Nikolaos Sapoutzis^1,2, Laura Corazza², Marjo Wijnen-Meijer^{2 *}

¹Public Health Department Hochtaunuskreis, Bad Homburg vor der Höhe, Germany
²Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany

*Corresponding Author: Marjo Wijnen-Meijer, Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany

Abstract
Covid-19 is an unpredictable event, defined as a public health crisis, and has a potentially catastrophic effect on the health status of the population. Through crisis management, governments seek to minimize negative consequences, while responding quickly and with high quality. It is a dynamic decision-making process with three phases to respond to a crisis: the pre-crisis phase, the crisis phase, and the post-crisis phase. During the Covid 19 crisis, the health care system was hit the hardest. Especially due to the increase in infections, the burden on the health system increased and the health care system was in danger of failing. By analyzing the first two phases of crisis management - the phase of prevention and preparation and the phase of response to the crisis - in different countries, it is clear that communication with stakeholders and the population is crucial for people's behavior during the crisis. Communication may cause people to panic and lead to further infections, or they can make informed decisions about their health-protective behavior and therefore accept restrictions on their privacy to escape restrictive bans. The post-crisis phase is of central importance, to learn from the crisis and to protect public health in the future. In this context, it is necessary to reflect on the way the population receives information and the communication strategies of governments. It could be seen as an opportunity for public health organizations to improve crisis management tools and roadmaps.

What is crisis management?
Crisis management is being defined as “a set of factors designed to combat crises and to lessen the actual damage inflicted by a crisis” [11]. Crisis management does not mean preventing crises, but minimizing negative consequences, responding quickly and with high quality, and being prepared for crises of all kinds [12]. Based on the literature on emergency preparedness, crisis management consists of four interrelated factors: Prevention, Preparation, Response, and Revision [11]. These factors are incorporated into a widely used approach in which crisis management involves three phases, to make the crisis management process a dynamic decision-making process [5,7,11]. The goal of this is to develop resilience to (future) crises [13]. Phase one is the pre-crisis phase, it consists of prevention and preparation for the upcoming crisis. Here, it is necessary to know the cause and how to strategically manage and prevent it tactically [5,11,14]. The second phase is the crisis phase, the response to the crisis. The last phase is the post-crisis phase it consists of recovery and rehabilitation [5,11].

The crisis managers in public health crises are the governments of each country [9].

How was crisis management handled during Covid-19?
Currently, the emergence and rapid global spread of the Covid-19 virus (SARS-CoV-2) is causing a worldwide crisis with health, economic, political, and social consequences [15]. Due to exponentially increasing patient numbers, the pandemic poses an unprecedented challenge to countries' healthcare systems [16]. Their countries' crisis management shows if they can handle the additional public health challenges [10, 16].

During a public health crisis, crisis management includes five factors to overcome a disaster. "(1) Disclosure of information about the cause; (2) Assessment of hazards and threats; (3) Establishment of information channels; (4) Creation and implementation of strategic crisis action plans; (5) Mobilization of critical resources" [17]. These factors are strongly focused on communication and have critical importance during the pre-crisis phase and preparation for the subsequent crisis phase [17,18]. The key component for success in dealing with a crisis is inter-and intra-organizational communication, networking among all stakeholders and with the population [14,19]. Especially during health crises, the population needs quality information to understand the decisions made by the government. So that they can make informed decisions about their health-protective behavior [4,7,20]. The example of China illustrates the impact of inadequate communication with the public and neglect of the five factors of crisis management. At the beginning of the Covid-19 outbreak, the Chinese government did not adequately inform its own population and the world about infectious diseases. Because of their strong media control, officials were late and slow in responding to the outbreaks, which led to panic among its own population, and more people got infected [17,18].

In phase two of crisis management, the crisis phase, measures restricting public life have been introduced worldwide to combat the Covid-19 pandemic. These measures are designed to prevent the overload or collapse of health care systems [9]. These include wearing face masks, adhering to social distancing, widespread testing, diagnostic capacity, contact tracing, mandatory quarantine, and partial border closures [9,16,21]. Using South Korea as an example, it is possible to see the importance of communication in crisis management. The government took a reactive crisis management approach. Instead of restrictive bans, the economy and borders remained open [16]. Instead, they used digital surveillance technologies to track contacts. These technologies were an invasion of citizens' privacy, which the population in South Korea tolerated because they were very well informed by the Center for Disease Control [16].

Especially during public health crises, the public needs a lot of information [4,19,22]. This is a major challenge for public health agencies and policymakers because little information is available about emerging diseases and the public cannot be fully informed [1,4]. Information that is difficult to access, contradictory, or ambiguous leads the public to have an elevated perception of a hazard [4,20,23]. This creates differences in media portrayal and crisis reality [7]. During the Covid-19 pandemic, it caused a stress reaction of the population, behavior emerged which was not recommended as a reaction to the actual danger, such as panic buying of consumer goods like toilet paper, water bottles, or hand sanitizers [20]. This highlights the importance of journalists and the need to meaningfully integrate them into the government's crisis communication system [7].

Outlook for communication crisis management
The population obtains information through a variety of formal and informal sources, including the Internet, newspaper, family, friends, colleagues, and social media [4,19,22]. In this context, excessive media exposure can have an impact on physical health, for example, leading to increased distress, stress, or worry [20]. Another major challenge in the crisis communication system is social media platforms and thus the transmission of misinformation [4,23,24]. Based on experience during the Ebola outbreak, Carney and Weber stress the importance of "public health intelligence" to ensure that all stakeholders are well informed and do not have to depend on hard-to-control news sources, such as social media [25]. It is necessary to correct misinformation; therefore, the credibility of the source is crucial. Influential sources of information include government health agencies, news media, and social peers. Social peers are peers or peer groups in the population who share more accurate information [24]. Urgent information should be communicated in real-time, especially during a crisis, to avoid speculation and misinformation [20].

Public health will continue to be threatened by infectious diseases. In addition, crises in contemporary societies are more difficult to manage due to globalization and the availability of many different information sources. Therefore, the third phase of crisis management, the post-crisis phase, takes central importance [6,11,26]. This involves reflecting on how the current pandemic was handled in the pre-crisis and crisis phases to better protect public health in the future. By evaluating the crisis communication strategy, organizational changes should be done to avoid risk amplification and the sharing of misinformation in the future.

Conclusion
As in any crisis, communication with different stakeholders, such as policymakers, the population, and health care workers, is crucial. In the post-crisis phase, an evaluation should be made of how this turned out so that lessons can be learned for a future crisis. Questions that can be asked are: were all those involved (e.g., different population groups) informed adequately and timely, which channels worked well for which group and which ones not so well, to what extent is the Sendai Framework for Disaster Risk Reduction form the United Nations applied? Since this crisis affected all countries, it would be very valuable to compare different strategies and their effects. All countries should enhance preparedness and be able to respond to the next public health crisis. “A threat anywhere is a threat everywhere,” therefore international collaborations and communications should be improved in order to address disasters that can expand globally [26]. This pandemic can be used as an opportunity to improve crisis management tools and roadmaps for public health organizations.

References

1. Quinn J, Zelený T, Subramaniam R, Bencko V (2017) Public Health Crisis in War and Conflict-Health Security in Aggregate. International Journal of Human–Computer Interaction. 25(1): 72.
2. World Health Organization, Regional Office for Europe (2012) Toolkit for assessing health-system capacity for crisis management. Strengthening health-system emergency preparedness. World Health Organization Regional Office for Europe, Copenhagen.
3. Coombs WT (2014) Ongoing Crisis Communication. Planning, Managing, and Responding. SAGE Publications.
4. Gui X, Kou Y, Pine KH, Chen Y (2017) Managing Uncertainty. In: Mark G, Fussell S, Lampe C, schraefel m, Hourcade JP, Appert C, Wigdor D (eds) Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems. ACM, New York, NY, USA, pp 4520–4533.
5. Burkle FM (2019) Challenges of Global Public Health Emergencies: Development of a Health-Crisis Management Framework. The Tohoku journal of experimental medicine. 249(1): 33–41.
6. Lalonde C (2007) Crisis management and organizational development: Towards the conception of a learning model in crisis management. Organization Development Journal. 25(1): 17.
7. Pan PL, Meng J (2016) Media Frames across Stages of Health Crisis: A Crisis Management Approach to News Coverage of Flu Pandemic. J Contingencies & Crisis Man. 24(2): 95–106.
8. United Nations Office for Disaster Risk Reduction (2015) Sendai Framework for Disaster Risk Reduction 2015 – 2030.
9. Steier J, Moxham J (2020) The load and capacity model of healthcare delivery: considerations for the crisis management of the COVID-19 pandemic. Journal of thoracic disease. 12(6): 3022–3030.
10. Bayntun C, Rockenschaub G, Murray V (2012) Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. 4: e5028b6037259a.
11. Coombs WT, Laufer D (2018) Global Crisis Management – Current Research and Future Directions. Journal of International Management. 24(3): 199–203.
12. Sahin S, Ulubeyli S, Kazaza A (2015) Innovative Crisis Management in Construction: Approaches and the Process. Procedia - Social and Behavioral Sciences. 195: 2298–2305.
13. Williams TA, Gruber DA, Sutcliffe KM, Shepherd DA, Zhao EY (2017) Organizational Response to Adversity: Fusing Crisis Management and Resilience Research Streams. ANNALS. 11(2): 733–769.
14. Taneja S, Pryor MG, Sewell S, Recuero AM (2014) Strategic crisis management: A basis for renewal and crisis prevention. Journal of Management Policy and Practice.15(1): 78.
15. Hartley DM, Perencevich EN (2020) Public Health Interventions for COVID-19: Emerging Evidence and Implications for an Evolving Public Health Crisis. JAMA. 323(19): 1908–1909.
16. Choi H, Cho W, Kim M-H, Hur J-Y (2020) Public Health Emergency and Crisis Management: Case Study of SARS-CoV-2 Outbreak. International journal of environmental research and public health 17(11): 3984.
17. Shangguan Z, Wang MY, Sun W (2020) What Caused the Outbreak of COVID-19 in China: From the Perspective of Crisis Management. International journal of environmental research and public health. 17(9): 3279.
18. Zhang J, Zhang R (2020) COVID-19 in China: Power, Transparency and Governance in Public Health Crisis. Healthcare (Basel, Switzerland. 8(3): 288.
19. Reuter C, Hughes AL, Kaufhold MA (2018) Social Media in Crisis Management: An Evaluation and Analysis of Crisis Informatics Research. International Journal of Human–Computer Interaction. 34(4): 280–294.
20. Garfin DR, Silver RC, Holman EA (2020) The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure. Health psychology. 39(5): 355– 357.
21. Neupane HC, Shrestha N, Adhikari S, Gauli B (2020) COVID 19 and Nepal: Identification of Critical Public Health Measures. JNMA; journal of the Nepal Medical Association. 58(225): 355– 359.
22. Palen L, Anderson KM (2016) Crisis informatics—New data for extraordinary times. Science. 353(6296): 224–225.
23. Vijaykumar S, Jin Y, Nowak GJ (2015) social media and the Virality of Risk: The Risk Amplification through Media Spread (RAMS) Model. Journal of Homeland Security and Emergency Management. 12(3): 653–677.
24. van der Meer TG, Jin Y (2020) Seeking formula for misinformation treatment in public health crises: The effects of corrective information type and source. Health Communication. 35(5): 560–575.
25. Carney TJ, Weber DJ (2015) Public Health Intelligence: Learning from the Ebola Crisis. American journal of public health. 105(9): 1740–1744.
26. Gao GF (2019) For a better world: Biosafety strategies to protect global health. Biosafety and health. 1(1): 1–3.