State of Vulnerability

Social distancing is important, but there’s more to consider


It’s widely agreed that the worst of all the acute outbreaks of infectious disease in modern times was the so-called Spanish flu pandemic of 1918–19. Almost 700,000 Americans, about two-thirds of one percent of the U.S. population, died in the space of about 15 months. But it’s worth remembering that, even in that maximally dire event, well over 99 percent of Americans survived. The world didn’t change and neither did the United States—by 1920, the U.S. population was larger than it had been before the flu hit.

Similarly, even among people who are infected with COVID-19, at least 80 percent are mild or moderately ill. Of the remainder, who get severely ill, most but not all need oxygen. And some die anyway. That’s the tragic part. But the chances of dying are dramatically dependent on the presence of underlying illness (cancer and chronic obstructive pulmonary disease, especially) but also on the adequacy of hospital care.

The logic of “social distancing” isn’t to stop the spread of COVID-19 altogether—you can’t stop the spread of viruses borne on respiratory secretions, because everyone has to breathe. The point is to slow the appearance of severe cases at hospitals. It’s not the most desirable way to handle a viral outbreak, but it’s likely to be an unavoidable one. Not surprisingly, the arrival of social distancing in the United States has had to come through the state of emergency. That’s not public health; it’s political theater. Banning flights from continental Europe. Requiring U.S. citizens who have been in Europe to go into isolation for two weeks—even if they can get a flight home.

In New York City, a state of emergency was declared after fewer than 100 coronavirus cases had been diagnosed. Meaning that the Metropolitan Museum of Art, the Metropolitan Opera, Carnegie Hall, and Broadway theaters are closed. Private schools and colleges have sent their students home. The two public universities CUNY and SUNY, with 700,000 students combined, have stopped all in-class teaching and shifted to online formats.

Political will in New York City has, for some years, seemed to align, however imperfectly and sometimes contentiously, with the public good. But now, even New York City—a capital of the tumult of human existence, the city where, as Saul Bellow put it, you “opened a jeweled door into degradation, from hypercivilized Byzantine luxury straight into the state of nature,” the place whose residents bore the disaster of September 11th and still bear being pressed up daily against our most shameful loathing and our worst fears—even NYC can’t bear this.

That 269 coronavirus cases have been identified in our city of 8.6 million people (as of Sunday morning) reminds me that, so far, the NYC COVID-19 outbreak is roughly equivalent to several subway cars full of people. Yet worry has obviously spread far more widely. Walking around the city this week, I hear “coronavirus” everywhere: in English, in Spanish, and even as an English word in the midst of a conversation in Korean. The subways have emptied out, the sidewalks are suddenly more capacious, and at Fanelli’s, an institution more honored in this town than is the mayoralty, the bar stools have been dutifully placed three feet apart.

There’s always been something endearingly childlike about New Yorkers—the way we squeeze up next to each other on buses, share life stories while waiting for the light to change, talk with our hands, hug one another, kvetch. But I can’t help feeling now that some extra regression has occurred in the face of a suddenly existential fear. As if, suddenly, the infantile drive to have Mother and Father assuage our anxiety has taken over. People have clamored for the mayor (Dad?) to close the public schools, as Los Angeles has done (to his credit, Mayor Bill de Blasio hasn’t caved on this: there are too many schoolkids who have no place to go during the day, being homeless, or have parents who can’t take time off from work and still pay the rent).  Stores are selling out of toilet paper—the anal fixation in a time of stress, of course. Life suddenly feels so elemental. [NOTE: Soon after this blog was posted, NYC did close its public schools.]

It’s a reminder that a state of emergency (with or without school closings) is a fraught state. The United States is very unlikely to summon the political will to create a medical care system that offers timely and adequate care for all (as I mentioned last week), so we do need to slow down the rate at which people sick with COVID-19 respiratory problems seek hospital care. The nation has fewer than a million hospital beds, so an increase of a few tens of thousands per month would quickly clog the system.

But the downsides to social distancing go well beyond not being able to cozy up to your drinking buddy on the next barstool. Social isolation is a main determinant of decline and debility in older Americans; if we are to curtail physical contact, the country will have to make special arrangements to avoid exacerbating a problem that has beset our aging population for some time.

And there are worrisome aspects of the political theater. A state of emergency readily becomes a state of exception—where the regular protections of citizenship or residency don’t fully apply. With fewer people at work at our institutions and in the streets and subways, there are fewer eyes on the authorities to keep them in line. It’s easier to buy into the state of emergency when you can only see it on television, easier to forget that those who declare emergencies need political legitimation, have political enemies they want to discredit and political debts to pay off, or are seeking reelection.

What I mean is that there’s a tradeoff: protecting our physical selves from the possibility of future infection means giving up some of the integrity of our private selves and community selves. It’s worth bearing the tradeoff in mind. Guarding against risk is an important thing, but not the only thing.

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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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