Mary Brindle: War and peace with covid-19

Metaphors of war were often rolled out as countries geared up for an initial wave of covid-19, but what analogies could be useful to us now as we adjust to living with the virus?

“This is a war, we have to treat it like a war.” Over the past few months, metaphors of war like this one by Andrew Cuomo, governor of New York, have been everywhere. 

As the world grappled with the emerging pandemic, politicians styled themselves as wartime leaders, and factories converted their efforts from the production of whiskey or sports equipment to hand sanitizer and face shields for medical providers. The common experiences of loss, fear, sacrifice, and struggle, and evocations of patriotic duty, helped to galvanize communities in responding to the pandemic and easily lent themselves to comparisons with a national war effort.

The center of the pandemic response in all nations settled in hospitals, with healthcare workers often assuming (willingly or unwillingly) the role of the frontline soldier seeing the impact of the “enemy” firsthand and assuming some of the greatest risks. The concept of a shared purpose and a shared enemy has inspired the courageous response of many people. But as this war has increasingly become a siege, battle analogies become strained.

The practice of medicine is of course full of war analogies. Patients confronting a cancer diagnosis are frequently described as “battling” the disease and the idea of bravery in the face of possible death is shared by the soldier and the patient. Early depictions of healthcare workers caring for patients with covid-19 as heroes have inspired pot banging and applause from grateful communities.

These analogies are helpful in that they instill gratitude for frontline workers and inspire courage and persistence in the face of adversity, but they are also, as other commentators have pointed out, problematic. 

The virus that we have cast as our foe is an “invisible enemy.” With covid-19, this enemy has often taken root in our homes, our friends, and is carried on or within our bodies. The concept of a unified approach where we are “all in this together” can feel strained and hollow when we remain, by necessity, apart; and when our own bodies and those of our families, friends, patients, and caregivers are the vehicles of the threat we face. 

The battleground during the pandemic is also difficult to define; it looks different in countries and cities across the world. In New Zealand, for example, an early, proactive response helped bring about a rapid near elimination of the virus and minimal disruption to life as usual. In other areas, the virus overwhelmed healthcare systems and caregivers, and recovery has been an ongoing struggle. 

In many places, as rates of infection have plateaued (but not waned) and outbreaks and a second peak are a constant risk, the public health messaging has started to feel more onerous. The militaristic jingoism of the initial response has faded, but is now increasingly adopted by protestors who champion independence and personal freedom over public safety. Military imagery also lends itself to driving wedges between countries, encouraging nationalistic and occasionally xenophobic responses.

It is in this environment of uncertainty, where the sacrifices have become harder to bear, it’s started to sink in that we must find a way to live with the spectre of covid-19—not just during wartime, but during peace as well. The language that seemed so well suited to gearing up for an initial wave must now transform, but what analogies could be useful to us now at this stage when it seems our best hope is to inspire people with values that relate to civic duty, social responsibility, and compassion?  

In the UK prime minister Boris Johnson has been quick to adopt the post-war rebuilding analogy—a questionable fit when the threat of coronavirus is far from over. Language and imagery that evokes an extension of the family microcosm may be the best analogy since it is rooted in trust, discipline, sacrifice, and compassion. It provides a natural extension to communities and countries. 

Leadership through discipline and compassion has been demonstrated in countries such as Germany and New Zealand and may provide a model for other countries looking for inspiration. The words of Jacinda Ardern, “Be strong, be kind, and unite against covid-19,” placed compassion as a national priority, while Angela Merkel encouraged her fellow citizens to perform “heroic acts of kindness.” There are, of course, many reasons why countries like New Zealand and Germany have, thus far, succeeded in their response to covid-19 while others have not. However, it is hard not to consider that turning away from a militaristic response and emphasizing kindness as a national priority may be part of a long term solution for all of us. 

There are a number of ways we can reorient ourselves. To start, we need to consciously shift as individuals, as well as societies, away from an exhausting battle ready response, where we alternate between panic and complacency and our actions are intermittent and aggressive. We need to consider that our most important sacrifices are not necessarily grand gestures, but the daily considerations that support our communities and other people’s feelings of safety through activities like public mask wearing and physical distancing. Our public health communications should emphasize that we are extending the responsibility we have to our families and friends to our communities—especially to people who are most vulnerable.

This switch to a philosophy that is based on not just “heroic” but everyday kindness will build strong communities and can also offer some measure of peace to all of us.

Mary Brindle is a pediatric surgeon at the University of Calgary and director of Safe Surgery Safe Systems at Ariadne Labs, Harvard TH Chan School of Public health. She is also the scientific director of the Alberta Surgery Strategic Clinical Network. Twitter @MaryEBrindle

Competing interests: Mary Brindle has grant support from the MacNeill Chair through the Alberta Children’s Hospital Foundation, the Canadian Institute for Health Research, the Calgary Center for Clinical Research at the University of Calgary, the Maternal Newborn Child and Youth Network Strategic Clinical Network of Alberta, the Argosy foundation, and the Extracorporeal Life Support Organization.