How to manage the slippery slope of Covid adherence: A recipe for the Quaranteam
Note: I’m a behavioral scientist, not a medical professional or epidemiologist. This post is written from a behavioral science perspective. This is not medical advice.
The grass is always greener. Single people in COVID crave some loving touch. People with significant others crave the social stimulation of another adult. No matter if you’re single or married, if you’re an introvert or extrovert, strict social distancing has us all wanting more. And because of that, we are tempted to cheat before guidelines are lifted.
Early data has shown that as time goes on we are taking more trips outside the home and venturing to the beach or parks. But if everyone cheats a bit, these small risks add up and we’re back where we started. This is worrisome since experts suggest we will need to do some form of distancing throughout 2020.
As the months drag on, we will need a way forward that incorporates our expectations of how humans are likely to adhere to guidelines and then adjust the guidelines to ensure optimal outcomes. Many models today do not build this in.
Economist Tyler Cowen has stated he is skeptical of models of epidemiology that do not consider adherence. Most behavioral scientists would agree, this is a problem to be addressed. The projections also agree. One forecast cited “increased mobility before the relaxation” as the reason for doubling their previous prediction of U.S fatalities.
This post proposes one method (and suggests the tactical recipe) for how we manage this slippery slope of adherence over time, accounting for people’s actual rather than idealized behavior.
Formalizing: The Quaranteam
The concept is already happening within pockets of people, USA Today has picked up the trend and Urban dictionary caught on.
You may already know it. Your gf or bf lives alone. And you live with roommates. What should you do? To avoid a break-up — or worse, a way-too-soon move-in that results in a break-up — your roommates agree he/she can come over, as long as they all agree not to see or visit anyone else.
The Quaranteam is a group of people who have agreed to only see each other. Some have called it a “Pod.” Prof Stefan Flasche, an epidemiologist at the London School of Hygiene and Tropical Medicine, said he preferred the formal term “contact clustering”. Belgium is dipping their toe in this direction by proposing to let groups of up to 10 people meet socially once a week, as long as it’s always the same 10.
A Quaranteam is like a family but of friends.
This concept doesn’t propose any new rules than exist today, it just extends them to people you may not live with. As a family of four, you are Quaranteamed with your spouse and kids. You can only be less than 6ft away from this group.
If you don’t have a family of four, you could pick three other people and Quaranteam with them. Same rules apply. You can only be less than 6ft away from this group.
This is the One Rule.
The One Rule of Quaranteaming: No Mixing Quaranteams.
When the Quaranteam extends beyond immediate family or people you don’t live with, it does introduce complexities. These complexities are worth articulating and setting norms for.
The complexities of Quaranteams
- How many people should be in your Quaranteam?
You could do a Quaranteam with two people. Or you could do a Quaranteam with 8 people. The important factor is if a member can commit to only being less than 6ft away from the other people in the Quaranteam. This is the One Rule — no mixing Quaranteams.
For example, if your friend has parents they would like to continue seeing, this friend should not be in your Quaranteam — unless the parents are also joining and adhere to the One Rule. If your friend has roommates, the roommates need to be in the Quaranteam and agree to the One Rule.
If one person in the Quaranteam still sees their Neighbor Bob, everyone is exposed to Neighbor Bob and the people that Neighbor Bob sees. This cannot happen. It is why strict adherence to the One Rule is so important. No one can make exceptions to this rule.
- How do you decide who is in your Quaranteam?
Quaranteams trust each other. They have to. They are putting their health at the hands of the other members. You need to know that your Quaranteam has indeed been sheltering in place and adhering to all the guidelines. Quaranteams could be an existing group of friends or two families that join up. You know these people well and you trust them to adhere to the One Rule. Your health is on the line. - How do you say NO to someone?
There is likely to be an awkward conversation ahead. Your family friend or neighbor asks you to be in their Quaranteam or they ask to be in yours. For whatever reason, you want to say no. The only advice is to say No gently and avoid negative comments. This is a time of heightened emotions and deepened loneliness. Try: “I’m honored you asked! Sadly, we agreed to limit it to only 4 people.” or “Thanks for asking. I’m afraid I have to say No. But I’d love to socially-distance hang-out or do a video call” - Dealing with slippery slopes within the Quaranteam
The longer this goes on, changes in circumstances within the Quaranteam become inevitable
Matt got a new job and is now an essential worker.
Shelby lost her job and needs to drive for Instacart to cover rent. But she promises she takes all the precautions
Lizzie needs to take care of her sick aunt.
Be conservative. If someone can no longer adhere to the One Rule, you need to cut them loose from the Quaranteam. The best way of handling that is clear guidelines and agreements upfront.
- How long does your Quaranteam last?
Assume you’ll be with your Quaranteam until the CDC releases new guidance. This is a marathon, not a sprint. And to be clear, this is NOT a weekend playdate. This is about creating a group of people who have taken optimal precautions and are choosing to treat each other as kin, for the foreseeable 2020 future. If someone has outstanding circumstances and asks to break from the Quaranteam, they shouldn’t come back until they have had a test or have taken at least two weeks of solo (no contact with others) Quarantine. - What happens if someone breaks the rules?
There is only One Rule. If someone breaks it, they should be asked to leave. We put others at risk if we don’t abide by this rule. One person’s actions will influence the whole Quaranteam’s health. There should be no question that if the one rule is broken, they will be asked to leave. - How do we start?
Current guidance suggests that if you don’t have symptoms for two weeks, you are likely in the clear. The Quaranteam should quarantine for two weeks prior to starting (or get tested when tests become widely available).
Decreasing mobility via behaviorally feasible guidelines
As a society, we are close to hitting our quarantine fatigue, with cell phone data showing more people are breaking rank. People are getting antsy. We need a way forward that allows people to stay safe, while also maintaining strict Quarantine norms for as long as the US needs.
Quaranteams don’t change the rules of social distancing. What Quaranteams do is create the language and the norms for people who may not have an immediate family or roommates to shelter-in-place with. If done correctly, Quaranteams allow people to avoid the scary depression of social isolation and loneliness, without risking society’s health.
The greatest risk is for some groups of people to adopt this approach on their own without general coordination, as the strict norms may not be clear to everyone involved. The intent is to decrease mobility with behaviorally feasible guidelines that can be maintained over much longer periods of time.
The below recipe helps articulate the steps required to make a successful and healthy Quaranteam. Hopefully, this common language will help us Quaranteam like champs.
The Quaranteam recipe:
Pick your Quaranteam:
- Agree on the number of people everyone is comfortable with
- Ask each person if they can abide by the One Rule. Get an active Yes. Don’t assume they agree. Make it explicit. Say it again and again.
- Ask everyone to agree to leave the Quaranteam if they cannot abide by the One Rule in the future.
Set up a video call to prep
- Agree on the norms for when you’re not with your Quaranteam. Aligning on these behaviors will ensure everyone is on the same page. How often do you go grocery shopping? (Limit this!) Do you wear a mask and gloves? (Yes!). Do you wipe down packages before touching? (Yes or wait to open!)
- Agree on the rules to get someone new into your Quaranteam. Quaranteams are consensus-driven machines because they are built on trust. For example, if everyone votes and one person says “No” to the newbie, the newbie cannot come in. Can everyone agree to that?
- Agree on the process for if someone wants to leave and come back — they cannot come back without getting tested. Agree on this protocol upfront.
Start the 2-week clock
- Pick a day to begin your Quaranteam! Unless people are living solo and not seeing anyone else, this should generally be two weeks out. Look into testing in your area to see if it’s possible.
HUG!
- Go to someone’s house in your Quaranteam and enjoy a BIG SQUISHY HUG. Have dinner together. HUG again.
Schedule a weekly check-in to sync up with your Quaranteam
- The guidance from the CDC will continue to evolve. Make sure you’re checking in with the group on how your norms change with the CDC guidance. Ask one person to be the schedule Queen or King and ensure everyone takes this check-in seriously.
