Life in a Pandemic: How Coronavirus Can Change Our Approach to Public Health

If you’re anything like me, you’ve been thinking about the coronavirus (or COVID-19) pandemic almost constantly.

Though we’ve experienced outbreaks and other public health emergencies in the past (like Ebola, Zika, and the swine flu, to name a few), this outbreak is arguably having more of an impact on Americans’ daily behaviors and lifestyle than any public health emergency in recent memory. Life as we know it is being upended to contain and mitigate the spread of COVID-19: Millions of children are out of school; employees are working remotely; public transportation systems are cutting back on service; public gatherings are being cancelled daily; gyms, bars, restaurants, and movie theaters are closing; and more.

And, while local, state, and federal governments are taking drastic (but necessary) measures, we as individuals are also taking simple, easy-to-implement steps to protect our communities. For example, we are increasing the length and frequency of our handwashing and are bumping elbows in lieu of handshakes. These are all part of regular, common sense preventive behaviors that public health educators have been communicating to people for years.

So, this has me thinking: What is it about coronavirus that has driven these changes, and what can we learn to make sure people continue practicing these common-sense preventive behaviors post-COVID-19?

Rapidly evolving risk perception. We’ve learned from our research on behalf of numerous health clients that a person’s perception of risk—including whether they think they are susceptible to a disease or condition and whether they believe the consequences are severe—is crucial to his or her adoption of preventive behaviors. This explains why the uptake of handwashing, staying at home when feeling sick, and other behaviors aimed at preventing coronavirus were slow to start: Initial reports suggested that only 16 percent of coronavirus cases were considered severe, and very few cases of coronavirus were identified in the U.S. during the initial weeks of the outbreak.[1] So, with a limited spread in the U.S., individuals had little reason or incentive to change their behavior: “Coronavirus is not severe, nor is it spreading in the U.S., so I am not at risk.”

However, as coronavirus hit closer to home, people began to take it more seriously and began to change their behavior. But it wasn’t necessarily one’s own risk perception that was driving the behavior change. As we’ve come to more fully understand the impact of coronavirus, we’ve learned that it doesn’t impact young, healthy people the same way it impacts older adults or those with underlying health conditions, like heart disease, lung disease, or diabetes.[2] Because of this, so many people I’ve talked to, especially my millennial peers, aren’t concerned with contracting coronavirus themselves. But they do worry about infecting others, whether it’s passing it along to a co-worker who recently completed chemo treatments or their aging grandmother. It is this concern about protecting those we care about that has driven individuals to practice preventive behaviors, like social distancing.

We’re also seeing our leaders leverage this concern. In a recent news conference, Washington Governor Jay Inslee said the penalties for not practicing social distancing are that “you might be killing your grandfather if you don’t do it.”[3] And in a recent White House press conference, Dr. Deborah Birx, the White House coronavirus response coordinator, specifically called on millennials to follow her team’s recently-released guidelines. In a follow-up interview on CBS News, when asked whether we could stop coronavirus by following the guidelines, she said, “This is a road map to prevent your grandmother from getting sick. This is a road map to prevent your grandmother from having to be hospitalized, or your grandfather. This is a road map of what everyone can do today to really protect the people who have been on cancer treatments, to really ensure that they can survive through this epidemic.”[4] Though difficult to hear, the sentiment is one that Americans have embraced: “This disease might not hurt me, but it can hurt my loved ones, and it’s up to all of us to protect each other.”

In addition to our desire to protect our loved ones, the exponential spread of COVID-19 over the last few weeks (and even days) is further driving people’s preventive behaviors, particularly as the virus has spread to those we know and respect. Relatively young, healthy, and prominent people have contracted the virus, forcing us to face the reality of the pandemic: Tom Hanks; Rita Wilson; Idris Elba; several NBA basketball players, including Utah Jazz center Rudy Gobert and Brooklyn Nets forward Kevin Durant; Sophie Gregoire Trudeau, the wife of Canadian Prime Minister Justin Trudeau; and I’m sure several other notables by the time this is posted. The spread of coronavirus across the country—and to people whose names we know—makes the virus a reality: “If people I know and respect are at risk of getting it, then I’m at risk of getting it, too.”

Altruistic tendencies. Part of our preventive behaviors around coronavirus are driven by our perception of risk, but they are also driven by our internal, altruistic motivation to act. Sometimes people are just genuinely inclined—and perhaps even eager—to do their part to end this pandemic. For example, many people have willingly taken on the burden of inconvenience by cancelling vacation plans or opting to eat at home instead of at a restaurant (when it’s an option) so that they can protect others in their communities. And it is truly admirable to see the willingness of many to embrace inconvenient alternatives for the sake of others.

Changing social norms. In addition to evolving risk perception, and perhaps even more so than altruistic tendencies, rapidly changing social norms—both at the institutional and individual level—have motivated social distancing in communities across the U.S. For example, just a couple of weeks ago it was unfathomable that mass sporting events, like the NCAA basketball tournament, the Masters tournament, or Major League Baseball opening weekend, would be cancelled. Yet, as soon as a few leagues began cancelling events, the dominos quickly fell. Certainly, these institutions want to keep people healthy and safe, but they also want to show that they are doing their part, just like their peers.

The same applies at the individual level. While many gyms across the country have closed either voluntarily or by mandate, my gym in North Carolina is still open. I’d still love to go to maintain a somewhat regular routine as well as my physical and mental health, but I have chosen not to. In this current climate, social norms dictate preventive behaviors, so I fear that others will judge me for going. After all, running on the treadmill next to someone isn’t exactly social distancing. I want to practice social distancing because I know the enormous benefit that can come from it, but admittedly, that is not the only reason why I’m avoiding the gym these days. Even though I know the benefits of preventive behaviors, I want others to perceive that I am doing my part to stop the spread of coronavirus in our community—and I think that sentiment speaks to many of us. Social distancing—perhaps to an extent initially driven by fear of judgement—has now become a social norm that people have embraced.

So, is there a silver lining to all of this?

While this outbreak is difficult to deal with and is going to have significant economic, social, and emotional ramifications (and more), it is laying the foundation for long-term behavior change. It’s clear that we don’t want to be in this situation ever again—and I believe that because of that, we will continue to be more committed to preventive health behaviors, like washing our hands for 20 seconds (not just when we use the restroom), avoiding touching our faces, and staying home and keeping our distance from others when we are sick. And whether we started engaging in those behaviors because of our perceived risk perception, our altruistic tendencies, or the impact of social norms, what’s important is that these behaviors stick so that we have an impact on future public health efforts and make a lasting difference in our world.

Laura Koehler, MPH, CHES
Account Supervisor

[1] https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

[2] https://www.cdc.gov/coronavirus/2019-ncov/summary.html

[3] https://www.latimes.com/world-nation/story/2020-03-11/inslee-restricts-gatherings-seattle

[4] https://www.cbsnews.com/news/white-house-coronavirus-response-coordinator-deborah-birx-first-interview-2020-03-16/