COVID-19: Adjustment Reactions, Internal Resets, and Denialism

#15,062

Just shy of 10 weeks ago - on the morning of New Year's Eve - the always vigilant newshounds on FluTrackers picked up some obscure reports from China on a cluster of unidentified pneumonia cases in Wuhan, China.  At 2am, I posted the first of 3 blogs (see China: 27 Cases of `Atypical Viral Pneumonia' Reported In Wuhan, Hubei) I would write that day on it.

Details were scant, and while this could be `anything', it also sounded like the opening salvo to every pandemic tabletop exercise I've been a part of. So while the threat was still unquantifiable,  Wuhan was suddenly on everyone in the `flu world's' radar. 

The next few days produced very little additional information, and that was worrisome as well.  But six days later, the WHO issued their first alert (see WHO DON Statement On Pneumonia of Unknown Cause – China), and the same day in Wuhan Health Commission: Pneumonia Cases Increase To 59 - Jan 5th, we learned that the outbreak was bigger, and had been going on longer, than we'd previously known.

While scarcely noticed by the mainstream press, the still undiagnosed outbreak in Wuhan was rapidly becoming the number one topic of conversation in Flublogia, and among infectious disease specialists around the world. 

Two days later (Jan 7th), in Hong Kong: Caught With Their Masks Down, we saw the first real indicator that the Wuhan pneumonia might have greater implications as masks in Hong Kong started selling out.

Although I feared I might be overreacting, I made it my first - you might want to start preparing for this - blog.  I write about preparedness a lot, and usually do something after the holidays every year, so I made it fairly generic.

But I did mention that face masks might become hard to find, and soon. Two weeks later, they would become almost impossible to find on Amazon. 

Even though I've been writing about pandemics, and the inevitability of seeing another severe one, for 15 years I was still having trouble actually believing this could be `it'.  Since I live in hurricane country, and stay pretty prepared anyway, I didn't do anything different personally, although I did start telling friends and family they might want to review their disaster plans.

Most ignored the message, and I wondered if I was the one overreacting.  

After all, there were only 59 cases. It was being presented as a zoonotic spillover at a `seafood market', and according to China, there was no indication of human-to-human spread. We'd been here before with H5N1, and H7N9, and while concerning, neither had `legs'.

I had several `Am I crazy, or does this look serious to you?' conversations with friends, particularly in Flublogia; other bloggers, a few researchers and scientists, and journalists.  Everyone seemed uneasy, but none of us - including myself - was convinced this epidemic was ready for prime time.

So while I kept watch, and blogged frequently on Wuhan, I kept doing blogs on avian flu outbreaks, earthquakes in Puerto Rico, and MERS-CoV in Saudi Arabia.  Trying to maintain business as usual, at least until we learned more. 

By January 9th, less than two weeks after the first reports out of Wuhan, in the WHO (WPRO) Statement On Cluster Of Pneumonia Cases In Wuhan, China, we learned this unidentified pneumonia was a novel coronavirus.

And that, quite frankly, was a wakeup call.

Although its virulence and transmissibility were still unknown, we'd been following SARS, MERS-CoV, and a number of bat-borne coronaviruses with pandemic potential for years.  While novel influenza has always been at the top of our pandemic worry list, since 2003, novel coronaviruses have been ranked high as well.

Four days later, we learned of the first exported nCoV case - in Thailand - and CDC issued updated Guidance and a Risk Assessment for this novel coronavirus (nCoV). 

At this point I was on board with the idea this epidemic might spread widely, although its virulence and transmissibility was still unknown.  Was this going to be like the mild 1947 and 1977 pseudo-pandemics I described in Pseudo Pandemics And Viral Interlopers?

Or was it going to be something more serious?

Frankly, my opinion - at least internally - was flip-flopping almost by the hour.  Some reports looked alarming, while others painted this threat as overblown.  I was going through my own `Adjustment Reaction', trying to be prudent, while at the same time trying not to overreact.

Which is something that I'm seeing a lot of online, in politicians, among public health officials, and in the stock market. And while this struggle to accept the COVID-19 threat as a real and imminent threat is understandable, the time for committing to action is growing short.  

It would take me another ten days before I was fully convinced that this novel coronavirus was a legitimate pandemic threat. And I've had 15 years to think about such things. On January 25th, in Not Too Soon To Be Thinking About Preparedness, I made the case for getting prepared. 

What helped me to get over this psychological `hump' was re-reading risk communication expert Peter Sandman's essay from 2005 called  Adjustment Reactions: The Teachable Moment in Crisis Communication.

It reminded me that a little bit of `over-reaction' was not only understandable, it was a natural, healthy, and useful survival skill. I highly recommend you read it (or anything else penned by Peter Sandman & Jody Lanard). 

A brief excerpt:

This is the teachable moment! Instead of criticizing or ridiculing people’s adjustment reactions to emerging crises, smart crisis communicators encourage the adjustment reactions, legitimize them, ally with them, and guide them.

It’s okay to tell people that they’re jumping the gun a little – that there is still time and you advise them to hold off on particular precautions until the risk gets closer, bigger, or clearer. It’s okay to recommend substitute precautions – precautions that are more useful or less burdensome or less likely to backfire than the ones they’re attracted to. It’s okay to remind them that nobody knows yet whether the situation will worsen or blow over, that they should try to stay poised to ramp up or ramp down their level of concern. That’s all part of guiding the adjustment reaction.

What isn’t okay is to suggest that people shouldn’t be worried yet, that they shouldn’t take any precautions or even think about what precautions they want to take until you give the word. It isn’t okay to tell people that their normal and useful impulse to rehearse is irrational or panicky. Healthy people are going to rehearse. They are going to imagine the worst before it happens and before we know for sure if it’s coming. They are going to take premature precautions. An adjustment reaction is a big improvement over being caught unawares. Don’t try to tell people not to have one. Help them have a good one.

While I personally `accepted' the inevitability of this pandemic more than 6 weeks ago, I still vacillate on how bad I think it might be.  I'm thinking it could be pretty bad, at least for many places and people around the world.

But whether that is 1918-bad, or not, I still don't know. But I consider it entirely possible. 

Predictions and projections don't really matter at this point. It is going to be what it is, and we will find out in the weeks ahead. We either go into this blindly clinging to the hope COVID-19 fizzles - or we do what we can now to blunt its impact - and accept that in some areas, we may overreact.

I know everyone out there is going through the same `is it, or isn't it' struggle that I've gone through over the past 10 weeks. And although I've written on this topic a thousand times, this all feels vaguely surreal, even to me.   

If you are worried, maybe even a little panicky, you are not alone.  You are having an `Adjustment Reaction' to a looming, but still unquantifiable threat. The best way to handle that is to take a deep breath, accept that COVID-19 poses a genuine if ill-defined  threat, and then do what you can reasonably do now to offset the risks to you and your family.

That is what makes having an Adjustment Reaction a useful, natural and healthy human response.  It helps us to prepare, and react, when conditions warrant.  

And that is why you should not only accept it, you should embrace it.