Getting Real: Disease Tourism

Read the latest installment of our Fictions series by Liz Williams here.

We are all currently having to acclimatise to a scenario where our day-to-day activities are subject to different restrictions related to the ongoing coronavirus pandemic. In the last month we have seen many regions, in the UK and globally, shift between alert or response levels as second, and in some cases third, waves of infection take hold. Our lives at work and beyond are largely influenced by the different restrictions in effect. There are personal and political tensions building, with regional battles ongoing and questions being raised about the Prime Minister’s approach to policing and enforcing restrictions.

In this blog we explore the latest short story written and how it relates to the COVID-19 response, what this means for individuals, different regions and the management of outbreaks. Crucially we consider what we do and don’t know about the feasibility of travelling, as well as whether local lockdowns can work in a highly individualised and divided society.

The most recent Fictions piece is quite different to the three we have published so far, from a stylistic and content perspective. To me, many of the societal features and the description of the main character’s life and choices are reminiscent of William Gibson’s imagined future in Neuromancer. The fashion choices and visual augmentations described also remind me of Suzanne Collins writing in The Hunger Games.

The substance of the story is related to a concept of “Disease Tourism”. The present story shares several themes with our story and blog which we published in September, about a societal health surveillance system. The facial recognition technology in night clubs is similar to some of the state surveillance systems discussed before, as are some of the concepts of “gaming the system” alongside the wider data implications we’ve explored before.

The imagined future is one of state-enforced safety from disease and the protagonist is looking for excitement and an escape from the mundane. Enforced safety, the ubiquity of social media and an abundance of incredibly advanced technology or entertainment appears to be an even larger and more significant part of life than the present. This is coupled with feelings of boredom and apathy, with many characters actively seeking danger and excitement. At present, there is ongoing consideration of the effects of social media and technology on the brain and behaviour – including in terms of dopamine, reward and addiction – although, in contrast with our fictional scenario, serotonin and mood do not seem to have received as much attention to date .

In the story, the main character is looking for distractions and thrills by holidaying in exotic environments, with a specific intention of catching a communicable disease. This is partially as a demonstration of social status, but the character also appears to have fetishised the scenario, to the extent that the ending appears to have some bizarre parallels with a martyr’s death: “I had achieved my life’s ambition”. Although it is quite an unusual cause with the main character to have given her life.

Voluntary infection is a concept which exists in a range of different settings in real life. The current race to find an effective COVID-19 vaccine has resulted in calls this week to find young volunteers to take part in “challenge-trials”. This form of trial is designed to speed up the process of testing the effectiveness of a vaccine, by purposefully exposing those in the trial to the virus, rather than waiting for trial participants to be exposed in a more routine fashion. This format of trial has been around for hundreds of years and is quite far removed from the context of the story, with an overall aim to provide protection, rather than to cause an epidemic.

Although not named as such, the story brings to mind the COVID-19 pandemic, with references to tracing cases and identifying local outbreaks which are all too familiar to us currently. The thermometers and scanners in night clubs, procedures at airports, different transition points and destinations are things many of us have now experienced but which just last year would have been very rare. Currently people do not seem to be trying to trick thermometer readings or health status checks to mask a fever or hide a positive test result. But it is not much of a stretch to imagine real world scenarios where the evasion of detection methods could become widespread over time. If access to loved ones, financial security or a range of essentials are affected by COVID-19 status, it has the potential to push people to make very difficult decisions.

From the earliest stages of the pandemic, travel corridors and air bridges became a focus of international policy discussion, at times with travel bans being used as a political tool. However as the second wave has grown and spread through Europe, many of these arrangements have been dismantled. Thinking back to the story and the use of various techniques to enable travel via the Penang-Heathrow air bridge, it is useful to reflect on our current situation. Adhering to self-isolation after travel is something the world largely must live with, and this is slightly different to being symptomatic or having a positive test result. There are many instances where this may be difficult to personally justify, for example, if you are the sole care provider for someone, or work on a contract which doesn’t provide sick pay, self-isolating based on travel guidance or the tracing app for two weeks is a significant decision. It has recently become apparent that the police are informed of compliance breaches from test and trace, although it is currently unclear how much information is shared and the extent of associated powers. In the story the authorities feature a few times, as undercover investigators as well as in a more official capacity to close down “darklabs” manufacturing communicable diseases.

With considerations of approaches to national lockdowns and regional or local lockdowns, we are starting to see heightened tensions with regions, questioning and rejecting central government rules. The UK has existed in a state of political tension for many years now, with the population divided on several key societal issues, with strong individual or group identities. A growth in populist approaches to political campaigning has contributed to this and we are seeing many consequences to this through coronavirus.

Whether entering different working environments, or travelling to different countries, it is becoming essential to be able to prove a certain health status. This could be through vaccination and immunization certificates, as you would with Hep B for work or yellow fever to travel, or it has been suggested for COVID-19 that the presence or absence of antibodies in your bloodstream could be used. While platforms are being developed to manage a global health passporting system for coronavirus it is not clear if: A) an individual can accurately prove their status, and B) how long that proof would remain valid for. This is as a result of ongoing concerns and conflicting evidence about COVID-19 testing type I and type II errors (false positives and false negatives), as well as the time window that antibodies appear, and persist in. One thing which is very clear is that the disease is highly variable in its manifestation, both symptomatically and biologically. We currently do not have a market ready vaccine, although there are six candidates in late stage trials, and questions remain about how quickly a vaccine can be rolled out and how effectively it will serve to protect populations.

There are many parallels between the story and our current circumstances. In recent weeks, many of us have been faced with the reality of a tiered system of regional restrictions for COVID-19. However, it is unclear exactly how this system will be enforced, sustained or successfully lifted. With such uncertainty in the future of vaccine candidates and testing approaches, community cohesion and both individual and collective responsibility to combat infection is essential.

There are many other technical, societal, and political themes mentioned in the story which would have been fascinating to explore. These include, AI romance and companionship, global health inequality, different test and trace approaches, as well as fashion-based personal augmentation and prosthetics.