Online panic: a coronavirus case study

LATEST EDIT on March 6th, 2020: This article was updated to reflect the current developments. We are now officially facing a pandemic. See tips at the end of the article to stay safe.

One of the very first things we tend to do when we think we’re getting sick is to look up our symptoms. We feel some pain, we notice a weird rash on our skin, and we quickly open our browser to find answers. The medical community even has a name for it: Doctor Google. Lately, the big bad wolf of diseases is a novel coronavirus, nicknamed “wuflu” by some, which has emerged from a seafood wholesale market in the centre of Wuhan in China. When we go into panic mode, interesting things happen. And with the Internet, we can actually explore some of these trends. Let’s have a look at some curious phenomena such as cyberchondria, video games as a coping mechanism for anxiety, and how this novel coronavirus has impacted the Corona beer brand.

From hypochondria to cyberchondria

While we often jokingly call ourselves or friends hypochondriacs when they seem to worry about every little physical or mental symptom, real or imagined, it’s an actual medical condition. No matter how minor the symptom may be, people who suffer from hypochondria are convinced they may be suffering from a serious illness. It’s not uncommon for hypochondriacs to continue worrying despite a thorough evaluation from a doctor showing no underlying medical basis for their concerns. A study found that about 3% of the visitors to primary care places suffer from hypochondria. Some psychiatrists prefer to call it “illness anxiety” or “health anxiety” to make it sound less pejorative.

Many people tend to carry their anxieties about their health onto their online search behaviour. In fact, about 80% of Americans check their symptoms online. But some tend to check more often than others. In fact, the Internet has created a new condition, which has yet to be included in official classification manuals, but has been studied by psychology researchers: cyberchondria. According to New York State Psychiatric Institute’s researchers, cyberchondria refers to “searching the web excessively for health care information.” Their research found that the constant online checking creates a vicious circle, where cyberchondriacs get increasingly anxious about their health.

There are five behaviours showing that you may suffer from cyberchondriacs:

  1. You think you may have several different diseases.
  2. Your health is actually stable.
  3. You spend a lot of time checking for health information online.
  4. You search for health information several times a day.
  5. Your online probing actually makes you feel more anxious.

If you answered yes to all of these, you may be suffering from cyberchondria. Which, ironically, would be an actual condition to worry about and seek help to treat with the support of medical professionals.

But even if you don’t suffer from full-blown cyberchondria, most people do worry about their health and check for symptoms and advice online. And when people read about potential epidemics and pandemics, the vast amount of information available online makes that behaviour much more common and much more intense.

Panic and pandemics

Ten years ago, the big bad wolf was a strain of influenza called H1N1. In a fascinating paper, researcher Sander Gilman explains how the fear of a global panic influenced how the disease was originally labelled. Here is a direct quote from the paper.

“On May 21, 2009, WHO’s Director-General, Margaret Chan decided that influenza A (H1N1) was not going to become a pandemic. Not because of any epidemiological rationale but because the very term “pandemic” was feared to trigger global panic. “Swine flu” would have become a stage six pandemic on that date. But Chan observed that “I know that you have given me a lot of trust and flexibility, and this is not an easy task. I need to balance how science should play a role and not to forget about the people.” Not “science” but public response was the key to the rethinking of what our present outbreak of H1N1 should be labelled. By June 11, 2009, H1N1 was a designated pandemic.”

The word “epidemic” was borrowed from the French language in the 17th century. English physician Thomas Lodge needed a new term to define the nature of the plague in his 1603 book A Treatise of the Plague. He chose “epidemic” and defined it as “a common and popular sickness, happening in some region, or country, at a certain time, caused by a certain indisposition of the air, or waters of the same region, producing in all sorts of people, one and the same sickness.” In 1666, Dutch physician Gideon Harvey created the word “pandemic” in his book The Anatomy of Consumptions. While an epidemic occurs when a disease affects a greater number people than usual in a specific area, a pandemic is considered an epidemic of worldwide proportions.

Online panic and coronavirus: ngram of epidemic in English books from 1500 to 2008
Side note: I have no idea how people referred to diseases that would affect many people in many places before these two terms were created. There have been many great epidemics and pandemics before the 17th century, such as the Play of Athens, which killed about 100,000 people in 430 BC, and the Great Plague, which killed between 75 and 200 million people in the 14th century. What words did people use? Pestilence? Divine retribution? In a private conversation, Dr John L Collins pointed out a potential explanation. Quoting him: "related to the term 'communicable diseases'—there wasn't sufficient verbal or other communication (even between cities) of the disease to know the extent of spread of illness and disease until some time after the events and subsequent deep analysis and limited reporting capability, and little—if any—need for a single word to describe these."

What’s interesting—and noted in Sander Gilman’s research paper—is that both “epidemic” and “pandemic” have also quickly taken on metaphorical and catastrophic meaning, and that transfer from scientific description to mythical metaphor still continues today. When they hear one of these words, people start panicking.

At first glance, the coronavirus has everything to induce a collective panic attack. The Guardian reports: “Human to human transmission has been confirmed by China’s national health commission. As of January 30, the death toll in China stands at 170, with 7,711 confirmed cases of infections. In the past week, the number of confirmed infections has more than tripled and cases have been found in 13 provinces.”

From a medical standpoint, coronavirus causes pneumonia, with breathing difficulties, coughs and sometimes fever and organ failure. Antibiotics and seasonal flu antiviral drugs don’t work. When you put it this way, it can be pretty scary.

To decide how scared you should be of a virus, you need to understand the concept of R0 (pronounced “R naught”), which stands for basic reproduction number. R0 is defined as “the expected number of secondary cases produced by a single infection in a completely susceptible population.”

Let’s say an infected person transmits the virus to X healthy people. That’s your R0. In an epidemic, X and thus the R0 would be greater than 1.

Let’s put things into perspective. The R0 of measles is between 12 and 18; for smallpox, polio, and rubella it’s between 5 and 7; for HIV/AIDS it’s between 2 and 5. And for the 2019 novel coronavirus many people are panicking about… The R0 is estimated by the WHO to be between 1.4 and 2.5. There are bigger estimates, such as the one from Jonathan Read of Lancaster University in England and colleagues, placing the R0 of the novel coronavirus at a much bigger 3.6 to 4.0, but even if that was the case, it’s still fairly low compared to other diseases.

Online panic and coronavirus: the actual basic reproduction numbers of various diseases

If you’re curious how this is being calculated, you can check this GitHub repo where Christian Althaus and Julien Riou of the University of Bern in Switzerland posted data supporting their calculation of the 2019 novel coronavirus R0.

Of course, the infectivity of a virus doesn’t tell the whole story. To decide how much you should panic, you need to look at its case-fatality rate—the proportion of deaths within people who get infected. And in the case of this particular strain of coronavirus, it’s not particularly high either, standing at about 2%. For comparison, the SARS strain of coronavirus had a death rate of more than 10%.

Another comparison yet to put things into perspective: 400,000 people die each year from the seasonal flu. And why do most of these people die? Because their immune system was already weak, and their physical condition not strong enough to fight the virus. That’s why most people who die from a seasonal flu infection are older people. And this is exactly what’s happening with this new strain of coronavirus: people who are already sick and older people tend to suffer the most from it.

If people looked for the right information, they would probably feel reassured by these numbers. But when we’re in panic mode, we don’t tend to ask the right questions.

EDIT February 18th, 2020: The R0 may in fact be much higher than the WHO estimate—which means the coronavirus is likely to spread faster than current predictions. See at the end of the article for tips to stay safe.

Coronavirus, Corona beer and conspiracies

I initially got the idea for this article after having a silly, late-night conversation, where we were wondering what sort of impact this coronavirus outbreak had on Corona, the beer brand from Mexico. I unfortunately couldn’t find any information about the actual impact on sales, but if you look up “corona beer virus” or “corona beer coronavirus” on Google Trends, you will see a steep increase in search volume in the past few days.

Online panic and coronavirus - Google Search trends for Corona Beer Virus

It may seem obvious to many of you, but there is absolutely no link between Corona beers and the coronavirus. As Jelisa Castrodale explains: “The only thing that Corona beer and nCoV [novel coronavirus] have in common is the origin of their names. In Latin, corona meant crown, and modern languages continue to reflect that; corona still translates to crown in modern Catalan, Spanish, and Italian, among others. (…) The drinkable Corona does predate the virus, though: Corona was first brewed in 1925, while human coronaviruses were not identified until 1965.”

Nonetheless, people can’t help but make the connection. Lion Breweries, the company in charge of distributing Corona in New Zealand, even had to publish a statement: “There is no connection whatsoever between the coronavirus and Corona beer. The safety of our consumers is our priority. Corona is brewed under the highest quality standards and is safe to be enjoyed by our consumers. The virus name reference to corona, Latin for crown or halo, is due to the shape of the virus which resembles a royal crown or solar corona.”

This may seem like an innocent connection to make, but some people are letting their imagination run wild and creating yet even more dubious stories. This strain of coronavirus has come with an online counterpart: rampant misinformation on social media. One of the most ridiculous rumours is that the coronavirus was created by the US Centers for Disease Control and Prevention (CDC), who registered a patent for the virus. It’s interesting because the most effective misinformation is often based on a grain of truth.

The CDC did register a patent in an effort to combat a different strain of coronavirus. It’s a common thing to do and doesn’t mean they created this virus or any other. The CDC does this to ensure access and to prevent others from controlling the biotechnology. Another conspiracy theory actually states that the coronavirus is a bio-weapon started by the Chinese government to reduce its own population.

Rumours are not only about what’s going on. The very dangerous rumour that people can protect themselves from the coronavirus by drinking bleach has been spreading online, emerging from QAnon, a far-right conspiracy theory group. Dubbed “Miracle Mineral Solution” or “MMS”, bleach-based products have long been promoted by fringe groups as a combination cure and vaccine for everything from cancer to HIV/AIDS. It doesn’t help that Donald Trump has routinely re-tweeted QAnon conspiracy theory content in the past, helping increase their reach.

Conspiracy theories linked to such viruses are not new. In a twenty-year old report suggesting strategies to “rebuild America’s defenses”, neoconservative think tank PNAC wrote: “Advanced forms of biological warfare that can target specific genotypes may transform biological warfare from the realm of terror to a politically useful tool.” Again, this is nonsense. As Bernhard said: “from a scientific perspective that makes little sense. There is no ‘race gene’ that could be used to safely discriminate between people of a certain heritage and others.”

Why do we try so hard to find patterns and connections where none exist? As we will see, these false narratives are paradoxically reassuring: by having an explanation—any explanation—as to what is going on and what to do, we feel like we’re regaining control over a stressful situation.

The power of illusory correlations

As human beings, we are desperate for patterns. The human propensity to seek patterns in random information even has a name: apophenia. The German term, Apophänie, was coined in 1958 by psychiatrist Klaus Conrad in a book about schizophrenia, and defined as “unmotivated seeing of connections accompanied by a specific feeling of abnormal meaningfulness.” Since then, the term has become used more generally, as this propensity is actually pretty common among humans. In 2008, science writer and founder of The Skeptics Society Michael Shermer also coined the word “patternicity”, which he defined as “the tendency to find meaningful patterns in meaningless noise.”

I myself explored the concept of illusory correlations before, which also describes our tendency to overestimate relationships between two variables even when no such relationship exists. When stressed or tired, the availability heuristic comes into play. We feel like the most easily accessible information must be more important than alternative pieces of information which are not as easily recalled. And so we make connections and correlations where none exist. Moreover, we may tend to make outrageous connections—such as linking the coronavirus to a beer brand or the conspiracy theories we explored—because shocking or surprising information is easier to recall.

Research suggests that there may be good reason for us to remember the bad stuff more vividly: it does make sense from an evolutionary standpoint. Noticing the weird, the out-of-the-ordinary, remembering the scary, the dangerous… All of these are great automatisms to develop when you have to survive in a wild habitat. But in a complex environment where we are prone to first-order thinking and false assumptions, our tendency to easily connect the dots may become the danger itself.

“In any high-stress, fast-paced field like medicine, superstitions run rampant when you feel a loss of control. This is especially true of emergency environments because you never know what will walk in. You need some way to explain the unpredictability of your environment.”

Dr. David Mandell.

Short-term, these superstitions and other illusory correlations may result in reduced levels of anxiety, as our mind clings onto these explanations to regain a feeling of control. However, long-term, these false narratives will negatively impact our decision-making, resulting in additional stress. What started as a biological virus which we seek to better understand becomes a mental virus affecting our ability to think. Instead of seeking patterns when none exist, what are safer ways to alleviate our anxiety when faced with such an outbreak?

Better coping mechanisms

One of the most surprising effects the coronavirus had was to make Plague Inc, a game which was released 8 years ago, suddenly one of the top grossing games in China. It’s not the first time people turn to this particular video game during an outbreak. Plague Inc actually sees a spike in users every time there’s a viral outbreak, from the Ebola virus to the flu. Plague Inc got so much traffic last week, it crashed. “It’s certainly possible that people are playing [Plague Inc] as a way to work through anxiety or put things into perspective,” mental health researcher Michelle Carras Colder told Business Insider.

Online panic and coronavirus: the Plague Inc game surges in popularity

Research indeed suggests that video games—even the most disturbing kinds of video games—can act as a form of therapy for people suffering from depression or post-traumatic stress disorder. For example, some military veterans play war video games as a way to make sense of their difficult experiences.

Video games which are well researched can also be a source of education. In 2013, the founder of Plague Inc, was invited to the CDC (the same US Centers for Disease Control and Prevention we mentioned earlier), where the game was praised for using “a non-traditional route to raise public awareness on epidemiology, disease transmission, and diseases/pandemic information.”

There’s surprisingly little research into effective coping mechanisms during an epidemic or a pandemic. While we’ve established that turning to Doctor Google may not be the best option, and that certain video games can surprisingly have a relaxing effect, what else can be done to cope with health anxiety?

In a study looking at how health workers managed to cope with the Ebola epidemic in Sierra Leone, researchers found some recurring themes. Peer and family support, a sense of meaning, education, and better use of social media. But if you live in a country where so far there hasn’t been anyone diagnosed with the coronavirus, you may not even need such heavy strategies. Instead, the NHS recommends some simple self-help strategies to use if you suffer from health anxiety.

  • Keep a journal. Note how often you look at health information, check your body, or ask people for reassurance, and try to gradually reduce how often you do these things over a week.
  • Challenge your thoughts. Draw a table with two columns and write your health worries in the first column. Then, write more balanced thoughts in the second column.
  • Keep busy. When you get the urge to check for health information online, distract yourself by doing something else, such as going for a walk.
  • Try to relax. You could for example try a short meditation, reading a few pages of a book, or going for a run.

Staying safe

Epidemics and pandemics are hard to control and harder to predict. While you should not panic, it’s important to follow basic rules during such times.

  • Wash your hands. Use either an alcohol-based hand gel or soap and water. Washing your hands with these for at least 20 seconds will kill viruses that may be on your hands.
  • Don’t touch your face. In particular, avoid touching your eyes, nose and mouth. Even if you’re making an effort to wash your hands, you will keep on touching many surfaces when you could pick up the virus.
  • Practice social distancing. Maintain at least one metre (3 feet) between yourself and other people—especially if they are coughing or sneezing. When possible, turn your face-to-face meetings into online calls.
  • Avoid unnecessary travel. Crowded spaces such as trains and airplanes increase the likelihood of picking up or transmitting the virus.
  • Stay home if you feel unwell. Finally, if you have any coronavirus symptoms such as a fever, cough and difficulty breathing, call a doctor and stay home until you receive further instructions.

I hope you found this journey through cyberchondria, the etymology of the terms “epidemic” and “pandemic”, the US patent system, conspiracy theories, video games, beer and psychology interesting. We all have different information-seeking behaviours, and sometimes it’s hard to tell fact from fiction. Whether looking up symptoms (“why am I coughing?”), trying to identify risk factors (“is it dangerous to drink Corona?”), exploring potential cures (“drink bleach to protect yourself”), we need to be careful about illusory correlations, false narratives, and our own anxieties. Staying calm so we can make rational decisions is often a better response.

This coronavirus Q&A page is regularly updated by WHO. Many countries are currently doing an amazing job at containing the virus. The bottom line is: don’t panic, but stay safe.

EDIT March 6th, 2020: We just crossed 100,000 cases today, and companies are starting to encourage their employees to work from home, often without any prior experience or proper training. If that’s your case, I collated some useful tips from seasoned remote workers.

Anne-Laure Le Cunff

I’m an ex-Googler, entrepreneur, and part-time neuroscience student at King’s College. If you found this article useful, subscribe to my weekly newsletter about mindful productivity.

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