Coronavirus as Crisis

We are not at war, America. There will be no victories or defeats.

Matthew Perkins (Flickr/mattyp)
Matthew Perkins (Flickr/mattyp)

Running this morning on a route that crosses over the Major Deegan Expressway in the Bronx, I noticed that, for the first time in a week, the Deegan was packed with southbound vehicles, slowed nearly to the viscous creep typical of a normal workday dawn. I wondered, are people getting tired of being cooped up at home and deciding to go to work? Or are these the people who must be at work despite the coronavirus situation, driving into town because they’ve become afraid of using the express buses or commuter trains? For most people, a crisis means constant improvisation.

And the new coronavirus outbreak is a crisis—in three distinct ways.

The first is that the United States must suddenly face its own incivility. The terms in the public conversation today—containment, mitigation, shelter in place, curfew, shutdown, lockdown, isolation, unauthorized travel—are the language of siege. Since the renaming, in 1902, of the first federal health agency as the U.S. Public Health and Marine Hospital Service, outbreaks of contagion have summoned a public health response. Until now. Today, our response is military, embattled, and, from the sound of much of the rhetoric, despairing.

We are not at war, America. There will be no victories or defeats. COVID-19 is a virus, not an enemy. The sick are not victims; they are ill people who need medical care. There are no battles to be fought, just work to be done.

The siege language hides (purposively, I suspect) a fundamental fact: a virus isn’t a thing in itself. Rather, it is part of a system, virus and host: COVID-19 and humans. The virus doesn’t exist without us; we are cohabiting now, we and COVID-19. The aim has to be to minimize the damage, including keeping people alive if they are sick.

Minimizing harm, caring for the sick, keeping people alive—this is what any civil society does. It’s normal. But American society frequently falls short of this modest aim. Here, the means of sidestepping vulnerability are purchasable. A college education, which does not come cheap even at public colleges, lowers an American’s mortality risk by 50 percent. Adequate nourishment, meanwhile, can reduce a person’s susceptibility to illness, and yet, 37 million Americans do not have consistent access to food that meets basic nutrient requirements.

The new coronavirus makes us face the gap between the American status quo and a fully civil society. You can self-isolate at home if you’re in the corporate world or teach remotely if you’re an academic, but if your income derives from gig work at a nail salon or driving for Uber, you must make the choice between being safe from infection and facing the possibility of becoming homeless. When COVID-19 infection leads to severe illness, timely and sufficient medical care makes the difference between recovery and death. But medical care in the United States is also a commodity that must be purchased. Some 27.5 million Americans, about 8.5 percent of the population, have no medical insurance, even after implementation of the Affordable Care Act. Of those who do have medical insurance, the 28 percent who got it through their employer and the more than 40 percent who bought it in the new health-insurance marketplaces are underinsured—that is, their insurance doesn’t cover their medical needs. The rate at which Americans die of illnesses that should have been prevented by timely medical care is half again higher than the rates in Canada and Germany. It’s twice that of Switzerland.

Second, we face a crisis of leadership. The playbook for a public health approach to contagion is clear and well known, and it has been practiced often: test widely for infection, trace contacts of the infected to locate further cases, isolate cases so they don’t infect others, refer the sick for treatment. But that has not happened yet in the United States. It should have, but it didn’t.

Sound public health leadership, had we had it, would have looked at the situation in China and developed a national plan, offered clear and consistent advice to states and localities, developed reporting and oversight systems to ensure consistency, and, above all, made or purchased millions of test kits and distributed them throughout the country. Sound public health leadership would have created contingency plans to accommodate people who get coronavirus but can’t pay for the medical procedures they might need. It would have offered frequent, clear, and consistent updates to Americans. The legislation passed on March 19 will finally guarantee cost-free COVID-19 testing. But testing is still infrequent here: only 82,000-odd tests had been done as of that date, a rate of testing about 16-fold less than Italy’s and 33-fold less than South Korea’s.

Why this kind of stewardship didn’t happen is hard to know. Perhaps there’s no hope for such stewardship in an administration that has not so much created a vacuum of leadership as actively attacked it. For instance, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has often tried to take on the role of communicator, only to be undermined by the president. We are left with the present siege situation.

Third, we also face a crisis in the psychic sense: unresolvable conflict, warring drives. Emotions are close to the surface. A yearning for the restoration of a world remembered as simpler or healthier or virus-free. Such memories are erroneous, but that’s how memory works; it doesn’t make yearning less powerful. We share an eagerness to be part of the unprecedented new thing, something to tell the grandchildren about in the future—to track the epidemic, to be part of it, to know it as personally affecting. We are driven to be worthy and valuable, to tell others what to do and then to be appreciated for it—the discourse becomes freighted with moral judgment: “boomers” not taking coronavirus seriously, neighbors “defying” social distancing, the failure to take events “seriously.”

Always, too, we fear dying. Perhaps we feel it more so, now that so many are stuck without companionship. We also fear, oddly enough, the embarrassment of even entertaining the prospect of dying here and now, in 21st-century America. We are, as Joan Didion writes in The Year of Magical Thinking, open not only to the possibility of averting death but also “to its punitive correlative, the message that if death catches us we have only ourselves to blame.” And always we are controlled by the other drives: Eros, avoidance of pain, desire to be loved.

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Philip Alcabes trained as an infectious-disease epidemiologist and has been writing about health and illness for the Scholar since 2004. He is a professor of public health at Hunter College of the City University of New York. He is the author of Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu, a history of epidemics as social phenomena.


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