Gambling at the Grocery Store: Risk Assessment During COVID-19

I’ll just pull out! Just one more round of poker… I don’t really like him but he’s so persistent, fine... we can get married.


Human decision-making is often not as secure and foolproof as we hope it to be. Immediate and even anticipated emotions, hormone levels, stress, and social pressure can all impact our ability to make sound decisions [1]. We are constantly weighing risks and forecasting potential outcomes, and our imperfect selves are often afflicted with biases [2]. In the wake of the Coronavirus pandemic and over half a million COVID-19 deaths in the United States alone, we have seen a flurry of perplexing behaviors exhibited by even the most trusted figures in society: persistent partying, wreckless travel to populated destinations for pleasure, and slandering of scientists and health officials, to provide a few examples.


From a disordered federal response to the crisis to the impacts of the mental strains of isolation and fear, there is a myriad of possible factors driving these sense-defying behaviors. This phenomenon has drawn researchers from nearly every discipline, all trying to understand this pattern and to construct public health policies that anticipate these behavioral tendencies.


A study tracking human mobility during the COVID-19 pandemic showed that there was a significant decline in human mobility after the declaration of COVID-19 as a pandemic as well as when the first coronavirus death was reported in a region [3]. Similarly, in an observational study of nearly 10,000 shoppers in the US, there was increased compliance in adherence to mask-wearing and social distancing after a mandate. But interestingly, gender, age, and location were factors that determined whether a person voluntarily wore a mask (with females and the elderly more likely to do so) [4]. In another 4,000 person study, the young, educated, and those unconcerned with being infected were the most resistant to wearing a mask [5]. For the younger members of society, a study of kindergarteners showed that a mother’s educational background and the preschooler’s place of residence were correlated with mask-wearing while gender, grades, the mother’s education, and the father’s occupation correlated with handwashing [6]. These trends indicate that mask-wearing, hand washing, and adherence to social distancing are deeply social behaviors.


The particular invisibility of this virus, namely where the sick lay isolated inwards shut off to the public, and thus suffer alone, removes the imminence of this threat. With an unclear central public health message, the stresses of uncertainty and the everpresent sensationalized media feed skew the perception of risk. And indeed, stay-at-home policies and social distancing behavior precipitated depression, anxiety disorders, intrusive thoughts, insomnia, and acute stress for many [7].


At a distance from the frontline workers working grueling hours at understaffed and under-resourced hospitals, the logical motivation to follow basic public health measures can begin to dissipate. Add to that a political campaign to politicize, delegitimize, and defame these guidelines or a peer group remissive and out of touch with the loss and grief of so many and we can easily be swayed to behave in dangerous ways.


However, establishing protective norms like mask-wearing or handwashing does not need to be coercive, even to the most resistant offenders. Yale researchers presented evidence from the US national response to conserve food during WWII that health regulations can be followed without coercion through good leadership and the provision of information that productively instills powerful personal attitudes towards a societal threat [8].


Humanizing the lives lost to the virus and the soldiering healthcare workers can reinforce positive social attitudes towards following proper mask-wearing measures. Throughout the pandemic, ICU nurses have not only been quitting in significant numbers but have been increasingly diagnosed with PTSD after experiencing such magnitudes of death and suffering within hospital walls [9]. Not only did thousands of nurses and doctors come out of retirement to support overfilled hospitals, but 3,600 healthcare workers died during the pandemic [10]. The stark contrast of this reality to politicians completely rolling back mask mandates and reopening business to 100% capacity [11] in a state with a severe nurse shortage [12] does not create an environment where public health measures can be easily respected.


As more and more people begin to get vaccinated and our sense of normality returns, it is important that we remember the shortcomings of our societal response to this pandemic and the greater depth of tragedy it may have contributed to. Research has indicated that adherence to public health measures depends on our collective cooperation. Our behaviors can influence those of others. As both Spiderman and the French philosopher, Voltaire once said, with great power comes great responsibility. And indeed, it seems that with a greater understanding of the power of our individual actions to influence those around us comes to a great responsibility.


References:

1. Kusev, Petko, et al. “Understanding Risky Behavior: The Influence of Cognitive, Emotional and Hormonal Factors on Decision-Making under Risk.” Frontiers, Frontiers, 16 Jan. 2017, www.frontiersin.org/articles/10.3389/fpsyg.2017.00102/full.

2. Wargo, Eric. “The Mechanics of Choice.” Association for Psychological Science - APS, 28 Dec. 2011, www.psychologicalscience.org/observer/the-mechanics-of-choice.

3. Chan, H.F., Skali, A., Savage, D.A. et al. Risk attitudes and human mobility during the COVID-19 pandemic. Sci Rep 10, 19931 (2020). https://doi.org/10.1038/s41598-020-76763-2

4. Haischer, Michael H., et al. “Who Is Wearing a Mask? Gender-, Age-, and Location-Related Differences during the COVID-19 Pandemic.” PLOS ONE, vol. 15, no. 10, 2020, doi:10.1371/journal.pone.0240785.

5. Barceló, Joan, and Greg Chih-Hsin Sheen. “Voluntary Adoption of Social Welfare-Enhancing Behavior: Mask-Wearing in Spain during the COVID-19 Outbreak.” PLOS ONE, vol. 15, no. 12, 2020, doi:10.1371/journal.pone.0242764.

6. Chen, Xuyu, et al. “Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China.” International Journal of Environmental Research and Public Health, MDPI, 22 Apr. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7215913/.

7. Marroquín, Brett, et al. “Mental Health during the COVID-19 Pandemic: Effects of Stay-at-Home Policies, Social Distancing Behavior, and Social Resources.” Psychiatry Research, Elsevier B.V., Nov. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7439968/.

8. Fischer, Ilan, et al. “The Behavioural Challenge of the COVID-19 Pandemic: Indirect Measurements and Personalized Attitude Changing Treatments (IMPACT).” Royal Society Open Science, The Royal Society, 26 Aug. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7481714/.

9. Caillet, Anaëlle, et al. “Psychological Impact of COVID-19 on ICU Caregivers.” Anaesthesia, Critical Care & Pain Medicine, Société Française D'anesthésie Et De Réanimation (Sfar). Published by Elsevier Masson SAS., Dec. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7522700/.

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