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Psychological
Aspects
in time of
Pandemic
Juan Moisés de la Serna
Translated by Jacqueline Passfield
Tektime Editorial
2020
“Psychological Aspects in time of Pandemic”
Written by Juan Moisés de la Serna
Translated by Jacqueline Passfield
1st edition: November 2020
© Juan Moisés de la Serna, 2020
© Tektime Editions, 2020
All rights reserved
Distributed by Tektime
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Prologue
In light of the very positive reception to the article entitled “Cual es el papel del psicólogo ante el nuevo Coronavirus (COVID-19)?” (“What is the role of psychology in the face of the new Coronavirus (COVID-19)?”) published in La Cátedra Abierta de Psicología y Neurosciencias on 12th February 2020, and the general interest evoked amongst fellow psychologists and other people with an interest in psychology, I have decided to produce this book, which addresses the subject of the psychological perspective in times of a pandemic.
Despite the fact that information concerning health crises such as COVID-19 is very recent and in some cases quite changeable, I am going to present a work based on current data sourced principally from scientific publications, and which will include, from the same sources, statements from various experts.
A book accessible to all who wish to delve into the psychological aspects of a mass phenomenon in times of a health crisis, as in the case of COVID-19..
Dedicated to my parents
INDEX
Prologue
Chapter 1: Introduction to COVID-19
The name of COVID-19
Adoption of Health Measures
List of Illustrations
Referenced Tweets
References
Chapter 2. Reactions to COVID-19
Decisions in the face of COVID-19
Irrational Behaviour
Racism in the face of COVID-19
Referenced Tweets
References
Chapter 3. Mental Health and Lockdown
Emotions in Lockdown
Depression in Lockdown
Anxiety in Lockdown
The Immune System in Lockdown
Diet in Lockdown
Sleep in Lockdown
Resilience in Lockdown
Referenced Tweets
References
Conclusions
Chapter 1: Introduction to COVID-19
One may speak of a personal or a social crisis. A personal crisis takes place when an internal or external circumstance occurs which changes the manner in which an individual perceives their own present, future and even past, making them question either their own role in life, or all their thoughts and beliefs up to that particular moment. Such is the case when a family member, particularly a close one, dies, or an accident occurs, with associated health or autonomy implications. One may also face a crisis due to emotional issues, such as the breakdown of a relationship, or the divorce of one’s parents as a teenager. From a psychological perspective, such crises are viewed as being caused by the effect of many different circumstances upon an individual. But then there are the social crises, as in the cases of humanitarian crises, where millions of people abandon all they have and flee towards an uncertain future. Likewise, economic crises, where thousands of people lose their jobs overnight and with them their incomes, putting both their own survival and those of their loved ones at risk (@NTN24ve, 2018) (See Illustration 1).
Included in this type of crisis are those related to health, in which a disease may put at risk the life of an individual who, a few days earlier was perfectly healthy. Pandemics and health emergencies may be included in this category, as in the case of COVID-19, a disease that has mobilized thousands of doctors and health personnel who struggle daily, even risking their own lives, in mitigating 
the effects of the virus,
Illustration 1. Tweet – Humanitarian Crisis
[Venezuela enters the list of countries with humanitarian crises, headed by Africa]
Whilst the media often affords the most visibility to numbers of cases and deaths, such information being provided from different governments and the webpage of the WHO (World Health Organisation), the Center for Systems Science and Engineering at John Hopkins University, USA (John Hopkins, CSSE, 2020) reports, numerically and visually, the numbers of cases, deaths and recoveries, both for each individual country and worldwide.
Illustration 2. Infections as at 7th March 2020
Thus, on 7th March 2020, which is when this book begins, the number of cases worldwide is 102.470, distributed amongst 101 countries. China has 80,651 cases, followed by South Korea with 7,041 and Iran with 4,747. Spain is in tenth position with 401 cases (See Illustration 2).
The portal also reports that the number of deaths to date is 3,491 people, with 57,462 having recovered from the disease.
Updating the previous data on 19th March 2020, the number affected worldwide is 218,827 people, distributed amongst 160 countries, with the number of worldwide deaths 8,811. (See Illustration 3)
Illustration 3. Infections as at 19th March 2020
Looking at Google (Google Trend, 2020) regarding the search trends for COVID-19, a term designated by the WHO on 11th February 2020 to refer to the new coronavirus that emerged in a province of China, and whose first case of the disease was reported on 31st December 2019 (WHO, 2020), it can be seen how numbers of searches for this term have been progressively increasing worldwide, doubling between 11th and 12th February, 23rd and 24th February and 1st and 2nd March, a reduction only observed between 28th 
February to March 1st (See Illustration 4).
Illustration 4. Evolution of the search term
Regarding interest shown by specific countries, it can be seen that the country that has generated most searches within the last month has been Singapore, followed by Iceland, China and Hong Kong. Out of the total 65 countries in Google’s results, USA is in 20th position and Spain is 48th. Turkey is in final position (See Illustration 5).
As can be seen, there is no direct correspondence between the countries with the greatest number of cases and the concern generated amongst their populations reflected in the searches. This may be due to other factors, such as the generation of alarmism in certain populations for instance, or usage of means other than Google to obtain pertinent information. For example, in some Asian 
countries the most commonly used search engine is Baidu.
Illustration 5. Searches by country
It should also be noted that COVID-19 was previously referred to as the new coronavirus 2019 (n-CoV) and also known as “China virus” or “Wuhan virus” – Wuhan being the name of the Chinese province where the virus originated, so some users will continue to search with these old terms. In addition, the term ‘coronavirus’, which is the name of the family of this particular virus, or simply ‘virus’ may be used. For this reason, if data is only collected for the term ‘COVID-19’ the overview would be incomplete. This could explain the difference demonstrated between countries in terms of number of deaths and order of interest shown from Google searches.
Therefore, if the previous search is carried out, but including the terms COVID, Virus and Coronavirus as search terms, it can be seen that concern for this issue began on 20th January 2020, and that the term COVID or COVID-19, which is its official name, is hardly used at all in information searches on the subject, with the search of the term Virus being considerably higher and the term 
Coronavirus higher still (See Illustration 6).
Illustration 6. Terms on Google related to COVID
In the previous graph one can see there was initial interest shown in both terms Virus and Coronavirus between 20th and 31st January followed by a progressive loss of interest up until 20th February when interest in the term Coronavirus increases exponentially.
Focussing on this last term, the country that has searched it the most on Google is Italy, followed by Singapore and Switzerland. Out of the 64 countries for which data is available Spain is in fifth place and USA is nineteenth (See Illustration 7).
This data does correspond to the growing number of infections, except in the case of Ireland where one could speak of an instance of social alarmism over actual data of the time.
Illustration 7. Search of the term Coronavirus by country
The name of COVID-19
One of the problems facing social psychologists is in achieving customer brand loyalty, a brand being that which is used in the identification of a certain person, product or company. Normally when thinking of a company like Coca-Cola, McDonald’s or IKEA, it is with reference to the products they sell. With other brands such as UPS, Iberia or Microsoft, it is with regards the services they offer. This is something which exerts a decisive influence on the purchase of any product or service, which is no longer based just on one’s own judgement, but on the influence of the opinion of others and the media via advertising.
If one thinks of Stephen Hawking, Barack Obama or Rafael Nadal in the same way, it is no longer in terms of products or services, but in respect of their personal branding or brand they have developed through their scientific, political and sporting careers respectively. In other words, emotional aspects become associated with a brand which may be linked to a person, a company and even a place.
The same happens when it comes to the naming of disasters, as in the case of the tropical cyclones which annually afflict a large part of the Caribbean and North America. According to the World Meteorological Organization (WMO, 2020) these names follow pre-established rotating lists, and for many they leave behind the memories of the effects of Hurricane Katrina in 2005 or Ike in 2008.
In principle the names bear no relation to the dates of the events, the damaging incidents themselves, or the most affected areas. Amongst them are English and Spanish names e.g. Barry, Gonzalo and they may be male or female e.g. Lorenzo, Laura. But does the name of a tropical cyclone have any impact upon the population?
An answer to this question has been sought by the Department of Administration and Business in conjunction with the Department of Psychology, the Institute of Communications Research, and the Women and Gender Surveys Research Laboratory of the University of Illinois; together with the Department of Statistics of Arizona State University (Jung, Shavitt, Viswanathan & Hilbe, 2014).
The study analysed the climatic consequences of hurricanes in the USA over the last six decades, differentiating between those with male and female names. The first finding was that those with female names had been the most destructive and the cause of most deaths.
It should be remembered that the list of names is preassigned and their assignment organised consecutively, so a priori there is no relationship between the gender of the name and the intensity of the hurricane. A list of hurricane names, 5 male and 5 female were given to 346 participants for them to rate the considered extent of each hurricane’s intensity on a Likert-type scale from 1 – 7. The results showed that male-named hurricanes tend to be evaluated as more destructive than female-named hurricanes, regardless of each participant’s gender.
This study made it possible to understand why, in the face of warnings from the authorities, sometimes more and sometimes fewer preventative measures tend to be taken. It is, in fact, simply due to whether the hurricane’s assigned name is male or female.
In contrast, the designation of diseases within the health field are usually indicated by an acronym which relates to certain identifying characteristics of its location, symptoms or consequences.
There have previously been several outbreaks of the coronavirus strain, as in the case of SARS-CoV which emerged in China in 2002 and whose acronym corresponds to Severe Acute Respiratory Syndrome, referring to its symptomology. The MERS-CoV virus emerged in Saudi Arabia in 2012 and its initials refer to the Middle East Respiratory Syndrome Coronavirus, describing both its location and symptoms. The acronym for COVID-19, which emerged in China in 2019, refers to the Coronavirus disease of 2019, with no indication as to its symptoms or source.
It should be noted that COVID-19 was not the first name to be used in the identification of this disease, but it was a term introduced almost two months after the first case was reported to the WHO. This has led some to argue that the motivations for changing and assigning it an ‘official’ name, were done to avoid the negative consequences of associating a type of disease with a region or population (@radioskyl,2020) (See Illustration 8).
The aim here would be to eliminate the names of ‘China virus’ or ‘Wuhan virus’, terms which point directly to the source of the infection. Some health professionals denounce this deference towards China, since the same consideration has not been shown towards other populations, as in the case of the Middle East Respiratory Syndrome Coronavirus, for instance.
As demonstrated in the previous section, despite the fact that an official name of COVID-19 has been assigned, the population has continued to use the terms ‘virus’ and more primarily ‘Coronavirus’ to find out about the symptoms, prevention measures and extent of this disease, and although it is still too early to understand the reason as to why the official name has ‘failed’, it must be taken into account that to create a new brand that is adhered to, a number of variables need to be taken into account, as 
analysed by Taylor’s University in Malaysia (Pool, 2016).
Illustration 8. Tweet - Name of Covid-19
[Director-General of WHO, Tedros Adhanom Ghebreyesus announced that the name of coronavirus has changed to COVID-19. An abbreviation of the disease that has caused the death of more than 1,000 people. The first vaccination “could be ready in 18 months”].
This research aimed to uncover the reasons for the success of certain brands versus the rest. To this end, a selection of fifty best-selling everyday products from the two main marketing companies was chosen in order to verify the brand’s effectiveness. After analysing the messages, pamphlets and publicity of the two brands circulated by the press and media networks, it was discovered, via the application of textual analysis and the interpretative method of research, that in order to maintain the loyalty of their customers, these brands underpin their foundations upon two principles The first principle is the ability to generate positive emotions, and the second the aesthetics of honesty, that is, that the product serves the purpose for which it is designed, whilst maintaining the advertised quality standards.
It should be mentioned at this point that the WHO, together with UNICEF, are the highest valued international agencies worldwide, according to the WIN/Gallup International Survey (WHO, 2014) which indicated that 72% of those interviewed had a positive opinion of these agencies. It would therefore have been expected that, by now, the search term ‘COVID-19’ would have been widely adopted. However, it must be taken into account that the announcement of the new name took place on 11th February (see Illustration 8) , whilst worldwide 
concern began almost a month earlier, on 20th January.
Illustration 9. Tweet - Image of COVID-19
[The new coronavirus is called SARS-CoV-2 and the disease it causes is COVID-19 (Coronavirus Disease 2019)
There thus remains a tendency for the terms ‘virus’ or ‘Coronavirus’ to continue to be used (CSIC,2020) (See Illustration 9).
In the photo, virus of the family Coronaviridae, to which the new coronavirus belongs. (Photo taken by virologist Luis Enjanes (@CNB_CSIC)]
.
Adoption of Health Measures
One of the most difficult phenomena for people to face is in terms of the adoption of healthy behaviour, which requires some time to accept, understand and assume.
Unlike other phenomena such as the latest trends, which have the ability to motivate the population, when it comes to health, the authorities are often faced with minimal success in their awareness campaigns. Such campaigns aimed at the recommendation of the adoption of healthy habits and behaviour are usually accompanied by restrictions and even penalties for those who do not comply.
However, the population struggles to see any ‘benefits’ in the short term, resulting in a reduction in any ‘interest’ and motivation for the adoption of these new habits, to the extent they may not even carry them out at all, thus failing to comply with the authorities’ recommendations.
Whilst health is an aspect of concern to society, the concept of prevention is not always understood and accepted in the same way, especially when it comes to the adoption of some behaviours which tend to go against those which are customary (MinInteriorAR, 2020) (See Illustration 10).
Illustration 10. Tweet - Prohibited Activities
[Look after your health and your family’s. Always remember not to share your mate 1, your utensils and other personal objects. Learn more at bit.ly/Coronavirus-Co ]\]
In the case of COVID-19, the population has been asked to ‘abandon’ some practices and adopt new ones. Going against ‘routine’, has made it difficult for many at first to adopt these recommended measures. This is because, sometimes, despite medical guidelines, the population does not acknowledge the risks to their health of certain behaviours, as previously mentioned. One such instance is in the practice of artificial tanning with UVA rays, an activity that has greatly increased in certain countries over recent years.
In some places being tanned has become something of a status symbol. One employee, having enjoyed a few days at the beach may return to work nice and brown, whilst the rest of the office, who have not been so lucky are still white and pale. On the contrary, in other places, being tanned is a sign of a lower social status, since the sun burns the skin of outside workers, giving it that characteristic brown colour, whilst other less manual jobs do not leave that ‘imprint’ on the body. It can therefore become a signal as to the economic status of the consumer, differentiating between those who can afford it and those who can’t.
In Western society today the first approach dominates, that is people feel good about themselves when tanned, something which takes time and in some cases money, to achieve. To meet this demand, a number of establishments have emerged, with UVA lamps which produce the same effect on the skin after one or more exposure sessions. And so, with this UVA ray system, the same tanned appearance is achieved as if one had gone on a relaxing beach holiday in the sun.
So, simply by spending a few minutes inside one of these devices, one can enjoy the ‘benefits’ of being 
considered of a higher economic status.
Illustration 11. Tweet - Relation between UVA rays and cancer.
[UVA rays cause cancer]
Despite the popularity of this system, in recent years medical research has been compiled which has discovered associations between the excessive use of UVA rays and skin cancer. Therefore, people who use and, more importantly, abuse these tanning sessions are voluntarily putting themselves at risk to skin diseases (adgs125, 2019) (See Illustration 11).
An investigation has been carried out to assess the psychological impacts of the usage of UVA rays by the Department of Dermatology, Warren Alpert Medical School; Department of Epidemiology, School of Public Health; Medical Centre, Providence VA Medical Centre; and the Department of Psychiatry and Human Behaviour, Warren Alpert Medical School, Brown University; together with Division of Network Medicine, Brigham Hospital; Department of Nutrition and Department of Epidemiology, Harvard School of Public Health; together with the Division of Adolescent Medicine, Boston Children’s Hospital; Department of Dermatology, Rhode Island Hospital (EE.UU.) together with the Department of Occupational and Environmental Health Sciences, Faculty of Public Health, University of Peking (China) (Li et al., 2017).
The study involved 67,910 women between the ages of 25 and 35 who were asked regards the frequency with which they used UVA ray tanning rooms. The aim of the study was to determine if there was an association between frequent indoor tanning and other mental disorders such as food addiction. To this end the Yale Food Addiction Scale was used (Flint et al, 2014). The participants’ clinical history as to whether or not they had suffered from depression was also taken into account.
The results showed a significant relationship between the presence of depression and greater use of UV rays. Also demonstrated was a significant relationship between the abuse of UV rays and symptoms associated with eating disorders, particularly anorexia.
As with other activities, the use of this type of service may be considered normal, except when control is lost and it becomes an addiction, that is to say it is being undertaken for its own sake, rather than for the benefits it may bring. Such behavioural addiction to tanning is called tanorexia. In this instance, the depressive symptoms appear to play a fundamental role in the formation or maintenance of the addiction to UVA rays, as if the individual attempts to ‘offset’ their state of mind by giving a ‘better’ image of themself to others.
Previous research has reported significant relationships between food disorders and depressive symptoms, but in this instance the relationship is mediated by an addictive behaviour, such is the abuse of UVA rays.
According to the conclusions of the study, consideration must be taken with individuals who abuse the use of UVA rays, since it may constitute depressive symptomatology and the suffering of anorexia.
Despite these findings, and the health problems associated with skin cancer discussed earlier, people find it difficult to give up this type of habit, since the short-term benefits of a tanned skin mean any long-term health damage is underestimated.
This type of attitude may also be witnessed in the undertaking of other unhealthy habits or those that entail long-term damage, where the consumer ‘assumes’ the risk, focussing on the short-term benefits, despite warnings from the authorities. For instance, for some years governments around the world have been trying to stop tobacco use. Furthermore, the authorities have had to ‘fight’ against the portrayal of this habit in films and the media where, in recent decades it was seen as socially accepted, despite the harmful effects on the health of the consumer and the people around them, in what is known as passive smoking (@CNPT_E, 2017) (See Illustration 12).
Existing measures tend to act in a dissuasive manner by putting all kinds of obstacles in the way of its consumption, stopping short of prohibition. Its display is limited to certain specially designed areas, the price is increased, and images are included on the packs of the negative health effects. However, some governments have decided to take a step further and employ the same mechanisms that for years served to spread and encourage tobacco use - television advertising. But are anti-tobacco 
advertisements effective?
Illustration 12. Tweet – Prohibition of Tobacco Advertising.
[ The #EmpaquetadoNeutro removes the advertising from tobacco and helps to reduce the prevalence of smoking in Spain]
This question has been addressed in research undertaken by the Department of Education, Seoul National University and the TESOL Department, Hankuk University of Foreign Studies (South Korea); along with the College of Nursing and Health Innovation, Arizona State University and the Department of Psychology, Jesuit University of Wheeling (USA) (Wilson et al., 2017).
The study involved 58 university students who were split into two groups, the first group viewed two emotionally focussed anti-smoking advertisements, whilst the other group viewed two logical, non- emotional type anti- smoking advertisements. Before and after the viewings all the participants undertook three tests, one related to transformation processes, one to depressive symptoms, and the third regards self-esteem. The results showed no significant differences pre or post viewing, either for the emotional or logical advertising, in any of the variables evaluated, i.e. participants appeared to pay no attention to the information given to them about the harmful effects of tobacco usage.
One of the limitations of the study is in the selection of the population chosen. Undoubtably the advertising is aimed at preventing young people from starting tobacco consumption, but since in many countries young people start smoking from the age of fourteen, a selection of participants from that age group should have been chosen instead of university students.
Despite the above, it should be noted that the effects of advertising are mainly based on repetition of relevant advertisements, to the extent that the information is learned. Therefore, the fact that the advertisements were viewed only once would explain the insufficient effects upon behaviour towards smoking, self-esteem or depressive symptoms.
In the specific case of COVID-19, and to the surprise of some, an unprecedented measure has been adopted, in the prohibition of all advertising regarding gambling. The idea is to prevent people who are spending a lot of time confined to their homes, becoming ‘hooked’ on gambling, which can lead not only to addiction, but also to economic ruin when monetary gambling is involved.
Considering that there are other concerns in a time of health crisis, people may not consider the adoption of such measures to be a priority. However, the government has primarily undertaken them to prevent the negative economic consequences gambling can bring about, not only in the altering of people’s moods which can lead to major depressive disorder, but also economic ruin which may lead 
to suicide.
Illustration 13. Tweet – Prohibition of Gambling Advertising
[Minister for Consumer Affairs, @garzon ‘’With regards gambling we have detected that there has been a growing incidence of online betting. That is why we have prohibited the advertising of gambling in any medium, except during the hours of 1am to 5am.”]
Such is the importance in the early prevention of behavioural addictions, for, as time passes, it becomes even harder to ‘kick the habit’, and in this particular instance, the new addict would continue to play after lockdown. It is consequently important that such measures are adopted in order to prevent negative effects on the physical and mental health of these potential gamblers (-consummogob,2020) (See Illustration 13).
Although such measures might be thought of as exaggerated or out of place, the reality is that our economic behaviour is governed by a multitude of internal and external variables. For example, one usually thinks about shopping in terms of prices. But how much are people willing to spend to buy things? This and other similar questions are dealt with by Consumer Psychology, a branch of study which analyses the behaviour of the individual when faced with varyingly complex economic decisions. The prototype for such investigations concern games of chance, that is, a situation where money may be won or lost dependent upon probabilities that the researcher manipulates.
It has been demonstrated that there are some people who are conservative in their value judgements, whilst others take more risks. It has also been observed that these personal variables are modified when subjected to temporary or continued consumption of certain addictive substances.
Based on this type of research, other variables, which may be implicated in whether an individual might assume lesser or greater economic costs are analysed, such as obesity. But are there differences in what an individual is willing to pay based on whether or not they are overweight? An answer to this has been sought by research undertaken by the Agricultural and Food Economics Unit, Agricultural Research and Technology Centre of Aragon, Agro-Food Institute of Aragon, University of Zaragoza (Spain), together with the Economic, Agricultural and Food Resources Area, Michigan State University (USA) (De-Magistris, López-Galán, & Caputo, 2016).
The study involved 309 participants, graded as to whether or not they were overweight (those with a body mass index greater than 30 (weight in kilograms divided by height squared) were overweight), and whether or not they accepted their own image in the mirror (using the standardised Body Image State Scale questionnaire (Cash, Fleming, Alindogan, Steadman, & Whitehead, 2002). Four groups were formed, not overweight with acceptance of mirror image; not overweight with non-acceptance of mirror image; overweight with acceptance of mirror image, and overweight with non-acceptance of mirror image.
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