The virus affects the global community and as we do not have drugs or vaccines the global response or “weapon” is preventive behaviour based on two principles: keep distance (if possible stay at home) and practice rigorous hygiene.
But what we learn now is that fighting the virus by human behaviour is a huge challenge.
We are asked (or forced) to limit our freedom and accept a prescription or even an order regarding social distancing and continuously practicing hand washing and disinfection.
The justification for this behavioural change comes from the estimated reduction of the health risks associated with a viral infection which is new and basically unknown.
The special and challenging characteristics of this unknown or only partially known threat lies in the fact that it is not only about my personal health risks but also about the health risks of others (this is different from the risks coming from non-communicable diseases).
So we all have to decide if we want to pay the price of a fundamental change in our behaviour to minimise the health risk for us individually and all the others.
A lot of medical questions come up about the risk.
How is my probability to get infected (contagiosity with respect to myself)?
What is my probability to infect other people when I am infected (contagiosity with respect to others)?
What happens if I get infected). In other words: How dangerous is the virus (asymptomatic, mild symptoms, severe symptoms, death)?
What happens to other people if I transmit the virus to them?
After recovering from the infection am I immune?
After recovering from the infection can I still infect other people?
There are three problems with the answers to these questions:
As this is a “new virus” the scientific data are only preliminary and change continuously.
Here the issue of scientific evidence come in.
What types of studies were made?
For the moment only retrospective studies are available. Prevalence studies on large samples where everybody is tested are still few and their representability for other samples in other regions or for a whole population is questionable.
As with all types of risk communications, statistical numbers need interpretation and they imply individual attributions. (“What does that number mean to me? Is 0.5% mortality high for me?”) These so called cognitive attributions are very much influenced by an individual’s biography, the personal values and the type of personality).
The answers to questions b, d, and f are very much related to my personal values. What does my behaviour mean to others, to which degree do I feel responsible for others.
It is also about my attitude towards those who do not follow the rules. Should they be reported, forced to change and if necessary punished?
So on the risk side of the equation there is a lot of uncertainty regarding numbers and a lot of individual weighting.
The second most important factor having an influence on my behaviour is the impact this behavioural change has on my life. What are the side effects?
How does it affect my professional and social life? What are the losses, the distress, what about my mental wellbeing, my habits etc.?
Theses consequences and their evaluation are again very individual and depend of course on the psychosocial situation.
Taking this complexity into account it becomes evident that the individual response to the preventive measures (a specific health behaviour) can be very different.
“I find that the risk is not really high and something we know from the flu or other things – this does not justify the imposed rules which limit my freedom. I accept the risk for me and do not want to follow the rules, this is my very personal decision.”
‘The individual should decide’ position.
“I find that the risk is low and that the imposed rules lead to other equal or even more important risks for me and the society (economic, political, mental health etc.).”
‘The side effects outweigh the benefit’ position.
“I find that saving lives is a primordial moral duty for individuals and societies. If we know how we can do it and we do not act in this way, this is irresponsible.”
‘The saving lives’ position.
“Even if you find the risk low for you, think of the others and their protection.”
‘The social responsibility’ position.
The discussion between the “positions” is often emotional.
Members of groups A and B accuse C and D of being guided by irrational anxiety and overestimation the risks and underestimation of the side effects
Members of groups C and D accuse A and B of being irresponsible and immoral.
For all groups the problem is that each one has arguments which are based on scientific uncertainty and personal belief systems.
The danger is that this situation lies in the emotional dynamics leading to division in society in a moment where we need collaboration and unity.
What do we experience with respect to social responses?
The diffuse anxiety provoked by an unknown threat and risk is overcome by personalising the enemy. There is no virus or a harmless virus or the virus itself is fabricated by those who want to either control and manipulate society, and/or want to make money and/or destroy political enemies. The narrative of the hidden superpower elite or a personalised enemy (Bill Gates) or a nation (China).
Another way of overcoming this anxiety is the belief in being invulnerable or being strong enough to pay the price. Get rid of the medical experts and the numbers you do not like. It is a bit the survival of the fittest narrative
The pandemic is experienced by some people as a (necessary) reminder that humankind has gone too far in dominating and manipulating nature and that nature fights back to teach us that we can only survive if we respect limits of growth.
At the other end there are those groups who cannot tolerate any uncertainty or loss of control. The belief that in our modern world we must know everything, must predict everything and control the virus by radical social distancing can lead to hostile behaviour towards those who are viewed to be irresponsible or even a source of infection. The neighbour as an enemy; stigmatisation of individuals and countries.
And the we have social response of solidarity, a feeling of belonging together, being part of the same challenge, a global community creating new responses and behaviours.
What should we do?
I think we should accept and achieve a consensus that we live in a situation of a public health experiment to cope with a threat characterised by lot of uncertainty.
In this experiment we have to undertake a constant process of learning based on systematic observation and collection of data.
From these transparent data about the state of the infection the strategies of mitigation, on one hand, or measures of opening, on the other hand, need to be developed and continuously explained to the public.
Both strategies need clear outcome criteria regarding the level of risk reduction (e.g. basic reproduction number) and the various side effects (economic, loss of jobs, less care for other medical conditions, such as mental and family health) which need to be monitored constantly.
To find the best strategies we need to listen to each other and collect all the knowledge we can have from virology, epidemiology, medical specialties, psychology and sociology. It is an experiment which has no blueprint in history.
This stepwise feedback approach may lead to a slow restoration of what we had before but it may also lead to new ways of life with new definitions of what we want and not want.
To put this approach into practice we need a social climate of solidarity and feelings of togetherness which go beyond borders and unite countries and regions which are affected in very different ways and to a very different degree by the crisis.
Acknowledgements
I want to thank K. Haldre for her thoughtful input to this paper.
Disclosure statement
No potential conflict of interest was reported by the author(s).