Ontological Uncertainty and Ontological Threat: COVID-19 and the UK

Ontological Uncertainty and Ontological Threat

COVID-19 and the UK

Michael P. Kelly

ABSTRACT Ontological security describes a state in which individuals feel that their life has meaning, which they and others understand and share; in which their life and continued existence is secure; and in which their sense of self is stable. In social life, this security is challenged from time to time, and acutely so in certain extreme circumstances. This essay argues that the experience of COVID-19 in the United Kingdom, with its concomitant mortality and the response of government, have served to challenge ontological security. At the start of lockdown and in the weeks that followed, the government’s strategy undermined that sense of security as well as trust in government itself. As the pandemic continued this had quite different consequences for different segments of the population, and these consequences may in turn interact with the disease itself.

The COVID-19 pandemic has undermined the routines and practices of ordinary everyday life in the United Kingdom. This has had serious consequences for ontological security—the sense that life is reasonably predictable and meaningful, and that the future holds few surprises (Giddens 1991). At the time of writing—mid-October 2020—ontological security in the UK has been undermined for many. For some, especially socially disadvantaged groups, Black and ethnic minorities, and the elderly, this is acutely the case. Ironically, this

Department of Public Health and Primary Care, University of Cambridge. Email: mk744@medschl.cam.ac.uk.

Perspectives in Biology and Medicine, volume 64, number 3 (summer 2021): 316–337. © 2021 by Johns Hopkins University Press

circumstance stems as much from the actions of government and public health authorities as from the disease itself.

I am a retired public health scientist and a sociologist. What follows is a personal set of observations on the pandemic in the UK, drawing on my training in both arenas. It is not based on an empirical investigation, but on my personal experience of living in the UK during the COVID-19 pandemic and conversations with colleagues, friends, family, and acquaintances, as well as on reading published scientific papers, pre-prints, newspapers, looking at the UK Government’s official website, and listening to and viewing radio, television and some social media. I do not claim it is systematic, but I use a well-established set of theoretical sociological theories to make sense of what I have seen and heard. This might perhaps form the basis for further empirical study in due course.

Social Life and Its Delicacy

Social life is delicate. Its fragility is apparent at junctures where the taken-for-granted normality of routine interaction and thoughts are fractured or disrupted. That has been what has happened since the pandemic took hold in the UK. The result is not social breakdown, but the effects on the populace have been to create a growing sense of weariness and despair about the future of the pandemic, and about the authorities’ inabilities to do very much about it. Harold Garfinkel’s (1967) experiments in ethnomethodology demonstrated that social life is delicate. He got ordinary people to behave in ways in which minor infractions of social intercourse were deliberately engineered—for example, asking his students to go home and act as if they were strangers in their own homes. A little bit of role-play, but one that quickly led to acute uneasiness in normal family life. COVID-19 has been a natural experiment in breakdown—if not fracture—arising from the disease, and that breakdown has been partly deliberately and partly unintentionally engineered by government.

Garfinkel’s experiments were about the micro social world, but sociology has long been interested in macro structural disruptions to social life, too. While acknowledging that social life is ordinarily in a continuous process of flux and change, sociology notes that there are also occasions when societies transform violently or seismically. Classical sociology focused on the transition, mostly gradual, from preindustrial to industrial societies, as evidenced in the work of such sociological pioneers as Marx, Weber, and Durkheim. But classical sociologists also examined how and why—in spite of both continuous and minor and major social realignments—social systems have a profound tendency towards continuity (Giddens 1971). Continuity might yet be a reason to be optimistic about COVID-19 into the longer run, but what of the uncertainties created to mental health, to jobs, to everyday social life, and indeed to existential futures, along the way?

The COVID-19 pandemic has been socially disruptive. Whether in the decades to come it will be viewed as seismic, or as merely a blip, remains to be seen. The narratives and discourse from medical, public health, political, and media sources have tended to emphasize the idea of a major disjunction. At the outset, narratives derived from experiences of war were particularly important, with the virus depicted as an enemy to all intents and purposes similar to a national foreign power engaged in aggressive warlike invasion. In the UK the claim was made that “We are all in this together” (Lacey, Kelly, and Jutel 2020). Political leaders drew upon this kind of imagery and metaphor to create feelings of solidarity and unity, but such solidarity has since begun to fracture in the UK. Nevertheless, the overarching importance of external threat initially held sway. Citizens were asked voluntarily to submit to new rules and regulations about socializing, going to bars and restaurants, going to work, travelling, and shopping. Schools, universities, and workplaces were closed down, and for periods people were variously encouraged—or required—not to leave their homes, or to do so only for very specific reasons.

At first there was a subtext that implied that, serious as this was, these were short-term measures. However, as the regulations continued for months and then a second wave of infections was predicted and observed, the idea that these were temporary disruptions has given way to a more-or-less explicit recognition that the readjustments to everyone’s lives would have to become normalized, at least for the time being. In October 2020, as infections began to increase once again and new heavy-duty restrictions were being placed on social and economic life, it was not clear, scientifically, whether and when the disruptions might come to an end, and what the implications longer term might be.

But how do we make sense of this? There is no shortage of journalistic and political and medical comment. I want to try to take a more analytic and sociological view.

Agency and Structure

There are two elements in social life that shape the nature of the social world: agency and structure (Giddens 1979, 1982). Humans have a sense of being unique individuals acting and thinking individually and in ways that are of their own choosing. They have agency. And indeed humans do, think, and say billions and billions of different things every moment, of every hour of every day. These include the mundane as well as the momentous. We might assume that out of these billions of actions we would simply have a chaotic social world of impenetrable complexity and essentially unknown and unknowable. Instead, out of these billions of different things people think, say, and do, patterns emerge. These patterns are often referred to as structures. The structures are real, not in a concrete sense, but in the sense that they are all around us and constrain what

we are able to say, think, and do. Examples of structures are such things as peer group pressure, social norms, formal legal and regulative systems, the market, social classes, castes, statuses, and patterns of advantage, discrimination, and disadvantage. These structures arise out of the multitude of individual actions but simultaneously limit, constrain, and sometimes determine which individual actions are possible. Further, ordinary human agents are varyingly aware of the structures around them. They are familiar parts of everyday life, and people orient their actions accordingly (Bourdieu 1990, 2000). Action and structure are in continuous processes of interaction, and the consequences of these interactions are social continuities and social change.

The overall result is that society has a systemic quality, which is over and above any one individual’s ability to change it. Of course, down the centuries, political leaders and individuals with their hands on the levers of state and economic power have sought to influence the behavior of others (Kelly 2016). Some individuals and groups have greater access to power and the ability to try to make others do what they want, but even those with absolute power are constrained in various ways by the structures around them. However, many people have only very limited access to power (Mann 1986). The options open to them are narrower and more limited. Although even in these circumstances people still have agency and will exercise it within the bounds of the possibilities that the structures allow, the constraints imposed by the powerful are real. In the case of the pandemic, efforts to protect health may also contribute to a toxic mix of disadvantage and disease interacting together.

The pandemic has had a significant effect on human agency. In order to break the lines of transmission of the virus, the UK Government has sought to change behavior in very significant ways, by drawing up a host of new regulations and rules that determine what people can or cannot do. In the four nations of the UK, there has been a continuous flow of such new controls since March 2020, as the various levels of government have sought to change structures to constrain agency. This has been done in the name of public safety and health protection, and at least initially, these measures appeared to be effective. People did as they were told. They internalized the messages about dangers and protecting the National Health Service (NHS), and gradually the numbers of cases subsided. But at the same time the very nature of society subtly shifted.

Self and Ontological Uncertainty

What of the consequences? At the heart of interactions between action and structure is the human self. Each of us has a self, a profound sense of being a unique individual separate from others. The self is that part of our being, which is experienced as making decisions—major and minor—about our day-to-day life. We have a sense of who and what we are, and what our place in the world is. Some

aspects of our self are transient: I am buying a newspaper, I am enjoying a walk in the countryside. Other aspects of self are more substantial: I am a writer, I am a sociologist. The substantial self constitutes those aspects that the person carries from situation to situation across the life course (Kelly et al. 2018).

For most of us, the thinking self has a sense of its own continuity in time and across place. It will recognize that it is the same person it was this morning when it had breakfast and when it enjoyed a movie last week, or when it was with friends at dinner a year ago. It will know that it is the same person it was when a student, a teenager, and a child. It will also recognize and know that it has changed at different points in its lifetime. There is ontological continuity, a continuous sense of being in the world. With continuity comes security. The self knows what to do in its day-to-day routine interactions. Most of us also have a clear sense of how we will manage particular tasks and problems in the future, mostly based on how we have done so in the past. That continuity in the substantial self means that the judgment processes we employ and the decisions we make have a routine quality. The things we do may be enacted with reliable degrees of competence. Into the future, while recognizing that it is in part uncertain, we work on the assumption that on the whole things are likely to much as they are today—tomorrow, next week, and even next year and beyond. In sociological jargon, we say that social life is “highly recursive,” and much of the time, we just take it for granted (Giddens 1979, 1982; Schutz 1964, 1967, 1970).

The potential for extreme discomfort and ontological insecurity comes from the experience that events going forward are neither predictable nor reasonable, and therefore that the continuities in the substantial self are threatened. There is a realization that our personal autobiography is about to change in unwelcome ways, and that our normal ways of behaving are unhelpful—or worse, dangerous and damaging. In such moments, we may have to do things we have never done before and for which we have little or no competence. There is no script or recipe to draw upon to know what to do or how to do it (Shove, Pantzar, and Watson 2012).

All of us will have some passing experience of this kind of breakdown. For example, this may happen in panic attacks, in moments when we feel lost in completely unfamiliar circumstances and situations, or when confronted with by someone intent on causing us harm and threatening physical violence. But for most of us these episodes are transient: we are able to regain our sense of continuity of self and reestablish some feeling of normality. However, the acute moments that transmute into chronic experience may lead to a separation from attachment to the familiar self and create a loss of ontological security. The certainty that is normally bound up with self drains away, and the subject is left to seek to establish some new sense of being in the world. Meaning needs to reestablished, because the emergent meanings from the events triggering these feelings are inconsistent with one’s sense of self.

In such acute circumstances, the empirical sense data the individual is processing are often inconsistent with previous firsthand experience of dealing with the world (Kelly et al 2018). This may lead the individual to draw upon vicarious experience—in other words, to rely on priors that reflect understandings of danger, threat, death, and injury described by others. While this throws the threat into stark relief, it provides little by way of skills or competencies to handle the current situation. Humans have high degrees of ability to cope with difficult and stressful situations. Lazarus’s important work on this ability describes the primary part of the process as “threat recognition,” and the second part as determining what to do about it (Lazarus and Folkman 1984). The problem with acute ontological insecurity is that the threat is tangible, but knowing what to do as an active process is far from clear.

Ontological security/insecurity is not binary. Clearly there are times where insecurity is acute, but it is probably more helpful to think of our ontological security as being on a spectrum. Where we are at any given moment on that spectrum will reflect our current, past, and anticipated future circumstances. There are some individuals and groups for whom insecurity is, or becomes, chronic rather than acute—for example, some refugees, the marginalized, the homeless, some persons whose illnesses are highly stigmatized or life threatening, those who are systematically discriminated against, and people trying to survive in conflict zones or in regions affected by famine. Anyone who claims to be taken seriously as a human, but whose claims are denied for whatever reason, has their ontological security challenged (Kelly et al. 2021). Societies and communities where economic and political security cannot be taken for granted create the potential for challenges to ontological security.

Nearly all of us experience a more-or-less salient background ontological insecurity, perhaps reflecting such things as knowledge of the threat to human existence from the climate emergency, the insecurity of global food and water supplies, or even just the recognition of our own mortality. But the extent to which these things are experienced as an immediate threat to self is variable. Humans have varying resources, as well as very well-developed ways of coping with threats and of keeping such fears at bay, but these are not limitless. The argument here is that wherever people are on the spectrum of security, the pandemic is likely to have impacted them. How those effects are felt, however, are likely to be patterned according to well-known, preexisting social and economic conditions.

The Experience of the Pandemic

So, how? In Britain in the first weeks of the COVID-19 pandemic, immediately after lockdown was imposed, ontological security was threatened—quite deliberately—by government messaging, and then rendered uncertain as events

unfolded. The ways that ordinary people habitually dealt with some life stressors became inappropriate or redundant, and the predictions that they were able to make about the future were increasingly discordant with the world as it was turning out to be. None of this is very surprising, although the way it happened is worth a closer look.

The expectation of a global pandemic had been anticipated for many decades, and the UK government had in place a system of pandemic preparedness. The idea of the possible threat was well known to public health specialists and medical practitioners, some officials, and some politicians. However, until early 2020, the UK public at large did not seem to be much concerned about the distant possibility of a pandemic. A critical weakness in the UK was that the planning and preparedness had been done on the basis of an expected epidemic of influenza, not a novel coronavirus, the pattern of transmission of which was dissimilar to influenza (Pegg, Booth, and Conn 2020). Surprisingly to me, there were other weaknesses in preparedness that were already well-known in government, following a simulation exercise in 2016, code-named Exercise Cygnus (Guardian 2020). Those weaknesses do not appear to have been acted upon, nor was the idea of a “black swan” disease—a non-influenza pandemic (Taleb 2007). Indeed, the Chief Medical Officer at the time of Cygnus has said that she had been reassured in 2015 by Public Health England that a SARS-type pandemic (SARS is a coronavirus) would never travel from the Far East to the shores of the UK (Gardner 2020).

The public in the UK spent the Christmas and New Year celebrations at the end of 2019 untroubled by the news of an outbreak of a pneumonia-type disease in a place in China most Britons had never heard of. The first main meeting of the government emergency committee took place in the UK at the end of January 2020. The public did not immediately engage. Through February, the NHS functioned as normal. In most hospitals no special precautions were obviously or ostentatiously put in place. In the middle of February, I was admitted as an emergency to a major teaching hospital in Edinburgh with a reoccurrence of a long-standing health problem. During my admission and treatment, none of the medical or nursing staff mentioned coronavirus or practiced any kind of out-ofthe-ordinary clinical social distancing or other precautions. I made a full recovery and wrote to the hospital soon after my discharge to thank them for my excellent care. On reflection, no one (including me) seemed to have been very worried, at least on the front line. Although as a retired public health scientist I was aware that the disease was spreading, neither I, nor any of the professional colleagues I talked to in Cambridge or Edinburgh, saw anything untoward coming down the track. We were of course all using our taken-for-granted routine ways of dealing with life, and I for one assumed that the pandemic preparedness of the nation would stand us in good stead. I thought the UK authorities had things comfortably in hand and even reassured several friends of this.

However, by the beginning of March the public was noticing the potential danger. Many clubs, societies, and organizations began voluntarily to suspend events, gatherings, and meetings. Meanwhile, the UK government only emphasized protective measures like hand washing, and some forms of social distancing. Then on March 23, 2020, following several days of increasingly alarming figures, Prime Minister Boris Johnson announced in a dramatic broadcast to the nation a lockdown for the whole country (Daily Telegraph 2020a). This was accompanied by a raft of highly threatening information about the number of cases, the probable number of deaths, and warnings to look out for the symptoms (although at that time the symptoms of loss of taste and smell were not included in the list). People with preexisting serious medical conditions were instructed to socially isolate and shield. The dangers of the disease were publicized widely. People were advised to stay away from hospitals, and many were sufficiently alarmed at the prospect of hospitals being major foci of infection that they voluntarily did so. A total lockdown had been put in place. Ordinary life was effectively closed down.

What followed was a most remarkable example of behavior change on a mass scale. The UK population did as it was told. “Stay home, protect the NHS,” the slogan went; and they did. Each day a solemn televised briefing was held live from Downing Street, during which the Prime Minister or other senior Cabinet Minister, flanked by the Chief Medical Officer and the Chief Scientific Advisor or other officials, would intone dramatic statistics about the actual and likely further death toll and the dangers facing the whole country. The messaging was clear and simple. There is a deadly disease which is likely to overwhelm the NHS, and all you as citizens can do is stay home and avoid contact with everyone else. The television, radio, and newspapers carried similarly dire warnings.

Claims were made early on in the daily government briefings that the government would follow the science, and on one occasion the Chief Scientific Advisor noted that they would follow the behavioral science too (Daily Telegraph 2020b). In this endeavor, a special committee called SAGE (the Scientific Advisory Group for Emergencies), consisting of scientific experts and others, existed to review evidence as far as it was available and to make recommendations to government in the handing of the emergency (UK Government 2020). SAGE consults with a number of expert groups, including one on modelling and one on behavioral science, respectively the Scientific Pandemic Influenza Group on Modelling (SPI-M) and the Independent Scientific Pandemic Group on Behaviors (SPI-B). In the early phases, according to the public record, one particularly influential series of papers produced was from the Medical Research Council Centre for Global Infectious Disease Analysis at Imperial College, London (ICL 2020). These modelling papers covered a range of topics, focusing initially on what was happening in China, and subsequently on estimates of what was going to happen in the UK. The results were not encouraging. These early predictions

from the Imperial College Group appear to have been very influential in shaping the UK Government’s response (Ferguson et al. 2020).

There has been much discussion since about the modelling and the possible errors in it, and about how other kinds of public health advice from practitioners and from local Medical Officers was ignored in favor of the models (Horton 2020; Scally, Jacobson, and Kamran 2020). The ideas in the models appear to have held sway politically and to have been the core rationale behind the government messaging. Whether in the corridors of power this was really the case, I don’t know: the political and scientific diarists have yet to tell us their background stories, and in due course there may be a public enquiry. However, from an external perspective, it seems highly likely that the worst-case scenario as predicted by the Imperial College models were the ones drawn upon initially to justify the draconian rules.

These rules are interesting because they struck at the very heart of ordinary everyday routines, of taken-for-granted ways of thinking and acting. The stark warnings about death played on people’s most elemental ontological fears. At first, the numbers of deaths in the UK were low, and the British media carried daily reports of the way that health services in northern Italy were collapsing under the weight of cases. However, the numbers of people dying each day in the UK began to rise, and the reality of the threat gradually crystalized. Reports emerged of doctors, nurses, and other health-care workers who had died in the line of duty. There may have been some, like myself, who noticed that in these early days almost all of the health workers who died seemed to be from Black and ethnic minority backgrounds, including senior hospital doctors. There was also the strong suggestion that certain preexisting conditions, like obesity and diabetes, made people more vulnerable. The idea that there was an interaction between infection and certain noncommunicable diseases, which are themselves concentrated in socioeconomically and ethnically disadvantaged groups, was abroad—though the implications were perhaps not immediately recognized. Those of us with backgrounds in public health could not easily find out in the early days—globally or nationally—what the breakdown of infections and deaths by age, social class, or ethnicity actually were (Bhopal 2020). Nevertheless, the reality of increasingly large numbers of people dying, including health-care workers, reinforced the government stricture to stay safe by staying home.

Simple everyday activities suddenly became transformed into terrifying vectors of infections—talking to someone, socializing in family groups, having a coffee or a beer in a cafe or pub, or walking close to someone in the street. At a micro level, the very basics of human movement, deportment, and conversation were transformed. Some things were proscribed completely. So, even if you had wanted to, you couldn’t have gone to a pub or restaurant or cafe, because they were all closed. The issue here is not just that ordinary routine interaction in these settings couldn’t happen because they were closed, but the routine social practices

of large swathes of people’s time were simply cut off, as was their income wholly or in part.

This was especially true in respect of work and education. A person’s work or student role is a central and core part of their substantial self and consumes a significant part of the day. It is also a platform for interactions with other people, whether workmates, school and college friends, customers, or clients. These highly significant aspects of substantial self were, for many, just stopped. People going to work, school, or college mostly have to travel there. That ended too. Many people take some kind of break during working hours for coffee or lunch, and to go out and buy some refreshments. That halted as well. Heading to the pub or wine bar on the way home was also a normal activity for many; it abruptly ended. All this social contact ceased. So for schoolchildren, students, and many workers (save those in jobs like delivery drivers, care workers, health-care staff, and what were defined as other key workers), the routine social practices that made up their working day became disconnected and attenuated. Primary social attachments were significantly reduced, and the opportunities for presentation of self were suddenly greatly diminished. It is through those social attachments that our presentation of self is acknowledged and reflected back to us, which allows our public social identity to be constructed. So when the arena where our humanity is confirmed was not just diminished but forcibly atrophied, our sense of future security and safety was challenged, our sense of who and what we are was thrown into doubt, and the ability for others to acknowledge who and what we are was cut off (Kelly et al. 2021).

This was problematic for very many people, but perhaps in different ways. Where material deprivation was not an issue, but where the performance of professional and sociable roles was no longer public, the closing off of opportunities was keenly felt but could be replaced quite swiftly by the use of computer platforms of various kinds. However, for those where the material basis of day-today life was more tenuous, the social closure had immediate consequences, both financially and also for the presentation and acknowledgment of self and therefore potentially for mental wellbeing. The tenuousness of many people’s material lives—that part of the population Savage (2015) called the “precariat”—was laid bare very swiftly. Although ontological security and insecurity are intrinsic to the human condition, breaking people’s ability to “just about manage,” to use the words of Theresa May, the former Prime Minister, happened for some people very quickly indeed. You don’t need to be a psychiatrist to see the potential dangers to psychological wellbeing of this rapid diminution of human association for everyone, and the double whammy of this when coupled with the reduction in the basic necessities of life for some. And bear in mind much of this originated with the authorities purposively framing highly threatening and frightening messages and statistics, and with the deliberate closure of large swathes of some industries. With the best of intentions, but with the potential for considerable potential collateral mental health and economic damage!

So the country was in a state of suspended animation. For many, online shopping and deliveries became the norm. Little road traffic was moving, rail services were cut back to a minimum. People stopped socializing. Normal life came to a near standstill. The infrastructures supporting work and travel were made idle. Supply chains, for a while at least, were disrupted as goods normally available in supermarkets and grocery shops disappeared from the shelves as panic buying ensued. Flour, toilet tissue, and sanitizer were among items that suddenly became hard to buy.

In some occupations, mostly middle-class ones, working from home was encouraged. Through the internet and various platforms like Zoom, Skype, and Teams, work was possible. While many tasks, meetings, preparation of reports and papers can be done in this way, in spite of connectivity, the actuality of the warmth of human contact was missing. However, salaries continued to be paid. On the other hand, for people who worked in retail, services, travel, the arts, construction, factories, and hospitality—a very large part of the economy—there was no work to do. For elderly people living in isolation, whose primary social contacts may have already been tenuous, and for those with serious underlying medical conditions, the problems were particularly acute. They were instructed to shield at home and not go out at all. They became, if they were not already, completely reliant on others, and it was soon clear that the infrastructure of state and voluntary help was not universally effective. The loneliness and social isolation descended like a mist on the lives of many.

These were unusual, not to say unique, circumstances. Social practices and their predictable, repetitive, recursive, and well-understood nature are the bedrock of ontological security for self (Shove, Pantzar, and Watson 2012). New meanings had to be found, and while some people adapted by using their skills in novel ways, for many this simply was not possible. The meanings attached to lots of everyday activities had to change profoundly—for example, socializing ceased to be a pleasant way of affirming human contact, affection, solidarity, and instead became a potential deadly vector of infection. Taken-for-granted assumptions shifted from being automatic background to everyday routines, to things that had to be thought about anew, and indeed rethought and to some extent worked out from first principles. For example, many parents found themselves at home all day with their children, having been made responsible for home schooling. They could not go and visit grandparents, or their friends or their children’s friends. The issue here is not that a completely new world had come into existence so much as a familiar world—while clearly still in plain sight—was out of reach. It was as if the taken-for-granted routine assumptions of everyday life had been pushed to one side. The competencies with which people used to do the things they needed to do were rendered wholly or partially redundant. New competencies had to be acquired, like doing online supermarket shopping and using various online communication platforms. Although few of these things were, or

are, individually insuperable, it was perhaps the fact that so many new things had to be acquired so quickly that made it feel so different. It was also the case that for those families and household units where there were barriers such as access to money, digital technologies, credit, and social space inside the home, the problems were much more acute and the longer-term future much more uncertain.

Another very noticeable development as time went by was the tendency of Ministers and some public health officials to switch to a language of punishment-centered enforcement. New laws were enacted, novel offences created, powers given to the police to enforce these with threats of fines and even imprisonment. The language and the narrative were no longer of voluntary compliance in a self-regulating, self-policing society, but of increasing observation and interference in the private sphere of people’s lives. Who was visiting whom? Which households were socializing in their homes in an illegal way, and so on? These became matters of legitimate interest for the state, which even seemed to encourage ordinary citizens to be its eyes and ears in this endeavor and to report their neighbors’ transgressions. In Scotland, what kind of sexual coupling was permissible with whom and where came into the orbit of legitimate state concern. It was all, of course, done in the name of protecting the public and the NHS, and most people probably went along with it with good grace, on the assumption that these were temporary measures which were designed to help. However, there was also a noticeable—and in my view very unwelcome—tendency for all sorts of petty officialdom to begin to appear: people with newly found authority began telling others what they must and must not do. This became even more marked as the various restrictions were slowly lifted after the first lockdown, and more social and economic activity got back underway.

Gradually the case numbers declined. There has been much discussion about the accuracy of the data, but the hardest end-point commonly used in the media—the number of daily deaths—began to fall. The impression, prompted by government ministers, was that the measures that they had put in place were causal and had worked. We were supposedly past the worst of it. It remains to be seen whether the relationships were causal or associational, and if associational or causal, what the mechanism were that worked (Parkkinen et al. 2018). Knowing the mechanisms will provide a better platform for interventions for the future, but I am personally very concerned that it is not obvious that the hard empirical investigations of the mechanisms involved in both transmission and prevention are being undertaken (Aronson et al. 2020; Horton 2020). For the time being, therefore, causality or association remains scientifically uncertain. I would, however, hazard a guess that, as the restrictions were lifted, the idea that they had worked provided comfort to many, and not just ministers. The public were thanked for their sacrifices, a return to life pre-COVID beckoned, and the country seemed to breathe a collective sigh of relief.

Between the Spikes in the Epidemic

In mid-July 2020, the Prime Minister appeared on television to tell the British public that it was time to start to return to work. Plans had already been put in place for schools to reopen before the summer holidays, which in England come in mid-July. The idea was that where people could return to their places of work, they should do so. This was a revealing moment. Quite how this was supposed to happen was not clear: the Prime Minister and his advisors seemed to have assumed that a swift return to life as it had been would be welcomed by the general public, and that there would be a rapid return to normal. Plans were in place for opening, in a limited way, other parts of the economy.

However, not only did comedians and commentators on social media have enormous fun at the Prime Minister’s expense because the messaging was so ambiguous, but the public were unmoved. Within a very short while, it became clear that people’s appetite for going back to normal and going out and about was lukewarm. The public exhibited very high degrees of caution and reluctance to follow the government’s new advice, at least at first. Focus groups conducted by the National Institute for Health Research Policy Research Unit showed that the population had bought into the messaging about staying safe, and that they were for the most part quite risk-averse (Lecouturier et al. 2021). The conventional psychological and communications wisdom is that fear messages are not an effective way to get people to change their behavior (Peters, Ruiter, and Kok 2013). In the event, compliance levels appear to have been very high, and the messaging about staying safe and the dangers to self, others, and the NHS had been internalized by many in the population. Over the next weeks and months, as aspects of life were opened up, more people gradually started to go out again. But things were different. Something as simple as going into a pub became much more effortful, requiring, very often, booking in advance, having one’s temperature taken, giving contact details, and then sitting down at a table screened off from others. The same was true of restaurants and cafes. Casual sociability became much less casual. Shopping was accompanied by the need to queue; gyms remained closed. In the event, schools did not reopen until after the summer holidays.

As I prepared this manuscript, the data once again were showing that the number of people testing positive was increasing, and so too the number of daily admissions to hospital and the total mortality. Once more, the predictions were dire, and new restrictions were being imposed on different parts of the country. More tests were being conducted, although the system of testing and contact tracing had been mired in controversy, especially in England, and appears to continue to function sub-optimally. The Prime Minister and the Secretary of State for Health, Matt Hancock, have tried to present themselves as on top of events, though even among their own backbenchers and newspapers normally solid in their support for the Conservative Party, enthusiasm seems to be draining away.

This has not been helped by a number of major foul-ups in normally well-functioning public services, such as school and university entrance examinations for 16- and 18-year-olds. Perhaps most damning was the story of care homes. It emerged that near the beginning of the first lockdown, in order to free up beds in NHS hospitals, many elderly patients had been discharged from the hospitals into care homes without having been tested for COVID-19. There was a very high level of spread of the virus in these environments, with corresponding very high mortality. Some parts of the public service have become surrounded by a narrative of muddle and incompetence, which in turn seems to emanate from the top of government. I say “surrounded by a narrative” because, although the apparent incompetence is widely reported in the media, many public organizations, for the present at least, do actually seem to be functioning reasonably well.

So what about ontological security? As the weeks have gone by, the efforts to undermine ontological security, which were central at the beginning of lockdown, have given way to much more heterogeneous messaging. As I noted above, the initial messaging was effective, in that large numbers of the public complied with the restrictions imposed on them. The messaging has changed many times subsequently, as have the regulations and rules, and with an increasing number of localized restrictions rather than national ones. With the four home nations of the UK pursuing slightly different regulatory approaches, this appears to have created a climate of ambiguity, and one where it is probably more appropriate to talk about ontological uncertainty rather than its complete undermining—for many people, but not all.

In October 2020, it seemed possible that in due course a national lockdown would once again be put in place.1 It was far from obvious how the population would respond and whether the messaging would focus on the threats of illness to life or threats of retribution if people did not comply with regulations. The population has settled into a way of living with the new arrangements and even the constantly changing rules and requirements. Previous social practices have been adapted, and new ones adopted. Nothing in life is absolutely predictable, as the saying goes, except death and taxes. But humans are very good at living with ordinary uncertainties and devising psychological and social strategies to adjust. By the time the end of the initial lockdown happened, many people probably saw the world as one that was a bit different, but which could be managed. However, the new infections, the new regulations and laws, the continuing apparent vacillation of governments, especially in England, have created an environment which is more uncertain for many and very uncertain for some. An environment has emerged where old skills and competencies, meanings and infrastructures

1And this is indeed what happened. Although it had been hoped that restrictions would be lifted in time for the Christmas and New Year holiday, in the event a complete lockdown was imposed from December 26, and most people’s Christmas plans were completely disrupted. Once again the majority of the population seemed to accept this with good grace.

have had to evolve. As ever, humans incorporate these new things into routine everyday life as best they can. But what is clearer now is that there are, and have been, considerable differences in different sections of the community. The less well-off, the elderly, and ethnic minorities have fared much worse.

In early October 2020 I received a text message from the Scottish NHS Test and Protect system telling me that I had been in close contact in the past week with someone who has tested positive for COVID-19. I was told to socially isolate for the next 10 days. As I sat typing this, wearing a mask and looking around at the four walls of my study, I thought of all the many ways my wife and I would need to adjust once more. Social isolation would prove to be a very personal illustration of the way micro social practices in my home would have to change. But there were no financial implications and I did not develop symptoms. It was an inconvenience, that’s all. But what of those many people for whom the life changes are highly significant?

It has been frequently suggested throughout the pandemic that the cost in terms of otherwise healthy peoples’ mental wellbeing has been considerable, and things have been made much worse for those with preexisting mental health conditions. One part of that effect on mental health is the continuing ontological uncertainty created by the disease itself and by the government responses to it. However, it is deeper than that. Normally stable liberal democracies like the UK have, for individual citizens, a relatively constant normal degree of certainty about how society operates. We grumble about politicians, but mostly things seem to roll on in a reasonably predictable way. There are also uncertainties that are just a normal part of life, both personally and collectively. However, because of the inherent adaptability of people, the majority routinely cope with the hassles of everyday life. But add together COVID-19 and the possible very long-term nature of the presence of the disease, the correspondingly rather greater degrees of uncertainty that this creates, and the economic crises of unemployment and job loss that the shutdown of the economy has engendered, and the future looks bleak indeed. The loss associated with redundancy is nearly always a major stimulus to ontological doubt, uncertainty, and threat. It is not a happy picture. Furthermore, of course, all of this happened in a society already deeply divided over Brexit. The routine practices of everyday life, and the habitual ways in which we cope with the varying degrees of uncertainty, are not only partly in disarray but so are the deeper bases of UK society. The nature of broader social and economic changes following in the wake of the epidemic are likely to be as hazardous as the virus itself.

Reflections

The ideas that have informed my thinking about the experience of the COVID-19 pandemic in Great Britain—ontological security, agency and structure, self, the

fragile nature of social life, social disruption and social dislocation, and inequalities in health—reflect my own interests as a sociologist and public health scientist. My working hypothesis is that ontological security in an advanced Western society like the UK for most of the population, most of the time, is simply taken for granted. The appearance of the pandemic, the apparent inability of the authorities to deal with it, the transformations to routine everyday life, have the potential to shake for some, and to undermine for others, their ontological security. The messaging used by government, particularly its messaging about death rates and especially projected death rates, at the very least would have reinforced, as it was intended to, the real dangers facing the population. But the threat was from the messages as well as the virus.

Although we do not as yet have definitive data, my guess is that the consequences of this pandemic will prove to be differential. Those with resources— economic, physical, psychological, and social, and who were otherwise already in reasonably good health—will be able to restore equilibrium relatively quickly. But where such protective resources are in short supply, the ability to keep control of everyday life will be that much more difficult. While these outcomes will not be strictly deterministic or linear, given everything else we know about health inequalities, the mental and physical health outcomes are likely to be much worse for the already relatively disadvantaged. Messaging from government did fluctuate, with bursts of optimism, interspersed with dire warnings. Optimism was linked to the idea that the pandemic would soon be over, the promise of a return to pre-COVID normality. The population has adapted, but it may be less well inclined toward the government now than at the beginning. This does not amount to a coherent theory, but the theoretical ideas I have drawn upon certainly help me, at least, make some sense of what has happened.

Michel Foucault (1973), writing about the epidemics in France in the 17th and 18th centuries, had some pointed observations of relevance for the current situation. He noted that the causal mechanisms leading to epidemics were not well understood then. Control of epidemics was through policing, in order to deal with the disposal of corpses, to control the sale of food, and to prohibit unhealthy housing. Messages were delivered to the public from the pulpit at Sunday Mass. Health inspectors were sent out. These were, he argues, political acts designed for social control, and they had major disruptive effects on the economy as well as leading to schisms and conflicts within parts of the medical establishment about control of the knowledge base.

Foucault’s account of the interesting combination of social control and control of the narrative by the consolidation of state power is eerily like current circumstances. The cause of the current epidemic is known to be a virus. But the manner of its transmission through human interactions and the degrees of risk to particular sectors of the population and in particular places is, in my view, not yet properly or mechanistically understood. There has also been a growing struggle

for control of the narrative within the medical establishment (Great Barrington Declaration 2020). The state is exercising increasing control over the population, just as in France in the 18th century, in the absence of any other proven medical strategy. Unfortunately, the strategy has not so far delivered a complete eradication of the virus, which the Prime Minister and the First Minister in Scotland both promised. Now, with rising infections, the same strategy about controlling the virus, which was at best only partly successful, is being reapplied. The public is pretty well aware of the uncertainties and the desperation in ministerial statements, so it remains to be seen how long the state will be able to hold the line. There has already been considerable pushback in some quarters to the imposition of new restrictions.

However, the troubling variations by socioeconomic position in rates of death and the consequences of the disruptions to everyday life, and the resources available to deal with, them remain. An argument has emerged that simply treating COVID-19 as an infectious disease, which has been pretty much the response in the UK and worldwide, is to misunderstand what is going on (Bambra et al. 2020). Richard Horton (2020), writing in the Lancet, captures the point nicely:

We have viewed the cause of this crisis as an infectious disease. All of our interventions have focused on cutting lines of viral transmission, thereby controlling the spread of the pathogen. The “science” that has guided governments has been driven mostly by epidemic modellers and infectious disease specialists, who understandably frame the present health emergency in centuries-old terms of plague. But what we have learned so far tells us that the story of COVID-19 is not so simple. Two categories of disease are interacting within specific populations—infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and an array of non-communicable diseases (NCDs). These conditions are clustering within social groups according to patterns of inequality deeply embedded in our societies. The aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease. COVID-19 is not a pandemic. It is a syndemic [emphasis added]. The syndemic nature of the threat we face means that a more nuanced approach is needed if we are to protect the health of our communities.

The implications of both Horton and Bambra and colleagues’ observations are that COVID-19 infection and social position (including ethnicity, age, class, and place—where noncommunicable diseases are most prevalent), are producing a mixed method of transmission that involves the interaction of biological and social phenomena. Social is not mere background or context; it is part of the dynamic process of infection, vulnerability, and prognosis. That the routines are everyday life are disrupted is common to everybody, but the consequences will be highly variable depending on social position and especially social disadvantage. Further, the undermining of everyday routines along with the new routines that

replace them are potentially much more toxic for some than for others. So, for some, ontological uncertainty may be the new normal; for others, whose starting social position was one of disadvantage and for whom the prevalence of noncommunicable disease was already much higher than other sectors of society, the result is likely to be real ontological threat. This is real, and it has real consequences manifested in rates of mortality.

Postscript January 2021

It is now early January 2021, and I am making the final revisions to this article following the comments from the reviewer. I myself never developed symptoms, and up to now I have no idea whether I was never infected or was asymptomatic.

Rereading my original draft, it is salutary to note how tricky, and perhaps unwise, it is to write about events as they are happening. As events move on, one’s perception and judgment of them changes. I have decided to take note of the reviewer’s comments, but not to revise the manuscript to update it in the light of how I see things now. I have left it as a record of the way I saw things in October 2020. I have not changed my mind greatly, but I want to add a gloss to a number of the points I initially made. Ontological security helps illuminate some of what has happened, but it is a bigger story than that.

By January 2021, the UK was back in a total lockdown, more or less, and case numbers were rising dramatically. On January 8, 2021, there were over 1,300 deaths, and more people in hospital with COVID-19 than at the height of the first wave of infection in April 2020. My sense is that the population was doing its best to get on with it. The ontological threats were as real as ever and, if anything, more acute. But perhaps we were all just getting used to it and no longer so horrified by the awful daily death toll. There is a kind of fatigue. The UK government appears to vacillate, and to have acted very slowly. It has attracted a very large amount of criticism. The devolved administrations seem to have acted more quickly, but overall mortality in Scotland, Northern Ireland, and Wales did not obviously suggest that their governmental strategies were more successful. But of course, we need a longer-term view on this. The medical profession seems to be more vociferous than ever, with the speciality societies taking to print and the airwaves, mostly in ways that reinforce the nature of the existential threats facing the country. And there remain dissenting medical voices, especially on social media.

The biggest change since October is that two vaccines are now being administered in the UK, and there are plans in place to get those most at risk vaccinated first, followed by the whole population. This will be a huge logistical task, and one on which much depends. I hope that it is successful, but in the last nearly 12 months almost all of the aspirations of government have fallen miserably short when it came to delivery. So we can at this stage only hope that in the case of

vaccines, things work better. One ray of hope is that the government plans to deploy the military to help with the rollout, rather than relying on their so far preferred solution of outsourcing to private sector contractors. Let us hope that administrative shortcomings do not add to ontological uncertainty.

The syndemic question, with which I ended the original piece, appears to me a very promising line of enquiry. The interaction between the virus, preceding conditions like coronary heart disease, type 2 diabetes, and obesity (and their associated concentration in particular population and ethnic groups), I suspect, may prove to be very important when we come to look back at what has happened. I have to admit that I was quite surprised to learn, after I wrote the original piece, that this syndemic link in the case of coronavirus had already been described in the literature, following the outbreak of SARS in 2003. And this description is not in an obscure blog, but in a textbook! Further, the original papers that Singer (2009) draws upon in the textbook are all in mainstream peer-reviewed journals (Chan et al. 2003; Chen-Yu et al. 2005; Leung et al. 2004; Wong et al. 2003; Yang et al. 2006). Perhaps others were very well aware of the connection, but as far as I can tell, this clue in the evidence base was never pressed into service relating to the kinds of preventive interventions which might have helped in the communities where the disease has taken such a great toll.

There is now a surge in new cases in the UK, said to be powered by a new variant, a mutation of the virus, which is more transmissible. I wonder if the enhanced transmissibility will simply wreak further havoc in the communities already most at risk and will drive up mortality there still further, or whether it will affect the incidence in a more even way across the population.

I have also begun to reflect on timescales. When the pandemic arrived, the public discourse was that it would likely be difficult, but that it was something we would get through, and get through pretty quickly—by the summer, then by the autumn, then by Christmas, and now by next summer (2021)! Because of the mutations, restrictions are finally being imposed on air travelers arriving into the UK from overseas. Although the timeline has been repeatedly pushed back, and the latest lockdown is scheduled to end more than 12 months after the first one was imposed, the underlying idea is still that we will come out the other side, and that in some sense the present privations, difficulties, and inconveniences will be behind us. Ontological security will be restored. Historically, the evidence doesn’t support this idea (Szreter 2021). When you look at the measures taken against bubonic plague in Europe from the 14th century on, the restrictions, quarantines, and isolations were in place for years, not months. At the heart of that historical strategy was the closure of borders. The infectious epidemics in the 19th century, such as cholera, did seem to run their courses more quickly, but only to return again in ways the Victorians and European jurisdictions found hard to fathom (Coleman 1982; Hamlin 2009). Perhaps it would all have been better if that historical understanding had been applied early on, and we had pre-

pared for a long haul, with closed borders, rather than the anticipation of a blip, and a return to the normality of the “sunny uplands” promised so often by the UK Prime Minister. Dealing with a long-term chronic problem requires very different skills and has very different consequences for ontological security than managing an acute problem, where the return to normality and a premorbid state is just around the corner. Such a realization might also have led to very different economic and educational responses. You can’t shut down an economy and take children out of school for years. You can’t run a health system in crisis mode for a similar amount of time. On reflection, though, it never occurred to me when I first heard of the outbreak in Wuhan just over a year ago that a very different response should probably have been planned for.

Sociologically, if I was starting this piece from scratch now, I think I might not have focused on ontological insecurity, but on biographical disruption (Bury 1982). This concept was generated in the study of chronic illness. It suggests that the key problem for someone who develops a long-term chronic condition is the way in which future personal biography has to be realigned with the uncertainties contingent on the realities of the disease, and a painful acknowledgment that a return to the premorbid state is not possible. The work on biographical disruption in chronic illness recounts individual illness experience. In the case of a pandemic, it is perhaps our collective biographies as families, neighborhoods, communities, nations, and as a human race that are in the process of having been disrupted and now need to be reconstructed.

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