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Visual representations of SARS‐CoV ‐2, emotions, and risk perception of COVID ‐19

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Abstract

Background and aims: Before COVID-19 was declared a global pandemic, the U.S. Centers for Disease Control and Prevention (CDC), the National Institute of Allergy and Infectious Diseases (NIAID), and many other organizations published many images of its pathogen (namely SARS-CoV-2) to raise public awareness of the disease. Despite their scientific and aesthetic values, such images may convey metaphoric meanings and cause a subsequent impact on viewers' fear and disgust. This study investigated how exposure to the SARS-CoV-2 images might shape viewers' fear, disgust, and risk perception of COVID-19. Methods: Seventy images depicting the SARS-CoV-2 were collected from the websites of CDC, NIAID, and third-party organizations in early 2020. We first showed the images to a group of 492 adults recruited from the Amazon Mechanical Turk (MTurk) and asked them to rate their levels of fear and disgust for each image. Results of this pre-test allowed us to identify images that evoked high, medium, and low levels of fear and disgust, which were then used as treatment stimuli for an online experiment with a national sample of 500 U.S. adults. Results: Exposure to the selected SARS-CoV-2 images caused different levels of disgust, but not fear, among the members of the national sample. Noticeably, the images evoking the highest level of disgust backfired among those who were least concerned about COVID and caused less fear than images evoking the lowest level of disgust. Image exposure was not associated with risk perception of the disease. Conclusion: This study found that the seemingly objective visualizations of the SARS-CoV-2 are not emotionally neutral. Scientists, agencies, and media professionals should be mindful of the potential emotional impact of science visualizations, such as when creating the iconic image for COVID-19 or other infectious diseases.
RESEARCH ARTICLE
Visual representations of SARS-CoV-2, emotions, and risk
perception of COVID-19
Nan Li | Amanda L. Molder | Shiyu Yang
Department of Life Sciences Communication,
University of Wisconsin-Madison College of
Agricultural and Life Sciences, Madison,
Wisconsin, USA
Correspondence
Nan Li, Department of Life Sciences
Communication, University of Wisconsin-
Madison College of Agricultural and Life
Sciences, Hiram Smith Hall, 1545 Observatory
Drive, Madison, WI 53706, USA.
Email: nli8@wisc.edu
Abstract
Background and Aims: Before COVID-19 was declared a global pandemic, the
U.S. Centers for Disease Control and Prevention (CDC), the National Institute of
Allergy and Infectious Diseases (NIAID), and many other organizations published
many images of its pathogen (namely SARS-CoV-2) to raise public awareness of the
disease. Despite their scientific and aesthetic values, such images may convey meta-
phoric meanings and cause a subsequent impact on viewers' fear and disgust. This
study investigated how exposure to the SARS-CoV-2 images might shape viewers'
fear, disgust, and risk perception of COVID-19.
Methods: Seventy images depicting the SARS-CoV-2 were collected from the
websites of CDC, NIAID, and third-party organizations in early 2020. We first
showed the images to a group of 492 adults recruited from the Amazon
Mechanical Turk (MTurk) and asked them to rate their levels of fear and disgust
for each image. Results of this pre-test allowed us to identify images that
evoked high, medium, and low levels of fear and disgust, which were then used
as treatment stimuli for an online experiment with a national sample of
500 U.S. adults.
Results: Exposure to the selected SARS-CoV-2 images caused different levels of
disgust, but not fear, among the members of the national sample. Noticeably, the
images evoking the highest level of disgust backfired among those who were
least concerned about COVID and caused less fear than images evoking the low-
est level of disgust. Image exposure was not associated with risk perception of
the disease.
Conclusion: This study found that the seemingly objective visualizations of the
SARS-CoV-2 are not emotionally neutral. Scientists, agencies, and media profes-
sionals should be mindful of the potential emotional impact of science visualiza-
tions, such as when creating the iconic image for COVID-19 or other infectious
diseases.
KEYWORDS
COVID-19, emotions, infectious diseases, public understanding, science visualizations
Received: 12 April 2021 Revised: 29 September 2021 Accepted: 18 October 2021
DOI: 10.1002/hsr2.496
&C?JRFѥ1AGCLACѥ0CNMPRQ
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited and is not used for commercial purposes.
© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.
Health Sci Rep. 2022;5:e496. wileyonlinelibrary.com/journal/hsr2 1of7
https://doi.org/10.1002/hsr2.496
1|INTRODUCTION
Before COVID-19 was declared a global pandemic in March 2020, the
CDC and NIAID published a series of publicly accessible pictures
depicting the pathogen that causes the disease, named Severe Acute
Respiratory Syndrome coronavirus 2 (SARS-CoV-2). These SARS-
CoV-2 images were quickly adopted by various forms of media and
frequently appeared in public education materials. The Emergency
Operations Center of the CDC tasked its visual information specialists
to illustrate an image of the virus shortly after initial cases were identi-
fied.
1
This illustrative image gave the virus a detailed, solo close-up
shot and was meant to convey the immediacy and claritythat the
public craved at the beginning of the crisis.
2
The red and gray spiky
ball,as it was colloquially known, had become one of the most identi-
fiable icons that visually defined the pandemic in the United States.
Later, the NIAID posted more than 100 of SARS-CoV-2 images
on its Flickr account for public consumption. These images were pro-
duced by the Rocky Mountain Laboratories using the scanning elec-
tron microscopes (SEM) and transmission electron microscopes
(TEM).
3
While SEM images show how the new coronavirus emerges
from the surface of human cells, the TEM images produce cross-
sections of its inner structure. Differing from the CDC's spiky ball
image, these images do not reveal the ultrastructural morphology
exhibited by the coronavirus but display what scientists can observe
in their labs. Alongside their aesthetic and scientific values, these
images also serve as prominent visual cues for the virus and
frequently appear on mass media and other popular outlets.
The visual representations of the SARS-CoV-2 not only show what
the virus may looklike, but also convey metaphoric meanings that
can subsequently evoke negative emotions, such as disgust and fear.
Disgust is a unique emotion that initially evolved as an effective mecha-
nism for orally rejecting harmful substances.
4
In a similar vein, fear,
which is an intervening variable between sets of context-dependent
stimuli and suites of behavioral response,helps humans avoid or cope
with threat.
5
Both emotions present evolutionary significance in
protecting human beings from exposure to infectious disease.
4,6
In centuries past, lethal infectious diseases were often visually
portrayed as metaphoric figures (eg, grim reaper, hunting ghosts) that
instill a sense of the supernatural and terrifying.
7
Such metaphoric
images function as visual bitesthat signal the presence of a pre-
packaged unit of thought.
8
For example, although the spiky ball
image and similar renditions portray the virus as lifeless, to some, they
look like menacing alien machinesthat can be perceived as artificial
and invasive.
9
Similarly, many TEM and SEM images display grouped
circles and cluttered dots that resemble other pathogens, such as bac-
teria and fungus. Images displaying irregular 3D shapes can remind
viewers of visually similar threats, such as tumors or cancer cells. As a
result, individuals may transmit negative impressions of the source
threats, such as harmful, infectious, and intrusive to the SARS-CoV-2
and hence perceive high levels of fear and disgust.
10
Furthermore, the presence of obnoxious colors and visual patterns
can heighten the potential emotional effects of metaphoric meanings.
Decades of research showed that colors are frequently associated with
emotions of various valence and strength.
11,12
The effects of color on
emotions are primarily caused by hue and can be explained by the
color-meaning associations.
13
For example, viewers may associate the
combined use of yellow and green in some SARS-CoV-2 images with
vomit and therefore develop feelings of sickness and disgust.
13
What is
more, the other color dimensions, including saturation and brightness,
can interact with hue to shape viewers' emotions.
14
For example,
although red and green usually evoke stronger and more positive feel-
ings than blue, the reverse is true when the colors are highly
saturated.
14
That explains why many SARS-CoV-2 images with pre-
dominately lowly saturated and dull colors appear to be more dreadful
and less pleasant than those with highly saturated and bright colors.
Noticeably, images with high-contrast energy at low spatial fre-
quencies, such as holes or repetitive patterns, can trigger disgust and
even induce trypophobia, which is an aversion to the sight of irregular
patterns or clusters of small holes.
15
Such visually intense patterns
may even cause fear when being used in combination with bright and
highly saturated coloration (eg, snakes with expressive scales).
16
Many
SEM images display clutters of dotted viruses, while the TEM images
show groups of crown-shaped circles. These images often use bright,
saturated colors to portray the virus while using muted, dull colors to
de-emphasize the background. Although the contrast helps create
visual hierarchy and enhances the visibility of portrayed viruses, it
may elicit fear and disgust because of the visual intensity of the
patterns.
Given these considerations, we hypothesized that the SARS-
CoV-2 images of various visual appearance will influence people's fear
and disgust toward the pathogen. Furthermore, we wondered if expo-
sure to the images that elicited high levels of fear and disgust would
polarize viewers' emotions, such that those who feel very negatively
about COVID-19 would perceive significantly more fear and disgust
when viewing these images than those who feel less negative. In addi-
tion, given the inherent relationship between negative emotions and
risk perception,
17-20
we hypothesized that exposure to images that
elicit the highest level of fear and disgust will cause a significantly
higher level of risk perception than exposure to the images that evoke
the lowest level of fear and disgust. We examined these hypotheses
in the following study.
2|METHODS
The goals of this study were to (a) identify the existing SARS-CoV-2
images that can trigger different levels of fear and disgust and
(b) examine how such images may influence a national sample of
U.S. adults' emotional response to COVID-19 and their risk perception
of the disease.
2.1 |Experimental stimuli
To achieve these goals, we first searched and collected all SARS-
CoV-2 images available via the CDC's Public Health Image Library
21
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and the NIAID's Flickr page.
22
In addition, we visited the Association
of Medical Illustrator's website and collected all images depicting the
pathogen featured in an article titled Medical and Scientific Visualiza-
tion of SARS-CoV-2.
23
This search allowed us to identify high-quality
images produced by third-party illustrators. In total, we collected
84 unique images. To assure the formatting consistency of the visual
stimuli, we excluded images with annotations, labels, captions, or
logos indicating the original source (N =14). The final sample of
70 images included all unduplicated images published by CDC and
NIAID, as well as some artistic and illustrative portrayals of the viruses
generated by third-party organizations, artists, and illustrators.
To further identify images that can evoke distinct levels of fear
and disgust among viewers, we conducted an online survey of
492 participants aged 18 or older recruited from the Amazon MTurk
on June 10, 2020. Notably, Amazon MTurk participants tend to be
younger, more educated, and liberal compared to the U.S. general
population.
24
We displayed the selected images in a random order
and asked participants two questions regarding how much fear and
disgust they had felt after seeing each image on a five-point-scale
(1 =none at all to 5 =a great deal). Each participant received $2 as
compensation upon the completion of the survey.
Results of this pre-test showed that the levels of fear and disgust
are highly correlated (Pearson's r=.945, P< .001). However, there
was significant difference in the level of fear and disgust evoked by
different images (see Figure 1). It appeared that images that evoke rel-
atively high levels of fear and disgust are likely to resemble other
disease-causing threats (eg, tumors, cancer cells, bacteria etc) and/or
display a combination of highly contrasting colors and trypophobia-
inducing patterns. In contrast, images that were composed of regular
shapes (eg, circle), simple patterns, and achromatic or less intrusive
colors (eg, black, gray, light blue etc) were likely to elicit lower levels
of fear and disgust. Noticeably, systematically identifying the exact
visual features that associate with fear and disgust in the collected
images of SARS-CoV-2 was beyond the scope of the current study.
What we attempted to do was to identify a subset of SARS-CoV-2
images that could reliably trigger distinct levels of disgust and fear and
be used as experimental stimuli for the follow-up study.
Based on the ratings of each image, we selected and grouped
images that triggered high, medium, and low levels of disgust and fear.
Also, to maximize the representativeness of the selected images, we
purposefully chose images displaying a variety of colors, shapes, visual
patterns for each group (see Figure 2). Results showed that Group
1 images elicit the highest level of fear (M
Fear
=2.91, SD
Fear
=1.08)
and disgust (M
Disgust
=3.07, SD
Disgust
=1.06) than Group 2 images
(M
Fear
=2.71, SD
Fear
=1.01; M
Disgust
=2.72, SD
Disgust
=1) and
Group 3 images (M
Fear
=2.31, SD
Fear
=0.98; M
Disgust
=2.30,
SD
Disgust
=0.98). A series of paired t-tests indicated that images
selected for Group 1 evoke higher level of disgust than those in Group
2(t
489
=11.94, P< .001) and Group 3 (t
489
=17.80, P< .001). Group
1 images also evoked higher level of fear than those in Group
2(t
489
=7.30, P< .001) and Group 3 (t
489
=16.19, P< .001). Simi-
larly, Group 2 images triggered higher level of disgust (t
489
=12.68,
P< .001) and fear (t
489
=13.91, P< .001) than those in Group
3. These images were used as experimental stimuli for the treatment
groups.
2.2 |Data, sample, and procedure
An online experiment was fielded between July 23 and August
3, 2020, using a national sample of 500 U.S. adults aged 18 or older.
The sampling firm, Marketing Systems Group, recruited SSRS Opinion
Panel members randomly based on nationally representative Address
Based Sample (ABS) design. The SSRS Opinion Panel is a nationally
representative panel of U.S adults aged 18 or older, run by the market
and survey firm, SSRS. To recruit participants from under-represented
FIGURE 1 Perceived fear and disgust
for SARS-Cov-2 images. Amazon MTurk
workers' average levels of fear and disgust
reported post exposure to 70 SARS-CoV-2
images. Data point labels indicated the
image ID. Full scales on both axes are 1 to
5. Data was collected on June 10, 2020
LI ET AL.3of7
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groups, a bilingual, random digit dialing (RDD) platform was used to
recruit participants who are Hispanic, African American, or from lower
income and lower education populations.
Upon the completion of the study, participants received $5 in the
form of an electronic gift card. In total, 1297 panelists were con-
tacted; the response rate was 43% for the RDD sample and 35% for
the ABS sample. All responses were weighted using the weights
adjusted for sex, age, education, census region, civic engagement,
household telephone usage, and internet access.
Participants were randomly assigned to one of four groups, three
of which viewed the SARS-CoV-2 images selected based on results of
the pre-test (ie, Group 1, Group 2, and Group 3 images), whereas the
fourth group received no visual stimuli. Respondents first answered a
series of questions regarding their experience with COVID-19 and
emotional response to the pandemic. After viewing seven images,
participants reported fear, disgust, and risk perception of COVID-19.
2.3 |Measures
Disgust and fear were reported using two questions: Thinking about
the images you just saw, how much disgust/fear do you feel?on a
five-point-scale (1 =none at all to 5 =a great deal). Two questions
were asked to measure participants' risk perception of COVID-19.
The first question asked, How risky do you think COVID-19 is?on a
five-point scale (1 =not risky to 5 =very risky). The second question
measured participants' worry level regarding COVID-19 (1 =not
worried to 5 =very worried). The two items were averaged to mea-
sure risk perception. In addition, participants reported how they feel
about COVID-19 using a series of semantic differential scales (from
1 to 5), including depressed cheerful,”“sad happy,”“angry-
peaceful,”“concerned unconcerned,”“afraid unafraid.The mean
value was used to measure participants' preexisting feelings toward
the COVID-19 pandemic.
2.4 |Data analysis
We conducted the statistical analyses between February 10 and
March 31, 2021, using SPSS, version 26 (IBM Corporation). To test
our hypotheses, we used a series of factorial analyses of variance to
examine the main effects of experimental treatment on fear, disgust,
and risk perception. We also conducted analysis of covariance
(ANCOVA) to examine the interactive effects of experimental treat-
ment and individuals' preexisting feelings toward COVID-19 on fear
and disgust. All Pvalues were 2-sided, and we considered a Pvalue of
less than .05 to be significant.
2.5 |Ethics and permissions
The study received approval from the Texas Tech University institu-
tional review board. Participants were informed that they would be
shown visual representations of the SARS-CoV-2 and report their
FIGURE 2 SARS-Cov-2 images evoking different levels of fear and disgust. Images of various appearance were selected based on the results
of the Amazon MTurk pre-test. Group 1 images evoked the highest level of fear and disgust, whereas Group 2 and Group 3 image evoked the
medium and low levels of fear and disgust, respectively. Readers may want to use color mode when printing these images as the visual difference
can be much less discernable when images are in black and white
4of7 LI ET AL.
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opinions on the COVID-19 pandemic. Participants indicated their
consent via an electronic form before completing the survey.
3|RESULTS
The 500 participants in the online survey were demographically diverse
and representative of the national population (mean [SD] age, 47.0
[17.4] years; 257 women [51.3%]; 192 high school or less education
[38.4%]). Results from factorial analyses of variance showed that partic-
ipants did not report significantly different levels of fear after viewing
the images. However, image exposure was associated with a significant
difference in disgust (F
2
=6.49; P=.002; η
p2
=0.034). A pairwise
comparison suggested that participants who viewed Group 1 images
and Group 3 images differ in their disgust post-exposure (t
238
=3.41,
P=.001). The mean difference between other pairwise groups (ie,
Group 1 vs Group 2, Group 2 vs Group 3) was not significant.
In addition, older, non-white individuals, as well as those with
lower household income, reported a higher level of fear when view-
ing the images; however, females, non-white individuals, as well as
those with lower education and household income reported a higher
level of disgust when viewing the images. Image exposure was not
associated with any significant change in participants' risk perception
of COVID-19. Nonetheless, females, older and non-white individuals
were likely to report a higher level of risk perception after viewing
the images.
Furthermore, one's preexisting feelings toward COVID-19 were
strongly related to fear resulted from image exposure. Specifically,
those who felt more negatively about COVID-19 perceived more fear
after seeing the images than those who felt less negatively
(F
1
=144.19, P< .001, partial η
p2
=0.303). An analysis of covariance
suggested that the interactive effects between feelings toward
COVID-19 and image exposure on fear is significant (F
2
=5.46,
P=.005, partial η
p2
=0.032). Specifically, the relationship between
individuals' preexisting feeling and fear was more significant among
those who viewed the Group 1 images (ie, images that evoked the
highest level of disgust in pre-test) than among those who viewed the
Group 3 images (ie, images that evoked the lowest level of disgust in
pre-test) (see Figure 3). In other words, people's fear became polarized
along their preexisting feelings toward COVID-19 after seeing the
images that elicited the highest level of disgust.
4|DISCUSSION
Visual representations of science, ranging from symbols, photo-
graphs, illustrations, or data graphs, are increasingly used as effective
tools for public communication.
25,26
When it comes to the health
and medical realm, science visualizations can help nonexperts
acknowledge the physical forms of living organisms or delineate
invisible objects, such as bacteria or viruses. When properly
designed, science visualizations can attract attention, pique curiosity,
facilitate understanding, and enhance trust in the conveyed mes-
sage.
25
As Rosello (1998) argued in an analysis of the HIV virus
images, scientific images could indicate that some people know and
work very hard at transmitting knowledge, the truthand therefore
elicit feelings of mastery or even aesthetic appreciation and
intellectual pleasure.
8
FIGURE 3 Interactive effects between emotional response to COVID-19 and group assignment on fear. The lines indicated predicted values.
The shaded area indicated confidence intervals at the 95% level
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Nonetheless, despite their scientific and aesthetic values, science
visualizations can shape viewers' emotional responses to the
portrayed subject due to their metaphoric meanings as well as the
presence of visually intense patterns. This study identified the SARS-
CoV-2 images published by CDC, NIAID, and third-party organizations
and illustrators. A pre-test revealed that the selected images evoke
distinct levels of fear and disgust among a group of participants rec-
ruited from the Amazon MTurk. However, exposure to the images
that elicited low, medium, and high levels of fear and disgust, caused
different levels of disgust, but not fear, among the members of a
national sample of U.S. adults (N =500). Especially for those who felt
less negatively about COVID-19, exposure to the perceivably most
disgusting images backfired, as such images made them perceive
lower levels of fear than exposure to the least disgusting images.
Image exposure did not associate with any significant change in risk
perception of the disease.
5|LIMITATIONS OF THE STUDY
First, although we failed to detect a relationship between image expo-
sure and risk perception, such result can be confounded by the ongo-
ing pandemic amid which the data was collected. The U.S. entered a
new phaseof the COVID-19 pandemic at the time of data collection
with a total of 155 000 infected cases.
27
The exacerbated pandemic
might increase participants' risk perception of COVID-19 to an
extremely high level, rendering the between-group difference insig-
nificant. Any interpretation of the results should not overly under-
estimate the effects of image exposure on risk perception merely
based on the insignificant findings of the study. In addition, the
study only recruited participants from the U.S. and used visual
stimuli generated mostly by U.S. organizations and institutions.
Considering the cultural differences in the associations between
visual features (eg, colors) and emotions,
28,29
the results might not
be generalizable to citizens of other countries. Future studies
should incorporate the implications of cultural factors when exam-
ining the effects of science visualizations on targeted populations.
6|CONCLUSIONS
Science visualizations are instrumental in educating the public
about a wide variety of health issues. However, seemingly objec-
tive images can be emotionally biased and polarize the viewers'
affective response to the depicted subject. Scientists, journalists,
and designers should be aware of the emotional implications of
science visualizations. Especially when designing an iconic image or
visual targeting a diverse audience, practitioners should empirically
examine the emotional impact of their material before using it as
part of a large-scale campaign or educational program. It is impor-
tant to assure the visuals not only inform the public of the
depicted subject but also convey the most appropriate and
intended emotions.
ACKNOWLEDGMENT
None declared.
FUNDING
None declared.
CONFLICT OF INTEREST
The authors reported no potential conflicts of interest.
AUTHOR CONTRIBUTIONS
Conceptualization: Nan Li.
Data Curation: Nan Li.
Formal Analysis: Nan Li.
Writing - Original Draft Preparation: Nan Li, Amanda L. Molder,
Shiyu Yang.
Writing - Review and Editing: Nan Li, Amanda L. Molder, Shiyu Yang.
All authors have read and approved the final version of the
manuscript.
Nan Li had full access to all the data in this study and takes complete
responsibility for the integrity of the data and the accuracy of the data
analysis.
TRANSPARENCY STATEMENT
Nan Li affirms that this manuscript is an honest, accurate, and transpar-
ent account of the study being reported; that no important aspects of
the study have been omitted, and that any discrepancies from the study
as planned (and, if relevant, registered) have been explained.
DATA AVAILABILITY STATEMENT
The datasets analyzed in the paper are available from the
corresponding author upon readers' requests.
ORCID
Nan Li https://orcid.org/0000-0001-5942-552X
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How to cite this article: Li N, Molder AL, Yang S. Visual
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