Keep calm and wash your hands: Britain’s strategy to beat virus

Boris Johnson, U.K. prime minister, pauses during a news conference inside No. 10 Downing Street in London, on March 9, 2020. (Bloomberg photo by Jason Alden)

While China quarantined 56 million people and the whole of Italy is on lock down to counter the spread of coronavirus, the U.K. is taking a radically different approach. Instead of keeping people inside their homes, Boris Johnson’s government is trying to get inside their heads.

A little-known team of advisers specializing in behavioral psychology is helping to steer the prime minister’s response to the health crisis, shunning headline measures like travel restrictions and quarantines to focus on a more banal task: finding ways to persuade people to wash their hands.

Johnson’s team say their approach, while more relaxed than other efforts around the world, is based on sophisticated modeling that could ultimately cut the virus mortality rate among high-risk groups in the U.K. by as much as a third. The risk for Johnson is he’ll shoulder the blame if the measures prove inadequate in the weeks and months ahead.

“We’re trying, in a way that hasn’t been done before, to use all the tools to hand: medical and mathematical but also behavioral,” said David Halpern, head of the government’s Behavioral Insights Team and a member of the committee managing the outbreak response.

At the heart of the U.K. strategy is a realization that, if coronavirus continues to spread, it will become impossible to stop most people catching it. Scientists on the team say their mission is to slow that process, reducing the number of people infected at any time and pushing the moment of peak infections into the summer months to ensure the National Health Service isn’t overloaded.

To achieve this, the U.K. Scientific Advisory Group for Emergencies (SAGE) have so far resisted calls for more draconian measures, such as banning people from attending soccer matches, or closing schools. When few people in Britain have the virus, such moves would achieve little, they argue.

Instead, they are using mathematical models to understand how the disease might spread — a challenge that relies heavily on predicting behavior.

That’s where Halpern’s experts come in. The group was set up a decade ago by former Prime Minister David Cameron to implement the insights of American economist Richard Thaler. At the time it was dubbed the “Nudge Unit” — after Thaler’s 2008 book on how small influences can help people to make better decisions.

Early work by the unit, which has carried out consultancy work in more than 30 countries, included text messages reminding people to pay their taxes on time.

But coronavirus is on another scale.

“The models rest heavily on what people will do,” Halpern said in an interview. “Will people comply with instructions, and to what extent? If kids don’t go to school, what will happen?”

An unintended outcome of closing schools, he said, could be children spending more time with grandparents — potentially putting a group the government especially wants to protect from infection at more risk.

In the same way, banning people from attending sports events, where scientists regard an infectious person as unlikely to pass the disease to very many around them, could be counter-productive if people instead watch matches in pubs, where the disease is more likely to spread.

Another risk is imposing restrictions too early in the outbreak, leading to people becoming fatigued and ignoring instructions when it matters.

One of the behavioral team’s insights is that people are more likely to obey rules if they have a coronavirus test and get results quickly. So scientists have pushed for much wider testing.

The main challenge, though, is more mundane.

“A lot of people don’t wash their hands very often,” Halpern said. “And certainly not for a very long time.”

His team is trying to create a “behavioral scaffolding to form a new habit,” he said — making hand-washing part of a routine, such as when people get home or to work and take their coats off.

While Halpern’s methods are new, he said they derive from a long scientific tradition. He cited a doctor working on a cholera outbreak in Victorian London who realized many victims were drawing water from a single pump. Taking the handle off the pump helped to end the outbreak.

One high-profile person who appears to be listening is Johnson, who told reporters Monday he’s dropped his policy of shaking hands.

“The behavioral psychologists say that if you don’t shake somebody’s hand then that sends an important message to them about the importance of washing your hands,” he explained.

Johnson also said measures adopted by other countries are not necessarily relevant to the U.K., which had 373 coronavirus cases as of Tuesday, according to the Department of Health. And there’s a debate over whether quarantine measures such as China’s will be effective, or whether the virus will simply re-emerge when restrictions are lifted.

But a “Keep Calm And Wash Your Hands” approach is still a gamble for Johnson. If locking down millions of people proves successful elsewhere, and the virus spreads uncontrollably across Britain, the policy will look like a terrible mistake.