Communicating Prevention in the COVID-19 Epidemic : Case Study on Macau SAR


 Background As the COVID-19 epidemic is unfolding, an infodemic has also developed. With commonplace social media usage, a massive amount of information and misinformation is spreading at the same time. Irrational responses are reported worldwide – face mask and detergent shortages, panic shopping, and xenophobia, which could possibly be a result of ineffective science communication. Using Macau SAR for a case study, this article sets out to understand effective prevention communication. Methods An observation study was conducted to understand Macau’s prevention communication in the COVID-19 epidemic. Results Macau has imposed a wide range of preventions, covering most dimensions of daily life. Lessons are learned in risk perception, language used, science communication, digital literacy, information flow, and support in STEM advancement. Conclusions Macau’s prevention communication is not perfect, but Macau’s experience offers insights to European authorities on how to contain the epidemic and minimize undesirable outcomes as the epidemic is just beginning in Europe.


Preventive Measures
The preventive measures taken against the COVID-19 epidemic so far are provided in Table 1. Be noted that these measures are not announced and imposed all at once on the same day. Rather, these are accumulated actions which are deemed necessary at the time according to the development of the epidemic. They are likely to change in the near future. Public Services • Limited hours are imposed for non-essential public services and the opening hours are announced on public institutions' websites and various social media channels. The public is granted grace period for certain obligatory processes. Most public services are resumed to provide only basic services on February 17, 2020.
Citizens are advised to make appointments online prior to visiting locations of public services. Normal operations are to resume on March 2, 2020.
• Most public facilities, such as swimming pools, libraries, and museums, are closed. Parks have been reopened for limited hours. Some sport facilities are set to reopen on March 2, 2020.
• Persons entering public institutions or facilities have to submit a health declaration whose form is available online on the Coordination Centre's website and Facebook page.
• The Fire Bureau has cancelled leaves to support rst response. • A pop-up noti cation is shown on most government department's website to remind viewers to cooperate and take preventions seriously (Fig. 1).

Education
• All levels of education are suspended until further notice. Resumption of school will be announced two weeks prior. Non-higher education may resume during late April, according to the Education and Youth Bureau [17].  [20].
• A man who committed fraud in face mask sales on social media was charged for criminal violations on February 27, 2020 [21].

Tourism
Macau citizens who are in highly affected area have been in contact with the Macau Government Tourism O ce. Some of them asked for evacuation aid. However, whether how or when they will be evacuation by the Macau government is still undetermined at the moment as coordination for movement involves authorities from different jurisdictions.
Public Inquiry A hotline is set up for residents to inquire information about the epidemic and advice for actions. The number and types of inquiry received each day are disclosed the next day on the Coordination Centre's website, Information Bureau's website, and various social media channels.
Community Announcement • The community announcement system is activated on February 6, 2020 to broadcast daily reminders of preventive measures every two hours from 10 am to 8 pm. There was a glitch in some of the systems that announcements were falsely broadcasted at the sleeping hours of February 11, 2020. This has been recti ed after complaints were received.
• Vehicles with portable speakers cruise the streets to remind the public to avoid nonessential outings.

Area of Concern Preventive Measures
Debunking Misinformation • Myths, rumours, and misinformation are debunked to prevent irrational responses. A section is dedicated to debunking misinformation on the website of the Coordination Centre's website.
• On February 14, 2020, the Coordination Centre clari ed a rumour which claims that the Health Bureau "has imported face masks infested with lice. As a result, the contracted pharmacies have to unbox the masks and repack them in storage bags for sales". The Coordination Centre responded that "the Health Bureau did not import any masks from the concerned brand. The face masks are packed in tens instead of in a box for sales. Rigorous inspection is imposed on the masks and they meet protection speci cations and health standard" [22].
• On February 8, 2020, to debunk a rumour circulated on the social media channel Wechat which claims that "a high amount of chlorine is added to tap water for sterilization. Tap water should be set aside for at least two hours prior to drinking or cooking.", Macao Water Supply Company responded that "residue chlorine concentration is strictly monitored and water is sampled daily at several points for water analysis to assure that standard of drinking water. There is no need to set aside tap water prior to using" on its Facebook Page [23].

Discussion
As no more cases have been con rmed since February 4, 2020, Macau's preventive measures should be considered adequate, but its prevention communication is not without aws. Lessons learned from Macau's prevention communication are discussed in this section.

Risk Perception
The preventive measures cover a wide range of daily life. Some of the measures seem to be draconian at rst glance, but they are not unfounded; they are all stemmed from the purpose of limiting crowds, thereby reducing the possibility of community outbreak. Considering that no community outbreak has happened in Macau, it is su ce to state that these measures are indeed collectively effective.
Most of these measures were imposed prior to Lunar New Year, which is a signi cant traditional festival in Chinese culture. Most citizens seem to have complied to the advised actions and avoided gathering during Lunar New Year. This could be explained by that the perceived high risks from the imminent danger outweighed the bene ts from festivities. The public's perception of risks is probably cultivated from the constant massive information feed from social media which is a phenomenon that was not experienced in the SARS epidemic.
On the other hand, when we compare the possible consequences of the climate crisis to that of the COVID-19 epidemic, the scale of damage of the former is much greater and long-lasting. Logically, we should have had plans in place to mitigate and adapt to rising sea levels as Macau is at a quite vulnerable location. Nonetheless, the government and citizens of Macau have not taken proactive climate actions which is ironic since Macau has already been a icted by super typhoons, storm surges, and oods caused by climate change. What could partially explain this is also risk perception. If a threat is not perceived as immediate and close to oneself, it is challenging to urge actions. By then, we will have to develop strategies to communicate the consequences of inaction and make the public care enough to drive actions. Yet, risk communication is on the delicate balance of generating rational action and mongering fear and should be performed with deliberation.

Language
As the number of non-Cantonese-speaking workers and immigrants (e.g. from China, the Philippines, Portugal) is growing in Macau, it is necessary to communicate preventive measures in these languages for adequate outreach. Although the Coordination Centre now disseminates information in Cantonese, Mandarin, Portuguese, English, and Chinese sign language through a variety of media including broadcast, print, display, and social media, most of the press releases, updates, and reports are still only in Chinese and Portuguese and staff at public services and facilities primarily communicate to the public in Cantonese. Some of the population groups could be, as a result, excluded form crucial information and act uninformed, imposing danger on themselves and others unintentionally and unknowingly. Prevention communication, therefore, requires consideration of the demographic composition.

Lack of Science Communicators
Science communication is the dissemination of science-related knowledge and information to the general public. There are many types and formats of science communication and of course science communicators also come in many different varieties. They usually have a background in STEM and could be public engagement and public relations o cers in research institute, lecturers, museum curators, comedians, and science slammers, etc. Generally, science journalists are also considered as a type of science communicators because they convert complex science-related knowledge to reporting that is digestible by the public. Good science communication can help the public understand complex issues better and act rationally. With a de ned target audience, good science communication can reach out and convey crucial information to them while also listening to their concerns.
However, science communication is still an emerging eld in Macau, so science communicators are low in supply or they are simply not o cially regarded as science communicators. Macau should, therefore, allocate more resources in science communication and training programmes for science communicators.
This could not only lay a foundation for better prevention and risk communication, but also nurture a rational society with a culture of science.

Digital Literacy and Exclusion
As internet connection and access to social media is commonplace in Macau, digital seems to be the optimal way to disseminate prevention information and updates of the epidemic. However, the use of this channel assumes that most people have acquired a decent level of digital literacy. The assumption may be true, but a group of people is excluded from important information. Traditional media should hence still be used to reach those who do not have access to internet or a basic level of digital literacy. Community announcement system and broadcast vehicles could be deployed to compensate the shortcomings of online dissemination as well, just as Macau have been doing (Figs. 3 and 4). A hotline for public inquiry is another more accessible way for clarifying the public's doubts and intaking public opinions. Digitization is inevitable; to create an inclusive digital environment, user interface and user experience should be a high priority. Digital literacy programmes should also be provided at the same time to close the digital divide. International Federation of Library Associations and Institutions' (IFLA) guidelines on public internet access in libraries could be a reference for action [27].

Too Much or Too Little Information?
There is an infodemic in the midst of the COVID-19 epidemic. The common use of social media could be a factor for this phenomenon. As not much is known about SARS-CoV-2, people are desperate to know more and tend to grasp on whatever information that is available to them. The same information, be that facts, speculations, myths, or rumours, is being circulated continually on social media and fed constantly to its viewers. This could generate a false consensus effect which is an attributional type of cognitive bias where one overestimates how many people agree with a certain matter. People then may potentially act or react based on the misinformation which they believe to be facts agreed by many.
Fortunately, Macau has not experienced major mass irrational responses, except the two instances where people did panic shopping for groceries and emptied many shelves of supermarkets. To assure residents that supply will be stable, the Macau government performs daily inspection and survey to report prices and inventory of different items. There have not been any panic shopping reported ever since. In this case, we can see that that particular irrational behaviour stemmed from the lack of information. Offering facts can diminish anxiety and irrational behaviours, but a better and more proactive way to counter misinformation is to make science communication a regular activity, which is explained previously.

Supporting STEM Advancement
Macau is more well-known for tourism and its infamous gaming industry. STEM (science, technology, engineering, mathematics) advances are rarely associated with Macau; or they are not commonly celebrated. Exceptions include the discovery of a new species Nanhaipotamon macau in 2018 [28]

Conclusions
Macau's fast responses to the COVID-19 epidemic offer insights into how to contain an epidemic and prevent mass panic. Its prevention communication is not perfect, but the lessons learned show us how to do better if we are to encounter similar scenarios in the future. As the epidemic is just beginning in Europe, European authorities should take notes from the experience of Macau so as to minimize undesirable outcomes.