The Social Scientists Fighting Back against COVID-19

The COVID-19 outbreak has filled the world with uncertainty. Thankfully, faculty members at CityU’s College of Liberal Arts and Social Sciences (CLASS) are using their expertise to answer the world’s most pressing questions about the virus. First, and most importantly, how to bring an end to the pandemic.

Dr Nicholas THOMAS, Associate Professor of the Department of Asian and International Studies, has been doing research on infectious diseases since the SARS pandemic, focusing in particular on the responses made by different Asian health care systems. He believes East Asian countries have, on the whole, tackled the problem very well, in part thanks to their recent experience with other infectious diseases.

“There are certainly some similarities [between SARS and COVID-19], but a key difference is that with COVID-19 there are more asymptomatic cases in circulation,” Thomas says. “This presents a degree of magnitude larger challenge for health care professionals and policy makers everywhere.”

Thomas believes that the governments in Hong Kong, South Korea, Taiwan, Japan and even mainland China deserve credit for doing a better job than those in the US and Europe.

“I do think that here in Asia the communities are more sensitised to infectious diseases, so we have seen quite a few regional countries’ populations take preventive measures ahead of any announcement from the government,” he says. “In addition, a place like Hong Kong has huge advantages over the US thanks to its great public health care. Here, you can go to a hospital and receive world-class testing and treatment for next to nothing. In the US, if you get sick, it could bankrupt you.”

Moreover, Thomas believes that the US and European governments “dropped the ball” when it came to taking any proactive safety measures and are now resorting to taking “reactive and poorly done” decisions.

“They had over a month, easily, to get ready for this, and they didn’t do anything about it,” he says. “There’s plenty of data that shows they were privy and sensitive to the outbreak in China and its effects, but this didn’t translate into any concrete action.”

Thomas believes that one key issue with Europe and the US is that, unlike many Southeast Asian nations, they were not hit nearly as badly by the major viruses of the past two decades, including SARS. Another fact worth noting is that casualties from season flu have been known to be particularly bad in the US in recent years—between 2017-2019 in excess of 80 million people fell ill with the flu, including over 95,000 deaths.

“The seasonal flu has been so bad in the US for the past three or four years yet it barely makes the news. They’ve become desensitised without realising the implications,” he says. “At the same time, governments weren’t willing to implement early preventive measures against COVID-19. The UK had an opportunity to go into a joint buy of medical equipment with other European nations and decided not to. It’s a classic case of the wrong priorities at the wrong time.”

With regard to China’s response to the outbreak, Thomas called it “unprecedented in its scale but ultimately very effective.”

“China actually went against major debates in the field which said large-scale quarantines don’t work, but they went ahead and said ‘hold on, yes they do’,” he says.

Thomas notes one huge advantage China has over the US and EU when it comes to implementing a nationwide lockdown—the fact that every state in the US and nation in the EU has its own public health care system.

According to him, another advantage in China’s response is its government’s ability to impose a centrally coordinated response; even though this necessitates a trade-off between individual rights and the rights of the community.

“It’s a significant weakness,” he states. “There’s no central or national-level legal mechanism in place [in America] to get people to stay at home. You’re seeing the same thing in Europe from nation to nation. You’ve got countries like France which will remain quarantined until mid-May, but other countries like Spain and Greece who want to resume their economies as soon as possible.”

What is especially fascinating about the major nations’ responses to the outbreak are the possible economic ramifications—and how these may affect future outbreaks.

“For countries that did not have strong economies before the crisis—such as Spain—the disease has caused an economic shock they are ill-equipped to cope with long term. So there will be social and political pressures to prioritise the economy over public health in order to avoid near-term threats such as mass unemployment and social unrest. But the problem is people can cross [EU] borders quite easily and as people become more mobile you’re looking at another possible wave.”

Furthermore, with China having nearly eradicated the disease within its borders, they are in a relatively safe position to resume economic activity compared to places like the US.

“China now has ‘first mover advantage’ which is a huge bonus in any economic situation,” Thomas says. “That is putting pressure on the US to open its economy back up too early in order to compete with China, and I absolutely believe they are planning to open things up too early.”

Unfortunately, the US and Europe resuming normal activities too soon may have consequences for Asia as well.

“The challenge that successful countries in the region are facing is that we are all repatriating a lot of people from around the world who have been caught up in Europe or North America who are carrying the virus, and we are seeing to a certain extent a new wave of transmissions coming through here,” Thomas says.

With regard to what Hong Kong and the rest of Asia must do to stay safe, Thomas’ advice is to “stay vigilant”.

“The reality is that COVID-19 is not going to go away any time soon. This is largely due to the presence of asymptomatic cases and also the uneven global response. The only way to mitigate the severity of future outbreaks is to embed the basics of good hygiene and social distancing as everyday norms in society. It is not hard to do and many people here in Hong Kong were already practising these safer behaviours,” Thomas says, “but diseases don’t stop at borders.”

Although stopping the virus is priority number one, followed closely by restarting national economies, ensuring citizens’ mental wellbeing recovers is equally important. Professor Samuel HO, CLASS Associate Dean (Faculty and Research) and Professor of Psychology in the Department of Social and Behavioural Sciences, says that COVID-19 could have a devastating effect on the mental health of Hong Kong citizens—especially for those who have been infected. His research examined the SARS outbreak of 2003 and its aftermath, and found that over 40 per cent of recovered SARS patients experienced chronic anxiety and depression, likely because of some form of post-traumatic stress.

“For most people that get infected, they are in the hospital for two to four weeks and they make a full recovery, so the physical damage is actually rather short-term,” says Ho, although treatment medication can also result in serious side effects.

“On the mental side, it can be chronic. In fact, for many people, this virus outbreak will be considered a traumatic event, and we are seeing the negative psychological effects it is having on people right now. Hong Kong was already going through something of a mental health crisis before the outbreak, with 11 per cent of citizens showing depressive symptoms compared to the usual six to seven per cent. This means the population is even more at risk.”

According to Ho, becoming ill during a large-scale pandemic can be more traumatic than catching the seasonal flu, even if the patient makes a full recovery. “This is partially because of the stigmatisation and labelling of the disease,” he explains. “With both SARS and COVID-19, you might be labelled as a carrier of the disease even after recovery.”

Specific mental health symptoms include intrusive thoughts and nightmares regarding the disease, avoidant and antisocial behaviour, and increased sensitivity towards anything to do with COVID-19.

Unfortunately, psychological damage caused by the disease is not solely reserved for the infected. The entire population is at risk of increased depression and anxiety because of factors including fear of contracting the disease and/or infecting loved ones, unemployment and uncertainty about financial security, and social isolation greatly disrupting regular routines.

Ho says that citizens may find themselves feeling differently at different stages during a pandemic.

“There is the pre-contemplation stage where people lack information about the disease and are largely ignorant of the consequences. During the contemplation stage, people are aware of the disease and may experience anxiety because they don’t know what they need to do to stay safe.”

“Next is the action stage, where people know what they must do to stay safe but may lack the skills and resources to execute them. For example, some people may not have enough money to afford face masks, particularly when there is a shortage. Last is the maintenance stage, in which people have the knowledge and the skills to take necessary safety measures.”

Ho points out that it may be difficult for a lot of Hongkongers to stay in the maintenance stage because a lot of people live in cramped conditions.

“Their homes are so small, it’d be a bit difficult to ask them to stay at home all day and maintain social distancing for a long period of time,” he says.

Ironically, it would seem that people with what Ho calls “blind confidence” may be better off, at least from a psychological standpoint, even though not heeding the government’s warnings puts themselves and others at risk.

“You see this phenomenon in smokers as well—they know that smoking causes cancer, but they don’t believe it will happen to them,” he says.

Those who believe COVID-19 to be a “conspiracy theory” may suffer psychological consequences too, as a result of being heavily criticised and ostracised by their communities. This is especially true in places like Hong Kong and other Asian countries where preventive measures like face masks have become the social norms.

Ho has provided a series of science-based tips to anyone whose mental health has suffered as a result of the disease.

“Understand what is controllable and what is not. For example, don’t blame yourself if you lose your job or are working less shifts because of the disease,” he says. “Furthermore, don’t let this spill over into other areas of your life. Just because you don’t have a job doesn’t mean you aren’t a good father or a good mother.”

Ho says it is important for everyone to re-establish some type of routine in which they make time for hobbies that they enjoy and are adept at. Furthermore, it is vital that they look ahead to the future in which the virus will inevitably pass and maintain a “hopeful style of thinking and cognition”.

“According to my research, people with this ‘hopeful’ style of thinking will be much more resilient, not just during a pandemic but in any sort of crisis situation,” he says. “Hopeful people are also able to disengage with old goals that are unrealistic during the pandemic and re-engage with new ones. Keep setting new, realistic goals and set smaller sub-goals along the way and get ready to change your goals again once the crisis is over.”

Lastly, while Ho acknowledges that there is often a genetic component as to whether someone will naturally be a hopeful thinker, “Fortunately, all of this is coachable behaviour. We just need to spread the message as effectively as possible.”