Plus ça change? The COVID-19 pandemic as continuity and change as reflected through risk theory

Abstract

On 30 December 2019, Dr Marjorie Pollack, deputy editor of ProMed, received information about a SARS-like disease in the Chinese city of Wuhan. Having checked the facts, she issued an alert to the worldwide network signalling the start of an outbreak of a highly infectious and dangerous disease. The new virus, SARS-CoV-2 spread rapidly from Wuhan causing a global pandemic of COVID-19. In this review, I examine the ways in which risk can provide insights into and an understanding of the social and cultural responses to the COVID-19 pandemic. I draw on three major theories that highlight the role of risk in contemporary societies: Beck and Giddens’s analysis of late modern society as risk society; Douglas’s analysis of the continuing significance of cultural theory in understanding the construction and use of risk to address social tensions and challenges; and Foucault’s analysis of governmentality and the use of discourses such as risk as a form of power and control.

Keywords:

• COVID-19
• SARS-CoV-2
• risk
• Risk Society
• cultural theory
• Governmentality

Introduction

Risk initially developed in the early modern period in the context of mercantile capitalism as a way of predicting the future and providing protection from the inevitable misfortunes of trading. For Enlightenment thinkers, it provided a way of creating a more rationale society through science- and evidence-based decisions. In the late twentieth century, social scientists developed more critical approaches to risk examining the ways it is embedded in key social process and is used as a form of social control. This more critical approach is evident in Beck and Giddens’s analyses of the key features of late modern societies or Risk Society, it is an important element in Douglas’s cultural theory and forms part of Foucault’s analysis of power or governmentality in modern societies. In this article, I will discuss these theories and the way they provide insights into the nature of risk in the COVID-19 pandemic.

Beck, Giddens and risk society

Beck (1992) argued that in late modern or Risk Society, traditional forms of social differentiation based on occupation, social class and wealth were increasingly replaced by exposures to the novel risks of modernity. The risks of pre-modern societies were often clearly marked, for example, by the smell of faeces deposited in the street or the visible smoke of fires. In contrast, many of the risks of modernity are invisible such as air pollution or radiation, and can only be identified by special technologies. Such risks are a product of the complex technologies of late modern societies. As Perrow (1984) observed, scientific knowledge enables modern societies to build sophisticated and complex systems that are also highly risky and prone to regular or ‘normal’ accidents resulting in human harm. Unlike localised pre-modern hazards, modern risks are global. The 1986 melt-down of a nuclear reactor in Chernobyl contaminated grasslands 3,000 miles away in the Lake District and sheep were still being tested for radiation poisoning 30 years later (Cumberland News, 2016).

In small-scale intimate premodern societies, individuals’ experience of misfortune were shaped by shared understanding and causes of such misfortune. The knowledge that shaped responses to illness such as belief in supernatural powers, formed part of doxa, the taken-for-granted and accepted truths that structure the experience the social and natural worlds (Bourdieu, 2013). In modern societies, such knowledge has increasingly been converted into expert scientific knowledge such as the medical knowledge, which underpins healthcare systems. These are abstract systems, which deploy ‘modes of technical knowledge, which have validity independent of the practitioner and clients who make use of them’ (Giddens, 1991, p. 18).

While risk has become globalised and ubiquitous, individual vulnerability has increased. In modern society individuals no longer have the protection of dense kinship networks that provide both identity, support and protection in intimate societies. Indeed, each individual has to construct their own identity, a process Giddens calls the reflexive project of the self (Giddens, 1991, p. 244) and provide their own protection. Beck and Giddens observed that providing protection from risk in late modern society depends more on knowledge than wealth. To protect themselves, individuals need to access the technologies and knowledge through which they can identify and mitigate risks, a process Giddens refers to as reflexivity (Giddens, 1991, p. 2). Reflexivity involves a focus on self and personal access to and use of knowledge. However, this process is made more difficult as in late modern society there is no single source of authority, but a multiplication of experts and expertise (Giddens, 1991, p. 195). As Giddens observed, there is ‘a plurality of heterogenous claims to knowledge, in which science does not have a privileged place’ (Giddens, 1990, p. 2). There are multiple sources often providing conflicting explanations and challenging each other. Individuals have to choose which source and which knowledge they trust. The lack of unified authority creates uncertainty and doubt and, potentially, a distrust in sources that claim authority (Giddens, 1990, p. 89). The challenges of choosing and trusting an authority are evident in the multiple channels of communication. In localised intimate societies, communication was direct; person-to-person. With the development of different modes of communication, individuals can access information from a range of sources and are not restricted to localised person-to-person communication. Giddens (1999) observed that a key feature of globalisation is the development of global communication such as the internet.

As Mythen (2021) has observed, Beck’s Risk Society hypothesis was grounded in growing public scepticism of the claims that scientific and technological progress created safer and more secure societies. Mythen noted that this scepticism reflected ‘the failure of regulatory institutions to manage major risk incidents and fears regarding the effects of rapidly developing sciences, such as the production of genetically modified foods, human cloning, and nanotechnology’ (Mythen, 2021, p. 535). While Beck’s work was characterised by a polemical style, which has led many to critique and nuance his arguments (see, for example, Mythen, 2005), a number of Beck’s core arguments about the nature of a novel, ‘second modernity’, characterised by global risks, have become increasingly pertinent for grasping the pandemic.

COVID-19: a ‘modern’ manufactured or man-made risk

COVID-19 was first identified in the city of Wuhan, China, in late 2019, and by March 2020 had been spread by airline travellers to become a global pandemic. It is a coronavirus and like SARS (probably) originated in the bat population of China (Hu et al., 2017). There is no clear evidence on how the virus jumped from animals to humans. The two main theories highlight the role of human activity and technology. At the time of writing, the most likely explanation is that the increased pressure of food production in China resulted in increased human incursions into bat habitats creating the conditions for zoonotic spillover, either by direct movement of the virus from bats to humans or indirectly via as yet unidentified intermediary species. However, in the absence of clear evidence of such transmission, a second theory has attracted some attention – that the virus was released by accident from a laboratory experimenting with bat viruses. One possible source of a lab accident was the Wuhan Institute of Virology. In this institute, scientists such as Shi Zhengli were working with dangerous SARS-like viruses from bat caves in China (Qiu, 2020) and it was possible that one of these viruses was accidentally released. Four of the five intelligence agencies reporting to the US President on the origins of the virus supported the theory that the pandemic originated in a zoonotic spillover, with one supporting the Lab accident theory (see Office of Director of National Intelligence, National Intelligence Council, 2021; Maxman & Mallapaty, 2021).

The Global impact of COVID-19

The joint chairs of the WHO Independent Panel characterised the pandemic as ‘the 21st century’s Chernobyl moment … because it has shown so clearly the gravity of the threat to [global] health and well-being’ (The Independent Panel for Pandemic Preparedness and Response, 2021). By 28 April 2021, the WHO estimated that in 223 countries worldwide at least 148 million people had been infected and over 3 million had died (The Independent Panel for Pandemic Preparedness and Response, 2021, p. 10).

Key role of science in identifying and managing the risks of COVID-19, consensus and disagreement

In late 2019 hospitals in Wuhan began admitting patients with breathing difficulties. Within a month, clinicians had identified the new disease as COVID-19, describing its signs and symptoms (Horton, 2020, pp. 41–42) and researchers had identified and genetically sequenced SARS-CoV-2, the virus causing the disease, enabling work to start on vaccines (Campbell, 2020). Epidemiologists had by then identified the individuals and groups most at-risk from COVID-19. In contrast to the rapid development of scientific consensus around the clinical definition of COVID-19, its epidemiology and the genetic sequencing of the SARS-CoV-2, there was disagreement and debate over the ways in which the virus spread. If the main mechanism for its spread was droplet infection, then personal hygiene such as hand washing and hand sanitising had a key role to play, however if it was spread through finer aerosol spray then masks and ventilation were crucial. As Greenhalgh and her colleagues have argued, it took some time for scientific consensus and associated public health measures to shift from focusing on droplets to aerosol spread (Greenhalgh et al., 2021).

Communication and the pandemic

Alongside the physical spread of SARS-CoV-2 from Wuhan, there was rapid communication of information so knowledge about the virus went ‘viral’ on the internet. On 30 December 2019, Dr Marjorie Pollack, Deputy Editor of ProMed, a programme searching the internet for information about unusual disease outbreaks, received an email about a cluster of pneumonia cases of unknown origin in Wuhan. She issued an appeal for more information on the ProMed network and located a media report in China confirming the cases. At the same time, she received an alert from an artificial intelligence system in the Boston’s Children hospital that also issued an alert about pneumonia cases in Wuhan. On the basis of this evidence Pollack issued a warning to 80,000 ProMed global community of doctors, epidemiologists and public health experts (Honigsbaum, 2020, pp. 261–262). Alongside these global networks and communication, more localised networks were salient for policy responses. In their study of the ways in which doctors at a Dutch teaching hospital responded to the challenge of COVID-19, de Graaff and his colleagues observed that the usual ways of managing risk through nationally agreed protocols no longer worked. Experts in the hospital (microbiologists and clinicians) created new protocols drawing on their tacit knowledge, expertise that they had developed through practice, and on the ‘deluge of COVID-19 research’ in other hospitals and research centres, which they often accessed through informal channels such as App groups and (evening) video calls (De Graaff, Bal and Bal, 2021).

Individual responsibility for risk in the pandemic

While most governments have taken measures to protect their populations from the virus, they have in practice placed the main responsibility for managing risk on the individual. At the start of the pandemic, many countries adopted a wait-and-see policy while seeking to ‘mitigate’ the impact of pandemic by identifying individuals who were at risk and advising them to take action to protect themselves. In the UK and the US, for example, government agencies warned older people and people with underlying health problems that they were at-risk and should minimise the risk of infection by minimising social contacts (Cabinet Office, 2020; CDC [Centers for Disease Control and Prevention], 2020).

Distrust of science and governments evidenced by COVID-19

From an early stage of the pandemic, a distrust of government was apparent, as reflected in theories that COVID-19 was a hoax and that lockdowns and vaccine campaigns were an infringement of individual liberty and a means of controlling the population (Alaszewski, 2021).

Mary Douglas, blame and the social construction of risk

In his earlier work, Beck viewed risk as a social reality, an objective fact that has social implications. Furthermore, he treated risk as an essentially modern phenomena. Douglas, in contrast, observed that while risk may be a modern phenomenon, other concepts such as sin play a similar role in other cultures (Douglas, 1990). Both sin and risk can be used to control behaviour by establishing the norms of social behaviour and allocating blame and sanctions if these norms are transgressed. Douglas noted that both risk and sin operate in and through time. She argued that before a bad event, the sinner about to sin or the risk-taker about to take the risk is warned of the dangers but if they ignore these warnings and the predicted bad event happens, then the sinner or risk-taker is blamed for failing to head the warnings (Douglas, 1990, p. 5; 1992). As Lupton noted in Douglas’s analysis of risk, every accident and misfortune, especially when they result in death, must be ‘chargeable to someone’s account’; someone must be blamed (Lupton, 1999, p. 45).

The disregard for warnings and subsequent allocation of blame can be seen in various modern disasters. In the case of BSE/vCJD (‘mad cow disease’ and its human version) Professor Richard Lacey, a microbiologist, was a dissenting scientist whose warnings that BSE could and would infect humans were ridiculed (Obituary, 2019). In 1996, the government had to admit that BSE had infected humans and appointed a team to investigate the failure to identify and mitigate this risk. In Annexe 2 of their report (The BSE Inquiry, 2000, p. 5), the team identified the key decisions that contributed to the disaster and blamed named individuals for failing to identify and manage risk.

Douglas observed that while dangers and hazards exist, in any given setting some hazards are selected for attention and mitigating action, while others are disregarded. Indeed, in some settings, risks are created which do not relate to a ‘real’ hazards. Douglas examined this in the context of an infectious disease, leprosy. Douglas (1991) noted that infection can be hidden, an individual can carry an infection and be a danger to others without any visible signs or symptoms. Thus, being identified as a ‘possibly infected’ and therefore dangerous person can result in social exclusion and rejection.

Douglas illustrated this analysis by examining the ways in which leprosy featured in early mediaeval Europe. She noted that in Western Europe at the end of the eleventh century and in the early twelfth century accusations of leprosy were rare and were made against people in power by their subordinates, for example, monks accused their abbots or knights their local lord. Douglas argued that such accusations were intended to restore the proper functioning of a local hierarchy. The leper went through a ceremony of ritual death and lost control of his property and office. Leprosy ‘was associated with sin, it was a chastisement by the hand of God’ (Douglas, 1991, p. 732) but it was not seen as a particular danger to others so at this stage, there were no restrictions on the leper’s freedom of movement.

In the twelfth century, the nature and significance of leprosy changed (Douglas, 1991, p. 732). The development of more centralised institutions, feudal kingdoms and the church, and new forms of mercantile wealth created new masses of people that threatened the established order; vagabonds, beggars and heretics. The pattern of leprosy changed with the rich and powerful apparently immune and the new poor being confined in leper colonies; ‘Landless persons whom no one wanted to know about were tidied away’ (Douglas, 1991, p. 732). Leprosy was now characterised as highly contagious and a sexually transmitted disease. Lepers were not only physically segregated, they were also socially excluded. Segregation protected the rest of society from the pollution of lepers.

Although leprosy attracted considerable attention in Western Europe during the twelfth century, it was poorly described and appears to have included a range of skin conditions. In contrast, in the East, of example, in the Latin Kingdom of Jerusalem, leprosy was accurately described, precisely diagnosed and treated with moral neutrality. Lepers in the Kingdom had full civic rights and were not excluded from society. There was an Order of Leper Knights and Baldwin IV, a leper, was King of Jerusalem from 1174 until his death in 1185 (Douglas, 1991, p. 733). The Kingdom was a small enclave of European nobility that had to survive in a hostile environment. This community therefore eschewed internal divisions and internal accusations of impurity to focus on protecting their borders, both physically and morally; for example there were severe penalties for any Christian who had sexual relations with a non-Christian.

In both West and East there was a threat of pollution from impure or filthy people, in the West this was from lepers, and in the East it was from infidels. Both used boundaries to delineate and control the danger, in the West the boundaries were internal, around the leper colonies, and in the East external, various city and castle walls.

Douglas sees blaming and ascribing dangerous polluting powers to individuals and groups who threaten ordered society as a universal phenomenon. As Douglas (1966) suggested in her classic text on Purity and Danger in many social settings, there is a struggle to maintain and protect purity from the ever-encroaching threat of pollution. When polluting impurity threatens to cross the boundary that separates it from the pure, action has to be taken to counter the danger by reinforcing the boundary and excluding any polluting impurity.

This cultural theory of risk highlights some important elements of the COVID-19 pandemic:

Blaming and accusations

The COVID-19 pandemic is a major global disaster that has caused widespread illness, death and economic disruption. Almost as soon as the pandemic started so did the blaming and accusations (Alaszewski, 2021). Some of these accusations have been across national borders. For example, Donald Trump, the US President accused the Chinese Communist Party and the WHO of failing to take action to prevent the spread of the virus and covering up evidence of their failures. The various accusations have given rise to a series of investigations and inquiries. For example, in response to accusations that it failed to respond swiftly enough to warn the world about the danger of COVID-19, the World Health Organization sponsored two inquiries, one into the global response to COVID-19 (The Independent Panel for Pandemic Preparedness and Response, 2021) and the other into the origins of SARS-CoV-2 (WHO, 2021c). It is not clear whether either of these have been successful, for example, the inquiry into the origins of SARS failed to either counter or confirm speculation that the virus was accidentally released from a laboratory in Wuhan.

Populist politics, purity and risk

Prior to the pandemic, populist politicians had been elected in a number of democratic countries. These parties tend to draw their support from social groups that have been adversely affected by globalisation, for example, people living in rural or de-industrialised areas. Populism draws on concepts of purity and danger. As Kriesi observed, the ideologies of populism see society as divided ‘into two homogenous and antagonistic groups, “the pure people” versus the “corrupt elite”’ (Kriesi, 2014, p. 362), with the ‘corrupt elite’ seeking to control and exploit the pure people. Thus, the elite can be blamed for the corruption in society and the Trumpian chants of ‘Lock her up’ and ‘Drain the swamp’ reflected the desire to exclude this elite.

Religious exclusivity and rejections of modernity

Within modern societies, religious communities often seek to maintain their religious beliefs and purity. Such communities may seek to separate themselves off from the rest of society, for example, by rejecting the secular state and privilege the knowledge from their sacred texts over that of knowledge derived from science. Such faith may involve an emphasis on the will of the divine and a rejection of secular risk-based systems. In the pandemic, religious sects, for example, ultra-Orthodox Jewish communities in the UK and the US have disregarded risk warnings. During the COVID-19 lockdown in New York, the Hasidic ultra-Orthodox Jewish community in Williamsburg was reported to have repeatedly broken lockdown regulations, culminating in police action on 28 April 2020 to break up a large crowd that had gathered at the funeral of Rabbi Chaim Mertz. This attracted widespread media coverage (Layne & Caspani, 2020). As Gross and Shovel noted in a study of ultra-orthodox communities in Israel, for members this community ‘risk science, which aims to imagine future situations and their probabilities is nothing but futile’ (Gross & Shuval, 2008, p. 555).

Culture and the protection of boundaries

Covid-19 is caused by a virus that enters the body mainly through the nose and mouth. To protect this entry point, public health experts have recommended that individuals should wear protective masks, especially in confined spaces. There has been considerable resistance to this in Europe and North America (Alaszewski, 2021). In contrast, in East Asia, and especially in Japan, mask wearing builds on existing cultural norms. In the 2009 swine flu epidemic the Japanese government extended the WHO guidelines for prevention, adding gargling and mask wearing and the Ministry of Health undertook large public health campaigns encouraging the Japanese to tearai (hand wash), ugai (gargle) and masku (wear protective masks) (Armstrong-Hough, 2015, p. 287). Armstrong-Hough argued that the recommendation about gargling and mask wearing were grounded in the cultural belief that the boundaries of the body need to be protected from pollution and that the throat is a major portal, a crucial border that needs special defended. Burgess and Horii (2012) observed that mask wearing is used in Japan as a protection against radiation, for example, after the Fukushima nuclear accident in 2011, and infectious disease. Their use started in 1918 during the Spanish flu pandemic, stimulated by traditional notions of purity and danger (Burgess & Horii, 2012, p. 1195).

Michel Foucault, risk and professional discourses

Like Douglas, risk researchers following the work of Foucault tend to see risk as a social construct that can be and is, used as an instrument of social control. His initial interest stemmed from his historical studies of the changing responses in Europe to individuals that threaten the social orders such as those with severe mental illness or criminals (Foucault, 1967; 1977). He observed that prior to the nineteenth century control and punishment were public and highly visiblefor example, the mad were chained in madhouses, and executions of criminals were public spectacles. In the early nineteenth century reformers changed societal responses to the threat of insanity, crime and disease by separating dangerous abnormal individuals from the rest of society and treating them behind the walls of institutions. The early part of the 19th was marked in Europe and North America by the widespread construction of buildings such as workhouses, lunatic asylums and prisons and the common incarceration of legally defined categories of people including paupers, lunatics and felons or criminals.

Such a major change in defining and responding to dangers has, of course, been well documented. The primary explanation for this change was that it was a benign reform drawing on the progressive ideas of the eighteenth century Enlightenment philosophers to create a more just, humane and rational society. The role of Revolutionary France in pioneering many of the reforms gave credence to the idea that they were a product of more enlightened thinking. For example, in Paris, Phillipe Pinel, who is often referred to as the founder of modern psychiatry, reformed the treatment of the mentally ill, in removing physical restraints such as iron shackles from the patients at Pitié-Salpêtrière and replacing them with moral treatment (Foucault, 1967, p. 469).

These new institutions were not just a practical way of managing the increasing number of individuals who were causing a nuisance and threat in the expanding urban centres of the industrial revolution, they were also a source of new knowledge. The new experts who managed these institutions claimed and were given the right to identify the abnormal and segregate them in the institutions. Once in the institutions, these same experts could study the abnormal to identify and name different types and examine the causes of these different types of abnormalities and ways of treating them. This process creates a distinctive expert language or discourse. For example, in 1798 Pinel published his classification or nosology of diseases and identified four types of mental disorders: melancholia, mania (with or without delirium), dementia and idiocy. This approach is still evident in the more fine-grained classification of mental disorders in the American Psychiatric Association publication of its Diagnostic and Statistical Manual of Mental Disorders first published in 1952 (DSM-I) and regularly updated thereafter (Holmes & Warelow, 1999, p. 167).

Starr refers to the power of experts such as medical professionals to define a specific type of abnormality or risk as cultural authority and defines it as ‘the probability that particular definitions of reality and judgments of meaning and value will prevail as valid and true’ (Starr, 1982, p. 13). In the new institutions, the new professional elites also exercised detailed control over the inmates’ lives, which Starr referred to as social authority, and the power to control the actions of others (Starr, 1982, p. 13).

As Foucault observed, part of this control was through the orderly structuring of time that underpinned the moral treatment of the mentally ill (Foucault, 1967. p. 194) and part was exercised through the physical structures of the institution. Foucault used the example of Jeremy Bentham’s panopticon to illustrate how the structure of the institution could be used to exert control (Foucault, 1977). Bentham was a utilitarian philosopher who contributed to the reform of the Poor Law in England in the early nineteenth century. His universal modern institution was a panopticon with a central tower and radiating wings. From the central tower, the institution’s authority could observe the activities of all the inmates all the time in all the wings. However, it was a one-way system: the inmates could not see into the central tower so could not tell if or when they were being observed. They were in Foucault’s terms subject to the gaze of authority.

From the start of the nineteenth century until the mid-20th century, institutions formed the basis of cultural and social authority. By the mid-20th century, the growth in the number and size of institutions meant that the reforming and therapeutic aspirations of the original reformers were no longer visible and their role in excluding and incarcerating inmates became the subject of scrutiny and criticism. Goffman (1961) provided one influential critique. Drawing on his experiences working in a very large institution, a mental hospital with over 4,000 inmates in Washington DC and a wide range of literature, he created an ideal type of the Asylum, that destroyed the identity of inmates, replacing it with institutional categorisation. He highlighted the role of the institutional regime in controlling the activities of inmates (Goffman, 1961, p. 6). Goffman noted the continual surveillance of inmates, but he also reflected on the poor design of many institutions that created spaces in which inmates could hide from scrutiny and that facilitated the creation of a hidden inmate underlife.

Various scandals and inquiries have resulted in a major restructuring of institutions, some survived and thrived like acute hospitals and prisons, albeit with increased external scrutiny, but others, such as hospitals for the mentally ill and those with learning disabilities and workhouses have been shut. This did not undermine the cultural and social authorities of experts, such as medical professionals. The expert gaze shifted from the institutions into the community.

While institutions such as hospitals provided the cases that doctors could use to identify diseases and their symptoms, the development of epidemiology enabled doctors identify the setting and factors, which caused such diseases. Armstrong (1995) has argued that this type of evidence changes the nature of illness through:

the novel and pivotal medical concept of risk. It is no longer the symptom or sign [in the body] pointing tantalisingly at the hidden pathological truth of disease, but the risk factor opening up a space of future illness potential [in the community]. (emphasis in the original, Armstrong, 1995, p. 400).

In this context, the binary divide between being health and illness is replaced by a continuum of risks, the probability of developing a disease. This in-betweenness can be seen in the concept of ‘pre-diabetes’. If an individual has a blood test, which identifies raised blood sugar levels, then their doctor may warn them that they are at risk of developing diabetes and label them as ‘pre-diabetic’, neither healthy nor ill (Hindhede, 2014).

In the field of mental health, the dismantling of large-scale institutions in many high-income countries has not undermined psychiatry, the medical specialism that claims authority in this area. The expansion of the cultural authority of psychiatry can be seen in the development of the medical classification of mental disorders. When the practice of psychiatry took place mainly in institutions, most psychiatrists identified a clear divide between normal people living in communities with good mental health and those in asylums with mental illness. As institutions started to close in the second part of the twentieth century and practice shifted to the community, psychiatrists started to recognise that many ‘normal’ people had mild mental health issues. Holmes and Warelow (1999) argued that this shift is evident in the changing expert discourse and especially in the changing classification of mental disorders evident in DSM-IV published by the APA in 1975. They argued that DSM-IV appears to be a liberal reform as it ‘provides a broad non-stigmatising approach to identifying and responding to a very wide range of human behaviour’ (Holmes & Warelow, 1999, p. 176). However, this redefinition of mental illness effectively defines the whole population as neither ‘“sane” nor “insane” but more-or-less “mentally disordered”’ (Holmes & Warelow, 1999, p. 176) and therefore ‘enables the psychiatric establishment to extend its legitimate authority to everyone’ (Holmes & Warelow, 1999, p. 176). Rather than treating mental illness, Holmes and Warelow argue that psychiatrists’ role has been recast to protect the security of the system by identifying and mitigating the risks, which mental illness poses to individuals and the community (Holmes & Warelow, 1999, p. 167).

Foucault argued that expert discourses have become so powerful that they are accepted as reality and the associated controls and disciplines become internalised. Individuals regulate their own behaviours through self-discipline, which Foucault (1988) labelled, technologies of the self. Foucault argued that individuals in modern societies self-discipline themselves, by managing their own bodies, conduct and way of being to enable themselves to reach a ‘state of happiness, purity, wisdom, perfection or immortality’ (Foucault, 1988, p. 18).

Foucault’s analysis of the ways in which professional discourses create and maintain the barriers between normality and abnormality and structure the ways in which risk is defined and managed highlights the key role that experts, especially the medical profession, continue to play in responding to risk. The COVID-19 pandemic experts, especially doctors, have played a key role in:

Naming the disease and its causes: from pneumonia of unknown causes via COVID-19 and SARS-CoV-2 to Alpha, Beta … variants

The naming of a new pathogen and the disease it causes shapes how the disease is framed and reflects the relative influence of different experts. Initially, the disease, which is now known as COVID-19 was referred to as pneumonia of unknown origin (by the Chinese authorities who wished to downplay the risks it posed) and as SARS (by doctors warning their colleagues of a deadly new disease). For example, Dr Li Wenliang, an ophthalmologist in Wuhan, posted on-line on 30 December 2019 that there were ‘7 SARS case confirmed’ (Honigsbaum, 2020, p. 262). On 7 January 2020 researchers in China identified the cause as a novel coronavirus and, in its situation report on 21 January, the WHO named the Novel Coronavirus, 2019-nCoV (WHO [World Health Organization], 2020). On 11 February 2020, the International Committee on the Taxonomy of Viruses named the virus, ‘severe acute respiratory syndrome coronavirus 2ʹ (SARS-CoV-2). The inclusion of SARS in the name caused some debate amongst virologists as the name was not consistent with the name the WHO chose for the disease, coronavirus disease 2019 later abbreviated to COVID-19, and might have adverse social and economic effects if the disease attenuated (Wu et al., (2020)). Despite attempts by Donald Trump to rename the virus, the Chinese Virus (Woodward, 2020, p. 283) to emphasise the Chinese role in the pandemic, these names have been accepted and have come into general use. As the virus is reproduced and mutated, new and more infectious variants have emerged. Initially, governments and the media named these variants after the places or countries in which they were first identified, for example, the Kent and Indian variants. The WHO, drawing on its public health expertise reviewed this and noted that such naming was ‘stigmatising and discriminatory’ (WHO, 2021a) and proposed new names based on the Greek alphabet so the Kent variant was renamed the Alpha variant and the Indian, Delta (WHO, 2021b).

Protecting hospitals from being overwhelmed

During the COVID-19 pandemic, there was a major shift in the normally accepted relationship between the public and the health care system. In normal times, the public are invited to treat hospitals as safe places where they will be protected, cared for and treated. During the COVID-19 pandemic, especially when there was uncontrolled transmission of the virus in the community, hospitals were no longer safe places. The public were asked to protect hospitals, and indeed the shift from wait and see to lockdown policies in countries such as Italy, the UK and the US came when hospitals reported they were being overwhelmed by COVID-19 patients. In the UK, this was evident in the government slogan justifying the lockdown in March 2020 which included the phrase: PROTECT THE NHS (Alaszewski, 2021).

Prescribing behaviour: self-discipline

While governments did enforce legal controls on individuals’ behaviour, especially during the peak waves of the pandemic, most sought to shape behaviour through advice and guidance by providing public health information and by passing the responsibility to individuals. This approach was evident in the UK following the passing of lockdown restrictions in the Summer of 2021. Despite rising rates of infections, the UK government relied on public health messaging, which emphasised the responsibility of individuals for managing risk, either through personal behaviour as in the UK slogan ‘Hands, Face, Space’, or in taking the COVID-19 vaccine (Alaszewski, 2021).

Maintaining the cultural authority of experts

The pandemic has provided experts, especially medical researchers, with an opportunity to enhance their cultural authority. One of the main features of the pandemic has been the speed with which clinicians and medical researchers recognised and described the symptoms of COVID-19, sequenced the genome of the virus causing the disease, developed clinical methods for managing patients with the disease, and developed vaccines to reduce rates of transmission and mitigate the effects of the disease. This rapid and effective response has been documented both by the media and by the doctors themselves (see, for example, Clarke, 2021; Francis, 2021). The cultural authority of experts was evident when policymakers justified their policy by claiming they were led by science and in the way in which leading scientists, such as Sir Patrick Vallance and Chris Witty in the UK and Anthony Fauci in the US, became regular TV commentators on the COVID-19. This cultural authority has been challenged both by conspiracy theorists and by populist politicians such as Donald Trump, but scientists and doctors have sought to reassert their authority using both mass and social media (Alaszewski, 2021).

Maintaining social authority

Experts have played a key role in shaping societal responses to the pandemic. One of the most distinctive features of the pandemic, the effective lockdown in many countries of all economic and social activities, was a response to events that were taking place in hospitals; particularly the overwhelming of medical services by a wave of admission of COVID-19 patients (Alaszewski, Forthcoming). During this crisis, doctors made the crucial decision about healthcare they shut down virtually all non-COVID services, restructured the hospitals and prioritised the treatment of those patients that were most likely to survive. De Graaff, Bal and Bal. (2021)provide a detailed ethnographic account of the ways in which staff at a University Hospital in the Netherlands managed the unprecedented risks and uncertainty of the first wave of COVID-19 admissions.

Closing comment – risk processes as continuity and change

In modern society, risk plays a key role in individual and collective decision-making. It provides a way of predicting futures and accounting for mistakes in the past.

The COVID-19 crisis provides an opportunity to reflect on the ways in which risk provides insights into the development of contemporary societies. While Beck, Giddens, Foucault and Douglas all highlight the key role of risk in contemporary social and cultural processes, they place a different emphasis on continuity and change. For Beck and Giddens, new types of risk characterise late modern societies. These new risks are global, a product of modern technologies and require special expertise and technology to identify and manage, but also ones that expose the vulnerability of individuals and uncertainties of knowledge. Some of the features of the pandemic clearly fit with this characterisation of risk. The pandemic is distinctly global, both in the spread of the virus and in the rapid communication about and sharing of knowledge about the virus. While the origins of the virus remains unclear, current theories about its origins implicate human interference with nature. While scientists have responded rapidly to identify the cause of COVID-19, develop treatments and vaccines, this knowledge has been challenged by hoax theorists and anti-vaxxers.

Foucault also highlights the ways in which risk reflects the development of modern society, focusing on the ways in which risk is constructed and used as a sophisticated system of social control. Foucault highlights the role of the eighteenth century European Enlightenment with its emphasis on rationality and scientific knowledge as the basis of professional power, as manifested in professional discourses defining normality/safety and abnormality/dangerousness. For Foucault, such power found physical expression in the asylums, workhouses and hospitals of the nineteenth century, which were the basis on which professionals developed their discourse, drawing the boundary between normal and abnormal and categorising different types of abnormality. In the twentieth century, this power moved out of institutions into the wider community and the boundaries between normality and abnormality were blurred by risk, with the whole population subject to surveillance and individuals internalising risk discourse through self-discipline, measures to minimise risk. Experts, especially those with a medical background, have played a key role in the pandemic. The language used to talk about the disease, COVID-19, SARS-CoV-2 and Alpha, Delta, and now Omicron variants, was created by and reflected the ways in which these experts viewed the world. During the pandemic, experts manifest both their cultural and social authorities. The major decisions that impacted on the economic and social well-being of populations during the pandemic, such as lockdowns, were ones that were triggered by warnings from experts, for example, that hospitals were being overwhelmed. During the pandemic, most of the population, especially those categorised as high-risk, have internalised hygienic measures and significantly altered their behaviour. The new COVID-19 discourse has mandated major changes in behaviour, such as social distancing, mask wear and vaccinations. While there has been some resistance, these measures have been accepted by the majority of the population.

Douglas’s work emphasised the continuity of responses to misfortunes and dangers. Like Beck, Giddens and Foucault, Douglas acknowledged that risk is a distinctive feature of modern society but it performs the same function as sin did in religious societies; it is a way of warning about the consequences of actions and allocating blame for failure to heed the warnings. For Douglas, the same social process can be seen in historical contexts, such as the construction of the dangers of leprosy and responses to them in the eleventh and twelfth centuries and as to contemporary dangers, such as COVID-19. There are similar symbolic systems, maintaining the purity of the body politic and individual bodies through reinforcing borders was evident in the eleventh and twelfth centuries, as it is today in response to the pandemic. The rhetoric of sin and risk continues to reflect and reinforce the tension and fault lines within society.

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