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.