Opinion | How to Deal With People Who Ignore Covid Safety

Covid-19 cases are up around the country, even in places that had low rates over the summer. In response, many states have increased restrictions and emphasized the need to prevent transmission. People are not listening.

Families continue to make Thanksgiving plans. Large gatherings are continuing despite the warnings. This is happening outside of the United States, as well. There’s a phrase for this: “pandemic fatigue.” People are tired of changing their behavior because of the coronavirus.

None of this should be surprising. People are often reluctant to do things they might find unpleasant to improve their health. The American government spends millions of dollars every year to educate the public about a healthy diet, for example. And yet most of this advice is ignored.

In my own work, I find little evidence of people changing their diet despite getting a diagnosis of diabetes. The same pattern occurs with infectious diseases. Even at the peak of the H.I.V. epidemic, before widespread treatments were available, data from several countries in sub-Saharan Africa showed limited reductions in risky sexual behavior.

It is even more difficult to get people to make changes for the health of others. One of the reasons we struggle to get full cooperation with vaccinations for flu or childhood illnesses is that the benefits are mostly to public health. Childhood vaccination resistance can be overcome, but mostly when it is linked to school attendance, as California’s recent experience in improving vaccination rates for measles has shown. When we have to rely on individuals to make good private decisions for the sake of public health, behavior change is elusive.

Stemming the spread of Covid-19 requires exactly this — a change in private behavior. The virus is being spread in informal settings like parties, sleepovers, dinners in people’s homes. The spread has accelerated in recent weeks, as colder weather has moved more social gatherings indoors.

When the problem is private spread, many public health levers are no longer useful. City and state officials can lower restaurant capacity, but that won’t matter if people are getting takeout and gathering with acquaintances elsewhere.

So what is the answer? I wish there were a magic bullet for behavior change, but there isn’t. We have to recognize the futility of relying exclusively on our current approaches, and then look for something new.

Other countries have managed this better. South Korea, for example, has much higher compliance with masking and other social distancing guidelines. But that is not all; testing, contact-tracing and other public health infrastructure have proved to be just as important.

Consider the case of South Korean nightclubs. After several infected people visited five big nightclubs over a short period, government officials used cellphone location data, credit card records and visitor lists to identify about 5,500 people who may have been contacts, of which about 1,200 were closely monitored. An additional 57,000 people who were in the area were encouraged to get tested for the coronavirus.

This could be considered a public health failure (perhaps these potential infections could have been avoided if nightclubs had been closed), but the incident didn’t lead to uncontrolled spread. In more recent outbreaks in China, the government has tested millions of people in a short period to limit spread. Even in the United States, some institutions that are now considered Covid-19 successes — such as elite universities or professional basketball teams — have accomplished this by using comprehensive testing, monitoring and isolation.

The Coronavirus Outbreak ›

Words to Know About Testing

Confused by the terms about coronavirus testing? Let us help:

    • Antibody: A protein produced by the immune system that can recognize and attach precisely to specific kinds of viruses, bacteria, or other invaders.
    • Antibody test/serology test: A test that detects antibodies specific to the coronavirus. Antibodies begin to appear in the blood about a week after the coronavirus has infected the body. Because antibodies take so long to develop, an antibody test can’t reliably diagnose an ongoing infection. But it can identify people who have been exposed to the coronavirus in the past.
    • Antigen test: This test detects bits of coronavirus proteins called antigens. Antigen tests are fast, taking as little as five minutes, but are less accurate than tests that detect genetic material from the virus.
    • Coronavirus: Any virus that belongs to the Orthocoronavirinae family of viruses. The coronavirus that causes Covid-19 is known as SARS-CoV-2.
    • Covid-19: The disease caused by the new coronavirus. The name is short for coronavirus disease 2019.
    • Isolation and quarantine: Isolation is the separation of people who know they are sick with a contagious disease from those who are not sick. Quarantine refers to restricting the movement of people who have been exposed to a virus.
    • Nasopharyngeal swab: A long, flexible stick, tipped with a soft swab, that is inserted deep into the nose to get samples from the space where the nasal cavity meets the throat. Samples for coronavirus tests can also be collected with swabs that do not go as deep into the nose — sometimes called nasal swabs — or oral or throat swabs.
    • Polymerase Chain Reaction (PCR): Scientists use PCR to make millions of copies of genetic material in a sample. Tests that use PCR enable researchers to detect the coronavirus even when it is scarce.
    • Viral load: The amount of virus in a person’s body. In people infected by the coronavirus, the viral load may peak before they start to show symptoms, if symptoms appear at all.

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