Ten considerations for effectively managing the COVID-19 transition

Abstract

Governments around the world have implemented measures to manage the transmission of coronavirus disease 2019 (COVID-19). While the majority of these measures are proving effective, they have a high social and economic cost, and response strategies are being adjusted. The World Health Organization (WHO) recommends that communities should have a voice, be informed and engaged, and participate in this transition phase. We propose ten considerations to support this principle: (1) implement a phased approach to a ‘new normal’; (2) balance individual rights with the social good; (3) prioritise people at highest risk of negative consequences; (4) provide special support for healthcare workers and care staff; (5) build, strengthen and maintain trust; (6) enlist existing social norms and foster healthy new norms; (7) increase resilience and self-efficacy; (8) use clear and positive language; (9) anticipate and manage misinformation; and (10) engage with media outlets. The transition phase should also be informed by real-time data according to which governmental responses should be updated.

Main

The rapid escalation and global spread of COVID-19 has prompted governments to implement policies and measures to manage virus transmission, which has given health systems time to prepare for and mitigate the impact of the pandemic. While the majority of these measures are proving effective, they have a high social, psychological1 and economic cost and are, therefore, not sustainable. Some countries and smaller jurisdictions are entering a phase of transition during which a “de-escalation of global actions may occur, and reduction in response activities or movement towards recovery actions by countries may be appropriate, according to their own risk assessments”2 (p. 14). This transition has challenges. Until a vaccine or effective treatment becomes available, public behaviour and adherence to national and sub-national response strategies—notably social and physical distancing measures (SPDM)—will continue to be key measures for controlling the virus. One of the six key criteria that the WHO Regional Office for Europe3 have defined for the transition is that communities should have a voice and be aware of and engaged in the transition process. We aim to support this principle with available evidence and expert advice. Note that due to the available research and experts involved in this work, the steps may be biased towards high-income, well-resourced countries. Applying them to other contexts may need additional adaptation.

Unwanted scenarios

At worst, a poorly timed and badly managed transition threatens the gains that each nation has collectively achieved, potentially with high social and economic costs4. Historical evidence from the 1918 influenza pandemic shows that a second wave of infection can follow the removal of SPDM and lockdowns5,6. Each country’s government can apply lessons learnt from experience and analyse the current situation to anticipate potential unwanted scenarios and plan mitigation measures. These scenarios are likely to vary depending on cultural context. However, in general, the following scenarios and situations would be helpful to consider.

A continuum of reactions

While there is no empirical evidence for a ‘continuum’, one may imagine a potential continuum of public responses to the pandemic. On one end may be a potential decline in feelings of fear and threat. Research reported in a non-peer-reviewed preprint found that a lack of perceived risk (for example, due to declining cases or psychological adjustment to the new situation) can cause decreased adherence to measures7 such as SPDM. Moreover, people’s desire to reduce loneliness as soon as possible after a period of prolonged enforced isolation may be strong: research reported in another non-peer-reviewed preprint suggests that the loosening of response measures might seem like standing in front of a rich buffet after a diet or period of fasting8. Just as we might be tempted to binge eat, our craving to socialise may grow with each day of the pandemic. At the other end of the continuum of reactions, distrust of authorities, conspiracy thinking or reactance (anger due to restrictions) may lead to social movements against SPDM norms and policies and a rise in prosocial closeness and interaction. These reactions may be underpinned by messages that question the appropriateness of government pandemic measures, which can increase distrust among broader segments of the population. This scenario is not dissimilar to events and patterns related to vaccination9,10,11. In addition, specific population groups may lack the capability to continue adhering to restrictions and recommendations. These groups may include youth, people with anxiety and other mental health disorders, people who lack social support structures, financially disadvantaged groups, the homeless, indigenous populations, mobile populations, people with chronic illness, people experiencing abuse or domestic violence, people living in long-term care facilities and the persons who care for them, and healthcare workers. People with lower health literacy may face additional difficulties when navigating these challenges12. Conversely, some people may be overly cautious due to fear and worry13 and may continue to over-implement restrictions14, avoid supportive social interactions and delay seeing health care providers for potentially life-saving measures, such as vaccinations or check-ups.

Uncertainty and lack of clarity

As response strategies are continuously adjusted, it is likely that debates in the political and public spheres related to unresolved dilemmas or the appropriateness of the implemented measures will increase. How measures are implemented can fluctuate between cultures characterized by societal tightness (for example, having strict rules and punishing deviance) versus societal looseness (for example, having more permissive rules and lax punishments)15. Moreover, the transition process is likely to be bidirectional and to require continuous adjustment3, and predictability will be challenging due to uncertainty regarding the evolution of the outbreak. People will need to navigate these adjustments and the lack of predictability, as well as complex and ambiguous messages (for example, see some friends but not too many friends) and possibly competing demands from the social and cultural environment regarding social interaction16,17. Collectively, these situations may result in individuals developing idiosyncratic interpretations of restrictions as a coping strategy18.

Stigma and discrimination

Disease can evoke fear and motivate people to separate themselves from infected individuals by stigmatising them19,20,21. Examples include the stigmatization of gay men as an early response to AIDS22 and of ‘Typhoid Mary’ (Mary Mallon) in the early twentieth century. The latter was apprehended by authorities in Manhattan for spreading typhoid via her work as a cook, which caused many deaths21. In the current situation, certain population groups (for example, health workers or certain ethnic groups) in some countries may be perceived and branded as virus transmitters23,24. COVID-19 may also become associated with unhygienic or careless practices. This thinking could increase the mental distress and anxiety of people who are infected25 (preprint without peer-review) and reduce compliance with regard to testing and engaging in the contact tracing process26. Moreover, individuals who are at higher risk of severe illness (and their families) may be advised to continue strict compliance with restrictions (for example, working from home). These individuals may be exposed to new forms of stigma, blame or discrimination as societal expectations shift, especially in contexts where legal terminology is unclear.

Ten considerations

Avoiding these potential unwanted scenarios calls for careful planning and consideration of the perspectives and engagement of populations3 and should be informed by evidence and expert advice from the social and behavioural sciences and medical humanities. To support a key WHO criterion for the transition (that communities should have a voice, be informed and engaged, and participate), we propose ten considerations for governments (Fig. 1).

Fig. 1: Ten considerations for effectively managing the COVID-19 transition.
figure1

The considerations substantiate the WHO/Euro principle #6, ‘Communities have a voice, are informed and engaged, and participate in the transition’3, and were derived from an online expert consultation. The considerations do not imply a temporal sequence and are interrelated, just as listening to communities, engaging with them and informing them are interlinked. The ten considerations are aimed at providing suggestions to governments. The awareness that there will be no going back to normal but a stepwise adaptation to a ‘new normal’ is in the centre of the transition process (#1). Giving communities a voice (#2–4), engaging them in the transition (#5–7) and informing them in the best possible way (#8–10)3 can help effectively manage the transition.

To gather existing evidence and experiences of previous crises and brainstorm how this information could support the transition phase, authors K.B.H. and C.B. convened a group of experts who reflect a diversity of academic disciplines, domain expertise and familiarity with infectious diseases in general and COVID-19 in particular. This brainstorming was conducted online over 3 days. The first authors synthesised the long list of relevant issues into a shortlist, which was commented on by the full group in a shared document. When a consensus was reached regarding the number of considerations and their respective scope, the first authors drafted the sections and the experts added evidence and relevant references. The entire group reviewed the final version. Thus, the resulting ten considerations, which are presented in Fig. 1 and explained with examples in Table 1, are based on expert advice and available evidence.

Table 1 Examples of how to enrich the ten considerations with real-time data and further evidence and how to apply the evidence obtained to inform the transition phase

Consideration 1 relates to the central idea that communities must be aware that there will be no going back to normal but a stepwise approach to a ‘new normal’. The other nine considerations relate to giving communities a voice (Considerations 2 to 4), engaging them in the transition (Considerations 5 to 7) and keeping them informed (Considerations 8 to 10)3. These considerations are intended to support authorities in tailoring response strategies that will be accepted by the population and priority target groups and that are likely to be effective3,9,27,28.

We suggest that, where possible, each consideration be monitored, informed and qualified using real-time empirical evidence. This could be achieved via population surveys29, media and social media monitoring, ethnographic studies, COVID-19 hotline monitoring and rapid assessment of specific population groups. While the following considerations have been devised for COVID-19, they may also be helpful for addressing future unexpected events.

Consideration 1: implement a phased approach to a new normal

At the centre of transition management is the assumption that an immediate return to normal will not be possible. Instead, the transition process will take place in accordance with a phased approach whereby society, systems and services are gradually re-opened, potentially in new forms. Each phase may involve adjustments to restrictions and potential re-employment of previous stricter measures. During this complex process, if people think that they are or soon will be returning to normal, their actions may hasten the onset of a second wave of the outbreak4. Empirical evidence on how to mitigate this and maximise the effectiveness of a phased approach to a new normal can be gained from studies that investigate how people acquire new habits. These include studies on adjusting social norms in new student populations30,31, evaluating procedures and aids for prisoners returning to society32, developing pedagogical steps for small children who learn to stay in kindergarten33 and normalising behaviours for people with eating disorders34. Different as they are, these studies all employ a step-by-step approach to practising new behaviours in old environments whereby successfully acquiring habits is a function of repetition35,36,37. In each case, the transition process is iterative. It involves detailed planning; setting goals for each stage; and stabilising, recapping and monitoring progress36, and it is underpinned by clear communication. The COVID-19 transition process involves defining and communicating specific phases in advance, while also accounting for the uncertainty of the outbreak evolution; preparing people for planned adjustments to the response strategy; and transparently communicating what is known, what is not known and the criteria applied when making decisions.

Consideration 2: balance individual rights with the social good

The pandemic has prompted governments to introduce temporary restrictions that infringe on individual rights, such as freedom of movement, freedom of assembly and the right to practise religion in groups. Public health approaches are often utilitarian in essence, which means that they maximise the overall benefit for the population38. Willingness to act for the benefit of society is subject to cultural differences and is more prominent in collectivist countries than in individualistic countries, where maximising individual benefit is prioritised39. These differences can also affect the level of acceptance of measures and make it difficult to predict acceptance of a strategy in multiple regions or countries (for example, wearing masks to protect others may be well accepted in some Asian countries, but this does not necessarily predict high willingness to wear masks in European countries). Difficult questions can also arise regarding how to balance utilitarian values conducive to public health with respect for individual rights, equity and personal dignity. For example, in certain limited cases, involuntary quarantine might be a legitimate public health option40,41,42. However, efforts to protect public health should respect fundamental rights, such as freedom of speech, privacy, due process of law, freedom from discrimination and freedom of religion. Restrictions that are not regarded as justified may also jeopardise public support for the pandemic response strategy and trust in authorities43. Challenging cases, such as people exercising freedom of speech to spread falsehoods that harm public health, may arise. Responses to these challenges may vary from country to country. However, in general, the continued adjustment of the response strategy, including decisions on which measures to adjust, lift or re-employ, should be maximally respectful of rights and the foundational interest of human dignity44. Empirical evidence can inform this decision-making by enabling authorities to understand norms and values, ensure the acceptability of implemented and planned measures with respect to both individual and societal gains, and detect shifts in acceptance or barriers to measures29,45.

Consideration 3: prioritise people at highest risk of negative consequences

The greatest negative impact of COVID-19 is felt amongst people who experience disadvantage, especially poor and underserved groups46 (see also ref. 47). Evidence from other infectious disease contexts shows that socioeconomic and equality-related disadvantages increase the risk of negative psychological, mental and physical health, social and economic consequences48,49,50. It is reasonable to assume that groups who suffer these consequences will also encounter difficulties in adhering to recommended behaviours in the long term. Therefore, mitigating the negative consequences for these groups will result in individual as well as collective gain. Surveys and rapid assessments can help identify priority groups who are likely to suffer the most. National response strategies could consider basic needs, such as access to food, safe housing, health care, social care and employment, as well as an understanding and acknowledgement of the barriers faced by these different groups. Structural interventions can help support recommended behaviours49,51,52. For instance, unpublished research reported in a non-peer-reviewed preprint suggests that a strategy for a staged return to work could involve return to work for people who are essential for the maintenance of the economic or health system53 or who face the least risk. Such a strategy could also include a needs assessment for new measures to be implemented to prevent or alleviate negative repercussions for those who cannot return to work, such as individuals and the families of individuals who are in COVID-19 risk groups. Working closely with unions, worker collectives and organisations that serve people at the margins can help ensure that the transition is structural.

Consideration 4: provide special support for healthcare and care staff

Many healthcare workers were already under pressure before the pandemic for a variety of structural, professional and personal reasons54, and the current situation adds to this pressure. In the transition phase, special concern for those who care for high-risk groups, including people who work in health care and public health, essential service workers and people who work in long-term care facilities, may be necessary. Special training, guidelines and support services may be needed. Healthcare workers and care staff will need to continue protecting themselves from virus exposure and are likely to need further emotional and psychological support to deal with the loss of colleagues or family members or post-traumatic stress. Surveys and rapid assessments of healthcare and care staff can provide insights into their needs and how to respond to these needs55. Access to workplace or home-based webinars56 and the development of structured information delivery during handovers and in-service meetings can support this important group. This support could be combined with financial and symbolic rewards and public recognition57,58.

Consideration 5: build, strengthen and maintain trust

By their nature, pandemics create inconsistency and uncertainty of a temporal, spatial and normative nature59. Science changes rapidly, and decisions may be tailored to certain contexts and be based on many considerations. This can produce inconsistencies between the risk of viral transmission and the restrictions that exist. Trust in institutions (i.e., perceptions of them as competent, honest and benevolent9,43) influences risk perceptions60, helps people manage complexity and is crucial for legitimising decisions made by authorities61,62,63. A strong sense of public trust is critical for harnessing public cooperation and achieving the high rates of behaviour adherence necessary for pandemic management. Therefore, actions and communication should aim to maintain or increase trust64.

Transparent communication of what is known, what is not known and what efforts are being taken to learn more can contribute to building a sense of trust65,66,67. Knowing the rationale for decisions makes it easier for people to internalise them into mechanisms of intrinsic motivation68, so scientific advice to governments should be transparent and not subject to political or government influence. Stakeholder coordination also contributes to trust as it generates consistency and reinforcement of messages65. Governments can obtain the support of individuals or groups who enjoy high levels of trust to communicate important messages or to reach more population groups in culturally and linguistically diverse populations (for example, religious leaders, former politicians and public figures from the arts, culture and sports). Moreover, robust democratic infrastructures for community voices and pathways for these voices to be translated into decision-making can help to maintain trust69. Open access to relevant information expressed in culturally sensitive language can also contribute to a transparent system70. Community engagement can demonstrate that the population is being heard and that their views are being considered by decision-makers71,72 and promote trust. Surveys and other opportunities to monitor and detect possible shifts in trust and understand how this may be related to new events or new restrictions can enable decision-makers to respond accordingly.

Consideration 6: enlist existing social norms and foster healthy new norms

Prevailing social norms shape people’s behaviours73,74. The rapid employment of risk-reduction strategies in many countries during the pandemic has been made possible by appealing to longstanding norms and, crucially, by creating new norms to support these strategies (for example, not shaking hands and staying at home). Social norms can also be invoked to support a transition, incremental or otherwise. Historical evidence shows that norms can shift rapidly as a consequence of high-profile actions by authoritative institutions75,76.

Once norms are established, they can be drawn upon for communication and to encourage or enforce social compliance. Emphasising the social norms of a target group (for example, health care workers, young people, the elderly, newcomers, ethnic groups and religious communities77) can increase adherence to interventions and improve the effectiveness of communication measures27,78,79. Meta-analytic evidence also suggests that exposure to depictions of risky behaviour is positively correlated with risk-taking, including exposure to risk-positive cognition and attitudes80. Thus, messages that privilege examples of desired behaviours are likely to lead to higher adherence than those that emphasise punishment for perceived breaches81. When measures are adjusted or when they become more local, messages about what is acceptable and appropriate behaviour may become mixed.

Even people who wish to abide by messages from public health authorities may feel pressure to comply with requests to violate the measures (and their private preferences) from others in their immediate environment17. Guidance on how to resist pressure to participate in large social gatherings and how to oppose pressure to violate social norms or expectations can be helpful (and can increase self-efficacy; see Consideration 7). Role models, influencers, religious leaders and others who are trusted or in the public eye can help to strengthen prevailing social norms and support new norms82. In connection with consolidating positive social norms, emphasising the existence of a broadly shared endeavour and social solidarity—a shared appreciation of interdependence among individuals in a society—and acknowledging that strict rules are useful in the context of high societal threats15,83 can be useful during mass emergencies that require collective action84. As suggested in the conclusions of preliminary unpublished work85, increasing people’s sense of social empathy towards those at highest risk could be helpful in the context of the COVID-19 transition phase for promoting prosocial actions, such as reducing crowds and avoiding the hoarding of essential supplies (for example, medical masks). Regular surveys and culturally sensitive studies can be employed to understand social norms and expectations related to COVID-19, detect shifts in these norms and possible new emerging issues (for example, stigma, misperceptions and conspiracy theories) and feed into planning and communicating the most socially acceptable measures.

Consideration 7: increase resilience and self-efficacy

Resilience has been defined as the ability to recover after a stressful period86. Higher levels of resilience among the public reduce the possible adverse effects of a crisis87. The COVID-19 pandemic confronts individuals with conflicting information and competing social interests and internal motivational dynamics, threatens daily incomes, and compromises the ability of individuals and communities to meet their basic needs, such as food or shelter16. In addition to ensuring the fulfilment of basic needs, strengthening resilience88,89 can be valuable for crisis management. Recommendations for strengthening resilience include accepting the inevitable (i.e., that the pandemic has already had a substantial impact on our societies, which may be alleviated but is not likely to end in the near future); focusing on positive gains (for example, being able to see some friends again even if we cannot attend large parties); drawing attention to progress (for example, identifying strategies that have been working); measuring and attending to people’s day-to-day emotional states and well-being and improvements in public health; taking responsibility (for example, acting where possible); understanding our limitations (making changes that are possible and accepting what is not changeable); reversing negative thoughts (focusing on learning rather than on mistakes); and knowing our strengths (highlighting past successes as individuals and communities and strengthening people’s sense of self-efficacy). In some settings, where basic needs are being met and appropriate resources are available, resilience training can be conducted using apps, online programs or large-scale media campaigns90,91.

One response to fear caused by previously unimaginable adversity is to attempt to control the fear by denying disturbing information and taking actions that are not consistent with individual or collective interests92,93. Such responses can cause non-compliance with public health recommendations; however, they can be mitigated by emphasising self-efficacy (the belief that an action can be completed94) and response efficacy (the belief that an action can reduce a threat93,95). Explaining what should be done (for example, regular handwashing with water and soap) and the reasons for doing it (for example, soap breaks down fatty membranes to destroy viruses and bacteria) can promote response efficacy96. Making change as easy as possible so that people understand the actions they should take to protect themselves and providing feedback on these actions can increase self-efficacy97. It can also increase health literacy, which is the ability to acquire, understand and use health information. Given the high levels of complex, contradictory and false information associated with this pandemic, health literacy is a critical issue, particularly for population groups who experience disadvantage12. Studies show that feeling able to protect oneself against COVID-19 and knowing about effective measures are predictors of protective behaviours95. Strengthening self-efficacy and response efficacy in a manner that reaches people with low health literacy can empower people to control and take ownership of their actions and generate adherence to protective measures. Should it be necessary to reinstate such measures during future waves of infection, people with high self-efficacy and response efficacy may be more willing to resume such measures, as they know the measures will protect them and they believe that they can adhere to the measures.

Consideration 8: use clear and positive language

Behavioural science emphasises the importance of ensuring clarity in language and reducing cognitive load98. If people find new guidance confusing or difficult to understand, they might ignore it. Complex guidance can create serious navigation problems. An emergency such as the COVID-19 pandemic is characterised by uncertainty, and clear guidance is needed. However, such guidance is often based on uncertain evidence. Research has shown that acknowledging uncertainty does not undermine trust67. Furthermore, while a language of crisis, panic and war can increase risk awareness—which may be needed—it can also cause anxiety, incite selfish or competitive reactions and undermine people’s sense of collective support and care99. Hoarding behaviour, which has been seen in many countries, may be a consequence of this rhetoric100. Crisis language may also cause over-cautiousness among some people, who, consequently, may not seek primary care or provide social support to people who need it. By contrast, the use of gain-frame language to highlight the collective gains already achieved and the benefits that could still be achieved may create more ownership and foster compliance with behavioural rules101. Building communication strategies that balance risk perception with risk assessment is also key for aligning people’s perception of risk with scientific estimations of the risks100. Some research suggests that people are less willing to make sacrifices for others when the benefits are uncertain102, so the benefits of compliant behaviour should be made concrete and visible. Ownership of something makes it more valuable to an individual (the endowment effect103). Moreover, hedonic framing, which combines smaller losses (for example, the inconvenience of wearing masks) with larger collective or individual gains (for example, being able to see friends again), could increase public acceptance of ongoing restrictions104. Therefore, the aim should be to highlight the gains that can be made from engaging in target behaviours and activate the internal moral compass that renders personal rewards less important than benefits to others99,105.

Consideration 9: anticipate and manage misinformation

COVID-19 is the first global public health emergency to occur in the era of widespread use of social media, the Internet and smartphones. The WHO has acknowledged the existence of an ‘infodemic’ in addition to the pandemic. The term ‘infodemic’ refers to the availability of an overwhelming amount of information, which can create confusion regarding which, if any, sources are trustworthy106. Pre-emptively exposing people to techniques that are often employed for misinformation and warning people against misleading techniques can reduce their susceptibility to future falsehoods107. This ‘prebunking’108,109,110 (or cognitive inoculation111,112) could activate resistance mechanisms in the public and empower people to assess the reliability of information107. However, some misinformation cannot be foreseen. Therefore, debunking approaches113, which counter widespread myths and uncover why they are wrong114,115,116, are also needed when misinformation is disseminated. Cognitive inoculation may also be useful for priming the public for the transition phase. This involves foreseeing the likelihood of widespread misinformation, explaining how people can manage this situation, addressing and talking openly about the possible aversive effects of physical isolation, reassuring people that these aversive effects are reversible and exploring how they can be addressed and mitigated. Pre-empting future waves of the virus based on currently available evidence and clearly communicating the potential continuous adjustment of restrictive measures may lay the foundation for greater acceptance. Prebunking and debunking approaches (i.e., inoculating people against misinformation before it spreads and correcting misinformation after it appears) will also be needed if and when a COVID-19 vaccine becomes available, as misinformation about this topic is likely to be disseminated.

Consideration 10: engage with media outlets

Non-peer-reviewed research has suggested that there are high levels of information-seeking during the COVID-19 pandemic117. During previous outbreaks of other diseases, combined trust in both the government and the media has been associated with increased preventive behaviours, such as hand-washing118. One study revealed that social media information increased risk perception during an outbreak, while legacy media, such as national television and broadsheet papers, increased proactive preventive behaviour119. For governments, media outlets are important influencers and critical channels for reaching the public. A non-peer-reviewed preprint has suggested that established news and online media outlets may alleviate discomfort during a crisis120. Credible media outlets can also showcase appropriate behaviours121 and provide helpful perspectives from trusted figures (for example, established social media influencers and medical professionals122,123,124). However, media consumption can also cause stress and anxiety and spread misinformation99. Since the media can play a critical role in communicating and balancing information and influencing public sentiment and discussion during a public health crisis125,126, the WHO has developed guidance on how authorities can work with the media127,128. A combined approach that targets legacy platforms, audience-specific and local outlets and social media may be the most efficient129. Particular groups may use, trust or feel represented by certain media119—which can be critical in a potentially increasingly polarised debate130—and behavioural studies stress the impact of communicating behavioural norms at a local level121. Thus, governments can continue to proactively reach out to a variety of media during the transition while respecting their independence and highlighting their role and potential influence131. Even if measures have not been implemented, journalists and media can frame shared understandings and prime their audiences for the future using strategies such as introducing important terminology132 (for example, ‘new normal’, ‘gradual changes’, ‘adjustments’, ‘need for cooperation’). The following key messages may be employed: this is an unprecedented situation; there may be changes to the strategy as we learn more; this is a solvable situation; and greater restrictions may become necessary again in the event of a second or third wave. Journalists and the media can support the framing of the transition phase as an all-of-society approach and responsibly perform their important role by avoiding actions such as feeding confusion and blame and reporting inconsistent messages, controversies, rumours, misinformation and speculation133,134.

Inform and qualify action with evidence from behavioural and cultural research

To effectively manage the transition phase, the considerations outlined above need to be adapted to individual contexts135. Thus, the process should be informed by a situation analysis and by current evidence from behavioural, social and cultural sciences applicable to the specific context (examples are provided in Table 1), and it should be supported by engagement with communities. Continued cultural adjustment of the response strategy fosters spaces for listening to the voices of diverse communities during the development of behavioural strategies and the creation of support processes for sustaining behaviours70,77,136,137. These data can help us understand how people are experiencing, interpreting, responding to and accepting the COVID-19 response and can inform the development of interventions and support the tailoring of measures to subgroups of the population.

Limitations

Although we sought experts from different global regions and drew on research from around the globe, we are aware that all but one of the experts live in high-income countries. Inevitably, their fields of study and lived experiences have shaped the final report. Furthermore, some aspects may be missing from one scientific perspective and overemphasised from another perspective. However, these limitations were weighed against the need to provide decision-makers with evidence in a very short time. We also acknowledge that the considerations described in this paper are based on evidence from various sources of literature, some of which relates to outbreaks, crises and pandemic situations and some that is unrelated to these situations. The validity and reliability of the evidence from many fields may be challenged as some studies have not been replicated138,139. A substantial portion of the evidence also originates in correlational studies, rather than randomized controlled trials (and systematic reviews and meta-analyses of high quality evidence). Moreover, most published research in the field of ‘behavioural science’ originates in Western, educated, industrialised, rich and democratic (WEIRD) countries140, which makes generalising the results to other contexts difficult141. These limitations have caused some scholars to argue that this type of science should not inform crisis response139. In this paper, however, we propose complementing existing evidence (summarised here) with real-time data collected in specific situations and countries29. This combination helps to interpret the newly generated evidence based on existing evidence and to generate and select relevant questions and variables to perform ad hoc crisis research. In no case should scientific evidence provide decision-makers with a false sense of certainty, as all evidence is surrounded by the uncertainty inherent in every scientific process. However, the evidence will help guide thinking and decision-making in a systematic way.

Conclusion

In sum, evidence from multiple sources allows us to better understand population perspectives, gauge emotional responses and subjective experiences, anticipate unwanted scenarios, introduce mitigation measures, and plan for the most effective actions to improve public understanding and compliance. Understanding how the pandemic and the restrictions imposed are affecting people’s everyday lives, their social and mental health, and their motivation and intentions to follow recommended practices is critical for the sustained success of the pandemic response during the transition3,28 and will be a valuable source for ensuring our preparedness for future pandemics.

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Acknowledgements

The authors are grateful to M.J. Crockett of Yale University and L. Lerner of the University of Erfurt for their valuable input. The authors are responsible for the views expressed in this article, which do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

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Correspondence to Katrine Bach Habersaat.

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Habersaat, K.B., Betsch, C., Danchin, M. et al. Ten considerations for effectively managing the COVID-19 transition. Nat Hum Behav (2020). https://doi.org/10.1038/s41562-020-0906-x

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