Role of social responsibility in prevention of the COVID-19 outbreak from systems thinking perspective

From December 2019, the public health crisis erupted with the outbreak of a novel virus called coronavirus disease 2019 (COVID-19) that has been associated with significant worldwide mortality.¹ The infected patients by COVID-19 show various symptoms such as severe pneumonia, acute respiratory syndrome, fever or chills, fatigue, nausea or vomiting, sore throat, multiple organ failure, and also the immune patterns of these people are changing with the progression of the disease.² According to World Health Organization's (WHO) reports, it generally has a 5–6-day incubation period and symptoms may appear 1–14 days after exposure to the virus. Human-to-human transmission is stated as the primary and the most important mode of transmission for COVID-19.³ In addition to the symptoms mentioned, anxiety is a common symptom in patients with chronic respiratory disorders that would significantly reduce their quality of life and have a long-term effect on their mental health. In fact, in most cases, measures of anxiety include physical body symptoms that can overlap with the symptoms of chronic respiratory disease and side-effects of medications.

From an epidemiological perspective, the rapid and accurate diagnosis of COVID-19 is critical to control the spread in the community. The swift current outbreak of COVID-19 has forced governments to implement rigorous policies and use a variety of contrivances to manage virus transmission; therefore, health systems would get enough time to prepare and reduce the impact of the pandemic. While most government actions are effective, they have high social, psychological, and economic costs, and at the same time, their results are not sustainable. Although the WHO recommends that communities and governments be more aware and act consciously, the superior they try, the more COVID-19 mortality rate reduces.

During the transmission and fast spreading of COVID-19, alongside the medical staff's non-stop efforts to inhibit this pandemic, “Social Responsibility”’ has been widely noticed. The implication is that almost all political leaders, health experts, and even celebrities have all called us to be responsible until the widespread outbreak of this virus be decreased and its calamitous' effects are minimized.⁴

To predict and prevent the behavior of COVID-19, it is necessary to deal with the intricate world with many interconnected concepts and factors that not only limit to a specific domain but also have complex and dynamic essences. Hence, it should be understood, managed, and controlled with a holistic and interdisciplinary perspective. In today's complex world, designing and implementing policies without understanding the underlying mechanisms that cause these complexities is not possible. Accordingly, system dynamics is used to understand the complexities and structural causes of such medley adaptive systems. Because society itself is a dynamic system, this approach by considering the pros and cons of each alternative and influential variable in the model would help policymakers understand the hazardous effect of the COVID-19 outbreak and its multifaceted consequences in society.⁵ Actually, systematic thinking help policymakers look at the problem beyond the chain of infection and have a better understanding of decisions with multiple consequences in the face of such a complex situation involving many interconnected factors.

Comprehension of the cause and effect enables us to analyze, sort out, and explain how changes have happened in the existing problems. In fact, by taking the advantages of causal loop diagrams, which reflect the causal connections among components of a system and how changes would affect other components and finally back to itself, we can draw an explicit map of the process of patients infected by COVID-19 and its transmission to others as presented in Fig. 1 .

Fig. 1.

Overview of a causal loop diagram for role of social responsibility to combat COVID-19. ‘B’ represents balancing or negative feedback and ‘R’ represents reinforcing or positive feedback. COVID-19, coronavirus disease 2019.

In the absence of COVID-19's vaccine, countries all around the world are implementing various forms of social responsibility as a policy to reduce the spread of the virus. One form of social responsibility is the social distancing that takes many forms, but the aim is to keep people physically away from each other that delay in its implementation is not as effective as in the early days. Two main influential factors in controlling the COVID-19 outbreak include increase in the quantity and speed of COVID-19 diagnostic tests and correctly applying the social distance regulations. Rapid testing is performing to detect the asymptomatic infected people in the community. Experiments show that severe social distancing rules have the potential to successfully reducing and delaying the disease onset.⁶ However, if the rigorous policy of social distancing performs carelessly, a large-scale intervention must be carried out through the extensive and rapid testing to prevent a widespread outbreak in the future.

Within the loops named ‘carelessness’ and ‘environment’ in Fig. 1, COVID-19 asymptomatic carriers can be considered as an exogenous variable that affects the intentions for more social interactions and failing to observe social distancing. If social interactions with asymptomatic coronavirus carriers increase in the community, the risk of the pandemic will increase which will lead to an increase in the number of patients. In the same loop, by timely announcing the number of infected people and identified patients, the number of social interactions and consequently the severity of the pandemic risk would be decreased and over time it can lead to a reduction in the number of cases.

As the number of patients is increasing, the risk of environmental pollution is increasing that results in the growth of the pandemic risk, raises the number of asymptomatic carriers, and consequently increases the number of patients. The easy spread of the virus and pass of infection to others have led people to daily use masks, gloves, and disinfectants to protect themselves that would lead to the production of large amounts of medical waste and environmental pollution. Some variables such as population density, family size, and different levels of social distancing contribute to environmental pollution and transmission or non-transmission of the virus.⁷

In the loop of ‘medical equipment’, we investigate the effect of the inadequacy of medical equipment alongside the long-term and continuous activities of medical staff. It is shown that an increase in the number of patients terminates the physical or mental health of medical staff which is the result of overworking, stress, and fatigue.⁸ In this regard, burnout syndrome has become much more prominent. In fact, prolonged wearing of personal protective equipment and the excessive heat generated by them, sleep deprivation, fatigue, and burnout syndrome all cause the helplessness of medical staff.⁹ This sense of helplessness and fatigue of the medical staff may increase the risk of infection among them, and consequently, the number of patients would increase.

In the loop of ‘government challenges’, the increase in the number of patients has led to a recession in economic activities, and this recession could lead to an increase in the number of patients. On the other hand, increasing the number of patients in the loop of ‘public concern’ lead to a growth of the community's concern and awareness and ultimately impelled a reduction in the number of the patients. However, record daily rise in COVID-19 has changed people's lifestyles, led to the loss of many jobs, and increased the threat to millions of people as many businesses have been shut down to control the spread of the virus. For example, almost all flights around the world have been canceled and transportation systems are closed, which totally has devastating consequences on the economy.

Finally, in the last loop entitled ‘public awarness’, an increase in the COVID-19 incidence rate entails an increase in the risk of anxiety. It should be noted that high anxiety could play a critical role in the development of maladaptive health behaviors. The outbreak of the COVID-19 pandemic or the other major ones is predicted to have negative destructive effects on individuals and society. Not only would the COVID-19 outbreak affect the mental health of many people but also the increase in the COVID-19 mortality would increase the growing anxiety and fear because people are afraid of endangering their own physical health and their loved ones. This increase in fear and anxiety can be reduced by raising public awareness of the issue and changing people's lifestyles and daily activities that could eventually lead to a decrease in the number of patients.¹⁰

In summary, due to the lengthy process of producing the COVID-19 vaccine, most countries are trying to implement various low-cost strategies to slow down the spread of the virus and try to normalize the living conditions in society besides reducing the current recession. Promote social distancing behaviors and widely wear masks are considered as the signs of social responsibility and accompanying people with medical staff and the governments to get out of this crisis.