Photo: Bridge to Nowhere from Barbara Friedman Flickr photostream

Uncertainty has become a staple of day to day life across the world in the past two years.  The COVID-19 pandemic has introduced uncertainty into all aspects of life, affecting our interactions with others, our work and home lives and our ability to make short or long term plans.

A plethora of academic research and opinion has emerged in response to this all-pervading uncertainty.  Some researchers have provided practical guidance on how healthcare professionals can help patients better deal with COVID-19 related uncertainty; others have provided “rules for managing uncertainty during a pandemic”, whilst other colleagues have talked about the impact of global levels of uncertainty.  Within health research, studies on long-term conditions have demonstrated how uncertainty exacerbates symptoms and negatively affects daily life and the ability to plan both short and long term activities.  Limitations that will be very familiar to those living with long term, fluctuating conditions are now becoming typical across the population.  But the cause of pandemic uncertainty does not just arise from the virus and its’ effect on the body. It also emerges through the national and global responses to the pandemic.

Shadreck Mwale argues that uncertainty during COVID-19 arises from the complexity of COVID-19 itself and its presentation, a lack of clear information and risk probabilities around who is most likely to be affected, leading to polarised responses from those deemed at high risk and those at low risk.  This has exacerbated a range of views, stoked by social media, on whether the virus is real, its potential impacts and how it should best be tackled, leading to a growth in covid conspiracies, many of which are tied up in debates around the covid-19 vaccines.  In a previous blog, Lesley Henderson explored the spread of anti-vaxxer conspiracy theories through social media.  She argued that we need to understand the link between anti-vax and conspiracy theories and ideas of civil empowerment and individual liberties.

This very argument was played out in the House of Commons when a group of Conservative MPs refused to wear masks, seen as an attack on their civil liberties, during a debate in parliament on responses to the new Omicron variant.  Several MPs spoke very strongly about COVID-19 mitigations attacking civil liberties and individual freedoms.  In this context, simply correcting the incorrect messages spread by anti-mask or anti-vax groups is insufficient.   This is because expertise is held under suspicion. Moreover, the science itself is uncertain, dealing with known and unknown unknowns in the face of a new variant of a relatively new virus. The result of uncertainty mixed with polarisation has be seen in protests across Europe in the past week in reaction to tightening of Covid-19 restrictions.

Whilst all of this is new, unique and novel – a once in a generation event – the underlying themes are somewhat familiar.

In researching this blog post, I came across a partially written blog I had planned for 2019 on uncertainty and Brexit.  In my notes, I talk about the fear in the media about how Brexit would affect foreign nationals living in the UK, businesses, healthcare, access to drugs, food supplies and much more.  In 2018 the BMJ talked about difficulties NHS trusts faced planning care in an era characterised by uncertainty.  Cordery, the deputy chief executive of NHS Providers at the time, was quoted saying:

“All of the uncertainty has just exacerbated an already difficult situation. Trusts have planned as far as they can, but so much of this is reliant on central government action.”

It wasn’t just NHS trusts struggling with uncertainty; in 2019, the King’s Fund published an article on broader NHS reform in a time of uncertainty caused by the Brexit debates and negotiations.  At the same time, pharmacists were increasingly concerned about difficulties accessing common drugs for their patients.  In January 2019, the European Federation of Pharmaceutical Industries and Associations (EFPIA) president called for governments to “put politics aside and  put measure in place to prevent patients being harmed by the consequences of Brexit”. In addition, uncertainty and fear of the unknown were recurrent themes in the media.

At that time, the UK was, arguably, more polarised than it had ever been, at least in relation to Brexit,  with a near 50/50 split in the population pro and anti Brexit and people strongly identifying with their chosen sides and actively disliking those on the other side. Alongside individual liberty, sovereignty and autonomy were debated fiercely.  And the polarised positions of the public haven’t changed. The latest British Attitudes Survey published in October 2021 found that 9 in 10 leave and remain voters stated that they would vote the same way again today. In addition, they found that respondents were more concerned about inequality than they had been for 20 years but remained polarised, with 31% of leave voters and only 17% of remain voters expressing trust in government.

So it’s against this backdrop that we find ourselves in a global pandemic characterised by the polarisation and uncertainty that we are already familiar with a healthy dose of fear.  Fear exacerbated by uncertainty. Fear that our loved ones or we will catch the virus or fear that we will give it to others, fear that the healthcare system will collapse, fear that the businesses we work for will become unviable and fold. And alongside this is the fear that our civil liberties and democracy are being eroded under the auspices of pandemic response.  And the fear that our NHS is being carved up and destroyed, and a growing and significant lack of trust in the responses of the government.

In August 2021 Colin Samson talked about the uncertainties around vaccines, their efficacy and the potential for new variants that may challenge them.

And now we have Omicron.

Here we are with a new variant that is potentially more infectious than previous versions of COVID-19 and may or may not respond to the current vaccines to a greater or lesser extent.  WHO has declared Omicron a ‘variant of concern’ whilst Dr Angelique Coetzee, the doctor who first noticed the new variant, has said symptoms appear ‘extremely mild’so far.  The mixed messaging exacerbates the polarisation, and the media stokes fear again, amplifying omicron-related uncertainty.  The BBC declares, “Omicron uncertainty hitting Wales tourism businesses”, the Mirror talks about the need for more Covid related restrictions in the run-up to Christmas, Inews focuses on uncertainty around holiday bookings for 2022, companies are cancelling Christmas parties, and schools are cancelling nativity plays.   Coverage of Omicron looks to further polarise the population, with media stories ramping up fear in the face of yet more uncertainty and fierce debate about the need for more restrictions to control the spread.