Drawing the Lines: Health scares in the age of SARS

Abstract

Epidemics of fear, perhaps also of disease: here are some important foci for our present anxieties. By ‘us’ I mean the various academics, experts and professionals, who in the ‘western’ nations of North America, Europe and Australia have ongoing conversations on these subjects. Some health professionals are worried about a vast outbreak of a new or re-emerging infectious disease; others are worried about being deliberately attacked with disease or with deadly gas. But also, many health professionals worry about the enormous impacts that these public fears may have on economies and societies: ‘the problem with SARS,’ I have heard several in Canada say, ‘was not SARS itself, but fear’. They meant that the disruptions of SARS were vastly disproportionate to its body count, a mere 44 deaths, and I know they recall, and would like to prevent, other situations where public worries unjustified by scientific evidence (say, of radiation from powerlines) caused trouble and expense. Yet they seem to make little professional effort to trace the tensions between their fears and their fears of fear. And so we who observe public health from the humanities worry and wonder about their (our) worrying: is ours a ‘risk society’, a ‘culture of fear’? In this chapter I will join these conversations to reflect on current concerns about, and responses to, the threats of infectious disease. First, I will situate these concerns and reactions in a more general context of concerns about ‘health scares’ – social, as opposed to individual, phenomena, wherein we see a strong reaction to a specific event that appears to threaten the health of some significant social group. This is not the problem of disease but of ‘fear itself’, in the terms used above. I then briefly discuss concerns with epidemics of new and re-emerging infectious diseases as a particular category of health scare. Here I remind the reader of the central role that real borders, and conceived boundaries, play in these concerns: nation states remain the basic units for preventing and managing disease events, and they produce instrumental categories (like ‘susceptible’ or ‘infectious’) whose crossings are cause for concern. I argue that this may be understood in terms of the logic of dangerousness outlined by Foucault, and, after him, Castel, and that this logic has been reasserted amid contemporary ideas of information flow and of risk. With all this in mind, I then retell the story of SARS in Canada, to show how containment strategies such as quarantine, policing air travel and hospital boundaries, and hygiene messaging, which had vast, largely negative social and economic impacts, were determined by the tensions between these logics of dangerousness and risk. Whether one quarantined newly adopted Chinese children or the nurse in a hospital with SARS patients, whether one spent money on thermal scanners in airports or on hospital emergency wards, such decisions depended, given these logics, on where one chose to ‘draw the line’