An interesting article in The Lancet Public Health journal published April 23, 2020 discussed the pitfalls of judgement during the COVID-19 pandemic. 

The author, Donald A Redelmeier, suggested that there were pitfalls, which if one was aware of might help to maintain behaviour change to fight the COVID-19 crisis. 

He described eight behavioural pitfalls. 

  • The Fear of the Unknown
    This is often at the route of fear-based psychopathologies. Originally COVID-19 was denoted as a coronavirus of unknown origin, raising a particularly ominous spectre of mystery and unseen troubles.

    This is often at the route of fear-based psychopathologies. Originally COVID-19 was denoted as a coronavirus of unknown origin, raising a particularly ominous spectre of mystery and unseen troubles.

    However, with time this mystery and newness will fade, and this will result in a reduction in attention.

    This may mean that the sense of threat will attenuate leading to a reduction in adherence to public health recommendations.

    Public relations reminders linked to the evolving situation are required in order for the public not to become complacent.
  • Personal Embarrassment
    One of the foremost preventative strategies is to avoid self-touching behaviour such as placing the hands on the face. This is a sensible recommendation because viral infection requires contact with a mucus membrane. However, we all have endless reflexive habitual actions that are hard to suppress.

    Any lapse in this preventative behaviour may be construed as a personal failure, visible to others and causing shame.

    Furthermore, any subsequent infection, which is connected to a preceding lapse will add to self-blame.

    It would be sensible for public health to counsel that momentary lapses are entirely normal, often surmountable and should be followed by a return to good behaviour.

    Celebrities who have tested positive can be shown as a way of mitigating any stigma.

  • Neglecting Other Risks
    Clearly COVID-19 is an overwhelming pre-occupation with all. As a result, it causes tunnel vision and results in a neglect of a multitude of other considerations – ongoing sleep, regular exercise, human companionship which in themselves merit continued attention.

    This is contrary to the overwhelming sense that all else can wait.

    Chronic diseases still need to be managed and keeping track of all these secondary risks is important.
  • Invisible Diseases
    COVID-19 can be diagnosed readily with the use of the PCR swab.

    By contrast most mental health disorders cannot be tracked with a test or a tangible sign.

    The physical distancing recommended for COVID-19 also carries the downside of increasing domestic frictions due to home isolation or increased home interactions. This could exacerbate any chronic psychiatric disorder such as paranoid schizophrenia, major depression, substance abuse and this in conjunction with the decreased access to psychiatric care will inevitably lead to increased mental health care.

    It is essential for consistent behaviour change to remain to support a healthy home environment.
  • Lack of Clear Feedback
    This apparent lack of strategy results from issues with testing, contact tracing, lack of vaccine and the lack of effective treatments. As a result of a fairly long incubation period for COVID-19 there is a protracted wait between symptoms, intervention and diagnosis.

    This time delay can lead to an unnerving interval in which psychosomatic symptoms and the sense of impending doom is felt. Furthermore, these feelings will fluctuate in later stages because of the difficulties in recognising a false finish or the second wave.

    Public Health England and the government should be urged against delivering daily epidemic reports because random changes could be mistaken for a real trend by the public.
  • Status Quo Bias
    Human behaviour is driven by a strong aversion to losses and a desire to maintain the status quo. This results in recouping losses rather than seizing opportunities.

    This new status quo is an opportunity for refocusing. Once the initial urgency is diminished, healthcare can review how it has adapted, for example, telemedicine.

    It is possible that important public health advances might be easier to implement during an epidemic than before its onset or once it has abated.
  • Ingrained Social Norms
    Dining with friends, caring for grandparents, welcoming patients warmly: these are all behaviours that have been promoted and polished over a lifetime. These norms are not easy to change.

    Broadcasting and reminding patients about changed norms with slogans, images and personal examples can help to facilitate the necessary behaviour change.

    Doctors and nurses within the medical profession are respected members in the community and can provide access to good information and act as role models to promote the right norms in and out of hospital. This approach could help to counteract the misinformation that circulates through the internet.
  • Hindsight
    This is the final pitfall. Once the pandemic has subsided there will inevitably be investigation.

    Hindsight bias might lead to castigating authorities and medical authorities who either overreacted or underreacted.

    Politicians may be accused by their adversaries of incompetence. The uneven distribution of cases within different countries will lead to further charges or inequality and injustice.

    Some of the accusations may well be justified, however dynamic and contradictory data might make it difficult to establish exactly what was known at the time and whether things could have turned out differently.

The collective mentality of the population that we are all in this together was challenging when the COVID-19 pandemic began and might prove equally difficult to sustain when it is over.  Considering judgemental pitfalls might help to make things a little easier. 

The London General Practice


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