Speaking of Psychology - Bonus Episode - Coronavirus Anxiety with Baruch Fischhoff, PhD

Episode Date: February 10, 2020

Fear about the coronavirus has gripped the world. While nearly all cases have been in China, that has not stopped people in other countries from worrying. This new illness certainly is frightening and needs attention, but it’s important to note that far more people die from an illness that’s all too familiar – the seasonal flu. Why are we so afraid of this novel coronavirus when we are much more likely to catch the flu? Our guest, Baruch Fischhoff, PhD, is a professor at Carnegie Mellon University and an expert on public perception of risk and human judgment and decision-making. He explains why we worry about new risks more than familiar ones, how to calm our anxiety and what are the psychological effects of being quarantined. Listen to Part 2 Join us online August 6-8 for APA 2020 Virtual.   Learn more about your ad choices. Visit megaphone.fm/adchoices

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Fear about the coronavirus has gripped the world. As I speak, more than 600 people have died from the virus and more than 31,000 people have become sick. That's according to the World Health Organization. Nearly all cases have been in China, but that hasn't stopped people in other countries from worrying. Here in the U.S., a dozen or so people have become ill so far. While this new illness certainly is frightening and needs attention, it's important to note that far more people die from an illness that's all too familiar, the seasonal flu.

An estimated 10,000 people have died from it this year in the U.S., according to the Centers for Disease Control, and 19 million have become sickened. Why are we so afraid of this novel coronavirus when we are much more likely to catch the flu? Our guest for this episode will explain why we worry about new risks more than familiar ones, how to calm our anxiety, and what are the psychological effects of being quarantine, which is what is happening to some people who have been exposed to this new bug. Dr. Baruch-Fishoff is a professor at Carnegie Mellon University and an expert on public perception of risk and human judgment and decision-making. Welcome, Dr. Fishoff. Thank you for having me. And thank you and APA for taking on this

issue. Absolutely. We're happy to have you here today. Dr. Fishoff, as I just shared, we know that the seasonal flu has sickened and killed way more people in the U.S. than this novel coronavirus. But can you explain why Americans are fearful of this new virus that's out there? Well, we don't really know how fearful Americans are. There's no systematic research as far as I know. So I can only answer based on my own observations and experience with other health health pandemic, some of which I've had an opportunity to work on. The difference or a major difference between, seasonal flu and coronavirus or other pandemics is that we understand seasonal flu very well. In fact, we're part of a project sponsored by CDC trying to get our predictions of seasonal

flu even more accurate. Whereas with coronavirus, we don't know where it's going. So the fact that we have had no deaths in the United States as yet is only a weak indicator of what the problem is going to be. And that projection will depend on two things that public health officials are still investigating. One is how transmissible the virus is among people who are asymptomatic. And second, how effective our public health measures will be. How can people manage their anxiety about this?

I mean, you see all these news stories, information on social media. It's hard not to get wrapped up in being worried about it. So if you're here in the U.S. or in a country that's not severely impacted like China, how can you manage your anxiety around this novel virus? I think the most useful thing that people can do at this stage is to find some trusted sources of information, like the Centers for Disease Control and Prevention or the World Health Organization or some of our major media, and just stick to them for information. And that will, you know, they're professionals.

They do the best job they can of gathering and communicating the information. And that will also protect you from, you know, from the irresponsible, the rumor mongers, the people who are using this as an opportunity to, you know, to sell things or to inflame racial hatred or ethnic hatred. So I think find a few good sources of information. If they tell you that the virus is still remote and they give you confident that our public health officials have the resources and the freedom to deal with this in a professional professional way, then you can afford to monitor it until they tell you something else. Yeah, I want to touch a little more about how the role of racism or xenophobia and all this. I mean, I recall similar panic about SARS and avian flu outbreaks. And just a few years ago, we were in panic mode about Ebola, which originated in Africa.

So how do you think that plays into all how people are reacting and these, like you said, the rumors you might fall prey to, that sort of thing. When a health problem like Ebola or coronavirus comes from abroad, we have poorer information about it than we do about health problems in this country. Often foreign places have poorer surveillance capability, so they just get. have the poor information. Sometimes they have authoritarian regimes who suppress the information. So we have greater uncertainty about things that come from places with poor information.

We also are vulnerable to people who have other access to grind seizing on this situation as a way to, as an opportunity to inflame xenophobia, fear of other ethnic groups. And, you know, we as individuals need to be above that, and we need to expect our leaders to calm them, to calm any of those fears and to stand up for people who are being unjustly criticized. I would say my university at Carnegie Mellon, I give our leadership a lot of credit. They've been on top of this issue from the very, very beginning. they've provided psychological support and practical support for people who've come back from China during the, who are in China during the winter break and might have a slightly higher probability of being affected.

So I think we need that kind of leadership throughout the country. And why do you think we are more afraid of something we don't know than we are of something we know? I mean, I think as I say that, I'm sort of like, okay, I see why people are worried about something they don't know. But can you get into the psychological reasons why this is the case? Well, putting on my risk analyst hat, I would say we have a poorer understanding of new viruses than we have of old viruses. The course of seasonal flu is pretty well predicted. We're part of a project sponsored by CDC that's getting those predictions even better. Whereas with coronavirus, we don't know where it's capable of going.

If you follow the public health literature, there's a vigorous debate about the effectiveness of the kind of quarantines that our country, the United States has. And there's a vigorous debate about whether the virus is transmissible when people are asymptomatic. If that's the case, then it's going to be harder to control it. And there's a lot of concern and legitimate concern about the public health officials about how much has, you know, how widely the disease was spread during the period in which the Chinese public health officials did not respond effectively, in part because of their political regime. Do you think some of the reactions we've seen, I'm talking about Americans being evacuated from China, canceling flights to and from China. The State Department has issued a travel warning against people going to China as well. Do you think those are warranted in this time we're in right now where there's a lot we don't understand about coronavirus? I would hope that those decisions are made on public health

grounds rather than political grounds. Sometimes leaders will do dramatic things in order to present themselves as what they view as leaders in ways that. that are ineffective. So the research on quarantines is that they're often ineffective unless they're accompanied by strong support for the people whose lives have been interrupted by the quarantines. That is, they need material support. If they're not able to work and living paycheck to paycheck

or gig to gig, somebody they need help in doing that. and they need it to be treated respectfully. If individuals fear that they're being not treated well, or countries feel as though they're not treated well, people will get around the vaccines or set a higher threshold for saying, you know, I'm not feeling so well, maybe I'm going to quarantine ourselves.

There's also risk if we rely on quarantines, that we will have opportunity costs of not doing other things that are more effective. As we feel, well, this takes care of the problem. You know, as you may know, in the last two or three years, there have been substantial cutbacks in the U.S. ability, capability for surveillance for pandemics. global health was demoted in its importance on the National Security Council. So if we aren't providing those, you know, if we're relying on quarantines and not providing our public health officials with the resources and autonomy that they need, we, you know, we may be creating problems down the road. And what about the shutting down of the Chinese city of Wuhan, which is the ground zero?

for the coronavirus. What kind of psychological effects could that have on the citizens? When often hears a claim that people are panicking and the people who study panic, which more sociologists than psychologists,

find that actual panics are rare. You see them more in movies than you actually see them in real life. Then under crisis situations, people typically rally around one another, they support one another, they act, they act bravely.

You can disrupt that if you deprive people of the opportunity to act in a coordinated way. Like if there are no trusted sources of information, then you get more, less coordinated information. I think the tragic situation of the people in Wuhan that are experiencing is a result of a, of a, I guess a political regime that didn't allow public health people to do their work. And then the problem got out of control. And then these draconian measures were implemented. And you would have to ask an epidemiologist just how effective this is likely to be. And what is the problem of the, I've seen an estimate of five million people.

people who left Wuhan during the time in which the response was paralyzed. You mean they left and then she was talking about it getting, you know, essentially out of the city limits? That's right. They left the city and some of them are out there and some of them are, you know, let's hope that very few of them are sick and that they're able to get better health care than they are than the people in Wuhan have who, from what I understand, that their local health officials just don't have the surge capacity.

to handle a pandemic. So people who are sick go from hospital to hospital and being unable to be treated. People who are sick with things other than than coronavirus but are uncertain maybe going to places where they're exposing themselves either to that or to or or to or to other things. So that's a reflection of a public health system that's been under under resourced. things that you would wonder about, you know, that I would wonder about in this country is, you know, how good is our surveillance capacity with the recent cuts?

What are we prepared? How are we responding to the disruption in the supply chain for basic medical supplies, including the masks that will be needed by health care officials if we have more of a pandemic, more of a pandemic here. Yeah, I imagine it's also very tough for people who are, you know, if their lives are put on hold there and they're, you know, healthy in a place like Wuhan, you know, that's, I'm sure that's a met very challenging as they wait for information. Yeah.

So I don't think it's something we've, I mean, maybe we've experienced here in the U.S., but seems pretty novel to me in terms of what I know about how we respond to illnesses here. So now moving into America, you know, as we speak, there's a lot of. about 350 Americans who are in quarantine on military bases. And from what I was reading, it's people who came from China, came from flights. They had to keep them in quarantine for a couple weeks. I was reading about two weeks just to monitor them, make sure they didn't have symptoms. And the interesting thing about this, and we certainly have a lot of info about how people are doing, they seem to be not doing too badly. The New York Times was saying the people in quarantine

have access to television, they're getting gourmet coffee, pizza, all that stuff. So it doesn't seem to be too bad. I mean, I'm sure it's probably still a little frightening. But, you know, despite the fun, I'm sure there could be lasting psychological effects of being, you know, shuttled from the plane into a military base and being under surveillance, you know, being their temperatures checked every couple hours or so, whatever it happens there. So I imagine some people probably have anxiety about it, even if they feel fine. Do you know the effects of a quarantine on someone?

So my understanding of the research on that kind of, of, of, stress is that there will be people who are, who have related traumas in their lives before that any stressful event, they're more vulnerable to any stressful event. So I think if one did a systematic interview person by person, you would find some variability. And you would also find that some people whose lives are more disrupted than others if they're responsible for vulnerable family members or if they are living, if they don't have the economic ability to withstand the loss of income for this period of time. I think what one sees superficially at a group level is what people usually do. They're resilient. They're mutually supportive. They rally to one another.

They try to make the best of a bad situation. And if we rely on people's natural resilience and if the authorities treat them in a respectful way and attend to their material needs as well as they can, one would expect most people to, I believe, to get through it well. I did find a study in the journal Emerging Infectious Diseases that studied 129 people who were quarantined with SARS. That was in the early 2000s, I believe. And they found that many had psychological distress, including post-traumatic stress, disorder and depression.

And I found that the longer someone was quarantined, the higher likelihood that he or she would experience PTSD symptoms. So obviously this shows that being isolated from others can bring up a host of negative feelings. Yeah. Why would you think PSD symptoms would be so high? Well, so SARS is different than, uh, different than coronavirus, you know, at this moment in that SARS had a much higher case fatality rate.

if the people were quarantined and either had symptoms or thought that they might get sick, there was a lot of legitimate anxiety. There was more people were dying. We didn't have a cure at that time or better cures at that time. And I suspect that the treatment, the social treatment might have been more stigmatized. and the longer you are isolated from your normal life, the more disrupted is, the more your vulnerabilities are being tested. And the more things that go wrong in the life that you're not able to keep together.

We all have a day-to-day challenge of keeping our lives together. So I think the combination of not knowing where this was going, which had legitimate the fears of which are much greater than the people who are currently quarantined in the U.S. regarding coronavirus and the longer, you know, disruption would have either triggered vulnerabilities, particularly people who are vulnerable already. It's interesting. And it also found that being an acquaintance or having direct exposure to someone with SARS was also associated with PTSD and depression.

Why would, why do you think that would be the case? So again, this is not my specialty, but from my understanding of that research literature for people that I've worked with is that maybe it's just a common sense result. You know, there are people we love and we care about them and we're anxious whenever they're sick. And in some ways, we're even more powerless than they are. They can, you know, they can rally and we can just worry. it seems like a normal, in some ways, a healthy human reaction that takes a toll. Yeah, that makes a lot of sense. I'm sure it's very difficult, especially in those situations, someone being quarantined.

There was a lot of fear at that time when SARS was out. So going back to the public health response, what is your perception of the public health, how officials are responding to it? They sort of seem like, I mean, there's a lot that's not known. And I understand, you know, there'll be meetings coming up. soon to talk about what we know about this virus, that sort of thing. But do you think they're in panic mode? I mean, obviously we've been through SARS, the avian flu, Ebola, swine flu, that sort of thing.

So what is your perception of what, how public officials are responding? I would say if panic is rare among the general public, it's almost non-existent among public health officials. They are the most idealistic, toughest, bravest, hard-wrest, hard-word. profession that you can that you can imagine. I think they're under a lot of pressure to deal with this. Deal with this. They have very few resources, which again have been cut back over the recent period. What I would like to see more from them is a more scientific approach to communication.

That is when we, you know, a scientific approach to risk communication would be starting, analyzing the decisions that people face, finding out what information is most critical to them, finding out what they currently believe, creating, drafting messages based on what we already know about how to communicate different things, and then testing those messages. And I don't have a sense that they're, you know, very well-intended messages, say at places like WHO or CDC have that rigor. So, for example, a question that is a specific decision that has occurred to many people is, should I be stocking face masks? And so what do I need to know in order to answer that question is one is, one is, how effective are face masks for today's risks, and will face masks be available should the risk

get greater? It's my understanding, not being a medical doctor, that face masks are not particularly effective even in, you know, even where they're not needed now, and they're actually not particularly effective unless you have a very high quality to protect yourself unless you have a very high quality face masks and are well trained and well disciplined and taking it on putting it on and taking it off that face masks will if you're sick with cold or flu or anything you can help to protect other other people but if you're worried about protecting yourself and you're not a health official you probably don't need to worry about it whether we will have face so what about in the future? So let's say there is flu and they will be useful and I think that I could

diligently put it on and take it off. Then it's really a question of who are the institutions that are responsible for ensuring that we have an adequate supply of FACTS, and they are distributed to the people who need them most. So for that, I need to be looking at, I don't know, the Department of Health and Human Services and see whether they are. there are people that I trust to handle this situation. And just as we close out, I want to summarize for our listeners just what they should take away from this. Can you talk about, can you just give me a few points they can take away from this podcast as they see how this virus plays out and how they might be managing how to manage their anxiety?

I think the first thing that people can do is to find a trusted source of information and just follow that. That will insulate them from rumors, and that will help them to get to have a clear picture and see how things are changed. Second thing is you can do, you know, a very simple risk analysis, which is to say, is there any reason to think that I am at risk? Are there cases where I am? Have I, if there are, have I come in contact with them? And third thing you could do is do a simple risk management, which is to figure out what are the few things that you can do most effectively. And if you go to these trusted sources, they will tell you that you should wash your hands really well and you should maintain a distance from somebody who might have the flu. And then you should avoid becoming a source of risk to other people by information.

insulating yourself if you're if you're sick, coughing into your sleeve, using a tissue, and throwing it out. So that will, if you do those three things, it will get you most of the information that you need and it will enable you to play a responsible role and getting on top of all of this. And it will protect you from seasonal flu, which at the moment is a bigger, bigger risk than coronavirus is and we hope the coronavirus ever will be. And maybe the fourth thing I would add is to be supportive of people who are under greater stress. So those will be people who, for whom, you know, who do have anxiety that's been triggered by

this or people who do feel like they've been discriminated or are worried about, about loved ones. And those are good things that we hope that we all do anyways. Thank you so much for those tips, Dr. Fishoff. I think that will be very helpful. I think this will help calm people's anxiety and, you know, help ease some of the worry that's out there. I appreciate your time.

Oh, thank you for, thank you for opportunity to talk with you. Yeah. And to our listeners, thanks for tuning in. Don't forget to let us know what you think about our podcast. You can email your comments and ideas to speaking of psychology at APA.org. That's speaking of psychology, all one word.org. And please give us a rating in iTunes. You can find previous episodes of Speaking of Psychology on Apple, Stitcher, Spotify, or wherever you get your podcasts.

You can also go to our website speakingofpsychology.org to listen to more episodes. I'm Caitlin Luna with the American Psychological Association. Thanks for listening.