For almost a year, many of us have watched in anger and frustration as we see others flout public health guidelines. A crisis that could have built social solidarity has pushed us further apart. In a year that has brought countless sources of stress and anxiety, the experience of seeing a friend post about a large indoor gathering on social media, a stranger without a mask, or a celebrity take a lavish international vacation is maddening. Those who are flouting guidelines form a broad spectrum from those confused by conflicting advice or suffering from “pandemic fatigue” to extreme cases that deny the existence of Covid-19 or reject expert consensus safety measures like mask-wearing despite mounting death tolls.                 

We cannot blame those who are confused by conflicting advice from authorities. The Trump Administration could have introduced centrally coordinated tracing and testing strategies and data-based federal guidelines to uniformly inform local restrictions at the beginning of the pandemic. Instead, states were left to design and enforce their own conflicting public health guidelines. Trump created further chaos by encouraging people to violate emergency orders and “liberate” their states from the most basic safety protocols such as mask-wearing. Residents of some states, like New York, that lived through the trauma of a massive outbreak early in the pandemic have watched in horror as others, like those in Florida, went on about their regular routines, having never been subject to strict public health measures or state mask mandates.

Not only are restrictions conflicting between states but also within the states. In November 2020, Rhode Island residents were prohibited from gathering indoors or outdoors with a single individual from outside their household, but restaurants were allowed to operate indoor dining with 66% capacity, and indoor gyms were operating with limited capacity. 

Across the country, people were encouraged not to gather together for Thanksgiving and Christmas meals while watching large groups gather to dine indoors at restaurants or frequent bars. While many understood the motivation to reopen restaurants was to restart the economy, the disconnect between what was done publicly and what was asked of us privately created a discrepancy that was hard to understand. Had the Trump administration provided greater economic security during the pandemic, businesses, individuals and local governments may not have been forced to make such dangerous decisions to preserve their economies and incomes.

The inconsistent reasoning behind restrictions erodes public trust and confuses people already exhausted from a year of risk assessment. Many believe that if businesses like restaurants or gyms are allowed to open, it must mean that they are safe, and this confusion over what is safe and what isn’t can lead to clashes with family members or friends over their concerns about the increased risk of infection in these spaces.                                  

Arguments over what is considered “safe” or “acceptable” behavior during the pandemic are causing divisive social fractures in the same way polarising political beliefs have in the last few years but with potentially higher stakes. A UK study noted that 56% of 2237 participants reported having had arguments, felt angry or had fallen out with others because of Covid-19, 22% of participants reported that they had confronted or reported someone. article continues after advertisement

 Adult children are exasperated at their high risk parents for taking unnecessary risks during the pandemic. Those who formed a “bubble” with close friends and family are shocked to find that they can’t agree on what constitutes high-risk behavior or that the size of their bubble has rapidly expanded without their consent. People who have cautiously spent much of the year isolated at home are enraged to regularly see their friends indoor dining, frequenting bars or jetting across the country, and bragging about it on social media. Many friends and family members in your immediate orbit may have initially agreed to vigilantly comply with all guidelines, but as we reach the one-year mark, they are letting down their guard.  

Healthcare workers have felt much of this anger, having risked their lives and endured unimaginable trauma to care for Covid-19 patients without sufficient PPE. In return for their service, they have watched members of the public carelessly violate public health guidelines, and a President ignore science and mock others for protecting themselves while wearing masks. They have then tangibly experienced the impact as hospitals fill up with Covid-19 patients which will undoubtedly contribute to their PTSD.              

All these experiences contribute to a feeling of helplessness and despair in the face of the pandemic. Many feel as if they have pointlessly suffered through isolating restrictions when they see stories of unmasked underground parties. The rise of mutual aid networks during the pandemic has restored some faith in humanity, but witnessing the repeated violation of Covid-19 public health guidelines that puts others at risk contributes to a degradation of social solidarity. Many have ended friendships, relationships and cut themselves off from family members over disagreements about Covid-19 safety precautions.     

With social distancing in place, it is difficult to replace those friendships and social networks in a meaningful way. The long-term effect is that many will emerge from this pandemic with reduced social support networks which we know are essential to maintaining optimal psychological and physical health. With 4 in 10 adults in the U.S. experiencing symptoms of anxiety or depressive disorder during the pandemic, this is yet another stressor that will contribute to the mental health syndemic evolving from Covid-19.article continues after advertisement

We need to learn from this experience and change how we communicate public health guidelines and information. The fundamental principles are simple enough, you need to be consistent, accurate, and not withhold vital information or set unrealistic expectations, it’s in the execution that the challenge lies. Finding the appropriate messenger for the right audience is key, they need to be well informed to build trust, and most importantly they need to demonstrate empathy.  

We have learnt during the pandemic that negative messaging or shaming does not encourage behavior change so we need to take a different approach. We need to understand why some Americans are still opposed to mask-wearing and find a different, more optimistic way to persuade them. Many non-masks wearers still dispute facts about Covid-19 transmission, but something no one can deny is the existence of is flu season. Cases of the flu have seen a historic global decline this season, with only one pediatric death reported in the US. This is a direct result of safety precautions like mask-wearing and social distancing and a big incentive for those who haven’t to start adopting those behaviors.                  

By having clearer, consistent guidelines communicated empathetically from the onset of a public health crisis, not only do we reduce transmission but we also reduce the stress associated with following those guidelines.