COVID-19 (the novel coronavirus) is a viral tornado. It hits a country, rages, picks up velocity and destroys life, minds, hearts, and everything familiar to a nation’s people.

Three weeks ago, an early morning tornado raged by our home, jarring us out of bed and destroying the neighborhood that holds our memories. It destroyed the familiar, the essential, the enjoyable, the predictable, and upended life as we knew it.

COVID-19 is its own tornado – suspending daily life within and beyond our neighborhoods, states, and national borders. This pandemic hit the United States hard in the weeks following the Nashville tornado, and we’ve all been spinning ever since.

At least 24 states and counting have imposed restrictions on citizens to slow the virus’s spread, stabilize infection rates, and reduce its human and economic toll. The World Health Organization and CDC recommend we all take specific actions to halt the spread of COVID-19. These actions include:

  • Keeping a social distance of three feet or more between one’s self and anyone coughing or sneezing
  • Frequently washing hands for 20 seconds with soap and water or an alcohol-based hand sanitizer
  • Avoiding hands-to-face contact, especially touching one’s eyes, nose, and mouth
  • Coughing and sneezing into a tissue or inner elbow, and wearing a face mask or self-quarantining, if ill

While these actions are reasonable in light of the virus’s severity, behavioral scientists have long known information and policy are necessary but insufficient to get people to do anything. If sufficient, we all wouldn’t be where we are today hiding from COVID-19 – on the verge of losing our jobs or working from home while home schooling our kids and fearing our next run to the grocery store.

How Behavioral Science Influences Population Change

Behavioral scientists of all stripes agree barriers to doing recommended, preventive behaviors will accelerate COVID-19 infection and spread, whereas eliminating barriers will have the opposite effect. History teaches us this. A single virus reared its head twice (called the Spanish Flu of 1918 and H1N1 of 2009) in U.S. history. In 1918, there were more barriers to hand washing and good hygiene (e.g., limited access to clean anything – water, soap, utensils, clothes) than there were in 2009. The presence and absence of hygienic barriers explains drastically different mortality rates to the same virus 91 years apart – 50-100 million versus less than 1 million, respectively.

Human beings’ longstanding cognitive biases are eliciting nonsensical behaviors and reactions to the COVID-19 pandemic. Even with news headlines and credible guidelines recommending strict social distancing, spring breakers flocked to Florida beaches, my 86-year-old grandmother keeps going to the bank, and the nation’s Walmart and Costco parking lots remain full. If we humans understand COVID-19 is dangerous, deadly and spreads between people in close proximity, shouldn’t we behave more rationally? Nope. Humans have a strong present bias, especially under threat. We discount future outcomes for near-term satisfaction. Let’s be on a beach with our friends now and not worry about getting sick in April.

Now, let’s consider the recommendation to avoid touching our face. The benefits might be obvious: reduce the chances of contracting the virus by keeping our hands away from our eyes, ears, nose, and mouth. However, the barrier to action is insidious: inertia from years of repeatedly touching our face without thinking. Our automatic, subconscious decision-making process (called System 1) causes us to rub our eye, scratch our nose, or push up our glasses. The Association for Professionals in Infection Control and Epidemiology estimates we touch our face an of average 23 times an hour!

Asking my husband to stop touching his face has and will continue to be ineffective. It is akin to trying to engage his conscious, effortful decision-making process (called System 2), which we humans use to make only 5% of our decisions. Like a seatbelt alert, cues to action effectively engage System 1 and get him and everyone else to do a recommended preventive behavior – put the seatbelt on.

Rapid, widespread deployment of alerts could both overcome our biases and barriers to COVID-19 preventive action and are more within reach than universal testing or a vaccine. For example, smartwatch companies could release face-touching alerts to warn people not to touch their face or Apple could release an iPhone Face-ID feature to remind people not to touch their face after they unlock their phone.

In addition to ceasing behaviors like touching our face, a pandemic brings other, new behaviors to adopt. Consider telehealth or virtual care to connect with a healthcare provider via audio and video conference from your computer, tablet, or smartphone. For people with these devices and Internet access, virtual care reduces known barriers to in-person care like travel time to clinic, difficulty navigating a large facility, and waiting time in a clinic waiting room. There are also timely benefits.

A few days ago, an endocrinologist virtually examined and advised my husband on a surgical procedure. It allowed him to be home, away from others to or from whom the virus might spread, until he needs surgery, while also reducing strain on our over-burdened healthcare system fighting this pandemic.

Frontline healthcare workers are doing their part to fight the COVID-19 pandemic, but they cannot do it alone. We all have to show up, ceasing the behaviors that spread the virus and adopting behaviors to prevent it. Behavioral science-backed solutions that effectively overcome our human biases and barriers to action may be the gateway out of this pandemic.

Takeaway

Just three weeks ago, I watched frontline tornado relief workers and volunteers, and our entire community work relentlessly to save, patch, and fix our local condition and literally turn the lights back on. If the 1998 Nashville tornado and two rounds of H1N1 have taught us anything, it’s that there can be light after darkness. It takes time, patience, and individual and collective human action – everyone doing their part – to make life as we know it come alive again. Only together will we beat this.

 


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