In early 2019, months before the world had heard of Covid-19I’m done writing a book with the title Pandemic psychology: Preparing for the next global outbreak of infectious diseases. The first publisher rejected it and dismissed it as “an interesting book that no one would want to read.” It was finally released in print in October 2019, a few weeks before the first documented cases of Covid-19 in Wuhan, China.
I wrote the book because, as a psychologist, I sought to deeply understand the interplay between human behavior, illness, distress, and social disorder. There is a lot to study. Which has been more than 20 pandemics over the last 200 years alone, including the “Russian flu” of 1889-90, which killed one million of the planet’s 1.5 billion people, and the infamous “Spanish flu” of 1918-20, which took more than 50 million lives. Fortunately, the 2003 SARS outbreak, which did not reach pandemic proportions, disappeared.
Although each pandemic had a unique historical context and disease characteristics, human behaviour was less varied than you might think.
In many major outbreaks in the last century, the news media reassured and alarmed the public, and political leaders downplayed the seriousness of keeping the economy running. There was an increase in xenophobia, racism, rumors, conspiracy theories, panic buying, quacks and profiteering. Emotional disorders such as anxiety and depression arose or worsened. There were protests over restrictions on social distance and related mandates and occasional violence, but more often an increase in altruism.
Many of these things have surprised community leaders during Covid-19; they should not. Mankind’s reactions to the current pandemic are reflected in the past, which may help plan our future.
Panic combined with rumors and misinformation can lead to desperate actions. During the Spanish flu, some people became ill from drinking hydrogen peroxide in the belief that it would kill bacteria, just as drinking or injecting bleach became a concern during Covid-19. During the cholera pandemics of the 19th century, there were rumors that the disease was caused by a poison introduced into the water supply to kill the poor. This led to extensive riots. Full-scale panic like this, however, is rare, at least for respiratory diseases like Covid-19.
Instead, when faced with threats like these, most people try to cope by finding ways to limit or control risk. This can be reassuring, even when the feeling of control is an illusion. During the Spanish flu, there were panicked purchases of aromatic bags of camphor, which people wore around their necks, although these were not reported to be more effective than carrying a good luck charm. During Covid-19, some people stored toilet paper; others diligently scrubbed surfaces in a “hygiene theater” long after research showed that this was not necessary. These actions do not do much to keep people safe, but still provide comfort.
Another common reaction is the flight from cities to perceived security sites such as the countryside. This can lead to infection far and wide. During the bubonic plague of 1527, theologian Martin Luther – the founder of Lutheranism – delivered a sermon on resisting the innate urge to flee from sickness. When a plague broke out in India in the city of Surat in 1994, there was a panicked exodus of tens of thousands of people. In the early days of Covid-19, many people traveled out of Wuhan (perhaps more for New Year’s holidays than out of fear); the number of infected cases in China marched upwards with the number of people on the move.
The denial problem
At the other end of the psychological spectrum from panic is denial: Some people consider the threat to be exaggerated or a hoax. During the Spanish Sick 1918-20, an Anti-Mask League was formed in San Francisco, arguing that masks were unnecessary, ineffective, and violated civil liberties.
My research team has studied thousands of Canadian and American adults during Covid-19. By mid-2020, about 15 per cent had Covid stress disorder, characterized by severe, disabling anxiety. These people tend to have a history of anxiety or emotional difficulties, which have been exacerbated by the pandemic.
Similarly, about 15 percent leaned toward denying the severity of the pandemic. These people tend to see themselves as highly healthy and impenetrable to Covid-19; they often ignore social distancing and have anti-mask and anti-vaccination attitudes. They are also likely to experience psychological reaction: an intense state of rejection of attempts at persuasion or regulation that is perceived as a threat to freedom of choice. Reactions such as anger are associated with antisocial and narcissistic personality traits and with political conservatism.
That challenge that officials face in response to a pandemic is to change behavior to minimize both loss of life and mental disorders. Governments typically respond with increasingly serious warnings to people rejecting the severity of a pandemic, which unfortunately increases the anxiety of people who are already afraid of the disease.
The government’s restrictions on socializing are particularly harsh: People are innately sociable and find it emotionally tiring to stay apart. Our ability to adhere to rules of social distancing tends to deteriorate over time. During the Spanish disease pandemic of 1918, public cooperation with such rules fell with successive waves of infection. For Covid-19, a study showed that during 2020 even as the mask bearing increased steadily, compliance with physical distance decreased. The toll on society’s economy and mental health is built up when strict restrictions remain in place over months or years; protests and other forms of insurgency intensified.
There are silver liners for pandemics. Altruism rises: People bring the sick supplies and cheer on health professionals. Our research under Covid-19 found that 77 percent of the thousands of people we surveyed (none of whom had even contracted Covid-19) experienced post-traumatic growth: positive personal changes due to stressors and other challenges experienced during the pandemic. Commonly reported positive changes included increased resistance to stress, deeper appreciation of friends and family, improved spirituality, and recognition of new opportunities. This goes beyond just “bouncing back” from adversity.
None of our current pandemic challenges are new. The question is whether we can learn from these experiences. Can governments change their response measures to minimize the 15 percent who are stressed or the 15 percent in denial while effectively keeping the infection at bay? Can social safety nets and counseling alleviate mental health issues and enhance the experiences of growth? It’s worth a try. Mankind has been here before and will be here again. Let’s be ready next time.