What can deliberately infecting healthy people tell us about infectious diseases? How is this useful for developing treatments, and how do we manage the risks?
- On 20th March, the Scientific Advisory Group for Emergencies (SAGE) released the evidence behind the government response to Coronavirus disease (COVID-19). This series of short articles summarises these 32 documents. You can view all our reporting on this topic under COVID-19.
- This article goes over insights from behavioural science such as the risk of public disorder and adherence to household isolation.
The Scientific Pandemic Influenza group on Behaviour (SPI-B) is a group of experts that advise SAGE. This advice is limited to anticipating and helping people adhere to the interventions proposed. Group members vary by the topic that is being considered. They have included health psychologists, social psychologists, anthropologists and historians. Experts from Government departments also input to discuss the issues they are facing.
SPI-B provided advice on the use of behavioural and social interventions (COVID-19: Behavioural and social interventions). They have also reported on risk of public disorder and guidance for self-isolation.
The evidence base available to make behavioural recommendations is limited. Studies have shown that the psychological and public responses to the 2009 influenza pandemic varied between countries. For self-isolation and quarantine, a rapid review of the evidence was conducted. This looked at both the psychological impact of quarantine, and ways to improve adherence. For school closures a further rapid evidence review was used.
SPI-B: Return on risk of public disorder (25 February 2020)
SPI-B, the behavioural subgroup of SAGE, was asked to consider the risk of public disorder. This was defined as opportunistic crime, community tension and rioting.
Their conclusions were:
- Large scale rioting is rarely seen in these situations.
- Acts of altruism will predominate.
- Public disorder is usually linked to perception of the Government response not the outbreak itself.
Specific issues facing the police may be:
- Low police numbers due to workplace absences.
- Police actions appearing to control rather than support the public.
The recommendations of SPI-B to further reduce the risk of public disorder were:
- Provide clear and transparent reasons for different strategies.
- Set clear expectations on how the response will develop.
- Promote a sense of “we are all in this together”.
In particular the public needs to understand why the UK response may be different to other countries. SPI-B recommended focusing early messaging on why actions are being taken. Clear expectations of how the response will develop also need to be laid out. This messaging should be coupled with reinforcing a sense of community. This will avoid creating tensions between groups and promote social norms around behaviours.
SPI-B: Insights on self-isolation and household isolation (9 March 2020)
SPI-B was asked to advise Public Health England on guidance for self-isolation of people with COVID-19 symptoms. In particular they considered:
- What are the barriers and facilitators to isolation?
- Do these change for vulnerable groups?
- How can altruism towards isolated groups be promoted?
- What communication strategies should be used to discourage attendance at schools and workplaces?
SPI-B provided Public Health England with advice on its draft guidance for home isolation. In particular they recommended considering more the specific needs of different audiences. They also recommended providing guidance on mental and physical well-being.
An area of difficulty with adherence is where people with symptoms are worried about staying at home. In particular they may worry that they will infected other members of the household. There is a need to understand the increased risk to other household members compared with isolating elsewhere.
Ways to increase adherence and reduce presenteeism (i.e. going to workplaces) could include:
- Emphasise the civic duty of isolating.
- Change social norms – allow others to express disapproval.
- Consider the organisations to which individuals belong e.g. health workforce.
- Emphasise how others are isolating.
- Try to give control and choice to individuals.
- Provide specific guidance to individuals in difficult circumstances.
- Community organisations will be important for providing support.
You can find more content from POST on COVID-19 here.
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