Pulling deaths from the future

How is it that we've normalized mass death during the pandemic?

In today’s post, I want to look at a factor of the coronavirus pandemic that too often gets reduced to simply another large number: the number of deaths from the illness in the United States. As cases and deaths climb these figures appear to have been somehow normalized, folded into a larger fabric of political resignation that verges on fatalism. I’m going to look at how that happened, try to suggest how to meaningfully understand these deaths, and how to advance a political conversation around them that doesn’t simply redound to “we need to believe in science.” As is often the case, this post draws from and expands on a conversation we had this week on the Death Panel podcast. You can listen to that episode, “The New Normal” here.

[Image description: Still from Adam Curtis, Hypernormalisation, 2016. Subtitle reads “Your body”]

In early May, the Milwaukee Journal Sentinel reported that county medical examiners would be reviewing local deaths suspected to be from COVID-19 to determine whether the pandemic was “pulling deaths from the future.” In other words, whether the pandemic had simply taken the lives of people who were already in ill health. This kind of narrative has been repeated endlessly during the crisis, from Bill O’Reilly stating the dead were “on their last legs anyway” to Wyoming school district trustee Kevin Christopherson proclaiming “Most … were people with pre-existing conditions or in old folks homes … They were going to die. They just died sooner.”

While it’s easy to decry the callousness of these framing devices, they do quite a bit to explicate the flaws in how we’ve internalized the pandemic, and in how we internalize public health more broadly. As an ontological exercise, understanding coronavirus deaths as inevitable or somehow dislocated in time (“pulled” from the future) amounts to a kind of grim divination. That the pandemic has disproportionately effected already marginalized or vulnerable people should be a significant call to political action, not a signal that deaths were somehow preordained.

More fundamentally, this logic sets up a binary between the vulnerable and the somehow ‘not vulnerable’ that is untenable in dealing with a novel virus. While it’s certainly true that some groups are at higher risk to the pandemic (as I’ll get into below), it has killed people of all ages and backgrounds, many without underlying conditions or comorbidities. In this sense a determination of increased coronavirus vulnerability is almost as absurd as the phrase “pre-existing conditions” itself.

This binary might help explain how the immensity of coronavirus deaths in the United States has become so normalized. The language of reopening and recovery dominates political discourse even as the U.S. approaches 1,000 deaths per day and accounts for a quarter of the pandemic’s entire global death toll. As long as a cultural understanding is maintained that deaths or prolonged illness are the unique burden of the vulnerable or those at “increased risk,” the mass death in front of us will be reduced to the sad, inevitable fate of others. It’s for this reason that I suspect the immensity of the crisis in jails and nursing homes alone has not produced widespread civil unrest. Headlines about breakouts among the institutionalized pass through the prejudices of the reader—what one person may correctly see as an atrocity another might reduce to an unfortunate circumstance.

The politics of mass death

Any crisis that produces mass death can be the catalyst for massive political change, but this change is far from an inevitability. It’s critical that we internalize the lessons from these events and utilize them to orient our actions accordingly. Helpfully, those who have gone looking for information linking underlying conditions to increased mortality from COVID-19 have produced work that demonstrates a need for systemic changes to our political economy.

One widely cited study, “OpenSAFELY: factors associated with COVID-19 death in 17 million patients,” is an analysis published this month of patients in the UK, assessing comorbidities and underlying conditions in 10,000 coronavirus deaths. This study is a fine example of why simply collecting information while willfully ignoring social constructs around it can be either misleading or, at worst, detrimental. (At some point I will have to revisit this point to expand on it and the shibboleth that is “evidence-based policy”).

For example, the authors casually note:

“People from black and minority ethnic (BME) groups are at increased risk of bad outcomes from COVID-19, for reasons that are unclear.”

This is data about patients in the UK so while I won’t make sweeping generalizations here, I think it’s safe to assume that the massive health impacts of systemic racism on open display in the United States probably carry over to the UK as well.

Also left unremarked, but no less alarming is the following observation:

We found a consistent pattern of increasing risk with greater deprivation, with the most deprived quintile having a HR of 1.80 compared to the least deprived, consistent with recent national statistics.

“Deprivation” here refers to economic deprivation; in other words, they found an increased likelihood of death due to coronavirus based on how poor the patient is, or the relative poverty of the area they live in.

These findings more or less confirm what should be readily evident to anyone critical of the functions of capitalism: the pandemic disproportionately harms the same groups our economic system is already plenty good at doing harm to, the poor and those who are already the targets of systems of oppression. This relates directly to something health policy people and social scientists call the “social determinants of health,” which refers to all of the myriad social and political factors that can and do impact an individual’s health. With that critical analysis left out, this study and analyses like it reinforce the binary above: that some groups are vulnerable and others are not, perhaps for “reasons that are unclear.”

Instead we should understand this information as showing us that our political economy is actively harming and endangering all of us. The reality at the core of the social determinants of health is that these are factors entirely under our control, precisely because they are social (and, by extension, political). As Tim Faust writes:

Just as a person with no place to live or no food to eat is likely to face worse health outcomes and require more (and more expensive) healthcare than a person with a safe home and a healthy diet, people who have been denied other social determinants will be sicker, die sooner, and require more medical care (which, under the current American model, they are unlikely to be able to access).

[T]he social conditions that make those illnesses more likely or more severe are absolutely within our control. There is no law of nature that denies every person in America a safe place to sleep or healthy food to eat. There is only an institutional refusal to see it provisioned.

[Image description: Dora Maar, Le Simulateur (1935); black and white photomontage depicting a lone figure in a “windowless, carceral space”]

Atrocity exhibition

This is what makes the endless calls to de-politicize the pandemic not only absurd, but dangerous. The act of upholding the political status quo during a pandemic is itself a political endeavor, clearly happening by force in American cities as we speak. To look at the disparities in who the crisis is killing and making ill is to hold a mirror to who we already chose to violently and systemically oppress. Coronavirus deaths must be politicized, must be interrogated and internalized. Otherwise we risk emerging from this crisis with nothing changed but the countless lost, and little but a monument to the dead.

[Image description: NY Gov. Andrew Cuomo gestures at green styrofoam sculpture depicting coronavirus deaths]

Thank you for reading Health and Capital. As I mentioned in my introductory post, if you enjoyed this and would like to support my ability to produce future posts, please subscribe, share links to it, tell me what you think, and become a patron of the Death Panel on PatreonDeath Panel is a podcast I co-host with Beatrice Adler-Bolton, Philip Rocco, and Vince Patti, and if you enjoy Health and Capital you will probably enjoy it as well.

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