I did not, until now, believe the Butterfly Effect. Popularised by the Hollywood film of that name, it was coined by the meteorologist Edward Lorenz who in the 1960s theorized that a small change in weather in one place – a butterfly flapping its wings can potentially cause a hurricane in a far-off place. But the origin of the COVID-19 epidemic is the perfect example for the Butterfly Effect. Believed to have originated from a bat or pangolin, the deadly virus jumped a species to cause chaos around the globe.

Yes, there have been epidemics before but somehow, they died down before much harm could be done. The COVID-19 virus by contrast at the time of writing has infected nearly two million and killed over a 100,000 people around the world. All continents other than remote Antarctica have been affected, air travel across the globe has come to a near standstill and many communities are in lockdown or had their movements severely restricted. As the world reels from the direct and indirect effects of the pandemic the rapidity escalation of the infection has given the world’s population little time to cope.

Social media is very active these days. And it has been suggested that science has been found to be wanting and is standing helpless. I respectfully differ. I firmly believe that more than ever it is the time to remain calm and trust in rational thinking and the scientific method. And that applies to how we are going to maintain our mental health too.

The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time by John Kelly dramatically describes another pandemic, a much worse one than the current one, which hit Europe in the 14^th century. Originating in Central Asia, it spread across Europe between 1347 and 1351 killing one third of the population – reducing it from 75 to 50 million. Half the population of Britain died as well.

The Black Death as it was called was caused by organism called Yersinia pestis transmitted to humans from infected fleas via rats that spread through seaports from ships. The disease is now known as the plague. The mortality rate for plague was around 60 percent compared to the COVID-19 virus which at its worst is less than 10 percent. In the 14^th century no one knew what caused the Black Death, uncertainty adding to the terror and panic that gripped the population. Amid the chaos, one city state in Europe – Venice, stood out.

There are two aspects to managing a threat such as pandemic. The first is risk management and the second resilience. Risk management is a series of steps we can take to reduce damage from a known threat. But when the cause of the threat is unknown, risk management is not possible. We are more fortunate than the Venetians in that in a short space of time, thanks to advances in science, we know quite a lot about the COVID-19 virus. We know how it is transmitted and can identify and take measures to reduce the risk. Physical distancing, wearing of masks and use of protective gear for high risk health staff are some of these measures. The final measures that will end the pandemic are an effective vaccine and specific treatments which are not available as yet. The lack of understanding of the cause of the Black Death meant that effective risk management was not possible. But what the Venetians did well, in contrast to the rest of Europe was the second measure; resilience. In systems management resilience focuses on maintaining a system functional through disturbances. Though such concepts did not exist in those times, Venetian state officials instinctively grasped the principles.

City officials traced the spread of plague from the ships through storehouses and the city. All incoming ships were stopped at outer islands where they were confined for 40 days before being allowed into the city. The concepts of Lazaretto (isolation in space) and Quarantine (isolation in time) were introduced in Venice. The Italian word quarantine is derived from the Latin for ‘forty’. What was so special about forty? The Venetians through observation thought that 40 days would be a reasonable time for Black Death to manifest. They overestimated the time as we now know the incubation period for plague is less than a week.

Later, again through observation, physical distancing between patients and healthy persons was introduced as well. Eventually the people of Venice did get hit hard. Sixty percent of their population died of the disease but in the end though epidemics of plague continued to ravage Europe through the next century, Venice remained free of further epidemics.

I think we in Sri Lanka are fortunate in having a team of officials who are following the Venetian system even though ironically this time Venice and the rest of Italy forgot their past at least initially and paid a heavy price. In Sri Lanka we have got it right but the danger now is that of complacence and social and economic frustration due to the enforced isolation which might result in us throwing caution to the wind, letting go of restrictions too early with possible disastrous consequences. Now that we have got the other bits right, it is more important than ever to maintain our mental resilience.

Let us see what science can teach us on that subject.

In his book Nerve: Poise Under Pressure, Serenity Under Stress, and the Brave New Science of Fear and Cool, science writer Taylor Clark writes on the science behind how well or badly persons face stressful circumstances. When faced with a threat the natural tendency of any animal including humans is to feel fearful. This a protective mechanism is inbuilt into our brains through years of evolution. Any person who claims otherwise is either highly abnormal or is lying. But the important difference between persons who maintain their cool and those who crack up is in how they deal with fear.

Here are some valuable tips from the book ‘Nerve’ on how you can maintain your cool in difficult times.

 

Learn to breathe:

When you are under stress, we tend to breathe shallowly and quickly at times even holding our breath. When we are calm, we breathe slowly and deeply. By deliberately controlling our breath we can calm our minds and send our minds the message that things are under control.

Here is the tactical breathing method taught by combat psychologist Dave Grossman for use in tense situations. Breathe through your nose to a slow count of four, hold for four counts, and exhale through your mouth for four counts. Repeat as necessary.

 

Put your feelings into words:

Research shows that talking or writing about your emotions helps the brain to process it. Speaking honestly about our emotions even negative ones without self-judgement or blame helps us come to terms with them. That is partly how psychotherapy works. But no need to rush to find a therapist – a friend or relative would do, and if you can’t find one, write in a diary. A personal journal of your worries and fears will help.

 

Train for the worst:

Training and repeated practice is the best way to prepare for a disaster or a difficult task. You have all been told by the media on what precautions you should take when going out for your essential needs. Practise in your mind and then run through a checklist of safety procedures when you return home.

 

Change your focus:

It is not fear that causes a breakdown but misdirected focus. When we focus inwards and worry about the worst that can happen, our minds disintegrate. A cool-headed hero is not a person who does not feel fear but a person who is able to concentrate on the present, on the task at hand rather than all the things that can go wrong in the future. How do you develop this ability? Meditation helps but might take years of practice to master. Without going that far, pause for a few moments a few times a day become consciously aware of what is happening around you. In ACT (Acceptance Commitment Therapy) we call this anchoring.

Here is a simple anchoring exercise you can do. Sit up straight on a chair. Push your feet firmly on to the floor. Notice what is happening to your body. Notice the thoughts running through your minds. Name 5 things you can see around you. Name 3 or 4 things you can hear. Notice your difficult thoughts again. Notice that your noticing self is different from your thoughts. Your body is separate from your thoughts. There is a room and a world around you where things are happening. You can repeat this exercise several times.

 

Mindfully disentangle from worries and anxious thoughts:

There are two ways to deal with anxious thoughts. First, we can wrestle with them and try to logically argue ourselves out of anxiety. That is the hard way and is often unsuccessful. The second is to distance yourself from the worrying thoughts. You can write a worry down on a piece of paper and look at it later during a designated worry time. Or you can take the mindfulness approach and let the thoughts come and go through your mind without getting hooked on the thoughts. That will need a little practice.

Here is the Leaves on Stream exercise from ACT. Sit comfortably in a chair and visualise yourself sitting near a gently flowing stream with leaves floating by on it. For the next few minutes each thought that arises in your mind place on a leaf and let it float by. Don’t dwell on or try to analyse your thoughts. With time you will learn to better manage your anxious thoughts.

 

Expose yourself to your fears:

Usually the treatment for an unreasonable fear or phobia is exposure or deliberately placing yourself in situations that invoke your particular fear. But of course, in these times when there is a real danger this advice comes with a caveat. Do not recklessly expose yourself to danger like the beach revellers on Bondi beach but with due precautions as advised by the experts try to go about your daily routine as much as possible.

 

Learn to accept uncertainty and lack of control:

When we feel uncertain about the future and helpless over our destiny, our anxiety will increase. These days with our normal routines breaking down life appears more uncertain than ever. But in the best of times life always had some uncertainty. The well-known Serenity Prayer is applicable here, “Grant me the serenity to accept the things I cannot change, Courage to accept the things I can and Wisdom to know the difference.”

 

Reframe the situation:

You can’t change facts but within the realities there is always room for a more positive reinterpretation. It is like framing a picture. The same picture can look beautiful or ugly depending on the appropriateness and elegance of the frame. Our minds tend to exaggerate danger. That is our inbuilt protection. In the ancient past it was better to mistake a rock for a sabre tooth tiger and live to see another day rather than vice versa and become food for a hungry predator. In our modern world there are no sabre tooth tigers but there is a dangerous virus lurking around. Still for all do not panic, take time to reappraise the situation and you will often find that it is not as bad as you initially thought.

 

Find a sense of humour:

Social media is full of jokes related to the pandemic. Though at times you might feel a sense of irritation that people are trivialising an important issue, humour plays an important role in managing anxiety in difficult times. Staying within the boundaries of social propriety, humour is helpful in reducing the effects of the grim realities of life.

 

Keep focused on your values:

Fear and anxiety may make our world appear chaotic and without purpose. So, aligning ourselves to a higher purpose be it spiritual, or personal will help in keeping control. Steven Hayes, the pioneer of acceptance commitment therapy believes that our emotional pain points to what is important to us.

 

I would leave you with this quote by the psychiatrist Victor Frankl who survived the worst possible situation a human can be put into – a Nazi concentration camp. He said: “There is nothing in the world, I venture to say, that would so effectively help one to survive even the worst conditions as the knowledge that there is a meaning in one’s life.”

 

Covid-19: The silver lining amid the hard medicine