Thread by @ASPphysician

This reflects entirely how a rational population would act: disease acquisition inversely proportional to risk.

Challenge: can we convince those at low personal risk to reduce risk-taking behaviour? Options below:

My bread-and-butter framework comes from @SusanMichie and colleagues: The behaviour change wheel: a new method for characterising and designing behaviour change interventions. doi: 10.1186/1748-5908-6-42
ncbi.nlm.nih.gov/pubmed/21513547

1. Education: this has a weak track record. But maybe universities/colleges—regardless of virtual or not—can make knowledge a criterion of ongoing assessment/performance.

2. Persuasion: tough sell so far. But if it were tied to their ability to maintain a reasonably free lifestyle, it might work. But just saying “do it!” hasn’t and won’t work. This has the greatest potential for success on campus (if campuses intend to stay open).

3. Incentivisation: unsure how this could/would work above/beyond persuasion. But perhaps sponsor “safe parties” in lieu of these unsafe ones. There are creative ways to do this responsibly using a harm-reduction framework.

4. Coercion: I’m rarely a fan of this method. Unless you are a parent of young children, in which case coercion is a legacy tactic for behaviour change.

5. Training: This COULD go the wrong way with young adults. But what if there were training videos of how to look cool being responsible? Training how to respond to situations that aren’t safe, how to have conversations with roommates, friends,family, etc.

6. Enablement: similar for incentives, but this is 🔑—pose the challenge to young adults to come up with solutions. Young Adults are smart (as evidenced by their rational approach to personal risk), so we should harness their brains and creativity.

We really need them to help us address the concept of “bubbles”—because they don’t function like nuclear families: they HAVE nuclear families, but have their YOUNG ADULT “families”, too. It ain’t easy for them to navigate this without home testing.

7. Modeling: when I asked my young adult kids to help me survey their peers, it was immediately clear that non-masking at parties is normalized. We need party “hosts” to start off wearing masks and for DMs/texts to say “bring a mask”

8. Environmental restructuring: Young adults need safe places to convene. Allow drinking and marijuana use outside (preferably in places separate from young children!), and create more outdoor spaces that are comfortable. Invest in pop-up nighttime park use for young adults.

9. Restrictions: wouldn’t go there. In fact, almost never go with restrictions. Not in my antimicrobial stewardship work, not as a parent, not as a basketball coach.

Addressing COVID-19 in young adults should be our highest priority based on our and international experience. Nobody seems to have got this right, yet.

One last nota bene: sex is important for young adults and promoting safe sex is always the right thing. But this pandemic is being driven by gatherings not 1-on-1 interactions. Targeting non-group sex as a risk for spread is low impact with a low likelihood of success.