Six weeks ago, it looked like the world might be able to contain the outbreak of Covid-19. Now, as global cases surpass 200,000, that moment feels very far away indeed. In France, police are patrolling streets to enforce a nationwide lockdown which will see violators hit with fines unless they have a written declaration explaining why they are outside. Spain, Brussels and Italy are all under similar lockdowns as their countries struggle to contain the outbreak.
In the UK, the government has so far taken a softer tack. On Monday Boris Johnson issued the strongest government advice yet – recommending social distancing for all, home quarantine for those with suspected cases of Covid-19 and social isolation for the most vulnerable – but stopping far short of the major measures seen elsewhere in Europe. While Johnson recommended against visiting pubs, theatres or restaurants, they’re remaining open, as long as they have customers willing to visit them.
Based on the advice of its team of epidemiologists, behavioural scientists and virologists, the UK government is leaving it down to citizens to choose how closely they stick to its health advice, for now at least. One reason for that is the tricky behavioural science behind getting people to stay indoors for long periods of time.
“One thing that's necessary for people to really support any kind of intervention is for it to be seen to be proportionate to the threat,” says Susan Michie, a professor of health psychology at University College London who is also a member of the scientific group advising the government’s response to Covid-19. Put in place a lockdown too early, and people may not be able to comply with it but go too late and you risk negating some of the possible public health benefits that come with wide social isolation.
This might explain the government’s slow policy of gradually introducing new advice and policies to deal with the outbreak. “If you look retrospectively, that has been a coherent strategy – they've been ratcheting up, bit-by-bit,” says Michie. What started with advice on hand-washing and calling 111 continued with isolation for those with symptoms and later social distancing for the entire population. In Italy, by contrast, the government rapidly expanded what was initially just a lockdown of Lombardy to include the whole of the country – a huge expansion in the space of a day.
But even though this slow ratcheting up of policies will mean that any eventual lockdown comes as less of a shock it doesn’t mean that everyone in the UK is adequately prepared for it. There are lots of reasons why people may choose not to comply with voluntary social distancing. People may be worried about their job security, their ability to pay the rent or to support relatives close to them. Unless the government solves those problems, people just won’t be able to distance themselves.
Although the chancellor Rishi Sunak outlined on March 17 a set of loans and guarantees to help businesses and homeowners in the short term, there was precious little support for people in more precarious financial situations – nothing for renters, workers in the gig economy or those who are self-employed. “There's no reason why [measures support people on low wages] couldn't have been put in place two weeks ago, or three weeks ago,” says Michie. “These things need to be put in place before you [start social distancing] not the other way round.”
So-called ‘behavioural fatigue’ has been proffered as another reason for the relatively steady roll-out of isolation measures. “If you tell people to stay at home too early,” the government’s chief scientific advisor Patrick Vallance said at a press conference on Thursday March 12, “they get fed up with this at the very point where you need them to stay at home.” This concept was roundly disputed by some behavioural scientists who wrote an open letter to the government that we just don’t know enough about behavioural fatigue to use it as a justification for pandemic policy.
Michie is even less equivocal on that front. “Behavioural fatigue isn't a thing. It was something that's been introduced into the narrative, but this is not something that came from the behavioural science advisory committee,” she says. There are a host of problems that might come from social isolation, including depression, loneliness and anxiety, but each of these are distinct constructs that can’t just be lumped together, she says.
Read more: The chancellor’s plan to save us from coronavirus won’t be enough
One problem with working out the best way to convince people to follow social isolation policies is that we just don’t have a lot of experience with such far-reaching interventions in the UK. Emma Anderson, a health psychologist at the University of Bristol says that past public health initiatives give us some hints about how the advice might pan out. Without government legislation to back it up, the 2007 indoor smoking ban wouldn’t have received much support, she says. “People probably would have just ignored that [...] but it was that direct action that led to the behaviour change and there was a subsequent attitude change.”
Shifting attitudes could prove key to getting people to accept social distancing measures. “If we can tap into a community identity, that can be really important,” Anderson says. “That taps into a sense of social norms – particularly in times of uncertainty and crisis we can look to other people to know how to behave.” In other words, if we see other people isolating themselves, we’ll start to think that we should be doing it too, and start thinking less well of people who aren’t following the same approach.
While we’re not so used to enforced isolation, silently judging people who deviate from societal norms is a national forte. In Brooklyn, the judgement has spilled out into the open with at least one enthusiastic social shamer shouting “flatten the curve, go home!” to people walking on the pavement below.
Although the Brooklyn apartment-dwellers may be taking a decidedly un-British approach to isolation, shame is an important trigger for behavioural change, says Adam Oliver, a behavioural economist at the London School of Economics. The plastic bag tax and drive to get people to pick up dog poop both tapped into feelings of shame and social obligation. “These relied on trying to provoke people’s guilt or shame [...] and they can be quite effective,” he says.
An effective way to get people to voluntarily stay home might be to tap into this sense of social obligation. “People generally think that they ought to be doing the right thing at this particular point in time,” Oliver says. Emphasising that social isolation isn’t only good for your health individually, but also necessary for protecting the most vulnerable people in society might tip them in favour of compliance.
But there remains one key problem with the UK’s current policy: confusion. Right now, the government advice is that those with coronavirus symptoms should self isolate, that everyone else should avoid all unnecessary social contact, and that people over 70 or with underlying health conditions should really, really avoid unnecessary social contact. This isn’t as simple as telling people to wash their hands more or having police patrolling the streets warning people to stay inside.
“The simpler [the rules] are, the easier they are to be followed,” says Matteo Galizzi, an association professor of behavioural science at the LSE. “It’s not as easy to respond to a partial lockdown measure as it is to a total one.” In London, which is ahead of the rest of the UK in its Covid-19 outbreak and reportedly on the verge of a possible lockdown, the decision to stay in our go outside may be about to get a lot simpler.
Matt Reynolds is WIRED's science editor. He tweets from @mattsreynolds1
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This article was originally published by WIRED UK
