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.”

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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:

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Medical uncertainty

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.”

Unfamiliarity

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.”

We want to hear from you: Are you a health care worker affected by the coronavirus outbreak? Please tell us about your experience.

Leadership failures

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.

Expert gaffes

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.

Beyond control

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.”

Non-medical anxiety

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.

  • After reading the comments I am beyond troubled. I live in hud housing. Low income. I have no money to buy enough food or sanitizer or gloves or masks or do the laundry like is suggested. I dont even have trash can liners. And I wont have the money for these things. I guess to each his own. But I wish my problem was my child not being able to go on vacation instead of not having any food or supplies to be able to stay put in my appartment. Do you think I should be worried about the diagnosed emphysema that I got 2 years ago. My pockets are empty and my shelves are bare.

    • So sorry for you. Please check your local resources for assistance-food pantry, church, etc. many people have been donating cleaning supplies for the last month or so. Good luck & God bless.

  • Funny, that in an article about anxiety and panic, the author engages in it, stating “…fatality rate that appears to be 20 to 30 times higher…” . That is an absurd statement at this point. South Korea has the most accurate data, because they did the most testing (so have the best denominator). Their fatality rate is 0.6%, which is extremely likely to be the *upper bound*. When all is said and done, the actual fatality rate probably be pegged even lower, maybe slightly higher than the 0.1% rate of seasonal flu. So 1 to 6 times as deadly is a far more accurate, and less anxiety-inducing estimate. See the work of Dr. Amesh Adalja at Johns Hopkins for confirmation. Or look at how the numbers in China changed once they expanded testing.

  • Thank you for writing this article! Even as someone with expertise in the healthcare and biosecurity spaces, I’m still anxious and stressed tracking the situation. I ended up making a game out of daily tasks to combat the epidemic to turn that energy into something productive and found it helped, then writing this blog post: https://nataliejingma.com/2020/03/09/a-game-to-help-combat-the-coronavirus-epidemic/

    It’s totally natural to feel anxious for all the reasons described in the article above, but if we can harness that energy with actionable steps, we can help relieve that anxiety and encourage effective measures against the epidemic.

    • Thank you for this comment. I went to your blog and enjoyed seeing the game, but could not post an answer. So I wanted to tell you here that just reading it helped allay my anxiety. Seeing the empty store shelves is frightening, but more because I feel the buyers’ extreme anxiety than because I cannot buy things now. I hope these people who overbuy will develop some community spirit and start to share (safely) with less fortunate neighbors, friends, and members of their community. That way we will all be safer…

  • On a very intolerably broad scale, the US resembles any third world / un-developed country as to the health care for its population. It is despicable that US people need to worry about whether they can afford the health care that at minimum keeps them alive. Shame on the miserable USA ! Yet when I hear or see signs “god bless America” it is clear that patriottism is so misguided that these people do not understand that it is their glorious leadership that fails them completely in nation-wide health care misery. That disposition is baffling – to anyone in or from any truly developed nation elsewhere on the globe.

  • Another thing is I’m sure some other factors are just other people in general. Most people with the cold and flu I have come across still go out and about. It might be work, going out to the shops, or still sending a kid to school. Or just noticing in shops nowadays more and more people do not cover their mouths when they cough or cover/shield nose when they sneeze. In some areas this has happened with the coronavirus in particular those who known somebody who had the virus ad were in close contact with them recently, or been to an area where it’s more highly prevalent. Some of those individuals still went out and about.

    Another thing it sure doesn’t help seeing people buy loo rolls, hand sanitisers, disinfecting wipes/sprays, paper towels, & tissues by the masses.

    I had come across someone in the shops that has purchased approximately 20 something disinfectant wipes and about the same for disinfectant sprays. Another person had a full on gas mask in another shop. On a news story level there are reports of fights and attacks that have erupted… over loo rolls.

    People are going to panic, and there should be no negativity to the people that are extremely worried about this.

  • I’ve always had health anxiety – last year I had over 50 GP appointments! I find it so hard to balance objective risk with my own perceived anxiety – driven risk. I’m really grateful that corona anxiety is being addressed objectively here! I can refer to this when I’m panicking.

    • That doesn’t sound like any way to live! May I suggest meditation? Or even medication? Before saying I could never do meditation, or I’ve tried it before, etc., know that everyone is terrible at it in the beginning. Get an app like Sam Harris “Waking Up” or one of the other ones, and calm yourself down 🙂 GL!

  • At age 69, there are two factors that keep me anxious. First, all the reassuring messages have that familiar caveat about the “elderly” (sometimes quantified as >65.) As an active relatively healthy senior with none of the underlying conditions normally mentioned (but with a few of my own which won’t be showing up in ant statistics for quite some time), I’m wondering to what extent I should limit my usual activities. The other factor is the miniscule availability of tests in the U.S. While my state has under 20 confirmed cases, how do I know it’s not suddenly going to balloon. For example, it appears that our state’s criteria for testing was expanded yesterday to include commercial labs (Oregon): so will there be a sudden increase in positives in my county in a few days? Or is there still a serious dearth of available tests…

    • Curtail social activities. Assume there are many more cases than have been announced. Avoid crowds. If you find yourself in any sealed metal tube with strangers, that’s a problem.

      I’m worried about contact with children and young people.

    • Your risk and underlying conditions are risk factors. It doesn’t matter if your conditions are different to the one’s mentioned. You should take as many precautions as possible until more is known.

  • What are some ways to help curb anxiety in teenagers? Our daughter (a Junior in high school) has already had a school trip canceled to France and Spain that she has been looking forward to this year. It was not planned until this June. In addition, other events have been canceled like an honors chorus event and a theater contest.
    Since we live in a small Northern Vermont town we think this is disconcerting to her as she thought she (and her friends) would be isolated from this event. In fact, her school is already practicing to have online classes tomorrow (again we can see this is causing anxiety). We have tried to assure her that there is a lot of unknown to deal with and that her school is just trying to be prepared and safe. That this will pass while acknowledging her feelings of frustration.
    Does anyone have anything to add to these ideas? We are trying to be prepared while not overreacting. We feel like not enough (if any) attention has been paid to the psychological effects this may already be having on kids who are very tuned in to social media and might be listening to adults discuss their fears, while also listening to teachers and administrators discuss ”contingency” plans at school or actually missing school.
    Advice? Thoughts?

    • Help her see these precautionary steps as ways she is helping other people. She is going to online classes to protect those in her community who are more vulnerable. Her school took an altruistic step of cancelling a trip that would have given them much joy in order to protect others. Etc. My 20-year old college son just made the decision to cancel a spring break trip in Miami with friends. I wanted him to make that call. But I let him make the decision and he ultimately decided that it was worth forgoing his short-term pleasure to reduce the odds of him becoming a vector during a time when it’s important to “flatten the curve.” I think we feel better when we make it about someone else’s gain, not our loss. Let that empower her.

    • Maja: I wish most kids were like your son. My son’s in college, and he’s not traveling, but almost all his classmates are headed to Florida or Hawaii on cheap flights. Our smallish city (Reno) has only a couple of known cases, but I fear what will happen when 23,000 college kids come back from Spring break. The school refuses to go on-line, so I see explosive growth here in a couple weeks. I’m guessing the school is getting pressure from the gaming industry not to upset the tourists. Probably the same in Las Vegas.

    • I also fear for some of the older professors who are going to have to share space with dozes (or more) students, some of which surely come back from Spring break with the virus.

    • Thanks for helping me understand the impacts of this worldwide event on other generations. I wonder if some of the teenage anxiety is about the prospect being overwhelmingly disappointed because a much-anticipated event doesn’t occur. (They’re already dealing with the disappointment of the European trip – that would be pretty devastating.) When I was that age I used to “pre-anticipate” disappointment (“for sure we lost that debate”) — go ahead and think through the worst case and preview how you’ll feel. Another tack is to remember that it’s the process leading up to an event that’s meaningful: every rehearsal, every in-person class has its moments which can be overlooked because they’re part of the routine. Maybe the kids can make some good videos now in lieu of cancelled performances and contests. In the meantime, all the skills and insights developed during preparations are still there for life. Finally, now that everyone has passports (!) it might help to spend some time dreaming and planning for things in 2021 and 2022. What do choral trips and semesters abroad look like for prospective colleges? Can kids start planning or at least imagining school trips or informal group trips for next year? They’re social media experts: can they do some planning & preparation on how to get through an isolated spring? (Alas that they have to develop some of this maturity so early.)

    • I hate to be a grinch, but we’ve forgotten what it’s like to live in a world of deadly infectious disease. Barely a century ago, a substantial portion of children did not survive childhood. My own parents were sometimes sequestered inside as a polio epidemic raged.

      Not to be callous, but if our greatest worry is that we’ll miss out on a trip to Europe, we’ve lost significant historical perspective.

    • It’s worth remembering too that they’ll hear a lot of messages that young people are very unlikely to become seriously ill – but at the same they’ll hear that their grandparents and older acquaintances are vulnerable. They may end up worrying quietly about a beloved grandparent.

    • Hi Jonah – I’m sure you have heard already, but I teach at UNR (Reno) and we have gone to online instruction for the remainder of the semester; not sure about TMCC. Students are also being asked to forgo returning from Spring Break, and only those with hardships are being permitted to continue to live in the dorms.

  • What ARE the expected medical costs for (1) patients and (2) citizens (taxes?) for COVD 19?

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