Health Literacy during COVID-19 — The everyday sidewalk maze of truth, science, and emotions

Preface: My role in this article is to point out my observations of people’s everyday activities from all walks of life from a health literacy designer’s perspective. There is no intention on my part to validate what is factual on the ever-changing landscape of the most severe worldwide public health event in the last hundred years.

As a health literacy designer, the events from this past year surrounding the pandemic of COVID-19 truly have tested how well the role of health literacy has or has not played out in the United States. As scary and unpredictable as this pandemic has been, it shines the light on how crucial the health literacy professionals’ role is during this ongoing worldwide pandemic.

From my observations from going to the supermarket during the height of the stay at home order here in the US, zoom meetings with friends, colleagues, and clients to gradually engaged in other social-distance compliant activities, a message was resonating. That message is — opinions, whether based upon fear, insecurity, emotional and mental states even before COVID coupled with political perspectives, truly have molded to what I refer to as the sidewalk maze of truth, science, and emotions.

What is the sidewalk maze of truth, science, and emotions?

To most of us, we have never been here before. Previous generations dealt with health crises such as Smallpox, Measles, and Polio. In my lifetime, thus far, we have had a plethora of cancers spreading across demographics. Also, the Swine Flu/H1NI pandemic, and finally, HIV, which took us all by surprise so quickly and profoundly affected our perceptions of sexual contact and relationships across demographics regardless of economic or cultural boundaries. Now, COVID-19 is upon us.

As someone who has worked on a variety of patient education and health literacy initiatives across a variety of public health emergencies and ongoing challenges, the COVID-19 pandemic has, in my opinion, amplified the work still be done. Regardless of demographics and socioeconomics segments, society must take the time to understand “Why” health literacy can save a life or avoid or minimize suffering.

Truth

This word should not be complicated, but the word “Truth” indeed has become one.

Too many were asking:

• Is the truth what the CDC or WHO recommends?
• Do I listen to my primary care doctor, friends, or family members?
• But what I read on social media said the opposite?

The term truth has become almost what streaming channel one chooses to tune into for their information. The result is a mixed bag of science, emotions, and how much effort one puts into researching their own from reputable sources. Access to a variety of devices with internet capability proved to be a double-edged sword.

Social media doesn’t help, but what it does do quite effectively is raise questions. The questions are not that apparent, but seeing some of what we have all witnessed in headlines, memes, videos, and social media comments, a hidden message IS there. The message is to search for the right question to ask; each of us has a responsibility to validate what we are reading. Is it opinionated, or is it based upon science or emotion?

Supermarket Science

Early on, a lot of people didn’t know what to do. What was extreme?

• Was wearing a gas mask to the supermarket warranted?
• Is throwing a used pair of surgical gloves into an empty shopping cart contributing to the problem?
• Did the surgical gloves make a difference once they were used to touch something on the shelf, the shopping cart, and then to your car door handle?
• Did using your knuckle and not your fingertips on the automated checkout machines prove just as effective if you just used hand sanitizer right when you got back in your car?
• Did understanding the simple task of washing hands as recommended truly resonate?
• How often were we aware of the significance of face touching oneself while in a public place?
• Was it understood that wearing a mask inappropriately was the same as wearing no mask at all?
• Was wearing a mask more dangerous than not wearing one?
• Did all of these questions raise mental health issues to the foreground on how one chooses to process their maze of truth, science, and emotions?

As a visual designer, I am always intrigued by studying what I see at some point. The COVID-19 pandemic will prove to be an essential lesson in how effectively health literacy translates a message.

We can not expect everyone to grasp concepts as an infectious disease expert, but isn’t it essential that some crucial concepts be understood and applied in their daily lives regardless of education level?

Terms like transmission rate (Rt), social distancing, the effectiveness of mask-wearing (the right type of mask), staying aware of symptoms, and understanding those at risk and understanding others’ risk and risk to themselves by their very own behaviors?

The entire COVID landscape was truly ever-evolving. With the accessibility of news, internet sources by the minute, we were on information overload. Regardless of the source, this flood of information made the labyrinth more like a maze. There were many points along the way that we “could” have overly complicated things for ourselves, or could we have not avoided it?

While no one source is the end-all on an evolving public health emergency such as COVID-19, how can we best communicate where each of us needs to choose where we devote our attention.? How does one indeed filter what is necessary?

Testing and Contact Tracing

To the everyday person, this can go either way. Countless personal experiences with those I’ve either communicated with directly or indirectly, testing and contact tracing was a topic of both suspicion and denial.

It was so bizarre at times that some thought if they were to do an internet search of the keyword “symptoms of COVID-19”, some IT government method would trace back to their device’s IP address, and someone would be knocking at your door to force them into quarantine. As bizarre as this may sound, you can see why emotions and perceptions are so intertwined due to the unknown of COVID to the everyday person. The potential interpretation of contact tracing and testing only amplifies the filtering health literacy provides to guide those through this maze.

Racial and Socioeconomic Disparities

Without a doubt looking at COVID-19 data, race, education level and socioeconomic status has and continues to have a profound negative effect on those affected by this pandemic. Also, while education levels played a part in someone’s understanding and perceptions that influence their daily behaviors, and how they may affect others around them have been apparent based upon the racial disparities due to COVID-19.

The unfortunate statistics of COVID-19 mortality by race and social-economic position are apparent. There are many reasons for that, from lack of education in health and basic science education concepts, access to healthcare, cultural behaviors, social attitudes, and behaviors. This was apparent regardless of whether those resided in an urban, suburban, or rural community.

Emotions

I left this for last because, in my own belief, a person’s emotional state when dealing with a crisis truly is the steering wheel of that individual’s guiding light of their path to truth and science that can help them cope over time. COVID-19 has, without a doubt, exacerbated the mental health challenges of everyone.

As a result of the pandemic, our emotions genuinely play a more significant role in how we carry about our business from shopping, walking through town, and engaging with others, whether a friend or a stranger. Besides, dealing with the stay-at-home orders was unheard of in generations of this time. There is no concept of why we needed to do this other than the fear of catching the virus or at best understand the threat of overloading the healthcare system. As of this writing, Southern California is dealing with that exact scenario at unprecedented levels. Before us, generations were told along the east coast of the United States to not have lights on during the night if their homes were along the shoreline for fear of Nazi U-boats spotting our coastline for military reconnaissance. Their eye was on the prize, to win the war! The bogeyman was visible; COVID-19 was only visible after it has affected someone.

Closing Thoughts

So we come to a new year filled with still many facets of the pandemic that still need to be worked through and resolved. What is apparent is just how crucial the mission of health literacy messaging, whether it is a community health initiative or a global pandemic.

Health literacy clearly plays a role in how someone carries themselves from their daily activities or employment and how well they understand the core messages. Through words and images and how they are packaged, health literacy has once again been amplified through this COVID-19 pandemic. So here we are, with several vaccines rolling out at a pace never seen before. Many perspectives and viewpoints on the vaccine development and opinions are now an additional component to some as they navigate this maze of COVID-19. For example, how well does one understand the difference between a live virus vaccine and a messenger RNA vaccine, and how are they are different? Regardless of fact versus fiction on talking points such as herd immunity, side-effects, effectiveness, mechanism of action, and truly understanding all of these facets about the COVID-19 vaccines, truth, science, and emotions will prevail way beyond the passing of the COVID-19 pandemic.