key: cord-0852969-dtckr7de
authors: Gellert, George A.; Gellert, Tess E.
title: Contextual wellness in the age of COVID‐19: Managing disproportionate pandemic anxiety and stress in Australia, Singapore and other nations achieving disease control success
date: 2022-01-10
journal: Health Promot J Austr
DOI: 10.1002/hpja.571
sha: 47d0dc06533bd9a4f18bdf132f5f3882622508fe
doc_id: 852969
cord_uid: dtckr7de

nan

As a digital wellness and population health company operating in Australia, Asia, Canada, and the United States, it has been surprising to observe very high levels of COVID-19 related anxiety and stress where the actual incidence and public health impact of SARS-CoV-2 is remarkably low. 1, 2 Logic would suggest that COVID-19-related anxiety and stress would be proportional to actual local incidence, hospitalisation rates, mortality and individual disease risk. However, the unique cultural, economic and political dimensions of the era in which this pandemic is occurring have contributed much to inverting that expectation.

In the United States, which has high rates of infection, over 30% of the vaccine-eligible population has declined vaccination, 3 and anti-mask and anti-vaccine protestations are occurring in many local communities. 4 If Americans are anxious about COVID-19, some are equally anxious about a perceived threat to civil liberties and individual right to choose whether to accept preventive measures. In contrast, in our experience advancing wellness and stress reduction programs, Australians and Singaporeans express anxiety not only about disruptions in employment, personal finances and stress associated with recurring lockdowns and loss of life normalcy, 1,2 but experience very high levels of anxiety related to individual risk of infection. 5 This is despite the absence of a substantial or high threat of infection, hospitalisation and death from COVID-19 in these nations. 5

A foundational pillar of wellness programs is effective education to help individuals comprehend and develop motivation to actively shape their personal risk for preventable illness, stress and anxiety. We are adapting our COVID-19-related wellness efforts to more clearly and compellingly communicate that the personal sac- The total cumulative number of Australian COVID-19 deaths is about 2200 within a population of 25 million, 8 contrasting the United States, 13 times larger with over 820,000 deaths so far. A closer comparable is Canada, with only 13 million people more than Australia, but 30,300 COVID-19 deaths. 8 If Canada's COVID-19 national disease control were as effective as Australia's, only about 3400 Canadians would have died thus far. If the US had been able to achieve the same level of disease control and rate of community viral transmission as Australia, only 29,000 Americans would have died. Australia is clearly one of the safest places to live in terms of COVID-19 risk. 8 Singapore has a cumulative total of 827 COVID-19 deaths in a population of 6 million, 8 and Singaporeans had a 9 times greater risk of being killed in a motor vehicle crash in 2020 than from COVID- 19. 9 A key question is the extent to which perceived risk correlates with actual risk. Patients with cardiovascular disease overestimate their 10-year actual risk, 10 but for communicable diseases like sexually transmitted infections, perceived risk is lower than actual risk. 11 Risk perception during an Ebola outbreak was based primarily on how individuals were educated about infection. 12 Whilst risk perception sometimes does align with actual risk, there are situations where perceived and actual risk diverge, such as with COVID-19 in Australia and Singapore. Regardless, emphasis should be placed on providing the public with accurate and straightforward information so that individuals can assess their risk appropriately.

Pandemic anxiety is no doubt multifactorial in origin. Frequent lockdowns have contributed to COVID-19 anxiety in high-performing nations. Melbourne is the most locked-down city in the world, with 262 days across six different lockdowns. 13 A high frequency of lockdowns may contribute to public anxiety disproportionate to actual individual risk of infection. 14 To contain even small outbreaks, Australian health authorities engaged lockdowns which, whilst effective in interrupting spread, implicitly created alarm and generated anxiety. Public perception of infection risk has thus been influenced by factors unrelated to actual incidence and risk.

Also contributing to COVID-19-related anxiety is news media.

The pandemic's impact in high incidence nations appeals to the media's financial interest and viewer volume-based advertisement revenue ("if it bleeds, it leads"). Pandemic media coverage has been consistently high in most nations, but varied in content. In Australia and Singapore, media focus aligns frequently with evidence-based science and preventive recommendations. 15 In contrast, in the US abundant misinformation (which lacks the intention to mislead), and disinformation (which knowingly conveys misleading information), 16 as masking and non-essential services lockdowns. 19 If nations with high pandemic control performance such as Australia and Singapore continue to be successful, contributors to this success will be studied to discern future best practices on how can be-and has been-struck successfully in differing national settings. These analyses will help us manage high levels of fear, anxiety and stress through the remainder of the COVID-19 pandemic, and in future potential pandemics of newly emerging infectious diseases where, as was the case for COVID-19 as well as the last pandemic of HIV/AIDS, disease control efforts will focus centrally on driving the adoption of personal protective behaviours.

The authors have no conflicts of interest related to this manuscript.

George A. Gellert https://orcid.org/0000-0002-3519-7486

Acute mental health responses during the COVID-19 pandemic in Australia

Population anxiety and positive behaviour change during the COVID-19 epidemic: Cross-sectional surveys in Singapore, China and Italy. Influenza Other Respir Viruses

Centers for Disease Control and Prevention. COVID-19 Vaccinations in the United States

Covid vaccination: Los Angeles' Dodger Stadium 'closed by protests

Elevated COVID-19 related stress and anxiety observed in Australian and Asian markets

NSW had the ingredients for a second wave, but two key differences changed everything

Why is Singapore's COVID-19 death rate the world's lowest

World Health Organization Data at WHO [Internet]. World Health Organization

Annual traffic statistics

url?sa=t&rct=j&q=&esrc=s&sourc e=web&cd=&ved=2ahUK Ewi Ts eX3vs jyA hU TP3 0 K HVLLB ncQ Fn oECBA Q AQ &url =https %3A%2F%2Fwww. police.gov.sg%2F-%2Fmed ia%2F554 534CC 8C294 DCE80 E3B79 316B7 C86C.ashx&usg=AOvVa w1gMa WPul4 Truik PoYuxjsX 10

Young people assess their risk of sexually transmissible diseases

Risk perception during the 2014-2015 Ebola outbreak in Sierra Leone

Melbourne reopens as world's most locked-down city eases pandemic restrictions

Crisis communication and public perception of COVID-19 risk in the era of social media

COVID-19 news and misinformation

Infodemic pathways: evaluating the role that traditional and social media play in cross-national information transfer

Denmark: the latest coronavirus counts, charts and maps

The impact of the COVID-19 pandemic on mental and physical health in Denmark -a longitudinal populationbased study before and during the first wave

Public health nonfeasance, misfeasance and malfeasance in the U.S. government response to COVID-19