The novel coronavirus has a long list of terrifying characteristics, spurring people from Japan to Europe to the U.S. to engage in panic buying, devour news coverage, steal hand sanitizer and face masks, fret that a throat tickle might mean a fatal illness, enter prepper mode, and otherwise succumb to Covid-19 anxiety.
“We are seeing increasing levels of anxiety [in the U.S.] over a relatively short period of time,” said Vaile Wright, director of clinical research and quality at the American Psychological Association.
Covid-19 distress has reached such levels that the World Health Organization on Tuesday issued guidelines for protecting mental health during the outbreak. “Avoid watching, reading or listening to news that cause you to feel anxious or distressed; seek information mainly to take practical steps to prepare your plans and protect yourself and loved ones,” it advised. “Seek information updates at specific times during the day once or twice. The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried.”
Some anxiety is clearly warranted, especially if it pushes people to take precautions against contracting or spreading the novel coronavirus. On Wednesday, the WHO declared the outbreak a pandemic, health care systems in some countries are being pushed to the breaking point, and the U.S. system could also be overwhelmed, with shortages of hospital beds and ventilators. Covid-19 is more transmissible than seasonal flu and also more deadly, with a fatality rate that appears to be 20 to 30 times higher. And unlike flu, no one has any immunity against this coronavirus from either previous exposure or vaccination. “The things people need to be doing are real,” Wright said.
As worrisome as these facts are, Wright and other psychologists identify seven additional reasons propelling Covid-19 anxiety to the point where it may be counterproductive, as WHO also recognized:
More than any other aspect of the pathogen and the disease it causes, uncertainties instill a deep sense of dread. The uncertainties include who is most at risk of infection or severe illness (or death), who can spread it, what protective steps are warranted (is hand-washing and staying away from indoor crowds sufficient, or should you not leave your home?), and how the outbreak will unfold. “What we know from the psychological science is, it’s uncertainty that drives anxiety,” Wright said.
That’s because “people fear the unknown,” said Mary Alvord, a clinical psychologist in Maryland and adjunct associate professor at the George Washington University School of Medicine and Health Sciences. With this virus, “we have torrents of uncertainty and a lack of clarity.” That applies not only to basic health questions such as the risk of becoming infected or severely ill but also to more mundane matters, such as whether to take a planned trip or attend a conference you’ve already paid for and whether your office will or business will be forced to close. “It’s the anxiety of uncertainty,” Alvord said. “And that’s a very normal response.”
The uncertainty about what’s coming and how bad it will be is something “the brain doesn’t like,” said clinical psychologist Neda Gould of Johns Hopkins University. “We don’t know what steps to take, which leaves us feeling vulnerable. We’re a society that likes to plan and to know what’s coming. Instead, we have these huge and unpredictable disruptions to our routine, which contribute to putting us on edge.”
The reason flu’s high fatality rate doesn’t spur dread (so little, that fewer than half of U.S. adults get vaccinated) is its familiarity. “The flu isn’t novel, it happens every year, and it has some predictability” in terms of seasonality, said Gould. Because the novel coronavirus came out of nowhere, “the unfamiliarity combines with the uncertainty” to increase anxiety. That is likely an evolutionary legacy: In the face of an unfamiliar risk, erring on the side of extreme caution is a better way to survive, and leave descendants, than cavalierly assuming everything will be fine.
“Your emotions, including anxiety, are there for a reason,” Wright said. “They communicate things to ourselves and motivate us to action.”
Contributing to anxiety is confused and confusing pronouncements from elected officials. For instance, after Vice President Mike Pence promised that “roughly 1.5 million tests” for Covid-19 would be available, they weren’t. President Trump told reporters last month that “anybody, right now and yesterday, that needs a test gets a test. They’re there, they have the tests, and the tests are beautiful.” Pence had to walk that back; the U.S. didn’t have enough test kits to meet demand. And Trump’s Feb. 2 assurance on Fox News that the U.S. had “pretty much shut it down coming in from China” lay a foundation for doubting subsequent attempts at reassurance.
“People in charge, especially in an environment of uncertainty, are supposed to have accurate information,” Wright said. “When they don’t, people will doubt any reassuring statements they make in the future.” When reassurances ring hollow, anxiety spirals.
While people might discount what politicians say, missteps by supposed experts ratchet up anxiety even further. Local health officials have given people in quarantine conflicting orders on what to do (stay inside? venture out in limited circumstances?); that stokes fears that the people who are supposed to know what they’re doing don’t.
When that happens on a national level, it’s even more alarming. Last month, coronavirus testing kits shipped to state and local health departments by the U.S. Centers for Disease Control and Prevention turned out to produce incorrect results.
“In some ways [missteps by leaders and experts] is the worst possible scenario,” Wright said: It makes people worry that those who are supposed to control the outbreak don’t know how to.
Uncertainty encompasses more than medical issues. People don’t know if their children’s school will close, if their jobs will disappear, if a planned trip will be scrubbed, even if their city will be put on lockdown. “Some of the anxiety comes from feeling out of control, like there’s nothing we can do about all these things that are important to our daily lives, or even plan for them,” Alvord said.
Personal vs. community risk
The brain is not very good at separating risks to a population from personal risks. Dramatic measures such as Italy’s locking down the country’s north, a rolling list of countries banning public gatherings and closing schools, and more all convey the (accurate) message that Covid-19 poses a systematic threat to public health. With the number of cases passing 118,000 worldwide, projections of millions more, and deaths at 4,000-plus, the risk to the community at large is clearly immense.
“When a country shuts down, it catches your attention,” Alvord said.
That’s difficult for the brain to reconcile with less alarming facts, like the very low risk to the average American of developing severe illness. (The risk to the elderly, to those with other illnesses, and to international travelers is greater.) Covid-19 is not the Black Death, or even SARS. “It’s hard for people to hold two conflicting ideas in their mind, the very real risk to a country and its economy and the much smaller risk to any individual,” Alvord said. “We tend to extrapolate [the former] to ourselves.”
In the U.S., financial anxiety in addition to health fears is having a synergistic effect. In a survey last week by HealthCare.com of nearly 2,500 people in the U.S., 48% of respondents said they are not very or not at all confident they could deal with the costs of developing Covid-19. Only 31% said they had sufficient savings to pay for the anticipated medical costs.