California doctor: Health officials should better trust the public and acknowledge what they’re feeling

Written by Amy Ta, produced by Nihar Patel

Rebellion is mounting against the latest coronavirus restrictions — and not only from restaurant owners. Some local lawmakers are against them, and some county sheriffs and police departments say they won’t enforce them. 

Meanwhile, COVID is spreading faster than ever. Hospital intensive care units in Southern California are in danger of being overwhelmed. So how can public health officials fight both lockdown fatigue and the pandemic?

Some experts argue that the “just say no” approach is flawed, that the public should be trusted more to do the right thing. Dr. Monica Gandhi is one of them. She’s a professor of medicine in the division of infectious diseases at UCSF. 

KCRW: The new lockdown orders allow some retail shopping and restaurant takeout (no dining indoor or outdoors). But people are prohibited from gathering with anyone outside their immediate household. What do you make of the rules? 

Dr. Monica Gandhi: “I think the rules could be modified and should be. Because I think it will engender greater public health trust and compliance with the guidelines if we take a more chiseled approach and kind of a sharper approach than applying a blunt instrument across the board.

I think the public knows quite a bit by now, you know, the media has done a great job at talking about the science of the virus. Nine months into this, we know a lot about the outdoors. We know a lot about outdoor playgrounds or places that are safer. And so to apply the same restrictions, essentially as in March, is too brunt of an approach.”

How would you soften or chisel this approach? 

“I was thinking about three things that I would have done differently. And I actually think that it's possible these three things are going to change based on what Governor Newsom said in his press conference yesterday, that things are going to change in these guidelines. 

One is outdoor playgrounds. There hasn't been an example of spread from surface transmission. That really has gone away. We didn't know what was going on in March. We had to close everything down, it was really scary. Could it be surfaces? Really, it isn't surfaces. It’s spread from the nose and mouth. And that's why universal masking is so important. 

But outdoor playgrounds are kind of a symbol of equity. It's a place where those who gather … don't have big backyards and aren't more wealthy. And so I really think that outdoor playgrounds [are] important for mental health and physical health. 

Second is I think that outdoor dining is complicated. Because though I think all the ventilation and masking and distancing and hand hygiene and cleaning probably did not drive rates of infection, it could be that it indicates another sort of behavior that people are gathering inside before they go outside. That's unclear and … may be related to contact tracing data that I'm not aware of. 

… If you're going to close a business like outdoor dining … you have to say … we're going to give you support for all your restaurant staff workers and for you. The federal government hasn't yet come through with their second stimulus package. That's very disappointing. 

… The third is outdoor gathering in small groups. With people walking together, two families gathering outside with masks and distancing, people know enough by now that that's safe. And because we're going into Christmas holidays, I would also chisel that recommendation. … Because what if you live alone? You're just going to be spending Christmas completely alone. And I think that's not sympathetic to the public.”

You're saying that the public should be trusted to act in a prudent manner, wear masks, keep distance, only socialize in small groups. But we saw what happened over the summer. We saw what happened recently with Thanksgiving, where people armed with this knowledge still went ahead and engaged in some risky socializing. And the virus is now where it is. So is it really possible that we can trust the public to implement these measures safely?

“I and others are getting this information from … the field of harm reduction messaging and the field of HIV. Because I've been an HIV doctor for years and years. And in the sense where there's a pathogen circulating like COVID or HIV … you have to acknowledge what people are feeling and doing … and think about the fact that the pathogen is not the only thing in their lives. They may be feeling profoundly lonely. They may be feeling very isolated. And instead, message in a way that you are meeting the people where they are, and not just only about the pathogen. And you will get more public health trust, I believe. And you will get more adherence to guidelines. 

… Perhaps it is the way that we are messaging that does not acknowledge loneliness, isolation, pandemic fatigue nine months in — that is leading to the ‘noncompliant behavior.’ 

… Those three things that I just said are not very different from what the guidelines are in place, right? They're very simple, three things. But it gives a sense of trust that people are going to see each other anyway. And if you restrict outside, then that can drive inside. And the concern is that by hiding and going inside, the spread could be more. 

So it takes a little more time. You have to work harder to put very specific guidelines into place. But I think it would allow for more trust of the public health message.”

Is it possible to regain that trust? Or is that horse out of the barn?

“Well I was interested in Governor Newsom saying it'll take a couple of days but I'm going to change the messaging. … Many lawmakers and parents … asking for outdoor playgrounds to be open, I'm wondering if that will be one of them. I'm wondering if outdoor dining, either support or giving stricter parameters around it, I'm hopeful that there's going to be some changes in the next couple of days. 

And I think they'll go a long way to make people think, okay, I just have to get through a little more time with this. And I actually trust that people recognize how hard it is.”



  • Monica Gandhi - infectious disease doctor and professor of medicine at UCSF