Posted 11 May 2020
As I would consider myself more of a numbers man than the touchy-feely sort, I have challenged myself today to look at something very much out of my comfort zone: Emotions. In my particular, I am going to share with you my personal experience of fear.
In the British Medical Journal there was a paper published at the end of April entitled “Mitigating the wider health effects of Covid-19 pandemic response’. The paper examines some of the contributory factors to future deaths following-on from social distancing measures. The paper considers strategies for mitigating the immediate deaths that may be saved in the short-term from severe social distancing versus the medium and long term deaths that will result from those same measures.
What appeals to me as a born-again statistician is the flow-chart at the end of the paper looking at those factors in graphical form. (The image attached to this post). The bottom line (literally and figuratively) of the diagram is sobering: There will be many contributions to excess death in the coming months and years. The paper does not attempt any metrics and makes no forecasts on how many people may die as a consequence of severe social distancing.
Of interest to me is how many of the boxes in this chart can be ‘worked-on’ now, even in the midst of lockdown. Some of the key boxes that fall into this category are:
“Fear and Anxiety”, “Stress and Boredom”, “Social Isolation” (which is different from social distancing), “Physical Inactivity” and “Social Disorder”.
The paper looks at how governments and health and social care organisations can mitigate some of these effects. I would suggest that there are probably actions we can all take to part-mitigate some of these boxes right now. Leaving these contributory factors unaddressed will be to the detriment of the individual and the population.
The box that intrigues me the most is the “Fear and Anxiety” box. Both of those emotions are as pandemic now as the virus and all it takes is a scan of a Social Media feed to see both of these emotions at work. The Social Media response to yesterday’s ‘Boris Announcement’ also makes it very clear that Fear and Anxiety beget Anger. Anger is then contributory to the last box I highlighted in my list: Social Disorder.
Both my training in biophysics and physiology and my more recent exposure to Chinese medicine philosophies allow me to recall:
– Fear is a natural emotion. It is a key part of our fight or flight response: Presented with a possible danger, the fear response better prepares us for either fighting that threat or running away from it. It is a normal part of physiological function. Sustained fear though is not. The ‘discharge’ of fear is an important part of the process: Fight the threat or get away from it and then the fear response can be tuned-out allowing you, your brain and your physiology to get on with more important things.
– The level of the fear response should be proportionate to the threat. Being cautious because of fear is one thing but being paralysed with it is another and detrimental to the individual. Conversely, being reckless because of an absence of an appropriate fear response could be just as life threatening.
– Prolonged and chronic low to moderate intensity fear often manifest as constant anxiety and can be detrimental to your well being and health. The “Stress and Boredom” box of the flow chart now comes into play.
– Once in the stress state, your brain filters information in a different way. Your fear response becomes amplified by potentiation (what I as a statistician might call confirmation bias): scary things become scarier. Your filters disproportionately dwell on information that confirms your fears often taking that information out of its true context and often discounting other information that might actually counter the appropriateness of the fear response in the first place. Social Media has a huge contribution to this – you create what appears on your feed by your ‘follows’ and ‘likes’; singling-out posts that confirm your fears will make more posts confirming those fears appear on your feed. Your fear response becomes stronger even though the reality of the threat might not have changed.
– Freeze and fright are possible responses in addition to fight and flight. The heightened state of fright will lead to being overwhelmed and obsessing rather than taking true effective action. This now touches on the “Physical Inactivity” box in the flow chart and also “Social Isolation” – you do not communicate with others even in the ways still possible under social distancing.
So my own thoughts gravitate to how pivotal the emotion of fear is amidst the mess. Mitigating this must surely therefore also be pivotal both for how we respond now to lockdown but also to change how we as individuals are impacted in the months and years ahead. Seeing how fear, and the accompanying emotions of anxiety and anger, are fanning and being fanned by media and social media is very worrying. There is a meme being circulated on Facebook at the moment, the final few words of which are ‘…there is room for you in ICU”. If anything is going to make fear worse, it is fear mongering such as that.
Although triggering the fight or flight response is instinctive, you can control the longevity and severity of the fear response it generates. I personally am not waiting for anyone else to manage it for me. I am under no illusion that Boris, Trump or anyone else has some magic words that will make it all go away and so it is pointless for me get angry at anything they do say. And besides, that anger would probably drag me off my fear management strategy too.
Maybe I am lucky because I can use numbers to reason my way out of emotions. Maybe that’s why I write these posts. My belief is that the world is full of risks – assess them, manage what you can manage but then accept those risks and move-on.
Let me give you two examples of how numbers today have been part of my fear management strategy.
1. A new piece of modelling suggests that if we take into account ‘population inhomogeneity’ (i.e. that there are super-spreaders of the virus, rather than each one of us equally likely to infect others) then the percentage of the population that has to have been exposed to the virus to achieve herd immunity threshold (HIT) is much lower than previous models have suggested. The predicted required infection levels are below those now seen in some populations.
2. A new study from Germany suggests that one third of the population may already have some adaptive immune system protection (T-cell mediated immunity) for the COVID-19 infection through contact with other forms of coronavirus (cold viruses).
Studies such as these mitigate the fear for me. And once that is managed, those other boxes become easier to manage too – plenty of exercise, no chance of boredom, and reaching out for social contact all become easier.
Not being paralysed with fear makes me less likely to spread it.