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‘Caution fatigue’ and the stress behind living through a pandemic

In the last four months, the coronavirus has not changed its tactics, but we humans in the United States have. Think back to late March, when large-scale lockdowns began in earnest in many parts of the country. What were your feelings about the COVID-19 pandemic back then? Were you worried about touching your groceries or too cautious to leave the house, or washing your hands more than you have in your entire life? Have you kept up the same vigilance, amid the balmy summer weather and calls to reopen schools?

Though there generally is adherence to public health guidelines like mask-wearing in an effort to suppress the spread of COVID-19, there are indications the perception of risk may be changing. The number of people who say they always wear masks in public has gone down slightly recently in countries like Spain, the United Kingdom, France and the U.S., according to polling by market research company YouGov.

And even as COVID-19 cases are surging to new heights across the U.S., it makes sense that people are likely to be more lax in their precautions than during the early days of the crisis, experts in risk perception say.

“We are always more frightened by a risk when it’s new,” said David Ropeik, an author and consultant who used to teach risk communication at Harvard University. “There’s a new fear that’s creeping up against and counterbalancing our fear of the disease, and it is fear or lack of control over our lives and our future.”

Nowadays, the main fear is the coronavirus, and people are grappling with how to put social distancing into practice on a daily basis. “If you think about the decisions people are making in their lives, much of our population has become intuitive epidemiologists,” said Baruch Fischhoff, a psychologist at Carnegie Mellon University.

In 2015, Fischhoff and colleagues surveyed people in the U.S. about their perception and understanding of the Ebola virus. “We asked people what ‘R-naught’ was, which we described in lay terms – for each person who gets the disease, how many people will catch it from them – and people gave us a quite good, reasonable estimate.”

“What the research finds is that if you get people’s attention and the information is presented clearly, people do pretty well” at evaluating risk, Fischhoff said.

People want to feel like they understand a hazardous, complicated situation such as an outbreak, Fischhoff contends, so they build mental models based on information they consume and have access to, and then make decisions based on how they perceive the models to work.

“They look for quantitative estimates if they can conceivably find them,” Fischhoff said. Then people essentially gamble with that knowledge.

Ropeik highlights a different way of thinking about how people respond to coronavirus risks — that emotional responses are much more important when perceiving risk. “A healthy brain, by its architecture and chemistry, guarantees that our first reaction to any input, whether it’s an external stimulus or a memory from inside the brain, will be with emotion first and reason second,” Ropeik said.

Citing the work of neuroscientist Joseph LeDoux, Ropeik said that perceived stimuli are processed by the amygdala, a part of the brain that deals in part with emotion, before they are routed to the prefrontal cortex, the seat of higher-order thinking and decision-making in the brain. The amygdala also triggers the fight or flight response, meaning fear can take hold before any deliberate thinking has taken place.

“The brain gives way more emphasis to emotion than reason,” Ropeik said.

Caution: Fatigue

To Jacqueline Gollan, a clinical psychologist at Northwestern University Feinberg School of Medicine, slipping vigilance may be an example of “caution fatigue,” a term she coined.

Gollan said she and colleagues first noticed this relaxation of precautions in people with depression, before the coronavirus pandemic began.

“We were seeing that a lot of patients who were suffering from depression were showing a lot of difficulty in moderating their exposure to really aversive situations,” Gollan said. “It was almost as though they just were ignoring a lot of the risk around them.” Gollan said her research found some of these patients were struggling with self-control and are less able to avoid risky situations like staying at a toxic work environment and drinking alcohol.

“With the pandemic, in general, I think it’s that people are just not interested or don’t have the energy to pay attention to the safety guidelines because they’re tired,” Gollan said. “They have mental or physical fatigue from continually dealing with the stressful situations around them. Our brains biologically adjust to alarms that are around us because it helps reduce our sense of stress, and so we will take longer to respond and we’ll start to ignore warnings.”

It’s a lot of psychological work to be making important decisions about your health and safety, and Fischhoff agrees that there is likely some aversion to that constant assessment.

There are other reasons for caution fatigue, Gollan said, like desensitization to the threat. But among the experts, the biggest point of agreement about why some people are relaxing their precautions was poor messaging around the risk itself, especially here in the U.S.

“You could look at the rhetoric of [President Donald] Trump over the last few months and he has been repeatedly short term: ‘It’s going to disappear one day. It’s gonna go down to zero,’” said Jay Van Bavel, a psychologist and social neuroscientist at New York University. “Some people are frustrated. They weren’t given the leadership around the type of choices they would have to make for a long period of time.”

U.S. messaging on public health guidelines during the pandemic has been much more patchwork and contradictory than in countries such as Japan, which has created a campaign of easily understandable health guidelines that flow from the top levels of government and are adjusted to local needs. Different groups and levels of government work together, instead of undermining each other or sparring politically.

Van Bavel, with Anton Gollwitzer and other colleagues, has been investigating whether political partisanship correlates to adherence to social distancing, comparing smartphone geotracking data during stay-at-home orders with 2016 presidential election returns.

Ropeik thinks that calls in March to flatten the curve was an important short-term goal, but may have doused the sense of urgency that many felt early on.

“The people who are doing the communicating well, like the World Health Organization, even they were focusing on the short term,” Ropeik said. “So when we achieved that, it’s like, ‘Well, we did what we were asked, it’s over.’ That’s poor risk management.”

So, what to do?

Gollan says she is planning more research into how people respond psychologically to the COVID-19 pandemic, but she and the others offered some key, actionable takeaways to help battle the stress now.

“Develop a cornerstone habit and then continue to build on that,” Gollan said. “For example, leaving the mask on the handle of the interior of the front door of your place. Just leave it hanging there and grab it as you’re heading out the door.”

Don’t overload on information, Ropeik said. “That level of awareness biologically puts us in a fight or flight response. Biologically, that response includes chemicals in our body that make us more sensitive to any other information being potentially risky. Disproportionately, when we’re in a stressed situation, we tend to see the world is darker than it actually is. That’s not good for our health. Stay informed, but not probably as informed as you’re staying already. Give yourself a break from the fear.”

Fischhoff agreed: “The facts change very slowly. If you check the headlines once a day, you pretty much know all you need to know about the changes in the science.”

On the messaging side, leaders have to step up and deliver clear health messages effectively to various audiences, Van Bavel said.

“Some things that Anthony Fauci has done, there was a period where he went on a lot of YouTube channels with influencers and talked to them about these issues,” Van Bavel said of Fauci, one of the country’s top public health experts. “That was a really smart way of getting to different audiences and deputizing those influencers to spread the message.”

Psychology of the next pandemic

It’s never too soon to plan our response to the next pandemic, and to do so, it is important to understand how people think and act in the midst of an outbreak.

In a matter of weeks earlier this spring, Van Bavel and colleagues pulled together a wide-ranging review of the current research, “Using social and behavioural science to support COVID-19 pandemic response,” which was published in Nature Human Behavior at the end of April.

In working on that article, the team came across a paper in Science from 1919 titled “The Lessons of the Pandemic”. Van Bavel was struck by how the lessons from the pandemic of 1918 were still applicable today.

“It was remarkable how on point it was,” Van Bavel said, particularly on how people are not aware of such threats, and the way avoiding other people goes against human nature.

The coronavirus we are battling now may be new, but human reactions to these types of risks are not.

“They stand the test of time, and maybe in 100 years we’ll be looking back and people will be making the same mistakes,” Van Bavel said.

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