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COVID-19: fear, explanation, action, unity and ingenuity and World Hand Hygiene Day

At the time of writing (31 March 2020) the COVID-19 emergency is beginning to take hold and many of you have been working flat out for the past six weeks in preparation for this. It is difficult to write an editorial that will have relevance in two months when, if the epidemiological modellers are correct in their forecast, we will hopefully be on our way out of the other side of the UK epidemic. All those working in the health service will have been giving their absolute best at considerable cost to themselves and their families, but many lives will also have been lost. In the March Editorial I wrote about Strong’s psychology of epidemics (1990) in which he describes three phenomena or “epidemics” that accompany the emergence of novel infections: fear, explanation and the need for action. Since the pandemic spread of HIV starting in the 1980s, the UK has been relatively untouched by novel infections. Severe Acute Respiratory Syndrome (SARS) in 2003 resulted in four confirmed cases and Middle Eastern Respiratory Syndrome (MERS) in 2012 in five confirmed cases and the UK did not experience the epidemics that Strong described. However, COVID-19 is a different matter. The daily press conferences in the middle weeks of March saw a slow and stealthy number of measures being put in place that impacted our daily lives and resulted in behaviour changes associated with self-preservation and taking the last opportunities to be “normal”. The need for strict social distancing, self-isolation, the suspension of normal everyday activity and liberties, and the constant media and social media focus on the lack of testing, personal protective equipment, ventilators and intensive-care beds is frightening. The increasing number of new cases and deaths in the UK coupled with similar coverage from around the world is sobering and individual stories of people fighting for their lives and dying without the comfort of loved ones is heart breaking: the epidemic of fear is well and truly with us. We have also seen the epidemic of explanation take hold of the nation. As a society we don’t deal well with uncertainty or the messages coming from experts that we are learning about COVID-19 as we go along. Experts differ in their opinions about what may and may not work in the UK, and the suggestion that what has been done in other countries may not work here for a range of complicated cultural and scientific reasons is perplexing. The language of epidemiologists, that we are trying to “flatten the curve” and not conducting an experiment in herd immunity is also quite alien. I find mathematical modelling a difficult science to understand, although I can grasp the principle that a model is only as good as the data you put into it, but that too is difficult for the public to understand. Forecasts are not facts or even pretty good predictions when you are learning as you go along, but they are helpful in helping you to consider what might happen given a specific set of parameters. Our admiration for the government advisers across the UK, who have supported and advised central and devolved governments is immense. They have been calm and consistent in their advice against a changing epidemiological landscape and an often-fractious media audience. Understanding and communicating risk is similarly fraught with missteps. Rowlands et al. (2015) indicate that 43% of people aged between 16 and 65 years find health information too complex, and when the information also requires maths skills this rises to 61%. There are 34.1 million adults in England aged 16–65 years, so this means that between 15 and 21 million people of working age across the country may not be able to understand and use the information they need to look after their health. Much of the information being provided about COVID-19 is available from internet sources and supposes that everyone has access and is able to negotiate web sites. However, we know that computer and internet literacy skills are lower among older adults when compared with the general population resulting in a “grey” digital divide, with many older people missing out on the benefits that computers and the COVID-19: fear, explanation, action, unity and ingenuity and World Hand Hygiene Day