Hidden Brain: How Trust May Help To Limit A Disease Outbreak

What helps to contain an epidemic? A study of the Ebola crisis suggests that patients' trust in health workers can encourage patients to report illnesses and receive treatment.

DAVID GREENE, HOST:

When we look at the coronavirus cases in the United States, we see this wide disparity across different states. Washington state, New York and California have many more cases than, say, Arkansas, Mississippi, Oklahoma. Well, new social science research looking at a different disease outbreak suggests that these disparities between states might offer us a clue about what's to come. But it might not be what you imagine.

To explain this we're joined by the host of the Hidden Brain podcast, Shankar Vedantam, who joins us regularly. Hi, Shankar.

SHANKAR VEDANTAM, BYLINE: Hey, David.

GREENE: So there really do seem to be these big differences in diagnosed coronavirus infections between states, between countries. Is there a way to explain them?

VEDANTAM: Well, there are two obvious explanations, David, and one that's less obvious. The first obvious explanation is that these places actually have higher levels of infection. And the other obvious explanation is that these places have better access to testing, so we're finding more cases because we're actually looking. But I came by some research into a less obvious theory. Oeindrila Dube and her colleagues analyzed two groups in the country of Sierra Leone. One had higher levels of trust in the government and in the medical system while the other had lower levels of trust. When the Ebola outbreak struck in 2014-2015, something very strange took place.

OEINDRILA DUBE: We would have forecast a smaller amount of Ebola present in these communities where trust had been built up and that had greater community involvement with health clinics. What we saw at first shocked us. It looked like there were more reported Ebola cases in the communities with these interventions.

GREENE: More cases in places where there was higher trust in the medical system - just make that connection for me, Shankar.

VEDANTAM: So the researchers kept following the data because they were puzzled by this, David. They expected exactly the opposite. But it turns out that one reason you can see high numbers of cases in areas where there is greater trust in the medical system is precisely because there is greater trust in the medical system - people come forward to be tested; they don't fear they will be ostracized or punished or stigmatized. And in fact, this is what the long-term data from Sierra Leone proved.

DUBE: What we ended up seeing is the places that actually had higher reported Ebola cases ended up also having fewer deaths out of those Ebola cases. So this is consistent with the idea that more people coming in and reporting and getting tested actually led to more treatment and faster containment of the disease.

GREENE: Shankar, I mean, this is so interesting. And it makes me wonder if there are some implications or lessons here as we deal with this coronavirus outbreak.

VEDANTAM: Exactly. And that's exactly how I was thinking about it, David. But I want to be cautious. We don't precisely know what's driving the disparities between states and between countries right now, so it's entirely possible the lesson from Sierra Leone does not apply here.

But there are two conclusions that are definitely useful. First, when we are early in a pandemic, we shouldn't assume that what we see now is what we are going to see. Things can change very dramatically. And second - and perhaps more important - I think we've seen this with many countries and many disease outbreaks - trust in the government and in medical experts can save lives. This virus isn't just testing our immune systems; it's testing the strength of our bonds with one another.

GREENE: Shankar, thanks so much for this as always.

VEDANTAM: Thank you, David.

GREENE: That's Shankar Vedantam. He joins us regularly to talk about social science research. And to hear more of his work, listen to his podcast Hidden Brain. The most recent episode looks at the insights we might be able to draw today from the 1918 flu pandemic.

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