COVID-19 - Dr. Jim Halverson

Ask Dr. Halverson: Understanding people's different responses to the pandemic

One of the biggest personal challenges I have had many times over the last several months has been trying to understand the extremely varied and often surprisingly angry responses by others to what I firmly believe is the greatest infectious disease threat our country has faced since polio in the 1940s and 1950s. 
Friends, patients, many of our political leaders and an often very vocal minority of our U.S. citizens continue to not accept or believe that COVID-19 is dangerous, and often berate those of us who do (often in response to being treated poorly by those who do believe the pandemic is very real). I now often understand these dramatically different responses by following the fundamental principles of human’s responses to grief that I learned at Duke Medical School in the late 1970s and many of you are also familiar with. Dr. Elisabeth Kubler-Ross in her book “On Death and Dying,” written in 1969, gives us significant insight into the somewhat universal process of how human beings grieve when affected by loss.


During the past several months, all of us have been grieving at times. We are grieving the loss of our freedoms, a predictable future and the lives and roles left behind in our rush away from the coronavirus. We are fearful about work, health, our families and our shared futures in ways that were unimaginable just a short time ago. We are afraid for our parents and grandparents, our children, our country, our way of life and our mortality. Our individual responses to these threats and fears have varied greatly.
Dr. Kubler-Ross provided an explanation of the five stages of grief. As the years went by, she revised her theories to acknowledge these stages are fluid. In other words, they may or may not occur in the order presented and some people may experience variations of the same stage multiple times, while some may skip a stage (or stages) altogether. Here are the stages and how reactions to the pandemic can vary.
Stage 1- DENIAL 
Evolution has created in humans the ability to deny both physical and emotional pain for a short period of time in the service of self-preservation.
Today, denial sounds like:
    • This whole thing is so overblown! What a media circus!
    • It’s the same as the flu! People get the flu every year and hardly anyone dies!
    • I’m not at risk (old, immune-compromised, heart or lung disease), so I’ll be fine.


Stage 2-ANGER 
The feeling of anger is empowering. We move toward anger to gain control over our fears. Rather than accepting and dealing with the problem, we turn hostile, blaming others, engaging in power struggles and sometimes refusing to comply with the rules.
Today, anger sounds like:
    •  This is China’s fault! If they’d quarantined earlier, we wouldn’t be having this problem!
    •  I don’t care what the governor of my state says about sheltering in place, I’m going to work today!
    •  Masks are useless! I’m not wearing one!
    •  This is ridiculous! This is going to cost us billions! 
Bargaining occurs when denial breaks down and we start to acknowledge the reality of the situation. It is a more constructive stage. A levelheaded assessment can be made about the pros and cons of difficult decisions being made by our governmental and public health leaders.
Today, bargaining sounds like:
    • This is painful but for the best. A temporary closure is costly now but will save lives and get us back to normal more quickly.
    • I may only get mild symptoms, but if my grandma were to get this, she’d be a goner.
    • If I can just make it to the end of the year, my life will no longer be in danger.


Depression occurs when reality fully sets in and there is no more room for denial. There is a sense of hopelessness. We engage in self-pity. We think that nothing can help now, despite evidence to the contrary. We rue the fact that our attempts at bargaining haven’t worked.
Today, depression sounds like:
    • This epidemic is the new normal. I can say goodbye to my hopes and dreams.
    • I am at high risk and likely to die alone. No one will come to help me when the time comes.
    • What’s the use, we’re all going to get the virus anyway?
Acceptance occurs when we finally acknowledge and surrender to the facts, whatever those facts happen to be. When we reach this stage, we can stop denying and fighting reality, and we can start dealing as effectively as we can with what has happened and what is happening.
Today, acceptance sounds like:
    • I can’t control the pandemic, but I can do my part by sheltering in place, washing my hands, social distancing and staying positive.
    • The world is going to change, but maybe when this is all over, we will be kinder to one another.
    • Wearing this mask is uncomfortable but is helping to protect those around me.
So, what lies ahead for us? It will not be an easy road, and it’s likely to involve periods of depression, anger and denial as we deal with each new development and each new loss. Nearly 8 billion people worldwide are threatened to some extent by COVIC-19.  Accepting that others are in different places emotionally on this journey can help us to better understand their responses. We cannot change them. But we can change how we respond to them.  Hopefully, our fears, anxiety and frustration with others can give way to humanity and compassion as we overcome the challenges ahead together.
Stay hopeful, stay safe and stay well.


— Dr. Jim Halverson is a longtime Ojai Valley physician, who is providing weekly updates on COVID-19 in a column for the Ojai Valley News.