Past plagues suggest Covid’s psychological aftermath might prove as deadly as the virus, says Sadakat Kadri
In the middle of March 2020, with Covid-19 rolling in, I spent a gloomy Wednesday wandering the botanical gardens at Kew. A friend had called that morning to offload a rumour. Someone she knew in Whitehall had apparently heard the army was going on standby. Thrilling as top secret gossip is, the idea of clandestine troop movements was making me anxious. A day earlier, Boris Johnson had promised “drastic measures to check the coronavirus’s progress”, and there are few politicians whose pursuit of drastic measures could reassure me less. Hence, Kew. I hoped it would be a calming experience.
That was Wednesday. By Friday, I was all for drastic action. The Prime Minister had announced England’s first lockdown, and another friend had been in touch to say a party he was planning that weekend would go ahead. Disdainful though I am of Johnson, the invitation annoyed me more. With all the passive aggression I could muster, I swotted up on epidemiology and told the world via Facebook why recent advice about “social distancing” made sense. My would-be host was probably displeased – he certainly didn’t Like the post – and though I never asked how the soirée went, our interactions have been going downhill ever since.
Other perspectives were as wobbly as mine. On 23 January 2020, when Chinese authorities barred entry to Wuhan and ordered residents to stay indoors or go to jail, lots of Westerners were amused or amazed. Locking down and sealing off a city to contain a disease seemed both anachronistic and dystopian: a medieval measure that only a hi-tech dictatorship could get away with. By March, the mood had shifted. With the spread of Covid-19 slowing in China, it became common in the West to hear that quarantines and travel bans were essential. Plenty of ordinarily easy-going folk were sure that opposing such constraints had always been reckless – perhaps even criminally negligent.
Personal perspectives have become intertwined with the pandemic’s most volatile political question: whether people are being hurt more by Covid-19 or the effort to control it
Fourteen months and three lockdowns later, the United Kingdom has recorded almost 128,000 Covid-19 deaths – the fifth highest fatality figure in the world – and one that suggests strongly that lethal mistakes were indeed made. Excess mortality rates are more illuminating, however, because they show how monthly deaths from all causes (including those brought about by lockdown constraints) compare to previous years – and though the UK’s position was unenviable for most of 2020, it’s improved considerably in recent months. A health ministry that was once an unfunny joke is meanwhile winning plaudits for the NHS vaccine roll-out. It’s not clear what the praise proves – except that the Prime Minister’s fondness for gambling and delegation paid off on this occasion – but there’s at least one observation that’s pretty certain. Opinions are still in flux.
That means any assessment of governmental performance can only be provisional. Despite the need for genuinely independent scrutiny of its preparedness and policy choices, evidence is still coming in. One aspect of the ongoing crisis demands immediate attention, though. Whatever might be said about the political side of this pandemic, its emotional dimension has been intense – and that’s posing a serious threat to mental health which could outlast Covid-19 itself.
With anti-depressant prescriptions at an all-time high and England’s hospital waiting lists at their longest since records began, charities have been sounding alarm bells for months. Last October, the Centre for Mental Health predicted that “up to ten million people (almost 20% of the population) will need either new or additional mental health support as a direct consequence of the [pandemic]. 1.5 million of those will be children and young people under eighteen.” A month later, Mind warned that “urgent and emergency referrals of people in crisis have shot up since the beginning of the first national lockdown, with figures for June and July higher than ever previously recorded.” Related problems like alcohol abuse and domestic violence have also surged, and personal perspectives have become intertwined with the pandemic’s most volatile political question: whether people are being hurt more by Covid-19 or the effort to control it. As that issue has come to monopolise chit-chat and parliamentary debate, older quarrels have almost fallen silent. Arguments about immigration, terrorism, the environment and the economy will one day ring out again, but the new fault line is still deepening.
Having decided last year that lockdowns are better than collapsed health services, I know where I stand. But though it’s tempting to caricature the other side, associating its arguments with the lunatics who fear nano-chipped vaccines and 5G mind control, I’m sure many of their arguments make sense. It’s at least arguable that measures to control Covid-19 have worsened well-being more than they have protected it. It’s also demonstrably true that sweeping public health powers are open to abuse. Today’s anti-lockdown gatherings are tame compared to “cholera riots” that swept Europe and the United States in the 1830s, and protesters back then weren’t pitchfork-wielding imbeciles: just slumdwellers living precarious lives, unhappy that officials wanted to evict, confine and forcibly medicate them. And governments today are certainly open to criticism. Many have used Covid restrictions as a pretext to harass opponents and victimise minorities; in this country, as elsewhere in Europe, the people arrested and penalised for violations have been disproportionately non-white.
Important as rationality is, however, it’s not logical disputation that’s energising the distress. In the face of lives lost and futures thwarted, it’s fear. There have been bleaker responses to disease – in 1348, for example, when thousands of Europeans greeted the Black Death by publicly whipping themselves and by massacring Jews – but people are certainly lashing out and flailing around. (The raves that erupted across England last summer recalled nothing so much as the dance frenzies that were once a regular sideshow of plague outbreaks in Europe.) Science itself is fuelling emotional conflicts. The online journals I’ve taken to skimming have fortified a commitment to all sorts of uncharitable conclusions: I now assume anti-maskers to be scientifically illiterate or sociopathic, for example, and I instinctively attribute vaccine hesitancy to underlying cowardice. Others, just as self-righteously, invoke alternative data to establish that masks are muzzles, and that people like me me are “sheeple”: fools incapable of understanding their own subjugation. That’s a broad gulf to bridge.
When I last saw the friend who’d been determined to party on in March 2020, we fumbled for common ground. It wasn’t there. As we trudged along a deserted Portobello Road in late December, a few days into England’s third and dreariest lockdown, he said he’d been convinced by internet research that Covid-19 was a psychosomatic condition. “Dark forces” had inflicted it on the world, and though he wasn’t sure of their motives, he thought the forces probably included the Queen of England and some very powerful “Rothschild bankers”. We parted with an agreement to disagree, but I don’t expect the debate to be resumed. Stances that began solidifying during the first lockdown won’t evaporate when the last one ends.
Oppressive though the first lockdown was, the spring of 2020 didn’t depress me. It was too dramatic for that. As I cycled through London’s empty streets – spooky as Pompeii, still as the Moon – it wasn’t the prospect of infection that troubled me so much as portents of apocalypse. Did China’s diseased bats and pangolins mean monstrous mutant microbes closer to home? Was clapping for NHS workers the sound of solidarity, or a noise to fill a void? Even the louder birdsong hinted at extinction. Humanity was in trouble; Planet Earth was happier than ever.
While some spiralled towards loneliness or claustrophobia, a sense of shared danger strengthened many households and relationships
The same fear that decelerated activity in March 2020 dynamised other lives too. While some spiralled towards loneliness or claustrophobia, a sense of shared danger strengthened many households and relationships. Routines were shattered, but also transformed. With the world turned upside down, some exceptionally vulnerable people were even normalised. When benefit offices closed and millions of workers went on furlough, the stigma of unemployment vanished. Official advice to disinfect regularly and keep strangers at a distance validated all sorts of obsessive and compulsive disorders. Even hypochondriacs had reasons to be cheerful, sort of.
Everyone’s lived through a long annus miserabilis, but it’s also been a fourteen-month roller-coaster ride. Insofar as the distinction between coronavirus regulations and government guidance has been understood at all, reactions have ranged from obedience and acquiescence to complacency and anger – and the lurches from isolation to release have reset expectations so many times that an end to the journey is almost unimaginable. When I recently discussed post-lockdown plans with a group of friends, the observation that rang truest was as ominous as it was plaintive. “I don’t know what returning to normal means”, said one. “I’m not even sure who I am any more.”
As might be expected at a time of great tension, signs of mania aren’t in short supply. Since the government flagged up 21 June as a day for the nation’s suffering to end, four months in advance, corporations from nightclubs to Nando’s have been scheduling midsummer celebrations. Exuberant socialites and over-worked journalists are meanwhile prophesying that Covid-19, like the Spanish Flu pandemic a century ago, is about to give way to a new Roaring Twenties. Even if you ignore the comparison’s downsides – fifty million deaths, followed by Fascism and the Wall Street Crash – that’s tempting fate. A virus that’s mutating billions of times each day won’t be over till it’s really over, and pockets of vaccine hesitancy may well make localised restrictions routine. Corks will pop when the last coronavirus regulation falls away, no doubt, but hangovers are just as certain. As the 1930s reminded the 1920s, civilisations don’t party their way out of catastrophe.
Epidemiological history also suggests that the nostalgists should be careful what they wish for. Spanish Flu had effects on mental health that long outlasted the Roaring Twenties. As had also been true of nineteenth-century influenza outbreaks, suicidal propensities seemed to rise in tandem with incidents of the disease, and as the flu subsided after 1919, a mysterious new syndrome involving symptoms ranging from insomnia to erotomania started to spread rapidly. The “sleepy sickness” would never be as lethal as the virus that had just swept the world, but its scale wasn’t small. By the time encephalitis lethargica stopped spreading in 1927, as suddenly and inexplicably as it had arrived, nearly half a million people were dead, and hundreds of thousands had been reduced to zombies.
Levels of distress were high already, because the First World War had left millions shell-shocked and bereaved, but anyone who’d survived a bout of influenza seems to have been distinctly more vulnerable. A scholar who’s sifted through medical records in Norway – a country that stayed neutral between 1914 and 1918 – found that While some spiralled towards loneliness or claustrophobia, a sense of shared danger strengthened many households and relationships throughout the first half of the 1920s, people who had had the flu virus were more than seven times likelier than anyone else to be hospitalised with brain disorders. And though no one ever established that the sleepy sickness was caused by Spanish Flu, there’s strong evidence of some kind of link. An increasingly plausible theory holds that sufferers were attacked by their own immune systems: in other words, the symptoms of encephalitis lethargica were by products of a successful effort to fight off the flu.
That reflects current research into Covid recovery which could carry significant consequences. An analysis published by The Lancet Psychiatry in April, which drew on data from 81 million health records, suggests that one in three people infected with coronavirus have gone on to experience neurological and psychiatric problems within six months. “Long Covid” is still more of a label than a diagnosis, but early research already indicates that some aspect of the disease – if not viral particles themselves, an overactive auto-immune response known as “a cytokine storm” – can spark mental disorders that are known to be recurrent or chronic.
The upshot is that a second health crisis is already on the way. The Government’s only response so far has been to earmark “around £500 million” extra for mental health services next year, and the Queen’s Speech indicated that social care reforms will be “brought forward” at some point in 2022. That had better be enough. Inadequate preparations for Covid-19 may or may not be judged excusable. A failure to anticipate its inevitable aftermath won’t be.
On the anniversary of my visit to Kew Gardens in March 2020, I made a return trip. The purpose in general was to exorcise pandemic demons, but I was also on a mission. Among the fifteen million trees uprooted by England’s great storm of 16 October 1987 is an oak planted in the grounds back in 1798 – and unlike the millions that fell, it’s still around. With freakish good fortune, winds ripped it from the earth only to plonk it right back again. And it didn’t just survive. The shallow root system, squashed like a pancake after two centuries, was rejuvenated – inspiring fresh approaches to soil aeration at Kew that have transformed tree management throughout the world.
The interest in arborology wasn’t quite as geeky as it might sound. I’d been reflecting on how surprises emerge from disasters. Any tree that’s shrugged off a cyclone is worth admiring in my book, but I hoped this oak in particular might suggest fresh perspectives on the pandemic. Past outbreaks of disease have always had their upsides. Though they necessarily leave wreckage in their wake, they’ve also accelerated medical research, turned stinking slums into boulevards with sewers, and inspired landscape architects to prettify hellholes from Hackney to Manhattan. Might responses to our current predicament improve lives again?
An affirmative answer depends on optimism rather than facts, and though my return to Kew was supposed to accentuate the positive, I’m not as confident as I’d like to be. Even at the time, circling the lucky oak concerned, I’d suspected that life after Covid won’t really feel much like an uplifted tree. It’s not the virus but lasting resentments that threaten to do most long-term damage. In a country that was already disunited after Brexit, intensified anxieties are now swirling: not just the obvious fears of sickness and death, but also the stresses of isolation or enforced cohabitation, concerns about education and career prospects, and worries about redundancy and impoverishment. The country’s polarised all over again, unevenly but bitterly, and even if Covid-19 were to disappear in the rear-view mirror, the unease, the dread and the anger would remain.
In a country that was already disunited after Brexit, intensified anxieties are now swirling: not just the obvious fears of death but also the stresses of isolation
Any individual who suffers serious shock or pain is liable to reshape or repress memories of the experience – and though a society can’t do that any more than it can regrow roots, another dark aspect of the Roaring Twenties suggests that collective trauma may also lie ahead. The 1920s fizzed with creative energy, and yet efforts to memorialise Spanish Flu’s devastation were vanishingly rare. Scientists and journalists tracked its progress, and a handful of artists captured its agonies – most hauntingly, Egon Schiele, whose self-portrait alongside a doomed wife and unborn child was completed three days before his death – but subsequent recollections aren’t now available anywhere except in a few obscure academic archives. The great pandemic novel never appeared, and it wasn’t until the 1970s that the world was reminded of sleepy sickness. By then, sufferers of chronic encephalitis lethargica were thin on the ground, but Oliver Sacks had been treating several survivors with a new drug – and in the book that made him famous, Awakenings, he described the very different treatment meted out to tens of thousands of others in the late 1920s. “Like lepers of the present century”, they had been shunted off to asylums and closed hospital wards where, for decades, they had been left to sleep their lives away.
One explanation often advanced for the forgetfulness holds that decimated populations were keen to put death behind them. It’s not that convincing, in that the millions killed in Europe’s trenches would be honoured on both sides of the Atlantic with sombre cemeteries, cenotaphs and eternal flames, but the link between pestilence and warfare is worthy of contemplation. In the only significant work of literature that ever addressed Spanish Flu head-on, a short story by Katherine Ann Porter, they are co-protagonists. Drawing on personal experience, Pale Horse, Pale Rider is a fever dream in prose. Its central character hallucinates a death she’ll escape, while influenza claims the Texan boyfriend who’s waiting for a ship to carry him to war. As normalcy returns, fighting ends in faraway Europe and wild celebrations erupt on the streets outside.
It’s a hypnotic novella: a slender monument to a killer at least as lethal as the First World War itself. Not every invocation of battle is as haunting. The Prime Minister has regularly compared Covid-19 to a violent adversary, but plans he’s promoting to memorialise the virus at St Paul’s Cathedral and elsewhere could easily reduce carnage into kitsch. Services of remembrance and rituals to hallow the fallen can soothe pain; to mend mental injuries, experience needs to be remembered. And when this pandemic ebbs, it won’t be a triumph. Pathogens don’t produce victors – just victims.
Sadakat Kadri is a lawyer, author, travel writer and journalist