Psychology of Viral Pandemic: What We Need to Know and Do

Contagious fear may be more dangerous than the viral contagion.

Posted Mar 01, 2020

Gerdalena/dreamtime
Source: Gerdalena/dreamtime

According to the World Health Organization (WHO) in 2003, the world faced an outbreak of a coronavirus referred to as Severe Acute Respiratory Syndrome (SARS). Approximately 8400 cases emerged in two dozen countries resulting in 813 recorded deaths.

Zhong Nanshan, director of the Guangzhou Respiratory Research Centre, said regarding the Severe Acute Respiratory Syndrome (SARS-CoV) outbreak: “The psychological fear [of disease] is more fearful than the disease itself. The psychological contagion effect is always more far-reaching than the physical contagion."

Dr. Nanshan may have an important point that is relevant today as we face the COVID-19 pandemic. Consider that the US Centers for Disease Control and Prevention (CDC) notes in the 2017-2018 flu season as many as 45 million cases of the seasonal flu arose resulting in 61,000 deaths. From October 2019 through March 2020, there have been at least 39 million flu illnesses, 400,000 hospitalizations, and likely over 30,000 deaths from seasonal flu in the United States.

Regarding COVID-19, CDC notes over 216,000 cases in the U.S. with over 5,100 deaths through the end of March. Experts now tell us to expect an excess of 100,000 deaths. There is no question COVID is a very serious illness that may result in more than twice the fatalities attributable to the seasonal flu. And yet the fear associated with COVID-19 has the potential to acutely cripple life as we know it through its effects on work, healthcare, school, travel, and supply chains far more than what one would expect in proportional comparison. Why? Because we feel out of control.

Stock Markets as a Proxy for Psychological Health

In the midst of the deadly seasonal flu, the U.S. stock markets set all-time records. Yet, in the early stages of COVID-19, the Dow Jones has dropped 8000 points in just over two weeks, the most rapid “correction” in history now placing the Dow into "bear market" territory. According to financial reports, this equates to a loss of over $5 trillion. And there is no bottom in sight. Psychiatrist Robert Ursano once summarized a similar situation well, saying, “The microbial world is mysterious, threatening, and frightening to many people…”

Human beings in general, and stock markets in particular, fear the unknown. Behavioral economist Richard Peterson notes, "It's irrational and it's fear, but it's important in financial markets because it changes economic behavior." David Fickling wrote in Bloomberg.com: “The next few months are likely to test all of us.” His prediction will surely extend far beyond the financial markets and reach into every aspect of our lives.

Fear can lead to irrational, even life-threatening actions. When we act out of fear, our thoughts are about the moment and seldom do we think about the long-term consequences of our actions. Recognizing this, financial advisors usually encourage us to rebalance portfolios, but not impulsively take all of our money out of the stock markets. The Surgeon General discourages us from hoarding face masks that do little to protect against the virus but may lead to a shortage of healthcare workers in hospitals. And CDC recommends getting a flu vaccine and taking realistic, practical steps every day to help stop the spread of the virus. More specifically, avoiding close contact with people who are ill, washing our hands often (for at least 20 seconds), and frequently cleaning and disinfecting surfaces at home, work or school. It’s also important to take flu antivirals if prescribed. 

ID174121449/dreamstime
Source: ID174121449/dreamstime

But fear, if based upon rumor or irresponsible speculation rather than knowledge, can be irrational and deadly if it leads to a distrust of healthcare authorities and worse yet hopelessness. If we distrust healthcare authorities, we are less likely to be compliant with critical recommendations that could curb the contagion of the virus. Thus more people would become infected and potentially die. If a sense of hopelessness descends we become numb, economic systems collapse, and once again we become medically non-compliant. In short, we lose the greatest strength we have, our humanity.

In the Roman poet Ovid’s Metamorphoses, Cephalus of Aegina describes the effect  a plague in his homeland had on the psyche of its victims: “As all hope of recovery waned, the [people], seeing a fatal termination approaching, gave in to whimsy and neglected all practical concerns, because nothing was any longer of importance.”

Lessons Learned

“Those who fail to read about the past are doomed to repeat it,” Santayana famously said. I shall leave the medical aspects of COVID-19 to the biologists, but I shall comment on the psychological implications of what we face.

Perhaps uniquely so for a psychologist, this is not my first encounter with responding to infectious diseases. I provided consultations to the government of Hong Kong in the wake of SARS and to the United States government over concerns for the H1N1 virus.

These reports are published elsewhere, but let me summarize a few of the lessons learned when responding to the psychological consequences of a pandemic.

  1. Effective, resilient, focused leadership that empowers people to act on their own behalf is essential. Experience and research have taught us that to be most effective in a crisis, leadership must provide the following (Everly, Strouse & Everly, 2010): a) an optimistic focused vision and realistic plan, b) decisive action (the error of acting prematurely is almost never as severe as the error of hesitating and acting too late), and c) honest, open, and frequent communications, in order to combat the “infodemic” of fear misinformation replete in social media. 
  2. To be most effective, leadership must structure its crisis communications to answer, updating as necessary, the following questions: a) What is the illness? b) How did the illness start? c) How contagious is the illness and how is it spread? d) What are the effects of the illness going to be and how lethal is it? e) What is leadership doing to contain the spread and how can people protect themselves? f) What should people do if they expect they have been infected? Our experience has taught us two powerful lessons and prescriptive principles about crisis psychology that are too often ignored by leadership and even public information specialists: First, anticipate and answer questions before they are asked. Second, most people want action-oriented information that is empowering. They want to know what to do (and why) in order to best help themselves. Empowering information brings structure and hope to chaos, ambiguity, and hopelessness.
  3. Health departments must establish continuing mental health surveillance in addition to physical health surveillance
  4. Health departments should prepare for a surge of mental health concerns related to the virus and its spread. People generally do not panic. They can, however, act irrationally when faced with a serious threat in the absence of credible information. Dr. Ronald Mandersheid in a 2007 report argued that a third of people will be psychologically unaffected, a third will be hypervigilant (anxious and fearful), while up to a third could be severely impacted psychologically (immobilized). Telephone hotlines and frequent public service announcements updating information in real time are essential. Psychological first aid (PFA) should be taught to anyone who might interface with the public. Health departments, hospitals, and clinics must also address the willingness (or resistance) of healthcare workers to respond to situations and environments wherein their health and the health of their families are in perceived jeopardy.
  5. Lastly, government and healthcare facilities should employ a resilience-focused continuum of care (cf. Johns Hopkins Resilience Continuum; Kaminsky, et al., 2006) consisting of psychological interventions designed to set appropriate expectations, provide crisis-oriented psychological first aid and triage, and prepare to provide treatment to those who become psychologically immobilized.
  6. Never forget, there is no such thing as an information vacuum. In the absence of credible action-oriented information, people will make up their own answers to the questions enumerated above. They will then spread them via social media. At this point, health authorities and governmental leadership will have lost control to those most distressed individuals with the best media feeds. 

© 2020, George S. Everly, Jr., PhD

References

Everly, GS, Jr., Strouse, DA, Everly, GS, III (2010). Resilient Leadership. NY: DiaMedica.

Kaminsky, MJ, McCabe, OL., Langlieb, A., & Everly, GS, Jr. (2007). An evidence-informed model of human resistance, resilience, & recovery: The Johns Hopkins’ outcomes-driven paradigm for disaster mental health services. Brief Therapy and Crisis Intervention, 7, 1-11.

Perrin, P. C., McCabe, O. L., Everly, G., & Links, J. M. (2009). Preparing for an influenza pandemic: Mental health considerations. Prehospital and Disaster Medicine, 24(3), 223-230. https://doi.org/10.1017/S1049023X0

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Saathoff G, & Everly GS, Jr. (2002). Psychological challenges of bioterror: Containing contagion. Int J Emerg Ment Health, 4, 245-252.

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