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Doctor Suggests Discussing Harm Reduction Instead Of Shaming People During Pandemic

People stand in line and wait to be tested outside of the Tufts coronavirus testing center on Tremont Street. (Jesse Costa/WBUR)
People stand in line and wait to be tested outside of the Tufts coronavirus testing center on Tremont Street. (Jesse Costa/WBUR)

The Centers for Disease Control and Prevention is advising Americans to postpone travel plans as nationwide COVID-19 surges overwhelm hospitals ahead of Christmas.

But as demonstrated on Thanksgiving when millions of people traveled by air, not everyone will follow that guidance.

Some researchers argue that pandemic fatigue is deepening, and the all-or-nothing abstinence approach to public health messaging is not working.

Dr. Eric Kutscher, an internal medicine physician at NYU Langone Health, says there’s no doubt the pandemic is out of control. But patchwork rules and messaging from state to state, city to city are “messy,” he says, and put too much reliance on the public to be “perfect” in social distancing or quarantining.

“I think there are real reasons why an abstinence approach to COVID-19 doesn’t work for many people,” he says, naming mental health as a major factor.

Instead of shaming people who aren’t able to quarantine to perfection, he says to instead try to communicate the risks, a concept known as harm reduction.

Harm reduction means providing guidance to decrease the overall amount of negative consequences that can result from human behavior, he explains. The term originated around HIV and needle exchanges, where people could swap used needles for clean, new ones. Since then, it has been applied to a plethora of public health messages, including safe sex and healthy eating, he says.

To be clear: Kutscher isn’t advocating for people to flout health experts’ COVID-19 guidance. What he is saying is that if you need to do something, be as safe as possible by employing harm reduction.

There are ethical questions involved in carving out exceptions as one sees fit, he says. If you have been abstaining from potentially risky behaviors, don’t stop now, he says. And if not, then “now’s a good time to try and think about how to make those behaviors safer,” he advises.

Think twice before jumping to judge or criticize a family member, friend, coworker or stranger’s behavior, he says. Shame and stigma don’t help the cause, he says, but an “open, fair conversation” may provide some benefit.

As a doctor, he finds shaming prevalent in the health care industry, where front line workers have been severely impacted by burnout from the coronavirus crisis.

“I think that it’s a gut, visceral response when we see the burden of this disease and have to deal with it,” he says. Instead, Kutscher says to think about how to engage folks — placing care first and foremost.

As Christmas approaches, Kutscher says connecting remotely is ideal. If you must gather, evaluate the risk before getting together with people outside of your bubble. Explicitly talk about the risks of meeting up, identify any underlying health conditions and discuss how isolated everyone has been, he says.

He advises to eat outside, and if it’s cold, then mask and bundle up and bring hand warmers. And he says to remember that a negative COVID-19 test isn’t “a license to gather maskless with your family.”

“If you are able to abstain from seeing your family this Christmas, I think right now, if there was ever a Christmas to do it, this is a Christmas to do it,” he says. “But if that doesn’t seem reasonable to you, then those are the steps that you can follow to make sure your gathering is as safe as possible.”


Ashley Locke produced and edited this interview for broadcast with Jill RyanSerena McMahon adapted it for the web.

This article was originally published on WBUR.org.

Copyright 2020 NPR. To see more, visit https://www.npr.org.