Coronavirus

I received word a couple days ago that the American Association of Geographers (AAG) is proceeding with its annual meeting in Denver in April, unlike many groups and companies that have spent the last week cancelling events because of the threat of coronavirus. The American Physical Union (APU) was set to host its annual conference in Denver this week as well, but decided to cancel, and that very much at the last minute, much to the displeasure of many its members, including those who had already arrived in Denver. At the best of times, I am wary of spending a few hours in an airport and then in a metal tube at 35,000 feet with a bunch of other people’s farts and coughs. The coronavirus concerns have heightened my apprehensions, but barring total catastrophe I am still headed to Denver with family in tow. But I am much more worried about exposure in the US than I am in Canada, given what appears to be a series of absolute failures by American officials and institutions to prepare testing kits and advance a more aggressive strategy of containment from the get-go. This is all exacerbated by the disgraceful state of preventive health care in the US, where getting tested for the virus can end up costing you quite a bit of money and people are prone to go to work when ill because there is no guaranteed paid sick leave. Couple that with the fact that a lot of people are not really paying attention to hand-washing or other other preventive measures or, worse, think the virus is a hoax, and you’ve got the potential for rapid and widespread transmission.

When I first started teaching my introductory human geography course here at Windsor in 2015, it was right on the heels of the Ebola outbreak in West Africa, which briefly caused panic in the US and Europe as a tiny handful of cases showed up in those places. These were all from people who had traveled to the outbreak zone, and many had been health workers with high potential for exposure to the virus. Aggressive screening and quarantine of those potentially exposed (helped by self-reporting by those who had been exposed and had some knowledge of the disease) helped prevent the spread of Ebola in Europe and the US. Ultimately, two people in the US died of the virus, one a health care worker who had been in the outbreak zone in West Africa, and the other a Liberian immigrant without health insurance who was initially turned away from a Dallas hospital. Ebola is a vicious disease, with debilitating and terrifying symptoms and a high mortality rate, though this also depends on the particular strain of the virus and, unsurprisingly, a range of social factors that shape one’s access to information, preventive care, and treatment. Official and public Ebola response in the US and Europe became quickly enmeshed in often condescending, uninformed, and racist stereotypes of Africa and Africans.

In my geography class I discussed the 2014 Ebola outbreak in relation to human-environment relations and the complex social calculus of exposure, risk, and vulnerability to hazards such as disease, climate change, and natural disasters. I had Neil Smith’s excellent 2006 essay “There’s No Such Thing as a Natural Disaster” in mind (I also eventually assigned it in later versions of the class), particularly this:

It is generally accepted among environmental geographers that there is no such thing as a natural disaster. In every phase and aspect of a disaster … the contours of disaster and the difference between who lives and who dies is to a greater or lesser extent a social calculus.

Is it right to think of Ebola, or coronavirus, or any other disease outbreak as a ‘natural disaster’? It’s not a flood or a hurricane, though epidemics and pandemics can be classified and treated as discrete events in similar ways. There is also certainly an environmental link to outbreaks of infectious disease in which a virus or other pathogen jumps a species barrier, especially when that is a byproduct of habitat loss and the incorporation of ever more species into the agricultural value chain. But there are lots of ways this can go. There are now over 100,000 confirmed cases worldwide, and many people are freaking out, stocking up on food, water, and other essentials as if they’re prepping for the zombie apocalypse.

Maybe this is a good idea. I have a lot of cans of beans, soup, and sliced peaches stored up in my basement, so I’m down for a quarantine, at least 14 days, but usually this is the kind of moment we might expect government to fill a gap, to stand in and provide the best possible information to the most people, and act according to public order and well-being. The response has been extremely varied between states, with many US local, state, and federal officials caught off-guard with their thumbs up their butts (which reminds me, by the way, to tell everyone to WASH YOUR F**KING HANDS, IT ISN’T THAT HARD) while South Korea is doing drive-through testing of thousands. China, meanwhile, which still accounts for about 80 percent of all cases, has seen its infection rate slow considerably as the initial confusion over the virus gives way to better management of new cases and quarantine procedures. Chinese officials reacted forcefully to quell the virus’ spread, through in doing so they resorted to an attempted quarantine of almost 60 million people, which is effectively impossible to achieve. Though the World Health Organization has praised China for its efforts to pin millions of people in place, activists and ordinary citizens in China have expressed anger and dismay at government misinformation, opacity, and heavy-handedness, often at great personal risk to themselves. Going back to the Ebola example from my class, it is easy enough to see that a wide array of social conditions shapes, as Smith calls it, “the difference between who lives and who dies,” and that simply locking things down is not going to be enough to contain and control the spread of novel infectious diseases. I gave that class a reading by Paul Farmer, a physician, professor, and infectious disease expert, from the October 2014 London Review of Books, in which he examines closely the social conditions that made the last major Ebola outbreak so deadly. Quarantine, he argues, is not enough in a world of globalized travel, trade, and labor, and it is the fragility and incapacity of health systems ravaged by 30-plus years of austerity that are the real culprits in the spread and mortality rate of Ebola.

But the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus. The obverse of this fact – and it is a fact – is the welcome news that the spread of the disease can be stopped by linking better infection control (to protect the uninfected) to improved clinical care (to save the afflicted). An Ebola diagnosis need not be a death sentence

He expands further on how globalized networks of travel and trade make large-scale quarantine a limited tool in the attempt to control infectious disease. Talking to a jeep driver in Zwedru, a city on the edge of the rain forest near the border between Liberia and Côte d’Ivoire, he writes:

‘It’s not just hunting and small-scale farming,’ he [their jeep driver] said. There were also mining, remittances from abroad and international trade. Many of the shopkeepers in town were from Guinea, Sierra Leone or Côte d’Ivoire. It may have looked like isolated rainforest, but the place is connected to the rest of West Africa. …That means it’s connected to the rest of the world too. … The day when enclosure might have worked is long gone. A CNN interviewer asked me if Ebola might spread to Europe and North America. ‘Of course it will,’ I replied. ‘We live in a global economy.’

And indeed we see this in the case of coronavirus as well. Enclosure and quarantine are effective to a degree, but by the time a disease is noticeable as a public health threat, quarantine can be counted on to slow transmission speeds beyond a certain area, but not stop the spread of the disease entirely. And it can be very effective in that sense, but the horse is out of the barn already then. By the time several cases in the Seattle area were confirmed as the novel coronavirus in February, researchers determined through genetic testing that the virus had likely already been circulating for a few weeks, despite the US and Canadian governments’ decisions to restrict travel to and from China. As one report states, travel restrictions are useful for slowing transmission, but their significance as a tool for controlling disease quickly drops off. In other words, yeah quarantine and other limitations on mobility are potentially useful but they won’t get you far. Part of the reason China had a high initial mortality rate (at least higher than what has been seen as the virus moves beyond China), is because so many people got sick all at once, a problem in fact heightened by quarantine, leaving people in place and sometimes with limited local access to medical care while increasing the probability of exposure and transmission.

Now, I am not a medical doctor and I cobbled this together from my own reading across multiple internet-based sources. But I would guess the US health care system, rickety and profit-driven and haphazard as it is, presents a host of problems for controlling the spread of infectious disease, especially something like coronavirus which seems to spread relatively easily and can often be asymptomatic, meaning someone may have it without knowing and spread it far and wide. Canadian health care systems, strained as they often are by wait times, nevertheless seem less prone to collapse because the system itself is more centrally managed and this can make crisis response more effective. These are of course national-level generalizations. Things might be different at the local scale and according to social class, racial status, and access to information. But I am not freaking out, still making travel plans while keeping an eye on my bunker prep, and washing my hands 15 times a day. So far, so good, and probably what I’d be doing anyway.