Protection or punishment—why do we impose public health measures? Since at least the time of the Black Death in 17th century England this controversy has swirled around quarantine and other restrictive public health measures. Then, as in present day Covid-19 pandemic times, individuals in the middle class bore the brunt of hardship because they lacked the means to escape plague stricken urban areas and, more importantly, to compensate for the financial hemorrhage which the restrictions forced upon their livelihoods. No matter the official state narrative, when plague control measures impose restrictions on rental income; call for the destruction of goods, the blacklisting of quarantined merchants, increased taxes; and generally result in the fizzling of demand for goods and services, these measures will certainly feel punitive to some. Yet to those unaffected individuals who remain alive because they did not become infected with Plague, these measures may feel necessary and those losses, distant—like collateral damage.
Pockets of resistance existed throughout plague times, and popular narratives of militaristic and punitive quarantine measures circulated in the form of published pamphlets and books. Severe enforcement backed plague control measures. In medieval Italy, where quarantine originated, violators could even face death. In 17th century England, violators faced either imprisonment or shutting-in—authorities made examples of those who dared to neglect their duties or refused to follow quarantine orders. Then, as now, individuals deliberately defied the rules and protested what they saw as punitive and overreaching measures. The tension between authority and liberty never fades. Wherever restrictions to civil liberty appear, so too will resistance to those restrictions. Opposition to plague control measures ended only when the plague did, just as oppositions to 1918 flu control measures ended only when that pandemic ended.
During the 1918-19 pandemic, cities which instituted early social distancing measures had lower death rates, and whenever political decision makers rescinded measures, infection rates soared and people died. Earlier, more decisive public health restrictions meant more solid control over the virus—fewer deaths. Prevent death by sacrificing livelihoods or spare livelihoods and sacrifice lives—an argument exists for each policy approach. Consider that for some, livelihood and life have no distinction and that for some, having every form of social contact and individual freedom removed is too high a price to pay to keep death away. Can we equate not dying with living? People grow tired of restrictive measures—the social and economic disturbances magnify as they pile atop one another. Living in constant fear of dying from a 21st plague and of facing the loss of livelihood, and doing so in total isolation, removed from human contact, has plunged humans across the globe into nervous system dysregulation. The human nervous system has a finite capacity to withstand and regulate itself through high levels of stress. Beyond that disruptions occur—in popular culture we speak of mental illness rather than nervous system dysregulation, in our quest to pathologise human behaviour. Nonetheless, we cannot ignore any of these disruptions and the harm they bring. Humans need to work, they need purpose and routine, they need human touch and live human connection, they require normalcy in order to function—this forced fear-based stasis cannot continue indefinitely, not on the ground in practical reality.
Unlike the 1918 pandemic, Covid-19 has not come at the end of a four year long world war—our economic recovery will look vastly different. Can we really compromise the well-being of individuals, communities, the economy to prop up safety, ie Covid-19 Zero? How long do we hide, knowing that hiding does not reduce the susceptibility of the population? Physician and medical historian Howard Markel writes, the cost of human life, especially for our own loved ones, far outweighs the drive to reopen the economy as soon (indeed, too soon) as possible. This facile statement seems like a given at first—we want to believe it—and yet, wait—what does the cost of human life mean, and can we honestly compartmentalise existence like this? Can we accurately depict life in these simplistic mutual exclusivities? Why can’t we value the sanctity of life whilst also valuing social and economic stability? Can we have both?
The historically recurring protection vs punishment debate surrounding plague and pandemic control measures reflects the delicate work of balancing collective wellbeing with individual freedom. It also reflects the seeming inevitable tendency of humans to pathologise/stigmatise/dehumanise/punish anyone deemed different or other. Protection vs punishment reminds us that we constantly must push back, challenge the state’s heavy-handed reach. John Stuart Mills wrote extensively on the tension between individual liberty and the good of the many—grappling with authority has plagued humans since we began to have thoughts. To what degree has the moralising of infectious disease fuelled state power over individual bodies? To what extent does our public health policy reflect an overall hierarchical valuation of human life? What lessons does history have for us? Anyone who has studied the history of plague control measures can see that quarantine isolation measures against Covid-19 of present-day elderly and infirm resemble the cruel shutting-in practises of medieval times—locking or boarding up of the infirm and exposed. The protection vs punishment debate also forces us to consider the degree to which we feel willing to relinquish our freedom in the name of safety or preserving life. Can we really equate preventing death with preserving life? I believe a distinction exists.
When does confinement become punitive? When does protection become deliberate exclusion? Who are we protecting? At what human cost? What if the pandemic control measures border on the abusive? Do we subject elders to cruel and inhumane treatment in order to save their lives? Who are we doing this for, when we abuse individuals to keep them alive? How many “young people” is an elder worth? How have governments used plagues and pandemics to filter and purge societies? Can we lay this squarely at the feet of government, or does a natural underlying process such as evolution exert an effect? COVID-19 is part of a bigger picture. Disrupted ecology and human-animal interactions are the cause of most emerging infectious diseases, according to epidemiologist Dr. David Fishman.This means the decisions we make as consumers plays a role. This means political decisions our elected representatives make play a role. This requires us to shift our thinking from planet earth as a static entity toward planet earth as a dynamic hive of intricately woven living ecologies. Covid-19 has shown us our vulnerabilities. How will we address them? Hiding doesn’t seem like the answer.
How does the pandemic upend the notion of long term care and challenge society to develop more humane alternatives? The concept of shunting elders into long term care facilities reminds me of The Homes for the Useless in Ayn Rand’s Anthem, where all humans age 45 would go to live—life expectancy did not extend much beyond 45 because people simply stopped living and did nothing. I’m not exactly sure what other outcome we expected from Covid-19 when we have built a society where we need to shut up our elders in poorly ventilated Homes for the Useless. Covid-19 aside, I believe Homes for the Useless hasten death. My father died in a care home 4 years ago and I often wonder if he would have lived longer had I been allowed to keep him and care for him at home. We now park human beings like we park cars—a car left parked and unused for a long time breaks down and becomes inoperable.
A weird and disturbing question haunts me of late—did we hasten elder death by shutting them in Homes for the Useless? We all but boarded them up inside their Homes for the Useless—I remember hearing about how these draconian measures would save elders, and hearing various officials wax eloquently about the value of elders blah blah—did we convince ourselves, I wonder? The outrage currently playing out in the media tells me we did not. How do we deal with the conundrum of biopower? How do we navigate choices we make which we may not even realise we’ve made—can we avoid what feels like social triage? Maybe we actually cannot. How can we temper the very thing upon which we have come to rely for collective survival?
How can we come to grips with the stark reality Foucault points out—that freedom does not exist without the willingness to die, and that we have evolved into a society which has conceded to the intrusions of what Foucault called biopower? It seems we must live at all cost, even to the point of having to secure the state’s permission to die. Foucault coined the term biopower to capture the tension between the collective body, the state in particular, and the individual body. Biopower means systemic power over life and to a certain extent, death—public health measures, for example. At this point in the pandemic it’s beginning to feel like we have shifted from keeping bodies safe against a virus to exorcising the virus from the collective body. We have become safetyists—we coddle ourselves—the demand for Covid-19 Zero reflects our unhealthy fixation with elimination of all risk—ie safety. Etymologically, safety has it’s root in the French word for salvation, and so denotes a sense of deliverance. Safety means control of recognized hazards—safety requires control, ie removal of freedom, to eliminate risk. Do we think if we hide long enough the threat will simply disappear?
Dr. Lisa Iannottone tweeted Is there another country where there are 0 national standards for controlling the pandemic? Where provincial politicians can make whatever stupid anti-science decision they want? Where there’s no federal leadership at all? Is this normal? Is Canada even a country @JustinTrudeau. Amrit tweetedit's frustrating because Dr. Bonnie Henry refuses to take a #COVIDZero strategy and implement policies that could get COVID rates to 0. This doesn't help enough when so many people are still travelling in and out of BC and we have more infectious strains in BC now. Taj Armstrong tweetedApparently a hot take: I don’t want to live in a society based around zero-risk. The range of reaction to Covid-19 and pandemic control measures varies wildly, with wokesters favouring hyperbole in their crusade for safety. A year into the pandemic the fatigue has pressed everyone heavily and fear still looms as the virus and its variants continue to spread. Like Taj Armstrong, I don’t believe it’s feasible to expect a Covid-19 Zero state.
When I read the rhetoric of those who advocate continued and stronger pandemic control measures, including enforcement and more severe penalties, I feel somewhat disconcerted at the number of Canadians who would embrace what seems like totalitarian rule—control over every aspect of life—in exchange for a promise of safety. Safety does seem very alluring. I admit, I didn’t quite understand the fierce negative reaction Trudeau received last year when he proposed invoking the Emergencies Act, and now, nearly a year later I do, and I can only imagine the social and political environment such overreach would have created. My reaction to individuals such as Dr. Iannottone, who propose increasing the power and reach of the federal government, resembles my reaction to anyone who would suggest slicing bread with a chainsaw. My reaction to individuals such as Amrit, who suggest it’s as simple as implementing policies that could get us to Covid-19 Zero? Rolls eyes—ok, so Bonnie Henry has a box in her closet that’s marked policies that will get us to Covid-Zero and she’s just being stubborn by not opening that box and using the contents?
The example Covid-19 Zero proponents commonly cite fails to convince me—Australia has no charter of rights to satisfy, and several of the restrictions it implemented would have met intense resistance in Canada. The Canada-America border must remain fairly porous in order for Canada to remain functional—the realities of sharing the largest undefended border with the largest superpower and largest Covid-19 infected country on the globe limited Canada’s pandemic policy options in reality, like it or not. Additionally, it seems unlikely at this point that the federal government would have legal grounds to declare a public welfare emergency. Recall, as mentioned above, that Canadian provinces rejected the option of a national state of emergency—the political will did not exist and that’s no one’s fault.
The Emergencies Act, 1985 stipulates that the feds consult the provinces and that cabinet may not use this act to address a situation confined to one province. When, in 1970, the late Trudeau invoked the War Measures Act, the precursor to the present day Emergencies Act, the Charter of Rights and Freedoms had not yet come into effect. Despite scholarly assurances that a pandemic such as Covid-19 would legally warrant invoking federal emergency measures, on the ground in real life it seems important to remember the gravity and power of this legislation—it exists as the very last resort. Emergency measures aside, The Constitution Act, 1867 requires Parliament to provide a rational basis for an intrusion such as legislating in areas of provincial jurisdiction.
Canadians simply cannot get swept into tyrannical governance by a well meaning leader who has in the past demonstrated a startling lack of transparency and evasion of accountability, purely based on fear-addled emotional rhetoric promoted by Twitterati Intelligentsia. Freedom demands a measure of decentralisation, such as the Canadian confederacy provides. Freedom requires a certain degree of risk—zero risk can only happen under total control. In other parts of the world people are willing to die in their revolutionary fights for freedom, every November 11th we honour those who died fighting for our freedom. How much do we value freedom, really, if we will readily sign over all of our individual liberties for the perception of safety? Yes, all these questions I’ve asked feel like difficult questions to face. Yet, I feel compelled to ask them out loud. We need to have this discussion.
How much trust can we place in experts and leaders, who have stood on their soap boxes over the past year and implored us all to do more, give up more, when some amongst them have taken clandestine holidays to exotic locations? How do we compute pandemic control measures which required people to die alone, without family at their side, and forbade families to have funerals and conduct normal grieving rituals and yet allowed masses of wokesters to gather and protest the death of George Floyd? How can we compute pandemic control measures which essentially deprived elders living in long term care residences their basic human rights by shutting them in and yet allowed culture war gatherings and protests?
Does anyone honestly expect that rational individuals can have trust in governments who apply measures this inconsistently and inhumanely? When did protection become a performance and not at all about preserving life or promoting wellbeing? Or perhaps I just never noticed until now? When did protection become punishment, or does it exist in a Schrödinger state—as both at once? Perhaps if decision makers could level with us—the main objective of pandemic control really centres on the preservation of our health care infrastructure—first and foremost this has been about protecting state interests and not preserving human life. Couching state interests in terms of saving lives sounds morally more appealing to the public, whose co-operation the state requires. Labelling as selfish all who dare to consider their own livelihood and the losses they’ve incurred because of Covid-19 injects morality and designates safety as the moral essential.
In my province of residence, British Columbia, the overdose epidemic claimed more lives than did Covid-19. The overdose epidemic has raged here for years, and governments took very little bold or concrete action to stop the deaths and to address the suffering of addiction and other social issues driving the epidemic in any real way—the policy structure upheld by the four pillars seems anemic at best and some of the pillars really don’t exist. In fact Premier Horgan himself downplayed the seriousness of the overdose epidemic in comparison to the Covid-19 crisis. The overdose epidemics deaths do not threatened the collective body—the integrity of governing systems and structures—the same way as do Covid-19 deaths, therefore response action needn’t occur with the same immediacy. We are willing to remove individual civil liberties and inflict wide reaching draconian restrictions to control the spread of a virus and we aren’t willing to invest in human capital to address the serious problems of trauma, addiction, poverty plaguing society, a policy decision which would have a far reaching ripple effect.
I believe lockdown had an important place in the toolbox of Covid-19 control measures at a particular point in the pandemic. I think the window for such measures has passed though, and I wonder how much ideology and emotion drives public policy experts and advisers right now. I continue to see epidemiologists promote the narrative that we could have Covid-19 Zero if only we did this or that particular course of action. Models and predictions seem well and good, however, humans respond to measures imposed upon them and “safety” has become an oppressive almost religious notion we must worship. Covid-19 Zero feels like some kind of religious purity goal that we must purchase with our suffering. Some have paid more than others. As time passes hiding from this single strand of positive sense RNA feels more like a painful collective exorcism than a series of measures designed to promote collective well-being. In the shadows cast by the pandemic, collective and individual well-being seem almost at odds.
Foucault wrote about two approaches to population health, which he called biopower. The first approach he called exclusion, he used lepers as an example. The second approach he described using plague shutting-in as an example. When the plague descended upon societies, control measures moved away from exclusion and toward confinement. Interestingly, in modern times societies seem to employ exclusion measures with marginalized segments of the population—having cast out the displaced, trauma-stricken, drug-addled individuals who live from one fix to the next, like ancient societies once cast out lepers. So, we shut in the elderly and infirm and we cast out the displaced and drug addicted—that describes our approach to public health, a curated society. We build a hierarchy like humans have always done in the past, only with new and different technology. We have centred safety, mistakenly believing it synonymous with wellbeing.
In The Machine Stops, E. M. Forster wrote, We created the Machine, to do our will, but we cannot make it do our will now. It has robbed us of the sense of space and of the sense of touch, it has blurred every human relation and narrowed down love to a carnal act, it has paralyzed our bodies and our wills, and now it compels us to worship it. In this early 20th century dystopian futuristic novella, society lives underground in individual pods, and the outdoors has become designated unsafe, a hostile environment—life consists of sitting inside one’s own pod and, in modern day terminology, surfing the internet and attending zoom video conferences. I’ve mentioned the segment of society who essentially would like life to become an indefinite re-enactment of The Machine Stops—such a manipulative power grab would solve nothing.
The point of diminishing returns has arrived for restrictive and isolating measures, it’s time to begin embracing this new normal, to shift away from the campaign of fear and safetyism—to begin normalising existence again. This feels nearly impossible to do with the oppressive fear narrative suffocating hope—always a new threat uncovered, always another layer of outrage required. One wonders to what end? Not well-being, surely. Safety—safety from a single strand of positive sense RNA. The virus has come to stay, the pandemic may well last another year or two, according to Nicholas Christakis. We have to begin in earnest accommodating this virus, respect—and not fear—must guide us. Tacitus said the desire for safety stands against every great and noble enterprise, and I think human society has begun to live this statement. We cannot control for all risk and expect to maintain freedom. We can be safe or we can be free—which one will we choose?
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