Our ability to make decisions under uncertain conditions is one of our most beneficial evolutionary advantages, it is also one of the tasks many people do poorly. Decision-making itself is a naturally complicated endeavour. We must process a wide variety of information; from our knowledge of the current risks posed, to our previous experiences with certain choices, and even our emotional state. When pressed for time, our decision-making relies on unconscious processes (cognitive tools such as heuristics and biases), instinctual systems akin to the type-1 thinking described by Daniel Kahneman  These biases can often leak into our conscious decision-making, and when faced with an existential threat of which we have little knowledge these biases can often become a crutch .
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Fear: the great motivator
If necessity is the mother of innovation, then fear is the architect of our status quo. Previous research has highlighted how anxiety disorders can result in risk-avoidant behaviours . This may also be the case in individuals with trait anxiety . Fear also drives further into our in-groups, especially when faced with the threat of contagious diseases . When faced with the uncertainty of COVID-19 we must remain aware of how our fears and biases tint the way we view the world.
The somatic marker hypothesis describes how physiological responses to a stimulus and their associated emotional states can influence decision-making. Damasio  highlights the importance of cognitive and emotional processes when evaluating the incentive value of each choice. Purely rational approaches to problem-solving may be resource-intensive, hence emotions can provide a guiding framework to work within. Neurologically, we understand that regions of brain involved in decision-making and risk assessment (the orbitofrontal cortex/Ventromedial prefrontal cortex) co-activate with regions involved in emotion regulation (amygdala) when faced with uncertainty . We can visualise this connection using diffusion-tensor imaging, with the uncinate fasciculus being the physical connection between these regions.
Virtual reconstruction of the uncinate fasciculus based on diffusion tensor imaging
So, what does this all mean? It means that in the face of this pandemic, people will behave irrationally. A person hoarding food and toilet paper may seem odd to others, but for that individual it is a means of attenuating their anxiety. And yet, we should have not been surprised when this behaviour spread. When faced with scarcity an individual will seek to acquire as many resources as possible, in turn causing others to feel anxious and do the same. Humans are inherently social creatures, and we have a natural talent for copying others.
Conspiracies and why we want to believe
In our age of information, everything we wish to know or understand can easily be found with a few google searches. Although it has never been easier to find something, it also easier to find misinformation especially when it confirms our existing beliefs (confirmation bias).
There are three major groups that help propagate the spread of misinformation:
- Those with an incentive to spread misinformation
- Those with a limited understanding of evidence-based medicine
- The conspiracy theorists
A recent report by Graphika  analysed the spread of misinformation and identified a discrepancy between left and right-leaning ideological groups in disseminating these stories. This is particularly evident when discussing health misinformation; 419 accounts identified in Graphika’s coronavirus conversation map overlapped with their broader misinformation map. Of these 419 accounts, 66% were associated with conservative ideologies. This is especially interesting in the context of Hydroxychloroquine.
Examples of several tweets by President Trump regarding Hydroxychloroquine
Hydroxychloroquine is an antiviral drug commonly used in treatment of certain types of malaria. However, it also has numerous side-effects including diarrhoea, vomiting and heart problems. Despite a lack of evidence, it was proposed as potential “cure” for COVID-19 by virologist Dr. Didier Raoult. This was picked up by several far-right French groups and spread across conservative networks internationally. Recent research has yet to demonstrate the clinical efficacy of hydroxychloroquine in treating COVID-19 but did find a potentially increased risk for developing arrhythmias .
Similar sentiments are echoed amongst other conservative figureheads
Although there is still much uncertainty regarding hydroxychloroquine, conservative figureheads such as US president Donald Trump and Brazilian president Jair Bolsonaro pushed the idea that it was a safe and effective treatment. By this point, Hydroxychloroquine was no longer just a potential treatment but a political symbol. Empowered by the support of a perceived authority figure, fears surrounding the usage of a potentially ineffective and harmful drug were alleviated. Our identity and our biases can greatly influence how we approach uncertainty .
In addition to this we have seen a new movement arise across several countries opposing lockdown measures designed to reduce the spread of COVID-19. Although it shares a lot of similarities to the Hydroxychloroquine stories, the target audience appears to be different. Whereas Hydroxychloroquine acted as symbol of “resistance” to the current pandemic, ironically, the anti-lockdown protests is based more on acceptance of COVID-19. Similarly funded by conservative groups in the US , the current narrative attempts to minimise the risks posed by COVID-19 and instead seeks to invoke fears of poverty and loss of freedom in their followers.
It is here that I would like to highlight a major issue in risk communication; access to, and the understanding of, information varies heavily between groups. Discussing risk requires a multi-level approach, helping those who are in a disadvantaged position understand what is being presented and why it is important to them. Unsurprisingly, those who design misinformation campaigns are extremely good at this.
Anti-lockdown messaging has become commonplace over the past few weeks
The anti-lockdown propaganda seems to exploit the limited understanding people have of epidemiology and evidence-based medicine. It is a complex topic, and so data-rich that it can often feel abstract or ephemeral. A common tactic used is to compare it to the “flu”, which to many people almost sounds like a harmless seasonal condition – despite the World Health Organisation providing an annual estimate 291,243–645,832 deaths globally for seasonal influenza-associated respiratory disorders . Notably this fosters the idea that COVID-19 will affect a “minority” of high-risk individuals. Although such a loss of life is lamentable, it is contrasted with the reader’s loss of personal freedoms and stokes their fears. A subtle approach, it alters the way an individual perceives their current risks, pushing for a revaluation of their priorities.
Finally, we approach the conspiracy theorists. A relatively new field of research in neuropsychology, several factors have revealed themselves to be useful when trying to understand why people believe in conspiracy theories. An extreme reaction to dealing with uncertainty, conspiracy theories are often defined by their lack of evidence, or twisted interpretation of evidence to push a narrative of government control and malicious intent.
Given that uncertainty can often give rise to feelings of stress and anxiety, it is not uncommon to develop coping mechanisms that are seen as unhealthy or irrational. Rituals and superstitious beliefs have to been known to reduce anxiety and improve an individual’s performance when faced with the unknown . Conspiracy theories are an extension of these superstitious beliefs, and individuals who believe them often deal with higher levels of anxiety and a greater need exert control over their lives . Feelings of powerlessness, narcissism, paranoia, and even uncertainty around individual’s own identity are also contributing factors . Furthermore, it appears that normal cognitive biases such “illusory correlations” and “confirmation bias” appear to be much more intense for those prone to conspiracy theory beliefs .
Although conspiracy theories may help in controlling an individual’s anxiety and create a sense of belonging (as part of a broader conspiracy theorist community), issues arise when these beliefs drive behaviours that put oneself or others at risks. One conspiracy theory that has arisen during the COVID-19 pandemic is the link between 5G and COVID-19 infections. An extension of previous 5G conspiracy theories, the current belief is that radiation from 5G masts are causing people to fall ill or catch the disease. Alternative theories are “Bill Gates will use the coronavirus vaccine to implant mind-control chips”, and that “the new £5 notes signalled the upcoming pandemic”.
Conspiracy theories regarding COVID-19 have had several real-world consequences
Much like other conspiracy theories a common of theme of “secretive cabals” and “societal control” pop up, often in very convoluted manners. Given the uncertainty surrounding our current predicament, it makes sense as to why people would latch onto something that gives them a feeling of control. Unfortunately, these beliefs have results in several attacks on public infrastructure , and threats against telecoms engineers . This is problematic to say the least. The spread from online forums to action that endangers peoples is a rapid escalation that needs to be addressed.
So where do we go from here?
Given the scale of this pandemic and extreme amount of uncertainty surrounding it developing a national response strategy would have been difficult, let alone a global response strategy. However, we cannot shy away from these uncertainties and must embrace them. Given the swath of models that exist, and with new data being collected daily, communication must remain clear and intelligible to members of the public and policymakers alike. When people lose trust in the institutions, they expect to protect them then they will look elsewhere for security even if it means eschewing data-driven approaches. Epidemiology is complex field of study, particularly amid a public health crisis. To expect people to become experts overnight is a preposterous belief, but they should still be given access to all readily available information. There are multiple ways to approach this:
- Maintain a steady stream of articles or press releases that can be interpreted by laypeople and experts alike, ensuring model outputs and their implications are explained; dialogue is crucial to understand the concerns of the public and to encourage a feeling of control or recognition
- Knowing what the public already understands, what they struggle with, how they conceptualise risk, and what quantitative or qualitative information they require can help alleviate their anxieties and allow them to become informed decision-makers
- Provide free guides and tutorials to improve scientific literacy and encourage the critical evaluation of news stories
- Ensure that mental health care services remain readily available, and develop tools to help the public understand the uncertainties surrounding this current pandemic
- Hold messengers and institutions accountable, both internally and through independent reviewers
- Provide the populace with financial support, and ensure their needs are met
This is not an exhaustive list. However, strong scientific communication coupled with a better understanding of our current strategy can empower individuals. So long as people feel hopeless, they will fall prey to groups that may exploit them or endanger them.
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