COVID-19: A Primer

The Anxiety of Culpability

The limits of what we can know and what we can do about it

By Philip Alcabes | March 31, 2020
Patrik Ragnarsson (Flickr/dentarg)
Patrik Ragnarsson (Flickr/dentarg)

Frustration. I know I’m supposed to do everything possible to reduce my risk of contracting COVID-19. And I know I’d better be proactive on this, because the federal government has already made clear it isn’t going to be doing anything helpful. Not competently, at least. But how to reduce risk? Handwashing? Yes, I’m an expert by now. Face mask? Some of my friends are furious at the World Health Organization for saying that face masks are only necessary for healthcare workers. I point out that the evidence for the effectiveness of face masks at the community level is equivocal. Well, my friends reply, they say it might help, and anyway it couldn’t hurt.

Part of the strangeness of the Coronavirus Era is the reliance on what “they” say. They say that if you have food delivered, you do not need to wipe down the carton before you touch it. They say that the virus isn’t carried on produce that’s delivered, but they (a different they?) say that in the supermarkets the produce might have been touched by other shoppers, so beware. They say to shop early in the day so the products on the shelves won’t have been handled by other shoppers. They say to carry a spray bottle of peroxide or at least some wipes. They say you don’t have to wipe down the mail but you should wipe down your doorknob.

They say social distancing is everyone’s responsibility, to prevent transmission. But how is this virus transmitted? Not known, exactly. Definitely by airborne droplets, the way flu virus is. That’s the basis for the six-foot rule: normally, airborne droplets exiting someone’s mouth or nose will fall to the ground pretty quickly, so the droplets from a cough won’t get to your mouth if you’re a couple of meters away from a cougher. Although who knows what “normally” means. At the same time, it seems clear that you can pick up the virus by touching surfaces that have been sneezed or coughed on and then touching your face. But does that include the ear or chin? How close to the nose and mouth does the face touch have to be? How long ago would the sneeze or cough have to have been?

What about aerosols? Sometimes, a virus can exit an infected person not just in droplets but in a mist of superfine particles (each less than five one-thousandths of a millimeter in diameter), floating in Brownian randomness around a room—this is, for instance, why an unimmunized person can be infected with measles virus by entering a room in which a child with active measles had been exhaling hours before, even though that child is no longer present. But what are the circumstances that make for infectious aerosols with COVID-19? How long would such aerosolized particles linger? And how would I know? These are questions that are currently under study. The answers, when they come, will inform clinical care, but knowledge about community transmission always takes much longer to arrive at. Definitive knowledge moves more slowly; what they say moves much faster.

They always have plenty to say. These days, and even before coronavirus, social media were making every piece of advice, no matter how useless or how incorrect, abundantly available. The stakes feel higher now, though. If I don’t do yoga or meditate for stress reduction, don’t drink green tea for the antioxidants, and don’t remember to change my Facebook password every three months (I don’t), I may nonetheless remain confident that both the world and I will muddle through. But if I should be wearing a mask when I go out for a walk and I don’t, will I get coronavirus and die? Worse, will I have contributed to the catastrophe by spreading virus to others? Suddenly, civilization seems to be on my shoulders. Yours, too.

It’s not just frustration I feel, then, but also the anxiety of culpability. It’s not only the sudden awareness of the closeness of death that makes the Coronavirus Era so disconcerting. It’s also the fear of terrible error.

Radio and TV news reports and many newspaper stories make error seem not just consequential but disastrous. Scenes of hospitals in northern Italy are photographed as if they were charnel houses. What exactly went wrong in Italy—why the case-fatality rate there is so much higher than elsewhere—remains to be understood, but the scenes are offered as an object lesson without an object. Someone did something wrong. The patient wasn’t diagnosed immediately, and now the hospital staff members have been exposed. The soccer match was played, the kids went to the beach together, the nursing-home visitors weren’t screened, the café remained open after the lockdown order, the waiting room was full … Fault was everywhere happening but nowhere recognized, and the result is visual, striking, reminiscent of The Seventh Seal but many-fold, a multitude of coffins.

The focus has shifted lately to the disaster underway in the United States and the greater disaster undoubtedly impending. The mortality projections are dread-inspiring (dread being, after all, what the people who create the mortality projections are intending to provoke). The association is clear. Italy: overwhelmed hospitals and days set aside for transporting the hundreds of caskets out of town. The United States: exponentially rising incidence curves and those fearsome death projections.

The news in New York City, not the first zone to be affected in the United States but the first to be affected profoundly, is worsening. More than 930 COVID-19 deaths had been registered in the city by the morning of March 31st, with no sign of an easing in the rate of increase. A thousand-bed naval hospital ship has just arrived, and additional hospital facilities are being constructed, including one in Central Park. But this is comfort of the coldest sort, more chilling than reassuring. Ad hoc morgues set up outside the city’s big public hospitals add eeriness to the scene, as horrifying as the photos from Italy. Trepidation persists: all of this, the social distancing and the masks and the hospital tents in the park—if it does make a difference, can it possibly be sufficient? It’s hard to avoid the feeling that the disaster will keep unfolding remorselessly until some unknowable stopping point. How much virus is in the air isn’t knowable, but anxiety can float everywhere, with the persistent sense of error—error by local officials, error by national planners, error of one’s own.

In the Bronx, where I live, the daffodils are out this week. The forsythia and the magnolia trees are in bloom. Red-winged blackbirds are holding their hoarse-voiced conversations in the wetlands. New growth has appeared on the two ancient rosebushes next to my house. The onset of spring around this morally tinged pandemic feels dissociative, unreal—as if someone hadn’t alerted Nature that the world has changed. I suppose Nature has no agendas, though. The cycle of seasons is as persistent as the relentlessness of birth and death, as the unpredictable occurrence of unbearable destruction.

Unpredictable, yes. Not that there were no predictions. At a time like this, it is easy to feel remorseful for not having paid attention to the most baleful predictions, in particular to the Cassandras who had been forecasting a pandemic like this one for many years. But someone is always forecasting a scourge. When, since Jeremiah, have they not? It’s not in human nature to heed these warnings fully—and often I’m grateful for that deafness. How would we live decently if we were constantly as afraid as the Cassandras want and seem to need us to be? As afraid as we are now? It’s so hard to keep in mind that the human problem, always, isn’t how to avoid death; it’s how to live.

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