When Marquita Burnett heard Philadelphia was moving to the "green" phase of reopening, she was confused. She was pretty sure the city had already earned a green designation from Pennsylvania's governor (it had). The next thing she knew, the city was scaling back some of the businesses it had planned to reopen (namely, indoor dining and gyms). But it was still calling this phase "restricted green."
"I feel like it's been back and forth — the mayor says one thing, the governor says another. So who do you really listen to?" asked Burnett, a 32-year-old teacher's assistant.
Looking for something to do with her 6-year-old son at the end of June, she saw the mayor announce that libraries could open in the new, modified green phase. But people who worked at the library were posting on Twitter that they were not open.
"The lines are very blurred," said Burnett. "Are we completely in the green, or not?"
When the coronavirus shutdown was ordered in March, the message was straightforward and simple: Stay at home; don't leave the house except to perform essential work or shop at essential businesses. However hard those restrictions were to stomach, they were clear.
Skip ahead four months. As businesses started to reopen, mixed messages on every level of government have made what's permissible and safe feel like a matter of interpretation.
Absent any overarching or consistent national messaging, elected officials are left to come up with localized rules, which at times contradict one another, presenting a false choice between personal freedoms and protecting one’s health. That forces individuals to make decisions about their actions that carry heavy moral weight.
Pennsylvania's phased reopening, coded according to the colors of a traffic light, factors in two indicators: the amount of virus circulating in the community, and the degree to which the economy is open.
"In the beginning, we had a plan where there was pretty tight linkage between level of viral transmission and reopening activities," said Dr. Susan Coffin, a pediatric infectious disease specialist working on Children's Hospital of Philadelphia's response to the pandemic. Over time, she said, though the color-coding system remained a good indicator for which businesses were opening up, it stopped reflecting the viral risk as closely as the number of new cases ebbed and flowed. And that, she said, has resulted in confusion.
Philadelphia in late July is officially in "modified, restricted green," and gyms have been allowed to reopen. Indoor dining remains off-limits.
"Now, we are seeing what might sound like a contradictory message: Yes, we are reopening, but, no, we don't want you to stop behaving as though there is virus in our community."
In neighboring New Jersey, by contrast, the phased reopening is incremental. There is no overall color-coding; instead, each phase offers a broad sense of what will change, and, industry-by-industry, individual restrictions are loosened one at a time.
For his part, Philadelphia Health Commissioner Thomas Farley said he wished people could have ignored Pennsylvania's color-coding altogether.
"The governor came up with this high-level plan with these three different colors, but clearly Philadelphia is unique," Farley told reporters at a June 30 press conference at which he announced the city would pause before entering the full green phase. "So we're calling it green, but I would rather have people focus less on the color and more on what activities are allowed and not allowed."
Part of the issue is that the science is evolving and information about the novel coronavirus changes rapidly. Masks, for example, were initially explicitly discouraged because of short supply. Once they became more available, and research emerged supporting their use, masks were back in full force.
Though health departments do their best to keep up with the research as it emerges — and to explain why their recommendations change, when they do — it can be hard to keep track of. And it doesn't help when politicians contradict the science-backed recommendations.
"We can't be out there as the secretary of health telling you to wear a mask and your local elected official is telling you, 'Don't wear a mask. You'll be fine,'" said April Hutcheson, communications director for the Pennsylvania Department of Health. "It makes the job more challenging."
But there is some messaging health departments can control. Pennsylvania laid out what many interpreted as specific metrics for testing capacity, contact tracing, nursing home outbreaks and the number of new cases that counties would have to hit to move to less restrictive phases by a certain date. Many counties in the southeastern part of the state didn't meet those benchmarks but transitioned anyway. The governor later said the metrics were not hard marks but would be considered in concert with other factors to determine overall risk.
Setting aside whether Pennsylvania's transition from red to yellow led to an increase in coronavirus cases, the mixed messaging was likely to contribute to distrust in government, said Ellen Peters, who runs the Center for Science Communication Research at the University of Oregon.
"It gives people inconsistent information, so you're being told, 'Eh, that didn't happen, but we're going to go ahead and do it anyway,'" said Peters, whose Oregon county similarly failed to meet its benchmarks but moved into a new phase anyway. "And so people are left with, 'Well, the guidelines don't matter then. If they don't matter, what else can I not trust that this city or state entity is telling me?'"
Research has shown that when people are stuck at an impasse, they are more likely to just opt for doing what they want to do in the first place.
How safe is safe?
The health departments at the city and state level point to their regular news briefings, where they advise not just which activities are safe, but also how to do them safely. Asking people to constantly evaluate what they consider safe is a tall order.
"What does it mean to be careful right now? I don't think that's actually a meaningful instruction," said Tess Wilkinson-Ryan, a professor of law and psychology at the University of Pennsylvania.
"The level of care we are asking of individuals is really high — we would never ask this in normal life."
At the start of the pandemic, what it meant to be safe was easier to grasp, said Wilkinson-Ryan. Memes like "flattening the curve" gave people new language they needed to understand the broader reasoning behind shutting down the economy. They felt like they were doing something by doing nothing — it created a norm. In the partial reopening, that norm is gone, but it is not clear what replaces it as people make decisions about how to keep themselves and others safe.
Wilkinson-Ryan confronted her own dilemma on safety. About six weeks into strict lockdown in Philadelphia, her husband was out walking the dog when the leash got tangled around his ankle, and he fell back and hit his head. He told her what had happened and she asked him who the president was, half-joking, to test for signs of a concussion. "He said, deadpan, 'George Bush.' And he wasn't joking."
Wilkinson-Ryan spent the next few hours trying to determine how severe her husband's concussion might be, and if it was bad, whether they should go to an emergency room that might be overwhelmed with contagious coronavirus patients.
Luckily, she was able to reach a pediatrician friend who advised her to take him to the hospital, where he was triaged into a non-COVID wing. He's now doing fine.
Wilkinson-Ryan is grateful she had a friend with expertise to call upon, but she longed for a set of clear-cut rules to guide her in that stressful moment.
Making their own decisions
Without those clear rules, Wilkinson-Ryan, Marquita Burnett and others have been left to make their own decisions based on a combination of the emerging science around the virus, whom they trust and what's most important to them.
Burnett, for instance, had been taking her son to get his hair cut on his barber's front porch. The barber always wore a mask and took the virus seriously, so when the barbershop reopened, she felt comfortable taking her son there.
But she's not comfortable with any of her typical summer activities, like going to the zoo, amusement parks or outdoor restaurants. If she can't predict the way a crowd of strangers will act, she's not taking the risk.
Despite her sound reasoning, it's easy to imagine someone else, confronted with the same choices, making the exact opposite decisions: skipping the barbershop because it's indoors; hitting the zoo because it's outside.
"It’s sort of like asking everyone to decide their own speed limit based on, like, the make and model of their car," said Wilkinson-Ryan. "'Think about who you're gonna drive with. Think about the importance of your destination. Good luck!'"
Because one person's idea of 'careful' in a pandemic is different from another's, she said, the most helpful instructions are those that are clear and specific: maximum capacities in public spaces; marks on the ground to denote 6 feet of distance; specific instructions for people on how often they should go to the grocery store.
Otherwise, people are likely to come to different conclusions based on the same information, which in turn, leads to public shaming. And that has its own risks.
"When someone gets angry, they shut down to new information. They react and simply do what they want to do," said Peters of the University of Oregon. "I could see where you could get much worse health behaviors from shaming other people."
She cited pictures of people on beaches as a flashpoint, where some felt justified shaming others. The perspective of some photos, though, may have made beaches look more crowded than they were. "Maybe in reality, people are pretty far apart and they're outdoors," she said.
Wilkinson-Ryan said the shaming is a natural result of a lack of clear norms in a new and changing environment. Overburdened with decisions, it's also a cognitive shortcut.
"It's easy and salient to think about what people in my neighborhood are doing wrong," said Wilkinson-Ryan. "They're sitting at the park, they're playing, they're touching each other. That's an availability bias: It comes easily to mind because it's part of my everyday life. You tend to place blame on the causes that come to mind quickly and easily."
She sees people blaming neighbors who make different decisions rather than holding state legislatures and Congress accountable.
In other countries, coordinated federal responses skirted this issue to some degree. National messaging meant there was no need to deputize hundreds of local health officials to project hyperlocal and often conflicting messages.
"It really is kind of ridiculous, that idea of asking all of these people to come up with their own experts and their own way of guiding behavior in the states or cities, rather than having the experts in the country come together and decide what is the best guidance for all of us and having the politicians stick with that," said Peters.
To streamline her own decision-making, Peters said she adopted a "What Would Anthony Fauci Do?" approach. But when everyone is guided by a different North Star, people are bound to crash into one another.
This story is part of a partnership that includes WHYY, NPR and Kaiser Health News.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.