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Social Survival in the Pandemic

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Life in the pandemic is not easy for anyone. What is the proper behavior? What is out of bounds? We know that assholes going out to lunch at a crowded Colorado restaurant to own the libs is very bad. But what about the park? For that matter, Rhode Island is opening limited outdoor dining on Saturday. Should I go? Am I a worse person for supporting the business or for going out to eat around other people? It’s hard to know.

Julia Marcus, who is a professor in population medicine, has a pretty interesting essay about this in The Atlantic, comparing it to the AIDS crisis.

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.

There are two obvious differences between AIDS and COVID-19. First, COVID is far more contagious to the general population. Second, AIDS was far more lethal. So COVID is more universal but also the vast majority of us will survive it. In the end, managing the actual people living through this time and the risk isn’t all that different. Moreover, there’s a general belief that people aren’t getting back to normal until after there’s a vaccination. That’s not realistic. It’s entirely possible there will never be a vaccine and we have to learn to live with it, as the World Health Organization suggested today. So how do we manage to move on, hopefully survive, and also maintain enough of a society that we don’t have massively increasing depression, anxiety, alcoholism, suicide, domestic violence, etc. It’s not easy, especially in the relatively early days of this.

Marcus suggests a few guidelines outside of what is almost certainly counterproductive social shaming. First, helping people understand the difference between high risk and low risk activities. Sensible enough. Makes sense to maybe avoid the gym and the bars. Second, and more tricky, is that there’s not a one size fits all solution. She posits that people breaking social distancing rules to some extent in order to have human interaction may have more benefit than a strict following of social distancing guidelines. I agree with this, as a general rule. Honestly, if I was dealing with this alone, I might well be suicidal and I do not say that lightly. The only thing getting me through this is my wife and cats. Those on their own, alone after two months, good lord. Is it worth it? That’s up to the individual but I wouldn’t blame anyone for saying it’s not for them.

Third, and perhaps more controversial, is to encourage positive behavior even when people choose to engage in high-risk activities. This advice obviously comes straight out of the history of AIDS, but it’s relevant.

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.

Where you might disagree is that there’s a big difference between AIDS and COVID transmission. I don’t know. These are tough questions.

Right now, people are scared enough that people are actually acting pretty responsibly, as polling shows repeatedly. Despite some asshats and the Wisconsin Supreme Court, even Republicans are mostly not going out, or at least claiming that. There has been some significant slippage in people staying at home over the last couple of weeks, but this is to be expected and I am not totally sure is a bad thing.

What this is doing is buying time and that’s great. Doctors are slowly beginning to figure out how to treat some of this and hospitals haven’t been overwhelmed. The longer we can do this, the better. But that’s not going to last long-term and recognizing that and thinking in terms of the intersection of public health and humans acting like humans is an important strategy going forward. It’s not an easy circle to square though.

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