I see a lot of people online and in the Stanford community casting doubt over the severity of the impending crisis a global COVID-19 pandemic represents and disregarding guidance to limit gatherings and social contact. Less than a week ago, I was expressing the same doubt. I’m sure I’m not alone, as someone sensitive to how fear and hysteria has been bottled and sold to masses throughout history, making scapegoats and targets out of innocent populations, in feeling initial suspicion over what we’re observing in the media surrounding the novel coronavirus. Especially when neither we, nor our parents or grandparents, have lived through a deadly pandemic, the racism and violence we observe growing across the country feels more virulent than the spread of infectious disease.
I am no biology major or epidemiology expert — I study history, and all I have is a healthy skepticism of the state and a little practice with research — so what I have learned about COVID-19 is entirely lifted from people smarter and more informed than I am. What I do know now, however, is that it’s undeniable that a) this epidemic is about to change everyday life for some time, and b) our government, at this point, cannot be trusted to accurately represent the magnitude of this crisis or do what is needed to adequately respond. Both of these realities have even greater implications for at-risk and marginalized communities, and dismissing the fear in some ways does them more harm than good.
To the first point: There is reason for concern, but collective and individual measures can help. On Friday, leaked slides from an American Hospital Association webinar in February on preparing for COVID-19 presented one doctor’s “Best Guess Epidemiology” for the spread and impact of the virus: 96 million cases, 4.8 million hospital admissions and 480,000 deaths. Other sources have voiced similarly foreboding forecasts, like WHO advisor Ira Longini and this disease model in STAT.
Some of the most catastrophic consequences, however, can be mitigated, with quick and collective education and mobilization. Drew Harris, population health and health policy expert at Jefferson University, produced this graphic to represent an epidemic peak without intervention versus one with intervention. The second curve — longer, flatter — is what public health systems are working toward. The horizontal dashed line cutting through the curves represents the capacities of our healthcare and emergency response systems to respond to pandemic. Above that line is when things start breaking down.
We’re seeing “above the line” happen in Italy, one of the hardest hit countries after China, where Antonio Pesenti, head of Lombardy’s intensive care unit, said that Italy’s best healthcare system is “on the brink of collapse.” Italy, for what it’s worth, has instituted precautions and responses still unseen in the United States. And now, we’re beginning to see collapse here: In Kirkland, Washington, nearly 30 first responders were put in isolation after exposure to the virus.
Without state-of-emergency measures yet imposed across America (and indeed, with them, when and if they happen), we each must prioritize doing our part through social distancing, reducing personal and household risk, etc. to get the bulk of the load at or below the threshold at which our systems begin collapsing. This means we’ll be here longer, but hopefully, we’ll avoid the worst possible scenario; by keeping ourselves as healthy as possible, those of us at lower risk won’t demand scarce hospital beds and treatment, and by slowing the rate of transmission, healthcare workers and facilities will have more breathing room to adequately handle this and other medical crises certain to arise.
However, to the second point: I am urgently frightened at what is about to happen. I’d like to believe that in times of strife, humanity can cooperate across borders and oceans to flatten the curve and protect each other. But history, and our current geopolitical situation, shows that on an international, diplomatic level, cooperation is unlikely for the time being. These crises only provide more fuel to the fire of xenophobic, white-supremacist, and extreme right-wing politics on the rise across the world. Viral outbreaks only offer despots and fascists opportunities to scapegoat and target already brutalized and vulnerable communities. Pandemics provide rationale to close borders and further police poor, homeless and migrant populations. Trump does all this masterfully, seamlessly moving from minimizing the severity of COVID-19 in America and his administration’s ineptitude in providing things like test kits to blaming open immigration policy; and people will buy in because they are afraid.
So, what does this mean? It means that our government’s responses (or lack thereof) make it much more difficult for some communities to access the care they need to ride this out. It means that our own fears will be weaponized against people, and that we have to reject the selfish urges that fear creates, be they panic-hoarding or tribalism on the one hand or careless dismissal that throws immunocompromised people under the rhetorical bus on the other. Our society is only as healthy as our most vulnerable citizens — the poor, the uninsured, the homeless, the transient, the disabled, the immunocompromised, the young and the old. At-risk communities desperately need the rest of us to regard this virus with the respect, and even alarm, it warrants, and to act accordingly.
If we aren’t listening to doctors, nurses, and communities at most risk, we are not just underprepared. We are guaranteeing suffering for communities to whom we owe so much and on whom we will continually rely even more as COVID-19 spreads by not taking this seriously and fighting for them to be as supported and provided for as we want and expect for ourselves.
Contact Emily Wilder at emwilder ‘at’ stanford.edu.