‘We heard from real people being affected in ordinary lives’

I only realised when we were arranging this Zoom that you're a couple… what was that like, when Covid hit?

KD: Doing the Covid project, we'd be giving presentations while in the same room on Zoom, but with different surnames displaying. We always felt like we had to explain, we write about adherence to rules, and we're not breaking them – we are married!

And you're a sociologist by background, Simon, whereas Kim you're a psychologist. It must have felt like your time had come!

KD: I'm a clinical psychologist, and when Simon and I met I was working on my first tenure position in Roosevelt. We just had this communication thing where I'd always be focusing on the individual and how the individual changes, and he'd be focusing on society and groups. We still have that, the different orientations. But we have found a lot more commonalities, and I've actually lured him over… he works in Psychology now!

SW: I was always a psychologist in disguise. Technically, my PhD was in Sociology, but I have always been drawn to the theories of social psychologists. William James Dewey, Al Bandura…

KD: …which is funny, because I actually learned from Bandura at Stanford!

SW: The pandemic was a real career moment, when I was drawn to this ability to speak in a more black-and-white way… to derive conclusions that seem to be more applicable to policymakers. You had behavioural scientists around the table, and if they weren't economists, they're probably health or behavioural psychologists. 

As well as working at Swansea University, I work in the Behavioural Insights Unit at the World Health Organization part-time, and they're very overt, 'we're behavioural scientists, and within that we're discipline agnostic'. We just use what we need to use – the theories, the tools, the methods, it doesn't matter if we call them psychology, sociology or anthropology. I like that. What's the problem, what do we want to fix, and how can we go about it?

KD: It was a shared goal, to do the best we could during the pandemic, and it broke discipline barriers. It broke all sorts of barriers for a lot of people.

I think what I've witnessed in the last decade or so is that the higher you go in trying to make use of psychology, the less protective you are over disciplinary boundaries. People sometimes see that as an abandoning of Psychology, for something with more status and rewards, but I don't think it's about that. I think it's about smart people drawing from a toolbox.

So tell me how the Public Views of Covid Project came about.

KD: We had a two-year-old and a four-year-old at home, so of course, we were like, 'We might as well start a study, right? What else are you going to do?' But more than that, it was just a wonderful way to come together and study the same thing.

SW: A lot of behavioural and social scientists looked at each other and said, 'We can use our expertise, knowledge and skills to make a difference'. The immunologists, vaccinologists, the biomedical scientists, they were the cavalry. But we were holding the fort. We needed behavioural science, and we still might in the future. There's a very real threat that in our lifetime, we might have a flu pandemic again, new variants of Covid, or other diseases. This brings a whole host of factors that we collectively study, like trust in institutions, inequalities, all these things that have been shaken by the last few years.

A lot of the psychology response in the early days was about predicting what people might do based on existing theories and research, and how you might change that behaviour. You were perhaps unusual in terms of that early focus on actual public views of what was happening?

KD: We got lucky with expertise. Simon had done focus groups, I've led group therapy, and together we were able to pull in people very quickly and really speak to them about their views, about what people were actually experiencing, not just what people thought might happen. We were able to concretely say what the big driving factors were. Loss was the big emerging theme in the beginning. We came up with alert fatigue soon after that. We were able to see these principles emerge from the groups, rather than coming from the theory. That was wonderful.

We got the qualitative data out there, those public views, and then we supported it with quantitative data over time.

SW: There's sometimes this methodolatry, a hierarchy of methods. In the early stages, I think we filled a niche – in-depth, longitudinal qualitative research, which is still relatively underused. We wanted to follow people over time, not necessarily asking 'How can we help policymakers devise policies that would encourage adherence to non-pharmaceutical interventions?' – what we were interested in was real people being affected in ordinary lives. 

We started off looking at the mental health impacts of lockdown, grounded in looking at the inequalities, but over time we found value in speaking to how we communicate public health policy in ways that are understandable and actionable for the public. That has broader implications, beyond outbreaks and infectious disease or emergencies, to how governments, scientific advisory groups and institutions like the NHS communicate to people.

KD: Policymakers were really listening to psychologists. We were able to present to the Welsh Technical Advisory Group for Covid; I got on the Scientific Advisory Board for that group. They would come and ask us questions, we could go to our focus groups, and it was this agile interchange that was really novel, I think.

Just unpick that main theme of loss a bit for me.

KD: There was a loss of social connection, which was a big one. Financial loss. The loss of structure came up over and over again – not being able to go to work, or a more structured environment, that was incredibly impactful. Probably about nine months in, it stopped being about loss… but that was the initial reaction we saw, and those self-reported losses and the qualitative data, had a very strong association with negative mood in the quantitative data. We could see that fluctuate together over time.

SW: People were restructuring, having new social patterns… this was an unprecedented pandemic, and people had to be very open and adaptive.

Getting back to the point about theories – there was this assumption around 'fatigue', that people would get fed up with sticking to rules. Psychologists like John Drury and Steve Reicher pushed back against that, and we got to interrogate it in the data. We found that people were able and willing to comply. To use the terms of the COM-B behaviour change model, it wasn't really about motivation. It was more about the capabilities and the opportunities. Did they know what they were being asked to do, and were they able to do it?

There were high stakes to these decisions. Avoidable lives were lost because of this persuasive view around fatigue. We found that for at least a couple of years, people will follow the law. We just need to know and to be clear what it is.

A lot of it is inevitably so individual, which presumably comes out in the interviews. 
When you mentioned loss of structure, my immediate thought was that I felt I found more structure in the early days, or certainly a simplified structure which suited me better.

KD: We have tons of transcripts from about 54 people who stuck with us the whole time – nine waves over three years. Early on it was loss, it was negative mood. And then that negative mood really wasn't as strong, around November into March 2021. That maps on to ONS data. It became more around adherence, messaging, and people looking back now that they had gone in and out of lockdown, and seeing how beneficial it was in a lot of ways. One of my students actually did a project around the positive messages in the transcripts.

I look back on 2021 as a time when we, collectively as a society, lost our minds. 2020 there was collective resilience, and then 2021 felt like the origin point for a lot of the 'culture wars'… Jon Ronson talked about it in his Things Fell Apart series.

SW: The people we spoke to in our research had this kind of learned helplessness… 'when will it all end?' They felt like they had been promised 'a few months and we're done, we've just got to do this'. Then it was, 'here we go again', and with Omicron that was measurably more transmissible.

KD: In 2020, everybody was unified against Covid. But then we started seeing real differences in deprivation. People living in inner cities, on very low income, they didn't have those green spaces to go to when they could go walking. In those groups, we didn't really see the positive messages. We started seeing the split – those who just viewed the pandemic as something absolutely horrible that destroyed their lives, and those who could see the benefits. People who could find the positive had different circumstances.

Simon, as a sociologist/psychologist in disguise, do you feel that those social and economic factors in how people viewed and responded to Covid has had enough emphasis? Because I'm the first to hold my hands up in terms of putting this issue together – I have not properly tackled the intersectionality of it at all.

SW: I don't think it's had enough emphasis from a policy perspective in terms of the necessary resource support, both at the time and looking back. We know that it was an unequal pandemic. How do we now support those individuals and communities that were harder hit – greater mortality, greater morbidity?

There was this other aspect, a media trope of the 'Covidiot', which some people assumed was certain communities, maybe with lower levels of formal education. But actually looking at the data, we found no inequalities by education or socioeconomic status in terms of motivation to adhere.

So no, I don't think it has had enough attention. And I'd love to go back and ask what people are up to, and how Covid has affected them? What's the legacy? What's the shadow?

KD: We actually recruited additional people from minority communities around 2022, and did some more groups specifically with them. We're still looking at that. But one of the things that came out was a strengthening of the ingroup/outgroup divide. People formed these communities even more strongly where they really felt like they'd been disadvantaged in the pandemic, and when they felt they had been treated unequally.

SW: There's a legacy to all this that we, as a scientific community, still need to look at. Vaccine hesitancy is one aspect: it has increased during the pandemic, and I think that's symptomatic of trust in institutions.

You've shut down the groups now, right?

KD: Yes. We noticed people just not wanting to talk about the pandemic. We did these closure groups, and the big message was they wanted to see it as something positive, usually in the past, or something just negative to get to be gotten through. I'm a stress researcher, so the idea this is a stressor in the past that has now ended is an odd one for me. I'm a believer in chronic stress. It still impacts you, it's ongoing. But for the people we spoke with, it's done.

I've felt that response from psychologists in putting together this issue. 'Why are you doing an issue on Covid, it's done'. But it's very clearly not.

KD: Absolutely. And it's an allostatic load too – that strain on your body dealing with a stressor for three years, in and out of lockdown. We're still seeing concentration issues, burnout, job overload. Those things that are the product of being in this chronic stress environment for years. And this affects the behaviours of society when it comes to vaccine hesitancy, adherence, presenteeism…

SW: Covid was earth-shattering, it was a fundamental reconstruction of social relations for a time. So I think there's something to be said about resilience, or the stickiness of behaviour – because we've gone back to how things were. Most people are living with and interpreting infections like they used to, right? There are people who still want to take additional measures, but on the whole, as a society and a culture, at least in the UK and similar countries, we've gone back to how we were. I think that's interesting because Kim and I were quite nuanced with that…

KD: Simon is very adherent – if we're sick, we need to stay separate, stay in. I'm a stress researcher, cortisol specifically, and I know how important being close to others, and physical touch, are for our wellbeing. Social support actually improves immunity. Isolation probably had one of the strongest impacts on mental health and wellbeing across the pandemic, especially for older individuals. So it's a balance, and we have this interesting conversation between us…

So much has changed. You see the next generation coming into the workplace, and that 'onboarding' can be pretty tricky for them when people have not fully returned to the office.

KD: You've got a son down here at Swansea Uni, haven't you? This generation of students we're seeing, how differently they're operating in university, their expectations, fears, anxieties… it's fascinating how different the university environment is now.

I think both my lads were relatively lucky in terms of the timing of it, but certainly, sixth form and GCSEs were disrupted, and that's a period when lifelong friendships and ways of doing things are set down. For that generation, the 'shadow' you mention could be long-lasting, and we probably won't know the full impact for years to come.

KD: The strongest mood impact we're seeing is for young adults. And they're being told to forget. If people don't want to talk about it and don't want to acknowledge it anymore, then where is their negative mood coming from? Where are their anxieties coming from? They're being told that there's no reason for that feeling when actually there are a lot of reasons. So we can't ignore Covid.

SW: That's why it's great, what you're doing with this issue. Because I think you're right – collectively, societally, politically, scientifically, people aren't paying attention. Kim and I had this early entry into Covid research, but it wasn't long before everyone – psychologists, sociologists, economists – was writing about Covid. And then it just dropped off. Now it's like nobody is. We need to take a pause and say, 'Are we OK?' Or if we might be OK, are they OK as well?