To mark Volunteers’ Week, Kirsteen Shields speaks about her work to co-ordinate volunteers to help local charity, Cyrenians.

What made me write this essay:

“For the past four years I have been writing a historical novel set in 1901 during what is known as the third plague pandemic, an outbreak of bubonic plague that killed millions of people in Asia but not very many in Europe. Over the last two months, friends and family, editors and journalists who know the subject of that novel, “Nights of Plague,” have been asking me a barrage of questions about pandemics.”

This sentence of Orhan Pamuk^[1] caught my attention to write this brief essay on the similarities between the philosophical reflections existing in the current Covid-19 and the past historical pandemics through a lens of literary studies.

Tracing the pandemics to COVID-19:

From plagues in medieval periods, Spanish Flu (1918), herpes and legionnaires’ disease (1970s), to AIDS (1980’s), Ebola (2013-2016), severe acute respiratory syndrome (SARS, 2002-2004), and now COVID-19, contagious diseases continue to threaten and damage human populations.^[2] It has become a common observation that the contagious diseases’ outbreak makes us feel like we are living within a dystopian novel. It may seem an unwelcome new territory for us, but mankind has in fact stood here before many times and written about it. According to Pamuk^[3] both fear of the germs and viruses and people’s initial responses matter. Through initial responses to the recent pandemic people became philosophical, inquisitive, and interrogatory; this can also mean “stoical” and accepting the grim situation.^[4] We wonder if philosophy can bring in clarity in this ethical and moral mess.^[5] In order to clear the confusion, scientists, literateurs, poets, chroniclers and historians are trying to address local situations and at the same time possess a “desire to identify universal truths about how societies respond to contagious disease”.^[6]

People and media have responded to epidemics by spreading rumor, false information, and portraying the disease as foreign and brought in with malicious intent. In Fyodor Dostoyevsky’s “Crime and Punishment”, the protagonist Raskolnikov “dreamed that the whole world was condemned to a terrible new strange plague that had come to Europe from the depths of Asia”.^[7] This statement can be evidenced by the dramatic aspect of epidemic response to stigmatise and allocate responsibility. From Jews in medieval Europe to meat mongers in Chinese markets, someone is always blamed. This story of blame exploits existing social divisions of religion, race, ethnicity, class, political or gender identity.^[8]

We feel very attracted towards the sense of mystery and darkness through the prediction of mortality and process of death after battling the invisible enemy.^[9] In the COVID-19 situation, authors may examine how far it, unlike the previous epidemics is evaluating situations where elderly people will die to retain the “lives, and futures, of the young?”.^[10] Poetess Pam Ayres’s latest ode to coronavirus contradicts this notion as she regains her strength  the age of 73.^[11]

Pandemics have affected social life since the establishment of civilisation. “Hippocrates recorded the first known pandemic in 412 BC, and numerous outbreaks were reported during the Middle Ages. The most notable epidemic, that of the ‘Spanish influenza’, occurred in 1918. Although more than 88 years have passed since that time, and memories of the disaster have become blurred, the sudden emergence of SARS and avian flu has reminded people of this painful past once more”.^[12] Defoe’s Chronicle^[13] shows us that behind physical and mental suffering there also lies an anger against fate, against a divine will that witnesses and perhaps even condones all this death and human suffering. In modern times we are orchestrated by our fear and the deaths. We share our anxieties and anger via different virtual network (Source: WhatsApp groups and Facebook groups, online fieldwork 2020). We wish we can build a kind of solidarity and resistance against fate and divinity.^[14]

Defoe^[15] wrote about people keeping their distance when they met each other on the streets during the plagues, but also asking each other for news and stories from their respective hometowns and neighborhoods, so that they might stitch together a broader picture of the disease. Only through that wider view could they hope to escape death and find a safe place.^[16] Likewise, in COVID-19 people created groups, blogs, and other social media platforms to exchange and record their sadness, grief, nostalgia, difficulties related to medical processes, missing attending to loved ones’ health crises including mental distraught, missing funerals, cancellation of marriages, big events, online, virtual or home-alone religious, literary and art festivals, online shopping slots, own creativities in different media (Source: WhatsApp groups and Facebook groups, Online field work 2020).

Much of the literature on plague and contagious diseases present the carelessness, incompetence, and selfishness of those in power as the sole instigator of the fury of masses^[17] can be compared with the current mismanagement of so many countries’ governments.^[18] Medieval writings, such as The Decameron by Giovanni Boccaccio (1313–1375) and The Canterbury Tales by Geoffrey Chaucer (1343–1400), emphasized human behavior: “the fear of contagion increased vices such as avarice, greed, and corruption, which paradoxically led to infection and thus to both moral and physical death”.^[19] Under current lockdown the above mentioned vices were displayed by elite and sometimes common citizens in urban settings in the hoarding of essentials from superstores and groceries.^[20] However, writers such as Defoe and Camus allowed their readers glimpses of didactic^[21] and existential^[22] philosophies respectively beneath the waves of vulnerabilities, and fears – as something innate to human nature. A Journal of the Plague Year,^[23] one of the most important works of literature ever written on contagion and human behaviour, tells us how in 1664, local authorities in some London neighborhoods tried to make the number of plague deaths appear lower than it was by registering other, invented diseases as the recorded cause of death.^[24] Many commentators claim that the current UK government has likewise undermined the real figures and have not counted death figures from care homes or other informal institutes and peoples’ residences.^[25]

To write the book The Plague,^[26] Camus immersed himself in the history of plagues. He read about Black Death in Europe in the 14^th century, the Italian plague of 1630, and the great plague of London of 1665 as well as plagues that ravaged cities on China’s eastern seaboard during the 18^th and 19^th centuries. However, Camus was not writing about one plague, as has sometimes been suggested, his was a metaphoric tale about the Nazi occupation of France.^[27] Like Camus’s Plague^[28], Blindness^[29] by Jose Saramago uses its pandemic as an allegory of society, where life is reduced to a substantial fight for survival and people succumb to a contagious form of blindness which can transform your vision into a visual milky sea.^[30]

Athanasius Kircher’s investigation can be an important early step to understanding contagion, and perhaps even the very first articulation of germ theory. Kircher was possibly the first to view infected blood through a microscope. During the summer and fall of 1656, as Kircher remembered it, the “altogether horrid and unrelenting carnage” of Naples was on everyone’s mind, and “each man, out of dread for the ever-looming image of death, was anxiously and solicitously seeking an antidote that would ensure recovery from so fierce an evil”.^[31] He predicted that the prospect of death could sometimes translate into increased inspiration, to achieve immortality. His keen observation (1658) through the Plague as reflected in Scrutinium psetis^[32], tells us “people scrubbed floors and walls with vinegar; burned rosemary, cypress, and juniper; and rubbed oils and essences on their skin. The wealthy left for the country if they could. Vagrants were sent to prison or conscripted to help the sick and scrub the streets of filth.”^[33]

Parallel to Defoe, Mary Shelley in The Last Man (1926) took her evidence from the riveting diary of plague, and created a kind of science fiction, zombie apocalypse and other apparent consequences of fate. ^[34] By identifying thus with the plague in her private journal and in The Last Man, Shelley confronted the fact that humanity is the author of its own disasters. As scientists now remind us daily, collective human behaviour will either drive up or flatten the curve of Covid-19’s rate of infection, Shelley also saw clearly that we are both the problem behind and the potential solution to such a pandemic.^[35] COVID-19 has creepily invaded the world without prior notice, leaving many, mainly the elderly and other vulnerable people isolated at home as the only means of staying healthy and virus-free. Could they remain healthy,virus-free or avoid deaths?

People discussing COVID-19 frequently cite the famous film Contagion (2011) which opens with a woman coughing. It’s not just nervous throat-clearing. The cough becomes the protagonist and blends with other characters in director Steven Soderbergh’s film, creating terror. Like under COVID-19 we find in the film the policy makers, “scientists and bureaucrats who are looking, for answers, devising containment strategies, working toward a vaccine”.^[36]

Modern British authors like Benedict, Vaughan, and Lesley are trying to create fiction under COVID-19 based on mid-life crisis, vaccines, tourists with masks in pubs, characters working in their pajamas, wildly getting on planes, journalists working from homes. They are predicting plots without excitement where characters will not interact, fight, kiss or make love, and face mental health problems. They need to explore the new norms depending on the imagination and the meaning of a multiple human calamity, across an entire overwhelmed population.^[37] COVID-19 will create a void in literary pursuits. Hence, rebuilding and resolving new kinds of literary plots and ideas shouldn’t exist in oblivion.

Conclusion:

A profound cultural and ethical aspect of all major epidemics is the loss of access to personal narratives. The collective replaces the individual as protagonist, and the health of the public takes precedence over that of the individual. “There is a paradox in the multiplication of personal catastrophe throughout a society”^[38].The accounting of the past sufferings as narrated in different literary and historical texts in this context can produce thick memory with “subjective specificity”[39].  Apocalyptic traditions of pandemics including COVID-19 are deeply rooted in religious and community narratives that are turned toward the ‘end times’.^[40]

Cynicism pervaded mankind in the past pandemics, but can we afford to be stoic under the current global crisis.  Crucial questions remain on how storytellers in the years to come will portray COVID-19. How will the authors and artists document “the surge in community spirit, the countless heroes among us?”.^[41] In summary, under COVID 19 we can expect to become more articulate in our artistic creations about our individual survival, isolation, vulnerability, uncertainty, and certainly the importance of collective introspection of inequality related to pandemic deaths^[42].

^[1] Pamuk, O. (2020), What the Great Pandemic Novels Teach Us, The New York Times, 23 April 2020 https://www.nytimes.com/2020/04/23/opinion/sunday/coronavirus-orhan-pamuk.html?fbclid=IwAR1NLcqUyD_T0Dz-hxcSQEdCimozN1aTEQteg7QDDUZ9J4fBiUMZjJowGRo

^[2] Jones, D. (2020), History in a Crisis -Lessons for Covid-19 , The New England Journal of Medicine, 12 March 2020 https://www.nejm.org/doi/full/10.1056/NEJMp2004361?fbclid=IwAR2tt8b7_JdRGrAVWOWcJdhPHPrhowTWKhTpz3rUTC6-lE0nrW3eAzxIA84#.XqrtrYkhAlo.facebook

^[3] Pamuk, O. (2020), What the Great Pandemic Novels Teach Us, The New York Times, 23 April 2020 https://www.nytimes.com/2020/04/23/opinion/sunday/coronavirus-orhan-pamuk.html?fbclid=IwAR1NLcqUyD_T0Dz-hxcSQEdCimozN1aTEQteg7QDDUZ9J4fBiUMZjJowGRo

^[4] Abell, S, (2020), A Note from the editor, Times Literary Supplement, 15 May 2020. https://www.the-tls.co.uk/articles/in-this-weeks-tls-31/

^[5] Abell, S, (2020), A Note from the editor, Times Literary Supplement, 15 May 2020. https://www.the-tls.co.uk/articles/in-this-weeks-tls-31/

^[6] Jones, D. (2020), History in a Crisis -Lessons for Covid-19 , The New England Journal of Medicine, 12 March 2020 https://www.nejm.org/doi/full/10.1056/NEJMp2004361?fbclid=IwAR2tt8b7_JdRGrAVWOWcJdhPHPrhowTWKhTpz3rUTC6-lE0nrW3eAzxIA84#.XqrtrYkhAlo.facebook

^[7] Pamuk, O. (2020), What the Great Pandemic Novels Teach Us, The New York Times, 23 April 2020 https://www.nytimes.com/2020/04/23/opinion/sunday/coronavirus-orhan-pamuk.html?fbclid=IwAR1NLcqUyD_T0Dz-hxcSQEdCimozN1aTEQteg7QDDUZ9J4fBiUMZjJowGRo

^[8] Jones, D. (2020), History in a Crisis -Lessons for Covid-19 , The New England Journal of Medicine, 12 March 2020 https://www.nejm.org/doi/full/10.1056/NEJMp2004361?fbclid=IwAR2tt8b7_JdRGrAVWOWcJdhPHPrhowTWKhTpz3rUTC6-lE0nrW3eAzxIA84#.XqrtrYkhAlo.facebook

^[9] Abell, S, (2020), A Note from the editor, Times Literary Supplement, 15 May 2020. https://www.the-tls.co.uk/articles/in-this-weeks-tls-31/

^[10] Abell, S, (2020), A Note from the editor, Times Literary Supplement, 15 May 2020. https://www.the-tls.co.uk/articles/in-this-weeks-tls-31/

^[11] http://livingelements.co.uk/a-topical-poem-by-pam-ayres-time-for-us-girls/

^[12] Cheng, J.F. and Leung, P.C., 2007, History of Infectious Diseases: What Happened in China During the 1918, International Journal of Infectious Diseases, Volume II, Issue 4, pp-360-364

^[13] Defoe, D. (1722), Journal of the Plague Year, in Jordison, S. (2020), Defoe’s Plague Year was written in 1722 but speaks clearly to our times, The Guardian, 5 May 2020. https://www.theguardian.com/books/booksblog/2020/may/05/defoe-a-journal-of-the-plague-year-1722-our-time

^[14] Pamuk, O. (2020), What the Great Pandemic Novels Teach Us, The New York Times, 23 April 2020 https://www.nytimes.com/2020/04/23/opinion/sunday/coronavirus-orhan-pamuk.html?fbclid=IwAR1NLcqUyD_T0Dz-hxcSQEdCimozN1aTEQteg7QDDUZ9J4fBiUMZjJowGRo

^[15] Defoe, D. (1722), Journal of the Plague Year, in Jordison, S. (2020), Defoe’s Plague Year was written in 1722 but speaks clearly to our times, The Guardian, 5 May 2020. https://www.theguardian.com/books/booksblog/2020/may/05/defoe-a-journal-of-the-plague-year-1722-our-time

^[16] Pamuk, O. (2020), What the Great Pandemic Novels Teach Us, The New York Times, 23 April 2020 https://www.nytimes.com/2020/04/23/opinion/sunday/coronavirus-orhan-pamuk.html?fbclid=IwAR1NLcqUyD_T0Dz-hxcSQEdCimozN1aTEQteg7QDDUZ9J4fBiUMZjJowGRo

^[17] See footnote 16.

^[18] https://www.ghe.law.ed.ac.uk/the-social-determinants-of-covid-19-and-bame-disproportionality-repost-by-nasar-meer-and-colleagues/ ; https://www.ghe.law.ed.ac.uk/the-lancet-what-does-it-mean-to-be-made-vulnerable-in-the-era-of-covid-19-by-ayesha-ahmad-et-al/; https://www.ghe.law.ed.ac.uk/blog-series-part-2-economic-impact-of-covid-19-migrant-labourers-in-india-by-nandini-sen-and-colleagues/; https://blogs.ed.ac.uk/covid19perspectives/2020/05/26/indias-informal-economy-gender-based-violence-and-mental-health-challenges-demand-crucial-inspection-write-nandini-sen-anusua-singh-roy-jayanta-bhattacharya-and-subrata-shankar-bagchi/

^[19] Riva, M. and et al, (2014), Pandemic Fear and Literature: Observations from Jack London’s The Scarlet Plague, Emerging Infectious Diseases, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193163/

^[20] https://www.ghe.law.ed.ac.uk/social-justice-and-global-ethics-are-key-to-pandemic-planning-and-response/ and on-line fieldwork via what’s app 2020

^[21] https://www.britannica.com/biography/Daniel-Defoe

^[22] Camus, A. (1947), The Plague, Penguin Books.

^[23] Defoe, D. (1722), Journal of the Plague Year, in Jordison, S. (2020), Defoe’s Plague Year was written in 1722 but speaks clearly to our times, The Guardian, 5 May 2020. https://www.theguardian.com/books/booksblog/2020/may/05/defoe-a-journal-of-the-plague-year-1722-our-time

^[24] See footnote 16.

^[25]  https://www.independent.co.uk/news/health/uk-coronavirus-deaths-latest-cases-covid-19-a9546506.html?fbclid=IwAR2WSMzIFZXCZgKhr1BGnVCC-SpDs8oG7-bSFNFm8np8F6A8cwhQiFQPrPA

^[26] See footnote 21.

^[27] Botton. A., 19 March 2020, Camus on the Coronavirus, The New York Times, https://www.nytimes.com/2020/03/19/opinion/sunday/coronavirus-camus-plague.html

^[28] See footnote 16.

^[29] Saramago, J. (1995, 2013) Blindness, Vintage.

^[30]  Penguin Features and articles 2020, Why people are turning to pandemic fiction to help process the Covid-19 crisis. https://www.penguin.co.uk/articles/2020/mar/pandemics-plagues-in-literature/?fbclid=IwAR1vkAi0ZgLif7–JdileeLeY7j14T-JdynfXVDUjZTzqCw2k2cRN-e-upw

^[31] https://publicdomainreview.org/essay/athanasius-kircher-study-of-the-plague; https://www.journals.uchicago.edu/doi/abs/10.1086/368490?journalCode=osiris

^[32] Scrutinium physico-medicum contagiosæ luis, quae pestis dicitur Athanasius Kircher1658 and Ars Magna Lucis Et Umbrae Athanasius Kircher1646

^[33] (Martha Baldwin, “Athanasius Kircher and the Magnetic Philosophy” (PhD diss., University of Chicago, 1987), 387–390 in  article of Glassie, J. 2020). (Athanasius Kircher, Scrutinium Physico-Medicum Contagiosae Luis, Quae Pestis Dicitur (Rome: Vitale Mascardi, 1658), Glassie, J. 2020). https://publicdomainreview.org/essay/athanasius-kircher-study-of-the-plague?fbclid=IwAR1We9bb_iEDPeljYqKdLYFRLJ61GPOxeCiCoPLxhl-ZRt3YoDa8nnU_a7g

^[34] See footnote 30.

^[35]    Botting, E. H. (2020), Journals of sorrow, Mary Shelley’s visions of contagion, Times Literary Supplement, 8 May 2020,   https://www.the-tls.co.uk/articles/in-this-weeks-tls-31/

^[36] Morris, W. 10 March 2020 For Me, Rewatching ‘Contagion’ Was Fun, Until It Wasn’t, The New York Times; https://www.nytimes.com/2020/03/10/movies/contagion-movie-coronavirus.html;

Bailey, J., (2020), The Ending of Steven Soderbergh’s Contagion, Revisited, Vulture, 30 January 2020.

^[37]  Flood. A, (2020), No Pubs, No Kissing, No Flying,-  How Covid-19 is Forcing Authors to Change their Novels, The Guardian, 1 June 2020; https://www.theguardian.com/books/2020/jun/01/no-pubs-no-kissing-no-flying-how-covid-19-is-forcing-authors-to-change-their-novels?fbclid=IwAR1dX8c0VKa8wTK2JGkz0wKaojmaSf4sRUkL5I8zEB4bNV9VsXx7AnEXTuM

^[38] Belling, C. (2009), Overwhelming the Medium: Fiction and Trauma of Pandemic Influenza in 1918, Literature and Medicine, Volume-28, Number-1, Johns Hopkins University Press; https://muse.jhu.edu/article/377046

[39] Belling, C. (2009), Overwhelming the Medium: Fiction and Trauma of Pandemic Influenza in 1918, Literature and Medicine, Volume-28, Number-1, Johns Hopkins University Press; https://muse.jhu.edu/article/377046

^[40] Peters. M. A., (2020), Love and social distancing in the time of Covid-19, The philosophy and literature of pandemics, Journal of Educational Philosophy and Theory, Taylor and Francis online. https://www.tandfonline.com/doi/full/10.1080/00131857.2020.1750091

^[41] Ciabattari, J. (2020), The Plague writers who predicted today, BBC Culture, 14 April 2020; https://www.bbc.com/culture/article/20200413-what-can-we-learn-from-pandemic-fiction

^[42] https://blogs.ed.ac.uk/covid19perspectives/2020/05/01/the-social-determinants-of-covid-19-and-blame-disproportionality-by-nasar-meer-kaveri-qureshi-ben-kasstan-and-sarah-hill/

Contact tracing has been remarkably successful at helping contain the COVID-19 pandemic in South Korea, Australia and Germany, as well as some smaller places. Using 21st-century systems of telecommunications and surveillance, healthcare workers in these places have led the way in identifying those who have been in contact with the infected, and then testing and isolating them.

Minus the modern technology, contact tracing goes back a long way. The American historian William Coleman’s wonderful 1987 book, Yellow Fever in the North, associates “case tracing” with the origins of epidemiology in the mid-19th century. The disease is spread via mosquitoes and not person to person, but that would only be discovered half a century later.

Read and listen more from the Recovery series here.

French physicians fighting yellow fever in the 1840s focused on finding the first case – what we would now call “patient zero”. Later in the 19th century, they began paying greater attention to connections between households, and people inside and outside of them.

The search for syphilis

The ideas behind contact tracing are much older, however. It was anticipated in the early 16th century in relation to the great pox, which would come to be known as syphilis thanks to a poem by the physician Girolamo Fracastoro from 1530. Physicians such as the celebrated anatomist Gabriele Falloppio, chair of medicine at the University of Padua, the citadel of 16th-century medical learning, sought to understand the origins of the disease using a different approach to the norm.

Instead of just relying on what the ancient and early medieval Arabic medical authorities had to say about diseases, Falloppio and other doctors sought to track the spread of this venereal disease by turning to contemporary histories, most prominently Christopher Columbus’s journals.

Through these works, they could track the progression of the disease from the Americas to hospitals in Barcelona. It then spread via soldiers recruited by King Ferdinand II of Aragon, and most significantly with the invasion of Italy and the siege of Naples in the winter of 1495 by King Charles VIII of France.

The siege and the ensuing dispersal of Charles’ mercenary soldiers to their homelands were the “superspreader events” that gave syphilis pandemic force. In the 1530s another physician, Bernardino Tomitano, also a chair of medicine at the University of Padua, followed the disease’s continued spread into eastern Europe, pinning it to Venetian commerce.

The rapid spread of syphilis broadened physicians’ notions about disease transmission and the role played by human carriers. But the earliest known example of doctors searching for specific contacts and disease networks relates not to the great pox but to a disease to which Europe had become grimly accustomed – the bubonic plague. And the physician involved is not nearly so famous as Falloppio or any chair of medicine at Padua, but a village doctor with a few publications to his name.

While treating patients on the shores of Lake Garda at Desenzano in northern Italy during the bubonic plague outbreak of 1576, Andrea Gratiolo used contact tracing in a manner we can recognise today. It was employed not to trace the spread of plague as such, but to disprove that it derived from a woman who was rumoured to have carried it to Desenzano from where she lived in Trento.

Gratiolo noted that the woman had “taken a small and tightly packed boat with 18 others … sleeping on top one another”. One woman had slept all night with her head in the accused woman’s lap. Gratiolo also investigated the household of the second woman and discovered that “she, her husband and their four small children all slept in the same bed”.

In a plague treatise published later that year, Gratiolo argued that the boat’s passengers and the entire household of the accused should have become infected, yet none had. In further evidence of contact tracing, he adds: “no other person [the accused] had associated or interacted with had caught the disease”.

Unrepentant rationalists

Gratiolo used the bulk of his treatise to blast universal theories that plague derived from certain configurations of the stars, corruption of air that was “thick, swampy, foggy and stunk”, bad food that corrupted the humours or “rumours that one individual was responsible for the transmission of plague into a large city”.

His notions didn’t spring from an ideological vacuum. During that peninsula-wide plague outbreak of 1574-78, other plague doctors were similarly going against the prevailing orthodoxies of the time.

Gratiolo even questioned the first principle of plague causation from the early Middle Ages that would to some extent endure until the 19th century – that it came from God to punish our sins. It may seem difficult to believe that at the pinnacle of the counter-Reformation, a village doctor argued that the influence of God was “irrelevant, not even a proper question for doctors to be asking”. To curb the spread of diseases, Gratiolo held that doctors should focus on natural causes and leave questions of God to the theologians.

Contact tracing was probably more widespread in 16th-century Europe than historians have been able to show, and not only in Italy. For instance, an undated hospital duty book from Nuremberg in Germany, compiled between 1500 and 1700, lists questions to be asked of every patient wishing treatment at any of the city’s facilities, regardless of the illness. These related to how, when, where and, if possible, from whom the patient had contracted it.

Both this evidence and Gratiolo’s plague investigation are good examples of how the received wisdom about origin stories can be misleading – just as today we may often assume that pandemics originate from a single “patient zero”. By 1576, our country doctor had already questioned that one, too. 

This article was originally published by The Conversation:  https://theconversation.com/contact-tracing-how-physicians-used-it-500-years-ago-to-control-the-bubonic-plague-139248

Samuel Cohn is an Honorary Fellow with  The Institute for Advanced Studies in the Humanities (IASH) at the University of Edinburgh and a Professor of Medieval History at the University of Glasgow. 

Mona O’Brien is a Graduate Teaching Assistant in History at the University of Glasgow exploreing the emotional, social and medical history of syphilis in the period c.1495-1820. 

Drivers who use ride-hailing apps like Uber are getting little help from their companies and fall through the cracks of government support.

After nine hours on the roads of Johannesburg, Dumele returns home tired and frustrated. Just two months ago, he would have ended the week with around R7,000 ($370) in his pocket from his job as an Uber driver. But since the coronavirus reached South Africa, business has ground to a halt.

From early March, his earnings halved. Since the imposition of a lockdown on 27 March, they have stopped altogether some days. “Today, I earned nothing,” he says.

Dumele is one of thousands of drivers in South Africa who rely on ride-hailing apps such as Uber, Bolt and similar domestic versions for their livelihoods. Under the country’s lockdown measures, they are still allowed to work to help transport essential workers, but only between 5-10am and 4-8pm.

Several who spoke to African Arguments said they are struggling to get any fares. Those still working can barely break even and all have had to find new ways to survive.

Dumele has sold some of his livestock for R2,400 ($125) to tide him over. His landlord, from whom he also rents his car, has also offered him support by waiving the car rental fee and giving him one meal a day.

Thepza, a driver in Cape Town, has used his savings to buy food to last until the end of April. He has also borrowed R500 ($25) but does not know what he will do when these supplies run out. He has stopped driving because he does not want to risk catching coronavirus and spreading it to his pregnant wife.

Tsietsi has also stopped working as it is not economical. He says the costs of renting a car, paying for fuel and buying airtime and data to support the ride-hailing app – which can come to around R5,000 ($260) a week – now far outweigh the potential income from fares.

Many drivers had already been straining to make ends meet before the pandemic hit. Uber has regularly reduced fares since it launched in 2013, meaning that drivers in South Africa were earning less per trip in 2020 than when they started. COVID-19 has made matters much worse.

Appealing for support

In response to coronavirus, Uber said it will offer 10 million free rides and deliveries to healthcare workers and those in need worldwide. It has done relatively little, however, to provide support to its drivers.

Many in South Africa are concerned about catching the disease through their passengers. “In the last 13 days, I found only one customer wearing a mask,” says Dumele. “What if I am infected? We are not getting any compensation for the risk we are taking.”

To address these concerns, Uber said it would send car disinfectants to drivers in areas most affected by the disease. South Africa is unlikely to be on this list. Many drivers there believe the company should either provide them with hand sanitiser and face masks or reimburse for buying these items themselves.

They also say that Uber should provide them basic financial support to survive. Some say that this would show the company cares for its drivers and repay their loyalty. “I am using the Uber app. We work for Uber. My source of income is Uber,” said one driver. Another suggestion was that the company should at least waive its 25% commission from fares in places facing lockdowns.

Uber has released a financial assistance policy to support drivers during the pandemic but with strict limitations. To be eligible, a person must have a confirmed case of COVID-19 or have been individually ordered by a doctor or public health official to self-quarantine. The thousands of drivers worldwide living under a local or national lockdown do not quality.

In the absence of support from Uber, some drivers say the government must step in. South Africa has announced various measures of social protection such as the Temporary Employee Relief Scheme (TERS), but this programme doesn’t apply to the 20% of the workforce that operates in the informal sector or to gig economy drivers who are not officially recognised as “employees”.

Others have suggested that governments could offer cash transfers to those in need, with ride-hailing companies sharing the costs of a “wage replacement” scheme. Given that many African governments are cash-strapped, such programmes might require support from multilateral organisations. Several African ministers have called on their international partners for debt relief to free up essential funds.

“Trapped”

For ride-hailing drivers in South Africa, the notion the COVID-19 pandemic does not discriminate between the rich and poor is a complete farce. They fall into a large swathe of society – alongside informal workers and many others struggling to make ends meet – for whom lockdowns are extremely hard to bear.

This group cannot work from home and cannot survive for long without a daily source of income. They tend to live in densely populated urban areas with dysfunctional public services. And as their already poorly paid jobs are not sufficiently formalised, they are not covered by social welfare protections.

The pandemic has exposed the brutal everyday reality of worker exploitation in the global gig economy. Better regulatory systems are needed to hold platform companies accountable, while governments must do more to protect vulnerable workers.

In the absence of this support, Uber drivers like Thepza are doing their best to adapt, borrowing from friends and family, appealing for support where possible and strategising on possible ways to make ends meet. But under the conditions of lockdown and feeling abandoned by their ride-hailing companies and the government, the options are scarce.

“I am trapped and it is really painful,” he says.

This article was originally published by African Arguments: https://africanarguments.org/2020/04/28/we-work-for-uber-south-africa-covid-19-gig-drivers-alone-wheel/

Dr Mohammad Amir Anwar  is a lecturer in African Studies and International Development at the University of Edinburgh and a Research Associate at the Oxford Internet Institute, University of Oxford.  He is also a Fellow of the World Economic Forum’s Global Future Council on Digital Economy and Society, and a Research Associate at the School of Tourism and Hospitality, University of Johannesburg. He holds a Ph.D in Geography from Trinity College Dublin. He has extensive experience of conducting research both in India and Africa. Follow his Twitter: @ibalilebali

In a recent briefing paper on the implications of the COVID-19 pandemic for cybercrime policing in Scotland commissioned by the Scottish Institute for Policing, we identified a range of ways in which cybercrime has been adapting in recent months. Online fraudsters are exploiting people’s fear and uncertainty during the outbreak, often simply lending a virus ‘flavour’ to their existing scams, but in some cases through novel opportunities created by lockdown and tracing. The wider challenge for police forces, including in Scotland, lies in the possibility that the pandemic leads to profound and lasting changes to people’s everyday activities. We outlined reasons why these changes could lead to an increase in cybercrime, and argued that whereas much cybercrime research has (rightly) emphasised its international or even global characteristics, certain forms of cybercrime, especially of the more rudimentary (but no less harmful) kind, often have a distinctively ‘local quality’. We concluded by arguing that this presents both a challenge and an opportunity for regional police forces such as Police Scotland: if cybercrime becomes more prevalent over the coming years police forces will need to develop further their capacity to prevent and investigate such offences; yet the local nature of such crime will mean that local forces will be very well positioned to respond. Working with, rather than on communities will be key to the effectiveness of this response.

As the news media has correctly reported, the past few months have witnessed a number of cybercrime attacks that have sought to utilise the public’s fear of the coronavirus, together with their uncertainty as to what is happening, by referring to COVID-19 in cybercrime attacks, for example in ‘phishing’ attacks that try to trick users into disclosing valuable information (such as passwords or bank account details). Moreover, there is evidence that cybercriminals have adapted the language of their attacks very rapidly in response to government initiatives. For example, the Department for Education published guidance on 19 March 2020 in relation to the provision of free school meals. Less than a week later, UK media reported instances of ‘free school meals’/COVID-19 phishing attacks. Whereas these forms of cybercrime are existing attacks dressed up in new terminology, and hence essentially ‘old wine in new bottles’, we have also witnessed somewhat more novel forms of attack, such as in spoofing ‘tracing apps’ or SMS notifications, which exploit the government’s attempts to control the spread of the virus.

Ongoing research by the researchers at the Cambridge Cybercrime Centre, utilising their collection of primary data from forums, chat channels, and marketplaces used by cybercrime communities, as well as from other sources, suggest that there has recently been an increase of activity in relation to various kinds of ‘high volume, low sophistication’ cybercrime, including phishing scams; Denial of Service attacks carried out through ‘booter’ services, which offer those with no technical skills the ability to knock others offline (often in online games) for small amounts of money; significant uplifts in some ancillary cybercrime markets, such as PayPal and Bitcoin exchanges on cybercrime forums; as well as some evidence of an increase in internet-facilitated bullying, harassment and hate crime. Although we do not yet know for sure, it appears possible that at least some of this increase is a result of many users (including adolescents and young adults) being confined to their homes during pandemic ‘lockdown’ curfews, with no school or work to occupy them for much of the day.

From the perspective of criminological theory, we might explain these processes in various ways. For example, ‘strain theory’ argues that some people will turn to crime in order to satisfy their desire for money if they lack an avenue to earn money legitimately. ‘Control theory’ posits that crime cannot occur when an individual is otherwise ‘involved’ in legitimate activities. Similarly, at the level of society as a whole, ‘routine activities theory’ contends that crime rate increases are explicable in terms of how broader societal changes may lead to changes in criminal opportunities.

As ‘lockdowns’ lift around the world (at least for now), and people gradually return to work and study, we might therefore expect the volume of cybercrime seen to increase during the pandemic now to subside.

However, our argument is that there are various reasons to suppose that the pandemic will lead to deeper social transformation and more lasting changes–which will in turn mean that criminal opportunities may remain at an increased level for some time to come. It appears increasingly likely that there will be no complete immediate end to the pandemic, that a threat will remain for some time, and that we may well experience successive waves of infection. Moreover, it would appear, for example, that the COVID-19 pandemic has both led to rapid changes in the construction of a ‘new normal’ of everyday life, and has ‘sped up’ a range of wider social and economic transformations that were previously under way, including remote working, home shopping, and use of online streaming services. At the same time, we may expect a decline in volumes of holidays taken, tourism, airline travel, restaurants, bars/pubs/clubs, attendance at sporting events, and use of public transport. Additionally, even despite the vast economic support and stimulus offered by central banks, it seems likely that the medium- to long-term effects on economic output and employment rates will be grave: to put it bluntly, many of those who are currently ‘furloughed’ may shortly find themselves unemployed as consumer spending and public finances dry up. Lastly, increased use of ‘Internet of Things’ devices such as home security webcams, or Internet-connected baby monitors may provide increased opportunities for cybercrime, especially since many such devices currently ship with poor cyber security. For all of these reasons, we suggest that the consequences of the pandemic, and particularly the ways in which it has accelerated wider social transformations already underway, will be long-lasting.

What then are the implications of this for policing? Further research is required, but initial findings would indicate that the low-sophistication yet high-volume cybercrime of the kinds we have discussed here may for various reasons often be targeted (whether wittingly or unwittingly) at victims who are geographically local to the offender. For example, in cases of cyber harassment the offender is often known to the victim; and users of ‘booters’ playing online games are often matched in servers with players from their own country (whom they then target). Given the ‘local’ dimension to these kinds of cybercrime, together with the fact that the powerful yet finite resources of law enforcement and intelligence agencies tasked with investigating serious crime are properly best used for that purpose, there would appear to be an argument for far greater involvement of local and regional police in cybercrime prevention and investigation over the coming years than there is at present. Moreover, since local policing often retains (or is in a position to develop) an emphasis on community connections, local relationships, and responsiveness to locally-defined problems, including those experienced by minority groups, we can expect such regional policing forces to be well-placed to develop further their capabilities for such a role. Lastly, as recent events have reminded us, it is vital that any expanded role for police in tackling cybercrime must be seen as just, fair and accountable if it is to remain legitimate in the eyes of the public.

Such an upskilling will not be easy, and will require a further move away from the ‘traditional’ self-understanding by the police as having a role primarily ‘on the street’, but since ultimately both cybercriminals and their victims reside in given localities (whether or not these are one and the same or are geographically remote from other another), the adaptations required of local policing may be smaller in kind than they might first appear.

This post draws from material originally contained in a Briefing Paper prepared by the authors for the Scottish Institute for Policing Research entitled, ‘The implications of the COVID-19 pandemic for cybercrime policing in Scotland: A rapid review of the evidence and future considerations’, published online in May 2020: http://www.sipr.ac.uk/assets/files/REiP%20-%20Pandemic%20Cyber%20-%20Collier_Horgan_Jones_Shepherd.pdf

Dr Ben Collier is a Postdoctoral Researcher at the Cambridge Cybercrime Centre, University of Cambridge.

Dr Shane Horgan is a Lecturer in Criminology at Edinburgh Napier University.

Dr Richard Jones is a Senior Lecturer in Criminology at the School of Law, University of Edinburgh.

Dr Lynsay Shepherd is a Lecturer in Usable Security at Abertay University.

The COVID-19 pandemic is increasing our reliance on the use of technology and digital platforms for education and research. From September, universities across Scotland will begin a phased approach to incorporate a combination of digital and in-person learning, also known as Hybrid Delivery.  To strengthen support for social science research in digital contexts, University of Edinburgh’s Centre for Data, Culture and Society  (CDCS) has launched a new research cluster focusing on Digital Social Science.

Research around the world is pivoting toward the digital in response to some of the constraints emerging from COVID-19, and the cluster’s current focus is on helping researchers navigate this change. For researchers who are unfamiliar with “digital social science” and “digital methods”, it may seem like an entirely new – and intimidating – realm. It’s true that digital environments offer novel types of data, and sometimes at quite a different scale. However, the basic tenets of sound research practices remain the same in digital spaces as they do in non-digital spaces. There is a lot of overlap between “digital” methods and more traditional methods. For example, online interviews, digital ethnographies and internet-based surveys rely on many of the same methodological practices and concepts as their analog counterparts. There are also a range of newer methods that allow for the exploration of digital formats.

The digital social science cluster examines the affordances and limitations of new digital methods, research ethics, data access issues, problems related to corporate relationships, and the design and use of new tools.  By sharing examples of projects that illustrate the uses and challenges posed by digital methods, we highlight the wide range of tools, methodologies and techniques that are used in digital social science research. The cluster also draws on experiences from previous and ongoing research projects to identify challenges and raise questions connected to different methods, whether that is community mapping, survey research, interviews, or geo-tracking. As a “methods lab” we aim to make methods, tools, datasets, and projects accessible to students and staff.

As the Cluster evolves, we plan on hosting a speaker series featuring field-leading researchers from around the world. We also hope to host digital and in-person workshops in order to provide a better understanding on everything that goes into digital social science. We will collaborate whenever possible with other CDCS clusters on these activities.

If you are interested in giving a talk or getting involved with the Digital Social Science cluster, please reach out to any of the co-directors.

Dr Karen Gregory is a senior lecturer in Sociology and the co-director of the Master of Science programme in Digital Society at the University of Edinburgh.

Dr Morgan Currie is a lecturer in Data and Society at the University of Edinburgh.

Dr Kate Miltner is a TRAIN@ED Postdoctoral Fellow at the University of Edinburgh.

Should people be forced to wear face masks in public? That’s the question facing governments as more countries unwind their lockdowns. Over 30 countries have made masks compulsory in public, including Germany, Austria and Poland. This is despite the science saying masks do little to protect wearers, and only might prevent them from infecting other people.

Nicola Sturgeon, the Scottish first minister, has nonetheless announced new guidelines advising Scots to wear masks for shopping or on public transport, while the UK government is expected to announce a new stance shortly. Meanwhile, US vice president Mike Pence has controversially refused to mask up.

This all has echoes of the great influenza pandemic, aka the Spanish flu, which killed some 50 million people in 1918-20. It’s a great case study in how people will put up with very tough restrictions, so long as they think they have merit.

The great shutdown

In the US, no disease in history led to such intrusive restrictions as the great influenza. These included closures of schools, churches, soda fountains, theatres, movie houses, department stores and barber shops, and regulations on how much space should be allocated to people in indoor public places.

There were fines against coughing, sneezing, spitting, kissing and even talking outdoors – those the Boston Globe called “big talkers”. Special influenza police were hired to round up children playing on street corners and occasionally even in their own backyards.

Restrictions were similarly tough in Canada, Australia and South Africa, though much less so in the UK and continental Europe. Where there were such restrictions, the public accepted it all with few objections. Unlike the long history of cholera, especially in Europe, or the plague in the Indian subcontinent from 1896 to around 1902, no mass violence erupted and blame was rare – even against Spaniards or minorities.

Face masks came closest to being the measure that people most objected to, even though masks were often popular at first. The Oklahoma City Times in October 1918 described an “army of young women war workers” appearing “on crowded street cars and at their desks with their faces muffled in gauze shields”. From the same month, The Ogden Standard reported that “masks are the vogue”, while the Washington Times told of how they were becoming “general” in Detroit.

Shifting science

There was scientific debate from the beginning about whether the masks were effective, but the game began to change after French bacteriologist Charles Nicolle discovered in October 1918 that the influenza was much smaller than any other known bacterium.

The news spread rapidly, even in small-town American newspapers. Cartoons were published that read, “like using barbed wire fences to shut out flies”. Yet this was just at the point that mortality rates were ramping up in the western states of the US and Canada. Despite Nicolle’s discovery, various authorities began making masks compulsory. San Francisco was the first major US city to do so in October 1918, continuing on and off over a three-month period.

Alberta in Canada did likewise, and New South Wales, Australia, followed suit when the disease arrived in January 1919 (the state basing its decision on scientific evidence older than Charles Nicolle’s findings). The only American state to make masks mandatory was (briefly) California, while on the east coast and in other countries including the UK they were merely recommended for most people.

Numerous photographs, like the one above, survive of large crowds wearing masks in the months after Nicolle’s discovery. But many had begun to distrust masks, and saw them as a violation of civil liberties. According to a November 1918 front page report from Utah’s Garland City Globe:

The average man wore the mask slung to the back of his neck until he came in sight of a policeman, and most people had holes cut into them to stick their cigars and cigarettes through.

Disobedience aplenty

San Francisco saw the creation of the anti-mask league, as well as protests and civil disobedience. People refused to wear masks in public or flaunted wearing them improperly. Some went to prison for not wearing them or refusing to pay fines.

In Tucson, Arizona, a banker insisted on going to jail instead of paying his fine for not masking up. In other western states, judges regularly refused to wear them in courtrooms. In Alberta, “scores” were fined in police courts for not wearing masks. In New South Wales, reports of violations flooded newspapers immediately after masks were made compulsory. Not even stretcher bearers carrying influenza victims followed the rules.

England was different. Masks were only advised as a precautionary measure in large cities, and then only for certain groups, such as influenza nurses in Manchester and Liverpool. Serious questions about efficacy only arose in March 1919, and only within the scientific community. Most British scientists now united against them, with the Lancet calling masks a “dubious remedy”.

These arguments were steadily being bolstered by statistics from the US. The head of California’s state board of health had presented late 1918 findings from San Francisco’s best run hospital showing that 78% of nurses became infected despite their careful wearing of masks.

Physicians and health authorities also presented statistics comparing San Francisco’s mortality rates with nearby San Mateo, Los Angeles and Chicago, none of which had made masks compulsory. Their mortality rates were either “no worse” or less. By the end of the pandemic in 1919, most scientists and health commissions had come to a consensus not unlike ours about the benefits of wearing masks.

Clearly, many of these details are relevant today. It’s telling that a frivolous requirement became such an issue while more severe rules banned things like talking on street corners, kissing your fiancé or attending religious services – even in the heart of America’s Bible belt.

Perhaps there’s something about masks and human impulses that has yet to be studied properly. If mass resistance to the mask should arise in the months to come, it will be interesting to see if new research will produce any useful findings on phobias about covering the face.

This article was originally published in The Conversation: https://theconversation.com/face-masks-what-the-spanish-flu-can-teach-us-about-making-them-compulsory-137648

Professor Samuel Cohn is an Honorary Fellow with  The Institute for Advanced Studies in the Humanities (IASH) at the University of Edinburgh and a Professor of Medieval History at the University of Glasgow. 

Children and young people with disabilities or Additional Support Needs (ASN) and their families face particular challenges as a result of school closure and other lockdown measures (1). In school, pupils with ASN benefit from teaching and support that is often simply not available at home and parents may or may not have the time or expertise to provide this level of support. We know that children and young people with additional support needs are at increased risk of social isolation, mental health and reduced attainment. 

Inclusive Digital Technology

The aspiration of Scotland’s Curriculum for Excellence is to “enable all children to develop their capacities as successful learners, confident individuals, responsible citizens and effective contributors to society”. So how can you become a successful learner if you can’t read books and learning materials? How can you develop your confidence if you depend on others to read to you or write for you? How can you exercise responsibility when you have difficulty understanding or expressing your views? How can you contribute effectively if you can’t speak, write or communicate? Here are some ways in which inclusive digital technology can provide positive answers to these questions:

• Learners with dyslexia or visual impairment who have difficulty with printed materials can access digital learning resources by altering the appearance of the text or by using computer readers. 
• Learners who have difficulty with handwriting or spelling can type or use computer dictation.
• Learners who have speech and language difficulty can use electronic aids to communicate.
• Learners who find things hard to understand can be helped by picture symbol materials.

Learning at home

My unit, CALL Scotland, is funded by Scottish Government to research, develop and support the application of digital technology for children with ASN in Scotland. One of the ways we do this is through partnerships with local authorities where we support individual learners. Yesterday I had a conversation with a parent of a learner in 4th year at a mainstream school. She has Cerebral Palsy that affects her fine motor control and she gets sore and tired when she writes or types. At school she uses an assistant to take notes in class and to scribe her work; time-limited exams and assessments are a particular challenge. At home, the assistant is not available and it’s a challenge for her parents and to find time to scribe, so we agreed that we will evaluate computer dictation as an alternative. If this works out, there are many benefits: she will have a skill that she can use at home, at school, and beyond – she hopes to go to University; she will be able to work independently without needing to rely on others; and it should make life easier for the whole family. 

Earlier this week a young man emailed to report that “I have got used to the Apple Pencil and I feel like a pro! I don’t use the extended keyboard as I use the touch screen keyboard because I find it easier. I don’t have to push a key down, I just tap it. I bet a feather could type on a touch screen. All the teachers are now using Teams or Show My Homework which is really good for me and makes the iPad incredibly useful. I am getting quicker and enjoying online learning.” At school, this learner’s physical disability meant that he too had relied on a scribe in class. Not long before school closure we loaned the technology for him to trial and it’s clear it’s helping him to develop his confidence and independence. Learning at home also suits him: he doesn’t need to leave early to wheel himself to the next class, and he can do his schoolwork when he has time and energy.

Digital Divide

However, we know that there is a digital divide (2)(3) and that the situation in other households is quite different. Even though digital technology has never been cheaper, more prevalent or more accessible (all the mainstream devices now have pretty good accessibility features), children need access to a device, they and their families need the skills to use it for learning, and teachers need to know how to create and use accessible digital learning resources. We know from calls, emails and social media that many families do not have access to the technologies or the skills to use them effectively. 

Independence

Throughout my career I have worked on technology in many different forms, from the CALL Smart Wheelchair in 1988, to SQA Digital Question Papers in 2008, but the driver has always been a desire to help people with disabilities to be successful, happy and independent. For many of us, digital technology makes life easier and more convenient (although not always, as we gaze with despair at an incomprehensible online form, or struggle in vain to find the document we thought we had saved but apparently haven’t). For some people with disabilities though, technology is absolutely vital – it is the ONLY way to read, write, communicate, research and access learning independently.    

During and after Covid-19

In Scotland we do OK with Inclusive Digital Technology. I give us 6, maybe 7 out of 10. We have Glow, free access to Microsoft and Google products, and a relatively good pupil to device ratio. Where we could do better, according to a new OECD report (4), are in the provision of adequate broadband, professional development, and digital pedagogy and expertise. With regard to assistive technology, we have a small number of specialists working in some parts of the country, and CALL provides free accessibility tools, the free Books for All online database of digital textbooks, free Scottish computer voices, free symbolised materials, and free information and advice. But assistive technology isn’t magic, it’s a specialised field, and in too many areas of Scotland learners and families do not have appropriate assistive technology or to skilled practitioners who can help. We need to, must do, and can do better, to enable learners with ASN to reach their potential.  

This article was originally published here: https://www.ed.ac.uk/covid-19-response/expert-insights/making-the-most-of-inclusive-technology-during-cov

Paul Nisbet is a Senior Research Fellow at Moray House School of Education and Sport at the University of Edinburgh, and Director of CALL Scotland, a Knowledge Exchange and Transfer Centre within Moray House. CALL (Communication, Access, Literacy and Learning) Scotland is the Scottish centre of excellence in the application of technology to support pupils with additional support needs. 

(1) Scottish Government (2020) Vulnerable children report: 15 May 2020

(2) Office for National Statistics (2019) Exploring the UK’s digital divide

(3) Scottish Government (2020) Schools to re-open in August

(4) OECD (2020) A framework to guide an education response to the COVID-19 Pandemic of 2020

Last weekend I received a letter from the Scottish Government, dated 18 May 2020, stating: “The NHS has identified you… as someone at risk of severe illness if you catch Coronovirus…. “It softens the blow by initially outlining how the government will be offering support during this period, before stating (bolded and underlined) “The safest course of action is for you to stay at home at all times and avoid face-to-face contact until at least 18 June”. This letter, to those in the highest risk group, is for our own protection and this action “will protect you from coming into contact with the virus, which could be very dangerous to you”.

In this short essay I reflect from the position of being placed by the Scottish Government in a vulnerable risk category and at risk of severe illness should I catch coronavirus. It is also informed by my background as a medical anthropologist and many years researching and writing critically on infectious diseases and their control. As a heuristic device I pose the question as to why I should adhere to the edict to stay at home as we move towards moving out of lockdown? Why should I trust the government, and the scientific advice, upon which this decision is made? In short, infectious disease outbreaks are always social and political, and their control by necessity involves sacrifices to be made in the name of the collective good. I do not dispute this. But we do need more visibly public debate into the ethics and politics of who bears the burden of the sacrifices, and one that takes to heart questions of social and economic inequalities

The letter provided a list of things to do to stay safe:

• DO STRICTLY AVOID contact with anyone who is displaying symptoms of coronavirus
• DON’T leave your home
• DON’T attend any gatherings
• DON’T go out for shopping, leisure or travel

This was followed by a list of dos – wash hands; keep in touch with medical services; and use remote technologies. The rest of my household, in addition, is affected as I should also ‘minimise the time I spend with others in shared spaces’; aim to keep two meters away from others; use separate towels, or if possible, a separate bathroom; and avoid using the kitchen when others are present; eat alone; and “if the rest of your household are able to follow this guidance to help keep you safe, there is no need for them to wear any special medical clothing or equipment”.

This is the first time I have received such a letter, and my reaction has been mixed. I have already read extensively around the rare medical condition I have – as a responsible “sanitary citizen”, that is my understandings of the body and health are inline with modern medical ideas that allow me access to the civil and social rights of citizenship – and weighed the potential risks that I may face from being infected from coronovirus. I am well aware of the potential drain to the NHS that I might become should I be ill. I am fortunate in being medically trained and as a social scientist I am able to read and interpret a wide range of scientific evidence. The condition I have is rare enough that the effects of coronavirus on those of us with it cannot be known yet with any statistical certainty, as the numbers required for the evidence is just not there. And from mid March, I have already had symptoms of coronavirus infection and was self-isolated, and quite ill for nearing a month, while fortunately avoiding hospital (I had considerable assistance over the phone from specialist NHS health professionals). I do not know for certain if I was infected because the policy at the time was to test for the presence of the virus only in those who were admitted to hospital.

Since recovering I have been exercising strict social distancing, exercising in the local park (this once daily trip out was keeping my anxiety levels at bay, and has become very important), but not entering into shops (unless absolutely necessary) or any other public space while out. I am fortunate in that I am able to work from home, have not been placed on furlough, and have a job that for the time being should be secure. Unlike so many others, my privilege means I do not have to physically put my body on the line and to place myself in potentially risky situations to maintain insecure income.

My reaction therefore is more ambiguous than thankfulness to a protecting and caring government. Why, then, should I adhere to these social segregation edicts that I have been on the receiving end of?

Firstly, the letter makes me feel as if I am personally responsible should I become infected (again?). The subtext is clear: It will be (partially, at least) my fault should I become ill. There seems no reflection on social determinants or inequalities, and all situations and contexts are placed on an equal footing. It also seems to make me responsible for the distance that others in the household should maintain from me. Living as we do in a small flat, this is physically all but impossible. How did it come to pass that the vulnerable themselves have now been made responsible for maintaining their own health in a pandemic? Just beneath the surface of this letter I can sense the lines of blame opening up; that it will be my own fault if I get ill, and perhaps further, that we will be responsible for potentially infecting others should we not obey these prolonged lockdown restrictions. But context is vital: social and financial privilege allow access to greater space within which to isolate and shield. We are not all in this together in the same way.

Why, then, have I received this letter now? One interpretation is that I have been in this vulnerable risk group for months, but that the Scottish Government is so slow and bureaucratically inept that I have only just now received it. But this is, I think, ungenerous. The second interpretation, which I am more inclined towards, is that a) the category of highest risk has expanded – perhaps as understanding of the clinical effects of coronavirus have developed, and who therefore is, or is not, at risk – and that b) receiving this letter is also part of the strategy adopted by the Scottish Government for our exit to lockdown. As we now know, Scotland’s exit strategy has diverged from that of England’s and is one that is seemingly more cautious. Fears of a “second wave” and what this will mean to both the capacity of the NHS to cope, to say nothing of the rise in deaths that may entail are central to scientific and public thinking.

Responses to the pandemic have been based on modelling exercises that are only as good as the interpretative parameters and data that is entered into them (one good thing that this pandemic has facilitated is a greater debate in the public sphere on scientific logic). We are all living through an immense social experiment based on modelling – as our civil liberties, often hard fought for over years are eroded all in the name of saving lives – and as we are subjected to a range of unprecedented social interventions by the state into the lives of us all. At the heart of the response is an immense paradox: that on the one hand the precautionary approach of science (requiring evidence before recommending something, for example around various treatments for symptoms), has been sacrificed to the one area of science for which there is little evidence, that of modelling for the future. Human sociality is not governed by the logic of mathematics. Modelling can only be really proven right in retrospect, and that I suspect only with wilful cherry picking of the post facto ‘evidence’. But again, this in itself is not enough to prevent me from not self-isolating and shielding.

It seems to me that in Scotland the government is currently implementing the recommendations of a model dubbed by the press the “Edinburgh Position”, based on an article of modelling on an idea called “segregation and shielding” or S & S.[1] [2]Basically this model looked at:

“S&S strategy using a mathematical model that segments the vulnerable population and their closest contacts, the “shielders”. We explore the effects on the epidemic curve of a gradual ramping up of protection for the vulnerable population and a gradual ramping down of restrictions on the non vulnerable population over a period of weeks after lockdown”,

to quote from the abstract. They acknowledge that the model borrows from ideas of ‘cocooning’ infants with shielded adults who have been vaccinated – an odd comparator, given there is no vaccine yet – but there is no precedent for this approach in the literature. They go on:

“We show that the range of options for relaxation in the general population can be increased by maintaining restrictions on the shielder segment and by intensive routine screening of shielders.”

In short, it looks as if those of us who are vulnerable are being asked to stay indoors with restrictions to both us, and those around us, so that the rest of you – the non-vulnerable – can get back to the semblance of a normal life. Frame it however you wish, but we – those who for a variety of reasons of health have restricted movements already – are being asked to further sacrifice our freedoms for the non-vulnerable majority. Again, I don’t necessarily have a problem in doing this, but there are some further questions that I would like to have some clarity on. Is this the only option, or a compromise because of an initial response that failed to bring community transmission down?

Scotland has its own scientific advisory group on COVID-19, to “supplement” that of the UK government. The membership of this group is known to the public and is published on the government website[3]. They have clearly learnt from the fiasco that surrounded the early UK government and SAGE – and one named advisor in Scotland has been a ferocious public critic of how the UK government has responded to the pandemic. One of the authors of the “S & S” paper is also on the advisory group. There is a welcome broader range of expertise here, but noticeably absent is humanities representation. Where are the bio-ethicists? The historians? The medical sociologists? Representation from vulnerable groups? Why, in short, is the advisory group not more diverse?

Now it may be that the current strategy – and the letter I received – is not based on this proposed model (in which case I am happy to be corrected – although the principle of the concerns will remain the same). But my question to the advisory committee is this: was this paper specifically, and the approaches it suggests, discussed? If not, what approaches to coming out of lockdown were discussed? And what were the parameters for this discussion?

There is evidence to show that there is greater buy in to restrictive public health measures with serious and sustained community involvement, as the literature around the effected communities of both HIV and Ebola show. Has this evidence from the social sciences been discussed, weighed up, and considered? Or does community involvement get jettisoned for paternalism with the need to ‘save lives’ in a crisis? Have the pitfalls historically, of segregating and shielding in all but name – both colonial and post-colonial in multiple contexts – been discussed and considered?[4] The group is well represented by public health experts, so can I assume that the broader social determinants of health, and the impact on those asked to stay in lockdown so the remainder of the healthy population can adapt to the ‘new normal’ have been considered? Has the impact of further lockdown for the vulnerable, and their mental and physical wellbeing been discussed?

It is quite possible, of course, that all this was fully thought through with the ‘deep dive’ approach on shielding that occurred at the last meeting – whatever that means (the minutes of the meetings held of the advisory group tell us next to nothing of any substance)[5].  But why not show us the evidence, please, that it has been. It may be that I (and can I project into ‘we’ here?) would buy into  segregation and shielding more if there was evidence to demonstrate that a broader range of positions has been considered. Personally, I need this, and assurance that we are not being placed at the mercy of an approach that is so blinkered to all but flattening curves and P values that there is little space for these other issues. The broader goals and principles of the Scottish Government’s framework for decision making suggest a “new normal” till a vaccine and potential treatments are available and in place[6]. This might be years away, and in the meantime, will this new normal involve myself, and others in my position in this high-risk category remaining segregated and shielded? What is the rationale for the June 18^th cut off date? What are the thresholds that are behind this date, and what plans are in place should they not be met? I would feel better placed to trust the edicts if I was reassured that a broad range of the ethical and social consequences had been fully deliberated upon.

Ian Harper is a Professor of Anthropology of Health and Development at the University of Edinburgh. He was the founding Director of  the Edinburgh Centre for Medical Anthropology and a co-founder of Anthropology Matters.

[1] https://www.wiki.ed.ac.uk/display/Epigroup/COVID-19+project?preview=/442891806/447360858/van%20Bunnik%20et%20al.%20SS%20manuscript%20050520.pdf

[2] For a fuller and critical engagement with this proposal see: Ganguli-Mitra A, Young I, Engelmann L et al. Segmenting communities as public health strategy: a view from the social sciences and humanities [version 1; peer review: awaiting peer review]. Wellcome Open Res 2020, 5:104 (https://doi.org/10.12688/wellcomeopenres.15975.1

[3] https://www.gov.scot/groups/scottish-government-covid-19-advisory-group/

[4] For more on these critical points see: Ganguli-Mitra A, Young I, Engelmann L et al. Segmenting communities as public health strategy: a view from the social sciences and humanities [version 1; peer review: awaiting peer review]. Wellcome Open Res 2020, 5:104 (https://doi.org/10.12688/wellcomeopenres.15975.1

[5] From the minutes of 14^th May 2020: “The Advisory Group held a deep dive discussion on shielding, noting that the primary aim of the policy is to save lives but that shielding is very onerous for those being asked to isolate themselves completely for an extended period of time. The group noted the importance of making use of scientific knowledge to determine which groups are truly at highest risk. The group considered different approaches being taken to shielding internationally, noting a wide variation in approach. The group discussed that age is the strongest general risk factor, but that rare conditions by their nature may be difficult to accurately determine a level of risk for as they won’t show up in statistics”.  (See: https://www.gov.scot/publications/scottish-government-covid-19-advisory-group-minutes-14-may-2020/ )

[6] “Recover to a new normal, carefully easing restrictions when safe to do so while maintaining necessary measures and ensuring that transmission remains controlled, supported by developments in medicine and technology”

“ With scientists around the world working on vaccines and treatments that are still potentially many months away, we need to find a way to live with this virus and minimise its harms. We need to ensure, that as far as we can, our children are educated, that businesses can reopen, and that society can function. But we must ensure that those things happen while we continue to suppress the spread of the virus”.

https://www.gov.scot/publications/coronavirus-covid-19-framework-decision-making/pages/2/

One of the effects of our arm’s length social life is that we interact with a limited range of interactional cues: our subconscious interpretation of body language, eye contact, tone of voice, is heavily truncated by the technology. There are many implications of that, not least for how we teach and engage students. They will have little sense of teachers and themselves as a classroom presence. It also has caused me to reflect on how we use these cues and others’ reactions for information verifiability. A part of my research is investigating how fake news and disinformation campaigns are produced and valued in the marketplace.

Disinformation operations are deliberate attempts to undermine trust in the public square and to create false narratives around public events. Rid (2020) outlines three key myths about them: 1. They take place in the shadows (in fact, disclosing that there is an active campaign can be useful to those running it) 2. They primarily use false information (in fact they often use real information but generate a fake context) 3. They are public (often they use ‘silent measures’ targeting people privately). Research indicates that how others respond to information is critical in deciding for us whether it is factual or not (Colliander, 2019). Social media platforms’ ability to counter the influence of fake news with verification tags and other methods are going to have a limited effect, other than enraging the US President.

Overall disinformation operations are about the intent, rather than the form, of the operation. For that reason tactical moves like disclosing an operation’s existence can be effective if the aim is to generate uncertainty. According to Rid (2020) what they do is attack the liberal epistemic order – the ground rock assumptions about shared knowledge that Western societies based public life on. That facts have their own life, independent of values and interests. Expertise should be independent of immediate political and strategic interest. That institutions should be built around those principles – a relatively impartial media, quiescent trade unions, autonomous universities, even churches and other private institutions, are part of the epistemic matrix undergirding liberalism.

It doesn’t take a genius to work out that this order has been eroded and hollowed out from multiple angles over the past decades by processes that have nothing to do with information operations. Established national, regional, and local newspapers have become uneconomic and replaced with a click-driven, rage fuelled, tribalist media. Increasingly the old institutions mimic the new. Some established newspapers evolved from staid, slightly dull, irritatingly unengaged publications to an outrage driven, highly partial, publication model. The independence universities and the professions once enjoyed has been similarly eroded by the imposition of market driven governance on higher education, the NHS, and other bodies. On the other hand Buzzfeed evolved in the opposite direction for a time. It also doesn’t take a genius to note that the liberal epistemic order was always less than it was cracked up to be, as noted by the Glasgow University Media Group among others.

The erosion of this may be overplayed – for example, most UK citizens still get their news from the BBC. however survey data notes that there is a definite loss of trust in national media among supporters of specific political viewpoints (Brexit and Scottish Nationalism being two). The liberal epistemic order was therefore neither as robust, nor agreed, nor as liberal as it proclaimed itself to be and may have been contingent on a specific configuration of post-WW2 Bretton Woods governance. We can see plenty of examples of where this faith in the impartiality of institutions was never the case e.g. widespread support for the Communist parties in Italy and France, which had their own media, trade unions and social life.

Building an alternative reality was a key aim of progressive movements at one time. Labour movements often had their own newspapers, building societies, welfare clubs, shops and funeral services. Shopping at ‘the coppie’ (The Co-Op) said a lot about one’s belonging, social class and politics. That alternative reality can be the basis for social solidarity. That isn’t to compare the two. Fake news is inherently damaging to any effort to build a better society or understand the one we are living in. But real life and life organised independently does provide a defence and a basis for building a resilient post-pandemic society. Part of this is resisting and questioning what underlies fake news – the continuous attack on autonomous knowledge and Enlightenment values which have eroded the resilience of democratic societies.

References:

Colliander J (2019) “This is fake news”: Investigating the role of conformity to other users’ views when commenting on and spreading disinformation in social media. Computers in Human Behavior 97: 202–215. DOI: 10.1016/j.chb.2019.03.032

Rid T (2020) Active Measures: The Secret History of Disinformation and Political Warfare. Farrar, Straus and Giroux.

Dr Angus Bancroft is a lecturer in the Department of Sociology at the University of Edinburgh.

This article was  first published in the Edinburgh Decameron: Lockdown Sociology at Work

Policy responses to the pandemic need to take account of underlying social inequities

We welcome Bryn Nelson’s analysis of the potentially positive effects of public and policy responses to COVID-19,[i] particularly in providing an opportunity to reassess priorities. Nelson highlights the unanticipated benefits of recent behaviour changes – but we suggest the real revolution is a re-discovery of the health potential of state intervention. Governments worldwide have taken unprecedented steps to suppress viral spread, strengthen health systems, and prioritise public health concerns over individual and market freedoms,[ii]^,[iii] with reductions in air pollution, road traffic accidents and sexually transmitted infections a direct (if temporary) result of the embrace of collective over individual liberty.[iv] Aside from an outbreak of alt-right protests,[v] the usual accusations of ‘nanny state’ interference[vi] have been replaced by calls for centralised governance, funding and control on a scale unseen in peacetime.[vii]

While applauding this paradigm shift, it’s important to acknowledge both its partial nature and its extremely uneven impacts – positive or otherwise.  As Nelson notes, negative impacts of the current pandemic (such as unemployment and hunger) are ‘unquestionably troubling’, and while governments proclaim that “we’re all in this together”[viii] it’s already clear the virus disproportionately affects the poor, ethnic minorities and other socially disadvantaged groups.[ix]^,[x] Even more troublingly, the very measures intended to suppress viral spread are themselves exacerbating underlying social inequities.[xi]^,[xii] While a drop in traffic is very welcome, the edict to ‘work from home’ is disastrous for casually-employed service or retail workers;[xiii] and while social distancing may have reduced viral transmission in some groups, its benefits are less evident for those who are homeless,[xiv] in overcrowded housing[xv] or refugee camps.[xvi] In maximising the potential for COVID-19 to have positive effects, we must understand and address why its negative effects are so starkly mediated by class, ethnicity and (dis)ability.

Back in 2008, the WHO Commission on the Social Determinants of Health highlighted that population health and its social distribution are driven by the conditions in which people are born, grow, live, work and age, and that social injustice is the biggest killer of all.[xvii] This insight provokes serious questions about the unequal effects of this pandemic and its associated policy responses,[xviii] both positive and negative. Like Nelson, we hope the currently crisis will produce valuable lessons – most especially in understanding the need for collective action to create a healthier and more equal society.

There are three critical issues here. First, if governments are serious about “preventing every avoidable death”, [xix] COVID response strategies need to take account of their unequal impacts. While many states have acted swiftly to support businesses and wage-earners,⁴ these interventions are largely blind to class, gender and race. Unemployment and food insecurity have already increased[xx] with disproportionate effects on women and low-income workers,¹³ and growing income inequalities are predicted.[xxi] Charities report dramatic increases in domestic violence[xxii] with an estimated doubling in domestic abuse killings since the start of the lockdown.[xxiii] While COVID-19 is already more fatal in Black and minority ethnic groups,[xxiv] we have yet to see the extent to which the response will exacerbate existing racial inequities in employment, income and housing.[xxv] Governments must recognise – and ameliorate – inequalities in the negative effects of COVID-19.

Second, when developing strategies for transitioning out of lockdown, governments need to take account of the unequal impacts of any changes. The Scottish Government has signalled its intention to ease restrictions in ways that “promote solidarity… promote equality… [and] align with our legal duties to protect human rights”.²³ Other governments should also consider how plans for lifting the lockdown can be tailored to minimize harm to already disadvantaged groups, and to ensure equal enjoyment of the associated benefits.

Finally, COVID-19 will produce a truly positive effect if the scale of the mobilisation to counter the pandemic can be matched by a sustained commitment to reducing social, economic and environmental inequalities in the longer term. Without such a commitment, we are perpetuating a situation in which many people live in a state of chronic vulnerability. This is bad for society, not only because it undermines social cohesion and trust,[xxvi] but because it places us all at increased risk.[xxvii] COVID-19 unmasks the illusion that health risk can be localised to the level of the individual, community, or even nation state.[xxviii]

If we’re serious about using this crisis to reassess our priorities, , we need to recognise the urgent need for change beyond individual ‘risky behaviour’. To paraphrase Rudolf Virchow, the promotion of health is a social science, and large-scale benefits come from political – not individual – change.[xxix] The genuinely positive effects of COVID-19 will come when we acknowledge the centrality of wealth redistribution, public provision and social protection to a resilient, healthy and fair society.^12,[xxx] Only then can governments begin to claim that we’re “all in it together”.

Dr Sarah Hill is a Senior Lecturer in Global Health Policy Unit, School of Social & Political Science, University of Edinburgh and of SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), UK

Professor Sharon Friel is the Director of SPECTRUM Consortium, UK and the Menzies Centre for Health Governance, School of Regulation and Global Governance (RegNet), Australian National University.

Professor Jeff Collin is a Professor of Global Health Policy in the School of Social & Political Science, University of Edinburgh and SPECTRUM Consortium.

A verion of this post originally appeared as a rapid response on the BMJ website in response to a feature article by Bryn Nelson entitled ‘The positive effects of covid-19’.

[i] Nelson B. The positive effects of covid-19. BMJ 2020;369;m1785 doi: 10.1136/bmj.m1785

[ii] Oxford COVID-19 Government Response Tracker. Oxford: Oxford University, Blavatnik School of Government. https://www.bsg.ox.ac.uk/research/research-projects/oxford-covid-19-government-response-tracker (accessed 25 March 2020)

[iii] Kickbush I, Leung GM, Bhutta ZA et al. Covid-19: how a virus is turning the world upside down [editorial]. BMJ 2020; 369:m1336 doi:10.1136/bmj.m1336

[iv] Gostin LO, Gostin KG. A broader liberty: JS Mill, paternalism, and the public’s health. Public Health 2009; 123(3): 214-221

[v] BBC News. Coronavirus lockdown protests: What’s behind the US demonstrations? BBC [online], 21 April 2020. URL https://www.bbc.co.uk/news/world-us-canada-52359100

[vi] Calman K. Beyond the ‘nanny state’: Stewardship and public health. Public Health 2009; 123(S): e6-10

[vii] Economist. Building up the pillars of state [briefing]. The Economist, March 28th 2020.

[viii] Bell T. Sunak’s plan is economically and morally the right thing to do [opinion]. Financial Times, March 21 2020. URL https://www.ft.com/content/70d45e68-6ab6-11ea-a6ac-9122541af204

[ix] Office of National Statistics. Deaths involving COVID-19 by local area and socioeconomic deprivation: deaths occurring between 1 March and 17 April 2020. Statistical bulletin. London: Office of National Statistics.

[x] Van Dorn A, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet 2020 395(10232): 1243-4

[xi] Friel S, Demio S. COVID-19: can we stop it being this generation’s Great Depression? 14 April 2020. Insightplus, Medical Journal of Australia. URL https://insightplus.mja.com.au/2020/14/covid-19-can-we-stop-it-being-this-generations-great-depression/

[xii] Banks J, Karjalainen H, Propper C, Stoye G, Zaranko B (2020). Recessions and health: The long-term health consequences of responses to coronavirus. IFS Briefing Note BN281. London: Institute for Fiscal Studies. https://www.ifs.org.uk/publications/14799

[xiii] Sainato M. Lack of paid leave will leave millions of US workers vulnerable to coronavirus. Guardian [online], 9 March 2020. URL https://www.theguardian.com/world/2020/mar/09/lack-paid-sick-leave-will-leave-millions-us-workers-vulnerable-coronavirus

[xiv] Eley A. Coronavirus: The rough sleepers who can’t self-isolate. BBC [online], 22 March 2020. London: British Broadcasting Corporation. URL https://www.bbc.co.uk/news/uk-51950920

[xv] Lancet. Redefining vulnerability in the era of COVID-19. Lancet 2020 395(10230): 1089. https://doi.org/10.1016/S0140-6736(20)30757-1

[xvi] Hargreaves S, Kumar BN, McKee M, Jones L, Veizis A. Europe’s migrant containment policies threaten the response to covid-19 [editorial]. BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1213

[xvii] WHO Commission on the Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organization.

[xviii] Joyce R, Xu X (2020). Sector shutdowns during the coronavirus crisis: which workers are most exposed? IFS Briefing Note BN278. London: Institute for Fiscal Studies. https://www.ifs.org.uk/publications/14791

[xix] Scottish Government. COVID-19 – A Framework for Decision Making. April 2020 Edinburgh: Scottish Government, 2020. URL https://www.gov.scot/publications/coronavirus-covid-19-framework-decision-making/

[xx] The Poverty Alliance. National organisations & the impact of Covid-19: Poverty Alliance briefing, 22nd April 2020. Edinburgh: The Poverty Alliance. URL https://www.povertyalliance.org/wp-content/uploads/2020/04/Covid-19-and-national-organisations-PA-briefing-22-April.pdf

[xxi] Crawford R, Davenport A, Joyce R, Levell P (2020). Household spending and coronavirus. IFS Briefing Note BN279. London: Institute for Fiscal Studies. https://www.ifs.org.uk/publications/14795

[xxii] Townsend M. Revealed: surge in domestic violence during Covid-19 crisis. The Guardian [online], 12 April 2020. URL https://www.theguardian.com/society/2020/apr/12/domestic-violence-surges-seven-hundred-per-cent-uk-coronavirus

[xxiii] Grierson J. Domestic abuse killings ‘more than double’ amid Covid-19 lockdown. Guardian [online], 15 April 2020. URL https://www.theguardian.com/society/2020/apr/15/domestic-abuse-killings-more-than-double-amid-covid-19-lockdown

[xxiv] Barr C, Kommenda N, McIntyre N, Voce Antonio. Ethnic minorities dying of Covid-19 at higher rate, analysis shows. Guardian [online], 22 April 2020. URL https://www.theguardian.com/world/2020/apr/22/racial-inequality-in-britain-found-a-risk-factor-for-covid-19

[xxv] Haque Z. Coronavirus will increase race inequalities [blog]. 26 March 2020. London: Runnymede Trust. URL https://www.runnymedetrust.org/blog/coronavirus-will-increase-race-inequalities

[xxvi] Wilkinson R, Pickett K. The Spirit Level. Why Equality is Better for Everyone. London: Penguin Books, 2010

[xxvii] Woodward A, Kawachi I. Why reduce health inequalities? Journal of Epidemiology & Community Health. 2000; 54(12):923-929.

[xxviii] Collin J, Lee K (2003). Globalisation and transborder health risk in the UK. London: The Nuffield Trust. https://www.nuffieldtrust.org.uk/research/globalisation-and-transborder-health-risk-in-the-uk-case-studies-in-tobacco-control-and-population-mobility

[xxix] Mackenbach J. Politics is nothing but medicine at a larger scale: reflections on public health’s biggest idea. J Epidemiol Community Health 2009; 63(3): 181-4 doi: 10.1136/jech.2008.077032

[xxx] Graham H. Unequal Lives. Health and Socioeconomic Inequalities. Maidenhead: Open University Press/McGraw Hill, 2007.

Economies based on high levels of leverage are inherently fragile and with no inbuilt resilience to withstand even mild shocks (let alone the ripple effects that the pandemic has caused. Even before the outbreak of COVID-19, the forecasts about global economic growth and the stability of financial markets were gradually getting darker. Both the International Monetary Fund (IMF) and the World Bank had warned that systemic risk — the risk of serious disturbance to the financial system — might be about to make a potent comeback due to trade wars and the very high levels of private sector debt. 

Financial instability has the potential to cause serious economic and social harm as it did in all earlier episodes of serious disturbance to the financial system like the 2008 banking crisis and the 2010-2015 sovereign debt crisis.1 Moreover, this century’s earlier episodes of serious disturbance to the financial system and the ensuing austerity policies sparked social discontent — which morphed into today’s populist movements and trade wars. 

Since 2008 a host of new financial regulations have tried to augment the resilience of the financial systems of G20 countries and prevent a new systemic episode of existential proportions. These regulations have mostly focused on banks which were at the heart of the previous two crises making them both more resilient and more risk averse. But the biggest source of worry these days, in spite of the severity of the GDP falls across the western economies, is not the regulated sector or the threat of an imminent sovereign collapse. It is rather the build-up of hidden levels of private indebtedness in the system of parallel lending we call shadow banking which proved troublesome in 2008 as well. Specifically, fears concentrate on a new segment of shadow banking markets, what I call the shadows of the shadow credit system, namely, short-term corporate-to-corporate lending. This relatively new development has all the ingredients to turn into a mighty catastrophe when combined with a major macroeconomic event such as the loss of economic activity due COVID-19 and a deep global recession. 

In the short-term an avalanche of central bank liquidity will make sure that we will not see a string of corporate bankruptcies as short-term debts will be rolled over. But should economic operators and markets always operate on the knife-edge? Is it too audacious to explain the current economic collapse as not being just the result of the pause of economic activity during the lockdowns but also due to a combination of debt accumulation and overreliance on the gig economy during the past decade? Was that a combination that could create a viable framework for resilient economic growth when so much relied on share buybacks, interest rate arbitrage, and short-term and insecure employment adding scores of new working poor?

There is of course much to lament about the current lack of coordination among G20 countries in tackling the consequences of Covid-19. Still, it may not be impossible, however, for the IMF and the Financial Stability Board (IMF and the FSB), to ask them to act in a coordinated way to make sure that their economies become less short-termist and leveraged. To begin with widespread accumulation of bad debts (so-called debt overhang) would mean a slower rate of economic recovery when the worst phase of the pandemic is over. 

There are two steps that the IMF and the FSB could recommend to G20 governments: 

(a) extend the regulatory net to all forms of credit intermediation and maturity transformation, obliging such entities to some form of licensing and a duty to act prudently when facilitating new lending; and

(b) use macroprudential powers beyond the regulated sector to avoid the emergence of a new generation of too-big-to-fail entities.

In addition, unregulated big corporations (over a certain turnover threshold) engaging in short-term lending to recycle their cash surpluses in global markets should be required by G20 regulators to observe large exposure restrictions in their short-term borrowing and lending outside the banking sector. They could also be made subject to a minimum of liquidity reserves to meet a portion of their short-term liabilities over a month. Given the lack of transparency in this sort of activity and the promise of yields in an environment of very low interest rates it may be absurd for authorities to merely rely on market discipline to restrain it.

Measures to restrict corporate short-term lending in shadow banking markets will prevent free-riding on the public safety net. They would also make the present economic crisis less devastating for individuals and households whose livelihoods depend on the solvency of these corporates. In the longer term, such restrictions would make corporate boards more determined to focus on productivity gains and innovation, moving away from the toxic mix of short-termism and debt-based capitalism of the last decade.

An earlier version of this opinion piece  was published by the Centre for International Governance Innovation (CIGI): https://www.cigionline.org/articles/covid-19-lays-bare-limits-debt-capitalism

Emilios Avgouleas holds the chair of banking law and finance at the University of Edinburgh and he is a visiting professor in the LUISS school of European political economy. 

(1) The authors of a recent collection published by CIGI: Arner, Avgouleas and Schwarcz (eds), Systemic Risk in the Financial Sector: 10 Years After the Crash (2019), offer a thorough exposition of the different facets of systemic risk and of ways to counter it. 

Blog series Part 1: Covid 19 – A Crucial Inspection by Nandini Sen and colleagues

The effects of Covid-19 have been considerable and far-reaching. In this four-part blog series, Nandini Sen, Anusua Singh Roy, Jayanta Bhattacharya, and Subrata Shankar Bagchi explore the impacts of Covid-19 within an Indian context. The first piece outlines the methodology of their research, the second focuses on Covid-19’s impact on India’s informal economy, the third examines the relationship between the pandemic and gender-based violence, and the final piece takes a closer look at the mental health challenges postgraduate students face in this current climate.

During 1867-69, quarantine in the Suez Canal was quite stringent. For its obvious trade and economic interests, England maneuvered quarantine laws for cholera – a pandemic of the period. More than hundred years back, in the years of 1918-1919, colonialised India was shaken by a similar complex pandemic called the Spanish Flu. Upon witnessing so many deaths, Gandhi said at the time that he had lost his desire to live [1]. Currently the mystery virus comes in 2020.

Coronavirus outbreaks surge worldwide; research teams are racing to understand a crucial epidemiological puzzle — what proportion of infected people have mild or no symptoms and might be passing the virus on to others. Some of the first detailed estimates of these covert cases suggest that they could represent some 60% of all infections [2].

In the following series of blogs, we will contribute toward three relevant and related topics, including economic impact, gender-based violence (GBV), and the sociocultural including mental health impact on a community of postgraduate students due to this pandemic, focusing on evidences from India. In this section we discuss the methodology adopted in our analysis.

We have conducted a comprehensive desk review using grey (such as reports and documents from humanitarian agencies and news media) and academic sources. The process includes an extensive search of information including literature on economic impact, gender-based violence and socio-cultural including mental health related to the lockdown under pandemic circumstances. The search strategy uses broad search terms to include any relevant sources with reference to the contextual economic factors, GBV and socio-cultural including mental health conditions.

Secondary research that involves a narrative review [3] informs the statistical content of this study. The flexibility and exhaustive nature of narrative reviews [4] allows for exploratory analysis of the aforementioned metrics, in the absence of complete data. Literature search focusing on quantitative studies and reports has been conducted in order to collate statistics relating to the economic situation, gender-based violence, and socio-cultural and mental health outcomes as consequences of the Covid-19. This is supplemented by illustrative summaries and interpretations, elucidating known information, and underlining potential gaps for further work.

References

[1] J. Bhattacharya, ‘Coronavirus: An Episode of a Different life?’, (2020) Guruchandali (Bengali e social journal), Kolkata, India.

[2] J. Qui, ‘Covert coronavirus infections could be seeding new outbreaks‘, (Nature, 20 March 2020).

[3] R. Ferrari, ‘Writing narrative style literature reviews’, (2015) Medical Writing, 24(4), 230-235.

[4] A. Y. Gasparyan and colleagues, ‘Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors,’ (2011) Rheumatology International, 31(11), 1409.

Blog Series part 2: Economic Impact of Covid 19: Migrant Labourers in India

In the context of the global pandemic of coronavirus, India’s migrant workers are facing the crisis of joblessness and homelessness within a dynamic influenced by population density, ‘policy-blindness’, ‘social nausea’,[1] and economic issues. This piece addresses the economic impact on migrant workers from the unorganised sectors in India after the Prime Minister giving only four hours’ notice in the first instance, imposed two phases of lockdowns in March 2020 and again in April 2020. The number of India’s internal migrants were estimated at a staggering 453.6 million [2] [3] as per the last census. This includes those who are employed in the informal sector, which constitute at least 80% of India’s workforce,[4] and those working as casual and cross-border labourers, accounting for one-third of all workers at the national level.[5] Such individuals represent a considerable volume of the workforce and it is imperative for the Government to ensure their safety and wellbeing.

The lockdown prompted a wave of mass migration across India, unlike anything seen since the Partition in 1947, as people began walking for hundreds of miles.[6] It resulted in people fearing the hunger more than the disease itself. The New York Times [7] reports the story of Pappu (32), who sees himself as doubly misfortunate, being vulnerable both to the disease and to acute hunger. Most migrants, having limited access to money or assets, little awareness of health and welfare services, or a solid understanding of their rights, face a sharp loss of equilibrium in their lives.[8] This is further reflected in the data on Covid-19 deaths that are not directly associated with the virus infection, but with the draconian actions of the lockdown – such as ‘suicide, due to lockdown, lathicharge, hunger, during migration etc.’.[9] A plot of non-virus deaths vs Covid-19 deaths [10] based on data collected from reliable news sources reveals a bleak testimony of the aftermath of the lockdown on vulnerable migrant workers. It shows a sharp rise in non-virus-related cumulative deaths from 27 March, with cumulative deaths not due to the virus remaining higher than that due to the virus for a span of about 2 weeks.

Uncertainty in the lives of workers, entrenched by hunger, and poverty set the scene for a rapid unfolding of the biggest migration ‘in India’s modern history’.[11] A stark illustration of how such workers are marginalised by government policy is provided. Although a financial aid package worth $22 billion was announced by the Government, it represents only 1% of India’s GDP,[12] far less than European countries whose economic responses to alleviate the Covid-19 crisis amount to more than 20% of their GDP.[13] In the country’s capital, New Delhi, the state government declared food relief measures for those who were ‘registered as beneficiaries under the food security law’, covering around 7.2 million (40%) of its population, and resulting in the potential exclusion of ‘millions of vulnerable families who are not on the Public Distribution System’ including a ‘large number of urban poor and migrants’.[14]

Leading economists Jean Dreze [15]and Jayati Ghosh [16] describe the lockdown as a disaster, and argue that the Government must take better care of its people. Ghosh further says, ‘We have never had a situation where the government has simultaneously shut down both supply and demand, with no planning, no safety net and not even allowing the people to prepare’. Massive logistical and imminent starvation challenges have been created for thousands of migrant workers in India whose lives were torn apart in response to the threat of the coronavirus pandemic UN report, 2 and 15 April 2020.[17] ‘With the money we have with us we cannot sustain ourselves more than two days and there is no sign of relief from government’, says Ram Singh, a ragpicker. Singh, along with others walking long distances testify they have lost their dignity in this crisis.[18]

The question remains, will food, wages, shelter, safety, medical empathy of migrant workers remain in limbo? Trade unions and social networks may need to collaborate in solidarity with migrant workers.

References

[1] A. Kumar, ‘Reading Ambedkar in the Time of Covid-19’, (2020) Economic and Political Weekly, 55(1), p. 34.

[2] A. Kundu and P. C. Mohanan, ‘Internal migration in India: a very moving story‘, (The Economic Times, 11 April 2017).

[3] S. Bansal, ‘45.36 crore Indians are internal migrants‘, The Hindu (2 December 2016)

[4] ‘Informal economy in South Asia‘, (International Labour Organization)

[5] Ministry of Labour & Employment, ‘Report on Fifth Annual Employment – Unemployment Survey (2015-16). Volume 1‘, (2016) Government of India. 

[6] ‘Coronavirus: India defiant as millions struggle under lockdown‘, (BBC News, 28 March 2020)

‘Coronavirus lockdown sparks mass migration in India‘, (BBC News, 30 March 2020)

H. Ellis-Petersen, ‘India racked by greatest exodus since partition due to coronavirus‘, The Guardian, 30 March 2020.

[7] M. Ali-Habib and S. Yasir, ‘India’s Coronavirus Lockdown Leaves Vast Numbers Stranded and Hungry‘, The New York Times, 29 March 2020.

[8] K. Wickramage and others, ‘Missing: Where Are the Migrants in Pandemic Influenza Preparedness Plans?’, (2018) Health and Human Rights Journal, 20(1), 251-258.

[9] ‘Media Reports based on Non Virus Deaths‘, (DataMeet)

[10] ‘Non Virus Deaths‘, (Thejesh GN)

[11] M. Ali-Habib and S. Yasir, ‘India’s Coronavirus Lockdown Leaves Vast Numbers Stranded and Hungry‘, The New York Times, 29 March 2020.

[12] ‘India coronavirus: $22bn bailout announced for the poor‘, (BBC News, 27 March 2020)

[13] S. Amaro, ‘Germany is vastly outspending other countries with its coronavirus stimulus‘, (CNBC, 20 April 2020)

[14] A. Yadav, ‘India: Hunger and uncertainty under Delhi’s coronavirus lockdown‘, (Al Jazeera, 19 April 2020)

[15] J. Dreze, ‘Migrant workers treated badly, more needs to be done to help them now‘, (India Today, 14 April 2020)

[16] K. Thapar, ‘Coronavirus Lockdown has Already Done More Damage to Economy than Demonetisation‘, (The Wire, 24 March 2020)

[17] S. Datta, ‘India: Migrant workers’ plight prompts UN call for ‘domestic solidarity’ in coronavirus battle‘, (UN News, 2 April 2020)

[18] H. Ellis-Peterson,’”I just want to go home”: the desperate millions hit by Modi’s brutal lockdown‘, The Guardian, 4 April 2020.

Blog Series Part 3: Covid-19 and Gender-based Violence in India

Indian policy-makers appear to be more concerned by the lockdown’s impact on finances and the economy than on social effects such as gender-based violence against women.[1] At a time when women are already shouldering a higher proportion of the domestic burden during the lockdown, escalating tensions related to the crisis in resource and space are further aggravating gender-based violence behind closed doors. Denied access to traditional forms of support of family, friends, and doctors, the hanging threat of gender-based violence for these women remain inside their own homes. The National Commission for Women (NCW) have reported various offences against women, recording 587 complaints of domestic violence in the period 23 March -16 April – an almost 50% increase from the 396 complaints registered before the lockdown within the period 27 February-22 March.[2]

According to the National Family Health Survey (NFHS) carried out in 2015-2016, 33% of women admitted to having experienced domestic violence, but less than 1% sought police assistance,² which suggests that even in ordinary times women are much less inclined to seek help from the authorities. These are far from ordinary times and it is not unlikely that women are in an even worse position to knock on doors for help against their abusers. Women’s organisations and activists reflect that had these abused women ‘known (about the lockdown) they would have tried to get out earlier and be at safer places’.[3]

The current crisis requires a gender lens, if we are to address the needs of those who are most affected by it. Across India, women are also shouldering the enormous burden of household chores.[4] The Organisation of Economic Cooperation and Development (OECD) reports that an average Indian woman spends almost 6 hours in unpaid chores per day, as opposed to their male counterparts who devote a meagre 51.8 minutes.[5]

Additionally, according to the WHO, ‘depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men’.[6] Research needs to be carried out on the short and long-term mental health repercussions, and more specifically, on the intensified impact of high-population density, poor water, sanitation, hygiene provision, and the inability to self-isolate on vulnerable working class women in the context of social and physical distancing. In India, vulnerable working-class women must fill in water at the crowded common tap, use public latrines, or sell vegetables in marketplaces making them more vulnerable to the disease. Frontline staff involved in India’s battle against the coronavirus comprise an astounding number of female community health workers – roughly 900,000. With a remuneration of only ₹30 (less than $1) per day however, ‘they are poorly paid, ill-prepared and vulnerable to attacks and social stigma’.[7]

Loss of wages, jobs, boredom and withdrawal from alcohol and drugs, lead men to direct their rage on women in the household.⁴ Worse still, women are now bound within the four walls of their homes with their abusers. In response to the alarming incidence of gender-based violence during the pandemic, the UN chief has requested governments of different countries including India to treat legal and medical affairs related to gender-based violence as emergency services.[8]

Gender-based violence related to lockdown is entirely dependent on access to social, economic, and political power.[9] In this regard, the situation is particularly severe for women in India. 81% are employed in the informal sector[10] which ‘is the worst hit by the coronavirus imposed economic slowdown’,[11] while only 29% of those with internet access are females[12], which acts as a deterrent against mental support and financial aid in these tough times.

Studies of past pandemics and current violence on women under lockdown should inform policy makers of different humanitarian bodies to develop mitigation measures (e.g. health, education, child-protection, security and justice, job creation, and humanitarian responses) to efficiently respond to violence against women and girls.[13]

References

[1] N. Lal, ‘India’s “Shadow Pandemic”, Domestic violence in India surges during the COVID-19 crisis‘, (The Diplomat, 17 April 2020).

[2] S. Rukmini, ‘Lockdown with Abusers: India Sees Surge in Domestic Violence‘, (Al Jazeera, 18 April 2020).

[3] ‘Domestic abuse cases rise as COVID-19 lockdown turns into captivity for many women‘, (Deccan Herald, 31 March 2020).

[4] M. Gupte and S. Dalvie, ‘The gendered impact of COVID-19 in India‘, (The Week, 9 April 2020).

[5] A. Khullar, ‘Gender analysis missing from India’s coronavirus strategy‘, (Deccan Herald, 9 April 2020).

[6] ‘Gender and women’s mental health‘, (World Health Organization).

[7] ‘India coronavirus: The underpaid and unprotected women leading the Covid-19 war‘, (BBC News, 17 April 2020).

[8] L. Deb Roy, ‘Domestic violence cases across India swell since coronavirus lockdown‘, (Outlook, 7 April 2020).

[9] A. Castro and P. Farmer, ‘Understanding and Addressing AIDS-Related Stigma: From Anthropological Theory to Clinical Practice in Haiti’, (2005) American Journal of Public Health, 95(1), 53-59.

[10] International Labour Organization, ‘Women and Men in the Informal Economy: A Statistical Picture (3^rd ed.)‘, (International Labour Organization, 2018).

[11] B. Kamdar, ‘India’s COVID–19 Gender Blind Spot. The Diplomat‘, (The Diplomat, 27 April 2020).

[12] United Nations Children’s Fund, ‘Children in a digital world‘, (UNICEF, 2017).

[13] ‘Why we need to talk more about the potential for COVID -19 to increase the risk of violence against women and girls‘, (Social Development Direct, 18 March 2020).

Blog Series Part 4: A Tale of Students in Higher Education in India and Abroad

The outbreak of COVID-19 has brought India to the brink of a catastrophic disaster which has far-reaching consequences on the Indian economy, well-being, and education. Students in higher education (HE) are shrouded within the cloud of uncertainty, frustration, dejection, and discouragement related to mental health conditions and a fear of financial bankruptcy after leaving their parental care. Higher education is not a priority of the Indian government, as is evident from the 2020-21 budget allotment towards it, a meagre 1.3% of the total expenditure.[1] Therefore, the apprehension of further neglect of students in HE is gaining more ground during this period of resource scarcity. The plot thickens as we see that in this pandemic the Reserve Bank of India has injected huge funds to revive the sick economy by giving incentives to the financial sector, industries, and businesses,[2] however simply forgetting to respond to the crisis of the students in HE.

Following guidelines laid out by the University Grants Commission and other apex education bodies, Covid-19 has led to the temporary closure of approximately 1000 universities and 40,000 colleges, impacting 37.5 million enrolled candidates and 1.4 million employed faculty.[3] Classroom teaching, which is the backbone of teaching within Indian universities, is withheld indefinitely. Online teaching efforts initiated by a few teachers are creating a digital divide among students as high-speed internet connection may be a dream for several students in higher education. The sudden closure of colleges and universities has caused the academic calendar to become completely chaotic, resulting in cancellation of examinations and students’ progress. The Central government has stopped research funds for basic research, a situation that is likely to be exacerbated in the aftermath of the pandemic. For instance, IIT Delhi is the first HE institute in India to obtain a mandate from the Indian Council for Medical Research for conducting polymerase chain reaction tests for Covid-19.[4]

The plight of female students is particularly severe in the current situation. This lockdown has resulted in cascading effects in the households of these students. Many are contemplating early exit from higher education in order to support their families. Female students are facing pressures to get married as soon as possible since their parents are no longer prepared to wait ‘indefinitely’. Gender-based inequalities are further compounded by an increased pressure on female students to perform household chores and their increased vulnerability to domestic abuse.

Lack of clarity around future employment and the climate of uncertainty have aggravated mental health issues. If the Government ignores the well-being of HE students and fails to provide mitigating measures, the Indian social fabric, economic development, research-based knowledge expansion, and gender-equality will be destroyed. It is unlikely that these students will be in a position to question state authority, let alone ask for what they might be entitled to. They face a lonely journey with little financial support, whereas their counterparts in Western countries such as the UK and Germany might receive financial and emotional support from their Universities or Governments.[5]

Equally worryingly, thousands of international Indian HE students, for example in the UK, are also facing the severe consequences of the current public health measures. They are unable to leave the UK due to the lockdown and are dependent on food charities due to financial hardship.[6] They have been made redundant from their part-time jobs and cannot meet basic living costs. [6] The Indian National Students’ Association and National Indian Students Alumni Union (NISAU) are receiving persistent calls from a huge number of students (3000) who request for food and accommodation. [6] Both organisations are trying to provide solutions and distribute food to stranded students from India. Labour MP for Ealing Southall, wrote to the UK education secretary, calling for universities to arrange money and minimum services from hardship funds, which are often discriminatory, for international students. [6] A few UK Universities and NGOs like NISAU are reaching out to support and help international Indian students tackle their challenges of accommodation, mental health, and food. [6]

References

[1] S. Alexander and N. Kwatra, ‘In fight against coronavirus, India’s universities have lagged far behind China’s‘, (Live Mint, 6 April 2020).

[2] ‘RBI Announces ₹ 50,000 crore Special Liquidity Facility for Mutual Funds (SLF-MF)‘, (Reserve Bank of India, 27 April 2020).

[3] KPMG, ‘Higher education in India and Covid-19‘, (KPMG, 2020).

[4] J. Lau, ‘India’s IITs join Covid-19 fight‘, (Times Higher Education, 29 April 2020).

[5] A. Packham, ‘“I can’t afford rent”: the students facing hardship during lockdown‘, The Guardian (24 April 2020).

[6] A. Fazackerley, ‘Indian students trapped in UK by coronavirus “actually starving”‘, The Guardian (1 May 2020).

This blog series was originally published by Justice in Global Health Emergencies & Humanitarian Crises: https://www.ghe.law.ed.ac.uk/blogs/

Dr Nandini Sen received her PhD at University of Frankfurt. She is a visiting research scholar at School of Social Sciences, Heriot Watt University, and an Associate of the Centre for South Asian Studies (CSAS) at the University of Edinburgh. since 2014 Her academic article Women and Gender in Rabindranath Tagore’s Short Stories from Anthropological Perspectives Challenging Kinship and Marriage was published in Anthropological Journal of European Culture in November 2016. Her book, South Asian Urban Marginalisation: A Waste-Picker Community in Calcutta, India., Routledge/Taylor and Francis (2018) has fetched both fame and critical reviews by academic colleagues and academics.

Dr Anusua Singh Roy is a Postdoctoral research fellow, Statistician at the School of Health Sciences at Queen Margaret University. Research interests include the use of national data sets in longitudinal, cross-sectional and survival probabilistic modelling to address health related and participation outcomes in children with disabilities and individuals with severe mental illness.

Subrata Shankar Bagchi is the Chair Professor in Anthropology at University of Calcutta and researcher on various socio-cultural issues in India.

Jayanta Bhattacharya by training a physician, did his PhD on history of medicine. He has widely published in the field of alternative medicine. He is a medical activist from India. He is the reviewer of the Bulletin of the WHO, Graduate Journal of Social Science, Social History of Medicine, Indian Journal of History of Science, Indian Journal of Medical Ethics and others.

Lloyd Rees, when discussing Australian modern art, argued that ‘the universal element in art, I feel, has often come from an intense localism’ (Rees in Butler & Donaldson 2015, 142). 

This quote has stayed with me since my Art History degree: Lloyd Rees was originally referring to the conflict between indigenous and Western symbolic vocabularies in the increasingly international trope of Australian modern art in 1930s Sydney. Although this quote is far from my life as a part-time GP receptionist, part-time Masters student in Global Health Policy in Scotland, the importance of ‘the local’ has been re-emphasised during the coronavirus pandemic. Working in the setting of community health has taught me that the universal element in healthcare often comes from intensely local care: care that is personalized, close to home and promotes both health and social well-being. The importance of local care has become central to the devastating impact of coronavirus in elderly populations, is an ongoing topical issue of care homes (Observer Reporters, 2020) and is changing what care will become. 

The UK population is ageing, and our health policy is adapting to suit the needs of this demographic. It is predicted that in 2066, 26% of the population will be 65 or older, compared to 18% in 2016 (ONS, 2018). Much of the integrated care that allows older people to be cared for at home was only established 20 years ago. In 2000 the NHS Reform Plan (Department of Health, 2000) introduced a new tier of services called ‘intermediate care’ to facilitate health and social care to older adults living in the community with the understanding that ‘older people have better health outcomes when they receive treatment closer to home’ (British Geriatrics Society 2019). The plan for care homes is arguably still being written. A key question being asked is; ‘Could nursing homes (NHS) transform from settings in which many residents dwell to settings in which the NH residents and those living in neighboring communities benefit from staff expertise to enhance quality of life and maintain or slow functional decline?’ (Laffon de Mazières 2017). Person-centred dementia care is an area of research that ‘is no longer seen as the ‘Cinderella’ part of the health service, but a progressive, specialist field’ (Baker 2015, 17).

In the first international study ‘that reviewed international COVID-19 guidance for a highly vulnerable population’ (Gilissen 2020, 10), the authors noted that in the guidance for nursing homes ‘several key aspects of palliative care, practical guidance, and broader structural and coordination considerations are largely absent’ (Gilissen 2020, 9). Aspects that were not addressed included: ‘holistic symptom assessment and management at the end of life… staff training (in particular for care assistants who deliver the majority of hands-on care in these settings)… comprehensive ACP communication… support for family including bereavement care, support for staff, and leadership and coordination related to palliative care’ (Gilissen 2020, 9&10).

Caring for the elderly is a complex and fragmented task. In the current pandemic politicians and health professionals should continue to work on effective strategies to prevent coronavirus in care homes, such as barrier nursing, testing of hospital patients discharged to homes, and testing of staff (Department of Health and Social Care 2020). However the difficulty of the task has been translated into public uncertainty, particularly around palliative care. Palliative care doctor Rachel Clarke writes in The Guardian, ‘the outrage over allegations that doctors have apparently been using the coronavirus pandemic to write off whole swathes of vulnerable patients has been painful to witness’ (Clarke 2020). As the pandemic continues the growing percentage of elderly deaths (Observer Reporters 2020) is a worrying statistic. The difficult and often misunderstood subject of palliative care, particularly in care homes, is therefore a topical and important issue. Working on the GP reception desk I am aware of the difficulties our local care home faces, and in order to find out more I spoke to the lead GP.

‘Care homes have more experience of death than the hospitals’, the GP pragmatically stated. ‘The majority of residents die within a few years of being admitted.’ Care homes therefore have a medical role in providing adequate healthcare and nursing support to patients. However, as the GP explains, ‘our interactions with the care home have been chaotic for years.’ Many care homes are profit-run organisations which are sadly understaffed in nursing roles. In Scotland the 2018 GP Contract (Scottish Population Health Directorate 2018) introduced the new role of Care Home Liaison Nurse, which as the GP lauded, ‘is one of the most significant additions to primary care’. This role has implemented a more organised system of communication as the nurses are now able to deal with the majority of calls from care homes and treat minor problems without the GP. In recent weeks the GPs and nurses have been supporting the care homes in the difficulties of preparing for coronavirus in the homes.

‘For the care homes now we are prescribing to every resident JIC medication, in case they need palliative support,’ the GP explains. ‘Residents are unlikely to be admitted to hospital if they contract COVID-19, and so will need the support in care homes in case it is terminal.’ Palliative JIC medication eases pain and confusion in the dying process. Ensuring that residents are able to get this medication is not to say that they will die, but to provide the correct medical support if needed. ‘Patients are having more distressing deaths in homes. I heard about a patient who needed extra morphine and midazolam. That is unusual’, the GP continues.

‘Care homes can be depressing places. They don’t always have the right mental stimulation for patients,’ the GP laments. ‘It is like the Dylan Thomas poem Do not go gentle into that good night. Your last few years of life have to be enjoyable. If you don’t have a satisfactory life, it prolongs your pain in death and you will fight death. But if you have a good experience of life at the end, dying is a lot easier.’ 

Care homes are important places that look after a vulnerable population often in the last years of life. For relatives the cost is huge, financially given a private sector nursing home costs an average of £847 per week (Curtis 2018) and emotionally costly too. For the elderly themselves however, living in a care home can be an experience of a ‘social death’. A social death is described as ‘the ways in which someone is treated as if they were dead or non-existent’ (Borgstrom 2017, 5). In this difficult position the elderly are vulnerable, lacking independence and voice, and in society we feel unable to talk about our elderly because ‘we lack a script, in general, for our long dying’ (Banner 2016, 7). People are living longer than ever and ‘because degenerative, chronic conditions have replaced acute diseases as the major cause of mortality’ (Abel, 2017, 1), death is now a gradual rather than sudden progress. This new chapter of life can be a complicated conclusion, with a variety of new medical, financial and social needs. It is a chapter for which ‘a script is sorely needed’ (Banner 2016, 7).

As Rachel Clarke notes in The Guardian, ‘pandemic medicine, we are learning, is far from ideal’ (Clarke 2020); but the flaws it exposes are the problems we need to solve. In Gilissen’s study of COVID guidance, the author noted that ‘non-physical (psychological, social or spiritual) needs were hardly addressed’ (Gilissen 2020, 10). Non-physical needs are important to our quality of life and ‘communication about the patient’s care values and preferences [are important] to develop a care plan for the future’ (Sebern et al. 2018, 644).  However our non-physical needs are also in part our non-medical needs, and discussions of how to care for the elderly go beyond the hospital and the care home. ‘Ideally, the patient should be at the heart of these discussions. Failing that, then their family, loved ones or advocate should, if possible, be consulted’ (Clarke 2020). The conversation about care for the elderly is a subject we all need to be part of. 

‘Epidemics are “mirrors held up to society”, revealing differences of ideology and power as well as the special terrors that haunt different populations’ (Briggs 2003, 8). The impact of coronavirus on care homes will haunt the UK public, particularly the relatives of residents which many of us are. But as the British Geriatrics Society reminds us, ‘ageism remains widespread. Quality of care of elderly patients remains a core criticism in spite of numerous reports and commissions in the past 20 years’ (BGS 2016). For the future, recognizing the vulnerability of the elderly, learning from the uncertainty and lack of guidance in COVID-19 and researching how to provide care for both physical and non-physical needs will be important to ensuring quality care for the elderly. The script for care homes will not be easily written, but the final chapter of our lives needs a personal, local and socially integrated conclusion. As American care activist Ai-jen Poo argues ‘the universality of the caregiving experience is certainly the basis for the next great wave of change’ (Poo 2017).

Taken from interviews for https://www.rovingreceptionist.com/. Interview reproduced with permission.  

Niamh Woodier is currently in the Masters in Science program in Global Health Policy at the University of Edinburgh and works as a part-time GP receptionist.  Working as a receptionist has given her an insight into the struggles patients and relatives face in caring for elderly relatives in a complex care system, and the anxiety everyone is facing currently about the status of their health. In order to informally document this time of change, she set herself up as a ‘roving receptionist’ to give a local and personal voice in the global crisis. She says: “It has been a privilege to engage with wider policy issues during my degree at Edinburgh, and in the future I hope to be able to advocate for the ethics of care.”

References:

Abel, E.K. (2017). Living in Death’s Shadow: Family Experiences of Terminal Care and Irreplaceable Loss. Baltimore: Johns Hopkins University Press., doi:10.1353/book.49471 [Accessed 22nd May 2020].

Baker, C. (2015). Developing excellent care for people with dementia living in care homes (Bradford Dementia Group good practice guides). London, [England] ; Philadelphia, Pennsylvania: Jessica Kingsley.

Banner, M. (2016). Scripts for Modern Dying: The Death before Death We Have Invented, the Death before Death We Fear and Some Take Too Literally, and the Death before Death Christians Believe in. Studies in Christian Ethics, 29(3), 249–255. https://doi.org/10.1177/0953946816642967 [Accessed 18th May 2020].

Borgstrom, E (2017), Social Death, QJM: An International Journal of Medicine, Volume 110, Issue 1, January 2017, Pages 5–7, https://doi.org/10.1093/qjmed/hcw183 [Accessed 18th May 2020].

 Briggs, C.L. & Mantini-Briggs, C., (2003). Stories in the time of cholera : racial profiling during a medical nightmare, Berkeley, Calif.: University of California Press.

British Geriatrics Society (2016) A Brief History of the Care of the Elderly Available online: https://www.bgs.org.uk/resources/a-brief-history-of-the-care-of-the-elderly [Accessed 18th May 2020].

British Geriatrics Society (2019) ‘The NHS long term plan promises better care closer to home but our hospitals must not be left behind’ says British Geriatrics Society’s President. Available online: https://www.bgs.org.uk/policy-and-media/%E2%80%98the-nhs-long-term-plan-promises-better-care-closer-to-home-but-our-hospitals-must [Accessed 18th May 2020].

Butler, R. & Donaldson, A.D.S., (2008). Stay, Go, or Come: A History of Australian Art, 1920-40. Australian and New Zealand Journal of Art: 21st-Century Art History, 9(1-2), pp.118–143. [Accessed 18th May 2020].

Clarke, R. (2020) Do not resuscitate’ orders have caused panic in the UK. Here is the truth. Guardian online, https://www.theguardian.com/commentisfree/2020/apr/08/do-not-resuscitate-orders-caused-panic-uk-truth [Accessed 18th May 2020].

Curtis, L. & Burns, A. (2018) Unit Costs of Health and Social Care 2018, Personal Social Services Research Unit, University of Kent, Canterbury. https://doi.org/10.22024/UniKent/01.02.70995​ [Accessed 18th May 2020].

Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform. London: Department of Health https://navigator.health.org.uk/content/nhs-plan-plan-investment-plan-reform-2000 [Accessed 26th March]

Department of Health and Social Care (2020) Government launches new portal for care homes to arrange coronavirus testing https://www.gov.uk/government/news/government-launches-new-portal-for-care-homes-to-arrange-coronavirus-testing [Accessed 25th May]

Gilissen J., Pivodic L, T. Unroe K., Van den Block L,. (2020) International COVID-19 palliative care guidance for nursing homes leaves key themes unaddressed. Journal of Pain and Symptom Management, Volume 0, Issue 0 (article in press) Available as Journal Pre-proof at: https://www.jpsmjournal.com/article/S0885-3924(20)30372-9/pdf [Accessed 19th May 2020].

Laffon de Mazières, C. et al., (2017). Prevention of Functional Decline by Reframing the Role of Nursing Homes? Journal of the American Medical Directors Association, 18(2), pp.105–110.

Observer Reporters (2020) Across the world, figures reveal horrific toll of care home deaths. Guardian online,

 https://www.theguardian.com/world/2020/may/16/across-the-world-figures-reveal-horrific-covid-19-toll-of-care-home-deaths [Accessed 18th May 2020].

Office for National Statistics (2018) Living longer: how our population is changing and why it matters https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13#how-is-the-uk-population-changing [Accessed 26th March]

Poo, A.-jen, (2017). Generation X: Being the Change We Need. Generations, 41(3), pp.90–92. Available online: https://search-proquest com.ezproxy.is.ed.ac.uk/docview/1968940960?accountid=10673&rfr_id=info%3Axri%2Fsid%3Aprimo [Accessed 19th May 2020].

Scottish Population Health Directorate (2018) The 2018 General Medical Services Contract in Scotland. Edinburgh: Scottish Government https://www.gov.scot/publications/gms-contract-scotland/ [Accessed 26th March]

Sebern, Margaret D., Sulemanjee, Nasir, Sebern, Mark J., Garnier‐Villarreal, Mauricio, & Whitlatch, Carol J. (2018). Does an intervention designed to improve self‐management, social support and awareness of palliative‐care address needs of persons with heart failure, family caregivers and clinicians? Journal of Clinical Nursing, 27(3-4), E643-E657.

People living in the Global North might argue that the coronavirus pandemic (COVID-19) is the greatest existential threat to life as we know it in the last 100 years. Yet for Syrians, the pandemic, while undeniably traumatic, is just one more event in a litany of equally-devastating hardships that have proven inescapable, difficult and necessary to endure. 

Years of protracted conflict mean that Syrians have become inured to living with significant risks and uncertainties about their future lives and livelihoods. While the attention and resources of apparent former ‘global health powerhouses’ like the UK and USA, are fixed on solving challenges posed by disease transmission and constraints on healthcare systems in their own countries, there is a growing danger that the impacts of disease incursion on displaced and vulnerable populations in fragile and conflict-affected states may be completely neglected. In countries everywhere, ensuring access to appropriate healthcare is the immediate priority in this outbreak. But in countries like Syria, effective solutions are also needed to support other types of life-sustaining interventions, such as local and cross-border distribution of food and agricultural inputs which facilitate labour, militate loss of income and prevent food insecurity and its attendant effects on starvation, malnutrition and mental health and well-being A successful response to this pandemic will therefore depend not just on top-down public-health interventions, but also uptake of cross-sectoral, culturally appropriate and locally-led approaches which translate high-level strategies derived not only from security, but also humanitarian and development agendas, into concrete policies and impactful activities on the ground. In Syria, where there are uncertainties about governance and weakened institutions, a community-led response to COVID-19 is a matter of increasing urgency. 

Challenges of implementing effective disease mitigation efforts in Syria

There are currently more than 4.7 million reported world-wide cases of COVID-19 and more than 315,000 COVID-related deaths (as of 18 May 2020). The risks to individuals from coronavirus are great: there is currently no vaccine, no cure and there is a non-negligible likelihood that intensive hospital care may be required for a realistic chance at recovery. We are still learning about the multi-systemic consequences of the disease; for some long-term health sequelae persist long after recovery.  

More than a decade of civil war and a collapsing economy have forced 6 million or more Syrians into crowded living conditions along the Syrian border, into neighbouring countries and failed states with fragile and fragmented healthcare systems. Syria is currently ranked as one of the least prepared countries in the world for emergency disease outbreak preparedness and response. Reported cases of COVID-19 in Syria are currently small in number (n= 59) but there are fears that most remain undetected due to inadequate testing capacity and an absence of functioning health centres. On the ground, it is becoming evident that few people are attending workshops or meetings delivering information about COVID-19, with most information about COVID-19 being obtained through social media.  The lack of public trust in the Syrian government, general lack of knowledge about clinical signs of disease and concurrent gaps in information campaigns, alongside fears over possible repercussions (including discrimination, detainment, disappearance), mean that people are deterred from seeking testing or treatment even if that capability were available to them. 

International aid is promised to support outbreak response efforts in Syria, but challenging to operationalise. Responders need to negotiate for permission with multiple local and international authorities, state- and non-state actors in border areas. Some NGOs are responding to the crisis in Northwest and Northeast Syria under the cross-border resolution, but this vital aid may be under threat if the UN Security Council does not overcome Russian and Chinese objections to the renewal (in July).

A curfew in government-controlled areas was initially put in place to encourage people to stay in their homes to reduce their risks of disease exposure and onward transmission. It is not at all evident that this made them safer or healthier. Individuals still need to leave home to collect their incomes- “I don’t have another choice … to survive”. “At home” for many Syrians is typically an overcrowded, physically and mentally stressful environment, without access to adequate supplies of food or other products. Conditions are far worse for those who live in north Syrian camps, where inadequate access to basic medical, water and sanitation facilities is commonplace and a single tent may shelter as many as five to 15 people. In Northeast Syria, for example, there are over 225,000 IDPs and refugees living in last resort sites without reliable or sufficient access to essential services such as health, WASH and shelter.  Although face masks and disinfection liquids may be available in some markets in north Syria, most people can’t buy them-  “these are available, but we don’t have income to purchase it. My priority is to purchase essential food items to survive”. Outside Syria,  the UNHCR is trying to ensure that there is full inclusion of refugees in the preparedness, prevention and response measures to the COVID-19 pandemic in the region, but it is unclear what provisions are available to Syrian refugees if the capacity of healthcare systems in host countries is overloaded. 

COVID-19 impacts on humanitarian efforts and longer-term food security and livelihoods in Syria

 Since mid-March, significant price increases in fuel and some shortages in basic goods, essential food items, and personal sterilization and protection items (such as face masks, hand sanitizers) have been reported across Syria. The exchange rate has weakened since mid-March to the lowest point on record. These factors, in combination with panic-buying, disrupted supply routes, reduced shop opening hours, reduced working hours, wages and household incomes and movement restrictions are likely to deepen pre-existing vulnerabilities.

Established survival mechanisms, which are traditionally relied on by displaced Syrians to cope with informality and lack of economic support (e.g. through transnational kinship support networks, early marriage, and child labour) may become distorted over the next weeks and months, leading to other unintended, negative consequences. Among the most vulnerable in Syrian society are day labourers, who depend on daily wages to cover the basic needs for their family. For displaced Syrians with no financial safety net, staying at home immediately worsens food security for entire households. Small-scale farmers and migratory agricultural workers in neighbouring countries will be affected too. Farmers will lose access to extension services, be hindered from working or hiring workers to help with the harvest commencing in May, and many will struggle to eat due to higher food prices/limited purchasing power due to their already insecure employment, legal status, and low-wages. Moreover, the pandemic will have important subsequent impacts on livestock sector due to reduced access to animal feed, vaccination and extension services. 

The longer-term costs and indirect impacts of COVID-19 on Syria’s reconstruction efforts and sustainable development will not be known for the foreseeable future. However, undoubtedly, Syrians and other peoples in fragile and conflict-affected states will feel the brunt of COVID-19 impacts, only serving to widen existing inequality gaps which will endure into future generations.  In the face of the uncertainty surrounding the COVID-19 outbreak, the 2030 “blueprint for shared prosperity in a sustainable world” offered by the UN Sustainable Development Goals (SDG), Syria and other places like it, is surely in jeopardy. A deep commitment for international cooperation as well as for peace-building and transitional justice will be needed.  How countries decide to support Syria during and after this health crisis, will be pivotal to the future of global health security – “a disease anywhere is a disease everywhere”.  But what happens next will undoubtedly depend on how those countries themselves, weather this storm.  

Authors: Dr Lisa Boden, Dr Ann-Christin Wagner, Dr Shaher Abdullateef and Dr Anas Al Kaddour are collaborating with other researchers from the Universities of Edinburgh and Aberdeen, and project partners from CARA (Council for At-Risk Academics) Syria Programme, on a SFC-GCRF COVID-19 grant for research with displaced Syrians in Lebanon, Jordan, Turkey, Iraqi Kurdistan and Northwest Syria.

Their new “From the FIELD” project uses remote surveys and ethnography to assess the impact of COVID-19 on local food supply chains and displaced people’s agricultural livelihoods in the Middle East.  For updates, follow the team members on Twitter: @Lisa_A_Boden, @ann_wagner_ed and @ShaherAbdulla 

“It is our task to resist the biologicalisation of this disease and instead to insist on a social and political critique of COVID-19. It is our task to understand what this disease means to the lives of those it has affected and to use that understanding not only to change our perspective of the world but also to change the world itself,” (Richard Horton, editor-in-chief of The Lancet).

Referring to renowned anthropologist Didier Fassin’s book ‘Life: A Critical User’s Manual’, in a recent editorial of The Lancet Horton alluded to the lack of science of the social in the response to this pandemic, which is a crisis about life itself.  While political leaders across the world have echoed the importance of social science to inform the COVID-19 response, little has been done to support and incorporate social science in the decisions they make on the pandemic, which impacts different social groups and communities differently.

Recognising this gap, the University of Edinburgh’s  (UoE) social scientists were recently granted awards  from the Scottish Funding Council-Global Challenges Research Fund (SFR-GCRF) to develop innovative and timely research that would support low and middle income countries (LMIC) in the COVID-19 response.   

“We are delighted to see these innovative projects that are expected to advance our understanding of social and political aspects of the pandemic. Building on past experience of the investigators and the long-standing local and international partnerships, the project outputs will directly contribute to global response to the pandemic,” said Dr Jeevan Sharma, Director of Research of the School of Social and Political Science.

The following is a brief summary of the awarded projects. 

Epidemic preparedness and laboratory strengthening in West Africa

Did the international response to the 2014-2016 Ebola outbreak help to prepare Sierra Leone’s health system for COVID-19? Dr Alice Street, principal investigator of a joint project between UOE’s DiaDev and London School of Hygiene and Tropical Medicine’s (LSHTM) EBOVAC-Salone argues that technology-focused responses to epidemic emergencies – such as the development of novel diagnostics, vaccines and drugs – frequently neglect the social infrastructures that underpin the success of the technological solutions. This research draws on the team’s collective experience of carrying out research on laboratory strengthening and vaccine development in Sierra Leone and collaborations with Sierra Leone scientists and scholars to examine the impact of the international response to Ebola on the country’s current epidemic preparedness. The research will be led by research fellow, Shona Lee, who completed her PhD at the Centre of African Studies in 2018 and has since worked on the EBOVAC-Salone project, and Eva Vernooij, DiaDev research fellow . DiaDev is an ERC funded project to investigate the role of diagnostic devices in strengthening under-resourced health systems. EBOVAC-Salone is a collaboration between LSHTM Sierra Leone’s College of Medicine and Allied Health Sciences to examine community experiences of vaccine trials. 

As the COVID-19 pandemic expands into Africa, social science has an important role to play in developing a culturally appropriate and socially feasible national and regional response. Dr Street says findings from this research have the potential to inform current COVID-19 testing strategies and diagnostic infrastructure development in the region, public messaging and communications, and the design and conduct of COVID-19 related research and trials. 

Dr Alice Street is a senior lecturer in the School of Social and Political Sciences, University of Edinburgh and an expert on diagnostic device in global health.

Infectious disease related stigma

Experiences have shown that stigma is a common social by-product of infectious disease outbreaks which often undermine public health measures and are targeted towards patients, their families and health care workers.  Dr Sudeepa Abeysinghe leads a joint project between UoE’s School of Social and Political Science (SSPS) and the University of Indonesia to look into health care associated stigma in Indonesia. 

This project aims to provide policy briefings related to mitigating stigma in health care workers through the study of public narratives of risk and threat that underpin stigmatization. The goal of the project is to reduce the risks faced by personnel aiding and maintaining the health care capacity in Indonesia.  

As with other LMICs of the Asia-Pacific region, COVID-19 presents a fundamental challenge to economic development and welfare in Indonesia. In highlighting and tackling stigma, this project eases the burden of stigmatisation in Indonesia and thereby impacts on the public health and wider burden of the pandemic in this context.  The results from this project will also benefit other relevant actors in the region, through the sharing of insights with the SEAOHUN (South-East Asia One Health University Network) says Dr Abeysinghe.

Dr Sudeepa Abesinghe is a senior lecturer in Global Health Policy in the School of Social and Political Sciences, University of Edinburgh.

Governance and accountability

Dr Jean-Benoit Falisse is the principal investigator of the project which draws on a unique network of in-country expertise in health systems and governance to map out and analyse the governance changes that have taken place during the COVID-19 pandemic in Kenya, Somalia, South Africa and the Democratic Republic of the Congo (DRC).  This is a joint project between UoE, AMREF International University in Kenya, Somali Institute of Development Research and Analysis in Somalia, Wits University in South Africa and University of Kinshasa in DRC.  

The aim of this project is equip countries with better tools to understand and act on the governance of COVID-19 through cross-country exchanges and reflections between policy influencers, says Dr Falisse. The project will produce an interactive public database that can be interoperated and cross-analysed with other mapping initiatives such as the stringency of the measures of the pandemic’s spread. This database will explore the socio-political environment, the actors or institutions involved, and the nature of the governance measures. Beyond the dataset, the academic analysis will contribute to re-formulating governance in health and pandemic preparedness, says Dr Falisse. 

Dr Jean-Benoit Falisse is a lecturer in Africa and International Development in the School of Social and Political Sciences, University of Edinburgh.

Lockdown diary

Dr Sarah Jane Cooper-Knock and her team are working with a team at the University of Western Cape in South Africa to continue their Lockdown Diary Project.  They are interested in the politics of urban life and issues of political inclusion, which is pursued through academia, activism and policy work. When the lockdown began, this project was developed with Impact Funding from UoE and is now being run with GCRF funding. 

The project involves asking people from across Cape Town to share regular WhatsApp diaries that describe their experiences of lockdown and its impact upon their communities. They currently have 70 participants from occupied buildings, informal settlements, townships and suburbs throughout Cape Town. Participants are diverse in terms of their location, age, gender, and race. The aim of the project is to share insights from lockdown with members of the public, policy makers, and responders to the crisis. 

Dr Sarah Jane Cooper-Knock is a lecturer in International Development at the Centre of African Studies and Social Anthropology at the University of Edinburgh.

COVID-19 and extreme heat for poor urban population

Dr Jamie Cross of CAHSS joins with Dr Daniel Friedrich of the School of Engineering and the International Federation of the Red Cross and Red Crescent Societies (IFRC) to look at the nexus of COVID-19 and extreme heat for poor urban populations in Sub Saharan Africa, South Asia and Southeast Asia. This project will assess the impact the lockdown on  existing vulnerabilities and exposure the people living in poorly ventilated housing faciliites of high density informal settlements in urban areas and prisons have as a result of heat stress  and reduced access to cooling and hydration infrastructures and services during the period of lockdown and social distancing.  

Dr Cross says the project involves 4000 respondents from vulnerable populations across four countries – India, Pakistan, Cameroon and Indonesia. The effects of extreme heat on poor populations is well documented and widely known to reduce labour inputs and capacity. Reducing the impact of health on health and productivity, both directly and through interactions with COVID-19 frees up capacity for the health response and for the economic activity at large, says Dr Cross. 

Dr Jamie Cross is a senior lecturer in Social Anthropology and the Associate Dean (Knowledge Exchange and Impact) of the College of Arts, Humanities and Social Sciences at the University of Edinburgh.

Dr Daniel Fredrich is a lecturer at the School of Engineering, Univeristy of Edinburgh.

Information technology for COVID-19 response

Dr Larissa Pschetz leads a team at the Univeristy of Edinburgh which is collaborating with partners to investigate the potential of digital tools to help mitigate the spread of COVID-19 in Jamaica. The project uses data modelling and prototype testing obtained from social analyisis and practical experimentation to carry out their research.  The project is done in collaboration with Mona Geoinfomatics, the Sir Lewis Institute of Social and Economic Studies (SALISES) at the University of West Indies in Jamaica, and the School of Computer Sciences in Univeristy of Glasgow. 

The project aims to inform people and support agencies, and to optimize resources available to treat and limt the spread of COVID-19 in developing countries.  Its findings will benefit Jamaica and other developing countries with similar socio-economic limitations and socio-technical characteristics.  The research will feed into current efforts to map the spead of the virus and will propose guidelines and recommendations for development of future technological applications. 

Dr Larissa Pschetz is a lecturer in Design at the University of Edinburgh. 

Using COVID-19 for risk ADAPTATION for climate change challenges

Vulnerable communities across the globe give insights on how to adapt to unprecedented risks of climate change through their recent changes to social and economic practices under COVID-19. Through collective action these communities minimise their COVID-19 exposure and adapt to challenges such as shortages of food and access to clean water through, for example, re-farming land and bartering goods. 

Such collective actions managing these new risks have been scare for other grand challenges such as climate change. “Collective action under COVID-19 can provide an insight on potential strategies and solutions for future climate change challenges,” Dr. Kathi Kaesehage, the principal investigator for this project explains, “It is of upmost importance to understand the new evolution of collective action and to preserve and replicate their structures and characteristics for the mitigation and adaptation other unprecedented risks such as climate change.”

An interdisciplinary team of researchers at the University of Edinburgh are working to understand COVID-19 risks in ways that recognise and adapt the practices and capabilities of vulnerable communities living in the intersection of urban-rural areas. The project approaches this challenge from the standpoint of analysing COVID-19 risk mitigation strategies through a case study approach with three communities in urban areas of Mexico, Colombia and the Galapagos Islands. Building on the collaborative relationships generated by previous research the team is working with local academics and community members in each location resulting in data that be co-produced. The outcomes will generate context-specific knowledge but also provide examples of best practice for similar risks such as climate change.

Dr Katharina Kaesehage is a Lecturer in Climate Change and Business Strategy, Business School and the Director of Research at the Centre for Business, Climate Change, Sustainability at the University of Edinburgh. 

The disproportionate impacts of Covid-19 on Black, Asian and minority ethnic (BAME) people in the UK (both within and outwith the medical professions) have sparked critical commentary, an evidence submission, and an official inquiry (headed by a ‘controversial’ figure largely discredited in antiracist, trade union and equality third sector circles).

While racial inequalities in England and Wales have been documented, the same for Scotland have yet to be revealed. Yet (with some exceptions, such as the evidence review), available analysis has often tended to homogenise ‘BME/BAME’ groups – either quantitatively or discursively. This homogenisation is, perhaps, an understandable response to a public health crisis which is exacerbating existing racial and ethnic inequalities, and in the form of grossly disproportionate mortality rates.

However, aggregation obscures the complexities of racism and how it is mutually constituted by other structural inequalities. There is thus a pressing need to disaggregate not only by specific ethnicity, but by intersections of other structural inequalities.

As intersectionality theory reveals, homogenising equality groups tends to privilege the advantaged within-groups: generalising across the category based on one particular position within it, effacing intersectional marginalisation in the process. Furthermore, the category BME/BAME can discursively de-gender women of colour. In the light of this, this article will reflect on the intersections of race and ethnicity with other inequalities, which we might bear in mind when reflecting on racial and ethnic inequalities and Covid-19, and which suggest possible directions for future research into inequalities and the pandemic. These intersections include disability, gender and gender identity, and sexual orientation, among other salient ones: class, nationality, migration status, and faith.

I do this with reference to claims made by equality third sector actors (organisations which have emerged because of inequality related to markers of identity, including racial justice, feminist, disability rights, and LGBTI rights organisations) in relation to other equality communities. These organisations play a key and at times overlooked role in policymaking, and an integral role in knowledge production about inequalities. Some of these other inequalities are more recently protected in equality legislation, and as such, data collection in relation to them is patchy or virtually non-existent (as is the case with trans status). Moreover, official statistics do not consistently examine all of these together. Therefore, we cannot gain a full understanding of the complexity of race, ethnicity and intersectional privilege and marginalisation in relation to the Covid-19 pandemic with reference to official statistics or existing research alone.

The ways in which these other structural inequalities intersect with institutional racism are not made explicit in these claims, so need to be further discerned – since the equality third sector remains largely siloed into ‘equality strands’, a situation which my research on intersectionality’s conceptualisation and operationalisation therein responded to. Claims from other equality sectors may also understandably employ strategic essentialism; in any case, these claims need not necessarily be understood as competing, in the knowledge that no inequalities are mutually exclusive (though of course all such claims can and should be subject to intersectional critique).

Disability

According to research by the Glasgow Disability Alliance, the largest disabled people’s membership organisation in Europe, COVID-19 has ‘supercharged’ inequalities already faced by disabled people. Disabled people, with BAME disabled people among them, already faced persistent isolation, poverty and exclusion from services, while the pandemic has led to increases in these factors as well as experiences of food insecurity.

According to disabled people’s organisations participating in my research, these experiences are particularly acute for BAME and other intersectionally marginalised disabled people. This intersection of race, disability and socioeconomic status is particularly significant given the correlations observed between markers of socioeconomic status, particularly deprivation, and vulnerability to COVID-19 in terms of both incidence and outcomes.

My research has found that UK-wide, BAME disabled people’s organisations have been particularly hard hit by cuts associated with austerity, with many such organisations who specifically advocated by and for disabled BAME people now dissolved.

Gender

Early research into gender differences and COVID-19 shows that proportionally more men than women die, while women of most minority ethnic groups are more likely to do so than white women, with Black women 4.3 times more likely. Research into other health indicators in the UK has found that BAME people are disproportionately diagnosed and treated at late stages, with particularly negative effects for women. One possible contributing factor to these differentials is ‘medical bias’, which has been named as a likely factor in racial inequalities in deaths from COVID-19 in the US.

Increasing incidence of domestic violence is a key gendered issue in relation to the pandemic. Commentary concerning this has largely been happening in parallel to, rather than with and through, commentary about racial and ethnic inequalities, in a familiar siloing which serves to marginalise the experiences and perspectives of women of colour, what Kimberlé Crenshaw named as political intersectionality (1991) in her still very relevant critiques of antiracist and feminist movements.

Specialised domestic violence services led by and for BAME women were already grossly underfunded compared with mainstream counterparts, and it is unclear how much, if any, of new funding committed for domestic violence services in the light of the pandemic will reach these services.

Sexual orientation and gender identity

The gendered implications of lockdown and proximity to abusive partners, with fewer options to leave have been highlighted. Yet the framing of domestic violence as an issue exclusively manifested in (heterosexual) intimate partner relationships or towards children in those contexts, has always served to mask (gendered), hetero/cissexist domestic violence and abuse experienced by lesbian, gay, bisexual and trans people from parents and family members (LGBT people may of course also be subject to domestic violence in intimate partner relationships).

This is an issue pertinent to all LGBT people, not just BAME LGBT people, but research indicates that the latter are underserved by LGBT specific services, access to which is even more limited for all in the current circumstances, even as many LGBT organisations report increased demand. Many LGBT people then, who may also be more likely to have ways of organising familial relationships which diverge from the (nuclear) ‘household’ which the lockdown policy is structured around, will have particularly challenging experiences of lockdown.

LGBT people experience health inequalities which may increase risk in relation to COVID-19. Furthermore, pre-existing health inequalities among LGBT people would suggest that vulnerability to COVID-19 may be particularly acute for BAME and other intersectionally marginalised LGBT people.

I have highlighted just a few issues which emerge when the intersections of race and ethnicity with disability, gender and gender identity, and sexual orientation are considered in relation to inequalities and COVID-19. The groups of BAME disabled and LGBT people, and BAME women and men, all overlap, and experiences vary further by specific ethnicity. In a context where equality claims making remains largely siloed, and attention to intersectionality is fragmentary at best, it remains to be seen whether the pandemic will exacerbate the homogenising tendency of these claims, or whether analysis might take care to highlight intersectional marginalisation among BAME people and within equality groups.

This article was originally published by Discover Society: https://discoversociety.org/2020/05/15/race-intersectionality-and-covid-19/

Ashlee Christoffersen is a PhD Candidate in Social policy at the University of Edinburgh and a former practitioner in the equality third sector. @ashlee_m_c

Reference

Crenshaw, Kimberlé Williams. 1991. “Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Colour.” Stanford Law Review 43 (6): 1241–99.

Introduction

I would like to offer a sober yet optimistic speculation on the renewal of community and civic solidarity in the face of the rapidly unfolding coronavirus pandemic. Over the last forty years, social and civic solidarity have been systematically undermined by the neoliberal project. Yet over a decade ago, a global crisis of neoliberal finance capitalism presented us with an unprecedented opportunity to break away from its orthodoxies and rebuild the solidarity necessary for democratic citizenship. Instead, we lived through an astonishing period during which the ‘alchemy of austerity’ reworked the crisis as one of a bloated and inefficient welfare state (Clarke and Newman, 2012). ‘Zombie’ neoliberalism staggered on and inequality grew, as communities across the UK organised to resist austerity and ameliorate the worst effects of brutal cuts and punitive welfare reform. Perversely, a solidaristic rhetoric of ‘sharing the pain’ was invoked to justify the very policies that undermined solidarity: the reduction or closure of essential public services, youth and community centres, public libraries, as well as welfare reforms that the UN Rapporteur on extreme poverty and human rights compared to Victorian Poor Laws (Alston, 2018). 

The pandemic has raised the stakes for those at the sharp end of all of this. Every day it becomes increasingly obvious how our experiences of daily life under ‘lockdown’ are fashioned by the intersecting dynamics of social class, ‘race’ and gender. Domestic violence has increased as women are trapped in homes with abusive partners (Townsend, 2020). Social distancing isn’t possible for those providing frontline services and those required to travel daily on crowded public transport in urban centres. As our world shrinks, the harsh reality of uneven development is starkly highlighted as issues of work, housing, public space (especially access to safe greenspace), transport, food security and broadband internet are felt most keenly by poorer communities. Despite this depressing portrait, there are also instances of, and opportunities for, solidarity. In this period of social distancing how might we build on these opportunities to reduce social distance?

The rediscovery of social solidarity 

In discussing solidarity, we ought to clarify its different meanings and inflections. Firstly, it is important to remember that solidarity isn’t exclusively a leftist concept tied to expansive articulations of social justice. Solidarity can be understood in exclusive terms, including nativist, conservative and xenophobic varieties (Scholz, 2015). Secondly, we can differentiate between social solidarity and civic solidarity (Scholz, 2015). Social solidarity is a descriptive concept, whilst civic solidarity is a normative concept. Roughly understood, social solidarity refers to the objective relations of interdependence underpinning a community or society. It is in this ‘social’ sense that we currently seem to be re-discovering solidarity, because in our shared vulnerability we are confronted with the reality of our mutual interdependence. We are all now expressing collective gratitude for our NHS. But more than this, we are suddenly alive to the reality that without our refuse workers, our Amazon employees, our gig economy delivery drivers, our supermarket workers, our teachers, our early-years workers, our care workers, our bus drivers, our cleaners, not to mention our NHS staff, life grinds to a spectacular halt. At the same time, we (men, in particular) are forced to confront the poorly paid or unpaid social reproductive labour undergirding the capitalist economy. For some of us, this rediscovery results in a type of ennui as the social hierarchy of labour flips on its head and we’re left contemplating the social value of our own jobs. Many people who ordinarily enjoy a higher degree of financial and job security are unceremoniously plunged into precarity as we are, once again, confronted with the shortcomings of the free market as a guarantor of human wellbeing. As a consequence, it is now much more difficult to ‘other’ those who depend on the welfare state. It turns out, we all do. This is the rediscovery of social solidarity.

The renewal of civic solidarity 

This rediscovery of social solidarity in the face of the pandemic has motivated acts of solidarity at every level—from the familial, to the local community, through to the national. Streets and local communities organise themselves into WhatsApp groups providing networks of support for each other and the more vulnerable; people volunteer with the NHS quite literally risking their lives to do so; people engage in quotidian but no less important acts of solidarity such as cutting the grass of elderly neighbours, buying groceries, emptying bins in local parks, and so on. Most visibly, we now stand on our doorsteps and clap every week for the NHS and keyworkers in a nation-wide collective display of symbolic solidarity. Whilst not to be underestimated, these solidarity acts aren’t enough on their own. 

My hope is that this acute crisis starkly highlights the more chronic crisis of care—of social reproductive labour—created by an economic system that treats it as a ‘free gift’ and therefore undermines the preconditions for its own reproduction (Arruza, Bhattacharya and Fraser, 2019). Tackling this demands that our rediscovery of social solidarity acts as a waystation to the renewal of civic solidarity. We can understand civic solidarity as the institutionalisation of our mutual obligations as citizens through the state. Civic solidarity is associated with the European tradition of social democracy, whereby social rights are guaranteed through an inclusive universal welfare state (Scholz, 2015; Stjernø 2005). To understand exactly what’s at stake here it’s useful to turn briefly to philosopher Michael Sandel’s arguments about social justice and civic virtue. Sandel recognizes that purely utilitarian justifications for democratic welfare states are lacking insofar as they fail to recognise how inequality systematically undermines the sense of community upon which democratic citizenship depends: 

Public institutions such as schools, parks, playgrounds, and community centres cease to be places where citizens from different walks of life encounter one another. Institutions that once gathered people together and served as informal schools of civic virtue become few and far between. (Sandel, 2009, p. 267)

Real community requires civic solidarity and it feels as though this moment offers an opportunity to draw parallels between the current context and the post-WWII context where a shared experience of hardship reduced social distance and generated the conditions for civic solidarity. However, nothing can simply be ‘read off’ from the existing conjuncture—it needs to be articulated into a coherent discourse adequate to the task of challenging the desire to return to ‘business as usual.’

Conclusion: ‘Never let a good crisis go to waste’ 

Over a decade beyond the crisis of 2008, we stand at another ideological crossroad. On the one hand, we have the opportunity to build momentum for a different politics, one which identifies and protects ‘non-market norms’ and institutionalises a renewed sense of civic solidarity; one which recognises and acts to address the crisis of care we currently face. On the other hand, we are tempted to return to ‘business as usual’. From the beginning of this pandemic, we have been confronted with the double peril of the virus and its impact on an economic model which values growth at any cost. As we navigate the media panic over recession and economic catastrophe, now is the time to emphasise the shameful disconnect between idle wealth and the dearth of socially useful investment produced by neoliberal capitalism. 

We know that GDP is a poor indicator for human wellbeing and the health of the body politic. We know that quality jobs didn’t follow economic recovery after 2008. We know that economic growth doesn’t ‘trickle down’ but rather ‘up’, that risk is socialised whilst profit is privatised. In a context of falling wages and job insecurity, we know that the compensatory consumerism ensured by mass credit, resource expropriation and labour exploitation is unjust and ecologically untenable. 

The very real danger lies in returning to ‘normal’ because the implications are terrifyingly plain to see: a return to a second round of ultra-austerity following a period of ‘crisis Keynesianism’, where we are urged to believe once again that we are ‘all in it together’, tasked with a collective duty to steady the ship following an unprecedented period of state spending to tackle the pandemic. In this neoliberal discourse, symbolic solidarity is allowed, even encouraged, whilst calls for civic solidarity are branded as disruptive or unpatriotic. Good neoliberals ‘never let a good crisis go to waste’ and this is how we should also see the task ahead of us—as an opportunity to weave together longstanding struggles against the privatisation of the commons, the crisis of reproductive labour, and thus for an expanded conception of labour rights and a humane and inclusive welfare state.

This article was first published in a new special issue of  Concept, which explores the pandemic from the perspective of work with communities. Republished here with thanks.

Dr Callum McGregor is Programme Director for MSc Social Justice and Community Action, and a lecturer in Education at the University of Edinburgh. 

References

Alston, P. (2018) Statement on visit to the United Kingdom, by Professor Philip Alston, UN Special Rapporteur on Extreme Poverty and Human Rights. Available from: https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=23881&LangID=E

Arruza, C., Bhattacharya, T. and Fraser, N. (2019) Feminism for the 99%: A Manifesto. London: Verso. 

Clarke, J. and Newman, J. (2012) ‘The alchemy of austerity’, Critical Social Policy, 32(3), pp. 299–319. 

Sandel, M. (2009) Justice: What’s the right thing to do? London: Penguin.

Scholz, S.J. (2015) ‘Seeking solidarity’, Philosophy Compass, 10(10), pp. 725-735. 

Stjernø, S. (2005) Solidarity in Europe: The history of an idea. Cambridge: Cambridge University Press.

Townsend, M. (April 12th, 2020) Revealed: Surge in domestic violence following Covid-19 crisis. The Guardian Online. Available from: https://www.theguardian.com/society/2020/apr/12/domestic-violence-surges-seven-hundred-per-cent-uk-coronavirus.

Perhaps Adam Smith knew all along

Compassion and economy are words which you rarely, if ever, see in the same sentence.

Yet none of us would be here without the love and compassion of our families when we were born and for years afterwards. Care for each other in the home is crucial to the functioning of the economy, but it is work that is not given value in GDP-focused assessments of the success of a nation. We,  as co-directors on the University of Edinburgh’s Global Compassion Initiative and Katherine Trebeck, researcher on wellbeing and the economy, make a case here that the COVID-19 global emergency means that we have not just an opportunity, but an imperative to create a more compassionate and a more successful economy than that which was already damaging people and planet as COVID-19 descended. 

Compassion

Archbishop Desmond Tutu defines compassion thus: 

“Compassion is not just feeling with someone, but seeking to change the situation if they are in pain, distress or suffering. Frequently people think compassion and love are merely sentimental. No! They are very demanding. If you are going to be compassionate, be prepared for action!” 

Compassion is now much in evidence around us as society organises to deal with the catastrophe of huge numbers of infections and deaths across the world. The pandemic has created huge new workloads for health and care staff, delivery drivers, shop workers and others, sometimes undertaken at great risk to themselves, as evidenced in the mounting numbers of COVID-19 deaths in these groups. Local community groups have responded to the pandemic by helping neighbours, vulnerable and elderly. GPs have rapidly changed their working practices and now see up to 90% of patients by video or telephone to protect patients and staff from infection.  Hospitals have prioritised COVID care. 

The Economy

We know that the economy in the UK and globally has taken an unprecedented hit and that life for us and future generations will be affected by the virus, with mass unemployment and the incomes being partially underwritten by Governments across the world. At the same time, we know that environmental breakdown, including climate change, is the biggest problem facing the human race and has not gone away when all eyes are on COVID-19. Climate change is a direct consequence of the way in which we have designed and run our global economic system. If we return quickly to the economic status quo, climate change will continue to accelerate and threaten the survival of many species, including the human one, within a few decades. But there is huge and perhaps understandable pressure, to do just that. Already we hear many calls for a return to normal, to get economies back on the road again and open for business. But a quick return to the status quo would see us step out of one frying pan into another. 

It is worth instead stepping back to the 18th century for a counter to this. Adam Smith is often said to be the originator of ’devil tak’ the hindmost’ market economics, but this is a misjudgement. He did say in the Wealth of Nations:

 ‘it is not from the benevolence of the butcher, the brewer, the baker that we expect our dinner, but from their regard to their own self-interest’. 

However, nowhere does Smith say that the butcher is not, or should not be, benevolent as a person.  His views on how trade should function within a society are well set out in the earlier Theory of Moral Sentiments, in which he states ‘how selfish soever man may be supposed, there are evidently some principles in his nature which interest him in the fortune of others, and render their happiness necessary to him.’ As Gordon Brown said in the Hugo Young Memorial lecture in 2005, ‘I have come to understand that the Wealth of Nations was underpinned by the Theory of Moral Sentiments, and that his invisible hand was dependent on the existence of a helping hand.’ And helping, we know, is often a compassionate action.

Smith’s approach to the economy is thus a direct predecessor of the concept of the Wellbeing Economy, in which humanity determines economics, not the other way round. Smith did not talk of growth but of ‘improvements’, and this should be how we think of the goal of economic policy beyond COVID-19. It is our task to ensure that a restored post-COVID-19 economy is an improvement on the old, that it allows us to return to meaningful work in a system that takes into account individual and planetary health, and thus addresses the challenges of intergenerational injustice, gross inequalities and catastrophic climate change. It must also address the spectre of mass unemployment, a significant post COVID-19 threat.

Sometimes, when people realise that they have to change, they will change. In our Universities now there is a huge focus on developing antibody tests, treatments and vaccines for COVID-19. These have been very quickly incentivised by Governments, industry and research funders, working often in concert.

However, we also need a focus on how incentives can help us better build a caring environment, which supports the many individual acts of kindness and compassion. The wellbeing economy approach (as championed by the Wellbeing Economy Alliance) to is to identify economic policies for a ‘great pause’, and then how to build back better. These represent a sensible—and compassionate—way out of here. Scotland’s membership of the Wellbeing Economy Governments(WEGo) since 2018 means that we have a head start.

We now need a strong parallel focus on economic research to identify how to create local, national and global economies for the future, both to avoid the secondary disaster of a great and long-lasting depression and to address the continuing challenges of climate change and persisting inequalities. Adam Smith would approve.

Professor John Gillies is Co-director, Global Compassion Initiative, Honorary Professor of General Practice, Usher Institute, University of Edinburgh. john.gillies@ed.ac.uk; @JohnGillies6  

Professor Liz Grant is Co-director, Global Compassion Initiative, Director, Global Health Academy, Assistant Principal for Global Health, University of Edinburgh. @lizgrant360

Katherine Trebeck is a researcher and writer on wellbeing economy matters, including for Wellbeing Economy Alliance. She is co-author with Jeremy Williams of The Economics of Arrival: ideas for a grown-up economy. Policy Press, Bristol, UK. 2019. @KTrebeck

References

Adam Smith: what he thought and why it matters. Jesse Norman MP. Allen Lane, London, 2018.