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.

The Innogen Institute is a collaboration between the University of Edinburgh and the Open University to produce research and support innovation in a profitable, safe and societally useful manner. It builds, nationally and internationally, on fundamental and applied research in science, medicine, engineering and social science. In April, the Innogen Institute discussed Professor Smita Srinivas’s co-authored article Economics and Public Health: a care for interdisciplinary cohesion in the time of coronavirus and the relevance of her work on the Covid-19 pandemic. Below is a summary of the interview by our COVID-19 Perspectives team. 

Professor Srinivas’s research focuses on economics, with emphasis on economic development, technological innovation, and industrial policy. One aspect is big picture economics for policy with relevant changes in the discipline, the other is microeconomics to examine empirically how technological capabilities, learning, and innovation evolve, which generate more or less useful developmental outcomes. For the last 20 years in addition to other industries, she has researched how vaccines and pharmaceuticals, with more recent work on diagnostics, come into being and are regulated. Although the perspective comes from economics, this research spans public policy and public health. Professor Srinivas explains that analysing the firms in these sectors reveals useful features of what they look like, how they perform, what they research or invest in, and how the learning and innovations that these firms generate are aligned with public benefit or are rewarded. From an industry dynamics viewpoint, public health is an industrial organisation problem requiring greater attention; the economics underlying public health – as with much of economics – is out of date. 

The economic discipline is, says Prof Srinivas, ‘deeply fractured’. This is affecting how we tackle several problems, including but not limited to: COVID-19, climate change, biodiversity, energy challenges, financial crashes, etc. She argues that students of economics today are not sufficiently taught the advances in domains such as evolutionary institutional analyses nor sufficient efforts made towards teaching a pluralist economics, which includes but is not limited to, what is termed ‘mainstream’ economics. Economists using a single or short list of methods are holding the discipline back, states Prof Srinivas, and ‘skewing public policy responses in a very alarming way’. 

Currently Prof Srinivas is overseeing two projects in India one involving several Innogen members and led by the Open University: Innovations for Cancer Care in Africa examines how India, Tanzania, Kenya and the UK address different types of cancer to ask questions on economics methodology and a comparative policy viewpoint. The second project is a long-standing research area and recent collaboration with public health and clinical specialists examining vaccine development and its economic considerations. She is also writing on diagnostics and covid testing. In many countries, COVID-19 is a threat but so are other diseases which are vector borne or infectious, such as dengue, H1N1, and which with others, may generate inexplicable fevers. Patients may come in with several confounding symptoms, which make diagnosing COVID-19 cases difficult and sideline other disease priorities for the country. Furthermore, the Technological Change Lab (TCLab) has launched an integrative initiative of Health, Industry and Ecology (HIE) to examine the resilience of food-health systems in the current context as well as in post-COVID-19 plans; the global organisation of the health industry; and comparative development lessons in and from India and other industrialising countries about relative successes around planning and policy. 

Prof Srinivas’s interest in these projects lies in the role of institutional change, including markets and their varieties, how they come to be and their regulation. Studying these factors is important in order to decide what policy responses should be and which non-market strategies to use. In the case of vaccine development, Prof Srinivas elaborates, market size and demand will determine if a private-sector led vaccine development initiative is reasonable, or which stakeholders should be involved. The seemingly infinite nature of the Covid-19 market and the frantic scrambling of companies to be the first, has left governments, donors and multilateral institutions overwhelmed and confused. Clarity on what types of markets are needed and why is essential, says Prof Srinivas, as are the instruments used. To this she points to the relevance of her 2006 publication on industrial procurement processes for vaccines that sped up learning at the level of firms, but which have reward and market design considerations for health impact. Attention to such policy instruments helps highlight the importance of a public stakeholder process built alongside industrial development: firms drawing on public resources or public data for example, might be required to create a different type of market. In any case, without taking the eye off public health outcomes, there are vital economic development considerations to be weighed, and the relevant economics that can best address this. Long-term economic strategies must be put into place for wider public benefit of technology transfer as well as private firm growth.

Summary by Ritti Soncco. Read the full interview on The Innogen Initiative website where the article was originally published: https://www.innogen.ac.uk/news/meet-our-researchers-prof-smita-srinivas

Prof Smita Srinivas is SGSS Professorial Research Fellow (Economics, Development) and Member of the Innogen Institute at The Open University (UK). In 2015 she received the EAEPE (European Association for Evolutionary Political Economy) Myrdal Prize for her book on the health industry “Market Menagerie: Health and Development in Late Industrial States” (Stanford University Press, 2012). She is the Founder Director of the Technological Change Lab (TCLab), a research platform, Visiting Professor at the National Centre for Biological Sciences (NCBS), TIFR, in Bengaluru, India, and Honorary Professor in the STEaPP department, University College London. 

If, like me, you find a measure of solace in comprehension, today’s global pandemic will likely represent a particular kind of intellectual discomfort. Though incisive perspectives are available, the geopolitical, sociological, economic and public health implications of Covid-19 are so vast and various as to frequently defy useful ad hoc analysis. The potentially cataclysmic consequences of this health emergency are intimidatingly numerous: transnational and localised, embodied and sociological, changing day by day. This coronavirus outbreak is ripples on ripples. It will take us years, if not decades, to fully come to terms with its implications on our social reality (if such a thing were even possible).

It would, however, be irresponsible to suggest that the impact of this virus was entirely unforeseeable. Prior to this outbreak, epidemics had not been assigned to the archives of history, or the mythology of Hollywood. Indeed, in recent years, SARS, Ebola and Zika all exposed the very real possibility and consequence of contagion. Better state preparedness was possible – warnings were issued and ignored. Western exceptionalism and colonial arrogance – long critiqued by any number of voices – likely prevented the UK government from learning more quickly, or more effectively, from South Korea and China. The policy of austerity wrought havoc on our national health system: its vulnerability to crisis was anticipated. There is a difference, after all, between struggling to comprehend the granularities of a specific social occurrence and knowing where the cracks are.

This is true for more than human health and infrastructure. Our social worlds are not random and arbitrarily structured, they adhere to regularities and to rules which shape individual chances and collective outcomes. As French sociologist Pierre Bourdieu observed ‘the games of life… [are] something other than simple games of chance offering at every moment the possibility of a miracle’. [1, p. 46] And of course, it is the task of sociologists and social theorists to explain these rules and regularities, as well as how they come to be, how they come to change and how they respond to pressure.

For a long time, critical social theorists, particularly feminist theorists, have argued that the logic of liberalism – a prevailing ideology within the western world – is premised on a political fiction. Put plainly, liberalism instructs that we, as human beings, are independent and unencumbered – relatively invulnerable to the vagaries of the social world, and our position in it. In turn, proponents of liberalism posit that – through ambition and endeavour – we can all sculpt out lives into whatever we desire them to be. No matter our backgrounds, or the resources immediately at our disposal, we can pull ourselves up by our bootstraps and strive. Black, white, gay, straight, woman or man – you can do it! The only thing that stands in your way, is you! If we flounder, are unsuccessful – poor and socially marginal – it is because we have failed or failed to try. If we are staggeringly affluent, it is because we have worked. We are neither victims of circumstance, nor the beneficiaries of privilege: we are masters of our fate and captains of our soul. This was the organising logic for Thatcher’s famous claim that there is ‘no such thing as society. There are individual men and women, and there are families.’

In the liberal imagination, then, dependency is abhorred: a condition of the very young, the very old, and the chronically, unforgivably lazy. Those who require income from the state are labelled morally reprehensible scroungers – maligned and blamed for their poverty. Parents who struggle to clothe and feed their children, are condemned for the irresponsibility of ever having children at all. Structural injustices are denied, and resistance to those injustices is framed as a politics of envy and unearned grievance. This is the logic we’ve built worlds around: businesses, schools, legal systems and social security provision, are all predicated on these assumptions. Individual responsibility, meritocracy and social mobility are celebrated, permeating our public discourse, guiding our behaviour and shaping our perspectives.

But liberalism is a fiction; we know it’s a fiction. What is more, we know that it is, always has been, and always will be, ill-equipped to understand or (in its instantiations) address the realities of the social world – whether quotidian in its violence, or unusually cataclysmic. We are not independent and unencumbered but, rather, heavily embedded in a network of relationships – with each other, the market, civic society, the state and so on. What’s more, the number, nature and quality of our relationships has a significant and enduring impact on our lives – supportive and lucrative relationships are asymmetrically distributed, as are the denigrating and impoverishing ones. In sum, the idea of a person invulnerable to the various (positive and negative) influences of the social world is absurd – a fiction sustained by the privileged, who would rather the formative nature of their dependencies be hidden, and their advantages read as the achievements of the meritorious. [2]

Covid-19 exposes the political fiction of liberalism, in both straightforward and complex ways. It demonstrates our inherent embodied vulnerability to others and to a world we cannot control: we are all, without exception, susceptible to the influence of each other and disease. And whilst reducing that susceptibility has been cast as an individual task, it nonetheless remains the case that its performance is heavily predicated on our relationships – to each other, to the market, to civic society, to the state. Our dependencies shape not only our ability to avoid disease, but the conditions within which we are able to do so. If our job is secure, our house safe, our communities supportive – we can relax in relative safety. If we live hand to mouth, in fear for our wellbeing, marginalised and excluded – a pandemic might not even register as an imminent threat. As Sarah Ahmed opined, ‘Privilege is a buffer zone, how much you have to fall back on when you lose something. Privilege does not mean we are invulnerable: things happen, shit happens. Privilege can however reduce the costs of vulnerability, so if things break down, if you break down, you are more likely to be looked after.’ [3]

But more than this, Covid-19 exposes the falsity of our social hierarchies, revealing the degree to which privilege depends on disadvantage – how privilege functions through extraction. We are only able to remain at home, fed and warm, because of relationships which were already very much in place before this pandemic occurred. We have not recently become – in the face of unprecedented crisis – dependent on factory workers, supermarket staff, delivery drivers, hospital cleaners, childcare providers and so on. We were always already dependent on groups of people routinely condemned for their relative lack of affluence. People who – despite massive endeavour – struggle to generate sufficient income but sometimes dare – nonetheless – to have children. Our dependencies have not only just materialised; their character has merely changed. And in this change, in this great unsettling, they have become visible. Coronavirus did not make society, it merely showed us it was there.

In a recent address to the nation, and in an obvious repudiation of Thatcher, the Prime Minister opined that ‘there was such a thing as a society’. Nice of him to notice. But his invocation of the term demonstrated a stunted and partial comprehension of its meaning. For him, society is a coming together, a collective endeavour, a performance of that mythological wartime spirit the British public always seem so excited about. But society is not necessarily a benign or benevolent force: it is a normatively ambivalent phenomena which can both support and stymie human flourishing. And at the moment, it is a system whose lifeblood depends on the sacrifices of the less advantaged. As I remarked in a recent publication, ‘Mainstream society makes itself tall by standing on the bodies of the marginalised.’ [4] How long do we imagine we can prevail upon such bodies to carry the weight?

It will be years, if not decades, until we fully understand the profound psychosocial, economic, political and cultural ramifications of Covid-19. The loss will be significant, the trauma profound, the ripples on ripples intricate in their manifestations. But we do know, have known, will know where the cracks are. And the lies of independence, meritocracy, the deserving rich and the undeserving poor, are some of the biggest cracks of all.

This article was originally published on the Justice in Global Health Emergencies & Humanitarian Crises webpage: https://www.ghe.law.ed.ac.uk/the-illumination-of-a-pandemic-by-rebecca-hewer/

Rebecca Hewer is a postdoctoral fellow with the Centre for Biomedicine, Self and Society at the University of Edinburgh. She is an interdisciplinary researcher, with an interest in critical social theory, whose work explores the socio-legal regulation of (women’s) bodies.

References

[1] Bourdieu, Pierre. 1986. “The Forms of Capital.” Cultural theory: An anthology 1: 81–93.

[2] Gilson, Erinn. 2011. “Vulnerability, Ignorance, and Oppression.” Hypatia 26(2): 308–32.

[3] Ahmed, Sara. 2014. “Selfcare as Warfare.” feministkilljoys. http://feministkilljoys.com/2014/08/25/selfcare-as-warfare/ (March 20, 2016).

[4] Hewer, Rebecca. 2019. “Vulnerability and the Consenting Subject: Reimagining Informed Consent in Embryo Donation.” Feminist Legal Studies 27(3): 287–310.

While human medicine takes centre stage, vets, vet nurses and researchers dedicated to caring for our pets and livestock, continue their work.

The University’s Easter Bush campus is home to some of the world’s foremost animal health experts. As with their counterparts in human medicine, they’re responding to the current crisis with innovation and dedication.

A number of researchers at the Roslin Institute are currently investigating various aspects of Covid-19 in an effort to find ways to combat the infection.

Continuity of care

At the Royal (Dick) School for Veterinary Studies Hospital for Small Animals, familiar to many members of the public for the care given to beloved family pets, work continues to provide diagnosis and treatment, albeit with adjustments. Keeping staff, students, clients and their animals safe is the first priority, with new methods of team working now in place, to minimise possible exposure to the virus.

Dr Sue Murphy is Director of the Small Animal Hospital: “By working within the Royal College of Veterinary Surgeons guidelines of seeing only urgent or emergency cases we are protecting the public and our staff, as well as ensuring the welfare of the animals under our care isn’t compromised.”

The Vet School has made available essential medical kit to NHS Lothian, with the provision of four ventilator machines and the donation of 450 surgical masks, and a quantity of surgical scrubs.

Looking after livestock

Large animal care responsibilities also continue for staff and students at Easter Bush. For many in the agricultural industry, Covid-19 could not have come at a worst time, as spring lambs and calves are born. The University’s Farm Animal Hospital and Practice provides essential advice to farmers and vets around the UK.

Keeping the nation fed requires healthy, productive livestock, meaning the role of vets and vet nurses is crucial. These professionals have adopted new working practices that enable them to continue to attend sick animals, while minimising contact with others.

Online support

With campus teaching suspended, keeping in touch online has become evermore vital. One example the Vet School has employed is the ‘Bit of Fresh Air’ Facebook sessions. Hosted every Monday afternoon for vet students, the interactive sessions are led by Lecturer in Veterinary Clinical Skills, Caroline Mosley.

Caroline says: “There is a very strong feeling of cohesiveness at Easter Bush, so losing this at a critical time of the year – in the run up to graduation – we wanted to give our students some way of staying in touch with staff. We have had some lovely feedback from students, saying they are missing Scotland and the University and that it was lovely to be on the live video and just see a bit of the outdoors, plus the animals that feature in them have been popular too.”

Making a difference

Staff and students are also volunteering at local charities, such as the Cyrenians and Trussell Trust, which support people who are disadvantaged and living in poverty.

Julian Mashingaidze, in his first year of a BSc in Global Agriculture and Food Security, says that while tiring, his voluntary work in a distribution warehouse has been very rewarding: “The Covid-19 situation had led me to start feeling useless and demotivated, but through helping out I have found a purpose. It has helped immensely with my mental health, which I’d been struggling with recently. Now I’m doing something that uplifts the local Edinburgh community while keeping me busy.”

Practical assistance has also been the aim of Amanda Warr, a post-doctoral researcher at the Roslin Institute. She has used her own 3-D printer to produce plastic components for face shields. These are used by front line NHS and care staff to protect themselves.

Amanda has already produced parts for more than 500 shields: “We get sent photos of workers wearing the shields, which is lovely and really reminds you that every shield is helping to protect a real person who is in a dangerous situation. It is heart warming to see them, and of course we are very grateful for everything they are doing.”

Donations to help Amanda’s efforts can be made at her GoFundMe page, here.

For Professor David Argyle, Dean of Veterinary Medicine, the key to overcoming this crisis is by calling upon the sense of unity traditionally enjoyed by staff and students at Easter Bush: “We have always had a really strong sense of community. These efforts to support the greatest public health crisis in decades shows our students and staff working together at their best through hugely challenging circumstances.”

This article was originally published on the University of Edinburgh Covid-19 Responses website: https://www.ed.ac.uk/covid-19-response/our-community/animal-care-remains-priority-during-covid-crisis

Ranald Leask is Corporate Communications  Manager for the University of Edinburgh 

In recent months, people’s mobility has been synonymous with the transmission of Coronavirus, and the Covid-19 pandemic has had a devastating impact. Global economies are in peril and the very future of humanity has been seriously threatened. Currently, there is almost no country in the world which has not been affected. Countries have adopted various measures to tackle this threat. Complete or partial lockdowns in mobility, in tandem with social distancing, have been seen as the most important primary measures to minimise infection rates.

Global lockdown and its impact on low-skilled and unskilled migrants

Considering how contagious Coronavirus is, most countries are following lockdown guidelines, which have created nightmare situations for many migrant workers. For example, India’s swiftly imposed lockdown has created havoc in the lives of migrant workers, causing suffering and uncertainty, as these workers have had no time to plan and prepare. They were forced to pack up their belongings and head home, and all within four hours. Within a short time, hundreds and thousands of migrants were out on the street, starting their journeys home.

Regional and global news channels showed images of migrants stranded in railway stations and walking along India’s long dusty roads. The sight of these men and women, some with babies on their backs, and carrying their possessions, was reminiscent of similar historical journeys made in 1947, at the time of Partition, when the Indian Independence Act came into force.

Following government-imposed lockdowns in several countries, the Nepal Embassy in New Delhi (and also in the Gulf states) issued a notice that all Nepali migrants should stay where they were, and not to break the government’s advice. They were not to travel, they were to maintain a social distancing policy, and to follow Government advice. However, as Nepali migrants in India revealed, many had nowhere to stay. They lost their jobs when factories, shops, and businesses were closed and construction sites halted, and landlords then asked them to vacate their accommodation.

Similarly, reports from journalists from the Gulf States have begun to emerge about the situation of Nepali migrants and of other migrants in Qatar, UAE, and in other countries, who were also left stranded following the lockdown. Despite the Covid-19 outbreak and social-distancing advice, some migrant workers have had to continue to work on the construction sites for the Qatar Olympics, and their lives remain as usual. A large number of migrant workers – Nepalis and other nationals – live in small over-crowded dormitories and have little choice for social distancing and self-isolating. A notable rise in Covid-19 cases in the Gulf States has been reported, with the majority of positive cases being migrant workers. The health and wellbeing of migrant labourers has always entailed a higher degree of occupational risk, even before the Covid-19 outbreak, as employers rarely put the needs of migrant labourers before profit. The crowded accommodation and the lack of choice about social distancing for low-income migrants means that the Covid-19 crisis will continue until migrants’ accommodation and other issues are addressed. Countries in Asia are already experiencing a second wave of Covid-19 transmission and migrants are hit the hardest by this.

Time for better welfare and justice for all migrants

It is clear that the concept of ‘social-distancing’ is achievable only by the most privileged groups in societies, not to those living in slums in Mumbai, Dhaka, and on construction sites in Qatar. When migrant workers lose their jobs and are evicted from their accommodation, social distancing becomes impossible. Most governments seem to have given little thought to the plight of migrant workers, and have failed to adopt any measures to support these underprivileged groups. The safety of vulnerable migrants has been an issue of low priority for employers and the governments of destination or home countries. Nepali and Indian authorities have turned a blind eye to the hundreds and thousands of workers stranded in India, and those at the India-Nepal border. Now is the time for us to learn a historical lessons from this pandemic: that all migrants should have access to basic social security and living wages; that governments should treat migrants with compassion, dignity, and respect. In global efforts to manage and control a pandemic effectively, the rights and welfare of migrant workers should not be sacrificed.

This article was originally published on the Justice in Global Health Emergencies & Humanitarian Crisis website: https://www.ghe.law.ed.ac.uk/nepali-migrant-workers-during-the-covid-19-crisis-by-radha-adhikari/

Radha Adhikari is a Research Fellow in SSPS, and currently working on a project examining the ‘Documentation of Nepali migrants’ death, injury and ill-treatment in transit and destinations’. Currently, the research fieldwork has been on hold due to Covid-19 outbreak.

Why did Croatia, Slovenia, Montenegro, Bosnia and Herzegovina, North Macedonia, Bulgaria, Hungary, Serbia and Ukraine respond much better than other countries of the European Union?

Nearly a month ago, I stressed that Croatia was the country with the lowest percentage of newly COVID-19 infected persons in Europe during the two weeks from the 2nd to the 17th of March, 2020. This means that our “first line of defense” did an excellent job. Then we went into quarantine at the right time, at a much earlier stage of the spread of the epidemic than pretty much anyone else in the European Union did. We have all become “Quarantine Croatia”, so I joined forces with our famous mathematician Toni Milun to explain together just how we came to be in this situation at all.

In mid-January 2020, a number of friends from Croatia suggested that I should start a new popular science series on Facebook in order to follow the COVID-19 epidemic in Wuhan. I called my Chinese colleagues at the time, asking them to briefly describe what was happening there. They conveyed a few simple but very helpful messages. What surprised me the most was the thought of putting 56 million people in quarantine for an extended period. That, then, on the 17th of January — so, just three months ago — sounded like a completely radical idea. But when I found out more, and then one week later — on the 23rd and 24th of January — I noticed that they’d indeed closed off Wuhan and fifteen other cities, I realized that it was an almost surreal event. One that was certainly worth following and writing about. Thus, on the 29th of January, “The ‘Quarantine of Wuhan’’ series began and in Croatian, it attracted more than 30,000 followers on Facebook, than 500,000 in Croatia’s media space when I started writing it for “Vecernji list” newspaper. The online version gets picked by other news portals, so it is now reaching more than 1 million people across the 6 countries from the former Yugoslavia.

My Chinese colleagues told me that more and more people with some sort of unusual pneumonia began to show up at Wuhan’s huge hospitals on a daily basis. That would usually drag on about ten days without responding to any sort of antibiotic therapy. Some people soon required additional oxygen or mechanical support to help them to breathe. When the doctors themselves became infected, the fear would grab them. How could it not? It was an unknown cause of pneumonia, and about one in ten patients would die even with hospital treatment. But what would surprise them was that the infected doctors had generally mild symptoms. They didn’t understand how it was possible that these infected patients were in such a poor condition but the infected doctors seemed much better if the cause of their respiratory infection was the same.

The answer to that enigma, however, could be found by looking through hospital windows to the streets of Wuhan, with its eleven million residents. To epidemiologists, such a rift of symptoms was a clear signal that an epidemic had to have been spreading rapidly among the population of that city for some time. It would be causing a broad spectrum of symptoms in different people. In the vast majority of those infected, the symptoms would be rather mild or moderate, so they would never report to the hospital. Symptoms would be worse in about fifteen percent of people and they would struggle to breathe, report to Wuhan’s hospitals and require extra oxygen. Only the remaining five percent of those affected with symptoms would end up in critical condition, in need of ventilators and intensive care. They further noticed that when doctors transmitted this unknown virus to other patients in the hospital, it would also kill about one in ten people who were infected. Those were mostly people who already had other serious illnesses. Men, smokers and older people were the most high-risk groups.

The doctors in the hospitals saw only that extreme part of the spectrum of the sick — serious and critical cases. Other infected residents, those with mild and moderate symptoms, walked around Wuhan spreading the infection at a rapid speed. Epidemiologists in Wuhan realized that the new illness would therefore not kill every tenth person it infects, but maybe every 100th person, maybe even every thousandth, depending on how many infected were there in the streets already.

The number of deaths in the hospitals could be used as a numerator, but all infected residents of Wuhan outside the hospital should have been placed in the denominator, i.e., the numerous people with milder symptoms. At the beginning of the epidemic in this city of eleven million people, no one knew if there were already a thousand, ten thousand, a hundred thousand, a million, or perhaps even ten million infected people. Therefore, quarantine had to be declared immediately. It was urgent to stop the ongoing exponential spread and only then explore what was going on.

***

It then became clear that COVID-19 was not an illness that primarily kills owing to the sheer severity of its symptoms. This was an illness that kills with an incredibly high rate of spread among the community. This spread leads to a tremendously rapid increase in the total number of infected people. With five percent of them falling critically ill, this would generate vast numbers of critically ill people, all of whom could no longer receive adequate care. That is why, for every deceased person who couldn’t be saved, there were several others who probably could be, but they all came in for treatment at the same time.

This overloaded the hospital’s intensive care facilities. My colleagues in China have told me that, after all the bad news from Wuhan that we’ve heard in the mainstream media, it would probably surprise us how relatively mild it is for most infected people once it reaches our part of the world through tourists or seafarers. They told me that the illness itself is not to be feared, but its rapid spread should be. Therefore, three things are crucial to its control:

(1) The spread from China to other countries should simply be stopped by the “first line of defense” — the constant isolation of the infected people and their contacts. This approach had proved successful and stopped two previous coronaviruses, SARS and MERS — although both of them had managed to spread to more than twenty countries from China and Saudi Arabia, respectively. Therefore, it seemed likely that this would work for COVID-19, too.

(2) We must be extremely careful if a virus manages to break through the “first line of defense”. That is when all those infected people with milder symptoms will start spreading it to the population very quickly, aided by the “super spreaders” that infect many individuals. Then the rate of increase in the number of cases can make anyone unpleasantly surprised and catch them entirely unprepared.

This is because the infections we’re confirming today reflect the spread of the infection days earlier and not the current situation. Between the infection and the diagnosis of the symptoms, there is a period of “incubation”, which lasts about a week. Therefore, if we diagnose 100 infected people on Saturday, we gain information about the spread of the infection since last Saturday. But during those seven days, the virus has spread rapidly, so today it has, in fact, infected more than 1,000 new people — who will only become visible to us next Saturday. This is the problem of “silent”, invisible, exponential growth, which isn’t intuitive to the human brain.

In short, the actual current state of the spread of the COVID-19 infection is always significantly worse for us, as the current number of confirmed cases indicates — about ten times worse. Therefore, if the virus breaks through the first line of defense, the key decision becomes to declare quarantine as soon as possible. In this way, the virus can’t escape our control and start infecting healthy individuals exponentially. The effects of quarantine will not be visible immediately, but only in a week’s time or later. Until then, terrible losses will be suffered if a state of quarantine is declared too late, as it happened in Italy and some other EU countries.

(3) Surely, we must take great care to prevent the virus from entering our hospitals or nursing homes, as it can create a huge amount of fatalities among patients who are already old, ailing and impaired. These three points are the standard epidemiological measures of protection, so it was quite clear what to do when COVID-19 knocked at our door. I began to closely monitor the results of the quarantine effect in Wuhan, but also a comparative increase in the number of cases in Europe.

***

One of the most important days of COVID-19 pandemic, at least so far, was probably the 8th of February, 2020. Thanks to several consecutive days of declining infections in Wuhan, it became clear that the epidemic in China was beginning to wane and would virtually be extinguished over the coming weeks. It was great news for all of us. It meant that the COVID-19 epidemic can, in fact, be suppressed even if the virus breaks through the first line of defense.

From the 8th of February to the 21st of February things were constantly getting better globally. The number of newly infected individuals in China had been steadily declining. China’s surrounding countries that already learned their lesson from the experience with SARS — Singapore, Vietnam, Taiwan, and Japan — “caught” the virus that spread from China using their first line of defense. They controlled it with a stricter regime along borders, with frequent testing and the isolation of the infected and their contacts. They didn’t even need a quarantine, as the first line of defense produced good results.

Furthermore, with the exception of three cases in Australia and one case in Argentina, there were no recorded deaths from COVID-19 in the entire Southern Hemisphere. It gave us all hope that COVID-19 would actually prove to be a seasonal virus and disappear from the Northern Hemisphere with the arrival of late spring and summer. And in Europe and the US, very rare cases of the disease were being easily ‘’captured’’ by their first lines of defense, which identified those who were affected and isolated them and all their contacts.

Since the 21st of February, however, South Korea and Iran unexpectedly came into focus. The former of the two countries had a really awkward incident, which I’ll describe in one of the future sequels as an example of another successful way to fight this virus. They were able to extend their first line of defense quite broadly and deeply and avoided quarantine. On the other hand, very little was known about the developments in Iran. I was worried that this country could eventually become the biggest problem with COVID-19 because it was the first less developed country in which the virus began to spread freely. On the positive side, however, Iranian epidemiologists are very adept at combating infectious diseases.

I also noticed that Italy jumped from 3 to 20 cases on the 21st of February. I assumed that this may be due to a group of infected tourists traveling together or perhaps a small epidemic within a retirement home. But on a day-to-day basis, on the 24th of February, Italy reported a total of 229 infected people, while other European Union (EU) countries had only a few cases and still controlled the epidemic relying on their first lines of defense.

***

When I landed in Zagreb four days later, on the 25th of February, Croatia diagnosed its first citizen infected with the novel coronavirus. Italy, our neighbor at the other side of the Adriatic Sea, already counted 322 infected by then. The virus had already penetrated their first line of defense by then, so I expected that they would declare a quarantine for at least the Lombardy area the very next morning.

If they’d already registered 322 infected people, it meant that there must have been many more infected in the population. However, the situation in all other EU countries was still calm. Their first lines of defense were expected to successfully control the entry of the virus. Any country within the European Union that got into trouble trying to contain the virus could always be isolated from the others in case of need. Italy was a pretty well-isolated country in terms of its geography anyway. I was assuming, in fact, that Italian authorities in charge of pandemic response would have had some additional reports from China, based on which they would have calculated their hospital capacity. It was plausible to conclude, at that point, that they were eager to preserve Italian tourism and the economy for as long as possible and prepare people for quarantine, which they’d obviously have to declare as the first such country in Europe.

Having landed in Zagreb, Croatia, I was really amazed by the panic that gripped people when they heard that our first case had been confirmed. I knew that our first line of defense could easily deal with sporadic infections. Meanwhile, the global situation was getting better day by day. For epidemiologists, the most important of all indicators during an epidemic is the transition of the number of newly infected cases from exponential growth to a linear growth, which indicates that the epidemic spread has greatly slowed down. The growth was exponential until about the 17th of February and then linear from the 17th of February to the 1st of March. After this “linear” period of growth, the epidemic is largely expected to enter into a final stage. This includes a steady decrease in the daily number of new cases and flattening of the curve that visualizes their growth. The epidemic ends when the curve becomes parallel with X-axis, which measures the time since the first confirmed case.

While I was in Zagreb, from the 25th of February to early March, all of the available data at the time fuelled the real hope that the first lines of defense of all developed countries would successfully stop it. There even seemed to be a good chance that the virus was indeed seasonal. We already knew that all Chinese provinces to which the virus had expanded from the Hubei province had already stopped and suppressed it — some thirty of them. Japan, Singapore, Taiwan, and South Korea had also succeeded. So why wouldn’t it be stopped by the EU and the US?

Owing to all that reassuring burden of evidence, panic in Zagreb didn’t really seem appropriate to me. As my return coincided with the first recorded case, the cameras of many televisions ‘’stumbled’’ upon me unexpectedly during a guest appearance at Edward Bernays University College, where I gave an invited lecture. At that time, I tried to allay concerns among the journalists and the general public, knowing that all epidemiological measures were delivering results globally. The virus was already under control in China and it was held back by the first lines of defense elsewhere.

When asked what kind of ailment was approaching our borders, I compared it to “more severe flu, but for which we don’t have a vaccine.” As an epidemiologist, I knew that severe flu season could lead to about 500,000 to 650,000 deaths a year, and without a vaccine, it would cause well over a million fatalities in the world.

It didn’t seem to me that COVID-19 could reach those numbers of deaths, given that it had been effectively halted in China at less than 5,000 deaths, and elsewhere the situation was quite calm. But what I wasn’t aware of was how little of a danger people in Croatia associate the flu with today. Unfortunately, this misunderstanding still follows me around in many conversations. Then, on the 1st of March, I explained on a very popular Croatian TV-show “Sunday at 2.00 pm”, that was watched by close to a quarter of the country’s population, that Croatians had no reason to panic. Unless the virus mutates, it could hardly endanger more than 0.5 to 1 percent of all infected people.

I also stressed that it would not endanger the younger age groups, but mostly those over fifty years of age. Also, I explained that it can’t even infect us all, because infecting the entire population would also become self-limiting at some point when the herd immunity threshold would be reached. To this day I didn’t need to change any of these predictions. However, after my appearance on that show, incredible things began to happen — as if it all suddenly became a nightmare designed for an epidemiologist.

First, on the 3rd of March, WHO Director Tedros Adhanom announced that the COVID-19 case-fatality rate so far had been 3.4%. This was not entirely inaccurate, because he explained that this was the death rate among all those who were positively tested, but not among all of those who were infected. Therefore, it wasn’t really a useful piece of information to communicate to the public as it magnified the real risk. Specifically, this figure of 3.4% was a combination of the case-fatality rate of hospital infections among the elderly and sick from Wuhan and Italy, which was as high as 5–10%, and the death rate when the virus has spread in the community, which is typically about 0.5–1%. Therefore, it wasn’t actually representative of either situation.

But how could I explain to anyone that the director of the World Health Organisation in Geneva doesn’t understand how confusing it was for the concerned public to hear such a high figure, which was perhaps five times larger than the one that was really more applicable? To make matters worse, though, he was first opposed by United States’ President, Mr. Donald Trump, who called that number “wrong”. I could understand that he was largely correct in doing so. Suddenly, I found myself in a situation where I had to explain to many of my fellow Croats that I wasn’t deliberately downplaying the danger of COVID-19 when I estimated the case-fatality rate, applicable to the whole population, to be 0.5–1%. And next to me, united in this view and opposing the director of the World Health Organisation in Geneva, stood Donald Trump. No wonder that many people who were trusting my assessment of the pandemic were about to lose their minds at that point. Fortunately, many other experts came forward over the next few days, confirming the estimates of 0.5–1% to be far more realistic at the population level.

Thus, I spent the days between the 5th to 7th of March trying to explain the applicable case-fatality rate in three consecutive long posts on Facebook, which attracted a flurry of comments. All of this at least contributed to my first notable newspaper column in Index.hr, which was a “long read” providing answers to 20 confusing initial questions about COVID-19. This column opened a series of columns that provided a health education campaign on COVID-19 which I then continued writing for the “Vecernji list” (Evening Herald) newspaper. As I mentioned, the series of columns attracted a large audience across six countries from former Yugoslavia — in addition to Croatia, it also gained influence in Slovenia, Bosnia and Herzegovina, Serbia, Montenegro, and North Macedonia. I hope that my series helped many to understand quite a bit more about the threat we were all facing. It also helped to reduce the noise and “infodemia”, working to oppose a deluge of unsubstantiated claims that were circulating in the media. However, as I was writing my columns, I also kept looking at the numbers of newly infected people around the world through the corner of my eye.

Suddenly, the situation in Italy was no longer clear to me. However, it got worse — the situation in the whole of Europe became a blur. What was everyone waiting for, why didn’t they declare quarantines? On Saturday evening, the 7th of March, Austria already had 79 cases, Sweden 161 cases, Belgium 169 cases, Switzerland 268 cases, Spain 500 cases, Germany 799 cases, France 949 cases… and Italy had 5883 confirmed infected people?!

Looking at all these figures, I was growing deeply concerned — and I just couldn’t believe the Italian situation. Their numbers indicated that they already had at least 60,000 infected people who were spreading the infection and that number would grow exponentially for at least another several days, even if they were to have declared quarantine the very next day. Whatever happens, from that point it was entirely clear that everyone in Europe would have to be quarantined, regardless of the fact that we in Croatia were still holding up with our first line of defense.

The next day, on the 8th of March, Lombardy was quarantined, but the news leaked to the media too soon. Numerous students fled to the south of the country, spreading the contagion. The whole of Italy was then quarantined. On the same day, on the 8th of March, I wrote a column “The Justification of the Huge Quarantines” where I explained the problem of a remarkably fast exponential growth in numbers of infected persons as a key problem of the COVID-19 pandemic.

It was clear to me at that point that we’ll have to be quarantined in Croatia in a few days. I started counting when it would be best to declare this. I figured that the first major jump from 10 to 20 infected people would be a good time. The number of infected people who would develop a severe form of disease would then, with a little luck, only rise to a very manageable level. Our health system should have a good chance of helping everyone, with a truly minimal number of serious cases of infection and hardly any fatalities, if we manage to avoid epidemics in hospitals, rehabilitation centers, and retirement homes.

That jump, from 14 to 19 infected people, happened on the 11th of March. At 3:00 am on the 12th of March I immediately posted a Facebook status with a new column that was spread through the Croatian online media space the very next day. It was entitled “Contrast is the mother of clarity”. It explained that we had the option to either quarantine very strictly within the next 30 hours and then cure the severely ill as they emerge. However, we could also choose to gamble and let the virus spread, hoping to save the economy and preserve normal life, but also prepare for a fairly large number of deaths. I knew that our epidemiologists in Croatia were looking at these figures and thinking about them, too. Therefore, I wanted to give them the support and confirm that the science was sound and fully behind them and that they weren’t wrong. It was, however, a rather unbelievable decision — to ask the whole nation to temporarily self-isolate.

In the Croatian case, that decision was further complicated. Namely, Croatia was holding the rotating Presidency of the European Union. On the 12th of March, it only had 19 persons who were confirmed to be infected and we were thinking about closing our borders. Other countries of the European Union, however, had already reported hundreds, if not thousands of infected people. Their numbers were growing exponentially, but they were not even suggesting such a move yet. I was pleased to see that as early as Friday, on the 13th of March, a decision was made to close the schools, sending a message to the population that Croatia was withdrawing into self-isolation.

We locked our country up exactly when we needed to, so we didn’t have to worry about too many infected cases. Before that, during the two weeks of March the 2nd to the 17th, Croatia was the country with the lowest percentage increase in newly infected cases in the European Union. That meant that our “first line of defense” did a great job and endured for the longest period of time. Then we went into quarantine at the right time, at a much earlier stage of the spread of the epidemic than most other European Union countries did. This has prevented a very large number of infections so that we don’t have to treat them.

A similar sequence of events also unraveled in other countries in Eastern Europe. The whole region of former Yugoslavia watched each other closely and moved into quarantine at the similar time, between the 13th and the 18th of March. Slovakia, Bulgaria, Hungary, Romania, and Ukraine all followed. It was favorable for all these countries, in a sense, that they do not have so much traffic and international transit as do some other countries in Central Europe, because Czechia and Poland fared quite a bit worse. In the countries of former Yugoslavia, we were certainly helped and influenced in all steps by the legacy of the great Andrija Stampar, a pioneer in public health globally. We also had a relatively recent war experience which forced us to re-read the books on the epidemiology of infectious diseases. Wealthy countries of the European Union did not have a reason to do this. But now that we are in lockdown, if anyone thinks this is the end of these dramatic events now, I’m afraid that they would be deluding themselves. This is just the end of the beginning.

This article was originally published on:  https://medium.com/@irudan/initial-response-to-covid-19-how-did-eastern-europe-get-it-right-cd20d53124dd

Professor Igor Ruden is Professor of International Health and Molecular Medicine at the Usher Institute; Director of the Centre for Global Health and the WHO Collaborating Centre at the University of Edinburgh, UK,  and Editor-in-Chief, Journal of Global Health

On 27 April 2020, the Students of Medical Anthropology (SoMA), a student-body subgroup of the Edinburgh Centre for Medical Anthropology (EdCMA), held their annual Symposium virtually. This year’s symposium was entitled ‘Uncertain Futures, Uncanny Present(s)” and was divided into two sections: what the covid-19 pandemic reveals and what the covid-19 obfuscates. The call for papers was open to postgraduate students and early career researchers regardless of university and discipline, and encouraged think pieces, works-in-progress, or completed articles discussing the impact of covid-19 on their research. Students from various British universities attended as speakers and audience members.

The Symposium highlighted how covid-19 is transforming PhD research in wide-ranging fields, regardless of academic focus or geographic locality. More importantly, however, the Symposium revealed the creativity, adaptability, and re-imagining made possible by the PhD researchers. In the concluding remarks, the participants brainstormed together that the overarching themes of the presentations demonstrated:

• Even disruption and absence can be data. Paying attention to these moments of interruption is important.
• The importance of resisting the naturalising of responses to the pandemic. These are not automatic responses; they are political. Anthropology is well-placed to highlight and explore this resistance.
• Covid-19 has dismantled the division of a researcher’s ‘home’ from a researcher’s ‘field’. Research at the moment is beyond anthropology at home.

The Symposium further served to provide some normalcy during the lockdown, offering students the opportunity to network, receive feedback on their work, and re-experience a conference setting at a time when academic life is disrupted.

Overview of papers

‘Reveal’

• The wisdom of Lyme disease patients – Ritti Soncco
• Healthcare in Bangladesh – Janet Perkins
• Social distancing in India – Jordan Mullard
• Healthcare in Taiwan – Yi-Cheng Wu
• Abortion pills access in the UK – Leah Eades

‘obfuscate’

• Military metaphors in Covid-19 – Iona Walker 
• Houses as public health technology – Imogen Bevan  
• Re-imagining death – Tara Pollak
• A world without touch – Andrea Lambell  
• Hospitals as environments in suspension – Cristina Moreno  Lozano

Summary of the Presentations

Ritti Soncco (University of Edinburgh) conceptualised that in this new world created by covid-19, those holding a torch and a map are people who have lived with chronic illnesses for years. Her interlocutors, people living with Lyme disease in Scotland, reacted with familiarity and preparedness to the lockdown, stockpiling and social distancing, enabled by years of experience due to their chronic illness. She explored her theory that these new and frightening ‘states of pandemic’ are, to the chronically ill, continued ‘states of normality’. In this world, nothing has really changed. This highlighted that the panic and fear many people felt at the start of the pandemic is a panic and fear Lyme disease patients have lived with for years. Her paper then elaborated on the lessons and advice her interlocutors gave to prepare the public for lockdown, concluding that now is an important time to remake visible those made invisible by their illnesses. Her paper is available here.

Janet Perkins (University of Edinburgh) described how covid-19 has highlighted the fragmentation and weakness in both the private and public health sectors in Bangladesh. Social distancing is a hard product to ‘sell’, where the ‘self’ begins with ‘the family’ and a crowd is more cosy than suffocating. Rather than a social good, healthcare is conceived akin to ‘charity’. The private sector, unregulated by the state, has the luxury of deciding if and when it would engage in the battle with covid-19. Some closed their doors; others rented out their beds to the elite in case these become sick. Until then, the beds remain empty. Perkins’ research concluded to explore how covid-19 revealed who could access healthcare and who couldn’t, as well as who was on the frontline – and who could opt out.

Jordan Mullard (University of Durham) questioned what it means to be ‘socially distant’ in India, describing two forms: vertical and horizontal. Vertical social distancing has been present for a long time in the form of caste and class. Horizontal social distancing, the harder one to enforce, takes place among people within the same group. The attempts to enforce social distancing as a duty have revealed that social distancing is a luxury because to be near is a necessity. She further questioned what duty means in a setting where solidarity, resistance and resilience are created through nearness. What are the associated moralities with this? Mullard argued that for this, it is important to engage simultaneously with moral anthropology and the anthropology of moralities, in order to explore duty, kinship, mutuality and responsibility. She concluded with the question: “Is duty to shame what guilt might be responsibility?” This paper is a work-in-progress with an upcoming publication. 

Yi-Cheng Wu (University of Durham) is currently witnessing covid-19 as a doctor in Taiwan and deconstructed what has been called Taiwan’s ‘advanced deployment’ strategy. His paper argued that war politics are never easy to measure, depicting how patriotic symbolism prevail and government officials are celebrated as ‘national heroes’. Expanding upon Taiwan’s medical strategy, Wu described medical staff as aggressive resisters of strategies, highlighting their demands for upgrades. Such upgrades, Wu exemplified, are thermal cameras at hospital entrances, and insurance cards which record a patient’s travel history data and can be read in card readers. Wu argued that the logic of ‘advanced deployment’ reveals Taiwan’s struggle for international recognition.

Leah Eades (University of Edinburgh)  opened with an international overview of abortion in the era of Covid-19, from Argentina to Poland. She described how some countries had attempted to implement stronger anti-abortion measures, using the lockdown as a means to bypass public protests, or by proclaiming abortions ‘non-essential’ elective procedures. Focusing then on England, Scotland and Wales (where the 1967 Abortion Act applies), she described the recent introduction of telemedicine abortion. In Northern Ireland, however, the government argued it did not have the resources to begin providing abortion services during the pandemic, stating women would need to travel to England for abortions in spite of the lockdown; following a 10-day standoff, the government now offers abortions in clinics, although not remotely as in the rest of the UK. Eades argued that Covid-19 has revealed a major reconfiguration of abortion access, with infrastructures affecting who can and who cannot access abortions of various kinds during this time. Equally, while medication abortion provides many opportunities, it is not available or appropriate to all. Eades concluded that the crisis reveals both the possibilities and shortcomings of abortion pills and a need to address the broader structural issues in which they are used.

Iona Walker (University of Edinburgh) asked in a more-than-human-world, what are the consequences of military language in response to threats of contagion and how do these differ for slow and quick crises? Walker explored covid-19 as a ‘fast’ crisis with military language transforming the social, political and material world of hospitals as warzones, masks as protective armour and political offices as war rooms – contrasting this with AMR as a ‘slow burn’ with consequences for shaping the movement of resources for an ‘arms race again bacteria’ and imagining bodily landscapes of fortress against superbugs. Her upcoming research seeks to understand the limits, possibilities and consequences of military language for human and microbial relationships and how these might be imagined differently.

Imogen Bevan (University of Edinburgh) deconstructed the NHS campaign ‘Stay Home, Stay Safe’ in her presentation. In Britain, home confinement seems to provoke little controversy, understood as a sacrifice willingly made in times of pandemic. Bio-surveillance technologies on the other hand provoke profound moral discomfort. Why is this? Isn’t the house also a technology of sorts? What is being expected of the house? And what might houses in times of covid-19 reveal about social relationships and values in contemporary Britain? Reflecting on past public health interventions on  and through  the house, Bevan’s talk explored the implications of rethinking houses as a public health technology of preparedness.

Tara Pollak (University of Edinburgh), whose PhD research is about pregnancy loss, used her paper to explore death during covid-19. She considered the narrative of ‘heroic death’ in relation to NHS workers, in contrast to ‘neglected narratives’ of deaths not reported, e.g., due to cancelled surgeries, reduced services, accidents or age. She explored the new productions around managing death, from the disruption of social and emotional networks to altered emotional labour of bereavement, asking how these deaths will be remembered and understood after the pandemic is over. “Death itself has become viral”, Pollak argued, concluding to ask: Will the current situation result in a memorialisation of essential workers? What are the socio-political implications of such memorialisation? Are we going to re-think how we report deaths in public health statistics and make sense of such numbers in emotionally intelligent ways? Are we going to talk about funeral poverty and the ways in which people relate to the dead socially, spiritually, materially?

Andrea Lambell (University of Durham) had planned her fieldwork around massage ethnography in palliative care – but in the world created by covid-19, ‘touch has become the thing we all crave and the thing we all fear at the same time’. As she cannot currently conduct fieldwork, Lambell has shifted her focus to explore what is hidden when touch is taken out of the communication repertoire of palliative care. ‘Covid has taken away my toolkit, it has taken away from all massage and touch therapists,’ she states. How will this gap be bridged? How do we reach out to people who are hidden, dying on their own? ‘If we are afraid of touch or becoming close physically to people, we as friends, family, neighbours, will struggle further to give end-of-life care,’ Lambell argued. Her new project will thereby explore non-verbal, non-tactile communication and how the loss of touch obscures communication. 

Cristina Moreno Lozano (University of Edinburgh) discussed how antibiotic stewardship programmes in hospitals and the problem of antimicrobial resistance (AMR) have been interrupted. Healthcare workers can think of nothing other than covid-19, they are exhausted and have worked heavy shifts for over 50 days by now. She argued for a perception of hospitals as more than buildings: they are enclosed environments, habitats, containing infrastructures, relationships, and technologies all at once, where microbial-human relationships are experienced and governed. Her paper was dedicated to the La Paz Hospital in Madrid, one of the most heavily transformed hospitals in Madrid to treat covid-19 patients in the past weeks. As an iconic feature, it represents a familiar skyline, reflections of privatisation and austerity, and unkept promises. The photographs she shared highlighted the hospital as a space/place which produces social value and mobilised affects, much as Alice Street, Janina Kehr or Fanny Chabrol have shown in their hospital ethnographies. Hospitals during the covid-19 pandemic are an enclosed environment where – resistant or non-resistant microbes, affected technology, care, experience and control relate to each other. All these things, argued Moreno, were already there before covid-19. What has changed is that covid-19 has put her project, antimicrobial stewardship programmes, and the La Paz Hospital into suspension, and now we can somewhat see what these hospitals ‘contain’ in greater detail.

Researchers from the Physical Activity for Health Research Centre (PAHRC) in Moray House School of Education and Sport have been contributing to a series of blogs in the British Journal of Sports Medicine that aim to promote physical activity during Covid-19.  These blogs have focused on adults, ‘at risk’ populations, and in this blog that follows on children and young people aged 5-18.  Each blog is accompanied by an infographic to summarise the blog, and present the information in a public-facing format.  In this blog, led by Dr Sam Fawkner and Dr Ailsa Niven, we draw on current evidence to focus on why children should be active, provide examples of activity, and importantly outline how to encourage this activity. 

Covid-19 presents many challenges and anxieties. For parents and carers of school-aged children (young people), daily lives are barely recognisable.  We are attempting to juggle work, life and schooling from home, while trying to keep everyone happy.  The benefits of physical activity for young people are widely recognised, and during COVID-19, moving more and sitting less is very important to help families maintain physical and mental health.  Being confined to home means that young people, who are used to school P.E., after school activities, active travel, organised sport and outdoor play, have to find a ‘new normal’. Screen use, which is mainly sedentary, has likely increased because of the switch to online education, entertainment and ‘babysitting’ services for overstretched parents.

In this blog, we focus on why encouraging our children to move more and sit less (if they can) is a priority at this trying time. We deliberately focus on being inside; although if guidelines allow, getting outside is also beneficial.

WHY?

Young people ideally should accumulate 60 minutes of at least moderate intensity activity a day; this can involve lots of short bouts of physical activity and a range of intensities. Over the week, activities should include some that stress muscles and bones (like yoga and jumping) and some to help promote movement skill (involving balance, coordination and body awareness).  These guidelines are based on evidence that more active young people have better health outcomes, including cardiovascular and bone health, muscle fitness and weight status.[1]  There is also evidence that increased physical activity is associated with enhanced mental health, improved cognitive (mental) function, aspects of self-esteem, and reduced depressive symptoms in young people.[2, 3]  As with adults, immediate benefits of each bout of activity may include reduced anxiety and a ‘feel good’ effect.[1]

what?

Activity ideas: games and yoga

Although there is limited evidence about the benefits of specific home-based activities for young people, any activity that gets your child moving is beneficial.  Activity ideas include playing traditional playground games indoors (e.g. hide and seek, tag, skipping), dancing to music, and getting creative (e.g. building an obstacle course, playing balloon volleyball, making an action movie or learning to juggle).  Check for age appropriate web-based activity programmes, such as The Body Coach.  Yoga has a range of positive benefits for young people and everyone can do it at home.  Try Cosmic Kids or The Yoga Crow.  A range of organisations offer ideas for home-based activities (e.g. Active Schools, Change for Life and SportEngland).  Try a few different activities and alternate them to keep young people interested. While 60 minutes a day is ideal, it may not always be achievable. Just remember that any opportunity to move more and sit less is good.

Moving more to help home-schooling, or combining them!

Physical activity (performed regularly as well as just a single bout) can help young people’s cognitive function and their attention.[4, 5]  So, a short bout of activity is a great way to break up periods of school work or screen use, and also help them focus on their work.  As well as the suggestions above, GoNoodle provides a series of short fun activity breaks for primary school children.

Combining physical activity with learning has cognitive benefits [6] and is fun, especially with younger children.  Turn ‘Simon says’ into a maths game, ‘Simon says jump 4+5 times’.  Do an activity (jump, burpee etc.) the number of times shown on a pair of dice or a playing card.  Count how many times you can hit a balloon between you.  Ask your child to spell out a word, and find objects in the house that begin with each of the letters as fast as they can. The opportunities are endless.

Moving more to break up sitting time

Sitting for long periods (especially when using screens) is associated with poor physical and mental health outcomes in young people.[7, 8]  If able, interrupting sitting time regularly with brief periods of movement will help, as will swapping sedentary gaming for active gaming.[9]  In school-based settings, young people are happy to work for short periods while standing, rather than sitting.[10] Try creating a makeshift standing desk, which the whole family could use.

HOW?

Motivating young people to move more

Despite our best intentions to encourage physical activity, every parent or carer has been faced with ‘but I don’t want to….go on a walk….dance…etc’.  Recent research provides guidance on how to create the best motivational environment to enhance physical activity and well-being.[11-13]  It isn’t rocket science to realise young people will be more motivated to engage in fun and enjoyable activities. Focus on the 3Cs of Competence, Control and Connectedness.

Competence; we are motivated to engage in and enjoy doing activities that we feel we can do.  1) Try to select activities for young people that are achievable but also challenging (if too easy, ask them ‘how could we make this harder – I think you could do more’).  2) Provide feedback to build feelings of competence; focus your feedback on self-improvement and effort ‘you worked really hard at that, and got better’, and try to avoid comparisons with others ‘but your sister can do that really well’.  3) Encourage your child to set achievable goals and keep a record to monitor progress.  We don’t know a great deal about the value of young people using wearables and apps to track physical activity, but if you have them, they could be a way for your child to set and monitor goals. Remember to be realistic given the current circumstances; unrealistic goals are unachievable and demotivating.

Control; relates to engaging your children in decision making, and providing opportunities for choice.  Let your children choose what activity to do (give them up to four options), when, and who with. Be creative and include variety (the links above will help).  Try ‘kids in charge’ sessions!  Feelings of control can be enhanced if we provide a reason for why we are being active (focus on immediate positive outcomes – ‘it will be fun and will help us all feel better’), and try to minimize controlling language (‘must’, ‘should’, ‘have to’).

Connectedness; relates to feeling supported and connected with others.  For some young people this could be achieved by parents/carers being active with them in a way that helps them feel competent and in control (see above). Getting involved and having fun models positive behaviour, and provides a focus for family time.  For some young people, connecting with their peer group through activity will help (e.g., online or by phone).

The 3Cs provides guidance, but no parent or carer will be able to adhere to them 100% of the time, and that is O.K. (https://selfdeterminationtheory.org/parenting/).  At this time, it is especially important to be kind to ourselves. Many of us are anxious and emotional (as are our children). Sometimes the time isn’t right – so don’t force it. Try again another time.

We hope that you find this useful to help keep our children active at this challenging time.  We’ve drawn from the latest scientific evidence, and our experiences as parents. Stay safe and be active when you can.

Samantha Fawkner ¹ (corresponding author) @s_fawkner, Ailsa Niven ¹ @AilsaNiven, Steven Hanson ² @SteveFloatBoat, Chloë Williamson ¹ @Chlobobs_, and Coral L Hanson ³ @HansonCoral

¹ Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK Email: s.fawkner@ed.ac.uk

² Floating Boat Design Solutions, Stocksfield, UK

³ School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK 

Competing interests

Website and YouTube links are provided for illustrative purposes. Dr Fawkner has an on-going professional relationship with The Yoga Crow. The authors have otherwise no affiliation to any of the organisations or companies referred to, and cannot comment directly on the activities promoted.

References

1. Department of Health and Human Services. 2018 Physical Activity Guidelines Advisory Committee Scientific Report [date accessed April 2020] https://health.gov/sites/default/files/2019-09/PAG_Advisory_Committee_Report.pdf; 2018
2. Biddle SJH, Ciaccioni S, Thomas G, et al. Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychol Sport Exerc 2019;42:146-55. doi: 10.1016/j.psychsport.2018.08.011
3. Dale LP, Vanderloo L, Moore S, et al. Physical activity and depression, anxiety, and self-esteem in children and youth: An umbrella systematic review. Ment Health Phys Act 2019;16:66-79. doi: 10.1016/j.mhpa.2018.12.001
4. de Greeff JW, Bosker RJ, Oosterlaan J, et al. Effects of physical activity on executive functions, attention and academic performance in preadolescent children: a meta-analysis. J Sci Med Sport 2018;21(5):501-07. doi: 10.1016/j.jsams.2017.09.595
5. Donnelly JE, Hillman CH, Castelli D, et al. Physical Activity, Fitness, Cognitive Function, and Academic Achievement in Children: A Systematic Review. Med Sci Sports Exerc 2016;48(6):1197-222. doi: 10.1249/mss.0000000000000901
6. Daly-Smith AJ, Zwolinsky S, McKenna J, et al. Systematic review of acute physically active learning and classroom movement breaks on children’s physical activity, cognition, academic performance and classroom behaviour: understanding critical design features. BMJ Open Sport Exerc Med 2018;4(1):e000341. doi: 10.1136/bmjsem-2018-000341
7. Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, et al. Role of Physical Activity and Sedentary Behavior in the Mental Health of Preschoolers, Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med 2019;49(9):1383-410. doi: 10.1007/s40279-019-01099-5
8. Tremblay MS, LeBlanc AG, Kho ME, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2011;8:98. doi: 10.1186/1479-5868-8-98
9. Sween J, Wallington SF, Sheppard V, et al. The role of exergaming in improving physical activity: a review. J Phys Act Health 2014;11(4):864-70. doi: 10.1123/jpah.2011-0425
10. Verloigne M, Ridgers ND, De Bourdeaudhuij I, et al. Effect and process evaluation of implementing standing desks in primary and secondary schools in Belgium: a cluster-randomised controlled trial. Int J Behav Nutr Phys Act 2018;15(1):94. doi: 10.1186/s12966-018-0726-9
11. Ha AS, Ng JYY, Lonsdale C, et al. Promoting physical activity in children through family-based intervention: protocol of the “Active 1 + FUN” randomized controlled trial.(Report). BMC Public Health 2019;19(1) doi: 10.1186/s12889-019-6537-3
12. Lubans DR, Lonsdale C, Cohen K, et al. Framework for the design and delivery of organized physical activity sessions for children and adolescents: rationale and description of the ‘SAAFE’ teaching principles. Int J Behav Nutr Phys Act 2017;14(1):24. doi: 10.1186/s12966-017-0479-x
13. Morgan PJ, Young MD, Barnes AT, et al. Engaging Fathers to Increase Physical Activity in Girls: The “Dads And Daughters Exercising and Empowered” (DADEE) Randomized Controlled Trial. Ann Behav Med 2019;53(1):39-52. doi: 10.1093/abm/kay015

Reproduced from Fawkner S, Niven A, Hanson S, Williamson C, Hanson C.L. (2020). Physical activity for children and young people aged 5-18 years during COVID-19. Stay safe; be active. British Journal of Sports Medicine Blog Published Online First: (13/04/2020).https://blogs.bmj.com/bjsm/2020/04/13/physical-activity-for-children-and-young-people-aged-5-18-years-during-covid-19-stay-safe-be-active/ with permission from BMJ Publishing Group Ltd.

Our work on previous emerging infectious diseases has built up a wealth of knowledge that we are bringing to bear on Covid-19.  This paper brings together some of this research: (i) demonstrating the importance of understanding human behavioural dynamics, (ii) supporting the role of innovation in diagnostics, drugs and vaccines for emerging infectious diseases, and (iii) justifying more rapid, adaptive regulatory systems, as part of an enabling innovation ecosystem.

In the run-up to the declaration of a Covid-19 pandemic, there have been major reactions in financial markets, with global recession and longer term structural adjustment on the cards. However, previous emerging infectious diseases have built up a wealth of knowledge that we are bringing to bear on Covid-19. Pandemic preparedness was initiated during the SARS outbreak in 2002. SARS was not declared a pandemic, but health care advisors became quickly attuned to the threat of emerging zoonotic diseases. SARS was followed by the H5N1 event in 2005, the H1N1 pandemic in 2009 (resulting in an estimated 84,000 deaths worldwide (1), MERS in 2012, H7N9 in 2013 and Ebola in 2019, all of which were thought to have pandemic potential at the time of outbreak. Throughout these previous challenges, as with Covid-19, governments have been faced with the mutually incompatible challenges of encouraging social distancing to minimise the spread of the disease and encouraging healthy people to go to work as usual to minimise the impact on the economy.

Each event has added to the body of knowledge that might be used by governments, regulators and health agencies on how to manage pandemic events and improve the chances of a quick recovery. 

Understanding human behaviour

The H5N1 epidemic did not, as had been feared, evolve to enable human-to-human transmission and the infection from birds to humans was restricted largely to East Asian countries. However, the case fatality rate (CFR) was ~60% leading to alarm and serious contingency planning for a pandemic outbreak. In the UK at the time, pandemic preparation included the prospect of simultaneously giving contradictory public messages – “business as usual” and “social distancing”, potentially leading to serious disruption of the economy (2) (Figure 1). The research underlying tis figure analysed the views of emergency responders on the UK’s preparedness plans, probably the best informed group to make such comments. It also looked at the economic value of a vaccine, given the expected tendency towards “prophylactic absenteeism” (top left-hand side of Figure 1), where healthy people would avoid going to work in case of contracting infection (3). Modelling the impact of the disease on UK GDP showed that, although prophylactic absenteeism would reduce the infection rate by ~1%, its impact on the economy would be in the billions of pounds. We proposed that the benefits of an effective vaccine or drug should be calculated, not just on the basis of its health impacts, but also on its economic value in giving people the confidence to continue to go to work. This study highlighted the importance of the expected CFR in determining the extent to which prophylactic absenteeism would occur. In the H1N1 event, the ‘problem-related’ behaviours described in Figure 1 began to appear in several countries, including the UK, but rapidly evaporated when it became clear that the CFR was similar to normal winter flu. This eliminated the need for the vaccines and drugs that had been made rapidly available in response to a higher expected CFR.

The role of innovation in diagnostics, drugs and vaccines

At the time of the H1N1 outbreak, vaccine manufacturing was dominated by a handful of multi-national corporations, with hope and trust mainly invested in standard inactivated or attenuated virus vaccines. The innovation ecosystem is now much more vibrant and varied, occupied by small, medium and large biotechnology firms, working in partnerships, consortia, and other collaborative arrangements. New scientific discoveries in synthetic biology, gene editing, and other biotechnologies are enabling small, agile and dynamic firms to develop radically new approaches to diagnosis and, potentially, treatment for Covid-19 (4). For example, Geovax (US) and BravoVax (Wuhan, China) are developing a vaccine using a ‘plug-and-display’ technology platform that uses virus-like particles and genetic material specific to Covid-19. This approach has been used to produce vaccines for Zika, Lassa fever and Ebola. iBio (US) and CC-Pharming (China) are developing a vaccine in plants that combines automated hydroponics, vertical farming systems and plant bioreactor technology to rapidly scale-up production. This has already been used to produce antibody candidates for Ebola, Dengue fever, HPV, seasonal and avian influenza. LineaRx (US) and Takis Biotech (Italy) have produced a synthetic gene to be delivered to muscles for the temporary generation of an antigen which could trigger an immune response against Covid-19 (5). APEIRON Biologics AG in Austria has a recombinant human enzyme product (APN01) which is already approved for other indications (e.g. acute lung injury) and is being trialled in Covid-19 patients in China in partnership with Angalpharma Co., Ltd (China) and dMed Pharmaceutical Co. (China) (6). Impressively this work is being undertaken without the coordination activities of the WHO which, during H1N1, developed and circulated both the seed strain and reagent and facilitated data sharing between vaccine producers (7).

More rapid, adaptive regulatory systems

During the H1N1 pandemic, the European Medicines Agency undertook significant regulatory adaptation, with new expedited review and licensing procedures (8). In April 2009, the new strain was identified and characterised. On June 11th, the WHO declared a pandemic, allowing fast track assessment of mock-up vaccines and rolling review of vaccine quality. Non-clinical and clinical pharmacovigilance (RMP) data and labelling information were submitted to the regulator by the Marketing Authorisation Holders. The timeframe for evaluation of the vaccines was reduced from 210 days to 70 days (9).

The H5N1 and H1N1 events also stimulated new approaches to health communication between public health agencies, healthcare organizations and frontline clinicians (11) and review and updating of risk assessment and management procedures (12).

Lessons for Covid-19

Covid-19 is again demonstrating the difficulty of adopting the necessary social distancing to protect the health of the population without also creating severe economic repercussions. Most governments have prioritised ‘social distancing’ over protecting the economy (‘business as usual’), even though the CFR for the majority of people seems to be low enough to avoid public panic. At the time of writing it is not clear how necessary this action is or how effective it will be. However, Covid-19 has re-emphasised the over-riding importance of setting up a new globally coordinated research programme to find more rapid ways: (i) to develop targeted diagnostics, drugs and vaccines, (ii) to scale up their production to meet the needs of global populations, and (iii) to develop routine, smarter and faster approaches to their regulation. The cost to the global economy of Covid-19 justifies whatever cost will be involved to deliver this outcome so that when the next pandemic comes along we are better prepared to deal with it.

This paper was originally published in the INNOGEN Policy Briefs: https://www.innogen.ac.uk/reports-and-commentaries

Dr Farah Huzair is the current programme director for the MSc in Management of Bioeconomy, Innovation and Governance in the department of Science, Technology and Innovation Studies, University of Edinburgh. Professor Joyce Tait is the director of INNOGEN in the department of Science, Technology and Innovation Studies, University of Edinburgh. 

References

1. CIDRAP (2020) “CDC estimate of global H1N1 pandemic deaths: 284,000” Available at: http://www.cidrap.umn.edu/news-perspective/2012/06/cdc-estimate-global-h1n1-pandemic-deaths-284000 Last accessed 16th March 2020.
2. Tait, J. (2011) “Innovation, Policy, and Public Interactions in the Management of Infectious Diseases” Available at: http://scienceforglobalpolicy.org/wp-content/uploads/5522b96206a09-Tait.pdf. Last accessed 16th March 2020.
3. Smith et al. (2009) “The economy-wide impact of pandemic influenza on the UK: A computable general equilibrium modelling experiment” BMJ;339: b4571 doi:10.1136/bmj.b4571
4. Clinical Trials Arena (17th February 2020) “Covid-19: Pharmaceutical companies and agencies that partnered for coronavirus vaccine development”. Available at: https://www.clinicaltrialsarena.com/analysis/covid-19-pharmaceutical-company-partnerships-for-coronavirus-vaccines-development/. Last accessed 16th March 2020.
5. Pharmaceutical technology (10th February 2020) “Applied DNA and Takis Biotech partner on coronavirus vaccine”. Available at: https://www.pharmaceutical-technology.com/news/applied-dna-coronavirus-vaccine/ . Last accessed 16th March 2020.
6. Pipeline Review.com (26th February, 2020) “APEIRON’s respiratory drug product to start pilot clinical trial to treat coronavirus disease COVID-19 in China”. Available at: https://pipelinereview.com/index.php/2020022673884/Proteins-and-Peptides/APEIRONs-respiratory-drug-product-to-start-pilot-clinical-trial-to-treat-coronavirus-disease-COVID-19-in-China.html . Last accessed 16th March 2020.
7. Huzair, F (2012). The influenza vaccine innovation system and lessons for PDPs. Human Vaccines & Immunotherapeutics. Vol 8, Issue 3. Available at: https://doi.org/10.4161/hv.18701. Last accessed 10 March 2020.
8. Shivji, R and Purves, J. (2009) “European Medicines Agency: Influenza Pandemic Preparedness”. In Risk Wise: Epidemics. J.Griffiths and R.Lambert eds. Available at: http://digital.tudor-rose.co.uk/risk-wise-epidemics/files/assets/common/downloads/publication.pdf. Last accessed 16th March 2020.
9. EMA (24th September 2009) “Pandemic influenza A(H1N1)v vaccines authorised via the core dossier procedure: Explanatory note on scientific considerations regarding the licensing of pandemic A(H1N1)v-vaccines” Available at: https://www.ema.europa.eu/en/documents/medicine-qa/explanatory-note-scientific-considerations-regarding-licensing-pandemic-ah1n1v-vaccines_en.pdf. Last accessed 16th March 2020
10. EMA ‘Vaccines for Pandemic Influenza’. Available at: https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/pandemic-influenza/vaccines-pandemic-influenza. Last accessed 19th March.
11. Abraham, T. (2011) “Lessons from the pandemic: the need for new tools for risk and outbreak communication” Emerging Health Threats Journal, Vol 4, Issue 1. Available at: https://www.tandfonline.com/doi/full/10.3402/ehtj.v4i0.7160. Last accessed 2020.
12. WHO (May, 2017) “Pandemic Influenza Risk Management”. Available at: https://www.who.int/influenza/preparedness/pandemic/PIRM_update_052017.pdf. Last accessed 16th March 2020.

Pseudonyms have been used for all people and places in order to protect the identity and anonymity of individuals

“Khulna’s Very Own Foreigner”

Four days turned my field site, and my place in it, upside down. It was early March 2020 and I had spent the previous four months establishing myself in Khulna, Bangladesh, to carry out ethnographic data collection for my PhD: untangling how human rights ideas intersect with women’s experiences of pregnancy and childbearing. I was lucky enough to have the support of friends and colleagues from icddr,b, an international public health research institution based in the capital of Dhaka, who had agreed to host me for my research in Khulna. I had a vibrant social work life: I shared an apartment with my roommate, Rosa, a young medical assistant who quickly became my ‘younger sister’, diligently correcting my Bangla and assisting me to navigate this unfamiliar location. I was taken in as family by the icddr,b field team, who invited me over regularly for dinners and painstakingly attempted to teach me to play cricket. I had built friendly relationships with the managers of the health facilities in the different sub-districts where I spent most of my days, who referred to me affectionately as ‘Khulna’s very own foreigner’. I did not hold any pretense that I was actually blending in by any stretch of the imagination. While bideshis, or foreigners, literally meaning from a place that is not part of the desh, or the homeland of Bangladesh, were certainly not unheard of around here, neither were we a common appearance. Unlike in Dhaka, people did not typically refrain from showing their intrigue with my presence. In some cases, women would ask politely to touch my pale arm or stroke my chestnut hair, which I typically accepted, or young men would ask to take a selfie with me, which I typically declined. 

Like in most parts of the world, COVID 19 was on people’s minds in Bangladesh by the end of February. You could not travel far without overhearing a conversation including the word ‘coronavirus’. However, no cases had been reported in the country up until that point, so there was still a sense of security. Indeed, the government had a particular interest in keeping COVID 19 from surfacing in the country: They were preparing for Mujib Borsho, or the Year of Mujib, to commemorate the centenary of the birth of the iconic figure Sheikh Mujibir Rahman, the leader of the liberation movement and first president of Bangladesh. Sheikh Mujib, known as the Father of the Nation, and the literal father of the current Prime Minister, Sheikh Hasina, had taken power of a newly liberated Bangladesh in 1972, but was assassinated in a coup d’état in 1975. The countdown to the inaugural event of Mujib Borsho, set for his birthday on March 17th, had been launched on January 10th, marking the day that Sheikh Mujib had returned to an independent Bangladesh after being held in captivity in Pakistan during the liberation war. Now you could hardly turn your head without some reminder: countdown clocks erected at government buildings counting down the days, hours, minutes and seconds; stickers with the Mujib Borsho logo on government hospital doors; banners and signs with images of him and his family; a daily news segment dedicated to his legacy. The grand inauguration was to be held in Dhaka, attended by hundreds of thousands of participants, including a number of heads of state and special guests, notably Prime Minister Justin Trudeau of Canada and Prime Minister Narendra Modi of India. 

“COVID WAS A DISEASE of the Bidesh“

Each morning, I watched on the news as the Director of the Institute of Epidemiology, Disease Control and Research (IEDCR) gave her perfunctory press briefing, each day wrapped in a different and elegant sari, assuring the country that there were no cases of COVID in Bangladesh. The main refrain was that COVID was a disease of the bidesh, foreign land, and that the country was taking efforts to ensure that people entering from abroad were screened, and if coming from certain places, quarantined for 14 days upon arrival. In tandem, I was hearing reports of a number of suspected cases and rumours that IECDR was refusing to test people. Each time the word bidesh was uttered in relationship to COVID, I could not help but take it just a little bit personally. One evening I found myself walking down the road with Azam, the field manager of icddr,b and one of my most trusted friends in Khulna. As we walked from the icddr,b office to my home, he informed me that icddr,b had instructed him to not shake hands with bideshis, indicating that he should keep his distance from me. I was taken a bit aback by his comment;  I had been maintaining close communication with the Dhaka icddr,b team and there had certainly been no such official instruction. 

This narrative of COVID’s association with the bidesh became simultaneously more pronounced as all the neighbouring countries of Bangladesh began reporting cases. As the discourse of social distancing became increasingly more entrenched throughout early March, the foreign dignitaries who had initially accepted the invitation to attend the Mujib Borsho inaugural event started to decline one by one. I began hearing more reports in Dhaka and in Khulna of suspected cases, but people seemed resigned to accept the open secret that nothing would, or could, be revealed officially until after the 17th of March.  I travelled back to Dhaka to attend a national dissemination event scheduled for March 8, hosted by icddr,b. It was an emotional lead up to the event, hosting around 200 people, including national public health leaders. Even as attendees were arriving there was still heated debates of whether it should be maintained or cancelled. Without clear guidance from the government in a country that was supposedly free from COVID, this was a particularly difficult and politically fraught decision to take. In the end, the show went on. 

After this event, I sat with the ten members of the icddr,b Dhaka team I was working most closely with at Gloria Jeans, a coffee shop located in one of the upscale areas of Dhaka. The mood was still light-hearted enough as we replayed the circus of events leading up to what finally turned out to be a successful event. And then the notification came. I am not sure who saw it first, but IECDR had announced that three people had tested positive for COVID in Bangladesh. Consistent with the narrative, two were men who had recently returned from Italy and the third was one of their family members. This news came as a jolt and immediately transformed our moods to something more sombre.

“Khulna no longer felt like home”

I returned to a transformed Khulna four days after I had left, admittedly unprepared for what I was to find. The announcement of the COVID cases had transformed Khulna into a place I no longer recognized. People on the streets were wearing masks now. I could feel people’s eyes fix on me and then readjust their masks over their mouth and nose while moving away to avoid me. The drivers of the CNGs, the small green three-wheeled vehicles that we took to move from village to village, were wearing masks. But it was not until I reached my destination, a small village about 45 minutes from the city of Khulna, that I realized just how deeply this ran. I had travelled there to visit a satellite clinic being run by a private hospital. In this temporary clinic, a paramedic was providing basic health consultations to women and children in an empty room. 

Like usual, there was an interest in my presence and the women gathered around me to ask the typical questions: Where was I from? Was I married? Did I have children? But it was only moments before the topics turned from the banal to deeper concerns: Did I have coronavirus? They had heard that the government was not letting bideshis in anymore. How did I get into the country? It was then that it sunk in. Even these women here, in such a remote place, had gotten the message: there was an infection ‘coronavirus’ which was a risk to them, and this was a risk from the bidesh, embodied by bideshis. And now I, quite possibly the only bideshi that they had interacted with, embodied this infection and I was seen as a risk of contamination. 

It was impossible not to notice the reactions that my presence provoked in the days that followed. Some responses felt more vicious than others. People who wanted to catch a glimpse of a bideshi would still approach me, but now women would cover their mouths and noses with a headscarf before getting close and would quickly retreat when I approached. In the market, men would shout out comments in my direction about coronavirus. 11-year-old boys wearing face masks would pretend to chase after me. Other responses felt more legitimately concerned, and some seemed intended to be supportive. For example, the deputy manager of the district hospital had assured Azam that I would be exempt from going before the board that they had established to examine any person coming from abroad to determine whether they were a risk to the district. “Don’t worry, Azam,” he had assured him. “Janet is your family. She will not have to face the board.” However, what struck me was that creating this board specifically for people coming from abroad, of which there were notably few here, had become the priority of this crisis in Khulna, amidst the many which could have been chosen, with health facilities underprepared for providing basic services.

I found myself ruminating over my security in ways I had not before. Was it even safe for me to visit the more remote areas? And if I chose to go, should I (God forbid) take a man with me to be more secure? Was it even ethical for me to go to health facilities where the patients would most likely associate me with COVID? Somehow, the fact that I was spending time with pregnant women made these ethical questions feel more weighted. Khulna no longer felt like home.

When I woke up to the news that the World Health Organization had declared COVID 19 a pandemic, I did not know that it would be my last morning waking up in Khulna.  I visited a sub-district hospital close to home that day. When I arrived, the health manager was standing out in the front of the building. He invited me into his office, and like usual I took the seat in front of his desk. The concern was visible in his face. A few patients passed in and out to consult him. In between, we chatted and sipped on the sugary black tea with fresh ginger he had asked his staff to serve us. He sighed heavily as he told me of his worries of what he now felt to be the inescapable approach of coronavirus. His hospital was already at capacity; what were they going to do when COVID patients started to come as well? He asked me whether I had brought hand sanitizer. I proudly held up my small bottle of the clear Purell liquid, which was finally going to use after six months in the country. The substance had already become scarce here, as it had elsewhere. He showed me his bottle of blue sanitizer in turn. “I had to bring this from home,” he told me, explaining that he did not have sanitizer or masks to protect himself or his health service providers. His anxiety was palpable. Inevitably, people passing through the office would make comments in my direction about coronavirus and the manager would assure them that I had been in Bangladesh for a long time and was not infectious. 

“COVID has allowed us to watch xenophobia produced in real time”

After that day, as flight routes started shutting down one by one, I knew that I had to return to my family in Europe before I no longer could. My last evening in Bangladesh was spent, once again, with the icddr,b team in the same Gloria Jeans where we had learned of the first COVID cases in Bangladesh. Sitting with some of my closest friends, we laughed and joked over coffee and greasy potato wedges. They teased me when I insisted that they accept my dab of hand sanitizer between touching their phones and grabbing a potato wedge. For some of them, my decision to go back to Switzerland did not make much sense. Of course they understood that I should be with my family during this turbulent period, but why go back to the epicentre of the pandemic when I could ride it out in the comparatively better off Bangladesh? 

I landed in Europe two days before what little of the Mujib Borsho inauguration ceremony was able to go on. There were still fireworks, but no crowds to admire them. As expected, things changed immediately after March 17th. Testing increased (though not sufficiently), cases started being confirmed on a daily basis, and people were officially dying as a result of COVID 19. Although schools were closed in the country as of March 18th, the government declared a national ‘holiday’ as of March 26th that keeps getting extended. A holiday sounds nicer than an emergency or a lockdown but is supposed to communicate the same idea. Everyone is scrambling to make sense of this situation, not only in terms of health, but in terms of the economic situation in a context in which a social safety net is something of a pipe dream. Watching from afar, I wish that we could go back to the frivolity of my last evening in Gloria Jeans, when someone could still throw out a far-fetched theory of the climate of Bangladesh being protective against COVID, or that Bangladeshis’ natural immunity will serve to fend it off—Europeans obviously have the weaker immune systems as they get annual flu shots and are not exposed to as many pathogens. These theories felt more hopeful than naïve, as none of us wanted to imagine the alternative. Now I can only watch from afar and hope that the worst-case scenarios do not materialize.

COVID 19 has not created xenophobia and it is unfortunately too much a part of what many people have to navigate in their everyday even under (more) normal circumstances. However, what COVID has allowed is for us to watch the insidious and swift ways in which xenophobia and racism are produced in real time. It is often heard that COVID 19 is an ‘invisible enemy’. While it may be true that the material virus is too small for the human eye to perceive, through politicizing it and associating it with particular bodies, we render the virus visible. Though manifesting differently, these xenophobic responses have been ubiquitous. At their most innocuous, they lead to a waste of valuable energy and resources that could be better directed towards working toward solutions that address this crisis shared by humanity. At their worst they have led to many people feeling less safe in this already destabilized world and to violence. It is my hope that when the dust has settled, we are able to use this experience to better understand how xenophobia is produced both politically and otherwise in order to work towards a world where there is less of it. 

Janet Perkins is a PhD candidate in Social Anthropology at the University of Edinburgh School of Social and Political Science. Her research focuses on human rights, women’s health and international development, building on extensive professional experience in global health and international development. 

One of the striking aspects of the Covid-19 crisis in the UK has been the apparent rehabilitation of the expert. Experts – whether economists, lawyers, civil servants or academics – were famously maligned during the Brexit debate. But the likes of Chris Whitty, Neil Ferguson and Catherine Calderwood have become household names over the past few weeks. The return of the expert is most vivid in the daily UK Government press conferences, where political leaders are flanked by scientific and medical advisors; and it’s constantly repeated in the Government’s reassurance that its policies are being guided by ‘the scientific advice’.

So why this damascene conversion to expertise? In my book The Political Uses of Expert Knowledge I distinguished three possible functions of expertise in politics: to inform policy; to substantiate particular claims or decisions; and to signal the competence of actors to take well-founded decisions. In fact, all three seem to be at play here.

First, it’s clear that the UK Government is keen to draw on expertise to fix the problem. Unlike in many other areas of policy where the effects of policy are diffuse and long-term, the government’s legitimacy in handling the pandemic is very closely dependent on actions it takes now. Whether it sustains the lockdown, rolls out testing, or expands ICU capacity, will have a very tangible effect on health outcomes. In this situation, it can’t get away with compelling rhetoric and symbolic gestures – or at least not for long. Which is, of course, why populist administrations may find themselves foundering in this situation.

Adding to the potential for exposure, these outcomes are being measured and compared across countries. The daily graphs showing trajectories in death-rates across countries can be a harsh indictment of the performance of governments. So it is crucial for political leaders to get this right, and mobilise the best evidence possible to guide actions. Contrast this to Brexit, where the effects of government actions were always going to be diffuse and difficult to attribute, partly explaining why government didn’t need to be so careful about heeding the evidence.

Of course, it’s never that clear what the ‘best’ evidence is, especially where different disciplinary perspectives produce conflicting conclusions, and where public health considerations need to be balanced against a wide range of social and economic factors. Officials are keenly aware of the uncertainty of science – which is partly why they tend to prefer trial-and-error, incremental approaches to testing new policies, rather than introducing new and untested interventions based on abstract modelling.

But this isn’t just about getting decisions right – politics never is. There is also a strong symbolic dimension to the use of expertise. The government wants to make it clear to the public that its decisions are based on scientific evidence. And different protagonists are keen to use scientific claims as ammunition to support their positions – the substantiating function of expert knowledge. To complicate matters, the government isn’t using expertise simply to validate claims, it also appears to be using it as an insurance policy. If things go wrong – and the curve gets too steep – it will be the scientific advice that is to blame.

And herein lies the risk, to both science and government. If science is held responsible for poor political decisions, its authority becomes eroded. Science does not, and cannot, offer definitive answers to new and complex social problems – just propositions and hypotheses that are more or less robust. So pinning policy on such uncertain claims is disingenuous, and will only serve to undermine trust in science.

The related risk for politics is that any attempt to blame the scientists will risk rebounding on them – playing the blame game will be seen as a sign of weakness and poor judgement.

So while it’s good to see the return of experts, let’s not burden them with unrealistic expectations, or conflate their role with that of political leaders. Science is a vital resource for modelling scenarios and developing medical and technical responses; but for many aspects of decision-making it is contested and uncertain. If we set our scientific advisors up to find policy solutions, we risk generating disillusionment with science, and, in the long term, further erosion of its authority.

Christina Boswell is Professor of Politics at the University of Edinburgh. Her books include: Manufacturing Political Trust: Targets and Performance Measurement in Public Policy (Cambridge, 2018); and The Political Uses of Expert Knowledge: Immigration Policy and Social Research (Cambridge, 2009).  Professor Boswell’s article featured in The Guardian: https://www.theguardian.com/world/2020/apr/23/scientists-criticise-uk-government-over-following-the-science

On 26 March 2020, Dr Luciana Brondi was interviewed by the InterSci Edinburgh team on a Facebook livestream on the historic and current significance of the COVID 19 as a public health issue.

Highlights from the interview include:

• How predictable a pandemic by an emerging virus infection like the current COVID 19 was and why
• Some of the main public health, clinical and research challenges posed by the current pandemic
• Concepts of infectious diseases epidemiology that are relevant to understand the main features of this current pandemic
• Measurements of infection transmission used in epidemiology and the current factors influencing the transmission of the novel CORONA virus (i.e., SARS-CoV-2)
• The clinical impact of COVID 19 in different countries depending on context-specific characteristics
• The importance of strong health systems in order to minimize both the mortality and the morbidity of this pandemic
• The importance of using epidemiological model-based predictions to devise effective strategies to “slow” such a fast spreading pandemic and save lives
• The likelihood that new interventions will be available in the near future to improve the control of the pandemics

Watch the complete interview here: https://www.facebook.com/InterSciEd/videos/243280723510523/

Dr Brondi is a physician and epidemiologist and has worked in the field of infectious diseases for over 25 years. Her work experience includes public health and research in Brazil, UK, Europe, South Asia and Sub Saharan Africa. Her main area of work in Public Health has been on Infectious Diseases Control, with emphasis on respiratory and vaccine preventable diseases.

Since 2012, she has been teaching (Masters in Public Health) and conducting research on Communicable Diseases Control and Epidemiology at Edinburgh University. Apart from infectious diseases, her main research interests include social determinants of health (including gender), especially in developing countries.

Medicine Anthropology Theory is an open-access journal in the anthropology of health, illness, and medicine. In January 2020, MAT moved to its new institutional home in Edinburgh, where the Edinburgh MAT collective has taken on the editorialship for the next five years. The MAT collective is based in the Edinburgh Centre for Medical Anthropology (EdCMA), at the School of Social and Political Science, at the University of Edinburgh.

The MAT collective is delighted to announce the publication of MAT’s virtual issue “Outbreaks, Epidemics, and Infectious Diseases”. This issue is a retrospective collection of pieces published in MAT in the past and has been curated by the MAT collective and editorial staff in response to the ongoing COVID-19 pandemic outbreak.

Over the past six years, MAT has published a large variety of readable, accessible and original research engaging ethnographically and critically with infectious diseases and epidemics. In the context of a global pandemic like the one we are witnessing, it is crucial to have cross-cultural perspectives, and a global scope to our understanding of epidemics and our responses to them.

We hope that this Virtual Issue, as well as the extended collection curated by our Assistant Editor (available in the opening blog) will enrich critical thinking, foster interdisciplinary exchange, and support the ongoing work of scholars in our community and beyond.

Find out more:

MAT Virtual Issue: Outbreaks, Epidemic, and Infectious Diseases

Medicine Anthropology Theory journal

The MAT collective, at the Edinburgh Centre for Medical Anthropology (EdCMA), University of Edinburgh