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Abstract Background Individual behavioural decisions are responses to a person’s perceived social norms that could be shaped by both their physical and social environment. In the context of the COVID-19 pandemic, these environments correspond to epidemiological risk from contacts and the social construction of risk by communication within networks of friends. Understanding the circumstances under which the influence of these different social networks can promote the acceptance of non-pharmaceutical interventions and consequently the adoption of protective behaviours is critical for guiding useful, practical public health messaging. Methods We explore how information from both physical contact and social communication layers of a multiplex network can contribute to flattening the epidemic curve in a community. Connections in the physical contact layer represent opportunities for transmission, while connections in the communication layer represent social interactions through which individuals may gain information, e.g. messaging friends. Results We show that maintaining focus on awareness of risk among each individual’s physical contacts promotes the greatest reduction in disease spread, but only when an individual is aware of the symptoms of a non-trivial proportion of their physical contacts (~ ≥ 20%). Information from the social communication layer without was less useful when these connections matched less well with physical contacts and contributed little in combination with accurate information from physical contacts. Conclusions We conclude that maintaining social focus on local outbreak status will allow individuals to structure their perceived social norms appropriately and respond more rapidly when risk increases. Finding ways to relay accurate local information from trusted community leaders could improve mitigation even where more intrusive/costly strategies, such as contact-tracing, are not possible. 

The global pandemic of COVID-19 revealed the dynamic heterogeneity in how individuals respond to infection risks, government orders, and community-specific social norms. Here we demonstrate how both individual observation and social learning are likely to shape behavioral, and therefore epidemiological, dynamics over time. Efforts to delay and reduce infections can compromise their own success, especially when disease risk and social learning interact within sub-populations, as when people observe others who are (a) infected and/or (b) socially distancing to protect themselves from infection. Simulating socially-learning agents who observe effects of a contagious virus, our modelling results are consistent with with 2020 data on mask-wearing in the U.S. and also concur with general observations of cohort induced differences in reactions to public health recommendations. We show how shifting reliance on types of learning affect the course of an outbreak, and could therefore factor into policy-based interventions incorporating age-based cohort differences in response behavior. 

Capturing the coupled dynamics between individual behavioural decisions that affect disease transmission and the epidemiology of outbreaks is critical to pandemic mitigation strategy. We develop a multiplex network approach to model how adherence to health-protective behaviours that impact COVID-19 spread are shaped by perceived risks and resulting community norms. We focus on three synergistic dynamics governing individual behavioural choices: (i) social construction of concern, (ii) awareness of disease incidence, and (iii) reassurance by lack of disease. We show why policies enacted early or broadly can cause communities to become reassured and therefore unwilling to maintain or adopt actions. Public health policies for which success relies on collective action should therefore exploit the behaviourally receptive phase ; the period between the generation of sufficient concern to foster adoption of novel actions and the relaxation of adherence driven by reassurance fostered by avoidance of negative outcomes over time. 

Abstract National responses to a pandemic require populations to comply through personal behaviors that occur in a cultural context. Here we show that aggregated cultural values of nations, derived from World Values Survey data, have been at least as important as top-down government actions in predicting the impact of COVID-19. At the population level, the cultural factor of cosmopolitanism, together with obesity, predict higher numbers of deaths in the first two months of COVID-19 on the scale of nations. At the state level, the complementary variables of government efficiency and public trust in institutions predict lower death numbers. The difference in effect between individual beliefs and behaviors, versus state-level actions, suggests that open cosmopolitan societies may face greater challenges in limiting a future pandemic or other event requiring a coordinated national response among the population. More generally, mass cultural values should be considered in crisis preparations.