The clocks run at slightly different speeds. Clashing timeframes in COVID-19 health risk governance

Abstract

Decision-making processes in times of crisis are rarely scrutinised. In this study we open up the ‘black box’ of regional COVID-19 decision-making. From March 2020 to June 2021, we had the unique opportunity to do (mostly) on-site ethnographic research and watch the unfolding of COVID-19 decision-making, as this took place in meetings. This enabled us to examine how timeframes played a key role within an important decision-making forum in the Netherlands: the ‘regional safety authority’, responsible for regional crisis and disaster management. Our study highlights how timeframes structure the ways in which normative choices and dilemmas are considered and political decisions are made. We identify three timeframes that ‘perform’ a specific temporality: the ‘no time to waste’ frame, the ‘taking the time’ frame and the ‘future time’ frame. These timeframes form a specific composition of (1) patterns of action, (2) objects at risk, and (3) values that feature in decision-making. We reveal how the ‘no time to waste’ frame dominated decision-making, producing a solitary focus on a rather narrow concept of safety, while other timeframes and other voices, measures and values were marginalised. We argue that timeframes can and should be negotiated and made explicit in a balanced approach to governing a pandemic or other types of long-term crisis.

Keywords:

• COVID-19
• timeframes
• values
• risk
• ethnography
• pandemic

Introduction

The first two years of the COVID-19 pandemic have been characterised as a crisis (Lupton, 2022). The literature on crisis management generally emphasises the need for urgent decision-making and remedial action under conditions of high uncertainty, in both a normative and epistemic sense (Boin et al., 2016; Evans, 2021; Parviainen et al., 2021). One of the defining components of crises then, is the idea that time is ‘at a premium’ (Boin et al., 2020). However, there is much that we do not know about the role that time plays in governing crises.

Decision-making in times of crisis is often an inscrutable process. Publicly, politicians and other decision-makers usually present decisions as the outcome of a rational process, obscuring that decision-making is often highly politicised and involves normative choices (Stone, 2012). During the COVID-19 pandemic, such choices concerned value trade-offs, for example between preventing the spread of infection and social safety and wellbeing (Lupton, 2022; van Bochove et al., 2022), and between rapid decision-making and democratic legitimacy (Parry et al., 2021).

In our analysis below we focus on the ways in which different timeframes influence processes of pandemic decision-making. Taking inspiration from Heyman (2010), we understand timeframes as the enactment of a specific temporal structure that results in specific modes of governance and bring specific actions, risks and values into being. By focusing on these timeframes and their effects, we respond to recent calls to incorporate timeframes and temporalities into COVID-19 research (Brown, 2020; Jarvis, 2021a, 2021b) in order to scrutinise how timeframes influence value trade-offs, and which values are bracketed off or looked past (Brown, 2020).

Social science research into COVID-19 policy and management is currently burgeoning (e.g. Alaszewski, 2021a; 2021b; Bal et al., 2020; De Graaff et al., 2021; Lupton, 2022; Suckert, 2021; van Bochove et al., 2022; Zinn, 2020), contributing to what Brown and Zinn (2021) coin a new sociology of pandemics. Some of these studies also focus on time, for example showing how the media constructed the crisis using different time narratives (Jarvis, 2021a, 2021b). None, to our knowledge, have examined how timeframes influence important decision-making fora in their daily practices.

Our study opens up the black box of decision-making and scrutinises decision-makers up close. We analyse decision-making in an important forum in the Netherlands: the regional safety authority,¹ the body responsible for regional crisis and disaster management, including major outbreaks of infectious diseases. COVID-19 was declared as a major incident because the impact of the virus was defined as having ‘more than local significance’, resulting in the need for coordination and a mandate regarding the implementation and execution of COVID-19 measures across municipalities. Consequently, decision-making power was transferred to the regional safety authority (see later for more context). Our analysis is based on an ethnographic case study for which we conducted 180+ hours of observations of crisis and other meetings and 16 semi-structured interviews with respondents from one regional safety authority in an urban area in the Netherlands. Foregrounding our analysis of governing the pandemic we were guided by the following question: ‘Which timeframes feature in decision-making on COVID-19 and how do they steer action, risk and values in governing the pandemic?’

The decision to foreground time was both theoretically and empirically informed. In our research we noticed very early on that the framing of time was of utmost importance within decision-making in different ways. We identified three timeframes in our results: the ‘no time to waste’ frame, the ‘taking the time’ frame and the ‘future time’ frame. These three timeframes are formed by – while simultaneously forming – a specific composition of (1) patterns of action (2) objects at risk, and (3) values that are foregrounded. Before presenting our findings, we situate the article’s theoretical underpinnings and methods, followed by a discussion of the entanglements between different timeframes and their consequences for health risk governance. We end the article with a brief conclusion.

Framing time

Time ‘does not exist outside action and interpretation’. This interpretation of time acts as a constitutive force that shapes decision-making through framing time in a specific way (Daipha, 2015, p. 203). Seen this way time is not a mere background variable, but instead is both constructed and a constituting force (Adam, 1990; Brown et al., 2013; Elias & van den Bergh, 1985; Giddens, 1984; Nowotny, 1992; Orlikowski & Yates, 2002) in and of decision-making. In this article we analyse how health risk governance is influenced by the framing of time.

To analyse timeframes within COVID-19 health risk governance, we build on literature on interpretative policy analysis approaches with a focus on framing. This literature offers insights into how framing time has consequences for practical action that is undertaken, for the object at risk that is brought into being and for the values that are foregrounded or ignored within decision-making. Hereto, we draw on framing studies focusing on organisations (Orlikowski & Gash, 1994) and the framing of policy controversies (Rein & Schön, 1993; Stone, 2012). This is our analytical angle for the construction of timeframes in crisis decision-making.

Originating in social cognitive research and symbolic interactionism, the framing literature argues that people align their actions with their reading of a situation. By enacting social reality and giving it meaning, people are also constructing it (Berger & Luckman, 1989 [1966]). Orlikowski and Gash (1994) use the term frame in this context to refer to the ways in which actors in organisations make sense of and give meaning to their work. Containing assumptions, expectations, and knowledge, symbolically articulated through metaphors, stories and visual imagery, a frame includes both a specifically formulated (policy) problem and its solution. A frame also defines boundaries, highlighting some parts while simultaneously obscuring others (Stone, 2012, p. 252). Frames therefore guide actors (implicitly) into sense-making and action; they both enable and constrain action, thereby reducing the complexity of social issues to a more structured and less ambiguous reality.

Through the practice of framing, actors choose to foreground or ignore specific aspects of a controversy or problem, turning them into a coherent storyline (Rein & Schön, 1993; Stone, 2012). Doing so gives rise to a specific frame that in turn appears as an objective reality to which actors must respond, highlighting the importance of framing as a discursive practice. For example, framing a situation such as the refugee crisis as ‘a tsunami’, as is done by certain political parties and certain media outlets, steers action towards specific ‘inevitable’ solutions, such as measures aimed at ‘pushing back’ people looking for refuge.

While decision-making naturally deals with external time pressure, it is simultaneously involved in the construction of particular temporalities (Barbehön, 2022). The interactive process of framing can present specific timeframes as an external social reality in need of a specific response. Creating a sense of urgency, for example – the compression of time – can be strategically negotiated by actors to enforce quick decision-making (Boin et al., 2016; 2020).

For the purpose of this paper, we are not only interested in studying how actors construct timeframes, but also aim to understand how these frames foreground certain courses of action, objects of risk and values at the cost of others.

Firstly, the way frames matter for practical action is nicely illustrated by Sager and Zuiderent-Jerak (2021), who address the constitutive force of time for decision-making within evidence-based medicine. These authors show how clinical outcomes are central to evidence-based medicine, but their prioritisation and decision-making depends upon the temporality of the relevant evidence. In their case, mobilising different temporal orderings results in different understandings of clinical outcomes and in different clinical actions being proposed when qualifying patients for an ICD (implantable cardioverter defibrillator). For example, by invoking biological versus chronological time, different trajectories for ICD procedures were suggested. Not only age but also the futures the procedure would produce for the individual patient at risk and for the sustainability of the health system within the region, proved to be of significance for decision-making.

Secondly, and in a similar vein, the object at risk does not reflect an objective quality of the object itself but is instead constituted in a specific context or frame. Heyman et al. (2013) explain how ‘a contingency will only become a risk if it involves outcomes which matter to the member of a particular social group’ (p. 400). In this context Boholm and Corvellec (2011), following Hilgartner (1992), emphasise the relational and interpretative nature of risk. According to them there is ‘a relationship of risk between a risk object and an object at risk, so that the risk object is considered, under certain contingent circumstances and in some causal way, to threaten the valued object at risk’ (Boholm & Corvellec, 2011, p. 176). This means that an object – not necessarily a material object but also a social or cultural phenomenon – becomes seen as vulnerable and ‘at risk’ if it is of importance within a cultural frame and therefore needs to be cared for or protected. For example, in the aforementioned ‘refugee crisis’ example, different objects at risk are at play which are closely related to the performed action: preventing migrants to cross the sea means that not the people fleeing from their country, but the European borders are seen as the object at risk in need of protection. Hence, risk is constituted through a specific relationship between actors and objects and the way these relationships are valued and evaluated (Boholm & Corvellec, 2011).

The third and last element important for our analysis, values, are located in the ‘thinking’ (Heyman et al., 2013) and practices (Oldenhof et al., 2022) of social actors. As we argue in this article it is important to analyse how timeframes play a role in dealing with multiple or conflicting values. In this context, Triandafilidis et al. (2017), for example, show how temporal frames influence smoking behaviour in young adults as they argue that health risks related to smoking are associated with long-term smoking at a later stage in life. Therefore, perceived values such as fun and stress-relief, outweigh values such as good health at an older age. In short, different temporalities can lead to the valuing of one thing over another. This is important not only for individual health related values such as individual health risk of smoking, but also in the wider context of health risk governance. Hence, understanding timeframes and how they foreground certain elements over others requires us to include values in decision-making.

Finally, frames need not be singular; multiple frames can exist alongside one another, conflict with or complement one another (Behr et al., 2015). It is therefore important to discern both the different timeframes put forward in decision-making as well as their interactions. We do this in our case study below.

Context: public health and the Dutch regional safety authority

Besides governing acute (hospital) care, pandemic governance was a matter of governing (public health in) the public domain. As Wallenburg et al. (2022) and van de Bovenkamp et al. (2017) describe, decision-making within the Dutch health care system is fragmented as a result of a layered and decentralised system. An example of this fragmentation is the division between health care (primary care and hospital care), social support, long-term care and public health, that each have their own laws, regulations, financial arrangement, decision-making structures and assigned authorities. In this article we focus exclusively on public health within the public domain.

In this context, the role of the regional safety authority in the Netherlands is paramount. The Netherlands is divided into 25 such regions.² The board of a regional safety authority consists of all mayors from cities within that region. One of these mayors, usually the mayor of the largest municipality, is appointed chairman. If a (threat of a) fire, disaster or crisis crosses the boundaries of municipal borders, the chairman of the regional safety authority becomes responsible instead of a municipal mayor. The regional safety authority is usually referred to as the ‘general column’ in opposition to the ‘white column’ of healthcare delivery and their most important tasks are (1) to prevent and fight fires, (2) preparing for risks, disasters and crises and (3) coordination, management and combating of disasters and crises, including major outbreaks of infectious disease (usually urgent and rapid crises, up until maximum 72 hours). Lastly, the Municipal Public Health Service (GGD) played an especially important role during the crisis in the Dutch context. Generally referred to as the ‘white column’, this authority is responsible for public health in the region and, under normal circumstances, for handling infectious diseases.³

Methodology

We had the unique opportunity to do (mostly) on-site ethnographic research and watch the unfolding of COVID-19 decision-making from up close from March 2020 until June 2021. On 22 March 2020, the first author joined the Director of Public Health for the first time and was invited to observe two types of crisis meetings. First, the regional public health crisis-meetings that met twice a week. Within these meetings all public health related issues were discussed and actions were coordinated. Moreover, information was prepared for decision-making in the regional crisis meeting. We also conducted observations of these regional crisis meetings. Here decision-making took place regarding the implementation of both national measures and additional regional measures and other organisational and logistic work related to the prevention of the spreading of the virus. The regional crisis meeting took place every weekday. After the first two months of the pandemic frequencies were reduced and could vary per month, depending on the ebb and flow of the infection rates.

From March 2020 to July 2020, the first author spent about three days a week within the walls of the public health department and regional safety authority, where she observed and spoke informally with the actors working on governing the pandemic. It was in April 2020 that she met the scenario team, part of the regional safety authority. After initially observing a few scenario team meetings without participating, the first author was asked to participate because the team could use specific sociological input to the scenarios that were created. Hence, in this case of the scenario team, non-participant observations turned into participant observations. We were well aware of the ethics of this move towards participatory observations. However, the exceptional context of the pandemic and the importance of giving back to the field, that so generously allowed us to look behind doors that were closed to everybody else, made us accept their invitation. The first author participated by sharing sociological insights on the worst, realistic and best-case scenarios as they were drawn by the team itself. For example, the scenario-team (without interference of the first author) drafted up a worst-case scenario related to social unrest and riots as a possible, worst-case result of enduring corona measures such as (partial) lockdowns. Subsequently, the first author reflected with the team members on the created scenario, providing sociological reflections regarding possible causes of urban riots as described in the literature. In this way the first author reflected with the team on the bases of their own insights but had neither a leading nor steering role in determining topics or creating scenarios.

In the end, the first author observed 66 regional crisis meetings, 22 local public health authority meetings and 26 scenario team meetings, in total more than 180 hours of meetings (see Table 1), and collected related documents, minutes and policy briefings that were instructive for understanding the meetings. When the first wave of the pandemic had subsided in June 2020, meetings and hence our observations reduced in frequency. In this relatively quiet period, we conducted semi-structured interviews (n = 16) with key figures from the crisis teams, including the director of Public Health and the Chairman of the regional safety authority, reflecting on our observations. When the second wave hit the Netherlands in the Autumn of 2020, we increased our observations again. After this second wave we presented our analysis on three separate occasions (in December 2020 and January 2021) to the various crisis teams to reflect on our findings with key participants, allowing us to validate our analysis.

Table 1. Overview data.

Overview data	Observation (in hours)	Interviews
Regional crisis meetings	83	7
Public Health crisis meetings	33	7
Scenarioteam crisis meetings	65	2
Total	181	16

Observations were documented in field notes and interviews transcribed verbatim. All data were analysed using Atlas.ti. The vignettes and quotes used in this paper have been translated from Dutch into English. Because each respondent in this case study has a unique job description, we do not disclose their positions. Although not all respondents have an equal position of power, they are all high-ranking administrators/policymakers/directors who actively participate in decision-making. For analytical clarity, we choose to only differentiate between our respondents by referring to either the ‘health’ or ‘general’ column or the corresponding field sites: regional safety authority/general column, Public Health actors/white column and scenario team. In the same vein, we do not disclose every detail about certain examples, for privacy reasons.

We started our observations with a general inquiry into regional decision-making during a healthcare crisis. Throughout the process of collecting data, we employed an abductive approach. This means that we repeatedly scrutinised the gathered data and compared it to relevant theoretical concepts (for example ‘the sociology of time’ ‘(public) values’ ‘the sociology of risk and uncertainty’, ‘framing’ and ‘the sociology of decision-making’) in order to analyse our findings. After a few weeks of observation and informal conversations, we inductively teased out the concept of timeframes as a sensitising concept (Bowen, 2006) as the framing of time played an important role in the language (metaphors, expressions, words and emotions) of many key-actors. We subsequently analysed time by specifically focusing on the use of metaphors for disasters and/or time. Many actors uttered expressions such as ‘putting out the fire’, ‘lacking time’, ‘getting ahead of time’ and ‘buying time’ as well as other keywords, warfare vocabulary, emotions and pleas related to a perceived ‘lack of time’, ‘taking the time’ or ‘the need to look beyond the here and now’, and pleas for ‘doing something yesterday rather than tomorrow’, ‘having to act now’ and ‘the need for longer-term perspective’ and ‘holding one’s horses’. These codes were subsequently discussed at length among the four authors resulting in the interpretation of three different manners in which actors were ‘doing’ time or making use of time. After the initial phase described above, all data were coded again, resulting in the analysis of three timeframes. The data showed how the three different timeframes were constitutive of – and constructed by – a specific (1) pattern of action (2) object at risk, and (3) values.

Ethics

Our research has been positively assessed by the Research Ethics Review Committee of the Erasmus School of Health Policy & Management (20–08 Bal; 21–09 Bal). We obtained prior consent from the participants for observations and interviews and quotes have been approved by the relevant participants.

Findings

Timeframe I: No time to waste

Inside the room I sense tension. The infection rates have been rising. There is disagreement between the ‘white’ [health] and ‘general’ column about the need to build an emergency hospital unit and on the fast pace of action. One key respondent from the ‘general column’ briskly states that they are ‘ … concerned, genuinely concerned. We work hard, we want to do even more if necessary. Tell us what it will take, tell us what you need, and we’ll provide it.’ He is fired up, and I sense a lot of agitation. Another actor from the general column takes over, agreeing with these concerns, stating that he too is angry and worried that they are not doing enough. Eventually he shouts, ‘I don’t want to find out, ten years from now, that I was playing in the Titanic’s orchestra’. Later that evening, the decision to build a temporary hospital unit is made.

(Field notes from observation of regional crisis meeting, March 2020)

This vignette exemplifies our first timeframe: no time to waste. This frame focuses on governing the near future and is primarily employed by the ‘general column’, key actors responsible for public safety and crisis management who usually operate within the context of short and sudden disasters and who are used to acting swiftly and with rigour to get the job done quickly. The fragment above describes a key moment when a difficult decision had to be made regarding a dreaded lack of healthcare capacity. The debate mainly dealt with pace and timing. Most team members were pushing to set up a temporary location for COVID-19 patients ‘today rather than tomorrow’. This was largely prompted by videos of Italian doctors and nurses warning other countries to prepare for the crisis by showing horrific images of patients dying in hospital corridors. Knowing that hospital capacity was limited in other regions of the Netherlands and lacking in their own, the team deemed the need for extra capacity in the near (and dystopian) future as urgent. The proposed solution, to build a temporary emergency hospital unit, was the subject of heated debate, with emotionally charged arguments pushing for a quick decision and rapid construction of a unit able to accommodate almost 700 patients, including intensive care patients. After the decision was taken, the unit was constructed ‘exceptionally quickly’ according to those involved, within two and a half weeks, with construction crews working 24 × 7 to finish it. The unit was never used.

Within the no time to waste frame, action was defined by a focus on finding immediate solutions in the here and now, informed by possible near and dystopian futures. The condition of incomplete knowledge was handled by a display of force, decisiveness, and swiftness in decision-making. By framing the situation as ‘it was on fire, it needed to be extinguished’ (interview, June 2020), actors operated from the view that time and knowledge were constantly lacking. To heighten the sense of urgency and anticipate potentially threatening futures, respondents often discursively used firefighting and military metaphors (‘war surgery’ and ‘peat fires’) or made emotionally charged appeals during crisis meetings (a cri de Coeur or exclaiming that they were ‘fed up’). Wanting to be ‘better safe than sorry’, decision-makers felt there was no time to lose and argued for decision-making to be done quickly.

This specific pattern of rapid and swift action, aligned with a focus on scarcity, logistics and disease control measures as objects at risk. For example, actors described the situation as a logistical crisis requiring an unconventional approach to redistributing scarcity and building infrastructures. To this end, officials promptly organised mass testing locations, hired extra medical and other staff, and rapidly and successfully resolved a lack of personal protective equipment, such as face masks. At times this resulted in bypassing regular decision-making and regulatory procedures because they were perceived as slowing down the process. For example, with regard to purchasing urgently needed personal protective equipment, a respondent explained:

Personal protective equipment needs to be purchased with the approval of the National Institute, but how long will approval before being allowed to purchase the equipment take? Well, it takes 14 days, so I say: well, I am not going to wait for that because in 14 days this batch (of personal protective equipment such as face masks) will be long sold to another buyer.’

(Interview with respondent from the regional safety authority, June 2020)

Instead of waiting for central procurement and regulatory procedures, the equipment was being purchased in unconventional ways. New partnerships emerged between official medical institutions and actors from the regional safety authority – outside of the regulatory alliances – to ensure the quality and safety of personal protective equipment.

The ‘no time to waste’ frame also foregrounded practices of strict enforcement of COVID-19 measures meant to prevent the virus’s spread. Local restrictions were added on top of national measures. For example, local authorities severely curtailed the use of public spaces, such as market squares, parks, and children’s playgrounds. Although the COVID-19 measures were drafted at national level, enforcement varied from one regional safety authority to another. Each region could also impose extra, local measures, if necessary, for example closing off specific areas.

Concerns about public values such as education, the social lives of young people, child abuse and domestic violence were pushed to the background in favour of efforts to contain infection rates. In order not to lose sight of the goal (preventing infections), keeping focus was deemed essential. Keeping this focus meant that although the existence of multiple values at stake was acknowledged, these other values were regarded as conflicting and of less importance than keeping infection rates as low as possible:

And again that’s why it often goes wrong in a crisis, because you want to serve all interests and that isn’t possible. We had only one interest and that was keeping the virus from spreading through the region, that was fairly clear.

(Interview with respondent from the regional safety authority, June 2020).

In grappling with and making judgements about value conflicts (Kornberger et al., 2019), the value of safety was narrowly defined (limiting SARS-CoV-2 infections and preventing scarcity of medical equipment and deaths) and made a priority value, colonising decision-making.

Interestingly, safety as a priority value was not only done in the context of preventing infections. Coming back to the vignette we started this paragraph with, the expression ‘not wanting to find out having been playing in the Titanic’s orchestra’, shows that liability was also deemed important. However, liability was not so much a concern in the here and now within this frame but something that would be important in the future. Being ‘better safe than sorry, meant that being responsible in the future about not having done enough, steered decision-making towards bold and fast action. Contrary to what might be expected, this frame did not significantly change over time during our research period between March 2020 until June 2021. However, next to the ‘no time to waste’ frame, other timeframes also played a role during the decision-making process.

Timeframe II: Taking the time

For that neighbourhood with its specific characteristics, you really want to know what is happening there with regards to the spread of the virus and the way people are responding to dealing with the virus, and what could then be effective interventions in such a place. But also, we first need to find out if what we think we know really is what there is to know? So, first of all, slow down and take notice: is what we think we know really true and why so?

(Interview with public health respondent, May 2020)

Parallel with the first timeframe, a second frame played a role during the meetings. This second frame of taking the time, focused on taking time to analyse underlying causes for puzzling situations and taking time to reflect on unintended side effects before acting. This frame was mainly put forward by public health actors, used to working in a context of diligence and carefulness. This frame was about staying in the here and now, and analogue to Haraway’s staying with the trouble (Haraway 2016) we analyse it as a way of taking moral response-ability by working in the present, with different actors, objects inflicted and affected by the pandemic, acknowledging that decision-making and responses will be difficult and imperfect. The quote above reveals how a public health team endeavoured to carefully analyse statistical differences in infection rates between urban districts, with some districts showing a much higher rate of infection than others. This deeper understanding was deemed essential because it would allow for situated policy responses instead of a one-size-fits-all approach. Examples include extra communication in certain districts to raise awareness of health risks, or keeping some public spaces open instead of closing them down because of a decline in wellbeing.

Practical action within this frame was characterised by carefulness. This resulted in a different relationship between incomplete knowledge and action in that actors took the time to examine, validate and reflect on the issues at hand to inform their decision-making. Contrary to the previous timeframe, key actors departing from this frame were motivated to learn more about the situation instead of acting purely on the basis of infection rates. Generally, and without denying the severity of the situation, this frame allowed for relative calm amid the cris de coeur. Actors used certain metaphors and expressions, such as ‘just stop and learn’ and wanting to ‘dance with the virus’, highlighting the need to learn to deal with the pandemic and to let decisions depend on the specifics of the situation. They also frequently pleaded for ‘slowing down’ and ‘a little more time’ for analysis or, as illustrated by the opening quotation, expressed the need to perform ‘deep dives’ into the data. This somewhat calmer pace and deeper focus were considered essential within this frame, because ‘getting things right’ was deemed more important than ‘getting things right now’ Moleman et al. (2022).

The object at risk within this timeframe was steered towards health in a broader sense (than infection rates) and bringing the right care to the right place. For example, ‘getting things right’ resulted in taking the time to learn why infection rates differed between urban districts or across the city as a whole at certain points in time, instead of merely focussing on enforcement of measures within those areas:

X expresses the need for further analysis of the infection rates (of the city as a whole as compared to other cities in the country), because what these rates really mean is still a mystery. X explains the necessity of not rushing and jumping at the problem but instead of taking the time to delve a little deeper into the material to find out things in greater depth. The analysis of the numbers simply needs more focus, X argues repeatedly.

(Observation from regional crisis meeting, October 2020)

As a result, regional public health data analysts found that some areas showed a higher number of infections and higher levels of mobility (specifically, travel by car) during a lockdown. Combining mobility data with data about the types of jobs local residents had produced a more nuanced understanding of the higher infection rate. For example, it was found that many residents in these areas had jobs involving manual labour that generally could not be done from home. The need to work on site resulted in higher levels of mobility and more interaction with others, both at work and during commuting hours.

This deeper knowledge legitimised differentiation in policy responses, resulting in situated measures aimed at delivering the right response in the right place. For example, it led to neighbourhoods receiving targeted communication in several languages about the importance of testing, to cooperation with local key actors to encourage residents to get tested, and to extra testing facilities at targeted sites. Besides these situated responses, this deeper knowledge also resulted in higher infection rates being accepted as inevitable in particular districts.

Importantly, within the taking the time frame multiple values were foregrounded in decision-making, such as quality of life and wellbeing as part of being careful and getting the right response. For example, by ‘bringing together the medical and the ethical’ (field notes public health crisis meeting, April 2020), as one respondent explained, actors grappled with values by moving beyond the focus of safety (limiting infection rates). Instead of adhering to a one-size-fits-all approach that characterised the no time to waste frame, actors within this frame felt that the restrictions and consequences should vary between different groups and locations. They argued that a lockdown did not affect everyone equally:

Staying home indoors is harder for people in specific parts of the city, who live with larger families in one house, who live in smaller homes, which are moreover in closer proximity to each other than in other parts of the city.

(Quote from regional crisis meeting, April 2020)

Moreover, it was thought that the lockdown was specifically burdensome for children living in such areas. Actors therefore favoured more lenient enforcement of the restrictions, for example by allowing parks, playgrounds and public sports facilities to remain open or – in the first wave of the pandemic and first lockdown – by supporting the elderly care organisations that favoured staying open for visiting family. Concerned about loneliness and quality of life, some of these organisations started situated pilot experiments with visitors under strict safety rules that were closely watched by public health analysts. This timeframe thus grappled with values by opening up the focus to include additional socio-medical values, such as wellbeing and quality of life, as co-existing with the value of safety-as-physical-health.

Timeframe III: Future timeframe: Scenario building

The discussion moves towards the topic of domestic violence and child abuse. Although police records show a decline in the number of reports of child or domestic abuse, members of the scenario team argue that a lockdown will have a negative effect on children living in families where abuse has already occurred. Scenario thinking reveals a chain of connections between a longer lockdown, anxiety and reduced personal space or opportunities to escape on the one hand and, on the other, higher stress levels and, at the end of the chain, issues of domestic abuse and declining mental health.

All participants actively contribute using their own professional expertise, and experience from their personal lives. News, other media items and research are shared and used to encourage critical and out-of-the-box thinking about the various consequences of pandemic restrictions for society. The endeavour results in a worst-case, best-case and realistic scenario description from a long-term and societal perspective which will be handed to the pandemic control operational unit.

(Field notes from observation of scenario team meeting, April2020)

The third frame is the future timeframe that anticipates different futures beyond the near future. The vignette above describes the first author’s initial encounter with the scenario team,⁴ a group of actors dedicated to moving the focus beyond the short term. In the vignette we read how actors thought about domestic and child abuse as possible consequences of the COVID-19 measures. In this instance, they argued that a decline in police reports of abuse could not possibly mean an actual decline in abuse, and they therefore searched for relevant alternative information. By looking past the horizon and foregrounding the longer-term, this frame further broadened the focus towards societal effects of the pandemic and associated policy measures. In this way, this timeframe considers the social and long-term consequences for society not only of the pandemic itself but also, and specifically, of the potential effects of policy measures.

Within this timeframe, action was characterised by practices of repair work: repairing knowledge gaps by constructing best-case, worst-case and realistic scenarios for the medium and long term consequences of the pandemic. This anticipatory practice, known as scenario thinking, involved preparing for future risks by the imaginary enactment of different futures. All kinds of possible outcomes were considered and worked out, including the development of possible interventions to inform decision-making. Often, the need to anticipate the longer term or societal scope was framed using metaphors, for example the need to ‘look beyond the horizon’ of the short-term issues at hand. Instead of ‘hammering down’ (no time to waste frame) or ‘dancing with’ (taking the timeframe) the virus, this frame focused on ‘living with the virus’ in the long run.

Within this frame attention was steered towards social stability as the object at risk. The scenario team felt that pandemic governance should look beyond the health issues and ask what the associated measures meant for society. Team members were concerned about social disruption, domestic violence, child abuse and the economic consequences of restrictive measures. They felt that nobody wanted to ‘talk about the consequences of relaxing some strict measures, the “hot potato” that is being passed on’ (field notes from observation of scenario team, April 2020). In this framing of the pandemic, actors considered the effects of policy measures instead of merely endorsing or enforcing them. The example below shows how a police officer advocated focusing on the long-term societal consequences for society:

An officer argues that we should not be looking into the sustainability of the coronavirus measures, their legal embeddedness or how to enforce them (such as the ways in which social distancing is being policed, preventing groups from gathering in public spaces), explaining that: ‘After shutting down a house party with 20 attendees, we now ask ourselves whether there’s a legal basis for enforcement, when in fact it would be better to ask ourselves exactly why do people behave this way.’ Therefore, we should focus on people’s behaviour and the long-term consequences of sustained coronavirus measures – such as allowing only three visitors into one’s home – for people and how they cope.

(Fieldnotes from observation of scenario team meeting, May 2020)

The officer continued by foregrounding people’s natural need for human contact and argued that they will either find ways to get it (for example, breaking the rules to organise house parties) or suffer the consequences of isolation and deteriorating mental health. Because both responses would have consequences for social stability and public order, a social and long-term perspective on society seemed more important to him than strict enforcement of measures or a firmer legal status.

Within the future timeframe attention was directed towards broader values at stake, such as social stability, continuity and public order, in addition to safety, wellbeing and quality of life. One striking example of foregrounding social stability and order was the emphasis on social unrest and disruption caused by ongoing COVID-19 measures. Operating within this timeframe meant that concerns and criticisms were taken seriously, informed by voices in the media explaining, for example, that ‘feeding one’s family is more important than following the rules’ (field notes from observation of scenario team meeting, June 2020). There was room to consider the effects of those critical voices too. Regarding the acceptance of and compliance with the restrictions, for example, the team used different scenarios mapping out the most severe consequences for public order and stability. Strikingly, the possibility of social unrest leading to dangerous rioting was even anticipated as a realistic and worst-case scenario respectively,⁵ long before such riots in fact occurred. To address this, the team advocated ‘offering the people prospects instead of hammering down all social and economic activity’, such as organising strictly controlled open-air festivities as a social outlet, extending the opening hours of shops and cultural institutions instead of restricting them so as to spread shoppers and visitors throughout the day, and allowing outdoor sports activities to continue in creative (and safe) ways so that people could keep fit, physically and mentally. This timeframe thus broadened the scope of decision-making to include a safe, healthy and social approach to ‘living with the virus’ in the long run.

A matter of time: clashing temporal frames

All three timeframes reveal a specific response to a situation of perceived risk and uncertainty (see Table 2). Although this situation was commonly characterised with the word ‘unprecedentedness’, ways of responding to it differed. As we have seen, the three timeframes can generally be linked to different organisational units and their institutional routines. However, there was also some differentiation as timeframes sometimes travelled through the various units. This indicates that timeframes are not necessarily exclusive to specific actors or units.

Table 2. The three timeframes.

	No time to waste	Taking the time	Future time
Focus	Short term	Short term	Medium and long term
Action/practices	Speedy and decisive action, lack of knowledge does not impede action: better safe than sorry	Carefulness: analysing to fill knowledge gaps: searching and validating (new) knowledge	Repair work: repairing knowledge gaps by constructing best-case, worst-case and realistic scenarios
Object at risk	Scarcity, logistics and compliance with coronavirus measures	Delivering the right care to the right place; health in a broader sense (broader than infection rates)	Social stability
Values	Safety in the narrow sense (preventing deaths) and accountability. Narrow view on values, prioritising one focus, does not change over time	Safety (prevention of deaths), wellbeing and quality of life. Multi-dimensional view of values, multiple values are considered as co-existent	Safety in the context of public order and social stability, and continuity. Multi-dimensional view of values, value prioritisation changes over time
Key actors	Public safety, crisis and risk management	Public health	Scenario team, crisis and risk management and public health

It was mainly in everyday practices and decision-making, when actors reasoning from all three timeframes sat together in crisis meetings, that the three frames intersected and were negotiated. It was in these moments that it became most clear that the frames were at odds with each other or, in the words of one respondent, how ‘the clocks run at slightly different speeds’. The pandemic contained alternating waves of infections of varying severity, nevertheless the presence – and dominance – of the timeframes that steered decision-making did not change significantly.

Throughout the course of our research, it was predominantly the no time to waste frame that dominated decision-making. This is not surprising as the no time to waste frame was mostly enacted by actors from the regional safety authority, who were used to dealing with crisis and disasters and hence claimed to have more knowledge on dealing with them. Moreover, it should be noted that the regional safety authority was headed by the city’s mayor who acts as the chairman. Naturally, having a mayor ultimately responsible and in control influenced the power dynamic within the governance approach. Early in the first weeks of the pandemic this dominant (institutional) position of the no time to waste frame was more or less accepted by all actors, although the other two timeframes certainly coexisted and occasionally clashed. However, after the initial weeks the timeframes started clashing more explicitly. Below we describe some of these critical moments.

The no time to waste frame and the taking the timeframe clashed on many occasions even in the early stages of the pandemic. A striking example was around the construction of an emergency hospital as described above, where a key actor from the ‘healthcare column’ pushed for a different pace than those from the ‘general column’. We saw here how some actors framed time as lacking and others as sufficient for diligent decision-making. The actors involved explained this as the difference between jumping at the problem immediately without full knowledge – as is customary for public safety actors – or being cautious and precise – qualities usually attributed to public health actors. Another striking example can be seen in the vignette below, which recounts a discussion about knowledge gaps in November 2020. At the time, the infection rates varied considerably between comparable cities and public health actors proposed further analysis to explain these variations. The discussion turned into a heated debate about the need for in-depth analysis:

Actor A states: ‘It’s absolutely urgent to pass on explanations (about the infection rates) to the national level. We must be able to take this to the national level now and not analyse it for another week, that will be too late.’

Actor D agrees that it is urgent but says that ‘what the numbers mean’ remains an open question. More focus is needed to find an explanation, and a little more time for a ‘deeper dive into the data’.

Actor A disagrees and is visibly irritated, asserting that ‘the numbers already say enough’.

Actor F disputes Actor A’s assertion and argues for more time to analyse the figures.

Actor G also wants to avoid wasting a lot of time and energy on calculating the numbers ‘to four decimal places’. To him, it’s all about the general picture.

Actor A agrees that it should be about broad outlines and argues against reporting the decimal places. ‘The infection rates are already coming down, so perhaps in two weeks no one will even ask about this, let’s not waste time on this.’

(Field notes from observation of regional crisis meeting, November 2020)

This fragment shows several actors operating from different timeframes. Actors arguing for more time and for not jumping to broad conclusions did so for several reasons. Firstly, they believed in the importance of more knowledge because it would help in future situations. Secondly, they argued that more knowledge could lead to better, situated policy responses instead of a one-size-fits-all approach. After this discussion, these actors were granted one day extra for their analysis. This way, values such as swiftness overruled precision and hence the values of safety and liability can be seen as dominating decision-making.

The no time to waste frame also occasionally clashed with the future timeframe, with the former always overruling the latter. While the incompatibility between these two frames was already obvious at the start of the pandemic, actual clashes became most apparent after the summer of 2020. In October, the scenario team presented its recommendations during the daily crisis meeting, against the backdrop of a second (partial) lockdown. The recommendations considered the long-term consequences of the coronavirus measures by addressing issues of public order, continuity, and stability. At the time, recreational and cultural institutions were closed and shop opening hours were limited. The recommendations proposed the exact opposite: to ‘open up society’ again. The scenario team recommended organising alternative forms of entertainment, such as open-air festivals instead of indoor discotheques, and extending the opening hours of shops, cinemas, museums and so on. With the media reporting growing public resistance to the coronavirus measures, the recommendations were also meant to stimulate societal and economic stability and continuity. However, the scenario team’s recommendations met with a harsh response:

Well, I think your recommendations have been overtaken by current events. If we move into the category ‘very serious’ (a high infection rate), then alternative forms (of entertainment) or extensions (of opening hours) are no longer appropriate, we must then look only at stricter measures, policing and influencing people’s behaviour.

(Quote from regional crisis meeting, October 2020)

As infection rates were still high, actors operating from the no time to waste frame immediately rejected the recommendations. Without further ado, the meeting moved on to the next topic on the agenda. Similar confrontations happened right up to the end of our research. Even then, more than a year into the pandemic, the no time to waste timeframe prevailed as safety continued to be framed as a matter of numbers that could not be neglected. For example, when the scenario team again actively pushed for ‘ … moving towards a different kind of pandemic approach, one that’s not just about enforcement but has leeway for long-term perspectives that are discussed together’ (Quote from observation of crisis meeting, April 2021), their arguments were dismissed because of a perceived ‘lack of time’ or ‘wrong timing’. Actors operating from the no time to waste frame argued that decision-making could not yet move beyond the high numbers, compliance with the coronavirus measures and capacity issues. As a result, values like social stability, continuity and well-being were once again overshadowed by an approach dominated by values such as safety and liability.

The dominance of the no time to waste frame did not stop actors from developing other perspectives, however. They anticipated the other two frames behind the scenes around their daily decision-making table, in their own organisational units and with other partners, endeavouring to exert as much influence as possible. In general, however, COVID-19 decision-making continued to focus on finding solutions for the short-term problems at hand, with little regard for other voices.

Discussion

More than three years after the discovery of the SARS-CoV-2 virus, in May 2023 the Director-General of the WHO (2023) declared that COVID-19 no longer constitutes a public health emergency of international concern but instead is now an established and ongoing health issue. Although the end of the pandemic was not widely televised, as predicted by Robertson and Doshi (2021), research organisations and governments are currently evaluating pandemic policies and decision-making. Many studies focus on effectiveness of measures in terms of infection rates and mortality (see Agyapon-Ntra & McSharry, 2023; Tsou et al., 2022), fitting in with the ‘no time to waste frame’, while only a minority take broader societal issues into account (see OvV, 2021; 2022; van Bochove et al., 2022). A key issue in these latter evaluations and in the broader public debate during the pandemic was how policy should incorporate different public values. Our paper contributes to this discussion by showing how timeframes foreground different patterns of action, objects at risk and values.

Our analysis fleshed out three timeframes: 1) the ‘no time to waste’ frame, 2) the ‘taking the time’ frame, and 3) the ‘future’ timeframe. We showed that the ‘no time to waste’ frame dominated decision-making in the Dutch urban region of our case study. This was the case throughout the pandemic, not only during the first wave, when knowledge was especially limited, but also beyond the first panic. Driven by a frame of lacking time and the precautionary notion that it was ‘better to be safe than sorry’, the infection rate as an object at risk remained leading. Consequentially, the values of safety (in terms of keeping infection rates low) and liability (in terms of being afraid that history will show not having done enough) overshadowed values like well-being, quality of life, social stability, and liability in the present.

In line with the literature on framing (Orlikowski & Gash, 1994; Rein & Schön, 1993; Stone, 2012) and in opposition to the objectified conception of time in crisis management literature, our study highlights how timeframes matter because they structure the ways in which normative choices and dilemmas are considered and political decisions are made. We have seen how the framing of time, for example as lacking or sufficing or using a longer-term or a shorter time reference, has consequences for practical action, the object at risk and the values at stake and vice versa how the organisational inclination towards a specific pattern of action, object and values informs the experience of time. We agree with Deborah Stone (2012) that decision-making is highly political and normative, rather than the outcome of a rational decision-making process. In our case, the no time to waste frame was particularly influential in shaping pandemic decision-making.

We do not mean to argue that one timeframe is better than another. In our case study, the ‘no time to waste’ frame ensured that ‘the job got done’. It did so, however, in a particular way. Actors created a sense of urgency that required fast decision-making, problem simplification and a single-minded focus. Consequences of this were that the municipal council’s enquiries regarding expenditure and restrictions on the use of public space were being stifled. Questions such as ‘who should show solidarity with whom’, ‘what kind of safety, and for whom’ and what type of responsibility remained unasked and therefore unanswered. Young people had to show solidarity with older frail persons, for example by not gathering in public spaces or in groups. In the same vein, vulnerable families had few options, despite concerns about abuse or deteriorating mental health. Interestingly, the notion that curtailing the use of public space to get people to stay at home for reasons of safety assumes that the home is a safe place for everyone (Milligan, 2009; van den Berg, 2020). With ‘no time to waste’ being dominant, however, other timeframes and, consequently, other values – local democracy, equity and wellbeing – voices and measures were side-lined.

Our analysis shows that as although the ‘no time to waste’ was dominant, it is not the only way to govern the pandemic. Importantly, as Giddens (1993, in Orlikowski & Yates, 2002, p. 688) argues, it is precisely because temporal regimes are constituted through and maintained by action that they too can be changed through processes of re-framing. Timeframes can – and should – be reshaped because different frames are crucial to making difficult political-administrative choices between the conflicting interests and values involved in a balanced approach to pandemic governance. Here, the work of Whyte (2020; 2021) offers an interesting alternative perspective. Whyte gives an account of the Indigenous way in which time is narrated as unfolding through kinship relations in the context of climate change, as opposed to the way in which time usually is narrated as unfolding through the passage of uniform linear units. Looking at time as unfolding through relations of kinship brings in a broader responsibility, as kinship relations are grounded in shared responsibilities. Hence, in the context of searching for solutions and measures, a coping strategy based on shared responsibilities moves beyond swift action that – as we have seen in our fieldwork – conceals the responsibility to others who are at risk of being harmed by pandemic measures (Whyte, 2021).

For our understanding of the underlying processes of decision-making it is important to consider the relationship between different constructions of time and specific patterns of action and subsequently the prioritisation of different objects at risk and values. Our empirical work shows that this is a reciprocal relationship. We analysed that framing time in a certain way generally led to considering different actions, values and objects at risk. Vice versa however, we also analysed that by deploying familiar patterns of action or prioritising certain values or objects at risk, a specific framing of time was reinforced. For example, by putting an emphasis on reducing the spread of infections, the ‘no time to waste’ frame became more dominant, whereas the other timeframes came into view when looking at the social consequences of measures taken to curb infection rates.

Moreover, our empirical work shows how the three timeframes were embedded in organisational structures and how they competed and were negotiated by different stakeholders. We have seen, for example, how a scenario team yielded a ‘future time’ frame by taking the longer view and looking beyond the pandemic horizon. Likewise, we have seen how public health actors in the ‘white column’ focused on ‘taking the time’ to make what they considered were important decisions. In these two approaches, we recognise ways in which actors try to consider the mutual and shared responsibilities through which time can unfold, as Whyte (2021) describes. We take inspiration from these alternative approaches because they show that the ‘no time to waste’ frame in governance is neither intrinsic nor absolute.

To this end, we argue that timeframes should be made explicit to allow multiple interests and values to be brought to the table. Hereto it is important to explicate which values and objects at risk are addressed or deemed important, to illuminate which shared responsibilities are at stake in looking for ways of managing the pandemic. It is paramount to emphasise, however, that alternative timeframes, interests, and values are only worth exploring if they are given a serious voice in decision-making. We argue that this can be achieved by making the idea of shared responsibilities part of the decision-making process. While such reflections might be difficult – if not impossible – at the height of a crisis, we have seen many moments in which reflexive discussions could have taken place, such as between the ‘waves’ of the pandemic. In our case study, such moments however were not used effectively. More thorough evaluations of decision-making practices would however have been possible.

Lastly, in pointing out the importance of timeframes for decision-makers and experts and how these frames impact the way in which interests and values are weighed in policy debates, we offer lessons for ‘pandemic preparedness’ and beyond, enriching the literature on temporality and decision-making (Barbehön 2021; Geiger et al., 2021). We have illuminated how different frames of time result in specific patterns of action, focusing on different objects at risk and public values, and why this is important for our understanding of the underlying processes of decision making, particularly in group decision-making or public forums where competing values and different groups are represented. Because time is a central feature in all situations of high-stake decision-making in the context of uncertainty and external pressure, it is important to consider time as mediating values and objects at risk. Our analysis of decision-making is timely, not only in the context of the discussions about pandemic preparedness but also, and more specifically, in relation to other disasters and crises involving conflicting interests and values. For example, decision-makers and experts grappling with the climate crisis could articulate and negotiate different timeframes as they seek to balance various interests and values in risk governance. Further research on time-framing would benefit from comparing timeframes within different types of crises to examine which frames prevail, why, and with what consequences for wider society.

Conclusion

In this study we examined how timeframes played a key role in COVID-19 policymaking in the ‘regional safety authorities’, an important decision-making forum in the Netherlands. We fleshed out three timeframes: 1) the ‘no time to waste’ frame, 2) the ‘taking the timeframe, and 3) the ‘future timeframe’ frame, as apparent in the analysis of our observational and interview data. We revealed how the no time to waste frame dominated decision-making, producing a solitary focus on a rather narrow view of safety, while side-lining other time-frames, voices, measures and values. For example, choices in focus were made between safety in terms of infection rates and wellbeing. We argued that timeframes can and should be made explicit and negotiated in decision-making.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded by the NWO project Corona: Fast-track Data program [440.20.018].

Notes

1. Regional safety authority is a translation from the Dutch ‘Veiligheidsregio’.

2. This division of 25 regions does not correspond with the administrative layer of 12 Dutch provinces, nor with the division of 10 regions for acute care delivery (ROAZ), adding to the fragmentation of the decision-making structure during the pandemic.

3. The Director of Public Health (DPG) manages both the public health department (GGD) and the Medical Assistance Organization in the Region (GHOR) and, as responsible for the GHOR, is also a member of the management of the regional safety authority. Within this context, the Director of Public Health provides integral advice on behalf of the entire ‘medical care chain’ of acute, public, social, and long-term care.

4. The scenario team was a new multidisciplinary advisory body consisting of representatives from the ‘general column’ (crisis and risk management, communication, population care and medical aid), the military, the police force, the fire brigade, civil servants from various municipal services and municipalities, a social scientist and, as from September 2020, public health actors from the ‘white/healthcare column’.

5. Riots had already been described as a worst-case scenario in mid-2020, long before the first riots occurred in February 2021 and again in November 2021. According to several actors, ‘Unfortunately, many worst-case scenarios eventually came true’.