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The Need for a Balanced Approach
It is important to take a balanced approach to this health threat—recognizing that there is a real threat of a pandemic that is likely to affect many people worldwide while at the same time avoiding unnecessary panic.
Too much optimism while diminishing the importance of this health threat might risk more lives. On the other hand, too much panic might exacerbate the mental health of millions of people. How do we strike a balance?
Follow CDC Guidelines
Every day the Center for Disease Control (CDC) issues reports about prevalence, proper hygiene, and travel advisories. As of today, March 3, 2020, the following guidelines are provided by the CDC.
Current risk assessment:
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For the general American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.
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People in communities where ongoing community spread with the virus that causes COVID-19 has been reported are at elevated, though still relatively low, risk of exposure.
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Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
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Close contacts of persons with COVID-19 also are at elevated risk of exposure.
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Travelers returning from affected international locations where community spread is occurring also are at elevated risk of exposure.
CDC has developed guidance to help in the risk assessment and management of people with potential exposures to COVID-19.
It is the mandate of the CDC to be prepared for worst-case scenarios and to offer transparency of information to help us make informed choices. As with any pandemic, information is fluid and updates may change the risk prospects for many of us. However, we can follow proper hygiene (handwashing, covering the face when coughing or sneezing, avoiding crowded gatherings in affected locations, and making informed choices about travel to areas at higher risk).
While many pandemics spread initially, most will show reduced spread in warmer months or where many people in the population have developed immunity. However, at this point in time, we do not know the extent of future spread, so being ready for plausible spread and virulence is a prudent way to think. There is legitimate concern about the risk of spread of this disease and I advise people to consult the CDC website for information about travel. But we have seen a great deal of panic, including fears of Asians, extreme worry about contamination, even people wearing masks walking the streets of New York City and elsewhere.
Dealing with Anxious Thoughts About Risk
We need to realize that much of what we need to know is not yet known. We still don't really know the death rates from the disease because we cannot rely on the Chinese data because many possible cases of people infected months ago may have gone unreported unless they ended up in the ICU. As a result of this uncertainty about the reliability of data (in China and Iran), we cannot reliably assess the death rates of those who contract the disease. Social media may add to the elevation of fear with people comparing the current pandemic with the Great Influenza of 1917-1921 which killed an estimated 50 million people. In fact, some social media posts compare this to the Bubonic Plague which may have had a death rate close to 50% and killed one-fourth of the people in Europe. These comparisons are not based on the current data about the coronavirus and social media adds to the exaggeration of risk.
How We Exaggerate Risk
We do know from the research on how people estimate risk and what drives worry is that certain factors lead to escalation of risk assessment. These include the following:
- Recency: The more recent the information, the higher value it is given. This is recent, one month for many of us. Recency makes us think it is highly risky.
- Salience: The more dramatic, memorable, intense the images and information are, the higher value. It's on the news, images of people in hospitals, empty shopping malls. Higher risk estimates.
- Availability: The more easily we can access the information, the greater the risk. You can't watch the news or look at the internet or social media without getting this information
- Uncertainty: Greater uncertainty leads to greater risk assessment. We don't know many of the relevant facts.
- Invisibility: If you cannot see it, you think there is a higher risk. We cannot see the virus or know who is a carrier so we estimate higher risk.
- Lack of Control: The less control you think you have, the greater the risk. People try to manifest control through avoidance, safety behaviors, etc.
- Horribleness: The more dramatically horrible the event, the greater the risk assessment. The idea of dying from respiratory failure seems horrible.
- Sudden change: Something that can happen suddenly is given greater emphasis. You can get sick and die in a week or two.
Now what is interesting is that all of these apply to past fears of terrorism, ebola, sars, and other sudden calamities. But if we look at what people die from in the USA, the most common causes of death are generally not characterized by these risk biases. See the following from the CDC for 2017.
Leading causes of death
- Heart disease: 647,457
- Cancer: 599,108
- Accidents (unintentional injuries): 169,936
- Chronic lower respiratory diseases: 160,201
- Stroke (cerebrovascular diseases): 146,383
- Alzheimer’s disease: 121,404
- Diabetes: 83,564
- Influenza and pneumonia: 55,672
- Nephritis, nephrotic syndrome, and nephrosis: 50,633
- Intentional self-harm (suicide): 47,17
Ignoring Probabilities
One of the common errors in our thinking about risk is to ignore probabilities. For example, as of today, March 3, 2020, there are 80,152 cases of coronavirus in China and 2,945 deaths. Every death is a tragedy, but we often don’t place it into the context of the probability at this moment of someone dying. For example, the population of China is around 1,480,000,000, rising every minute. The probability as of today of dying from Coronavirus in China is .0000199. Of course, the probabilities will increase as more cases emerge. But we tend to focus on specific occurrences and anecdotes. We do not report how many people do not have the disease. We ignore probabilities.
As is obvious, the most common causes of death are seldom the main issues that people are worried about in therapy—unless there is a real case of the illness. Many of these could have been prevented or delayed through lifestyle choices— diet, exercise, reduced weight, smoking, avoiding alcohol or drugs, driving carefully while sober, etc. Ironically, what is familiar and ongoing which confers cumulative risk is discounted because we seldom fear what we have gotten used to.
During the fear of terrorism years ago, there was an epidemic of anxiety. But you were more likely to die tripping over a baby or drowning in your bathtub. But the fear persisted.
We should not dismiss risk issues and fears. There is a difference between rational and unreasonable fear. The CDC has given us reasonable guidelines for proper hygiene, travel warnings, precautions, need for backup medications, etc. The greatest "rate of contagion" right now is not the virus, it is the fear. This does not mean we should minimize the pandemic, but we can follow reasonable precautions without concluding that any one individual is at great risk.
Try to take a balanced approach, too much fear makes us unnecessarily miserable, but too little fear may put you at unnecessary risk.
