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Indiana could received its first supply of coronavirus vaccine in November, federal health officials say. However, there are still many questions about the vaccine.

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Wear your blank, watch your blank, and blank your blanks. At this stage of the pandemic, does anyone need help filling in the blanks of the simple steps we all can take to curb the spread of the coronavirus? And yet, it appears enough of us just aren’t taking them.

As coronavirus cases have soared, Gov. Eric Holcomb and state and local health officials have repeatedly implored Hoosiers to adopt these basic public health practices, along with avoiding large public gatherings and staying home if you feel ill.

One need only look at coronavirus numbers to see the message may still not be getting through to many. Since the start of October, the number of people in Indiana infected has soared from below 15,000 to more than 70,000, according to the Regenstrief Institute, an Indianapolis research organization. Nearly twice as many people are hospitalized for COVID treatment today in the state’s hospitals as were hospitalized during the peak in the spring.

On Wednesday Holcomb invited three Indiana hospital executives to appear at his weekly coronavirus press briefing and issue their own plea to the public to, yes, do all those things — wear masks, watch distances, and wash hands.

Public health experts say they are not surprised that despite repeated pleas to people to do the right thing, too many people just, well, don’t.

Several factors may explain why Holcomb and others have reminded people again and again to make these behaviors second nature, public health experts say. People often take the lead from what they see others doing, be those individuals national leaders or their neighbors. People need consistent messages that leave no doubt about the best course of action. And, in many instances, they need laws or policies to ensure they do what they are asked.  

History has taught us that it can take decades for people to adopt public health behaviors, said Monica Kasting, an assistant professor in Purdue University’s Department of Public Health.

“Just saying that people should do it without any enforcement hasn’t worked for any public health practice that we see,” she said. “Just hoping people do it is not going to work.”

Making the unhealthy choice the hard choice

Consider seat belts. At first people fought back when public health officials first started recommending everyone buckle up in cars, she said. Eventually after years, the idea became widely accepted and entrenched in the law to the point where failing to do so can result in a ticket and a fine.  

For the most part, people understand and accept the wisdom of following these behaviors, Kasting said. But that doesn’t mean they necessarily do. Encouraging people to opt for preventive healthy behaviors can prove a challenge.

“What you have to do from a public health perspective most of the time is to make the healthy choice the easy choice and the unhealthy choice the hard choice,” said Kasting, who added that she would like to see Holcomb enforce the state’s mask mandate.

The more distant a threat seems, the less likely we are to act, she said. The more immediate a threat, the more likely we will respond. People are more willing to be tested for a disease than they are to engage in behavior to prevent it; for instance, people are more likely to agree to be screened for cervical cancer than they are to be vaccinated against it., she said.

In a similar vein, while people may still not follow the public health measures to stop the spread, once they fear infection, they will go for testing.

“People are much more willing to catch a disease early through screening and testing than to engage in healthy behaviors,” Kasting said. “It’s hard to get people to have future oriented thinking to do something that’s inconvenient. It’s much easier once they have a symptom to then address it at the time.”

Sending a strong public health message requires consistent information, particularly at the national level, public health experts agree. The western countries that have controlled the virus better than others have leaders who have followed the science and repeatedly appeared in public wearing masks, said Dr. Gabriel Bosslet, a pulmonologist at the Indiana University School of Medicine and the Hoosier behind the Hoosier COVID-19 Update, a Facebook page on which he tracks the virus.

In the wake of 9/11, Americans came together to help the nation heal, he said. Americans had a shared enemy: the terrorists. The nation’s leaders could have spurred people to do something similar during the pandemic, uniting in our actions to keep the virus at bay. Instead, people are split on how to respond.

“Rather than leaders having chosen to make the virus the other,” Bosslet said, “they have made other humans the other. We all should be pointing at the virus together and yelling at the virus.” 

How behaviors increase risk

Just as there has not been unity in attacking the virus, states have taken a variety of approaches to policy aimed at lowering spread. A recent New York Times report found that states that had the least restrictions now are experiencing the worst outbreaks.

Indiana came in 18th in the ranking of states going least to most restrictive. Indiana is among eight states with the greatest number of current hospitalizations per 100,000 people, and only 10 states have more cases per 100,000 than Indiana,  according to the New York Times analysis.

In Indiana, people have been going out and about more than they have in other parts of the country, research by a consortium of professors from different universities found. The group, behind a project known as A 50-State COVID-19 Survey, has been exploring people’s behaviors and how those are changing over the course of the pandemic.

The survey found that more people in Indiana are going to work, the store and visiting friends than people in the country as a whole are, said David Lazer, the website’s co-lead and a professor of computational social science at Northeastern University. When it came to visiting bars, Indiana was way above average — no doubt aided by the fact that in some other states bars may have had more restrictions placed upon them.

“It does seem to be in a systematic fashion that folks in Indiana are behaving in a riskier fashion,” Lazer said.

The fact that Hoosiers have the capability of going out also may decrease the likelihood that they will follow those public health recommendations that officials have pushed again and again.

Keeping bars and restaurants open while encouraging people to socially distance makes little sense, public health experts say. Such settings lend themselves to intimate social interactions that basically require people to lean close. Eating and drinking require people to lower their masks. Consuming alcohol can impair one’s judgment.

Having bars and restaurants open, even at reduced capacity, sends a message that the situation is not all that dire.

“Clearly if you can go get a beer and hang out in a bar, how serious can it be,” Lazer said. “It does send a message that it’s not so serious. … If you can get together in a restaurant, surely you can get together with your friends in your home.”

The answer lies not in merely closing such establishments but in also finding ways to subsidize the owners so that the decision does not pit public health against people’s financial well-being, many experts agree. 

Why a local approach might work better

Whether businesses are open or closed, there are better and worse ways of communicating the basic steps one can take as an individual to persuade people to change their behaviors. For many people pandemic fatigue has set in, making it more difficult for officials to convey the message, said Ana Bento, assistant professor at Indiana University’s School of Public Health.

Policies targeted for specific counties, as Holcomb has encouraged, may resonate more with individuals, especially if big announcements accompany any change in policy, Bento said. People may be more inclined to follow recommendations that come at the county level because they will view the threat as more immediate.

If the same announcement comes from a higher-level official, “I may think this is a problem of my state, not my county,” Bento said.

Other public health experts say that the most successful way to get people to change their ways is to reach skeptics not necessarily through policies but through friendships.

If people see people they know or celebrities they recognize recommending a set of actions, they may be more likely to adopt those behaviors, said Lindsey Leininger, chief executive officer of Dear Pandemic, a website run by an interdisciplinary team of researchers that provides information on the coronavirus.

People may not be as likely to listen to the medical establishment from on high as they might be to respond to a local school nurse or librarian, Leininger said. Finding the right person to send such messages is particularly important for states like Indiana, which has a mix of liberals and conservatives.

“It’s going to take the right messenger for the place. … That personal connection is more powerful than any one policy, said Leininger, a clinical professor at Dartmouth’s Tuck School of Business, “To me, this is really the path forward.”        

Once the message is sent, however, the even more difficult task becomes persuading those who hear it to put it into action.

Solving this puzzle is an age-old conundrum for the field of public health because it can be so easy to rationalize not doing what the experts recommend — be that losing weight, exercising, undergoing colon cancer screening, or taking steps to lower one’s risk of contracting coronavirus.

“I think people really believe these behaviors prevent the spread of the virus. The communication issue is getting them to do it and to understand the necessity of it,” Kasting said. “They think it’s an all or nothing — either we go back to sheltering in place or we don’t. And they don’t understand there’s a middle ground. … People really, really want to live in a black or white world, and we live in a gray world.”  

Contact IndyStar reporter Shari Rudavsky at [email protected] Follow her on Facebook and on Twitter: @srudavsky.

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