Many aren’t buying public officials’ ‘stay-at-home’ message; experts say there’s a better way
LOS ANGELES — With the coronavirus running rampant in Los Angeles and hospitals projected to overflow by Christmas, officials have fallen back on a familiar refrain: Stay home.
“My message couldn’t be simpler: It’s time to hunker down. It’s time to cancel everything,” Los Angeles Mayor Eric Garcetti said last week. “If you’re able to stay home, stay home.”
Some 33 million Californians are now under a new regional stay-at-home order that began Sunday night, a last-ditch effort to turn the corner on an alarming rise in coronavirus cases statewide. The blunt messaging worked to bend the curve in the spring, when fear of the novel virus and the insidious ways it might spread kept many indoors. But nine months later, the words seem to have lost their meaning.
The percentage of Angelenos staying home except for essential activities has remained unchanged since mid-june — around 55% — despite pleas from health officials in recent weeks for people to cut down on their activities, according to a survey conducted by USC.
A similar story has played out nationwide, as millions of Americans zigzagged across the country to visit family over the Thanksgiving holiday, flouting the advice of health officials.
“It’s not because the public is irresponsible; it’s because they are losing trust in public health officials who put out arbitrary restrictions,” said Dr. Monica Gandhi, an infectious-disease specialist at UC San Francisco.
“We are failing in our public health messaging.”
Health officials are up against a fatigued public, as well as a number of people who don’t believe in the danger of the virus, Gandhi said. But she is also part of a growing number of experts who think there’s a better way to engage those who do want to take the pandemic seriously — by taking a lesson from the public health strategy known as harm reduction.
Typically used to describe sexeducation programs and needle exchanges for drug users, harm reduction aims to mitigate the risks of dangerous behaviors instead of trying to get people to cease altogether.
When it comes to the COVID-19 pandemic, a harm-reduction approach would encourage masking and social distancing instead of demanding that people have no contact at all with friends or family they don’t live with. In other words, even during a pandemic, abstinence-only isn’t effective.
L.A., however, has adopted more of a “just say no” attitude. Last week the county became one of the only places in the nation to halt all outdoor gatherings among people who aren’t in the same household, prohibiting two friends from meeting up in a park or going on a hike with masks on. Gov. Gavin Newsom followed suit and included the ban in his regional stay-at-home order.
California officials are desperate to reverse an unprecedented flood of new coronavirus cases up and down the state, and even their critics acknowledge the impossibility of the situation. But banning relatively safe outdoor activities risks alienating people who want to follow the rules but feel exhausted, disregarded and sometimes confused by them, Brown University health economist Emily Oster said.
“Some of the things they’re telling you not to do are incredibly low-risk,” Oster said. “When you are so strict about what people can do, they stop listening.”
Aggressive shutdowns and widespread closures of businesses can persuade people to stay home and ultimately turn the tide on a major surge, as has happened in other parts of the world, experts say. And it is possible that the increasingly urgent pleas of officials in recent days may indeed push large numbers of people to start staying home again.
But in L.A. County, the latest measures have already sparked unprecedented backlash, particularly because of what many see as inconsistent policies. Unlike successful lockdowns in other countries that keep people inside by closing almost all businesses, officials here are reluctant to close shops without federal aid to ease financial losses.
So in L.A.’S current version of a shutdown, people are asked to shelter in place while bigbox stores and malls welcome customers for holiday shopping.
“It says it’s not safe to even leave your house, stay home as much as you can, but I’m forced to go to work,” said L.A. retail employee Toby Thomas, who has an autoimmune condition that makes her especially vulnerable to COVID-19. “They’re just contradicting themselves with everything that they say.”
The concept of harm reduction originally came into use in the 1980s when doctors and activists struggled to reduce
HIV transmission among people injecting drugs. Instead of stopping them from using drugs altogether, they opted to provide clean needles that would at least make the behavior safer.
The philosophy now applies to any public health issue for which mitigating risk has been found to be more effective than an allor-nothing approach, including providing condoms to teenagers to promote safer sex or slowly weaning patients off junk food to improve their diet, said Dr. Eric Kutscher, an internal medicine physician at New York University.
Kutscher, who recently wrote about harm reduction and COVID-19, said it acknowledges an uncomfortable truth: that people are going to socialize whether they are allowed to or not.
He added that he thinks health officials’ rhetoric lacks nuance in part because they were initially trying to drown out President Trump’s downplaying the threat of the virus. But as a front-line physician, Kutscher fears that the current messaging shames people and doesn’t consider their needs — that they may still have to go into work, that they may be lonely and depressed.
“Clearly what we’re doing is not working,” Kutscher said.
“The idea of people gathering on Thanksgiving, it’s terrifying. It really upsets me, but I think we need to figure out how to get beyond that visceral response to instead focus on an actual productive conversation.”