A Proposed Public Health Response To Facilitate Continued Adherence To COVID-19 Restrictions

At the beginning of the COVID-19 outbreak, 46 million people were placed under a 76-day lockdown in Wuhan, China. The conversation around this initial story centered on the resilience of that population, isolating in the face of an unknown and deadly threat. Following the further spread of the virus, countless messages of unity and hope poured in from many corners of the world. Stories of struggles while in quarantine were contextualized as making a difference for overwhelmed health care systems. Similarly, the majority of the U.S. public response has supported a unified effort. Yet a growing segment of the American population has become increasingly frustrated to the point of jeopardizing their own health and that of those around them. This vocal group reflects a national rise in restlessness after many weeks of stay-at-home restrictions.

At the beginning of the U.S. pandemic, a significant number of citizens flouted the proclamation of a National Public Health Emergency and CDC travel advisories in pursuit of planned vacations. Furthermore, after less than one month of stay-at-home orders, largely unmasked protestors on either side of party lines rallied in multiple states across the country. The demonstrations were accompanied by guns, “Land of the Free” signs, and multiple presidential “LIBERATE” tweets. Although the majority of Americans disagree with the protestors, this behavior reflects nationwide conversations that have framed adherence to public health policies to be at the expense of personal liberties.

To continue to motivate individuals to follow state and federal COVID-19 restrictions, even as re-openings begin, public health officials in the United States should take measures to reconcile the individual value of personal freedom with the group benefits of societal efforts. To facilitate this, we propose the following.

Actively incentivizing the public to behave in a socially responsible manner can encourage compliance with health recommendations. People, particularly vulnerable populations, need to be provided the means to feasibly comply with the appeals of the government. With other countries utilizing approaches such as loan forgiveness, rent suspension, and even universal basic income, there is an established precedent for America to follow suit in the form of location-based financial rewards and more widespread support services.

Furthermore, public health officials should work with media outlets to adjust the lens through which COVID-19 guidelines are disseminated. There are people for whom concerns related to the virus are secondary to other matters. While for some, “socially distance to flatten the curve” will adequately persuade, others might need to hear “socially distance to protect yourself and your family.” By acknowledging and appealing to the diverse motivations present in our population, leaders can promote greater personal investment in disease mitigation efforts.

In the long term, increasing awareness of key federal and state public health officials during non-emergency periods will foster public trust and increase amenability during times of crisis. Acquiescing to official recommendations places large restrictions on people across the country, many of whom simply cannot afford the change. In order for people to personally sacrifice and abide by public health guidelines, it is critical for the public to trust and believe that appointed representatives have their best interests in mind.

At this moment, the priorities of many Americans and its public health officials are not fully aligned. According to a 2015 WHO report, “the best medical care in the world remains limited if its provision does not align with the priorities and perceived needs of those it seeks to serve.” Yet there is a precedent for collaborative agreement in America regarding the sacrifice of certain personal freedoms for the sake of public health. These include past national campaigns that have promoted vaccinations, discouraged smoking, and increased awareness of the HIV/AIDS epidemic. These aforementioned efforts required and received widespread cooperation after framing public health guidelines to match the priorities of the then-population. Similarly, the COVID-19 landscape in the United States now calls for even higher levels of understanding and participation. As we move forward, it will be imperative to determine a path that we can jointly agree upon, both to protect our community and ourselves.

Vismaya S. Bachu and Sajya M. Singh are medical students.

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