Friday 27 March 2020

Covid-19 and the Disaster Research Gold Rush


As I write, the Covid-19 pandemic is ramping up in many countries. So is the response by academic authors. In 2015 Gaillard and Gomez published an interesting paper on the "disaster research gold rush". It was inspired by some thoughts expressed in 1967 by eminent sociologists of disaster on problems associated with researching transient events (Dynes et al. 1967). In the life-cycle of a disaster, when is it appropriate to do such research?

Disasters give rise to many imperatives. They also generate 'perishable' data that, if they are not collected, will disappear without trace. By common consent, disaster researchers rarely go to events in the early stage of the crisis. To interrupt vital life-saving efforts with social surveys or demands for data would be unconscionable. However, it is a different matter if the researcher can work without visiting the site, putting a foot in the door of the emergency room or stumbling across the path of rescuers.

I am the editor-in-chief of a large international academic journal. The Covid-19 gold rush has already begun. The trickle of papers threatens to turn into a raging torrent, and the disaster is not yet half way through the crisis phase. This points to a conflict. On the positive side, academics wish to throw light on the problems caused by Covid-19, suggest solutions and launch valuable new initiatives. They also wish to capture experience and preserve it as evidence on which to base future policies and plans. On the negative side, there seems to be an urge to be the first in the field with a paper, as if this were are race to be won.

Authors can write in haste and repent at their leisure: editors can rue the day. Much of what is written will need to be reconsidered in the light of the outcome of the pandemic, which is months away, and the post-event debate that follows it. I admit that this is equally true of the present blog, but my criticism is not aimed at those who express an opinion. Debate is healthy, even when there is a need for national and international solidarity. However, any analysis based on half the story is likely to be suspect.

A positive side of the urge to publish is the desire to contribute to the debate before it lapses because attention is diverted to other issues. However, there is a prevailing question about how soon in the sequence of a disaster is it appropriate to take stock? This depends on how easy it is for earlier conclusions to be invalidated by the progress of events. The question is then, to what extent is this predictable or likely to create exigencies that cannot be included in the present analysis?

The Covid-19 pandemic is distinguished by high levels of uncertainty in many of the tenets that anchor the scenario: infection rates, geographical spread, case-fatality rates, government policies and their impacts, public discipline or indiscipline in the face of emergency measures, and repercussions on the economy and people's livelihoods. These factors militate against an over-hasty academic response. So when you read academic papers written in the thick of Covid-19, caveat lector!

References

Dynes, R.R., J.E. Haas and E.L. Quarantelli 1967. Administrative, methodological, and theoretical problems of disaster research. Indian Sociological Bulletin 4: 215-227.

Gaillard, J-C. and C. Gomez 2015. Post-disaster research: is there gold worth the rush? Jàmbá: Journal of Disaster Risk Studies 7(1), Article no. 120, 1-6.

Thursday 26 March 2020

Interpreting the Pandemic for Decision Making and Action



As the Covid-19 pandemic progresses, causing distributed crises in one country after another, it is like watching all I have taught about for the last four decades flash past in a sort of speeded-up film.

In disasters of this kind, three attitudes are common. Normalcy bias, the tendency to accept the most reassuring interpretation of a situation, tells people that it will not be as bad as it seems. The syndrome of personal invulnerability tells them that the worst can only happen to other people. This leads to cognitive dissonance, simultaneous belief in two incompatible ideas. All of these are misleading states of mind, perhaps dangerously so, and especially when found in politicians and decision makers. Other states of mind combine with the three syndromes to worsen the environment of reaction to the crisis.

For a century, the Hollywood model of disaster has been widely disseminated in disaster movies. The underlying precept of this is that beneath the civilised veneer of society pervasive anarchy lurks, which in cases of extreme disruption would bring out the "savage" in ordinary people, a tendency to safeguard their own interests by all conceivable means, including extreme violence. The Hollywood model relies on heroes and villains. In disaster movies the villains either have rapacious ulterior motives connected with power and greed, or they are immune to common sense. The hero (almost always a man, not a woman, who is invariably his loyal supporter) is a young, fit, active, misunderstood visionary, the only person who can see the truth and is prepared to fight for it. Against all odds, he wins. What nonsense! In reality, fighting disasters is a collective effort that places complete reliance of developing enough consensus for measures to work. It demands meticulous prior planning and the development of detailed scenarios before the phenomenon strikes. While anti-social behaviour does not disappear, especially where it is ingrained in society, there is often an upwelling of social participation, which the sociologists know as the therapeutic community.

For Covid-19 we had the scenarios. I have taught them at least once a year for more than a decade. My primary message was that a pandemic is as much a socio-economic and behavioural problem as a medical and epidemiological one. There was nothing visionary about my approach. It was based on material that has been well publicised and freely available since the second half of the first decade of the century. Normalcy bias, fiscal stringency and the ideology of profit conspired to stop preparations from being effective. Dire warnings were given by emergency planners and epidemiologists. There were ignored or underrated, largely because dire warnings tend to be discounted. They do not encourage decision makers to assume responsibility.

What is now fascinating about the consequences of this is that improvisation is being used frantically to cover the yawning gaps in preparedness. Improvisation cannot be totally avoided in disaster, but failure to prepare leads to avoidable deaths and suffering. Hospital beds, medical staff, personal protective equipment, ventilators, vaccines, antivirals, palliative medicines, economic subsidies, payment for holidays, substitute wages, organised assistance, the policing of social distancing, the reorganisation of public transport and basic services, emergency communication, they are all being improvised. It is rather too much and hence the task is simply overwhelming.

For many people, the Hollywood interpretation, familiar as it is, was the only model they had recourse to in order to understand the workings of this disaster. It rapidly proved unserviceable and has been abandoned by many, thank goodness. However, it has been followed by catastrophism. We might see this interpretation as one of the "orderly breakdown" of society, in contrast to the anarchic version propounded by Hollywood. Inasmuch as there is a model, it is the 1920s, a dire period that led, through mass unemployment, general strikes and failure to care for demobilised servicemen, to the Great Crash of 1929, and ultimately the Second World War. Perhaps the overriding question is "after Covid-19 has finally abated, to what extent will the world be the same as it was?" There is little sense that it will be a better, stronger, more prosperous place.

A related question concerns whether the lessons of this pandemic will be learned. The indications are, at best, mixed. There is often a tendency to assume, once a disaster has passed and recovery is well underway, that it is "all over", an episode that will not be repeated. One of the greatest lessons is the imperative need to take emergency planning and preparedness more seriously. I hope that this will be received in full, resources will be supplied and major effort will be expended, but I am not going to bet on it.

In previous posts, I have suggested that disasters need to be understood with more emphasis on their context. I suggested the "egg model", in which the yolk is a set of causal factors directly related to disasters and the white is all the factors that impinge on the yolk without being direct causes of disaster. In another model, general vulnerability encapsulates specific vulnerability to disasters. We will need to look long and hard at the context of future susceptibility to disasters and chart the interaction in a world that will inevitably bear the marks of this major upheaval. Until some form of stability is reached, progress on this important task is likely to be very restricted.

Sunday 15 March 2020

Covid-19: An Address


Once upon a time in Tuscany, when my son was very young, I lamented to a friend that all he seemed to have learned at school was how to swear and blaspheme. My friend put on a wise expression and said, very sagely, "David, you must remember that swearing and blaspheming are an ancient tradition in our countryside here." I mention this because, in AD 1244, a group of men in a bothy decided that they were swearing and blaspheming too much and each time they did it they would put a groat in a jar. At the end of the year they would open up the container and spend the proceeds on a feast. As it happened, when they came to open the jar there was so much money in it that they hadn't got the nerve to spend it on food and drink for themselves. So they founded a rescue and care society. Thus was born the Venerable Company of the Misericordia. After 776 years it is still headquartered in the same building, situated next to the cathedral in central Florence. In the small Tuscan town in which I live, the Misericordia did not arrive for a further 291 years (in 1535, precisely), but what are a few centuries between friends?

An organisation of this kind obviously has very deep roots. And there is great pride in it. Moreover, it started a process of creating associations that proliferated to the point that volunteer organisations are the backbone of the Italian civil protection system and there are 3,600 of them. They connect the world of emergencies with the general population. In the last four earthquakes in thed affected areas there were more rescuers than population, which is a remarkable achievement, especially as they are trained, organised and equipped. Most importantly, they are a full part of the system.

In times of grave crisis, we need solidarity, but where are we going to get it? The Covid-19 pandemic ought to teach us the importance of both preparedness and social participation. With regard to preparedness, emergency response consists of planned activities, standardised procedures and improvisation. Too much of the last of these is tantamount to negligence, because it shows up the lack of planning and preparedness. Social participation is about the democratisation of emergency response. Civil protection is us–all of us. It works best where people are protagonists and assume some responsibility for their own destinies. Participatory civil protection is prudent. It draws in the beneficiaries of the system as actors and protagonists, but it, too, needs to be organised in advance, with foresight.

Different countries have different attitudes to emergency preparedness and the protection of the general public. These stem from their administrative and legal systems and cultures, and from the attitude of the holders of power to direct democracy. Cyclone Nargis devastated Myanmar and killed 136,000 of its citizens, in part because they had no role in creating resilience against such an event.

In Britain, there is a culture of "leave it to the experts", or perhaps, given the anti-intellectual wind blowing through the country, disdain for experts (a paradox, indeed). Since the stand-on-your-own-two-feet privations of the Second World War, there has been a gradual and sustained retreat from personal respomsability in favour of leaving the work to officialdom–and blaming officialdom when there are shortcomings in its response. There has also been the ideological assault of Thatcherism, a retreat from social provision and a gradual abandonment of the idea of participatory democracy. "There is no such thing as society," she said, and did her best to make it a self-fufilling prophecy. At the same time, control of the country's assets became ever more centralised.

Britain does not lack a social conscience, or sensitivity to social issues. Many people labour ceaselessly to provide what the state has increasingly turned away from. When there is a major crisis, the response is generally to revive what sociologists call the 'therapeutic community'. But it has been weakened. Britain follows, not the continental European model of solidarity, but the American model of individualism, and this is particularly true in civil protection. It is a pity, as the United States have lost the lead in this field–if they ever had it. The coup de grâce was the response to Hurricane Katrina in August 2005. It was a model of inefficiency and failure.

Commentators and officials used to say that "Britain does not have disasters". We have instead, "major incidents". Why we should be so reticent about calling them disasters is a mystery to me, for that is what they are. Covid-19 is rather more than a "major incident". It is a gargantuan civil contingency that will leave its mark for decades to come–among those who survive it.

There was a period in the decade of the 2000s and early 2010s in which pandemics were the focus of emergency planners' attention. They were then supplanted by a renewed emphasis on counter-terrorism and that in turn was overlain by frantic preparations for the supply-chain disaster of Brexit (emergency response is very much a "flavour of the month" business, just like ice-cream shops). Looking at the current British response to Covid-19, it is difficult to see quite where all that effort on pandemic emergency planning went. Perhaps the answer is that it is too difficult to plan a system that has been decimated, after eight years of Draconian budget cuts. However, it is not exactly easy to organise an alternative system in the thick of the emergency. Voluntarism comes in three types: spontaneous, organised and organised-and-incorporated. The last of these makes a real civil protection system. The first is inefficient because it is shorn of training and equipment, it is not adequately absorbed into the emergency response machine, and it has to be organised with much effort on the spur of the moment. That is what we are currently seeing in Britain. But at least we are seeing an attempt to generate solidarity, even if it is not of the optimum kind.

Emergency planning is something that needs to be done in times of quiescence and peace, but it also goes on throughout the emergency, as the provisions that were made in advance have to be adapted to the dynamic, evolving situation. Much use is made of scenarios. A scenario is not a prediction of the future. In this context, it is a systematic exploration of a range of possible future outcomes. For pandemics, we use parametric models. These are simply sets of equations in which, on the basis of–often flimsy–assumptions and a minimal amount of data–coefficients are set and calculations are made. Garbage in-garbage out if the sum total of the data and the assumptions are not adequate. And the trouble with pandemics is that there is truly massive uncertainty: disease transmission rates, infectiousness, survival rates, social behaviour, the effect of emergency measures, healthcare response–they are all infinitely mutable.

Under such circumstances, two elements of strategy are to be recommended, neither of which has been properly practised in Britain. One is not to discuss the worst case scenario unless there is a very strong practical reason for doing so. The other is to devote very substantial resources to early preparedness, as a precautionary measure and a demonstration of prudence. "Normalcy bias" makes us assume that it won't be that bad. It might be, so we must be ready to fight it.

Besides Covid-19, the shadow of another phantom stalks us. That is the Hollywood model of emergencies. Research (including my research) shows that it is remarkably resilient, not only among the general public, but also among the emergency response communty and the political classes. In essence, the Hollywood model is one in which a destabilising emergency causes the breakdown of society, revealing the essentially selfish, self-seeking egotism of its members. The antidote is marshall law. There have been rumours about preparations for this in Britain, a country which tends to look upon emergencies as public order problems. If we ever arrive at such a situation it will be a sad, sad indictment of British society. It would presuppose that, by and large, people have no social conscience and that the fabric of society is completely threadbare. As that seems unlikely, I think the model should be dropped like a hot potato. It is as well to remember that outbreaks of looting tend to occur strictly where there are substantial preconditions for them. They do not happen spontaneously in a completely unpredictable manner. Nor do other forms of antisocial behaviour. In this, we reap what we sow.

Disasters need to be seen in the contexts in which they occur--I nearly said the context in which we generate them, for they are not natural. Identity politics, scapegoating, contraction in the welfare safety net and public services, all these impinge, negatively, on the developing disaster scenario. For many people, Covid-19 is a bolt from the blue. It either is or will become a major source of anxiety and destabilisation in their lives. Yet what is happening is predictable and was predicted, comprehensively and repeatedly. The question is who was listening? And who was willing to act? There is now a major opportunity to rethink the tenets of modern life and refound them on the basis of prudence, solidarity and participation. And let us not forget that for the inhabitants of Syria, Yemen and all those places where grinding poverty routinely overwhelms people, existential threats have been the normal way of life. The influenza pandemic of 1918-1920 killed most of its victims in developing countries that entirely lacked health-care systems. That is a sobering lesson. Amartya Sen wrote that health care is a prerequisite of development: never more than now.

Wednesday 11 March 2020

Covid-19: Elements of a Scenario



It is now more than ten years since there was a general push to induce countries to plan for pandemics (WHO 2005). In some quarters, it had an immediate effect (e.g., US Homeland Security Council 2005, UK Government 2008), while in others it did not. In 2020, some confusion arises from the fact that much of the planning refers to influenza, whereas the SARS category of diseases is not strictly a 'flu virus, but most of the planning principles are exactly the same, so this is mainly a labelling issue.

In the wake of the WHO report, Professor Ziad Abdeen of the Palestinian Health Authority said about pandemics: "My task is to tell you things you don't want to know, and ask you to spend money you haven't got on something you don't think will happen." About the same time, 2007, Dr Michael Leavitt of the US Department of Health and Human Services wrote: "We don't know when a pandemic will arrive. However, two things are certain: everything that we do before will seem alarmist; and everything that we do afterwards will seem insufficient." Nevertheless, Dr Margaret Chan, then the Director of the Communicable Diseases Section of the WHO, stated "For the first time in human history, we have the ability to prepare ourselves for a pandemic before it arrives. Therefore, the world community must take action immediately." That was at a time when an influenza pandemic with devastating consequences was greatly feared. When it came, in 2009, it was less deadly than expected, but that does not negate the possibility of a highly contagious disease with a case fatality rate equivalent to that of SARS in 2003, namely 10%.

Major epidemics and pandemics (what is the difference?) are crises which have to be managed simultaneously at several levels, from international to local. They also involve very high degrees of uncertainty. The mathematical models that are used to predict the diffusion of diseases tend to be parametric and to depend on simple but debatable assumptions (e.g. Mathews et al. 2007). If the progress of the disease is linear or simple non-linear, that is acceptable. However, aggregate human behaviour and many local factors, including prevention measures, can modify the prognosis.

I have no magic answers to the problem of the SARS-CoV-2 virus. One thing we know about pandemics is that the socio-economic effects, not only the medical ones, can be profound. Vast mutations in society, economy and social behaviour are possible. Although we hope that they will be temporary, they may well have some lasting effects. For example, civil aviation is particularly vulnerable. Based on SARS 2003 and early infection rates, a projection for the effect of Covid-19 on the airlines shows a dip for six to nine months (Pearce 2020). However, this depends on whether companies manage to remain solvent during and after the crisis. The civil aviation landscape could change drastically in the longer term.

The figure above is an attempt to summarise the issues connected with the Covid-19 pandemic. In each of the five categories there are opposites or alternatives. Thus, the vulnerability and fragility of people and society need to be seen in the light of socio-economic changes induced by the epidemic. Here is how I would classify the impacts and challenges. This is intended as the basis for possible scenarios of the outcome of the pandemic.

Severe negative impact:-
  • transportation, especially civil aviation and trains
  • hospitality and tourism
  • catering
  • the entertainment industry and cultural attractions
  • general medicine
  • ill and handicapped people
Under severe duress:-
  • decision making systems and decision makers
  • police
  • hospitals
  • civil protection forces
  • social welfare systems, including non-governmental ones
  • insurance
  • prisons
  • civil liberties?
Under duress:-
  • food supply and supermarkets, including supply chain
  • general consumption of consumer goods and consumer durables
  • distribution systems
  • IT systems
  • manufacturing
  • basic infrastructural services
Presenting opportunities:-
  • sanitary items, pharmaceuticals
  • vaccine research, production and distribution
  • security industry
  • information services (mass media, social media)
Changing and needing to adapt:-
  • mass media
  • the financial system
Intangible effects:-
  • trust in authorities
  • medical ethics (in the apportionment of and priorities for healthcare and vaccination)
  • difficulties associated with work
  • difficulties associated with social interaction (family, recreation, etc.)
  • difficulties associated with procuring reliable, intelligible information
  • being in the wrong place at the wrong time
  • general uncertainty in the evolution of the epidemic
These, then, are the possible building blocks of scenarios that could be used for future planning. It is important to ensure that emergency planning measures are balanced among society's and people's needs. This is where scenarios can help by providing the broad overview of demand for help. It is also important to remember that the Covid-19 pandemic occurs in the context of other developments. These include post-recession recovery, polarisation and wealth distribution issues, and the pressing need for climate change adaptation. In Britain, they also include the Brexit negotiations and the shape of the post-Brexit economy that will emerge after 2020.

A very important question to be answered is how a country functions amidst a general shut-down, something that is looking increasingly necessary in a number of places. This matter has to be examined from the point of view of citizens, workers, decision makers, crisis responders, and other stakeholders. Perhaps comparisons with the general strike of 1926 might yield some insights. However, it is important not to overdo historical comparisons, as we know from looking at the effects of the 1918 'Spanish' influenza (Spinney 2018).

Finally, another aspect to take into consideration is the politicisation of disease. The 'Spanish flu' was so called because Spain was liberal in its control of information, yet the virus came from China. Wherever a disease comes from, and whoever brings it, there is no justification for creating scapegoats. One has the impression that in 2020 the world needs to relearn the practice of solidarity between nations and between communities. This brings us back to context, and the potential role of identity politics, a corrosive role if ever there were such a thing.

References


Mathews, J.D., C.T. McCaw, J. McVernon, E.S. McBryde and J.M. McCaw 2007. A biological model for influenza transmission: pandemic planning implications of asymptomatic infection and immunity. PLoS One 2007:2(11): e1220, 1-6.

Pearce, B. 2020. COVID-19 Updated Impact Assessment of the Novel Coronavirus. International Air Transport Association, Geneva, 14 pp.

Spinney, L. 2018. Pale Rider: The Spanish Flu of 1918 and How it Changed the World. Jonathan Cape, London, 352 pp.

US Homeland Security Council 2005. National Strategy for Pandemic Influenza. US Government, Washington DC, 12 pp.

UK Government 2008. Pandemic Flu: UK International Preparedness Strategy. United Kingdom Cabinet Office, London, 27 pp.

WHO 2005. Global Influenza Preparedness Plan: The Role of WHO and Recommendations for National Measures Before and During Pandemics. Department of Communicable Disease Surveillance and Response, Global Influenza Programme, World Health Organisation, 49 pp.