Friday, March 20, 2020

Are Pandemics Worse than We Think? Adding Loss of Inclusion to Loss of Lives

Now that the world is dealing with the Coronavirus turning from an epidemic to a pandemic, it may be time to talk about something we learnt from the Ebola virus. This is a lesson from research by April Wright, Alan Meyer, Trish Reay,and Jonathan Staggs published in Administrative Science Quarterly, and it concerns the social distancing that many places in the world now practice to mitigate the effects of this disease.

We understand that social distancing is inconvenient. In Singapore, which currently has a mild form of it because the Coronavirus is controlled well here, temperature checks when going into certain buildings are inconvenient, we eat at restaurants less often than we would like, and a shopping center (such as the one housing my gym) is a place to think twice about entering. Other places are much worse off, with people quarantined to their dwellings except for emergencies, and all community meeting places and arrangements canceled.

What this research points out is that places of social inclusion are essential to society. Places of inclusion are where people gather to have their needs provided by society, from private actors, government actors, or voluntary associations. They include the sports stadium of the local team, the unemployment office, the church, and the soup kitchen for the homeless. All these are places that provide practical goods and services, but they also serve a symbolic role of defining the community and affirming people’s inclusion in the community.

The importance of places of social inclusion was shown prominently when their research at a public Emergency Department (ED) in Australia suddenly involved the Ebola epidemic. ED doctors and nurses handle many kinds of risks to patients and themselves, but Ebola was unusual because it was an unknown situation, and one that could lead to exhaustion of ED resources and even temporary closure of the ED. This was a situation that invoked fear and a feeling of threat because the physicians understood that turning away any patients was more than failing to provide medical services; it meant an unmet human need. Although most people rarely interact with EDs, they are places of social inclusion that need to stay available.

To manage the Ebola situation in addition to the regular claims on their resources, the ED rationed resources carefully and enabled resource use whenever possible. Doctors and nurses also went to extraordinary lengths to avoid closing down and to keep the ED safe for both patients and employees. In the end, many ED personnel dealt with the situation by reasoning that the Ebola risk, although new, was not so much greater than the risk posed by violent patients or other infectious diseases, which they already dealt with routinely.

If we tie this research to the Coronavirus situation, we should be aware of some differences. The personnel at this ED were very conscious of its role as a place of social inclusion and did their best to stay open and admit patients. And when all was said and done, they had treated no Ebola patients, only some suspected cases. Is that what we will see in the current situation? I doubt it.

Not all places of social inclusion recognize that they have this role, and few are staffed by individuals who have taken an oath to protect the patient and the community, as many doctors do. The Coronavirus will see many places of social inclusion close, by their own volition or by public policy. Few places of social inclusion will be as safe from infections as the Australian ED studied in this research. Ebola was rare and not very contagious but was feared because it was so grimly deadly. The Coronavirus is now widespread and appears to be more contagious than the flu, and deadlier.

For a while, places of social inclusion will be lost, and this will be a great loss to communities and their inhabitants. A significant measure of community resilience will be how quickly the places of social inclusion can open again and serve their community. In the meantime, let’s hope that communities can improvise safe places of social inclusion, as Italians have done by singing from their balconies.

Wright, A. L., Meyer, A. D., Reay, T., & Staggs, J. 2020. Maintaining Places of Social Inclusion: Ebola and the Emergency Department. Administrative Science Quarterly, forthcoming. 

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