Blog2nd April 2020
“We’re going to beat it together…Stay home. Protect the NHS and save lives.” The words of Prime Minister Boris Johnson on 27 March.
Melanie Challenger is a member of the Nuffield Council on Bioethics and a writer / researcher across environmental history and philosophy
Johnson, like other state leaders around the world, is asking people to take extraordinary actions to prevent the spread of SARS-CoV-2, the pathogen that has caused a pandemic of the respiratory disease COVID-19. His was a firm but polite request, but one reinforced by emergency mandates and the warning that “staying home” could be made an involuntary act.
Over the evolving timescale of this pandemic, what has played out before us is the scramble of governments and public health bodies to work out how best to convey information to their audiences. What governments want in a crisis is for their peoples to cooperate. But what information will persuade people to act the right way? For the most part, people are now complying with official guidance. But it’s early days. What we know is that preventative decisions came in too late.
Governments have deployed statistics and epidemiological models, both deliberately and unintentionally, as scare tactics to persuade. But making existential threats salient might not induce the best kinds of cooperation in the long run. There may be a fine line here between informing people about the seriousness of the situation and scaring people senseless. Individuals now receive death counts from COVID-19 in real-time. The number of cases is tracked by the hour. We assume that people have a right to this information. That may be so. But if the information is supposed to provide a public service during a crisis, it’s worth knowing what such information can do to people. And how it can make people act.
There’s a wealth of research from the social sciences on human behaviours when existential threats or mortality are made salient. We undergo physiological changes – stress hormone levels alter, heart rate can alter, blood pressure can modulate, along with our sensitive neurochemistry. These subtle, invisible changes in response to a threat can cause alterations in mood, and in sleeping and eating patterns. This can be exacerbated by other stressful circumstances.
It would be nice to believe that humans are simply rational in the face of such threats. Not so. Humans are social animals. We have evolved methods of responding to stresses that require social closeness. We mitigate stresses through proximity. This is a significant challenge when we’re being asked to socially distance – the exact opposite of what comes naturally to most of us. Fear and uncertainty can be a toxic combination for those with mental health conditions or pre-existing worries. And sometimes it is all too much. One of Germany’s finance ministers, Thomas Schaefer committed suicide in late March, troubled by potential economic consequences. Earlier in the month, nineteen-year-old Emily Owen took her own life over fears of the pandemic. There are other reports from across the world of coronavirus-related suicides.
The way science is reported in a crisis matters. Scientific models are incredibly important for those working behind the scenes to try and gather as much information as possible on a new pathogen. But how useful are they for the rest of us? Most people are left to interpret the data amid a welter of information. On social media, graphs that seem to forecast what might happen in the future – always reassuring when we feel out of control – are being posted every minute. But almost all of these graphs rely on estimated rather than real data. We see numbers that appear to be rising exponentially in real-time. But data has a time lag. The daily figures on cases of COVID-19 are a picture of the spread of the disease several weeks ago. Likewise, if COVID-19 will cause death, this will be several weeks, even months, after the initial exposure to the virus. It still isn’t made clear enough to people that criteria for both causes of death and positive cases of SARS-CoV-2 are not identical across the globe. It can take time to clarify what figures mean, and whether diagnostics have a role in changes in the numbers. Sudden spikes in cases or in deaths can be very frightening for people, and contribute to feelings of helplessness. And when something appears to be a current picture of events but, in reality, is an older picture of viral spread, people can quickly become demoralised or feel that their actions are having no effect.
Tedros Adhanom Ghebreyesus, WHO Director-General, has repeatedly warned against an “infodemic” as contagious as the virus in question. This proliferation of information can muffle the simple messages that are needed. And an overreliance on numbers can have unhelpful consequences, even for those who ought to understand the science. When cases appeared to be only a few thousand, GPs used their commonsense that a patient’s symptoms were much more likely to be caused by a rhinovirus or influenza of some type. But many more cases were circulating in Britain and other countries than appeared in the official figures. This can encourage complacency early on in a pandemic.
What we don’t want is for science and government to work together in a way that lacks transparency or is condescending. But scientists and those in governance have a responsibility to be pragmatic about the unknowns. Chief Medical Officer, Chris Whitty has repeatedly warned that we don’t know anything for certain. This includes the number of cases and the number of deaths. It might help, then, to be clear about what is uncertain and certain about what is clear. Otherwise, the danger is that we erode belief in expertise or that we provoke public mistrust or apathy. In all this, there is a danger that we frighten people in a way that is detrimental to their wellbeing or decision-making. Fear isn’t a rational counsellor. It would certainly be wise to anticipate a reactionary response to the reality of dangers that modern societies thought they’d outsmarted.
In order to cooperate in a pandemic, people have to incur some costs, and some of those might be significant. But how do we persuade people to measure the costs they will incur without recourse to fear? Have we underestimated the potential positive messaging of prevention? A lesson we may learn from this pandemic is that proactive prevention may be more effective than panicked persuasion. Would it have been helpful, as soon as a new infectious disease had emerged with pandemic potential, for our leaders to broadcast and inform people with a very simple mantra: We have become aware of a new infectious disease for which we don’t have immunity. We must act now to prevent a pandemic before it is too late. You can help us to prevent it by staying home for a period of one month, while we track and isolate each case. A 2018 Nature paper by Anne-Marike Schiffer proposes that people respond best in a task when they believe their responses are more accurate and more immediately effective. In other words, that one’s actions will be the fastest and best in a situation. People also accept sacrifices for a shared and positive goal. The official line was that if we ask too much too soon, we risk ennui. But, if we act quickly to prevent a pandemic, then there’s less time for ennui to set in. Part of the preparedness for future health crises should include a robust analysis of the best strategies for cooperation. Priming people with data they don’t fully understand or with data that frightens might be less effective than priming people with the positive ends we are trying to achieve. A reassuring goal may be more persuasive than a terrifying reason.