How Framing Distorts COVID-19 Risk

Reference Dependence

The way we appraise anything in our lives - the taste of food, the value of a car, or the risk we face from a disease - is often shaped by comparing and contrasting the matter of interest with alternative options, rather than through objective means. This psychological phenomenon is called “reference dependence.”

When appraising something like the flavor of ice cream, our judgments are typically relative rather than purely objective. Our perception of the flavor is influenced by comparisons to other flavors, past experiences, expectations, and the context in which we’re tasting the ice cream. For example, a person might perceive vanilla as less exciting if they recently had a rich chocolate flavor.

Marketers often exploit reference dependence by setting high initial prices for products (creating a reference point) and then offering discounts. The discount is perceived as a gain relative to the high reference price, making the offer more attractive. How then should we frame our opinions and personal risk assessments of contracting SARS-CoV-2?

Framing the Risk of COVID-19

Given the importance of first impressions in shaping our opinions on a topic, let’s examine the leading causes of death in 2020 to see how COVID-19 compares.

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From the initial view, we see that COVID-19 was the third leading cause of death in 2020. While significant, it doesn’t feel as alarming when compared to the much larger death toll from Cardiovascular Disease, which accounted for nearly double the deaths. This can lead one to believe there are worse problems than COVID-19 that deserve more attention and resources, like addressing the obesity epidemic instead of focusing on measures such as masking, contact tracing, and quarantining.

But is this a fair comparison?

Comparing Apples to Apples

Cardiovascular Disease isn’t a single disease; it’s a category that encompasses many different conditions. The same is true for Cancer. These umbrella terms include various diseases affecting different organs, with distinct prognoses and treatments. COVID-19, however, is one specific disease. In essence, we’re comparing a singular disease to categories composed of many distinct conditions.

To accurately assess the true impact of COVID-19, we need an apples-to-apples comparison between causes of death.

As we shift to a more detailed breakdown, we see that, in proportion to other specific diseases, COVID-19 accounts for a much higher percentage of deaths. Even though the absolute number of deaths remains the same, the framing of this data changes our perception of the disease’s severity.

Another crucial point is that prior COVID-19 infection is now recognized as a significant risk factor for developing heart problems. This suggests that a notable portion of those who have died from Cardiovascular Disease may not have developed these issues had they not been infected with SARS-CoV-2. In such cases, these deaths might be better understood as consequences of COVID-19.

Moreover, unlike Cardiovascular Disease or Cancer, COVID-19 is contagious. Efforts to protect individuals from COVID-19 also help safeguard entire communities, making its management even more critical.

The Dangers of Misleading Framing

While death is an important metric, it is far from the only one that should shape our understanding of the pandemic’s dangers. Focusing solely on mortality rates risks overlooking the extensive long-term health impacts COVID-19 has inflicted on millions of people. This includes chronic disabilities, lingering symptoms, and an increased risk of developing other serious conditions like Heart Disease.

Just as marketers exploit reference dependence to make us believe we’re getting a good deal while they profit, the way causes of death are framed can mislead us into thinking that COVID-19 is less dangerous than it truly is.

Methodology

Base mortality numbers come from the 2020 CDC mortality report. Cardiovascular Disease deaths come from table 14-2 and 14-4 from the AHA. Cancer deaths come from the American Cancer Society Cancer Facts & Figures 2020 report.