The Pandemic Lens^®

People have been responding to pandemics for centuries with fear, panic, avoidance, blame, uncertainty, and confusion. How did our ancestors get through? How do we carry on through the COVID-19 pandemic?

Lately, I’ve been compelled to read stories about how others have survived something. The circumstances are less important to me than how they got through—how they responded to and managed unexpected and uncontrollable adversity. Did survivors of other pandemics, wars, or life-threatening illness rise to the occasion with strength and resilience to do what needed to be done, or did they retreat to a familiar comfort zone to calm their fears and anxieties, or rely on others to help them get through? How did they deal with the chaos and uncertainty? Fear is a human condition, and survival is a human instinct. We feel compelled to do something.

Some of us seek information—staying informed helps us feel in control. If we know the risks, we might be able to avoid them. Others seek escape through drinking, eating, or staying busy, thereby minimizing the opportunity for intrusive thoughts or fears. Denial, too, is a form of control. And some feel an intense need to share their feelings and discomfort—to help process and make sense of overwhelming circumstances and emotions. One strategy is not better than the other. We are all doers, feelers, and thinkers at one time or another.

Whether we use cognitive, behavioral, or emotional strategies to deal with stress, our motivation is the same. We want to understand, make sense of, order and control, protect ourselves and others, and manage the challenge and our response to it. We are all doing our best to get through, aren’t we?

Although the COVID-19 pandemic might be novel and new—inciting both our naïve immune system and our fear-driven psyche—our response is likely familiar. We are creatures of habit. We tend to fall back on whatever strategy worked in the past (or sometimes didn’t, but it’s all we know). After reading historical accounts and stories of earlier pandemics, I’ve realized that humans have quite similar emotional responses to crises, but we often have quite different strategies for getting through.

 

How Others Got Through

According to online and published historical records, people living through the bubonic plague (Black Death) and the Spanish flu responded with fear, panic, avoidance, blame, uncertainty, and confusion, as well as, I’m guessing, more positive responses that aren’t reported in historical documents. Why is it that we either selectively recall or cling to the negative circumstances in life? Reports of neighbors lashing out at each other, admonishing each other, or people turning inward and fretting about their own souls or sins, reflect both the uniqueness of human responses and the powerlessness we feel when confronted by a terrifying outcome we seem to have no explanation for or control over. Doing something, or even just understanding how an event came to be, can give us a feeling of control. But is that enough?

What helped our ancestors get through centuries of intermittent episodes of bubonic plague (1347-1900) and the most lethal pandemic ever recorded, the Spanish Influenza (1918-1920)? There are few personal accounts of their state of mind, but we know what they did. Quite surprising to me was their consistent, methodical response to quarantine the ill from the well (40 days was the norm), social distance (windows were carved into buildings to sell wine during the Italian plague of 1629), and wear masks (physicians wore duckbill-like masks, in which to stuff protective herbs, during the bubonic plague of the 16^th century).

These strategies reduced the spread of disease, even if the people practicing them didn’t know why. It would take until 1898 to finally discover that fleas from infected rodents transmitted the bubonic plague-causing bacteria (Yersinia pestis) to other animals and humans. And it wasn’t until the 1990s, when scientists mapped the human genome and extricated a frozen female in Alaska, that the H1N1 virus was determined to cause the Spanish flu.

Meanwhile, germ theory, acknowledged in the mid-1800s, resulted in more vigorous hand washing and hygiene and use of open-air spaces. People opened windows in their homes (contradicting their former belief that outside air would bring in illness), and outdoor schoolrooms were constructed to keep children in school during the 1918-1919 Spanish flu.

And yet, controversy prevailed around these practices, just as it does today. The mayor of San Francisco reportedly wore his mask under his chin during the Armistice Day Parade (November 11, 1918), and thousands ignored social distancing and lined the streets to celebrate the end of WWI. Cases of Spanish flu skyrocketed shortly after, as reported in Pale Rider, by Laura Spinney (2018) and The Great Influenza, by John M. Barry (2005).  

In Hamnet (2020), Maggie O’Farrell writes a fictionalized, but historical, account of how William Shakespeare’s only son Hamnet might have died at the age of eleven from bubonic plague. (At the time he died in 1596, death records did not report the cause of death, although bubonic plague has been speculated by others). In the book, Hamnet’s mother agonizes over how she could have been so preoccupied with saving his twin sister Judith that she missed how pale, weak, and “ghostlike” Hamnet was. Hamnet dies, Judith survives, and the family grieves and moves on with life in unique ways. You can probably guess how Shakespeare coped with his only son’s death. (Hint: Hamlet was performed in London four years later).

O’Farrell’s personal experiences facing death no doubt inform her interpretation of what it could have been like for Hamnet’s family. In her memoir I Am, I Am, I Am: Seventeen Brushes with Death (2018), O’Farrell shows how courage, strength, determination, and gratitude help us get through life’s most fearsome encounters and not give in to fear. Michele Harper (The Beauty in Breaking, 2020) similarly dives into the hard stuff and demonstrates how knowing oneself, setting boundaries, letting go, and staying present to life, with compassion, helps us make sense of and get through situations of life and death.

Throughout this long and undulating COVID-19 pandemic, each of us is likely to use whatever strategies work to calm our fears, soothe our grief, distract us from ruminating over the past, restore a sense of routine, and keep us focused on the goal of getting through and keeping things as normal as possible. We are survivors. That’s what I keep telling myself, anyway. We’ve all been through something in our lives that required fortitude, strength, courage, perseverance, trust, faith—whatever it is we rely on to “get through” when life challenges us in unexpected ways. What has gotten you through past misfortune? Is it helping you now?

 

Survival Mode

Back in March, when COVID-19 cases in older adults and persons with comorbidities far exceeded those in any other population cohort, I determinedly sprang into action to find and review our wills, draft password lists, and organize bills and files. What if our worst fear materialized and our sons had to “take over” for us? My laser focus was fueled by the contrived urgency of this happening “any day” or “tomorrow.” And for some, it did, including a friend and former colleague who died in early May after a “brief and aggressive attack” by COVID-19.

In my view, I was living from one life-preserving immune-antibody infusion to the next, treatments I’d been getting every three weeks for fifteen years. After each infusion, I would ask myself what I needed to accomplish in the next three weeks, and I set out to do the most important things first.

I had relied on this same strategy when my son was diagnosed with leukemia twenty years ago. I buried my emotions and flew into action. I called it “survival mode.” I learned to put one foot in front of the other as we followed the treatment roadmap and adapted our lives to new routines and new identities. Setbacks reminded me of our vulnerability, and I learned to let go of my expectations and to accept help along the way. At the end of the first turbulent year of treatment, we entered a less aggressive “maintenance” phase that lasted an additional two years. Only then could I take a deep breath and reflect back on what we had been through and how we had survived.

There is no roadmap for the coronavirus pandemic. No one really knows the trajectory it will take, the consequences we will face, or even the best strategies for treatment and survival. We are reacting when we are accustomed to forecasting. The uncertain future binds us to the moment, which is a good thing, if we can stay centered, keep perspective, and manage the anxiety of not knowing.

How do we stay in the moment when we no longer have routines and the “rules” seem to change daily? We put one foot in front of the other, focus on today, and stay adaptable and flexible, like a tree bending in the wind. Looking back triggers feelings of loss and regret. Looking forward incites anxiety. So, we draw back into the moment, reflecting and modifying our perspective each step of the way forward. And that’s how we get through.

 

Uncertainty

How long will we have to endure the uncertainty, the restrictions, the protective behaviors that have by now become quite familiar? How long will we have to be on guard against this potentially fatal or protracted illness? Even with promising vaccines on the horizon, it will take many months to produce, distribute, and prioritize and vaccinate those who are willing. Herd immunity (estimated at fifty to seventy percent of the population) requires an effective vaccine and willing recipients. Meanwhile—at least for the next year—we will still need to wear masks, social distance, wash hands, and be vigilant. We are all tired of the isolation, change in our routines, lack of fun in our lives, monotony, missed events, loss of traditions and celebrations, disconnect with family and loved ones, and the stress of job changes and financial uncertainty. All the stuff of our daily lives will remain in limbo for a while.

The first bubonic plague (The Black Death, 1347-1353) took six years to subside (can you imagine?), although subsequent outbreaks lasted one to two years, as did the Spanish flu. (Although two-thirds of the deaths from the Spanish flu occurred in the first 24 weeks). The SARS-CoV-2 (COVID-19) coronavirus and H1N1 influenza (Spanish flu) are different respiratory viruses, but they both appear for the first time and share eerily similar symptoms and method of contagion, if not comparable trajectories. The only certainties are that many will die and social distancing works.

How did other pandemic survivors live with the ongoing uncertainty? I can only guess that they did what we do now—live in the moment, adapt routines, try to prevent illness and take care of others, and just get through the days, one step at a time. If anything, their days already were centered on sustenance, shelter, and survival.

The coronavirus may never entirely go away. Just as the H1N1 influenza virus resurfaced in 2009 (swine flu pandemic), and other influenza A and B viruses mutate annually, SARS-CoV-2 may subsist at a lower level of infectivity (vaccines and herd immunity are never 100% effective), or it may mutate and regenerate as a pandemic again in the future.

Surviving leukemia didn’t end the uncertainty. Instead, it brought new fears of relapse and long-term and late-effects of treatment, including a higher risk of a second cancer. But we moved on, reclaiming life and three years of childhood. As with anything, time and distance provide perspective.

What will we remember twenty years from now? Will we think about what we did to control the virus (or what we failed to do), how we responded (or didn’t respond), or the emotions (both positive and negative) that drove our actions and reactions during this time of crises? Will you be able to see how you survived, overcame, and got through the worst of times, and what you learned about yourself, others, and life?

When faced with cancer, coronavirus, or other life-altering and life-threatening illness, our survival instincts kick in and we are forced to face our mortality. We never go back to “before.” We move on, changed in some elemental way. I believe the COVID-19 pandemic will similarly teach us how to face our greatest fears, let go of our expectations, and learn to live in the moment.

We learn resilience throughout our lives—from family, culture, experiences, and opportunities. COVID-19 is just one of the circumstances challenging us to do the best we can as we live through the stress, uncertainty, and unpredictable path forward.

Sometimes it is enough to just get through.

Copyright © 2020 Janice Post White