Everything old is new again
Everything we’re seeing in the current COVID-19 outbreak has been seen before in previous epidemics and pandemics; the rise of fear, racism, panic buying of food and medicines, conspiracy theories, the proliferation of quack cures, and avoidance of places associated with particular ethnicities. These things have been observed in pandemics dating back to medieval plagues, if not earlier. Jewish people were feared and shunned during the Bubonic Plague in the 1500s. During the 1918 Spanish flu, which occurred during World War I, people in America feared that influenza was being deliberately spread by Germans. During the 2003 SARS outbreak, there was shunning, avoidance, and discrimination against Chinese people. During the 2015 Zika pandemic, conspiracy theorists claimed that the virus was bioengineered by the Monsanto corporation.
COVID-19 is on the cusp of becoming a pandemic but so far in Canada there been only been a trickle of cases. Yet, the psychological fallout has been considerable. According to an Angus Reid poll in early February 2020, 7% of Canadians—that is, an estimated 2.6 million people—were “very concerned” about becoming infected even though at the time there were only four Canadian cases of COVID-19. In the same survey, 3% of respondents—that is, an estimated 1.1 million people—had purchased facemasks, even though there is no evidence that facemasks protect the healthy public.
In the same poll, a third of people were not confident that the healthcare system in their community was prepared to deal with new cases of COVID-19. Lack of faith in the healthcare system is likely to fuel fears about the consequences of becoming infected. Lack of trust in health authorities can also lead to noncompliance with public health measures such as hygiene guidelines.
Managing pandemics is largely a psychological problem because the methods of controlling infection are behavioural in nature. The public must agree to adhere to things such as performing basic hygiene such as handwashing and covering coughs, adhering to voluntary isolation when one is infected, and seeking vaccination if a vaccine is available. Nonadherence to each of these measures is a notorious problem, occurring even during pandemics.
Have we learned the lessons of past pandemics?
Have health authorities such as the WHO learned the lessons of previous epidemics and pandemics? Yes and no. The WHO carefully selected the name of the new coronavirus, COVID-19, avoiding reference to places, animals, or people. This is in contrast to the names of earlier influenza pandemics or epidemics, which were given labels such as Hong Kong flu or Russian flu, which provoked discrimination, and Swine flu or Avian flu, which provoked the needless slaughter animals.
Misinformation has long been recognized as an important problem in managing public reactions to pandemics. The WHO recognize the problem of the overabundance of information—an “infodemic”—which makes it difficult for people to identify trustworthy sources of information and guidance. Social media have been identified as important sources of rumors, unfounded conspiracy theories, and other sources of misinformation. Censorship of misleading information is impractical and likely to backfire. Censorship will incite a proliferation of conspiracy theories about COVID-19. More workable solutions are being sought, such as tweaking Internet search engines so that the top hits in a given search are more likely to be linked to reliable sources of information.
There are two important lessons from past pandemics that have not been learned by health authorities. These concern the burden of the “worried-well” on the healthcare system and the problem of infection-related racism.
Past pandemics have shown that we need to think more broadly about the coming demands on the health care system. We need to think about the surge of worried-well people into clinics and hospital ERs. That is, the influx of people who misinterpret minor coughs and sniffles as signs of possible infection with COVID-19. Research from the 2009 H1N1 influenza pandemic has shown that the number of worried-well presenting to hospitals can be as great or greater than the number of people actually infected with the virus.
Infection-related racism is a well-known problem that commonly arises when people are frightened of being infected by “outsiders”. For COVID-19, this problem has not been addressed in any meaningful way by health authorities. To deal with COVID-19 related racism it is important to understand the motivational roots of xenophobia.
Xenophobia: A primitive aspect of human nature
Pandemics reveal a primitive side of human nature; a xenophobic, tribalistic, “us versus them” mentality. From an evolutionary perspective, fear and avoidance of strangers is an effective way of avoiding infection. This is because a common way of getting diseases is from other humans, especially when foreign groups intermingle, in which one group introduces a disease that the other group has never encountered and has no immunity. European explorers to the Americas, for example, brought smallpox, influenza, and other viruses, which decimated the indigenous inhabitants. Accordingly, research shows that when people are threatened with infection from a new, potentially dangerous pathogen, there is a corresponding increase in racism and other forms of xenophobia. People who greatly worry about their health are especially likely to become xenophobic when they feel threatened with infection.
Understanding the psychological roots of xenophobia is important for dealing with the problem of COVID-19 related racism. Xenophobia arises when people are threatened with infection, with some people reacting more extremely than others. The fact that infection-related xenophobia is common doesn’t make it morally right. There is a pressing need to understand how it happens and how it might be managed. A short-term “band-aid” solution is to target racist behaviours by educating people about COVID-19 related racism is irrational and morally unacceptable. Unfortunately, however, suppressing racist behaviours doesn’t necessarily change racist attitudes. Currently, there are no easy solutions to this pressing problem.
What will happen when a vaccine becomes available?
When a vaccine for COVID-19 becomes available, we will face a new problem: Many people won’t get vaccinated. This occurred during the 2009 H1N1 influenza pandemic, in which more than 60% of people did not seek vaccination, according to studies conducted in Canada, the US, and UK. In a study conducted in Switzerland during the same pandemic, fewer than 20% of people sought vaccination. Regarding COVID-19, a recent US survey found that only 48% of people said they would get immunized if a vaccine became available.
Researchers have long recognized the problem of “vaccination hesitancy”, because it is a major problem for seasonal influenza. Indeed, the WHO declared that vaccination hesitancy, for vaccinations in general, was one of the Top 10 threats to global health in 2019. It is important to understand people’s reasons for not getting vaccinated. There has been a considerable amount of research done on this topic, but mostly focusing on seasonal influenza and other common diseases. Health promotion strategies have been developed to encourage vaccination, but it remains to be seen whether they will be useful in encouraging people to get vaccinated against COVID-19.
There has been much excitement about the possibility of a COVID-19 vaccine. Unfortunately, the vaccine will have little impact on halting the spread of infection if most people don’t get vaccinated.