Coronavirus, Fear, Anxiety, and Faith

Chuck Ruby, Ph.D., Psychologist

It began on New Year's Eve 2019. Chinese officials announced that doctors in Hubei province were treating more than two dozen patients who were suffering from viral pneumonia. Within days, more and more cases emerged across Asia, and on January 11th, a  61-year-old man in China would be the first to die from COVID-19. In the intervening weeks, a rising and widespread sense of fear has accompanied the virus' spread to over 200 countries and the number of people infected has exceeded a million. Of those infected, more than 60,000 have died.

It is difficult to get a clear measure of COVID-19's true incidence, prevalence, and fatality rate because it is exponentially spreading well ahead of attempts to identify it, and there has been a shortage of tests kits needed in order to confirm infection. Further, COVID-19 has a longer incubation period, in contrast to influenza, and this increases the chances of person-to-person transmission by asymptomatic people. Therefore, health officials estimate the true prevalence of COVID-19 is greater than the above numbers indicate.

For this reason, many governments have ordered people to self-quarantine and "distance" from others in an attempt to slow the virus' spread. Health systems are at maximum capacity and are becoming overwhelmed. In many places they are witnessing a shortage of essential medical supplies and equipment not only for detecting the virus, but also to treat it. The world economies are suffering greatly.

Few people alive today have witnessed such an impactful crisis. The potential risks and inherent uncertainties of this disease fuels the emotional distress that gets labeled with the various "anxiety disorders." Thus, it is very likely that we'll see an increase in diagnoses such as "generalized anxiety disorder," "obsessive-compulsive disorder," and "post-traumatic stress disorder" among the people who seek out professional help during and after this crisis. Whereas the term "anxiety disorder" is only a figurative use of medical language and not descriptive of a real illness, it nonetheless refers to a very real problem.

The fear we are seeing with COVID-19 is the key feature of the anxiety problem. In contrast to an illness, "anxiety" is our natural and expectable response to fear. In other words, it is what we do in an attempt to deal with and reduce fear. Specifically, it is a ramping up of attention and vigilance focused on the threat in order to reduce the uncertainties about it. When we can gain more certainty about the feared thing through hypervigilance, such as what it is, where it is, and how dangerous it is, we can potentially take action that will reduce the fear and, thus, the turn toward anxiety.

However, when it is not possible to eliminate uncertainty about the feared thing, as is mostly the case with the invisible coronavirus, we still might attempt to do so through increasing hypervigilance - anxiety. Think of this like having several radars focused in all directions at once, with sensitivity to the maximum level. Yet, despite this ever-increasing heightened state of alert, we still aren't able to see the threat more clearly and so we can't reduce the uncertainty or fear any further. Furthermore, despite this unproductive level of hypervigilance, there is a reluctance to turn off the radars except for one or two, "just in case," so we don't miss something.

In all of this, it is important to remember that fear, per se, is not the principal problem. Fear is inherent in life and it is meaningful - it points to the solution. It helps us identify potential threats and motivates us to take protective action. Instead of the fear, the principal problem is when the increasing hypervigilance in response to fear reaches a point where the costs far outweigh the benefits. That point was described more than a century ago with the so-called Yerkes-Dodson law, which proposed that hypervigilance (stress) enhances performance until it reaches a point of diminishing returns. Any increase in hypervigilance past that point is counterproductive and detrimental to our sense of well-being. It actually results in an increase in fear. So, there is typically a spiral of increasing hypervigilance, which leads to more fear, which leads to increasing hypervigilance, which leads to more fear, and so on. The end result can be panic attacks and confused/disorganized thoughts.

So, our challenge during this medical crisis is to be vigilant in planning and preparing by finding out what we can about COVID-19, what we can do to stem its transmission, what we can do to protect ourselves, and then taking action to the extent that we can. In doing this, it is important to avoid rumors and conspiracy theories about the virus, and to get information from reputable and credible sources. Above all, it is important to use critical thinking when evaluating information.

But we have to be honest with ourselves that, just as with many trials in life, we will never achieve 100% certainty about it or how we will be ultimately affected. This will leave us with a continuing sense of fear about which we can do nothing, but accept it. That level of uncertainty also means that faith in the process is crucial - being willing to go forward despite the uncertainty and fear, and carry on with our lives as much as we can, nonetheless.