On this episode of The Big 5, Dr. Nicki O’Brien tells us about her innovative work using animated GIFs to teach people about COVID-19 health behaviors like mask wearing and hand washing in Guatemala. She also discusses a funded PhD project starting October 2022. Applications due February 18, 2022.
To follow Nicki on Twitter: @NickijObrien
Check out the GIFs here. And an article about the GIFs can be found here.
Interested in the PhD opportunity? The advert can be found here.
You can find the transcript for this episode here.
It took a while to be officially recognised, but smell loss eventually became known to be one of the defining features of COVID-19. It’s now widely acknowledged that COVID-19 has a unique effect on smell receptors, and about 10% of those who lose their smell are still reporting problems with smell and taste six months later.
The effects of this can be profound. So we wanted to document what it was like to live with long-term smell and taste problems, and we did this by working with the smell-loss charity AbScent, which has an online support group for people with post-COVID smell problems.
By speaking to people in this group, we were able to build a picture of the wider impacts of disrupted smell following COVID-19. At the time of conducting our research, over 9,000 people had joined the group. Every day we were seeing new accounts of the devastating effect of sensory change.
We started posting questions to get a better sense of what was going on, and the response was overwhelming. People really wanted their experiences to be heard. With the consent of participants, we began to analyse their responses. We ran every theme we detected past the group and got them to comment on our research paper before we finalised it. We wanted to be sure we were telling their stories correctly. Here’s what we found out.
The end of food satisfaction
It’s been hard for people even close to me to understand the severity of the loss and how it’s affected my life.
Before we go further, let’s define a few key terms. Anosmia is total loss of smell. Parosmia is where normal smells are distorted, usually unpleasantly. Taste is what is picked up by the receptors on the tongue. Flavour is the total sensory experience of food, to which smell is the major contributor, but the other senses are also involved. This means that even if your taste (tongue) is fine, loss of smell will seriously affect flavour.
The first thing that struck us was how unpredictable and disorientating the sensory loss experience could be. For some, the effects were absolute:
It was like a light switch: from 100% to 0% in a couple of hours… No distorted smells, no whiffs, nothing. It’s like my nose switched off.
For others, things were more fluid. Anosmia could mutate into parosmia. Food that was fine one day could become disgusting the next. This “chaos narrative” – as sociologists call it – meant that smell loss was very difficult to live with, let alone manage. A condition over which there was no control.
The effect on appetite was also unpredictable. As might be expected, people had trouble eating – particularly when normal smells were distorted. Some were really struggling, reporting malnutrition and severe weight loss.
Less obviously, some people reported weight gain. These were usually people with anosmia, who were “chasing flavour” after losing their sense of smell. You can understand this if you realise the distinction between wanting and liking in what psychologists call the pleasure cycle.
Wanting is where you are chasing the thing you are going to consume. Liking is when you have got it and you are savouring it. In anosmia, that savouring part is no longer there, but this doesn’t stop the wanting:
Food satisfaction is lacking and I see myself eating more to try to get that satisfied feeling… I am gaining weight due to a constant urge to satisfy what can never be satisfied.
Intimacy is a scent
But it wasn’t all about food. Until you lose it, you don’t realise how essential eating is to everyday joys, especially social pleasures:
I am grieving for my lost senses. No more wine and cheese tasting nights or gin cocktails with my “girls”.
Even more heartbreaking was the effect of sensory changes on intimate relationships. There were a lot of posts where people described the loneliness of no longer being able to smell their partner or their children. Again, until it is gone, you don’t realise how important smell is to intimacy and connection. Even worse was the effect of parosmia:
His natural odour used to make me want him; now it makes me vomit.
How do you tell your lover that?
Some people’s relationships with themselves and the world had also changed. Some with no sense of smell reported feeling detached from themselves and the world. With parosmia, it could be more disturbing yet, with disgusting smells being triggered by everyday scents, making the world feel like a dangerous and confusing place.
For some these sensory changes were, fortunately, temporary. However, months down the line, many are stuck with profound sensory changes, with all the distress that brings. While there is evidence that smell training helps sensory recovery in other conditions, we are still at the early stages of understanding and developing treatments for what amounts to a pandemic of altered sensing.
In the year since the city of Wuhan, China, went into the world’s first coronavirus lockdown, we have all had to live under some form of pandemic-related restriction.
Some countries have opted for strict national lockdowns, like the one currently in place in the UK, while other countries such as Taiwan have opted for border closures and mandatory quarantine for overseas arrivals. Such different approaches to restricting movement have different effects on our well-being.
Researchers around the world are now focusing on what the specific impact of lockdown, quarantine and isolation might have upon our mental health. Lockdown, in the context of COVID-19, refers to implementation of strict community restrictions on travel and social interaction as well as denying access to public spaces.
Quarantine is a restriction of movement of those people who have been exposed to a contagious disease to observe whether they will become ill. In Australia, for example, all overseas arrivals must spend 14 days in hotel quarantine before being allowed into the community.
Self-isolation, meanwhile, is the separation of those who have become sick as a result of a contagious disease in order to separate them from others who are not sick.
Looking to past pandemics can help us understand this one. A recent academic review examined studies of people who had been quarantined as a result of other disease outbreaks such as Ebola, SARS and swine flu. The review concluded that quarantine can lead to a number of harmful psychological effects.
One outcome is the fear and anxiety that can increase due to worries about catching or transmitting the virus, and concerns about the health, social and economic effects of the pandemic. Individuals can also experience anger at the changing policies and protocols that impinge upon their everyday life and feelings of control.
And the long-term effects of quarantine can lead to some people subsequently developing a post-traumatic stress reaction, which can manifest in feelings of exhaustion, low mood and irritability.
Lockdown vs self-isolation
For lockdown and self-isolation measures, we have data from the COVID-19 pandemic itself.
Research from Italy, which was hit hard early in the pandemic and had an extensive lockdown, has found that more than one-third of the general public experienced significant psychological distress during the second month of coronavirus restrictions.
In a forthcoming study, my colleagues and I looked at what impact lockdown and had on psychological well-being and happiness compared to self-isolation. From March to July 2020, we assessed a sample of UK adults who were under one of three types of restrictions: self-isolation, full lockdown or partial lockdown (full lockdown is remaining at home and not going to work, whereas partial lockdown allows you to go to work).
After controlling for variations in age and sex, we found that those in self-isolation reported significantly lower levels of psychological well-being and happiness when compared to those in lockdown or those in partial lockdown, with no difference between the last two groups.
These findings suggest that self-isolation impairs psychological well-being and happiness to a greater degree than lockdown.
Caging the social animal
COVID-19 restrictions heighten the fears people have about health and safety as well as financial and social consequences. Self-isolation may add to this due to a prolonged separation from friends and family – those who provide a close support network. This is because during self-isolation you should avoid contact with everyone, even those in your household.
The finding of no difference between those in full lockdown and partial lockdown is equally interesting. This suggests that people can maintain a sense of satisfaction, optimism, engagement and a positive mood state despite the restrictions placed upon them, testifying to the resilience of humans under difficult conditions.
Humans are essentially social animals. Our large brains have developed to embrace social contact and develop skills that have helped us survive and prosper. These skills include language, problem-solving and planning, as well as empathy and care for others. We are hard-wired for social contact and communication.
Social isolation breaks many of these forms of communication and interactions, which are key to forming strong social bonds. It should therefore come as no surprise to find that prolonged periods of isolation can lead to a range of psychological problems, just as it does in the abnormal behaviour and communication found in a caged animal.
One year on, we are still yet to understand the full psychological fallout of COVID-19. But working out how different restrictions affect us our inner social animal is an important place to start as we navigate our way out of this pandemic and prepare for the next one.