April 2020
Uncertainty and anxiety: the ‘responsible public’ in lockdown
By Shadreck Mwale, 4 April 2020.
If you want to see the impact of the lockdown, the first thing you will want to do is look outside your window. Listen to the eerie silence in the streets- no moving traffic or people. If you can take your once a day exercise time allowance outdoors, pay attention to how narrow footpaths really are. They are not wide enough for maintaining the two-metre social distance. And you probably have already experienced the awkward greetings on footpaths and pavements.
In this piece, I reflect on two separate events over the course of two days experiencing uncertainty and anxiety induced by CoVID- 19. As someone whose other half works on the front line in the NHS, I developed a cough. For me, this was an ordinary cough with a simple aetiological cause – ‘allergic reaction – due to spending too much time in a dusty shed one afternoon’. Nevertheless, as Hannah Bradby points out, times of ‘ordinary’ coughs are long gone. Today, a cough, sniffle or slight headache requires more attention and requires vigilance and strict self-surveillance. This is because among other things, we have to consider ourselves already infected and therefore, should look out for the signs and symptoms. Now post lockdown I am unsure what my cough means for me and my household, and those I may have walked by on my time of exercise outdoors. I wrestled with a number of questions- is this the beginning of the CoVID-19? Is this it? Suffice to say amid all the unknowns, a decision was made, my other half had to work from home that day. Luckily for me, the cough dissipated just as quick as it appeared, was gone, never to return by the following day. Not that I have stopped feeling paranoid or suspicious of every small change in my body since. The experience left me feeling anxious about how one can tell they have got the virus. How different is it to all symptoms I have felt before?
The following day, I had a telephone conversation with a friend who was returning home after a week away for work. While they were away, one family member had developed a cough- not progressive and with no other symptoms. Having spent time away from home, they were not sure whether to return home or stay away. Worried they may be taking the infection home or indeed risking catching whatever was brewing in their household. During this conversation, it was clear that we were both anxious about the current situation. Anxiety was exacerbated by the lack of clarity- both in terms of what constitutes CoVID-19 symptoms and when one has to call for help. Would it not help to test everyone with signs and symptoms to ascertain a condition and dispel the anxiety induced by having a slight cough or headache? We wondered…..
These experiences brought home the anxiety and uncertainty that the pandemic brings with it. Exemplifying Lupton’s (2012) argument about the moral discourse associated with access to medical services, especially access to emergency services. The moral discourse is evident in the NHS (1997) patients charter which aimed to ‘balance patient’s rights of access to NHS services with their responsibility to use services wisely‘. Therefore, over this period of time, access to Accident and Emergency Services, (including Primary Care) to see one’s GP has required a responsible public- able to assess whether one’s condition is a “real” emergency and wise to avoid wasting valuable time and scarce NHS resources. The need for such individual and public responsibility, the ability to assess their symptoms and decide on an appropriate responsible course of action, has become even more crucial in the current context. In the digital age, the responsible public is expected to engage and interpret online information, assumed to be accessible to everyone, as well as constant, at times conflicting news headlines, and online symptom trackers and assess whether their symptoms are those of CoVID-19 and take necessary steps. However, in the context of lack of prior experience or contact with those who may have the condition to draw on as their basis of ‘knowledge’, the responsible public is left uncertain and anxious.
Uncertainty is a complex concept with a cluster of meanings and definitions- here I refer to uncertainty as a state where information about CoVID-19 is insufficient, leading to uncertainty on what the public should do when confronted with what could be the onset of CoVID-19. The point here is not that we should avoid uncertainty. In essence, it is an impossible task, as uncertainty is an inherent part of medicine. Within medicine, uncertain information plays a significant role in promoting autonomy. However, in the current context uncertainty is problematic, and brings to mind Han et al ‘s classification of uncertainty as it relates to complexity, probabilities and ambiguity in health contexts.
First, uncertainty today results from the complexity of CoVID-19 – its fast infection rate, mortality rate, lack of known treatments and preventative vaccines like other types of flu, never mind that you can be fully contagious and completely asymptomatic! The evolving and varied nature of symptoms experienced by patients across the globe adds to the complexity of CoVID-19. It is confounding both the medical practitioners and politicians, leading to a lack of consensus on what actions are to be taken. For example what does a lockdown look like and what does it involve? Who and how is it to be enforced? As such the responsible public is left equally confused and anxious.
Second, uncertainty is borne from the fact that CoVID-19 is also associated with risk probabilities. Medical and policy pronouncements have recently emphasised that specific demographics are more at risk than others of contracting the virus. Resulting in a relaxed attitude among some demographics who feel they have a low probability of contracting the virus. However, recent news headlines challenge these assumptions with news reports indicating younger and healthier people can contract and die from the CoVID-19. This raises questions about what risk really means in this context, further adding to anxiety public attempting to behave responsibly.
Third, CoVID-19 uncertainty results from vague available information. There is paucity of information on symptoms or what course of action the responsible public has to take when they suspect they have symptoms. Even more unclear is when to call 111, 999 or when hospitalisation must be sought -illustrated in increasing sobering recent news media reports of people dying in self isolation, possibly their attempt at acting responsibly.
As Han et al observe, the issue with these forms of Uncertainty is that they lead to harms -such as anxiety and sadly, according to media reports, death in self isolation, and consequently undermines autonomy for the public to behave responsibly. Clearly what the public needs to act responsibly, is clear guidelines on what actions are to be taken when, where and how while acknowledging the uncertainty in such guidelines. Whether it is social distancing, length or frequency of exercise, what to do when symptoms emerge, at what point to call for help and where this help should be sought. The current flux in information on the C0VID-19 lockdown makes a responsible public anxious. Quite where this leaves universal healthcare systems, both now, and post pandemic, is difficult or impossible to say.
