Coronavirus Conversations:

Alison Buttenheim

March 12, 2020

Photo via Centers for Disease Control and Prevention 

The novel coronavirus, known as COVID-19, is challenging health care systems around the world.

This episode is the first in a limited series of conversations with people who are being forced to make difficult decisions in a rapidly evolving situation with many unknowns.

If you have a story you’d like to share, you can email us at

Listen to the conversation below or scroll down for the transcript and more information.

Alison Buttenheim

Alison Buttenheim, Associate Professor of Nursing and Health Policy at the University of Pennsylvania

Dan Gorenstein: Hey, it’s Dan. We’ve been thinking a lot about the best way we can contribute to coverage of the coronavirus.

The situation is evolving rapidly, and there are many news organizations already providing great reporting.

We kept coming back to our core mission — telling stories about problems with no easy fix.

So starting today, we’re going to be releasing additional episodes, bringing you conversations with people making difficult decisions as they grapple with the coronavirus.

These episodes may run for a few weeks, maybe longer. The point is to give listeners a place to hear how others are facing down their own tough choices.

We begin with Alison Buttenheim, who I spoke with on March 11.

Alison Buttenheim: I’m an associate professor of nursing and health policy at the University of Pennsylvania.

DG: And I love how you described your expertise to me earlier on the phone. What do you say?

AB: So I’m a social scientist who studies the behavioral aspects of infectious disease prevention.

DG: You’re not an epidemiologist.

AB: I’m not an epidemiologist. I’m not really a social epidemiologist. I have a PhD in community health sciences.

DG: Which means what?

AB: Which means I study how communities track, prevent, treat disease at a population level.

DG: And so when it comes to coronavirus, what does that mean?

AB: So it means I think a lot about how human behavior responds to that virus, how people are making decisions about prevention, about containment and about changing their daily life so that this doesn’t go “boom.”

DG: Are you going “boom?”

AB: It’s a stressful time. I feel like, I looked actually at my Twitter account today at the graph where it shows how much engagement you’ve had, and it basically matches the epidemic curve. Around like Feb. 25, pople started asking me questions.

DG: On Twitter.

AB: On Twitter and in real life about what do I do? Do I change my routines? Do I keep my kid out of school?

DG: One of the things we’re going to do with this series, Alison, is begin to explore the daily decisions that people are making, really kind of looking at the tradeoffs that they face and having folks walk us through the sorts of hard decisions they’ve got to make. What’s a decision that you’ve been facing in the last few days that’s been really hard for you?

AB: So one thing that’s been top of mind for me as a mom is a big event scheduled at my kid’s school tomorrow. This is an annual event for all the kids who take Greek and Latin. It’s like a classics nerd fest — lasts all day, lots of parents come, there’s a big feast, a big Mediterranean potluck feast, speeches, performances. It’s very fun. I love it.

DG: What do you love about it?

AB: Oh, I mean, the classics community at this school is really great. My kids have taken a lot of Greek and Latin classes. The teachers are wonderful. It’s this long-standing tradition. So there’s always a triumph, there’s always a Greek sacrifice. The Latin 1 students go out into the graveyard and take the auspices to see if it’s going to be a, you know, an auspicious day. It’s really wonderful. And it’s been going on for decades. And as the outbreak news has unfolded this week, really trying to weigh the pluses and minuses of going. My parents, who are both 77 years old, they wanted to come because my youngest kids are seniors, it’s our last Classics Day at this school. Very, very hard decision.

DG: What’s the hard decision?

AB: As a social scientist, someone who looks at behavior around infectious disease prevention, it’s very easy for me to say that the correct decision is not to go. We all should be implementing very aggressive social distancing measures right now, and social distancing means not showing up at events with lots of people and spending time in, you know, closed spaces with sustained contact. So does this count as an event that I should have stepped back from? Absolutely.

DG: Like there’s there’s no doubt in your mind. This is putting your health and the health of sort of that herd community kind of thing at risk.

AB: So probably not my health, right? And that’s what’s hard about this. You know, the outbreak in the U.S. is evolving very rapidly. We’re having lots more new cases every day and more new cases today than we did yesterday and the day before. And what we want to do is not fuel that fire. And every person who shows up to any event is in a small way fueling that fire. And you’ve probably heard the “flatten the curve” term a lot recently, that flatten the curve term means if we can reduce the amount of social contact people have, we’re going to have fewer people completely overburdening, overtaxing our health system. So it sounds like, you know, what difference can it make for like one mom to show up at one event? But all those individual decisions grouped together mean we’re going to have a faster outbreak than we would otherwise.

DG: So what did you decide?

AB: I decided to go.

DG: What were you thinking?

AB: I was thinking I’m making a lot of other decisions in my life that are having me step back, lean out, stay put. And I thought I’m allowed this one.

DG: You gave yourself permission.

AB: I gave myself permission to go to Classics Day. When I did the tradeoff calculation, I came down on the side of going. And about a half an hour before I came into the studio this afternoon, the school canceled school for tomorrow and the next day, including Classics Day. Classics Day is canceled. And I have to say in the midst of like a lot of sadness — this is a great event, it was my kids last year — I am enormously relieved to have that decision taken out of my hands. And that’s when I say I think the school did the right thing. And one of the right things about that was not having all the individual parents make the decision to go or not go.

DG: I’m curious as an expert in behavior around contagious diseases, what’s the intellectual lesson you derive from this sort of personal hard decision you’re trying to make?

AB: So one thing that comes to mind is dual selves theory, that we have we really have two selves. We have a very impulsive, emotional, makes decisions in the moment, makes decisions based on sort of emotional and social factors. Call that system one. And we have System 2 that is much more rational and deliberate. And, you know, usually for the most part System 2 makes better decisions for us than System 1. And even as someone who knows that theory, knows that I’ve got System 1 and System 2 battling. In this case, I as an individual and as what we would say a very sophisticated individual in terms of knowing what’s going on inside my brain, I was still going to let System 1 win this one. And one way to get around faulty decisions by System 1 is to take the decision making process away from the individual. And if institutions can make those decisions for us, a lot of that stress and cognitive burden and angst about it is taken away, and we get the social distancing accomplished that we need to have to keep this outbreak in check.

DG: So we really need our employers, the sports leagues that are hosting major events, the people who are hosting conferences.

AB: Oh, my gosh, yes.

DG: We need all of these people to say, “We’re gonna cancel. We’re going to put this online.”

AB: Yep. We have this little tiny Instagram account that I just started yesterday called Those Nerdy Girls where people are basically asking questions, and most of the questions are an anecdote, a travel anecdote. So, I was supposed to fly to San Diego and do X Y Z or drive to Florida and visit my grandparents or hey, it’s just in rural New York, not many people around. And it’s only an hour and a half drive away. And we were just going to go to a small museum exhibit. Would that be okay? And every time we’re saying, “Those Nerdy Girls recommend not doing that.” And I think people also, again, just want an external voice to say, nope, not a good idea because they’re invested enough in the trip and the plans and, you know, getting together with friends or relatives that it’s too hard for them to tell themselves no. And they all say, “That’s what I thought.” It’s just really helpful to have someone else say no.

DG: So what do you say to the individuals where the employers or the schools or whatever, they’re not making that decision for them?

AB: It’s a great question, and of course, I should say there are lots and lots of employers who can’t grant that social distancing to their employees and lots of employees who can’t take advantage of it. So we should be real about who’s able to even do this. But if you’re in the position of you’re able to make that decision and you’re wondering if you should or not, think about the vulnerable people in your community who are particularly vulnerable to this disease. That’s anybody over 60. That’s anybody with a chronic disease, and remember that you probably know a lot of people with a chronic disease whose disease is not visible to you, people with immune disorders, people who are gonna be particularly hard hit. Taking any steps you can towards social distancing to reduce that number of cases is a great thing. It’s what will make the difference between this being a real disruptive disaster for this country versus a very hard thing that we get through.

DG: Alison, thanks so much for talking with us.

AB: Thanks for having me, Dan.

DG: We’ll be bringing you more stories in the coming weeks from people dealing with hard decisions. If you have a story, a tough choice you’re grappling with in the midst of the outbreak, you can email us at or find us on Twitter, we’re @tradeoffspod.

I’m Dan Gorenstein, This is Tradeoffs.

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Additional Resources & Credits

COVID-19 Information and Updates

World Health Organization

Centers for Disease Control and Prevention

Johns Hopkins University Coronavirus Resource Center

Social Distancing Research

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures (Fong et al, Emerging Infectious Diseases, 2020)

The Effect of Reactive School Closure on Community Influenza-Like Illness Counts in the State of Michigan During the 2009 H1N1 Pandemic (Davis et al, Clinical Infectious Diseases, 2015)

Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic (Markel et al, JAMA, 2007)


Music in this episode written and performed by Dylan Magierek, courtesy of Badman Recording.

This episode was produced and mixed by Ryan Levi.