A Blog by Jonathan Low

 

Dec 13, 2020

As Gov't Abdicates, Individuals Take Responsibility For Covid Behavior, Defining Risk

Without a national Covid strategy and, in many cases without a state or local strategy, individuals are being charged with and are taking responsibility. So it is no wonder that the definition of risky behavior is fragmented. JL

Julia Marcus reports in The Atlantic:

Many long months into this pandemic, people are at their wits’ end: economically depleted, socially isolated, and disgruntled about—and in some cases genuinely baffled by—the arbitrariness of some of the restrictions on their daily lives. A web of illogical rules transfer the responsibility for containing the pandemic—and the blame for failing to do so—from public authorities to the individual. Americans have been told during this pandemic that taking risks is a sign of bad character—so it’s no surprise when people are reluctant to notify others whom they may have exposed or engage with contact tracers.Pandemic shaming, a national pastime since the spring, intensified in the weeks leading up to Thanksgiving. Thousands waited in line, some for many hours, for a preholiday coronavirus test, only to be rebuked as careless, selfish violators of public-health rules. “I do want people to understand that testing on Thursday so you can party on Saturday: That doesn’t work,” said Barbara Ferrer, Los Angeles County’s director of public health. “It’s not effective, and you really are in some ways wasting a valuable resource.” Those long lines included people whose families were begging them to visit; students whose campuses had just closed for the semester; and people who were observing state rules requiring visitors to get tested 72 hours before arriving. 
Yet even people who were trying to be careful weren’t spared from criticism: Many news articles and comments from public officials portrayed Thanksgiving travelers, regardless of the precautions they were taking, as irresponsible people. On social media, they were maligned as #covidiots, recklessly endangering themselves and their loved ones. 
What happened then is about to happen again, as millions of Americans travel for the winter holidays and decide whether and how to gather with relatives. Public-health messaging and policies during the pandemic have acknowledged that trips to grocery stores and pharmacies are essential, while grossly underestimating the strong need people feel to be close to one another. Lecturing showed its limits in late November: While millions heeded the recommendation to stay home, millions of others did not.

When a public-health approach isn’t producing the desired outcome, it’s time to try something different. Instead of yelling even louder about Christmas than about Thanksgiving, government officials, health professionals, and ordinary Americans alike might try this: Stop all the chastising. Remember that the public is fraying. And consider the possibility that when huge numbers of people indicate through their actions that seeing loved ones in person is nonnegotiable, they need practical ways to reduce risk that go beyond “Just say no.”  

Anger at people who are flouting public-health guidelines is understandable, not least for exhausted health-care workers and those who are especially vulnerable to infection. But many long months into this pandemic, people are at their wits’ end: economically depleted, socially isolated, and disgruntled about—and in some cases genuinely baffled by—the arbitrariness of some of the restrictions on their daily lives. And if the HIV epidemic has revealed anything, it’s that shaming does little to deter risky behavior. Instead, it perpetuates stigma, which drives behavior underground and hinders prevention efforts. Americans have been told during this pandemic that taking any risks, no matter how carefully calculated, is a sign of bad character—so it’s no surprise when people are reluctant to notify others whom they may have exposed or engage with contact tracers.

As the country enters the most devastating months of the pandemic and hospitals become overwhelmed, officials are erring on the side of abstinence-only recommendations regarding social contact. Like the unfounded concerns about harm reduction for HIV and substance use, the worry is that risk-mitigation tools, such as testing, will give people a false sense of security and promote bad behavior. This misguided notion has been used as an excuse not to offer testing, including on some college campuses. But people who are willing to wait for hours to get tested are not acting irresponsibly—they’re trying, albeit with a far-from-perfect strategy, to reduce the risk of inadvertently transmitting the virus to others. Yes, it would be safer for them to stay home, and the limitations of testing need to be clearly communicated. But if people are going to travel or gather anyway, testing is better than nothing.

As cases surged in the fall, elected officials blamed the trend on misbehavior at private social gatherings. Restaurants, stores, and other workplaces aren’t the problem, the talking point goes; people just need to behave better everywhere else—in parks, playgrounds, and their own homes. But the resulting message to the public has been nonsensical. Through their policies, states are telling Americans that dining indoors is safe in revenue-generating situations, such as at a restaurant or formally catered event, while private holiday dinners are roundly condemned. Some communities have gone as far as banning all social interactions between people from more than one household, including outdoors. In truth, states probably can’t afford to pay businesses to stay closed, yet governors are under tremendous pressure to act. The result is a web of illogical rules that transfer the responsibility for containing the pandemic—and the blame for failing to do so—from public authorities to the individual.

If elected officials are going to scold the public for their disobedience, the least they can do is practice what they preach. But one after another, they’ve been caught breaking their own rules. Governor Andrew Cuomo berated New Yorkers the week before Thanksgiving: “If you’re socially distant, and you wore a mask, and you were smart, none of this would be a problem—it’s all self-imposed.” Throwing in some fat-shaming for good measure, he added, “If you didn’t eat the cheesecake, you wouldn’t have a weight problem.” Just days later, Cuomo said his own Thanksgiving plans included getting together with his two daughters and his 89-year-old mother, plans he later canceled amid a public outcry. Maybe governors and mayors are just hypocrites, but the other possibility is that they’re human too, and that even people who understand the risks of family gatherings—and chide others for taking them—feel the powerful draw to this important part of life.

Very few people want to get infected or get others sick. When people take risks, it often reflects an unmet need: for a paycheck, for social connection, for accurate information about how to protect themselves. Acknowledging and meeting people’s needs will reduce risk behavior; finger-wagging won’t.

Despite all of the media focus on holiday travel, this pandemic has been shaped more by where people need to be than by where they want to be. While many Americans were busy reprimanding one another for Thanksgiving dinners, people quietly continued to travel for other reasons: Truckers delivered goods around the country; migrant workers kept farms going. The moral outrage about people enjoying themselves during a pandemic is a distraction from where that outrage would be more useful: in pressuring governments to protect the marginalized populations that are most at risk, even when they are less visible—and provoke less indignation—than a crowd of holiday travelers sitting in an airport and hoping for the best.

As the winter holidays approach and cases continue to surge across the country, people need clear and consistent messaging about the very high risks of travel and gathering. And, just like safer-sex education, guidance for this holiday season must also include nuanced information about how people can protect themselves if they travel to that Christmas dinner anyway: minimizing contacts and testing before and afterward, keeping gatherings small, driving instead of flying, masking when indoors or close to others, meeting outdoors if feasible, and increasing ventilation when outdoors isn’t an option. Giving any risk-mitigation advice might seem imprudent when the dangers of social contact are so acute, but adherence to public-health recommendations is never universal, and everyone needs access to information and tools to stay safer.

No matter how comprehensive, public-health messaging won’t solve structural problems. The Thanksgiving testing debacle was indicative, more than anything, of a failure of the public-health system: Nearly a year into the pandemic, testing capacity is woefully inadequate and needs to be increased as much as possible before Christmas. And instead of closing outdoor venues and banning all outdoor gatherings, which have been deemed inessential pleasures in a pandemic, communities could do the opposite. Like Montreal, they can create appealing public spaces where people can gather more safely, equipped with open-air tents and heat lamps. They can outfit local parks with firepits and wood, as Calgary did. They can offer free outdoor activities, such as ice-skating, snowshoeing, and even art installations, to reduce pandemic fatigue and lure people away from indoor gatherings. Health agencies can urge people—for just this one year—to exchange gifts by mail and replace the indoor dinner with an outdoor picnic (in warmer states) or a family campfire (in colder ones). Rather than imposing rules that neglect the realities of human behavior and then reprimanding people for breaking them, the message could be a more pragmatic and compassionate one: We understand that this is hard and that social connection is important for health, so we will support you in gathering more safely.

With the federal government catastrophically failing to respond to the worst pandemic in a century, it feels like only personal responsibility can save us—so of course we’re turning on one another. But viruses are not moral agents, and infection is not a personal failure. Especially with vaccines so close to distribution, Americans need to keep one another safe, and that includes directing our outrage toward institutional deficiencies, rather than fixating on individual ones. Lambasting people for their risky behavior may be effective in expressing frustration over a mismanaged pandemic, but it’s counterproductive to what really matters: reducing infections.

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