Numbers are the grammar of policy today. With the coronavirus pandemic, controversy and colloquy alike revolve around the number of tests, hospitalizations, or deaths that should signal the time for “reopening”; the number of worshipers who may be allowed in a church, mosque, or synagogue at once; the number of feet apart residents should, or must, maintain between themselves and others in a park or at the beach. And, always, numbers of dollars.
Numbers are also a key to cultural meanings. That over 100,000 Americans have died from confirmed coronavirus infection is supposed to unlock meanings that wouldn’t be evident had there been a dozen deaths, or a hundred. Exactly what 100,000 deaths means, as always, is up for grabs. That the death toll in the United States is greater than in any other single country is held to be significant, a reminder of a “very bad gift from China” to the president, to others a sign of Americans’ essential unhealthiness, to others a harm wrought by our phantasmagoric medical-care system. That it is roughly twice the number of Americans killed in the Vietnam war and a fourth the number who died in World War II is also held to be significant, a sign of the cruelty of nature or of malfeasance by the federal government. Many people say that the number of deaths from confirmed coronavirus infections is not the true number—which is higher or lower. And that, too, would be significant.
But numbers are abstractions. In the struggles over meaning, they’re neutral.
What is a “true” number of coronavirus deaths? At least for now, every death is understood in relation to coronavirus. The infant who dies of the Kawasaki-like inflammatory condition that might have something to do with coronavirus infection (or might not) is a casualty of the pandemic. So, too, is the young nurse whose lungs were overwhelmed, tested positive for the virus, and died in a hospital; the emergency-room physician who couldn’t get adequate protective gear; the bus driver; the kid in an overcrowded jail. The older man with a chronic heart condition who, unable to get care at an overburdened hospital, died at home is counted among the coronavirus-associated deaths (public health officials compile this number by comparing the death toll in one place in one period of 2020 to the number of deaths in the same period in recent years; in New York City from March to early May it is estimated to be over 5,200). For a death that isn’t remotely attributable to the coronavirus, the death notice carefully points that out: the decedent succumbed to pancreatic cancer, or just “natural causes,” an emphatic negation of coronavirus death. Death is coronavirus today.
This way of thinking is laudable, in a sense. A disease outbreak claims lives in all sorts of ways, by direct infection and a plethora of indirect effects. The latter might include preoccupying medical staff so as to prevent them from attending to people who don’t have the outbreak disease. But the effect is emblematic of a sea change in how epidemics are apprehended.
The change in how we attach meaning to diseases has little to do with numbers and much to do with words. The word cancer was famously unutterable until fairly recently. Its remorseless (and, until about 50 years ago, irremediable) grip was so equated with death that cancer sufferers were simply not told what was about to kill them. Tuberculosis, too, couldn’t be said, even to those dying from it. Just two months before his death, Franz Kafka sent a letter from a sanitarium to the surgeon Robert Klopstock, in which he says he hears nothing definite about his condition: “everybody drops into a shy, evasive, glassy-eyed manner of speech,” he writes.
The bacterial cause of tuberculosis wasn’t recognized until the 1880s; reliably effective treatment didn’t begin until the advent of streptomycin in the late 1940s. For much of modern history, TB was “consumption”—an accurate enough metaphor for the occupation of the lung tissue by cells and fluid responding to tubercle bacilli, but also one that readily gestured toward passion. The artistic temperament was invoked. Anne and Emily Brontë, Elizabeth Barrett Browning, Katherine Mansfield, John Keats, and a legion of other well-known writers died of consumption. Indeed, the appeal to temperament, to some metaphysical underlay, was so powerful that the consumptive could be imagined to be succumbing not to an overpowering pathology resulting from infection, but to an overabundance of feelings.
HIV/AIDS, also freighted with metaphor, gestured toward different passions. The original name, “acquired immune deficiency syndrome,” which was coined by the Centers for Disease Control in 1982, signaled a refusal on the part of American health authorities to name what was really happening as a disease. In a way, the naming was a relief, because it replaced a range of informal names for the then-new condition that hinged on homosexuality, and thereby pathologized it: gay plague, gay cancer, and so forth. But the word AIDS was itself the darkest—most fatal—of the stigmata of social undesirability. When Rock Hudson collapsed in a hotel room from complications of AIDS, in 1985, his publicist’s statement said he had liver cancer. The notorious attorney Roy Cohn, who died of AIDS a year later, also claimed that it was liver cancer that was killing him. To them, to die of AIDS would have been to die in disgrace.
The shift, with coronavirus, from such aversion to a stunning alacrity about naming the illness is striking. An epidemic must be declared. An epidemic (or, as now, a pandemic) signals that sensibilities about value and meaning have coalesced, for once, around one threat. And here is where imputing meaning to numbers bumps up against all numbers’ essential abstractness.
In the past, the declarations that made one outbreak into an epidemic, while another was just part of the normal tide of life and death, were clear. That America was troubled by sexual license in general and homosexuality in particular in the 1980s was the backdrop against which a new outbreak became the AIDS epidemic. In the 2010s, in an America led by a black president, a new awareness of rising discontent among poor whites was the stage on which an upsurge in opiate overdoses turned into an epidemic.
By contrast, more than 100,000 Americans die of stroke every year, but stroke is a normal health assault. Nobody ever talks about an epidemic of stroke; it’s normal. Roughly 270,000 new cases of breast cancer are diagnosed each year in the United States. About 40,000 American women die of it annually. Like stroke, breast cancer is never an epidemic: somehow, it doesn’t qualify. Stroke and breast cancer don’t highlight any of our discomforts.
In the early 2000s, the declaring of epidemics entered a new phase. I called it (in my book Dread: How Fear and Fantasy Fueled Epidemics) a kind of “postmodern” germ theory: a shift in the stated source of threat from outside the human body—the microbe—to within it. The epidemics of the first years of the 21st century, including obesity, depression, attention-deficit/hyperactivity disorder (ADHD), and opiate painkiller use, weren’t conventional illnesses at all: neither infections, nor cancer, nor the result of chronic vascular problems or hypertension. They were regular aspects of the awkwardness of human life in society—social problems, long recognized as unpleasant. They had only recently been medicalized as diseases.
Once you’ve declared a problem to be a disease, you call in the epidemiologists to collect data. Now richly described in numbers, these disease conditions are soon accoutered with possible social meanings. Whereas in the 1920s Americans had been warned that they could come down with polio by consorting with immigrants and in the 1980s we were warned we might contract HIV through same-sex intercourse, now, in the 2000s, we must be prevented from “contracting” obesity, prescription misuse, depression, and so forth. School gardens replaced regular math and science classes because children should learn “healthy eating”; doctors were arrested and locked up for writing too many OxyContin prescriptions; parents who sought to have their children diagnosed with ADHD in hopes that Adderall would enhance the kids’ SAT scores were vilified for “neuroenhancement.”
These new epidemics aren’t simply the basis for political responses, as polio, syphilis, and AIDS had been in their day; they’re statements of power and our relation to it. In that sense, they are the result of politics. Cause and effect are blurred, but meaning is everywhere. When an outbreak of measles occurs now, it isn’t attributed to the measles virus but to “anti-vaxxers.” If your body-mass index is high, if you sell your OxyContin to someone for whom it wasn’t prescribed, if your kid has been diagnosed with ADHD but isn’t taking Adderall—if you contribute to the bad thinking that is declared to be the source of an epidemic, you’ve betrayed the public weal.
In the new context, the coronavirus is both an actor and the stage on which the drama takes place—an immersive set, without a fourth wall. Coronavirus is what is happening to you, to me, to everyone at once. Whether we are infected or not, sick or not, grieving or not, we are in the play. The coronavirus pandemic goes beyond the politicizing of the epidemic to highlight unpleasant social phenomena like addiction or troubling ones like immigration. The distinctions between the nanoscale virus itself (only 60 to 140 millionths of a millimeter in diameter, according to the CDC), the physiological effects of viral infection, its symptoms, the medical management of viral illness, the political responses to illnesses and deaths attributed to viral infection, the mathematical models with their charts and numbers, and the social-media responses to the political policies and the numbers—these boundaries are elided. Reality and virtual reality commingle. What we have is the Coronavirus World.
This is unprecedented. Although much reference is made nowadays to the 1918–19 flu epidemic, there was no Influenza World. Indeed, as Alfred Crosby showed in his seminal work on that outbreak, America’s Forgotten Pandemic (1976), press coverage was deliberately downplayed, and sometimes outright censored, in order not to undercut the triumphal news of victory in the Great War. Nor was there an AIDS World (except to gay activists, those suffering from the illness, and their intimates). Indeed, the staunch collective refusal to see AIDS as being central to American life in the 1980s was the basis for vituperation by writers to whom it did matter: Randi Shilts, Larry Kramer, Michael Callen, and others. Neither was there any Opioid Overdose World—on the contrary, the main point of the narrative about the opioid epidemic was that it was happening to other people, to the people who lived in places where there were no jobs or hope (unlike the places where the researchers and writers lived). That is, it was happening to Americans in “despair,” as the famous analysis by economists Angus Deaton and Anne Case put it.
Coronavirus is the pandemic for the world of immersive experiences, for augmented reality and virtual-reality headsets, Instagram and TikTok. An understanding of the universe’s essential truths is perfectly accessible, or so it may be imagined. Mainstream media, social media, “experts” on health and medicine, and officials, have collectively projected it: Coronavirus World is the all-encompassing experiential declaration of how we live now.
In a time when numbers are so often on our minds, or our smartphones, it’s good that the mainstream media are also highlighting the personal stories of individuals who suffer from coronavirus infection, die from it, care for those who are suffering, and, all too often, all three. Somewhere between the unfathomably large numbers (more than five million cases and 346,000 deaths worldwide, as of this writing) and the meanings attached to them on the one hand, and the heartrending personal suffering on the other, is society’s experience. About society’s experience there are all sorts of grabs at meaning. Only one or two of them—selections to be made by tomorrow’s powerful—will be called “the history of the coronavirus pandemic.” These will be backed by numbers of deaths, tests, lockdown duration, number of masks used, and so forth. None of them will be the truth.
