Pandemics and the costs of preparedness
Update: I originally posted this on 27th Feb and since then the whole country is under virtual lockdown with emergency powers. Reposting it now – slightly out of date but the sentiment remains the same.
Although WHO have not called it at the of writing it is apparent that COVID-19 is likely to become a global pandemic. Like all disasters, pandemics expose marked differences between health systems and exacerbate existing social inequalities. Similarly, preparedness advice is often written from a perspective that does not take into account material inequalities in society and individuates responsibility for suffering. This is something that I have been researching and writing about for a number of years and I previously commented on the ethnic and social disparities in pandemic preparedness in 2010. Writing on the H1N1 guidance I wrote that ‘In the H1N1 leaflet, you are advised to stay put for up to two weeks. You need a lot of resources to do that, and these publications presuppose that you have them.’ Nothing has really changed. In the UK the advice on how to self-isolate following exposure to COVID-19, which is an excellent public health measure in itself, makes assumptions about how most people actually live, and exposes how the State tends to think about working class people more generally.
To explain these points I base my analysis on the Public Health England factsheet “Advice Sheet – Home Isolation“. This advice may be updated and if there is a need for a significant proportion of the population to self isolate it may have to.
The advice is titled ‘stay at home’ which is a familiar phrase from UK public information going back at least to the 1970s. In this case it seems to be good advice in terms of mitigating against the spread of a virus but has unfortunate echos of previous public information films and booklets and recent contexts where ‘stay put’ had horrific consequences. Like all UK government public information the factsheet starts with some knowing advice from the State in terms of what might have been previously described as ‘advice for the householder’:-
Your local health protection team and your doctor have agreed that you may stay at home while you wait for the results of tests for COVID-19 (SARS-CoV-2) infection. This is because you do not need to be admitted to hospital and because you have agreed to follow the important instructions described below.
This is an important statement as it makes a covert reference to the power of the State to impose quarantine. You are staying at home because you have agreed to follow the (good) advice below otherwise the State can use its powers to impose quarantine on you. This raises interesting questions about whether the guidance, or support available, actually enables people to abide by this guidance and how powers might be used to enforce this.
The guidance then discusses how quarantine might be practised:-
You should stay in a well-ventilated room with a window to outside that can be opened, separate from other people in your home. Keep the door closed. Use a separate bathroom from the rest of the household, if available. If you have to share these facilities, regular cleaning will be required.
There are assumptions about where people live and what they are able to do in this statement. Having a well-ventilated room, with a window, and a separate bathroom seems to imply that a person will be living somewhere like this:-
Rather than this:-
If separate bathroom facilities are not available then there is guidance about regular cleaning, bathroom rotas and separate towels but this seems to be written assuming some kind of commune rather than the realities of people with children or other caring responsibilities often coping on their own. In the latter cases (which would be considerable) it is (to me) quite unimaginable that a carer or parent would not risk exposure to COVID-19 rather than isolate a child or otherwise vulnerable person with a ‘bathroom rota’. In a later section the advice (with good reason) seems to advise against inviting someone from outside the household to provide support but it is not clear how working class single parent households would be able to cope with a COVID-19 infection otherwise:-
Only those who live in your home should be allowed to stay. Do not invite or allow visitors to enter. If you think there is an essential need for someone to visit, then discuss it with your designated medical contact first. If it urgent to speak to someone who is not a member of your household, do this over the phone.
In terms of food, there is also an expectation that this will be available for the period of quarantine (perhaps 14 days). I have written at length previously on the lack of connection between this sort of advice and food poverty in the UK. The alternative it seems is to make use of online grocery deliveries or food deliveries:-
You will need to ask for help if you require groceries, other shopping or medications. Alternatively, you can order by phone or online. The delivery instruction needs to state that the items are to be left outside, or in the porch, or as appropriate for your home.
In China and Hong Kong the use of delivery services of the Deliveroo and Uber Eats variety have become increasingly popular due to quarantine and one might expect a similar pattern in the UK. However, references to home delivery and the need to purchase face-masks and cleaning substances makes it clear that this is a quarantine that requires economic resources and stockpiling.
I am not asking that Public Health England or the Government enact some kind of ‘woke preparedness’ but rather that greater consideration for the material nature of people’s lives is written into the guidance and that this is matched by resources. This is not just for reasons of equity, although questions of who survives and who suffers are ethical questions of the deepest kind, but also in terms of the logic of pandemic preparedness. ‘Asking for help’ is a weak way of phrasing what people in working class communities do all of the time. We might assume that social forms of ‘help’ are already being maximised. What it means to be altruistic in a pandemic context needs to be thought through. It would take a particular form of altruism for a working class community to organise to clean the toilet of an elderly couple where one party suffers from COVID-19, for example. However, forms of mutual aid might arise that do not involve breaking quarantine such as ordering supplies for those who can not otherwise afford it. Communities might collectively buy, or appropriate in other ways, the resources that they might need and they are already doing this even without COVID-19.
A truly radical, but perhaps necessary, response is that if this really is a 1918 type of pandemic where the world economy comes to a sudden stop that we should collectivise the forms of health and care necessary to deal with a pandemic. This would not only include the National Health Service (including Public Health England who have to meet multiple agendas on a limited budget and those parts of the NHS which have been asset stripped) but also community care and food provision. The collective resources of the supermarkets, their delivery networks, the logistics of the technology multinationals and the home delivery companies could be deployed to ensure that all those who are in quarantine get what they need. This does not necessarily have to be some form of ‘Pandemic Corbynism’ but we might be entering an era where forms of disaster socialism or disaster anarchism become political alternatives at the community level in the UK.
I have a tendency to think dystopia is the breeding ground of utopia but even the most cold hearted neo-liberal could understand the negative externalities of breaking quarantine to obtain cheap food. Otherwise almost by definition the advice is set up to be broken, particularly in economically excluded communities, and then the powers of the State to impose fines and other punishments will be deployed. Guess who will be the target of these?