Lectures

The Bubble: A New Medical and Public Health Vocabulary For COVID-19 Times

This article is part of the series:

Bubble, bubble, Mum, Mum, give bubble!

The task of keeping a two-year-old busy at home during a national ‘Level 4’ lockdown to prevent the spread of global virus, involves a lot of play with bubbles. We have a bubble machine that runs soap water and our kid can run through it for 15 minutes, enough time for me to reply to a few student emails. But on March 25th, “The Bubble” moved from being about play, to a very serious strategy to manage and hopefully mitigate the spread of COVID-19 in Aotearoa, New Zealand. 

As a feminist medical anthropologist living, working, and caring in Aotearoa New Zealand, with close family in India, United States, and Spain, I have been carefully examining and reflecting on how COVID-19 is shaping various local landscapes. Globally, each country is creating, testing, and implementing various strategies to address the medical, economic, and social challenges this pandemic poses – from complete lockdowns to planned physical distancing. Due to my own personal and professional interests, I have been watching how the current situation has unfolded globally, while simultaneously paying particular attention to Aotearoa’s modelling, response, and messaging. An island nation, ostensibly committed to the wellbeing of its Pacific neighbours, helmed by a charismatic leader, Aotearoa New Zealand has gained international recognition as a country that has managed the “COVID-19 crisis” well.

One of the key components of managing COVID-19’s community spread in Aotearoa was an (initially) ambiguous concept of “bubble” as a space (home, dorm, shared flats, etc.) to which its inhabitants were constrained. Additionally, those in your “bubble” were the only people you were allowed to have any physical contact with. The bubble became a prominent part of our everyday lives. On Wednesday, March 25 the country went into complete lockdown. We were told that this meant no movement of people was allowed, unless they were providing absolutely essential services. My husband, who is categorised as an essential services worker, was issued a letter allowing him to travel into the city for work. Similar letters were issued across the country to other essential workers who had to travel for their jobs in hospitals, certain government offices, and grocery stores. Everyone else was only allowed to go for “brisk walks” around their neighbourhoods and shop at their local grocery store or pharmacy. All other non-medical non-essential movement and gatherings were forbidden. While this minimal level of movement was allowed, other collective activities, including vising dying family members or attending their funerals, was not permissible. The idea of the complete lockdown was to prevent community spread and try and get the country (and economy) back on track quickly after the four–week Level 4 lockdown.[i] We were told we could only socialize within our bubble. This strategy seems to be working. The country has gained recognition in the international press as the local virus’ management trajectory moved from #flatteningthecurve rather quickly to #eliminatethevirus. To this date, community spread has been curtailed in Aotearoa. The success of the “bubble” here could impact policy and vocabulary globally as we continue to live with COVID-19 for the foreseeable future.

“The bubble” becomes part of all our collective vocabulary!

This directive to live with/in our bubble came to us through an “emergency message” that beeped into our phones on Tuesday March 24th, 2020. The message instructed us that “wherever you are at 11:59 pm, is where you will stay for the duration of the Level 4 lockdown.” Throughout press conferences, news stories, and media discourse “The Bubble” became a way to reimagine the spaces in which we already lived and who could be included in our everyday social lives. It conceptualized the group of people you live with as your bubble and limited your physical interaction with/in that limited number of people. Everyone was given 48 hours to negotiate with whom and where their bubble would be formed. Some bubbles included intergenerational families, while other single-person households were given the option of merging into another bubble. Policy sought to strike a balance between isolating with a few people and not allowing people to feel isolated if living alone. 

The bubble was integrated into Kiwi vocabulary almost instantly. Within the week, tweets surfaced about good parenting with/in the bubble and email signatures ended with ‘stay safe in your bubble.’ It shaped everyday life for over four weeks, and will continue to do so as the discourse shifts to larger bubbles – that is, to increasing some of our interactions and movements, but still maintaining physical distance to continue mitigating the spread of the virus. 

The Bubble is no child’s play! 

Seeing this discourse around “The Bubble” and “Our Bubble” emerge and shape social practices (only one person from your bubble goes to the store, children were told about the ‘bubble formation’ of staying away from others, etc.), I was reminded that we have all heard of “the bubble” in different contexts previously. I remember living in the US when both the techno-economic Silicon Valley “tech bubble” and the “housing bubble” burst. And let us not forget about the economic shining star of bubbles – the speculative bubble. Within economics and finance, bubbles have shaped policy and practice. Peter M. Garber, opened his book Famous First Bubbles: The Fundamental of Early Manias with the lines, “Bubbles lie at the intersection between finance, economics, and psychology” (Garber 2001, ix). His book offered a historical account of three early commodity-inspired economic bubbles—the Dutch tulip mania, the Mississippi bubble, and the South Sea Bubble. Garber maps out the way these bubbles or “manias” were integral parts of a particular economic pattern and not aberrations. Bubbles and their bursting is accepted nomenclature in the financial world. Here the bubble was imagined as an overrun of speculative value, a result of capitalist effervescence. As bubbles popped economies came back to reality. 

Another space where “the bubble” has been part of the popular imaginary is in medical fiction (based on real medical cases). In 1976, a made-for-television movie featuring John Travolta called The Boy in The Plastic Bubble. The movie was based on the lives of David Vetter and Ted DeVita who were immunocompromised. And I am sure nobody has forgotten the more recent American movie, Bubble Boy, with Jake Gyllenhaal moving his bubble across the country for true love. These two movies are the closest I have come to seeing the bubble serve a medical purpose in the public imaginary (even though bubbles are all over medical spaces irrespective – i.e., bubbles in IVs or injections for example). A bit less famous is Bubble by Stewart Foster. This is a novel that takes us along a journey with a young boy who lives in a hospital and worries about stepping out – as the dangers of moving outside his bubble are known to him and his team of medical specialists. 

But while it is part of the public imaginary (within and beyond medical spaces), “the bubble” has rarely been used by epidemiologists (or other medical professionals). They use the word ‘isolation’ as opposed to ‘bubble’ living because bubbles connote fragility. A bubble burst would be fatal. And we know bubbles burst (or deflate, as articulated about genomic sciences in the now well read and debated “Deflating the Genomic Bubble” article in Science in 2011). 

In the recent past, the topology of the “the bubble” has been an interesting and complex conceptual frame to think with and through. John Thackara’s In the Bubble: Designing in a Complex World (Thackara 2005) was a book that asked about the utility of and dependence on technology. Thackara drew from a range of everyday examples to argue that things, spaces, technologies without people were problematic and needed to be rethought. He offers ideas for another world, still technologically savvy, but also redesigned with the human at the centre of that bubble. When I mentioned this article to my bubble-mate, he recommended that I look up Peter Sloterdijk first book in the Spheres series titled Bubbles Spheres Volume I: Microspherology (Sloterdijk 2011).[ii] It is a philosophical conversation that draws on science, art, and metaphysics to suggest that human life is an immunological project as opposed to a temporal one. While I cannot do justice to his argument in this short blog, I recommend the introduction as a starting point if the conversation on “the bubble” fascinates you as much as it does me. Early in the book Sloterdijk outlines his reason for thinking about bubbles in the first volume of “spheres.” He is inspired by Sir John Everett Millais’s 1887 painting “Bubbles,” which shows a little boy with a soap bubble as it gently floats above his head[iii]. However, the book is an interesting (albeit sometimes convoluted) engagement on thinking though this effervescent thing in the air – the bubble – as a way to rethink human history (and perhaps human futures). 

The three books I draw on conceptually have done some important and early work in the economic, financial, technological, and philosophical realm. These works allow for me to think and write about “the bubble” both conceptually and also map towards a clear public health intervention. However, they also pose a challenge and are limited in that they have not helped how we think about the bubble through a critical feminist, caregiving, racially and sexually diverse, marginalized lens. The medical space where the bubble (and bubbles in general) do vital work has not been explored. What does the concept of the bubble do differently for different lives? What does the medical bubble offer us conceptually, just as the tech and finance bubbles have historically? As COVID-19 consumes our everyday (both real and imagined), we have to think innovatively about physical distancing norms while simultaneously building social solidarity. The Bubble allows us one such opportunity, so long as we are willing to expand the bubble and also live with/in busted bubbles. We have to ask, what does the bubble do (or not do) to social lives and medical everyday as an artefact of emergency public health measures? 

My 2-year-old can be kept busy for a while running through and trying to hold and merge bubbles. The bubbles bring him equal amount joy and annoyances, as most burst, the moment he touches them. 

COVID-19 has made a medical public health conversation around the bubble emerge. In Aotearoa New Zealand the policy discourse and practice around the bubble, supported by scientists and policy makers, seems to date to be working as a strategy to manage community spread of the virus. Yet, we are unique, in that we are led by a relatively young feminist prime minister, who listens carefully to scientists and trusts the medical establishment. We are also an island nation with a small population (five million) and island living is itself a kind of bubble. These factors have made compliance around social (physical) distancing (mostly) possible across the country. Like elsewhere, COVID-19 in Aotearoa New Zealand has raised a mirror to the many social differences and inequalities that shape our everyday lives. These in turn manifest in the shape of our own bubbles. Yet the topology of bubble and its homologies across other domains of thought raises conceptual questions beyond these socio-economic manifestations. Perhaps the challenge will arise if we continue our bubble living longer-term and/or if the concept of the bubble transfers to different countries trying to strategize ways to deal with COVID-19 and citizen wellbeing. 

While the immediate epidemiological benefits of living in the bubble during a pandemic with characteristics like COVID-19 are relatively clear – limiting interactions and thus curtailing the spread of an extremely dangerous virus – there are limitations that cannot be ignored. Bubbles burst. And therein lies the utility of using ‘the bubble’ as a temporary measure for this current emergency. It is language couched in child’s play and can compel people to pay attention to the fragility of the bubble. It asks everyone to take care because the bubbles can burst so easily and each bursting comes with risks. The language of temporality built into the bubble acknowledges that the bubble is not sustainable for most. I am in many ways a global citizen, with deep entanglements in many countries – both personal and professional. I will need to breach my current bubble to physically reconnect with family and friends again in the (hopefully) new future. The bubble also limits our ability to know other worlds intimately, let alone change them. Bubbles offer us a transparency, yet diffracted light distorts what is see in/through bubble layers. The bubble can create a particular border politics that gets internalized, if not checked and curtailed. That is the temptation to stay in one’s own comfort bubble permanently shaping immigration and border policies locally and globally. Bubbles could make borderlands dangerous again (with real medical or state-imposed threats for violating borders), as opposed to places of possibilities (Anzaldúa 2007). As a feminist scholar, I can see the bubble emerging as problematic jubilatory discourse around the nuclear family as a site for care. The bubble limits, even if it protects. 

But luckily bubbles are temporary, they burst! The bubble is good in the short term, bad for the long term, but its greatest contribution to the current discourses is that is it temporary. It pops. It thus compels us to create a world that we can live in, beyond the bubble. It entangles us with a very concrete demand for a future-making project – one that safeguards its most vulnerable.

The materiality of the bubble allows us to think anew not just medical spaces in times of an emergency, but also larger political projects. Bubbles are transparent, they’re fragile, they’re weightless, they’re shiny, and they are an improbable expression of the physics of surface tensions. They have similarities and differences with other spherical objects like balls, clouds, and balloons (to list but a few). While I am interested in the imaginative (and some very material) resources that the bubble lends us currently, I also want to examine from within medical anthropological spaces what the bubble may offer for structural changes for public health. Deployed very strategically (and perhaps as ambiguous policy initially), the Bubble to contain COVID-19 promises us an end to this bubble living. And that is the value of the Bubble as a public health initiative. It enables policy that temporarily creates space and distance between people and lives; but is committed to staying temporary. Medical anthropologists, along with other academics and activist will have to encourage the use of “the bubble” to ensure public health currently as it allows us to work towards a bubble future making project. That is a world without bubbles of privilege and non-privilege (or as we know them currently – slums, bastis, and/or ghettos). 

As I reflect on “the bubble” from within my own bubble, I have recently been invited to join up with a group of Anthropologists here in Aotearoa New Zealand and LSE, UK on the experiences of lockdown in both these countries. We want to collectively look at how care is negotiated in times of COVID-19 as we practice physical distancing and call it different things in different countries. I look forward to working in a different intellectual space – bubble – just as I desperately look forward to a future where living in the bubble is not an option for anyone. While we talk of the COVID-19 initiated discourse around the medical bubble, I want to move that conversation further. For a truly egalitarian future, we will have to work as academics and as activists to burst every bubble responsibly. I look forward to thinking about the bubble as health-related public-policy mechanism to address the way we live in a COVID-19 world, but also a metaphor for a future making project. 

Garber, when defining the bubble (from largely a finance and economics perspective) writes:

“Bubble is one of the most beautiful concepts in economics and finance in that this it is a fuzzy word filled with import but lacking a solid operational definition. Thus, one can make whatever wants of it.” (Garber 2001, 4)

However, given our current COVID-19 world, we are going to have to co-opt the language and meanings of the bubble as policy across the world takes into account various ways we manage social distancing, while ensuring people are able to live healthy (and ha, productive!) lives. As medical anthropologists, we are going to have to work with public health officials and epidemiologists as we figure out ways to take care of those who need to be in bubbles, to burst bubbles when we need to, and then work towards creating a bubble free world where being removed from another’s misery is not an option – but rather, only a collective global bubble. 

The bubble conceptualized as language for medical care and social distancing in Aotearoa New Zealand in 2020 may be the start of a global way to talk about, make accessible, and increase compliance to social distancing rules in a COVID-19 world. We will be living with COVID-19 for a long time, and will have to work, live, love, care, play with/in bubbles to ensure the health and wellbeing of our fellow citizens. But just as we live in our bubbles and “carry on,” we’ll have to remind ourselves that there are important things beyond our bubble and it is our duty to slowly and responsibly burst our bubbles or merge our bubbles. We will have to design our research to account for the life with/in bubbles, but also constantly ask of our participants and ourselves what life outside the bubble ought to look like and how we can make it possible. We will have to care for the bubble, but also, when the time is right, burst that bubble. We will need to come to term with impermanence – particularly in global public health policy. 

I gently tell my bub, “Bubble finished, bubble over, bubble finished” as I put away his bubble play. Through his few tears and low grade ‘level-1’ tantrum, I re-direct my 2-year-old into the next activity. 

He needs to know: bubbles are important but also temporary. He needs to know that sometimes we need bubbles for joy and caring for our community; but also, that we have to burst bubbles so we can all be equally happy together. We have to imagine a future beyond the bubble, while living with/in the bubble. 

I have to start training him early. It’s now time to play with Lego and build something  new!!!


Nayantara Sheoran Appleton is a Senior Lecturer at the interdisciplinary Centre for Science in Society, Victoria University of Wellington, Aotearoa New Zealand. Trained as a feminist medical anthropologist and STS Scholar (with a PhD in cultural studies) her first project is a book manuscript titled Emergency Contraception: Medicine, Media, and the (re)Imagined Family Planning Project in Contemporary India (under contract at Rutgers University Press). Her second project is on the ethics and regulations of stem cell research and therapies in India. Having recently moved to Aotearoa New Zealand, she is now starting to conceptualize a project that explores relationship between immigrant and indigenous communities – both within and beyond the medical space. Her research interests are in the following areas: Feminist Medical Anthropology and Science and Technology Studies (STS); Cultural Studies and Media; Reproductive and Contraceptive Justice; Population and Demographic Politics vis-à-vis climate change; Critical Kinship; Ethics and Governance; Regenerative Medicine; Critical Science Communication; Immigrant and Indigenous Relations; and Ethnographic Research Methods. And now Bubbles! 

Acknowledgments 

A special thank you to my bubble-mates for listening to me go on about “the Bubble” and then providing feedback on this early version of the article. Eli Elinoff, Ashely Elinoff, Courtney Addison, Michael Appleton, and of course little Samraj….thank you for playing along with/in my bubble! 

Bibliography

 Anzaldúa, Gloria. 2007. Borderlands: The New Mestiza = La Frontera. 3rd ed. San Francisco: Aunt Lute Books.

Garber, Peter M. 2001. Famous First Bubbles: The Fundamentals of Early Manias. MIT Press.

Sloterdijk, Peter. 2011. Bubbles. Vol. Spheres Volume I. 3 vols. Cambridge, MA: MIT Press. https://mitpress.mit.edu/books/bubbles.

Thackara, John. 2005. In the Bubble: Designing in a Complex World. Cambridge, Mass: MIT Press.


[i]The country’s level-4 lockdown ended on Tuesday, April 28th almost five weeks after it started. 

[ii]As can be imagined, this is a hefty tome of a book and I have not yet finished reading this book, but will be doing it for the larger, more developed article version of this piece. It will allow me to revisit some of my cultural studies training and use that lens to think through the medical discourse around “The Bubble” as a way to live/imagine our lives in COVID-19 times.  

[iii]Where is the art with little girls playing with bubbles? Or were bubbles just reserved for us to wash dishes with. The conversation on the bubble has to be queered and feminized. 


4 Responses to The Bubble: A New Medical and Public Health Vocabulary For COVID-19 Times

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