With nearly 210,000 confirmed cases and 8,650 deaths in at least 166 countries or territories, COVID-19, also known as coronavirus, has become the latest threat both to human health and the global economy. With no vaccine against the disease to date, prevention looks like the only available option to mitigate the spread of the virus. Washing hands frequently, covering nose and mouth with the elbow or a handkerchief when sneezing or coughing, and keeping a prudent distance from other people in public places are some of the main recommendations made by agencies like the U.S. Centers for Disease Control and Prevention (CDC).
Behavioral economics recently explored interventions that have succeeded in boosting these preemptive actions. Procrastination (“let’s leave it all for tomorrow”), frequent oblivion and lack of attention may often hinder their implementation. For example, while avoiding touching eyes, nose and mouth are in the list of recommendations to stop the virus from spreading, a study conducted in 2015 showed that we touch our faces 23 times an hour on average.
Another study, published in March 2020 by Haushofer and Metcalf of the Princeton University, underscores that behavioral economics interventions such as installing low-cost household soap dispensers, embedding toys in children’s soap or launching emotional hygiene-promotion campaigns have proved extremely effective to stimulate hand washing. The authors point to two key features of the process by which infectious diseases are transmitted that boost the effectiveness of this type of interventions.
First, the nonlinear dynamics of infection transmission. Epidemiological models suggest that increasing the rate of the population covered by a given preventive intervention in a community (called “saturation”) reduces the infection’s incidence in a greater than proportional degree due to the effect of indirect protection – every covered person reduces the infection exposure risk for those who get in contact with him or her (see Figure 1). In the case of COVID-19, the returns to saturation are expected to be major and incremental. This can be achieved not just by raising the number of people who receive the intervention, but also when “good habits” are transmitted from treated individuals to others who may also adopt them. The authors, therefore, consider that it is crucial to focus the interventions on people who are at the center of a network and who are “good” at spreading information among peers or who have the ability to increase “dissemination”.
Source: Haushofer, J. and Metcalf, J. (2020) Combining behavioral economics and infectious disease epidemiology to mitigate the COVID-19 outbreak. Consulted at: www.princeton.edu/haushofer/publications/Haushofer_Metcalf_Corona_2020-03-06.pdf
It should be noted however that while information and behavior can go “viral”, so can fear. The fright of COVID-19, a new, highly contagious virus that can be fatal, is real. While this makes the population more alert both to the progress of the outbreak and to the habits that should be adopted to prevent disease transmission, it is paramount to avoid panicking.
These days we witness a shortage of gel alcohol, disinfecting wipes, and even facial masks. In fact, the state of New York has begun producing its own hand sanitizer to tackle the scarcity of the product. In a recent posting, “Nudge” author Cass Sunstein points to so-called “probability neglect”, which refers to people’s exaggerated perception of their own exposure to the risk of contracting the COVID-19 virus. This means that whenever an event triggers negative emotions, people tend to disregard how likely it is to occur and focus exclusively on its potential impacts. Sunstein stresses that it is crucial for the population to start thinking again in terms of probability to prevent fear and its associated costs from spreading more than they should. This means that the interventions to be undertaken should factor in this “probability neglect” so as to push for the desired behavior changes without underestimating the risks posed by COVID-19, but at the same time preserving the necessary calm.
The second characteristic of infectious disease contagion mentioned by Haushofer and Metcalf is the complex time-course of outbreaks. Interventions aimed at reducing infection transmission can have different effects at different points of the outbreak. While interventions are expected to yield a drop in the number of total infected people, infections may extend over time (as opposed to concentrating at the time of the virus outbreak). This implies that interventions need to cause behavioral changes that are maintained over a long period of time and that for them to have a full effect it is crucial to look into their impact at different points in time, or alternatively to use bioindicators in order to determine if a person has been exposed to the virus. An intervention based on behavioral economics means, on the one hand, an opportunity to effect permanent changes that can translate in new habits with more long-term health benefits, and on the other, a reduction in the risk of overburdening healthcare systems – a major concern associated with the COVID-19 crisis.
Changing some habits can be really hard, even when the right information is available. Public sector interventions oriented to behavioral change need not only to be effective and efficient – they also require support from the community and must be in sync with the institutional context where they are implemented. Behavioral economics interventions leading to best hygiene and prevention practices, together with what we know about infectious disease epidemiology and the lessons that we are hurriedly learning from the COVID-19 pandemic will be part of the toolkit in the quest for solutions to put this health menace behind us as quickly as possible.