Facing Fear and resilience in the face of uncertainty
I was in New York City last week at a dinner hosted by the Pasteur Foundation.
At the event, there was no shaking hands but a lot of elbow bumps, handwashing and cleaning surfaces assiduously. It was a whirlwind visit of less than 24 hours, but everywhere, talk was of the virus. The driver who picked us up at the airport said business had plummeted in the past 1.5 weeks. Walking through LaGuardia Airport, the decreased numbers of travelers were striking. I talked with a lawyer who said he wasn’t particularly worried, business leaders who recounted how they were adapting business practices so they could keep going in the midst of corona chaos, and a driver who said with certainty that the Mayor said he would close down the city if there were another case of COVID-19. “The whole city?” I asked, and he said yes. For a good description of how New Yorkers are adapting and coping, see The New York Times, “New York in the Age of Coronavirus.”
Talk of nothing but COVID-19
I took a walk, and everywhere I heard snatches of conversations about COVID-19 — what people were doing to protect themselves, whether they were worried or thought it was overblown. I talked with people in their 30s and 40s who said they weren’t worried, because they aren’t in a high-risk group. Having studied the attributions people make about their own risks, it’s interesting to hear people’s mental models about this disease. When the risks are known, it’s one thing, but COVID-19 has more unknowns than knowns. Discounting one’s own risk, because data show that those who become infected and die are mostly older, fails to acknowledge data that show younger people are not immune. Moreover, even if they were, they still can pass the disease to others who may be more vulnerable. When the 1918 pandemic flu struck North Carolina, one of the most tragic deaths was the president of UNC-Chapel Hill, Edward Kidder Graham, who was only 42 years at the time. In public health, we tend to talk about populations and population risk, but there always will be victims who don’t fit the mold or who represent a subtype that has not yet been characterized.
I was in NYC less than one week ago, but already, the situation with COVID-19 has shifted rapidly as the virus has started working its way across the United States. Today, eight states are in emergency status. It’s a bit like watching an impending hurricane on the screen as it works its way from the starting point to various destinations, including our own. We know it is going to hit. We don’t know how bad it will be or precise locations. The waiting is stressful, but it gives us some time to prepare.
Prepare: Be smart about this one
Epidemics and pandemics highlight our global interconnectedness and how few degrees of separation exist between people. The first identified COVID-19 case in North Carolina was someone who had visited the nursing home in Kirkland, Washington, where many cases have occurred. (I say identified, because there likely are many more cases that those confirmed. The shortage of test kits means a lot of infected people have not been tested.) In today’s world, a person from Raleigh, N.C., gets on a plane and visits a family member in Kirkland, then comes home and inadvertently exposes many others to risk, including those around his/her seat on a plane. We owe other people our best efforts at protection. I hope it continues to be true that most young people are not at high risk for COVID-19, but they can walk around with undetected infection, putting at risk their older relatives and the unknown people with whom they interact routinely in everyday life. I am much more industrious about cleaning all the surfaces I touched on the elliptical than I was in the past.
It’s not all bad
There are some apparent success stories from which we can learn. Although Taiwan is a much smaller country than either the United States or China, because of its proximity to China, it was projected that COVID-19 would be a significant threat there. Through a variety of proactive, traditional and cutting-edge methods, Taiwan has managed to control the epidemic, according to Wang et al., 2019. As the authors wrote, “In a crisis, governments often make difficult decisions under uncertainty and time constraints. These decisions must be both culturally appropriate and sensitive to the population. Through early recognition of the crisis, daily briefings to the public, and simple health messaging, the government was able to reassure the public by delivering timely, accurate, and transparent information regarding the evolving epidemic. Taiwan is an example of how a society can respond quickly to a crisis and protect the interests of its citizens.”
Uncertainty is hard to handle
There is a lot of ambiguity about this virus, and we, as humans, don’t like ambiguity and uncertainty. It is likely to get worse — that is, many more cases and deaths — before it gets better. Numbers of cases will increase as testing takes off, because there is undoubtedly a large reservoir of undetected disease. Our lives already are being changed, and they may be affected much more if the United States experiences a broader scale outbreak, as has happened in other countries. We must rely on science and evidence as much as possible in making decisions, and we should not be paralyzed. False promises and bravado will not help us. Wishing won’t help us, and lying most certainly will not help us. If there are not enough tests for everyone who should be tested, leaders should say that. It’s possible that there could be seasonal changes in spread, but no one should say that’s likely since we don’t know. We may suddenly find ourselves with greatly restricted movements or not. I have not even mentioned the huge, trillion dollar impact on the economy in the US, the larger toll on the global economy, and our jobs, 401Ks and futures. Most people alive today never have been in quite this position. It’s frightening, but we can’t let fear overtake us, because fear can immobilize. We must summon the strengths we might not even know we have to face this looming storm with resoluteness, resilience and preparedness.
As Carl Sagan wrote in The Demon-Haunted World: Science as a Candle in the Dark (1995),
Humans may crave absolute certainty; they may aspire to it; they may pretend, as partisans of certain religions do, to have attained it. But the history of science — by far the most successful claim to knowledge accessible to humans — teaches that the most we can hope for is successive improvement in our understanding, learning from our mistakes, an asymptotic approach to the Universe, but with the proviso that absolute certainty will always elude us.
We will always be mired in error. The most each generation can hope for is to reduce the error bars a little, and to add to the body of data to which error bars apply. The error bar is a pervasive, visible self-assessment of the reliability of our knowledge.
Preparation: good for us and society
One of the best ways of coping with the unknown is to prepare, says Dr. Zaynep Tufekci, associate professor at the UNC School of Information and Library Science.
Preparing for the almost inevitable global spread of this virus, now dubbed COVID-19, is one of the most pro-social, altruistic things you can do in response to potential disruptions of this kind. We should prepare, not because we may feel personally at risk, but so that we can help lessen the risk for everyone. We should prepare not because we are facing a doomsday scenario out of our control, but because we can alter every aspect of this risk we face as a society.
That’s right, you should prepare because your neighbors need you to prepare — especially your elderly neighbors, your neighbors who work at hospitals, your neighbors with chronic illnesses, and your neighbors who may not have the means or the time to prepare because of lack of resources or time.
As Dr. Tufekci points out in Scientific American, we should prepare, because we all are part of larger communities, and what we do as individuals — our own behavior — can make a difference in who lives and who dies. Tufecki gives us a reason to act that is larger than ourselves — the good of the commons — the recognition that what we do as individuals can affect society at large — individuals, families, communities, countries.
This is an uncomfortable time. We must learn how to cope and be patient even while this threat seems to envelop us. I find that the best way to deal with fear is to master everything I can — do everything that is within my power to control — to avert the undesired outcome (e.g., handwashing, avoiding handshakes, aggressive surface cleaning, covering sneezes, avoiding symptomatic individuals, convening the right people to plan what we will do if the university closes for some period, devising alternative personal plans and being prepared at home by buying food with a long shelf life, having plenty of pet food on hand, having sufficient medications and more), find outlets for fears and anxieties, and then keep moving steadily forward.
While all of this is happening, we still have jobs to do, if we are fortunate, homes to maintain and all that. It’s a lot like when we know some really bad weather probably is coming our way: we don’t just sit and wait. We do our best to prepare and hope (maybe pray) that the big one will miss us. We see this coming. We hope it will not be as bad as it could be, but we also recognize that it could be far worse. Tufekci gives us hope that our actions could pay dividends: “[H]ere’s the thing. Such epidemiological numbers are not fixed or immutable. They are not constants that exist independent of our actions. Where they land depends on the characteristics of the pathogen but also our response. By preparing now, we can alter both of those key numbers and save many lives.”
This is the human condition in the time of COVID-19.