: 10.1002/rhc3.12219
                Affiliations
                [ 1 ] Department of Behavioral and Policy Sciences RAND Corporation Santa Monica California USA
                [ 2 ] Department of Health Policy and Management UCLA Fielding School of Public Health Los Angeles California USA
                [ 3 ] Patient Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery Brigham and Women's Hospital Boston Massachusetts USA
                [ 4 ] RAND Pardee Graduate School RAND Corporation Santa Monica California USA
                Author notes
                [*] [* ] Correspondence Sangeeta C. Ahluwalia, Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, USA.

                Email: sahluwal@ 123456rand.org

                Author information
                http://orcid.org/0000-0003-0152-0369
                Article
                Publisher ID: RHC312219
                DOI: 10.1002/rhc3.12219
                PMC ID: 8242428
                PubMed ID: 34226844
                SO-VID: 08646722-3714-4bc9-bef2-ce48f9d35ba3
                Copyright © © 2021 Policy Studies Organization
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date revision received : 14 January 2021
                Date received : 28 August 2020
                Date accepted : 18 January 2021
                Page count
                Figures: 3, Tables: 1, Pages: 20, Words: 9916
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:30.06.2021

                Keywords: risk communication,risk perception
                Data availability:
                Keywords: risk communication, risk perception

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