Expert explains what we need to learn to live safely with COVID-19 -- because we can't stay isolated forever

Abstinence-only doesn't work for sex and substance abuse, and it's not likely to work for living through the coronavirus epidemic.

Americans needed to #StayHome when the virus first began to spread exponentially in order to flatten the curve and buy time to bulk up necessary medical supplies, but isolation is too damaging to mental health, physical health and the economy to serve as a long-term strategy against the pandemic, according to Harvard professor Julia Marcus in a new column for The Atlantic.

"Public-health campaigns that promote the total elimination of risk, such as abstinence-only sex education, are a missed opportunity to support lower-risk behaviors that are more sustainable in the long term," wrote Marcus, who teaches population medicine. "Abstinence-only education is not just ineffective, but it’s been associated with worse health outcomes, in part because it deprives people of an understanding of how to reduce their risk if they do choose to have sex."

Marcus compared the anger toward crowds gathering on beaches and at restaurants to the stigmatizing of those who continued to have sex, even taking some risk reduction measures, during the HIV epidemic.

"The anger behind shaming is understandable," she wrote. "Calling out seemingly dangerous behavior can also provide an illusion of control at a time when it’s particularly hard to come by. But, as years of research on HIV prevention have shown, shaming doesn’t eliminate risky behavior — it just drives it underground. Even today, many gay men hesitate to disclose their sexual history to health-care providers because of the stigma that they anticipate. Shaming people for their behavior can backfire."

Instead, Marcus wrote, state and local health departments must provide tools and strategies to mitigate risks and allow some normalcy to return, as safely as possible

"What does harm reduction look like for the coronavirus?" Marcus wrote. "First, policy makers and health experts can help the public differentiate between lower-risk and higher-risk activities; these authorities can also offer support for the lower-risk ones when sustained abstinence isn’t an option."

Research so far has shown that some activities and settings are much riskier than others.

"Enclosed and crowded settings, especially with prolonged and close contact, have the highest risk of transmission, while casual interaction in outdoor settings seems to be much lower risk," Marcus wrote. "A sustainable anti-coronavirus strategy would still advise against house parties. But it could also involve redesigning outdoor and indoor spaces to reduce crowding, increase ventilation, and promote physical distancing, thereby allowing people to live their lives while mitigating — but not eliminating — risk."