25th March 2020

Note: since I wrote this blog the recommendations to social distance have become even more constraining. Nevertheless, the basic principles to have clearer and precise communications still stand. Now read on

It is only a week since the UK government recommended that people should work from home and practice social distancing to reduce the transmission of COVID-19. Despite having been informed that these measures help to save lives, many people appeared not to follow this advice and some continued to flock to clubs, bars and restaurants. And when these were closed, people continued to go out – only this time to open spaces such as parks and beaches. For a behavioural scientist this response is fascinating.

Why, in the face of the most severe global pandemic in living memory, are people not following this advice? Surely, most people do not wilfully want to endanger their own and other’s lives? And surely most people are not deliberately being difficult and rebellious?  To try to understand this response, I went back to the work I did previously on pandemic flu to see if there were any obvious answers (Rubinstein et al, 2015; Marcu et al 2015).

A few years back I conducted research with people, especially people who were most at-risk from pandemic flu, to see how they would respond under different pandemic scenarios. One of the scenarios we put forward was every bit as bad as the one we are currently experiencing.

Even among the group of people who would suffer most severely if they contracted pandemic flu (people with COPD, older people and pregnant women) there were barriers to taking protective actions. These included a lack of knowledge that no-one is immune to a novel virus, a belief that having a healthy lifestyle prevents them from becoming ill and over-optimism that they were unlikely to be infected. All contributed to an unwillingness to ‘do the right thing’. In the latest pandemic the relatively high infection and case fatality rates are becoming clearer every day. So, how can we make sense of these seemingly counter-intuitive (and potentially deadly) responses?

One way to frame our understanding is through a behavioural model which was originally developed to work out the impact of fear messages – Protection Motivation Theory (Maddux & Rogers, 1983). Maddux and Rogers argued that if you want people to take protective actions, you need to get the balance right between creating a sense of fear and giving people the ability to cope. People assess a fearful situation according to how severe they think it is and whether they believe they are personally susceptible. They assess the ability to cope on the basis of whether the solution they are given is likely to be effective and on the basis of whether they are capable of performing the solution.

In the case of COVID-19 you can see that different governments have had difficulty in getting the balance of these messages right. The severity of the situation is obvious – every news outlet loudly proclaims the latest figures on how many people have been infected (though we don’t really know for sure as not everyone has been tested) and they inform people of the number of new deaths each day. The problem with raising fear levels is that if they get too high some people panic and just switch off or become fatalistic.

One way to reduce the fear is to give people workable solutions. This was done effectively by telling people to wash their hands regularly for 20 seconds to the tune of Happy Birthday. This was quickly taken up – the instructions were clear and precise, everyone is able to wash their hands and most can sing Happy Birthday (twice). It made the activity fun and people quickly began to come up with alternative songs to sing once the fun of singing Happy Birthday to yourself wore thin.

However, the same is not true for social distancing. The official data released on 6 March 2020 by the Scientific Advisory Group for Emergencies, indicates that social distancing can delay the peak of the virus by 3-5 weeks and that the peak itself will be reduced by up to 50-60% if we follow instructions. Furthermore, if we all socially distanced the number of cases and deaths would be reduced by 20-25%. It is, as they say, a no-brainer.
I would argue that the problem is that the communication around social distancing has lacked the clarity and precision that we saw with the advice to wash our hands regularly. People are asking ‘What exactly is social distancing? Does it mean we should see people less often or not all? Is it OK to see family but not friends?’ Are we safer outdoors than indoors?’

Given what we now know I would suggest that there are some aspects of communications that can be strengthened. Specifically

• Emphasising more strongly that no-one (not even you) can be immune to a novel virus – we are all susceptible.
• Being much more precise about what social distancing actually is. To do this we might consider a video or demo showing what social distancing looks like in reality in various scenarios, e.g. at home, in the park, in the shops; a rule of thumb that doesn’t require a grasp of distance (perhaps measured in arms away from you) and a demonstration of how the virus travels and leaves it’s trace, during any type of interaction.
• Explaining in more detail – again using demos or videos – the impact of social distancing in delaying the time and size of the peak, and on the reduction in the number of cases and deaths.

No doubt over the next weeks and months we will learn much more about the interventions that successfully help to minimise the impact of COVID-19. If we want to ensure that people follow advice and do not need to be actively coerced, communications have to be much clearer and more precise. If there is any room for ambiguity people find it hard to do the right thing and end up endangering their own lives and the lives of their loved ones.

References
Maddux, J. E., & Rogers, R. W. (1983). Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. Journal of Experimental Social Psychology, 19(5), 469–479.
Marcu, A, Rubinstein, H, Michie, S & Yardley L (2015) Accounting for personal and professional choices for pandemic influenza vaccination amongst English healthcare workers. Vaccine, 33 (19), 2267-2272.
Rubinstein, H, Marcu, A, Yardley L & Michie S (2015) Public preferences for vaccination and antiviral medicines under different pandemic flu outbreak scenarios. BMC Public Health, 15:190