Diary of a cough: meaning matters

Diary of a cough: meaning matters

Hannah Bradby

I’ve had a cough for all of the year 2020. It started on January 1st,  after sharing Christmas meals and their preparation with an explosively sneezing brother.  In my family we like to blame our infections on a particular person, ideally a relative.

As I travelled back home for work, I coughed into the crook of arm, washed my hands, rested, drank a lot of tea and thought of my brother.  After a few days working from home, the cough calmed down enough to take it to work. Nobody remarked on my cough. It turned out to be a discretely persistent little number that kept on reminding me of my family Christmas.

By late February, with the arrival of Covid-19 in Europe, my persistent dull little cough was still there. Nobody remarked upon it.

By the second week of March, when WHO confirmed Covid-19 to be a pandemic, people couldn’t ignore a cough.  Returning from winter holidays in Northern Italy, the dry novel-corona-cough was fanning out across Europe.

At work, I was still lecturing. Occasionally I had to cough, at which point I  turned my back on all present with my mouth firmly lodged in my elbow-pit. My (mild) symptoms hadn’t changed and my bodily health hadn’t worsened. But my persistent cough had taken on a new potential threat. By the third week of March a bottle of hand disinfectant appeared (mysteriously) on my office desk. Teaching and meetings had migrated online: boom-time for Zoom. Most colleagues were working from home. My boss had taken to wearing gardening gloves indoors.

So now, towards the end of March, my Christmas cough is (I hope) finally abating. Northern Europe is braced for the spread of Covid-19. Staying away from friends and neighbours is being promoted as socially responsible and panic-buying toilet paper is not.

The arrival of Covid-19 shows, brutally and subtly, how central the social relations of illness are to understanding what is going on around us. Disease plays out in networks connecting individuals, markets, institutions, as well as geographical locations. At the end of March, the widespread awareness of the pandemic, means that a cough takes on meaning that it didn’t have three months ago.

We can see the meaning of the Covid-19 pandemic being worked out before our eyes in global news reporting: contested meaning in action. It’s unsettling because those meanings play out in policy that has implications for the lives of people we know and perhaps even love.

The battle of epistemologies is on our screens: epidemiologists, behavioural scientists and public health experts’ interpretations of the evidence are parsed and spun by national politicians. The rich ecology of social media throws up alternative versions, that are not necessarily worse. Outraged commentators ask how we could have had Covid-19 evidence since January, and yet still be prevaricating over enforced shut-down? Because evidence has to be interpreted and meaning has to be made: it’s a social process.

The argument for herd immunity was made in the UK, with the suggestion that the UK could weather the infections. Was it really new data that informed the announcement of school closures in the third week of March, or was it herd mentality? Pressure from neighbouring countries’ shut-down? If other countries were sacrificing economic growth in favour of human survival, the optics of sacrificing old people to keep businesses going didn’t look so good.

The case for herd immunity is still being made in Sweden, with precautions advised for the over 70s. But is this all over 70s or just those with dodgy lungs?  When is a risk-group a rule and when does that rule apply? Is a 69 year old safe to visit her grandchildren? An emergency doctor, when asked this question on television, replied ‘No!’ But is it the population rather than the 69-year old grandmother herself who is benefitting from avoiding her grandchildren? Do people over 70 years have to choose between loneliness and infection?

Whether Sweden’s lack of lock-down is a good interpretation of the evidence so far, given that social distancing is a way of life, is unclear. What is clear is that there is no silver bullet solution to Covid-19.

And even if a consensus on the public health policy implications of the epidemiological evidence from Wuhan Province and the Lombardi region arrives, will it help me to decide whether to visit my ageing aunt, or send my kids to school? The perennial problem for scientifically-informed medicine is how to make population data relevant for individual decisions. What does the relative risk say about looking after my relatives?

Covid-19 has no respect for national boundaries or class distinctions. But the marginalised and poor will suffer the worst: mortgage payment holidays won’t help with rental payments. Homeless people cannot self-isolate to protect others, let alone care for themselves. The virus is useful for anti-Chinese prejudice and can support class prejudice too. The director of The Swedish Public Health Agency told a press conference that people returning from skiing holidays in Northern Italy were not tested, despite the known infection risk, because the holidays were expensive and the skiers were highly educated. When University-educated travellers who could afford such holidays experienced symptoms, they would be bound to attend appropriate healthcare straight away. Good job poor, ill-educated Swedes can’t afford to ski in Italy!

So, thanks for asking.

Yes, my cough is clearing up. It’s just a cough. A friendly cough: my brother’s cough.

Except when it’s not.

 

Hannah Bradby teaches at Uppsala University and blogs for Cost of Living.

 

2 Comment responses

  1. Avatar
    March 25, 2020

    Lovely piece. Charles Peirce, the founder of semiosis, or semiotic thought, said that all knowledge comes in signs. Your cough is – or thankfully now was – a sign too. (Private Eye once parodied the Conservative politician Iain Duncan Smith, author of Universal Credit as ‘cough’ – a sign of his vacuousness and banality.)

    Interesting experiment by the Swedes too (covered in the FT today.) But of course there is a big argument about this remedy there. ‘Herd think’, thankfully, hasn’t (yet) become ‘group think’.

    In another version of this sacrificial approach to public health I see that Texas Republicans think that the elderly and vulnerable should offer their lives for the good of ‘the economy’. Not sure how Republican voters, overwhelmingly the elderly, would think about that.

    Reply

    • Avatar
      March 26, 2020

      Thanks for the semiotic underlining.
      Subtle symptom signs tend to get lost in over-bearing biomedical epistemology, especially when it also serves the needs of economic growth. Lock down is interesting because it brakes (or even breaks) economic growth.
      Are those Texan Republicans facing a trolley problem?

      Reply

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