Words matter. If officials want people to buy into lifestyle changes, they need to use more inviting terminology say Joanne Silberner and Howard Frumkin

Staying home. Not hugging or touching friends or lovers. Closing businesses, avoiding recreational facilities, shutting down schools. It takes real commitment to slow the coronavirus pandemic. 

But across the English-speaking world, some of the language deployed in the fight against covid-19 is more daunting than motivational. Some changes in terminology might expedite the needed changes in behaviour. Call it covid-19’s metamorphoses.  

Here are our candidates:

Social distancing: The biggest problem with social distancing is that it’s dangerous. Lonely people are more prone to heart disease, depression, and other maladies¹ Loneliness undermines immune function.² Without social contacts, older people are at risk of cognitive loss.³ Lonely people die sooner.⁴ Where social bonds are strong, people are more physically active, less obese, and less depressed.⁵ After all, we’re social creatures. People know this, and across the world, they’re connecting with friends, neighbours, and loved ones through phone calls, video conferences, on-line group activities, even singing out the window. So let’s drop the term social distancing, when what we really mean is physical distancing.

Essential workers: We need doctors and nurses, first responders, hospital cleaners, delivery drivers, grocery store staff, and agricultural workers to keep working so the rest of us can safely cocoon. They are doing so, often heroically. (They are to be distinguished from the Easter bunny, named an essential worker over Easter weekend by the governor of the state of Maine.)

But the term “essential worker” implies that everybody else is inconsequential. Teachers, construction workers, artists, IT staffers, grandparents, restaurant servers, journalists, and homemakers—to name just a few—are essential to a functioning society. So let’s call the people we need to be on the job right now lifeline workers, reflecting the immediacy of their work, avoiding ugly implications about who is essential and who is not.

Essential businesses: In the US, the definition of “essential businesses” rests with individual states. The Arizona governor at first allowed hair and nail salons to open, but later reversed that decision, leaving some state residents wondering if their leaders knew what they were doing. In late March, the Trump administration advised states that gun stores represent “essential critical infrastructure” and should remain open, a widely criticised move. The state of Washington includes liquor stores and recreational marijuana stores on its list. Whether such stores should be open is a matter of public health debate, but calling them “essential businesses” may be going a bit too far. The World Health Organization in early April advised governments to restrict access to alcohol during the pandemic, noting that that alcohol consumption at this time “can exacerbate health vulnerability, risk-taking behaviours, mental health issues and violence” (and clarifying, for those in doubt, that drinking will not destroy the virus). 

In the interest of accuracy, and to shed unnecessary baggage, how about just specifying businesses allowed to stay open.

Lockdown: Yes, we have to stay home, and yes, lots of businesses have to shutter. But do we have to use the language of a penitentiary?  The UK announced restrictions on leaving home, public gatherings, and other activities in late March. In the US such restrictions are determined by individual states. In both nations, compliance is generally voluntary, and police enforcement is generally proportionate.

But from Kenya to Paraguay, from India to Liberia, police and soldiers have reportedly humiliated, beaten, and even shot people thought to be violating covid-19-related restrictions on movement (for example, here, here and here).  These are “lockdowns” complete with excessive state violence. 

The word lockdown is not a welcoming one. “Shelter in place” is far more engaging—after all, everybody craves shelter in a storm—but in the US, sadly, that term connotes what schools and businesses have to do when an active shooter shows up. How about telling people to keep “safe at home” rather than announce the imposition of a lockdown?

Language that is unclear—or worse, that conveys inadvertent and counterproductive meanings—undermines public discourse.⁶ This is as true in public health as anywhere; successful behaviour change efforts, like those crucial to defeating covid-19, depend in part on accurate and compelling language.^7-9

At times like these, we need solidarity, generosity, courage, and patience. Health professionals, the press, and political leaders can help propel these attitudes and behaviours by choosing our words carefully

Joanne Silberner is a features editor at The BMJ and a freelance journalist in Boston, USA.

Howard Frumkin is professor emeritus and former Dean at the University of Washington School of Public Health, and former director of the National Center for Environmental Health at the US Centers for Disease Control and Prevention. 

Competing interests: None declared

References:

1. Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public health. 2017;152:157-71.
2. Jaremka LM, Fagundes CP, Peng J, Bennett JM, Glaser R, Malarkey WB, et al. Loneliness promotes inflammation during acute stress. Psychological science. 2013;24(7):1089-97.
3. Bassuk SS, Glass TA, Berkman LF. Social Disengagement and Incident Cognitive Decline in Community-Dwelling Elderly Persons. Annals of internal medicine. 1999;131(3):165-73.
4. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS medicine. 2010;7(7):e1000316.
5. Pérez E, Braën C, Boyer G, Mercille G, Rehany É, Deslauriers V, et al. Neighbourhood community life and health: A systematic review of reviews. Health & place. 2019:102238.
6. Orwell G. Politics and the English language. Horizon. 1946:252-65.
7. Randolph W, Viswanath K. Lessons Learned from Public Health Mass Media Campaigns: Marketing Health in a Crowded Media World. Annual review of public health. 2004;25(1):419-37.
8. Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet (London, England). 2010;376(9748):1261-71.
9. Parvanta C, Nelson dE, Parvanta SA, Harner RN, editors. Essentials of Public Heatlh Communication. Burlington, MA: Jones & Bartlett 2010.