COVID (Post-Sabbatical) Diary #5: Ten Thoughts on Five Years of the Pandemic

It was, in one sense, laughable to suppose that I would ever stop thinking about the pandemic after the winter of 2020, but I did stop writing about it. I continued instead to consume it, through a fall down an ever-deepening rabbit holes. And it continued to consume me.  

Many things happened to the online information landscape in this period, as the pandemic was officially declared over, both restrictions and services dropped, and (at least in the US) the inexorable rise of Trump and his coterie of tech oligarchs toward a second presidency began – not to mention the tectonic geopolitical shifts of the Ukraine and Palestine wars. Constructing a representative political spectrum of scientific and public health opinion from a single platform, as I did back in 2020 in an earlier post, would be impossible today, akin in its naïveté to the notion of Twitter as Habermasian public sphere back in the Arab Spring days. Platforms are fragmented, manipulated, and compromised beyond repair. But they did represent, for better or worse, the mediating informational landscape through which the pandemic took place. Even my own awareness of the airborne nature of the disease and the benefits of masking began, I’m not ashamed to admit, with Michael Osterholm’s appearance on Joe Rogan (viewed on YouTube late at night) – an ironic example of the remarkable reach that podcast had even then.

 

Looking back on the past five years, half a decade, the period crystallizes in a few distinct ways: first, as the ‘days of being online.’ I’m not ashamed of this, even though it did delay my work considerably and took months off my life I could have spent being more productive. When great historical change happens, it’s worth not looking away. The information I gathered kept me alive, if not quite sane. Like a chemotherapy drug, it saved me but at great personal cost – such treatments should always be stopped once the prescribed course is finished. 

 

Second, as a well-defined interregnum between the crumbling of an old order and the terrifying revelation of the contours of the new. A singular crisis (the pandemic) transformed into a ‘polycrisis’ (along with inflation, war, and climate breakdown) and then into a ‘permacrisis’ that will define the rest of my lifetime on a planetary scale (though we should be mindful of Janet Roitman’s admonition). It comes into view, I imagine, how the twentieth century’s interwar once did to those who lived through it.

 

Third, as a time in my personal life when I got old and lost and gained many things: lost most friendships, the opportunity to have children and buy a house, valuable time I could have spent advancing my research (but here I discovered how hard it is to pivot in one’s expertise, and how important networking and institutional support is in this profession); but gained an awareness of what I truly value and the kind of life I could (and sometimes do) pursue with intention and meaning. I suspect I’m not alone in this respect, but living through a pandemic with eyes open will do that to anyone (as the characters in Camus’s La peste express so beautifully). 

 

When drawing conclusions about what this period has meant for health and capitalism (the subject of this post), I have taken my cues from voices once considered radical on the suppression-mitigation spectrum, the ones who still advocate for protection and highlight the continuing toll taken by the virus: Julia Doubleday’s Substack posts on the end of public health and liberals’ complicity in pandemic denial, Nate Bear’s observations of societal ‘unmooring,’ and the excellent work done by the Death Panel podcast (coming from a solid disability history framework). I do think these perspectives rely on unexamined narratives of linear progress towards ‘justice’ (that do befit committed activists but do not map onto my inner understanding of the world), and also leave open the question of the state and the tensions between authoritarianism and mutual aid that drove so much of the Red/Green-to-Brown pipeline of the past few years (culminating in the Trump-RFK Jr. axis, as discussed below). So I will try to express where I am now, looking back at my earlier posts and reframing and recontextualizing the pandemic as I see it in early 2025. Most of these thoughts were first put to paper in the spring of 2024 in Europe, and updated in light of political developments in the US since then. 

 

1. When it comes to the disease itself, I ended my October 2020 post by speculating on a future of low-to-medium endemicity, with COVID installed as a permanent fixture of the disease burden disproportionately affecting vulnerable and marginalized populations or popping up in localized outbreaks (much like tuberculosis, HIV, malaria, or indeed the third plague). In 2020, this was considered a hopelessly pessimistic, even alarmist, scenario. I could not have foreseen what would happen in 2021: the Delta wave (which unleashed shocking devastation in India in particular) in the spring, the waning of the vaccines against Delta in the summer (first demonstrated in Israeli studies), and finally the emergence of Omicron on a warm and sunny Thanksgiving Day (first identified in South Africa). Along with the fateful day of March 11, 2020 (when Trump shakily announced a Europe travel ban), I remember these three events – where I was and how I felt – as vividly as I do other epochal historical moments of my lifetime like 9/11. The fact that most people don’t speaks to the deliberately muddled media messaging around the pandemic. 

 

I’ve now come to think of Omicron as a milestone in world history similar to the detonation of the first nuclear bomb on July 16, 1945 (so memorably depicted by Christopher Nolan in Oppenheimer) or the year 1952 (put forward as a specific starting date of the Anthropocene due to accumulating plutonium levels). If the Trinity test inaugurated a nuclear age, haunted by the existential fear of human extinction, Omicron marked the true start of the Virocene, an epoch when Angus Deaton’s ‘Great Escape’ is grinding to a halt and life expectancy and health gains since the Industrial Revolution have begun to reverse. The unstoppable tidal waves of sickness and disability set in motion by Omicron constitute a slow catastrophe that is just too big and too diffuse to even imagine for most people. 

 

To put it more simply, we have never experienced a respiratory pathogen that is highly transmissible year-round and indefinitely causes excess morbidity across the entire global population. No historical parallel can help us fully understand it, in the same way that no analogies to warfare before the atomic bomb could capture the altered realities of nuclear conflict after 1945 (or that no climatological records, however extreme, can predict the future course and consequences of runaway anthropogenic climate change). 

 

2. Part of the confusion around the virus that continues to persist lies in the underappreciation of intrinsic severity. Vulgarized pop virology and immunology (such as the notion that Omicron and its successors mutated to become ‘more transmissible and less lethal’) has shifted focus from the basic properties of the virus and the many ways it can (still) cause damage. True physiological adaptation to a persistent pathogen, as in bats, can happen but it takes thousands of years, never a few months. The mountain of scientific studies that explore SARS-CoV-2’s effects on almost every organ of the body, and the circulatory system in particular, provide ample mechanistic evidence of its dangers – much like measuring the teeth of a predator is a useful proxy for its risk to humans (regardless of how well we may believe it has been tamed). 

 

Whenever I hear SARS-2 lumped in with the generic category ‘respiratory viruses,’ or compared with the flu (a once fringe Trumpian position roundly mocked by bien pensant liberals, now the orthodoxy of the medical and scientific establishment across the world), I often use the analogy of cats and tigers. Yes, they are both ‘felines,’ but that tells us little about the relative risks each poses to us. Anecdotally, one can have many pleasant encounters with a tiger that do not result in any harm, or be hurt or even killed by a cat. Yet it would be an insult to common sense and basic self-preservation to shrug our shoulders if tigers were as common as cats, left to roam in an out of homes and public spaces at will because they are ‘just felines.’ We know that tigers belong away from humans, and should be handled carefully by trained professionals if at all, whereas we can indeed ‘live with’ cats and even servals (common colds, seasonal flu, or RSV in this analogy), despite their sharp claws and occasionally nasty temperaments. If, somehow, millions of tigers were let loose upon the world, we would have to take extreme measures to protect ourselves as much as possible, rather than retroactively downgrading the threat because the situation was allowed to get bad. The analogy appears absurd only because we are much better at ascertaining the properties of a mammal than of an invisible virus, and because we have been deceived by political leaders and complicit virologists and epidemiologists  who do possess the ability to ascertain the threat correctly. 

 

3. Most people I meet think the first year and a half of the pandemic was exceptionally bad, leading to justified extreme measures (lockdowns, travel bans, vaccine mandates), and that around 2022 the pandemic became less bad and the measures correspondingly less justified. My view is precisely the opposite. The uncertainties of the first year warranted greater caution about how much society should be upended, whereas the sinking realization of permanent endemicity should have led to a ramping up of permanent mitigation (through a massive push for ventilation and redesigning public spaces, a normalization of masking indoors and flexible working arrangements, cultural changes to leisure practices and social norms, the expansion of infrastructures of research, care and treatment, and so on). For this reason, I did end up making common cause with so-called ‘lockdown skeptics’ in late 2020 to early 2021 but departed from them when their true agenda became clear later that year. 

 

Here I claim no special insight as a historian and someone from within the credentialed academic community (with just two or three degrees of separation from many of these figures). I was simply duped, like millions of people around the world who followed the lockdown skepticism to New-Age-inflected fascism trajectory. I took at face value the claims of people like Vinay Prasad, Stefan Baral, and Monica Gandhi (or, in my field, Toby Green) to be dissident progressives concerned with the inequities of essential workers or the Global South. I hung on to the mantra of ‘resources before restrictions’ because it did align with my own convictions – only to realize that those who put forward this conceit had no intention to ever fight for any kind of ‘resources’ to be directed at mitigating the pandemic (not N95 respirators, tests, vaccines, or HEPA filters in buildings, and absolutely not any sort of confrontational political push for universal healthcare). They just meant business-as-usual.

 

4. So who gets the blame for the normalization of mass death and disability after 2022? My proportions have remained consistent: 40% goes to the government and public health establishment that makes policies and guides behavior (until the end of 2024, that means the Biden administration in the US), 40% to capitalists and their paid ‘merchants of doubt’ who push governments to abandon mitigation (that means Prasad et. al.), and 20% to ordinary people, who despite all the misinformation and societal pressure, still have the capacity and responsibility to act ethically and resist – again, as the characters of La Peste memorably do. On this latter point I differ with many progressives and Leftists, for whom it is important never to blame or stigmatize individuals (influenced by the precedent of HIV). But as much as I appreciate and share that concern, the failure to care for others and the self can never be fully excused – even and perhaps especially in the most difficult circumstances.

 

5. I have found it much harder to let go of the Illichian (via David Cayley or Dugald Hine) and Agambenian critique of the lockdowns as a state of exception, but its limits have been painfully brought to light. There was a kernel of truth and value to it in 2020, when we all felt the absurd weight of the state and its surveillance technologies bearing down on us. But the critique was ultimately directed toward the wrong target. The true Agambenian ‘bare life’ is the state of compromised health to which we are unwittingly doomed after repeat infections. It is the long COVID patient, debilitatingly or silently disabled, who falsely lives by merely existing – not being the victim of a ‘severe’ case or becoming a death statistic, but prevented nonetheless from a full and active life. In the world of 2020-21, when people took unusual and extreme actions to prevent death at all costs and states declared that to be their goal, the critique made some sense. In the post-2022 world, it is passé – today, permanent COVID (not permanent lockdown) constitutes ‘bare life.’ 

 

Here I will admit that the hopelessly misguided original public health messaging (to ‘stay at home’ rather than to go outside, to close off one’s world rather than to expand it) created this perverse outcome. It never ceases to amaze and baffle me how figures of the Left Conservative/New Age Right movement, who advocate decentralized, small-scale, low-tech, back-to-nature ‘trad’ living fail to see how the pandemic created a vital opening for their ideas – not only in opposition to the lockdowns but because of them. Being outside, not trapped in a gas-guzzling commute or stuffy office building in a ‘bullshit job,’ gave many people (myself included) a sense of profound personal freedom and fulfillment. Whereas biomedical technologies like vaccines were demonized as high-modernist attempts to surveil and control, the Corsi-Rosenthal box (a simple, low-cost engineering solution) and the DIY mask were perfect illustrations of the kinds of ‘intermediate technology’ championed by low- or anti-modernists. But then I remember that my experience was both idiosyncratically personal (like the prototypical convert, I believed only when I was ready to receive the Word) and marked by work-from-home privilege, and that most people did correctly associate lockdowns with confinement and restriction. When I opposed the lockdowns ‘as they really were,’ it was because I wanted everyone to have the opportunity to reject the status quo in an emancipatory sense, not rush mindlessly ‘back to normal.’ 

 

6. The lockdowns should be understood as the last gasp or authoritarian spasm of public health, a ‘zombie state’ briefly awakened from the torpor of slow neoliberal poison for one last hurrah – before a final death in the spring of 2022. But its excesses and exclusions were the same as those of the governments of the late nineteenth and twentieth centuries, from colonial regimes to liberal welfare states to communist dictatorships. The pandemic was a reminder of what public health and state power used to be, both in terms of provision (Operation Warp Speed, free tests) and restrictions. The popular backlash was thus exclusively against the state, and not against capital as in 2008 (except in distorted and displaced ways like fixating on vaccines and pharmaceutical companies vs. real estate, airlines, restaurants, and other interests who stood to benefit from going ‘back to normal’). The strangeness of the lockdowns can be ascribed to the fact that SARS-2/COVID was the first global pandemic to unfold in a post-neoliberal and post-industrial era. The hastily awakened state remembered how to do certain things but no longer had the capacity or the instruments to do them, and it faced a population that no longer expected much of it. Hence the wild swing from ‘wartime emergency’ and ‘national sacrifice austerity’ mode in spring 2020 to laissez-faire two years later, which remains totally incomprehensible to most people. 

 

Slowly making the pandemic disappear, as in the infamous color manipulations on CDC maps, did not appease skeptics and active conspiracists, assuaging their paranoia by trying to put the genie back in the bottle (as governments around the world foolishly hoped it would). Instead, it confirmed their worst fears – that the whole pandemic was a hoax, scam, or mirage manipulated by a power-hungry globalist élite – far more than actually following through on a ‘new normal’ of degrowth and constrained consumption (which would have confirmed that the élites believed what they said). In this narrative, it was heroic resistance that foiled the best laid plans of the globalists, who must now be punished with a show of counterforce to restore a purist utopia of untainted ‘natural’ selves and communities. This is the MAGA + MAHA project in the US, with clear fascist and eugenicist overtones. 

 

7. The lockdowns exposed the fine line, if not dangerous overlap, between discourses of austerity and degrowth (I was not wrong to identify the Ceaușescu spirit in the original measures, which really did subordinate the economy to the state and paid the price with the sharpest fiscal and productivity crash in recorded history). The climate conversation, from peak oil to rewilding, got hopelessly entangled with the pandemic, building on extant dynamics from the protest-ridden 2010s (think gilets jaunes on the one hand, Extinction Rebellion on the other). Left critics of the lockdowns saw them as austerity (and were not entirely wrong to have done so), whereas those on the Right saw them as a frightening preview of what degrowth would mean (also not entirely wrong, as Branko Milanović explains).

 

Meanwhile, the provision of vaccines and tests (but not ventilation and building retrofitting) evoked the missing corner of the triangle, war production (or the Green New Deal) as Keynesian stimulus. I distinctly remember feeling the power of the (American) state when I drove into the requisitioned Six Flags amusement park for free mass vaccination, when I picked up free tests from the library, or when I received a signed check from the President. Many others no doubt felt the same, giving a complete lie to austerity rhetoric from the 2010s that universal healthcare or basic incomes were unattainable. Despite the hardships of the first year, by 2021 Americans were saving like never before and enjoying the benefits of a robust welfare net not seen for decades. When the measures began to be pulled back in early 2022, it sent a clear message: ‘Everything is possible, and yet nothing will happen.’ I remember equally vividly when the last COVID clinic closed in DC and feeling a sense of dull, impotent rage that has never left me – and has not, despite the Trump-led dismantling of public health, allowed me to forgive the Democratic Party.  

     ‘The state’

I’ve had many conversations about ventilation over the past five years (I don’t plan to have any more for a while) that ended abruptly with ‘That sounds like a good idea but it’s never going to happen.’ The bitter irony, of course, is that large-scale engineering and architectural changes to buildings did happen in the past, in response to tuberculosis and the 1918 flu, only to be supplanted by the biomedical silver bullets of antibiotics and vaccines (the failure to satisfactorily ‘bury’ the McKeown hypothesis lies behind much of the widespread public confusion and distrust of medical expertise today). 

 

8. The unresolved question of the origins of COVID stemmed from a related discursive paralysis about how to understand ‘nature’ in the Anthropocene. Zoonosis was conceptually foreordained by the One Health framework and could be spun as the ‘revenge of nature’ on an encroaching humanity (remember ‘We are the virus’ and the fetishization of wild animals taking over abandoned cities?). Lab leak, meanwhile, spoke to a different kind of ‘revenge of nature,’ namely the humbling of scientific hubris (the doyen of this theme, Michael Crichton, notably authored both Jurassic Park and State of Fear). Anti-mask arguments accordingly held that a mere man-made fabric (no matter how well designed or robustly tested) could not possibly stem the airborne flow of viruses (conceived as an unstoppable force of nature leading to the Arcadian equilibrium of ‘herd immunity’). 

 

9. The pandemic, like all others in history, occurred in its own peculiar cultural, social, political, and discursive contexts. It is impossible to imagine the trajectory of HIV-AIDS in the United States, Southern Africa, or Eastern Europe apart from its emergence during deindustrialization and early neoliberalism in the 1980s. It is equally impossible to imagine the outbreak of the third plague pandemic in India outside of the ‘high noon’ of the Raj (recurring cholera epidemics provide a contrast case – but was cholera different due to epidemiology or history?). SARS-2/COVID was thus not only intertwined with climate anxiety, the end of neoliberalism, and the rise of the transnational populist/fascist Right, but also with digital technology (already busily colonizing everyday life in the 2010s and then enabling the lockdowns), BLM and racial justice claims, the return of inflation and crime, and eventually the Russia-Ukraine and Israel-Hamas wars. 

 

Municipal and state mask bans, which began to appear across the US in 2024 (including in blue states) and will no doubt accelerate in the near future under Trump, demonstrate how such conflation operates. For petty state officials like New York mayor Eric Adams, who have long dissembled about the efficacy and purpose of masking, and who embrace digital surveillance as a tool of control, the twinned threats of crime and opposition to Israel justify a remarkably intrusive and totalitarian ‘right to the face’ (analogous to the veil controversies of the 2000s, when the visual scan of the Other was bizarrely exalted as a cornerstone of Enlightenment reason and democratic citizenship). But pro-Palestinian activists and actual street criminals are not blameless – again, as the progressive Left would have it. By wearing masks to conceal their identities at outdoor protests and inconsistently using health as a pretense for doing so, they weaken even further what should be the accepted social meaning of the respirator – personal protective equipment (PPE) used by individuals when exposed to a hazard if the hazard cannot be removed. A similar unfortunate error occurred from rudimentary misinterpretations of poor-quality studies of cloth face coverings back in 2020, when masks (of any kind) became symbols of ‘care’ worn ‘for others.’ This poisoned the well both scientifically (how could a filter work in one direction but not the other, skeptics rightly wondered?) and discursively (by denying a useful argument for increased uptake based on rational individual self-interest). 

 

The fact that the pandemic began at the exact end of a turbulent decade (late in 2019) and exactly thirty years after 1989, is almost too good to be true in terms of bookending a historical period. This temporal conjunction alone, albeit subconsciously, enhanced visceral popular reactions to the pandemic (like Indians’ millenarian expectations of Kali Yuga in the bleak, famine-ridden 1890s). Yet the event-ness of the pandemic, so discrete and in such sharp relief with what came before and after, in turn allows it to be bounded and closed off, forgotten by some and remembered by others as a mediatized global headline (akin to a terrorist attack or natural disaster) rather than a genuine paradigm shift (the permanent introduction of a new disease in humans, the end of a global economic and political order). 

 

It is commonly believed among the dwindling ‘COVID-conscious’ crowd on social media that Davos élites, athletes, politicians, and celebrities continue to protect themselves in secret through testing and treatment while the rest of us suffer. In part this stems from some good old-fashioned occupational health protections gained through collective bargaining in industries like Hollywood, and some of it from occasional glimpses of HEPA filters. But it is nothing more than a self-soothing conspiracy theory. Global élites are just as willing as ordinary people to become repeatedly infected, subject to the death drive (Thanatos) that Freud identified in Civilization and its Discontents, on the verge of a catastrophic global war. We really are, as they said back in 2020, ‘all in this together’ – but not in a good way.  

 

10. What have I learned, then? That the biopolitical state of the nineteenth and twentieth centuries (capitalist, socialist, or colonial) has morphed into an unwieldy but destructive necropolitical state-capital assemblage that seeks to let and make die. A question that I hope I can answer in my future research, if I ever get there, is about how older biopolitical states and corporations decided whether their workers and subjects should live or die – rethinking the origins of occupational and public health from the other side of their decline. As human labor is automated away by AI, and the tidal waves of viral infection ebb and flow, the future is grimly clear. But the past can still surprise us.

COVID Sabbatical Diary #4: Of Vaccines and Variants

 ‘No wise man has a Policy,’ said the Viceroy. ‘A Policy is the blackmail levied on the Fool by the Unforeseen. I am not the former, and I do not believe in the latter.’

- Rudyard Kipling, "A Germ-Destroyer" (1887)

 

Reader, I failed to take a break. In the months since my last post, which I naïvely envisioned as an exorcism of COVID-19 obsessions, three significant developments have kept me (and many others) glued to a steady stream of news and tweets: the onset of a massive winter wave across the northern hemisphere; the approval of two mRNA vaccines, hailed as the beginning of the end of the pandemic; and the emergence of potentially more transmissible variants in the UK and South Africa, which sparked renewed global panic reminiscent of March. Now that my leave is almost over (with very little real work to show for it), I will try once again to move on by reflecting on these developments in relation the suppression vs. mitigation spectrum described earlier and by looking ahead to the future. 

My thesis is simple: everything has changed and nothing has changed. In other words, the many contradictions unleashed by the virus and the unprecedented response to it have only deepened. 

I. The Wave

The winter wave was already on the horizon in October, but the speed and scale with which it took hold was surprising (in many countries and regions far exceeding the spring). The already shaky correlation with various non-pharmaceutical interventions (NPIs), from hard lockdowns to voluntary guidelines to aggressive test-trace-isolate infrastructures, has grown weaker. South Korea, the poster child for the latter approach, is being hit hard. Meanwhile, Sweden's apparent success over the summer has been exposed as a mirage and Anders Tegnell has exited stage right. I won't go farther down this road since country comparisons are useless and counterproductive, little more than a political parlor game. The more interesting question to ask is about hindsight. Does this "prove" that, like endemic coronaviruses, SARS-CoV-2 is intrinsically seasonal? And even if it isn't, how should we assess public health messaging over the summer when cases stayed low in many countries and US states? 

It now seems obvious, as Zeynep Tufekci points out, that people should have been encouraged in no uncertain terms to take advantage of the warm weather and go outdoors as much as possible (including properly distanced socializing and, I would add, schooling), as well as take care of medical appointments and other needs in anticipation of a more difficult time ahead. Instead, officials turned the dial up to 11 in the spring, down to maybe 8 or 9 in the summer, and then quickly back up to 11 in the winter. Meanwhile, pandemic fatigue predictably increased in a linear fashion. Each passing day spent cut off from family and friends, or struggling to balance precarious work and childcare, eroded people's resilience. Whenever scientific experts and political leaders warned about the dangers of surges, spikes, and a "dark winter" ahead, I asked myself when it was ever advisable to go outside or do anything - if not now. At a particular time of year or case rate? According to government rules (which allowed, for example, indoor dining), epidemiological considerations (a specific case rate or R number), or personal risk assessments? The lack of a long-term strategy and failures of communication pushed public trust well past the breaking point at the worst possible moment. 

For steadfast mitigators like Julia Marcus, Stefan Baral, and Monica Gandhi, the steep rise in cases is all the more reason to promote empathetic, nuanced, and resource-based messaging rather than heavy-handed restrictions and toxic shaming. For hardcore suppressors, the latest wave provides yet more evidence of governmental and individual failures to "control" the virus and do the "right thing" in limiting social interactions, respectively. The response can only be more restrictions, more shaming, and even the deliberate promotion of fear (more on this later). 

What would I do, to move briefly from critique to prescription? Start with two basic premises, inspired by Baral's mantra of "resources before restrictions:" 1) don't impose any restrictions that you can't/won't enforce (Taiwan-style border controls and testing at airports - sure, vague "stay-at-home" orders like in California - no) and 2) that you can't/won't pay for (business closures without furloughs, quarantine without paid leave or facilities). Or, following the old Marxian chestnut, "From each according to his ability [distance as much as you can given your living conditions/financial constraints and other considerations, including mental health], to each according to his needs [more resources to high-risk and vulnerable populations, from nursing homes to essential workers, and safer socialization options for everyone]." Instead we have, "Follow these confusing and constantly changing rules indefinitely or you're a bad person, and maybe you'll get a stimulus check soon." 

II. The Variant

The identification of reportedly more transmissible variants in the UK and South Africa dropped like a bombshell in late December - a plot twist fit for the penultimate episode of the season. Perhaps due to the symbolism of a "cancelled Christmas," the news captured the public imagination much more than the D614G mutation in the summer or the Danish minks in the autumn. A familiar state of all-encompassing panic ensued, with sudden border closures and supply chain disruptions (exacerbated by Brexit) creating new apocalyptic scenarios. Would mitigation measures (being outdoors, wearing masks, socially distancing) even work anymore? If the variant was up to 70% more transmissible (a disputed number based on preliminary epidemiological data), would this mean longer and harder lockdowns - for "many months," as Health Secretary Matt Hancock bleakly warned? Rumors began to circulate that the variant produced more severe disease in children and young people (yet another silver lining gone, this time really no more school!). Antibody and vaccine escape, an ever-present possibility with viral mutations, is just around the corner as the next big threat. 

Should it be confirmed, a more transmissible (if not more pathogenic) virus takes us right back to square one. We are in March again, facing a big unknown. The variant is already all over southeast England, as SARS-CoV-2 was in Wuhan and northern Italy. We can safely assume it is also in many other places and will continue to spread. What to do? 

It's worth revisiting the crucial issue of how and why existing pandemic preparedness plans were swiftly abandoned in March. None of the NPIs that became public health orthodoxy overnight, from business and school shutdowns to universal masking and contact tracing, were recommended by the WHO in 2019. Indeed, there was a rock-solid consensus against such measures. Suppressors celebrate the triumph of a proactive SARS/MERS model over a passive "influenza model," but provide no systematic justification beyond anecdotal success stories of highly disparate countries (Taiwan, New Zealand, Vietnam, maybe South Korea). If pressed, they might point to certain aspects that make SARS-CoV-2 both easier and more imperative to contain: higher dispersion (k) through superspreader events, a longer disease course leading to greater hospitalizations and mortality/morbidity, etc. Such claims do not stand up to rigorous scrutiny. Hospitalizations and deaths were obvious areas of concern (H1N1 in 2009 may have been a bust, but the 1968-69 H3N2 pandemic was comparable in severity to the present one). Still, the transmissibility of the virus plus the collateral damage and uncertain benefit of NPIs sufficed to close the case. It may have been a good bet for Taiwan and South Korea to treat a novel coronavirus like SARS or MERS in the beginning. And SARS-CoV-2 did appear much easier to control than anticipated - though we have no historical examples of sustained, large-scale attempts at suppressing pandemic influenza for comparison. I suspect it was this paradoxically "optimistic" realization that lay behind the mysterious abandonment of "flatten the curve" and the about-face of experts like Michael Osterholm (see also previous post). How else to explain Dr. Tedros's remarkable statement on March 9 that this "would be the first pandemic in history that could be controlled"? 

To clarify the contradiction, the higher the R, the less like SARS or MERS the virus becomes. Yet rather than cast doubt on the feasibility of the suppression strategy, the mere existence of these variants supplies self-evident proof that more suppression is needed. If less virus circulates, there are fewer opportunities to mutate - a reassuringly obvious conclusion. But we don't yet know how the variants arose (it may have taken just one immunocompromised host, not unlike the original spillover), why they spread more quickly (higher viral load? more efficient ACE2 receptor binding?), and what their consequences will be. If/when the next big change comes along (antibody or vaccine escape, increased pathogenicity), the cycle will surely repeat - a Groundhog Day-style nightmare of rolling lockdowns accompanied by the same exhausting debates. 

The pandemic discourse rests on an almost philosophical conundrum about how to act in a crisis. Think of public health officials as teachers, intermediary figures of authority who have been trained for years to promote student learning by providing information, assuming the burden of communicating it in the most compelling way, offering support and guidance, and relying on persuasion rather than coercion. But what if test scores suddenly acquired urgency, say because of a state ultimatum that the school will lose funding or that certain students must pass or be expelled? Would this justify abandoning all previous lesson plans and adopting a different set of tools, including mandated homework hours, invasive surveillance technology, or public shaming (dunce caps)? And if other schools in the district seem to improve their practice test scores by using some of these methods, should you follow suit? How much do the resources of the school or the characteristics of the student population matter? You only have until the end of the academic year - the clock is ticking. How can you tell what "works"? Do you carry on as usual, intensify existing practices, or adopt new ones? There are no easy or obvious answers. 

III. The Vaccine 

The triumphant arrival of vaccines, the alpha and omega of this pandemic year (developed in January, approved in December) provides an important clue to the choices we've made. The vaccine is more than a "silver bullet" or  "technological fix." It constitutes an entire techno-utopian horizon of possibility. It is the original sin of the pandemic response, underpinning both Trumpian selective apathy (carry on as usual because the vaccine is on the way, the government will spend as much money as it takes on Operation Warp Speed - but not PPE or paid leave) and lockdown absolutism (just stay inside for a few more months because "the cavalry is coming" -  an apt metaphor given American militarism and frontier mythology). The temporality of the pandemic (remember the constant refrain of "12-18 months"?) has been almost entirely dictated by the vaccine, creating unrealistic expectations of a neat resolution that are sure to be frustrated. 

The ethics, politics, and logistics of vaccine distribution will take center stage over the next few months, and will be as fiercely contested as the suppression vs. mitigation debate. Everyone agrees that older adults (65+) and essential workers should be prioritized, though not necessarily in that order. However these categories are spliced, the differential impact of the disease comes into stark relief and contrast with the indiscriminate approach of lockdowns and mass testing. If preventing deaths by age stratification is the guiding principle, why did nursing homes and their workers not get absolute first claim on resources (PPE, paid leave, quarantine hotels, testing kits) from the start? If equity or reducing community transmission are the main criteria, shouldn't prisoners, farm laborers, and other vulnerable populations move right to the front of the line? The latter thought exercise reveals, once again, why outwardly "progressive" public health goals are incompatible with a neoliberal capitalist system. There are many other ways in which vaccines could theoretically be distributed (randomly/by lottery, through markets/the price mechanism, first come-first serve, cronyism and "connections" etc.). The combination of the ones we adopt will say something about the kind of society we live in. There are no easy or obvious answers. 

One book that helped me make sense of these dynamics in a longer term historical context is Vaccine Nation by Elena Conis (Chicago, 2014). Conis argues that the availability of vaccines has fundamentally changed how diseases have been framed by scientific experts, governments, and the public. In the mid- to late 1960s, measles and mumps went from routine childhood afflictions to deadly enemies with a litany of horrific complications. Whereas widespread panic over polio in the 1950s had created an organic demand for the Salk and Sabin vaccines, the public was much less sold on the necessity of inoculation against these milder diseases. The impulse to eradicate them was culturally produced in an era of "high modernist" (James Scott's words) overconfidence in the power of science and the federal government to gain mastery over nature. Success against smallpox in the Third World, through a combination of vaccination and targeted field epidemiology, fueled the fantasy. 

In turn, a growing anti-vaccination movement in the 1970s and 80s drew on environmentalism (specifically revelations of the hidden damage wrought by asbestos, tobacco, and DDT) and second-wave feminism to build a critique of vaccination as unnatural - a mirror image of the official disease discourse. Whereas the public health establishment spread alarm about the complications of measles and mumps, skeptics amplified the side effects of vaccines (both real and exaggerated). They also promoted "natural immunity" through infection as superior to "artificial" vaccine-induced immunity. Whereas vaccination campaigns relied on gendered notions of mothers' responsibility to inoculate their children and protect society at large, skeptics insisted on mothers' responsibility to make the best decisions to protect their children. The media contributed to further polarization in the 1990s and 2000s by reducing the complex issue of vaccination to a moralistic conflict between "science" and "anti-vaxxers," shaming skeptics (stereotypically, middle-class white women) as "selfish" killers and obscuring other reasons for the stubborn persistence of preventable disease (poverty, inequality, access to housing and healthcare). 

The parallels with COVID-19 are suggestive. Concern about possible long-term side effects from "rushed" vaccines using "unproven" mRNA technology mirrors anxieties over "long COVID" from above (used as a justification for lockdowns) and below (shared in social media forums by victims, most of them women, who feel ignored and dismissed). The WHO's rewriting of the definition of "herd immunity" to exclude previous infection mirrors vaccine skeptics' unwavering belief in the superiority of "natural" immunity. Shaming has become routinized and weaponized, with a sharper edge in terms of age, class, and race. The impulse to increase compliance with restrictions and vaccine uptake by stoking fear of the disease is rooted in decades of public health practice.   

In the political arena, Conis shows how vaccines have repeatedly been imagined as a "great equalizer" in a profoundly unequal and broken healthcare system. Both the Carter and Clinton administrations embarked on mass immunization drives as a substitute for, or shortcut to, structural reforms. The shocking disconnect between the discourse of "overwhelmed hospitals" and the lack of progress on Medicare for All is as American as apple pie and as old as bell bottomed jeans. The pandemic response reinscribes the logic of austerity and personal responsibility under the cloak of communal solidarity and shared sacrifice. 

There is one crucial departure. Unlike past diseases, whether endemic or pandemic, COVID-19 was framed as vaccine preventable well before vaccines were actually available. This, too, explains the early consensus that it could be controlled. Fantasies of eradication are always culturally produced. As sociologist Harish Naraindas has written, the fight against smallpox in the early 1970s shifted to an "offensive strategy of ‘search and destroy’ whose purpose was to ferret out Agent Pox," informed by the Vietnam War. In eastern India, where the steel town of Jamshedpur emerged as the focal point of the last major outbreak, it overlapped with ongoing state and corporate incursions into the lands and bodies of indigenous people. In 2020, COVID suppression has been made thinkable by the enhanced carceral and surveillance powers of states and corporations, even as their abilities to provide resources and deliver care have been hollowed out. 

COVID Sabbatical Diary #3: My Changing Views on Everything

With a wink and a nod to Leszek Kołakowski, in this third diary I will try to write down some of my thoughts on the pandemic and how they have changed over time from early March to early October. It is no exaggeration to say that I have spent a few hours each day (usually more) over the past seven months reading about COVID-19 and other infectious diseases in history. I have trawled Reddit, Twitter, and YouTube, refreshed the Guardian and Washington Post liveblogs like slot machines, attended specialist lectures on Zoom, read monographs, journal articles, and scientific papers (including many dodgy preprints), religiously listened to podcasts like This Week in Virology, and had numerous conversations (some becoming heated debates) with friends on e-mail, text, WhatsApp, old-fashioned phone, and socially distanced walks. Of course, I could do all this only because I am privileged enough to be on leave with few other obligations. It's been intellectually thrilling but also exhausting, and I'm ready to take a break. 

In the process, I have come to believe that speaking about the pandemic with any degree of authority as a novice requires sustained research and reflection. In the real world, as citizens and vulnerable bodies, we cannot escape taking positions and making choices on a daily basis (do I wear a mask? see my friends? travel? protest?) without the luxury of time to research and reflect. So my first premise is that almost everyone's positions and choices are mediated by a relationship with expertise and its dissemination through media. The "discourse" of the disease is crucial and should be analyzed as such. What governments, scientists, and ordinary people say, and how it changes over time, is very much in the wheelhouse of the historian.  

The starting point for my intervention is a "taxonomy" of pandemic expertise I made at the end of September. I had grown increasingly frustrated with two diametrically opposed but equally destructive tendencies in the US and UK. One is crude scientism, best represented by Medium's patronizing "50 Experts to Trust" list published on September 18th, which reproduced the notion of SCIENCE as a unitary, self-evident set of truths that people should passively accept rather than a messy set of debates to critically examine. In the Trump-centered media ecology of the present, this corresponds to the bland "fact-checking" that has cannibalized politics. The other tendency corresponds to "both sides" rhetoric, which assumes there are only two approaches to a particular issue that can be set against each other without nuance or context. It is best exemplified by the war of open letters at the beginning of the UK second wave, misleadingly glossed by the Guardian as "lockdowners vs. liberatarians." In the Medium list, there is no acknowledgment of disagreements on policy. In the Guardian article, the fact that many critics of lockdowns are not libertarians, nor primarily invested in economic concerns, is left out. Nor is "lockdown" a well-defined and coherent position. The real conflict is between suppression and mitigation in the arena of public health broadly construed, which takes the form of a spectrum with blurry boundaries and many overlaps that are not immediately obvious. 

My attempt to visualize this spectrum using a select few experts I've followed on Twitter and in other online spaces is discussed below in Part I. It has helped me clarify my own evolving stance (see Part II). Since it looks like COVID-19 will be with us for a long time, the premise of the exercise shouldn't become dated too quickly (even as the specifics might). And in the long run, it could also prove useful to writing intellectual histories of the pandemic in comparative perspective (Part III).

 

I. Demystifying expertise: assembling the taxonomy  

Starting from the left, a few panic merchants or doom mongers proclaim that COVID-19 is basically the end of the world. The most vocal is Eric Feigl-Ding, a faux-epidemiologist with dubious credentials who sounded the alarm in January and mostly tweets about partisan politics. Physicist and "complex systems analyst" Yaneer Bar-Yam once predicted that Ebola would lead to the extinction of humanity and has banged the drum for eliminating the virus completely. 

In the category of maximum or heavy suppression, I would put Michael Osterholm and Peter Hotez, who both appeared on Joe Rogan early on to bring attention to the seriousness of the virus. I have followed Osterholm more closely than any other single expert, keeping up with his weekly podcast and CIDRAP Viewpoints. He is a bit of a special case, since his prophecies of impending doom were also accompanied (at first) by doubts about the efficacy of masks, opposition to school closures, suspicion of mass testing (whether PCR or antigen), and promotion of nursing home "bubbling" and ILI (influenza-like illness) surveillance to manage rather than end the spread of the virus (which he regarded as inevitable). During the summer, Osterholm switched to calling for a full national lockdown and stopped discussing most of the above. My own interpretation is that he has been trying to remain the chief COVID Cassandra, which means different things at different stages of the pandemic. But he nonetheless deserves credit for sticking close to the science on masks (rejecting, for example, CDC Director Redfield's assertion that masks alone could drive the virus "into the ground"), and for promoting sensible outdoor activities early on.  

Devi Sridhar is one of the most eloquent proponents of "maximum suppression" or "Zero COVID." Her interview with the skeptical YouTube channel UnHerd and Guardian op-ed make the best case for this strategy. Sridhar notes that it does not actually seek to eradicate the virus but to get as close to zero as possible and then open up to "normal" after a period of time (basically the New Zealand playbook). This involves strict lockdowns, border controls, and building up a robust regime of testing-tracing-isolation. 

The moderate suppression/Trump bad category includes figures like Marc Lipsitch, Ashish Jha, and Carl Bergstrom, more preoccupied with the failed response of the Trump administration than with policy as such. But there are discernible differences of tone and emphasis among them, with Bergstrom a bit more open-minded (for example, praising universities for successfully deploying rapid testing to reopen in the autumn, which for me counts as mitigation). One could say moderate suppressors are less ambitious or radical in the scale of societal interventions they think will be required and less likely to defend lockdowns, preferring to start with the basics of countering Trump's laissez-faire.  

Trevor Bedford and Youyang Gu both called attention to the late August drop in cases in states like Florida and Texas around the 20% population infection threshold, a then-contested proposal that entered the vernacular as "partial herd immunity." Gu's work also helped curb the excesses of the IHME model, which had been wildly off the mark in predicting the number of deaths.  

The mitigation category includes epidemiologists like Julia Marcus and Stefan Baral who are equally attentive to second-order effects of the response (like treatment of other diseases, racial disparities, economic inequalities, mental health, child development) as to the burden of COVID - and who do not see rolling lockdowns (periodic mandated government closures) as a sustainable strategy. Marcus warned about the dangers of quarantine fatigue and excessive shaming and policing. Drawing on their own work with HIV/AIDS, Marcus and Baral frame the debate in familiar terms as abstinence-only vs. harm reduction. Alasdair Munro, a pediatric specialist, has called for making the education of young children the highest priority (schools should be the last thing to close and the first thing to open). He has also invoked Amartya Sen's Development as Freedom as an organizing framework (rather than libertarian notions of individual freedom). 

This group also stresses the need for clear guidance on transmission to promote (and not just tolerate) safer activities, e.g. being outdoors. Marcus and Muge Cevik co-authored a paper making this very argument. A simple test to distinguish between moderate suppression and mitigation at this stage is whether you think playgrounds for children should open. Are you generally supportive but cautious or do you see it as an imperative? A more technical difference lies in how to explain the absence of school and business closures, travel restrictions, and community masking in previous pandemic influenza plans. Suppressors like Sridhar point to the fundamentally different nature of the disease, while mitigators assume that basic public health precepts should not be sacrificed regardless (this is the essence of the Swedish model, at least in theory). 

Francois Balloux has been one of the most acerbic and occasionally philosophical exponents of charting a middle course between doing nothing and attempting total elimination. His interview with UnHerd encapsulates the mitigation position, nicely contrasting with Sridhar's. Like others in this category, he sees tradeoffs as inevitable, adopts a broad conception of freedom, and rejects fear-based messaging and "new normal" rhetoric as self-defeating. But he is a bit farther along the spectrum by endorsing age stratification ("shielding" of the elderly) and co-signing the skeptics' letter to the UK government. 

Katherine Yih and Martin Kulldorff's Jacobin interview touched a raw nerve on the Left by using the critique of second-order effects to advocate for rapid acquisition of "herd immunity" as a goal (the logic being that the least vulnerable, such as the young and able-bodied, should be infected first). In response, Gregg Gonsalves has brought his background as an HIV/AIDS activist to bear on the debate, taking an impassioned stand against this position and calling for a "new politics of care" to address the inequities exacerbated by the pandemic.    

The final category is the NBD (no big deal) school of thought, which not only sees rapid herd immunity as the safest route out of the pandemic but also tends to minimize the impact of the disease itself. In the Stanford cluster above the line, Michael Levitt, John Ioannidis, and Jay Bhattacharya had promoted early studies predicting an astronomically low IFR (infection fatality rate) and declared the premature end of the pandemic before the summer. In the UK, Sunetra Gupta and the Oxford group below the line made waves with unsubstantiated claims of 50% seroprevalence in March (!) and preexisting immunity for the same purpose (this is different from the "partial" immunity or slowdown at 20% in the course of an outbreak). In early October, the two groups (plus Kulldorff) came together to issue the AIER-sponsored Great Barrington Declaration, rebranding their strategy as "Focused Protection." This has predictably provoked a fierce backlash from Gonsalves, Lipsitch, et. al. As winter looms and cases rise at the time of writing, the debate is uglier and more politicized than ever. 

There is a certain level of dishonesty, conflict of interest, and showmanship at both extremes, but this should not entirely discredit them. The map is not the territory. A linear spectrum, no matter how blurry the boundaries between categories, tends to overstate differences. Neither suppressors nor mitigators see repeated lockdowns as intrinsically desirable; they are nonetheless a key part of the toolkit for the former and something to be avoided at all costs for the latter. There are also significant disciplinary variations. Most epidemiologists and public health professionals are (for now) on the middle of the spectrum, while mathematical and computational analysts dominate both fringes. 

I have deliberately excluded medical doctors and avoided debates about sequelae and long-term effects, which are usually cited in defense of suppression but can also be seen as "normal" aspects of viral infections (Ed Yong's Atlantic piece on myocarditis strikes the right balance). Regarding transmission (fomite vs. droplet vs. aerosol), the paranoid hygiene theater of disinfecting surfaces goes on even as we increasingly recognize improved ventilation as the single most effective measure. There is growing evidence that close- to medium-range aerosols in indoor spaces are in fact the dominant route (contrary to the current position of the WHO and CDC). But this does not automatically suggest a suppression policy, since exposure time and proximity still determine the likelihood of infection. It does have massive implications for our social and cultural responses to the pandemic, as I will explain below. 

II. My journey along the axis: a personal intellectual history 

In late March and early April, as Italy and New York experienced devastating outbreaks with hospitals at the point of collapse, I was fully on board with total lockdowns. As someone lying perpetually in wait for the terminal crisis of late stage capitalism (see my February post about the elections), I was charged with excitement about UBI (even Mitt Romney suddenly sounded like Andrew Yang) and the mobilization of the productive power of the state (by invoking the Defense Production Act to scale up PPE and perhaps even redirecting the planning powers of Wal-Mart and Amazon toward quasi-socialist ends). As time went on I began to realize that Godot wasn't showing up, and the kinds of radical changes that we often imagine as appearing out of thin air during a crisis actually need to be fought for and won. Latching onto lockdowns, an authoritarian measure imposed on an emergency basis by all different types of governments (extreme right in the US, UK, Australia, India, center-left in Italy, NZ, state capitalist in China), is no way to do it. Public health is not a vehicle for positive social change. Positive social change is rather a precondition for successful public health. 

To take the obvious parallel, the Green New Deal would be a planned long-term project to deal with climate change, implemented by a government democratically elected on that platform. Trump or Boris suddenly panicking about a hurricane,  pouring billions of federal dollars into wind farms, and arresting anyone who uses a plastic bag isn't the same thing - and would in fact be irreparably damaging to the cause. There is no mechanism to get us from A (our unequal and broken capitalist society) to B (the safety nets necessary to cushion the blow of lockdowns) in the timeframe of an emergency. The rise of mutual aid and continued union organizing provide hope, but these are bottom-up responses that scale slowly and require sustained in-person interaction. 

In the rarefied realm of critical theory, voices of dissent about the human costs of lockdowns emerged right away. Unsurprisingly, Giorgio Agamben saw in the crisis a perfect instantiation of biopolitics and "bare life" - while Slavoj Zizek, equally unsurprisingly, sensed an opportunity for the new communism. What is surprising in retrospect is how intense the backlash against Agamben was, the visceral public spectacle of death at the height of the outbreak (think of the hospitals in Bergamo) seemingly delegitimizing critique itself. When the rubber hit the road, "social construction" and "discourse analysis" (not to speak of 90s idealism like "development as freedom") were dismissed as luxuries, childish playthings to be put away. We were going through Joan Scott's "Evidence of Experience" in reverse. People are dying out there - so stop thinking. My journey since April has not been one of becoming a COVID "truther" or "skeptic," or recasting Agamben as a hero rather than villain, but of reinstating the primacy of discourse and reopening the window of critical inquiry about the present. Above all this is a matter of scale. We must carve out a space of reflection and ethical choice that does not rest on the particular (my dying friend or relative, or my other friend or relative suffering as a result of the lockdowns) or on the abstract/aggregate (how many total deaths are acceptable?). 

A good example of walking this fine line is an April essay on Ivan Illich (subject of my previous post) by David Cayley. Illich's attack on modern medicine in Medical Nemesis (1974), like his critique of schools, is good to think with in pandemic times even as it translates poorly (or not at all) into political or personal choices that we are forced to make. This is especially true for those of us with firsthand experience of the horrific conditions of both pre-COVID life and COVID death in nursing homes. Neither the abstract "grandma" to be saved in the meme, nor the equally abstract idea of death as natural and to be welcomed, bears any relation to the agonizing realities of human suffering in such settings. As Cayley writes, 

"Is there a way to move from granny as a “demographic” to a person who can be nursed and comforted and accompanied to the end of her road; from The Economy as the ultimate abstraction to the shop down the street in which someone has invested all they have and which they may now lose."

However, we cannot pick any particular person or experience and fix them as the single point from which to construct an ironclad position, fortified by moral self-righteousness. 

Returning to the realm of public health, medical anthropologist Carlo Caduff raised many of these issues in his article "What Went Wrong: Corona and the World after the Full Stop," drafted in April-May and published in June. Caduff was writing from India, which was then experiencing one of the world's harshest and most destructive lockdowns (with millions of migrant workers fleeing cities on foot in a tragic echo of Partition). His first book was an ethnography of pandemic preparedness for an avian flu outbreak that never came; incidentally, it opens with a prescient vignette about Michael Osterholm's "apocalyptic expectations." When I first read Caduff on COVID, I took seriously his analysis of authoritarianism, mass panic, and the neoliberal hollowing out of public health, but dismissed his arguments about the disease itself, testing accuracy, death counts, etc. The most important contribution of the article was to construct a preliminary genealogy of lockdowns, from China (which used them selectively to "quarantine" Wuhan and other "hotspots") to Italy and beyond (where they suddenly became a preferred front-line intervention, overturning public health orthodoxy). When future histories of the pandemic will be written, the crucial moment may turn out to be the decision to extend Lombardy's restrictions to the whole of Italy on March 9, which set the tone for other countries to follow. We might call this the "precautionary" vs. the "circuit breaker" or "ring-fencing" lockdown, even as it was recognized at the time as coming too late, a sign of failure rather than a proactive measure.

In mid-May, I tried to summarize my feelings about the science and politics of the pandemic to a skeptical friend, directly responding to Caduff's article:

With a disease that's only 5-6 months old with an average death rate of 1% and uncertain long-term complications that spreads very fast and retains the capacity to overwhelm hospitals (see Tanzania, Russia, Brazil, and even Bombay just in the last few days/weeks), it's best to proceed cautiously. That means opening up slowly and keeping the growth rate linear at least. 

Elective surgeries, routine vaccinations, and check-ups should resume (I went for a CT scan on Monday and may have been exposed, but didn't feel more at risk than at the grocery store and definitely less than at a party or teaching a class on campus). Kids should go back to school like in Denmark and Germany. Colleges should probably stay online in the fall, adopt some type of hybrid system in the spring, then return to normality in 2021-22. We should have a UBI (even Mitt Romney was on board last month!) and bring back some manufacturing (especially for things like PPE - Taiwan rocked it on that front) so we don't desperately depend on hair salons, restaurants, and tattoo parlors to sustain local economies. Hire people to be contact tracers instead of Uber drivers. Have tech companies develop public health infrastructure with the same zeal they devoted to useless consumption. Why protest with guns this time when we were ok with surveillance capitalism for over a decade? Travel, concerts, and sports are not human rights and if the skeptics urge us to live with covid-19 because pandemics are 'nothing new' in human history, then we should also acknowledge that for most of history there was also no expectation to instantly transport ourselves halfway around the world for business meetings, leisure, or even seeing our families. "Good travels at a snail's pace," as the Mahatma said.

The other contradiction is that if this is indeed not that bad and will just go away, then Austria and Vietnam and New Zealand and South Korea and all these other countries that crushed the curve will have basically gotten away with it - better lockdowns, fewer deaths, faster economic recoveries. If the virus is as bad as I think it is and will spread forever until 'herd immunity,' then it's still worth going slowly rather than a partial, half-baked lockdown followed by a rushed & desperate reopening. 

Anyway, all this is truly academic since we don't, and won't, ever act collectively, plan ahead with a long-term vision, or have the political structures and institutions that would allow us to do so. We'll just channel systemic failures into individualized/atomized actions like your friend calling the cops on soccer players or Whole Foods shoppers, or deniers killing security guards for enforcing mask policies, deliberately infecting people etc. In some ways parallel to climate change, where it all boils down to virtue-signaling ('I drive a hybrid') vs. denialism ('I'll buy an SUV to own the libtards'). 

Reading it back now, I'm struck by the fact that I was attempting to graft elements of mitigation (keeping schools and hospitals open, phasing universities back in, opposing shaming, personally assessing risk, allowing the disease to spread as long as the "growth rate is linear") onto a scaffolding of suppression. As I'll explain below, some of my beliefs about what is "essential" have not changed even as I've moved away from the "crisis as opportunity" narrative and the idea that curves can be indefinitely "crushed."  

So when did I start to lose faith in suppression? The turning point came in mid-July with Washington, DC's outdoor mask mandate, followed by the reimposition of hard lockdowns in Auckland and Melbourne, which made it crystal clear that the notion of "flattening the curve" to avoid overwhelming hospitals from March and April had been replaced by complete elimination as an ideal. Looking at the DC region's curves (snapshot below), it seemed like the initial objective had been achieved. But a Washington Post article from early September stating that cases had "plateaued" and "could stay this way for months" was framed as a story of failure ("not a good thing," said Mayor Bowser). This made no sense unless suppression, not mitigation, had become official policy. But no such announcement had been made. What were we actually trying to achieve and where were we going? Who gets to decide these questions, and how? 

I couldn't square the circle until I found the ur-text, the key that unlocked the history and meaning of the whole pandemic response. Unlike the esoteric readings I've discussed so far, it was a plain and simple commentary for CIDRAP (Osterholm's group!) by veteran risk communication specialist Peter Sandman (who advised governments and the WHO during SARS, H1N1, and Ebola). His focus is precisely what I've termed the "discourse" that mediates our relationship with the disease. Step by step, Sandman shows how public health officials and political leaders first ignored and "over-reassured" the public ("nothing to worry about"), then suddenly panicked and overreacted by imposing indiscriminate preventative lockdowns. Once this decision had been taken, they had to face the reality that cases would rise as soon as restrictions were loosened and "pandemic fatigue" set in. Therefore, Sandman argues, officials had to invent a new rationale for lockdowns (preventing infections and "saving lives") and consign "flatten the curve" to oblivion. The predictable consequence was rising social conflict, political polarization, and breakdown of trust between experts and the public. Looking ahead, Sandman envisions keeping the curve as high (rather than as low) as possible - in other words, mitigation: 

A successful lockdown flattens the curve just fine, whether or not the curve in a particular place really needed such a radical flattening. But when you come out of lockdown and start to resurrect your economy, the curve necessarily rises. The challenge is to flatten it again, at a level that's higher than suppression/lockdown but still low enough for healthcare systems to stay functional. Why higher than suppression/lockdown? Because societies can't stay locked down forever. Flattening the curve doesn't mean flattening it as low as possible. The goal is to balance infection control against all your other priorities like jobs and education. 

What about the outdoor mask mandate? Why was it such a trigger for me, to the extent that I became almost obsessed by it? By now, we have a fairly clear understanding of how SARS-CoV2 transmits. Even the outdoor cases detailed in the Cevik and Marcus paper I mentioned earlier were the result of prolonged contact (close-range conversation) or crowded areas. As I have repeatedly explained to anyone who would listen, it is impossible to infect someone while passing them by on the sidewalk, even if you tried - contrary to numerous scare-mongering news reports about joggers and bikers that appeared early on (I refuse to link to any of them). Even rare anecdotes of presumed infection in line at grocery stores (why not inside?!) require time and proximity. And even the most hardcore aerosol scientists pursue common sense in their own lives: 

"Marr told me that she wears her mask outdoors only if she’s interacting with people, if she’s in a crowd, or if she cannot maintain distance. Yet, in the United States, many locales are mandating masks indoors and outdoors under the same rules, forcing even the solitary person walking her dog to mask up."

With increasing alarm and dismay, I observed the emergence of bizarre ritualistic behaviors on the streets of DC (pedestrians crossing the street or ostentatiously sliding their masks on and off when walking by someone) but shrugged it off as a harmless byproduct of poor risk communication. Mandates enforced by arbitrary and often racialized policing are another matter. They are not only useless (a form of "pandemic theater") but also counterproductive ("more likely to reduce trust than infections"), as Marcus explains. 

Sandman's comment on outdoor masks, in response to Joe Biden's announcement that he would implement a blanket national mandate if elected, is once again helpful. With a simple back-of-the-envelope calculation, he shows that it would be far more worthwhile to focus on providing better masks (N95s and the like) to those who need them than to shame or punish those who refuse to comply. Mathematician Wes Pegden makes a similar point in this thread (the goal should be to get as many people as possible to wear masks in the situations that matter most). I still cannot believe how many KN95s and KF94s I see on young adults in their 20s and 30s walking or biking alone outdoors, while essential workers from grocery store clerks to bus drivers and even nurses have to make do with surgical or cloth masks and while indoor dining (with no masks on when eating) is allowed to resume. This is an unacceptable failure for which public health officials' mixed messaging must share the blame. The emergence of mask "deniers" or refuseniks is perhaps to be expected in a hyper-polarized political landscape during an election year, but surely any Martian who descended upon Earth and was shown a series of headlines about masks since February and an explanation of what we know about transmission would put 2 and 2 together. "Denial" is not an ingrained psycho-social condition but a logical outcome of institutionalized panic and confusion. 

Rituals of avoidance on the street also point to the further erosion of solidarity and trust as people come to see each other as vectors of disease rather than fellow citizens "in the same boat." Gentrifiers in DC, who only related to the city as consumers in the first place, see no reason to stay with fancy restaurants and coffee shops closed and fall back on coded language straight out of 1980s and 90s crime paranoia: 

"They didn’t feel all that safe hanging out at public parks or along 14th Street, upset by the number of maskless pedestrians and uncertain about what kind of threat they posed."

As Susan Sontag would have anticipated, we can't resist thinking about disease in metaphors. COVID-19 visits both the undeserving (those who took precautions but were undone by the irresponsibility of others) and the deserving (those who irresponsibly spread it to others), but it must always carry a lesson, a moral, a warning. Someone is always at fault (China, Trump, Cuomo, anti-maskers, 5G, yourself). We must not lose control or let it happen again. The virus is a foreign invader, an enemy to wage war on. The mask is not a tool to help reduce transmission in certain settings but a potent symbol of communitarian solidarity, or maybe libertarian freedom. Everything is discourse, discourse is everything. 

Meanwhile, authoritarian states have unquestionably used lockdown as a pretext to crack down, in China, Rwanda, India, and elsewhere. Democracies like Spain and Australia have exercised their newfound emergency powers by selectively targeting poor immigrant neighborhoods. In the year of "defund the police," the contradiction is almost too much to bear (maybe "social workers" shouldn't be sent to your house when you call 911, but they sure as hell should be in charge of public health rather than cops!). The infrastructure for treating other deadly infectious diseases (TB kills over 400,000 people a year in India) has been decimated, decades of progress wiped out in one fell swoop. As for children, I don't necessarily mourn the demise of schools (see previous post on Illich). "Bare education" has been provided to them online, in the same way that "bare life" has been saved. What is to be mourned is the loss of community and socialization by confining them in households or tiny "pods" and inculcating fear and distrust in them. Such losses cannot easily be quantified and set off against the disease burden of COVID-19 (as skeptics rush to do), and they might well be reversible. But they make the progressive or Left case for suppression (especially from a Global South perspective) seem weaker by the day. 

What about Sweden, the poster child for an alternative approach? Much has been written about Anders Tegnell, the most unlikely breakout supporting actor in season 1 of the pandemic. My own take is that the Swedish model is paradoxically more and less democratic than elsewhere, which is its key distinguishing feature. While Tegnell has full control of setting policy (a perfect technocracy apparently excising politics entirely), 'on the ground' implementation has been non-coercive and relied on public trust and voluntary participation. In the US, such an approach might have involved simultaneously centralizing national decision-making and communication in the CDC (not in a shambolic, revolving door White House Task Force) and decentralizing at the state and local level. Whatever happened to the much-touted interstate compacts on the West and East coasts in April? Germany's federal government structure has not impeded a mostly effective response. Nor has Japan's lack of emergency powers (similar to Sweden) and culture of persuasion (which is not an essentialist trait but has its own complex biopolitical history). 

As of early October, some countries may be slouching toward true mitigation at last. As new lockdowns loom and outdoor mask mandates are frantically imposed as a last line of defense, the WHO's Europe Director sees an opportunity to "move beyond biomedical science" and "integrate real community participation into public health policy." Increasing democratization (going well beyond the Swedish model) is the only hope and only way to "live with the virus." This is a proposition likely to elicit agreement across the suppression-mitigation spectrum; the challenge is to make it happen. Then again, a crisis is not necessarily an opportunity. 

III. Quarantine like it's 1899: lessons from the past 

I want to close this post with two historical frames of comparison - one professional, the other personal. The COVID-19 pandemic has taken a remarkably similar course to the Third Plague Pandemic in colonial India. Consider the following passages from Raj Chandavarkar's classic essay "Plague Panic and Epidemic Politics in India, 1896-1914": 

The vigorous and energetic intervention of the state, in itself prompted by the general panic, bore no direct relation to the virulence of the epidemic.

There was neither a uniform nor a homogeneous, culturally specific Indian response, and further that the response of the populace, like that of the state, was integral to, and the product of, the generalized panic from which none escaped. While antipathy to the plague measures was often shared by disparate social groups who might have nothing else in common, it arose less from the stirrings of an autonomous realm of popular culture than from the political conjuncture in which the plague was constructed.

As the disease took on the character of a plague of the poor, it came to be seen as endemic. 'We Europeans are indifferent', declared one of their number as the plague revived yet again, in its annual cycle, in March 1902: 'for the statistics show that fewer Europeans have died from plague than die each year from cholera, so we can chance plague as we chance cholera.' Bubonic plague had become simply another disease in the formidable pantheon of plagues which flourished in India's malignant climate and integral to the burden which the white man carried dutifully.

The pattern of state intervention in the plague epidemic was unique in the history of colonial India. It cannot be taken to exemplify 'the interventionist ambitions and capacity of India's mature colonial state'. The scale and consistency of state intervention, as it entered homes, meddled with caste and religious practices, regulated the disposal of the dead and restricted the free movement of people, was unprecedented. And the colonial state would never again orchestrate such a penetrative programme of government, intrude so remorselessly upon the private domain, or attempt to exert such ambitious and extensive measures of social control. 

Nonetheless, policies, formulated on the assumption that the plague was a virulently infectious disease, proved at best oppressive and at worst fatal. Thus, the stringent inspections along the railway lines and at ports yielded a minute number of plague cases, although many tens of thousands were detained under 'suspicion'.When roofs were removed, floors dug up, houses flooded with disinfectant, the rats simply moved away and spread the infection. By pumping the sewers with disinfectants, rats were driven into houses and carried the fleas with them to infect the inhabitants. Had the scientists and medical experts given the rat flea theory more serious consideration, they may have resolved some of the conundrums – for instance, the erratic and spasmodic pattern of its dissemination – posed at the time by the epidemiology of the plague. Moreover, its implications for changing the direction of plague policy, swiftly seen as ineffectual, were substantial. For it suggested the need to switch the emphasis from the inspection and control of human beings to that of merchandise and from disinfection to disinfestation. As it was, plague policies put forward as rational measures to control the epidemic among traditional, ignorant people fell prey to the superstitions of science, derived from preconceptions about Indian society and generated by a wider discourse in which the experts shared.

The excesses and desperation of official policies fed upon and fattened the terror which the epidemic unleashed upon those exposed to the disease. Many responded to the desperation of official measures with an equally desperate resistance to and refusal of official, even medical, intervention. What colonial officials saw as an irrational and obscurantist resistance to the dictates of science and reason only incited them to further, yet more ferocious and despairing executive action. In this way, panic, terror and guilt engorged each other in a seemingly unending spiral.

Then, as now, panic and rumors spread both at the top and bottom of the social order (think back to Trump's and Boris's genuinely frightened televised speeches alongside toilet paper hoarding at the end of March). A strange new disease originating in China, fraught with Orientalist stereotypes and geopolitical anxieties (India as the first line of defense against the return of the "Black Death" from the East), sparked an unprecedented and ultimately short-lived deployment of state power. Rather than disappearing at the end of a neat curve, it became endemic - a disease of the poor that flared up locally for decades with little notice. Transmission dynamics were poorly understood and communicated from the start. The plague response was the exact opposite of the COVID-19 response in the exaggerated focus on quarantining humans as vectors (rather than hunting down rats). In other ways, such as excessive disinfection ("hygiene theater"), failure to appreciate dispersion (k), and "superstitious" solutions like mandated outdoor masking, they are depressingly alike. 

The plague accentuated the authoritarian, racialized, and inegalitarian character of the Raj, exposing the wide gulf between the rulers and the ruled. The colonial state learned its lesson and never tried such interventions again - nor did it invest more in public health (as the 1918 influenza pandemic would prove) or democratize in any way. Discontent was channeled into everyday and spectacular acts of resistance, like the assassination of plague commissioner Rand by the Chapekar brothers (an inflection point in the rise of nationalism), but also further divided Indians among themselves. 

On the economic front, the protracted crisis we may now be entering reminds me of Romania's dark decade of the 1980s, when I was born. The countless miseries of that period, from food shortages to intensifying repression, can be attributed to the fateful and ultimately suicidal decision to pay off all foreign debts in the aftermath of the 1970s oil shocks. This objective was achieved in April 1989, a few months before the collapse of the regime. It is profoundly ironic that the "evils of communism" were in fact the consequence of (voluntary) austerity in a capitalist world system, but never mind. This summer, I couldn't escape the nagging feeling that "suppress every case" would end up having the same effect as "pay every debt," leading to precarity and pain for millions. 

     Ceaușescu inspecting the harvest

It must also be said that much of what middle-class urbanites in the West have lost under lockdown is not "essential." International leisure travel, nightclubs, bars and restaurants, and so on are the functional equivalent of the bananas and oranges that became fetishistically charged for the ersatz middle-class urbanites of the Eastern Bloc. These are the byproducts of globalized capitalism, status symbols or markers of what constitutes the "good life" in mass consumer society. The true cost of the crisis will rather be borne by the poorest and most vulnerable, in rising hunger, morbidity, unemployment, and political instability across the world.