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How Quebec’s bungled messaging is hampering the anti-virus effort

Quebec’s health minister was irked — and it showed.

Christian Dubé had just been asked about a party at a restaurant in Laval where revellers were cavorting maskless, in joyful violation of essentially every public health recommendation.

“I’m going to uncross my arms because the moment you talked to me about that, I crossed them. That’s not very good, eh?” he told Journal de Québec reporter Geneviève Lajoie during a news conference on Tuesday.

Yes, you might say the man who’s managing the province’s day-to-day pandemic response is sensitive to verbal and non-verbal communications.

The Quebec government, like many others, has been grappling with two big challenges as it tries to steer a COVID-weary populace through the latest phase of the pandemic: how to keep people on their toes without having them tune out and how to keep an economy afloat while mitigating the danger to vulnerable populations.

It is like walking a tightrope.

“On the one hand, they want to protect the population … and on the other hand, they’ve got to keep the economy going, they’ve got to keep the population feeling positive,” said David Levine, a former junior Quebec health minister, hospital administrator and director-general of Montreal’s regional health authority.

covid 19 montreal restaurant
A patrons enjoys a glass of wine at the bar of Lemeac restaurant on the first day after novel coronavirus restrictions were lifted to visit restaurants in Montreal on June 22. (Christinne Muschi/Reuters)

The fact that Quebec has already been through a lockdown and is now in its sixth month of pandemic vigilance and privation makes it increasingly difficult to hold the public’s attention. As Dubé said this week, “People are tired.”

But the perils of muddled communications are real.

If the province decided to order another full lockdown, would  people go along with it?

How much leeway does Quebec City have to make and enforce tough decisions?

The fact is, not everyone is listening to what the government is saying.

Earlier this month, researchers at Concordia University in Montreal published findings from an international survey of global attitudes that established a correlation between messaging and behaviour.

They found that 12 to 25 per cent of people, most of them men and women in their 20s, aren’t engaging with the public health discourse.

“The things that really resonate with them are things around the economic side of things,” Dr. Simon Bacon, one of the study’s principal investigators, told Radio Noon, “… and yet, there’s not real talk about any of that. In fact, most of the messaging has been all around health, which we know doesn’t really resonate with this group at all.”

Or as Levine put it, there’s a balance to be struck between safety and hope. Practically speaking, the provincial government has settled on a plan in which it’s making a general appeal to caution and individual responsibility, but without meaningful coercive measures to uphold either.

It’s no wonder the messages seem, at best, mixed.

“People are very confused,” said Kim Lavoie, a psychology professor at the Université du Québec à Montréal, who holds a Canada Research Chair in behavioural medicine. “Whenever there’s an inconsistency, it gives space to people to say, ‘Well, both these things can’t be true, so I’m going to go with whatever suits me best.'”

WATCH | Six months into the pandemic, does Quebec have its messaging on track?:

An expert in behavioural medicine warns the Quebec government’s new COVID-19 awareness campaign could backfire. CBC Montreal’s Debra Arbec speaks with Kim Lavoie, the chair of behavioural medicine at UQAM. 4:45

Lavoie, who co-led the Concordia study, understands the challenges and is reluctant to openly criticize her public health colleagues, but, she said: “What I think is missing for most people … is a transparent, common-sense plan.”

The province’s colour-coded alert system, for example, is an idea that could work. But its clarity has been undermined by confusion over what the various levels actually mean.

Going from yellow to orange is intuitively bad, but it’s not always clear what exactly the progression involves.

“We have an algorithm now: If we move into orange, this is what happens. And even there, we’re already starting to make compromises,” Lavoie said. “We’re in orange now, so [gatherings are] going from 10 people to six, but it could be eight if you’re in the same family. But if you’re nine, well no, that’s no good. It’s hard to know what to believe.

“Again, it leaves room for people to say, ‘That doesn’t work for me, so I’m going to ignore it.'”

covid 19 test lines montreal
People line up for a COVID-19 test at Montreal’s Hôtel Dieu Hospital. (Ivanoh Demers/Radio-Canada)

Inconsistencies have also plagued other aspects of Quebec’s messaging:

  • Stay home, but don’t forget to support bars, restaurants and local businesses.
  • You’ll have to wear a mask to go into a store or dentist’s office, but if you’re one of 25 to 30 students in a classroom, you can take it off.
  • Please avoid gatherings, but if you’re having members of one other household over, it’s probably OK.

“Is the message clear? I don’t think so,” Levine said.

Levine has experience, having spearheaded the response to the H1N1 swine flu pandemic in 2009 (he also contracted the disease).

That episode is mostly remembered for what didn’t happen — “We were very lucky,” Levine said — but the messaging lessons from that period still hold.

“Make it short, make it clear, keep repeating it, find a level we can live with and stick there,” the former Parti Québécois cabinet member said. “The idea of changing it, up and down, up and down, is what ends up being confusing for a population ” 

The current government, headed by the Coalition Avenir Québec, appears to be trying to walk a very fine line — hoping that people act as if the province were in a lockdown, without actually having to make that decision and enforce everything that comes with it.

Dr. Horacio Arruda, Quebec’s public health director, says the number of COVID-19 infections is on the rise. (Sylvain Roy Roussel/Radio-Canada)

Dr. Horacio Arruda, the province’s public health director, essentially said as much this week.

Arruda was being asked about why so many people seem so confused about the limits on gatherings.

“I’ll tell you quite honestly, if we wanted to be simple in terms of communication, we’d bring up one number. The number to remember, right now, is six. And actually, in the current context, we’ve asked people not [to] gather … try to avoid dinners with people who don’t live in your house in order to try and stop this spread,” he said.

Dubé also acknowledged that the message has occasionally become garbled.

“You’re right, our communications haven’t been perfect,” he said on Tuesday. “We’re going to adjust in the coming days, and you’re right to mention it, but I think we must explain to Quebecers that we want to find the right compromise to continue to live our lives while making the sacrifices we can stand.”

By Thursday, Dubé had refined his talking points, asking people to avoid large Thanksgiving gatherings so they can get together and celebrate Christmas.

Then on Friday, he said: “You asked us: Is the message getting out? I think that by better explaining what’s happening we can make a difference in the short term…. It becomes a little unreal, we’ve been in this situation six months. And I think our role — and I’ve said we can improve every day — is to say, ‘We can see we’re at the foot of that [second] wave.'”

And so, a new message: For the next 28 days, please don’t socialize.

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