Anxious About COVID-19? There's Only so Much You Can Control

This post was written by Dipal Nagda and J. Wesley Boyd.

America has historically been considered the land of rugged individualism as well as the place where hard work pays off and where industrious people can create their own destiny.

Moreover, Americans strongly believe in individual choice. We pride ourselves on our ability to choose everything from our brand of shampoo to our spiritual practices. As author Amy Choi argues, “Our preferences . . . become who we are. We feel acutely the need to construct a personal narrative out of our choices and, thus, construct our own identity.”

What is often overlooked in these lofty notions about freedom of choice and choosing one’s own path is that, in reality, the extent to which any particular individual can influence their own fate is heavily influenced by one’s socioeconomic status.

Think about it. Educated, wealthy individuals have often been able to make reality conform to their desires and plans. They often can obtain the things that they desire, whether it is admission to an elite college, a prestigious job, or high-achieving children. Of course, there are setbacks here or there—a rejection from an Ivy League school or a child with a serious illness—but by and large, upper-class individuals are able to succeed in making the world conform to their desires. By contrast, individuals at the lower rungs of society are often at the mercy of fate, with little control over their lives.

Given this reality, it is not surprising that studies have shown that being wealthy is correlated with a higher demand for personal choice and greater perceived restrictions on personal freedoms (Eisen et al., 2018). Conversely, the environment of poorer communities translates to a focus that is more centered on the community compared to the individual (Stephens et al., 2011)—a finding that is not surprising given the harsh demands placed on those at the bottom rungs of society.

A similar disparity in perceived agency exists in health outcomes between different communities. Affluent individuals have more resources and capital to influence many of the determinants of ultimate health outcomes—environment, education, and nutrition, to name a few. A multi-country meta-analysis found that being poorer, on the other hand, was associated with more incidence of smoking, diabetes, high blood pressure, physical inactivity, and alcohol intake, along with higher mortality rates in general (Stringhini et al., 2017).

Against this backdrop, over the last number of weeks, a tiny virus—unseen by the naked eye—has entirely called into question the sense of agency of even the well-to-do folks everywhere, putting into question their ability to control their destiny.

The coronavirus has done so in part because it has struck people indiscriminately, with no respect for individuals’ socioeconomic backgrounds. We have all now heard about all of the actors, celebrities, politicians, athletes, and other famous people who have tested positive and suffered from the virus. The infectibility and unpredictability of the illness course have been a jarring wake-up call. It has been a painful, anxiety-provoking reminder that none of us can fully control our fates, no matter our wealth, healthy diets, or intense exercise regimes. And, at present, there is no vaccine against the coronavirus and no treatment regimen that guarantees recovery from infection.

Even though coronavirus might infect anyone and everyone—and even though everyone might feel vulnerable to infection—the coronavirus, like other burdens of health, and its economic impacts hit lower SES communities the hardest. In New York City, the lowest median income neighborhoods have both high infection and mortality rates. Lower SES communities do not have the same ability to stay at home or distance themselves. And all too often, they do not have the health insurance or access to first-rate medical facilities that wealthier individuals do. As a result, even though the virus itself might not care about social status, the sad reality is that it is killing poor people and minorities at far greater rates than well-to-do white Americans.

The societal response to the virus—demanding quarantine and shutting down business as usual in a plethora of ways—has quite literally stripped Americans of their personal freedoms and has resulted in a temporary suspension of our individual civil liberties—the freedom to gather, the freedom of movement, the freedom to travel. We can no longer choose, to the same extent as before, how we spend our weekends, who we meet, and where we go for dinner.

Perhaps it is this sudden and complete loss of perceived control over both our health and our freedoms, that has resulted in an overwhelming sense of anxiety. In a country that has been historically rooted in individual choices and agency, a sweeping pandemic has rattled our fundamental perceptions of ourselves.

Do we still have agency and control over our own fates? To an extent, of course, the answer is yes. But the coronavirus has put in all of our faces that we do not have the same measure of control over our own health that many of us once thought we did.

In conclusion, the coronavirus serves as a powerful reminder that even in the land of rugged individualism, we are more connected to those around us than we might have imagined.

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Dipal Nagda, B.S., is a second-year medical student at Harvard Medical School.