Journal of Community & Public Health Nursing
Open Access

A farmer has a pond. On day 1, there is one lilly pad. He knows that they grow fast and will double every day and completely cover his pond in 30 days. On what day will his pond be 50% covered? On what day will his pond be 1% covered?

Surprise:

50% coverage - day 29

1% coverage - day 24

I am treating COVID-19 patients. My role has been more of keeping people out of the hospital and preventing the virus to hit vulnerable, high risk groups. By my observations and recently paying more attention to the news I’ve been intrigued by some of the psychological factors playing out right in front of us during our country’s pandemic response.

Day in and day out, as a physician I’m guided by research and data to do the right thing for the patients I see, and most of all “...to do no harm.” I’ve been baffled by how our country is handling this crisis given its exposure to plenty of research and data. At best, there has been a hodgepodge of decision making. My emotions urge me to call out all of those who I think are deaf to the health warnings. This extends to our chief executive and goes all the way down to the people that I see in the grocery store who aren’t wearing a mask. I don’t want to believe that people are really that obtuse so I’ve been searching for a reason; an explanation for the reckless behavior on public display in person and on TV that puts us all at risk for COVID-19 infection. I make no excuse for anyone but I’m looking to put light onto the barrier that I think we need to recognize. Psychologists call it normalcy bias.

Normalcy bias, in its most stripped down form is the psychological state of denial. It is the tendency for people to believe that things in life will continue to go on the way they always have. It’s how many of us are wired. It ’ s a defense mechanism. Unfortunately, when facing trauma it denies the majority of us to act effectively in the face of crisis or impending doom.

Normalcy bias prevents us from understanding the possibility or the seriousness of a crisis or natural disaster, or it can lead ourselves to believe that nothing serious is going to happen. Those people most afflicted with normalcy bias are the first ones to say “...that won’t happen here,” or, “never mind the evacuation notice, it won’t be that bad.” A favorite exhibition of normalcy bias is for someone to cast doubt on the legitimacy of a crisis by citing any conspiracy theory. In essence, they just can’t cognitively deal with it. A 2018 study showed that 41% of people in the US were not prepared for a disaster. Psychologists have gone further. By studying automobile accidents, airline accidents, nuclear disasters and natural disasters, only about 30% of people can act quickly and decisively in a crisis, big or small.

So why is there normalcy bias? As social beings, we are sensitive to the perception of others viewing us as abnormal.Within social relationships, very few want to be seen as alarmist, overreactive or a fool because if they are wrong about a threat then they will be regarded as less credible in the future. Social shaming reinforces our normalcy bias. It’s not cool to overreact. Every parent has heard that from their adolescent.

So let’s consider the farmer’s example above. The farmer knows the facts. He doesn’t want his pond choked with lilly pads. He knows what will inevitably happen if he does nothing. What he may not know is how long it will take to happen. Since it takes 24 days for only 1% of his pond to be covered, he sees no big problem and has had the past 24 days to reinforce his normalcy bias. By the time he realizes his pond is entirely covered in just 6 days, it’s too late. He is overwhelmed. He missed his chance to take care of the problem.

Now, let’s take the farmer’s problem and apply it to the Coronavirus pandemic in our country. Instead of lilly pads in a pond, we are now talking about invisible particles that spread from person to person through the air and from surfaces.Those particles can hide in someone for up to 2 weeks before it ’s obvious they have them. There are countless warnings about the danger of these particles that you can’t see. Unless you are in healthcare, chances are you don’t know anyone with an infection and even a much lesser chance that you have actually seen someone with the acute illness. Putting it all together, normalcy bias leads us to think there isn’t much of a problem. So, as we often like to say, “it won’t happen to me. That’s someone else’s problem”

As for our government response, they have collectively shown us normalcy bias on steroids. Furthermore, they have added another dimension; inconsistency, which has only fanned the flames of normalcy bias. Both are on full display in the daily media. Some state’s governors have moved quickly, well before the lilly pad growth got out of hand. Other states, however have waited until late in the game to do something. As of this writing, seven states have not instituted stay-athome orders to slow the virus. It would come as no surprise that these same states also have a later estimated peak in Coronavirus cases and will probably act as a viral reservoir for all of us, extending the infection curve, from what it could have been.

Our chief executive has also sent conflicting messages which only embolden anyone ’ s normalcy bias. Originally, he downplayed the threat, only to find himself quickly overrun with lilly pads. Despite an abundance of research evidence, our commander-in-chief and his administration was ultimately caught unprepared. He won’t wear a mask. He is giving us all a master class in normalcy bias.

There are many other factors that are contributing to the US pandemic response but the virus is dictating the terms on how this is going to play out. Fortunately, we are studying it, learning more every day and can predict it to a reasonable degree. It appears that the biggest problem we have with the pandemic right now is with ourselves.

Normalcy bias is impairing us from making the best decisions, from the chief executive on down to the maskless shopper in the grocery store. Now that we are calling out the normalcy bias that we have within ourselves, let’s accept it, use it as cover, save face with it and move on. Let’s get it together, everyone. For the 70% of people who can’t act in a crisis, that’s the curve we need to flatten. So I’m asking those afflicted with normalcy bias to follow the doers. It’s ok. It’s for our collective good. Here’s what the doers are saying:

Wash your hands

Stay at home

Practice social distancing

Wear a mask. If not for yourself then for someone you care about, or maybe just for that other person in your grocery aisle.

We are all in this together so be kind. Thank healthcare workers and first responders... anyone working against the pandemic. They are experiencing the most stressful time of their professional lives and probably won’t tell you.

Lastly, thank the people who taught them. They gave us the knowledge to keep us all safe.

Dr. Koman is a family physician with Genesis Medical Associates in McCandless.

CARL: feel free to alter as you wish.