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  • The intersection of antimicrobial resistance (AMR) and climate change impacts human health, ecosystems, and socio-economic stability
  • AMR complicates disease treatment and medical procedures, while climate change alters disease dynamics, expands pathogen ranges, and threatens clean water and sanitation
  • Combined, AMR and climate change strain healthcare systems, exacerbate health disparities, and threaten food security, especially for vulnerable communities
  • Coordinated global responses integrating health, environmental, and developmental perspectives are needed to promote resilience, sustainability, and improved health outcomes
 
Antimicrobial Resistance and Climate Change: A Global Crisis
 
On September 26, 2024, the United Nations General Assembly will convene a High-Level Meeting on antimicrobial resistance (AMR) in New York. Drug-resistant infections transcend borders, making it impossible for any single country to tackle AMR on its own. This meeting offers an opportunity for global leaders to collaboratively address the threat that AMR poses to public health, food security, and the attainment of the 2030 Sustainable Development Goals. According to recent estimates, ~1.3m deaths worldwide in 2019 were caused by drug-resistant infections. If current trends continue, by 2050, AMR is projected to cause ~10m deaths annually, with costs to the global economy >US$100trn. Furthermore, this trend could force ~24m more people into extreme poverty over the next decade. These figures emphasise the threat posed by AMR, far surpassing the impact of COVID-19.

In the landscape of contemporary global health challenges, two significant and interconnected threats demand attention: AMR and climate change. These issues, though distinct in nature, share an interconnectedness that magnifies their collective impact on human health, ecological integrity, and socio-economic stability.

AMR poses a growing risk as microbes evolve to withstand the drugs designed to combat them. This phenomenon complicates the treatment of infectious diseases and jeopardises the effectiveness of medical procedures ranging from surgeries to cancer treatments. Concurrently, climate change exacerbates these challenges by altering disease dynamics, expanding the geographical range of vectors and pathogens, and compromising access to clean water and sanitation: fundamental prerequisites for health.

Moreover, the convergence of AMR and climate change intensifies the strain on vulnerable populations, exacerbates health disparities, and threatens food security and agricultural productivity. These issues transcend national borders, necessitating coordinated global responses that integrate health, environmental, and developmental perspectives. Hence, the UN meeting in September 2024, which marks only the second such gathering in its 79-year history. By recognising and addressing the interconnectedness of these dual crises, we can promote resilience, support sustainable development, and safeguard the wellbeing of present and future generations worldwide.

 
Understanding Antimicrobial Resistance

AMR refers to the ability of microorganisms - primarily bacteria, viruses, fungi, and parasites - to evolve and withstand the effects of antimicrobial agents, including antibiotics, antivirals, and antifungals. While this evolutionary process is natural, human activities have accelerated it, particularly through the overuse and misuse of antimicrobial drugs in human medicine, agriculture, and veterinary practices.
The consequences of AMR are extensive and multifaceted. In healthcare settings, infections that were once treatable with common antibiotics are becoming increasingly difficult, if not impossible, to cure. This resistance leads to prolonged illnesses, longer hospital stays, higher medical costs, and increased mortality rates. Moreover, the rise of multidrug-resistant strains poses a threat to medical procedures, such as surgeries, chemotherapy, and organ transplants, which rely on effective antimicrobial prophylaxes and treatment.
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Beyond healthcare, AMR threatens food security and safety. The widespread use of antimicrobials in agriculture to promote growth and prevent disease in livestock leads to the development of resistant bacteria that can enter the food chain. These resistant strains can then be transmitted to humans through the consumption of contaminated food, direct contact with animals, or environmental pathways, such as water and soil.

The environmental impact of AMR is also significant. Antimicrobial residues from pharmaceuticals, agricultural runoff, and waste from healthcare facilities can persist in the environment, promoting the development and spread of resistance among environmental microorganisms. This environmental reservoir of resistance genes can transfer to human and animal pathogens, further complicating the management of infectious diseases.

Addressing AMR requires a comprehensive and coordinated approach, including the promotion of responsible antimicrobial use, investment in research and development (R&D) of new drugs, and the implementation of robust surveillance systems to monitor resistance patterns. Public awareness and education on the prudent use of antimicrobials are equally important in mitigating this global threat.

 
The Rise of Climate Change

Climate change presents a distinct and significant set of challenges to global ecosystems and human societies. Primarily driven by anthropogenic activities such as the burning of fossil fuels, deforestation, and industrial emissions, climate change manifests in rising global temperatures, altered precipitation patterns, more frequent and severe extreme weather events, and sea-level rise. These changes disrupt ecosystems, endanger biodiversity, and threaten human livelihoods, particularly in vulnerable communities with limited resources to adapt.

The implications of climate change are far-reaching and complex. Increased risks of natural disasters, such as hurricanes, floods, and wildfires, lead to loss of life, property damage, and economic instability. Altered precipitation patterns can result in prolonged droughts in some regions and excessive rainfall in others, affecting agricultural productivity and leading to food and water insecurity. As these climatic conditions shift, they also change the habitats and behaviours of disease vectors like mosquitoes and ticks, altering disease patterns and potentially introducing new health threats to populations unaccustomed to such risks.

These environmental shifts have indirect effects on human health, exacerbating existing health disparities and amplifying the burden on healthcare systems already strained by other challenges, such as AMR. The displacement of populations due to rising sea levels, extreme weather events, and deteriorating living conditions further compounds these issues, creating climate refugees who require humanitarian assistance and healthcare support.

 
Convergence of Threats

The convergence of AMR and climate change amplifies their individual impacts, creating a scenario where each phenomenon exacerbates the effects of the other. This interplay is illustrated through several mechanisms. Climate change significantly alters ecological systems, influencing the geographic distribution and prevalence of infectious diseases. Warmer temperatures, for example, can expand the range of disease vectors like mosquitoes, leading to increased transmission of diseases such as malaria and dengue fever. In a context of AMR, where effective treatments for these diseases are diminishing, the burden on healthcare systems and affected populations intensifies, making it harder to manage and control outbreaks.

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Climate change-induced extreme weather events, such as hurricanes, floods, and heatwaves, pose risks to healthcare infrastructure and services. Disruptions in healthcare provision can compromise infection control measures and lead to increased transmission of resistant pathogens within healthcare settings. Moreover, displaced populations and compromised living conditions post-disaster create environments conducive to disease outbreaks, further challenging already strained healthcare resources. The vulnerability of healthcare infrastructure to climate-related disruptions emphasises the need for resilient systems that can withstand and adapt to these changes.
Agriculture is both a contributor to and influenced by climate change. Changing weather patterns impact crop yields and livestock production, leading to shifts in agricultural practices, including the increased use of antimicrobials in animal husbandry to prevent disease and promote growth under stressful conditions. Global antimicrobial use in food animal production was ~63,151 tons in 2010 and is expected to increase by ~67% to ~105,596 tons by 2030. Around 80% of food-producing animals and birds receive medication for at least part of their lives. Antimicrobials used in food animals constitute ~80% of the total antimicrobial consumption in the US each year. Most of the global rise (~67%) in antimicrobial use is driven by the growing population of animals raised for food.

Increased temperatures and altered precipitation patterns also impact food safety, with potential implications for foodborne illnesses caused by resistant pathogens. These agricultural shifts not only shape food security but also introduce resistant bacteria into the food chain and the environment, posing further risks to human health.

Climate change also affects global trade routes and patterns, influencing the movement of goods and people. This interconnectedness facilitates the spread of infectious diseases and resistant microbes across borders, complicating efforts to contain AMR on a global scale. The emergence of new pathogens and resistant strains in different regions points to the need for coordinated international efforts to address these interconnected challenges. The combined threats of AMR and climate change necessitate comprehensive, integrated strategies that involve local, national, and global collaboration to mitigate their multifaceted impacts. Addressing these interconnected challenges is essential for promoting public health, environmental sustainability, and global socio-economic stability.

 
Projected Impact and Future Scenarios

The projected impact of the combined threats of AMR and climate change paints a distressing picture for global health and wellbeing. As AMR reduces the effectiveness of existing treatments, healthcare systems face increased pressure to develop new antimicrobial agents. However, the pipeline for new antibiotics is limited due to scientific and economic challenges. Climate change-induced health crises further strain these systems, potentially overwhelming their capacity to respond effectively. The economic burden of AMR is substantial. The World Bank estimates that AMR could result in ~US$1trn additional healthcare costs by 2050, and ~US$1trn to ~US$3.4trn gross domestic product (GDP) losses per year by 2030. Climate change exacerbates these costs through disruptions to agricultural productivity, healthcare expenditures, and labour productivity. Socio-economic disparities are likely to widen as vulnerable populations bear the brunt of these combined impacts, leading to increased poverty and reduced access to essential services.

Ecosystems, which provide services such as water purification, carbon sequestration, and biodiversity maintenance, are also under threat. Climate change and AMR compromise these services, undermining environmental resilience and exacerbating the vulnerability of both natural and human systems. The degradation of ecosystems can lead to the loss of biodiversity, further disrupting ecological balance and increasing the spread of resistant pathogens. As these environmental and health challenges intensify, the global community faces a future where traditional methods of disease control and prevention may no longer be effective, necessitating innovative approaches and robust international cooperation to safeguard human health and maintain ecological stability.

 
Mitigation and Adaptation Strategies

Tackling the intertwined challenges of AMR and climate change requires well-coordinated, comprehensive strategies implemented at local, national, and global levels. Enhanced surveillance and monitoring systems are important for tracking resistant pathogens and infectious diseases, allowing for early detection and response. Integrating environmental and climate data into these surveillance frameworks provides a more detailed understanding of disease dynamics and antimicrobial use patterns, helping to identify and address emerging threats more effectively.

Promoting the sustainable use of antimicrobials in human medicine, agriculture, and veterinary practices is essential to mitigate the spread of resistance. This involves advocating for responsible prescribing and use, implementing regulations to curb overuse and misuse, and promoting alternative practices such as vaccination and improved hygiene. These measures can reduce reliance on antimicrobial agents and slow the development of resistance.

Building resilient healthcare infrastructure capable of withstanding climate-related disruptions is critical for maintaining health services during crises. This includes enhancing infection prevention and control measures, improving disaster preparedness, and ensuring access to essential healthcare services during and after extreme weather events. Strengthening healthcare systems' capacity to cope with both AMR and climate impacts can prevent service disruptions and manage disease outbreaks more effectively.

Mitigating climate change through emissions reduction and adaptation strategies is crucial for reducing the frequency and severity of climate-related health impacts. Investing in renewable energy sources, promoting sustainable agricultural practices, and developing resilient urban planning are integral to these efforts. Such investments address climate change and support broader efforts to combat AMR by reducing environmental pressures that contribute to resistance.

International collaboration and governance frameworks are indispensable in addressing the global challenges posed by AMR and climate change. These frameworks should promote information sharing, capacity building, and equitable access to resources. Global health agencies, such as the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO), play pivotal roles in facilitating collaboration and setting international standards for antimicrobial use and climate resilience.

An approach that integrates health, environmental, and socio-economic considerations is necessary to effectively tackle these threats. By investing in R&D, promoting sustainable practices, and fostering international cooperation, the global community can develop strategies to mitigate the impacts of AMR and climate change. Such an approach will help safeguard public health, enhance ecological stability, and ensure socio-economic resilience, ultimately securing a healthier and more sustainable future for all.

 
Takeaways

The interconnected threats of AMR and climate change demand urgent and coordinated global action. Each poses challenges to human health, the environment, and socio-economic stability, but their convergence magnifies the impact, creating a complex web of risks that transcends borders and disciplines. Addressing these threats requires integrated strategies that recognise their interconnectedness, fostering resilience through sustainable practices, robust healthcare systems, and international cooperation. By enhancing surveillance, promoting responsible antimicrobial use, and mitigating climate change, we can build a future that not only curbs the rise of resistance and mitigates environmental degradation but also strengthens the foundations of global health and ecological integrity. The path forward necessitates innovation, investment, and a unified global commitment to safeguard the wellbeing of current and future generations. Let us hope that the United Nations General Assembly meeting in September 2024 to address this issue will energise international responses.
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Dr. Mukesh Sharda BAMS, Ph.D., is a renowned Ayurvedic rheumatologist-CEO and Founder of Dr. Sharda Ayurveda practicing for more than 15+ years and successfully treated more than 50k+ patients worldwide for all chronic diseases.


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  • The CoVID-19 pandemic has been controlled by government policies that restrict individual behaviour 
  • Even if the accelerated vaccine development goes to plan and is successful, government restrictions will be necessary for some time yet 
  • Recent research suggests that, at the height of the CoVID-19 pandemic, people with narcissistic and other “dark” personality traits flouted public health restrictions  
  • Research has also shown that the coronavirus can be spread by a relatively small group of individuals who break public health protocols 
  • Could a small group of asymptomatically infected individuals with narcissistic traits trigger a renewed and significantly more devastating outbreak of CoVID-19?
  
Narcissism and a second more devastating wave of CoVID-19
 
 
Research suggests that in early 2020, at the height of the CoVID-19 pandemic, people with narcissistic and other “dark” personality traits, (Machiavellianism and psychopathy) flouted public health restrictions, such as social distancing, stay-at-home measures, mask-wearing and hand washing, introduced to prevent the spread of the coronavirus.
 
The fastest and deepest global economic shock in history

The outbreak of CoVID-19 in December 2019 started an epidemic of acute respiratory syndrome in humans in Wuhan, China, which quickly became a pandemic responsible for the fastest and deepest global economic shock in history. In a matter of weeks, stock markets collapsed, credit markets froze, huge bankruptcies occurred, unemployment rose above 10% and annual GDP rates contracted by 8% or more. In the absence of either a vaccine or a therapy, the social and behavioural sciences were used by governments to help align human behaviour with the recommendations of epidemiologists and public health experts to reduce the impact of the coronavirus outbreak. 
 
Measures were successful and as nations regained control of the virus’s transmission and reduced the burden on their healthcare systems, restrictions were relaxed or removed to re-energise damaged economies and encourage more viable lifestyles with the virus still in circulation. In many countries, this increased the incidence levels of CoVID-19, hospitalisations and deaths; and governments had no alternative but to re-instate selected restrictions on people’s behaviours.
 
Now, some ten months after the initial outbreak, governments throughout the world are bracing themselves in the knowledge that a relatively small group of people who flout restrictions could cause the coronavirus to return, which some analysts suggest could be more devastating than the impact of its initial outbreak. This is because healthcare systems have been significantly weakened and are struggling to cope with huge backlogs of patients whose treatments have been delayed because of the coronavirus, economies have been damaged, and the annual winter flu epidemic is expected in most Western developed nations.
 
In this Commentary

This Commentary describes the findings of three recent studies, which examine the relationships between the Dark Triad traits (i.e., narcissism, Machiavellianism and psychopathy) and behaviours related to the COVID-19 pandemic. Findings suggest that, at the height of the pandemic in March and April 2020, people with narcissistic and psychopathic personality traits were more likely to ignore rules, such as hand washing, social distancing, staying-at-home and mask-wearing and therefore could have become super spreaders of the disease. The Commentary focusses on narcissistic traits. We begin by underlining some of the challenges of developing and manufacturing a CoVID-19 vaccine at scale, which is safe and effective. We then describe Narcissistic Personality Disorder (NPD) and the R number, which governments have used to explain how well the virus is being controlled. We also describe the lesser known K metric, which is critical to epidemiologists’ attempts at understanding how CoVID-19 is actually transmitted. We then briefly describe the concepts of super spreaders and super-spreading events, which help to explain how a relatively small group of people can have a significant impact on the transmission of the coronavirus. Brief descriptions of the findings of three recent research studies follow. These suggest that people with narcissistic and other “dark” personality traits, break public health restrictions. Finally, we draw attention to the limitations of the studies and provide some “takeaways”.
 
Developing and scaling vaccines is challenging

Although scientists look likely to produce a CoVID-19 vaccine much faster than anyone could have predicted, and governments have pre-purchased about 4bn doses of these for delivery at the end of 2020, developing a safe and effective vaccine at scale is challenging. The failure rate of vaccines that reach advanced clinical trials is as high as 80%. Some CoVID-19 vaccines in production that receive regulatory approval might only provide partial or temporary protection, others might require more than one dose to be effective. So, even if the accelerated vaccine development goes to plan and is successful, it is not altogether clear whether this would secure protection for enough people throughout the world to halt the spread of the virus in the medium term. Thus, it seems reasonable to assume that, behavioural techniques to slow or stop the spread of the coronavirus will be needed for some time yet, and people with narcissistic personality traits could reduce the effectiveness of these endeavours.
 

Narcissistic Personality Disorder

Narcissism is a pattern of grandiosity, a need for admiration and a lack of empathy. The condition has its genesis  in Greek mythology, and a beautiful and proud young man called Narcissus, the son of the river god Cephissus and the nymph Liriope. Many fell in love with Narcissus, but he only showed them disdain and contempt. When Nemesis, the goddess of retribution and revenge, learned of this she decided to punish Narcissus for his behaviour and led him to a pool where he saw his reflection in the water and fell in love with it. Narcissistic personality disorder (NPD) is rare. Although the term NPD has been used since 1968, only in 1980 was it officially recognized in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, which is a taxonomic and diagnostic manual published by the American Psychiatric Association. Notwithstanding, in all probability we all know someone with narcissistic tendencies, which we often dismiss as just a “big ego” problem. And, if we are honest, at some point in our lives, we have demonstrated some narcissistic traits. The signs and symptoms of NPD include: (i) having an exaggerated sense of self-importance and a sense of entitlement, (ii) wanting constant, excessive admiration, (iii) expecting to be recognized as superior even without achievements that warrant it, (iv) exaggerating achievements and talents, (v) believing that you are superior and desiring to associate with equally ‘special’ people, (vi) having an inability or unwillingness to  recognize the needs and feelings of others, (vii) expecting special favours and unquestioning compliance, and (viii) taking advantage of others to get what you want. Although research in social and personality psychology has added significantly to our general understanding of narcissism, it has been one of the least studied personality disorders, mainly because of its low societal urgency and health costs. The causes of NPD are unknown, and the condition remains a controversial diagnosis. Some researchers think that overprotective or neglectful parenting styles may have an impact. Genetics and neurobiology also may play a role in the development of NPD. Given the challenges of diagnosing the condition, prevalence rates vary significantly. For instance, in the US, reported prevalence in the general population varies from 0.5% to 5%. NPD is less frequently identified in psychiatric settings, but more often seen in private clinical settings and applied to higher-functioning patients.
 
R number

In early 2020, during the height of the coronavirus crisis, politicians throughout the world and public health officials constantly referred to the R or R0 number to indicate the spread of the virus. As a consequence, most people now know that R refers to the average number of people one person with coronavirus is likely to infect. R is calculated through a combination of data and modelling, which includes hospital and intensive care admissions, people testing positive, deaths and surveys of people’s contacts. R indicates whether the number of infected people is increasing or decreasing. When R is above 1, the virus will grow exponentially in a population with no immunity. At 1, the disease remains steady. Below 1, the virus will gradually infect fewer people, until the epidemic dries up. However, in real life, some people with the disease infect many others, while others with the coronavirus do not spread the disease at all. This means that the R number hides significant differences between individuals and their impact on virus transmission.
K number

To compensate for this, epidemiologists use an additional metric referred to as K, which describes the pattern of CoVID-19 transmission. K is the statistical value, which indicates  the variability in the number of new coronavirus cases that each person has infected. A high K value (>5), tells us that most people are generating similar numbers of secondary cases. A low value for K (>1)  tells us that a small number of infected people can trigger significant numbers of new cases relatively quickly.
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Key to controlling CoVID-19

Epidemiologists believe the K number, or the role played by variable transmission of the coronavirus, is critical to controlling its spread. Notwithstanding, what makes controlling the transmission of the coronavirus more challenging is the fact that many highly infectious people are asymptomatic. According to research findings of a paper published in the June 2020 edition of The Annals of Internal Medicine, 40% to 45% of those infected by CoVID-19 display no signs or symptoms of the disease at all, which suggests that, “the virus might have a greater potential than previously estimated to spread silently and deeply through human populations”. Thus, understanding why and how the virus is transmitted is key to gaining control of the CoVID-19 pandemic and stopping a second wave of cases.
 
Super-spreaders

As we have suggested, there is wide variability in the behaviours of infected individuals and their subsequent roles in spreading the coronavirus. A paper published in the June 2020 edition of Wellcome Open Research analysed the spread of CoVID-19 from China and estimated the K value to be as low as 0.1.  This suggested that 80% of new coronavirus cases were caused by only about 10% of infected individuals. An infected individual who breaks the rules is likely to generate significantly more secondary cases that an infected person who does not broach public health protocols. The Wellcome paper demonstrates how a relatively small number of infected people who flout government guidelines could become ‘super-spreaders’ and cause CoVID-19 to quickly rebound, even if locally eradicated. Thus, identifying and tracking super-spreaders, is fundamental to preventing future outbreaks.
 
Super spreading events

Super spreaders are responsible for super spreading events, which are not well understood and are challenging to study. Although there is no universally agreed definition of a super spreading event, it is generally assumed to be an incident in which someone passes on the virus to six or more people. Examples of super-spreading events of CoVID-19 include outbreaks in Seoul nightclubs in South Koreameat packing plants in the US and overcrowded clothes factories in the UK.
 
Three studies

We now turn to the findings of three recent research studies, which suggest that some super-spreaders of CoVID-19 might be people with specific personality traits. The first study we describe is entitled, “Adaptive and Dark Personality Traits in the Covid-19 Pandemic”. It is published in the June 2020 edition of the Journal of Social Psychological and Personality Science and was carried out by Pavel Blagov, who is the director of the Personality Laboratory at Whitman College, USA. The second and third studies are Polish and both published in the July 2020 edition of  Journal of the International Society for the Study of Individual Differences. One is entitled “Adaptive and maladaptive behavior during the COVID-19 pandemic”, and was conducted by researchers from SWPS University of Social Sciences and Humanities, Poland. The third study is entitled, “Who complies with the restrictions to reduce the spread of COVID-19?”, which was carried out by researchers from the University of Warsaw.
 
The Whitman College Study

In late March 2020, Blagov surveyed 502 American adults, to assess their personalities and gauge how compliant they were with public health protocols for reducing the impact of CoVID-19 such as; social distancing, wearing protective gear or following basic hygiene rules. While the majority of participants reported adherence to public health restrictions, some did not. The  study found that individuals with the so-called "Dark Triad" personality traits (narcissism, Machiavellianism and psychopathy) were more likely to purposely disregard protocols intended to reduce the spread of the coronavirus. The respondents who showed disinterest in the recommended health procedures scored higher on sub-traits of meanness and disinhibition. According to Blagov, it is possible that rule breakers become super-spreaders of CoVID-19 and “have a disproportionate impact on the pandemic by failing to protect themselves and others”.  

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At the height of the pandemic, narcissists and others with dark personality traits tended to act contrary to public health recommendations. They showed less inhibition to risk and disregarded other people's safety; manifestations of which included, not covering themselves when sneezing or coughing in public, touching communal facilities, not staying at home, not keeping their distance from others and not washing their hands frequently. The  study concludes that, “there may be a minority of people with particular personality styles (on the narcissism and psychopathy spectrum) that have a disproportionate impact on the pandemic by failing to protect themselves and others.”
The  SWPS Study

These findings are supported by the  SWPS study, which is based on an online survey of 755 people (332 male and 423 female) between 15th and 29th March 2020, which was during the first month of the national CoVID-19 lockdown in Poland. The cohort was middle class with ages ranging from 18 to 78, (M = 45.83, SD = 14.98). Over 40% of the participants had either a high school or a university education.  Findings suggest that people with narcissistic or psychopathic tendencies were more likely to hoard essentials during lockdown mainly because they had a heightened sense of entitlement, which manifested itself in being greedier and more competitive.

Also, researchers suggest that participants with narcissistic personalities tend to be self-centred and lack empathy, and therefore more likely to exploit other people. People with psychopathic tendencies may be more cruel, deceitful and manipulative while coming across superficially charming.  According to BartÅ‚omiej Nowak, the lead author of the study, narcissists are: (i) more impulsive, (ii) focused on self-interest, (iii) tend toward risk-taking and (iv) less likely to comply with measures to reduce the spread of the coronavirus.

 
The Warsaw Study

The Warsaw study set out to use the CoVID-19 pandemic to understand who complies with public health restrictions  to reduce the spread of the coronavirus. Researchers hypothesised that narcissistic and psychopathic personality traits of rivalry and lack of empathy may be associated with less compliance towards government imposed coronavirus restrictions. The study was based on an online survey carried out between 14th and 30th April 2020, which was at the height of the coronavirus crisis in Europe. There were 263 participants (27.8% male, 71.5% female, 0.8% “other”) aged between 18 and 80  (M = 28.96, SD = 10.64) and about half (49%) had a university education. 
 
The study’s findings support those of the previous two studies described above. Researchers found that compliance with public health guidelines to control CoVID-19 was low among participants who had narcissistic tendencies. Participants scoring low on agreeableness and high on aspects of narcissism and psychopathy were less likely to comply with public health restrictions. People with narcissistic traits had a sense of entitlement and perceived the restrictions as the Government forcing its will upon them.
 
Limitations of the studies

All three studies have limitations, which include being based upon relatively small samples. Data are cross sectional rather than time series and collected at the beginning of public health restrictions when it seems reasonable to assume that “people may be more likely to engage in prevention and adhere to restrictions”. The US and Poland are both developed economies with different cultures that might not be relevant for other regions of the world and, in the case of the two Polish studies, participants were drawn from a relatively homogeneous group.
 
Takeaways

Findings of the three studies described in this Commentary are not sufficiently robust to definitively say that people with narcissistic traits are super-spreaders of CoVID-19. Not everyone who defies coronavirus restrictions does so because of dark personality characteristics. Indeed, there are many factors at play in understanding behaviours during the coronavirus pandemic. Notwithstanding, from the evidence presented in the three papers, it seems reasonable to suggest that people with narcissistic tendencies, and who are asymptomatically infected with the coronavirus, could become super-spreaders and have a disproportionate impact on the transmission of CoVID-19.
 
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Lalor Plaza Medical Centre

Lalor Plaza Medical Centre
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