Why emotional epidemiology is key to a successful COVID-19 response 

Understanding COVID-19’s RNA nucleotide sequences, supply chains and the efficacy of face masks versus hand sanitisers isn’t particularly effective if we don’t also understand emotional epidemiology.

Following the swine flu outbreak in 2009, an article in the New England Journal of Medicine warned clinicians to be aware of initial panic on the part of their patients, followed by complacence - and to be on the look-out for attitudinal change. But the lessons, it seems, have not been learned. All over the world, psychology and behavioural analysis have been utilised as an afterthought more than as a preventative or integrated strategy in efforts to contain COVID-19.

In countries like Malaysia, India and Sri Lanka, where the practice and study of psychology is severely underdeveloped and unregulated, we are seeing deeply problematic actions arising at the intersectionality of culture, religion and politics. This results in behaviours that psychologists could very likely map, and which should be included alongside medically driven models. In pursuit of the right to religious freedom in India and Malaysia, for example, thousands of people could be - and could already have been - infected with the virus, severely challenging those populations’ fundamental human right to life. In March, the attendance of 10,000 worshippers at a religious festival in March outside Kuala Lumpur - despite warnings - came as a surprise to many, and is the cause of an estimated two-thirds of the COVID-19 cases in Malaysia. My research, however, on global health and behaviour in South and Southeast Asia demonstrated how Malaysia is becomingly increasingly more religiously fundamentalist and that religious disregard for a virus was not only likely but to be assumed in any simulation.

In a destructive and symbiotic relationship, governments worldwide are failing their citizens - and, in turn, citizens are failing to follow government orders, while also failing themselves and each other. This is, in part, the result of psychological distortions which - if understood and acted upon expediently - could help to prevent the grief and trauma currently battering the world.

Two such distortions - originally applied to the climate crisis and now equally applicable to COVID-19 - are what Dr Robert Gifford calls the dragon of uncertainty and the dragon of environmental numbness. We have seen, for example, a few world leaders 'acting through inaction'; this has been manifested in their early assumptions that there were enough hospital beds, protective uniforms, masks and other equipment to handle a full-blown epidemic - or that, through what psychologists call magical thinking, they will simply appear. Meanwhile, Malaysian residents had barely digested what was widely touted as a backdoor coup and illegitimate change of government in early March in a country still reeling economically and psychologically from the disappearance of flight MH 370 and a corruption scandal when COVID-19 hit. In theory, this meant that while #NotMyPM was trending on Twitter in Malaysia, a psychological contagion was spreading - one focused on feelings such as injustice and helplessness rather than on rationality.

A psychological analysis of politics yields itself to the idea that emotions are more rational than we think. An individual whose first speech as Prime Minister implores the nation to “Give me a chance” is likely to be risk averse, as demonstrated by this effort to solidify a precarious position. Prime Minister Muhyiddin lacked the political will to enforce mosques and temples to shut down - whereas, had he created a behavioural insights team as the former UK Prime Minister David Cameron had done, he might have been advised that deep economic recession and the loss of thousands of lives are more upsetting to voters than the cancellation of religious festivities.

The importance of psychological messaging and the 'question behaviour effect' helps set a trajectory that either devastates or delivers. In the times that governments and states do employ psychology, it is more about strategy than science - and it is often used in nefarious ways. In the guise of science but led actually by economic scarcity, messages such as 'testing is not required' often mean 'we do not have enough testing kits'. 'Masks are not effective', meanwhile, can mean 'we do not have enough masks for healthcare workers'.

Cryptic messaging from the Malaysian PM’s office saying wait for an important message prompted many people to panic buy, eschewing social distancing and assuming the worst. The UK government, meanwhile, spoke about the numbers buying survival supplies - which causes a spike in people buying, not a reprieve.

In return, COVID-19 has also highlighted the intersections of identities that lend themselves to inequality. Social distancing is a privilege, as it implies you have room to do so, as is access to water for hand sanitation. The harrowing burden of the lack of accessibility, affordability, and unpaid care labour during the pandemic falls unequally on the shoulders of the differently able, daily wage earners, women and the LGBTQIA community, increasing rates of depression and anxiety.

Seeded deep within the hearts of institutions, movements, statuary bodies and human beings is a fundamental need be liked, accepted and met with approval. Governments have had to weigh the pros and cons of acting too fast against acting too slowly, both of which are economically costly - and the optimism bias fallacy and overestimation of resources have been in in full force, as states have displayed the fawn (people-pleasing) and freeze responses to trauma once COVID-19 reached their borders.

This COVID-19 intermission is a rare opportunity for every country to make its inner mission one of refusing to any longer normalise the abnormal - an approach which has led to systemic ennui and blindness. This pandemic will leave in its wake increased incidence of suicide, crippled health infrastructure, increased divorce rates, domestic violence, child abuse, and exacerbated mental health conditions.

These are daily issues that psychologists are trained to face calmly with deep understanding and under intense pressure. The policies and politics of each state ought to be altered; no longer should mental health come last (if at all) in their list of priorities. Instead, they should champion the idea that acting to reduce psychological distress is upholding a fundamental human right to health, one that the World Health Organisation defines as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.