Second Thoughts Regarding the Second Wave
Originally submitted as an assignment for class, but the assignment was an op-ed and this feels like it'll remain (painfully) relevant for a while.
The heavily anticipated (and yet still underprepared for) second wave of COVID-19 has begun. This time presents many of the same challenges surrounding protective public health behaviours like mask-wearing, social distancing, and lockdown compliance, as well as a continuation and worsening of related issues including unemployment, food insecurity, homelessness, childcare and schooling at home, domestic violence, high rates of mental illness, and more. New considerations in the application of behavioural science should include the way that overwhelming uncertainty has been papered over with a false sense of certainty and the diminishing sense of social cohesion in how the pandemic is experienced.
What we are allowed to do versus what we should do
COVID-19 brought the vastest amount of shared uncertainty the world has experienced in recent decades, perhaps ever. With plans cancelled and routines disrupted, COVID-19 remains a daunting threat that exploits our biases in risk perception and intertemporal choice. In March, the mandate was clear — stay at home to stop the spread. Sacrifice now so that we can go back to normal sooner, placing hope in a closer but still uncertain end date for the pandemic. It’s not hard to understand that. Given the appropriate guidelines and financial support it doesn’t have to be extremely difficult to follow it either, an overarching certainty in response to the uncertain.
When the partial reopening and mix of restrictions began, everyone was forced to navigate this with their own understanding of what is risky and what isn’t. The UK’s “Rule of Six” attempted to provide a clear guideline, to mixed results. Setting numbers like this follows the EAST framework set forth by the Behavioural Insights Team by making the rules easy to recall (Behavioural Insights Team, 2015). Yet there is the potential flaw of creating a false sense of security when people follow the rules. Coronavirus doesn’t wait until a quorum of seven to join the party, and six people gathered in a restaurant with ten other groups of six eating and chatting is drastically different risk-wise from six people two metres apart in a park. People tend to push against the limits of a rule. Small gatherings may now be driving the spike in COVID cases, and will raise more concern as we approach the holidays. Both Dr. Anthony Fauci, the US’s top infectious disease expert, and the Center for Disease Control have emphasized this in recent weeks (Hellmann, 2020). The UK Behavioural Insights Team conducted an online experiment in October to test the public’s understanding of the tiered restrictions in England. The reassuring news was that while many people were unfamiliar with the details of tiers’ rules, they erred on the side of caution by assuming behaviours were restricted even when they weren’t. But concerningly, one in five respondents didn’t know that meeting outdoors is much less risky than meeting indoors (Egan et al., 2020). Though the UK is now in a stricter lockdown, it will be important after 2 December to dispel misconceptions and to provide guidelines and rules of thumb for living in a COVID world that are more adaptable to varying contexts. We must balance clarity and certainty against oversimplification.
Expecting everyone to conduct an accurate risk calculation each time they go outside is expecting far too much. Instead, our automatic systems (System 1) kick in and we rely on a combination of heuristics including optimism bias, social norms created by personal social circles, and self-herding (Kahneman, 2011; Weinstein, 1980; Ariely, 2008).
Optimism feels scarce in these times, yet many of us are also reliant on optimism bias to continue living our lives. Sure, 1.29 million people have tested positive in the UK, but it won’t be me. Researchers at UCL found through a survey of 1,145 Americans that the public pessimism about COVID and peoples’ risk of infection coexists with a private optimism about one’s own risk of infection (Globig et al., 2020). Young people in particular may hold the private optimism that even if they were infected, they would be asymptomatic. Another concern related to optimism bias is the tumble downwards when our optimism is continually shot down. 2021 seemed far away and hopeful six months ago, but now it seems inevitable that COVID-19 will follow us into a new year of chaos. Instead of citing a perfect vaccine on the horizon, it would be best for governments to manage expectations more consistently and accurately, and highlight how interventions like masks and social distancing have had a significant impact on reducing transmission.
Rather than operating on a collective set of social norms, the norms of pandemic behaviour have become localized to communities and subgroups. What we see friends and family doing based on what they tell us and what we see on social media shapes what we understand as acceptable behavior. We trust those around us as examples and may also use them as justification for our risky behaviours (Legros & Cislaghi, 2020). As more people post their indoor brunch pictures, it feels normal to make plans to dine indoors, even though little regarding COVID prevalence or transmission has improved. In fact, it’s gotten worse as cases have run rampant with flawed or no contact tracing in the UK and US respectively. Increasingly, it can actually feel out of line with social norms to cancel or refuse plans due to COVID concern.
Self-herding, or the tendency to trust and follow the same decisions we made in the past, enforces behaviours as time goes on, making it increasingly difficult to change behaviour. Even though every gathering or social outing is a gamble with regards to coronavirus, the more often one goes out without contracting COVID, the more it feels like it is okay to do so. People are becoming accustomed to living in COVID limbo. When COVID arrived, it disrupted the status quo. But now, even though no one may explicitly enjoy this bizarre suspension between normal life and lockdown, there is an acceptance of this as the status quo and a lockdown as a regression or explicitly worse than what we have now.
Are we still all in this together?
At the start of the pandemic, there was some prevailing baseline sentiment of “we’re all in this together.” We celebrated frontline workers and buckled down. Many public health campaigns leveraged this sense of solidarity to promote mask-wearing and social distancing. Months later, the story has evolved. The pandemic has fallen disproportionately on the most vulnerable groups. While the economy has largely recovered for white-collar workers, it has not for the working class (Long, 2020). Women suffer disproportionately as a result of household burdens and which industries have been hardest hit (Boesch & Madowitz, 2020). There are the relatable complaints about Zoom meetings, and then there are the millions of people being evicted from their homes in the US (Conlin & Walljasper, 2020). Healthcare workers are burnt out and feel inadequately supported (Society of Occupational Medicine, 2020; Barnes & Morris, 2020; Yong, 2020). There is diminishing trust in government now that people have seen the mishandling up close and have comparisons to make against other, more successful countries (Reuters Institute for the Study of Journalism, 2020; Aksoy et al., 2020). Misinformation about the coronavirus and the political responses to it remain rampant. In the US, the mixed messages coming from different politicians have left heads spinning and cancelled out the potential benefits of credible and authoritative messengers. Different audiences may respond drastically differently now than they did before. The actual disease is not the only health threat in these pandemic times — many people feel that the problems weighing on them the most are not the ones being addressed.
For those in the negative space of the identifiable victim effect — those who don’t know someone with a severe case of COVID — the threat of coronavirus seems less imminent. There is a disparity in the realities of those who have seen COVID up close in family, friends, or patients, and those who have been insulated from it. This has contributed to a polarization in which people feel the need to shame and blame others for disobeying COVID restrictions. While well-intentioned, this encourages dogmatism and increases the sense of stigma surrounding COVID that can make people less likely to seek testing or to share their results with contact tracers or those around them, and also makes people who do end up contracting COVID-19 feel at fault in an already difficult situation (Marcus, 2020). Fear-based or overly moralizing messaging risks alienating people into not disclosing and not even wanting to think about COVID risks.
The challenges that lie ahead are similar to those we had in March. The stakes are higher than ever, and we have a better grasp of what can and should be done. Simultaneously, behavioural science considerations differ now compared to the first wave of COVID-19 because many people have adapted to the strange status quo of COVID limbo and the sense of solidarity across society has been worn down. Going forward, policymakers and public health officials ought to acknowledge this and adjust their messaging and policy strategies accordingly. Everyone is in a different mindset than they were in March and have had a wide variety of experiences with this pandemic; it will take an adaptive and empathetic behavioural science approach to help end this pandemic.
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Thanks for making it to the end! If you thought this was interesting, I’d be honored if you subscribed for more of me applying behavioural science to my crises about the world and/or shared this post with friends. :)
If you’re interested in other reading about the big ideas regarding pandemic restrictions and how we (the US, mainly) have gone horribly wrong, here are a few pieces that I really appreciated and I’ve been thinking about recently:
The Logic of Pandemic Restrictions is Falling Apart by Amanda Mull, explaining how things still being open confuses people about risk because they’re trusting authorities to be careful and how authorities have to answer to business interests.
Sorry to Burst Your Quarantine Bubble by Rachel Gutman, on how quarantine “pods” and “bubbles” mean very different (and often flawed) things to different people across the country.
“No One is Listening to Us” by Ed Yong (all his work on the pandemic is excellent), on how frontline healthcare workers feel reliving the supply shortages and full ICUs of the spring a second time, and feeling unsupported by their communities and governments.
“New York City’s 3 Percent Problem” from The Daily podcast, on Bill DeBlasio’s 3% benchmark on test positivity to close schools (elementary schools are now going to reopen though I think).
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References:
Aksoy, C., Eichengreen, B., & Saka, O. (2020). The Political Scar of Epidemics. Systemic Risk Centre, London School of Economics and Political Science. https://www.systemicrisk.ac.uk/sites/default/files/2020-08/dp-97.pdf
Ariely, D. (2008). Predictably Irrational: The hidden forces that shape our decisions. HarperCollins Publishers.
Barnes, O. & Morris, C. (2020, October 23). Covid: The NHS workers ‘still recovering’ as second wave looms. BBC News. https://www.bbc.co.uk/news/explainers-54623919
Behavioural Insights Team. (2015). EAST: Four simple ways to apply behavioural insights. UK Cabinet Office, Behavioural Insights Team. https://www.behaviouralinsights.co.uk/wp-content/uploads/2015/07/BIT-Publication-EAST_FA_WEB.pdf
Boesch, D. & Madowitz, M. (2020). The Shambolic Response to the Public Health and Economic Crisis Has Women on the Brink as the Job Recovery Stalls. Center for American Progress. https://www.americanprogress.org/issues/economy/reports/2020/10/22/492179/shambolic-response-public-health-economic-crisis-women-brink-job-recovery-stalls/
Conlin, M. & Walljasper, C. (2020, October 19). Time’s up: After a reprieve, a wave of evictions expected across U.S. Reuters. https://www.reuters.com/article/us-usa-housing-eviction-insight-idUSKBN27415U
Egan, M., Loke, T., Mottershaw, A., & Xu, Y. (2020, November 3). Do you understand the guidance? Four findings from an experiment with 3,702 adults in England. The Behavioural Insights Team. https://www.bi.team/blogs/do-you-understand-the-guidance-four-findings-from-an-experiment-with-3702-adults-in-england/.
Globig, L. K., Blain, B., & Sharot, T. (2020, May 29). When Private Optimism meets Public Despair: Dissociable effects on behavior and well-being. PsyArXiv. https://doi.org/10.31234/osf.io/gbdn8
Harriss, A., Kinman, G., & Teoh, K. (2020). The Mental Health and Wellbeing of Nurses and Midwives in the United Kingdom. Society for Occupational Medicine. https://www.som.org.uk/sites/som.org.uk/files/The_Mental_Health_and_Wellbeing_of_Nurses_and_Midwives_in_the_United_Kingdom.pdf
Hellmann, J. (2020, October 14). Small gatherings causing new COVID-19 infections, CDC director warns. The Hill. https://thehill.com/homenews/house/520969-small-gatherings-causing-new-covid-19-infections-cdc-director-warns
Kahneman, D. (2011). Thinking, Fast and Slow. Farrar, Straus and Giroux.
Legros, S., & Cislaghi, B. (2020). Mapping the Social-Norms Literature: An Overview of Reviews. Perspectives on Psychological Science, 15(1), 62–80. https://doi.org/10.1177/1745691619866455
Long, H. (2020, August 13. The recession is over for the rich, but the working class is far from recovered. The Washington Post. https://www.washingtonpost.com/road-to-recovery/2020/08/13/recession-is-over-rich-working-class-is-far-recovered/
Marcus, J. (2020, May 11). Quarantine Fatigue Is Real. The Atlantic.https://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/
Reuters Institute for the Study of Journalism, University of Oxford. (2020). Trust in UK government and news media COVID-19 information down, concerns over misinformation from government and politicians up [Fact sheet]. https://reutersinstitute.politics.ox.ac.uk/trust-uk-government-and-news-media-covid-19-information-down-concerns-over-misinformation
Weinstein, N. D. (1980). Unrealistic optimism about future life events. Journal of Personality and Social Psychology, 39(5), 806–820. https://doi.org/10.1037/0022-3514.39.5.806
Yong, E. (2020, November 13). ‘No One Is Listening to Us’. The Atlantic. https://www.theatlantic.com/health/archive/2020/11/third-surge-breaking-healthcare-workers/617091/