Has A Year of Living with COVID-19 Rewired Our Brains?

Has A Year of Living with COVID-19 Rewired Our Brains?

12/15/2020

Photo: Nathalie Lees/The Guardian

TheGuardian.com

When the bubonic plague spread through England in the 17th century, Sir Isaac Newton fled Cambridge where he was studying for the safety of his family home in Lincolnshire. The Newtons did not live in a cramped apartment; they enjoyed a large garden with many fruit trees. In these uncertain times, out of step with ordinary life, his mind roamed free of routines and social distractions. And it was in this context that a single apple falling from a tree struck him as more intriguing than any of the apples he had previously seen fall. Gravity was a gift of the plague. So, how is this pandemic going for you?

In different ways, this is likely a question we are all asking ourselves. Whether you have experienced illness, relocated, lost a loved one or a job, got a kitten or got divorced, eaten more or exercised more, spent longer showering each morning, or reached every day for the same clothes, it is an inescapable truth that the pandemic alters us all. But how? And when will we have answers to these questions – because surely there will be a time when we can scan our personal balance sheets and see in the credit column something more than grey hairs, a thicker waist, and a kitten? (Actually, the kitten is pretty rewarding.) What might be the psychological impact of living through a pandemic? Will it change us forever? 

“People talk about the return to normality, and I don’t think that is going to happen,” says Frank Snowden, a historian of pandemics at Yale, and the author of Epidemics and Society: From the Black Death to the Present. Snowden has spent 40 years studying pandemics. Then last spring, just as his phone was going crazy with people wanting to know if history could shed light on Covid-19, his life’s work landed in his lap. He caught the coronavirus.

Snowden believes that Covid-19 was not a random event. All pandemics “afflict societies through the specific vulnerabilities people have created by their relationships with the environment, other species, and each other,” he says. Each pandemic has its own properties, and this one – a bit like the bubonic plague – affects mental health. Snowden sees a second pandemic coming “in the train of the Covid-19 first pandemic … [a] psychological pandemic”.

Aoife O’Donovan, an associate professor of psychiatry at the UCSF Weill Institute for Neurosciences in California, who specializes in trauma, agrees. “We are dealing with so many layers of uncertainty,” she says. “Truly horrible things have happened and they will happen to others and we don’t know when or to whom or how and it is really demanding cognitively and physiologically.”

The impact is experienced throughout the body, she says, because when people perceive a threat, abstract or actual, they activate a biological stress response. Cortisol mobilizes glucose. The immune system is triggered, increasing levels of inflammation. This affects the function of the brain, making people more sensitive to threats and less sensitive to rewards.

In practice, this means that your immune system may be activated simply by hearing someone next to you cough, or by the sight of all those face masks and the proliferation of a color that surely Pantone should rename “surgical blue”, or by a stranger walking towards you, or even, as O’Donovan found, seeing a friend’s cleaner in the background of a Zoom call, maskless. And because, O’Donovan points out, government regulations are by necessity broad and changeable, “as individuals we have to make lots of choices. This is uncertainty on a really intense scale.”

The unique characteristics of Covid-19 play into this sense of uncertainty. The illness “is much more complex than anyone imagined in the beginning”, Snowden says, a sort of shapeshifting adversary. In some it is a respiratory disease, in others gastrointestinal, in others it can cause delirium and cognitive impairment, in some it has a very long tail, while many experience it as asymptomatic. Most of us will never know if we have had it, and not knowing spurs a constant self-scrutiny. Symptom checkers raise questions more than they allay fears: when does tiredness become fatigued? When does a cough become “continuous”?

O’Donovan sighs. She sounds tired; this is a busy time to be a threat researcher and her whole life is work now. She finds the body’s response to uncertainty “beautiful” – its ability to mobilize to see off danger – but she’s concerned that it is ill-suited to frequent and prolonged threats. “This chronic activation can be harmful in the long term. It accelerates biological ageing and increases the risk for diseases of aging,” she says.

In daily life, uncertainty has played out in countless tiny ways as we try to reorient ourselves in a crisis, in the absence of the usual landmarks – schools, families, friendships, routines, and rituals. Previously habitual rhythms, of time alone and time with others, the commute, and even postal deliveries are askew.

There is no new normal – just an evolving estrangement. Even a simple “how are you?” is heavy with hidden questions (are you infectious?), and rarely brings a straightforward answer; more likely a hypervigilant account of a mysterious high temperature experienced back in February.

Thomas Dixon, a historian of emotions at Queen Mary University of London, says that when the pandemic hit, he stopped opening his emails with the phrase “I hope this finds you well.”

The old “social dances” – as the psychotherapist Philippa Perry calls them – of finding a seat in a cafe or on the bus have not only vanished, taking with them opportunities to experience a sense of belonging, but have been replaced with dances of rejection. Perry thinks that’s why she misses the Pret a Manger queue. “We were all waiting to pay for our sandwiches that we were all taking back to our desks. It was a sort of group activity even if I didn’t know the other people in the group.”

In contrast, pandemic queues are not organic; they are a series of regularly spaced people being processed by a wayfinding system. Further rejection occurs if a pedestrian steps into the gutter to avoid you, or when the delivery person you used to enjoy greeting sees you at the door and lunges backwards. It provides no consolation, Perry says, to understand cognitively why we repel others. The sense of rejection remains.

The word “contagion” comes from the Latin for “with” and “touch”, so it is no wonder that social touch is demonised in a pandemic. But at what cost? The neuroscientists Francis McGlone and Merle Fairhurst study nerve fibres called C-tactile afferents, which are concentrated in hard-to-reach places such as the back and shoulders. They wire social touch into a complex reward system, so that when we are stroked, touched, hugged or patted, oxytocin is released, lowering the heart rate and inhibiting the production of cortisone. “Very subtle requirements,” says McGlone, “to keep you on an even plane.”

But McGlone is worried. “Everywhere I look at changes of behaviour during the pandemic, this little flag is flying, this nerve fibre – touch, touch, touch!” While some people – especially those locked down with young children – might be experiencing more touch, others are going entirely without. Fairhurst is examining the data collected from a large survey she and McGlone launched in May, and she is finding those most at risk from the negative emotional impact of loss of touch are young people. “Age is a significant indicator of loneliness and depression,” she says. The loss of the connecting power of touch triggers “factors that contribute to depression – sadness, lower energy levels, lethargy”.

“We are becoming a sort of non-person,” says Perry. Masks render us mostly faceless. Hand sanitiser is a physical screen. Fairhurst sees it as “a barrier, like not speaking somebody’s language”. And Perry is not the only one to favour the “non-person clothes” of pyjamas and tracksuits. Somehow, the repeat-wearing of clothes makes all clothing feel like fatigues. They suit our weariness, and add an extra layer to it.

No element of Covid-19 has dehumanised people more than the way it has led us to experience death. Individuals become single units in a very long and horribly growing number, of course. But before they become statistics, the dying are condemned to isolation. “They are literally depersonalised,” Snowden says. He lost his sister during the pandemic. “I didn’t see her, and nor was she with her family … It breaks bonds and estranges people.”

For a short while, the pandemic may have made people feel as if they were somehow together in those plastic envelopes that Clarke describes; literally so for those who posted YouTube videos of homemade plastic “cuddle curtains” through which to hug loved ones. “If you know the literature on disasters, immediately afterwards you get this altruistic community thing where you all have this sense of common fate,” says John Drury, a professor at the University of Sussex who specialises in crowd psychology. “But you can’t sustain that.”

Now, allied to the depersonalisation is a heightened sense of individualism – it’s a tough combination to feel both more of an individual and less of a person. “We are no longer in it together in the same way,” says Clarke, the musician, says.

Greater individualism can be seen at international and political level too, as when Donald Trump moved to withdraw the US from the World Health Organization. His description of Covid-19 as the “Wuhan virus” or “kung flu” melded the fear of an other – which a pandemic is likely to generate – to racism. From the UK and Germany to the US, there has been a rise in the incidence of racist hate crimes towards some Asian communities.

What you can do, and probably have done, is adopt compensatory behaviours. The maladaptive of these will add to that lengthening second pandemic, the psychological aftermath of the first. In Scotland, for instance, substance abuse deaths have risen by a third; the British Liver Trust has reported a 500% rise in calls to its helpline; domestic violence has surged worldwide.

But even the tiniest positive alterations to habit can be hugely effective. Fairhurst, for instance, wears more perfume and spends longer washing her hair – “a direct activation” of her C-tactile afferent nerves, she thinks. Her research data has shown that “people who are less lonely are those who are grooming more”. Snowden survived his isolation intact partly thanks to a Zoom group of school friends who meet online each week despite not having got together for 56 years previously. Dixon did art with his children. Drury, “a very functional person” who would walk only if he needed something, now walks “for emotional and mental health”.

“We had pandemics in the past and we are still here,” says Fairhurst. To adapt is to survive. To notice the adaptations, however small, is to appreciate humanity.

So will the pandemic alter us for the long term?

O’Donovan, in San Francisco, who has for years studied post-traumatic stress disorder, believes an increase in the incidence of PTSD will probably follow Covid-19. It is also likely that Covid‑19 will challenge the criteria for diagnosing PTSD. While 20% to 30% of those who go into intensive care units will later experience PTSD, what of those who fear for their lives in previously innocuous situations – such as in the grocery store or on public transport? Might PTSD be triggered by a close stranger’s uninhibited cough? There are people who recovered from Sars in 2003 and were still being treated for PTSD more than a decade later. “We have a lot of work to do,” O’Donovan says.

And then there is the possibility that the fear of Covid-19 may outlive the worst of the disease itself. Drury thinks people will easily relearn how to behave in a crowd. The big question is for how long will they fear crowds. After the London bombings of 2005, the terror threat level was lowered and people resumed their travel habits, he points out. But this summer, when the British government urged a mass return to work, many resisted. “They believed … that there was still danger.” What follows the pandemic will depend on how safe people feel. And all the while, the more “systemic inflammation” people have, because their biological response to stressors is activated, the more sensitive they will be to perceived social threats.

No wonder, then, that for Thomas Dixon, the emotional historian, the pandemic is “akin to a world war” in its emotional fallout. “We will have, I assume, a global recession. There is going to be serious suffering and inequality and poverty. It is a world event with big emotional consequences, and it seems to me that in times of adversity people’s emotional repertoire changes,” he says. He thinks that “a more resilient, and perhaps more reserved, emotional style” might evolve out of the pandemic and its aftermath.

Snowden says: “There are silver linings in something uniquely bad and dark. Maybe as a result of this we will transform our healthcare system so that it pays proper attention to mental as well as physical health. Maybe [the pandemic] will help us rethink what medicine is for.”

And maybe, a little like Newton’s orchard, the pandemic will give us a chance to see things we have seen many times before, but with new clarity. It would seem unlikely that every person who worked solely in an office will spend every working day in one post-vaccination. Changes to road layouts and car exclusions are underway in many cities, with Carlos Moreno’s “15-minute city” concept gaining critical airtime from Paris to Buenos Aires. In late 19th-century England the telephone was introduced in hospitals to help people with scarlet fever communicate with their loved ones; it caught on. With coronavirus, FaceTime and Zoom have offered the same solace of remote connection (though when some meetings shift back offline, and Zoom is no longer there to arbitrate on conversational turn-taking, and remind us of people’s names, we may have to relearn some communication skills).

“We can use this pandemic as a galvanising force for change,” says Alexandre White of Johns Hopkins University, who would like to see a universal healthcare act in the US “to prevent a lot of the worst healthcare outcomes that come from inequality but also to minimise the economic, social and health inequality in the first place. The conditions of possibility are there.”

And maybe that is the point – to see these times as creating the conditions for new opportunities. The challenges will be many; the fallout painful. But there is an opening for previously unthinkable change, not only to the structures of societies, but also in countless small ways – privately, personally. We have lived for months at close quarters with ourselves. We will deepen our appreciation of some of the simple things we have missed, and some of the pleasures that have helped us through, even if it is only the taste of a new season apple. And in some measure, we will know ourselves better.

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