Behavioural change is slow and painful in time of corona
More than half a million people have already died in the coronavirus pandemic, and still the message hasn’t got through about how big a risk the disease poses.
The world over, public health guidance is to wear masks, maintain as much physical distance as possible from other people, and avoid crowds. Yet people are congregating in large numbers on beaches, at parties and in bars, and many consider directives to wear masks an abrogation of their rights.
SA is no exception, and compliance with the guidelines is patchy at best. That’s despite the country having confirmed more than 215,000 cases and over 3,500 Covid-19 deaths in little more than four months.
Experts say the figures grossly underestimate the prevalence of the disease.
Public hospitals are already taking strain in the Western Cape, Gauteng and Eastern Cape, and it is clear that things will get worse. With no cure or vaccine likely to be available any time soon, social distancing, hand hygiene and masks are the only weapons in the armamentarium.
The mixed response was plainly evident during a stroll around Cape Town’s Green Point suburb on an icy Friday morning. Retailers scrupulously wiped down trolleys, carefully limited the number of shoppers, and insisted customers wore masks and sanitised their hands before entry. But down the street, Lycra-clad cyclists stood barely inches from each other as they drank takeaway coffee, not a face covering in sight.
A few blocks away, labourers huddled on the pavement, hoping for a day’s work on a construction site, some with masks, some without.
HIV EXPERIENCE
Local experts are grappling with why so many people cannot or will not change their behaviour, despite SA’s devastating experience with HIV.
DG Murray Trust CEO David Harrison, who previously led a major government-funded HIV prevention programme called loveLife, says research shows people who don’t have a strong sense of future possibilities are more likely to take risks.
This helps explain why HIV incidence tends to be highest in informal settlements, where opportunities are scant,.
But it doesn’t explain why people who appear to have a great deal to lose are taking risks with Covid-19.
“I am puzzled as to why an accountant, or somebody who has a lot to live for, would be out and about without a mask. I don’t believe it is the denialism we are seeing in the US. It is simply a failure to internalise the risks. Wealthy people somehow feel they are immune, while fatalism may drive behaviour in poorer communities,” he says
Unlike many developed countries, such as the UK and Spain, which are easing lockdown restrictions as their coronavirus cases decline, SA is opening up as the numbers soar. By Wednesday, SA ranked 14th on the global coronavirus league table, with more confirmed cases than Turkey, France or Germany, according to the Johns Hopkins University tracker.
“We are dealing with a serious contradiction, and we are not alone. India, Pakistan and Russia are all in the same boat. If we were to do it purely on a health basis, we would still be in lockdown,” says Salim Abdool Karim, who chairs health minister Zweli Mkhize’s advisory committee on Covid-19.
Paradoxically, the lockdown’s success in delaying infections in many parts of the country has undermined the message that this is a serious and potentially lethal disease.
“We told people in March this is a serious problem, stay home. So they did. And weeks later they look out of the window and say ‘What problem are you talking about? You made us do all this for a very mild condition, and most people get better.’ But the reason they don’t see the mass graves is because they stayed home,” says Karim.
The government took SA into lockdown with the message that it was acting to protect people. It has now shifted the narrative, emphasising that individuals must take responsibility for their own actions.
The initial authoritarian stance was a mistake, says Harrison, as it triggered a response of “do not tell me what to do”.
“Until recently there has been very little messaging to shift our collective anxiety into collective agency, and to say the power rests in our hands.
“We have missed a massive opportunity,” he says.
Harrison suggests some people are driven more by a desperate desire for a return to normality than a deliberate decision to flout official guidelines. “This is a once-in-a-century experience. People are hearing this may continue until the end of 2021 and can’t cope.”
Wits sociologist David Dickinson says that even in the best of circumstances, governments
RESEARCH SHOWS PEOPLE WHO DON’T HAVE A STRONG SENSE OF FUTURE POSSIBILITIES ARE MORE LIKELY TO TAKE RISK
face an uphill task trying to persuade people to change their behaviour. It took decades before people in the UK buckled up and stopped drinking and driving. Attempting to get people to wear masks, stop hugging, and to keep their distance from friends and family was always going to be tough.
“To be physically close is really important. We are trying to change a very deep human behaviour,” he says. Trying to do that at high speed is even more difficult. But to make matters worse, the government lost credibility with its ban on tobacco sales, and skewed the pitch for future public health campaigning.
“It should have been telling people to stop sharing cigarettes, which people in townships do all the time,” Dickinson says.
The experience of countries such as Italy, which has one of Europe’s highest Covid-19 death rates per million population, has shown that people will quickly change their behaviour when they see people dying in large numbers, says Wits vaccinologist Shabir Madhi.
“When the bodies started to be loaded onto trucks, people really understood. It seems people need to be shaken for the message to get through.”