How Covid-19 created a new hierarchy of suffering

Private trauma has been overshadowed by the public health emergency, leading many to feel their individual troubles count for less.

By Julian Baggini

“Do you normally talk like this?” The third time a doctor asked me this I realised that I was in a worse state than I had thought. My “flu” had been raging for nine days. I had lost any appetite and felt terribly weak. After visiting my GP I was sent to have a chest X-ray, the results of which saw me admitted to the respiratory unit of the Bristol Royal Infirmary.

Within a day I was in intensive care. The doctors were seriously thinking about intubating me. I was quickly attached to multiple tubes and a catheter and was on oxygen 24 hours a day. Tests were done but no one was sure what had caused this pneumonia.

I had several atypical symptoms. One of the strangest was that I had unstoppable hiccups. After a couple of days, medics shoved a tube down my throat, gases were released and finally the hiccups stopped. More seriously, although my oxygen levels were low, I didn’t feel breathless or distressed (this “happy hypoxia” would later turn out to be one of the more unusual symptoms of Covid-19).

I was lucky. I was never intubated and after eight days, at the end of February 2020, I was discharged and started on a slow recovery over the following months. I had fallen ill when coronavirus was still a foreign news story, something that was raging in China – there was no Covid testing in UK hospitals. Ever since, I have wondered: did I have it?

I still don’t know. A consultant reviewing my case for a check-up a few months later told me she had gone through the case notes thinking “Covid, Covid, Covid…”. I paid to have an antibody test four months later but the negative result was not definitive.

Why should it matter? What I went through would not be made any better or worse if I knew it was Covid. Curiosity is a big motivator. But is that it?

If I’m honest, I think that I want my illness to have been Covid because that would somehow make it more meaningful, more significant. If it was Covid, I had a role in this grand global drama. If it wasn’t, it was just another private trauma, and who these days has got the spare emotional energy to deal with one of those?

I suspect this desire for our suffering to have some wider meaning is not unusual. From the start of the pandemic, our attempts at resilience rallied around the slogan “we’re all in this together”. But so many of our problems have nothing to do with Covid at all. And when we pull together around one thing, everything else tends to fade away. How many have felt their own suffering has been less important, and so somehow excluded?

We know this happened in at least one way. In April 2020, an NHS England Poll suggested that four in ten people were not seeking help from their GP because they were afraid to be a burden on the NHS during the pandemic. By October, nearly half of those surveyed still said they would delay or not seek medical help at all, with 22 per cent citing not wanting to be a burden on the health service as a motivation.

The language of burden only makes sense if there is a hierarchy of need in which some claims on doctors’ time are considered more legitimate than others. This shows that a significant percentage of the population have not just internalised the feeling that their individual suffering counts for less, they have explicitly validated it.

The idea of hierarchies of illness is something the medical profession has been aware of for decades. In 1943, the philosopher and physician Georges Canguilhem talked about a “vulgar hierarchy of diseases” based on “the extent to which symptoms can be readily identified and localised in the body”. His key insight was that forming a clear idea of an illness in itself makes us feel that we have more control over it. “To see an entity is already to foresee an action.”

More recently, a distinction is made between high prestige illnesses such as breast cancer and heart disease, which are well known and elicit sympathy, and low prestige ones, such as inflammatory bowel disease, metabolic disorders and lung cancer, which are often seen as embarrassing or self-inflicted.

Hierarchies of suffering affect more than just health issues. If you have lost your job because of lockdown, you have a sense that you are one victim among millions. If you lost it for any other reason, you belong to a club of one.

The contrast is even more acute when a business goes bust. The fact that there is no shame in going under because the pandemic stopped you trading can make those who failed simply because their business plan didn’t work look and feel even worse in comparison. It is the difference between being unlucky and feeling at fault.

Then there is what the charity Mind called the “second pandemic” of mental health as the virus resurged this winter. But, again, if your depression or anxiety has nothing to do with Covid-19, you are excluded from the dominant narrative.

All of this creates a pressure to tell a story in which the pandemic was a factor, even if it wasn’t. That way, we get more sympathy from others and can perhaps also be more compassionate with ourselves. But if we succumb to this temptation and convince ourselves that our problems are the result of the pandemic, we risk evading the real reasons behind them, postponing the necessary reckoning with the underlying causes until coronavirus retreats.

The most insidious effect of our new hierarchy of suffering is a sense of guilt: if you think you have got a problem when the world is in distress from Covid, it had better be a big one. But it is simply false that if you have escaped the ravages of coronavirus, only to be caught in those of something else, your own suffering counts for less.

One year into the pandemic, it is time to consciously step back from the crisis that has obscured all else and check up on all those we might have neglected as a result. We keep learning that the victims of Covid are more than simply those who are directly affected by the disease. Now we can see that, paradoxically, it includes many who were not affected by it all.

Julian Baggini’s most recent book is “How the World Thinks” (Granta)