Some people listen to health experts, others ignore them: What it means for America's future with COVID-19

Since COVID-19 arrived in the U.S. earlier this year, the virus has sickened more than 5 million Americans, claimed at least 167,000 lives and wrought financial ruin.

Some Americans have been dutifully following the recommendations of public health experts – forgoing touch, canceling travel, holing up at home with kids while trying to work. Others have balked at the most basic precautions, refusing to wear masks and continuing to gather in large groups.

Psychology and public health experts say variations in how people respond to public health recommendations can be attributed to differences in how they navigate threats as well as social and cultural factors. These factors may also influence whether people are able to sustain behavior changes for the long haul ahead – exhausted parents, frayed front-line workers, the millions of Americans worn down by isolation.

"It is easy to think that people don’t follow the recommendations because they don’t want to, but there are also systemic and situational issues at play that affect people’s behavior," said Stephen Broomell, an associate professor at Carnegie Mellon University who studies judgment and decision making under uncertainty. "These can range from problems with communication, comprehension and personal risk assessment."

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While many countries have halted the spread of COVID-19, the U.S. on Thursday reported the most COVID-19-related deaths in one day since May. Beating the pandemic, experts say, requires large-scale cooperation for much longer than anyone anticipated.

"Until we get a vaccine, our only real tools are behavioral. We have to think through the lens of behavioral science. What can we do to nudge and encourage and cajole and motivate people to do the right thing?" said Jay Van Bavel, an associate professor of psychology and neural science at New York University.

"I think many people were hoping we would shut everything down for two weeks ... and then go back to normal. But since we didn't do it well enough originally, we are in this ongoing nightmare."

What health officials are working against

A 2016 study found that changing health-related behavior is neither obvious nor common sense, but rather "requires careful, thoughtful work that leads to a deep understanding of the nature of what motivates people and the pressures that act upon them."

Human behavior is complicated. Telling people what they ought to do to keep themselves and others safe seems basic, but behavior changes don't happen in a vacuum. They occur in the context of the societies in which people live and the groups to which they belong.

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In the U.S., health officials are asking people to think about the collective good in a country rooted in individualism. Countries that emphasize the importance of duty and obligation, such as Asian societies, have an easier time motivating people to do what's right over what's desirable.

"If you look at countries that are more collectivistic ... people feel more pressure to go along with what's good for the group," Van Bavel said. "Here we have traditions of individualism, which most of the time are great, but in a context of a pandemic are not so great and often very dangerous for everybody."

Some people also may want to follow the recommendations but can't. They may live with someone who isn't adhering to CDC guidelines, or they have a job, particularly a low-wage one, where they can't social-distance or take paid sick leave. People who are homeless can't shelter in place. Some trauma survivors may have a difficult time wearing masks.

Missed opportunities mean an uphill climb

Experts say what happens in the early days of a crisis can be key to how well people respond to what's being asked of them.

Earlier this year, President Donald Trump said “the coronavirus is very much under control." In February he said cases were “going to be down to close to zero.”

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Trump's statements often contracted ones from Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who has repeatedly emphasized the need for behavior changes to curb the spread of COVID-19. Research shows people are more likely to adopt public health recommendations when they are clearly and consistently communicated.

Masks, for example, weren't initially a recommendation, and even once they became one, there were conflicting messages from the White House on their importance. The president wore a mask publicly for the first time in July.

"Unfortunately, wearing a mask wasn’t one of the behaviors that people adopted in the first weeks of the pandemic," Broomell said. "Because of this, most people experienced surviving the start of the pandemic without a mask. Only the small proportion that encountered the virus and got sick had the correct feedback that their behaviors were not actually as effective as they thought."

Focus on shared national identity and avoid shaming

America is deeply polarized. One of the most persistent gaps in adherence to social distancing, hand-washing, masks, soon vaccines – is the difference between Democrats and Republicans.

A recent Gallup poll found 81% of Democrats are willing to be vaccinated if a free and FDA-approved one were available, while 47% of Republicans say the same.

So-called filter bubbles – where people encounter only information that aligns with their existing beliefs – can create alternate realities around risks and actions necessary to mitigate them. Social media is ripe for conspiracy theories and misinformation, making it difficult for some people who get their news online to separate fact from fiction.

Van Bavel says that to encourage cross-pollination of good health-related behaviors, people should focus more on their shared sense of national identity.

"To appeal to somebody who's different from you politically, appeal to ... your sense of shared purpose," he said.

Shame and humiliation are not effective tactics to change behavior, experts say. If you want to persuade a Republican to wear a mask, Van Bavel said, show them the recent pictures of Trump wearing one, or the one of Dick Cheney that went viral.

Provide leadership on the importance of vaccination

Health experts say that to win the fight against COVID-19, widespread vaccination is essential, but the Gallup poll found that overall one in three Americans say they won't get the vaccine when it becomes available.

Different strategies will be needed to address different causes of vaccine hesitancy. People concerned about safety will need reassurance; people of color will need to be engaged in a process that builds trust; and people worried about government overreach will need to be heard, said Monica Schoch-Spana, a senior scholar with the Johns Hopkins Center for Health Security.

Visible leadership will be key.

"You're going to need people like the president getting a shot of the vaccine in a press conference," Van Bavel said. "That's the type of leadership you need. Role modeling, showing the right norms, illustrating that it's easy and harmless, that he trusts the process."

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Now is the time to model behaviors you want to see in others

People are more likely to cooperate when they believe others are cooperating.

"Even if you don't agree with something like wearing a mask, if you see everybody around you in your community or in your neighborhood doing it, you're more likely to do it," Van Bavel said. "That's part of human nature, and there's lots of evidence that norms matter for our behavior in lots of different situations."

Everyone has the ability to exert influence – the president, the media, individual community members. Peer pressure can be an effective nudge.

"We all exert influence on others around us," Van Bavel said. "What we wear, how we act, what we post on social media, those provide clues for other people about how to behave."

Consider talking about these changes as the 'new normal'

Broomell says that if people think about some changes as the new normal versus a response to a temporary crisis it may promote the healthy behaviors experts want to see.

"Exhaustion can come from, among other things, having to pay special attention to your behaviors, waiting for the day you no longer need to perform them, and not knowing when it will end. For certain behaviors, one way to help people maintain vigilance is to establish a norm for their performance," he said.

Remind people what they do matters

People are resilient, and experts say it's worth reminding Americans what the country has already survived, including two world wars.

To weather this crisis, people need to be reminded that their actions matter – that those actions are what will see the country through the pandemic with fewer lives lost.

"If we all pull together for six more months, the vaccines look to be on track and we might be through this," Van Bavel said. "We might not have to lose our grandparents or colleagues or neighbors. Can you just pull through for six more months doing the right things? Because we're going to look back and be really devastated if we've lost loved ones because we just couldn't be patient enough."

Contributing: Karen Weintraub

This article originally appeared on USA TODAY: COVID restrictions: Why Americans don't wear face masks, distance