44 International The EconomistAugust 29th 2020
21easier to open new wounds. If nothing is
done, this can permanently damage a soci-
ety—and even destroy it. In Buffalo Creek
untreated grief and neglect en masse led to
the demise of several towns.
Though the term may have been new,
the experience of collective trauma was
not. Mass trauma has now been identified
in the context of wars, natural disasters
and terrorist attacks. Research shows that
people and communities are typically very
resilient. Yet exposure to death puts them
at greater risk of lasting affliction. Violence
and disasters owing to negligence—such as
the Buffalo Creek flood or the explosion on
August 4th at a warehouse in Beirut that
killed some 150 people—are more likely to
lead to trauma than “acts of God” such as
hurricanes or earthquakes.
Pandemics do not fall neatly into either
category. During the Severe Acute Respira-
tory Syndrome (sars) outbreak in Hong
Kong in 2003, nearly 40% of the population
experienced increased stress, 16% showed
signs of trauma and only 25% believed they
were very likely to survive if they contract-
ed the disease even though the death rate
was around 10% of people infected. A re-
view of studies involving patients treated
for sarsfound that a third went on to de-
velop symptoms of post-traumatic stress
disorder (ptsd), a condition that can result
in vivid flashbacks and difficulty sleeping.
But past epidemics are imperfect proxies
for covid-19. Its unprecedented reach
across the globe and into nearly every as-
pect of life makes it more like a world war.
There were no large-scale psychological
studies during the first or the second world
wars, though the Holocaust would become
the event most deeply associated with
mass death and grief. Researchers in the
early 2000s found roughly half of Holo-
caust survivors were still suffering from
ptsd. Many had other disorders such as
schizophrenia. Even among non-Jewish
Europeans who were children during the
war, 10-40% still had ptsd symptoms. In
communities of survivors, research has
shown that “inherited trauma” can be
passed to subsequent generations, by
growing up flooded with their parents’
memories, and possibly, through genes.
The suffering caused by covid-19 falls
far short of the horrors of the Holocaust.
Still, Krzysztof Kaniasty, a psychologist
and disaster expert, points out that the
pandemic presents nearly all the risk fac-
tors for ptsd. It has caused sudden death,
life-changing events, large-scale social
ruptures and chronic stressors like uncer-
tainty and the added hassles of daily life.
The luckiest will suffer mildly from one
or two of these effects. Yet more than at any
other point in recent history, millions of
people have been slammed by all of them.
In the first large-scale survey of a devel-
oped country struck by covid-19, publishedin July by Psychiatry Research, 29% of 15,530
Britons surveyed met the criteria for a gen-
eral psychiatric disorder. In Spain, where a
shortage of protective kit has meant nearly
a sixth of all covid-19 infections are of
health workers, more than half are show-
ing signs of ptsd. Another study found
86% of Bangladeshis are dealing with co-
vid-related stress, resulting in insomnia,
irritability and family problems.
There are signs of hope. In the long run
people fare better when they perceive
strong social support in the aftermath of a
catastrophe and worse when they feel ne-
glected or excluded. “Strong communities
buffer against adverse traumatic effects,”
says Joshua Morganstein of the Uniformed
Services University in Bethesda, Maryland.
His studies of health workers in Florida
after hurricanes in 2004 and 2005 found
lower rates of ptsdand depression among
those who reported living in places with
tight-knit social circles, which are better
able to organise in times of crisis.Adverse learning conditions
On February 21st the first case of covid-19 in
Italy was diagnosed at a small hospital in
Codogno, a serene town with cobbled
streets not far from the river Po. Its inhabit-
ants were soon experiencing drama of a
sort they had seen only in films. Road-
blocks were thrown up around the newly
declared “red zone” and residents besieged
pharmacies for personal protective equip-
ment (ppe), which quickly ran out. “It was
like being in a war with an invisible ene-
my,” says Rosa Cavalli, whose family owns
one of the pharmacies.
But within days, 100 people were work-
ing as volunteers at an operation centre run
by Italy’s disaster-response service. The
struggling community radio station,
which was renamed “Red Zone Radio”, be-
gan putting out twice-daily bulletins tocounter fake news and conspiracy theo-
ries. “There was an initial moment of dis-
orientation,” says Nicoletta Porcu, a psy-
chologist who formed part of a crisis group
with colleagues. But the outpouring of sup-
port helped the town emerge strengthened
from the trauma.
Mr Kaniasty, the professor, has found
that “received support” that might come in
the form of a donation is less important for
psychological outcomes than “perceived
support”, the feeling that people can rely on
their neighbours. As Codogno came out of
lockdown in June, the degree of compli-
ance with distancing rules—necessary for
recovery—was astonishingly universal.
The parish priest, Monsignor Iginio Pass-
erini, was taken aback during confession to
hear a young boy list among his sins that of
having lowered his face mask outdoors.
Mass tragedies can teach groups of peo-
ple how to avoid or mitigate them in future.
Such “adversarial growth” helps explain
why commuters in Hong Kong wore masks
before any covid-19 cases had been report-
ed. Most credit the territory’s scarring ex-
perience with sars, which included tragic
mistakes. But it also raised the profile of
doctors. A record number of students ap-
plied to study medicine. The government
added isolation wards in hospitals, trained
infection specialists and stockpiled ppe.
Such investments paid off this year. Not
a single covid-19 death was reported among
Hong Kong’s hospital workers. The re-
sponse earned the unpopular government
a ratings boost, but a controversial security
law has undermined public trust and may
compromise its mass-testing strategy.
Covid-19 is easier to deal with than some
traumas. It moves more slowly and is more
dispersed than a natural disaster, buying
governments time. Unlike a war or a terro-
rist attack, there is no direct human enemy
to blame. Some find comfort in the fact that
the whole world is going through hardship
at once. When Wayne Bai, a worker at a tele-
coms company in Wuhan, made a business
trip the day after the city’s lockdown lifted,
he was denied a room at seven hotels. But
his annoyance faded as the virus spread
across the globe.
This universality has drawbacks, of
course. One is that poor countries cannot
turn as readily to rich ones for money or
supplies. Aid workers who usually arrive
after disasters would have been welcome
in Guayaquil, Ecuador, where funeral ser-
vices collapsed in late March, leading to a
pile-up of bodies in homes. Zaida Rovira of
the public ombudsman’s office recalls try-
ing to console a 70-year-old who had spent
four days with his brother’s body in the
room they shared. At the Guasmo hospital,
relatives had to enter refrigerated contain-
ers to look through hundreds of unlabelled
corpses. More than 70 remain unidenti-
Ecuador’s deep trauma fied. Only recently did staff start collecting