December 4, 2020

another way

The numbers don’t lie, infections and deaths are rising. I worry about the increase and, especially, about the large increase in projected deaths, now possibly reaching 540,000 deaths by April 1st, up from the 470,000 estimated last week. The estimate is higher if mandates ease, lower if we get a strong vaccine rolled out, even lower if we could get people to comply with universal masking.

Last night, in frustration and pessimism, I wrote about the evidence that “entitled” people were more likely to not follow mask mandates. But the truth is more complex than that. Some non adherence is based on feeling entitled, but some non adherence is based on dis-information, some based on need to keep working, while not making waves to do so. Other reasons exist too.

I wrote about the concept of harm reduction back in May. Harm reduction is used in treating drug addiction, by reducing risks, but not insisting on abstinence. Harm reduction is a much more realistic approach that helps with behavior changes, without judgement. It has been shown to help people actually move away from their addictions into sobriety.

Public shaming does not always work. Harm reduction is quite possibly the approach we need now to help with behavior change. This makes sense to me, having worked in HIV prevention for years. An interesting phenomenon is the “f*** it effect” or more politely known as “Abstinence Violation Effect”, which can make any slip up feel like a failure, so people say “I have already failed, I might as well….” and continue the dangerous behavior more so. One beer becomes 10. One sexual encounter becomes several. One bowl of ice cream becomes the whole container.

Recognizing this can help us help ourselves prevent slip ups to minimize our risks and help others who are having a harder time make better choices. We need to remember that for many people social isolation evokes cravings similar to hunger. Helping them choose less risky options can help them cope better.

Helping more people make mask wearing a priority is key to decreasing deaths, along with getting people ready for vaccines. We need to cut the number of infections, not just to prevent deaths, but also to prevent the chronic symptoms that develop after infection which are becoming more concerning. We are coming into a long winter of pain and any help we can get now will make a difference.

Wash your hands, cover your nose, keep safe six, and help others make better choices.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://betsybrownmd.substack.com/p/may-14-2020

https://www.psychiatryadvisor.com/home/topics/general-psychiatry/psychological-entitlement-associated-with-not-following-covid-19-health-guidelines/

https://www.medscape.com/viewarticle/941944#vp_1 harm reduction

https://web.archive.org/web/20130826051448/http:/www.time.com/time/health/article/0,8599,1868965,00.html

abstinence violation effect the f*** it effect

https://www.nature.com/articles/s41593-020-00742-z

https://en.wikipedia.org/wiki/Harm_reduction

https://www.nytimes.com/2020/12/04/health/covid-long-term-symptoms.html

https://covid19.healthdata.org/united-states-of-america?view=total-deaths&tab=trend