In this essay Philippa Nicole Barr reflects on the epistemic uncertainty that characterised the Covid-19 pandemic and the possibilities opened up by forbearance.
The beginning of a pandemic is often typified by changing knowledge and emotions. When the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, it began to publish updates and information for the public. In a Situation Report published on 10 July 2020 it advised people to be wary of touching potentially contaminated surfaces:
“Respiratory droplets from infected individuals can also land on objects, creating fomites (contaminated surfaces)…it is likely that people can also be infected by touching these surfaces and touching their eyes, nose or mouth before cleaning their hands”.
I wiped down shared surfaces, wiped my laptop, wiped my phone. I washed my hands at home and sanitised everywhere else. These micro-rituals were an embodied adaptation to the new risk.
As the pandemic unfolded, various strategies were adopted worldwide to mitigate its spread, each shaped by specific cultural, economic, administrative and historical conditions. By December 2021 the WHO recognised the transmission of the virus through air, indicating that COVID-19 might be airborne in “indoor, crowded, and inadequately ventilated spaces” (WHO, 23 December 2021). This new understanding led to changes in public health directives in many Western countries, urging people to ‘mask up’ and prioritise ventilation over surface cleanliness.
In Sydney I adopted new habits. I tried to keep the windows open, mind the numbers in a room. The sense of stale air caused suspicion. Articles appeared exhorting employers to ventilate better, to prevent their staff sharing each other’s exhalations. This progression, from surface wiping to putting on masks and opening windows, exemplifies changes in our embodied responses to evolving knowledge. This essay explores how epistemic uncertainty, a concept which I will explain below, shaped responses to the COVID-19 pandemic. I consider Nicholas Shackel’s concept of ‘epistemic forbearance’ as a response to uncertain circumstances and incomplete or changing knowledge, and think about the temporal and economic contexts in which it may be applicable.
Epistemic uncertainty in science
Epistemic uncertainty is a form of uncertainty that can potentially be resolved through further research (Janssen et al 2021, 603). It is particularly prevalent during the early stages of a pandemic or epidemic, when knowledge of a novel pathogen and how it spreads is incomplete (Viale 2021, 149-150; Bjarnadottir et al 2019). This type of uncertainty was evident during the initial phases of the Covid-19 pandemic. In Nature Medicine, Pertwee et al highlighted how an ‘epidemic of uncertainty’ was undermining public trust (Pertwee et al 2022, 456–459).
The consequences of epistemic uncertainty, which is to say, uncertainty resulting from incomplete or changing knowledge, influence emotions and, in turn, policy. Science journalist Dylan Lewis argued, in relation to Covid-19, that delays to updates and advice following evidence of aerosol transmission risks exacerbated distrust and confusion amongst the public (Lewis 2022). Analysis of Covid-19 policies in Quebec demonstrate that higher levels of epistemic uncertainty led to more coercive governmental measures, such as a curfew implemented by the government to control mobility and transmission of the virus (Lemor and Monpetit 2024, 12). The authors of this research argue that policy decisions driven by fear of the uncertain were rolled back when additional data became available, allowing for the reopening of public enterprises like museums and restaurants (Lemor and Monpetit 2024, 4 and 10).
The dynamic interaction between emotion and uncertainty is termed ’emotional epidemiology’ by Associate Professor of Medicine Danielle Ofri. She has observed that emotional reactions to new illnesses evolve in response to uncertainty, a lack of resolution, or rumour (Ofri 2009, 2594-2595). Likewise, my research on emotional responses in historical epidemics, outlined in Emotion and Uncertainty in the 1900 Sydney Plague, argues that
“[a] transforming context actively intervenes in and changes sensitivities and the ways in which people respond to things, educating feelings, for better or worse” (Barr 2024, 55).
Thus, in pandemic contexts, policy responses and public health strategies are not only about managing the disease but also about managing emotions generated by uncertainty. This often necessitates adaptive strategies as knowledge accumulates over time – making time a crucial factor in the kinds of emotions influenced by uncertainty, and how uncertainty is managed.
Temporality and uncertainty
In countries defined by the World Bank as ‘high income’, Covid-19 was a relatively fast paced pandemic. By the 10th of January 2020, the DNA of Covid-19 was published by a consortium led by Yong-Zhen Zhang of the Shanghai Public Health Clinical Centre and School of Public Health on virological.org. Transmission was also rapid, as asymptomatic people who were unknowingly infected travelled from Wuhan to other parts of China and internationally.
Initially, the ambiguity and lack of projected duration or scope provoked stress, anxiety, panic – and action. A sense of urgency influenced scientific inquiry. Research into and production of a vaccine was frequently, almost universally, described as a “race”. The journal Science described the hasty production of research as resulting in a “firehose of data” (Kupferschmidt, 2020). Surveillance methods, such as testing and screening, contact tracing, and wastewater testing, quickly detected disease spread. This changing knowledge influenced new orientations, practices and experiences, from meeting people outside, replacing hand shaking with elbow taps, remote working and schooling, and the many other changes to ordinary practices in response to new public health rules. There was no doubt that in the very early stages, the rapid unfolding of events and the accompanying ambiguity contributed to a sense of panic. There were differences of opinion about whether it was the end of an era or a brief change.
In certain places slow responsiveness was also evident. Nature reported that “in many countries, officials were slow to act, ignored scientific advice or struggled to ramp up testing” (Callaway et al 2020). Temporal inequality was exacerbated between specific groups in high income countries, such as migrants or those from less advantaged socio-economic backgrounds who faced slower and less consistent access to safety, testing and treatment (Cingolani 2024).
In some low- and middle-income countries Covid-19 was also slower in regard to diagnosis and surveillance. The United Nations Development Program described a “slower and delayed vaccination rollout”. This resulted from fewer resources (from medical staff to infrastructure), or what is described as “low health system capacity”, as well as vaccine production and distribution. In 2023 an article in Nature Communications Earth and Environment argued that the Covid-19 pandemic has slowed progress internationally toward Sustainable Development Goals through “restricted activities, slowed economies, and reduced investment in areas other than health systems” (Yuan et al 2023). According to the World Bank,
“[t]he COVID-19 pandemic led to an unprecedented reversal of consistent decline in global poverty and caused the single largest annual increase in poverty rates since global poverty monitoring began”.
Nevertheless, where impacts and response were slower, Covid-19 arguably caused less of an acute temporal disruption. Instead of a sharp break from normalcy, the prolonged nature of the threat and a lack of resolution at times led to its normalisation. Regarding the experiences of migrant agricultural workers in Italy, Anthropologist Pietro Cingolani claims, “People find themselves in a condition of temporal disorientation, in which past experience is no longer useful for moving through the present or predicting the future” (Cingolani 2024, 2 and 6). This may result in a different kind of temporal experience, where the pandemic is subsumed into a background of hardship or crisis rather than foregrounded as a specific event.
Responding to uncertainty with forbearance
The ‘virtue’ of ‘epistemic forbearance’, as defined by Nicholas Shackel, represents a disciplined approach to knowledge and belief management under conditions of profound uncertainty, such as those present during a pandemic. As knowledge evolves, epistemic forbearance supports a readiness to revise beliefs. It calls for flexible thinking rather than “uncertainty phobia”, or the tendency to adopt dogmatic, rigid or extreme positions in response to the stress or uncertainty (Shackel 2022, 272). With the hallmark of complex crises being a kind of “unrelievable wild uncertainty”, there is a need for openness to new information and adaptability, such as the shift from wiping surfaces to masking as knowledge of disease transmission was updated (Shackel 2022, 271). Shackel’s approach aligns with recommendations for handling scientific uncertainty made by Koffman et al, who claim that instead of trying to “outsmart” uncertainty we should acknowledge it and work with it “effectively and efficiently” (Koffman et al, 2020, 211).
An acceptance that crisis will produce uncertainty may enable new embodied habits to be adopted with greater ease (Shackel 2022, 271-272). However, it would appear that this virtue is best adapted to fast pandemics, imagined specifically in relation to how Covid-19 unfolded in the West. In slower paced contexts, where change is gradual, or resolution elusive, can epistemic forbearance also ward against complacency and frustration that can accompany long periods without updates?
Conclusion
The ‘virtue’ of epistemic forbearance requires an adaptability to change, a patience to wait for new information, and an awareness that further change may be required as knowledge evolves. In simple terms, epistemic forbearance is a kind of fortitude, living with the discomfort that knowledge is provisional, and advice will change. Cultivating epistemic forbearance, at institutional, social and personal levels, may be useful to effectively and differently managing the uncertainties that inevitably accompany global health crises, the emergence of knowledge and habit change.
To hear more on the themes discussed in this article feel free to register to join the upcoming event: 5 years since Covid-19: shaping the future of global health.
About the author
Philippa Nicole Barr is affiliated with Australian National University and Western Sydney University. She is the author of Uncertainty and Emotion in the 1900 Sydney Plague published in 2024 by Cambridge University Press, and can be found on Twitter/X @philippabarr_
References
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