On Monday, the U.S. reached a heartbreaking 500,000 deaths from COVID-19.

But widespread death from COVID-19 isn't necessarily inevitable.

Data from Johns Hopkins University shows that some countries have had few cases and fewer deaths per capita. The U.S. has had 152 deaths per 100,000 people, for example, versus .03 in Burundi and .04 in Taiwan.

There are many reasons for these differences among countries, but a study in The LancetPlanetary Health published last month suggests that a key factor may be cultural.

The study looks at "loose" nations — those with relaxed social norms and fewer rules and restrictions — and "tight" nations, those with stricter rules and restrictions and harsher disciplinary measures. And it found that "loose" nations had five times more cases (7,132 cases per million people versus 1,428 per million) and over eight times more deaths from COVID-19 (183 deaths per million people versus 21 per million) than "tight" countries during the first ten months of the pandemic.

Michele Gelfand, the lead author of the study and a professor at the University of Maryland who specializes in cross cultural psychology, previously published work on tight- and loose- rules nations in Scienceand in a 2018 book, Rule Makers, Rule Breakers: How Tight and Loose Cultures Wire Our World.

Gelfand says her past research suggested that tight cultures may be better equipped to respond to a global pandemic than loose cultures because their citizensmay be more willing to cooperate with rules, and that the pandemic "is the first time we have been able to examine how countries around the world respond to the same collective threat simultaneously."

For the Lancet article, the researchers examined data from 57 countries in the fall of 2020 using the online database "Our World in Data," which provides daily updates on COVID-19 cases and deaths. They paired this information with previous research classifying each of the countries on a scale of cultural tightness or looseness. Results revealed that nations categorized as looser — like the U.S., Brazil and Spain — experienced significantly more cases and deaths from COVID-19 by October 2020 than countries like South Korea, Taiwan and Singapore, which have much tighter cultures.

NPR talks to Gelfand about the findings and about how understanding the concepts of "looser" and "tighter" nations might lead to measures that help prevent COVID-19 cases and deaths as the pandemic continues.

This interview has been edited for length and clarity.

How did your past research bring you to your current findings about the pandemic?

One of the things I've been looking at for many years is how strictly cultures abide by social norms. All cultures have social norms that are kind of unwritten rules for social behavior. We don't face backward in elevators. We don't start singing loudly in movie theaters. And we behave this way because it helps us to coordinate with other human beings, to help our societies function. [Norms] are really the glue that keep us together.

One thing we learned during our earlier work is that some cultures abide by social norms quite strictly. And these differences are not random. Tight cultures tend to have had a lot of threat in their histories from Mother Nature, like disasters, famine and pathogen outbreaks, and non-natural threats such as invasions on their territory. And the idea is when you have a lot of collective threat you need strict rules. They help people coordinate and predict each other's behavior. So, in a sense, you can think about it from an evolutionary perspective that following rules helps us to survive chaos and crisis.

Can you change a culture to make it tighter?

Yes, but you need leadership to tell you this is a really dangerous situation. And you need people from the bottom up being willing to sacrifice some of the freedom for rules to keep the whole country safe. And that's what's happening in New Zealand, where they had few cases and few deaths per million, and where they're really very egalitarian. My interpretation is that people said look, "We all have to follow the rules to keep people safe."

Can you give us some examples of how tight and loose cultures operate when there's not a pandemic going on?

Loose cultures tend to have a lot of openness and tight cultures struggle with openness. We know that tight cultures in general have less crime and more monitoring of [citizens'] behavior and [more] security personnel and police per capita.

Loose cultures corner the market on openness toward people from different races and religion and are far more creative in terms of idea generation and ability to think outside the box.

Do you think it's possible to tighten up as needed?

Yeah, absolutely. I mean I would call that ambidexterity — the ability to tighten up when there's an objective threat and to loosen up when the threat is diminished. People who don't like the idea of tightening would need to understand that this is temporary and the quicker we tighten the quicker it will reduce the threat and the quicker we can get back to our freedom-loving behavior.

I imagine people are worried, though, about long-term consequences of tightening up.

We shouldn't confuse authoritarianism with tightness.

Following rules in terms of wearing masks and social distancing will help get us back faster to opening up the economy and to saving our freedom. And we can also look to other cultures that have been able to open up with greater success, like Taiwan for example. Increased self-regulation and [abidance of] physical distancing, wearing masks and avoiding large crowds allowed the country to keep both the infection and mortality rates low without shutting down the economy entirely. We need to think of this as being situation-specific in terms of following certain types of rules.

It requires using cultural intelligence to understand when we deploy tightness and when we deploy looseness. And my optimistic view is that we're going to learn how to communicate about threats better, how to nudge people to follow rules, so that people understand the danger but also feel empowered to deal with it.

[In the U.S., for example, we] need to have national unity to cope with collective threat so that we are prepared as a nation to come together like we have in the past during other collected threats, such as after September 11.

Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter: @fkritz

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