**1. Introduction**

A month before the Chinese Spring Festival, the Chinese government reported multiple cases of pneumonia of unknown etiology in Wuhan, Hubei Province, China in December 2019. On January 20, 2020, there were 282 confirmed cases in and around Wuhan, of which 51 were severely ill, 12 were in a critical condition and six deaths as reported to the World Health Organization (WHO) [1]. Three days later public health officials in China implemented strict control measures in Wuhan with a complete lockdown of the population that lasted 76-days. Wuhan is the largest city in Hubei province with a population of over 14 million people [2].

A week later on January 30 2020, WHO declared this outbreak a public health emergency of international concern (PHEIC). The outbreak was caused by a novel coronavirus, SARS-CoV-2, and the disease was named COVID-19 [3, 4]. Since then, almost all countries started implementing several Nonpharmaceutical Interventions (NPIs) such as contact tracing, social distancing, mask wearing, self- isolation, school closures, business closures and countrywide lockdowns at different levels of strictness to stop the spread of the disease.

At the beginning of a pandemic several NPIs can be implemented by public health officials as a way to slow disease transmission until an effective vaccine or antiviral treatment becomes available. Implemented public health measures place restrictions on individuals and understanding how individuals respond and whether they are likely to comply or break new rules is extremely important. Measures can theoretically greatly influence and reduce the spread of the infection. However, human choice and self-interest chosen over altruism, among many other factors, can hamper NPI effectiveness and disease control efforts.

For example, lockdowns and self-isolation (self-quarantine) can be highly effective in reducing transmission but can result in population-wide socioeconomic and psychosocial impacts [5]. Adverse effects from extended isolation have been reported in a number of groups including children and adolescents [6, 7], immigrant workers [8, 9] and adults [10, 11]. Children experienced changes to their eating habits, sleep disturbances, depression and symptoms of anxiety [12–14]. Adults reported increased mental health issues, anxiety, stigma, depression, alcohol related harm, and domestic violence [10, 11, 15].

There are a number of demographics, social and psychological factors underpinning engagement with quarantine, lockdown, and compliance with public health directives regarding personal protective behaviors. Factors include perception of susceptibility to the infection, severity of the infection, perception of the effectiveness of ongoing public health measures, and their ability to conduct the activity safely (self-efficacy) [16]. One of the main reasons identified in research literature for non-adherence to quarantine and self-isolation is the perception of lower risk for the disease or having fewer risk factors [17]. Psychological fatigue is also suggested as a possible reason for NPI non-compliance [18, 19].

While cultural and social factors might be challenged by fear [20], the economic difficulty faced by some groups and especially minorities in some places, plays a role in human choice. This might partly explain the disproportionate COVID-19 incidence and mortality faced by minorities in the US, Australia, Canada, and the UK [21–24]. Similarly, migrant workers in low-income countries are also an economically vulnerable population group [25]. Thus, cultural dimensions (see **Figure 1**) can greatly affect uptake and adherence to NPIs [26–30] as well as disease transmission and mortality [31].

Initial and ongoing compliance by individuals is promoted by the existing level of infrastructure, resources, stockpiles, inter-pandemic planning, communication efforts from authoritative sources and the country's capacity. People afraid of contracting a viral infection will adhere to the best hygienic procedures, use masks, practice social distancing and avoid crowded places. While such measures act to delay the spread of viral diseases, like COVID-19, it will not completely protect the population. Public health directives that seek to reduce population-level risk factors and disease transmission are closely aligned with the idea of each individual practicing the best hygienic procedures, collectively, to achieve high compliance.

Indeed, economic growth and capacity as measured by gross domestic product (GDP) provides a measure of the pre-existing infrastructure to maintain and enforce law and order, regulate economic activity, and provide public goods during a protracted pandemic wave [32]. Many countries in less-developed parts of the

*Human Cultural Dimensions and Behavior during COVID-19 Can Lead to Policy Resistance… DOI: http://dx.doi.org/10.5772/intechopen.96689*

#### **Figure 1.**

*A comparison of six cultural dimensions among six countries. For discussion see the text. (data source: https:// www.hofstede-insights.com/).*

world lack this capacity and are more vulnerable to system shocks like pandemics that disrupt economic growth and reduce GDP (**Figure 2**) [33].

Two decades ago, British psychologist James Reason introduced the Swiss Cheese Model to describe how failures in complex systems occur [34]. In his model he suggested that multiple defenses can be in place, whose function is to protect individuals from hazards, but these can possess inherent weaknesses. Multiple safeguards or barriers are like slices of Swiss cheese, having many transient holes. Having holes in any one "slice" does not normally cause a bad outcome. If the holes in many layers line up so they permit a trajectory of accident opportunity through the layers, then it allows for hazard exposure resulting in victims. The holes in the established defenses arise for two reasons: active failures and latent conditions. Nearly all adverse events involve a combination of these two sets of factors.

Google mobility data trends reported from mid-February to mid-December 2020 provide insight into the conditions and active failures during the COVID-19

#### **Figure 2.**

*Daily new cases and lockdown stringency index for the six countries. The day '0' starts with the date January 22, 2020. The percentage reduction in the growth rates of GDP in 2020 due to COVID are as follows: India 10.29%, US -5.91%, Nigeria 3.41%, Italy 10.6%, Japan 5.27%, UK -10.2%. Data source: Our world in data, https://ourworldindata.org/covid-mobility-trends, and https://www.statista.com.*

#### **Figure 3.**

*Google mobility trends: Movement of people during COVID-19 lockdown period: (a) India, (b) United States (MA-Massachusetts, MI-Michigan, NY-New York, and WI, OR - Wisconsin, Oregon), (c) Nigeria, (d) Italy, (e) Japan, and (f) UK. For discussion, see the text. (data source: Our world in data, https://ourworldindata. org/covid-mobility-trends).*

pandemic stemming from changes in human behaviors. In India (**Figure 3a**) there was good compliance at the beginning of the 74-day lockdown that began on March 25, 2020. However, as the lockdown progressed movement in all tracked mobility categories slowly increased until the end of lockdown. Retail and recreation showed an increase at the beginning of the lockdown as some people ignored social isolation to maintain their livelihoods.

Unlike India, the United States (**Figure 3b**) did not implement a nationwide lockdown, instead many states put in place lockdowns of various lengths ranging from 20–267 days (many states began lockdowns during the third week of March 2020). Compliance remained high for the first month and slowly mobility in all categories increased. Notably, mobility to parks and other open spaces increased significantly as shorter lockdowns in some states ended as spring weather arrived.

Nigeria (**Figure 3c**) imposed a 13-day lockdown on March 30 2020 with good compliance. Once the short lockdown ended mobility trended back upwards towards normal levels over the next two months.

Italy (**Figure 3d**) implemented a 70-day nationwide lockdown that began on March 9 2020 after large clusters of cases were reported in Northern regions of the country. Compliance was good with decreased mobility in all categories except visits to parks and outside spaces.

Japan (**Figure 3e**) was one of the few countries that did not use a lockdown strategy, mobility decreased to transit stations, retail businesses and workplaces as people followed government guidance and avoided hotspot areas and mass gatherings.

The UK (**Figure 3f**) used a 112-day nationwide lockdown that began on March 23, 2020 with good compliance during the first month then mobility increased in all categories. Changes in mobility were similar to what was observed in the United States and Italy. People in the UK spent increasing amounts of time outdoors and in parks during the lockdown [35].

The Swiss Cheese Model can be applied to pandemic defenses or safeguards showing that there are two levels protecting people: personal and interpersonal safeguards. When applying the Swiss Cheese Model to COVID-19 the pandemic barriers which can fail are the early NPIs such as social distancing, self-isolation and *Human Cultural Dimensions and Behavior during COVID-19 Can Lead to Policy Resistance… DOI: http://dx.doi.org/10.5772/intechopen.96689*

lockdowns. For the model we group these NPIs collectively as "social isolation" barriers. In this chapter, we focus on human behavior of social isolation decision-making during the pandemic and its impact on socio-economic growth. Integrating evolutionary game theory, economic growth model and a deterministic disease transmission model, we develop a conceptual framework to analyze the situation using a Swiss Cheese Model approach. We illustrate the main scenario of social isolation versus no social isolation and its effects on growth by numerically simulating the model.
