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Everyone doing their bit

By Sarah Whitebloom

People need simple choices, not suggestions, in the Covid-19 crisis - so they do things that are good for them and for the community by default, according to Dr Kate Orkin, senior research fellow in behavioural economics with Oxford’s Blavatnik School of Government.

Dr Orkin points out that, in Choice Architecture, Richard Thaler and Cass Sunstein highlight that people have limited attention or ‘headspace’ and can be nudged to make better choices (as judged by themselves) without forcing them to act. But nudging in the current context does not mean making suggestions as to whether people should stay at home. They need to be given simple choices, she says: ‘The famous example of this was when it became the default option to save in pensions in the US - more people saved,’ she says.

To encourage cooperation, basic game theory suggests, you need to have some sanctions to get people to cooperate, says Dr Orkin. This can include fines but also social pressure. Dr Orkin maintains: ‘Statistics show that 82 per cent of Britons would support the police being able to arrest or prosecute anyone who should be self-isolating but isn’t.’

Statistics show that 82 per cent of Britons would support the police being able to arrest or prosecute anyone who should be self-isolating but isn’t

But, key to encouraging people is to highlight that the majority is doing the right thing, not that the minority is doing the wrong thing. According to Dr Orkin: ‘Research shows that, if you highlight people doing a bad thing, it suggests it isn’t that bad and they do it more.

‘It is much more effective to highlight positive behaviour or ask people to do the right thing.’

Dr Orkin says: ‘These Italian mayors all over social media scolding their constituents for doing the wrong thing may be funny, but evidence suggests it isn’t actually very helpful.’

People learn socially, she says, they watch what others around them do and they’re very influenced by people like them.

‘Evidence from smoking cessation, exercise, diabetes management programmes show people are very influenced by hearing from others like them who have managed to make a positive change. And it helps if it is relatable: if people who can talk about how they’ve struggled and overcome those struggles.’

 But will it be a problem to start with three weeks social-distancing, if it then has to be extended? Will it be less likely that people less likely to stick to it?

‘I don’t think so,’ says Dr Orkin. ‘It is true that people tend to set reference points or targets and stop when they reach their goals. But that’s instinctive behaviour – it is not difficult to overcome. ‘

 She adds: ‘There is this sense are hard and fast rules about human behaviour. But we are agents, we can control our actions. We can also be quite easily guided.’

Appropriate wartime analogies might be...in Dunkirk where the big transport ships are being overturned in the channel they send in all the little boats: everyone needs to play their part. 

Dr Orkin points out that the renowned psychologist Daniel Kahneman uses this idea of System 1 and System 2 - we almost have two brains. System 1 is automatic thinking, almost by instinct. We are guided by emotions, we use rules of thumb, we overinterpret cues. This particularly kicks in when we’re tired, hungry or anxious. System 2 is more considered and rational.

In the current crisis, Dr Orkin says, public health action should have simple structures to guide people when they’re using system 1.

‘So just set the default: don’t go out the house. Or – you can only buy two packets of loo roll.’

But, she says: ‘If you need people to make an active choice, you want to help people switch into system 2. And you want to give them motivation to do the right thing.’

This can be used by everyone – supermarket managers managing queues, local councils managing parks.  As for whether it would be appropriate for the authorities to put people on a ‘war footing’, using analogies from wartime to encourage ‘good’ behaviour, Dr Orkin says that, in her opinion: ‘Appeals to do the right thing are effective, appeals to civic duty are effective. I personally think you want a message which emphasises that everyone has to play a role and it isn’t going to be fixed by one grand plan.’

Appropriate wartime analogies might be: Your actions have consequences for others. Don’t leave your black-out curtains open, the whole street will get bombed, not just you. Or, she says, there’s the scene in Dunkirk where the big transport ships are being overturned in the channel and then they send in all the little boats: everyone needs to play their part.

family working

If families are going to survive the Covid-19 lockdown happily, planning is going to be key, according to Professor Ann Buchanan of Oxford’s department of social policy, who has come up with the Four Bs as a plan for a successful family lockdown.

A good way to handle to stress is to have a routine that happens five days a week with more relaxed days at weekends

Planning needs to go into daily life, she maintains, in order to alleviate the inevitable stress on both children and parents of constant contact. Professor Buchanan’s Four Bs are all about planning. She says: ‘A good way to handle to stress is to have a routine that happens five days a week with more relaxed days at weekends. But, kids of all ages, also need the Four Bs.’

  • First, Busy.  The temptation is that younger children will spend their time in front of the TV while older children spend all day on social media.
  • Second, Brain. Hopefully, schools have given projects/challenges, which they work on with friends, but which also require some work on their own.
  • Third, Body. Exercise.  The government has set strict rules- no team games but walking, cycling, running are all allowed.   
  • Finally, Buddies.  Most kids are good at linking up with friends on social media. But, if parents are not careful, this can be a full day activity.

Professor Buchanan says: ‘My instinct would be to divide the day into three - Brain in the morning, Body in the afternoon and Buddies after tea.’

And, she says: ‘Once children get a routine, parents will have time to concentrate on their work. So settling children is good for parental mental health. They need to look after themselves. Many parents are struggling with less money on top of all the other problems.’’

The beauty of the Four Bs, though, is that you don’t need children for them to work. Everyone benefits from having a routine, according to the Professor.

 ‘You need to get up at regular times and not just wear sloppy clothes,’ she says.

This crisis and the prime minister’s call to stay at home came suddenly on families, who may, in normal times, see little of each other.  Coronavirus left no opportunity for planning - and there is no knowing how long this situation will continue

But why is this period proving so difficult for families? Isn’t it good for parents and children to be together? And, after all, we are together at other times of year; Christmas and holidays. But, says Professor Buchanan, this crisis and the prime minister’s call to stay at home came suddenly on families, who may, in normal times, see little of each other.  Coronavirus left no opportunity for planning - and there is no knowing how long this situation will continue.

‘It’s challenging,’ she says. ‘Christmas and holidays are limited and it can be stressful just being together for two weeks. We don’t know how long this is going to go on.’

Being thrown together overnight, with little opportunity even to go outside, has created a ‘very intense’ situation. Professor Buchanan says: ‘These are stressful times for parents...They may have their own work to do, but they also have to think about their children's wellbeing. Meanwhile, many children will be anxious and worry about their own health.’

A key way to maintain motivation, for teenagers and adults alike, is to focus on the fact that self-isolation is for doing something for someone else. Professor Buchanan says: ‘It gives them a purpose, if you appeal to people’s better nature. [If they don’t think about their situation] It takes them out of themselves. The fact that it is a global emergency in that it is not just our emergency.

‘It always makes you feel better if you’re doing something for someone else – or saving the world.’  

Vintage propaganda poster

By Sarah Whitebloom

Self-isolation, lock-downs, economic chaos and closed borders: responses to today’s COVID-19 pandemic have their roots in history. In the past, there has also been panic-buying, attempted flight, fake news, quack remedies, beleaguered health authorities and a race for vaccines – all in the face of millions of deaths.

From earliest history to the SARS epidemic, the world has endured plagues, viruses and infections that have inspired panic among populations, rulers and politicians alike – as well as countless untimely deaths.  From the Black Death of 1348 to the London plague of 1665, from the repeated impact of cholera in the 19th and 20th centuries, to the millions lost in the 1918 ‘Spanish’ flu, leaders have often struggled to know what to do while populations have reacted with fear and later, occasionally, fury. The reaction to COVID-19 can be seen very much in this tradition, as concern has turned into pressure for the strictest containment measures, alongside the determined – and unprecedentedly rapid - pursuit of a cure.

During cholera epidemics, propaganda was used to urge people to pursue physically and morally 'healthy' habits from staying calm and washing their hands – just as it has been today -  to praying for salvation and quitting alcohol. In the 1918 epidemic, face masks were in common use and, in earlier times, people were ordered to quarantine. In the distant past, though, civil disorder sometimes followed. Public compliance eventually turned into public dissatisfaction with measures, which included infected people literally being shut into their houses.

In the 1918 epidemic, face masks were in common use and, in earlier times, people were ordered to quarantine

As in the past, in the current crisis there will be ‘pinch points’, according to historians, for instance if the number of cases rises despite social distancing and the authorities will need to issue reassurance or adjust the measures being taken. While social distancing is an internationally agreed approach, as the situation changes, governments around the world will be under pressure to put in place policies for an eventual move to less draconian measures. At that point, Oxford Professor of the History of Medicine, Mark Harrison, maintains international leaders will need to look for an ‘exit strategy’ or an end in sight from the current lockdown approach.  Professor Harrison says: ‘Governments will need to ask, how do we de-escalate? What measures do we put in place and can we re-escalate at a later point?’

Although the threat to life from the plague was in a completely different order to that presented by COVID-19, the measures taken in London in 1665 were not dissimilar to current international social distancing.  From the beginning of the plague outbreak, there was strict quarantine of infected people, trades closed down and many fled the city. But, in chaotic Restoration-era London, crime  and disorder followed harsh restrictions. Samuel Pepys wrote in his diary: This day, much against my will, I did in Drury Lane see two or three houses marked with a red cross upon the doors, and ‘Lord Have Mercy upon Us’ writ there – which was a sad sight to me, being the first of the kind… that I ever saw.’

Although the threat to life from the plague was in a completely different order to that presented by COVID-19, the measures taken in London in 1665 were not dissimilar to current international social distancing

Opposition was swift. In the documents of a case discussed at court at Whitehall in the presence of Charles II, 28 April 1665, it states: Upon Information given unto this Board, that the house, the Signe of the ship in the New buildings in St.Giles in the fields, was shutt up as suspected to bee infected with the Plague, & a Cross and paper fixed, on the doore; And that the said Cross & paper were taken off, & the door opened, in a riotious manner, & the people of the house permitted, to goe abroad into the street promiscuously, with others.’

This was not an isolated incident. In a letter from a civil servant, 1665, also in the National Archive, it states: ‘Death is now become so familiar, and the People soe insensible of danger, that they look upon such as provide for the publick safety, as Tyrants and Oppressors.

Government experts are already talking about scaling back the strict measures over time. The current lockdown is initially going to last three weeks. And over the next 12 months greater and lesser restrictions may be applied, depending on the course of the virus. 

Widespread use of testing offers a way of relaxing measures but GPS monitoring advocated in South Korea is proving controversial there.  Professor Harrison says: ‘Maybe they [the government] will have to communicate with people that they will have to accept some risk as a price for their freedom. Maybe they will have to make available more intensive care beds, in expectation of more cases....The prime minister said there was light at the end of the tunnel of 12 weeks. That is the target. But there could be dissatisfaction if de-escalation doesn’t happen...Resentment could build up.'

In one important respect parts of the COVID-19 response are very different from previous centuries - or even decades.  This includes the speed with which scientists have been able to identify, sequence, and share information about a completely novel pathogen, the development of promising diagnostics, vaccines, and treatments within just over three months of the virus being identified, and global real-time disease surveillance

Problems could arise, if, as happened in 1665, there are secondary waves of infection. The plague raged in the City for more than 12 months, but according to the Bills of Mortality, the peak was not reached until September 1665 – a full year after the first reports of illness. And there were still deaths after this peak, affecting some people who had returned to London, in the expectation it had ended.  Professor Harrison says: ‘It is still too early to say what is working and what isn’t [in terms of the fight against the virus]. There’s a reasonable high probability that there will be some immunity [for people who have had the virus] but we don’t know how long that would last.’

Careful studying of how countries such as China and South Korea, which rapidly implemented strict social distancing early on and then balance a de-escalation of measures, will provide valuable lessons for the rest of the world. 

Dr Claas Kirchhelle, lecturer in the history of medicine at University College Dublin and fellow of the research and policy unit, the Oxford Martin School, says: 'Restricting the movement of people and implementing other rudimentary forms of social distancing have been mainstays of disease responses for centuries - alongside rumours, stigmatisation, and often desperate attempts to find remedies ranging from charms to quack medicines'.

Responses often varied according to cultural precedents and the specific biological profile of the pathogens involved. But, he says, in one important respect parts of the COVID-19 response are very different from previous centuries - or even decades.  This includes the speed with which scientists have been able to identify, sequence, and share information about a completely novel pathogen, the development of promising diagnostics, vaccines, and treatments within just over three months of the virus being identified, and global real-time disease surveillance.

Dr Kirchhelle says the response to COVID-19 marks a dramatic acceleration of disease response strategies, which gradually emerged from the second half of the 19th century onwards. During this period, the discovery of germ-theory gradually revealed the biological causes and transmission modes of previously mysterious and untreatable diseases.

Resulting blessings were manifold: from increasingly reliable diagnostics and more targeted non-therapeutic interventions like chlorination or campaigns against flea-bearing rats to the development of effective vaccines and specific therapies like antibiotics. At the same time, nation states also became better at coordinating their response to international disease outbreaks.  Convened in response to the cholera pandemics sweeping the globe, a series of international sanitary conferences began to lay the legal groundwork for standardised quarantine periods, disinfection methods, and international information sharing on infectious disease.

At the time of the 1918 flu pandemic, many people expected that science and officials would be able to take action. But the tried-and-tested approaches of traditional bacteriology failed. The disease was not caused by a bacterium but by an unusually deadly influenza virus. Not knowing what this was meant ‘they didn’t know what they were facing’. Coming at the end of the Great War and with actual incidence rates often censored by wartime and post-war governments, the 'flu' was able to move quickly around the world and across a broken Europe. And, as now, many people thought it was ‘just flu’. Dr Kirchhelle says: ‘There seemed no way to stop it spreading; it was explosive and devastating.’ Many people actually died of bacterial superinfections, which spread easily in malnourished bodies and in mass wards and could today have been treated with antibiotics.

Concerted international action has been critical in terms of tackling COVID-19. Although the current advice is very much in line with traditional attempts to starve a disease of susceptible new bodies, the rapid scientific response to a rapidly spreading infection has been ground-breaking. According to Dr Kirchhelle: ‘There has been a radical sharing of information and a very rapid sequencing of the pathogen's genetic code.’

He concludes: ‘The WHO in particular has worked well, despite chronic underfunding, and the fact that it has few actual powers to enforce compliance. The COVID-19 pandemic shows that new pathogens can rapidly spread globally. Hopefully, our current experience of vulnerability will lead to a long-term strengthening of international cooperation when it comes to tackling infectious disease and improving health systems in all parts of the world.'

Economic impact of coronavirus

 

by Sarah Whitebloom

Measures taken by governments in the coming months to control COVID-19 will determine the impact of the pandemic on the global and national economies, according to Oxford professor of economics Simon Wren-Lewis. In his latest blog, Professor Wren-Lewis argues: ‘It is impossible to predict what the full year impact will be until we know what controls are essential and what controls can be relaxed while maintaining an effective test/trace/isolate regime.’

His work modelling the impact of a pandemic – which anticipated a six per cent fall in GDP over 12 months – was based on the crisis lasting just three months. But, with COVID-19 set to be present in the community for a longer period, the way that the response is managed and implemented will be critical to its economic impact.

‘We assumed the pandemic was just a three month affair. If we look at our severe pandemic case including falling social consumption, we had GDP in the pandemic quarter falling by 30 per cent. There was a similar fall in consumption. However, because our severe pandemic lasted for just one quarter, GDP for the year as a whole fell by only six per cent. So how good a guide are those numbers to this coronavirus pandemic?’

Key to the economic impact will be ‘the strength of social distancing controls, the degree of business and worker support from governments and whether governments can relax social distancing before three months are up

Professor Wren-Lewis says the predicted fall of 30 per cent ‘does not look obviously wrong and may well be an underestimate’. But, he emphasises ‘this is not a precise figure’.

It is what comes next that is crucial. Key to the economic impact will be ‘the strength of social distancing controls, the degree of business and worker support from governments and whether governments can relax social distancing before three months are up’.

Professor Wren-Lewis says: ‘Once the number of cases are brought right down, it is likely governments will do what China is currently doing, and move to a strict contain regime,’ he writes. ‘This involves a very stringent regime to test those who might still get the virus and the isolation of known contacts, combined with some continuation of social distancing controls....I think this will inevitably be how other countries deal with the virus once numbers are down.’

But, he warns: ‘Some will do it well, and others may not, leading to controls being reintroduced.’

Despite the expected longer term presence of COVID-19, the theory behind the earlier modelling essentially holds true, according to Professor Wren-Lewis. The main supply side impact comes from school closures which, as he says, now look set to last until the summer. Meanwhile, workers will be reluctant to use grandparents – unlike the assumptions in the study.

The study had predicted a fall in social consumption and a heavy impact on the leisure industry – which has been borne out. But, Professor Wren-Lewis says: ‘There is a limit to how far GDP can fall because we will not eat less, and we will not spend less on housing or heating. Expenditure on clothing and particularly durables may be delayed to some extent, as people avoid personal contact, but online purchases should continue.’

Professor Simon Wren-Lewis says: ‘There is a limit to how far GDP can fall because we will not eat less, and we will not spend less on housing or heating

This is why the action that governments take now is so critical. Professor Wren-Lewis says: ‘We assumed there would be no attempt at suppression beyond school closures...This coronavirus pandemic will not be a one quarter affair, because governments quite rightly have not been prepared to see a short sharp peak where their health services will be overwhelmed.’ 

Talking about initial responses to COVID-19, he continues: ‘Nearly all Western governments underestimated how quickly the virus would spread.’

But, he says: ‘It is easier to control the virus by relaxing controls than creating such controls from scratch...The key issue for the economy once numbers come down is how many controls can be reduced or eliminated while keeping a lid on new case numbers.’

The key issue for the economy once numbers come down is how many controls can be reduced or eliminated while keeping a lid on new case numbers

At the heart of this, on the supply side, will be ‘whether schools reopen’ and on the demand side, ‘what parts of social consumption can be made safer’. Professor Wren-Lewis says: ‘Because some relaxation will almost certainly be possible, then GDP growth will partially bounce back, but how much they will bounce back is very unclear at present...our study, which had GDP being above the no-pandemic case in the second quarter, does not apply to the pandemic we are now in.

‘As a result, the first year GDP impact of a six per cent fall our study is much too small. It is impossible to predict what the full year impact will be until we know what controls are essential and what controls can be relaxed while maintaining an effective test/trace/isolate regime. We will get some idea from China’.

 Read more on Professor Wren-Lewis’s blog: https://mainlymacro.blogspot.com/2020/03/the-economic-effects-of-pandemic.html

 

Woman panic buying toilet paper

By Sarah Whitebloom

The UK Government is currently asking people to limit non-essential contact and travel to work from home, in order to slow the spread of COVID-19. But it has not – to date - put in place a system of enforced regulation of movement, unlike some other countries in Europe. The UK action relies heavily on individuals complying with official messaging – doing what they’re told. Will it work?

The UK action relies heavily on individuals complying with official messaging 

What does behavioural science tell us about whether people comply with measures that are not compulsory? If you appeal to people’s sense of ‘doing the right thing’, they tend to do it, according to Dr Kate Orkin, senior research fellow in behavioural economics with Oxford’s Blavatnik School of Government, in two recent interviews on BBC’s ‘Beyond 100 Days’.

Behavioural economics’ research from non-pandemic contexts suggests that making behaviours a moral duty will be effective, Dr Orkin says.  This suggests the UK Government’s compliance-based approach may have some success.  By contrast, it can be ineffective to try to change a problematic behaviour by highlighting that many other people are doing it.

Dr Orkin quotes one study which documents efforts in the Arizona’s Petrified Forest National Park to stop people removing petrified wood. Researchers tested signs with different messages. One sign said ‘Many people keep taking the wood and it is changing the state of the park’. When that sign was up, more wood was taken. According to Dr Orkin: ‘In contrast, when signs simply asked people please not to take the wood, much less wood was taken.’

If you appeal to people’s sense of ‘doing the right thing’, they tend to do it

She argues that the recent statements by the Italian foreign minister, Luigi Di Maio, have been a model here. On 12 March, he made a strong appeal to civic duty, saying: ‘Our grandfathers were drafted to go to war; we're being asked to stay at home.’

He also highlighted that ‘the huge majority of citizens are respecting the rules’ – a key factor in encouraging people to comply is for them to know others are doing the same.  

People should realise how much they influence one another. Dr Orkin says: ‘A strong influence on people’s decisions to protect themselves from risk is what people around them are doing.’

She says, if people take Government advice, that will influence those around them to do so too.

These lessons also applied during recent water shortages in Cape Town, South Africa, and Bogota, Colombia. Dr Orkin says, people ‘pulled together’ to make massive, fast cuts in water consumption before cities ran out of water, after strong appeals by local administrations.

So why are people panic buying toilet paper, even when they have been told not to do so?

So why are people panic buying toilet paper, even when they have been told not to do so?

There are two main reasons, according to Dr Orkin. She says: ‘Research shows that, when people feel they lack control, they are more likely to buy useful items, items with a purpose.’

But, she says, the content of messaging is another factor: ‘If you tell people that everyone is doing a bad thing [such as panic buying toilet paper], they will do it as well.’

There are, however, simple solutions. For example, she says that many stores have placed limits on the number of essential items consumers can buy, helping them to overcome their own emotional reactions.

‘It’s really important that people understand the psychology behind why they do things,’ says Dr Orkin.

Dr Kate Orkin leads the Mind and Behaviour Research Group at the Centre for the Study of African Economies at the Blavatnik School of Government.