The Behavioral Element is Key to Defeating Corona

Israel unfortunately continues to reel under the onslaught of the Coronavirus pandemic. During the first wave of Corona, Israel deftly – although at a staggering societal cost – effectively contained the spread of Corona via a strict program of enforced maximal social distancing, namely a nationwide shutdown. Israel’s response at the time was swift, decisive and ultimately effective in the goal of minimizing spread of the disease, keeping the rate of illness and death to an enviable minimum, as compared to countries of similar size and socioeconomic composition.

In contrast, Israel currently is struggling to find its footing during this second wave of Corona. As Prime Minister Netanyahu recently acknowledged, the “opening up” of the country was too quick and insufficiently planned, leading to a rapid re-spread of Corona throughout the population, with numbers of cases reaching unparalleled levels, and a death rate that slowly but relentlessly climbs. The new Corona Czar, Professor Ronni Gamzu, has rolled out a number of new initiatives, taking his plan directly to the people in an attempt to engage and actively partner with the populace to defeat Corona. Various ministries are preparing operational plans for running schools, businesses and religious-cultural venues in a Corona-safe fashion. The threat of another nationwide shutdown continues to be waved intermittently to try and rekindle the flagging motivation of a tired and demoralized nation. Everyone of course hopes and prays that an effective and safe vaccine will soon be found and save us all.

Unfortunately, while all of these efforts are commendable and at first glance seem to be pushing the country in the right direction, they all fundamentally miss the true essential target, while still being “close enough” to appear to be on the mark. At the end of the day, one can build perfect models or systems of running schools, businesses, wedding-halls and houses of worship in a Corona-safe fashion. The numbers of people allowed in a store, square-meters per occupant, and age of students and days per week of school attendance can be worked out comprehensively to the very last jot and tittle. But if the core variable to defeat Corona is not directly, comprehensively and relentlessly pursued, every system-oriented effort is doomed to fail in the medium and long run. What is this key ingredient? The human dimension – human behavior and the ability to consistently and independently comply with the simple but challenging code of conduct necessary to defeat Corona.

The behaviors needed to ultimately defeat Corona have been known for months – effective mask wearing, sustained social distancing and basic hygienic practices. No more but also no less. One can have the safest possible business or school in terms of numbers of rooms, outdoor meeting venues, provision of ample supplies of protective equipment, and Alco-Gel by the liter – but if the human behavioral dimension is not decisively addressed, if the staff, customers and students do not understand, internalize and adhere to the rules and regulations on their own, these other preventive measures at best only delay the inevitable spread of Corona. Similarly, increased Corona-testing capabilities, rapid implementation of quarantine, and a system of strict monitoring and enforcement are indeed very important in order to limit the spread. But as experience has unfortunately shown, these secondary efforts at slowing viral spread, cannot possibly keep up with the Coronavirus in the absence of a widespread,  disciplined and long-term effort on the part of the population at large.

A nationwide lock-down would once again unquestionably stop the spread of Corona, within weeks causing the number of new cases to drop precipitously. But has been already pointed out by many, a nearly identical outcome could be achieved were the population to adopt the simple – but apparently challenging – code of personal responsibility and behavior needed to defeat Corona. Ultimately, the failure of our population to discipline itself and constrain its social intercourse according to the rules that the Coronavirus itself has established, will doom to failure any and all system-based or technology-based plans that fail to prioritize the human component at their core. And as any casual observer walking the streets can see, effective mask wearing and adequate social distancing are simply not being practiced anywhere near widely or consistently enough.

What can be done? It is natural during a fast-moving and life-threatening crisis to become focused on the immediate and short-term issues, such as hospital capacity, number of medical staff and equipment, maximizing economic productivity in the day-to-day, designing models of safe return-to-school/employment, and the like. This is both natural and necessary. I would suggest however, that these endeavors must be joined to – and even made secondary to – an intense, comprehensive, long-term, aggressive and relentless laser-focused effort aimed squarely at arousing the motivation of the populace, engaging and mobilizing its cooperation,  and utilizing proven methods of shaping and influencing human behavior.

This type of focus would lead to a completely new perspective on measuring progress in the fight against Corona. Currently we hear primarily about number of new cases, deaths, and percentage of tests that are positive. But the changed focus onto individual human behavior would lead to the creation of entirely new parameters with which to measure success in the campaign against Corona. These parameters could include variables such as percentage of stores, restaurants, wedding halls, houses of worship or schools inspected that were in full compliance, not only with having a Corona-safe system in place but with observed Corona-safe behaviors actually practiced by its clientele. Or percentage of people observed in public adhering to proper Corona-safe behaviors. Or percentage of pictures or advertisements in newspapers, magazines and websites which displayed proper Corona safety practices. These parameters would complement the medical variables currently monitored in order to give a more accurate measurement of true sustainable progress against Corona.

I have previously laid out a number of concrete ideas towards this goal, (see https://blogs.timesofisrael.com/corona-is-more-about-human-behavior-than-microbiology/), including:

  1. Massive, widespread and ongoing sophisticated advertising on all available media to promote the critical behavior changes needed to defeat Corona
  2. Harnessing the power of the media to promote core public health behaviors and to prevent images and messages that undermine these behaviors
  3. Focused enforcement efforts on places of congregation (schools, halls, and other areas of indoor public gatherings) with powerful means of positive reinforcement as well as punishment
  4. Creation of a widespread system of intensive and ongoing liaison with key demographic subgroups to ensure culturally relevant methods of behavioral modification and to help garner cooperation

But beyond these specific recommendations, what is fundamentally needed by our government and our country’s leadership is a sea-change of perspective and even nomenclature. This change begins with the acknowledgment that we – together with all the nations of the world – are fighting a war against Corona, in the literal sense of the word. The Corona is steadily attacking the ability of our society to function, incapacitating people directly through illness and death, and indirectly and more slowly through economic devastation, demoralization and depression, interruption of education and vocation, and ultimate erosion of trust in core societal institutions. This is an all-out war. All wars are contests of will and determination, and are won ultimately when leaders arouse sufficient motivation and mobilize determined and sustained bold behavior on the part of its citizens and soldiers. This adoption of a wartime mentality – and the necessary consequences thereof, as will be outlined momentarily – is a necessary step to ensure victory in our current fight against Corona.

During times of actual war, the war effort insinuates itself into every individual’s consciousness and into every arena of public and private life. To a degree this occurs naturally and automatically. But more relevant to our war on Corona, during wartime governments actively take steps to create and strengthen this focused mentality and the required core behaviors necessary to achieve victory. All other issues move to the back burner. Leaders communicate regularly with the public, building trust, clarifying the goals and moral basis of the campaign, and outlining what sacrifices such a campaign demands of each member of the society. While people do continue to work and study, fall in love and marry, eat, drink, sleep and exercise, psychologically the war effort underlies, shapes and influences everything else, dominating the public consciousness and agenda.

Militaries invest massive amounts of time and resources into creating and maintaining the discipline and internally regulated codes of conduct needed to produce reliable and effective soldiers. Together with this discipline training, the military has well-developed systems of rewards and punishments to enforce the discipline and codes of behavior. Sophisticated weaponry is only as good as the skill and discipline of the soldiers operating it. Moreover, for every soldier operating bravely on the front lines, there are countless others faithfully and reliably performing their duties behind the scenes, day after day churning out the difficult and perhaps rote itinerary of their tasks, all for the sake of the war effort and ultimate victory. Publicizing and glorifying acts of bravery and heroism, awarding of medals and honors, and blanketing the airways with messages of national unity, patriotic music and images, all serve to strengthen the national resolve and willingness to make daily but also long-term sacrifices for the war effort.

The general population is enlisted as well. Governments and communities proactively and intensively persuade or even pressure all members of society to purchase war bonds, donate time and other resources, volunteer for service, ration products vitally needed for the war effort, multiply mutual aid projects, and intensify religious and spiritual life, as well as many others. These behaviors reflect the willingness of the populace to accept responsibility for the success of the national mission and to make painful sacrifices for the achievement of this mission.

In the war on Corona, each and every citizen is a soldier on the front line. No community or geographic district is spared the dire effects of this pandemic nor can it avoid accepting direct responsibility for ensuring the outcome of the battle. Our leaders need to mobilize all of the country’s soldiers for this war; failure to do so ensures defeat. Just as in a military campaign the disciplined action of each soldier and citizen is needed for the entire war machine to succeed, so too in our society the Corona-safe performance of each and every citizen-soldier is needed.

There is much more that can and must be done to promote such an attitude and to enlist – nay demand – the needed behavioral change within the entire population. To explore but one example – our educational system. The educational system has thus far been viewed as a part of the problem, a veritable breeding ground for the spread of Corona, that by necessity must remain open for economic reasons and to help support faltering families.

In truth, it is time for a sea-change in this realm. Once the focus of the war on Corona is squarely trained upon population-wide behavioral change, our educational system at large should immediately become viewed as a core and potent weapon in the fight against Corona. Israel is a country of deep values, many of which coalesce around principles of accepting personal responsibility for the well-being of society. Whether framed in general concepts of personal responsibility, honed during formative years in youth organizations, military or national service, or in inspiring religious/spiritual concepts of laws “between man and fellow man” and the sanctity of life, we are a nation with a history, culture and vocabulary rich in relevant concepts and terms for this aspect of the war on Corona.

The educational system – of all demographic subgroups and at all levels and ages – should be mobilized, instructed and incentivized to immediately develop broad-ranging curricula related to Corona, with the predominant emphasis on acquiring and sustaining the Corona-safe code of behavior. Certainly the relevant anatomy, microbiology, epidemiology and public health principles need to be taught. But most importantly, a value-based curriculum needs to be quickly compiled and disseminated, bringing together age and community-appropriate concepts of civics, social contract, personal responsibility and self-sacrifice, relevant religious principles and teachings. These should be coupled with instruction in the relevant psychological and behavioral principles and techniques related to tolerating discomfort, self-awareness and mindfulness as well as delayed gratification. Instruction manuals for teachers to conduct classes and group sessions promoting social and personal responsibility and withstanding negative peer-pressure must all be developed quickly.

From the perspective of the educational system, the practical and safety challenges of Corona should be leveraged into the values-education opportunity of a generation. During more conventional times, few other scenarios present the real-time life-laboratory opportunities for studying values and the challenges of their implementation, with near-daily opportunities for identifying and overcoming the difficulties and hardships of the Corona-safe behavioral code of conduct. Secular and religious schools alike should embrace the vast educational opportunities inherent in these most unusual times as well as their critical role in helping our nation win the war on Corona.

The example of the educational system is but one. In a similar vein, every instrument of society and every arm of the government needs to ask itself – and indeed be asked by society – what it can and must do in the war on Corona. Figures from general culture – celebrities, musicians, athletes, actors, entertainers – need to be actively mobilized by the country to spread the message of personal responsibility and adherence to Corona-safe behavior. As mentioned earlier, the genius of the advertising industry needs to be given the resources and the mandate to develop attractive, compelling and nearly irresistible messages relevant to adherence to public health recommendations. Fashion leaders and their marketing staffs need to quickly develop ways to make mask wearing and social distancing “the in fashion”, utilizing behavioral science principles to shape Corona-safe behaviors. Religious leaders and communities need to be encouraged and persuaded to take upon themselves this task with fervor, bringing to bear the full weight and power of organized religious communities to the war effort.

Unlike eating, drinking, sleeping and other behaviors with a strong intrinsic biologically driven basis, wearing masks and standing two meters from each other have no biological basis, and no intrinsic reward system to promote and sustain the behavior. The disciplined expression of Corona-safe behavior is artificial and extrinsic, it needs to be first acquired and then artificially sustained by wedding together many of the fields and approaches mentioned thus far. At the end of the day, this is the critical link in the chain that is sorely lacking in our country’s efforts to defeat Corona to date.

In conclusion, Corona-safe individual behavior lies at the foundation of any and all other system-level efforts being made to combat Corona. The development of “Corona safe systems” – schools, workplaces, businesses, and the like – will only be effective if comprehensive, intensive and aggressive efforts are made to shape our society’s behavior at the individual level. The failure to develop the personal responsibility and discipline needed to consistently adhere to these Corona-safe behaviors will ultimately doom the new systems to fail. Our leadership and government must immediately invest significant resources into society-wide and long-term interventions aimed at developing and sustaining these individual Corona-safe behaviors. Viewing the campaign against Corona as a war, adopting a wartime mentality and level of psychological mobilization, defining each and every citizen as a front-line soldier and undertaking the needed significant steps to train and discipline them accordingly, will provide all members of society with the tools to keep themselves – and the rest of us – safe and healthy.

About the Author
David Blass MD is a psychiatrist and Unit Director of the NeuroBehavioral Unit at the Abarbanel Mental Health Center, Bat Yam.
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