Alison Bashford is Research Professor in History at the University of New South Wales Sydney. Her work connects the history of science, global history, and environmental history. Her books include Global Population: History, Geopolitics, and Life on Earth (Columbia, 2014), Contagion, w/ Claire Hooker (2002, Routledge), and the edited volumes Quarantine (2016) and Medicine at the Border (2006).
Simukai Chigudu is associate professor of African Politics and Fellow of St Antony's College, University of Oxford. Prior to academia, he was a medical doctor in the UK’s National Health Service. He is the author of The Political Life of an Epidemic: Cholera, Crisis and Citizenship in Zimbabwe (Cambridge, 2020).
Deborah Coen is professor in the Department of History at Yale University and chair of the Program in the History of Science and Medicine. Her research focuses on the modern physical and environmental sciences and on central European intellectual and cultural history. Her books include Climate in Motion (2018, Chicago) and The Earthquake Observers: Disaster Science from Lisbon to Richter (2013, Chicago).
Richard Keller is professor in the Department of History, and Department of Medical History and Bioethics at the University of Wisconsin-Madison. His research focuses on the history of European and colonial medicine, as well as public health and environmental history. His books include Fatal Isolation: The Devastating Paris Heat Wave of 2003 (2015, Chicago).
Julie Livingston, Silver Professor of History and Social and Cultural Analysis at New York University, was named a MacArthur Fellow in 2013. Her work is at the intersection of history, anthropology, and public health. Self-Devouring Growth: A Planetary Parable (2019, Duke) is her latest book.
Nayan Shah is professor of American Studies and Ethnicity and History at the University of Southern California. His research examines historical struggles over bodies, space and the exercise of state power from the mid-19th to the 21st century. His books include Contagious Divides: Epidemics and Race in San Francisco's Chinatown (2001, Berkeley).
Paul Weindling is Wellcome Trust Research Professor in the History of Medicine at Oxford Brookes University. His research covers evolution and society, public health, and human experimentation post-1800. His books include Epidemics and Genocide in Eastern Europe, 1890–1945(2000, Oxford) and Victims and Survivors of Nazi Human Experiments (2014, Bloomsbury).
A. L.: Historian of Medicine Charles Rosenberg famously argued in the 1980s that epidemics operate as a form of “dramaturgy” — in other words, as inherently constructed events that are patterned as stories or narratives. The stories taking shape around COVID-19 seem to be featuring certain key motifs that we’ve seen many times before — for instance, the virus as malevolent actor, often ascribed to a specific ethnic or social group; and metaphors of containment (“walls”) and destruction (“war”). What have you noticed in the story that has been told thus far about COVID-19 as it relates to other epidemics, disasters, and crises you’ve studied? What’s been left out? How has this shaped our understanding and response to COVID-19?
JULIE LIVINGSTON: From the first moments in Wuhan, we have watched this epidemic follow the predictable dramaturgy laid out by Rosenberg. But, analytically, I find that I am more interested in the prehistory and long aftermath than the discrete event. Any dramaturgy that begins in Wuhan takes the epidemic out of the larger flow of historical time. It separates this event as somehow distinct from the massive fires that engulfed Australia a few months ago, the Ebola epidemic of 2014, the ongoing Chennai water crisis, or Hurricane Katrina. And yet zoonosis can’t be understood apart from the same larger forces that have produced the unprecedented drought cycles or the warming of our oceans: decades of land speculation, agribusiness, industrial toxicity, commodification of nature. Indeed the sixth extinction, which reminds us of the intense pressures on wild species as their habitats give way to industrial terraforming, helps us understand escalating incidents of zoonosis (here I like the work of evolutionary biologist Rob Wallace). Whenever this pandemic ends, or perhaps when it ends as “emergency” and becomes sedimented in poor communities, then, insofar as life returns to “normal,” it will in fact be the normal of climate-change-induced emergency. The pandemic could inspire new forms of consumption and international cooperation, and a new impetus toward redistribution and recognition of our interdependence. Or not.
DEBORAH COEN: I should say, first, that unlike the others here, I am not a historian of medicine and have never researched historical epidemics. I approach these questions from the perspective of a historian of modern science with an abiding interest in how people cope with uncertainty. In my research into the histories of climate science and seismology, I have been particularly interested in the implications of turning a natural disaster into a field site for scientific research.
One prevalent narrative in media reporting on the outbreak is that “fear” of the virus is making people behave irrationally. Headlines ask, “Why Are We So Afraid?” and offer guidance on “Managing Stress, Fear, and Anxiety.” Newspapers seize on stories like that of the man who shot himself and his wife because he suspected (wrongly, it turned out) that they had caught the virus. Whether the story revolves around domestic violence or excessive toilet-paper buying, the message is the same: our emotional reactions to the crisis are suspect. As a historian of science, I am interested in the work that these narratives do. For one thing, they introduce a new type of expert into the crisis: the social scientist of disaster. The disaster scientist is an expert not on epidemics or earthquakes or terrorism per se but on disaster as a generalized phenomenon. The cause of the disaster is immaterial; instead, it’s the response that’s the object of study. These experts will likely tell you that they are a wholly new breed. In fact, the CDC helped launch a “disaster science” research program in 2014, and new journals and degree-granting programs in “disaster science” have sprouted up just in the last couple of years.
Disaster science represents a troubling form of expertise for many reasons. Let me mention only two here. First, its research methods depend on turning victims and emergency responders into experimental subjects. Much of this research must be conducted in the heat of the moment, risking interference with research efforts and making it impossible to consult with an Institutional Review Board. Second, disaster science decouples analysis of the triggering event from that of the psycho-social response. Whatever the victims’ affective response may be, it becomes impossible to define it as rational, because the target of the affect has been removed from the picture. This is not a new move. I’ve written about the roots in the 1960s of this mode of disaster science, when the US government was concerned with predicting public behavior in the event of a nuclear attack. Social scientists hit on the idea of using natural disasters as analogues, arguing that the triggering event was irrelevant, and so the discipline of disaster science was born in all but name. The axiom that hazards were interchangeable allowed disaster experts to reify something they called risk — an abstraction shorn, by definition, of the specificities that make hazards so resistant to prediction and control. In the 1970s and ’80s, experts in “risk analysis” convinced many policy makers that the public could not be trusted to identify what constituted a risk. The layperson’s emotional response to a hazard became a problem to be “managed.” But fear and anxiety are not the problem. On the contrary, emotions are part of how we as humans learn about the world. This has been a tenet of philosophy since ancient times. Modern empiricism was founded on the Humean principle that hope and fear were necessary inputs into inductive inferences about the future. The media should allow fear to do its vital work, instead of giving disaster experts a platform to explain it away.
SIMUKAI CHIGUDU: It intrigues me how this novel virus and pandemic have been framed within familiar narratives and endowed with meaning according to preexisting tropes. Alongside Rosenberg, Priscilla Wald’s deconstruction of “the outbreak narrative” is an indispensable intellectual tool for making sense of the dramaturgy of COVID-19.
Drawing on Wald’s work, I see a narrative that links disease emergence to worldwide transformations, often framed as globalization. Wet markets in Wuhan have stoked anxieties about our species being at an ecological brink — China, a feared and powerful “other,” might tip us into collective destruction. The speed and patterns with which the virus has spread have elicited contradictory reactions about the obsolescence and tenacity of borders, the threat and benevolence of strangers, the failures and redemptive potential of medical science.
Africa, my home continent and primary site of study, has been discursively placed as the virus’s final frontier, where, we are assured, it will yield untold damage. Legitimate concerns about weak health systems, densely populated urban centers, and a history of devastating epidemics mingle with racist ideas about the primordial nature of poverty there and of a people incapable of responding with ingenuity to a crisis. Contrasting the horror of COVID-19 in the Global North with its presumed trajectory in Africa offers an important yet ignored political question about how and why the suffering induced by communicable diseases is treated as unthinkable in one place and inevitable in another.
ALISON BASHFORD: Many of us have been writing about past epidemics for so long that critique of the mode of discussion, and especially of war metaphors, seems straightforward if not obvious. Or better, awareness and critique is now standard, certainly in the scholarly domain, but I would say in the popular domain, too. Rehearsing what seemed new in the early 1990s high poststructuralist moment (not that Rosenberg quite belonged there) is thus not especially rewarding as an intellectual prospect. The critique may still be “true” in the world, but does any of it take us by surprise as scholars? Surely we’re in post-critique mode now. My first response as an historian to coronavirus was to write “Beyond Quarantine Critique” for Somatosphere. War, walls, containment, race and ethnicity, scaled cordon sanitaire — all the ideas that framed my own work long ago in Imperial Hygiene, in Medicine at the Border, in Isolation: places and practices of exclusion, and the authors with whom I worked closely on some of those projects — Alex Stern, Paul Weindling, Renisa Mawani, and many more — are certainly in circulation. I’m not disputing that, but what seemed new in the world of ideas in the 1990s, around anthrax scares and then SARS, is now part of everyday conversation and exchange.
In truth, metaphors and epidemic dramaturgy always seemed less interesting to me than more empirical matters concerning legal operations: how, precisely, quarantine and immigration laws are twinned, for example. And especially, the empirical matter of the disease clause that sits inside almost every immigration act on the planet, which most scholars, including initially myself, ignored in favor of analyzing racial exclusion, but that right now is being put into operation across the globe.
By far the most intellectually engaging element of the coronavirus crisis for me has been the phenomenon of cruise ships unable to dock. We did not see anything like this with SARS, bird flu, Ebola, and it has returned us all to a strangely maritime world, the maritime origins of quarantine. And as many of us discussed in Quarantine: Local and Global Histories, the 18th-century Mediterranean practice of not allowing diseased ships to pull in was quite different to the 19th-century Pacific practice of requiring diseased ships to pull in to a designated quarantine station. In the former, ships sailed from port to port seeking a place to disembark. Then, as now, they were stranded in in-between places, governed perhaps by the law of the sea, but perhaps not. A strange kind of statelessness.
PAUL WEINDLING: Epidemics are crises of social structure and organization, testing resources of medical knowledge and care. The origin of any new disease is invariably an opportunity for historical detective work. Determining the origins of AIDS, for instance, meant negotiating issues of stigma to arrive at novel sources such as blood banks in Sub-Saharan Africa. The issue of origin, part of a story of mutation and crossover, is being taken up in narratives of suppression and an ongoing scapegoating-and-blame campaign.
My research focuses on analyzing the differing responses to the twin epidemics of typhus and influenza in 1918. Typhus involved a sanitary “iron curtain” of delousing stations to defend Western Europe from a new “Black Death.” This meant typhus was a managed epidemic in contrast to the unmanageable hurricane-like progress of influenza. Virology as a science was so limited in 1918 that the virus’s cause was misattributed to a “bacillus influenzae.” To be sure, even in 2020 a single new virus type like COVID-19 is full of unknowns.
In the United Kingdom, COVID-19 became less a political discourse about the National Health Service and more of an expert-dominated discourse. Experts in epidemiology and public health appeared to shape UK policy and countermeasures by offering the government predictions that can then be “managed.” The country was plunged into scenarios involving “herd immunity,” the prevalence of “antibodies,” and how to test for these. This predicted future stands in marked contrast to actual quality-of-clinical-care concerns; the lack of personal protective equipment and ventilators; the elderly as exceptionally vulnerable; and the dawning realization that residential care had been shamefully overlooked by political elites. One conclusion is that the government was three weeks late in ordering lockdown; and it fatally abandoned tracing and isolation strategies (successfully sustained in Germany and South Korea), overprovided new Nightingale Hospitals for intensive care but underprovided testing facilities and personal protection equipment, and forgot about care homes for the elderly (and their care providers). Britain’s “managed” approach was thus catastrophically mismanaged to produce what is likely to be the highest COVID-19 death rate in Europe.
Referencing earlier successes and failures in combating epidemics, the historian of public health Sally Sheard has called for an evidence-based discourse. In the 1980s, the onset of AIDS had historians actively involved in policy-making discussions. I would like to see historians examining responses in terms of historical and public accountability by evaluating policy, public impact, and efficacy.
The shift from a political to a biomedical science-framed public health discourse has been very pronounced. The UK saw an initial tracing stage for instance, when traditional public health methods were deployed, similar to measures used against bird and swine flus, and to cholera and typhoid in the 19th century. But then a new species of expert seized center stage and epidemiological modelers adopted a depersonalized view: they set to one side contact tracing and testing, calling instead for a predictive effort to change the shape of the mortality curve to a more gradual one, to ensure that clinical facilities would not be overwhelmed. So began self-isolation. Alternative approaches like Germany’s mass testing or South Korea’s approach based on intensive testing and tracing were ignored. As it happens, Germany has a 150-year history of laboratory testing. The UK was remarkably slow to scale up testing. Predictive epidemiology has ended up eclipsing crucial issues like clinical care, and the need to test medical staff. An inexperienced new government ignored prior pandemic exercises and plans, resulting in a muddle of catch-up measures, costing the lives of patients and health workers, most notably from ethnic minorities.
Scientific inadequacies exist alongside the old metaphors intended to conceal them. In Britain, to legitimate emergency measures, we hear the rousing 1940 battle cry of “turning the tide of war.” The Blitz was evoked in the context of reinforcing testing facilities for COVID-19, and a hoped-for Dunkirk fleet of little laboratories coming to the rescue was evoked in the wake of Germany’s immense testing capacity and lower death rate. Certainly World War II saw remarkable medical collaboration on the Allied side, but the current resort to that beleaguered period is a sign of things going awry. A patchwork of historical metaphors poorly hides defects in provision and planning as Britain vegetates in its prolonged lockdown.
NAYAN SHAH: The war narrative has an intentional history in public health campaigns. It seeks to discipline society and mobilize resources of a nation “under siege.” The invisible virus is hard to imagine, so human enemies must be targeted and shunned. In this way, medical scrutiny and public fears are directed toward the “super-spreader,” “patient zero,” or “asymptomatic carrier.” This defensive strategy combines with beliefs that one’s personal health and status can in fact be protected, with the creation of pariahs becoming part of that protection.
I worry about how war imagery fans the flames of violence. In the United States, we are reading reports of verbal and physical attacks on Chinese, other Asian people, and people of color out of deep-seated racial anxieties; in China, there are reports of growing suspicion of African students; and, in many urban parts of the world, migrant workers are both acutely vulnerable to illness and politically targeted. It is also disturbing to hear that health workers in Mexico City, Indore, India, and Cortland, New York, have been publicly targeted. Not only are care workers acutely vulnerable to shortages in personal protective equipment, but news of general vulnerability is twisted into a fear that medical workers on the front lines are spreading COVID-19.
RICHARD KELLER: Rosenberg’s “dramaturgy” model holds up well in the case of COVID-19: the granting of agency to a non-living virus, the rampant ethnicization of the so-called “Wuhan” or “China virus,” and the military metaphors surrounding the effort to control its spread. But what’s so remarkable is just how limiting this particular model is as a tool for thinking about the pandemic. To circumscribe the pandemic with such a narrative device is to make it discrete rather than one facet of a broader experience of late capitalist modernity, or of peak Anthropocene. To take just one example, think about the alleged origins of COVID-19 in the Wuhan “wet market.” Yes, a live animal market represents one possible zoonotic space. But a zoonotic jump is only one condition allowing for the irruption of a pandemic. Far more important to the propagation of a disease is a broader ecology that favors the virus’s sustained spread through a vulnerable population. Urban density represents a particularly friendly ecology for this virus, but what about the culture of American individualism? A broader recognition of shared social responsibility has helped to tamp down the virus in South Korea. But the radical individualism of the United States — to say nothing of the federalism that allows individual states to establish local ordinances and responses — has only fanned the flames of the pandemic here. A brilliant satirical essay in The Elephant described the American epidemic in the language that Westerners used for the 2014 Ebola epidemic in West Africa, skewering American self-reliance and a health-care system that abandons the most vulnerable as symptoms of a pathogenic culture. The waves of infection following the diaspora of spring breakers, as well as clusters of infection linked to the Wisconsin election on April 7, are just two ecological factors rooted in a dysfunctional political culture.
Another important limitation of the dramaturgy model is that it assumes an ending. But as Guillaume Lachenal and Gaëtan Thomas — citing Dora Vargha — have noted, most epidemics involve no such closure. There will be no returning to a pre-COVID-19 past, but what remains to be seen is what a pandemic future will look like. Will we return to shaking hands? Will we witness a dramatic expansion of mask societies? How, and in what ways, will the radical pivot to online learning mid-semester favor the wholesale liquidation of higher education? Will study abroad ever return to its former levels, especially as new pandemics emerge to occupy new social niches?
A. L.: Have events of the past weeks paralleled any of your existing research concerns or spurred you to develop new ones? And on a personal level, how have you navigated living through something you have directly or indirectly studied in your own work?
BASHFORD: The pandemic has made me perceive how far beyond “globalization” we now are. Globalization — and the whole possibility of rethinking history in global terms — was the exciting new frame behind the SARS-inspired conference that became Medicine at the Border. The subtitle was chosen carefully: “Disease, Globalization and Security, 1850 to the Present.” We certainly have a new present. The difficult thing to understand now, however, is not the regulation of international borders and movement, or the impact of globalized economies. Rather, it is the new insistence on regulating internal, intra-state movement. In many states, this translates into unprecedented experimentation with regulating internal movement. But is it actually unprecedented? The new fashion for the term “unprecedented” surely invites us historians to adjudicate — in fact, it moves us back beyond the 19th- and early 20th-century consolidation of powers that enabled the regulation of movement between nation-states (the sudden, multiple immigration and aliens acts) toward the earlier regulation of movement within states: between parishes, onto or out of reserves, and into or out of plague towns. Thinking historically about local, intra-state movement and its regulation is now seeming at once more useful and more difficult to historicize than rehearsing what we already know as historians about the regulation of international movement.
CHIGUDU: My first book, The Political Life of an Epidemic: Cholera, Crisis and Citizenship in Zimbabwe, is a study of the complex sociopolitical causes and consequences of Zimbabwe’s catastrophic cholera outbreak of 2008–’09, which I argue was a “manmade” disaster. It exacerbated preexisting social inequalities and exposed fundamental weaknesses in the global humanitarian response to epidemics. The fraught and manifold politics of that outbreak invites us to conceive of epidemics as having multiple ontologies. Epidemics are, in other words, simultaneously many different things: infectious disease, spreading through a given population longer than normally expected; social phenomena, spreading through populations in socially patterned ways; historical phenomena, often the culmination of multi-scalar, political economic processes that obtain over time; and political phenomena, the declaration of an epidemic almost always being followed by political contests over the attention, resources, and priority that said epidemic should receive. They are never “only” emergencies. Like cholera, COVID-19 has “multiple ontologies.”
WEINDLING: Coincidentally, my current research is on typhus and World War II, which is why I am editing an unpublished text on epidemic control in the German-occupied East by the director of the Hygiene Institute of the Waffen-SS, Joachim Mrugowsky. I am also researching how Nazi experimentation on deceased Polish Jewish typhus victims was exploited, with resonances for today with brain tissue sample research and disposal of the dead, already a significant problem in Spain and New York; and I’m looking at the added grief that bedside exclusion can carry here in the UK. With Sevasti Trubeta and Christian Promitzer, we are in the final stages of editing a book on sanitary borders. Closing borders to people but allowing goods to pass echoes contemporary issues with erecting new medical barriers across previously open European spaces. It is also closely associated with Europe’s refugee crisis, the deepening sanitary problems in refugee camps and inadequate housing.
SHAH: I am particularly concerned by news reports about spiking infection rates in immigrant detention centers and prisons. Elderly nursing homes, as well as prisons and detention centers, suffer from shortages of protective equipment and lack distancing options. There have been calls for the early releases of the most vulnerable prisoners and detainees to ensure that the prisoner does not die under state custody. This diverts attention from the endemic health crises in these underfunded institutions. Administrators fear the death of a person in their custody and the possibility of a public inquiry developing after evidence of years of rampant neglect, indifference, or abuse.
LIVINGSTON: I find many of my current or recent research concerns surfacing in new ways in the epidemic. First, I recognize a key issue here that I have been thinking about for many years: the complex relationship between “chronic” illness and “acute infectious disease.” Over a decade ago, when I did the research for my book Improvising Medicine, I saw how the cancer epidemic was in fact about comorbidity, the presence of HIV revealing a hidden and escalating burden of cancer, with HIV, TB, diabetes, hypertension, and cancers working together synergistically. And that comorbidity was being produced through a particular political economy rooted in racial capital and colonialism. Now, here at home in the United States, I am seeing another epidemic of comorbidity. COVID-19 is surfacing the population’s tremendous burden of chronic disease along with its chronic exposure to air pollution, and then harnessing those forms of slow violence to the accelerated pace of acute infectious disease at epidemic proportions. Racial and class disparities in disease burden — amplified in this case through a combination of environmental racism, industrial agriculture, and the mal-distribution of health care, all of these lying atop disparities in low-wage “front-line” work (grocery stores, Amazon, delivery, home health aides, and other low-level health workers like emergency medical technicians) — are in turn producing profound racial disparities in COVID-19 deaths. This normal cost of doing business in America is now suddenly revealed as the emergency it has long been. Meanwhile, in southern Africa where I have long worked, many are anxiously watching how things will play out when this virus runs through a population with a historically high burden of tuberculosis and HIV.
Second, my most recent book, Self-Devouring Growth: A Planetary Parable as Told from Southern Africa, examines the long-term public health consequences of unrestrained economic growth, much in the same way as I see this epidemic as horrifically manifesting the problem of self-devouring growth. The pandemic shakes the system of global capitalism to its core, revealing multiple fault lines — from the problem of supply chains to the ways capitalism mobilizes a rhetoric of sacrifice and triage. The commodity fetish is completely naked now. From the meat-processing plant to the grocery store, the workers who are made to risk their lives for our food are now revealed. I had been preparing to write a sequel, a book that attempts to imagine what a new, fairer, and less destructive world might look like, and that project is gaining momentum.
KELLER: I’ve spent a great deal of time in recent years thinking about the social factors that influence disease ecology. One question I’m working on is how the emergence of Lyme disease and HIV/AIDS are linked to a particular series of ecological changes in America’s cities and suburbs in the 1960s and ’70s. As cities fell into economic decline — New York’s bankruptcy is paradigmatic here — and white flight prompted waves of suburban development, new relationships between people and their environments emerged. And even though an atmosphere of addiction, desperation, and disinvestment looks nothing like the rise of affluent, bucolic suburban landscapes, there are close connections between the two insofar as phenomena like redlining and restrictive covenants helped to galvanize both trends.
On the personal side, I’ve been navigating the pandemic and its disruptions primarily through a significant reorganization of my teaching. I’m running a course on the history of modern medicine and public health right now, with predominantly pre-med students. With the move to online learning, I’ve rewritten the syllabus to focus on historicizing the current pandemic. Most students have elected to keep a pandemic journal for the remainder of the semester, and they’ve volunteered to donate them to the Wisconsin Historical Society after the semester’s end. (This was an idea I borrowed from @cjdenial at Knox College.) I’ve set up a discussion board where students can share their experiences of the pandemic as well. Between the journal entries and the discussion board, it’s clear that this has been a wrenching experience for my students. Many are suffering greatly from the economic repercussions of the pandemic. Others have seen relationships fall apart. A number of them work in health care, and they are terrified by what they’re seeing and how ill prepared our hospital system is.
COEN: For many people, the shift to working from home feels profoundly disorienting. This may be especially true for academics. Going to campus means setting aside the emotional intensity of family life in order to take up cerebral concerns. We may even think of ourselves as different people in these two spheres. Yet my own research reminds me that this division between work and home is a surprisingly recent invention. For a long time I’ve been interested in the historical relationship between domesticity and the practice of science. Until the late 19th century, a laboratory was often a makeshift space in a basement or attic, and a field station was no more than a backyard. Nineteenth-century scientists would have been bemused by our perception that home life is somehow too affect-laden to be conducive to scholarship. On the contrary, they were grateful for the aid of relatives and domestic servants, whether as technicians, scribes, or observers. The practice of science at home meant that many middle- and working-class women contributed to research in ways that were never acknowledged in print. So it was that my first experience with online teaching two weeks ago was a meeting of my undergraduate seminar on Gender and Science devoted to the topic of “domestic science.” We read about Charles Darwin’s scientific household, and I invited the students to reflect on their own experiences of scholarly work from home. I think that recognizing the historical contingency of our work/home dichotomy helped free up their critical faculties: we fell into conversation about how isolation was shifting gender roles in their families and accentuating class divides among students. I had worried that they would be reluctant to speak at all on Zoom, but in fact they seemed reluctant to stop.
A. L.: Medical crises and their management through public health have often proved to be engines for social change while also enabling the expansion of state power. What are your thoughts on current developments in your own domestic context?
BASHFORD: Again, rather than globalization being the useful idea, plain old national comparison is more instructive. The massive difference in traditions with respect to state responsibility for citizen health is apparent. One republic’s inadequacy in particular is demonstrably apparent: the United States. I think what we’re witnessing is that well-used state power is a good thing. A necessary thing. Neoliberalism doesn’t help us in this context. At the same time, liberalism’s backstory enables historians to show that principles of free trade and movement have long been tied to the twinned regulations of quarantine and immigration controls. The UK’s history is the most interesting in this regard, liberals holding out against (European) quarantine measures, and even more uniquely, holding out for decades against immigration restriction.
CHIGUDU: Zimbabwe’s 2008–’09 cholera outbreak occurred at the height of the country’s hyperinflation, and in the aftermath of unconscionable electoral violence. The ruling party and the opposition were at a political impasse when they were entering a long series of negotiations to determine how to govern the country. Amid all the recriminations for the outbreak and its deaths, the humanitarian response to the disease was ultimately driven by an assemblage of domestic and international institutions, all working below the radar of partisan politics. This response did not expand bureaucratic state power. Instead, it undermined Zimbabwe’s bureaucracies by mostly yielding command of the medical humanitarian cholera response to non-state entities. The justification for yielding: Something had to be done to stop the emergency since state bureaucracies were incapacitated and ill equipped to deliver.
The prevailing focus on cholera as a humanitarian emergency in Zimbabwe overshadowed attention to what it in fact was: a long-term crisis of public health infrastructure precipitated by a short-term political-economic crisis. The management of the cholera outbreak was therefore not an engine for social change. It was a conservative and narrow medical response that left the underlying determinants of the cholera outbreak — poor sanitation, food insecurity, overcrowded housing — intact. The political risk posed by COVID-19 in Zimbabwe is that we will see another potentially catastrophic outbreak further weakening the country’s bureaucracies, with the humanitarian responses ultimately filling in the gaps; there will be no accountability for the crisis, and no structural change taking place.
SHAH: Proposals for linking a person’s identity with recovery and immunity are one avenue for the expansion of state power. If ending blanket stay-at-home orders were to involve a certification for antibodies by way of “immunity cards,” then this could serve as a potential passport to mobility for some, while others would be required to shelter in place. It reminds me of the vaccination cards required of the Chinese and Japanese for leaving Chinatown during the quarantine of San Francisco in 1900. Most Chinese residents feared the dangerous side effects of the experimental vaccination, but they had no choice but to comply in getting vaccinated to access work opportunities in the city and across the country.
The focus now in 2020 is on preventive measures — masks, social distancing, handwashing — which is creating a new repertoire for what being a hygienic citizen means. We are likely to wait years for the magic bullet vaccine or anti-viral to be developed.
I’m fascinated with the kinds of therapeutic experimentation happening in the interim in homes and clinics, communicated by phone, email, WhatsApp, text, and Twitter. What are on-the-ground strategies for symptom relief, for reducing fevers and clearing nasal and throat passages, for preventing the deeper incursions of the virus into the lungs? What kinds of home remedies are circulating, including folk health knowledge? What kinds of ideas about the body, illness, and recovery are being transmitted from traditional Chinese medicine, Ayurveda, homeopathic cures, ad hoc pharmacological experimentation? What is the ever-expanding repertoire of symptoms that are linked to COVID-19 as opposed to other viruses? We are all living with coronavirus, and caregivers are using their own ingenuity and knowledge to learn how to treat those who become ill, to moderate the path of the illness, so that it does not lead to hospitalization. In other crises, such as HIV/AIDS, polio, tuberculosis, there were also new cultures of care, social networks of solidarity and mutual aid, and political challenges to the existing power structure. I’m paying attention to who the survivors and caregivers are, and who is fighting for the redistribution of resources and assistance. Will there be social movements for protection and care of the most vulnerable and those who are targeted as diseased pariahs?
A. L.: Most media coverage of COVID-19 that has included a historical dimension has focused almost entirely on the 1918 influenza pandemic. Privately, some historians have criticized this — for being inaccurate, misleading, or facilitating the exclusion of more instructive examples. What’s your view?
BASHFORD: History has hit the news more often in the last month than ever. This is a good thing for historians. It’s entirely understandable that the Spanish flu is the reference point, the epidemic benchmark. But as a historian, I think the third plague of the mid-19th to mid-20th century is productive to think with — less in terms of the era’s response to rats than to the environment and architecture. The disinfection, fumigation, wall cleaning, slum-clearing response, for better or worse, are all familiar. And although many people seek a parallel historical crisis — a similar epidemic or pandemic — in fact “quarantine” has long occurred in fairly undramatic and quotidian moments. The odd smallpox case here. Yellow fever possibly there. A ship therefore quarantined. Nobody liked it, but it was not necessarily a practice undertaken in emergency or crisis contexts. I’m keen to examine practices rather than particular crises. Rituals of fumigation and disinfection — of paper, letters, envelopes, materials — that characterized earlier and apparently stranger times have returned.
LIVINGSTON: The HIV/AIDS pandemic is my model, perhaps because it is the pandemic I know best and lived through. There are crucial differences to be sure, but each time I see footage from inside a hospital in New York City right now, I see a hospital very much like the ones I saw in southern Africa at the height of the AIDS epidemic, operating at well over capacity, running out of critical supplies, improvising care and knowledge, with medical staff living in fear of infection. The early years of the AIDS epidemic were awash in false information, government passivity, and ineptitude. There were questions and debates over counting practices, models, and projections, all of which were politicized. Even as I sit here, there is a field hospital in Central Park, gifted and run by an evangelical organization (Samaritan’s Purse), which professes hatred, explicitly denigrating many in our city, including Muslims and LBGTQ persons. Yet, as was so often expected of Africans during the AIDS pandemic, we New Yorkers must grit our teeth because of the failures of our leadership. We must sit here and say thank you to bigots while anxiously wondering if we can trust them enough not to kill us or triage care through their own twisted bioethics. We can only hope that a new grassroots organization like ACT UP may yet come to hold our leaders accountable. After all, it was AIDS activists who taught NIAID Director Dr. Anthony Fauci so much.
KELLER: Nothing good ever seems to come of the political consolidation of a state of exception. Regarding the parallels with 1918, it’s an obvious comparison. But I think there are other ways to use the past to illuminate the present. One thing that opened my students’ eyes was their realization of just how deadly COVID-19 has been in certain populations. When we were still meeting face-to-face, they trivialized the pandemic as affecting only the elderly. But their jaws dropped when they realized that, in the Italian case, COVID-19 was just as deadly for the elderly as smallpox was for European children in the 18th century. Other pandemics offer valuable comparisons as well. European authorities prioritized the economy over their citizens’ lives during the cholera pandemics of the mid-19th century. Their recommendations for avoiding cholera effectively amounted to counseling their citizens and subjects not to be poor. The same applies to social distancing today: the policy assumes that one lives in secure housing, with the ability to stockpile weeks of groceries and other supplies in the face of lost wages. And finally, there’s the third plague pandemic of 1894–1901, which brought with it vast consequences, including an explosion of anti-Asian racism in the United States, but also a major boost to the Indian independence movement, and even a rationale for a nascent apartheid system in South Africa. One imagines the political and social consequences of this pandemic will be equally far-reaching.
WEINDLING: As mentioned earlier, typhus was the companion of influenza in 1918–1920. At the time, it received more epidemiological attention from the new League of Nations Sanitary Division, but typhus has retrospectively been forgotten as hygienic standards rose. With parallels to today, typhus prevention placed great emphasis on personal spacing and protective clothing, hygiene of interior space, and routines of disinfection and cleansing.
COEN: The comparison to the 1918 influenza pandemic is interesting because it reminds us of a very different era of “disaster science.” The long 19th century saw the rise of efforts to interpret epidemics and other “natural” disasters — including famines, droughts, storms, and earthquakes — from a scientific perspective. Yet this was a very different enterprise from the disaster science of the late 20th and 21st centuries. For the fledgling science of epidemiology (or “medical geography,” as it was then known), as for climatology, and seismology, disasters were opportunities because they generated copious data in the form of eyewitness testimony. Before reliable technologies of remote, mechanical observation, each of these sciences depended on the accounts of lay eyewitnesses as a window onto the workings of nature. Medical geography, for instance, relied on patients’ own accounts of the course of an illness and their own observations of the conditions that gave rise to it. The 1918 pandemic came at a transitional moment not only for epidemiology. At the risk of over-generalizing, I would say that the trend in all these field sciences was to replace lay reports with instrumental observations. Seismometer readings were displacing the accounts of earthquake victims, just as microbial cultures grown in a lab took priority over the narratives of patients. This transition spelled the end of an era of lively communication between scientists and non-scientists about natural hazards, and the start of a new age in which experts’ accounts of disease, as of other threats, no longer bore much resemblance to the experiences of people on the ground. None of this earlier history of disaster science has figured in our search for comparisons to the current pandemic, but it should.
SHAH: I think it’s important to understand what purposes the 1918 influenza story serves. So many different lessons are being drawn regarding the worldwide scale of that pandemic — from the recurrent waves of its spread to the visibility of the disjuncture between health-care infrastructure and medical technology. Lessons are being drawn, too, from what urban strategies of quarantine and shutdown worked or failed, the concurrent ravages of World War I and the high incidence of secondary bacterial infections.
The 1918 pandemic plays a part in a family legend of my own; it wiped out most of my mother’s family, who lived at the time in a small city in western India, already vulnerable by famine. Only my infant maternal grandfather, his father and aunt survived the “plague” that killed his mother, uncles, siblings. The family had to regroup, and for several decades they shared their household with orphans from a family of a different Hindu caste and alongside Muslim families. The shared experience of devastation created new households, spiritual movements, and political alliances, including bringing surviving young men into the non-cooperation and civil disobedience campaigns against British rule. In my father’s family, which lived less than a half-mile away, the aftermath stimulated regional migrations and, in another generation and half, for both families an emptying out of their ancestral homes to access education and opportunity across the globe.
The regrouping of survivors is what fascinates me. At the moment in the United States, it seems that sheltering in place and social distancing are consolidating and barricading nuclear family households. What will the crisis do to the prevailing social and political order? How will the survivors regroup? Is the containment of the nuclear family household sustainable or viable? Are new constellations of care, kinship, and habitation being brought into being in the wake of massive unemployment, the housing crises, and the need to band together. How and with whom survivors live, how care and well-being is shared, and what neighborhood ties are deemed essential will all look quite different depending upon the vulnerabilities, dislocation, and disorder of the pandemic’s aftermath.
A. L.: Your publications feature on “Corona required reading lists.” What book(s) have you been turning to in your own reading?
BASHFORD: I’ve been reading Renisa Mawani’s recent book Across Oceans of Law: The Komagata Maru and Jurisdiction in the Time of Empire on the phenomenon of ships suspended in place and time. Largely about the implementation of various immigration acts. The immigration acts of virtually every jurisdiction in the world contains a disease clause of some description.
SHAH: I’m reading John Mckiernan-González’s Fevered Measures, Robert Peckham’s Empires of Panic and Epidemics in Modern Asia, and Jih-Fei Cheng, Alexandra Juhasz, and Nishant Shahani’s (ed) AIDS and the Distribution of Crises.
WEINDLING: While modern historical research offers useful accounts of localized epidemics and vaccine development for comparison and context, classics like Sinclair Lewis’s novel Arrowsmith and Paul De Kruif’s Microbe Hunters remain excellent resources. Ludwik Fleck’s writings on his period in Buchenwald working on vaccine production also sheds fascinating light on how scientific facts remain constructed and socially construed. A new generation of scholars is shedding light on typhus. Łukasz Mieszkowski is researching sanitary trains in the new Polish state after World War I, and Eva Hallama the delousing of forced labor from the point of view of shame. Nazi concentration camps and ghettoes struggled to stem epidemics. Miriam Offer has looked at ghetto health arrangements and Sari J. Siegel the role of Jewish prisoner medical personnel in Nazi camps. These raise the question of how we determine the threshold between an epidemic and a genocidal situation. We are far from such a point, but containment of populations and eradication certainly carry risky historical baggage.
LIVINGSTON: I am too distracted to read beyond the length of a short article or essay. I especially recommend the recent essay entitled “We Are Living in Failed State” by George Packer in The Atlantic, and everything by science writer Ed Yong, also in The Atlantic. I find Yong stunningly good, and am grateful we have such a fine science writer to help make sense of such a complicated and shifting terrain. I’ve also been watching quite a bit of TV.
KELLER: I’m turning to fiction — rereading William Gibson’s The Peripheral, which makes awfully similar connections between climate catastrophe and a series of pandemics in a highly probable near future, as well as his newer novel, Agency. Other stuff I’ve been thinking about includes the work of people like Adriana Petryna, João Biehl, and Jeanne Guillemin, all of whom have written fantastic monographs about peculiar forms of political economy and the vulnerabilities they generate.
COEN: Right now, I’m more grateful than ever for the alternate universe of a novel. But when I’m not escaping into fiction, I’m trying to learn more about the recent history of expertise. I’m making my way through three fascinating new books on this topic: Chris Kelty’s The Participant, David Demortain’s The Science of Bureaucracy, and Gil Eyal’s The Crisis of Expertise.
A. L.: Who gets to decide when a crisis ends? Please discuss the ways this question has been contested in the epidemics or disasters that you’ve studied. As a historian, how have you negotiated the idea of closure, or its absence, for specific communities in your analysis of those events?
COEN: This question points to the problems with the concept of crisis. Joe Masco calls crisis a “conservative” concept, in that it implicitly prescribes a return to the status quo, short-circuiting the work of imagining a better future. Any definition of the present “crisis” needs to consider the underlying conditions: the long history of environmental abuse, combined with economic and health precarity. If historians have a role to play at a moment of “crisis,” it is to encourage people to keep this large-scale, long-term picture in view, and to continue to do so even after the crisis “ends.” Richard has suggested a marvelous way to do so: invite people to create their own pandemic archive. In the 19th century, this invitation would have come not from historians but from scientists and physicians. Nineteenth-century “disaster science” proceeded, whenever possible, by collecting detailed reports from eyewitnesses. For scientists, these reports constituted data about natural forces, as well as about human responses to them. They understood themselves to be building an archive to serve both present and future researchers, even if they couldn’t imagine the questions we might ask of it. But for those who penned the reports, I imagine they were a welcome opportunity for reflection. For victims, self-reporting was an opportunity to process the event, to dwell on its effects on their homes, bodies, and psyches, even to speculate about the conditions that might have triggered or exacerbated it.
LIVINGSTON: There will surely be an end to this pandemic, and in my mind it might look something like this. The end will be declared with great fanfare and relief. Narcissists of many stripes will try to claim credit, including our president here in the United States. A time will yet come when we can finally congregate in restaurants and bars, use public transportation with confidence, shed our masks. Despite a chaotic rollout, there will be a triumphant celebration of a vaccine-as-solution (all the more so if it is American-made). At least in New York City where I live, it will be a tremendously sad time as we begin to take in all that we have lost. Anxious and profound poverty awaits millions who have lost their livelihood. After the “end,” the surveillance state will remain strengthened, and disaster capitalists will reap new gains in the interest of “rebuilding.” Telemedicine, which has been catapulted forward by this epidemic, will be further normalized. Patterns of global commerce, consumption, and immigration may well be permanently altered. But if this epidemic is anything like so many before it, I can also imagine its sedimentation in poor communities, particularly in parts of the Global South, even as northern nations begin to vaccinate in earnest and declare the event over. Remember that only one disease (smallpox) has ever been eradicated globally despite sustained efforts to replicate that success. And remember that the normal that Americans want to get back to is one characterized by high rates of cancer, diabetes, heart disease, and other chronic illnesses that COVID-19 has surfaced. Those epidemics will continue, as accepted side effects of our economic and political systems, collateral damage that disproportionately affects the black, brown, and poor. The collective urgency we now feel will dissipate back into individuated narratives of misfortune.
In the bigger planetary picture, I imagine this is a crisis that will give way to other crises, because the conditions of possibility are ongoing. In East Africa right now, crops are being destroyed by a locust invasion of biblical proportions. The hurricanes, fires, and pollution are the normal to which we hope to return. I see this epidemic as a dramatic moment within what is now our new historical era, the age of disaster, of climate change and toxicity. In that sense, this event may yet prepare us to finally face our new truths with the gravity and creativity they require.
WEINDLING: Closure as transformation was signaled after the influenza pandemic when the League of Nations Epidemic Commission became the League of Nations Health Organization. This was a scientifically innovative international body enjoying US support through the Rockefeller Foundation for a range of pioneering initiatives from vaccines to nutrition. Again, we have in the United States a visionary foundation with a global orientation. And we have a president who is at times disengaged or argues for a rapid exit, and who has astonished the world with maverick remedies. Closure might be — as in China — the reassertion of the normal, albeit backed by an assertion of state power, or — as in the United States — a highly contested election. The UK’s prime minister, a convalescing patient, seems intent on keeping the country locked down for as long as possible.
CHIGUDU: At the heart of the larger political dynamics that follow disasters are the ways in which the provision of relief and the identification of blame and failure are established and translated through moral-cognitive frameworks. Those who have the capacity and willingness to visibly provide relief can potentially gain legitimacy, gratitude, and public standing while those who are seen to be inactive, absent, or profiting from the misery of others can potentially be delegitimized.
The high stakes of Zimbabwe’s 2008–’09 cholera crisis gave rise to a contentious and confrontational politics. Different organizational entities, communities, and individuals collided with one another in their attempts to command the narrative and shape a response according to their respective ideologies, institutional mandates, and political ambitions.
Humanitarian and human rights organizations sought to protect vulnerable people from what they saw as the depredations of Mugabe’s government. They argued that the cholera crisis could be resolved through a combination of medical treatment for the disease’s victims and legal action against a government guilty of “criminal negligence.” The main opposition parties saw resolution as being a change of government and argued that cholera exposed the ruling party’s shortcomings. The ruling party weathered these attacks by forging a coalition government with the opposition while deflecting critiques from civil society. The end of the crisis was ultimately contingent on political calculation and the leveraging of power.
BASHFORD: The idea and experience of crisis scales up and down from the intimate to the international. Modern states have moderated and adjudicated this for better or worse; and the tightly integrated and shared history between public health and the formation and characteristics of various kinds of states is a pressing one. Epidemiological intelligence, as it used to be called, is a strange hybrid of clinical and statistical expertise plus state structures plus communication technologies, made useful or useless over time and space. The states that manage epidemics are also in a position to close them, as are agreed-upon supra-national bodies like the League of Nations Health Committee or the WHO. An “end” can, in fact, be quite literal in this context — elimination or eradication. Toward zero is such an interesting idea, as is risk minimization. With the coronavirus crisis, I’ve become aware of the poor timing of so many scholarly debates. There are often insufficient lags and disconnects between trends in humanities and social sciences scholarship and ideal moments for their application. The “risk” literature of the 1990s — Giddens and Beck — had great purchase because of HIV/AIDS (the crisis that hasn’t ended). That was good and not coincidental timing. But all those ideas should be returning now when risk is being assessed in acute rather than chronic circumstances. Scholars — especially junior scholars who want to make their mark — are often disinclined to return to earlier conceptual breakthroughs precisely because they’re old. But we’re all managing risk now.
KELLER: Any “end” will be dubious, illusory, and politically instrumentalized, and will represent a return to a state of extraordinary precarity for most who’ve experienced it. And the pandemic’s continuation will be baked into the local social worlds of those least able to withstand the additional blow. This will invariably concentrate in the Global South, but also in significant pockets of the United States and Europe. Like tuberculosis, COVID-19 or its successors will likely become a characteristic risk of all forms of institutionalization.
The end of the pandemic on an epidemiological front is of course only one end. Think also of the beginnings launched by this pandemic. Already universities are talking about “virtualizing” study abroad experiences, and we’ve been instructed to brace for a fall semester that either starts online or features a similar mid-semester pivot, should pandemic conditions return in October or November. But how long can institutions withstand such uncertainty before they inevitably transform their practices on a permanent basis? What further vulnerabilities will the shrinking of state, donor, and grant support expose at the modern university? At a more fundamental level, how might our patterns of consumption change? As a child of the Cold War, I remember hearing stories about Soviets queueing for toilet paper as a basic condition of communism. How ironic our current state under late capitalism with its fetish for efficiency!
A. L.: This pandemic has arrived on the tail of a decade investigating “fake news.” But for some historians the concept is nothing new, paralleling earlier shifts in new mediums of knowledge; strategies of financial or political profit; objects of sociological study; and, challenges to public health’s monopoly on truth. In prior health crises, what were the normative stakes of regulating information consumption? How was “fake news” understood, and does it feel anachronistic and/or useful in this regard?
COEN: Given such present-day concerns, it may be hard to believe that scientists once turned to newspapers as a source of data. In the second half of the 19th century, scientists were increasingly interested in constructing global maps of phenomena like epidemics, earthquakes, and storms. Where else could they look for accounts of these phenomena worldwide but in newspapers? Today you can still leaf through some of the collections of clipped articles these scholars pasted together to serve as databases. Yet these same scientists complained that the press tended to exaggerate or sensationalize accounts of natural disasters. They also faulted the papers for providing a platform to contrarian “experts.” At the time, none of these scientific disciplines claimed to be predictive, but that didn’t stop some individuals — most notoriously, Rudolf Falb. Falb was a former theologian in rural Austria who gained an international following for his forecasts of natural disasters (based on calculations of the alignment of the earth, sun, and moon), prompting evacuations as far away as Peru. (When nothing happened at the predicted location, Falb simply pointed to an event elsewhere at roughly the same time to “confirm” his forecast.) Professional scientists concluded that newspaper editors were committed to selling papers, not communicating science. As a consequence, scientists learned to refrain from issuing predictions and to keep discussions of possible future disasters behind closed doors. This is a lesson that many scientists today continue to take to heart. We have yet to create the conditions for a robust public conversation about the uncertainty of epidemiological knowledge. This is evident in the maps and graphs that the media typically use to visualize global data on the spread of the virus. Absent from these visualizations is any indication of the uncertainty that derives from the fraught process of comparing data collected in different countries under very different conditions according to methods that are only weakly standardized. The point is that there is no simple opposition between fake news and hard facts when it comes to minimally predictable hazards.
CHIGUDU: Zimbabwe’s 2008–’09 cholera outbreak saw a frantic rush among diverse agencies to shape perceptions of the epidemic. When foreign governments and journalists condemned former president Robert Mugabe for his mismanagement, the country was labeled a “failed state.” These accusations provoked a belligerent counternarrative from parts of the Zimbabwean government. The Minister of Information at the time claimed that British secret agents had entered the country to spread cholera and anthrax as biological weapons to precipitate regime change in the country.
In civic life, the Zimbabwean rumor mill was running on overdrive as people speculated about the government’s role in the cholera outbreak. Large numbers of people dismissed the suggestion that the British caused cholera in Zimbabwe, instead asserting that it was Mugabe’s regime that had launched “biological warfare” in the country. They suggested that cholera was “sprayed” into the Harare’s high-density townships, which were epicenters of the outbreak. Others suggested that the government bought “fake water treatment chemicals” from China, which could not clear water sources of the cholera bacteria.
These cholera stories were narrated in relation to anxieties about failed governance, political conflict, human rights violations, environmental degradation, and institutional corruption. How people had hitherto experienced Zimbabwe’s political-economic crisis deeply affected how they perceived and reacted to the disease. Public health information does not exist in a vacuum; it is inevitably interpreted and contextualized in wider social and political contexts.
WEINDLING: Typhus played a central role in the tragedy of the Holocaust. Cleansing with delousing showers seemed familiar from anti-epidemic routines, which offered a cover for genocide and mass destruction. This was the “fake” of colossal proportions. To be sure, infected groups have not been portrayed as pathogens to be eradicated, but the rationing of resources does raise uncomfortable questions about the valuing of life. We need to be vigilant about guarding against the “slippery slope” when containment and isolation with neglect of the infected leads to death. Certainly viral eradication scenarios, however seductive, require judicious caution and the upholding of humane ethical values in their realization.
BASHFORD: It’s perhaps more useful to consider population-level health scares than to apply “fake news” retrospectively. The contagion of rumor — the exponential spread of formalized and informal information — is a longstanding object of inquiry in scholarship on actual contagion. And managing rumors — with the multiple truths or fabrications within them — has almost always been the business of managing infectious disease and knowledge of potential cures. In places where smallpox was not endemic, which usually triggered the quarantining of an incoming ship (19th-century Australia for instance), asymptomatic passengers were sometimes required to be vaccinated as a condition for leaving quarantine. The health scares about vaccination were harder for public health authorities to manage than the health scares about smallpox. The history of the idea of verification is perhaps more interesting than that of fake news. Mary Poovey’s book A History of the Modern Fact helps us contextualize the current moment within a long modern history of truth-claims and their verification, as well as history of statistics — the science of the state. Indeed, what was once the “science of the state” is now the quotidian language and business of all: “the curve” has never had such an eager audience.
KELLER: We are witnessing the culmination of a crisis of mistrust in expertise. Social media teems with conservative voices contesting the death toll, insisting that those who “died with COVID-19” are far greater in number than those who “died from COVID-19.” By this reckoning, anyone whose death certificate does not list COVID-19 as a proximate cause of death should not count. Yet the history of vital statistics reporting demonstrates that death certificates are often incomplete and unreliable documents. In fact, a death certificate will not list COVID-19 as the cause, even if one is attributed: instead, it will list pneumonia, or congestive heart failure, or another physiological dysfunction as the cause of death. Confirmed cases are a better proxy for understanding the scale of the pandemic. Yet, as a recent New York Times story reported, people who have died at home before receiving a diagnosis are not being tested — the tests are too precious to waste on those who’ve already succumbed. So the confirmed case count is already far too low. Those who mistrust the numbers insist that deaths among confirmed cases overstate the impact of the disease, as they include COVID-19-positive patients who’ve really died of cancer or heart disease or traffic accidents. But those anomalies are vanishingly small when compared with deaths among those who haven’t been tested — or those who’ve died of other causes but were either turned away from overwhelmed hospitals or who feared infection in hospitals in the first place. An excess mortality measurement — a comparison of the death toll in 2020 compared to five-year average of weekly deaths in the same period from 2015 to 2019 — will tell the real story of the pandemic’s impact. And while skeptics will surely cry “fake news” at this staggering and inclusive number, the medical examiners, funeral directors, and emergency room staff who are now drowning in the dead and dying will see here a clear statistical reflection of what they are experiencing.
Alex Langstaff is a PhD candidate in history at New York University, and lecturer at Cooper Union.
Featured image: : Compound microscope used to examine meat, France, 1851-1900. Credit: Science Museum, London. Attribution 4.0 International (CC BY 4.0)
Banner image: Model of Mass Radiography Unit, England, 1948-1955. Credit: Science Museum, London. Attribution 4.0 International (CC BY 4.0)