A ringside view of the 21st century’s deadliest disease4 min read . Updated: 19 Nov 2020, 08:51 PM IST
Being a covid patient could make one mull over the theory of 'social proof', by which individuals assume that others’ behaviour is appropriate and they are influenced by others’ actions, attitudes and beliefs
A ringside view of the dreaded covid is not what one would consider remotely desirable. Yet, when one does get a chance, unwittingly as it were, to go through the “jaws of the pandemic", one has to consider it a chance of a lifetime. As I went through a phase of moving from covid negative to positive to “recovered" to “hospitalized" and further, I tried to adopt a detached view and see the disease for what it really is. There were some invaluable lessons, even as I tried to go through Richard Thaler’s Misbehaving: The Making of Behavioral Economics, for fresh perspectives on my own behaviour. As newspapers splashed the story of a likely new vaccine, I could see that the battle with the pandemic can never be won through vaccines alone. It would require a multi-pronged approach, identifying every stage of the disease, understanding the behavioural dimensions of decision-making at each stage, and designing behavioural interventions for each.
The mind, you realize, is our biggest asset. It is also, unfortunately, our biggest enemy. And it “misbehaves" big time. As the government opens up restaurants, pubs and places of worship, the challenges posed by the patron groups of each will be very different. How do you get people to maintain social distancing and wear masks each time they go out or socialize with people? How to tackle sentiments, where the very act of worship may be seen as providing a ring of protection? The task gets more complicated since offending age groups would probably never directly experience the ill effects of such lapses; they would also never see themselves as harbingers of doom.
Regulation and making mask-wearing mandatory may not be enough. The theory of “social proof" states that people, acting individually, would be influenced by the actions, attitudes and beliefs of others, assuming that their behaviour is appropriate. Unless there are measures to get society to behave, measures to control individuals would fail miserably. Theatre and restaurant owners, as also the managements of worship venues, will need to devise variants of “pandemic pods", where groups of people are advised to visit such public places together based on their self-certification of being covid-free and commitment to follow norms. The deviance of a member would result in retribution for the entire group.
Having an asymptomatic patient is bad enough, for s/he may think covid is much ado about nothing. It gets worse if you have a patient in a covid ward who, Trump-like, has had the world at his beck and call, and is used to being in control. As the disease lays boundaries on what one can or can’t do physically, the mind unfortunately refuses to heed these, giving rise to fear, denial, depression and possibly worse. It appears that middle-aged patients are the most vulnerable to intensive care unit (ICU) psychosis, while octogenarians and nonagenarians are seen to walk out of the ICU, none the worse, as they’re often less aware of risks.
As the doctor attending to me summarized neatly on day one of my hospitalization, “ Those who lose the battle of covid are those who have lost their mind." The words came to haunt me as I lay in my hospital bed, and the disease took me on its roller-coaster, with oxygen being provided when my SpO2 dropped. Even as the mind recoiled at oxygen tubes being inserted, a young covid nurse put things in perspective: “Be prepared for anything. It will be easier. Just have one goal—to recover and get out." I learnt that many in my age group lose the battle to weak nerves. How does one drive home the need for acceptance? It might help if messages to this effect are put up in every room in a covid ward, besides positive messages reinforcing the fact that covid is curable.
Finally, the post-recovery effects of covid have to be managed as well. These include debilitating physical after-effects, such as relatively benign aches and pains; they also include the more serious possible paralytic attacks that are now in evidence. Additionally, studies, such as those published in the journal Lancet Psychiatry, have found mental health challenges, including cognitive, psychological and neurological symptoms common among people who have recovered from covid. As the study states, “The possibility that SARS-CoV-2 is neurotropic emphasises the need for evaluation of potential short-term and long-term effects on the nervous system." The impact of such mental trauma on human productivity has not been estimated, and points to a need for an urgent system of mental-health services, which would work at the local-community level to mitigate stress factors, as identified. There is also a need to provide such services to the medical fraternity—our doctors and health workers, that is, who have been working non-stop for the past eight months.
The next round of covid will be a battle of the mind. It will need to be recognized as such and worked upon differently. Policymakers need to learn and put in place a different set of interventions, so as to foster a behavioural framework suitable to this phase of the pandemic and thus maximize impact. These are the author’s personal views.
Tulsi Jayakumar is professor of economics at SP Jain Institute of Management and Research, Mumbai.