Editorial

Abstract

Covid 19 – living the experience As I sit at my desk at home in suburban Brisbane, following the dictates on self-isolation shared with so many around the world, I am forced to contemplate the limits of human prediction. I look out on a world which few could have predicted six months ago. My thoughts at that time were all about 2020 as a metaphor for perfect vision and a plea for it to herald a new period of clarity which would arm us in resolving the whole host of false divisions that surrounded us. False, because so many appear to be generated by the use of polarised labelling strategies which sought to categorise humans by a whole range of identities, while losing the essential humanity and individuality which we all share. This was a troublesome trend and one which seemed reminiscent of the biblical tale concerning the tower of Babel, when a single unified language was what we needed to create harmony in a globalising world. However, yesterday’s concerns have, at least for the moment, been overshadowed by a more urgent and unifying concern with humanity’s health and wellbeing. For now, this concern has created a world which we would not have recognised in 2019. We rely more than ever on our various forms of electronic media to beam instant shots of the streets of London, New York, Berlin, Paris, Hong Kong etc. These centres of our worldly activity normally characterised by hustle and bustle, are now serenely peaceful and ordered. Their magnificent buildings have become foregrounded, assuming a dignity and presence that is more commonly overshadowed by the mad ceaseless scramble of humanity all around them. From there however the cameras can jump to some of the less fortunate areas of the globe. These streets are still teeming with people in close confined areas. There is little hope here of following frequent extended hand washing practices, let alone achieving the social distance prescribed to those of us in the global North. From this desk top perspective, it has been interesting to chart the mood as the crisis has unfolded. It has moved from a slightly distant sense of superiority as the news slowly unfolded about events in remote Wuhan. The explanation that the origins were from a live market, where customs unfamiliar to our hygienic pre-packaged approach to food consumption were practised, added to this sense of separateness and exoticism surrounding the source and initial development of the virus. However, this changed to a growing sense of concern as its growth and transmission slowly began to reveal the vulnerability of all cultures to its spread. At this early stage, countries who took steps to limit travel from infected areas seemed to gain some advantage. Australia, as just one example banned flights from China and required all Chinese students coming to study in Australia to self-isolate for two weeks in a third intermediate port. It was a step that had considerable economic costs associated with it. One that was vociferously resisted at the time by the university sector increasingly dependent on the revenue generated by servicing Chinese students. But it was when the epicentre moved to northern Italy, that the entire messaging around the event began to change internationally. At this time the tone became increasingly fearful, anxious and urgent as reports of overwhelmed hospitals and mass burials began to dominate the news. Consequently, governments attracted little criticism but were rather widely supported in the action of radically closing down their countries in order to limit human interaction. The debate had become one around the choice between health and economic wellbeing. The fact that the decision has been overwhelmingly for health, has been encouraging. It has not however stopped the pressure from those who believe that economic well-being is a determinant of human well-being, questioning the decisions of politicians and the advice of public health scientists that have dominated the responses to date. At this stage, the lives versus livelihoods debate has a long way still to run. Of some particular interest has been the musings of the opinion writers who have predicted that the events of these last months will change our world forever. Some of these predictions have included the idea that rather than piling into common office spaces working remotely from home and other advantageous locations will be here to stay. Schools and universities will become centres of learning more conveniently accessed on-line rather than face to face. Many shopping centres will become redundant and goods will increasingly be delivered via collection centres or couriers direct to the home. Social distancing will impact our consumption of entertainment at common venues and lifestyle events such as dining out. At the macro level, it has been predicted that globalisation in its present form will be reversed. The pandemic has led to actions being taken at national levels and movement being controlled by the strengthening and increased control of physical borders. Tourism has ground to a halt and may not resume on its current scale or in its present form as unnecessary travel, at least across borders, will become permanently reduced. Advocates of change have pointed to some of the unpredicted benefits that have been occurring. These include a drop in air pollution: increased interaction within families; more reading undertaken by younger adults; more systematic incorporation of exercise into daily life, and; a rediscovered sense of community with many initiatives paying tribute to the health and essential services workers who have been placed at the forefront of this latest struggle with nature. Of course, for all those who point to benefits in the forced lifestyle changes we have been experiencing, there are those who would tell a contrary tale. Demonstrations in the US have led the push by those who just want things to get back to normal as quickly as possible. For this group, confinement at home creates more problems. These may be a function of the proximity of modern cramped living quarters, today’s crowded city life, dysfunctional relationships, the boredom of self-entertainment or simply the anxiety that comes with an insecure livelihood and an unclear future. Personally however, I am left with two significant questions about our future stimulated by the events that have been ushered in by 2020. The first is how is it that the world has been caught so unprepared by this pandemic? The second is to what extent do we have the ability to recalibrate our current practices and view an alternative future? In considering the first, it has been enlightening to observe the extent to which politicians have turned to scientific expertise in order to determine their actions. Terms like ‘flattening the curve’, ‘community transmission rates’, have become part of our daily lexicon as the statistical modellers advance their predictions as to how the disease will spread and impact on our health systems. The fact that scientists are presented as the acceptable and credible authority and the basis for our actions reflects a growing dependency on data and modelling that has infused our society generally. This acceptance has been used to strengthen the actions on behalf of the human lives first and foremost position. For those who pursue the livelihoods argument even bigger figures are available to be thrown about. These relate to concepts such as numbers of jobless, increase in national debt, growth in domestic violence, rise in mental illness etc. However, given that they are more clearly estimates and based on less certain assumptions and variables, they do not at this stage seem to carry the impact of the data produced by public health experts. This is not surprising but perhaps not justifiable when we consider the failure of the public health lobby to adequately prepare or forewarn us of the current crisis in the first place. Statistical predictive models are built around historical data, yet their accuracy depends upon the quality of those data. Their robustness for extrapolation to new settings for example will differ as these differ in a multitude of subtle ways from the contexts in which they were initially gathered. Our often uncritical dependence upon ‘scientific’ processes has become worrying, given that as humans, even when guided by such useful tools, we still tend to repeat mistakes or ignore warnings. At such a time it is an opportunity for us to return to the reservoir of human wisdom to be found in places such as our great literature. Works such as The Plague by Albert Camus make fascinating and educative reading for us at this time. As the writer observes Everybody knows that pestilences have a way of recurring in the world, yet somehow, we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history, yet always plagues and wars take people equally by surprise. So it is that we constantly fail to study let alone learn the lessons of history. Yet 2020 mirrors 1919, as at that time the world was reeling with the impact of the Spanish ‘Flu, which infected 500 million people and killed an estimated 50 million. This was more than the 40 million casualties of the four years of the preceding Great War. There have of course been other pestilences since then and much more recently. Is our stubborn failure to learn because we fail to value history and the knowledge of our forebears? Yet we can accept with so little question the accuracy of predictions based on numbers, even with varying and unquestioned levels of validity and reliability. As to the second question, many writers have been observing some beneficial changes in our behaviour and our environment, which have emerged in association with this sudden break in our normal patterns of activity. It has given us the excuse to reevaluate some of our practices and identify some clear bene