Social distancing with an awareness of clinical vulnerability: uncertainty, insecurity and coronaphobia
The extent to which social distancing disrupts fundamental aspects of embodiment, intercorporeality and trust, together with the wider economic and political upheavals caused by the pandemic, has led to a widespread atmosphere of global uncertainty experienced on both an emotional and social level (Carel et al. 2020). This is arguably especially the case for people living with COPD: they are told they are “at risk” and “vulnerable” to becoming seriously ill or die from COVID-19 (nhs.uk 2020); they have been subjected to the most stringent forms of social distancing (gov.uk 2020); they are uniquely aware of what breathlessness is and feels like (Philip et al. 2020; Askov Mousing and Sørensen 2021). Whereas people with a range of pre-existing illnesses and disabilities have expressed fears about not being prioritised for COVID-19 medical treatment, people with respiratory conditions are uniquely attuned to what this potential denial of treatment might involve, and to the discomfort and terror of how a breathless death from respiratory failure might feel (Philip et al. 2020). Emerging research suggests that the COVID-19 pandemic may significantly be harming the interoceptive abilities and mental resilience of people with long-term respiratory conditions (De Lucia et al. 2020), and is causing existential fear and anxietymost acutely among people with COPD (Askov Mousing and Sørensen 2021). Given this, and given the burgeoning global phenomena of “coronaphobia” and Covid-related increases in mental ill-health (Dubey et al. 2020), more research into the wellbeing and psychosocial needs of people with COPD throughout social distancing is needed (Yohannes 2021).
Social distancing when isolated to begin with: relational, digital and health inequalities
The so-called “new normal” of the emerging rituals and etiquette of socially distanced interactions are rapidly and often creatively evolving, both face to face and online (Carel et al. 2020; Katila et al. 2020). These preclude the instinct and intuition which have historically informed intercorporeal interactions (Dolezal 2017; Dolezal 2020). For people for whose social relationships involve high levels of human touch through handshakes, embraces or other rituals of status and intimacy, the social distancing of both online and face-to-face encounters can be emotionally draining (Carel et al. 2020) and may lead to uncertainties and ambiguities of social status, positioning and expectation (Katila et al. 2020). People must now discuss and agree in advance whether they will shake hands, how far apart they will stand and which toilets they will use. In addition, face coverings and poor telephone or internet connections can reduce the audibility of voices and obscure the non-verbal communication from expressions which accompany speech, meaning that people must work harder to understand one another (Katila et al. 2020). Given that people with COPD are usually older and less socially advantaged than the population in general (DoH 2011; WHO 2019), it is reasonable to assume that many will be harder of hearing and less able to afford the higher quality electronic devices required for optimal online communication.
Newly emerging online means of interaction and relatedness, for example group video chats rather than travel to events, can provide social opportunities that might not otherwise be accessible to people isolated by limited mobility or other physical impairments (Goli 2020; Rossolatos 2020; Vallee 2020). Social distancing is not necessarily entirely detrimental to social relationships among those who use the internet. However, the growing status and importance of social media and video conferencing as a phenomenologically existing real place by definition excluded those who do not use the internet. Although no specific data exist, it is reasonable to assume the demographic and social profile of people with COPD (DoH 2011; WHO 2019) means that, even in the most technologically developed societies, many cannot access the internet. People with COPD are vulnerable to new ways of becoming lonely, and emerging research suggests their loneliness to be phenomenologically unique (Burlacu et al. 2021).
Social distancing has moved online not only social relationships but professional and public services; people are newly required, for example, to send photo and videos messages of medical symptoms to their doctors and to attend the funerals of their friends via livestream. For those who cannot access online technology due to poverty, remoteness, or lack of infrastructure, for those who struggle to operate digital devices and for those who are uncomfortable with such innovations, this can exacerbate what was already a complicated and multi-faceted “digital divide”, among older adults (Beaunoyer et al. 2020; Ramsetty and Adams 2020). Yoeli and Macnaughton (2021) have found that, for people with COPD, internet use, isolation, and coping are largely socially patterned. Further research is needed, and future research must remain attuned to the specific barriers to social interaction and online care with which people with COPD contend.
Social distancing as a stigmatised being: fear, mistrust, and scapegoating
By foregrounding the COVID-19 infection risk that individuals pose to one another, social distancing reduces the human body from a social to a physical entity, and then further to a potentially pathological one. The basic premise of social distancing is that all humans are potential carriers of COVID-19 and that all humans bodies are an infection risk both to and from one another (Dolezal 2020; Goli 2020). Inherent within the avoidance of proximity and touch is a fundamental mistrust of other people, and a fear of their bodies. This fear and mistrust is being enacted not only at an individual and interpersonal but a social and global level, attenuating the atmosphere of economic and political and economic uncertainty and crisis the pandemic has brought (Carel et al. 2020).
Plagues and pandemics throughout history have repeatedly demonstrated that people perceived as most vulnerable to the virus have been stigmatised (Logie and Turan 2020), and already-marginalised groups have been scapegoated as potential carriers and spreaders (Jones 2020). Although parallels are frequently drawn between COVID-19 and the global AIDS pandemic of the 1980s and 1990s, the differing means of transmission between the viruses responsible have led to subtly different stigmas. As a blood-borne virus, AIDS specifically requires sexual transmission or intravenous access; as an airborne virus, COVID-19 requires only physical proximity, or an absence of social distancing. Whereas AIDS stigmatised and scapegoated people primarily for their perceived behavioural choices, albeit with overtones of racism (gay sub-cultures, drug users, hypersexualised black men), COVID-19 stigmatises only bodies, and particularly bodies regarded as “deviant” or “other”.
Within the global climate of mistrust and uncertainty, certain groups are finding the experience of having their “different” or “other-ed” bodies stigmatised or shamed is a familiar one—women, queer or disabled people and people of colour (Dolezal 2015a, b)—something which may explain the resurgence of Black Lives Matter protests during the COVID-19 pandemic (Crooks et al. 2021). Given this, given the disproportionate scapegoating of black people during the AIDS pandemic (Logie and Turan 2020), and given the increasingly emotively contested explanations for the increased prevalence and mortality of COVID-19 among people of black and Asian heritage across Europe and North America and people of indigenous heritage across the Americas and Australasia (Blundell et al. 2020), it is likely that the pandemic stigmatisation of people with COPD will become intersectional. People with COPD from disadvantaged racial or ethnic minorities are thereby likely to experience this intensified stigma most acutely (Devakumar et al. 2020). Researchers, like health and social care practitioners, must remain conscious of this.