With the coronavirus running rampant across large swaths of California and hospitals projected to overflow by Christmas, public officials have fallen back on a familiar refrain: Stay home.

Some 33 million Californians are now under a new regional stay-at-home order that began Sunday night, a last-ditch effort to turn the corner on an alarming rise in coronavirus cases statewide. The blunt messaging worked to bend the curve in the spring, when fear of the novel virus and the insidious ways it might spread kept many indoors. But nine months later, the words seem to have lost their meaning.

A similar story has played out nationwide, as millions of Americans zigzagged across the country to visit family over the Thanksgiving holiday, flouting the advice of health officials.

“It’s not because the public is irresponsible; it’s because they are losing trust in public health officials who put out arbitrary restrictions,” said Dr. Monica Gandhi, an infectious-disease specialist at UC San Francisco. “We are failing in our public health messaging.”

But pandemic response guided by a concept known as “harm reduction” would detail the risk levels of different activities and let people decide on their comfort levels, with perhaps the most dangerous settings prohibited altogether. Public health research has found that this strategy makes people feel empowered to make their own choices and that, ultimately, they don’t take more risks than they would have otherwise.

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