Why will we remember what we remember about COVID-19?
Sandro Galea
Physician | Epidemiologist | Author | Dean and Robert A. Knox Professor at Boston University School of Public Health
Some thoughts on why we embrace certain narratives and not others, and how this might shape our long-term thinking about the pandemic. Part two of two.
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Last week, I suggested that, while the COVID moment is far from over, it is possible to see the outlines of what well may become the dominant narratives of this historical period, the key stories we will tell when we look back on the pandemic. The stories that, to my thinking, could rise to the surface are: the story of scientific excellence (reflected centrally in the rapid development of mRNA vaccines), the story of the presence of inequities in both morbidity and mortality from COVID and in populations that faced the brunt of the economic costs of the steps we took to mitigate the pandemic, the story of widespread loss of trust in institutions as a consequence of partisanship and the spread of misinformation, and the fact that, for all the suffering caused by COVID, it could have been far worse, had we faced a more lethal contagion.
Fundamentally, these stories inform a core narrative of why we believed what we believed during COVID—why we came to regard the virus as a threat worth shutting down the world over, worth the pursuit of novel vaccines, worth better understanding inequities, worth trying to convey accurate information in a climate of institutional mistrust, and worth recognizing that the next contagion could be worse. Today’s Healthiest Goldfish will consider why we will remember what we remember about COVID—why certain narratives may “stick” while others may not. Such a consideration is useful, I think, because it reflects why opinions cohere among groups, and the values and habits of thought that underlie the choice to embrace, or not embrace, the narratives that inform health. How we prepare for the next pandemic will depend, in large part, on the story we tell about this one. The better we understand the forces that shape our narratives about health, the healthier we can be, and the better we can prepare for the next pandemic.
It strikes me that certain narratives are likelier to stick when they meet the following three criteria: they seem to fulfill our pre-existing biases, they fulfill an aesthetic need for coherence (i.e., they seem to “connect the dots,” reflecting some measure of order in a chaotic world), and—yes—they are told by dominant groups, promoted by those in power, by “winners.”
The first point—that we are likelier to believe stories that seem to fulfill our pre-existing biases—is supported by the existence of something with which we in the research field are well familiar: confirmation bias. This is the tendency to embrace information that appears to match one’s current beliefs. Given the power of confirmation bias, it is not hard to see how the stories we embrace about the world might be the ones which seem to most align with how we already believe the world to be. If, for example, we think the world to be a network of sinister conspiracies, we are likelier to believe theories which incline towards the conspiratorial. If, on the other hand, we generally trust institutions, we are likelier to be open to what authority figures tell us, shaping our sense of narrative. If, say, one is already inclined to mistrust the safety of vaccines, it is likelier one would be skeptical of the COVID vaccine, as many currently are.
The second point, that we are likelier to embrace stories that fulfill an aesthetic need for coherence—is supported by the fact that humans are pattern-detecting creatures evolutionarily disposed towards perspectives which help us to organize reality so we can better navigate it. Stories, in their very structure, turn otherwise random events into patterns, with beginnings, middles, and ends. Stories are made more powerful when they apply this framework to our existing biases, reinforcing the pattern of narrative structure with the pattern of our preconceived notions.
During COVID, this was reflected by the evolving story about the origins of the virus. For a long time, the consensus was that the virus was likely of zoonotic origin. This story helped align the seeming arbitrariness of a pandemic emerging unexpectedly with an established pattern. Viruses had jumped from bats before; it stood to reason, then, that this story was a plausible explanation of the emergence of COVID. It is for perhaps this reason that it took so long for the mainstream to consider an alternative hypothesis now gaining credibility—that the virus leaked from a lab. That possibility does not align so well with the patterns that lend coherence to our thinking about viruses. For this reason, the resistance it has encountered further suggests the power of stories that support recognizable patterns.
Finally, it is indeed difficult to deny that stories have added power when they are told by dominant groups—by the “winners.” This does not necessarily mean the winners of the wars of conquest that have long shaped history. In our own time, it is perhaps likelier to mean societal elites—those who are in positions of power and influence. A key example of this emerged during COVID, as the country’s renewed engagement with the issue of race, in the wake of the murder of George Floyd, made it clear that the story of race in the US had long been incomplete, excluding much of the injustice and painful experience faced by communities of color. This status quo was enforced by a narrative which served those in positions of privilege, at the expense of those at an historical disadvantage. Our efforts towards changing this narrative have been inextricably linked to our efforts to change this distribution of privilege, suggesting how the stories we tell are shaped by the distribution of social and material resources in our society.
So, understanding that these factors shape why we embrace the stories we embrace, what are some lessons we can draw from how they intersected with the COVID moment?
First, we should be mindful of the biases that so deeply influence the stories we tell. In particular, we should take care that these biases do not cause us to embrace a distorted narrative, one founded on falsehoods and fear and which can exacerbate group pathologies like the hate that informs poor health. We saw this challenge play out during COVID, particularly early in the pandemic, as the geopolitical rivalry between the US and China made many predisposed to blame the Chinese people themselves for the virus. This, at times, tipped into outright anti-Asian racism, as a consequence of national mistrust and the crude stereotypes that are so often entangled with our collective biases. A healthy world is one where these biases, while perhaps ineradicable from human nature, no longer inform an embrace of narratives that support an unreasonable, divisive response to challenges.
Second, in our instinct to embrace narratives that seem to connect the dots and align with our preexisting worldview, we should take care that we do not embrace inaccurate stories simply because they appear to match the political or cultural narrative with which we identify. In the early days of the pandemic, for example, a narrative emerged in the media that some blue states, in widely embracing lockdowns, were doing better, while some red states, in apparently flouting COVID protocols, were doing poorly. Below, for example, are some early headlines about California’s performance during the pandemic.
And here are some early headlines about Florida’s performance:
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As the pandemic wore on, however, it became clear that these narratives no longer sufficed. The difference between red state and blue state performance became less well-defined, and more ambiguous. As circumstances changed, so did the headlines.
The complexity of state-by-state performance complicated easy partisan narratives about health in a time of pandemic. This suggests that when we are presented with a narrative that seems to connect the dots in a way that matches our preexisting worldview, we should think critically about it, and remain open to changes in the story, as events unfold and new information comes in.
Finally, an understanding of how victors/dominant groups often shape the stories we embrace should influence how we engage with groups that lack the privilege that generates this influence. While we did not know, in advance of COVID, that a pandemic would soon strike, we did know that our society was characterized by deep health inequities, which meant that in the event of a large-scale crisis of any kind, these groups would likely suffer most. Yet these inequities were not sufficiently part of the story we tell ourselves about health—a story more often characterized by the promise of medicine than by the socioeconomic inequities that create the poor health that makes medicine necessary. Because our story was incomplete, we did not do enough to address these inequities when we had the chance, leaving communities vulnerable to COVID.
This failure suggests the importance of the stories we tell about COVID. The stories we embrace are shaped by deep cognitive biases as much as, if not more than, they are shaped by an impartial accounting of the facts. With this in mind, it is all the more necessary that we make the effort to elevate stories that will help us get to a better world, that will help turn the memory of a difficult historical moment into the basis for a healthier future.
Sandro Galea, MD, DrPH, is Professor and Dean at the Boston University School of Public Health. His upcoming book, The Contagion Next Time, will be published in fall 2021. Subscribe to his weekly newsletter, The Healthiest Goldfish, or follow him on Twitter: @sandrogalea