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IN TIME OF PLAGUE / Vol. 87, No. 2 (Summer 2020)

Arien Mack, Editor

The impact of COVID-19 varies depending on the social class that one belong to. The simple measures of washing hands and maintaining distance imposed by many governments cannot be fulfilled by millions of people. Inequality signals an often deadly division among social groups.

This brief comment offers parallels between the AIDS epidemic and recent COVID-19 pandemic. HIV arrived at a time when communicable disease was considered a waning human health threat. Both epidemics revealed how the setting in which a communicable disease takes hold and spreads has more to do with social vulnerabilities than the biology of the causative agent. In the United States, longstanding racial hierarchies are inscribed on the population patterns of both AIDS and COVID-19, with blacks and Latinos far more likely to be exposed to viral infection and to die of the disease. The societal structures underlying both epidemics are explored.

While the unfolding of COVID-19 threatens potentially tens of thousands of lives in South Africa through its direct health impacts, it is simultaneously tearing apart the social fabric of this deeply unequal society in all branches of human endeavor. The choice of public health instruments such as the severe lockdown to address the pressing need to "flatten the curve" came with deep, unexpected costs to families and communities as the economy ground to a halt, including all branches of the informal sector. Almost immediately, other public health crises emerged. These public health choices generate a form of social triage.

The histories of epidemics and statistics have been intertwined since at least the seventeenth century. In ordinary circumstances, orienting policy and daily practice on one kind of number, averages, makes good sense. But under extraordinary circumstances, in which the present breaks radically with the past, averages no longer have traction. Not only epidemics but also global connectivity without global governance and accelerating climate change may invalidate averages based on the assumption of stable conditions.

The essay concludes that despite a sterling record in infectious disease response in the past, despite experiences around the world with infectious diseases, the U.S. Federal Government’s response to COVID-19 has been bungled. Almost every lesson, from knowing the truth, establishing superior surveillance, building coalitions and working with WHO, has been violated. It is a humiliating episode for public health that has seen public servants become private servants to the president.

Because the U.S., like many nations, wasn’t ready to handle an infectious disease epidemic, the nation has two bad choices: (1) put the economy in deep freeze and suffer the devastation of lower incomes, bankruptcy, and unemployment; or (2) restart the economy without a vaccine or sufficient testing. Fortunately saving lives will mean less economic loss because government fiscal and monetary policy has been aggressive and swift.

Plauges have haunted us with collective memories throughout history, but forgetting the trauma and emotional intensity has proven to be a symptom of many crises. Society might have been more prepared for COVID-19 if the onslaughts of the Spanish Influenza of 1918 were properly documented. With the establishment of archives, as well as various social practices, society might “never forget” the pandemic and will be more equipped to handle the next one.

Rarely has there been a time when so few mathematical equations have so greatly changed the course of global events as during the SARS-CoV-2 pandemic in the winter of 2020. Mathematical models traditionally help us understand and control the complex world in which we live; models of COVID-19 have now helped shape that world in ways we are just beginning to comprehend.

By considering the similarities and differences between Weimar 1933 and Hungary 2020, the article draws some general conclusions about the vulnerability of liberal democracies to being exploited by executives.

Similar themes appear in articles written thirty-five years ago about the AIDS epidemic and reports emerging today in the midst of the COVID-19 pandemic. Despite these many similarities between the decades-long AIDS epidemic and the COVID-19 pandemic, some differences exist, as well.

As the SARS-CoV-2 virus spreads across the world in early 2020, attention has focused on laboratory testing and vaccine development. This is important and necessary work, but we cannot fully understand how the virus works by looking through a microscope. We must also address the social and cultural aspects of viral pandemics. In fact, the devastation of COVID-19 results from social norms and political decisions as much as from biological causes. In this paper we employ a cultural contexts of health approach to show how the ways we conceptualize, and misunderstand, viral transmission affect how we deal with viral pandemics.

Healthcare professionals are responding heroically to the COVID-19 epidemic. Despite the danger to them and their families, few question whether they have a duty to treat. That wasn’t true 40 years ago when AIDS exploded, eventually taking more than 700,000 American lives. The moral imperative that we currently find so natural isn’t automatic, but mediated by how we perceive those at risk, what sacrifices we consider reasonable, and the quality of leadership. That becomes clearer when reexamining the 1980s, as in our oral history of the first generation of physicians who committed themselves to care for AIDS patients.

I hope this publication provides an occasion to employ pandemic events such as cholera, AIDS, and COVID-19 as occasions for analysis and reflection, for understanding the cultural and structural realities that play a role in constituting our understanding of sickness and our responses to its incidence.

This paper briefly compares the coronavirus pandemic to historical shocks that reduced economic inequality and argues that the current crisis is unlikely to have a similar effect.

The novel coronavirus has introduced Albert Camus’s novel, The Plague, to a new generation of readers. Numerous articles and essays have used the novel in order to understand our current plague.


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