1. Culturing a Pandemic
A useful place to start when trying to understand how societies respond to pandemics is Lowell Carr’s catchily-titled Disaster and the Sequence-pattern Concept of Social Change (1932). According to Carr, the way in which “a community reacts to disaster is… determined by its culture, its morale, its leadership, the speed, scope, complexity and violence of the catastrophe itself.” What’s so interesting about Carr’s list of determinants is that it focuses not just on the obvious natural aspects to a disaster (speed of occurrence, scale of destruction and so on) but also on some of the perhaps less obvious social aspects such as leadership structures within societies experiencing disaster, the cultural values that dominate within such societies and so on. It’s this dual aspect to his thinking that makes the book’s core message so relevant today. If we want to understand how a society responds to disaster, Carr’s suggestion is to treat it not just as a natural phenomenon but as a cultural event too.
The UK’s response to COVID-19, for example, has focused on developing an understanding of the virus as a natural, biological object: What is its genetic structure? Is it airborne? Can we create a vaccine? How does it affect the human body? But as Carr suggests, that type of knowledge doesn’t develop in a vacuum. Scientific efforts to probe and understand the virus as a natural object have taken place in a society that’s also been developing an understanding of the virus as a cultural object. The problem we’ve got, however, is that mainstream cultural understandings have all too often been fed by hysteria. That this constitutes a problem is unquestionable. Pandemics like COVID-19 always possess a certain speed, scope, complexity, and violence. But how we respond ultimately depends upon the cultural lens through which we encounter that speed, scope, complexity and violence. Viewing COVID-19 in a state of heightened hysteria isn’t going to make it particularly easy for us to formulate any kind of workable, common-sense response.
By the way, it’s not that experts and expertise don’t matter. They do. Every society needs experts to anticipate and mitigate the damage something like COVID-19 is capable of causing. It’s worth emphasising this point because the idea that lockdown sceptics are fervent devotees of neo-medieval revivalism has become something of an obsession to Guardian journalists. “Ah, ’tis sad,” they picture us sighing wistfully to ourselves, sat in our pants, bedsit curtains drawn, watching Nigel Farage speeches on YouTube and every so often hitting pause to troll the parents of recently-deceased NHS key workers on Twitter, “if only we could return to those glorious days before Johnny Foreigner foisted his fussy, nannying biomedicine on us; a time when men were men, Britain ruled the waves and all an invalid needed was a chisel through his skull, a leech up his arsehole and a stern admonishment to stop malingering ringing in his ears as he’s dragged back to the poorhouse.”
Back in the real world, however, the issue is not so much expertise as the culture within which expertise is enabled to respond to a pandemic. We could know everything there is to know about the coronavirus from a virological perspective, but that wouldn’t help if it existed within a culture where people were so frightened by COVID-19 that they saw wetting their beds as the only viable, rational course of action to pursue. Similarly, you can have as many scientists, virologists, epidemiologists, mathematicians and clinicians as you like; but decisions about which experts get the ear of government, which get favourable write-ups in the mainstream media and which end up on government special advisory panels – those decisions reflect and are driven by a society’s overarching values, fears, anxieties, norms, assumptions, prejudices, obsessions and expectations. In the same way that scientists “culture” viruses in laboratories before studying them, so too does society “culture” its disasters before deciding how to respond to them.
In this context, delving into the historical archive becomes a useful exercise. Indeed, the philosopher Michel Foucault1 once remarked that historical investigations were useful not so much for knowing as for “cutting”; that is, for disturbing the foundations of the present, making the given once more appear strange and causing us to wonder at how it came to appear so natural. If a particular society at a particular moment in time has the power to frame how its members respond to something like a pandemic, then understanding how that happened during previous pandemics helps us to “cut” more effectively into COVID-19’s burgeoning lockdown culture. Is our supposedly measured, expertise-driven lockdown culture the only possible societal response to a pandemic, or could things be otherwise? In what follows, a brief overview of the UK’s hysterical reaction to COVID-19 in 2020 (section 2) sets up a discussion of the UK’s response to the Asian Flu of 1957 (section 3). How did 1950s Brits react to what was, arguably, an even deadlier pandemic? Were they alarmed? Did they panic? Was there hysteria? And how does that response compare to our own response to COVID-19? Do we now live in the best of all possible worlds – a world in which individual safety is adjudged as important as collective prosperity? Or might our forebears, biomedically less knowledgeable though they undoubtedly were, nevertheless have interesting things to tell us about collective resilience and stoicism in the face of biological adversity?
2. COVID-19 and Hysteria
For some months now, large sections of society have been responding to COVID-19 with all the rhetorical, discursive and stylistic flourishes of a semi-functional hysteric. To avoid any confusion let’s be clear about what this means. In using a word like “hysterical” to describe mainstream responses to COVID-19 I do not wish to suggest that COVID-19 related illness is an insignificant or an illusory phenomenon – it’s killed many people. Nor am I wishing to suggest that the levels of public and governmental alarm surrounding COVID-19 are out of proportion to the medical risk posed. The scientific and medical facts are not yet fully known and, in any case, even once firmly established will remain largely inaccessible to a layperson such as myself. What I do want to suggest, however, is that mainstream coverage of COVID-19 has been “hysterical” in terms of:
- Its high emotional content – extreme-case emotion words in particular have proliferated (fright, alarm, depression, terror, etc.).
- The scale of the coverage generated – like a hysteric, it goes “on and on”.
- The extraordinary narratorial scaling-up we’ve witnessed within that coverage – an issue that arguably could be said to involve “a pandemic of mild/moderate respiratory illness with a mortality rate below 1%” has quickly come to be framed as if presaging “the end of the world, capitalism, workplaces, high streets, tourism, traditional forms of social interaction, casual sex, etc.”
It’s also important to remember that “hysteria” is not simply about actions or behaviours that are in excess of the supposed disaster provoking them: it’s about actions and behaviours that attain autonomy from the original “disaster”. As performances, they sustain themselves independently of that initial cause. That’s why we refer to hysterical people as “going on and on”, or as “shouting and screaming”. In their words and their actions we glimpse reality but dimly, through a miasma of hyperbole and melodrama. Concern becomes “terror”, worry turns into “depression”. Words like “just” or “only” very rarely appear in their discourse, either. The police can’t just tell crowds to move along – they have to shout “You are killing people!”. A BBC journalist can’t just be criticised for a question she asked the First Minister of Scotland about her Government’s response to COVID-19 – she has to be sacked. Large swathes of the media aren’t content just to “report” the news, they have to become the news. It’s not enough to be objective journalists, they have to be activists; and, what’s more, angry activists. Things are too terrifying, too threatening, to hold back. Emily Maitliss can’t just introduce a COVID-19 themed episode of Newsnight, she has to perform a straight-to-camera harangue of the government, the sullen, contemptuous anger of her flaring nostrils a staccato accompaniment to the righteousness implied by those fleeting, beautifully rhythmic undulations of her eyebrows. Finally, consider the NHS. To a lot of people right now the NHS isn’t just a taxpayer-funded organisation, it’s a religion. It isn’t populated by dedicated, hard-working, salaried staff who are just doing the best they can in a difficult, potentially life-threatening situation. It’s populated by angels. Superheroes. Gods. NHS managers aren’t just struggling to procure PPE in a highly competitive global marketplace: they’re the victims of savage – indeed evil – Tory cuts. Nor are we supposed to feel “just” a private, inner warmth towards these fellow citizens – people who, like us, are under quite a bit of pressure but still managing to carry on. No, we’re supposed to clap and cheer for them every Thursday evening outside our homes. More exhibitionism than citizenship, banging our pots and pans together, gurgling and burping, whistling and whooping, dribbling and gurning. Like so many gaudy monuments to emotional incontinence, surrounded by the rubble of our self-respect. And what about those who might not want to join in with these jolly little experiments in North Korean sociality? Do we just accept that non-participation is their inalienable right in a liberal democracy? No. We bully them. We post letters through their doors. We troll them. Tory Scum! Sickos! Get coronavirus and die!
This is what it means to respond to a pandemic through the lens of hysteria. However bad you think things are – they’re much, much worse! That person out there in the park isn’t going for a stroll – he’s killing people! Dominic Cummings isn’t just visiting Barnard Castle – he’s costing lives! Whatever your employer does to make your workplace safe for a return to work – it won’t be enough! And so on. In the age of COVID-19 there could conceivably have been sound epidemiological reasons for complex, global societies like the UK to roll out temporary lockdown arrangements. But one suspects that popular culture would have thrust us all headfirst into the quicksand of some form of lockdown soon enough, with or without that reasoning.
3. The 1957-58 Asian Flu and Stoicism
The problem that initially appears to confront you whilst researching the UK’s response to the 1957-58 Asian Flu is a lack of data (more on this later). The real problem, however, is not so much data you don’t have as the tone and content of the data you do have. Sifting through a relatively meagre collection of newspaper articles, first-hand accounts, Hansard documents, National Archive records and letters to medical journals like the Lancet and the British Medical Journal you quickly start to doubt the methodological validity of the exercise you’ve embarked upon. It’s all so utterly, unrelentingly banal. A vicar in Chelmsford gets the sniffles and has to shorten one of his congregation’s favourite sermons by half a minute; an amateur football match is postponed (but not cancelled) in Barnsley due to a few players feeling a bit rummy; a village fete just south of Ely reports that although three less stalls were taken this year as compared to last year, nevertheless, the Church Restoration Fund still received £2 7s 5d; a pupil at Eton spends a day in bed with a slight temperature but rises from his sickbed to score a magnificent 52 not out against an MCC second XI the following week; a housewife in Swindon demands a home visit from her GP although, as that GP subsequently reports to the Lancet, she doesn’t really need one and is perfectly well. That’s the level at which things seem to trundle along in 1957. Engage with this stuff for long enough and you start to wonder whether the entirety of the UK’s news output for that year was some sort of private joke perpetrated on a naïve and unwitting public by a young Alan Bennett.
This of course stands in marked contrast to today. As we’ve seen, when it comes to COVID-19 every news channel, Twitter feed and newspaper page has been filled with tales of such death, destruction and damnation as to make the New Testament’s Book of Revelation look a touch underdone in places. Lockdown sceptic or no, it’s difficult to live amidst such a culture without feeling that at any moment four horsemen might canter over the horizon, rip a few tuneless incantations from their chests like a dystopian Barbershop quartet and then get down to the business of saying it with scythes. Apocalypticism starts to permeate every fibre of your being. Surely, your subconscious mind starts to nag away at you, the two pandemics aren’t comparable? Surely, COVID-19 has to be one of the most nightmarish episodes ever to have darkened our shores… doesn’t it?
Er, no. As Hugh Pennington noted recently in the LRB, the Asian Flu was “by far the most lethal pandemic to affect Britain at any time in the hundred years after the ‘Spanish’ flu pandemic at the end of the First World War.” Cold hard facts support this claim. For all one’s initial cultural sense that the 1957–58 pandemic must surely have been trivial in comparison to COVID-19, when the two are put up against each other in a game of statistics top trumps, the former more than holds its own. Just as COVID-19 represented a novel coronavirus, so too did the pathogen behind the Asian Flu – influenza A subtype H2N2, a novel strain of influenza. Both therefore entered into populations that had little or no immunity to them. As of May 2020, COVID-19 had killed 339,000 people worldwide. Estimates for the global death toll of the Asian Flu on the other hand vary from between 1.5 and 4 million – Gatherer (2009) published an estimate of 1.5 million, while Michaelis et al. (2009) suggested something more like 2–4 million. That already sounds like quite a lot of deaths. But when you scale those figures up to reflect population growth since 1957–58, you realise that what happened back then would be the equivalent of a pandemic killing between 3–6 million people in 2020 (world population in 1960 was 3 billion; world population in 2020 was approximately 7.5 billion). What’s also remarkable about the Asian Flu pandemic is its infectivity. Despite the world being much less globalised in 1957, an isolated outbreak in Hong Kong managed to spread across the world in less than eight months (see diagram, below). Writing in the British Medical Journal, a British GP at the time expressed “amazement” at the extraordinary infectivity of the disease.
The influenza pandemic 1957–58. Point of origin (▮) February 1957; lines of spread of pandemic (→); number of months after February 1957 (0) when epidemic infection was recorded (number accompanies corresponding arrow).
A Times newspaper comment on April 17th to the effect that “an influenza epidemic has affected thousands of Hong Kong residents” was one of the first English-language references to the pandemic. By May there were reports of 100,000 cases in Taiwan and over 1 million cases in India. The UK’s first cases came in late June, although the most serious outbreak occurred in August. From mid-September onwards the virus spread from the North, the West and from Wales to the South, the East and to Scotland. In total, it’s estimated that anywhere from 9–12 million people contracted H2N2 in the UK. That’s the equivalent of 15.4 million reported cases in the UK of 2020 (UK population 1957–58 was 52m; in 2020 it’s 67m). To put that into comparative context, the UK currently has 254,000 confirmed COVID-19 cases. There were also around 33,000 deaths directly attributable to H2N2 in the UK (although one wonders how many elderly deaths at the time may have been due to H2N2 but attributed to other, underlying conditions on death certificates). Again, scaling that figure up to the UK’s population in 2020 gives an equivalent death toll of 42,000. Deaths from COVID-19 to date (May 2020) stand at 37,048. In passing, it’s worth noting that the UK was far less densely populated in 1957–58, and a far greater proportion of social interaction took place at local or regional levels. It’s arguable therefore that in 1957–58 the country was spared more deaths by the fact that its way of life naturally embodied elements of today’s “social distancing” strategy. As with COVID-19, symptoms were mostly mild, and patients usually recovered after a period of bed rest. Onset was sudden and patients would complain of wobbly legs and a chill followed by prostration, sore throats, running nose, coughs and a high fever. Young children, particularly boys, suffered nose bleeds. In fact, one feature of the Asian Flu that undoubtedly did make it more socially disruptive than COVID-19 was its relatively unusual predilection for younger hosts. In COVID-19’s case we’ve seen that it’s almost entirely populations aged over 45 that suffer severe clinical symptoms, additional complications and/or death. In the UK’s first wave of Asian Flu during summer 1957, however, the core group of sufferers were aged 5–39 years with 49% of that group aged between 5–14 years. It killed quickly, too: around 20% of its younger victims died before even getting to hospital and nearly 70% were dead within 48 hours of admission. (Sadly, the elderly suffered later, with this same strain of influenza coming back for them during a second wave in the winter of 1957–58.)
Those, in sum, are what we might call the facts of the matter. It has to be said that neither COVID-19 nor H2N2 come out of this section with any particular credit. Considered purely as natural, biological entities, there’s little to separate the two reprobates in terms of devilment and mischief. But how did the Brits of 1957 respond to H2N2? Were the media fearful? Did the government panic? Were doctors terrified? Before answering these questions, let’s set some parameters for the discussions that follow. Earlier, I suggested that our mainstream cultural response to COVID-19 exhibited a “hysterical style” in terms of:
- Its high emotional content.
- The scale of the coverage generated.
- The remarkable narratorial scaling-up evident within that coverage – the pandemic is never portrayed as “just” a pandemic, but also as something that prefigures “the end of the world, capitalism, workplaces, high streets, tourism, traditional forms of social interaction, casual sex, etc.”
What I want to suggest now is that the articles, archive materials and letters to editors, etc., gathered together from 1957 evidence a very different style of pandemic response. Where contemporary responses to COVID-19 have largely been shrill and hysterical, responses to H2N2 were largely stoical; that is, calm, measured and accepting. Specifically, the style we uncover is stoical in terms of:
- Its low (as opposed to high) emotional content.
- The paucity (as opposed to the scale) of coverage.
- The remarkable scaling-down (as opposed to scaling up) evident within the coverage, where a pandemic is only ever “just” a pandemic.
Let’s consider each component part of this stoic style in turn.
3.1. Lack of Coverage
The pandemic generated what appears to modern, 21st century eyes to have been very little media coverage. The British Newspaper Archive, for example, lists just 427 articles containing the words “flu,” or “influenza” or “Hong Kong” and/or “Asian” and/or “Asiatic,” in the period from 1 January to 31 December 1957. It’s probable that the BBC alone produces that many stories about COVID-19 across its various news platforms in an average day. Although the pandemic first spread to our shores in late May or early June that year, levels of reportage only peaked in September (205 articles) and October (163) before then falling away in November (21) and December (11). Across June (35), July (57) and August (85) relatively little attention was given to the epidemic. That’s a bit like our friends in the contemporary media suddenly waking up in June 2020 to the fact that COVID-19 had been in the country since early-March 2020. It’s also true to say that very few political memoirs, autobiographies or hospital histories of or about that time refer to the pandemic of 1957. Reflecting on this dearth of documentary evidence, the microbiologist Hugh Pennington remarked that it’s as if the pandemic “ha[d] been airbrushed out of history”. But is “airbrushed” the right metaphor? Taken at face value this is a word that implies, somewhat improbably, that whatever was written about the pandemic had subsequently been deleted. I think what Pennington’s suggesting, though, is something more like: “Something big happened, it could have generated more written interest, but for some reason it didn’t.” But even on this reading, is his assumption that people in the 1950s thought of the pandemic as a “big thing” correct? Did they, like us, see environmental catastrophes and epidemiological crises in every disposable plastic cup or sneeze on a Tube station platform? One suspects not. Reminiscing about this tumultuous post-War, mid-20th century period, the French philosopher Michel Serres once wrote that the formative experiences of those born into the 1930s were the horrors of war:
At age six, the war of 1936 in Spain, at age nine, the blitzkrieg of 1939; at age twelve, the tragedy of the concentration camps and deportations… at age fifteen, Hiroshima. In short, from age nine to seventeen, when the body and sensitivity are being formed, it was the reign of hunger and rationing, death and bombings… We continued immediately with the colonial wars, in Indochina and then in Algeria… I was six [in 1936] for my first dead bodies, twenty-six [in 1956] for the last ones.
Serres, M., Latour, B., Conversations on Science, Culture and Time (Michigan: University of Michigan Press, 1995).
We’re also talking about a generation who grew up in a world where infectious disease was still a relatively normal part of everyday life. Mumps, measles, chicken pox, German measles – all would regularly sweep through entire schools and towns. Polio too: that disabling, life-threatening condition, was an ever-present reality. Before a vaccine was introduced in the late 1950s, for instance, epidemics would result in up to 7,760 cases of paralytic polio in the UK each year, with an average of 750 deaths. So perhaps the issue here is less that the 1957–58 pandemic was airbrushed from history, and rather more that people living in the 1950s didn’t quiver like aspens every time the world reminded them that life could occasionally be a little difficult.
3.2. Low Emotional Content
What does a pandemic response that’s low in emotional content look like? It’s fair to say we already know what it doesn’t look like. Contemporary responses to COVID-19 tend to start where dictionary definitions of emotionalism leave off, proliferating extreme emotion words and eschewing descriptions of cognitive actions. In his May 10th televised speech to the nation, for example, Boris Johnson was quick to impute certain emotions to his audience. “There are millions of people,” he declared, “who are both fearful of this terrible disease, and at the same time also fearful of what this long period of enforced inactivity will do to their livelihoods and their mental and physical wellbeing.” Fearful. Note that. Not “concerned”. Not “arguing” for a pandemic response in which quarantine strategies don’t feature quite so prominently. Just fearful. Not that the media have shown much emotional restraint either. According to The Guardian, manual workers aren’t just “going back” or “returning” to work: they’re being “forced” back. Nor are they just “concerned” about this. They “fear for [their] health”. Intriguingly, one interviewee also suggested that going back to work was like “dancing with the devil”. Elsewhere, The Times Educational Supplement informs us that teachers in England facing a return to school are “fearful for their lives”. Like some impromptu game of poker hysteria, teachers in Belfast then see those English fears and immediately raise them a determination to retire rather than return to the classroom.
So what’s so different about the UK’s response in 1957? What does it mean to suggest that mainstream response to H2N2 was low in emotional content? Certainly in the corpus I examined it means above all that they contain no emotion words, indeed no emotional content at all. The prose style is dry, matter of fact, and eerily reminiscent of the register normally to be found within a doctor-patient interaction. For example:
Commenting on reports about influenza pneumonia, Dr. Cowan said, “always when there is a lot of influenza, a few people develop pneumonia, but they are a very small proportion of the whole. What I want to emphasise is that these cases of pneumonia are the exception and not the rule.
Motherwell Times, October 25th 1957. Emphasis mine.
As in this case, direct quotes from experts usually appear and can often span several paragraphs. The journalist, with all his or her rhetorical artistry, isn’t the star. It’s the doctor with his or her dour, stolid and factually-focused prose that grabs the limelight. Note also that scary information is immediately surrounded by statistics and contextual information capable of rendering the scary information “extremely unlikely” as opposed to “likely” (see emboldened sections). We see this strategy elsewhere too:
Asian influenza is just another kind of influenza and no worse than plenty of ordinary English influenzas. It is quite a short illness lasting about three days. The following simple instructions will help if your doctor cannot get to you promptly: go to bed in a well-ventilated room. Drink large quantities of water and take light food if you want it.
Hastings and St. Leonards Observer, October 5th 1957. Emphasis mine.
These minimisation strategies matter because they deliberately avoid cueing readers to have an emotional response to what they’re reading. Emotion, remember, is essentially a strong feeling stimulated by one’s circumstances. Strong stimuli generate strong emotions. That’s why scary circumstances tend to stimulate fear, terror and fright. Mundane, everyday circumstances on the other hand, contain few if any strong stimuli. There’s nothing frightening about banality; about things you can point at and say, “that’s normal”. In every instance where these articles touch on scary things that might appear to be creeping closer to people’s everyday life, they quickly smother those “scary things” in statistics and contextual information capable of proving otherwise. Where the hysterical style renders everyday life as a death-trap, the stoical style foregrounds the mundanity, the ordinariness of the everyday.
To be sure, we do see emotion words being used in a minority of cases drawn from the 1957 corpus, but only ever in contexts where an author wishes to instruct us in how not to response to the pandemic (see emboldened sections, below):
The Medical Officer of Health in one newspaper article as follows: avoid crowded places as much as possible while the outbreak is on, apart from that people should lead their normal lives and not be afraid they are going to catch influenza.
Hastings and St. Leonards Observer, October 5th 1957. Emphasis mine.
Risk of mild influenza epidemic in Britain. Britain may be in for an epidemic of mild influenza. “Ordinary” germ ministry official stress there is no cause for alarm as the “flu” germ is of a perfectly ordinary variety resulting in temperatures which last two or three days.
Birmingham Daily Post, June 6th 1957. Emphasis mine.
Each time a heightened emotion appears, it’s already too late for the hysteric to react – alas, the emotion word has had a negative adverb – “not” or “no” – placed right in front of it! Elsewhere, even more complicated rhetorical work is performed to “trigger” calm and stoic readers:
Asian flu has been so much in the news recently that some people have panicked about the present epidemic.
Skegness Standard, October 9th 1957. Emphasis mine.
The “some people” here is nice. It avoids implicating the reader in the problem: “We the reasonable majority have stayed calm, but sadly ‘some people’ have shown a herd-like tendency to be panicked by the media.” Having expertly separated his moral readers from a reprobate minority, the journalist goes on to discuss what “we” need to do to avoid “unnecessary worry”. Note the immediate emotional downgrade here: in the space of two sentences we’ve travelled from a world of unnecessary “panic” (sudden, uncontrollable fear or anxiety) to “worry”, which involves less intense feelings of trouble or concern. Panic is never okay. Panic is to be frowned upon. In the case of “worry”, however, the journalist is willing to concede that some worry may be necessary. “Unnecessary worries”, on the other hand, can and must be dispelled.
To avoid unnecessary worries it is important that we should realise just what we are up against.
Okay, I’m all ears.
Perhaps the word Asian – because it started in the Far East – has given it a sinister and somewhat macabre character.
Hmm. Not really. But go on.
Let us be quite clear about it – influenza is a disease that is always with us, and it is found all over the world.
As in previous extracts, what we’re being given is context, this time historical and geographical context. Panic decontextualizes things, placing you at the centre of a terrifying universe – extraordinary things are likely to happen to you, right now. Rationality contextualises everything. To see yourself existing within a wider world, at a particular point in time, however, is to make panic appear irrational – childishly petulant, even. So now that the pandemic has been contextualised, “what precautions can we take against the Asian flu?”
The old precautions still hold good. First of all keep as fit as possible, don’t overtire yourself, get your full quota of sleep and eat an ample diet. Secondly, avoid crowds and keep your windows open – in other words plenty of fresh air.
Anything else?
Finally – don’t worry. If you are unfortunate to catch it, don’t panic.
Here’s a final example.
The influenza epidemic is running its expected course. In the main it has been mild.
Not that there’s any complacency about this.
We are not minimising its extent, nor are we overlooking the numbers of deaths which have shocked many areas.
Lancashire Evening Post, October 11th 1957.
Shock is an interesting word to use when minimising emotion. To impute to people an emotion like “shock” is to suggest they have experienced an intense but fleeting response to the pandemic. Earlier, we saw teachers and manual workers describing themselves as “frightened” of COVID-19. Fright can be induced by something that has happened, or just as easily by something that might happen but never does. It’s in this latter sense that the teachers and manual workers appear to be invoking the term frightened: they might die, they might get ill. The state of being frightened, in other words, doesn’t need an external stimulus to continue being experienced: at any point, in any workplace, in any classroom, you might contract COVID-19. Like hysteria, it’s an emotion capable of feeding on itself. Shock, on the other hand, is only ever precipitated by a sudden surprising event or experience. No-one, after all, is ever described as being shocked by something that could happen but doesn’t ever happen. Shock can only be experienced in the here and now, as some event or experience unfolds. In this case, the numbers of deaths reported in a certain area are said to have precipitated shock. Fearful people would continue to be frightened by what this information augured for them; shocked people, on the other hand, would process such information, recover their emotional equilibrium, and move on.
3.3. Scaling Down
Anyone who’s prone to bouts of hysteria will know that the internet can be a dangerous thing. A few minutes’ surfing is all it takes to discover that that slight, almost imperceptible rash you’ve had on your arm for a day or two is in fact a symptom of either Creutzfeldt-Jakob disease, leukaemia, or possibly even HIV (or… oh my god, oh my god, oh my god – all of them!). It can’t just be a rash that will fade in a few days, there’s got to be something else going on. Something bigger. Something more worrying. Something that’s going to kill you. Mainstream journalists appear to have been engaging in similarly hysterical processes of “scaling-up” when responding to COVID-19. Very rarely are their stories simply about a novel coronavirus with the capacity to overload the human immune system. That’s not enough. They’re worried, you see, that something bigger is going on. And that’s why they feel compelled to write about how COVID-19 will also ruin sport, despoil society, asphyxiate consumerism, end tourism, cancel capitalism, destroy workplaces (and so on). COVID-19 won’t just “affect,” or “have an impact” on the British high street; it will “vastly accelerate” its “decline”. It isn’t enough for The Times to query when summer holidays will return; it has to ask: “is this the end of the summer holiday?” Over at the Guardian, COVID-19 isn’t just making things a little tricky for everyone: it’s precipitating a “global crisis”. True, life does often seem to be one long riot of global crises for Guardian readers (crises which can of course be experienced vicariously from the safe surroundings of the many vegan delicatessens dotted around Islington), but unlike the dozen or so other global crises the Guardian reported on last week, COVID-19 could actually be the one that “change[s] the world”. Spare a thought, too, for millennials: COVID-19 hasn’t just put a temporary hold on stuff like casual sex, ghosting and pretending you’re polyamorous to mask a complete lack of personality, it’s “ruptured romance”. And what about workplaces? Surely, we’ll be back in those same open-plan offices hating ourselves soon enough. Not according to the BBC. “Pandemic-proofing” offices will involve “long-term design upgrades that put hygiene at the heart of workplace planning”.
In the case of H2N2, however, media reports of and about the pandemic very rarely documented anything other than the pandemic itself: how many people have died so far, what the symptoms are, what to do if you get ill (and so on). Rather than scaling-up the problem there is, if anything, a scaling down. Trawling through the available data, one gets the sense that society more generally was content to consider the pandemic as “just” a pandemic rather than a social catastrophe. Consider the following first-hand account of experiencing and surviving H2N2 in the US.
I spent a week in my college infirmary with a case of the H2N2 virus… My fever spiked to 105, and I was sicker than I’d ever been. The infirmary quickly filled with other cases, though some ailing students toughed it out in their dorm rooms with aspirin and orange juice. The college itself did not close, and the surrounding town did not impose restrictions on public gatherings. The day that I was discharged from the infirmary, I played in an intercollegiate soccer game, which drew a big crowd.
It’s fascinating to sit here, in the lockdown society of 2020, and read about a pandemic response from history that involved society doing its best to keep going (emboldened sections, above). Back then you got ill, you went to bed, you got better, you re-joined society, and society continued to function. That was it. In the UK, something of this stoic philosophy was at the heart of the pandemic response rolled-out by a then recently instilled Conservative Government under the leadership of Harold Macmillan. Rather than dragging power and authority towards Whitehall, Macmillian seemed happy enough to devolve most of the operational, day-to-day responsibility for responding to the pandemic down to local and regional medical authorities. To be sure, the Government advised those with symptoms to stay at home, but otherwise took little national action as the flu spread right across the country during the autumn. Senior figures within the medical establishment of the time also seemed happy to adopt this hands-off approach. “In the end, and in spite of the scare stuff in the lay press,” wrote Ian Watson, Director of the College of General Practitioners’ Epidemic Observation Unit to a local GP on 24 June, 1957, “we will have our epidemic of influenza, of a type not very different from what we know already, with complications in the usual age groups.”
The result was a pandemic response that by today’s standards looks astonishingly laissez-faire. Some mines and factories shut, but that was due to a shortage of fit employees rather than Government diktat. Public gatherings were not stopped. In some areas, schools were closed (up to 100,000 children were off in London at the height of the outbreak), but few sporting events or other mass gatherings were cancelled. By early June, as the first cases were beginning to appear, Macmillan’s health secretary Dennis Vosper had yet to make a public statement setting out the threat posed by H2N2. The virus was at its peak when Aneurin Bevan was heckled at the Labour Party Conference on October 3rd 1957 for arguing that unilateral disarmament wasn’t possible. It was still going about its infective business when CND held its first meeting at Westminster Central Hall on February 17th 1958. During the winter of 1957, Macmillan was kept busy not by the Asian Flu pandemic but by the events that followed the world’s first nuclear reactor accident, when Windscale Pile No. 1 caught fire. President Eisenhower meanwhile was preoccupied by the Russians’ launching of Sputnik 1 on October 4th. In October, during the peak of the outbreak in Britain, the Conservative party conference went ahead as usual. In his speech to conference Macmillan didn’t even mention the pandemic.
One figure who symbolises this scaled-down approach to the pandemic is a junior Health Minister by the name of John Vaughan-Morgan. A quite remarkable man was Vaughan-Morgan. Utterly unflappable, provocatively gnomic at the despatch box and possessed of apparently limitless reserves of indifference for everyone and everything around him. A sense of the unruffled solemnity with which he faced down the 1957-58 Asian Flu pandemic is captured wonderfully in three House of Commons exchanges from the period. In each case he appears as a junior Health Minister fielding questions from the House. I’ve transcribed the extracts below, editing them slightly (but only slightly) for comic effect. You can read the exchanges in full in Hansard (or alternatively here):
House of Commons Debate on Asian Influenza, 1 July
| MP | If there is any serious danger of an epidemic of this influenza, will my hon. Friend see that the general public are informed in good time from official sources what they should do? |
| Vaughan-Morgan | Yes, I will certainly bear that in mind. |
House of Commons Debate on Smallpox and Asian Influenza, 15 July
| MP | Is my hon. Friend aware that a troopship from Malaya arrived at Southampton last week carrying amongst others, 208 people suffering from Asiatic flu? |
| Vaughan-Morgan | Of course. |
| MP | What steps will my hon. Friend be taking to protect and cure those sufferers? |
| Vaughan-Morgan | None. There were no cases of influenza on board when the ship arrived at Southampton. No action is therefore necessary. |
| MP | Is my hon. Friend aware of the increased incidence of Asian flu in Great Britain? |
| Vaughan-Morgan | Yes. |
| MP | And has he been able to trace the sources of infection? |
| Vaughan-Morgan | Of course. In cases where influenza of the Asian type has been identified, the infection has occurred, not unnaturally, in persons recently arrived from Asia. |
| MP | And what extra steps is my hon. Friend taking to protect the British people from these infections? |
| Vaughan-Morgan | None, my hon. Friend. None at all. Normal routine action in the case of epidemics is being taken. |
House of Commons Debate on Asian Influenza, 22 July
| MP | Will my hon. Friend be making a statement regarding the new oriental influenza? |
| Vaughan-Morgan | No. |
| MP | What precautionary action is my hon. Friend’s Department taking? |
| Vaughan-Morgan | None. Frankly, we have more important things to be getting on with. Besides, there have been no developments since my answers to Questions on this subject on 1st July, except that laboratory confirmation has now been obtained that persons suffering from the Asian type of influenza have arrived in this country. There is, however, at present no sign of any material spread of the infection here so far. |
| MP | Bearing in mind that resistance to this type of infection tends to decrease from the end of September onwards, may I ask if the hon. Gentleman has examined the records of his Department as to the state of public morale in 1917 at the time of the last major influenza epidemic? |
| Vaughan-Morgan | No. In any case, I should say that only a hysteric, a drunk, or possibly a woman, would say that the two were comparable. |
| MP | Does the hon. Gentlemen not feel that lessons can be learned from those records? |
| Vaughan-Morgan | (Yawn). I refer the hon. Gentlemen to my previous answer. |
| MP | Will he also consider issuing some sort of statement to the public in due course in order to allay anxiety? |
| Vaughan-Morgan | No. In lieu of such wanton exhibitionism, however, I hope my previous answers will be noted and allay any anxiety that might arise in those more bovine members of the British public. All the evidence so far suggests this epidemic is and will be of a mild nature in this country. If this is a convenient moment for me to give advice to the House as to what hon. Members should do if they are unfortunate enough to get this influenza, the best clinical advice I have had so far is to go to bed. |
“Everything is under control. No-one should be panicking. The little people will survive as long as they remain calm. Now if you’ll excuse me, I have a table booked at the Carlton.”
By August 1957, however, and with the virus spreading all over north-west England, Macmillan started to take a little more notice. He wrote to Vaughan-Morgan on August 23rd 1957, asking about the virus that was “appearing to excite a good deal of public interest”. Vaughan-Morgan’s reply barely managed to conceal its scorn for the intelligence of its recipient (the Prime Minister of the UK, remember): “The general assessment seems to be that eventually [the flu] will affect up to 20% of the population,” he wrote, before adding very much in the manner of the Senior Head Boy at Eton dressing down his Fag for having asked a footling question, that “this is a heaven-sent topic for the press during the ‘silly season’.” The silly season! Vaughan-Morgan’s specialist Mastermind subject would undoubtedly have been “minimisation”, or possibly “the art of scaling down risk”. Patient suffering from severe anal haemorrhaging? “Dicky tummy!” Ethnic cleansing in the Balkans? “Handbags at dawn!” One imagines Vaughan-Morgan touring India’s grimmest leper colonies as part of a Ministry of Health deputation before returning to Whitehall muttering darkly about the deplorable propensity of certain of Her Majesty’s subcontinental subjects to overstate the social significance of eczema and psoriasis. Despite Vaughan-Morgan’s indifference, however, the Prime Minister did forward this correspondence to his Press Secretary with the comment “I am worried about the public relations side of all this”, and a Cabinet meeting was hastily convened. Macmillan finally released a public statement about the virus on September 9th, seventeen days after the press reports which had first caught his eye. That’s over four months after the first cases of Asian Flu appeared. To put that in context, if COVID-19 first appeared in the UK in March 2020 it’s the equivalent of Boris Johnson holding the first of the Government’s 5pm daily press briefings at some point in July 2020… and then not bothering to do any more after that.
3.4. Costs and Benefits
As something of a coda to section 3, it’s worth comparing the economic costs and consequences of the UK’s stoic response to H2N2 in 1957 to the costs and consequences of the hysterical response we’ve been pursuing in the case of COVID-19. As we’re all aware, the UK decided in March 2020 that it would be really sensible to shut up shop, pop a “closed for business” sign in the window, cancel all upcoming customer orders, burn the remaining stock, turn off the lights and then retreat to the (now empty) stockroom to hide under a disused pallet and keep itself entertained by, alternately, hyperventilating into a brown paper bag, wetting itself, and whimpering. But what of the UK of 1957–58? As far as the records from that period show, it made a valiant attempt to keep its economy and society up and running. Loss of work time to sickness was inevitably colossal. On top of existing social benefits, it’s been estimated that an additional £10 million was spent on those who were incapacitated by the virus. 2 Adjusting for inflation, that figure would today equate to £243 million. The Times (February 26th 1959) also estimated that if you exclude those additional sickness benefits the overall cost to the UK economy of the pandemic in terms of lost earnings was roughly £100 million. Again, adjusting for inflation gives us a figure of £2.43 billion in today’s money. As a rough estimate, then, it’s likely that the inflation adjusted cost of the 1957 pandemic to the UK was around £2.6 billion. That’s a lot of money. Or is it? Perhaps not, particularly if we consider those losses in light of the contemporary political and economic context. The UK’s Office for Budget Responsibility recently calculated that the current UK Government’s Coronavirus Job Retention Scheme (i.e. Rishi Sunak’s set of “furlough” schemes designed to protect businesses through the worst of the lockdown and subsequent downturn) will amount to £103.6bn of taxpayer support. To that already gargantuan figure we must also add the cost of the Government’s Coronavirus Interruption Loan Scheme (Cbils) for small and medium-sizes businesses – roughly £4 billion – and, in addition, the cost of the Government’s fund for start-up business support – roughly £750 million. The grand total of our economic response to COVID-19 so far thus stands at £108.35 billion. That’s right, the cost of the UK’s response to a respiratory illness with an overall death rate of 0.66% (and 0.0016% in children aged nine and under) has been £108.35 billion. That’s roughly the total net wealth of Cyprus, or, depending on how you like your distressing financial comparisons, the annual GDP of the Ukraine. In percentage terms (and again adjusting for inflation), the UK’s contemporary response to COVID-19 has so far been 4,358% more expensive than the response pursued by the UK Government of 1957-58.
But having spent so little, and having had to struggle through the pandemic of 1957-58 with a depleted workforce, surely the UK economy must subsequently have suffered an almighty contraction? Surely it was inevitable that a dreadful and protracted recession would follow in the wake of the 1957–58 UK Government’s parsimonious folly? Well no, actually. GDP growth across 1957 was remarkably buoyant given the circumstances:
- 1957 Q1, +2.0%
- 1957 Q2, 0%
- 1957 Q3, -0.6%
- 1957 Q4, +0.1%
Adding these figures together gives us total annual GDP growth of +1.5% for the year of the pandemic. The figures for 1958 are below.
- 1958 Q1, +1.7%
- 1958 Q2, -2.5%
- 1958 Q3, +2.2%
- 1958 Q4, +0.1%
Despite the quarterly figures being a little more turbulent, nevertheless, the annualised growth rate ends up just the same as in 1957–58, at +1.5%. A workable definition of a recession is when a country experiences two consecutive quarters of negative economic growth. So what this data reveals is the remarkable fact that the UK didn’t experience a recession either during or after the Asian Flu pandemic of 1957. It’s also worth pointing out that the -2.5% GDP contraction recorded in Q2 of 1958 probably had less to do with the fall-out from the H2N2 pandemic than what we now know as “the Eisenhower Recession” over in the US. To use a particularly apt economic metaphor, “America sneezed, and we (probably) caught a cold.”
So where does this leave us? If the UK’s 1957–58 pandemic response cost just £2.43 billion and yielded such excellent results, then surely our recent and 4,358% costlier pandemic response of £108.35 billion augurs well for the future. What, then, might we look forward to receiving in return for this colossal investment? A retirement age of 45? Record levels of employment and double-digit wage growth across the next decade? Well, no. Not exactly. Sadly, leading British economists warned recently that the UK economy is heading towards a record fall. Their forecast is for a GDP contraction of 14% in Q2 of 2020. Elsewhere, the OBR have been warning that the UK economy could actually shrink by as much as 35% during that same quarter, with two million job losses thrown in for good measure. Over the course of the year, the OBR also predict a total GDP contraction of -13.5%.
Not much to write home about, is it? Personally, I’d be a bit upset if I’d invested £108.35 billion and ended up with a kick in the teeth, my home being taken off me and a P45 ready and waiting for me in the HR office at work. But then the Government doesn’t spend its own money, does it? It spends our money. So I suppose £103.5 billion is neither here nor there to them, really. An easy come, easy go kind of deal. Maybe when we’re all living rough near London Bridge we could club together and get some T-shirts made: “I went to the magic money tree…” printed neatly on the front, with “…and all I got was this lousy recession” scrawled on the back in our own blood. Although maybe not; maybe we should save that money just in case the food bank runs out of food.
Conclusions: From Stoicism to Hysteria?
In 1957 the UK responded to a global pandemic with cool, calm stoicism. The pandemic was “just” a pandemic, not a social catastrophe. Citizens could cope. Death was the exception not the rule. Society (and the economy that paid for it) would struggle on. People would continue to go about their everyday lives. Fast forward to the UK of 2020, and we encounter a society that’s responding to a similarly infectious, similarly dangerous pandemic with what amounts to shrill, hyperventilating hysteria. The pandemic will destroy everything we know and hold dear about life. Individuals can’t cope. Death lurks around every corner. Society (and the economy that pays for it) must be suspended. People must be protected from the myriad risks posed by everyday life. Whereas the stoic proclaims, “I’ll manage, let me be!” the hysteric wails, “I can’t cope, help me!”
Flitting back and forth between these two pandemic responses is like tracing the contours of a profound cultural shift that’s taken place across Western societies over the past 60 years. There was a time when people, individuals, citizens (whatever you want to call them) were seen, conceptualised and treated as resilient, capable and autonomous beings. The stoicism of the UK’s response to H2N2 was the natural corollary to this way of understanding what it meant to be a person in society – after all, if someone was resilient, capable and autonomous, then the onus was on them to take something like a global pandemic in their stride without too much external intervention. In recent years, however, there’s been a slight but nonetheless significant change to the way we conceptualise “personhood”. It’s not necessarily that we hear less about resilience and autonomy; it’s that the significance of problems like vulnerability and fragility has increased. The hysteria of the UK’s response to COVID-19 is the natural corollary to this new, rapidly emerging vision of personhood: if you’re vulnerable and fragile then the onus is on you to allow others to look after you during a global pandemic.
But so what? Is this even a problem? Deep down aren’t we’re all fragile? Don’t we all sometimes feel vulnerable? Of course. But we aren’t talking about “literal” vulnerability or “actual” fragility. We’re talking about vulnerability and fragility as concepts, as terms that feature within debates taking place at governmental, policy and regulatory levels regarding people’s potentialities in society: What are people capable of? What should they be capable of? What can we trust them to be capable of? The relatively recent emergence in the West of phenomena like health and safety, safeguarding and risk assessments perhaps hints at the types of answers these questions have been receiving. The ideal person whom policy makers have in their heads as they design these initiatives is not an autonomous, resilient being. He’s vulnerable. He needs protecting from his own autonomy. Want to use an angle grinder? Fill out a health and safety sheet. Using bleach to clean a toilet? Complete a risk assessment. Successive governments have, in these ways, slowly been redrawing the boundaries of personhood. Unpredictable and unruly autonomy and resilience? Out. Predictable and malleable vulnerability and fragility? Very much in. Perhaps the most remarkable thing about the UK Government’s response to COVID-19 is that in the space of two short months it has achieved what three decades of health and safety regulation couldn’t – it’s encouraged large swathes of people to appreciate the benefits of being considered vulnerable by authority. Do this, don’t do that; touch this, don’t touch that; walk here, don’t walk there. Loss of autonomy suddenly seems a small price to pay when it preserves what you now know to be your fragile, vulnerable body.
But does any of this philosophical chit-chat really matter? Can’t we just learn the political lessons from the UK’s lockdown mistakes, hold a government inquiry, sack the Health Minister, draw a line under the whole debacle and move on? Perhaps we can. But one wonders what “moving on” would really amount to in such a scenario. Those same governmental understandings of personhood would still be in place – indeed, if anything, they’d have been strengthened by many months of getting away with ordering people not to die. That’s likely to be a bit of a problem when it comes to “moving on”. Let’s imagine, for the sake of argument, that another pandemic hoves into view in six months’ time. What then? The type of pandemic response advocated by most lockdown sceptics – i.e. no lockdown, or just quarantining those most at risk with everyone else getting on with the business of daily life – presumes precisely the type of resilient and autonomous citizen that Western governments no longer recognise or want to factor into the design and implementation of their policies. They just don’t see people in the same way that lockdown sceptics see people. Almost certainly, then, a return to lockdown would quickly ensue. Perhaps if we “moved on” for a long enough amount of time, we’d wake up one day and find that as vulnerable, fragile people we needed lockdown protection from more than just global pandemics. “Arrgh! Nigel Farage is about to release another video documenting illegal immigration through the port of Dover. Quick, kids! Into the panic room!” “Eek! Sales of wood-burning stoves in the UK increased by 3.7% during the last financial quarter! Keep an eye out for tsunamis and head for the bunker!” That’s the problem with “moving on”: it treats the problem we’ve got right now as a purely political one. But look hard enough behind anything you regard as a “political problem”, and you’ll almost certainly uncover a well worked-out philosophical position structuring it. That’s why the historic data discussed in this essay is so relevant to the current political problem of how we might unpick the West’s burgeoning lockdown cultures. 1957 isn’t just 60 years ago; it’s an entire philosophy away. It provides a position from which to envision disaster responses very different to our own. The ideal person whom policy makers had in their minds when they designed policy back in the 1950s wasn’t a vulnerable hysteric: it was an autonomous, capable and resilient being. If policy makers thought that way once, they can (potentially) get to thinking that way again.
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I thought the whole point of Our Wonderful NHS (Peace be upon it) was to encourage people to keep well and healthy so they never have to use it.
Post war, with obesity levels very low, rationing in force, many young men and women just coming out of military service, we were pretty healthy, in many ways. As time has gone on the population has become health poor, and the NHS has stopped being the place to go when you are ill, but when you are ‘not well’, not well being subjective and the place where many people who don’t need medical assistance end up. Add to it the range of care provided, the increased breadth of treatments and service. It has become a monster that so many people think should respond to them for the very slightest concerns, for free, from cradle to grave. The NHS has to redefine its purpose, imo. It cannot be all things to all patients.
In 1948 there was absolutely no perception of the advances to be made in medicine, which has kept people alive for much longer and allowed them to contract many more serious, chronic conditions. Can we think of any other organisation that has not changed for over 70+ years?
Also, increasing prosperity has led to a massive increase in obesity and associated illnesses. The obesity crisis was noticeable in the USA back in the 1970s, so why did our ‘sainted’, ‘envy of the world’ national HEALTH service not consider the implications for the UK? Because the whole mangement structure is totally useless. They see the NHS as a job for life so there is absolutely no need to think about changes or improvements for the future benefit of the organisation as they will always be able to demand more taxpayers’ money to waste on useless issues; such as reorganisations and the creation of EDI posts, while claiming the NHS is in crisis. The so-called crises are a function of the incompetent management. The more crises they have, the more managers they need to resolve the crisis. QED
If you were running an organisation where 44% of the budget went on staff costs and 14% went on medicines which budget would you look to first reduce? BTW the proportion of the NHS budget spent on medicines has remained around 12/14% since the 1960s
Wrt “any other organisation that has not changed for 70 years” How about the House of Lords for a start?
Post war people coming out of military service were pretty healthy… yer wot?
PTSD, hearing impaired by gunfire, limbs blown off, organ injuries from bullet wounds, blinded by shrapnel, malnourished, long term effect of tropical diseases and other illnesses because of insanitary conditions, long spells in POW camps, cardiovascular problems caused by constant high adrenaline levels, and the many mental problems of having lived in Hell for years on end.
Most serious health conditions are a function of older age: dementia, arthritis, diabetes, cancers, joint replacement, cardiovascular, pulmonary, kidney, liver conditions, anaemia, high/low blood pressure, etc.
An NHS supposedly to make people healthier and thus live longer, inevitably will have to do more and cost more because more people will live longer to get diseases that need treatments, plus advances in medical science and technology will mean more things can be treated.
Bonus: increase life expectancy could only ever bankrupt the State pension scheme.
The Welfare State was the huge bribe to get the British to vote Labour in 1945. It was also a huge con, and the British people have enjoyed being conned ever since.
The NHS almost entirely treats symptoms of illness, without removing the causes of illness. The treatments have side effects which can create more symptoms, which are treated by treatments which have more side effects, for which more treatments may be needed.
Meanwhile, as the original causes of illness have not been removed, further symptoms will sooner or later develop, along with the symptoms arising from the treatments.
So it’s a never-ending cycle of symptom treatment, which, funnily enough, is great for the profits of pharmaceutical companies, as well as for the doctors who treat symptoms, as they will never be short of work.
Whereas there is not so much profit to be made from removing causes.
But the NHS appears to have reached the point where doctors are not just never short of work, they are becoming overwhelmed with the amount of work they are being faced with. Because they hardly ever treat causes.
So true about not treating the underlying cause! I had a private SLT practice for a number of years, the aim being to cure & discharge. At one conference one of the presentations was about models of business, the presenter couldn’t get his head around how by curing we did away with repeat customers!
It was & remains the only time in my clinical career where I was afforded the freedom to treat & cure with the patient’s clinical needs central to the interventions.
The majority of the patients self funded, very few had insurance & the insurance only paid out for 8 – 10 sessions, yet with highly motivated patients to carry out daily therapy was more than sufficient. The lack of motivation in patients in the NHS to carry out independent rehab is a juge block to successful therapy outcomes. As it is a ‘free’ service, the patients expectation is that therapy is done to them rather than they actually have to take responsibility for their recovery.
Like the author, I have only ever known the NHS to be in financial crisis. My profession has always been a Cinderella service – being able to communicate isn’t life threatening – & is a luxurious addition to the vital life saving professions, even where being unable to swallow is part of the disease.
I concur that the number of patients one is able to treat each day has reduced due to increased demand for ‘accoutability’ & processes inflicted in the name of ‘efficiency’. So glad to no longer be a part of it.
I think you mean “basket case”, not “basket cast”.
Great, thanks. One small picky point:
“Failure to recover after the pandemic”
There was no pandemic.
Thank you, tof, I won’t bother writing my comment now!
We have to keep pointing this out, don’t we?!
Abolition of the NHS is essential but politically unfeasible while the NHS retains sufficient public support for advocacy of abolition to be politically highly risky. Public support for the NHS is probably shallower than is commonly supposed, however, and could ebb away quickly if the string case for abolition was made. The destruction of the utterly corrupt and useless Conservative Party is necessary for the British people to be liberated from the bloated and increasingly autocratic state sector including the NHS.
A policy allowing individuals to opt out of NHS cover and receive a tax rebate proportional to the actuarial value to the individual of the NHS would be a way of generating real change in healthcare provision while reassuring those not ready to give up on NHS style healthcare.
And you think that “the bloated and increasingly autocratic state sector including the NHS” will be improved when the Conservatives are voted out and Sir Keir Smarmer’s lot take over? Based on years of experience of the socialists running the country into the ground, you’re having a laugh.
Can you give me an example of one Blair/Brown policy which the Pretendy-CONs haven’t either meekly accepted or made worse over the past 12 years.
I can’t think of a single positive policy they’ve implemented – except a weak version of Brexit which they were forced to do by Farage and the Brexit Party or see their Party annihilated.
As an experienced patient over the years, I think it’s worth pointing out that many specialists are not solely employed by the NHS at all. Sometimes they work independently, or for another firm, and sometimes for an NHS branch. E.g. some years ago, with private insurance, I saw the same guy rather earlier than I would have done if I stayed on an NHS “waiting list”. No shortage of Bupa run places just round the corner from an NHS building, after all.
The organisation is hard to understand, but it is quite different from many company structures.
During the covid saga, my mum needed an urgent cataract operation. She was referred to a surgeon at the local hospital who told her there is a long waiting list due to the hospital being overloaded because of covid. He said he could do it privately though, which she went for. The surprise is that the operation was done at the same hospital, although in a different private only wing.
The social insurance schemes in Continental Europe work well because patients know the true costs of consultations, treatment and medication. Often they have to pay for them and claim back the part covered by insurance.
“Free at the point of use” is as much of a chimera as the Magic Money Tree. There’s no such thing as a free lunch.
This is total BS.
The insurance component has absolutely nothing to do with these systems higher efficiencies at the point of care.
To the contrary, they add just another layer of bureaucracy and cost.
The 90% mandatorily ‘health insured’ Germans at the hundreds of Krankenkassen with their hundreds of CEOs&co have absolutely no such transparency or incentive. A totally unrelated policy of charging them a nominal 10€ per quarterly practice visit actually had that effect, but it was cancelled after protests by the very same doctors that wanted it to be inteoduced, because it was so successful that they had too little to do and charge! The 10% mandatory ‘private’ insured at about 150 private Krankenkassen with hundreds of CEOs&co again have that transparency and some incentives to save, but that is more than made up for by doctors&co charging them 2.3 to 3.5 X as much as the 90% quasi-state insured are charged for the exact same procedure by the exact same doctors.
At the poc, it’s a question of education, organisation/bureaucracy, incentives, politics and work ethics which result in higher efficiency there.
No other health system was Covid only for a year, only the UK’s.
Dentists operated as normal after 2 weeks.
German GPs are usually operating as a private practice for 3 decades before the next one, often a relative, takes it over, have little staff turnover, see their patients directly and do house calls, and unlike the dentists, their charges and reimbursements are so that usually they can’t and don’t drive Porsches.
(Which is why many jumped eagerly on the gene-therapy bandwagon, which paid them royally in contrast.)
In short: the British health system and services could be improved, but replacing single receiver and payor NI and free at the poc with a hodgepodge of ‘insurances’ and part payments and part aid payments etc. is not something that will increase efficiency and lower costs- it will only lower efficiency and increase cost.
Because it is long term programme for introducing socialism, masquerading as a health service. You only have to look at the ever increasing proportion of the national budget that it consumes, the belligerence and arrogance of the people who work there, the complete lack of accountability for their many and continual failures, the total lack of focus on delivering a quality service to the payers, and the political untouchability of every aspect of the organisation.
While I agree that the NHS is mainly an Ill-Health Service it’s rather unfair to accuse its workers as belligerent and arrogant, though I was the latter. My belligerence was aimed at managers who tried to stop me working so hard – by trying to limit outpatient numbers without examining why patients were being seen (a joined-up thinking problem) and by reducing my surgical colleague’s theatre hours by insisting on rigid start and finish times. Thus, if a theatre session was due to begin at 8.30 that was not the time of the first operation, but the time at which the theatre was set up, and lists were not allowed to overrun. I also tried to stop MRSA patients being admitted to my rehab unit, where my patients with serious long-term illnesses were at significant risk, only to find myself overruled by managers. Then there was a failed hospitals merger (which I had predicted, and over which I was given a verbal warning for dissent, and this is over a decade ago). But you are right about the lack of accountability; the CE who oversaw the failed merger was promoted! Try my book…
Any public service is essentially like an obese person with a sugar addiction.
Over time it will get fatter, sicker, more lazy, harder to shift, and then die.
In Australia, before our health system became socialised, the small, rural town I hailed from had 3 GP’s who performed obstetrics including Caesarian, did surgery and anaesthetics. There were visiting general surgeons and a professor of ENT.
Now the town has 1 visiting GP, who does no procedures whatsoever.
But we have loads of managers and admin staff to tell the medical staff what they are doing wrong, and to teach the DEI principles.
Socialism never works!
And it always runs out of other peoples’ money
A thoughtful piece. My own experience (39 years in the NHS and 11 years retired, plus growing up with two GP parents) identified the same issues, but there is more to be decided. Part of the reason that hospital care costs have burgeoned is that we can do far more, with new surgical techniques, new investigations such as MRI, new drugs. Another part is the additional cost of single room hospitals. A third is the most uncomfortable to confront; I believe we are to often spending vast sums on people who should not be treated. Consider an elderly lady, admitted from a care home after a fall, partly blind, deaf, struggling with a seized hip and with a chronic urine infection (drug resistant), aged 94 and tired of life. You could operate on the broken shoulder, do the hip as well, and send her to ICU post-op. Or you could decide that life after discharge will be as difficult and expensive as it was before, and grant her a quiet and dignified death by doing nothing. Shorter and cheaper hospital stay as a by-product. And before anyone says anything, that was my mother, a long retired GP. Treating her would have been what I have termed futility medicine.
Reform? But what reform? Since the NHS began there have been numerous attempts at reform. That none has worked suggests that reform may not be possible, but see my book “Mad Medicine” for some ideas (www.amazon.com/author/andrewbamji)
The intervention arm of not intervening with patient consent is too often overlooked as one has to do something.
Currently there are drug protocols being used on patients such as your mother in hospitals comprising of midazolam & morphine, prescribed together, which have no such benign outcome as being in the patient’s best interests.
The very best care homes used to do everything within their abilities to keep an elderly, frail individual comfortable & in familiar surroundings, not so sure now.
It’s a basket case because successive governments have treated it like a political sacred cow and drenched it with money it hardly knows how to spend, aside from meaningless management positions and they know that their job performance is beyond criticism. It will carry on because politicians haven’t the backbone to confront it.
The increasing costs and the possibilities of more complex procedures, costly drugs and diagnostics together with a growing population mean that the NHS model is unsustainable.
Furthermore the increasing obesity levels have a major impact on general health (diabetes, cancer, arthritis) resulting in rising demands on the NHS.
I’d refer everyone to Ed Hoskin’s excellent piece here on November 29 2022 (https://dailysceptic.org/2022/11/29/how-to-fix-the-nhs/) about how well the French system works by contrast. Which I can confirm from personal experience after living there for 5 years. They have more doctors and nurses and other health professionals, who are paid less (!), fewer administrators and managers, and they spend less as a % of gdp than we do. The only cure for the NHS is to blow it up.
Eat a decent, varied diet; exercise; take ginger and eat oily fish or take fish oil capsules. There is a wealth of information about natural alternatives to prescription medicines on the net.
Look after your own health. The NHS won’t do it for you and many working in the “medical profession” are compromised by their association with Big Pharma.
…and steer clear of fake ‘vaccines’ and anything created with warp speed…
The People’s Health Alliance is a growing group of healthcare professionals set up as a viable alternative to the failing NHS which is growing rapidly in the UK & the model is being used around the globe.
The People’s Health Alliance – For The People, by The People
Excellent summary. But the consequences of this latter-day religion are even more dire than merely the unending huge cost for a poor service.You put your finger on it with:
“We all know what to do, but we don’t know how to get re-elected once we have done it.”
Collapse of the NHS means exile for a 1,000 years for whichever party is in power. This was the major reason for Johnson inflicting the scourge of a ‘Lockdown'(a word that should be banned from the English language!). We were within a whisker of stopping the collapsing dominos across the world, but for the cult of the NHS. Recall the first of the government’s 3 commandments: ‘Save the NHS‘. ‘Save Lives’ came only second. (God only knows what rubbish came third!)
Why?
Because it is a State run, non-contestable monopoly operated to meet ideological and political aims.
It does not therefore have any of the normal incentives of private business in a free, competitive market, it does not have to serve consumer interests to survive because it can never go bankrupt, no investor can lose their money as it has no investors just people coerced to pay for its losses, no worker can lose their job.
This why every State-run enterprise, in any place at any time was a basket case, and why we got rid of all the others here in the UK.
I am weary of people keep asking why the NHS is such a sack of merde and how can it be fixed.
Why can’t an elephant fly? How do we fix it so it flies?
Fred Karno’s army on steroids. Privatisation is the only way I’m afraid.
Have some knowledge of the French, American and English versions of healthcare. In France patients pay a small proportion of the cost of treatment which is covered normally by a moderately priced insurance almost everyone in France has. My mother in law was treated very well in France for what was eventually terminal cancer. My son married an america young lady and moved to America where he was terrified of health costs if the need arose and decided it was necessary to buy health insurance at a very expensive rate which at that stage he could hardly afford. It is not uncommon for people who develop health issues in America with inadequate or non existent health insurance to be financially broken by the cost of their health treatment. Fortunately he now has a job where part of his salary pays for good health insurance which is quite common for professionals in America, but many others need to pay the high insurance cost or risk the very high American health treatment costs. In the UK I need an operation for joint problems, but had a full pre-op examination which discovered in addition to my high blood pressure, I had heart problems. since then I have had very good care from the cardiac specialist and cardiac specialist nurse at Yeovil Hospital with the objective of dealing with my heart problem and reducing my blood pressure which now seems to be improving towards the point where I should be able to have my operation. I can’t fault the treatment I have had from the NHS, but I understand there are issues and shortages which need to be dealt with, more by reoganisation than just providing more money. I think it is necessary for government to listen to health professionals within the NHS at every level and develop a viable plan to put things right.
You can criticize the NHS all you like for its truly scandalous waste of manpower and materials but abolition will achieve nothing while UK management is so inefficient, corrupted and class ridden.