‘Let the world dream otherwise’: The slow disaster involving PPE and distancing in health and social care communication

Abstract

For intermittent periods between 2020 and 2022 during the Covid-19 pandemic, the general population of England was required to wear a face-covering in public spaces. Rules which prevented touch and proximity (described as ‘social distancing’) were also introduced and repeatedly altered over time. Further items of personal protective equipment (PPE) were required to be worn by people in health and social care roles and environments in different combinations and circumstances over the same period. These artefacts, combined with the denial of touch and proximity, created physiological, psychological, and cultural barriers to communication.
My research establishes the barriers and facilitators of health and care interactions in the presence of PPE and distancing, identifies the wider socio-political and cultural determinants which influenced these barriers and facilitators, and recognises the consequences for disaster recovery and emergency preparedness.
The case-based thematic analysis of survey responses of 464 people and interviews with 33 participants in August-December 2020, and the subsequent re-interviewing of nine interview participants in March-May 2022, identified that people who gave and/or received health or social care were susceptible to ‘communication distress’: the term I use for the suffering caused by the inability to be understood and/or to fully understand as a result of the adverse body-mind sensory and cognitive experience endured when interacting in the presence of PPE and distancing. This and other deficiencies in social interaction, and ever-changing departures from the normative order, gave rise to moral uncertainty and societal ‘anomie’.
Sensitisation and habituation to the physical and psychological experience of PPE and distancing was influenced by the quality of the pre-existing resources, relationships, skills, and circumstances of those who interacted; the quality and availability of PPE artefacts; the equipment and infrastructure required to facilitate remote communication; and the quality of
explicit and implicit communication emanating from the authorities responsible for the infection control measures, especially the levels of contradiction within.
Communication distress in the face of the threat to health posed by Covid-19 interacted with the concurrent and pre-existing factors of structural violence, epistemic injustice, and betrayal of trust in the manner of a syndemic. As a result, some participants experienced moral distress and moral injury both through their professional and social roles and/or through their experiences as people in need of health and care support.
Societal prescriptive forgetting was encouraged by media outlets which supported the government of the time, and by people in influential positions who had a vested interest in the construction of a post-Covid culture which reverted to the pre-pandemic status quo: a narrative which was at odds with persistent PPE-wearing and distancing in health and care communication. The initial objectification of health and social care workers as ‘heroes’ with unlimited coping capabilities exacerbated subsequent demonisation and, combined with exhaustion and moral injury, prompted some people to question their professional care-giving identities and practice their own ‘self-compassionate disconnection’, making substantial changes to their work/life balance as a form of self-care. Communication distress was also a factor in ‘institutional distancing’: the pre-existing and/or Covid-related absence of support services which led to an increase in the unacknowledged burden of unpaid family care.
This research documents a governmental and societal failure to acknowledge the extent of communication distress, its causes, and its consequences. In the face of the high probability of another event which will require the use of PPE and distancing in health and care communication, I conclude that this syndemic is an unrecognised, yet ongoing, disaster of gradual onset.