Public Perception vs Public Health: Why Infectious Disease Preparedness Still Matters

More than 6 years after the COVID-19 pandemic began, concern about infectious diseases remains high, but has public understanding kept pace? In this exclusive Infection Control Today^® (ICT^®) interview, Norris Gearhart, CR, executive vice president of Regulatory Business Practice at First Onsite, discusses why public concern is justified, where misconceptions persist, and how education, environmental hygiene, and preparedness remain essential for protecting communities from emerging infectious disease threats.

ICT: The survey found that 61% of Americans remain concerned about the transmission of infectious diseases in public settings, and 56% are worried about another global pandemic. More than 6 years after COVID-19 emerged, what do these findings tell us about how public perceptions of infection risk have changed, and are these concerns justified based on the current infectious disease landscape?

Norris Gearhart, CR: Yes, I believe the concerns are completely justified. As to how these public perceptions have changed, have they? From my perspective, very little behavior has changed regarding the professed concerns, and if I see anything, it is that we as a society have changed our behavior for the worse.

When I am traveling through airports and other public venues, I see the same inconsiderate behaviors toward both our fellow humans and potential pathogen risks as before the COVID-19 shutdown. I see people using the restroom without washing their hands or not washing them effectively, which can increase the spread of pathogens. I see sneezing and coughing without covering their mouths or using their hand without thinking of washing it prior to touching something or someone else. I see the crowding of personal space and the lack of ventilation and airflow. I see people who use cleaners and disinfectants without understanding how to use them effectively.

This misuse creates a placebo effect, making them feel like they have done something good. The reality is that they may have contributed to creating resistance in a pathogen to the active ingredient in their cleaning product. There is a decline in flu and COVID-19 vaccination, and resistance to receiving vaccinations that have proven safe and saved hundreds of millions from suffering life-altering consequences or death. These are basic personal discipline and value decisions being made without any consideration of risks to community health.

Decisions driven by misinformation, laziness, and fear. This opens the discussion to our country’s understanding of public health risk mitigation from communicable diseases in general. I have had many discussions about the flu vaccine and people’s reasons for not getting it annually. Regardless of the excuse for not getting vaccinated, what I hear in their responses is a lack of understanding of the science and why they should get vaccinated. That is a failing of our public health system to educate. Using the flu vaccine as an example, if you are not young, old, or immunocompromised and you get the flu, chances are you will feel miserable for a week or so, but you recover and are fine.

Why take the “risk” or inconvenience of getting the shot? The reason for the person who doesn’t get the flu shot, regardless of the excuse, is not about them or their personal freedoms. It is for the greater good and protection of the community. It is to protect the vulnerable in society. Think of those you may expose if you contract the virus. Your young children or older parents, those with weak immune systems due to other health conditions. Think of limiting the host opportunity for the virus to grow and mutate, which you provide by not getting vaccinated.

Think of someone other than yourself. I know that is not a popular mantra these days. I do see greater acceptance of people who choose to wear masks in public places. That is what I see and not much else. One of the reasons this current Ebola outbreak got as bad as it has seemingly out of nowhere is because, as a country, we defunded or eliminated the very agencies and organizations tasked with monitoring contagious diseases around the world and containing them. Every potential contagious health risk is only an airplane ride away from impacting us here at our home. So, we should be concerned about the next potential risk.

ICT: Recent headlines involving measles outbreaks, Ebola activity in Africa, and reported hantavirus cases have received significant media attention. How much do current outbreak events influence public risk perception, and what is the difference between a heightened awareness of risk and an accurate understanding of actual public health threats?

NG: There is a lot to unpack in this series of questions wrapped up as one. My opinion of the public’s risk perception based on current events is that, for the public at large, it is one of blissful ignorance. These are events happening to “others” and “over there” that are nothing more than small-talk conversations. A significant portion of the population does not trust information from the scientific community or government agencies responsible for public health.

Sadly, this provides the opportunity for pseudoscience and groupthink to muddy the water with misinformation and more distrust of mainstream, scientifically vetted messaging. The result is greater societal angst about not trusting any source or only trusting sources that align with their predisposed belief system and those with whom they associate or identify.

Please recognize that I am painting with a broad brush with my remarks. My perspective is formed by my experience working as a consultant across many industries during the COVID-19 pandemic, as well as my personal experience with past MERS Coronavirus and Ebola outbreaks. A true heightened awareness and accurate understanding are, in my mind, difficult to separate. Heightened awareness means knowing the risk exists, the mechanism of transmission, and what I need to do to protect myself.

Accurate understanding comes as an individual educates themselves about what the pathogens are, ie, gram-positive or gram-negative bacteria, enveloped or nonenveloped viruses, spores or endospores, fungi, parasites, or prions. How does the pathogen survive in the environment? What is the primary means of transmission? What disinfectant active ingredient is effective for killing or inactivating the pathogen, and what personal protection precautions are necessary? Bonus points if they understand log reduction and the proper application of the disinfectant to achieve the product's efficacy claims.

ICT: The survey also found substantial concern about environmental contamination and hidden damage to buildings following severe weather. From an infection prevention and environmental health perspective, how closely are these concerns connected, and what risks do organizations sometimes overlook when restoring buildings after flooding, water intrusion, or other disasters?

NG: There has been a lot of education and training within the disaster mitigation and repair industry over the last 30 years regarding structural drying, microbial growth, mitigation, and remediation. Reputable structural water damage mitigation and repair contractors use advanced tools like thermal imaging to identify potential hidden pockets of moisture or moisture intrusion. These moisture reservoirs, once identified, can be properly dried, and the conditions corrected.

The use of containment barriers, negative air pressure inside the contained workspace, and HEPA air scrubbing provides effective environmental controls to prevent cross-contamination of the unaffected areas within the built environment. Concerns about hidden contamination of the indoor built environment are reasonable and legitimate. However, they are less likely to be microbial than other unseen environmental hazards. These can include lead and asbestos in building materials and finishes.

External environmental contamination that enters the property, such as smog, industrial toxins, or wildfire smoke. Other events or activities can leave potentially hazardous exposure risks within the property, such as police actions, ie, tear gas, life events like hoarding, deaths, illegal drug use or production, each has nuances that are easy to miss by an inexperienced contractor. Whenever you are concerned about the health of the indoor built environment, it is critical that reputable professionals are retained and used in alignment with their areas of expertise. One should also consider third-party post-remediation validation of the work completed.

ICT: You helped author the ANSI/IICRC S410 Standard for Professional Cleaning of the Built Environment for Infection Prevention and Control. Where do you see the biggest gap between what the public assumes is happening to protect indoor environments and what organizations are actually doing to control contamination and infectious disease risks?

NG: Too often, janitorial service companies are performing cleaning tasks for which they are not properly trained. Part of professional training includes recognizing when a task is beyond your understanding of the associated risk and/or the skills required to perform it. Cleaning up blood may not seem like a big deal to someone who has never undergone training in bloodborne pathogens. It is easy for an untrained worker to fail to recognize a hazard to themselves or other occupants. They may not understand the risks associated with cross-contamination. They may not have the correct tools available, ie, an industrial HEPA vacuum, or know what active ingredient should be in their cleaning agent.

Facility hygiene is an umbrella term for keeping the building clean, in good repair, and operating safely for occupants. Are the heating, ventilation, and air conditioning systems being cleaned and maintained regularly? I have been in buildings where, comparing the indoor air quality to the air quality outside, I found that the quality (cleanliness) of the air coming out of the vents was 10 to 50 times worse than the outside air quality. This is an example of an environmental risk in which the particles are smaller than the human eye can see, yet potentially devastating to someone with a compromised immune system or respiratory disease.

ICT: Younger generations reported significantly higher levels of concern across multiple risk categories. What do you think is driving these generational differences, and how should health care facilities, schools, employers, and public venues respond to evolving expectations around infection prevention, environmental safety, and preparedness?

NG: I am not a social psychologist; however, I believe it is directly related to their shorter time on this planet and the compressed frame of reference they have compared to what they have lived through in their young lives. They experienced a worldwide pandemic and its consequences.

Old guys like me lived most of our lives in a world where we had eradicated measles, smallpox, and polio, had not experienced anything like COVID-19, and had a Laissez-Faire attitude about germs, “Exposure strengthens your immune system” world.

Many young people today live in close proximity in urban environments, where exposure risks and the potential for adverse outcomes are higher than in more rural areas. They are connected to the web and exposed to tidal waves of information, often conflicting information. The key is education and the reestablishment of trust in our scientific institutions and public health agencies. They are smart and frustrated by the lies and lack of transparency. I am counting on them with their questions and concerns to help drive the types of change necessary.