In a crisis? I beg you, go beyond nudges

Feature photo by Edwin Hooper on Unsplash

The world has been battling the COVID-19 coronavirus (also known as SARS-nCov-2) for over two months. Since the alarm was first sounded in Wuhan, China in January the virus has been declared a pandemic. While most of Asia managed to stem the tide from the first wave of cases from Mainland China, things have changed drastically since.

Dealing with the second wave: nudges are not enough

Whatever the criticism about China’s data and level of forthrightness about COVID-19, one fact remains: by shutting down entire cities, China bought the world time to prepare for the coronavirus. Other East Asian and South East Asian nations followed up quickly with infectious disease taskforces, which helped to flatten the curve further.

Since then, the situation has changed. China no longer has the most number of confirmed COVID-19 cases or deaths. Singapore and Hong Kong have been pushed off the leaderboard of confirmed cases.

Total confirmed cases: 685,623

Data as of 29 March 2020, 11:12:45PM
Source: Johns Hopkins Center for Systems Science and Engineering (COVID-19 cases dashboard, Global Health Security Index)


Photo by Iñaki del Olmo on Unsplash

What led to this? Differences in policy-making approaches

  1. Asia policymakers applied the whole range of policy tools at their disposal (more below)
  2. The West saw the coronavirus as being too far away, and infecting people who were different from them — different palates and (perceived) hygiene levels. In other words, the Construal-Level Theory of psychological distance
  3. Over-reliance on behavioural science in policy-making, with the UK as an example.

Here is an example of how the governments and societies of Hong Kong, Taiwan, and Singapore responded. Their approach can be summarised as:

A) Transparency
B) Comprehensive, proactive testing
C) Quick identification of close contacts
D) Strict penalties for breaching quarantine

Handwashing is an important step to hygiene
Photo by F Cary Snyder on Unsplash

Falling back on the habits developed from SARS

In times of crisis, nudges will never be enough. That’s because we’re all trying to develop a habit, and that takes time. Societies such as Taiwan, Singapore, and Hong Kong had the benefit of going through “the dress rehearsal” of SARS in 2003, as Jeremy Lim, co-director of the Leadership Institute for Global Health Transformation at the National University of Singapore puts it.
Which is why when the coronavirus landed on their shores, the three societies immediately fell back on the systems and habits that were developed from the experience of SARS. In particular, frequent hand-washing and the use of face masks.

Frequent hand-washing

  • In Hong Kong, people washed their hands more often during the SARS outbreak, and were slow to shake the new habit. Even after SARS ended, Hong Kong people continued washing their hands with a similarly high frequency for the next 22 months. What helped: Reminders from the family and girlfriends or wives.
  • In Singapore, the government placed posters detailing the 7-steps of hand-washing at the sinks in common toilets, one poster per sink. These posters have been resurrected with COVID-19, with the addition of singing ‘Happy Birthday’ twice. Everyone knows the lyrics, and it’s simple enough for a child to follow.
  • In Taiwan, the focus was on hand-washing in the hospitals, as a major factor in the spread of SARS came from hospitalised patients who had not yet been classified as SARS patients.

Use of face masks

  • Before SARS, it was uncommon to wear face masks on the streets of Hong Kong and Taiwan. Face masks were only used by those who were sick, or had something to hide. However, the use of face masks was perceived as a positive action during the SARS outbreak.
  • In Hong Kong and Taiwan, it became a social norm and symbol of civic responsibility. Residents wanted to show their solidarity with healthcare workers in a highly visible manner.
There is controversy over the use of face masks that’s split along West vs Asia lines. However, some public health experts are starting to think that the messaging should change as it can be useful to protect others from our respiratory droplets. In addition, new randomised trials in Hong Kong and Germany show that when face masks are used together with hand-washing, it prevents the transmission of flu within households.

Singapore flats with high rise apartments
Photo by fleur kaan on Unsplash

Nudges create new habits, and habits take time to develop

Given Singapore’s experience with SARS, one might have thought that it’d be a breeze for the government introduce new nudges. But being from Singapore myself, I can testify that it wasn’t so smooth, because existing habits needed to be broken before new ones could be formed. And so I leave you with a sample of the nudges that the authorities and society are trying to introduce — and how some of them needed other policy tools to be useful.

Supermarket checkout queues

Existing habit: Queuing at the supermarket checkout counter
Desired new habit: Shoppers should be at least 1-metre apart in the checkout queues

Supermarkets introduced markings to indicate the 1-metre markings. Shoppers initially did not notice the markings or understand it until there was widespread education and social enforcement. Now, they queue right.

Seating arrangements at foodcourts (community food centres)

Existing habit: Fill all seats available, share tables if necessary
Desired new habit: Diners should have at least 1 seat between them

Alternate seats were marked with tape to indicate that they are not for use. Initially, diners were confused over the markings until there was widespread education and social enforcement, with the threat of official penalties. Since then, there has been better compliance.

Standing on the escalator

Existing habit: Fill all steps, with 1 between for personal space)
Desired new habit: Leave 2-3 steps between each person on the escalator

Some retailers have introduced markers to remind shoppers, compliance has been observed. At train stations, signs have been put up to remind commuters to stay 3 steps apart. Anecdotally, commuters complied with it.

Social distancing on public transport

Existing habit: Peak hour crush on public transport
Desired new habit: More space between commuters, as authorities encourage telecommuting arrangements

With Singapore on its largest work-from-home experiment, the crowds have thinned. However, little change has been observed in terms of public transport habits.

Spending leisure time in the malls

Existing habit: Visiting the mall for leisure, essentials, and everything in-between.
Desired new habit: Reduce mall visits

Malls must limit the number of shoppers on their premises. Choke points were seen outside some shopping centres. In a Whatsapp message , authorities advised those in Singapore to defer non-essential trips to the mall.

Nightlife and entertainment venues with crowds

Existing habit: Vibrant nightlife including bars, karaoke outlets, cinemas, theatres.
Desired new habit: Reduce social gatherings before bars and entertainment venues were closed from 27 March

Party-goers thronged the nightspots and organised “farewell parties”. Some clubs ditched their farewell party plans after netizens decried them as being irresponsible, and the Singapore Tourism Board, Enterprise Singapore and Singapore Police Force issued a joint statement urging responsible implementation of safe-distancing measures.

 

Stay safe, practice good hand hygiene, and may we survive this pandemic well.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.