Health

Why Months Of 'Stay Home' Messaging Didn’t Work In Ontario

The COVID messaging contained a preponderance of confusing and unhelpful information, known in common parlance as BS. The results were disastrous.

“We have to hunker down, I just can’t stress this enough,” Ontario Premier Doug Ford said in a press conference last week, signalling the arrival of more restrictions. “This is crunch time right now.” Those restrictions arrived Tuesday, to both relief and frustration. Relief in many quarters that the government has put in place a stay-at-home order and other measures to address Ontario’s alarming COVID-19 numbers (a seven-day average of 3,480 new daily cases). And frustration, surely all around, that a province that has already been on high alert or some form of lockdown since November now needs new restrictions because the situation is so grim.

How did we get here: the dire numbers in the latest modelling, strained hospital systems, the bleak winter ahead? Depending on whom you ask, that comes down to a tangle of factors: the province’s slow, and many would say inadequate, response to rising COVID cases and hospitalizations; breakdowns in testing and contact tracing; reopening schools with high community transmission (and without smaller class sizes or improved ventilation); the realities of indoor transmission in winter, particularly in workplaces that can’t be shut down.

In any case, even before the new measures were announced, we had reached the phase of proceedings where blame settles on the behaviour of citizens: Why didn’t we do our part? After all, the mantra as of November was Stay Home. Don’t leave your house except for groceries and essentials. Don’t see anyone. “You should assume [the virus] is everywhere,” Dr. Eileen de Villa, Toronto’s medical officer of health, told residents Nov. 10 as the city closed gyms, theatres and indoor dining. In December, Toronto mayor John Tory tweeted with familiar glibness, “1. Stay home 2. Refer to 1.”

Why didn’t we? Nearly half of Canadians polled by Leger and the Association for Canadian Studies, a non-profit, said they gathered with friends or family over the holidays. Within Ontario, cellphone mobility data and the jump in cases in areas outside hot spots such as Toronto and Peel support the idea that many did. Recent reports from my informal “stringers” across Toronto noted packed toboggan hills and rinks; gaggles of unmasked people walking together; parties in backyards (sometimes in tents, with heaters inside; why not up the ante?); people driving from one jurisdiction to another to find an open mall.

Commentators have proffered a string of plausible reasons for why we didn’t comply: COVID fatigue; a sense of privilege among the financially comfortable, some of whom see COVID as someone else’s problem; a peculiar sense of Canadian exceptionalism that leads us to make bad choices. But here’s one that that might play a bigger role in transmission than we realize: the extremely high levels of, if you’ll pardon me, bullshit in both policy and communications around COVID.

The word may be crass, but it’s the right one here. The government and medical officials who insisted we stay home while they jetted off to tropical destinations (or packed into local restaurants) are only the most obvious symptom. Ontarians have faced a bullshit epidemic on top of a pandemic, and the accompanying dissonance may have fuelled some of our bad decision making of late.

To put it in technical terms, B.S. isn’t a lie or a denial or subversion of actual facts. The American philosopher Harry Frankfurt wrote in his charming 2005 bestseller On Bullshit that this presumes a knowledge of and interest in the facts; rather, bullshit doesn’t care all that much about the facts. When bullshit becomes prevalent in society, it erodes public interest in the truth, which for Frankfurt makes it more dangerous than a lie.

Who exactly was meant to #stayhome from November onward? The people piling on to highways and buses to get to and from work—because they were required to by employers (including some government officials)? The essential workers reporting to factories, warehouses and grocery stores? The shoppers who in the weeks before Christmas were not flouting any law by streaming into big-box stores? The children and teachers dispatched to schools every day since September?

In other words, authorities collectively told us for months to stay home, but there was no meaningful way for many people to do so. When hot spots, and later the province, did lock down, the choices seemed arbitrary. Toronto’s pseudo lockdown shuttered small stores that might only ever have a few customers at a time but enabled crowding at large retailers. Ice-cream shops were essential; bookshops and toy stores were not. In Peel region, 3 per cent of outbreaks were traced to restaurants, while industrial settings and schools/ daycares accounted for 22 and 20 per cent respectively; only indoor dining was addressed. And lockdown announcements seemed timed so residents could squeeze in a shopping spree or religious service before lifesaving emergency measures kicked in. Looming scarcity often provokes the impulse to binge, and the data showed many did, with disastrous results.

Restricting movement and gatherings clearly helps contain COVID; a Nature study looking at 226 countries found those were among the most effective measures last spring. But even now, Ontario’s new measures are full of inconsistencies. While there is a stay-at-home order, travel is not prohibited. “‘We are not recommending intra-provincial travel’ is not the same as ‘We are prohibiting intra-provincial travel except for emergencies,’” Dr. Irfan Dhalla, a physician and vice president of Unity Health Toronto, pointed out on social media. Non-essential retailers may stay open for curbside pickup—but people are only allowed to leave the house for essentials. And although the government’s own health experts acknowledged that restrictions won’t work without social supports for workers, no such supports were announced.

All this sounds suspiciously like bullshit. Our politicians, unlike some in other places, did not deny the COVID crisis, and they didn’t willfully lie to us. Well, but for a few suspiciously tanned senior officials turned viral sensations (see “I went to a beach resort and all I got was this lousy scandal”). Rather, the COVID message we heard—by which I mean the stew of contradictory directions we’ve had from authorities for months—contained a preponderance of disingenuous, confusing and ultimately unhelpful information, known in common parlance as BS.

On Bullshit tells a story about an ailing friend of Wittgenstein’s who reportedly annoyed the German philosopher by using an inapt comparison to her condition. “Her fault is not that she fails to get things right, but that she is not even trying…” Frankfurt explains. The essence of bullshit, he adds, is this “indifference to how things really are.”

“Stay home” was advice authorities knew many people couldn’t take. Front line workers were one example. “If the only message is ‘stay home,’ you’re ignoring that massive population that can’t,” Dr. Sumon Chakrabarti, an infectious-diseases specialist at Trillium Health Partners in Mississauga, said in an interview. What could actually help stem transmission, he noted, is policies such as isolation centres for sick essential workers, or paid sick leave, a measure that many health experts have been advocating, given that only 10 per cent of low-wage and essential workers have access to it.

But, for months, these concerns remained well outside the discourse; Chakrabarti calls that “a failure of messaging.” Instead, small indoor dinners or family gatherings—citizen behaviour—remained the focus. “Nobody was talking about essential workers [when] even in the summertime in Quebec and Ontario, we had cases in factories, in food-processing plants.”

Stay Home (as opposed to a stay-at-home government order) was also advice many people weren’t likely to take even if they could, especially indefinitely. Total quarantine would have stopped the spread of COVID—just as not having sex would stop pregnancy and the spread of sexually transmitted diseases. But decades of sex education and mitigation strategies for drug abuse have taught us that abstinence campaigns, when they fail, produce higher-risk behavior. And they often fail. Teenage girls who take purity pledges, a 2016 University of Massachusetts study found, have a more than 50 per cent risk of non-marital pregnancy versus teens who don’t; they’re also at higher risk for HPV.

Early in another plague, the AIDS epidemic, some officials tried employing the same hammy hand. A 1980s poster from the U.S. Centers for Disease Control features a photograph of a person—a young woman, perhaps—dressed in fashionably tattered jeans and seated on a chair, legs tightly crossed. “There’s a simple way to prevent AIDS,” large type proclaimed. But in practice, abstaining isn’t a great means of prevention, because most people don’t stick with it.

More effective AIDS messaging—even within communities more at risk—shifted the emphasis from telling people they shouldn’t to telling them how they could safely.

Sex educators have long followed this course. Harms-reduction approaches to drug abuse, too, rely on a similar strategy. Not taking drugs is the best way to avoid an overdose. But even Canada’s police chiefs now acknowledge that people do use drugs, and do overdose, and what’s needed isn’t a criminal-justice system that punishes them, but social services that mitigate the harm. (The radical change of position was announced last summer.) Naloxone kits, not “just say no” stickers, are part of the toolkit of today.

Ontario’s residents were less lucky when it comes to COVID. “The abstinence stuff in the long haul doesn’t work,” says Chakrabarti. “The idea of giving people safe alternatives is very important.” The official mantra of abstinence wasn’t just ineffectual; It was downright cruel. Signs on highways told us to Stay Home and our premier, looking stricken, implored us to do our part, but much in our environment remained unchanged. Even as cases climbed and medical experts expressed alarm, large retailers, schools, and businesses remained open with few modifications; airlines advertised seat sales; winter market attractions were bejewelled with lights.

For months it has fallen to us to reconcile the contradictory information, and that task can be taxing. “When we are overwhelmed with false, or potentially false, statements,” author Maria Konnikova has written about fake news, “our brains pretty quickly become so overworked that we stop trying to sift through everything.” Konnikova calls it “cognitive load.” Ontarians, thankfully, aren’t facing fake news or lies from authorities, but choosing between two truths that smell a bit fishy—it’s safe for our kids to be in a small, unventilated classroom with 20 other kids all day; it’s unsafe for us to be in a shop for half hour with three other people—can be overwhelming, too. So can thinking through every decision not covered by the panicked call to shelter in place.

Should we have steeled ourselves and followed guidelines to distance and not mingle indoors? Of course we should have. Faults in government messaging didn’t compel us to break the rules. But when we’re fatigued or overwhelmed, we’re more prone to poor choices.

Stay Home was useful guidance in the spring, when we knew less about the virus, Chakrabarti said. By the fall, the idea had diminishing returns. “It’s important to keep the recommendations where they have the highest yield,” he explained. The real goal, to cut transmission and minimize mass hospitalizations that overwhelm the health care system, he believes, could have been accomplished with more strategic messaging, teaching the public to mitigate risk effectively, and putting in place measures like sick pay. Restrictions and lockdowns become necessary, but he is wary of interventions like curfews, or the emerging direction, in some quarters, to wear masks outdoors even when physically distancing. (If the more contagious new COVID variant turns out to require this, that’s another matter.)

The idea of social abstinence after months of laissez faire pandemic policy was especially confounding—and impractical as the holidays approached. It was predictable that the same humans who failed to stay away from their mothers on Mothers’ Day or their families at Thanksgiving would gather with loved ones for the holidays. Why not help us navigate those decisions responsibly? Doctors and journalists did their part to demonstrate the range of what safe celebrations could look like, but there was little official guidance beyond Don’t.

The science actually suggests a more nuanced approach could work. We knew from ten months’ worth of research that COVID transmission involves a stew of factors: viral load (how much virus is in the infected person’s nose), length of exposure, physical proximity, the influence of mitigating measures such as masks and quarantines. Could authorities have told us ways to have small degrees of safe social contact? It would have served as a useful reminder that any less caution was too little. And if there really was no safe way to have contact, it would have helped to have clearer messaging on why not.

There was a moment, in late spring, 2020, when Ontario’s pandemic response accomplished this. As governments everywhere struggled to balance health and safety with mental wellness, Ontario came out with a remarkably humane and savvy approach. With the COVID curve flattening reassuringly, it allowed residents to expand their social bubbles, carefully. We are the same people we were then—only more tired or lonely or bored, yearning more for social connection.

I’m not unsympathetic to the delicate position occupied by health officials. This isn’t the spring of 2020; the numbers are truly grim, and have been for weeks. It’s understandable experts were loath to tell people it’s okay to gather for fear it led to riskier behaviour. The trouble is, in the absence of such guidelines, people didn’t abstain. They made up their own. Like opioid users or the people who take purity vows, they indulged in risky ways, and many continued to do so after the holidays. Would less bullshit in public-health guidance—and more strategic government policy—have helped us avoid the present crisis? Perhaps.

Nearly a hundred years ago, Harry Frankfurt notes, the Times Literary Supplement defined bull as “a combination of bluff, bravado, ‘hot air’ and what we used to call in the Army ‘Kidding the troops.’” That last one rings especially true these days.

The troops, however well kidded, eventually meet reality. That would be where we are now, facing harsher (or at least harsher-sounding) measures, and with the added strain of a super contagious variant of COVID that demands even more vigilance and resolve. We weren’t well served by the bluster—chief medical officer David Williams suggesting in October that cases were plateauing; Ford forgiving a growing roster of rule-breaking MPPs; the pandemic showmanship of “Wait till you see these numbers, folks.” Nor were we helped by the blunt-instrument admonitions, however well intentioned. But we are in it now, frustrated and fatigued. And following the “stay at home” guidance of the same authorities who’ve fallen short in their own efforts is really our only way out.