The terms of togetherness created by the pandemic might be effective as a public health strategy, but require scrutiny once the dust settles, writes Annemarie Jutel 

COMMENT: One of the most powerful appeals during the Covid-19 pandemic has been the reminder “we’re in this together”. We have been asked to get back together again, with the surfacing of new community cases.

Referring to us as the ‘team of five million’ is a powerful call to action. This is more than a public health ploy, it is built into the fabric of diagnosis. Diagnosis connects people in both positive and negative ways. 

As a classification tool, diagnosis generalises, taking individual symptoms, history, and lab work and slotting them into a category of disease to which many others belong, with all the benefits that this can bring to understanding an ailment and its treatment. The individual patient is no longer an individual, rather a ‘case’ amongst others, which gives solid clues to what therapy is best, what outcome is expected.

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While a Covid-19 diagnosis might seem to separate individuals, by placing them intophysical isolation or quarantine, it also provides new connections. Contact tracing puts other people into isolation: simultaneously together and apart. Covid-19 binds individuals to the spirit of the nation.

Diagnosis and the national interest go hand-in-hand. The International Classification of Diseases (ICD) was developed on the heels of successive cholera epidemics. By classifying and giving the same names for diseases across national boundaries, the ICD enabled pandemics to be labelled. 

Nations themselves are created by pandemics too. As Billig describes in his book Banal Nationalism, little things create the nation — the use of words like ‘here,’ and ‘us,’ and ‘them’. These words focus the attention on the imaginary thing that ‘we’ are.

The WHO situation reports provide a kind of score chart for each country. The numbers of new cases and of deaths, organised by region and by country allow ‘us’ to see how ‘we’re’ doing compared to the rest of ‘them’, basking in the glory of low case numbers, or wallowing in shame at high ones, depending on where we sit on the infectious disease league tables. Be it influenza, SARS, HIV or Covid-19, diagnoses punctuate nationhood. This morning’s social media is full of comparisons of Ardern to Johnson, of New Zealand to Australia, of valour against sloven.

The solidarity discourse, and imagined fellowship, is strengthened by the idea of an adversary. For the ‘team of five million’, every potential assault on the disease-free status of their nation assembles (worthy) citizens more tightly – and unites them against others.  

Homecoming, for example, has been harsh for New Zealanders returning from other nations after the onset of the Covid-19 pandemic. Bitter social media and talk-back exchanges reveal New Zealand-based New Zealanders critical of what they see as tainted citizens and residents. They protest in particular the late returnees, the citizens, who, like foreign invaders, bring the virus back across national boundaries, even if only to a quarantine centre. Director-General of Health Ashley Bloomfield was quick to explain at last night’s press conference that the initial community case “did everything right”, to head off potential resentment.

Also tainted in earlier community case outbreaks were our Pacific Island neighbours. While many were hoping at the end of July 2020 to hear plans for the relaxation of border restrictions between New Zealand and Cook Islands, instead, they received news of a new cluster in Auckland, including the former Prime Minister of the Cook Islands, Dr Joe Williams. This news gave rise to further unification, by casting the people diagnosed either with Covid-19 or as close-Covid contacts as adversaries and their national origin as ‘not us’.

The initial flurry of social media responses to that Auckland cluster was so divisive as to generate a call from the then-Minister of Health Chris Hipkins at his daily press briefing to stop spreading rumours. “Not only was it harmful and dangerous, it was totally and utterly wrong,” said Hipkins. These racist insinuations were yet another form of generalisation, both by and of the insulters.

Group-making is powerfully hidden in the fabric of the medical and social systems in which we experience Covid-19. Diagnosis offers a means by which an exercise of patriotism, a devotion to the collective – albeit a sometimes nasty, denunciating, and racist devotion – occurs.

The terms of togetherness created by the pandemic are terms that may be effective as a public health strategy, but require scrutiny once the dust settles. The collective identity may move from a team of five million to a herd, but with it comes enmity, censure, and reproach, as much as camaraderie.

This article originally appeared in long form in Perspectives in Biology and Medicine vol. 64 no. 3, 2021, p. 339-351 as In This Together: Diagnosis and the Imaginary Nation.

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