Julia Marcus: Use the lessons from safer-sex policy to encourage safer pandemic behavior

Over the last few months, Julia Marcus — an epidemiologist at Harvard Medical School — has been writing articles for the Atlantic that make a solid point: If you want people to act more safely in the pandemic, use the lessons from decades of safer-sex research.

When it comes to sex, as she points out, public-health experts have learned that abstinence-only messages do not work for the great mass of the public. Attempting to shame folks into not having sex merely causes a cascade of harms, personal and civic.

What does work is safer-sex policy: You assume people are going to have sex because it's a natural human need, so you focus your public policy on making it as safe as possible for them to do so. And you back that policy up with clear messaging and resources.

Over the last few months, Marcus has been using this incredibly useful lens in pondering how to encourage people to adopt healthy pandemic practices — from wearing masks to convening socially in safer ways. As she argues, attempting to shame folks into wearing masks and avoiding social contact won't work. Far more productive would be for officials to assume — as with sex — social contact is a central human need, and people are gonna engage in it even if you forbid it. So it's better to acknowledge that need, and acknowledge how the safer practices — condoms, say, with safe sex, and masks with COVID-19 — can be uncomfortable and awkward at first.

If we've learned one thing from decades of safe sex is that you have to meet people where they are. In her latest Atlantic piece, Marcus applies this thinking to the coming holiday season:

As the winter holidays approach and cases continue to surge across the country, people need clear and consistent messaging about the very high risks of travel and gathering. And, just like safer-sex education, guidance for this holiday season must also include nuanced information about how people can protect themselves if they travel to that Christmas dinner anyway: minimizing contacts and testing before and afterward, keeping gatherings small, driving instead of flying, masking when indoors or close to others, meeting outdoors if feasible, and increasing ventilation when outdoors isn't an option. Giving any risk-mitigation advice might seem imprudent when the dangers of social contact are so acute, but adherence to public-health recommendations is never universal, and everyone needs access to information and tools to stay safer.

And as she points out, governments can do lots of things to actively make it easier to socially convene safely — indeed, they need to do these structural things …

No matter how comprehensive, public-health messaging won't solve structural problems. The Thanksgiving testing debacle was indicative, more than anything, of a failure of the public-health system: Nearly a year into the pandemic, testing capacity is woefully inadequate and needs to be increased as much as possible before Christmas. And instead of closing outdoor venues and banning all outdoor gatherings, which have been deemed inessential pleasures in a pandemic, communities could do the opposite. Like Montreal, they can create appealing public spaces where people can gather more safely, equipped with open-air tents and heat lamps. They can outfit local parks with firepits and wood, as Calgary did. They can offer free outdoor activities, such as ice-skatingsnowshoeing, and even art installations, to reduce pandemic fatigue and lure people away from indoor gatherings. Health agencies can urge people—for just this one year—to exchange gifts by mail and replace the indoor dinner with an outdoor picnic (in warmer states) or a family campfire (in colder ones). Rather than imposing rules that neglect the realities of human behavior and then reprimanding people for breaking them, the message could be a more pragmatic and compassionate one: We understand that this is hard and that social connection is important for health, so we will support you in gathering more safely.

Of course, even the smartest and most compassionate public policy won't necessarily reach someone who's convinced COVID-19 is a hoax, and smart public policy won't be enacted by state or city leaders who believe the same. But Marcus' point here is aimed at the mass of people who are at least slightly concerned about the pandemic — but confused or turned off by the often-conflicting advice they've gotten, even from well-meaning public health officials.

It's worth reading all her pieces going back to the spring: Her archive is here.

(That CC-2.0-licensed photo of COVID-19 courtesy NIAD)