Pandemic decision-making is difficult and exhausting. Here’s the psychology that explains why
So much uncertainty around risk can make it extra hard to decide what to do. Richard Drury/DigitalVision via Getty Images
You want to sit down for an indoor dinner with friends. A couple of years ago, this was a simple enough activity that required minimal planning. However, that is not the case in today’s world. Many people now face a stream of further considerations about benefits and risks.
Will I enjoy the experience? What are the potential downsides? Am I comfortable with the restaurant’s pandemic-related policies? What’s the ventilation like? Is it very busy there at this time of day? Am I planning to see lots of people, or people with compromised immune systems, in the near future?
This is exhausting! As scientists at the Learning and Decision-Making Lab at Rutgers University-Newark, we’ve noticed how many decision-making processes are affected by the pandemic. The accumulation of choices people are making throughout the day leads to what psychologists call decision fatigue – you can end up feeling overwhelmed and make bad decisions. The current pandemic can make this situation more pronounced, as even the choices and activities that should be the most simple can now feel tinged with risk and uncertainty.
Risk involves known probabilities – for example, the likelihood of losing a certain hand in poker. But uncertainty is an unknown probability – you can never really know the exact chance of catching COVID-19 by engaging in certain activities. Human beings tend to be both risk-averse and uncertainty-averse, meaning that you likely avoid both when you can. And when you can’t – as during a confusing phase of a pandemic – it can be draining to try to decide what to do.
Rules are easy, decisions are hard
Before the COVID-19 pandemic, most people didn’t think through some basic decisions in the same way they might now. In fact, even early in the pandemic you didn’t really need to. There were rules to follow whether you liked them or not. Capacity was limited, hours were restricted, or shops were closed. People were strongly urged to opt out of activities they’d normally engage in.
This is evident in data we collected from university students in fall 2020 and spring 2021. One question we asked was, “What has been the hardest part of the pandemic for you?” Responses included “Not being able to see my friends and family,” “Having to take classes online,” “Being forced to stay home” and many other similar frustrations.
Many of our survey respondents were either not able to do things they wanted to do or were forced to do things they didn’t want to do. In either case, the guidelines were clear-cut and the decisions were less of a struggle.
A pandemic world that is open for business sets the scene for a lot more daily decisions. pixdeluxe/E+ via Getty Images
As restrictions ease and people think about “living with” the coronavirus, the current phase of the pandemic brings with it a new need to make cost-benefit calculations.
It’s important to remember that not everyone has experienced these kinds of decisions in the same way. Throughout the course of the pandemic there have been people who did not have the luxury of choice and needed to go to work regardless of the risk. There have also been those who have taken risks all along. On the other end of the spectrum, some people continue to stay isolated and avoid almost every situation with the potential for contracting COVID-19.
Those who experience the most decision fatigue are those who are in the middle – they want to avoid COVID-19 but also want to get back to the activities they enjoyed before the pandemic.
Shortcuts can short-circuit decision-making
Psychologist Daniel Kahneman wrote in his book “Thinking, Fast and Slow” that “when faced with a difficult question, we often answer an easier one instead.”
Making decisions about risk and uncertainty is hard. For instance, trying to think through the probability of catching a potentially deadly virus while going to an indoor movie theater is difficult. So people tend to think in terms of binaries – “this is safe” or “this is unsafe” – because it’s easier.
The problem is that answering easier questions instead of trickier ones leaves you vulnerable to cognitive biases, or errors in thought that affect your decision-making.
One of the most prevalent of these biases is the availability heuristic. That’s what psychologists call the tendency to judge the likelihood of an event based on how easily it comes to mind. How much a certain event is covered in the media, or whether you’ve seen instances of it recently in your life, can sway your estimate. For example, if you’ve seen stories of a plane crash in the news recently, you may believe the probability of being in a plane crash to be higher than it actually is.
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The effect of the availability heuristic on pandemic-era decision-making often manifests as making choices based on individual cases rather than on overall trends. On one side, people may feel fine going to a crowded indoor concert because they know others in their lives who have done this and have been fine – so they judge the likelihood of catching the coronavirus to be lower as a result. On the other hand, someone who knows a friend whose child caught COVID-19 at school may now think the risks of transmission in schools are much higher than they really are.
Furthermore, the availability heuristic means these days you think much more about the risks of catching COVID-19 than about other risks life entails that receive less media attention. While you’re worrying about the adequacy of a restaurant’s ventilation system, you overlook the danger of getting into a car accident on your way there.
You can’t know for sure whether you’ll get infected after meeting a friend. LeoPatrizi/E+ via Getty Images
A constant process
Decisions in general, and during a pandemic in particular, are about weighing risks and benefits and dealing with risk and uncertainty.
Because of the nature of probability, you can’t be sure in advance whether you’ll catch COVID-19 after agreeing to dine at a friend’s house. Furthermore, the outcome does not make your decision right or wrong. If you weigh the risks and benefits and accept that dinner invitation, only to end up contracting COVID-19 at the meal, it doesn’t mean you made the wrong decision – it just means you rolled the dice and came up short.
On the flip side, if you accept the dinner invitation and don’t end up with COVID-19, don’t get too smug; another time, the outcome might be different. All you can do is try to weigh what you know of the costs and benefits and make the best decisions you can.
During this next phase of the pandemic, we recommend remembering that uncertainty is a part of life. Be kind to yourself and others as we all try to make our best choices.
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
Edward A. "Doc" Rogers/Library of Congress via AP, File
How it started: Unclear, but probably not in Spain. It was a particularly deadly strain of H1N1 influenza and first took root in the U.S. in Kansas.
The disease was so virulent and killed so many young people that if you heard “‘This is just ordinary influenza by another name,’ you knew that was a lie,” said John Barry, the author of “The Great Influenza.”
If the flu did hit your town, it hit hard: A young person could wake up in the morning feeling well and be dead 24 hours later. Half the people who died of the flu in 1918 were in their 20s and 30s.
“It was a spooky time,” said Georges Benjamin, executive director of the American Public Health Association.
So how did we, as a species, beat the Spanish flu? We didn’t. We survived it. A third of the world’s population was believed to have contracted the Spanish flu during that pandemic, and it had a case-fatality rate of as high as 10-20% globally and 2.5% in the United States. Roughly 675,000 people in America died out of a population of 103.2 million, a number recently surpassed by COVID-19 victims of a 2020 U.S. population of 329.5 million. Flu vaccines wouldn’t be developed until the 1930s and wouldn’t become widely available for another decade.
Ultimately, the virus went through a process called attenuation. Basically, it got less bad. We still have descendent strains of the Spanish flu floating around today. It’s endemic, not a pandemic.
As a society, we accept a certain amount of death from known diseases. The normal seasonal flu usually kills less than 0.1% of people who contract it. Deaths have been between 12,000 and 52,000 people in the U.S. annually for the past decade.
The regular seasonal flu is both less contagious and less deadly than COVID-19. That people were washing hands, working from home and socially distancing in the winter 2020 flu season likely contributed to the fact that it was a comparably light flu season.
How it ended: Endemic
AP Photo, File
How it started: The first documented polio epidemic in the United States was in 1894. Outbreaks occurred throughout the first half of the 20th century, primarily killing children and leaving many more paralyzed.
Polio reached pandemic levels by the 1940s. There were more than 600,000 cases of polio in the United States in the 20th century, and nearly 60,000 deaths — a case fatality rate of 9.8%. In 1952 alone, there were 57,628 reported cases of polio resulting in 3,145 deaths.
“Polio was every mother’s scourge,” Benjamin said. “People were afraid to death of polio.”
Polio was highly contagious: In a household with an infected adult or child, 90% to 100% of susceptible people would develop evidence in their blood of also having been infected. Polio is not spread through the air — transmission occurs from oral-oral infection (say, sharing a drinking glass), or by “what’s nicely called hand-fecal,” Paula Cannon, a virology professor at the University of Southern California Keck School of Medicine, told me. “People poop it out, and people get it on their hands and they make you a sandwich.”
Polio, like COVID-19, could have devastating long-term effects even if you survived the initial infection. President Franklin Roosevelt was among the thousands of people who lived with permanent paralysis from polio. Others spent weeks, years, or the rest of their lives in iron lungs.
Precautions were taken during the polio pandemic. Schools and public pools closed. Then, in 1955, a miracle: a vaccine.
A two-dose course of the polio vaccine proved to be about 90% effective — similar to the effectiveness of our current COVID-19 vaccines. Vaccine technology was still relatively new, and the polio vaccine was not without side effects. A small number of people who got that vaccine got polio from it. Another subset of recipients developed Guillain-Barre syndrome, a noncontagious autoimmune disorder that can cause paralysis or nerve damage. A botched batch killed some of the people who received it.
Benjamin said the polio vaccine campaign became a moment of national unity: “Jonas Salk and the folks that solved the polio problem were national heroes.”
By 1979, polio was eradicated in the United States.
How it ended: Vaccination
AP Photo/Frank Franklin II
How it started: The disease had been observed in the Eastern Hemisphere dating to as early as 1157 B.C., and European colonizers first brought smallpox to North America’s previously unexposed Native population in the early 1500s. Globally, smallpox is estimated to have killed more than 300 million people just in the 20th century. The case fatality rate of variola major, which caused the majority of smallpox infections, is around 30%.
Outbreaks continued in North America through the centuries after it arrived here. We fought back by trying to infect people with a weakened version of it, long before vaccines existed. An enslaved man named Onesimus is believed to have introduced the concept of smallpox inoculation to North America in 1721 when he told slave owner Cotton Mather that he had undergone it in West Africa. Mather tried to convince doctors to consider inoculating residents during that outbreak, to limited success. One doctor who inoculated 287 patients reported only 2% of them died of smallpox, compared with a 14.8% death rate among the general population.
In 1777, George Washington ordered troops who had not already had the disease to undergo a version of inoculation in which pus from a smallpox sore was introduced into an open cut. Most people who were inoculated developed a mild case of smallpox, then developed natural immunity. Some died, though at a far lower rate compared with other ways of contracting the disease.
Edward Jenner first demonstrated the effectiveness of his newly created smallpox vaccine in England in 1796. Vaccination spread throughout the world.
But while early vaccines reduced smallpox’s power, it still existed: An outbreak hit New York City in 1947. It demonstrated that the vaccines were not 100% effective in everyone forever: 47-year-old Eugene Le Bar, the first fatality, had a smallpox vaccine scar. Israel Weinstein, the city’s health commissioner, held a news conference urging all New Yorkers to get vaccinated against smallpox, whether for the first time or what we would now call a “booster shot.”
The mayor and President Harry Truman got vaccinated on camera. In less than one month, 6.35 million New Yorkers were vaccinated, in a city of 7.8 million. The final toll of the New York outbreak: 12 cases of smallpox, resulting in 2 deaths.
Our country’s final outbreak affected eight people in the Rio Grande Valley in 1949. In 1959, the World Health Organization announced a plan to eradicate smallpox globally with vaccinations. The disease was declared eradicated in 1980.
How it ended: Vaccination
(AP Photo/Bebeto Matthews
How it started: In 1981, the CDC announced the first cases of what we would later call AIDS.
Roughly half of Americans who contracted HIV in the early 1980s died of an HIV/AIDS-related condition within two years. Deaths from HIV peaked in the 1990s, with roughly 50,000 in 1995, and have decreased steadily since then: As of 2019, roughly 1.2 million Americans are HIV-positive; there were 5,044 deaths attributed to HIV that year.
Unlike COVID-19, which was quickly identified as a respiratory disease, HIV spread for years before scientists knew for sure how it was transmitted.
Today, we know how to prevent the spread of HIV, and treatments for it have progressed to the point where early intervention can make the virus completely undetectable.
Around 700,000 people in the U.S. have died of HIV-related illnesses in the 40 years since the disease appeared.
How it ended: Endemic
AP Photo/Eugene Hoshiko
How it started: SARS first appeared in China in 2002 before making its way to the United States and 28 other countries.
Severe acute respiratory syndrome — quickly shortened to SARS in headlines and news coverage — is caused by a coronavirus named SARS-CoV, or SARS-associated coronavirus. COVID-19 is caused by a virus so similar that it’s called SARS-CoV-2.
Globally, more than 8,000 people contracted SARS during the outbreak, and 916 died. One hundred fifteen cases of SARS were suspected in the United States; only eight people had laboratory-confirmed cases of the disease, and none of them died. Like COVID-19, fatality rates from SARS were very low for young people — less than 1% for people under 25 — up to a more than 50% rate for people over 65. Overall, the case fatality rate was 11%.
Public anxiety was widespread, including in areas unaffected by SARS.
SARS and COVID-19 have a lot in common. But the diseases weren’t exactly the same, said Benjamin, who worked for the CDC during the SARS epidemic.
Conversely to COVID-19, he said, the response to SARS was robust and immediate. The WHO issued a global alert about an unknown and severe form of pneumonia in Asia on March 12, 2003. The CDC activated its Emergency Operations Center by March 14, and issued an alert for travelers entering the U.S. from Hong Kong and parts of China the next day. Pandemic planning and guidance went into effect by the end of that month.
In the case of SARS, the disease stopped spreading before a vaccine or cure could be created.
How it ended: Died out after being controlled by public health measures
AP Photo/Paul Sancya
How it started: Both the Spanish flu and swine flu were caused by the same type of virus: influenza A H1N1.
Ultimately, according to the CDC, there were about 60.8 million cases of swine flu in the U.S. from April 2009 to April 2010, with 274,304 hospitalizations and 12,469 deaths. So there were millions more cases of swine flu than there were of COVID-19 in the same time period, but a fraction of the fatalities. Eighty percent of swine flu deaths were in people younger than 65.
It was first detected in California on April 15, 2009, and the CDC and the Obama administration declared public health emergencies before the end of that month. In the same month cases were first detected, the CDC started identifying the virus strain for a potential vaccine. The first flu shots with H1N1 protections went into arms in October 2009. WHO declared the swine flu pandemic over in August 2010. But like Spanish flu, swine flu never completely went away.
How it ended: Endemic
AP Photo/Jerome Delay, File
How it started: From 2014 to 2016, 28,616 people in West Africa had Ebola, and 11,310 died — a 39.5% case fatality rate. Despite widespread fears about it spreading here, only two people contracted Ebola on U.S. soil, and neither died.
So how did we escape Ebola? Unlike COVID-19, Ebola isn’t transmitted in the air, and there’s no asymptomatic spread. It spreads through the bodily fluids of people actively experiencing symptoms, either directly or through bedding and other objects they’ve touched. If you haven’t been within 3 feet of a person with Ebola, you have almost no risk of getting it.
Part of the problem in Africa, Benjamin said, was that families traditionally washed the bodies of the deceased, exposing themselves to infected fluids. Once adequate equipment was delivered to affected areas and precautions were taken by health care workers and families of the victims, the disease could be controlled.
While this particular outbreak ended in 2016, it’s very possible we will see another Ebola event in the future. An Ebola vaccine was approved by the FDA in 2019.
How it ended: Subsided after being controlled by public health measures
AP Photo/Jae C. Hong
The most likely outcome at this point is that COVID-19 is here to stay, Benjamin said: “I think most people now think that it will be endemic for a while.”
COVID-19 has a lot going for it, as far as viruses go: Unlike Ebola and SARS, it can be spread by people who don’t realize they have it. Unlike smallpox, it can jump species, infecting animals and then potentially reinfecting us. Unlike polio, one person can unwittingly spread it to a room full of people, and not enough people are willing to get vaccinated at once to stop it in its tracks.
So what happens next? In some populations, enough people will get vaccinated to achieve something like herd immunity. In others, it will burn through the population until everyone’s had it, and either achieves naturally gained immunity (which confers less long-term protection than vaccination) or dies. People still die from influenza and HIV in the United States; a disease becoming endemic isn’t exactly a happy ending.
How it ends: A combination of vaccine- and naturally gained immunity, attenuation, availability of rapid testing, and improvements in treatment for active cases could turn it into what skeptics called it to begin with: a bad cold or flu.
David J. Phillip
A worker prepares to administer a COVID-19 test at the 2022 Winter Olympics, Tuesday, Feb. 1, 2022, in Beijing. (AP Photo/David J. Phillip)
Workers wearing personal protective equipment bury bodies in a trench on Hart Island, Thursday, April 9, 2020, in the Bronx borough of New York. (AP Photo/John Minchillo)
Francisco Espana, 60, looks at the Mediterranean sea from a promenade next to the Hospital del Mar in Barcelona, Spain, Friday, Sept. 4, 2020. Francisco spent 52 days in the intensive care unit at the hospital due to the coronavirus, but today he was allowed by his doctors to spend almost ten minutes at the seaside as part of his recovery therapy. (AP Photo/Emilio Morenatti)
Jae C. Hong
Romelia Navarro, 64, weeps while hugging her husband, Antonio, in his final moments in a COVID-19 unit at St. Jude Medical Center in Fullerton, Calif., July 31, 2020. (AP Photo/Jae C. Hong)
Masrat Farid, a healthcare worker, prepares to administer a dose of Covishield vaccine to Rubia Begum inside a hut during a COVID-19 vaccination drive in Gagangeer, northeast of Srinagar, Indian controlled Kashmir on June 22, 2021. Farid has traveled long distances to vaccinate mostly shepherds and nomadic herders in the remote meadows of the Himalayan region of Indian-controlled Kashmir. (AP Photo/Dar Yasin)
People watch burning funeral pyres of their relatives who died of COVID-19 in a ground that has been converted into a crematorium in New Delhi, India, Thursday, May 6, 2021. (AP Photo/Ishant Chauhan)
Chinese paramilitary police wearing goggles and face masks march in formation at the Yanqing National Sliding Center during an IBSF sanctioned race, a test event for the 2022 Winter Olympics, in Beijing, Monday, Oct. 25, 2021. (AP Photo/Mark Schiefelbein)
New Yorkers who died during the coronavirus pandemic are projected onto the Brooklyn Bridge during a commemoration ceremony Sunday, March 14, 2021, in Brooklyn, NY. (AP Photo/Kevin Hagen)
Eduardo Munoz Alvarez
Family members, reflected in the window, wave goodbye to nursing home resident Barbara Farrior, 85, at the end of their visit at the Hebrew Home at Riverdale on Thanksgiving, Thursday, Nov. 26, 2020, in New York. The home offered drive-up visits for families of residents struggling with celebrating the holiday alone. (AP Photo/Eduardo Munoz Alvarez)
Cleric women wearing protective clothing and "chador," a head-to-toe garment, arrive a cemetery to prepare the body of a victim who died from the new coronavirus for a funeral, in the city of Ghaemshahr, in north of Iran, Thursday, April 30, 2020. (AP Photo/Ebrahim Noroozi)
Woman attend their yoga exercise in a park while heavy fog envelops the areas of Lahore, Pakistan, Wednesday, Feb. 17, 2021. (AP Photo/K.M. Chaudary)
Debora Aberastegui holds the hands of her father Pedro Aberastegui through a plastic sleeve at the Reminiscencias residence for the elderly in Tandil, Argentina, Monday, April 5, 2021. Residents here do not have physical contact with their families or leave the residence due to the COVID-19 pandemic, but stay active with group activities within the facility. (AP Photo/Natacha Pisarenko)
A neonatologist examines Maria Alvarez's newborn baby girl at the National Maternal Perinatal Institute in an isolated area reserved for mothers infected with COVID-19, in Lima, Peru, Wednesday, July 29, 2020. The 24-year-old first-time mother wept during her labor not just from pain, but because the baby would be born without her father. The baby's father died from the new coronavirus in June. (AP Photo/Rodrigo Abd)
Protesters dance and embrace as a song plays over the speakers, during an ongoing protest against COVID-19 measures that has grown into a broader anti-government protest, in Ottawa, Ontario, on Thursday, Feb. 17, 2022. (Justin Tang/The Canadian Press via AP)
Corazona Pena's body lies wrapped in plastic by a Peruvian COVID-19 specialized government team in Pucallpa, in Peru's Ucayali region, Tuesday, Sept. 29, 2020. (AP Photo/Rodrigo Abd)
Wearing masks and plastic gloves amid the spread of the coronavirus, girls raise her hands during class in Havana, Cuba, Monday, Nov. 2, 2020. (AP Photo/Ramon Espinosa)
Cast members wear face masks backstage under COVID-19 protocol measures during a performance of "Rusalka" opera at the Teatro Real in Madrid, Spain, Thursday, Nov. 12, 2020. (AP Photo/Bernat Armangue)
A patient rests in a chair next to his bed at the COVID-19 ward at a hospital in Barcelona, Spain, Wednesday, Nov. 18, 2020. (AP Photo/Emilio Morenatti)
Patients lie on hospital beds as they wait at a temporary makeshift treatment area outside Caritas Medical Centre in Hong Kong, Friday, Feb. 18, 2022. (AP Photo/Kin Cheung)
A pathologist conducts an autopsy on a man who died from COVID-19 in an anatomical theater at the Lviv National Medical University in Lviv, Western Ukraine, on Tuesday, Jan. 5, 2021. (AP Photo/Mstyslav Chernov)
Siny Gueye, center left, is joined by other women fish processors to sing a blessing and thankful song at Bargny beach, east of Dakar, Senegal, Thursday April 1, 2021. (AP Photo/Leo Correa)
Ng Han Guan
A cat is carried inside a backpack in Wuhan on Sunday, Oct. 18, 2020. (AP Photo/Ng Han Guan)
Israeli child Rafael Peled, 8, looks through a VR virtual reality goggles as he receives a Pfizer COVID-19 vaccine from medical staff at the Sheba Tel Hashomer Hospital in Ramat Gan, Israel, Monday, Nov. 22, 2021. (AP Photo/Oded Balilty)
Blanca Ortiz, 84, celebrates after learning from nurses that she will be dismissed from the Eurnekian Ezeiza Hospital, on the outskirts of Buenos Aires, Argentina, on Aug. 13, 2020, several weeks after being admitted with COVID-19. (AP Photo/Natacha Pisarenko)
Father Vasily Gelevan, wearing a biohazard suit and gloves to protect against the coronavirus, gives the Bible to kiss to Serafima Matveyeva, 92, who is suspected of being infected with the coronavirus, at her apartment in Moscow, Russia, May 26, 2020. In addition to his regular duties as a Russian Orthodox priest, Father Vasily visits people infected with COVID-19 at their homes and hospitals. (AP Photo/Alexander Zemlianichenko)
Ng Han Guan
Residents climb onto chairs to buy groceries from vendors behind barriers used to seal off a neighborhood in Wuhan in central China's Hubei province on Friday, April 3, 2020. (AP Photo/Ng Han Guan)
A health worker arrives to screen people for symptoms of COVID-19 in Dharavi, one of Asia's biggest slums, in Mumbai, India, Friday, Sept. 4, 2020. (AP Photo/Rafiq Maqbool)
Coffins carrying the bodies of people who died of coronavirus and are stored waiting to be buried or incinerated in an underground parking lot at the Collserola funeral home in Barcelona, Spain, Thursday, April 2, 2020. (AP Photo/Felipe Dana)
SOS Funeral workers transport by boat the coffin containing the body of a suspected COVID-19 victim that died in a river-side community near Manaus, Brazil on May 14, 2020. The victim, an 86-year-old woman, lived by the Negro river, the largest tributary to the Amazon river. (AP Photo/Felipe Dana)
A woman bangs a pot in support of medical staff who are working on the front lines of the COVID-19 outbreak during a partial lockdown against the spread of the coronavirus in Brussels on March 31, 2020. (AP Photo/Francisco Seco)
Jackals eat dog food that was left for them by an Israeli woman at Hayarkon Park in Tel Aviv, Israel on April 10, 202. When Tel Aviv was in lockdown due to the coronavirus pandemic, it cleared the way for packs of jackals to take over this urban oasis in the heart of the city. (AP Photo/Oded Balilty)