Soldier on with Covid, Soldier on
On Coffee and Codral ™️
Back in the late 1980’s, when I was 17 and 18, I not infrequently worked two back-to-back nine hour shifts while sporting a military-grade flu, dosed up on coffee and Codral ™️ cold and flu tablets. The setting was a busy 24 hour restaurant on Bourke Street, in Melbourne’s CBD. I cannot even imagine how many people I inadvertently infected.
Having left home weeks after turning 17, it wasn’t long before I dropped out of high school. With no formal qualifications or training – not even a high school certificate – if I wasn’t waiting on tables, preparing meals in the kitchen, or clearing and cleaning tables and washing up, then by the week’s end I would be out on the street. Covering the rent for my cramped little room, in a long-gone seedy South Yarra guest house, was a weekly challenge.
Worse, though, if I called in sick and took the time I needed to recover, then I would potentially have no shifts next week, because the roster for next week was usually just a version of this week’s roster. Why would the management reinvent the roster each week ex nihilo, when they could just run with the roster that worked this week? An unfortunate side effect of this otherwise-sensible approach to rostering staff, was that if your name had been erased off this week’s roster and replaced by whoever covered your shifts, then your name also would not appear on the new roster. Not for any nefarious reasons, but just because management forgot you were sick, and in copying over this week’s roster to next week, they did not remember to schedule you on.
I also didn’t want to let people down. If I called in sick or had to let the shift manager know that I was too sick and needed to go home and rest, then someone else would cop a phone call at 1am from a distressed shift manager, pleading with them to come in and help out. Then they’d be saying “bye bye” to their one day off, the shift manager would be inconvenienced, and I’d feel like I had let the whole team down.
Lastly, think whatever you want about high school drop-outs, but I was ambitious. At the time, I wanted to become a shift manager and a qualified chef, and you just couldn’t do that unless you were prepared to push yourself. Sometimes, unless you pushed yourself really hard, and that’s precisely what I did.
Changing Values
In those days, Codral ™️ cold and flu tablets saved me from poverty. They also enabled me to pursue my ambitions – to have ambitions, despite my crummy circumstances – and to be a team player.
If you don’t remember the ear-worm advertising jingle or its lyrics, here’s a link, but the chorus went like this: “Soldier on with Codral, Soldier on!” The images depicted adults from all walks of life — all responsible people, strong people, successful people. They’d woken up with cold and flu symptoms, people were depending on them, and they weren’t going to call in sick. Calling in sick was for people who let the side down, for bludgers, for losers — it was certainly not what all of these clearly morally upright and hard-working citizens did. They all had jobs to get on with, real work to do, and so they reached for their packet of Codral ™️ – a potent cocktail of two pain killers (paracetamol and codeine) and a decongestant with speedy stimulant properties (pseudoephedrine) – and they soldiered on!
Just imagine how well that advertisement would go down today!
Yet, it was evidently seen as perfectly appropriate for airing on commercial television channels. In fact, I never found a pharmacy that didn’t carry it when I needed to soldier on. Occasionally, though, in the middle of winter when everyone was coming down with a cold or flu, it would sell out and I had to drag myself from pharmacy to pharmacy to find one that had it in stock. Since it was apparently quite popular, I gather that I wasn’t the only one who thought that running on Codral ™️ while sporting the flu was a reasonable thing to do.
Until relatively recently, soldiering on was the norm — it was at least permissible, and sometimes in some circles it was even thought of as the right thing to do. Despite the fact that we were all spreading our germs around. I cannot help wondering whether soldiering on contributed to ramping up the pace at which coronaviruses mutated. After all, we dosed ourselves up with meds, and created a perfect environment for them — we could still keep working, and they could keep spreading throughout society. For whatever reason, though, the medical consequences of this pharmacologically-enabled recklessness either weren’t noticed or they weren’t given due consideration. Or maybe we were simply all complicit in wilfully ignoring the social side effects that we inflicted on others when we took Codral ™️, and wilfully ignored the broader potential consequences?
I am pretty certain that, given the present day circumstances, the problems with “soldiering on” would not go un-noticed today. Indeed, after spending a few minutes on the manufacturer’s web site just then, I couldn’t even locate that original Codral ™️ cold and flu formula – the one that contained codeine and pseudoephedrine. What I found, however, was a brand new socially responsible message:
We salute you Australia for finding new ways to soldier on.
Codral’s ™️ web site.
Well done, Codral ™️ — I salute you too. However, although I’m glad that pharmaceutically-enabled soldiering on is no longer in vogue, I worry about a different danger that lurks in today’s heightened focus on the medical.
Framing a Pandemic
It’s tempting to think of the Covid-19 pandemic as a medical problem. After all, there’s a virus — it’s called SARS-CoV-2. This virus causes an illness we’ve named Covid-19 — “COVID” being an acronym for COrona VIrus Disease, and the “19” is a reference to the year 2019 when it was originally called the “novel coronavirus”. The foregoing details, obtained from the World Health Organisation’s web site, also have a medical ring since health sounds like something that the medical professions know about. Surely viruses, illnesses, and diseases – and possibly health – are paradigmatic examples of medical things, aren’t they?
When we frame a situation like the Covid-19 pandemic as a medical situation – as a medical problem – it’s natural to follow through by setting out in search of medical solutions. Maths problems have maths solutions, engineering problems need engineering solutions, moral problems require moral solutions, aesthetic problems call out for aesthetic solutions, and… you probably get the picture. Not surprisingly, over the last six months we’ve heard a lot about a lot of medical things, and also a lot about a lot of non-medical things that are framed as medical things.
Doctors, nurses, paramedics, epidemiologists, and other kinds of medical practitioners and researchers. Hospitals, ventilators, testing kits, contact tracing humans and apps. Face masks and other personal protective equipment, alcoholic hand sanitisers, disinfectant wipes, disinfectant sprays, and good old fashioned soap and water. Quarantine, self-isolation, social distancing, as well as working and learning from home. But nothing else quite captures the medical genre of the foregoing solutions – a genre that stems from the original framing this situation as a medical problem – as the hopes that we appear to have pinned on a vaccine, a treatment, or a cure.
There’s nothing surprising about how we’ve approached this pandemic. Moreover, I am deeply grateful to all the health professionals and scientists who have given everything they have to keep us safe, and have worked incredibly long hours to save the lives of people whose health is in a critical condition. They have risked – and they continue to risk, in large measure because of a long-standing inadequate supply of personal protective equipment – their very own lives across hospitals, doctors’ clinics, aged care homes, pharmacies, and in countless other places and contexts.
Lest any of the above comes across the wrong way – as a glorification of my and others’ reckless behaviour prior to the Covid-19 pandemic, or as a lack of gratitude for all of these people’s tireless efforts – let me state for the record:
For crying out loud, can we please start helping our medical professionals?
Quoting myself here to put my view about this matter on the record.
And I don’t just mean by wearing masks in public, taking better care of how we conduct ourselves in public spaces, and staying home and self-isolating when directed to do so, though all of these things would certainly be a good start.
The health sector is buckling from the pressure that has been placed upon it by this pandemic. At the time of publishing this essay, on 15 August 2020, in the United States of America alone, the death toll stands at 940 health care workers. The SARS-CoV-2 virus, along with inadequate supplies of personal and protective equipment, have claimed these people’s lives. In the state of Victoria, healthcare workers make up a mind-boggling fifteen percent of all infections. The risks that have been foisted on healthcare workers comprise serious workplace health and safety concerns that should have been addressed long ago. As Dr David Berger, a GP and emergency medicine specialist has put it:
If this was a factory, it would have been shut down.
David Berger, quoted in this ABC Online news story.
Apart from those who will lose their lives, who knows how many more health care workers will spend the rest of their lives battling with the debilitating chronic health problems that seem to now be surfacing in the aftermath of infection.
So, again, my aim is distinctly not to criticise the medical profession, nor even to criticise the medical framing. Rather, my aim is to illuminate that we are currently overlooking many other potential things that we could do to help carry some of the incredible burden of fighting the pandemic. A burden that, at the present moment, has been placed chiefly on the shoulders of medical professionals.
Non-Medical Conditions of Medical Conditions
My aim in this essay is to highlight how other professions and disciplines could chip in, and the way I shall do this in the remainder of this essay is by arguing that although Covid-19 is indeed a medical condition, the conditions – or, put another way, the causal factors – that sustain and propagate it (or, equally, that could help to suppress or eliminate it) are not just medical. As a starting point, we might say that the Covid-19 pandemic is a situation sustained by factors that span across at least the medical, political, economic, social, technological, legal, environmental, and axiological (i.e. value) domains. Consequently, to tackle this pandemic effectively, we must identify and target the wide range of factors that sustain and propagate it, rather than expecting miracles to be delivered by only targeting the medical factors.
The personal anecdote with which I started this essay was intended to highlight the role that economic factors, as well as my values, played thirty years ago when I shared my germs around with co-workers and guests at the 24 hour restaurant where I worked in Melbourne’s CBD. Going on recent news reports about Victoria’s struggle with containing the Covid-19 outbreak, I suspect that these same factors still play a role thirty years later in people’s spreading of the SARS-CoV-2 virus. Ingrained cultural and social norms and values, like those that the now-abandoned Codral ™️ cold and flu advertisements contained, can undermine even the most robust public health effort, and so too can economic factors. When we ask people to self-isolate – to place themselves into quarantine – we are asking them to make sacrifices for us. We are not asking them to do it for themselves – they are already infected – and if we really want them to do it, then we should reciprocate by assuring them that we will provide for their needs. And although a once-off $300 or $450 hardship payment, or even a more generous once-off $1,500 payment, might cover lost earnings while a person self-quarantines, it offers absolutely no protection against losing your job when your name stops being copied across from this week’s roster to next week’s roster.
Income security could be provided by a robust social welfare system – perhaps even by adopting a universal basic income– however that this is a highly divisive political and politicised topic. This topic exposes deeply-rooted values – about such things as not sponging off others and having “the right” work ethic – which sit at the heart of this political divide, and which ultimately need to be addressed.
Similarly, within certain age groups and sectors of the public, men are significantly less likely than women to see a doctor, even for a routine check-up. The factors are complex, but ingrained macho stereotypes appear to be in the mix. Perhaps this explains why more 20-29 year old women, by comparison to men in the same age bracket, are being diagnosed with Covid-19 — i.e. maybe men in this age group feel more affected by the gendered factors than women in this age group? I put this as a question because I honestly do not know, but if gender norms play a role in how well we can test, track, and trace the spread of the SARS-CoV-2 virus, then addressing these gender norms might provide an important leverage point in helping us to send out the right message so that young men also get tested.
Consider also the role of legal factors on how the Covid-19 pandemic unfolds. If we enshrine in law the right to physical exercise – or if we have to debate whether the right to not wear face masks is on a par with a constitutional right to bear arms – then that will impose very real constraints on what we may legitimately ask people to do and refrain from doing, and slow down our response to the Covid-19 pandemic. Also, although I understand the logic of deterrence, there may be something self-defeating about using sticks instead of carrots. The threat of legal sanction for non-compliance – slapping a fine onto someone who fails to self-isolate – may backfire if it is imposed on someone who is already struggling to make ends meet financially. For them, a fine will make it more not less likely that they will need to go to work. Might carrots – for instance, in the form of financial incentives for self-sacrificing for the public good – perhaps be more effective than sticks? Because my aim in this section is to sketch the role that other factors might play, and to motivate research and action in other domains, I again end this paragraph with a question — not because I think what I asked is right, but to demonstrate the kind of questions I think we should be asking.
The technological factors that underpin this pandemic also extend way further than just the medical technologies at our disposal. Consider for instance the wide range of technologies that make up what we call “transport”. Covid-19 has shut down the world’s biggest airlines, and public transport systems have also taken a massive blow. The global economy, our national economies, and our cities’ economies have all been critically reliant upon these transport systems. Might the technologies that comprise our transport systems (and the technologies that comprised Codral ™️ cold and flu tablets) have inadvertently created the very conditions in which a natural phenomenon like a constantly mutating coronavirus, could eventually spread like wildfire and grind the world to a halt? Might our need to return to normal, to find ways of outsmarting the virus, so that we can continue living life the way we did before the pandemic struck, sow the seeds of an even more devastating pandemic in the future?
Notice, also, that the environments in which overcrowding and community transmission occurs – for instance, on public transport – is something that happens during the peak hours. But “peak hours” is not an immutable natural fact — it is the result of the daily choices we make, which in turn are linked to organizing our societies and economies around requiring people to synchronise their lives to the nine-to-five Monday-to-Friday work week. What if we organised our societies and economies differently, though? Perhaps if we spread out the days and times when people arrive at school and work more evenly?
If you have the stomach for taking the red pill rather than the blue pill, then here’s another observation: the seven day week and twenty four hour day don’t actually exist. Seriously, we invented them, we maintain them, but we have a choice — to either keep maintaining them (if they are useful), or to abandon them (if they are not). Thus, rather than even talking of spreading out more evenly the days and times when people go to work and school, what if we instead just ignored those imagined entities, looked at the actual world and the constraints of the Covid-19 pandemic – as well as considered where we would rather end up in the future – and then organised our societies and economies in a way that doesn’t treat the seven day week and twenty four hour day as if they were real? If we are to stand a fighting chance against the Covid-19 pandemic – if we want to roll up our sleeves, and take the boxing gloves off – then why would we constrain our thinking by clinging to things that exist only in our collective imaginations and habituated practices?
We Have a Situation
If the Covid-19 pandemic were solely a medical problem, then it might make sense to respond to it solely by throwing at it all the medical solutions we can find. However, the situation we know as “the Covid-19 pandemic” is not solely a medical situation.
As I argued above, there are at least eight distinct domains of causal factors that contribute to this situation – I discussed the medical, political, economic, social, technological, legal, environmental, and axiological domains – and causal interactions take place between entities that span across these eight categories all the time. In case you’re wondering where I got those eight domains from, it’s basically the six factors within the PESTLE framework, together with medical factors and values (axiological factors). By limiting our thinking about the Covid-19 pandemic, and our range of available responses to the medical domain, we not only impose an incredibly heavy burden on the medical profession. We are also expecting the impossible from the medical profession, and we severely handicap ourselves by failing to think about- and develop strategies for action across all the other domains.
However, there is nothing special about the PESTLE framework – I see no special reason to think that there are just eight kinds of factors – and our situation is in fact way more amorphous rather than more fine-grained. Put bluntly, the laws of nature do not necessarily observe or obey the disciplinary and professional boundaries we invented. Those eight categories are convenient simplifications which we have employed to study- and to think about the world. But a more accurate account of the situation we are in is that there are causal interactions that take place between things in the world, and the names of the categories that we attach to those things do not refer to anything real. Like the seven day week and twenty four hour day, disciplinary and professional boundaries are mythical creatures that we fashioned with the powers of our imagination. Pretending that they are real – treating this as a medical situation – is seriously holding back our ability to recognise and tackle the full range of factors that causally underpin the Covid-19 pandemic.
The upshot of this section’s observation is that it will take way more discipline – though not disciplinarity – as well as nuance, to figure out how else we can frame and approach our present situation. It’s way easier to ask people to remain within their professions and disciplines, and to look at what they can contribute to an interdisciplinary Covid-19 strategy. Many of us have trained for decades to see the world through the lenses of our professions and disciplines, and it doesn’t take much effort to keep looking at the world that way. It takes a lot more effort to consider how our professional and disciplinary lenses might be preventing us from noticing our blind spots.
Complexity
Moreover, the effects of earlier causal interactions between the different things that exist in the world create the future environment in which new interactions will take place. Practically, what this means is that any interventions we design today will, of necessity, need to be revised and updated tomorrow, or later down the track. Not because those interventions were faulty originally, but because if they are effective – indeed, if they have any effects on the world today, whether intended or unintended – then tomorrow our interventions will face a different/changed world, and in that world those interventions may no longer be (as) effective.
The world is a complex and dynamic system in which non-linear causal interactions take place all the time. These interactions take place between a wide range of factors, and the situations we encounter and find ourselves in emerge from this complexity. Thus, to deal effectively with these situations, we cannot afford to treat them as if they were static and confined to disciplines we invented. Although the corridors of university departments are often located in completely different brick and mortar buildings – often arranged along even broader scholarly distinctions between faculties and schools – that is a matter of how we think about the world (epistemology), not what the world is actually like (ontology).
This is not to deny that epistemology can produce ontological effects and vice-versa, since what we believe impacts on how we behave, which in turn alters the world, and that – if we are sufficiently observant – in turn impacts on what we believe. George Soros – the billionaire, philanthropist, and philosopher – offers a very compelling account of how our actions create causally potent feedback loops between the epistemic and ontological domains. However, my point for the present moment is simply that sloppy thinking – that is, thinking which conflates the disciplines we imagined into existence, and that we maintain through our actions, with phenomena observed at lower levels of organization – is only something that is likely to get us into trouble. The effects of our beliefs can be very real – like when the state executes a condemned inmate because of the conviction that this is required for justice to be done – however the epistemic status of the entities we invented and their ontological manifestation due to our actions based on our beliefs, is not a sound basis for conflating epistemic and ontological matters.
The world is messy — it is complex, not simple or complicated, it is replete with so-called “wicked problems” in which how we frame the situation has paramount consequences for the solutions we end up considering. Furthermore, the strategies we employ to tackle the situations we encounter must match the level of complexity of those situations in order to stand a chance of being successful. Right now, however, we are burdening the entire medical system by a complicated and monodisciplinary framing of a complex and transdisciplinary situation. This is nothing short of expecting the medical sector to deal with a situation comprised by factors that fall well beyond its scope. And although there is nothing new in the observation that the pandemic has had a wide range of effects on non-medical domains, there is a big difference between trying to mitigate the (e.g.) economic effects of a medical pandemic, and recognizing that those economic effects will in turn themselves have further flow-on effects on other domains, including but not limited to the medical domain. If we truly want to win the fight against the Covid-19 pandemic – and if we do not want to inadvertently create the conditions that are ripe for future pandemics by simply re-enabling ourselves to keep on working in precisely the way we had been until earlier this year when Covid-19 ground everything to a halt, by latching onto a vaccine (if one ever eventuates) and soldiering on, and by recreating the brittle system we previously had – then it’s time we give the medical professionals a helping hand. It is time to ask the humanities, law, social and political sciences, and scholars within the environmental and technological disciplines that are not directly concerned with narrowly-framed medical problems, to think about how they too might help.
To be perfectly clear, I’m not suggesting that we should fight the Covid-19 pandemic through interpretive dance, or that if we get more into positive thinking and flower-power then the situation will go away. Again, lest I am misunderstood, I have nothing in principle against interpretive dance, positive thinking, and flower-power. For all I know, they might have critically important roles to play. My point is, however, that we won’t know whether they do or don’t have a role to play, until we stop looking at the world through the lenses of the disciplines and professions we invented. We must take seriously the fact that although we have framed Covid-19 as a medical condition – an illness or disease – the conditions or factors which support this pandemic (or, which can help us fight it) are not in any sense only (or even chiefly) medical.
How we define this situation – how we frame it – plays a powerful role in what strategies we adopt to address it. And my point, so far, has been that we need to reframe how we understand the Covid-19 pandemic situation we’re in.
A Transdisciplinary Covid-19 Strategy
Just briefly, I want to return to my personal anecdote. So, eventually, I went back to night school, got my high school certificate, got into university to study computer science, though I graduated with a major in philosophy and minors in computer science and sociology, continued on to write a doctoral dissertation in the philosophy of law, then moved into a postdoctoral fellowship about law and neuroscience, which eventually brought me back to Codral ™️ cold and flu tablets when I ran an international research project about cognitive enhancement, colloquially known as “smart drugs”. Once I was done with smart drugs, I realised that the very same issues I’d been thinking, writing, and talking about within the framing of neuro-everything – neurolaw, neuroethics, neuroeudaimonia, etc – are in fact raised by all manner of technologies. Hence, these days I find myself working in the Faculty of Transdisciplinary Innovation – naturally, from home, like so many other scholars – at University of Technology Sydney.
Given what I said above about the disciplines and professions – that they do not actually exist, but are rather convenient fictions; that provide us with one way to think about the world, but that the world does not even notice let alone work in accordance with the dictates of the disciplines referred to by those categories – it’s positively dangerous that the current Australian federal government has recently decided that the humanities and law are less socially useful than other disciplines and professions.
When we start prioritising some disciplines and professions as more important and others as less important, we fall into the trap of treating our imagined categories as if they were something real. The Australian federal government’s current stance on this issue is not unlike suggesting that the kidneys and pancreas are less important than the heart or the brain — it’s worse than nonsense on stilts.
We do not need a post-pandemic recovery plan that treats fictional entities as if they were real. What we need – and what the medical profession needs – is a helping hand from a genuinely transdisciplinary Covid-19 strategy. To effectively tackle this pandemic, and to avoid creating conditions that are ripe for the next pandemic, we need to identify and address the non-medical conditions of medical conditions.