Speaking of Psychology: Coronavirus Anxiety

February 15, 2020 - American Psychological Association

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About the expert: Baruch Fischhoff, PhD

Baruch Fischhoff, PhD Baruch Fischhoff, PhD, is Howard Heinz university professor in the department of Engineering and Public Policy and the Institute for Politics and Strategy at Carnegie Mellon University. A graduate of the Detroit Public Schools, he holds a BS (mathematics, psychology) from Wayne State University and a PhD (psychology) from the Hebrew University of Jerusalem. He is a member of the National Academy of Sciences and of the National Academy of Medicine and has served on many National Academies of Sciences, Engineering, and Medicine committees. He is past president of the Society for Judgment and Decision Making and of the Society for Risk Analysis. He has chaired the Food and Drug Administration Risk Communication Advisory Committee and been a member of the Eugene Commission on the Rights of Women, the department of Homeland Security Science and Technology Advisory Committee and the Environmental Protection Agency Scientific Advisory Board, where he chaired the Homeland Security Advisory Committee. His books include "Acceptable Risk," "Risk: A Very Short Introduction," "Judgment and Decision Making," "A Two-State Solution in the Middle East: Prospects and Possibilities”, “Counting Civilian Casualties” and “Communicating Risks and Benefits: An Evidence-Based Guide.”


Kaitlin Luna: Hello, and welcome to Speaking of Psychology, a bi-weekly podcast from the American Psychological Association that explores the connections between psychological science and everyday life. I'm your host Kaitlin Luna. Fear about the coronavirus has gripped the world. As I speak, more than 600 people have died from the virus, and more than 31,000 people have become sick. That's according to the World Health Organization.

Nearly all cases have been in China, but that hasn't stopped other people from other countries from worrying. Here in the US, a dozen or so people have become ill so far. While this new illness certainly is frightening and needs attention, it's important to note that far more people die from an illness that all too familiar, the seasonal flu. An estimated 10,000 people have died from it this year in the US according to the Centers for Disease Control, and 19 million have become sickened.

Why are we so afraid of this novel coronavirus when we are much more likely to catch the flu? Our guest for this episode will explain why we worry about new risks more than familiar ones, how to calm our anxiety, and more to the psychological effects of being quarantined, which is what is happening to some people who've been exposed to this new bug.

Dr. Baruch Fischhoff is a professor at Carnegie Mellon University and an expert on public perception of risk and human judgment and decision-making. Welcome, Dr. Fischhoff.

Baruch Fischhoff: Hello. Thank you for having me. Thank you, APA, for taking on this issue.

Luna: Yes, absolutely. We're happy to have you here today. Dr. Fischhoff, as I just shared, we know that the seasonal flu has sickened and killed way more people in the US than this novel coronavirus. Can you explain why Americans are fearful of this new virus that's out there?

Fischhoff: We don't really know how fearful Americans are. There is no systematic research, as far as I know, so I can only answer based on my own observations and experience with other health pandemics which I had an opportunity to work on. The major difference between seasonal flu and coronavirus, or other pandemics is that we understand seasonal flu very well.

In fact, we're part of a project sponsored by CDC trying to get our predictions of seasonal flu even more accurate. Whereas with coronavirus, we don't know where it's going. The fact that we have had no deaths in the United States as yet, is only a week indicator of what the problem is going to be. That projection will depend on two things that public health officials are still investigating. One is how transmissible the virus is when people who are asymptomatic, and second, how effective our public health measures will be.

Luna: How can people manage their anxiety about this? You see all these new stories, information on social media, it's hard not to get wrapped up in being worried about it. If you're here in the US or in a country that's not severely impacted like China, how can you manage your anxiety around this novel virus?

Fischhoff: I think the most useful thing that people can do at this stage is to find some trusted sources of information like the Centers for Disease Control and Prevention, or the World Health Organization, or some of our major media, and just stick to them for information. They're professionals. They do the best job they can of gathering and communicating the information. That will also protect you from the irresponsible, the rumor mongers, the people who are using this as an opportunity to sell things or to inflame racial hatred or ethnic hatred.

I think, find a few good sources of information. If they tell you that the virus is still remote and they give you confidence that our public health officials have the resources and the freedom to deal with this in a professional way, then you can afford to monitor until they tell you something else.

Luna: I want to talk to you a little more about how the rule of racism or xenophobia in all this. I recall a similar panic about the SARS and Avian flu outbreaks. Just a few years ago, we were in panic mode about Ebola, which originated in Africa. How do you think that plays into all how people are reacting, and the rumors you might fall prey to, that sort of thing?

Fischhoff: When a health problem like Ebola or coronavirus comes from abroad, we have poor information about it than we do about health problems in this country. Often foreign places have poorer surveillance capability, so they just gather poor information. Sometimes they have authoritarian regimes who suppress the information. We have greater uncertainty about things that come from places with poor information.

We also are vulnerable to people who have other access to grind seizing on this situation as an opportunity to inflame xenophobia, fear of other ethnic groups. We as individuals need to be above that. We expect our leaders to calm them, to calm any of those fears and to stand up for people who are being unjustly criticized.

I would say in my university at Carnegie Melon, I give our leadership a lot of credit. They've been on top of this issue from the very beginning. They provided psychological support and practical support for people who've come back from China during the winter break and might have a slightly higher probability of being affected. I think we need that kind of leadership throughout the country.

Luna: Why do you think we are more afraid of something we don't know than we are of something we know? As I say that, I was really like, "I see why people are worried about something they don't know." Can you get in the psychological reasons why this is the case?

Fischhoff: Well, putting on my risk analyst hat, I would say we have a poorer understanding of new viruses than we have of old viruses. The course of seasonal flu is pretty well predicted. We're part of a project sponsored by CDC that's getting those predictions even better. Whereas with coronavirus, we don't know where it's capable of going. If you follow the public health literature, there is a vigorous debate about the effectiveness of the kind quarantines that our country or the United States has.

There is a vigorous debate about whether the virus is transmissible when people are asymptomatic. If that's the case, then it's going to be harder to control it. There is a lot of concern and legitimate concern, the public health officials, about how widely the disease was spread during the period in which the Chinese public health officials did not respond effectively, in part because of their political regime.

Luna: Do you think some of the reactions we've seen-- I'm talking about Americans being evacuated from China, canceling flights to and from China. The State Department has issued a travel warning against people going to China as well. Do you think these are warranted in this time we're in right now where there is a lot we don't understand about coronavirus?

Fischhoff: I would hope that those decisions are made on public health grounds, rather than political grounds. Sometimes leaders will do dramatic things in order to present themselves as what they view as leaders in ways that are ineffective. The research on quarantines is that they're often ineffective, unless they're accompanied by strong support from the people whose lives have been interrupted by the quarantines, that is they need material support.

If they're not able to work and living paycheck to paycheck or gig to gig, somebody, they need help in doing that, they needed to be treated respectfully. If individuals fear that they're being not treated well, or countries feel as though they're not treated well, people will get around the vaccines or set a higher threshold for saying, "I'm not feeling so well, maybe I'm going to quarantine ourselves."

There is also a risk if we rely on quarantines that we will have opportunity cost of not doing other things that are more effective. It feels like, will this take care of the problem? As you may know, in the last two or three years, there have been substantial cutbacks in the US capability for surveillance for pandemics. Global health was demoted and its importance on the National Security Council. If we're relying on quarantines and not providing our public health officials with the resources and autonomy that they need, we may be creating problems down the road.

Luna: What about the shutting down of the Chinese city of Wuhan, which is the ground zero for the coronavirus? What psychological effects could that have on the citizens?

Fischhoff: When I often hear is a claim that people are panicking. The people who study panic, which is more sociologists than psychologists find that actual panics are rare. You'll see them more in movies than you actually see them in real life. Under crisis situations, people typically rally around one another, they support one another, they act bravely. You can disrupt that if you deprive people of the opportunity to act in a coordinated way.

If there are no trusted sources of information, then you get more or less coordinated information. I think the tragic situation of the people in Wuhan are experiencing is a result of I guess a political regime that didn't allow public health people to do their work, and then the problem got out of control, and then these draconian measures either were implemented.

You would have to ask it an epidemiologist is just how effective this is likely to be, and what is the problem of the-- I've seen an estimate of five million people who left Wuhan during the time in which the response was paralyzed.

Luna: Do you mean they left and then you're talking about getting essentially out of the city limits.

Fischhoff: That's right. They left the city and some of them are out there and some of them are-- let's hope that very few of them are sick and that they're able to get better health care than the people in Wuhan have who, from what I understand that their local health officials just don't have the surge capacity to handle a pandemic. People who are sick, go from hospital to hospital and being unable to be treated.

People who are sick with things other than coronavirus but are uncertain maybe going to places where they're exposing themselves either to that or to other things. That's a reflection of a public health system that's been under-resourced. Things that I would wonder about in this country is how good is our surveillance capacity with the recent cuts?

What are we prepared? How are we responding to the disruption in the supply chain for basic medical supplies including the masks that will be needed by healthcare officials if we have more of a pandemic here?

Luna: Yes. I imagine it's also very tough for people who are-- If their lives are put on hold there and they're healthy in a place like Wuhan. I'm sure it's very challenging if they wait for information. I don't think it's something maybe we've experienced here in the US, but it seems pretty novel to me in terms of what I know about how we respond to illnesses here.

Now, moving into America. As we speak there is about 350 Americans who are in quarantine on military bases. From what I was reading, it's people who came from China, came from flights, they had to keep them in quarantine for a couple of weeks. It's really about two weeks just to monitor them, make sure they didn't have symptoms.

The interesting thing about this, and we certainly have a lot of info about how people are doing, they seem to be not doing too badly. The New York Times is saying the people in quarantine have access to television, they're getting gourmet coffee, pizza, all that stuff. It does it seem to be too bad. I'm sure it's probably still a little frightening.

Despite the fun, I'm sure there could be lasting psychological effects of being shuttled from the plane into a military base and being under surveillance, being their temperatures checked every couple hours or so whatever happens there. I imagine these people probably have anxiety about it even if they feel fine. Do you know the effects of a quarantine on someone?

Fischhoff: My understanding of the research on that kind of stress is that there will be people who have related traumas in their lives before that any stressful event. They're more vulnerable to any stressful event. I think if one did a systematic interview person by person, you would find some variability that-- You would also find that some people whose lives are more disrupted than others, if they're responsible for a vulnerable family members, or if they don't have the economic ability to withstand the loss of income for this period of time.

I think that what one sees superficially at a group level is what people usually do. They're resilient, they're mutually supportive, they rally to one another, they try to make the best of a bad situation. If we rely on people's natural resilience and if the authorities treat them in a respectful way and minute in and attend to their material needs as well as they can, one would expect most people I believe to get through it well.

Luna: I did find a study in the journal Emerging Infectious Diseases that studied 129 people who were quarantined with SARS, that was in the early 2000s I believe. They found that many had psychological distress including post-traumatic stress disorder and depression. They found that the longer someone was quarantined, the higher likelihood that he or she would experience PTSD symptoms. Obviously, this shows that being isolated from others can bring up a host of negative feelings. Why would you think PTSD symptoms would be so high?

Fischhoff: Well, SARS is different than coronavirus at this moment, in that SARS had a much higher case fatality rate. If the people were quarantined, and either had symptoms or thought that they might get sick, there was a lot of legitimate anxiety as more people were dying. We didn't have a cure at that time or better cures at that time.

I suspect that the social treatment might have been more stigmatizing, and the longer you are isolated from your normal life, the more disrupted is the more your vulnerabilities are being tested, and the more things that go wrong in the life that you're not able to keep together. We all have day to day challenge of keeping our lives together.

I think the combination of not knowing where this was going, which had legitimate fears of which much greater than the people who are currently quarantined in the US regarding coronavirus and the longer disruption would have either triggered vulnerabilities particularly people who are vulnerable already.

Luna: It's interesting. I also found that being an acquaintance or having direct exposure to someone with SARS was also associated with PTSD and depression. Why would you think that would be the case?

Fischhoff: Again, this is not my specialty, but from my understanding of that research literature from people that I've worked with, is that maybe it's just a common-sense result. There are people we love, and we care about them, and we're anxious whenever they're sick. In some ways, we're even more powerless than they are. They can rally and we can just worry. It seems a normal, in some ways a healthy human reaction that takes a toll.

Luna: Yes. That makes a lot of sense. I'm sure it's very difficult especially in those situations when being in quarantine, there was a lot of fear at that time when SARS was out. Going back to the public health response. What is your perception of the public health? How officials are responding to it?

They seem like-- I mean there's a lot that is not known, and I understand there'll be meetings coming up soon to talk about what we know about this virus, that sort of thing. Do you think that they're in panic mode? Obviously, we've been through SARS, the avian flu, Ebola, swine flu that sort of thing. What is your perception of how public officials are responding?

Fischhoff: I would say if panic is rare among the general public, it's almost non-existent among public health officials. They are the most idealistic, toughest, bravest, hardworking profession that you can imagine. I think they're under a lot of pressure to deal with this. They have very few resources, which again, have been cut back over the recent period.

What I would like to see more from them is a more scientific approach to communication, that is when we-- A scientific approach to risk communication would be starting analyzing the decisions that people face, finding out what information is most critical to them, finding out what they currently believe, drafting messages based on what we already know about how to communicate different things, and then testing those messages.

I don't have a sense that they're very well intended messages, at places like WHO or CDC have that rigor. For example, a question that is a specific decision that has occurred to many people is, should I be stocking facemasks? What do I need to know in order to answer that question? One is how effective are face masks for today's risks and will face masks be available, should the risk get greater?

It's my understanding, not being a medical doctor, that face masks are not particularly effective, even worse, they're not needed now. They're actually not particularly effective unless you have a very high quality to protect yourself, unless you have a very high quality face mask and are well trained and well-disciplined in putting it on and taking it off.

Face masks will, if you're sick with cold or flu or anything, you can help to protect other people, but if you're worried about protecting yourself, and you're not a health official, you probably don't need to worry about it. What about in the future? Let's say there is flu and they will be useful and I think that I could diligently put it on and take it off, then it's really a question of, who are the institutions that are responsible for ensuring that we have an adequate supply of facemasks and they are distributed to the people who need them most? For that, I need to be looking at the Department of Health and Human Services and see whether there are people that I trust to handle this situation.

Luna: Just as we close out, I want to summarize for our listeners, just what did you take away from this? Can you just give me a few points they can take away from this podcast as they see how this virus plays out and how they might be managing how to manage their anxiety?

Fischhoff: I think the first thing that people can do is to find a trusted source of information and just follow that. That will insulate them from rumors, and that will help them to get a clear picture and see how things are changed. Second thing is, you can do a very simple risk analysis which is to say, is there any reason to think that I am at risk? Are there cases where I am, if there are, have I come in contact with them? Third thing you could do is, do a simple risk management, which is to figure out what are the few things that you can do most effectively?

If you go to these trusted sources, they will tell you that you should wash your hands really well, and you should maintain a distance from somebody who might have the flu. Then you should avoid becoming a source of risk to other people, by insulating yourself if you're sick, coughing into your sleeve using a tissue and throwing it out. If you do those three things, it will get you most of the information that you need, and it will enable you to play a responsible role and getting on top of all of this and it will protect you from seasonal flu, which at the moment is a bigger risk than coronavirus is, and we hope the coronavirus ever will be.

Maybe the fourth thing I would add is to be supportive of people who are under greater stress. Those will be people who do have anxiety that's been triggered by this or people who do feel like they've been discriminated or worried about loved ones. Those are again things that we hope that we all do anyways.

Luna: Thank you so much for those tips, Dr. Fischhoff. I think that will be very helpful. This will help calm people's anxiety and help ease some of the worry that's out there. I appreciate your time.

Fischhoff: Thank you for the opportunity to talk with you.