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* The Atlantic has helped lead the way in COVID-19 coverage. And this new article is fascinating. An excerpt…
Public-health campaigns that promote the total elimination of risk, such as abstinence-only sex education, are a missed opportunity to support lower-risk behaviors that are more sustainable in the long term. Abstinence-only education is not just ineffective, but it’s been associated with worse health outcomes, in part because it deprives people of an understanding of how to reduce their risk if they do choose to have sex. And without a nuanced approach to risk, abstinence-only messaging can inadvertently stigmatize anything less than 100 percent risk reduction. Americans have seen this unfold in real time over the past two months as pandemic shaming—the invective, online and in person, directed at those perceived as violating social-distancing rules—has become a national pastime.
The anger behind shaming is understandable. Photos of crowded beaches or videos of people at a large indoor party may make viewers feel as if they’re watching coronavirus transmission in action. Calling out seemingly dangerous behavior can also provide an illusion of control at a time when it’s particularly hard to come by. But, as years of research on HIV prevention have shown, shaming doesn’t eliminate risky behavior—it just drives it underground. Even today, many gay men hesitate to disclose their sexual history to health-care providers because of the stigma that they anticipate. Shaming people for their behavior can backfire.
Berkowitz and Callen knew that indefinite abstinence wasn’t realistic for everyone, and instead of shaming, tried to give gay men the tools they needed to be able to have sex with a low but non-zero risk of HIV transmission. In essence, this is the harm-reduction model, which recognizes that some people are going to take risks, whether public-health experts want them to or not—and instead of condemnation, offers them strategies to reduce any potential harms. This approach meets people where they are and acknowledges that individual-level decisions happen in a broader context, which may include factors that are out of people’s control.
What does harm reduction look like for the coronavirus? First, policy makers and health experts can help the public differentiate between lower-risk and higher-risk activities; these authorities can also offer support for the lower-risk ones when sustained abstinence isn’t an option. Scientists still have a lot to learn about this new virus, but early epidemiological studies suggest that not all activities or settings confer an equal risk for coronavirus transmission. Enclosed and crowded settings, especially with prolonged and close contact, have the highest risk of transmission, while casual interaction in outdoor settings seems to be much lower risk. A sustainable anti-coronavirus strategy would still advise against house parties. But it could also involve redesigning outdoor and indoor spaces to reduce crowding, increase ventilation, and promote physical distancing, thereby allowing people to live their lives while mitigating—but not eliminating—risk.
Second, health experts can also acknowledge the contextual factors that affect both a person’s decisions and their risk of coronavirus transmission. Some people are seeking human contact outside of their households because of intense loneliness, anxiety, or a desire for pleasure. The decision to go for a run with a friend or gather in a park with extended family may be in conflict with current public-health guidance in some communities, but for some people, the low risk of coronavirus transmission in these settings may be outweighed by the health benefits of human connection, exercise, and being outdoors. We can also acknowledge that some people can’t comply with public-health guidance because of structural factors, including systemic racism, that render physical distancing a privilege. If we ignore this broader context, people of color will continue to bear the brunt of not only the pandemic itself, but also American society’s response to it.
Third, Americans can accept that, despite our best efforts, some people will choose to engage in higher-risk activities—and instead of shaming them, we can provide them with tools to reduce any potential harms. Want to see your grandkids? Still planning to have that party? Meet up outside. Don’t share food or drinks. Wear masks. Keep your hands clean. And stay home if you’re sick.
* Related…
* Don’t Close Parks. Open Up Streets.
posted by Rich Miller
Monday, May 11, 20 @ 12:41 pm
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The excerpt from this article seems right on, with the need to have a differentiated response that responds to actual human behavior and the fact that the stay at home orders were instituted to preserve hospital capacity not to completely eliminate risk from the virus. See the examples in the southern states of opening the restaurants at reduced capacity, and people policing themselves and some people not utilizing them at all. Our politicians need to study behavorial economics and bake this into their public health driven metrics. Each has its place, but many people who point to the “science” also are not factoring in human behavior (some people who may not hesitate go to a crowded forest preserve on a weekend also may answer a poll question they way they feel they “should” by saying that they still support all the stay at home order rules - something I’ve observed first hand in my own conversations with people and then watching their how their actual behavior differs). If all of Illinois, including Chicago isn’t into stage 3 of the Restore Illinois plan by early June, with good weather you’re simply going to see more of people acting in a way that isn’t always consistent with what they state
Comment by Gary Becker Monday, May 11, 20 @ 12:50 pm
“Americans can accept that, despite our best efforts, some people will choose to engage in higher-risk activities—and instead of shaming them, we can provide them with tools to reduce any potential harms. *** Meet up outside. Don’t share food or drinks. Wear masks. Keep your hands clean. And stay home if you’re sick.”
Sounds reasonable — until you read the comments on this page bemoaning the terrible, unbearable burden of merely wearing a mask to protect the health of others.
It seems that some people will choose to engage in higher-risk activities and demand to do so without making any compromises to reduce potential harms.
And they’ll declare themselves patriots for doing it.
– MrJM
Comment by @misterjayem Monday, May 11, 20 @ 12:56 pm
So 72 of Wisconsin’s finest now test positive for COVID-19. Forgive my lack of compassion but our family has been in the fight as doctors and nurses. They are exhausted. This astro-turf campaign the DeVos’ and their ilk financed will surely continue to weigh heavily on our health care providers. Where will we find their replacements?
Comment by Thankful1 Monday, May 11, 20 @ 1:02 pm
misterjayem is right, there will always be knuckleheads on both ends of the spectrum. I think that the mask requirement makes a lot of sense, and I wish it was instituted sooner (full disclosure I’m a Republican that lives in Lake County), but at some point that has to be balanced out with allowing people some important freedoms in exchange. If we can get to the point where kids can go to outdoor-focused summer camps (with reasonable modifications) workers can return to work where it really is essential for them to physically be there (meaning those in knowledge intensive industries may still be able to work from home, putting fewer individuals at risk) and restaurants can open up with outdoor seating and capacity limits, I think we’ll be at a better place. The problem is, this can’t wait much longer or the economic and social ramifications will be increasingly more problematic. The much overused “new normal” means actually going about much of our daily activities, but in a well thought out way so that the health of vulnerable populations are protected. It’s a balancing act and I have more faith in the overall citizenry to figure it out than I do the politicians or the media
Comment by Gary Becker Monday, May 11, 20 @ 1:10 pm
==the stay at home orders were instituted to preserve hospital capacity not to completely eliminate risk from the virus==
I keep seeing people say this, but it’s a misrepresentation of what anyone’s trying to do with continued orders, and completely misses that no where in the world has started their “reopening” with a mere flattening of the curve.
Of course, other countries have workplace safety requirements and health systems that help their response.
Comment by In 630 Monday, May 11, 20 @ 1:32 pm
I just can’t figure out how a restaurant will be profitable when they can only have 25% of their seats filled. And churches? And schools? Those are the three big things for me. Wear a mask and open everything else up? Fine. Show me how to safely open churches, schools and restaurants before there is a vaccine or highly effective treatment.
Comment by Ducky LaMoore Monday, May 11, 20 @ 1:34 pm
===Third, Americans can accept that, despite our best efforts, some people will choose to engage in higher-risk activities—and instead of shaming them, we can provide them with tools to reduce any potential harms. Want to see your grandkids? Still planning to have that party? Meet up outside. Don’t share food or drinks. Wear masks. Keep your hands clean. And stay home if you’re sick.===
Good advice. Many of the people likely to engage in such high-risk activities are the least likely to heed it. For them wearing a mask = tyranny.
The failure of federal leadership cost us the chance for containment. The ongoing failure of federal leadership and patchwork state-by-state approach, combined with stay-at-home fatigue, has likely cost us the chance for effective mitigation.
Speaking personally, I’m bracing for impact and not placing any confidence in plans that require responsible behavior. It seems about 30% of our fellow citizens can’t handle it, and that’s big enough to endanger all of us.
Comment by Moe Berg Monday, May 11, 20 @ 1:40 pm
Ducky. You raise some good points, but they’re not insurmountable. Restaurants (at least in the summer) can have outdoor seating at a reasonable distance where transmission is less (and have fewer indoors). Combine this with the current take-away and you might get back to 2/3 capacity (enough to maybe keep the lights on until there’s a good therapeutic or vaccine). Churches could have outdoor services (mine does anyways in the summer - then again, I live in the suburbs and this is a possibility). Also, once you get into Phase 4 and can have larger capacity gatherings up to 50, you could just have certain people go to particular services and rotate and allocate as needed. Schools are a bit tricker, but its essential to figure out by fall as people’s ability to work in many cases depends on their children physically being in school (particularly at lower income levels). Kids are at much lower risk for severe outcomes. If were in phase 4, just get rid of the assemblies and large group activities and keep kids in closer contact with their own classes. If there need to be some legal protections for “at risk” teachers to temporarily be on disability, etc. it would be a small price to pay for getting society back to some sense of normalcy. The first step in this is getting kids back to outdoor focused summer camps as soon as mid-June (yes they can learn to be good citizens and wear face coverings as needed when not eating, etc.). Given the CDC research on sunlight killing the virus very effectively, combined with kids being at less risk, and the greatly reduced transmission outdoors, this is a critical step, particularly for low-income kids in Chicago whose parents have jobs that often require them physically to be at work.
Comment by Gary Becker Monday, May 11, 20 @ 1:52 pm
I realize the comments are a small number here but the general tone seems to be one of “we can’t do anything until…” The … is always a moving target. The initial guidance promoted was to stay home to, yes, flatten the curve. But that was focused on not overwhelming medical resources. However now we keep hearing a message, with variations, that lives are at risk if we open up before a cure or treatment. Perhaps those saying this don’t mean it but it sure sounds like all or nothing talk. I think most of us realize that life is about calculated risk. (If you’ve driven on the Dan Ryan at any time of day you know it’s more than calculated, it’s real) The fatality numbers for COVID 19 continue to show an almost negligible death rate if you are under 20. If you start adding up daily deaths in Ilinois somewhere around 90% of deaths are people over 60, and that’s just a raw statistic. We have every reason to believe that we can open up our state with targeted populations being encouraged to avoid certain situations and locations. We can set up specific reasonable accommodations for this group and then allow the rest of us to get our economic health back in order. And yes I am over 60 and recognize the limitations it may impose on me. But i think this is what is needed. The question is will the most selfish generation (Baby-Boomers) be willing to emulate their parents, the Greatest Generation, and help save this country.
Comment by NeverPoliticallyCorrect Monday, May 11, 20 @ 1:58 pm
It has always been true that young people engage in risky behavior; certainly not all young people, but the feeling that one is invincible is more prevalent in the young.
This is evidenced in extreme sports, binge drinking, reckless driving, and other activities that can cause serious injury or death.
With age comes wisdom, and caution. But certainly not in all cases. There are some blockheaded geezers too.
It seems to me that Governor Pritzker has a careful but realistic plan to reopen the state. Wearing a mask is an inconvenience, not a burden.
Comment by Streator Curmudgeon Monday, May 11, 20 @ 1:59 pm
- Gary Becker -
With respect, and with respect to your (honestly) thoughtful words;
Have we even had 14 days of decline in Illinois?
Comment by Oswego Willy Monday, May 11, 20 @ 2:00 pm
=== If you start adding up daily deaths in Ilinois somewhere around 90% of deaths are people over 60, and that’s just a raw statistic. We have every reason to believe that we can open up our state with targeted populations being encouraged to avoid certain situations and locations. We can set up specific reasonable accommodations for this group and then allow the rest of us to get our economic health back in order. And yes I am over 60 and recognize the limitations it may impose on me. But i think this is what is needed.===
Saying you’re willing to die for money isn’t the best way to convince me that opening a state is worth it.
… then again, I’m not Lt. Gov Dan Patrick who all but said seniors should sacrifice themselves for other people’s money.
News flash; that was panned nationally.
Comment by Oswego Willy Monday, May 11, 20 @ 2:04 pm
NeverPoliticallyCorrect - You’re spot on with your answer, particularly the last sentence (I’m an X’er with a seven year old son). I’m cynical about the boomers being able to do the right thing, but I hope the boomers will be able to live up to the old Winston Churchill saying “Americans can always be trusted to do the right thing, once all other possibilities have been exhausted” (snark intended so don’t get too mad at me!)
Comment by Gary Becker Monday, May 11, 20 @ 2:07 pm
=== We have every reason to believe that we can open up our state with targeted populations being encouraged to avoid certain situations and locations. We can set up specific reasonable accommodations for this group and then allow the rest of us to get our economic health back in order.===
To be even more crystal clear;
Deciding by “age” who should be at risk to infection or worse is not being thoughtful to anything but an arbitrary number so money is acquired.
“You’re 33. Get to work”
Yikes.
“But it’s not safe and you’re putting not only my life but my family’s life and anyone I come in contact with life’s too”
“You’re 33. Go to work”
You seeing this yet?
Comment by Oswego Willy Monday, May 11, 20 @ 2:13 pm
=However now we keep hearing a message, with variations, that lives are at risk if we open up before a cure or treatment.=
I believe that’s critics who try to advance the argument that we’re moving the goal posts and/or going to be in an indefinite lockdown. Nobody has ever said that everything has to be on hold until there’s a cure or treatment although large spectator events might be the exception. What we have to do is identify those individuals who may unwittingly spread the disease to the vulnerable groups and right now our ability to do that is limited. We’ve either given up in some states or allowed ourselves to think it’s not necessary or possible.
There’s always been a clear way out of this. The issue is whether or not we’re willing to commit to the plan to make that happen.
Comment by Pundent Monday, May 11, 20 @ 2:16 pm
Adding onto Oswego Willy’s comments, for all of you saying, essentially “it’s only the old and the already sick” who are at-risk/dying - you are clearly not considering:
1. There is still so much we don’t know about this *novel* coronavirus.
2. We do know that people in their 30s and 40s with no co-morbidities are dying from Covid-19 strokes and heart attacks.
3. We do know that children, who were wrongly claimed to be not susceptible to the virus, are manifesting symptoms consistent with Kawasaki Disease.
4. We do know that some who have “recovered” are maimed, severely weakened, and dealing with neurological, kidney, and heart issues.
5. We have no idea how people thought to be recovered may be faring in 6-months or a year or 2-years.
No one should think themselves or their loved ones are safe.
Comment by Moe Berg Monday, May 11, 20 @ 2:24 pm
Most of the recommendations are just that . . . . .recommendations on the honor system. No real enforcement mechanisms.
The recommendations only hold up so long as the populace is willing to abide by them. That is wearing off in places with very few fatalities. Look at the traffic in your own community. I suspect increased traffic is undeniably the reality in many, if not all, communities with low fatality rates.
The end of May could well be the bell weather in terms of enforceability in some areas. Politicians are rarely behind the enforceability curve.
Following science is most certainly the preferred path. When those in the majority start ignoring the prescribed precautions, the enforceability factor changes and elected are never far behind.
Comment by In the End Monday, May 11, 20 @ 2:27 pm
My family has to minimize risk until a vaccine is deployed. I sympathize with those who need to work. A few years back my working kept the insurance that paid for my wife’s chemo. Given the risk of Covid vs. the loss of chemo, I would go to work.
Societies have functioned with higher risks of death than we have today even with Covid. I think we will have to move into a new world where death is more present. Not that we should seek death. Just recognize that it is present.
Had this disease hit in 1944 we would have mourned the dead and kept on working and fighting. Today we have the wealth to buy time. Not clear how much time we can buy.
Comment by Last Bull Moose Monday, May 11, 20 @ 2:30 pm
traffic. OMIGOD. Every day we go to the house in Chicago that my wife inherited to work on it and prepare it for sale. Her sister died 11 months before Wuhan so there is no virus there, unless we carried it in, in which case we have it. Saturday was a nightmare. 17 mph on North Avenue in a 40 zone. Cars everywhere. Cinco de Mayo traffic? Or is everyone sick of staying home? We are eating out, Chinese takeout or Burger drive-through more and more because it’s actually cheaper than paying the exorbitant price for meat in supermarkets. Strange when meat packers are closing for lack of demand isn’t it?
Comment by Streamwood Retiree Monday, May 11, 20 @ 3:01 pm
“Enclosed and crowded settings, especially with prolonged and close contact, have the highest risk of transmission, while casual interaction in outdoor settings seems to be much lower risk.”
This is something I have been thinking about. Like allow activities to become legal outdoors even if they remain banned indoors.
Comment by Blake Monday, May 11, 20 @ 4:01 pm
i live close to Lincoln Park in Chicago. I agree with closing the lakefront trails. But later the Mayor closed all of Lincoln Park. This seemed counter productive in alignment with the harm reduction concept. One issue is it limited the area for people to walk outside and resulted in more people coming into contact with each via over crowded sidewalks with joggers. If you put me in charge with unlimited funds I would hire people to walk around parks and elsewhere to educate people about risks. Have a six foot pole to show what that really looks like. Talk to people about how playing spike ball means they are all touching same item. It was different but the safe/safer sex education campaigns used similar approaches with success. And I don’t watch much regular tv but role modeling there is critical.
Comment by Chicago Guy Monday, May 11, 20 @ 8:10 pm
== how a restaurant will be profitable when they can only have 25% of their seats filled ==
But it can slow the bleeding and keep the lights on a bit longer
Comment by RNUG Tuesday, May 12, 20 @ 12:16 am
== how to safely open churches, ==
Outdoor, drive-in style. Several churchs are doing that, and it works for the nice weather. Biggest issue I saw was the church’s Wi-Fi router was overwhelmed by people trying to use Facebook Live to get the audio.
Comment by RNUG Tuesday, May 12, 20 @ 12:25 am