Keep Calm, Carry On, and Wash Your Hands

Today’s Occasional Read:
Dori B. Reissman et al.
Pandemic Influenza Preparedness: Adaptive Responses to an Evolving Challenge
Journal of Homeland Security and Emergency Management
V. 3, No. 2, Article 13, 2006

Welcome to our new reality.

As the country slowly shuts down due to the CoronaVirus pandemic [], I decided to return from my long hiatus of reading and writing about a scholarly article to focus on the literature that discusses the psychological impact of dealing with a global health crisis like this.

This article was written in 2006, in response to the avian flu virus, but it honestly could have been written yesterday. I found so much content here that is extremely relevant to life today.

The authors begin by defining a pandemic virus as having four characteristics; (1) it’s a new virus emerging from an animal-related source; (2) people don’t have immunity to it; (3) people get sick from it; and (4) the virus spreads easily and efficiently, “through coughing, sneezing,or a hand-shake.” (p.1)

Check, check, check, and check.

A 21st century pandemic is also defined by the fact that the today’s public health and health care systems can easily be rendered unable to cope with the sheer volume of sick people, a problem that is exacerbated by many of the technical advances and conveniences of modern life (overcrowded urban areas, foreign travel, and the fact that people are living longer).

Because of this, preparation for a pandemic, according to the authors, is key. An ideal pandemic preparation framework is comprised of three elements:

“(1) surveillance and early detection

“(2) community containment strategies (movement restrictions, facility closure, and health care service continuity) that would serve to decrease disease transmission and

“(3) mass prophylaxis strategies using vaccines and antiviral medication, as available and appropriate.”

To implement this framework successfully, government officials must be sufficiently aware of and be able to implement certain principles of “applied behavioral science,” which involves identifying, understanding, and accommodating the social and psychological reasons people think and act they way they do especially under times of stress. (p.2)

One of the most important aspects of applied behavioral science in the area of pandemic is to understand how people are going to act in response to their actual and perceived needs. Obviously, sick people (and even people who think they might be sick) are going to look for competent, timely, and affordable medical care. They will also want information and leadership from those in trusted positions, whether it’s the government, the medical community, an educational setting, a religious community, or something else. Many people are going to be dealing with fear, anger, uncertainty, helplessness, and despair, all of which can be exacerbated by physical or mental health conditions that are unrelated to the virus but also desperately need treatment.

Due to this combination of factors, the situation may eventually reach what the authors call a “tipping point” (based on a concept by the author Malcolm Gladwell), at which the actions of those managing the public health situation determine whether healthy outcomes can be accomplished or not. To achieve healthy outcomes, according to the authors, the response system must have “the capacity and ability … to understand and manipulate the factors.” (p.5)

What does this look like? A public health initiative responding to a pandemic must include these three features successful:

“(1) Measures to shape the public’s behaviors so that they are adaptive and risk-reducing as possible.

“(2) Measures to reduce social and emotional deterioration and improve functioning.

“(3) Measure to support key personnel in critical infrastructure functions (e.g. healthcare, emergency responders, child-serving education or care, utilities, food, transportation.)” (p.5)

Of these three features, the authors spend most of the rest of the article discussing “adaptive behaviors.” In the end, this is all about how public health officials build credibility and encourage members of the public to (1) believe what the officials say, and (2) follow the officials’ instructions, which is critical if the public is to adapt successfully to the new normal that is the pandemic.

A major element of credibility building is communication. Public health officials must communicate with the public in a “productive and effective way, ” and to recommend ways in which people’s behavior can and should be adapted so that they are in line with “realistic assessments of threat.” (p. 7) What does a pandemic-related message from a public official need to be credible? It is helpful if it comes from an expert, of course. It should also reflect an appreciation for the diversity of its audience, and it should facilitate, as much as possible, a dialogue through which people can get answers to their questions. It should also be clear about what knowledge is known and what is still emerging, with truthful reports about how public officials are working to fill knowledge gaps.

Messages from public officials should be broadcast across several media types, including websites, social networks, TV, radio, and billboards. They should also be transmitted through local, community-based communication channels: in schools, in universities, in workplaces, and in community gathering places. Communication should reflect the diverse information needs of communities who are the highest-risk of not only getting sick, but also of missing or not understanding the information they need to get the care they require. Accordingly, messages should be of varying lengths and complexity, and should be produced in multiple languages.

Communications from public authorities should also encourage positive adaptability behaviors as much as possible, and “provide guidance about building resilience — including tips for increasing social support, maintaining optimism, setting manageable goals, achieving emotional and social balance, and employing problem-focused and emotion focused coping.” (p.9)

Another job of a public education campaign during a pandemic is to dispel myths and rumors, as they lead to “vulnerability, psychological distress, and increase non-specific medical complaints leading to a surge in demand for medical attention.” (p. 11) Instead, the messages from this type of campaign can and should be crafted to include narratives describing positive results from people engaging in recommended collaborative activities.

Finally, any communication initiative of this type must focus on fostering what the authors call “adaptive functioning” in the community, which presents the information about the approaching pandemic as early and with as much certainty as possible. The timing of this message is critical because members of the public need to time to prepare for what’s ahead, not just physically, but also emotionally. Done correctly, this communication includes “teaching about expected reactions and improving coping skills to better manage the emotional fall-out from [the pandemic], such as grief, anxiety, apathy, dysfunction, and volatility.” (p. 14)

Well. Reading this article was both a blessing and a curse. I knew that there had to be some science that explained how public officials can craft messages of care, concern, information, and hope during a public health crisis like a pandemic. This article confirms that I was correct in believing that. However, what is demoralizing beyond words is that clearly no one in our government (especially at the federal level) has bothered to read this science. The messaging from them, thus far, has been sloppy, xenophobic, condescending, and disorganized. There is no discernable plan in place to test and treat all of the Americans who are, undoubtedly, going to get sick from this virus. There is no thoughtfulness to the communication, nothing that gives any of us the confidence that a grown-up is in charge and steering the ship. Where are the experts who really understand the science of pandemics, and have the plan that we need to get through it? They are surely not working for the current administration.

So I guess all I can say is wash your hands, and hope it will all be OK.

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