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Germophobes to the Left and Right

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With the SARS-CoV-2 pandemic hopefully waning, it will be time for many to take a step back and assess the collateral damage. And there is, and is going to be, a lot of it.

With two years of overreaction to and media obsession with the myriad of ways that COVID-19 can kill or permanently disable people, there’s reason to believe a major subset of the population that was faithfully adherent to public health edicts about non-pharmaceutical interventions will remain mentally scarred.

Some might not be able to shake themselves out of the nascent germophobia that wasn’t just encouraged, but mandated. Good thing that a manual for post-pandemic germophobia is on the way. But it’s not just me; others are voicing concern as well. The media did a heckuva job scaring the hell out of people, and someone has got to clean up the mess.

The Behavioral Immune System Gone Awry

People haven’t become less vulnerable to germophobia after major improvements in sanitation and antimicrobial therapies of the last century. In fact, as death from infectious diseases have become more rare, our fear seems to have increased, and this fear can and has result in a lot of collateral damage, including an unnecessary burden on healthcare facilities.

In 2019, Steven Taylor, author of The Psychology of Pandemics, explained:

Fear of an impending pandemic can precede any actual pandemic and may have to be dealt with in addition to managing the pandemic itself.  The surge of patients on hospitals can occur even when an outbreak is only a rumor. 

This happened during the 2009 swine flu pandemic:

At a time when there was a heightened public concern about influenza but little disease prevalence in Utah, emergency room departments experienced substantial surges in patient volumes, with the volumes comparable to the increases experience when the disease finally reached the state. Most of the surge was due to pediatric visits. Young children frequently contract diseases with flu-like features (e.g., fever, cough congestion), which were likely misinterpreted by their parents as possible signs of swine flu.

But that was influenza. With COVID-19 shutdowns emergency room admissions tanked, even for necessary conditions like heart attacks, because people were so irrationally terrified they refused to seek critical care. For months during the pandemic, the hold line of my local hospital featured a doctor who implored people to seek care if they had signs of a heart attack, “The potential for permanent damage is much greater from a heart attack than from the coronavirus.” Just because people weren’t going to the hospital for heart attacks, doesn’t mean they weren’t having them. They were just dying at home, or suffering permanent damage.

Once infected with irrational fear, people will exhibit irrational behaviors, all due to a warped perception of risk. From The Psychology of Pandemics:

People may go to great lengths to “decontaminate” perceived sources of infection or to remove perceived contaminants from themselves. This may involve behaviors that are more extreme than mere handwashing. During the SARS outbreak, one woman in Beijing microwaved banknotes that she had acquired form a bank, fearing that the notes were infected. The outcome was predictable; the money burst into flames and was incinerated. For example, some people have been getting vaccinated twice in one flu season.

Everyone has by now seen many examples of this first hand. During my walks, I’d see a couple cross the street thirty yards ahead of me on the sidewalk, just to give me “social distance”. Others would meticulously wash or even bleach their groceries. I saw a guy riding a motorcycle without a helmet wearing a mask. That’s some seriously deficient risk analysis.

The fear of contagion during a pandemic can become so great, that people begin to lose their own humanity. Communities break apart. Sick or vulnerable people are abandoned, shunned, or neglectedPets or other animals that could be sources of infection are abandoned, abused, or destroyed, and foreigners and other outgroups may be blamed, marginalized, and even persecuted. All of this can and has happened, especially during the current pandemic.

These examples of disease avoidance are based on natural impulses. Just like the cellular and molecular immune system studied by immunologists like me, some psychologists study the behavioral immune system (BIS). Instead of cells and molecules that attack foreign invaders, the BIS concept focuses on what motivates people to avoid infectious diseases, with the main factors being perceived vulnerability to disease and disgust sensitivity, and how their behavior is affected. When you see or smell rotting meat or a stranger that looks ill, your BIS kicks in and tells you to avoid them. In this way, the physical immune system is complemented by the psychological one, that hopefully keeps our exposure to deadly contagions to a minimum.

Researchers have shown that people are pretty adept at making judgements of others, not just on visual cues, but also based on scent. Individuals have different scents that are associated with genes of the adaptive immune response, particularly the major histocompatibility complex, or MHC. MHC genes are important for determining our adaptive immune response to just about anything, and the ability of humans to detect MHC differences in scent might be an evolved mechanism for determining genetic compatibility. Women who rated the attractiveness of a scent based on T-shirts worn by men tended to rate scents associated with particular set of MHC genes as more or less attractive, without even having seen the men that wore them!

People can also sense others who are infected using their sense of smell. This is true for not just infection, but even mere signs of one; a study where only a small amount of the immune-stimulating bacterial cell wall component LPS was injected into volunteers resulted in their T-shirts being rated more unpleasant than shirts from a control group. Again, the raters didn’t even see the injected subjects, who weren’t really infected—yet their bodies had received a strong signal of infection that was enough to change their odor, signaling their potential infection to others.

Infection and our immune responses to it aren’t just sensed by others—those doing the sensing also experience physiological reactions to disgust cues, even if conveyed in the form of harmless images, with some being powerful enough to cause an increase in body temperature and increased sensitivity to pain. Furthermore, increases in fever-inducing inflammatory cytokines (i.e. intercellular signaling molecules of the immune system) are also associated with decreased social behavior in mice—which makes sense—as not only do individuals not want to be around others that are infected, most people who are sick just want to be left alone. All of these cues and our responses to them are facets of a normal behavioral immune response.

However, in a germophobe, the BIS goes too far. Germophobes may believe themselves to be highly vulnerable to severe disease, even if they are relatively healthy and in reality carry a low risk. Any adverse bodily sensation may be interpreted as an early sign of infection, and result in maladaptive behaviors like excessive hand washing or constantly seeking confirmation of their perceived infection through repeated testing and doctor visits, and then citing any concern shared by their doctor as validation of their own fears. They become anxious and intolerant of uncertainty, and may see signs of contagion where others would not, in schools or events, even those that occur in low-risk areas (e.g. outdoors).

The result of these delusions are maladaptive behaviors that are completely out of line with the individual’s own risk, often causing harm, not only to the germophobe, but also to those around them. These irrational fears, and a desire to control them with false assurances, can in part explain how children were treated the last few years, and how blanket mask mandates were rationalized even in the absence of prior scientific consensus.

The Politics of Disgust

In addition to perceived vulnerability to disease, the second major factor of the behavioral immune system is disgust sensitivity. Some researchers believe there are universal cues that incite disgust in the majority of people, regardless of geography or genetic makeup. Bodily wastes, gore, spoiled or unfamiliar foods or certain animals are considered universal disgust cues. Objects that resemble others in these categories may also incite disgust, even if individuals are aware they are being tricked (for example, fudge resembling dog feces, or being asked to eat out of a new and perfectly clean toilet). During the swine flu pandemic of 2009, people who scored highly on tests of disgust sensitivity were likely to have a heightened sense of vulnerability to infection. Thus, researchers can predict where people fall on the germophobe spectrum by how strongly and consistently they exhibit disgust in response to smells, objects, or pictures.

Women tend to score higher on disgust tests than men, and this is likely due to the chance of passing a disease to their child in utero; women are especially sensitive following ovulation and during the first trimester of pregnancy. It’s easy for most to recall a pregnant woman who spent a good chunk of her first trimester feeling absolutely awful—this is part of a natural mechanism for protecting both the mother and the baby from infection. Her condition is also a result of a dampened immune response, which protects the developing fetus from immune attack. After all, the fetus contains MHC genes from the father as well as the mother—it’s basically a transplanted tissue that the mother’s immune system needs to learn to accept. And that can result in feeling awful and an increased sensitivity to certain smells and foods.

Researchers have been very interested in how political beliefs align with an individual’s sense of disgust. Media interest in this topic also spiked in the United States after Donald Trump, a notorious germophobe, was elected President. Trump has been known for decades to avoid shaking hands wherever possible, and, when not possible, liberally applying hand sanitizer supplied by an aide immediately afterwards. While in the White House, he would chastise anyone coughing in meetings or interviews, sometimes even forcing offending individuals out of the room. Since the rise of Trump and his unlikely election took left-leaning (and quite a few right-leaning) people by surprise, journalists and researchers (i.e. left-leaning) wanted to know—what motivates Trump and his followers?

Trump’s germophobia was an obvious target. To left-leaning journalists and researchers, Trump was also obviously xenophobic because of his anti-immigration stance. From there, it wasn’t a big cognitive leap to assume that his xenophobia and germophobia were related, as fear of infection has been related to fear of foreigners or other out-groups, especially during pandemics.  And a 2008 study had already reported a correlation between  “contagion anxiety” and support for the then Republican presidential nominee Senator John McCain over Democratic nominee Barak Obama. How could journalists not cover that?

As author Kathleen McAuliffe put it:

Whether or not pathogens shape the contours of entire societies, we can say with confidence that a dread of contagion can warp our personal values. If people are made aware of this unconscious bias, will it tilt attitudes leftward? Democrats might want to find out because Donald Trump — a self-professed germophobe — is doing an excellent job exploiting the disgust of the Republican base.

In February, 2018, a group of Swedish researchers reported results from two studiesthat they concluded showed a slight association between body odor disgust sensitivity, authoritarian attitudes, and support for Donald Trump, who at the time of data collection had not yet been elected. Quite predictably, media outlets loved it, as it confirmed everything they already believed.

But what do studies of disgust sensitivity and political leanings really show? Or more importantly, what don’t they show? The Swedish 2018 study didn’t find an association between conservative beliefs and disgust, while previous studies had. That’s because the researchers surveyed people in two different countries, Denmark and the United States, and there are differences in what one might call a “conservative” between those countries, whereas in previous studies only conservatives in the United States were surveyed.

Instead, the results of the Swedish study were more consistent regarding “authoritarian” attitudes, which were measured by agreement with statements such as “God’s laws about abortion, pornography and marriage must be strictly followed before it is too late, violations must be punished.” While these statements reflect a certain strain of conservatism, people who broadly identify as conservative will have all sorts of reactions to them, with cultural differences a major factor in those reactions.

Studies linking disgust sensitivity to voting preferences also can’t explain why there is a link, or, even if it is present, whether or not it is meaningful, only that a link was observed. Consequently, many of the explanations for the link amount to confirmation bias-fueled guessing. Many researchers have tried to examine political preferences as if they are part of an innate, evolved behavior. But what if these behaviors aren’t part of an innate behavioral immune system, but rather, part of an adaptive BIS? What if being a conservative, which can happen for a variety of reasons, makes you more likely to want to avoid smelly hippies, rather than wanting to avoid smelly hippies making you a conservative?

Like political views, cultural factors also influence what people think is disgusting. In Iceland and Greenland, rotted meat is routinely eaten because it provides vitamins for a population that won’t get as much as it needs from fruits and vegetables. Does that mean there are no conservatives in those places, because they all died from scurvy years ago? No, it just means that just like with every study, the presence of a correlation doesn’t imply causation, and there are always influencing factors that have likely not been considered. And how important is disgust sensitivity in proportion to other political views? Even if the differences in disgust sensitivity and their association with political views are meaningful, they might be easily overridden by other factors like significant threats to individual and civil liberties.

That’s one explanation of what happened in the COVID-19 pandemic, because if conservatives are more easily disgusted by the threat of disease, they haven’t been doing a bang-up job of expressing it in the last two years. Conservatives were more likely to be skeptical or downright dismissive, or should I say disgusted of media coverage of the risks of severe disease and death, while liberals were more likely to believe every word of it. Politics trampled right over the weak associations between political views and disgust sensitivity.

Some researchers have attempted to reconcile COVID-19 pandemic politics with the prevailing consensus about the relationship between political views and disgust sensitivity. Authors of one recent paper conclude that:

In two pre-registered studies, socially conservative attitudes correlate with self-reported COVID-19 prophylactic behaviors, but only among Democrats. Reflecting larger societal divisions, among Republicans and Independents, the absence of a positive relationship between social conservatism and COVID-19 precautions appears driven by lower trust in scientists, lower trust in liberal and moderate sources, lesser consumption of liberal news media, and greater economic conservatism.

In other words, people who were more socially conservative, yet voted Democrat, exhibited the highest disgust sensitivity and avoidance behaviors in relation to COVID-19. Republicans weren’t affected because they weren’t buying the narrative or were more concerned about the tradeoffs of harsh mitigation measures.

Another argument against the innate programming of disgust comes from studies of children, as they don’t seem to have a fully developed sense of what’s locally disgusting until about age five. Although little kids like to say something is “yucky”, it doesn’t mean they think that’s substantially different from saying, “I really don’t like this!” Mostly, little kids learn what foods and objects to avoid by observing and imitating what their parents avoid, a learned social behavior that is much more difficult for autistic children to acquire. Kids seem to develop their sense of disgust from observing their parents and others in their social circles, and develop their perceived vulnerability to disease as adults in part based on their experiences with childhood illness.

Beyond all the media interest in political views and disgust sensitivity remains an obvious question: Does increased disgust sensitivity actually help people avoid infections? Is being a germophobe worth it? Only a couple of studies have attempted to examine this possibility. An Australian survey study of 616 adults in 2008 found that people with heightened contamination and disgust sensitivities also had significantly fewer recent infections. In contrast, increased contamination sensitivity alone was associated with more infections. Meaning that people that got more infections were more scared of getting infections, but if they were also disgusted more easily, they tended to have less recent infections. This was interpreted by the authors as causal, meaning it was the increased contamination and disgust sensitivities that motivated individuals to exhibit hygienic behavior that likely reduced infections (hand washing, etc). 

However, a second study of people in rural Bangladesh was unable to find an association between disgust sensitivity and recent infections or frequency of childhood illnesses. Thus, only two studies have examined illness histories and pathogen avoidance, with mixed results. The relative ability of conservatives to avoid infectious disease compared to liberals also remains unexplored.

When considering the results of these studies, one assumption many people make is one that I’ve already explored—that avoiding infections is always equivalent to good health. It’s difficult to accept such a broad assumption, because there are many outcomes of infection—there are infections you don’t even really notice (i.e. subclinical), infections that are merely inconvenient (a cold), infections that incapacitate you for a few days (bad flu), some that send you to the hospital (pneumonia or meningitis), and others that send you to the morgue (like viral hemorrhagic fever). If you get a protective immune memory response from the first three outcomes that helps you avoid the last two outcomes later on, then pathogen avoidance may not always be in your best interest! 

But alas, it’s difficult for a germophobe to buy this argument, because even if death or disability from some infections are rare, it’s still possible! 

The pandemic and the harsh responses to it have made one thing clear—germophobia therapists have their work cut out for them.

Republished from the author’s Substack

Author

  • Associate Professor of Microbiology and Immunology at Indiana University School of Medicine - Terre Haute. Formerly CDC/NIOSH. Immunology of Infectious Disease.


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