This article, in a slightly edited form, first appeared on Pain News Network on March 28, 2020.

Updated on March 29, 2020 at 6:48 PM Eastern Time.

At 7:09 a.m. Mountain Time on Wednesday, March 18, 2020, a 5.7 magnitude earthquake struck Salt Lake City, Utah — the city in which I live. Though it caused little damage, naturally, the earthquake created immense fear.

This occurred during a week in which the Dow Jones Industrial Average (DJIA) plunged, setting a record for the largest stock market drop in U.S. history. Although only about 50 percent of U.S. citizens own stocks, the impact of the enormous amount of wealth lost will have a ripple effect on every American.

In addition, like the rest of world, we face the coronavirus. Because Salt Lakers have experienced a trifecta of calamities, our fear is palpable.

We Are All Concerned Now

As you know, intense fear is not limited to those who live in Salt Lake City. It is ubiquitous. People all around the world are experiencing nearly unprecedented levels of fear in the face of the pandemic. As a friend of mine said, it feels like an apocalypse of biblical proportions.

Fear is a primordial emotion that can protect humans from danger, but it can also be destructive.

Typically, fear is proportional to three factors: the magnitude of the threat; how well we can predict and control the potential harm; and whether we can see that the threat’s end is in sight. Since we know so little about the novel coronavirus, all three factors contribute to our fear.

A 2016 paper published in Disaster Health described Fear-Related Behaviors (FRBs) that occur during mass threats to a society. The study finds that FRBs have four possible outcomes: they can increase harm, have no effect on harm, decrease harm, or prevent harm. Since we are all terrified, it may be helpful to know the consequences our fear may have.

What We Can Learn from the Recent Ebola Outbreak

The 2013-2016 West Africa Ebola Virus Disease (EVD) outbreak may be the best and most recent example of how to predict the effects of FRBs on COVID-19.

More than 28,600 people became ill from EVD in Guinea, Liberia, and Sierra Leone. Given EVD’s mortality rate of nearly 40 percent, it caused approximately 11,300 deaths.

Examining the behaviors and outcomes of EVD may portend the outcome of the COVID-19 pandemic if the FRBs we exhibit with the novel coronavirus are proportionately similar to those caused by the EVD outbreak.

Consequences of FRBs During the EVD Crisis

There were five overarching consequences of FRBs during the EVD crisis.

1. Fear accelerated the transmission of Ebola. Those who lived in infected areas tried to escape by traveling to places they perceived as less infected. In effect, they tried to outrun the infection, but that proved impossible. They carried the disease with them, infecting Ebola-free communities and increasing the number of deaths. Ignoring the risk would have the same effect in the United States.
2. Fear — in combination with lack of resources — discouraged some of those who were infected from seeking care for their disease. They may have died from EVD unnecessarily. Those who are underinsured or lack insurance in the United States now may also decline to seek care.
3. The fear of being exposed to EVD prevented some people with other life-threatening diseases from getting the health care they needed. That may happen now, too. People who have heart disease, diabetes, immunosuppressed cancer, or chronic pain may not seek treatment because they fear being exposed to the coronavirus through contact with healthcare providers or other patients in physicians’ offices.
4. Fear of EVD increased the number of people with mental health disorders. Fear-induced stress may have caused trauma and exacerbated existing mental health problems. Also, survivors involved in providing care to the ill were often blamed for spreading the disease. Some may have suffered from survivor’s guilt. Therefore, depression and other mental health disorders were common in survivors.
5. The belief that specific countries were responsible for the origin and spread of EVD led to widespread discrimination and ostracism. This, in turn, caused serious social and economic consequences. We see that scenario play out again whenever someone calls the coronavirus the “Chinese virus.”

Fear Can Increase or Mitigate Harm

On the other hand, fear can also mitigate harm. In the case of COVID-19, the prospect of what may happen if we do nothing is overwhelming. Therefore, our fear may motivate us to protect ourselves and families by adhering to the advice of experts in such health organizations as CDC and WHO. That may save lives.

Consider your own behavior in light of the five FRBs described above. Ask yourself:

• Could any of your avoidance or panicked behaviors be accelerating the transmission of COVID-19?
• If you have symptoms that suggest you may have the coronavirus, are you in denial rather than seeking care (perhaps via telehealth resources)?
• If you are coping with other medical conditions, are you avoiding the doctor’s office, or are you pursuing the health care you need?
• If you are feeling overwhelmed by the fear and stress inherent in this situation, are you seeking support or professional help?
• Do you acknowledge, and help others understand, that China, as the unfortunate initial vector of COVID-19, bears no responsibility for it and does not deserve to be our scapegoat?

In such an interconnected world, our individual responses determine our collective experience. We must not let fear make the crisis worse. Fear can help protect us, but it can also be our enemy.

We don’t need another enemy. The virus is enough of an adversary for us to deal with. We must avoid giving fear undue power over our actions and judgment at such a critical time.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.