How do People React in a Pandemic?

What do we know about people’s reactions during a flu pandemic? As H1N1 swine flu has made clear, answers to this question depend on the severity of the outbreak:

If it is a pandemic wave causing mild disease and low death rates, research on people’s reactions to the risk of infection, possible death and a more severe outbreak provides important guidelines for journalists covering this story.
If the outbreak is already causing severe disease and high death rates, research on people’s reactions to similar disasters can guide journalists’ understanding of what to expect as the tragedy unfolds.


On this page...
Peter Sandman, Risk Communication Consultant, Princeton, New Jersey:
  Reactions and overreactions »
  Denial versus panic »
  The five principle bulwarks against denial »
   
Sandro Galea, University of Michigan epidemiologist:
  The five stages of reaction to a disaster »




Peter Sandman, Risk Communication Consultant, Princeton, New Jersey, on Human Reactions to Risk and Why Denial is a Bigger Problem than Panic:


Reactions and overreactions

When people initially become aware of a risk, they overreact. They have a temporary short-term overreaction. People pause what they're doing, become hyper-vigilant, check out the environment more carefully than they normally would and—this is perhaps the most important characteristic of the adjustment reaction—they take precautions that may be excessive, may be inappropriate, and are certainly premature.

For example, a person might go get Tamiflu, even though the government thinks that they shouldn't.

The knee-jerk reaction of overreacting early to a potential crisis is extremely useful. Like other knee-jerk reflexes, it protects us. People who have gone through it come out on the other side calmer and better able to cope. People become able to cope with a crisis by going through an adjustment reaction, either in mid-crisis, in which case they're late in coping, or they do that in advance of the crisis, in which case they are ready to cope.

We want people to have this reaction early rather than late, and the way to accomplish that is to guide the adjustment reaction, rather than trashing it, as it seems officials often do and journalists sometimes do.



Denial versus panic

The problem isn’t panic. The problem is denial. Denial is why panic is rare. We are equipped with a circuit breaker and when we're about to panic, we go into denial instead. Denial is not useful in that people in denial don't take precautions, but it's preferable to panic. People who are panicking do themselves harm. Those who are in denial don't accomplish much, but at least they don't make things any worse. Denial is nature's way of protecting us from the horrible effects of panic and, whereas panic is rare, denial is extremely common.

We need conscious effort on the part of both the sources and on the part of journalists to protect people from denial by seducing them out of denial.



Five principle bulwarks against denial

1. Legitimize fear. People go into denial because they don't feel entitled to be afraid. The more entitled people feel to be afraid, the less likely they are to go into denial. This is why the message, "Don't be afraid," is a very destructive message in serious circumstances. Much superior is the message, "Well, of course, you're afraid, I'm afraid too. We're all afraid. We'll get through this together."
2. Things to do. It's not that if you have things to do you are less afraid; it's that if you have things to do you are better able to bear your fear. The military understands this very well. It tries to keep soldiers busy so that they can tolerate their fear.
3. Things to decide. Whenever possible, offer people menus of things to do so they have opportunities to decide what they want to do and what they don't want to do. This makes them less likely to go with the denial, because it makes them more able to bear their fear.
4. Love. Anyone who has had the experience of loving knows that we are much better able to bear fear on behalf of those we love than on our own behalf. The military knows well that soldiers don't fight for their country, they fight for their buddies. Again, it's not that loving makes you less afraid, it's that loving makes you more able to bear your fear.
5. Hate. This is the more controversial bulwark. Having somebody you hate, or maybe a virus you hate, can enable you to bear your fear and hang in there without tripping the circuit breaker into denial.

Fear is a solution, not the problem. It simply makes no sense to say, "I want you to take precautions, but I don't want you to be afraid."


Learn more from Peter Sandman »



Sandro Galea, University of Michigan epidemiologist

Using evidence from a systematic study of major disasters in the past 50 years, epidemiologist Sandro Galea has developed a framework that identifies five stages of reaction to a disaster:


Five stages of reaction to a disaster

1. Self-Preservation: The first reaction to a disaster is fear and initial anxiety. People are afraid. They seek information. They do what is necessary to figure out how to save themselves.
2. Group Preservation: With the right information provided, there is a tremendous effort—usually guided by what we call pro-social behavior—to help others.
3. Blame Setting: This involves internalizing and many psychological consequences fall in place during this stage. With disasters, we talk a lot about emotional responses, about change in normal activities. This leads into efforts to try to figure out who is to blame and to do something about it by addressing the vulnerabilities and strengths that we have that resulted in that hazard becoming a disaster.
4. Justice Seeking: This involves externalizing. It's part of seeking redress and leads to taking action against the perceived perpetrators of the disaster.
5. Renormalizing: Individuals and groups adapt to the threat.

Learn more about Galea’s five stages »




Editor’s note: The content of this page was originally generated during discussions at the December 2006 Nieman Conference “The Next Big Health Crisis—And How to Cover It,” made possible with the generous support of the Dart Foundation. The transcripts have been edited to make the material accessible in this online guide.