The social consequences of microbial epidemics
can result in temporary collapse of societal order. Three phases typically
occur: fear – rationalization – action. Civilized behavior, pain-stakingly
learned over millennia, is easily cast aside, resulting in selfishness,
persecution, stigmatization, avoidance and segregation.
Fortunately, at least in the past, things have returned to normal quite rapidly,
after the epidemic disappears. Existential threats such as pandemics can also
generate positive consequences such as speedy clinical trials
Smallpox, malaria,
cholera, tuberculosis, typhoid, the black plague, yellow fever, influenza, HIV,
Ebola, Zika and corona viruses. Microbial pests are nothing new to humankind.
Societal reaction has also stayed the same. According to Philip Strong (1990),
a microbial epidemic results in the psychological plagues of fear, panic,
suspicion and stigma. This initial phase is followed by explanation and rationalization.
The third phase is characterized by action.
Fear
The
psychological consequences of epidemics are strikingly similar to the actual
epidemic. In our current age when information is available ubiquitously,
without any delay or filter, fear and panic spread even faster than the
microbe. Fear leads to stigmatization, avoidance and segregation, all of which
have already been seen with corona.
Rationalization
The second psychological
phase, the explanation for the pandemic, appears straight-forward once the
causative microbe has been identified. However, there are many things which remain
unclear in the current corona pandemic. How contagious is the virus and for how
long? Can symptom-free people spread the virus? What is the death rate? How
many people die with corona instead of because of corona? Why does the virus
seem to spread more in some countries than others? Will there be second, third
and fourth waves like with the Spanish flu?
All kinds
of explanations and theories are abundant. Many people are unable to decide how
they rate the importance of the pandemic and which restrictions on our freedoms
they consider acceptable. How much economic punishment and social problems can
be tolerated to fight or delay the epidemic?
Unbelievers
and pandemia cynics can suddenly become messianic, rushing out to warn and
convert others.
Rationalization
can have a metaphysical aspect. Who is to blame? God? People from some country?
Society?
All kinds
of moralization is also seen. Initially, China was blamed. Then, Europe was
blamed. Smokers deserve some blame if they get the disease? Old and ill people
are to blame because they burden health care?
Action
The third
phase, action, was initiated with different speed in different countries. In
some East Asian countries, rigorous action was taken rapidly, resulting in fast
control of the first wave of the pandemic. In many Western countries, the virus
was able to spread more widely before countermeasures were implemented. Many
political leaders displayed plenty of initial self-deception. Also, the degree
of the measures taken varied. For example, geographical quarantine, closing of
schools, restaurants and services varied between countries.
Just like
corona is able to infect almost anyone, also the psychological consequences –
fear, explanation, action – have been seen in all levels of society. Anyone can
panic, then rationalize and then call for action. Terror and irrational
behavior can occur despite a person’s education or experience.
Why do epidemics cause so much anxiety
Why is
corona feared much more than cancer or cardiovascular diseases, which kill up
to 10 and 20 million people every year, respectively? One obvious reason is
contagiousness - no one can feel safe. However, seasonal influenza kills
hundreds of thousands each year, and in bad years the death toll goes up to millions.
As of 6 Apr 2020, corona has killed about 70 000 people in the first 5 months
of the pandemic, and some of these deaths might have been with corona instead of due to
corona.
Admittedly, the corona death toll is still on the increase and we don’t
know yet how high it will rise. Nevertheless, keeping in mind that 160 000
people die each day from different causes, and corona currently causes about 3%
of these deaths, mortality alone does not seem to explain the magnitude of anxiety
seen.
Another
reason is that the newer the disease, the bigger the fear, and the more
dramatic the call for action. With new diseases there can also be a feeling of
helplessness, as there are no vaccines or proven drugs.
In an amazing
contrast, underlining how we become tolerized to older threats, each year
hundreds of thousands of doses of influenza vaccine go unused. Even among risk
groups the coverage of influenza vaccination is frequently less than 50%,
depending on the country. Well known killers such as smoking and alcohol use
are allowed in most countries. Consumption of red meat, fat and sugar is
allowed despite known increases in risks of cancer and cardiovascular diseases.
Contributing
to anxiety about new diseases, there is the media-propelled fear of the
unknown. The disease has spread rapidly; how many people will eventually die?
Will health care systems be able to cope? At what price? In developed
countries, health care has already been under increasing pressure because of
aging populations. Which diseases will be de-prioritized to deal with corona?
Positive aspects
Are there
any good sides to a pandemic like corona? It is part of human psychology to
think that whatever doesn’t kill us makes us stronger. That something good will
arise from something bad. Perhaps globalization and unnecessary travel will be
reduced, resulting in benefits to the environment? Perhaps people and systems will
be more aware of infectious agents and try to avoid spreading them? Microbe
awareness is the only way to reduce the frequency of future pandemics and infectious
diseases in general. Otherwise, problems caused by microbes will just keep on
increasing, because the population of the world is still going up and the
amount of travelling has also grown constantly. The more contacts between
people from different regions, the more fertile ground for microbes to spread.
We have
already seen some positive aspects developing. Increased caring has emerged in
many people. Neighbors have started helping each other. Teddy bears line
windows. Citizens are collecting money to buy new respirators for the local
hospital.
From a
scientific and medical perspective, perhaps the most striking phenomenon has
been the extremely rapid initiation of clinical trials with both new and old
corona drugs and vaccines. This is in sharp contrast to the usual pace of
clinical trials. It can take years to set up clinical trials in oncology, despite
the huge unmet clinical need in most metastatic types of cancer (Hemminki 2015).
In many metastatic tumors, the death risk is nearly 100%, which is much higher
than with corona.
Summary
The
psychological consequences of pandemics are fear, rationalization and action.
The newer the disease, the more profound these reactions are. Despite
improvements in medicine and hygiene over centuries, psychological reactions to
epidemics have remained unchanged. Threat of contagion generates a
psychological flight-or-fight response, often bringing out the worst in
humankind, underlining evolutionarily conserved survival mechanisms.
Akseli
Hemminki, MD, PhD, eMBA
Professor
of Oncology
References
Hemminki A.
Crossing the Valley of Death with Advanced Therapy. Published by Nomerta,
Turku, Finland, 2015. Available at http://www.nomerta.net and several e-book
stores globally
Philip
Strong. Epidemic psychology: a model. Sociol Health Illness 1990. Vol 12; No 3:
249-259. Free on the web.
