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Friday, March 22, 2024

Can the Public Be Trusted in a Pandemic?

One thing is now frighteningly clear: Limiting the death toll and broader impacts of this nightmare requires everyone to do their part. Stay put and practice safe hygiene. Yet that fact—that truth—raises an uncomfortable question: Can the public be trusted to behave responsibly?

The cynical answer is easy: nope. There is certainly evidence, of a kind, supporting this conclusion. America’s public education system is in shambles and has been for ages; our commander in chief is spewing potentially deadly misinformation and floating the idea of relaxing social distancing by Easter; Fox News, the dominant cable news channel, downplayed the pandemic’s seriousness; millions of Americans are influenced by quacks on Facebook who fear vaccines almost as much as they fear gluten.

For even more alarming examples of your fellow Americans failing to engender confidence, consider Sanitizer Man, toilet paper hoarders, booming business at a Bay Area gun store, and the college students gathered for spring break in South Florida—global pandemic be, like, damned. Last Sunday, The New York Times aggregated snippets of reporting from around the country for a story about “deniers and disbelievers” that could be boiled down to this: America’s army of morons is out in force, making this catastrophe worse.

Although not a balm for current anxieties, you may be interested to know that this urgent question—can we the people pull this off?—is at the heart of modern-day social psychology and decision science. A vast body of research in this field documents our cognitive biases and tendency to misjudge and misinterpret information. This would suggest that expecting everyone to master isolation and hygiene practices on short notice isn’t realistic. But there is another school of thought among researchers who study decisionmaking that may surprise you, and may even offer hope.

Let’s not mince words: We are wildly fallible creatures. Human cognition is clouded by all kinds of heuristics—mental shortcuts—and biases that mar our judgment and undermine our often well-intentioned quest for rational thinking and responsible action. If that’s news to you,(a) Where have you been? (b) Check out Nudge, Predictably Irrational, Sway, Freakonomics, Factfulness, much of the Malcolm Gladwell cannon, Shankar Vedantam’s Hidden Brain on NPR, or Daniel Kahneman’s masterful Thinking, Fast and Slow. Those should get you started.

I don’t know exactly why, but I love this stuff. Perhaps there’s something strangely poetic about the fact that rational thought itself is a chimera. A less grandiose possibility is that I’ve fallen for what one critic of behavioral economics calls “the poor man’s way of saying, ‘Hey, I’m smart.’”

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But back to Covid-19. In light of said fallibility, and knowing there are Americans, right now, denying the seriousness of this crisis, it’s only natural to worry that our cognitive biases will undermine decisionmaking about how to behave these next three or 33 weeks. Some may even conclude that, because permitting people to decide for themselves how to behave can be “problematic,” it would be wise for leadership to double down on restrictions enforcement or manipulate the public for its own good.

Public health experts are essentially united about the importance of leveling with the public, no matter how scary the information. But politicians? Calibrating public statements, ginning up fears or delivering overly calming messages, would be well within the range of normal. In a world obsessed with human foibles (and books about them), why wouldn’t politicians believe that the public—cue Jack Nicholson—can’t handle the truth?

Indeed, certain studies support the view that our biases could get us in trouble right now, or at least hinder our capacity to understand just how dire this situation is. Take for example, the difficulty of understanding exponential growth. In a 1975 paper, researchers William Wagenaar and Sabato D. Sagaria dryly note that many damaging global problems—population growth, pollution, food shortages—are driven by exponential processes. Addressing these issues, they wrote, “will depend on the cooperation of individual citizens.” So they figured it would be a good idea to see if people can quickly and intuitively grasp just how explosive exponential growth can be.

The results were not, shall we say, encouraging. As Wagenaar and Sagaria showed, and subsequent research has since replicated, most of us underestimate exponential processes time and time again. (Two-thirds of subjects in one experiment underestimated exponential growth by 90 percent or more.) No matter how the information is presented—tables or graphs depicting the process over time—we struggle to intuitively get our heads around how fast things spin out of control.

But do such cognitive blind spots, spotlighted in comfortable research settings, actually cripple our ability to grasp the magnitude of this pandemic and thus behave accordingly? Baruch Fischhoff doesn’t think so. Fischhoff is a psychologist at Carnegie Mellon University and former president of the Society for Risk Analysis. He works at the intersection of risk analysis, risk communication, and human behavior, and he has spent decades thinking about and investigating these very questions. In many ways, his entire career has pointed toward this harrowing moment in history.

Fischhoff is a torchbearer for a less common worldview within the field of decision science. “I’m very reluctant to give up on people,” he says. As Fischhoff sees it, humans are more level-headed than the breathless news reports and social media posts about “covidiots” would suggest.

But to tap into the sensible side of human nature, you have to give people the information they need. Right now that means solid scientific information: Who is most at risk? How does the virus spread? What is social distancing, exactly? What percentage of people around my community have tested positive for the virus but are asymptomatic?

Suppose that tomorrow, a public official were to say there is a 10 percent chance that we can relax social distancing in three weeks, and a 90 percent chance that we won’t be out of the woods until the end of the calendar year. Good start, theoretical public official! “That precision matters for people trying to plan their lives,” Fischhoff says. Much more so than, say, Trump, adrift in a press briefing, talking about the “great buildings” of Lower Manhattan.

When presented with the right quantitative information in the right ways, the public can handle the math. The research backs this up, Fischoff says. He points to research in meteorology that dates back to 1980 as an example. Prior work had suggested that nonexperts had trouble understanding probabilities, in this case the probability-of-precipitation statements made by weather forecasters. Allan Murphy, a professor of atmospheric sciences at Oregon State University, led a study to examine this idea of layperson limitations.

What Murphy and colleagues found was that people have little difficulty understanding the difference between, say, a 30 percent and a 75 percent chance of rain. The ambiguity, in fact, was with the word rain. Will it be an all-day affair, whipped sideways by the wind? Or are we talking showers with intermittent sun? Is it rain at the specific location where meteorologists measure precipitation? Or will it cover a wide area?

While the experts figured, or were perhaps quick to believe, the public couldn’t correctly interpret information presented in probabilistic terms, it turned out that the use of quantitative information wasn’t the problem. “People can understand probabilities if it’s clear what they’re attached to,” Fischhoff says. The results of the rain study proved instrumental in convincing the National Weather Service to use numerical probability-of-precipitation forecasts, which is why they’re ubiquitous today. (I wrote briefly about the rain study and Fischhoff in a 2014 story.)

But let’s be real: Benign weather forecasts are a lot different from communications about Covid-19. Much of the present skepticism about our fellow citizens’ behavior is rooted in a suspicion that most of us are frankly innumerate. (How many times have you heard someone say they suck at math?) With the trajectory of the pandemic tied directly to our capacity to understand quantitative information and act accordingly, maybe the chroniclers of cognitive bias are right; maybe we’re just not equipped to flatten the curve without lots of nudging. Shoving, even.

Fischhoff disagrees, and plenty of research has shown that, again, if people are given the right information, they can indeed make reasonable assessments. In a 2017 paper in Risk Analysis, Fischhoff and colleagues looked at public understanding of Ebola risk. One of their questions was how nonexperts estimate R-naught compared with the scientific estimate. (R-naught refers to the reproduction number, the figure that indicates how infectious a disease is.)

What they found was that respondents’ judgments were generally in line with scientific knowledge. “People sort of had it,” Fischhoff told me. “They gave us probabilities that were consistent and pretty close to reality.” They had built up a mental model of how the disease works. That, Fischhoff says, coupled with observations about the epidemic—news reports, protective gear in media images, stories about the health care system, pronouncements from public health officials, and so on—enabled them to make statistical estimates that were generally accurate.

Nor was this a one-off finding. A decade ago, Lisa Schwartz and Steven Woloshin of the Department of Veterans Affairs and Dartmouth Institute for Health Policy and Clinical Practice came up with the idea for something called the Drug Facts Box. Like the Nutrition Facts Box on the back of your cereal or orange juice container, the Drug Facts Box accompanying medicines would present, in an easily digestible format, the “benefit and harm data for each indication of a drug.”

The box would include comparisons to alternative treatments (or no medication), as well as numerical estimates of benefits presented in meaningful units—for sleeping pills, for example, sleep differences as measured in minutes. In addition, the box gave consumers a sense of how good the data are, what the evidence is.

In their effort to convince the FDA to start using this tool, Schwartz and Woloshin conducted a series of experiments to find out whether everyday people could understand the information provided. “When we first proposed the Drug Facts Box,” they wrote in a 2013 PNAS paper, “the FDA expressed concern about whether consumers could understand the data. Based on a series of studies, we are confident that most can.”

Such findings are relevant today, Fischhoff says, not only because they inform our overall judgment of public competence, but also because of possible Covid-19 vaccine trials on the near horizon. These vaccines could have greater than usual risk because of greater than usual benefit. People are going to need to know this quantitative information, and studies like these indicate that we can handle it.

In the Ebola paper, Fischhoff and his coauthors concluded that “there is reason for optimism” about public understanding of risk, with the critical and oft-repeated caveat that it all rides on precise communications. “Precise messages could provide the public with the information needed to manage disease risks when making personal choices, evaluating public health policies, and interpreting the pronouncements of politicians and pundits.” Put another way: more Anthony Fauci, less Trump.

Yet perhaps the most common source of doubt about our collective ability to step up is the idea that our emotions frequently get the better of us. The irrational choices we make when tempers flare; our habit of choosing short-term rewards over larger long-term gains; our bias for thinking tomorrow will be much like today; how making plans tricks us into thinking the future will jive with them (so unfair, that one!); our tendency to think past events were more predictable back then; the strange mental defenses we’ve conjured to fend off the fear of death. We’re all tangled up, and for confirmation you need look no further than toilet paper sales or gun stores.

You’d be wrong, though. (Thank you, confirmation bias.) There are always outliers, sure. But as Fischhoff explains, we should hold off on judgment and consider the decisions themselves, the context in which they were made, and the data (or lack thereof) that informed them. Spotlighting the deniers and disbelievers, although potentially useful because of the effect of public shaming, does nothing to address the bad messaging so often to blame for people’s seemingly poor decisions. During this pandemic, it’s imperative that leaders “communicate information in the best way possible so as to expand the envelope of informed choice as far as possible,” Fischhoff says. “If the communication is lousy, people can’t make good decisions. They don’t look like good decisionmakers because they haven’t been given half a chance.”

This assessment fits the toilet paper hoarders to a T(P). For at least two months, many of our country’s most powerful leaders assured us that the novel coronavirus was a nonissue, even though experts knew otherwise and were sounding the alarm. As recently as March 12, Trump was saying that Covid-19 would "go away.” On March 15, he said: “We’re going to be so good.” Meanwhile, FOX News hosts dutifully parroted his misinformation. (Or is it the other way around?)

Then it was U-turn city, with authorities like the CDC telling us—first older and more vulnerable populations, then everyone—to stock up on food, medicines, and household goods, including toilet paper. But how much? No official guidance on that. Nor did anyone, least of all Trump Administration officials, appear to shore up the supply chain in advance of this stock-up order. “All of a sudden you tell people to go get things that aren’t available,” Fischhoff says. “You’ve asked them to do the impossible and then accuse them of irrationality, hoarding, and antisocial behavior.”

Similar analysis could be applied to the gun store owner. Profiteering? Maybe. But maybe they are facing a household catastrophe we know nothing about, with a laid-off spouse, no health insurance, or some other crushing financial pressure. Most of what they had to go on was the order to close for an indefinite period of time, with little indication that the state or federal government would be there to help small businesses like this one. Was it so irrational then, so irresponsible, of that store owner to stay open an extra day or two? As Fischhoff reminded me: “We can’t know why other people do what they do unless we actually study them.”

The spring break revelers are probably the hardest to sympathize with. Why were people on the beach? “I haven’t studied them, so I don’t know,” Fischhoff says. But he can make informed guesses: “It could be that, up until a few days ago, they still didn’t understand their choices.” Keep in mind that testing has been woefully inadequate, so these vacationers likely didn’t know the prevalence of the virus. And Florida governor Ron DeSantis, refusing to close all beaches and toeing the line with the White House’s relentless downplaying, wasn’t exactly helping to spread solid information.

Even those of us who are, for better and for worse, consuming pandemic-related information by the truckload, we are just now forging a “mental model of how our behavior can have devastating effects on people we do not know or see—as part of the chain reaction creating the disease’s exponential spread,” Fischhoff says. Maybe we should go easy on the spring breakers for being just a week or so behind America’s awareness curve.

Yes, it’s important to spotlight egregious examples of people flouting social distancing guidelines or putting the public at risk in other ways. But let’s not let that distract us. Our attention should remain squarely on the villains whose dismissals and deadly ineptitude only help the virus—and on the doctors, nurses, first responders, public servants, and other heroes who are risking their lives for all of us.

Can the public be trusted? We may have our flaws and cognitive blind spots, but from the findings of scientists like Fischhoff, as well as the innumerable acts of kindness and innovation we are seeing and hearing about, there is reason for hope. Reason to have faith that neighbors and strangers alike can do the right thing. We can. We must. Stay home.

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