Pandemic is a scary word. But intense fear of the novel coronavirus almost seems as pervasive as the virus itself.
Coronavirus cases have now been confirmed in more than 100 countries, with varying levels of disruption to daily life around the world. Understandably, people are concerned about the health and well-being of themselves and their loved ones. But the pandemic is also bringing out the worst in us.
Supermarkets and stores have become the Wild West, where it’s every man or woman for themselves — especially in matters involving toilet paper. Shoppers are duking it out to decide who gets the last roll. In Australia, a coffee shop is accepting toilet paper as currency. In Hong Kong, knife-wielding men robbed a store and walked away with 600 rolls of toilet paper — a heist of $130.
But response to the coronavirus goes beyond panic-buying and hoarding. People with seasonal allergies have become targets of sneeze shaming — a plane headed to New Jersey landed in Denver when a group became “disruptive” after a fellow passenger experienced a bout of allergic sneezing. Coronavirus-fueled hate crimes are making headlines as well.
What explains the rise of stockpiling, hysteria, xenophobia and conspiracy theories amid the coronavirus? Discover spoke with clinical psychologist Steven Taylor about the psychological fallout caused by pandemics.
Taylor is regarded as an expert on the psychological reactions prompted by pandemics. In his new book, The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease, Taylor explores how people respond to pandemics and how these behaviors spread.
Q: How do you define fear — and what role does it play during pandemics?
A: Fear is an emotional, behavioral and physiological coping reaction to perceived threats. As we’ve seen in this pandemic, the fear arrives well before the actual infection — people are experiencing anticipatory anxiety. It’s a means of keeping themselves safe and protecting their families. By and large, fear is an adaptive response. It’s a useful alarm system that stops us from getting into danger. It’s only when it becomes excessively intense or persistent — or when there’s no danger — that it becomes a problem.
Q: Why do we succumb to these fears, even if we know on some level that they’re irrational?
A: We have two levels of thinking. We have our rational mind that tells us, “No, I don’t need to buy another roll of toilet paper.” But we also have a more primitive, visceral, gut reaction that says, “Well, I better be safe than sorry.” The herd instinct can also kick in, where people suspend judgement and start doing what everyone else is doing. So, if everyone else is panic-buying supplies, people follow the herd.
Q: Why are new threats, like the coronavirus, often more anxiety-provoking than familiar threats?
A: With novel threats, it’s the uncertainty — a great deal of people have difficulty dealing with uncertainty. What makes coronavirus particularly provoking for some people is that there are a lot of unknowns about it, it does kill people [and] it is more severe than seasonal influenza. And we’ve seen graphic images of people on the internet wearing masks and so forth. The other thing is that most people have not had direct experience with infection of COVID-19. In the abstract, we know that the illness is generally mild, unless you’re an older person or frail.
Now that COVID-19’s being declared a pandemic, we’re seeing images comparing it to the Spanish flu — people are lined up for hospital beds and stacks of coffins. Once the infection becomes more widespread, and people realize that, “Oh, it’s mild,” I expect the fear response to diminish.
Q: How do other psychological factors influence how people cope with pandemics? Are there differences across different populations?
A: There are individual differences in how people cope with threat. But it’s important to realize that there’s a point that’s not widely discussed in the media: In general, people are highly resilient. Our communities, populations and countries are resilient to stress.
Most people are appropriately concerned. But some people find self-isolation stressful, and some will worry about their family or friends. But most people will get through this without debilitating anxiety. That said, there will be a proportion of people — and it’s really difficult to predict how many, [around] 10 percent or maybe more — who respond with excessive, debilitating anxiety. These are often the people who have preexisting anxiety disorders or emotional problems. Or people who have personality characteristics, such as a tendency to be intolerant of uncertainty or a tendency to worry a lot about minor things.
Q: What is a “normal” response to the coronavirus — and what would an irrational reaction look like?
A: A normal response would be paying attention to credible news sources and avoiding websites devoted to conspiracy theories or rumors. They’re following the guidelines of health authorities, they have a two-week supply of food and toiletries and are prepared for the possibility of self-isolation. They [should also] have [a plan] to fend off the boredom of two weeks of isolation. They might be concerned, but it’s not consuming their life and they’re able to get on with their everyday life. That’s an example of adaptive coping, or normal coping.
Excessive coping would be someone who’s worried all the time and is frightened of foreigners because of fear of infection. They’re constantly checking their own [body] temperature or checking news sources, especially dramatic news sources, and they are getting alarmed at the images they see. They’re becoming highly isolated [and] are experiencing symptoms like headaches, insomnia and irritability because they are so stressed out.
There’s going to be an understandable tendency for people to misinterpret everyday coughs and sniffles as COVID-19 symptoms — in themselves and among members of their families. That’s fine, but what’s really important is what you do to that. If everyone rushed to the emergency room every time they got a cough or a cold, they’d overwhelm the health care system.
Q: How can psychological factors influence the spread of an infection?
A: When you look at how pandemics are managed, a population has to agree to do stuff. They have to agree to get vaccinated if there’s a vaccine available. They have to agree to wash their hands and cover their cough, to not congregate in groups, to self-isolate. The battle is people have to agree to limit their freedoms in some fashion. If people choose not to do that, or find it stressful to self-isolate, that’s going to hamper the control of the infection.
Q: Why are people panic-buying and stockpiling supplies?
A: Everyone is being told they need to stock up for two weeks. And most people don’t do that often, so they don’t really think about what they need — which isn’t a whole lot, by the way. Inevitably, there will be someone in the crowd — maybe a few people — who are very anxious and will over-purchase. Because we’re social beings, we interpret the danger of the situation based on how other people are reacting.
With panic-buying, people feel a strong sense of urgency and a fear of scarcity. There’s almost a fear contagion effect. They think, “If they’re doing it, I better do it, too.” There are images of people with overstocked shopping carts and empty supermarket shelves going viral.
People want to find a way of staying in control of the situation. After all, government and health authorities are telling us this is a big, scary problem. Yet the government is telling us that we don’t need to do anything special like wear big masks — just wash your hands and cover your mouth when you cough. In the minds of many people, that’s not enough for them to cope, they feel like they actually need to be doing something — anything — to make themselves feel more prepared. And that could be something that’s fueling panic-buying.
Q: Why do pandemics often trigger xenophobia?
A: There’s a concept called the behavioral immune system. It’s based on the idea that our biological immune system is not sufficient to help us avoid infections, because we can’t see things like microbes or bacteria or viruses. This behavioral immune system is like a psychological system that enables us to detect pathogens by looking at cues. So if I see a dirty handrailing, that’s going to activate my behavioral immune system and set off an alarm to not touch that dirty handrailing. This system is also set off by foreign people.
This system evolved because foreigners were typically the sources of dangerous infections. When two groups intermingle, one group might carry an infection that the other group has never encountered, and therefore has no natural immunity. We’ve seen that many times throughout history. In a sense, we are hardwired to be xenophobic.
With this outbreak, which originated in Wuhan, [China], there was an upsurge in racial discrimination, avoidance and fear of people of Chinese ancestry. That reaction was stronger in some people than others. People who feel that they are highly vulnerable to disease are more likely to respond with stronger racism.
And we can predict that this behavioral immune system — this fear of other people — will crop up again. People who are coming to the United States from Europe, for example, might be the target of discrimination. With SARS, people in the community feared and avoided health care workers who worked with SARS patients. They feared and avoided their families, too. Again, it’s part of this xenophobic reaction.
Q: What are the psychological effects of social distancing and quarantines?
A: Seniors are being told not to gather in groups, to stay home, not to travel. In other words, they should self-isolate. We know that social isolation, loneliness and depression are prevalent problems for our senior community, and now we’re telling them to stay away from their sources of social connection and enjoyment. We need to consider those aspects. For example, encouraging people to be connected digitally or on social media.
Quarantine is a stressful experience. Some SARS quarantine patients developed PTSD as a result of their quarantine. They recovered from the virus, but the PTSD persisted. Quarantine can be a scary experience, particularly if you develop symptoms. Imagine you’re isolated, your freedom is limited — it’s almost like you’re in prison. And you’ve got severe respiratory symptoms. This makes me wonder about the cruise ship passengers who were quarantined, particularly the ones in cabins without windows, fresh air or balconies. I sincerely hope that health care authorities are following up with these people in terms of their psychological well-being to make sure they don’t develop lingering problems.
Q: How does the public response to a pandemic change over time?
A: Fears will wax and wane depending on what happens. There was a spike in fear when the [World Health Organization] started using the “p” word — pandemic. That caused a spike in people’s anxiety. What will happen in the coming weeks depends on what sort of social and economic fallout comes from COVID-19.
Q: From a public health perspective, what can be done to manage anxiety and distress for an entire community or country?
A: Community leaders need to be shown that they’re doing something, and that they have a sensible plan. They need to be seen as transparent — that they’re not hiding anything or working for ulterior motives, for example. They need to be seen as forthright in acknowledging uncertainties and addressing any rumors out there.
If you take an authoritarian approach in an individualist country, such as many Western countries, [by] telling people what to do, you’re going to get some kickback. That’s called psychological reactance. People will resist threats to their freedoms or liberties.
How do you encourage people to self-isolate when it’s boring or stressful? That might mean getting community leaders to talk to their constituents and get people to understand that self-isolating isn’t just for the only for the good of themselves, but for the community.
Q: Do you have any advice for people during the current coronavirus pandemic?
A: Treat this as something to be planned for and remind yourself that you’ll get through it. This problem will be over soon, or eventually. Be proactive and not reactive. What are you going to do to keep yourself occupied in your apartment for two weeks? It’s not going to be a fun experience, but what can you do to make it a little easier?
We also have to think about what we’ll do when a vaccine becomes available. Vaccination hesitancy, people reluctant to get vaccinated, is a huge problem. In 2019, the WHO listed vaccination hesitancy as one of the top 10 global health threats. Even during pandemics, people have declined vaccination — like with the 2009 H1N1 pandemic. Obviously, if people refuse to get vaccinated, it’s going to make it even more difficult to bring this pandemic to an end. So, it’s really important that when a vaccine is available, people are diligent in getting vaccinated.
Editor’s Note: This Q&A was edited for clarity and length.
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