At the height of the pandemic, there was hope that lessons learned from this period would provide the foundations for a healthier society. No longer would snotty commuters swap germs on packed trains; if people were ill, they would stay home – or at least wear masks to protect others.
Now few people are masking, and I have lost track of the number of friends with “colds” who have happily coughed on me in recent weeks. Rather than “building back better”, the country seems to have reverted to business as usual, circa 2019.
It did not have to be this way, psychologists stress. And we may have missed the perfect opportunity to boost the nation’s health and productivity.
“Being sick with flu or endless colds is not good for individuals, for families, or for a productive workforce,” said Prof Susan Michie, the director of the Centre for Behaviour Change at University College London.
“Having adopted these new behaviours, we could have been encouraged to say: ‘Actually, this is worth thinking about to protect you and others from numerous other illnesses’. There hasn’t been a sense of learning from the past – or from elsewhere.”
Asia could have provided a good starting point. Although surgical masks were in use before the 2002-04 Sars epidemic, the outbreak embedded the habit of wearing one to protect others from infection. Three months after the epidemic was declared over in Hong Kong, 60%-70% of people said they would wear a mask in public spaces or the workplace if they had cold- or flu-like symptoms, while 94% reported still frequently washing their hands.
Michie said: “Some of it is about social norms, but interpersonal trust is also much higher in many south-east Asian countries than it is here – and we know that trust is really important in terms of adherence to protective measures.”
Western countries such as the UK also tend to be more individualistic: “There’s more of a ‘Do I fancy it, or not’ [attitude] in the UK, rather than a sense of societal obligation and responsibility.”
Even so, psychologists dispute the notion that widespread behavioural change could not happen here. Before the introduction of an indoor smoking ban, many derided the idea that people would move their habit outdoors to protect others’ health.
Michie also remembers the furore when legislation was brought in to make the wearing of seatbelts compulsory: “People said, ‘No one will do this’ and ‘It’s a terrible infringement of individual freedoms’. But the combination of legislation, backed up by clear and coherent messaging, meant that everybody took it on board.”
A key problem is that many of the healthy behaviours enacted at the peak of the pandemic – regular hand-washing, social distancing, mask-wearing, working from home, and self-isolating when sick – were inseparable from the Covid rules, which chopped and changed according to the level of infection.
Stephen Reicher, a professor of social psychology at the University of St Andrews, said: “It was never argued that measures like ventilation aren’t just about Covid. They aren’t even just about infectious disease. There is a whole literature showing that poorly ventilated spaces impact cognitive performance, leading to declines in task performance and complex decision-making. So, for schools and universities, which are about learning, and offices, where people are taking important decisions, good ventilation is a good idea.
“The problem is, we never posed things in those terms. It was just about Covid. So, if you forget about Covid then you forget about those measures, as opposed to thinking about: how do we produce a healthier society?”
Being ill is not just a miserable inconvenience, it can also be expensive. According to a recent report by the National Engineering Policy Centre, even outside a pandemic, the lives lost and sick days caused by seasonal influenza cost roughly £8bn a year.
As the UK faces a potential “twindemic” of Covid and influenza in the coming months – not to mention an abundance of everyday colds and stomach bugs – this failure to build back better may yet come back to bite us.
Already, health leaders are urging a return to mask-wearing with the number of people testing positive for Covid in England rising. According to data from the Office for National Statistics, the number of people testing positive for Covid rose by 29% between the weeks ending 17 September and 24 September. All UK hospitals are under significant pressure and a new Covid surge is “a very heavy straw on the camel’s back”, the leaders said.
Politicians were warned about the risks of reverting to business as usual once Covid restrictions were lifted. In its final report, the government’s Scientific Pandemic Insights Group on Behaviour (SPI-B) – of which Michie and Reicher were members – outlined strategies for embedding “Covid-safe” behaviours into people’s everyday routines.
Having commissioned the report, the government did “absolutely nothing with it”, Michie said.
Central to SPI-B’s recommendations was the need for “a coordinated programme to shape the financial, physical and social infrastructure in the United Kingdom”, the report said. “Education, regulation, communications, social marketing and provision of resources will be required to ensure that all sections of society have the capability, opportunity and motivation to enact the behaviours long term.”
Staying home when unwell, or wearing a good-quality mask is not always practical without adequate support, Reicher explained: “When Boris Johnson announced the lifting of all measures, he was asked: ‘Shouldn’t people stay at home if they’re infected?’ He said: ‘I wish we were more like Germany, where when people are sick they stay at home.’ What he failed to mention was that in Germany sick pay is 100% of people’s income, whereas the UK has one of the lowest rates in the OECD [Organisation for Economic Cooperation and Development].
“Now we have a cost of living crisis, the odds of people being able to lose out on income and stay at home if they’re ill is even more fanciful. The same goes for buying Covid tests if you’ve got symptoms.”
In the absence of state support, the onus is on those who can afford to protect others, to do their bit. This includes employers and educational organisations. “Nobody questions the fact that we have clean drinking water at work, but we’re still getting unsafe air,” said Michie. “It doesn’t make sense.”
Spreading the message that seasonal coughs, colds and other everyday infections are not inevitable, and there are ways to reduce the risks, is a good first step.
Seasonal sickness etiquette
Do: Keep your distance from other people if you are unwell, and ideally stay at home.
Do: Wear a good quality FFP3 mask if you have cold-like symptoms and cannot stay at home – or if you are in close contact with someone who has symptoms.
Do: Regularly wash your hands with soap and water, or use hand gel if this is impractical.
Do: Ventilate shared spaces by opening windows and doors.
Do: Sterilise frequently touched surfaces, such as handrails and doorknobs.
Do: Close the toilet seat before you flush, as small amounts of what you are flushing become aerosolised, meaning you can breathe them in. And many people with Covid shed the virus in their poo.
Don’t: Shrug off symptoms such as a sore throat, runny nose or fever as “just a cold”. If you can afford a Covid test, do one.
Don’t: Assume that if you tested negative for Covid yesterday, you do not have it today.
Don’t: Leave used tissues or Covid swabs lying around.
Don’t: Assume that other people will be fine if you give them Covid. Even with vaccines, some people remain vulnerable to serious disease or long Covid.
