Here we go again…..

My last blog post on Covid-19 (Coronavirus 6: keeping a sense of perspective…) was over a year ago (8 December 2020). I had thought at the time that might be the last, but with recent guidance and ‘Plan B’ introduced in the run up to Christmas 2021 then some further reflections may be worthwhile.

When does urgency cross over into panic? Some of the most recent media coverage and Government policy pronouncements at times does have an air of 'headless chicken' about it. Earlier in the year I posted a blog on Celebrating Uncertainty, noting that anxiety and corresponding worry are responses to an intolerance of uncertainty. Government also dislikes uncertainty, and so seeks out advice and looks to issue guidance that tries to create certainty. But you can't make certain that which is inherently uncertain; you can't wish uncertainty away.

The Omicron variant brings added uncertainty to a time when people crave the certainty of arrangements long planned, of families and friends getting together, celebrating etc. We don't yet know whether Omicron is more or less dangerous than the Delta variant; though it seems to be more transmissible early indications from South Africa suggest it may be somewhat milder, or at least that may be the effect if there is a high degree of immunity among the population (natural or from vaccines). With this uncertainty we all too easily lose sight of more positive signals - that vaccination helps protect, even two jabs and especially a third booster jab. That face masks and ventilation help also to mitigate risk, as does social distancing. And we don't have to spend time in crowded places if we don't wish to. So actually, there are a lot of things we can do to manage our own risks that can still allow us to do some of the things we want to do. 

Anxiety is a fear that something bad is going to happen and I won't be able to cope. We overestimate the likelihood and severity of the bad thing happening, and underestimate our ability to cope while at the same time ignoring the positive things we can do, because our focus of attention is on the threat. A more realistic appraisal allows us to recognise where we have agency, control.

In London, on the underground, for example, since face coverings were made mandatory again compliance has shot up - I now see around 90% compliance compared to before when at times it may have been nearer to 30%. Even there, you can choose when to travel, where to stand or sit - you can manage your exposure even in an enclosed space.

Critical thinking?

We also need to apply some critical analysis to news reports and headline data. Little if any distinction is made in the media between increasing Covid case numbers and the fact that testing massively increased in mid-December (up to 50% more since end of November). Yes, infections have been increasing, but so has testing because everyone has been encouraged to test before socialising. We don't yet have a clear picture what proportion of the increased reported numbers has been due to Omicron, Delta or testing, though that should become clearer over the coming days and weeks, and as personal behaviour change begins to impact. Critical will be what effect it will have on hospitalization and deaths. Nevertheless, the high level of vaccinations in the UK is still likely to mean a higher degree of immunity to severe illness compared to last year.

As a society and as individuals we have become accustomed to instant information at our finger tips and so we feel at a loss when the information and certainty we desire isn't immediately forthcoming. That's also how conspiracy theories take hold - they offer spurious 'certainty'. We have no patience; we want action from Government to give us more certainty, which either leads to rushed decisions to be seen to be doing something, or what might be seen as a delay in acting when unsure. But the tone from Government could perhaps be one of calm reassurance and guidance rather than either blind panic or 'it's up to you to decide'. And science is uncertain so we shouldn’t expect it to give us certainty.

Above all, we need to recognise that there are always costs and consequences as well as benefits in taking action. It's the job of politicians to weigh up the evidence, and those costs and benefits across the board and not make decisions solely on the basis of just one disease. Such a decision will have many other consequences, including for wider public health. Assessments of likely impacts of action should be undertaken in advance where possible, or if there is insufficient time then at least evaluating the impacts of policy decisions as they are implemented and lessons learned quickly. For one thing, we should not underestimate the impact that lockdown, isolation and Covid-anxiety has had on people's livelihoods and mental health. I have seen the major effect it has had on many clients' physical and mental wellbeing over the last 18 months; lockdown and working from home especially disrupts daily routine, social interaction and diurnal rhythms affecting sleep, mood and focus and often exacerbates pre-existing issues. We also need to be careful that we don't use scare tactics to ensure compliance with guidance because that will store up longer term problems for mental health for which the NHS will be surely ill-prepared.

Resilience….

Perhaps, rather than how dreadful everything seems, we could look at how we make the best out of the situation we find ourselves in - in the present moment - even if it's not ideal or what we would prefer. Worrying about Covid is not a helpful coping strategy - it won't help solve it. As individuals, and collectively, we will have to develop greater psychological flexibility and resilience because Covid is not going away.

Bill Sheate, 21 December 2021