Fear is the New Pandemic

We moved from the early uncertainties associated with COIV-19 to more knowledge about it, but is fear the new pandemic?[i]

“Fear is an insidious and deadly thing. It can warp judgment, freeze reflexes, breed mistakes. Worse, it’s contagious.”[ii]― Jimmy Stewart

In early January 2020, the COVID-19 situation was underplayed clinically, emerging data were unclear, it was thought to be more local than global, and there was some denial as to its seriousness.  While coronaviruses are common and known, e.g., they can cause nose, throat and sinus infections.[iii]  The emerging coronavirus was labeled as SARS-CoV-2, a new type by the World Health Organization.  The disease caused by SAR-CoV-2 is COVID-19.  What was known at the onset in the United States, was that SARS-CoV-2/COVID-19 did not fit into a known bucket, i.e., it was unclear as to what or how serious it was.  During January 2020, people were probably thinking physicians knew more about COVID-19 than they really did.  As will be seen, this did not portend well for the emerging COVID-19.

Concern about the deadly nature of coronaviruses could not be understated.  While the COVID-19 situation was unfolding in January 2020, history of other coronaviruses showed death rates for those infected of between about 10% to 40%.

Middle East Respiratory Syndrome (MERS) was a viral respiratory illness, a corona virus (MERS-CoV), that was new to humans. It was first reported in Saudi Arabia in 2012.[iv]  While the world-wide infected population was low, about 1700 cases, most MERS patients developed severe respiratory illness with a reported fatality rate of 30-40% of those infected.[v]

Severe acute respiratory syndrome or SARS was a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARS-CoV).[vi] SARS was first reported in Asia in February 2003 before being contained and eliminated in 2004.  The reported fatality rate was slightly less than 10% of those infected.

Patients with suspected COVID-19 symptoms began being seen in late February 2020.  However, there were early calls about unusual symptoms, like loss of sense of smell.  Patients with these early symptoms, well, it was really too early to know with any certainty if they had COVID-19 or not.  The patient population seen by the physician seemed very educated and health conscious.  Early callers were in the senior citizen age group.

But things began changing when the World Health Organization declared COVID-19 a pandemic on 11 March 2020.  At the beginning of that month, patient call volume increased dramatically along with a change in demographics, callers were younger than the early callers.  Change included recognition that doctors did not know as much as the public thought they did.  This lowered the perceived confidence in the medical profession.

Concerned patients split into two distinct groups.  The initial elderly cohort of those concerned about the virus and its implications for them.

Then calls shifted to a younger age group – the question was, “Am I sick”?  For convenience, we can refer to these younger patients as “Millennials”, those generally born between about 1981 and 1996.  This category has an age span of about 24-39 years of age.[vii]

The Millennials had suddenly lost their security.  They could no longer do what they wanted to do.  They were not used to hearing “no”, were fearful of visiting their parents and grandparents as they did not want to transmit the virus to them, and they became really scared.  This virus could kill me!

Compounding this newfound millennial fear was the lack of an experience-base to draw upon, i.e., no coping skills.  The older generation, boomers if you will, learned from the greatest generation that endured the great depression, World War II, and the Korean War.  Not only that but boomers came of age in the turbulent 1960s and 1970s.  Perhaps it is not a question of coping skills for them, rather it was life experience that prepared them for hardships.

So, when COVID-19 came on the scene, testing was only performed in local hospitals and limited to those 65 years and older.  Millennials were trying to find out what to do, some went to hospitals but tests were not generally available to them.

What changed in the patients you were seeing?  Fear – the nature of it changed from losing the ‘security’ of being able to do what they always did, to, my world has changed and this could kill me.

Clinically, people are so much more affected by stress, too much change in a short period of time.  It affects families, paralyzed mode at home, could not do anything.

We have to learn to think outside the box, earlier.  We should not be so complacent when we see what is happening in the world.  And, we must be careful with what we trust, e.g., we must look at data ourselves and not trust someone to do it for you.  Physicians can control things but not as much as we sometimes think.

Fear is contagious.  You fear what you are talking about.  That talk feeds on itself and causes more problems.  We need a new way of talking about problems, so we need to avoid overbearing talk of fear as it will eventually crush us.

This is a great time for people to reflect on what they have control over and what they do not.  We need to be more concerned about balance.  Now is the time for people to take responsibility for themselves.

References:

[i] This article was informed by a conversation with a Primary Care Physician in mid-July 2020.

[ii] https://www.lifehack.org/articles/communication/inspiring-quotes-about-fear.html

[iii] Clinical details on corona viruses are cited on the WebMD web site at:  https://www.webmd.com/lung/coronavirus

[iv] See:  https://www.cdc.gov/coronavirus/mers/about/index.html

[v] de Wit, E., van Doremalen, N., Falzarano, D. et al. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol 14, 523–534 (2016). https://doi.org/10.1038/nrmicro.2016.81

[vi] See:  https://www.cdc.gov/sars/index.html

[vii] For example age groups, see https://www.kasasa.com/articles/generations/gen-x-gen-y-gen-z