The following is a guest post by Melissa Garrido, PhD (@GarridoMelissa). She is the Associate Director of the Partnered Evidence-based Policy Resource Center (PEPReC) at the Boston VA Healthcare System, U.S. Department of Veterans Affairs, and a Research Associate Professor with the Department of Health Law, Policy, and Management at Boston University School of Public Health.
On March 19, the Washington Post reported that some spring breakers still insisted on gathering in Miami to party. The quotes reflect indifference to the ongoing COVID-19 pandemic. This response isn’t restricted to 20-somethings. Earlier, Senator Ron Johnson also downplayed the risk, urging people to put risks into “perspective” and stating that “… the flip side of this is the vast majority of people who get coronavirus do survive.”
Why isn’t everyone taking the risk of COVID-19 seriously? Responses are indicative of a larger phenomenon — most of us are terrible at translating a statement of the risk or likelihood of an outcome into rational action. (This is part of the appeal of casinos, the lottery, and game shows like Deal or No Deal.)
In part, this is due to limited numeracy — comprehension of numbers and arithmetic. Graphics, like ones illustrating how to “flatten the curve”, help overcome this.
Regardless of numeracy, however, irrational decision-making is common. In a 2016 article in the American Journal of Preventive Medicine, Jennifer Matjasko and colleagues outline frequently encountered types of irrationality, some of which are especially relevant today:
- Time inconsistent preferences. In general, people prioritize a short-term gain, even if it might have longer-term adverse consequences. Case in point: Spring breakers prioritizing short-term entertainment over longer-term health status.
- Framing effects. People may engage in different physical distancing behaviors if the risks of COVID-19 are framed as a loss (2.6% chance of death*) rather than a gain (97.4% chance of survival).
- Availability heuristic. We often discount risk when we don’t have a readily available example of the adverse outcome. Reports of COVID-19 have been in the news for months, but the risk felt abstract to many of us. As knowledge of confirmed local cases increases, so has the public’s engagement in risk mitigation strategies.
- Misperceptions of social norms. Individuals may continue to travel or congregate if they mistakenly believe most of their peers are doing so.
How do we help people appropriately respond to risk? Sebastian Linnemayr and colleagues suggest that disaster preparedness and response messages be rephrased as social norms rather than instructions. For instance, if a community leader can credibly state that the majority of residents are refraining from air travel, that may be more effective than exhorting people to stay home.
They also suggest that phrasing messages in terms of short-term losses may be more effective than messages that focus on gains or a longer time horizon, although they point out that the evidence for this strategy on an event of this scale is weak. Linking messages to stay home to proximal risks like reduced income or unemployment due to sickness may help more people understand the risks.
Understanding and responding to misperceptions of risk is just one small way to mitigate the effects of COVID-19. For a more comprehensive, longer-term strategy, see Aaron Carroll’s and Ashish Jha’s thoughts here.
* Mid-point of CDC’s estimated mortality rate