This is a marathon, not a sprint!

Reliance on reactions that evolved to deal with life on the African savannah may not help in the modern world.

After several weeks of steady positive progress, Covid-19 is back with a vengeance. And for the first time, we've had a cluster in an old folks home. That's a worry. Until now, Hong Kong has proven adept at protecting our senior citizens from the ravages of Covid-19. Thus, a scramble is underway to revisit precautions and protection. 

Cases amongst taxi drivers and younger people also prompted immediate agonizing. Why is this occurring now? How come the routes of transmission aren't understood? Until all the contact data is in, we can only speculate.  

As of 11th July, Hong Kong has recorded 1,432 cases, with seven deaths. That remains a remarkable achievement given our crowded conditions, plus our proximity to the initial epicentre in Wuhan. Plus, we continue to import cases, although it's the local transmission that causes real concern. Therefore the government has responded; social distancing rules are back, and schools are closing early for the summer. 

How people respond to any crisis is driving the trends we are seeing. For starters, Covid-19 is not a 'black-swan' event. Scientists warned us for decades that a pandemic was coming. Besides, Hong Kong has a long history of dealing with such outbreaks. 

During the SARS pandemic of 2003, Hong Kong suffered 40% of the world's recorded deaths. Then in 1997, LAM Hoi-ka, a previously healthy three-year-old boy, became the first victim of H5N1. That virus raised the possibility of a deadly global pandemic. In total, six people died when H5N1 first jumped the species barrier from poultry to humans. By late December 1997, the government slaughtered 1.3 million chickens in a bid to stop the spread of the disease. This mass cull interrupted the range of the outbreak. 

Before that, the infamous Hong Kong flu of 1968 killed an estimated one to four million people worldwide. That outbreak reached its highest local intensity within two weeks before travelling the globe. 

While scientists urgently track down the origins and spread of these viruses, the rest of us look on, digest the news and react. Unfortunately, evolution didn't endow humans with the ability to fight Covid-19 specifically. Instead, it provided us with a broad set of responses to dangers, seen and unseen, that drive our actions. 

In all pandemics, our psychological make-up steers behavioural biases that help us deal with the crisis. Yet, these same traits can trip us up, especially in protracted events. Reliance on reactions that evolved to deal with life on the African savannah may not help in the modern world. The graph below illustrates human responses to pandemics over time.

At first, we tend to underestimate the personal threat. Our optimism bias and inability to assess probabilities mean we believe it won't impact us. Then as a situation escalates, we exhibit 'herding' behaviours that lead us to follow the crowd. That can drive such events as panic buying as we mirror the actions of the majority.

This response can be beneficial if people follow others to start wearing masks, ensuring the majority take precautions. Likewise, hand-washing and other safeguards that help defeat a virus gather momentum from such 'herding' behaviours.  

Although, as we perceive the danger is receding, we ease off. Allied to this is the numbing effect. Hearing of deaths day-after-day can cause us to develop risk-fatigue as we seek a return to normalcy. After a protracted period of secureness, our inherent optimism bias again causes us to think the threat is over.

Thus, over time, we become complacent and take less stringent precautions. This 'letting down of the guard' can spread through a population and provide an opportunity for the virus to reemerge in the so-called second and third waves. On Fathers Day June 21st, Hong Kong began that relaxation process. 

Included in our repertoire is a tendency to seek a return to the routine when we perceive a risk has gone. That evolved trait served us well down the millennium — I can't see the lion; therefore, it's not there and can venture out. Thus to sustain our guard, it is necessary to remind the population of the dangers by exploiting fear as a tool.

​After all, we use fear all the time to get compliance for ourselves and others. Drink too much alcohol, and you'll damage your liver. Don't smoke, or you will get cancer. Stay healthy, take exercise to avoid a heart attack. The list is endless.

The challenge is getting people to follow precautions when needed, but then letting things relax when possible. This conscious effort of seesawing messages is a delicate balancing act. Several points are worth noting.

Relying on the experts to do the messaging is effective because politicians come to any press conference with a great deal of baggage that clouds their messages. In Hong Kong, Dr Chuang Shuk-Kwan of the Centre for Health Protection has earned a reputation for her steadfast delivery. Dr Chuang ticks the following boxes.

• She's candid and acknowledges uncertainty — "We are not sure about the source of infection yet."
• She has empathy. 
• She's avoided over-reassurance — Yesterday she asserted the situation is 'critical'. Too much reassurance can backfire. For example, when people are in outrage, reassurance can increase their anger because their perception is that you are not telling them the truth or you are not taking their concerns seriously. Instead, tell people how scary the situation is, even though the actual numbers are small, and watch them get calmer. 
• She's transparent — when things went wrong, or she provided misleading data, she's admitted it. 
• She gives people something to do — wear a mask, keep social distancing, seek medical attention. Action helps with fear, outrage, panic and even denial. If you have things to do, you can tolerate more fear.
• She's a woman. There is considerable speculation that places with women leading the effort against Covid-19 are doing better. We know the genders have different levels of risk aversion, which may be a factor. Leadership styles may well be an influence. Whether this will stand up to critical analysis remains to be seen; nonetheless, it's an intriguing argument that merits study.

So, keep wearing those masks, wash your hands, clean the high traffic surfaces and avoid crowds unless necessary. And if your place is failing badly, try letting the ladies take charge.