Author: Mayarí Hengstermann, Ph.D., co-investigator at The Centre of Health Studies (Centro de Estudios en Salud CES) at Universidad del Valle de Guatemala (UVG).
Field site: Mayarí’s research takes place in rural sites in Guatemala, but is also part of a multi-sited research project taking place in Guatemala, Rwanda, Peru and India.
“No news is the best news”
*I would like to express my deepest appreciation to Lara, who accepted to help me with this work and let me record our conversations. I changed the names of all the people who wanted the remain anonymous.
Lara is 76. Just like many of her friends, she grew up, worked and lived in a world in which news was only read in newspapers, broadcast on TV and radio, or heard via storytelling. Around 10 years ago, Lara started using a mobile phone, which was a milestone for her. She was amazed at how easy it was to communicate with friends she had stopped being in contact with due to long distance and a lack of means to see them. Now she can receive personal messages, pictures and has access to music, videos and news. Like many other people, she uses her phone to connect with others and to access information from different sources and places. Lara used to comment on news that circulated through Facebook and WhatsApp with her family and friends. However, what used to be a meaningful way to relate to others now makes her feel anxious and lost:
“You don’t know what to believe anymore and every day I hear different things about COVID-19. I used to share information with my friends, but now I don’t because I don’t know if what I just read or saw is true or not, or maybe they don’t want to hear about it. Four weeks ago, it was said that wearing a mask doesn’t help and now people have to use a mask and gloves if they want to be outside. A friend from Spain sent me a video where a physician explains why it is important to boost our immune system to prevent getting weaker if we catch the virus, but in a magazine, they printed an ideography and it’s like there is not much you can do besides avoiding exposure, which is almost impossible. Every morning I feel like no news is the best news.”
Although Lara tried not to get overwhelmed by the news she read or heard, she couldn’t help feeling it. The quantity of COVID-19 related news, which seems to be pumped out everywhere, increases every second. The information overload generated in the past weeks has become a significant issue. Lara cannot leave her house, she has not received her treatment for depression, and Guatemala, the country she lives in, has declared a strict curfew alongside a lockdown and restrictions regarding social contact. All the information concerning COVID-19 surpasses Lara’s area of expertise and she cannot make out if the quality of the information is good, trustworthy or not. Like many of us, Lara senses a pressing need for an information detox. But Lara also belongs to a group of people who are at an increased risk of catching the virus and dying as a result.
Older people are now feeling more isolated and hopeless than ever. These moralities and emotions, however, vary greatly from place to place, from country to country. While in Germany the current petition is to “protect us to protect them”, the governor’s plea from Texas, Dan Patrick, was“old people should volunteer to die to save the economy”. Dan’s statement, said in a different tone, is shared by many who think that we need to prioritise the needs of many, not the urges ‘of a few’, implying that it is vital for the economy to thrive again as soon as possible. Thus, the discursive framings are outlined by political and economic institutions,, adding to a mix of different ‘sides’ and measures to the current pandemic. Not only does this result in dissimilar understandings and realities created by COVID-19 news, but it also turns some places into hostile and dangerous territory.
Explaining the (still) unexplainable
“I got a video where a man explains why wearing a mask made of simple textile fabric doesn’t help protect me or others. You will need what people use at hospitals, but that’s just wrong, they are struggling now, people working at the hospitals don’t have enough equipment. But anyway, you can’t find such masks anymore, they are sold out. My friend Oli texted me that in Mexico, people are now acting aggressively towards physicians and nurses, fearing that they are contagious. Some physicians have already been badly injured. I’ve been sent a few links with information about how this virus is transmitted but while some explain it’s through droplets, others describe that the virus may also be in the air, so you can spread it through talking and breathing”.
Information travels faster in places where people make use of multiple technologies, with the downside being that such a vast amount of information cannot be handled properly, creating a mental fog. Information overload can reach such a saturation point that it makes people feel more confused than knowledgeable. Additionally, false stories or data, sensationalist and fake news spread more rapidly than scientific information that adds a cognitive burden. In some cases, too much information can result in the trivialisation of its content. I particularly work on ‘health literacy’ and how concepts of ‘health beliefs’ relate to healthcare systems. Base on a broader definition, for instance by the WHO (1998), the term ‘health literacy’ describes ‘the cognitive and social skills which determine the motivation and ability of individuals to gain, to access, to understand, and to use information in ways which promote and maintain good health’. Education, world-view, socio-cultural backgrounds, identity, socio-economic status, religion and political contexts are relevant to understanding concepts of disease, disease prevention and promotion.
When people are confronted with information that is new but similar to other data, statements or practices, the first thing people do is try to relate this with previous information to ‘make sense’ of the new facts in order to establish or learn new perspectives or confront them if perceived as doubtful or unreasonable. When the information is completely new however, the process of acknowledging that information as trustworthy needs another path, which is primarily its source. These different forms of knowledge are the result of propositional, experiential or referential knowledge. In other words, we know because we have an information-based understanding; because we have gathered experience through exposure to such information or events, or because we trust the source, overlapping old with new information. But people do not only process and decode ‘data’, they also act on it. People react differently to information depending on their psychosocial-cultural and biological environments which influence their responses. Health literacy, thus, is also about cognitive processes, i.e. how people create a conceptual dimension that delineates the possibilities for knowing and more importantly, it creates a decision-making frame. During my years of research, I have come to observe how people search for evidence. Surprisingly, people tend to seek information from non-official sources to augment data, the primary reason being that it is easier to understand and avoids getting lost in details, which at times occurs at the expense of quality. Depending on the topic or questions, Google seems to be a common internet search engine that compresses many online platforms, by filtering information using specific algorithms to deliver “useful” and “relevant” information. For many people, social media, blogs, and YouTube are also important sources of information. Discerning what content is appropriate or trustworthy however, is part of the mix, blending important news with a disproportional amount of irrelevant and bogus information.
Throughout my years of research, one of the main problems with exploring health literacy is that some behaviours contradict or challenge what people think they know or understand. Why does analytical or critical thinking become impaired? One explanation is that immediate, emotional reactions affect logical reason, which means decision-making in times of emotional fatigue, distress, and fear or that anxiety requires significant energy, impacting the effective recalling of stored information, reducing people’s ability to focus. COVID-19 has the particularity of disrupting and challenging in many ways human life, even if it does so differently at an individual level. The amount of information that circulates has implications that can trigger or exacerbate previous emotional conditions that are the result in a deterioration or aggravation of people’s psychological state.
Lara, who suffers from depression, is putting additional efforts into allocating her attention to information that provides answers to the pandemic, trying to focus on the ‘facts free of personal value’ that could have a negative emotional cost. Mary, one of Lara’s friends, is having recurrent panic attacks, and is wracked by anxiety, fearing she will suddenly die of COVID-19:
“I don’t call Mary much these days, because there is not much we can talk about but COVID-19 and she isn’t handling it very well…she can’t sneeze without thinking it isn’t COVID-19.” Lara explains.
Thus, Sars-CoV-2 is not merely a biological and biomedical concept but a notion driven by people’s (mis)understandings, (lack of) knowledge, values, emotions, experiences, economic possibilities, social networks and available health services. Biomedical frameworks are powerful and live from their impartiality altogether with a high level of generality and consensus. In this context, Rapp (1990) notes, ‘the language of biomedical science is powerful. Its neutralising vocabulary, explanatory syntax, and distancing pragmatics provide universal descriptions of human bodies and their life process that appear to be pre-cultural or non-cultural’. While the conceptualisation of Sars-CoV-2 includes signs, symptoms and risks, personal responses include affective behaviours and make use of any available cognitive and physical resources. Therefore, COVID-19 does not only concern a biological condition, but includes a broader social order, producing or affecting personal and family dynamics and relationships that transcend a biological order or status. Therefore, the content of information that can be found, is collected not in ‘isolation’ but within specific contexts.
From a theoretical point of view, this framework is essential to discussing how the information concerning COVID-19 ‘makes sense’, to evaluate the ideas of ‘barriers’, ‘risk’, and ‘expected’ behaviours. One of the obstacles to accessing reliable information is that people need be conscious about what they are feeding: their craving for comprehension, their anxieties or even their amusements. Health literacy follows a long path and relies on facts that are never totally complete and require constant verification, since the very nature of science is that lives in a continuous rather than in a rigid state. Attempting to explain a rather complex phenomenon requires an oversimplification of notions to make it understandable with the result of becoming just fractions of a bigger matrix, leaving gaps to spread misinformation.
Information Consumerism or Abstinence?
COVID-19 is an overwhelming event, and its implications permeate unprecedentedly every aspect of people’s life, adding to the everyday worries, sadness and problems, new fears which rapidly have started to overtake people.
All information is partial and requires multiple explanations. COVID-19 is an excellent example of how health literacy plays a significant role in the use of online information and platforms to acquire relevant information. It is explained as being an infectious disease, causing respiratory illness (like the flu), with symptoms such as high fever, cough, and in more severe cases breathing difficulty, caused by a new virus that spreads primarily through contact with an infected person when they sneeze or cough. These facts are fulfilled with a biomedical and biological jargon that requires a formal comprehension of what all this means to develop awareness and decision-making. The fundamental aspect of health literacy -or any form of knowledge- is that this allows people to gain control over their health or their ability to seek out appropriate information, seeking actively to challenge information to ensure a better understanding. In other words, health literacy consists of the capacity to critically distinguish the various types of information and sources, accepting and recognising its intricacy.
After months of being exposed to COVID-19, many and different types of information have been generated, enabling people from a range of backgrounds and literacy to access online information. It is important to acknowledge the importance of communicating in vocabulary everyone can understand, including translation and interpretation when needed. Engaging people in critical thinking about the ‘why’ concerning COVID-19 opens up the possibility of challenging the different needs for information. Conversations with different people show that understandings and needs for specific information vary widely. Among elderly people, for example, grows a sentiment central to their personal state: information should increase the planning of the process of other forms of protection for them that is not only social seclusion.
Lara accepts and understands the measures taken by the government for this particular context, even when some of the symptoms of her depression have now worsened. Many of her friends are dealing or coping differently with COVID-19. Information is sought or rejected depending on the particular context:
“When I was young, information arrived when events were a fact, news about an event were described in detail, but now it is like all the information is in a state of becoming, always unfinished, which leaves me with a sense of uneasiness. I got even a video from Clara explaining homemade remedies made with garlic and onions can help to fight the virus, or how putting onions around the house prevents the virus from getting in. I don’t know how all this nonsense can be just ‘put out there’. Clara told me that because there is too much information, you don’t know that to believe anymore, so this looks harmless to do and that’s what some people in Venezuela are apparently doing. Can you imagine? Clara! who was a teacher, believes in that, I’m not surprised that people believe in anything now”.
Accessing and sharing information is also sharing values, ideas, concerns and possibilities. Thus, information mobilises people and plays a key role in everyday life. On the basis of the landscapes that information creates, people build their capacity to act, since information is a tool and resource aimed at setting coherent behaviours. When each person has a different idea about what information is important, trustworthy and desirable, the result could be people having assumptions, rather than an understanding of the issues at stake.
The Dunning-Kruger effect of the manifold COVID-19 information
“I was hearing COVID-19 experts every day. From ‘I read it on the news, to my son told me’ people seem to have become virologists, epidemiologists, physicians, psychologists, politicians and economists in a couple of weeks! After we talked about this last time, I realised that my friends and people I talk to just repeat what they read or heard but are not being critical about it, you know? You can’t talk about this anymore, each person is going through a personal journey. I have cut the COVID-19 news to the weekly magazine I’m now reading and the twelve o’clock radio news. If there is something ‘urgent’ or new measures I’m informed by my good friend Miriam who is taking care of one of her siblings who has been ill, so she only highlights the ‘do’ and ‘don’t’. If I want to know why, then I wait for the magazine on Sunday”.
Lara’s method for handling the information concerning COVID-19 seems to be a good way for her to face all the predicaments, contradictions, assumptions and most of all uncertainties that increase every day. The government has now declared that leaving the house without a mask can result in a fine equivalent to 1,500 euros if the person tests positive for COVID-19. Still, there are people who are not or cannot follow the protocols. COVID-19 has also increased the number of crimes, femicides, child abuse and suicides, along with economic difficulties. Unimaginable personal and social difficulties are likely to emerge. The temporary measures to address the immediate problem are creating unforeseen outcomes. The everyday news about Corona is now permeating unthinkable aspects of life as people have known it, competing or exasperating fiercely against ‘past’ tribulations as well as creating experiences of mistrust and stigma. Misinformation and fear are rampant, and these are at a constant ‘advantage’ when compared with the dissemination of trustworthy and optimistic information.
I have not been able to reach Lara after our last conversation last week. Her depression has reached a critical point. ‘No news is the best news’ does not always apply to all events.