Thank you to Toni Fazaeli for her response to my last blog post, drawing my attention to an article in the New Scientist on ‘Missed Connections’. The article focuses on social connections, from casual conversations on the bus to relationships with extended family and friends. All are much reduced in the present circumstances, and closely linked to health and wellbeing.
The extent and quality of social relations are essential to our social fabric and as such have been a major focus for study. In the 1990s, for example, epidemiologists did a comparative study looking at death rates across states in the USA using data from the General Social Surveys and counted how many people from each state were members of voluntary organisations. In short, the higher the group membership within a state, the lower was the death rate. Variations on this study have been repeated many times in the intervening years, and the findings continue to ring true.
This is what social scientists refer to as ‘social capital’ – the range and quality of positive connections between individuals and the social networks that embody people’s involvement in community life. Social capital knits society together and has a positive effect on public life. It can be seen as a measure of a society’s success in expressing kinship and kindness. In fact, the seeming erosion of social capital was what drove us to write our book, ‘Intelligent Kindness’. It is the threat to social capital that upsets me as much as anything else about this pandemic.
I know we’ve said a lot about conditions in hospitals, but bear with me if I begin by exploring this again. Let’s look for a moment at the erosion of social capital in ICU in particular, where I have been trying to get groups of doctors and nurses together to step back to think and talk together about the impact of the last few months and how they are going to sustain themselves over the winter. The logistics are difficult. First, the rooms that might be available for such work are either deemed too small (there are notices on the door saying ‘only 3 people allowed’) or they’ve been commandeered for extra patient space. Second, it is always, of course, difficult to get teams doing shift work together at any one time, and any hope that the busy Covid-surge period would be followed by a period of relative calm and recovery, is proving ill-founded. ICUs are as busy as ever with the non-Covid patients whose problems have been untreated and building up over the last few months, including complex post-op patients and people who have taken serious overdoses. When there might be what looks like a relatively quiet shift, any nurses over and above the set minimum staffing tend to get redeployed to other wards. No allowance is made for the need to ‘decompress’, debrief, regroup.
Indeed, it is hard to see how regrouping will happen. When we do manage to gather a few individuals together, it is clear how few opportunities they now have in their working lives to talk to each other. PPE and social distancing make everything so difficult. It is hard, for example, for nurses to organise their break at the same time as a colleague as they might have done in the past. The ritual of tea and toast at the 6am handover no longer happens and the number of people in the handover is greatly reduced, with the result that some staff feel left out, peripheral. The coffee breaks where consultants used to try to touch base with each other have more or less been abandoned, as have more formal ‘academic’ activities such as journal clubs. Perhaps most worrying, informal contact between the different professions has reduced, with people working in silos and misunderstandings more likely to arise. ICUs, I should point out, are usually rightly proud of their team working, realising that a focus on the group dynamic is all important to working well together in a crisis.
Elsewhere in the hospital, clinicians are being encouraged to do as much as possible of their out-patient work on-line. Indeed, they are being positively discouraged from seeing out-patients face to face. Some of them are opting to work from home. Whilst none of this is necessarily bad in itself, the cumulative effect is that contact and connection is reduced. There have been numerous research studies showing that a well-placed coffee area can greatly enhance a working environment, not just in terms of staff morale and well-being, but in output and efficiency. Creative ideas are much more likely to emerge from relaxed informal conversation than tedious, micro-managed meetings.
Moving to a different sector, my heart sank at the news recently that the AUT was campaigning for universities to work totally on-line till at least Christmas. I am someone who is usually supportive of trade unions, but I feel frankly furious at their hyperbole likening university environments to care homes. I recognise that universities and unions have been neglected and undermined by this government, and that the ‘frighten in March, then bully in August’ approach inspires anger and anxiety. But a campaign of exaggerated fear can only feed into a malignant vicious circle.
As every statistician will tell you, the age link with death from this virus is exponential – the risk doubling every five to six years, creating a startlingly straight line on a log scale. I know this fact is difficult to get one’s head around, but if academics can’t grasp it, there’s not much chance for the rest of us. The risk increases 12-13% for every added year of age from two years old to 95. In short, young adults are extremely unlikely to die from Covid19. And most staff will be at low risk of serious illness, with relatively simple safety measures available for those who are vulnerable, or, indeed, anxious.
Anyone who spends any time with young people knows how much isolation from their peer group is hurting, even damaging, them; and the evidence from research studies on social capital backs this up. Having friends is good for you and even increases your life expectancy. In a memorably catchy phrase, Robert Putnam, Harvard Professor of Public Policy, claims that ‘Joining and participating in just one group cuts in half your odds of dying next year!’ An exclusively online educational offering will continue to deprive and harm. The more confident students will meet at the pub anyway, and just be less inspired and energised by the academic work and university clubs, organisations and activities that they might have otherwise joined. But what of those from overseas, and those who are shy or struggling with mental health problems who desperately need to be part of a social network? What about those who, as well as missing out on such ordinary interaction, find online interaction and learning difficult? Of course, the risks involved in face-to-face contact on campus need to be managed. For a start, staff and students with particular physical vulnerabilities should be protected. And I agree strongly that rapid-turn-around testing should be easily accessible to everyone as soon as possible. There are universities that are ahead of the game with this and have taken the initiative to organise it locally.
Some university staff have, I know, put a lot of time and energy into putting together a hybrid model of face to face and on-line teaching, ensuring that their students are not let down academically and socially, whilst risk assessing the environment to minimise the risk of catching or spreading Covid-19. A range of simple initiatives to ensure creative face-to-face interaction are being implemented, such as using large lecture halls for socially distanced small seminars – something made possible by putting the otherwise crowded lectures on-line.
One aspect of the unions’ concern is that large movements of young people across the country will intensify the spread of the virus. This is, of course, a potential risk, but one that can be mitigated by behaviour. In Leicester and an increasing number of other places, cases of younger people with the virus have been high, whilst the spread to older people, serious illness and hospitalisations has been very low. This suggests that young people in the city are behaving responsibly, socially distancing and protecting older generations. Even in a city like Leicester, where cases are deemed sufficiently high for ongoing local lock-down restrictions, unless you are in the very frail elderly category, the risks to most of us from over-dosing or knife crime have been much higher over the last few weeks than the risksof succumbing to corona virus. Mental health difficulties and crime, of course, have an obvious negative correlation with social capital.
It is impossible to return to the old normal. But if there is any chance of ‘building back better’, social capital – with its important links to equality and democracy as well as to education, crime reduction, mental health and social wellbeing – has to be an important part of the equation.