The Prime Minister’s address to the nation on April 20, though fairly motivational, confounded the expectations of much of the nation’s commonality. Apart from a coherent plea to States to avoid total lockdowns and a romantic COVID-19 situational briefing of sorts, much of it was optimistic yet stultifying rhetoric that could hardly have any influence on mass behaviour towards COVID-19. Nonetheless, while much of the visual aspect of the Prime Minister’s address was similar to the ones held last year, one conspicuous element was missing — that of a symbolic mask. While a number of alibis for the same are possible, it is an insignia that speaks volumes about our approach toward the second wave of COVID-19 .
Administrative fatigue
Medicine and social science are two essential pillars of public health. However, medical interventions have historically been the ones to usurp the public health space. Much to the detriment of public health, this has time and again resulted in a subconscious dismissal of social science-based approaches that hold the keys to the public health castle. The situation with the second wave is hardly different. In our besottedness with strategies such as mass vaccination, which although of unrivalled significance have considerable near-term limitations, the simplest yet most crucial behavioural interventions have been given a criminally light touch at a time when they were supposed to be accentuated.
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And this goes beyond the abomination of political rallies potentially spreading infection, or public representatives failing at crucial public messaging by not wearing masks themselves. Take the instance of a mofussil town that no longer sees honking vehicles traverse the streets every morning, airing social distancing and masking messages, unlike during the first wave. Or the near-disappearance after the first wave of rings drawn outside of a shopping store to encourage social distancing. Surmount these with counter-intuitive public policies at the grass-roots level, and you have a perfect recipe for a flaring pandemic.
For example, even before an official order was promulgated in Maharashtra, local police forced shops to remain open for only four hours during the day in certain localities, creating panic among customers and shopkeepers. The idea of limiting open-hours derives from the theoretical precept of rationing services to discourage over-consumption, much like waiting times. But the same fosters over-crowding, non-compliance with COVID-19-appropriate behaviour by both shopkeepers and customers, and is practically counterproductive when an infectious pandemic is in question.
Similarly, it is possible to locate beneficiaries lined up outside some vaccination centres from midnight till noon for physical tokens, while the politically well-connected get their way within minutes. All of these indicate that much like pandemic fatigue among the public, administrative and governance fatigue is real, and that the crucial lessons from the early days of the pandemic have been squandered rather than strengthened.
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Poor messaging
Another example of administrative fatigue, resulting from a subconscious dismissal of behavioural approaches, is the poor risk communication and public messaging that has accompanied the second wave. Health behaviours, once firmly embedded, are expected to be swiftly elicited on subsequent occasions. The concept is much like immunological memory where the body exerts a stronger response to a disease agent upon the second or third infection. Such embedded health behaviours in some East Asian countries have resulted in prompt and widespread public adoption of measures such as masking on the whiff of an infectious outbreak. The same cannot be expected for India given our lesser exposure to infectious pandemics. Nonetheless, a strong and subtle nudge was imperative during the second wave to quickly bring back COVID-19-appropriate behaviours with renewed vigour. This has failed, and that too during more pressing times than before.
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As is often humorously exclaimed, the worst way to calm someone down is by telling them to calm down. Reducing the risk communication strategy to simple messages such as “please wear masks” is unlikely to work particularly in a setting of widespread pandemic fatigue, and where mixed signals are continuously disseminated by political representatives. Altering health behaviour, in addition to altering physical and social contexts, involves skilful and emphatic messaging that incentivises adoption of the right behaviours. Unfortunately, the public health messaging strategy during the second wave has been more generic, muffled, and far more equivocal than the first wave.
A perspective
An over-medicalised public health emergency is a disaster superimposed on another. Multiple fundamental aspects of COVID-19 vaccines and the protection afforded by them still remain fuzzy. Further, there are non-negotiable aspects such as the lag between vaccination and protection, and the gargantuan challenge of vaccinating a large population as ours. Overcoming our preoccupation with medical solutions and looking at behavioural approaches as more than mere rituals will be imperative to combat this second wave.
Dr. Soham D. Bhaduri is a physician, public health policy researcher and commentator
