Historicising "containment and delay": COVID-19, the NHS and high-risk patients

How and why to use 'vulnerability': an interdisciplinary analysis of disease risk, indeterminacy and normality

In recent years, 'vulnerability' has been getting more traction in theoretical, professional and popular spaces as an alternative or complement to the concept of risk. As a group of science and technology studies scholars with different disciplinary orientations yet a shared concern with biomedicine, self and society, we investigate how vulnerability has become a salient and even dominant idiom for discussing disease and disease risk. We argue that this is at least partly due to an inherent indeterminacy in what 'vulnerability' means and does, both within and across different discourses. Through a review of feminist and disability theory, and a discussion of how vulnerability and disease both get recruited into a binary conceptualisation of normal versus abnormal, we argue that vulnerability's indeterminacy is, in fact, its strength, and that it should be used differently than risk. Using COVID-19 management in the UK as an illustration of the current ambivalence and ambiguity in how vulnerability versus risk is applied, we suggest that instead of being codified or quantified, as it has started to be in some biomedical and public health applications, vulnerability and its remedies should be determined in conjunction with affected communities and in ways that are polyvalent, flexible and nuanced. The concept of vulnerability encapsulates an important precept: we must recognise inequality as undesirable while not attempting to 'solve' it in deterministic ways. Rather than becoming fixed into labels, unidirectional causalities or top-down universalising metrics, vulnerability could be used to insist on relational, context-specific understandings of disease and disease risk-in line with contemporary social justice movements that require non-hierarchical and non-universal approaches to problems and solutions.

A review and agenda for integrated disease models including social and behavioural factors

Social and behavioural factors are critical to the emergence, spread and containment of human disease, and are key determinants of the course, duration and outcomes of disease outbreaks. Recent epidemics of Ebola in West Africa and coronavirus disease 2019 (COVID-19) globally have reinforced the importance of developing infectious disease models that better integrate social and behavioural dynamics and theories. Meanwhile, the growth in capacity, coordination and prioritization of social science research and of risk communication and community engagement (RCCE) practice within the current pandemic response provides an opportunity for collaboration among epidemiological modellers, social scientists and RCCE practitioners towards a mutually beneficial research and practice agenda. Here, we provide a review of the current modelling methodologies and describe the challenges and opportunities for integrating them with social science research and RCCE practice. Finally, we set out an agenda for advancing transdisciplinary collaboration for integrated disease modelling and for more robust policy and practice for reducing disease transmission.

'Containment, delay, mitigation': waiting and care in the time of a pandemic

In this paper, we take up three terms - containment, delay, mitigation - that have been used by the UK Government to describe their phased response to the COVID-19 pandemic. Although the terms refer to a political and public health strategy - contain the virus, flatten the peak of the epidemic, mitigate its effects - we offer a psychosocial reading that draws attention to the relation between time and care embedded in each term. We do so to call for the development of a form of care-ful attention under conditions that tend to prompt action rather than reflection, closing down time for thinking. Using Adriana Cavarero's notion of 'horrorism', in which violence is enacted at precisely the point that care is most needed, we discuss the ever-present possibility of failures  within acts of care. We argue that dwelling in the temporality of delay can be understood as an act of care if delaying allows us to pay care-ful attention to violence. We then circle back to a point in twentieth-century history - World War II - that was also concerned with an existential threat requiring a response from a whole population. Our purpose is not to invoke a fantasised narrative of 'Blitz spirit', but to suggest that the British psychoanalytic tradition born of that moment offers resources for understanding how to keep thinking while 'under fire' through containing unbearable anxiety and the capacity for violence in the intersubjective space and time between people. In conditions of lockdown and what will be a long and drawn-out 'after life' of COVID-19, this commitment to thinking in and with delay and containment might help to inhabit this time of waiting - waiting that is the management and mitigation of a future threat, but also a time of care in and for the present.

The politics of staying behind the frontline of coronavirus

Intended as a contribution to the Waiting in Pandemic Times project Collection in response to COVID-19, this short theoretical paper views the coronavirus crisis in terms of its unpredictable effects on the interior life of the National Health Service (NHS) workforce. Written immediately following the suspension (due to the pandemic) of an ethnographic investigation of waiting in a general practice in London, it tracks the first signs that working definitions of time would struggle to survive the onset of a temporality of acute crisis in the NHS. The paper considers what it might mean for healthcare practitioners at this particular moment in the NHS’s history to be living through an experience of ‘the ordinary’ breaking down. It also follows hints of new temporal modes of care appearing during this same period when one kind of crisis in the NHS has been put on hold, and another (the crisis of coronavirus) is just getting underway.

The politics of staying behind the frontline of coronavirus

Intended as a contribution to the Waiting in Pandemic Times project Collection in response to COVID-19, this short theoretical paper views the coronavirus crisis in terms of its unpredictable effects on the interior life of the National Health Service (NHS) workforce. Written immediately following the suspension (due to the pandemic) of an ethnographic investigation of waiting in a general practice in London, it tracks the first signs that working definitions of time would struggle to survive the onset of a temporality of acute crisis in the NHS. The paper considers what it might mean for healthcare practitioners at this particular moment in the NHS's history to be living through an experience of 'the ordinary' breaking down. It also follows hints of new temporal modes of care appearing during this same period when one kind of crisis in the NHS has been put on hold, and another (the crisis of coronavirus) is just getting underway.

'Containment, delay, mitigation': waiting and care in the time of a pandemic

In this paper we take up three terms - containment, delay, mitigation - that have been used by the UK Government to describe their phased response to the COVID-19 pandemic. Although the terms refer to a political and public health strategy - contain the virus, flatten the peak of the epidemic, mitigate its effects - we offer a psychosocial reading that draws attention to the relation between time and care embedded in each term. We do so to call for the development of a form of care-ful attention under conditions that tend to prompt action rather than reflection, closing down time for thinking. Using Adriana Cavarero's notion of 'horrorism', in which violence is enacted at precisely the point that care is most needed, we discuss the ever-present possibility of failures  within acts of care. We argue that dwelling in the temporality of delay can be understood as an act of care if delaying allows us to pay care-ful attention to violence. We then circle back to a point in twentieth-century history - World War II - that was also concerned with an existential threat requiring a response from a whole population. Our purpose is not to invoke a fantasised narrative of 'Blitz spirit', but to suggest that the British psychoanalytic tradition born of that moment offers resources for understanding how to keep thinking while 'under fire' through containing unbearable anxiety and the capacity for violence in the intersubjective space and time between people. In conditions of lockdown and what will be a long and drawn-out 'after life' of COVID-19, this commitment to thinking in and with delay and containment might help to inhabit this time of waiting - waiting that is the management and mitigation of a future threat, but also a time of care in and for the present.

Having a moment: the revolutionary semiotic of COVID-19

The time of COVID-19 represents a distinct, but currently under-defined and under-theorised, temporal moment. Using semiotic methods, this paper examines how the mechanical actions of the virus, through becoming social, create a new viral time, heralding an already-arrived new historical epoch. This epoch, which is simultaneously both homogenous and undifferentiated at one tempo, and supercharged with change, events and radically uncertain futurity at another, is riven with revolutionary potential. The existential challenge posed to the faltering socio-economic order is evidenced by a panicked political response combining reactionary attempts to reimpose temporal certainty and fixity, with desperate material concessions to a public suddenly expelled from a previously subsuming dominant productive time of capitalism. As such, this temporal crisis offers the necessary, if not sufficient, moment for profound re-imaginings of our productive and social relations, and an opportunity to look beyond the possible end of the world, and towards the end of capitalism.

Waiting for other people: a psychoanalytic interpretation of the time for action

Typical responses to a confrontation with failures in authority, or what Lacanians term 'the lack in the Other', involve attempts to shore it up. A patient undergoing psychoanalysis eventually faces the impossibility of doing this successfully; the Other will always be lacking. This creates a space through which she can reimagine how she might intervene in her suffering. Similarly, when coronavirus forces us to confront the brute fact of the lack in the Other at the socio-political level, we have the opportunity to discover a space for acting rather than continuing symptomatic behaviour that increasingly fails to work.