The epidemic and its committees

What is very striking in this global epidemic is that all governments, dictatorships, democracies whether illiberal or not, populisms of all kinds and all forms are led to take drastic measures to manage the population. How to justify them? Pure autocrats, those actually so or who merely dream they are, rely only on themselves. Bolsonaro gives his arms of honor and Putin declares that Russia is under control. For the others, the use of scientific committees advising the government has become a necessity in an uncertain environment.

If we take the English and French cases, it is clear that the same remedy displayed gives rise to very different measures taken. One point should be emphasized at the outset: despite the apparent massive differences in the measures taken, they are based on the same studies. It is all the easier to note that, as Darwin dictates, the English epidemiologists have a prestige and an authority recognized worldwide. A long chain of transmission has enabled English evolutionary biologists to contribute mainly to the “new synthesis” combining Mendelian genetics and Darwinian natural selection in a mathematical modeling of population genetics. From Ronald Aylmer on.

Fisher to Richard Dawkins and John Maynard Smith, Oxford and Cambridge have produced an impeccable line of evolutionary biologists and epidemiologists. We will come back to the potential strangeness of the opinions supported by these scientists, because biologist is a risky profession. It predisposes one to make generalizations about biological types [sur l’espèce] that may occasionally seem strange, if not dangerous.

This time it’s not from Oxbridge that the voice of authority comes, but from Imperial College London. On March 16, Neil Ferguson’s team provided record reports and modeling of possible scenarios in record time for both the British and French governments. This report was taken up by the committee of ten French experts as an example, both because it came from a prestigious source and because it dared to present risky perspectives.

Herd immunity and Ferguson’s accordion

 The team at Imperial college put the real of the epidemic into numbers on the basis of two options and five possible actions to slow the virus. “These two options are qualified as ‘mitigation’ and ‘suppression’ (containment), playing on five types of action: isolation of confirmed cases at home; quarantining their families; social distancing of people over 70; distancing widened to the whole population; the closure of schools and universities.”[i]

The first option, mitigation, does not aim to halt the virus, but wants to control it by taking actions according to the five possible actions, as a minimum, in order to obtain immunity for the population as quickly as possible, leading to a decline in the number of cases when the group collective protection is reached – or “herd immunity” as they say in English. The concept is brutal in its original language: herd as in a herd of animals. This is why translations generally euphemize the concept. Talking about group immunity or collective immunity is more human.

“The second option, containment, aims to get a given individual to spread the virus to less than one person, leading to the end of the epidemic. This authoritarian strategy applied by China presupposes more radical measures going as far as confining the entire population. But after five months of such a regime, the epidemic could flare up again when the measures are stopped.” Whatever solution is chosen, what remains to be achieved is, whether we like it or not, herd immunity to a virus about which there is much to learn.

For the team at Imperial College, whether a lot of people are allowed to be infected or a lot of people are contained is not a question of absolute principle, but a pragmatic question. The fundamental basis for the calculation has to be the resource of intensive care beds available to each health care system. The concept ‘bed’ implies both the object and the personnel required to operate it. And it takes a lot of people.

This is why, in a first instance, on the 15^th of March, standing alongside Boris Johnson and his counterpart, the chief medical officer, the British government’s chief scientific advisor, Patrick Vallance stated quite clearly: “It’s not possible to stop everyone getting it and it’s also not desirable, because we need to have some immunity to protect ourselves in the future.”[ii]

The application of the concept of herd immunity – which comes from the theory of vaccines – to a situation where none exists has shocked people. P. Vallance is the former head of research and development for GlaxoSmithKline. His adherence to the logic of the market is acquired. And such a declaration, bordering on laissez-faire, has certainly been inspired by Brexit advisor Dominic Cummings.[iii] The authorities therefore let the Bath Half Marathon run, because according to their reasoning, they are young and fit people, if they become infected, they will increase general immunity and there will be few serious cases among them.

But very quickly, the figures became unavoidable. For immunity, 60% of the population would have to be infected, or 40 million people in Britain. As 5% of cases are currently considered to be serious, this would mean 2 million serious cases, probably distributed over a fairly short time frame, which has to be compared with a similar number of intensive care beds as in France: that is, depending on availability, between 5,000 and 7,000 beds.

The editor of the world’s most prestigious medical journal, The Lancet, tweeted, “The UK government – Matt Hancock and Boris Johnson – claim they are following the science. But that is not true. The evidence is clear. We need urgent implementation of social distancing and closure policies. The government is playing roulette with the public. This is a major error.”[iv] Boris Johnson’s neo-Churchillian calls to prepare the population to lose loved ones have of course not reassured anyone.

In a more reasonable and less neoliberal way, Ferguson’s team have indicated a path, which is however staggering in the constraints that would need to be imposed and in the reinvention of all our ways of going about our daily business that it entails. The only reasonable way would be to alternate periods of complete confinement with periods of stress relief in a way that would be correlated with the number of intensive care beds occupied in hospitals. When full containment has freed enough beds, the constraints would be loosened so that another part of the population becomes infected, until sufficient group immunity is reached. In Ferguson’s models, maximum constraints would be required between one-third and one-half of the time, for 18 months, until a vaccine can be developed and distributed on a mass scale. “These alarming conclusions echo the work of the Inserm-Sorbonne University Epix-Lab laboratory led by Vittoria Colizza (Inserm, Sorbonne-University), showing the effectiveness and limitations of school closures and the development of telework.”[v] It will take a long time. Nobody fundamentally says otherwise. We will be living the accordion of the constraints [in stops-and-starts], until the vaccine arrives.

Numbers and the impossible to bear

In the first session of Jacques-Alain Miller’s course entitled “The Other Who Doesn’t Exist and Its Ethics Committees” – a course in which I participated – he was led to articulate a certain impasse in the discourse of science, since it is no longer able to appease the anxieties of the subject of contemporary civilization, immersed as he is in the feeling that everything is semblance. This subject is confronted with the Other “in its ruination.”[vi] In our civilization, we know “explicitly, implicitly, while misrecognising it, unconsciously, but [we know] that the Other is only a semblant.”[vii] The term semblant is here taken in its broadest sense. It includes arithmetic calculation [le calcul].

We live in the empire of semblants.[viii] With this word, Lacan gave new life to the title of Roland Barthes’ essay, Empire of Signs. It was an opportunity to underline how close, for him, Japan seemed to be to Europe, thoroughly imbued with the civilization of science “the only communication that occurred there for me […] is also the only kind that over there as elsewhere can be communication, in not being dialogue: namely, scientific discourse.”[ix] The empire of semblants is not just one of the names of Japan, it is also one of the names of our civilization that is revealed.

It is from the inexistence of the Other that would guarantee the real of science that another real arises for the subject who lives in language – that of anxiety, hope, love, hate, madness and feeblemindedness [débilité mentale]. All these affects and passions will be lying in wait for us as we confront the virus; they accompany the scientific “proofs” like their shadow. As J.-A. Miller pointed out very well: “The inexistence of the Other is not antinomic to the real, on the contrary, it is correlative to it. […] It is […] the real proper to the unconscious, at least the one to which, according to Lacan’s expression, the unconscious testifies, […] the real as it manifests itself in the clinic as the impossible to bear.”

The impossible to bear is also present in these unavoidable choices that the ethical committees are trying to overcome, for there have already been and there will be major ethical problems to confront, whether at the level of medicine, as such, or on a personal level. As an expert simply puts it, on a medical level: “The difference today is that we will give up resuscitating people who, in current practice, could have benefited from treatment and survived. The lack of available resources determines the choices, not the medical criteria usually applicable.”[x]

On a personal level, the way everyone is able to interpret the appallingly restrictive instructions they are given introduces a critical variable into any overall calculation. The impact of the measures taken in European democracies may be sufficient, “but it very much depends on the way people behave and how they apply these instructions […]

In a state that is not totalitarian, it is a question of personal ethics. This can undermine the model one way or another.”[xi] No doubt it is because of these ethical uncertainties – which will come to the fore in a second phase – that European governments have found it necessary to turn to scientific committees.

Our future of numerical constraints

Confinement has given rise to original demonstrations of solidarity and ways of doing things that emphasize a regained sense of belonging to a community – one that is not simply that of a biological herd, but invents ways of being part of a collective society, like the Italians who sing in chorus from their balconies or applaud their national health staff. In Spain, the ironic twist of the authorization passes that allow one to walk one’s dog also testifies to the search for the right way to live, together, the unbearable constraints that fall from above.

But these constraints, which are certainly based on science, do nothing to alleviate the anxiety that each person feels about what awaits us. And we must prepare ourselves to be able to discuss, together, the merits of the intrusive mechanisms that will be put in place to keep us in check until the development of a vaccine, which is the only tenable outcome.

In Denmark, on the 12^th of March, lawmakers passed an emergency law that allows authorities to use coercion to examine, treat or isolate an infected person. The most powerful and, at the same time, most subtle form of constraint will be the use of individual tracking apps to regulate the constraints in their severity and in their application. As early as the 17^th of March, drawing on examples from Israeli and Singapore, the editor of the MIT Technology Review predicted our new digital future: “Ultimately, however, I predict that we’ll restore the ability to socialize safely by developing more sophisticated ways to identify who is a disease risk and who isn’t, and discriminating—legally—against those who are. We can see harbingers of this in the measures some countries are taking today. Israel is going to use the cell-phone location data with which its intelligence services track terrorists to trace people who’ve been in touch with known carriers of the virus. Singapore does exhaustive contact tracing and publishes detailed data on each known case, all but identifying people by name.”[xii]

While doing everything we can to help hospitals and health personnel to meet the public health imperatives that are overwhelming them, we must also, one by one, help to elucidate how the practices of collective constraints to which we consent must be developed in such a way as to ensure they are livable. Not only top-down, but also bottom-up, by showing the right ways to respond to it. This implies transparency in the health data and the policies that are being developed, beyond the tremendous effort of clarity of the Ferguson report.

Translated by Philip Dravers
 

Originally published in Lacan Quotidien 874, 19^th March 2020, available here.

[i] Morin H., Benkimoun P. & Hecketsweiler C., « Covid-19 : les scénarios décisifs de modélisateurs britanniques » / « Coronavirus : des modélisations montrent que l’endiguement du virus prendra plusieurs mois », Le Monde, 17 March 2020, available here.

[ii] Ducourtreux C., «“L’immunité collective” : stratégie risquée du Royaume-Uni pour lutter contre le coronavirus », Le Monde, 15 March 2020, available here.

[iii] Cf. “No 10 denies claim Dominic Cummings argued to ‘let old people die'”, The Guardian, available here. [Reference added to the original [TN].

[iv] Horton R., quoted by ibid., available here.

[v] Morin H., Benkimoun P. & Hecketsweiler C., « Coronavirus : des modélisations montrent que l’endiguement du virus prendra plusieurs mois », op. cit. & « Expected Impact of School Closure and Telework to Mitigate COVID-19 Epidemic in France », available here.

[vi] Miller J.-A., « L’orientation lacanienne. L’Autre qui n’existe pas et ses comités d’éthique » (1996-1997), lesson of 20 November 1996, unpublished.

[vii] Ibid.

[viii] Lacan, J. “Lituraterre”, trans. A.R. Price, Hurly-Burly 9 (2013), p. 38.

[ix] Ibid.

[x] Hirsch E. (professeur d’éthique médicale à l’université Paris-Saclay), « Covid-19 : des choix éthiques redoutables attendent les équipes médicales », on an opinion page on the website of Figaro, 17 March 2020, available here.

[xi] Cauchemez S. (epidemiologist at the Institut Pasteur and modeller for the AP-HP), quoted by Hecketsweiler C. & Pietralunga C., « Virus : les simulations alarmantes pour la France », Le Monde, 17 March 2020, available here.

[xii] Lichfield G., “We’re not going back to normal”, MIT Technology Review, 17 March 2020, available here.