Pandemic Series Ep 5: Can Events Help Antidote Fear

“In Mexico, we say hi by kissing on the cheek. I remember saying, “Is this ever going to come back?” I used to go to a gym, and they closed the gym. But when I went back in mid-June, one of the people who used to go there came out and said hi with a kiss. I felt like, gasp, and then I realised there’s no danger. For me, I thought, “Maybe things are going back to normal.” We forgot pretty quickly. The next two weeks, it was over. We were going to parties again.” GRAHAM, 2020

We are at a stage in this global pandemic where we wonder if things will ever go back to normal again. In the UK, it’s been over six months since the country went into lockdown and as we move into winter and a second lockdown, our exhausted minds are grappling with the concept that we are not near the end of this yet. We found a sliver of hope during the summer months as case numbers dwindled, fuelling our capacity to hold on a little longer. Now we’re tired, and suffering from pandemic fatigue.

However, one can find solace in the fact that, although unprecedented in our lifetime, this is not the first epidemic or pandemic our world has experienced. As a species, we have survived this before: 1918 Spanish Flu (that most resembles our experience today), 1957 Asian Flu epidemic, 1981 AIDS pandemic, 2002 – 2004 SARS epidemic, 2009 – 2010 H1N1 Swine Flu, and 2014 – 2016 Ebola epidemic. However, when I looked into studies on each epidemic/pandemic, a recurring theme arose: fear. The fear of a pandemic; stirred by media, often times had a more severe impact on people than the disease itself.

Human beings are social animals. We were not designed to live in isolation and it is our innate response to care for one another, even in the face of fear. When something like a pandemic affects our world; suddenly the very people whom we are drawn to in order to maintain survival, become a perceived threat. Furthermore, as we can also be a source of infection, we become a perceived threat to others. All of a sudden we find ourselves experiencing internal confliction in our primitive nature: the desire to be physically close to one another and keep others and ourselves safe.

Events are a prime example catalyst of initiating human connection, providing opportunity to create and foster human social connection. Evidence shows attending mass gatherings can enhance wellbeing (Kearns et al, 2017) and that experiencing an event in the company of others antidotes the effect of isolation (Torres et al, 2018). The pandemic is having a serious impact on our health and wellbeing, and strategies like physical distancing, hand washing and mask wearing help keep us safe. But could events have more of a positive impact than negative impact in this environment?

Impact of the fear pandemic

Billieux et al (2020) classifies the COVID-19 fear experiences into four categories:

• Fear for/of the body
• Fear for/of significant others
• Fear of not knowing/fear of knowing
• Fear of taking action/fear of inaction

Fear is a basic human emotion that is triggered in response to a perceived threat. This response activates a branch of our Autonomic Nervous System (ANS), responsible for regulating blood pressure, heart rate, sweating and respiratory rate, called the Sympathetic Nervous System (SNS) (Chung et al, 2019). The SNS is more commonly known as the ‘fight, flight or freeze’ response. The stress we experience motivates us to get out of dangerous situations. Historically, this primitive response worked well when we were hunter gatherers and met face to face with a predator, giving us a chance of survival. Cortisol (the stress hormone) is released, our hearts race, lung capacity increases, enabling us to run faster or fight with more strength. Once we are out of danger, the Parasympathetic Nervous System (PNS) or ‘rest and digest’, takes over to reduce heart rate and blood pressure (Chung et al, 2019).

The issue with today’s western society is that we don’t meet (actual) tigers in the jungle anymore. Instead, cyclical living has been replaced with 24/7 work and we rarely disconnect from the outside world, bombarded by information. This information, be it a sensationalising media headline, is absorbed as a threat, triggering fear and activating the SNS. Once this threat subsides, we can relax back to the PNS resting state. Yet this is not usually the case. The perceived threat does not subside as we continue to read the news, scroll through social media, consume media headlines, watching covid case numbers rise.

The impact of this perpetual stress loop takes a serious toll on our physical and mental health as we remain in the ANS, unable to rest and rehabilitate, as the PNS is imperative for maintaining good prefrontal cortex function (responsible for complex cognition, social behaviour, decision making and personality expression) (Roos et al, 2017). Therefore the fear of a pandemic can have worse implications than the virus itself (Honigsbaum, 2013). Dr. Murray, who treated Ebola patients wrote:

“If we are not prepared to fight fear and ignorance as actively and as thoughtfully as we fight any other virus, it is possible that fear can do terrible harm to vulnerable people, even in places that never see a single case of infection during an outbreak. And a fear epidemic can have far worse consequences when complicated by issues of race, privilege, and language.” KOLATA, 2002

In a 2008 study on the true economic impact of SARS (Brown and Smith, 2008), reality was not ‘as bad’ as the models had predicted with most countries experiencing ‘bounce back’ after the virus subsided faster than predicted in their economy (Dombey, 2004). The important lesson they highlighted, was understanding the impact caused by media sensationalism.

In January 2020, two months before the UK went into lockdown, in excess of 41,000 English-language print news articles mentioned ‘coronavirus’. This, in comparison to 1,800 mentions by British press of ebola in August 2018, which was the first month of the outbreak, serves to highlight the extreme focus by British media on COVID-19. Sensationalising and dramatic fear-inducing words such as ‘deadly’, ‘infecting’, ‘out of control’, and ‘many victims’, were being used months before the virus settled in the UK (Chaiuk and Dunaievska, 2020). This approach by media incited fear into the public long before the reality of the virus reached the country.

The economic impact of SARS was largely determined by people’s choices to reduce public interaction (travel, tourism and leisure) which reinforced the importance of correctly portraying the risk of the outbreak to the population of a country or state (Brown and Smith, 2008). If the government, fanned by media, do not remain close to the truth of the situation of their territory, the impact rebounds.

Changing behaviour

As we have seen from history, pandemics not only bring up deeply rooted fears but can modify human behaviour greatly (Riva, 2014). Dombey (2004) identified some behaviour changes, post-SARS in China, included increased focus on family timeinstead of visiting friends or eating out, andincrease in physical activities. We can see slivers of this evidence now where small towns design low-risk community focused events such as a Drive-In Bingo, allowing attendees to feel safe in their cars and still able to participate in social activity (Donaghy, 2020).

Human Beings by our very nature are designed to adapt. Unlike most other animals, humans lack the urgent need to be able to stand or fly the moment we are born. We are weak and vulnerable for years, needing others to care for us until we are able to ourselves. Indeed our strength lies in this weakness as through this vulnerability, we are able to grow, learn from others and adapt to our environment in order to survive and thrive (Boyd et al, 2011). Even as adults we continue to learn and adapt to our environment, a term now well known as neuroplasticity (Fuchs and Flügge, 2014).

An antidote to fear

There is hope for us as we move through and come out of this pandemic, and working to remedy the four categories of fear mentioned above will help keep us going. For example, to antidote to fear of/for the body is to take care of it. If we ensure we get enough relaxation, eat healthy food and exercise, we can keep our immune system strong. Indeed the antidote to fear for/of significant others is to ensure we have enough connection with the people we care about in the best way we can, by phone or video call. Where isolation further fans the flames of fear, togetherness can reduce it.

Events are one conduit to entice us to step out and connect with other human beings, providing an opportunity to foster social support which can reduce the impact of stress (Drury, 2020). Evidence shows that attending events can antidote isolation, increase wellbeing and the very act of gathering for purpose, connecting with other human beings, can ignite strong collective and positive emotions (Kearns et al, 2017; Torres et al, 2018; Drury, 2020). This experience allows a person to feel safe as they identify with a group and experience them as a source of support (Khan et al, 2014). The resulting impact on the body lowers stress, as the PNS is triggered, allowing the body to relax as it is no longer ‘in danger’. Furthermore, this positive experience can contribute in increasing a person’s resilience to stressful situations (such as this pandemic) (Hopkins and Reicher, 2017).

Can events go ahead?

As humans adapt to their environment, so does the event industry. There is more academic research coming to light indicating that the type of eventis key of whether or not a virus transmits across the audience, rather than any event in general (Ishola and Phin, 2011; Nunan and Brassey, 2020). Events with long durations, high density and low hygiene facilities increase the risk of transmission, namely music festivals and pilgrimages (Ishola and Phin, 2011; Botelho-Nevers and Gautret, 2013; Gautret and Steffen 2016).

Events are not homogenous and should be appropriately risk assessed. As with all risk management, best practice lies in not taking a blanket approach to risk assessing an industry. Each event is unique and approaching them with universal capacity restrictions gives the illusion that safety lies in numbers. For example, an outdoor event is already lower risk (of virus transmission) than an indoor event purely because of ventilation, as being outdoors is up to twenty times safer than indoors (Qian et al, 2020). If we can apply adequate public health risk management strategies to events, there should be no reason why an event cannot go ahead safely. Even the World Health Organisation is supportive of events going ahead as they also recognise that events have a profoundly positive effect on our health.

Evidence is mounting in support of events. Recently, an experiment conducted in Germany with over a thousand people, simulated virus transmission at a live music concert audience. The results were promising, indicating that with good ventilation, good hygiene and strategies to reduce contact can help in the reducing transmission of the virus. I have shared the full list of recommendations by the researchers:

• Event venues require ventilation technology that provides adequate ventilation and a regular exchange of air. It makes sense to create an evaluation system for suitable ventilation technology.
• Hygiene concepts must continue to be in place for as long as the pandemic persists: compulsory use of face masks in the arena, hygiene stewards to ensure compliance with the hygiene standards.
• The seating plan and thus the number of guests should be adjusted based on incidence.
• The venue should be accessed through several entrances to direct visitor flows. Waiting areas should be moved outdoors.
• During the event, food should be eaten in the seating areas to prevent crowding and long periods of contact at snack bars.

These strategies, among others, have already been a key part of many event organisers’ public health risk assessments in recent events and discussed in Episode 2 and Episode 4. There are competent and qualified crowd safety and health and safety advisors embedded in the industry that can support event organisers in developing safe events.

The fear pandemic stemming from COVID-19 has affected all of humanity. The more disconnected we feel, the more damage fear can cause our physical and mental health. Events are one way to foster social connection in a safe manner than can reduce stress and improve wellbeing. Do certain types of events have a more positive social, wellbeing and health impact than potential negative impact on a crowd? Is a blanket ban the best solution, or are we gathering enough evidence to demonstrate that we can keep people safe at events?

References

Billieux, J., Schimmenti, A. and Starcevic, V. (2020) “The four horsemen of fear:  an integrated model of understanding fear experiences during the covid-19 pandemic.” Clinical Neuropsychiatry, 17(2) pp. 41–45.

Botelho-Nevers, E. and Gautret, P. (2013) “Outbreaks associated to large open air festivals, including music festivals, 1980 to 2012.” Euro Surveillance, 18(11).

Boyd, R., Richerson, P. J. and Henrich, J. (2011) “The cultural niche: Why social learning is essential for human adaptation.” InProceedings of the National Academy of Sciences of the United States of  America. National Academy of Science (Supplement 2: In the Light of Evolution V:  Cooperation and Conflict), pp. 10918–10925.

Brown, M. R. and Smith, R. D. (2008) “The economic impact of SARS: How does the reality match the predictions?” Health Policy, 88(1) pp. 110–120.

Chaiuk, T. A. and Dunaievska, O. V. (2020) “Fear Culture in Media: An Examination on Coronavirus Discourse.” Journal of History Culture and Art Research, 9(2) pp. 184–194.

Dombey, O. (2004) “The effects of SARS on the Chinese tourism industry.” Journal of Vacation Marketing, 10(1) pp. 4–10.

Donaghy, K. (2020) “I dress up and have my hair done, it’s the greatest thing ever” – the rise of drive-in bingo. Independent. [Online] [Accessed on August 10th, 2020] https://www.independent.ie/life/i-dress-up-and-have-my-hair-done-its-the-greatest-thing-ever-the-rise-of-drive-in-bingo-39429974.html.

Drury, J. (2020) “Recent developments in the psychology of crowds and collective behaviour.” Current Opinion in Psychology, 35 pp. 12–16.

Fuchs, E. and Flügge, G. (2014) “Adult Neuroplasticity: More Than 40 Years of Research.” Neural Plasticity, 2014 pp. 1–10.

Graham, R. (2020) https://slate.com/human-interest/2020/04/coronavirus-life-after-sars-ebola-flu-polio-h1n1-recovery.html

Gautret, P. and Steffen, R. (2016) “Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence?” International Journal of Infectious Diseases, 47 pp. 46–52.

Honigsbaum, M. (2013) “Regulating the 1918–19 Pandemic: Flu, Stoicism and the Northcliffe Press.” Medical History, 57(2) pp. 165–185.

Hopkins, N. and Reicher, S. D. (2017) “Social identity and health at mass gatherings.” European Journal of Social Psychology, 47(7) pp. 867–877.

Ishola, D. A. and Phin, N. (2011) “Could influenza transmission be reduced by restricting mass gatherings? Towards an evidence-based policy framework.” Journal of Epidemiology and Global Health, 1(1) pp. 33–60.

Khan, S. S., Hopkins, N., Reicher, S., Tewari, S., Srinivasan, N. and Stevenson, C. (2014) “Shared identity predicts enhanced health at a mass gathering.” Group Processes and Intergroup Relations, 18(4) pp. 504–522.

Kearns, M., Muldoon, O. T., Msetfi, R. M. and Surgenor, P. W. G. (2017) “Darkness into light? Identification with the crowd at a suicide prevention fundraiser promotes well‐being amongst participants.” European Journal of Social Psychology, 47(7) pp. 878–888.

Kolata, G. (2020) https://www.nytimes.com/2020/05/10/health/coronavirus-plague-pandemic-history.html

Nunan, D. and Brassey, J. (2020) “What is the evidence for mass gatherings during global pandemics? A rapid summary of best-available evidence.” Centre for Evidence-Based Medicine, March, pp. 1–8.

Riva, M. A., Benedetti, M. and Cesana, G. (2014) “Pandemic Fear and Literature: Observations from Jack London’s The Scarlet Plague.” Emerging Infectious Diseases, 20(10).

Roos, L. E., Knight, E. L., Beauchamp, K. G., Berkman, E. T., Faraday, K., Hyslop, K. and Fisher, P. A. (2017) “Acute stress impairs inhibitory control based on individual differences in parasympathetic nervous system activity.” Biological Psychology, 125 pp. 58–63.

Torres, E. C., Moreira, S. and Lopes, R. C. (2018) “Understanding how and why people participate in crowd events.” Social Science Information, 57(2) pp. 304–321.

Qian, H., Miao, T., Liu, L., Zheng, X., Luo, D. and Li, Y. (2020) “Indoor transmission of SARS- Co V-2.” (MedRXiv), April.