The Human Drive for Return to Normal

The Human Drive?for Return to Normal

By, Harry Rosenthal, Retired

Introduction

Of the many things which surprised me as a risk professional, regarding COVID-19 pandemic is how human factors have moved to the front of pandemic planning. Over the years, ?I have written several pandemic plans and consulted on many more, however, ?much of the plans’ content focused ?on responses, procedures and rules. I seem to have ignored how people might respond to those procedures and rules. The plans were very strong in shutdowns, cleaning, PPE, etc but quite weak in how to deal with large groups of people and their differing levels of compliance, as part of the planning process. Perhaps because we originally based these plans on earlier documents covering fires, earthquakes and other disasters where the road to recovery was much clearer. As a result, we produced volumes, which were ?protocol rich but ?consideration of human response poor.

Certainly, the focus of these older pandemic plans were on prompt and correct medical response structures needed in place to deal with a pandemic. They were fine-tuned during the?SARS, MERs, bird flu etc outbreaks and the planning?focused on detection, quick response, command structures, facility ?isolation, medical treatment, work arounds and, finally, ?a return to normal. That “return to normal” always was the title of the final section in the plan, clearly building expectations that outbreaks, such as the ones listed above, would have reasonably short lifecycles, and ?that, if the plan was followed, the endgame would be life as it was before. We?clearly believed there was always an identifiable return to normal phase of the event.

The Big Change

COVID has changed ?the way we look at pandemic and disaster planning. ?Major events always compel us to re-examine and rework our past plans. A recent example would be earthquake planning?prior to the 2011 Christchurch earthquake. Before Christchurch,?the bulk of the disaster planning document was in the section titled “After the Quake”. It was in this section the command structures, rules, procedures, etc ?were recorded. In Christchurch, we learned, ?it could be a long time before “the quake” was over, with significant aftershocks lasting months. It was unclear when “after” was going to be, so post-event recovery actions had to commence, even while the event was still technically underway. ?The lesson for disaster planners was that even though we like to separate our plans in to nice, distinct chapters (suitable for training), the on the ground reality can be something completely different. There may be no clean end to the event. No ?single day when we can declare, “We have returned normal!”

Back to COVID. Looking at the plans which had the Return to Normal chapter, I realise that we wrote those chapters not only for training purposes, to trigger when emergency staff can get back to their regular jobs, but because we are human. ?There appears to be a deeply ingrained desire for humans, facing an emergency, to “get back to normal”. You see this this human aspect at work in many places. I have been in displaced persons camps, where people were settled in temporary housing. It was clear that most of the refugees, were trying to reconstruct what was “a normal life” for them, before the disaster, war, famine, etc. In the camps, if you ignore the affectations of housing, security, tents, barbwire, etc, ?you would see strong evidence that people were trying to carry on life as normal as possible. They were cooking, playing sports, enjoying games, and going about their daily routine, trying to reconstruct their concept of “normal”. ?I recall reading about England during the Blitz in WWII, where the London population continued life as normal, even though everyone knew houses would be bombed at night, and some of their neighbours (or themselves)?might be killed in the bombing. A human desire to revert to a concept of normal.

This reversion to normal was recently illustrated to me in Australia, over the summer holiday period of 2021/22. ?The graph ?(nsw covid case graph - Search (bing.com) shows the number of cases reported in New South Wales, starting on September 2021 and ending in January 2022. Not the traditional flu season.

The graph clearly illustrates that over the 2021 holidays, the spread of COVID increased dramatically, in direct contrast to the period of government mandated restrictions prior to the easing of restrictions for the holiday period. ?

This result came as a surprise at the time. The state was almost 95% double vaxed. There was significant public resources spent on educating the population on the steps to take to minimise the spread of the virus, such as mask wearing, hand hygiene, social distancing, etc. From the data it looks as if the residents of the state suddenly suffered from a collective, COVID amnesia, forgetting the lessons of the previous 18 months and suddenly all went to their: ?“return to normal” setting, ?in spite of the fact the virus was still present and still deadly.

This “deadly” dimension is illustrated in the graph nsw covid death graph - Search (bing.com) which records COVID fatalities from infections which mostly had their genesis during the holiday increases illustrated above. ?The mortality rate increased substantially, and it was clear the people of New South Wales were paying a price, in lives, for the privilege of acting like it was possible to return to normal.

At some stage, this had to happen. When a population reaches a certain level of vaccination, and has received vast amounts of health education, then it is time to ?let them loose. It must be seen how the population learns to live with the infection as they ?use the?heath-safety information acquired over the past year and a half. ??The data shows that many individuals rapidly reverted to unsafe pandemic?behaviours, making poor decisions on their exposure risk and rewards. The graphs only illustrate the ramifications of such decisions. This is not to say everyone actually forgot all they’d learned about the virus, but it is clear that behaviours, amongst large segments of the population reverted back to their concept of normal, and the ?fatal disease spread significantly as a result.

What changed just prior to the holiday?

1.??????Reductions in mandated restrictions. While the list is far too long for this article, ?State Health authorities loosened up restrictions regarding capacity in public places, activities such as dancing, ?the rules regarding mask wearing and limits on houseguests.

2.??????The State reached a very high level of compliance in vaccinations, which warranted a public ?reward, such as a loosening of the rules.

3.??????Many families had been separated during the 2020 Christmas holidays, by government health orders, therefore it was a time for holiday family reunions which ?had?not been permitted previously.

4.??????It was during the long, school summer holiday. There were many students interested in resuming summer fun, denied to them over the past year.

Drivers in The Sudden Change in Behaviour

Assuming there is no such thing as collective COVID-19 amnesia, why did so many people suddenly disregard the heath advice of the past and act in ways which rapidly spread the disease? There was a well-known risk to the elderly and vulnerable family members, as well as to the unvaccinated minority. The following are suggested possible reasons that a return to normal behaviour pattern trumped extensive heath education, resulting ?in spikes in cases and deaths

1.??????The Return to Normal Effect. ?Crisis planners underestimated the power of the return to normal human setting. The power of return to normal may have overridden?the health programming and education of the previous 18 months. There is very little ?more the government/society could have done during the pandemic in Australia to promote healthy habits and viral infection prevention. There were anti-infection prompts everywhere, in the media, in signage, in social media, in law, etc. ?We had a saturation of flu prevention messaging, which, coupled with health order restrictions, police enforcement and community compliance, truly kept a lid on infection in Australia, delivering infection rates and mortality rates which were the envy of the Western World. We can always argue whether it was adequate messaging, too restrictive or enforced with too heavy a hand, but the data speaks for itself, with low infection rates and low mortality rates.?For example, I recall substantial lockdowns, travel restrictions, and increased health orders in August 2021, with 70% of the state’s population vaccinated, when cases jumped up to 1,500 a day with 7 deaths. This was regarded as extremely serious! The vast majority of residents complied with the reintroduced regulations, as these new case rates were regarded as intolerable. In the later weeks of the December 2021, after the summer holiday?period visits started, cases were averaging 40,000 to 50,000 a day. There were significant increases in death rates, as those cases worked their way through the system. In spite of the dramatic uptick of new cases, the rules were not significantly changed. The State was trying to return to normal. In some states, the loosening up of restrictions was called “Freedom Day”, also demarking the past from the return to normal future.

This massive uptick in personal ?risk decision making and taking?was not done in ignorance of the risk profile. People knew they could spread COVID but decided to seek “normal” lifestyles, ?with eyes wide open. The statistical consequences we see illustrated in the graphs.

2.??????The Peltzman Effect. I have been looking for some theoretical framework to describe this phenomena of sudden disregard for COVID safety and have been hard pressed. The best I can find is the Peltzman Effect. The Peltzman Effect says that once increased safety measures are introduced, people’s behaviour changes to increased risk taking, as they feel safer due to the recent risk reduction innovations. ?It was developed in the 70’s when car seat belt and other passenger safety features were required by law. It was anticipated that the introduction of ?such safety features would reduce?the rates of vehicular fatalities, but the data indicated that it had no effect on overall fatality rates. The Peltzman Effect?says that people felt safer while driving, therefore they drove in a “riskier” fashion, resulting in no change to fatality rates. (See: The Peltzman Effect: How Safety Perception Increases Risk - Tradestops ) In our example, perhaps widespread vaccinations resulted in a Peltzman Effect, where large numbers of people felt that they could participate in riskier behaviour as the risk of serious illness and death was believed to have decreased. ?This view might have been correct, if not for the elderly, those with underlying medical complications and the unvaccinated.

3.??????The Right to Party Effect. Perhaps the Beastie Boys suggested the correct reason for COVID amnesia. They write, “You gotta fight for your right to party.” ?(See: beastie boys you gotta fight lyrics - Search (bing.com) ) This sagely advice seems to recognise that a characteristic of human nature, is to party. ?Growing up in New Orleans,?you are destined to learn two things. What Dixieland jazz music sounds like, and how to party. Mardi Gras aside, the most common implementation of the skill of partying is during hurricanes. ??It is a widely practiced ritual. Residents of the city, once they learn a major storm is bearing down on them, almost universally ?decide not?to evacuate, but rather, invite their neighbours over for a Hurricane Party. Of course, the papers are filled the next day with stories of hurricane parties which were interrupted by deep flooding, having the roof of the house torn off, or all the windows being blown out. The strange thing is that regardless of the severity of the storm, the mortality rate or the extensiveness of the damage, residents will again and again elect to hold a party, rather than evacuate at the next storm. I have seen this instinct in play several times, initially believing people repeated this risky behaviour because human memories were short, and people simply forgot about the destruction of the last storm. In reality, the Hurricane Party is a coping method, as well as a tradition. ?

This concept of “right to party” in adversity, is not a new idea. In Edgar Allan Poe’s shorty story, The Masque of the Red Death, ?(See: The Masque of the Red Death - Wikipedia ) a Prince is trying to avoid a dangerous plague, by hiding in his abbey. For some reason, (we now call “right to party”), he throws a party for his wealthy friends, and (spoiler alert) they all perish, because the plague comes to the party too. While the story itself is not factual, it does illustrate, the human need to party in the face of adversity, as a coping method. Even when the consequences are clearly understood. Sound familiar?

Summary

It is clear that the significant uptick in COVID cases in the Summer of 2021/2022 was the result of large numbers of people, making poor health decisions regarding their COVID risk profile. If not presenting an increased risk to themselves, these actions resulted in a significant increase in COVID hospitalisations and ?COVID deaths, achieving levels which were regarded as unacceptable only months previously. The medical system was able to cope with this sudden surge and not brought to the breaking point. This is a testament to the resilience of the State’s public health system and the people who work in that system. ?While it can be argued that certain age groups were more responsible for this uptick than others (i.e., the 20- to 29-year-old age group was the fastest growing demographic for COVID infection around Christmas 2021), it is clear that “eyes wide open” ?risk taking behaviour was widespread across the entire New South Wales population group.

Understanding what drives this need of humans to jump the gun, and return to risky behaviour, could redefine what we mean by return to normal in our pandemic plans. The plans should take in to account human behaviour, as well as command and control structures. It should anticipate that procedures will not always be followed by large groups of people because the need to recapture their earlier, normal lives is strong. Stronger than health education.

Future pandemic planners will have to take into account how humans respond to adversity, as well as how organisations respond to adversity. They will have to balance the drive for a return to normal, against the costs in economic and societal impacts of striving for normal. For organisations, the return to normal metrics tend to be clear, such as productivity, expenses, ROI, etc. We know when a company has returned to normal and plans often contain such metrics. It is harder to find return to normal metrics for the humans who work in those organisations or the communities in which those organisations operate. How do the humans return to normal as well? Should the human return to normal ?be as important as the corporate/entity’s return??What are some metrics?

These are issues which future pandemic planners will have to grapple. They will include things like vaccination requirements, working from home policies and workers compensation rules. ?Perhaps plans need to help employees develop a new model of “normal”. That like earthquakes, the aftershocks will continue ?for a long time and the return to a normal will be a long road. One shared by a community as well as the organisation. Maybe such spikes in cases and deaths are unavoidable, but it is never wise to drive a heath system so close to the brink. Future planning will recognise this human drive to put blinkers on, and hone in on “normal”. It will make our planning better, and benefit humans as well as organisations.?