Measure, Case, Health

One year later, and the Coronavirus Act that has enabled much of the UK Government’s lockdown has just been renewed for another six months. Debate in the lead-up to its renewal has included admissions from the Prime Minister of his failure last year to introduce measures early enough and ‘hard’ enough, submissions from Tory opponents of the Act showing that cases of COVID-19 are now so low as to make continued measures unnecessary, and ongoing concern by the bravest Tory of them all, Charles Walker, about the health of the population when measures continue in defiance of falling cases.

All of these aspects of the debate are important. But it is well past time for scientific analyses and disagreements in respect of measures, cases and health to be supplemented, perhaps even undercut, by a philosophical perspective. These concepts – measure, case, health – have this year been our bread and butter. We have bandied them endlessly, sometimes desperately. But are we fully aware of what they mean?

In a short essay from 1990, entitled “Philosophy and Practical Medicine”, the German philosopher, Hans-Georg Gadamer, provides us with just what we need: a philosophical account of the concepts of measure, case, and health, which reveals just how truncated has been the understanding and application of them during the past year.

When the Prime Minister speaks of his Government’s “measures”, as he has done this year ad nauseam, he is using the word “measure” to refer to a course of action taken to realise a specific project, in this case the project of defeating ‘Coronavirus’. We have lived by his measures this year, whether we have liked them or not and whether we have obeyed them or not. Can we deny that they have shaped our lives more dramatically than anything the Government has done before in our lifetimes?

Yet, as Gadamer reminds us, the concept of measure implies more than a mere strategy to reach a given end. And its further implications clarify a conflation from which we have suffered grievously this year.

A measure can be something applied to an object or event from the outside, an objective standard against which its significance is established – as when we describe a person as six feet tall. On the other hand, the measure of an object or event can be inherent, designating a significance that is to be discerned not by the imposition of objective criteria so much as by judgement and experience – when we have ‘got the measure’ of a person, we have judged over time what that person is about, what she is likely to say and do in certain situations, what she likes and dislikes, and so on.

There are few who would argue that objective measures of a person – their height, their weight, their age – generate anything like the kind of understanding produced by having got their measure.

But, sadly, it is the former of these two meanings of the word measure that has dominated this year. From the infamous models of Neil Ferguson and his colleagues at Imperial College London, to calculations of the numbers of PCR positives and Covid deaths, we have applied to the SARS-CoV-2 virus and its progress through the UK population a set of stultifying objective standards against which its significance has been measured constantly and without question.

Have we established a real understanding of this virus in the process? Or have we entirely forgotten to get its measure, that is, to judge its inherent significance – how threatening it really is to the average person in their everyday routine; how serious its symptoms are relative to normal flu; the salience of its hyper-transmissibility; how it responds to already-established treatments; how its impact is affected by various efforts to contain it? Have we in fact obscured the true significance of this virus precisely by our constantly establishing its significance according to objective measures?

The UK Government has invested billions of pounds to measure this virus. And the recent budget has set aside billions more. But in the throes of this spending spree, are we omitting to get the measure of this virus, to understand what this virus is really about?

We opponents of Government Covid policies have not always identified this fundamental omission. On the contrary – to the extent that we have sought to undermine Government policies by engaging in objective measuring of our own, we have bolstered the principle that the issue is to be resolved according to measures that are applied from the outside.

And there is good reason to play the Government at its own game: to count the number of people who have died alone due to Covid quarantines; to establish the percentage decline in GDP and rise in unemployment figures due to business closures; to enumerate ‘our’ dead and show that it is greater than ‘theirs’. But in doing this, we must take care not to further obfuscate that which, above all else, the Government’s policies cannot withstand: the inherent significance of the SARS-CoV-2 virus and of the efforts to contain it.

Objective measures do contribute to establishing the inherent significance of the virus and its mitigation, of course. It is helpful to know the infection-fatality rate of COVID-19. It is important to know how many people committed suicide this year. But knowing these facts does not complete our understanding of the significance of Covid. For, we have yet to really get its measure.

How, then, do you get the measure of something? In a way, there is nothing easier. If, that is, you live through it. The school caretaker, who has been working during all the stay-at-home orders, wears his mask under his chin and swings Joseph into the air whenever he sees him; the upholsterers who I thought were never coming huddled in consultation with me about the springs of our old sofa, with not a mask nor a glove nor, it appeared, a thought for a deadly virus; the man who removed the paint from our sandstone said he doesn’t believe a word of the hype and just gets on with his own life; and Lucy, the acupuncturist at the Chinese Medical Clinic, inserts needles in the pressure points of her unmasked clients’ bodies with bare genius hands and never a word about staying safe.

If you have kept on living and working in the world through the Covid crisis, if you have been among others who have kept on living and working too, you will likely have got the measure of the virus fairly quickly and with ease. Bodies were not dropping all around you; you didn’t get sick before the masks were introduced; your old dad had it but is fine now; and a neighbour died with it but he’d had a heart attack too.

We call it common sense – this getting the measure of a thing. Often, we do not rate it very highly. But a judgement that is formed in concert with those around you and in the process of living, can have about it a soundness and reality that conclusions derived from the application of objective criteria are often without.

There is no combination of objective measurements that will wholly capture the significance of a highly transmissible respiratory disease. Contingent factors – of age, state of health, lifestyle, anxiety levels, occupation, ethnic background, temperament, and so on – are so abundant that the permutations and combinations are infinite.

Still less is there any combination of objective measurements to capture the meaning of an unprecedented lockdown of a UK population of 65 million and more – whether or not you have a small garden becomes important and no objective standard will measure that or the myriad other significant factors.

The SARS-CoV-2 virus is certainly a biological assault – though, outside of its amplification by governments across the globe, it is far from an unprecedented one. But even a biological assault is not to be understood only by measuring it according to objective standards; the complexity of its effects, its transmissibility, its response to treatments, its seasonality, its relation to other coronaviruses, and so on, mean that its true significance is to be established internally to its operations among us, and not only externally according to theories and models.

And if the measure of a biological assault is not to be got only by measuring it, how much less what Frank Palmer in the Conservative Woman described as the “moral assault” of the government lockdowns that have been our response? As Palmer expressed it, you cannot put loss of freedom and personal distress on a butcher’s scales. To understand them, you need what Gadamer would call common sense.

Perhaps the greatest objection to the Government measures of the last year, then, is that they robbed a goodly percentage of the population of the very conditions necessary to get the measure of Covid. By issuing the stay-at-home orders and imposing masking and distancing, the Government deprived us of the experience of living and working in the world in concert with others that is necessary to making a common sense judgement .

Our thirst for the outcome of the constant imposition of objective measurement procedures on the progress of the virus was surely due in part to the Government’s dissolution of the ingredients for discerning its inherent measure. Indeed, so removed were we from common sense that it came to seem to us as outlandish and fantastical, as if our imposition of models and theories – our poorly understood and articulated objective standard of ‘R’, for example – was not the real outlandishness and fantasy.

By ordering us not to live and work among others in the world as the virus travelled through, the Government dramatically reduced the likelihood of our getting the measure of it.

But it did something else too. It remade us all into ‘cases’.

Also in his essay, Gadamer describes two meanings of the concept of ‘case’, the conflation of which has this year condemned us to a half-life, if not to no life at all.

A ‘case’ can be an instance of a particular rule or principle. It is this meaning of case that has overshadowed our Covid year – several thousand people every day were reported to be Covid cases. Swabs from their nose and throat, when amplified beyond all scientific plausibility, were found to contain viral fragments compatible with the profile of SARS-CoV-2. And we ruminated over rising cases and falling cases as if our life depended on it… which, in a way, it did.

But who were these cases, really? If ‘case numbers’ were intended to represent sick or infectious people, then the whole project was misguided from the start. For, as Gadamer points out, a person amounts to a case of a disease not by being an instance of a general rule or principle or cycle threshold, but by the extent to which they are functional – are they still involved in their daily routine, can they go to work, do they exhibit their usual good humour, and so on? You are a case of the flu, or you have a case of the flu, if you are sufficiently tired and aching and feverish and phlegm-ridden that you cannot go to work or laugh or joke or cook the dinner, or whatever. You are a case to the extent that you are out of life. That is when you are sick. And, as we are informed by several scientists in the field, that is when you are infectious – asymptomatic transmission of respiratory disease is negligible, they say.

So, all of those Covid ‘cases’ were not cases at all, for they were called cases and reported as cases only on the basis of the submission of a sample of their tissue to a somewhat vacillating general rule. Almost none of them was a case in the proper human sense of the term, for almost none of them was unable to laugh or go to work or be involved in their daily routine…

…but wait – almost all of them were unable to laugh or go to work or be involved in their daily routine. We were in lockdown, after all, with much of our life suspended, with work at the least disrupted but possibly suspended too, and with very little indeed to laugh and joke about.

The Government’s lockdown policy made cases of us all – not only by applying to so many of us who had no symptoms a general principle according to which we were determined to be a Covid case, but crucially by denying us the conditions against which it would have been possible to determine whether we really were a Covid case.

By ordering us to stay at home, by disrupting our work practices, by stripping our lives of their joy, by prising us away from human contact, the Government sentenced us all to the conditions that would usually only apply if we were actually sick, if we were actually a case of something. When so many of us were then told that a PCR test had found us to be a Covid case, we had nothing at all with which to push back; we were already as-if sick. We could not reply that we felt our usual selves and ready for anything, because nothing was ready for us and no one was their usual self.

Thus it was that the Government’s lockdown of its population stripped so many of us of the means of determining whether we were really a case of anything and allowed the inhuman meaning of ‘case’ – the particular instance of a general rule – to carry the day.

And did it ever carry the day: the amount of testing of the healthy population exceeded anything anyone might have predicted. And on it goes, with rumours that all adults in England are to be sent the means of testing themselves twice a week for the foreseeable future. This testing of the healthy and the subsequent quarantine of those who receive a positive test result has been the defining aspect of our Covid year and, vaccines notwithstanding, it shows no sign of abating.

But the question is this: how long does one remain a healthy person in such a cycle of testing and quarantine? How long before the implicit suspicion of the entire population for being unhealthy becomes self-fulfilling, by making the population unhealthy?

Or has this in fact already been achieved?

As Gadamer explains in his essay, being healthy depends upon a certain inattentiveness, a kind of carelessness. We examine illness. We test for illness. We diagnose illness. We treat illness. But for there to be health, it is necessary that we do not examine, that we do not test, that we do not diagnose, that we do not treat. We must take health somewhat for granted or we are not healthy. We must forget about health or we are not healthy.

Health, Gadamer explains, requires trust: the more you examine it, the more you look for it, the more you seek to bolster it, often the more you damage it. Just as trust in a romantic relationship requires a level of carelessness, a lack of focus, or it is eroded, so too the trust that is necessary for health begins to recede once we begin to question whether or not we are healthy.

Health is, of necessity, tacit. Enigmatic. It is that which cannot be entirely specified. It is that which is only there if it is hidden.

Only think, then, how disastrous has been the past year’s relentless battering of the population on the matter of their health. How badgered we have been, to be vigilant for symptoms in ourselves and others, to test ourselves and others, to distance, to mask, to act like we’ve got it. How utterly destructive of the possibility of our health, that we have been so ceaselessly commanded – and in the name of our health – to look for our health, to reconfirm our health, to prove our health, to chase our health into its hiding places.

If we were in a romantic relationship with our health, we would this year, and very quickly, have entered upon the kind of suspicious watchfulness of it that no relationship can easily survive. The trust that Gadamer reminds us is essential to it has been broken.

reThe Government’s Covid strategy has been self-fulfilling. If we were outraged at the testing and quarantining of healthy people, after a short while of testing and quarantining, people were no longer really healthy. There are explicit accounts of mounting problems with physical and mental health – the recent publication of the HART group makes sobering reading. But there are also the lower level symptoms, of fatigue, inertia, anxiety, and aching, which damage quality of life and constitute lack of health. I suspect that there is almost no one who has not, at the very least, experienced some combination of these. Adults and children alike. The Government’s big health drive, supposedly to save our National Health Service, has ruined the health of the nation.

We have countered the Government’s attack on the nation’s health this year. In particular, and due to the commitment of Professor Karol Sikora and others, the fall in the rate of diagnosis of cancers has been described and publicised. But there may be a more fundamental problem about the Government’s Covid health policies even than missed cancer screenings, and more profound redress to make even than reinstating them.

If Gadamer is correct and human health is an essentially tacit phenomenon, then of utmost importance may be, not the return of more screening, but regaining the trust that is health and that can only be restored by forgetting about our health for a while, by seeing friends and family, by going to the pub, by playing sports and taking a holiday, by working hard and enjoying the warmth and togetherness of crowds.

In his essay, Gadamer explains one last implication of the concept of ‘measure’. It signifies something quite the opposite of the Prime Minister’s measures, which are strategies to fulfil a given project. What it indicates, in fact, is the very thing required to establish the projects that are to be fulfilled, that are worthy of striving towards and investing resources in. When a person is ‘measured,’ they have the kind of calm moderateness that is capable not only of judging how a thing is to be done, but of judging what should be done. They are capable, in short, of wisdom.

It is this kind of ‘measure’ – the wisdom to identify the aims that are worth pursuing – that Gadamer, after Plato, names as essential to the true statesman. Without it, he is only a functionary.

A constant refrain of our Government ministers this year has been that they are ‘following the science’. But they are supposed to be leaders, not followers. They are supposed to name the aims worth realising and the values worth cherishing, and not merely come up with means to the ends of expert advisers. They are supposed to be measured, and not only a fount of more measures.

Originally published on Lockdown Sceptics on 27 March 2021