How does the pandemic end? Losing control of the COVID-19 pandemic illness narrative

ABSTRACT

The end of a pandemic is as much a political act as biological reality. It is over not simply when case counts or deaths are reduced to some objectively determined acceptable level but also when, and if, the public accepts the stories that politicians and health officials tell about it. This paper has three aims. First, to develop the concept of a pandemic illness narrative – a public narrative that makes the experience of an outbreak meaningful to a community of people and explains when it will be finished. Using the case of the United States, the paper then examines how American state organisations and public health officials tried to disseminate a version of the ‘restitution illness narrative’ to make sense out of the COVID-19 pandemic and explain how it would ultimately end. Lastly, the paper describes the factors that made this narrative ultimately implausible to the American public. As most Americans are now seemingly indifferent about the pandemic, it has ended in the United States without ever actually being narratively concluded.

KEYWORDS:

• COVID-19
• infectious disease control
• illness narratives
• pandemic illness narratives

When is an outbreak over?

When vaccines for COVID-19 first became available in early 2021, it seemed like the beginning of the end of the pandemic in the United States. Public health officials, and even President Biden, cautiously began to tell a hopeful story in which, through the ‘miracle of science’, the outbreak might soon be over and the country would be able to return to a ‘new normal’. Yet, when a significant number of Americans refused to get vaccinated and then the Delta and Omicron waves struck, producing a high number of cases and deaths, the American public lost hope that the pandemic was anywhere close to ending.

The experience of COVID-19 in the United States shows that determining the end of an outbreak has as much to do with politics as it does with biology. It is over not simply when deaths or case counts drop below some objectively pre-determined level, but also based on whether the public accepts the narratives that public health officials and politicians tell about the pandemic. The COVID-19 pandemic did not come to an end in the United States in 2021 (and in one sense, never has) because politicians and health officials lost control of the narrative of the pandemic. This occurred for two reasons: first, the Trump administration refused to tell a meaningful story of the outbreak, and then later the public lost faith in the hopeful story the Biden administration tried to disseminate.

This paper has three aims. First, using research on public narratives and the idea of illness narratives, it develops the concept of a pandemic illness narrative. Constructed from pre-existing templates that resonate in a culture, public narratives allow human communities to make the flow of time meaningful and provide a sense of what the future holds. Similarly, illness narratives provide persons a sense of what their life story means now that they have an illness. A pandemic illness narrative is thus a meaning-filled story a community of people tell about a pandemic and how it will ultimately end. Crucially, pandemic illness narratives shape our experience of time during an outbreak and especially our sense of the future.

Second, the paper aims to provide an example of a pandemic illness narrative by using the case of COVID-19 in the United States. I examine how health officials and politicians in the Biden administration tried to disseminate a version of the ‘restitution illness narrative’ (Frank, 1995) to give meaning to the pandemic and manage how people think it would end. Lastly, the paper examines the various factors that made this story unconvincing and describes how U.S. health officials eventually lost control of the pandemic illness narrative.

As well as deadly, pandemics are socially disruptive. Collective narratives are one way that a community of people attempt to make meaning out of an outbreak and regain a sense of control over what is happening. Pandemic illness narratives not only provide a degree of order in the face of chaos, but also a sense of solidarity; a feeling that we will all get through this story together. Yet, a certain level of solidarity is also needed for pandemic illness narratives to be accepted. We shall see that it was, in part, the lack of solidarity in the United States that made the Biden administration lose control of the narrative of the COVID-19 pandemic.

Conceptualising pandemic illness narratives

Public narratives and illness narratives

After the so-called ‘narrative turn’ thirty years ago (see Goodson & Gill, 2011), social scientists have become increasingly aware of the importance of stories. Although definitions vary, a public narrative is when events are placed in a temporal order through the use of plots that resonate in the culture of a society. A plot is the overall structure of a story through which particular events gain significance; it is through the use of a plot that discrete events become connected moments in an evolving story (Polkinghorne, 1995, 1988; Polletta et al., 2011; Somers, 1994). The overall story and the particular events that make it up are normative: that is, there is a point to the story, a reason why it unfolds the way it does (Bruner, 1991; Polletta et al., 2011). Specifically, preceding events in a story are there to lead up to and contribute to a meaningful conclusion (Polkinghorne, 1995).

In this way, narrative is a particular type of mental experience of the world; rather than placing objects into discrete categories, ‘narrative cognition’ achieves understanding by linking events together (Bruner, 1986). Through a process of ‘narrative smoothing’ (Spence, 1986), only relevant events are selected and by the temporal logic of the narrative, later events gain significance by following earlier ones (Polletta et al., 2011). The process of drawing disparate events together and turning them into an organised whole through the use of a plot is called ‘narrative configuration’ (Polkinghorne, 1995) or simply ‘emplotment’ (Somers, 1994).

The relationship between experience and narrative is complicated. The stories we tell are powerful enough to shape how persons and communities experience events (Gottschall, 2012). Yet, to be accepted, narratives must also provide a somewhat accurate reflection of experience. As Polkinghorne (1995, p. 16) writes, ‘The final story must fit the data while at the same time bringing an order and meaningfulness that is not apparent in the data themselves’.

Narratives not only help create a meaningful reality (Bruner, 1991), but also shape our experience of the flow of time (Carr, 1986; Misztal, 2020; Ricoeur, 1979). In this regard, narratives are as much about the future as they are about the past. As it has not yet happened, the future is, almost by definition, undetermined; multiple possible scenarios could play out – one might or might not get fired, war could or could not break out. The undetermined nature of the future is unsettling to humans. By proclaiming the existence of a narrative that claims that a series of events will lead to a certain outcome, we are able to gain a sense of control over the future (whether or not this control is realised is another story).

Narratives come in genres; that is, there is a stock set of stereotypical plots (e.g. success, tragedy, overcoming adversity, etc.) that are a part of the culture of each society (Bruner, 1991; Polletta et al., 2011). Existing beyond individual persons and their minds, these public narratives can range from simple family stories, organisational myths (e.g. Apple being founded in a garage), to master narratives such as the ‘Enlightenment’. Public narratives are shaped by many social institutions including, but not limited to, religious organisations, the state, and the media. These public narratives provide the general framework of a story that can then be adapted by individuals to explain individual life events (e.g. getting fired from a job) to collective events (e.g. the experience of an economic downturn) (Somers, 1994).

Research is still needed to understand what factors make a narrative persuasive enough to dominate national political discourse (Polletta et al., 2011). Narratives that mesh with deeply held values and call up and refer to other public narratives are seen to be particularly effective (Polletta et al., 2011; Polletta & Callahan, 2017). Stories that do resonate can influence how a person views the ‘story’ of their life and possibly provide a ‘narrative identity’ (see McAdams, 2018). For social groups, such as nations, narratives can provide a ‘collective identity’ and a sense of belonging. However, for a public narrative to take hold, there must also be enough national solidarity to begin with (Carr, 1986; Polletta et al., 2011).

One specific narrative that influences the lives of individuals and groups is the illness narrative. To make sense of an illness, and the suffering that comes with it, persons tell a meaningful story that integrates the illness with their previous lived experience (Frank, 1995; Hurwitz & Bates, 2016; Kleinman, 1988). The diagnosis of a serious illness can be experienced as a ‘biographic disruption’ – an event that breaks a person’s routine social roles, the expectations they have for their lives, and requires them to fundamentally rethink their self-concept (Bury, 1982; Locock & Ziébland, 2015). In the language of Frank (1995), a bad diagnosis creates ‘narrative wreckage’ as the existing story a person has been telling about their life can no longer continue in the same way. A person now has to tell a new story that incorporates the illness; a story that restores the narrative order the illness destroyed, but also recognises that the illness will continue to create disorder in one’s life. Like other narratives, illness narratives create a new identity based around the illness and the story that is told about it (Frank, 1995; Locock & Ziébland, 2015). As Kleinman (1988) summarises:

The illness narrative is a story the patient tells, and significant others retell, to give coherence to the distinctive events and long-term course of suffering. The plot lines, core metaphors, and rhetorical devices that structure the illness narrative are drawn from cultural and personal models for arranging experiences in meaningful ways and for effectively communicating those meanings. The narrative does not only reflect illness experiences, but rather shapes the experience of symptoms and suffering (p. 49)

As Kleinman suggests, illness narratives are themselves public narratives – pre-existing stories of illness that subsist in a culture. Persons adapt these narratives to understand their own illness experience. Frank (1995) describes three public narratives of illness: the chaos, quest, and restitution narratives. Below I argue that the Biden administration tried, but ultimately failed, to have the American public adopt a ‘restitution narrative’ of the COVID-19 pandemic.

The pandemic illness narrative of COVID-19

While previous work has used the concept of illness narratives to understand the COVID-19 pandemic, it has typically focused on the experience of individuals. Pinsker (2022) describes the ‘narrative fatigue’ some individuals experience from the duration of the pandemic and the changing narratives that accompany it. Others (e.g. Rushforth et al., 2021) examine the illness narratives of persons with ‘long-Covid’. This paper uses the concept of illness narratives to examine the potential development of a collective story of the pandemic. Rosenberg (1989) comes closest to this idea when he describes an epidemic as a ‘dramaturgical event’ consisting of three acts: progressive revelation, managing randomness, and negotiating public response.

During an outbreak a community of people can develop a pandemic illness narrative. The story of a pandemic is an illness narrative in that, like other illness narratives, it attempts to make sense out of an event that threatens the physical health of persons. The onset of an outbreak is akin to a biographic disruption that persons experience when they receive a bad diagnosis; it is a disruptive event that forces a community to develop a story that gives meaning to the outbreak and provides an expectation of when it will be over. Yet, unlike most illness narratives, the story of the pandemic is a collective narrative – it is not just about the sickness of a single person (e.g. a story of someone infected with SARS-CoV-2), but a story about the threat to the health of the entire community. It is a public narrative not only because it draws on a communal set of stock narratives to tell its story, but also because it is a story about the public that allow people to make meaning out of a collective historical event together.

Pandemic illness narratives have many of the same features of narratives described above. They connect a series of events together to tell a compelling story. Individual events (e.g. the first domestic case, rising case rates, mutations of the virus, the various waves of the pandemic, the development of vaccines) become connected parts of the pandemic story. Through a process of ‘narrative smoothing’, specific events are emphasised (e.g. the Delta wave) while other aspects become background (e.g. racial disparities in mortality) or subplots (e.g. ‘long COVID’). Events are no longer understood on their own (e.g. supplies running out in grocery stores as a hardship), but rather as a part of the story of the pandemic. In this way, the story provides a meaningful normative understanding of the pandemic. Persons and groups are even given evocative characters to play; health care and other ‘essential’ workers receive the narrative identity of ‘heroes’ in the pandemic story (Cox, 2020).

Importantly, a pandemic illness narrative is not only a description of what is happening, but it also shapes how people experience it; by placing events in a meaningful story, the narrative becomes part of our lived pandemic experience. As described above, pandemic illness narratives are based on a stock of pre-existing set of generic stories that exist in one’s culture. Depending on which ‘public narrative’ is applied to the pandemic, events can take on different meanings; for example, the application of vaccines to counter the pandemic can be seen as an overreach by a despotic government or as the enlightened progress of science. Yet for a story of the pandemic to be practically accepted it must also provide a reasonably accurate reflection of lived experience. A story too far removed from ‘events on the ground’ will no longer be believable. As we will see, part of the problem in the United States is that the Biden administration’s hopeful story that COVID-19 would end through the use of vaccines no longer felt authentic when the Delta and Omicron waves occurred.

Narrative control over time

Possibly the most important aspect of pandemic illness narratives is how they shape our sense of time. It tells us how far along we are in the outbreak and how much further we have to go. Events are now signs of where we are in the pandemic story (e.g. supplies running out in a grocery stores means we are at the start whereas the development of vaccines is the beginning of the end). Pandemic illness narratives tell us perhaps the most important thing we want to know: how close we are to it being over.

Pandemics are not only deadly, but also socially destabilising. A pandemic produces a ‘collective stress situation’ in which there is a rupture in the social order as the demands on the social system far exceed the capabilities of the system to fulfil them (Sjoberg, 1962). One way in which pandemics are socially destabilising is that they diminish our sense of the routine flow of time. Normally there is a certain repetitive expectation of what the future holds, but a crisis like a pandemic diminishes that sense of temporal order. As there is a breakdown in the routine flow of social life (e.g. there is a decay in the communal Monday to Friday workweek), people have less certainty about what the future might hold. In short, like other disasters (though perhaps greater as they last longer), pandemics create temporal anomie. The start is a form of communal ‘narrative wreckage’. The crisis of the pandemic halts the existing story of a community – with its predictions of a routine future – and places people in a situation in which they no longer know what is going to happen. It is not a wreckage of a single life story, but rather the communal story people tell no longer holds true as the pandemic helps destroy the existing public narrative.

A pandemic illness narrative is able to counteract the temporal disorder produced by an outbreak. It is during such periods when the future seems so uncertain, that pandemic illness narratives become important for retaining a sense of control over time. As Swidler (1986) notes, it is during ‘unsettled periods’ that culture – symbols, values, and the stories people tell – become ever more crucial. As the pandemic illness narrative provides a prediction about how the outbreak will unfold, and when it will ultimately end, it gives people back their sense of mastery of the future that has become uncertain.

Development of a COVID-19 pandemic illness narrative in the United States

The experience of COVID-19 in the United States provides an intriguing case study to examine the development, and also failure, of the narrative configuration of a pandemic illness narrative. After addressing the experience of narrative wreckage brought on by the pandemic and the Trump White House’s refusal to develop a pandemic narrative, this part of the paper focuses on how public health experts and government officials in the Biden administration sought to use the framework of a restitution illness narrative to manage Americans’ experience of the pandemic and provide the public a sense of when it would be over.

There were – and are – various competing narratives of the pandemic in America. It was viewed as a test of national resiliency (Friedman, 2022), retribution for the way humans treat the environment (Valliantos, 2020), or proof of the level of inequality (Perry et al., 2021). As well, multiple social actors (e.g. medical professionals, religious leaders, the mass media, etc.) influenced Americans understanding of the pandemic and which narrative should be applied to it. I focus on the narrative configuration of the Biden administration because while it may have not been the only actor shaping the pandemic narrative it was a key player; it had (or at least, should have had) the resources and institutional presence to be impactful. Further, an analysis of the government’s role in shaping the pandemic illness narrative allows us to understand how state power can be used to attempt to control cultural and symbolic aspects of society.

The narrative wreckage of the COVID-19 pandemic

The SARS-CoV-2 pandemic began in China in December of 2019. By February of 2020 the United States had experienced its first death and by March there was over 81,000 confirmed cases and more than 1,000 deaths. With over 100,000 deaths, by May America was one of the worst affected nations. Routine social life was quickly disrupted. The CDC recommended no gatherings of more than 10 people, many people began to wear face masks in public, and most K–12 schools and universities switched to online learning. By April nearly 10 million Americans were unemployed and those that could were working from home (Taylor, 2021).

The pandemic soon dominated the mass media and some newspaper headlines began to describe it in dire terms: ‘The coronavirus could kill 3,000 Americans per day by June 1’ (Perret, 2020) and ‘“Pandemics kill just as much as nuclear bombs”: Historians warn about dangers of reopening too soon’ (Haythorn, 2020). In the United States, the outbreak created both a collective stress situation and narrative wreckage. The national story the public participated in could no longer continue as persons became unsure about what the future might hold.

It is during such an ‘unsettled period’ that a pandemic illness narrative could have given the American public a sense of what the outbreak would be like. Yet, it was during this early part of the outbreak that the Trump administration resisted telling a story about the pandemic. At the end of February, President Trump declared that cases would soon be down to zero (Yong, 2020) and stated that ‘It’s going to disappear. One day, it’s like a miracle, it will disappear’ (Summers, 2020). At the same time, Republican governors such as Doug Ducey of Arizona began to relax restrictions arguing that the pandemic was essentially over even though public health experts made it clear that this was not the case (Achenbach et al., 2021). As cases and deaths continued to climb during the summer, the President declared that cases were actually going down and that for the majority of people the symptoms were no worse than the flu (Summers, 2020).

Indeed, President Trump told journalist Bob Woodward that he knowingly downplayed the risk of COVID-19 even though he knew it was ‘deadly’ (Forgey & Choi, 2020). It should be noted that others in the federal government, such as Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases (NIAID), provided the American public an honest assessment of the threat that the COVID-19 pandemic posed (see Summers, 2020). While many commentators have faulted the Trump administration for its poor handling of the outbreak (see Yong, 2020), it also failed to provide a cohesive narrative of the pandemic.

Restitution illness narrative of the coronavirus pandemic by the Biden administration

I argue that it was only after the conclusion of the 2020 presidential election and the availability of the first vaccines in late 2020 that an official narrative of the pandemic began to be developed by the U.S. government. This effort became more fully realised when President Biden took office in January 2021. The narrative that the new administration attempted to disseminate was a version of what Frank (1995) calls the ‘restitution illness narrative’. In this redemptive story the protagonist starts off healthy, discovers they are sick, and then with the aid of medical treatment gets better. In this story illness is a transitory hardship that does not produce long-term change; instead life returns to the ‘normal’ condition of being healthy. The patient is asked to ignore their diseased state and look into the future when they will be well again. The progression of the story is summed up by Frank (1995, p. 77): ‘Yesterday I was healthy, today I’m sick, but tomorrow I’ll be healthy again’. It is a hopeful story in which the protagonist envisions a future self returned to their previous state of health.

The restitution narrative has a long history in Western culture; an example can be seen in the biblical story of Job who is beset by various hardships and illnesses, but who because of his faith is restored (and more) to his original position (Frank, 1995). In the restitution narrative, illness is a test of one’s character; it is an adversity that must be faced and overcome. One show’s one’s moral value by keeping a positive attitude and fighting the illness, secure in the knowledge that it will one day be defeated. A contemporary example is the ideal of the breast cancer ‘survivor’ who exhibits strength and resilience (Kaiser, 2008). Frank (1995, p. 83) claims that the restitution narrative is the ‘culturally preferred narrative’ in the United States. It is a story of illness that people, particularly medical professionals, like to tell so much so that the narrative is sometimes forced onto illness experiences (e.g. chronic illness and terminal cases) that do not quite fit (France et al., 2013; Frank, 1995).

As mentioned, illness narratives, like the restitution narrative, are typically individual stories told to and by the sick to understand their own personal experience of illness. I claim that a collective version of the restitution narrative disseminated by the Biden administration became a pandemic illness narrative; it provided a story that gave meaning to the shared experience of the outbreak and gave the public a sense of how it would progress and ultimately end. The pandemic is described as a collective hardship similar to an individual with a bad diagnosis. This hardship must be faced and then, with the aid of medicine, overcome so that the nation can be returned to its typical healthy state.

This narrative was publicly expressed by health officials of the Biden administration (see White House COVID-19 Response Team, 2021a; White House COVID-19 Response Team, 2021b; White House COVID-19 Response Team, 2021c) and, in particular, by the head of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci (see Fauci, 2021a, 2021b; Kenen, 2021; King, 2021). For example, in an interview with The Washington Post, Dr. Fauci claims that the pandemic, ‘ … will end. We will get out of this and we will return to normal. Don’t give up. Don’t despair. Don’t throw caution to the wind. We can end this. The combination of pulling together with public health measures and the scientific advances of vaccines and therapies and preventions. I will guarantee you that’ (Edgers, 2020).

Perhaps the best example of the restitution illness narrative of the pandemic was expressed by President Biden in his 11 March 2021, speech on the outbreak. The president begins by describing the hardship the country has been through:

While it was different for everyone, we all lost something. A collective suffering. A collective sacrifice. A year filled with the loss of life — and the loss of living for all of us … I’ll close with this. We’ve lost so much over the last year. We’ve lost family and friends. We’ve lost businesses and dreams we spent years building. We’ve lost time — time with each other (Biden, 2021a)

The pandemic is portrayed as a communal sickness, a collective tragedy, experienced by the entire country. Biden also describes the pandemic as a test of the moral character of the nation, a test which the nation passed:

We’ve seen frontline and essential workers risking their lives, sometimes losing them, to save and help others. Researchers and scientists racing for a vaccine. And so many of you, as Hemingway wrote, “being strong in all the broken places” (Biden, 2021a).

Then, the story continues, it is through the medical aid of vaccines that the country will be able to return to a healthy state again: ‘The development, manufacture, and distribution of the vaccines in record time is a true miracle of science. It is one of the most extraordinary achievements any country has ever accomplished’ (Biden, 2021a). Overall, Biden provides a hopeful narrative in which, through the assistance of the medical intervention of vaccines, the country will overcome this adversity and be returned to its normal state of health:

Finding light in the darkness is a very American thing to do … We’re seizing this moment. And history, I believe, will record: We faced and overcame one of the toughest and darkest periods in this nation’s history — darkest we’ve ever known. I promise you, we’ll come out stronger with a renewed faith in ourselves, a renewed commitment to one another, to our communities, and to our country (Biden, 2021a)

In a similar vein, in a March 10th speech Biden states,

There is light at the end of this dark tunnel of the past year, but we cannot let our guard down now or assume that victory is inevitable. Together, we’re going to get through this pandemic and usher in a healthier and more hopeful future. (Biden, 2021b)

Perhaps most importantly, Biden provides a timeline for when there might be a conclusion to the pandemic story and the outbreak could begin to be over: ‘After this long hard year, that will make this Independence Day something truly special, where we not only mark our independence as a nation, but we begin to mark our independence from this virus’ (Biden, 2021a).

The restitution illness narrative that the Biden administration tried to disseminate is a good example, as outlined above, of the features of a pandemic illness narrative. It was a story that did not just describe, but attempted to shape American’s experience of the pandemic by producing a clear coherent plot of overcoming adversity. This story of the pandemic was developed to resonate with the redemptive narrative type that is culturally preferred in America; Biden himself notes that, ‘Finding light in the darkness is a very American thing to do … ’ The narrative provided meaning to the pandemic by being seen as a test of moral character of the country; a test that the country, almost by necessity, passed. Most importantly, the narrative gave Americans a sense of when the pandemic would be over, i.e. beginning 4 July 2021 (an important cultural date that resonates with the nation’s cultural values of freedom and independence). In this way, the narrative attempted to exert a sense of control over a future that had become uncertain. It allowed Americans to look past the present and see a future in which the country had returned to its’ ‘normal’ healthy state.

Losing control of the COVID-19 pandemic illness narrative

Although state officials tried to use a restitution illness narrative to shape the public’s experience of the pandemic, by the end of 2021 most Americans no longer found this story persuasive. According to Gallup survey data, from the start to the middle of 2021, an increasing number of Americans believed that the ‘coronavirus situation’ was improving, such that by a mid-June poll 89% of Americans believed it was getting either a lot or at least a little better. In the same month, Gallup reported that 83% of Americans thought that the pandemic would be over by the end of the year (Saad, 2022). For a time, it seemed as if the American public had accepted, at least partially, the restitution narrative.

This hopeful view of the pandemic soon collapsed. By August of 2021, Gallup recorded only 15% of Americans believed that the situation was getting better and 68% viewed it getting a lot or a little worse. By October, eight in ten Americans thought that the pandemic would continue either throughout 2022 (53%) or indefinitely (30%). Polling from May 2022 shows that half of Americans believe that their lives will never return to normal (Saad, 2022). By the end of 2021, I argue that public health officials in the Biden administration had essentially lost control of the official narrative of the pandemic; the American public saw no end to the outbreak and thus no longer found the restitution story persuasive.

Why were Americans not persuaded by a narrative that Frank (1995) claims is so culturally dominant? The main reason is obvious: the Delta and Omicron waves of the outbreak meant that the restitution narrative no longer ‘fit’ Americans experience of the pandemic. By the end of July, the Delta variant of SARS-CoV-2 became the dominant strain within the United States and produced over 150,000 new cases each week and a weekly death toll of just over 2,200. The Omicron variant of the virus that became dominant by the end of 2021 was even more virulent and though it had a lower mortality rate, it still produced over 2,100 deaths a week (Masson, 2022). The Delta and Omicron waves dealt a deadly blow to the hopeful story of the restitution narrative and created instead a sense of fatigue and a feeling of ‘narrative whiplash’ – switching narratives so quickly such that all stories of it cease to be meaningful (Pinsker, 2022).

One reason that the Delta and Omicron waves were so deadly was because many Americans refused to get vaccinated (see Pertwee et al., 2022). The U.S. vaccination rate has flattened out at 64% of the population fully vaccinated – one of the lowest rates among high-income countries (Schreiber, 2022). Consequently, by May of 2022 the United States officially recorded over 1 million deaths from the coronavirus (Donovan, 2022). While public narratives are powerful enough to shape experience, they are no longer persuasive if too far removed from persons’ everyday reality. The restitution narrative that claimed that the worst was over and the pandemic was coming to an end could no longer be reconciled with increasing cases and deaths.

While the Delta and Omicron waves of the outbreak are the main reasons that the restitution narrative became untenable in the United States, there were other factors also at play. Political polarisation has been steadily increasing in the United States over the last thirty years such that by 2022, 72% of Republicans believed that Democrats are immoral and dishonest and 63% of Democrats believed the same about Republicans (Pew Research Center, 2022). Polarisation intensified during the pandemic as Democrats and Republicans held increasingly divergent views and behaviours related to the outbreak. For example, compared to Democrats, Americans identifying as Republican were less likely to wear face masks, were less likely to comply with recommendations to go into a ‘lockdown’, and were (and are) less likely to get vaccinated (Saad, 2022). The level of antipathy Americans hold towards one another and the divergence in views about the pandemic has meant that there is not enough social solidarity for the American public to coalesce around a single story of the pandemic.

Similarly, media fragmentation has also limited officials’ ability to unite the American public around a common pandemic illness narrative. The development of a ‘high-choice’ media environment, in which news organisations cater to the pre-existing political views of consumers (see Van Aelst et al., 2017), has meant that social groups have fundamentally different views of social issues including, as seen above, different views of the COVID-19 pandemic.

Additionally, the growing prevalence of misinformation and disinformation during and after the 2016 presidential election (see Allcott & Gentzkow, 2017) has made a significant portion of the public suspicious of any ‘official’ account of the pandemic and more accepting of false information about the virus. For example, survey data has found that three-quarters of Americans believed at least one false statement about COVID-19 with nearly half of Republicans (46%) and nearly two-thirds (64%) of the unvaccinated believing half of the false statements (Kaiser Family Foundation, 2021). Essentially, polarisation, media fragmentation, and misinformation have meant that there is actually not a single American ‘public’ that health officials can convince to band together around a single narrative of the pandemic.

Although the American public have not accepted the restitution illness narrative, neither do they believe that the pandemic is still ongoing. Recent public opinion analysis shows that concerns over the pandemic are fading in the United States. Only 19% of Americans now believe that the coronavirus pandemic is a big problem (it rated the lowest of 12 issues respondents were asked about) (Drezner, 2022) and less than a quarter (24%) are now worried about contracting the virus (Rubinkam & Fingerhut, 2022). Thus, most Americans seem to have decided that the outbreak is over without experiencing a narrative ending to it.¹

Pandemic illness narratives and stability, state power, and solidarity

A pandemic illness narrative is a meaning-filled story of how an outbreak will unfold and ultimately end. It allows a community of people to have a sense of control over the future when the future feels decidedly uncertain. Constructed from pre-existing narratives that resonate in a society, pandemic illness narratives are potentially able to shape the public’s experience of an outbreak. This paper has focused on the ability, and inability, of U.S. state organisations and government officials to produce a story of COVID-19 based on the restitution illness narrative. This narrative described the pandemic as a national crisis that would be overcome through the medical response of vaccines allowing the country to return to its previous healthy state. The fact that it ultimately failed to be accepted by the American public is explained not just because the Delta and Omicron waves of the virus made it implausible, but also from the high level of polarisation, media fragmentation, and mis/disinformation that exists in the country.

Pandemic illness narratives highlight the social and political aspect of outbreaks. If accepted, they can counteract the social disorder that outbreaks tend to unleash. By providing a generic story, pandemic illness narratives can make the experience of an outbreak more understandable and thus less chaotic. By applying a narrative structure (i.e. a plot), the crisis becomes more familiar and predictable to the public. I have argued that what is key in this regard is how a pandemic illness narrative provides a sense of control over the future by offering a prognosis of how the outbreak will unfold and ultimately end.

Pandemic illness narratives also exemplify the ideological power of the state. Weick (1995) and others (Abolafia, 2010; Brown, 2004) examine how organisations utilise narrative ‘sensemaking’ to try to ensure that a certain interpretation of an ambiguous event is favoured. President Biden likewise tried, unsuccessfully, to produce a redemptive pandemic illness narrative in which the nation would come together to triumph over a collective threat so that the public would have a positive perception of the administration’s handling of the crisis.

A successful pandemic illness narrative is able to foster a sense of solidarity; all hearing the same story of the outbreak, in which they are each a part, people can gain a sense that they will get through the crisis together. America experienced this type of pandemic solidarity during the polio outbreaks of the twentieth century. Viewed as a collective threat to the nation’s health, the public was mobilised to find a cure through fundraising events such as ‘Birthday Balls’ for President Roosevelt and the March of Dimes organisation. When the Salk vaccine became available in the 1950s, people lined-up to get shots (Seytre & Shaffer, 2005). In stark contrast to the fractured narrative experience of COVID-19, the united response to polio shows that a collective understanding of infectious disease is able to produce social solidarity in America.

While pandemic illness narratives can produce solidarity, a certain level of solidarity is also necessary for a narrative of a pandemic to be accepted. It is this lack of solidarity in the United States that made the federal government (ordinarily a powerful social actor) lose control of the narrative of the pandemic. Instead of uniting around a single story of the pandemic, the United States experienced a fractured narrative understanding of the pandemic as multiple stories competed with each other, each one lacking the social power to dominate the public sphere. It is, in part, because there was no widespread common story of the outbreak that the pandemic was never actually narratively concluded in the United States.

Acknowledgments

The author would like to thank Patricia Hanen and two anonymous reviewers for reading earlier versions of the paper and providing valuable feedback.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The liminal state of the end of the pandemic in America is exemplified by remarks made by President Biden. In a September 2022 television interview, he unexpectantly declared that, ‘the pandemic is over’ and then three days later had to take back the statement and say that the pandemic ‘basically is not where it was’ (Feinberg, 2022).