The Psychology of Pandemics

That's a really good question. History has taught us that we're not very good at learning the lessons of the past. We forget, too quickly, the lessons of the past. Everything we're seeing in the current pandemic has happened in previous pandemics--fear, racism, panic buying, distress over self-isolation, and so on. The problem is that when a pandemic is over, people tend forget about it and move onto whatever else is immediate in their life. This time around we need to do things differently. We need to use the lessons learned from COVID-19 to prepare for the next pandemic. That said, history has taught us some important things for the current pandemic. One of the most important things concerns vaccination hesitancy. In past pandemics and epidemics, many people have neglected to get vaccinated, for a variety of reasons. We can expect that the same thing will happen for COVID-19, when a vaccine becomes available. So, we need to be proactive; to start a community dialogue about the importance of getting vaccinated when a vaccine becomes available.

Some people are highly anxious about COVID-19. But as a community, are we over-reacting? The public opinion surveys I've seen suggest that most people are concerned but not panicking. Social distancing strategies, such as closing schools or cancelling concerts, might seem dramatic but they are good way of stemming the spread of infection.

Conspiracy theories arise during times of uncertainty to help people make sense of threatening events. People differ in their tendency to embrace conspiracy theories and there are various reasons why people engage in conspiratorial thinking. Overall, the research suggests that conspiracy theories appeal to people who seek accuracy or meaning about personally important issues, but lack the cognitive resources or have other problems that prevent them from finding the answers to questions by more rational means. For example, people who strongly believe in conspiracy theories tend to have a poorer ability to critically analyze the source and contents of news stories, as indicated, for example, by the tendency to believe in fake news. Conspiracy theories may also allow people to feel that they possess rare, important information that other people do not have, making them feel special and thus boosting their self-esteem.

This is an important but very broad question. My response here is geared specifically toward healthcare workers (HCWs) and their organizational infrastructure, all of which are vital the battle against COVID-19. HCWs are at risk for experiencing various kinds of job-related stressors, including (1) a heightened risk of personal infection, sickness, and death, due to their frequent contact with pandemic patients, (2) overwork and fatigue, (3) exposure to the death of others, including exposure to deaths on a mass scale, (4) the inability to save their patients despite great efforts, (5) threats of violence from people seeking scarce or limited medical resources, (6) separation from family, loved ones, and social supports during the pandemic response, and (7) the stress of inadvertently spreading infection to others, including friends, family and loved ones. Therefore, it is important to provide training to HCWs, such as hospital nursing and medical staff, on the psychological aspects and treatment of pandemic-related distress. Treatment resources particularly for front-line HCWs would also be useful, such as collaborative pandemic planning and organizational preparedness training, increasing emotional resilience by promoting adaptive coping (training in stress management, encouraging self-care such as taking regular breaks), provision of peer support, identifying those at high risk and providing intervention, and offering long-term support after the event to assist with residual effects. For front-line healthcare teams, it is important to build team cohesion and morale so as to combat fear, helplessness, and burnout. Healthcare workers also would likely need support if they or their families being threatened or ostracized because people fear exposure to disease.

The book is available from Cambridge Publishers.

I agree that it can be challenging to get younger children to practice good hygiene. It can help to enlist an older child as a helper; that is, a child who can model good hand washing etc. Sometimes kids are more likely to listen to, and imitate, other children around their own age.

Very little is known about how children were affected in past pandemics. Descriptions at the time of the Spanish flu (around 1918) suggest that some children developed symptoms similar to those of posttraumatic stress disorder. For example, vivid, intrusive, and persistent images of their parents' coffins. Very little in the way of mental health treatment was available back then.

There will be various types of long-term patterns. The main pattern will be resilience: People may feel stressed during the pandemic but will make a full recovery afterwards. They may, however, see the world differently than they did before; that is, they may have to adjust to the “new normal” if COVID-19 becomes a recurrent (e.g., seasonal) infection. A minority of people will have lingering psychological problems. It is difficult to predict how many people will have long-term problems. Such problems could include long-lasting depression, anxiety, or symptoms of posttraumatic stress disorder. Risk factors for long-term problems include (a) a history of previous emotional problems, and (b) exposure to severe stressors during the pandemic. Stressors include severe, life-threatening illness, death of loved ones, severe financial hardships and economic losses (e.g., due to social distancing), and stressful experiences during quarantine (e.g., severe symptoms combined with absence of contact with friends or loved ones).

Burnout among healthcare workers (HCWs) is a major concern, and HCWs are at risk for becoming infected with COVID-19, which creates additional stress. During the SARS outbreak, being quarantined was particularly stressful for HCWs, and some developed symptoms of post-traumatic stress disorder (PTSD). But on the other hand, research shows that most people are resilient to stress. For the current pandemic, some, and perhaps most, HCWs will emerge from this event will little or no lingering psychological ill effects. But some HCWs may develop emotional problems such as symptoms of PTSD. A supportive work environment is essential for protecting frontline HCWs.

There are a variety factors that influence whether a person under- or over-estimates the seriousness of COVID-19. These include trust in information they receive from government, health authorities, and the news media. People with low trust are likely to dismiss warnings. In addition, some people are overly optimistic in the way they view themselves and the world. They tend to dismiss health warnings because they believe that they will not be affected.

At the other end of the spectrum are people who overestimate the risk posed by COVID-19. They tend to be people with pre-existing anxiety problems are likely to become highly anxious during the current pandemic. People with Generalized Anxiety Disorder, for example, tend to chronically worry about a variety of things (e.g., their job, health, finances, family, etc.) and therefore are likely to worry excessively during the COVID-19 pandemic. People who score high on particular personality traits are also likely to be especially anxious during the COVID-19 pandemic. These include traits such as Negative Emotionality (i.e., the longstanding tendency to be easily distressed or upset by day-to-day stressors) and Intolerance of Uncertainty (i.e., the tendency to become anxious when faced with uncertainties in their lives). COVID-19 is associated with various kinds of uncertainties, and so people who have difficulty coping with uncertainty are likely to be particularly anxious.

Seniors have a heightened risk of mortality from COVID-19, especially those who are medically frail. So, a degree of anxiety is very understandable. It is important that seniors have assurance that their living circumstances are safe, including assurances that their healthcare providers are practicing good hygiene. Beyond that, the same anxiety management strategies that are used for people in general can be used with seniors; for example, practice the stress-management strategies that you would normally use, maintain a healthy lifestyle, limit your exposure to sensationalistic news media or social media, and remind yourself of the facts: Your odds of harm are low if you practice good hygiene.

I would begin by asking your children what they know about COVID-19. What have they heard from their friends, their friend's parents, from their teachers, seen on the Internet, and so forth? This will give you a good understand about the basis of their fears. Perhaps they're frightened that they may die, or perhaps they're frightened that a parent or grandparent might die. Once you understand the basis of their fears, then you'll be in a good position to address their concerns. You might tell your children that the illness is mostly mild, and that they and everyone else can stay safe by washing their hands, covering their coughs, and following whatever social distancing recommendations are in place in your community. You might also want to limit the amount of time the children spend looking at fear-evoking images or videos of the pandemic, which have been circulating on the Internet. Keeping regular routines is also important. Carrying on as normal, as far as possible, can have a calming effect. For example, if you're in self-isolation with your children you could maintain regular meal times and bed times, and so on.