Endemic to Alienation

David A. Banks

In “The Best of Both Worlds,” the two-part Star Trek: The Next Generation episode that spans the third and fourth seasons, Captain Picard is kidnapped by the Borg and transformed into Locutus, a spokesperson their collective uses to communicate with what they call our “individualistic society.” Picard’s assimilation into the Borg’s cybernetic hivemind also means that they know all his tactics and how his crew thinks. Not only are the Enterprise’s defenses compromised, their offensive capabilities are neutralized because the Borg have adapted their shields specifically to guard against their weapons. You get only a few shots of your phaser before they’re immune. 

Studying COVID-19 is a bit like trying to fight the Borg. The virus has an uncanny ability to outmaneuver us at every turn. The viruses infecting people in Wuhan, Italy, and the United States appear to be slightly different, and as of July, a more contagious variant named ‘D614G’ is circumnavigating the globe. It seems largely immune to existing antivirals and treatment regimens, but also seems adept at exploiting our public health strategies. Almost a year into the pandemic, it is still not completely clear whether the virus is airborne, why some people remain asymptomatic, or even how long survivors of the disease carry antibodies. Researchers are still cataloging both the short-term symptoms and the long-term effects of the disease, which may include permanent damage to the lungs, kidneys, heart, and brain. Even who can get it and spread it is changing: Children seem to rarely come down with symptoms, but we are only just now realizing their noses may carry “up  to 100 times more” of the virus.  The uprisings across the United States do not appear to have spread the illness, but partying and work does

There have been more than a few comparisons between the COVID-19 pandemic and the flu pandemic of 1918, commonly referred to then and now as the “Spanish Flu,” since newspapers in Spain were the first to report on it—even though it was first detected in Kansas and the Western Front of World War I. The 1918 flu pandemic came just as American and European scientific communities had dispensed completely with the miasma theory of contagion and were starting to fully adopt and implement germ theory. The miasma theory saw illness as the result of noxious or poisonous air that had discrete physical sources, like rotting matter or overcrowded living conditions. It did not account for person-to-person transmission. 

Contra popular conceptions of science, major discoveries take years to percolate through society. Even well into the twentieth century, when viruses and bacteria were known causes of illness, getting fresh air was considered a cure for what ailed you. That was why public health solutions well into the 1930s largely consisted of changes to the built environment: public parks, more and bigger windows, public baths, and sewage systems. That radiator in your apartment that’s always too hot? It was designed to be that way so you could open your windows in the dead of winter. 

While scientists work diligently on a vaccine and antiviral therapies, anyone involved in a functioning government has returned to the miasma days of public health. Governments are experimenting with means old and new of organizing people in time and space to maximize access to fresh air. Due to the few things we do know about how the virus spreads—it doesn’t stay on surfaces very long, but it is easy to catch when an infected person talks, coughs, or sneezes around you—we really do need fresh air more than anything. People need to stay apart and, when that’s infeasible, wear masks. This is the same strategy that fourteenth-century Venetians used to guard against the plague.   

It’s ironic that we find ourselves resorting to public health strategies from the miasma days of medicine. But perhaps this can help us see beyond the frame of viruses infecting individual bodies and instead consider the virus as having adapted to and infected the institutions and built environments of global capitalism. What if we assumed that, just like the Borg, COVID-19 has learned everything about us and is adapting to exploit not just our bodies’ immune systems but our failing healthcare networks, untrustworthy institutions, and epistemological uncertainty? 

Such a shift in perspective makes the virus look less like an unpredictable respiratory infection and more like an exploiter of very predictable and identifiable weaknesses in the world order. COVID-19 can sit, wait, and spread asymptomatically as hosts fly and drive across nations. It slows down the healthy but burns through the poor and elderly who are often warehoused and concentrated in convenient (for the virus) institutions, slums, and ghettos. It hastens the death of those that are weakened by the ravages of a bad diet, exposure to environmental toxins, and chronic stress. And masks—the cheap, easy-to-implement way to severely reduce the spread of the virus—require trust in public authority and a willingness to act not for your own safety but the safety of those around you, something that our individualistic society seems incapable of comprehending.

To begin investigating COVID-19 like it is an infection of a planetary system, rather than a pandemic spreading among humans, it makes sense to look at how humans normally die. By analyzing pre-pandemic deaths and their underlying causes, we can perceive all the lapses in care and judgement we have already been making. Finally, we have to decide what changes we are willing to make, such that our way of life is less compatible with both this virus and future outbreaks. We can learn a bit from what some countries have done already to combat the pandemic, but we can also envision brand new worlds.

Death Configurations

It is a matter of nature that people die every day, but how they die is in many ways a function of politics. Let’s call this function—the constituent variables of which include those marginalized populations treated as disposable, the limits of capitalist health science, and the political will to make economic sacrifices for health benefits—a “death configuration.” The aggregate global outcome of the contemporary death configuration can be understood by breaking down the top ten global causes of death. According to the World Health Organization (WHO) the three leading causes of death are as follows: ischemic heart disease, stroke, and chronic obstructive pulmonary disease. Closely linked are the sixth and seventh causes of death: cancer of the respiratory system and diabetes. Numbers four, nine, and ten are diseases that you can catch from the environment or other people: lower respiratory infections like COVID-19 (but also influenzas and other coronaviruses like SARS and MERS), diarrheal diseases, and tuberculosis. The only non-disease cause of death comes in at number eight: road injuries. Alzheimer’s and other forms of dementia sit at number five.

With at least half a million already dead, COVID-19 may unseat heart disease’s 15-year winning streak at the top of the charts. Then again, since one of the leading factors in developing a heart problem is low physical activity, our quarantine lifestyles may keep heart attack and stroke rates fairly high. The absolute number of car-related fatalities has decreased in the United States as people hunker down and telecommute, but thanks to clearer streets, we are driving faster and dying at a higher rate per mile driven

These two surface-level observations—that avoiding lower respiratory illnesses could theoretically contribute to heart disease, and that even though we’re driving less, we seem determined to still die behind the wheel—suggest a profound truth: that our death configuration isn’t just static, it is stable. That is, our global society must produce diseases of the heart and lungs and we must mangle our bodies in high speed collisions in order for everything else to work properly. How this stability comes about is evident when we go a bit deeper into the causes of these deaths. All three cardiopulmonary diseases that beat out lower respiratory infections, according to the WHO, stem from the same factors: hypertension, elevated lipids, diabetes (a top-ten killer on its own), smoking, low physical activity levels, unhealthy diets, and abdominal obesity. Anyone with even a passing familiarity with food justice will know that all of these problems are organized around class and, in most countries, racial dimensions. In an interview with Guernica, community organizer and gardener Karen Washington describes this dynamic in blunt terms:

“In my neighborhood, there is a fast-food restaurant on every block, from Wendy’s to Kentucky Fried Chicken to Popeye’s to Little Caesar’s Pizza. Now drugstores are popping up on every corner, too. So you have the fast-food restaurants that of course cause the diet-related diseases, and you have the pharmaceutical companies there to fix it. They go hand in hand.”

But even if food apartheid ended tomorrow and every street corner had a fully stocked produce section, there would still be years of habits, prejudices, marketing, and cultural affinities that stand in the way of better relationships with fruits and vegetables. Fresh food takes time to prepare, and it’s hard to learn to cook if you didn’t grow up around family or friends that did. Food is social and ingrained in our workaday habits. Add on top of that the marketing and potentially addictive nature of sugar, and one gets a sense of just how difficult this problem is. 

Our global dietary problem is exacerbated by a lack of physical activity, which can be at least partially explained by the emotionally and physically exhausting work that most living humans are caught up in. The degradation of communal activity in the United States memorably chronicled by Robert Putnam in Bowling Alone, along with the meteoric rise of car ownership around the world, commute times, pointless desk work, and global obesity rates, all track together in an overdetermined but irrefutably linked trend. 

As is already becoming apparent, the car is about as important a factor in our death configuration as our global food system, maybe more. It directly elevates death rates through car accidents, but in a more roundabout way, contributes to sedentary lifestyles by replacing walking, biking, and other forms of active transit with sitting in increasingly long commutes. Designing the landscape for cars makes every other form of transportation harder to use, meaning that anyone who cannot afford a car is forced to traverse a terrain of the exaggerated distances cars demand. That means everyone is that much further from decent food and each other. That translates into spending more time getting around and less time cooking, socializing, and otherwise reproducing society. 

The pollution from transportation accounts for a quarter of all greenhouse gas emissions, and car exhaust is a major contributor to that. And as we put more resources into roads at the expense of more efficient forms of transport like electrified trains and streetcars, we also ensure that goods continue to be transported via diesel trucks. All this exhaust is linked to death number six: cancers of the lungs and bronchial tubes. The poor are most likely to be exposed to carcinogens, including through cigarettes—at a global scale, smoking has been shifting from affluent to poorer nations as manufacturers seek less regulated markets. This has led to a concentration of smoking deaths in poorer nations, as wealthier ones see a precipitous decline.

Deaths due to communicable diseases, the ones that you can catch from animals (including fellow humans) or contaminated food and drink, have the biggest wealth disparities. More than half of all deaths in low-income countries are attributable to what the WHO calls, “Group I conditions, which include communicable diseases, maternal causes, conditions arising during pregnancy and childbirth, and nutritional deficiencies. By contrast, less than 7% of deaths in high-income countries were due to such causes.” For low-income countries, HIV/AIDS is still the number four killer, along with several other Group 1 conditions that do not show up in the top ten lists of richer nations: malaria, pre-term birth complications, and birth-related trauma. The number one killer in low-income countries? Lower respiratory infections. These deaths are, in a word, preventable. Healthcare for child-bearing people has advanced considerably but is still allocated along deeply racist and classist lines. Even within rich nations, infant and maternal mortality rates among the poor are reprehensibly high. In the United States, Black people have an infant mortality rate of 11.4, compared to 4.9 for whites.

As for disease, palliative therapies that have to be taken for the rest of one’s life have replaced far less lucrative cures. New antibiotics and antivirals that prevent infection, rather than treat symptoms, are practically nonexistent. According to Mike Davis

“Of the 18 largest pharmaceutical companies, 15 have totally abandoned the field. Heart medicines, addictive tranquilizers, and treatments for male impotence are profit leaders, not the defenses against hospital infections, emergent diseases, and traditional tropical killers. A universal vaccine for influenza—that is to say, a vaccine that targets the immutable parts of the virus’s surface proteins—has been a possibility for decades, but never a profitable priority.”

It is the simple fact that cures and vaccines are simply not profitable that has put the world’s poor in needless jeopardy for decades. The rest of the world has only just now had to reckon with this moral catastrophe.

Enter the Coronavirus

Having gone over our contemporary death configurations and seeing how some of the most gruesome and preventable deaths are disproportionately distributed to the poor, it is now time to look at how the coronavirus fits into this schema. The most productive way to do so is to look at how previous coronavirus-caused illnesses like SARS and influenza have attained, or nearly attained, pandemic status. Comorbidity—the presence of and deathly synergistic relationship between two or more medical conditions—is an important part of the story. For example, flu vaccines are strongly encouraged for people with a history of diabetes, heart disease, and stroke, since deaths from those conditions spike with the seasonal flu.

COVID-19 has, so far, given us every indication that it too will become an ever-evolving seasonal pestilence with similar consequences. It comes for the healthy and unhealthy alike, though there appear to be increased risks for medical conditions endemic to poverty, including heart disease, diabetes, hypertension, and obesity. But what I want to focus on here are the ways that COVID-19 appears to have evolved to spread fast and dig into our global society, not just individual patients. 

In his disturbingly prescient 2005 book The Monster at Our Door, Mike Davis provides a comprehensive look at the global viral pandemic we are long overdue for and the relatively smaller seasonal epidemics that occur everywhere domesticated birds, pigs, and humans interact. Arkansas, Holland, and the Guangdong Valley are all major suppliers of poultry and pork and have historically been epicenters of influenza outbreaks. “The superurbanization of the human population,” Davis argues, “has been paralleled by an equally dense urbanization of its meat supply.” Within this intense concentration of people, pigs, and poultry, a virus can use the trial and error of evolution to achieve the characteristics that help it spread at pandemic rates. 

Any virus with pandemic aspirations needs to keep its hosts alive long enough to spread, while being aggressive enough within the body to take over cells and reproduce. Death occurs when a virus weakens the body enough that pneumonia or some other condition (often bacterial infection) sets in. SARS, which was a coronavirus like COVID-19, was deadly (1 in 10 died), but human hosts fell ill early on in the virus’ incubation period, and almost no one was an asymptomatic carrier. This meant that the disease was fairly easy to identify, test for, and contain. Influenza, on the other hand, spreads with the help of asymptomatic carriers. Even if someone does start to feel ill, they may have been contagious for days or weeks beforehand. 

In comparing SARS and the flu, Davis also concludes that, “the 2002-3 SARS pandemic had a fortuitous geography. China and Singapore were both authoritarian states with the capacity to impose effective, militarized quarantines.” Had slower-moving governments experienced the first cases, the virus may have spread much further. But COVID-19 began in China as well, and spread first to South Korea, a nation that, due to a different coronavirus outbreak in 2015, had developed and implemented strict pandemic emergency powers. And yet it still got out. Why?

Unlike previous coronavirus outbreaks like SARS and Middle Eastern Respiratory Syndrome (MERS was what hit South Korea in 2015), COVID-19 borrowed influenza’s stealthy tactics. It can lay dormant for weeks while it sheds virus to surrounding potential hosts. The range and severity of symptoms vary widely. This may be due to individuals’ unique mix of acquired immunities from other, far less dangerous coronaviruses, which are responsible for about a third of common colds. It spreads faster than most nations can test and trace, and the symptoms are perplexing if they appear at all, meaning that our centuries-old technique of identifying the sick and putting them in quarantine is far less effective.

Even in countries that have severely reduced the spread of the virus, there’s variation in successful containment measures. South Korea used a combination of early testing, high-tech contact tracing, and an elaborate isolation system for the infected. Norway, meanwhile, relied on social distancing, closed borders, and restricted public gatherings, but junked its contact-tracing app after it was deemed too much of a privacy risk. New Zealand’s approach was “go early and go hard,” which involved a mandatory nation-wide self-quarantine that was supported by a generous economic stimulus. Vietnam and Cuba have also had great success due to early action and generous support for quarantining.

Contrast these success stories—from communist and social-democratic countries—with the disasters in nations led by far-right despots like Trump in the U.S., Bolsonaro in Brazil, Modi in India, and Putin in Russia. Indians have endured one of the strictest lockdowns, the U.S. has administered countless tests, and Brazil has a fairly good track record of dealing with past pandemics. And yet none of this has stopped each of these nations from, as I write, occupying the top four spots for COVID-19 cases. What they all have in common is a disregard for the poor. In the U.S., Black people are three times more likely to get COVID-19; in Brazil, they are twice as likely to get it. India’s poor have received virtually no support, and Russia has used the pandemic as an opportunity to monitor dissenters.

COVID-19 seems to have mated the deadliest qualities of influenza and its coronavirus forebears. Like influenza, it can mutate quickly as it jumps between host species and spreads quietly between asymptomatic carriers and pre-symptomatic victims. And as a coronavirus, it dissimulates its presence among dozens of different symptoms and benefits from our considerable lack of at-hand antiviral treatments.

But even the single worst pandemic in recorded history, the 1918 flu, was relegated mostly to the poor, who suffered the vast majority of deaths. In Iran, which had the highest death rate of any country, the flu, according to Davis, “formed lucrative partnerships with other epidemic diseases” like cholera and typhus. In India, the most deaths were recorded in the slums around Bombay, where the poor died by the millions. The fact that COVID-19—while certainly following the well-worn path of other viral respiratory illnesses and killing the poor in record numbers in meatpacking plants and prisons—has been so successful in Europe and the U.S. suggests that it has found a way to leap over the usual class boundaries.

One answer can be found in part of the death configuration we haven’t discussed yet: dementia. Nursing homes have been some of the biggest hotspots in the United States. Just like prisons and meatpacking plants (the only places where cases are worse), these are places for forgotten people. But unlike chicken processors and prisoners, the elderly cannot be so deftly and crushingly policed and isolated. Nursing homes are in residential neighborhoods and staffed by hundreds of healthcare providers that often hold second and third jobs in hospitals and private residencies. It is one of the more porous barriers in the class line. 

But one of the most disturbing ways that COVID-19 takes advantage of the status quo is in our inability to depoliticize such a straightforward and time-tested public health measure as wearing a mask. In all four of the worst-case countries, government officials have resisted wearing masks in public and have trafficked in unfounded theories that hydroxychloroquine is a ready-made cure. Perhaps it is time to think of poor information diets as just as risky as poor nutritional diets. Perhaps the effects of consuming misinformation like the “Plandemic” video—in which Judy Mikovits warns that, “Wearing the mask literally activates your own virus”—should be taken as seriously as a history of hypertension. It weakens our ability to fight back, not with our immune systems but with tools and personal protective equipment.

The virus spreads better when we don’t trust or care about each other. It thrives on the hubris of Ski-Doo salesmen who believe it is a fundamental human right to get service with a smile at Panera. Worst of all, it is a virus that—like viruses before it—will do most of its killing in the forgotten corners of our society: in the slum, in the nursing home, and in the homeless shelter. The half-century spent dismantling social safety nets means that there are more of these forgotten corners, and they are more obscured from view than ever before. COVID-19 lives as institutions die. All of this points to what is ultimately a simple idea: COVID-19 is endemic to alienation.

What Do We Do About It?

There are two ways of reacting to this new perspective. The first is to take this as an opportunity to redouble efforts at public information campaigns that implore people to avoid the contributing factors to heart disease, diabetes, and road injuries. To debunk misinformation with helpful warning signs and replace it with useful information from credible institutions. This is bound to fail, as it is unlikely that a stable, worldwide trend of any kind—let alone something with life-and-death consequences—is just a matter of individuals making the wrong decisions. It is so hard to get humans to act in unison around anything that this kind of robust pattern must be enforced through many interlocking forms of oppression with multiple failsafes. Remember: this death configuration has been stable for years and is therefore likely the normal output of how the world is arranged. And when it comes to believing that masks are a violation of some imagined freedom, the problem isn’t bad information—its ideology. No amount of debunking will prevent this.

Which leads us to the second, inevitable, reaction to COVID-19: throw out the system it has adapted itself to. In The Best of Both Worlds, the crew must start from scratch and make up a brand new plan to save humanity from the relentless Borg collective. In Star Trek, the crew is in agreement that the Borg are real and that it is in all of their best interests to defeat them. We do not have it that easy. Karen Washington, in that same Guernica interview quoted above, continues:

“The fact is, if you do prevention, someone is going to lose money. If you give people access to really good food and a living-wage job, someone is going to lose money. As long as people are poor and as long as people are sick, there are jobs to be made. Follow the money.”

Following the money leads leftists to a familiar place: the contradictions of capital and the necessary revolution to bring about the vastly better world we deserve. But what will such a world look like, and how will it guard against pandemics such as COVID-19? 

Not even Karl Marx attempted to depict a communist feature in any detail, but a broad outline is both warranted and possible given what COVID-19 has taught us. While the pandemic has made us all reacquaint ourselves with a sort of miasma-based public health regime that demands clean air, that does not mean we should give up on cities. When it comes to COVID-19, urban density does not appear to have a direct impact on infection rates, and in fact the percentage of patients that die goes down with density.

This study, published by Shima Hamidi and colleagues at Johns Hopkins’s Department of Environmental Health and Engineering, makes a fine but crucial distinction between the dangers and benefits of riding out a pandemic in a big city. They found “that connectivity matters more than density in the spread of the COVID-19 pandemic.” This is because cities, especially vast metroplexes like New York City or Wuhan, “are more likely to exchange tourists and businesspeople within themselves and with other parts, thus increasing the risk of cross-border infections.” What is more interesting still is that urban American counties actually have higher rates of recovery and lower rates of mortality, which the researchers chalk up to the “superior health and educational systems” found in cities compared to more rural parts of the country. 

Still though, we should heed Davis’s warning that unchecked urbanism has given rise to a concomitantly unsustainable food system that gives rise to pandemics. We have to strive for a unification of urban society that is capable of bringing to bear the collective wisdom of humanity and a more distributed agrarian network that respects all species and does away with factory farming. This was, in fact, the very program designed by the grandfather of modern urban planning: Ebenezer Howard.

The Hamidi study is just a small glimpse into the geosocial nature of COVID-19. It shows that through our collective ability to educate and care for one another, we can overcome the ravages of disease and blight. Indeed, a well-educated, caring society rooted in a kind of decentralized urbanism appears to be the opposite of what the coronavirus needs in order to spread. We can make a world that is safer, cleaner, and more caring. Our physical and emotional coming together is not a danger in these deadly times. It is the only thing that can save us. ♦

David A. Banks (@da_Banks) is writing a book about cities, authenticity, and the attention economy. He lives in Troy, NY.

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