LESSONS FROM COVID: ARE WE MORE OR LESS RESILIENT THAN WE THOUGHT? -ELLIE CANNON
Resilience is thought to be one’s ability to survive and thrive but most importantly adapt in the face of significant adversity or trauma. We look at biological resilience in plants in the desert, adapted physically and chemically over hundreds of thousands of years to cope with little water and scorching sunshine, into unique species thriving in an extreme environment. Other species did not develop that resilience and are no longer seen growing in the sand.
Psychology defines resilience in humans as being able to adjust in the face of threat, stress or significant trauma, and not only survive but adapt and grow. It is the emotional agility that we see in those who survive childhood trauma, war or bereavement and that inner trait we often admire that helps those individuals continue life after tragedy. In essence, resilience means that adverse life events do not define and dictate the outcome of your life, but rather allows you to grow and adapt instead.
Biologically we have built up huge resilience over the last centuries: the advent of clean water, antibiotics, X-ray imaging, vaccination and genetic therapies have foisted upon us biological resilience to survive and adapt to biological threats. In 1841 the average life expectancy of a newborn girl in the UK was 43; in the 21st century this has doubled. As a global species we are stronger, taller, healthier and have a greater capacity to fight disease across developed and developing countries. And then along came Covid.
To scientists, coronaviruses are nothing new. Seven are well known with four causing mild diseases like the common cold and chest infections. It is the others that have caused the greatest threat: 2002 SARS, 2012 MERS and now SARS Cov-2. Biologically we can certainly say that this virus is resilient. An incredibly simple piece of genetic material known as RNA wrapped in a fatty envelope: it has the ability to infect humans and animals, survive in air droplets and on surfaces and on average transmit to three people for every one person it infects. Globally it has infected over 54 million people in all territories of the world bar Antarctica and isolated South Pacific islands.
Biologically, Covid has shown us that we are not at all naturally resilient; a shocking realisation given we can vaccinate against cancer, transplant organs and eradicate Polio. We have seen immense vulnerability across the globe from nation to nation, the death toll speaks for itself. Of course, much of this aetiologically has been political, logistical and even environmental: the virus survives well in temperate climates and less so in hot humidity. But above all else, we were vulnerable as a species to this virus.
Our bodies carried no prior immunity and the disease it caused was utterly new and different to other respiratory viruses and pneumoniae doctors are used to. Covid was first identified as a new emerging viral pneumonia that caused blood clots, inflammation of the heart, brain injury and stroke in the sickest of patients. A clever spike protein on the envelope of the virus is able to attach itself to the cells of human lungs, underpinning the respiratory symptoms and disease that can prove fatal. Intensive care specialists around the world described the deterioration and symptoms of their patients as like nothing they had seen before.
But although no natural resilience was there to this virus, we have quickly started to build it in the way we build it when we spray crops with insecticide. Collective intellectual and scientific strength has allowed humans to develop some biological resilience despite it naturally lacking. I have found it odd, almost laughable, that in such a technological and digitally enabled world, we relied on hand washing, social distance and physical barriers to protect ourselves but this is what was required. Simple and basic, not dissimilar to avoiding the contagion air during the Black Death almost 700 years ago, has afforded us some extrinsic resilience that our bodies naturally lack.
Developing natural biological resilience is not an option we can wait for but just like emotional resilience, we can build it up around us to help survive and adapt. And biological resilience has been built around the world. Protecting the vulnerable, development of therapeutics and the advent of vaccination is how a 21st century species develops biological resilience when natural selection - unlike our desert plants– is not something we can wait for. We have no natural resilience to diphtheria or measles, we have built it through scientific rigour and collaboration; this learned resilience is what we can hope for now with Covid.
Countries like Taiwan did an exemplary job at bypassing the need for inherent biological resilience and extrinsically built what our species lacked: defence against Covid. Tech innovation, open data, early travel control in January and financial incentive for quarantine really meant as individuals there was no need for biological resilience, as their country was doing it for them. The country had resilience through a combination of political, scientific and experiential factors meaning the health and resilience of each individual per se became less relevant. This country-built resilience translated into a mere 73 deaths in a country of 24 million.
Biological resilience has been created across the globe in 2020 despite the human species being completely vulnerable. We did not have time to wait for inherent biological species-wide resilience: countries who survived and adapted through Covid had the agility and resources to formulate resilience, where it was naturally lacking in all of us. Others must learn from them.
And what of emotional resilience in humans? Harder to build and certainly harder to quantify.
In the majority of countries, Covid measures to create physical resilience, have taken their toll on the emotional resilience of the individuals. Emotional resilience is borne of those very factors which we had to abandon so suddenly and starkly to physically avoid the virus: human contact, education, work, social exercise, cultural experience and joy. These mundane routine daily experiences unwittingly provide the protective factors for our emotional resilience: relationships, purpose, goals, achievements and support. Combined with the mental toll from the virus of fear, uncertainty, anxiety and grief, our collective emotional resilience has had a grave test.
While physical resilience is easy to quantify in mortality rates and case numbers, it is harder to say where we are left with our emotional resilience. Adults and children throughout the world have had to look for other ways to boost resilience – studies show that a wide range of strategies have been used including exercising within restrictions, spending time outdoors and maintaining connections with loved ones through new and innovative ways. But some coping strategies have also led to harm and even greater risk to physical and emotional health when people resort to alcohol consumption, drug use, over eating and worsening aggression and irritation.
Relationships are one of the fundamental foundations that humans need to build resilience: study after study shows it is consistent childhood relationships that build resilience, a finding echoed in the workplace, where positive relationships reduce work-based stress even in the highest-octane environments. And yet all aspects of our relationships have suffered through separation, isolation and distance. Partners separated, loss of physical intimacy, loss of therapeutic relationships with healthcare professionals, teachers and colleagues have a profound impact on emotional resilience at all levels of society.
Many people have coped with the pandemic but that is not truly resilience which is adapting and surviving and growing. Around the world people have certainly coped with the death of loved ones, the frightening images and the loss of financial stability. Children and young people coped with the loss of education, rites of passage and milestones but their resilience is unknown – when will we know if this generation will survive to be stronger and more adaptable? Only time will tell over years and decades whether or not the majority of us were truly resilient which will be borne out in figures for mental health problems, suicide and life educational goals and attainment.
How mentally resilient an individual can be, although we all faced the same pandemic, is a reflection of their own history, social circumstance and even demographic. Employment plays a huge role as a protective factor for wellbeing and mental health; it is unsurprising that mental health research in the United Kingdom showed that unemployed people were twice as likely to say they were not coping well during the pandemic. And this jolt to resilience will continue long after the virus has left us due to the economic crisis that will follow.
Countries have been able to foster emotional resilience in their population, either through longstanding measures or emergency ones for 2020. Giving people financial and physical security when employment prospects are uncertain can be of value. Provision of safe healthcare, trustworthy news sources and figures in power all enable mental resilience in a population: simply put it is far easier to survive and adapt if you have social scaffolding to help you do that and the faith in those offering it.
Governments do have a responsibility to lead on all aspects of recovery from Covid – the physical and economic recovery, but also the emotional recovery of populations which may still have yet to reach their nadir. This will take an understanding of what underpins emotional resilience in a population and empowering it just as rigorously as we empower the medical advances.
The author is a London-based GP and author