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Tanzina Vega: By now, many of us have heard the basic recommendations for stopping the spread of the coronavirus, wash your hands, wear a mask and stay six-feet away from others. These basic recommendations have become staples of public service announcements from national and state governments, as well as healthcare companies.

Female Speaker 2: I wear a mask because I can, but my baby can't.

Female Speaker 3: Do it for their future's.

Female Speaker 4: Even though there is so much against us.

Male Speaker 1: You will see me choose to protect myself and my community from the coronavirus by wearing a face cover.

Male Speaker 2: Because it's going to take all of us thinking about one another, and even with my face covered, you will see me.

Tanzina: As COVID-19 continues to spike through the winter, my next guest says these tame ads aren't doing enough. She says that public service announcements about the virus need to be more graphic in depicting the reality of the coronavirus and maybe even instill some fear in us. She wrote about this in an op-ed last week in The New York Times. I'm Tanzina Vega, and that's where we start today on The Takeaway. Elisabeth Rosenthal is Editor-in-Chief of Kaiser Health News, a former emergency room physician, and author of "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back." Elisabeth, welcome back to The Takeaway.

Elisabeth Rosenthal: Good to be back, Tanzina.

Tanzina: You wrote a piece in The New York Times where you make the case for trying fear-based messaging around COVID-19. Why do you think that that's the case, and what do you mean?

Elisabeth: First of all, I don't think "fear" is the right word. The social scientists, they talk about these ads as fear-based, but I think of them as reality-based ads. The reason I say this is because I look at all these PSA's public service ads and/or announcements, and they're all kind of- you said tame, I think of them as lame. They're exhortational. They're cute.

They're the kind of ads I usually associate with like pooper scooper, or "Don't spread your legs on the subway," but we have a serious pandemic going. I think the reality of getting a bad case of COVID is ugly, it's scary, and people should be reacting to that. When people tell me, "Oh, studies are mixed on whether fear-based ads work," I say, "Look, we've been trying these cute ads for eight months now, and it's not working in many parts of the country," so time to step up our game, or to change our strategy.

Tanzina: One of the things you talk about in your piece is the use of ventilators and how, I think-- We've been preparing for this conversation, we on the show, we're talking a little bit about how Americans really understand a ventilator, what the process is like and what it's really like. Tell us a little bit about what it's really like. Do you think showing something like that to Americans would change their minds?

Elisabeth: It's hard to watch is the problem, and in this day and age of trigger warnings, it's ugly, it's hard for children. You don't want children to see it, but it is the reality. When I was a medical resident and we had to put people on ventilators, in the black humor of residency, we called it "torturing people," not because it isn't a good thing, if you're likely to need it, and if it will help, it's great. They're fabulous technology, but it's really uncomfortable.

You can't talk, you've got a tube down your throat, you're gagging, you’re fighting the ventilator. Part of the problem is, many people know people now who've had mild cases of COVID, but the people who've had the bad cases are in intensive care units, or they're isolated, or in their homes because they're too out of breath to go out, and we don't see enough of those people.

There's, to me, this odd dichotomy, we see those bad cases on the news on some stations, but we don't see them in public service ads. The public service ads are playing nice and exhortational, "Do it for your neighbor," and in TV we're showing, "Wow, this can be really bad," but we've got to merge those two thoughts.

Tanzina: You mentioned also in your piece, and I remember a lot of these ads when I was a kid, "to stop smoking" adverts and messages that many of us saw as children, that were pretty graphic. It showed deformed faces and people who had lost parts of their bodies as a result of smoking, that did not prevent a lot of people from smoking. It was a different time, a different era, but I think that they're- personally, I think that they're pretty effective, as a former smoker myself. Is that the tack that you would take with these ads?

Elisabeth: As of now? Yes. I might not have said so seven, eight months ago, but, like you, I'm from New York. I know how bad it was there. You always hope that people will listen to do the right thing, but in many parts of the country, they're not, and the smoking ads, sure not everyone stopped smoking, but between 1967 and 1970, when there was a very concerted campaign on TV at the time, smoking rates dropped by about 5%, and where they've been tried for smoking, they're very effective.

Now, you can find studies showing that fear-based ads are mostly effective for one-time interventions rather than prolonged behavior. Yes, that's true, but I would say, and as a former smoker, stopping smoking is really, really hard. If an ad can make people stop smoking, it should be able to make people just put on a face mask for the next six months while the vaccine rolls out.

Tanzina: In theory, yes, and yet, there are- we've had very mixed messaging from the federal government on down, particularly at the federal government in terms of the politicization of this virus, in terms of how masks themselves have become a political statement. Is it too late, Elisabeth, to try to come out with a new approach at this point, given where we are today?

Elisabeth: I don't think so, and here I invoke my hero in this, Dr. Fauci, it's not too late, we can still do a lot. Certainly, the people who are saying this is a hoax, even as they're going into the ICU, "I couldn't have COVID," you're never going to convince them, but I think there's a lot of the country that's confused, in part because they've heard this mixed messaging from the White House and from some of the public health people, in part because it's a new virus, we've been learning things about it over the last eight months.

At the beginning, it didn't seem like masks made much of a difference, but very early on, we knew they did. I think people are a little confused. There's a big part of the population that you could reach. The thing is, if we go from 50% masking to 70% masking in a community, that will make a big difference in spread. If we go from 50% to 90%, that would make a huge difference. I think, yes, sure, there's some people you're never going to convince. There's some people that are going to smoke until they get lung cancer, but there are a whole lot of people out there, I think, we can still reach with a new kind of public service announcement.

Tanzina: I want to talk a little bit about some of the memes that we're even seeing. I saw something, and even some journalism that's coming out, that really speaks to the opposite of what you're saying, which is, let's meet people where they are. For example, if we know people aren't going to wear masks and we know they're not going to not travel for the holidays, then let's give them tips on how to do it as safely as possible.

I have very mixed feelings about that. I think that that's somewhat irresponsible, but at the same time, you have people that say, "Look, you've got to meet people where they are, and we have to be realistic about what Americans are willing and not willing to do." What are your thoughts on that?

Elisabeth: I don't think it has to be either/or. I don't object to some PSA's being exhortational and saying to a 25-year-old, who's going to fly, "This is the way to do it safely," or "Quarantine before you see your grandmother." I think you need that information too, but I do think you also need to show people what it looks like to be a COVID long-hauler, what it looks like to be on a ventilator.

I think almost the scarier part, because when you're on a ventilator, you're usually very sedated, is when you're lying in bed in an ICU, not quite needing a ventilator, but watching those oxygen saturation numbers rise and dip above your head thinking, "Oh my gosh, where's this headed?" That is terrifying. I have a friend who's an infectious disease doctor in Tampa General, and she said, "A lot of people say, 'Oh, I have a cousin who had it. It's not so bad,'" where masking is not prevalent at the moment and, yes, for many people will not be so bad. My son had COVID, he had a mild case. My mother had COVID, she died from it. We have to express the range of possibilities and make it clear to people that you don't know, even if you're 25, whether you're going to have a really bad case or a mild case. One of the PSA's I'd like to see is from an NFL football player who has a long haul COVID syndrome, who is missing the season, his short of breath when he, a really fit person previously, has to climb up the stairs. That's powerful.

Tanzina: What about in the world of journalism, Elisabeth, the world that you and I both are deeply familiar in and committed to? Do journalists need to be more direct about the effects of particularly severe cases of COVID-19, and also just how they talk about it and how they--? We're going to have a conversation a little bit on the show about the images that they use. Where would you say, "The media is on this so far"?

Elisabeth: It's a little bit all over the map. I think the media has tried to show how bad COVID can get. We've certainly seen scenes within ICUs. We've had doctors and nurses in tears because they're trying to do their best, they're exhausted. We do see, particularly on television, on cable, on the internet memes of how bad it can get, but the media in particular, and how Americans digest the media at the moment, is so affiliated with your political party.

Those messages may not get to people who are looking primarily at the more right-leaning media who've downplayed COVID or even said it's a hoax. I think the media has tried its best. Some of it is genuinely hard because it's hard to get reporters into an ICU, and you probably don't want them.

They're interfering with the desperate work that that's being done. It's funny, one little thing we talked about is the photo that went with my story in The New York Times, my op-ed, about how we have to scare people a little bit more. Again, it's reality show people not scare people was of an empty stretcher. I was like, "That's a weird choice. Why don't we put someone on a vent in that time slot?" I think the media has tried its best and has done a pretty good job, but our electorate, our country is very polarized in what kind of media chooses to believe, so--

Tanzina: Elisabeth Rosenthal is Editor-in-Chief of Kaiser Health News, and author of "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back." Elisabeth, thanks for joining us.

Elisabeth: Thanks, Tanzina.

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