The Overwhelming Theme of 2020: Which Lives Matter? Part 1 — The COVID-19 Pandemic
The events of this year have been monumental and relentless. The COVID-19 global pandemic shut down the world, forced us to distance ourselves from our friends and neighbors, and made us consider what it meant to be “essential”. The myriad of natural disasters reminded us of the climate change emergencies to come while leaving damage that persisted long after attention shifted elsewhere. The deaths of George Floyd and Breonna Taylor and the protests that followed made us confront the culture of the police and its role in communities along with the veneration of symbols and structures that harm POC. All of these events are important in their own right, but in truth they are but different manifestations of a single question: Which lives matter? Or, to be more precise, which lives do we as a nation see as invaluable— and which do we see as expendable?
This is Part 1 of a four part series highlighting the events of 2020 and the lives that are dismissed during them. This first part takes a look at the COVID-19 pandemic.
One of the defining characteristics of this pandemic is its disproportionate effects on the elderly and those with “underlying conditions”. In mid-June, an estimated 43 percent of COVID-19 deaths in this country at that point came from nursing homes. The Centers for Disease Control and Prevention (CDC) released a study showing that hospitalizations and deaths among those with a preexisting condition were 6 and 12 times higher respectively than those who did not. This has led some to reject the idea that we should disrupt every day life to control the virus. The chief economist of a conservative think tank argued that schools should be open because “very few kids die” and it is mostly the “elderly and Hispanic dying”. A school board trustee in Wyoming insisted the deaths in his state at that time were either people with preexisting conditions or people in nursing homes. His exact words: “They were going to die. They just died sooner.”
They were going to die. Tell that to Caitlin Whisnant or Kimora Lynum or any of the many, many young people in the US that died from COVID-19, because being less of a risk to die is not the same thing as being at no risk of dying. Tell that to Nadeen Ismael or Justin Hunter or all the other people who suddenly are left without their parents or other loved ones. Tell that to the thousands and thousands of people that had years and decades of life left in this world. One of the places that does an excellent job of highlighting the lives lost during this pandemic is the FacesOfCOVID Twitter account. The account posts news reports and obituaries submitted by loved ones of those that died from COVID-19. They even started a series of videos to commemorate these lives.
The news reports and obituaries drive home that these aren’t merely “old people” or “people with pre-existing conditions”. They are people with families and friends and legacies left behind, and to dismiss deaths as only happening to certain people is to dismiss those legacies. It tells the Betty and Curtis Tarpleys of the world that their old age means there’s no reason to sacrifice to protect them. It tells the Caitlins and Kimoras of the world that their deaths are an anomaly, so there’s no reason to sacrifice to protect them. It tells the Nadeens and Justins of the world that it’s not worth trying to protect their family because after all, they were going to die. It reduces all of their connections and influence and friendships to demographic statistics. In short, it is to say that their lives don’t matter.
Of course, when it comes to this pandemic, it’s not only the deaths that matter. There have been many stories of people enduring long-term health complications after a COVID “recovery”. Deemed “long-haulers”, they have contended with a myriad of symptoms ranging from light sensitivity to excessive bruising to dysautonomia, a condition in which problems occur in the autonomous nervous system. Naturally, these symptoms have also had negative psychological effects on some of them. When one long-hauler could not perform a basic task for his job, he cried on his the way home. Another had thoughts of suicide after four months of symptoms, emergency room trips, and fatigue that prevented her from returning to her job teaching seventh and eighth graders.
Clearly, the lives of these long-haulers have been profoundly changed despite surviving COVID-19. However, when it comes to the pandemic, they tend to be reduced to hypotheticals or left out of the discussion entirely. In a September news conference, Florida Governor Ron DeSantis displayed a chart from the CDC showing COVID-19 mortality rates by age group, clearly in an attempt to downplay the severity of the virus for those who are under 70. In fact, in that press conference he remarked that COVID-19 was less severe than the seasonal flu for those under 50.
But this is incorrect in a way that happens too often when talking about COVID-19: it conflates “severity” with “fatality”. Imagine going up to an amputee veteran or a cancer patient and telling them their medical conditional wasn’t serious because they’re alive. It would defy compassion, empathy, and understanding — not to mention common sense — to do so. And yet, people tend to describe COVID-19 in these binary terms, especially with younger people. Hailing low mortality rates doesn’t mean much to a person that undergoes a double lung transplant to survive COVID-19. Needing dialysis means a case was serious, no matter how many times someone insists that cases don’t matter if deaths are down. A 99 percent survival rate does not change that almost a quarter of those hospitalized develop heart damage which can develop into more severe heart conditions. A binary view of COVID-19, only thinking of terms of whether someone is alive, dismisses those that do survive, but whose lives are dramatically transformed by the disease.
This pandemic is also notable for its disproportionate toll on minority populations in different areas. In Texas, Hispanic people represent 55 percent of COVID-19 deaths in Texas while representing only 39 percent of the population. Washington D.C is even more disproportionate; there, Black people represent 76 percent of COVID-19 deaths while only representing 47 percent of the population. In fact, in 34 of the 50 states, there is either a case disparity or a death disparity of COVID-19 among Black people. Note the definition of disparity as defined by The COVID Tracking Project:
We flag a group’s case or death proportion as suggestive of racial/ethnic disparity when it meets three criteria:
1. Is at least 33% higher than the Census Percentage of Population.
2. Remains elevated whether we include or exclude cases/deaths with unknown race/ethnicity.
3. Is based on at least 30 actual cases or deaths.
For Native Americans and Alaskan Natives, there is a case or death disparity in every state where they represent more than 1 percent of the population except for Wyoming and North Dakota. In June, the situation got so severe in New Mexico that the Navajo Nation received aid from humanitarian organization Doctors Without Borders. But far too often when talking about the pandemic, the severity of its impact on minority communities is neglected.
This impact is even extended to the hospital care that they receive. As hospitalizations increase, states may enter crisis care where hospitals ration the care that people get. According to Governor Gary Herbert, Utah may be close to implementing such standards of care. However, as laid out in this Appeal article, the algorithms used to determine who gets care penalizes minority groups, no matter how much the algorithms try to avoid such a scenario. For example, consider Utah’s crisis standard of care guidelines. It includes an assessment called Modified Sequential Organ Failure Assessment, which considers heath variables such as oxygen needed, hypotension and creatinine levels. However, as explained in the Appeal article, Black patients are more likely to have higher creatinine levels, either naturally or through underlying kidney disease. Under these guidelines, Black patients are less likely to receive care in a crisis situation. This is just one example of how the pandemic disproportionally impacts minorities. Downplaying the pandemic serves to deny the reality that minorities face during this time.
There are other places where the pandemic has been especially salient. One of the most consistent hotspots for COVID-19 has been prisons and jails. There was a time in late April where 8 out of the top 10 COVID-19 hotspots were in jails and prisons. In Texas, almost 6 percent of one prison unit died from COVID-19. In state after state, the rate at which prisoners contract COVID-19 far outpace the general population, even with inadequate testing at some facilities to catch outbreaks. For most of those states, this has corresponded with an elevated death rate of prisoners.
However, even with this precarious spread, there does not seem to be much of a meaningful effort from states to greatly reduce the capacity of their prisons. While some prisoners have been released due to the pandemic in different states, it usually does not markedly change the capacity of prisons in that state. During a pandemic where businesses are routinely limited to operate at 50 percent or even 25 percent if at all, prisons have largely remained at a high capacity.
The natural response would be to mass release prisoners, either through early releases, pardons, or commutations. But of course, there is always heavy pushback against this sort of suggestion. Inevitably, stories are written about violent offenders being released, usually paired with the family of a released prisoner’s victims being distraught about the situation. Of course this leads one to question why prisoners should be released, especially if some of those released are violent offenders.
This can be answered from two different perspectives: community and moral. From a community standpoint, releasing prisoners reduces the risk for COVID-19 spread to the rest of the community. Because staff enters and exits a prison, an outbreak in a prison can affect the general community. For example, consider Juneau County, a small Wisconsin county of about 26,000 people that also holds a medium security state prison. In mid-August, an outbreak occurred in that facility; now that outbreak accounts for about one-third of all total cases and one half of active cases in the county. The outbreak is so bad that the county dashboard differentiates between cases from the prison and cases in the general community. Juneau County is not the only county where this occurs. Below is a small sample of counties where a substantial portion of cases stem from an outbreak at a correctional facility.
Releasing prisoners is a public health response that can protect the rest of the community from a increase in COVID-19 cases.
From an moral perspective, it also makes sense to release prisoners. Even incarcerated, these are still human beings; denying them the chance of full health is tantamount to discarding their life. In some cases, it discards them before they are even convicted of a crime. Often times, people talk about rehabilitating prisoners and giving them a second chance of life. That rhetoric is pointless if our society is just going to neglect their lives while incarcerated. What good is a second chance at life if suffering from COVID-19 debilitates your first one? Also, for those wary about crime if prisoners are released, city after city has shown that this can be done without increasing the crime rate in the area. Releasing prisoners protects their own health and well-being and shows that these people also matter.
However, the group that might be the most effected by the virus is frontline health care workers. As the profession that interacts the most often with people with COVID-19, these workers have an elevated risk of catching the virus. Some estimates say that frontline workers are 12 times more likely to test positive than the general population. This risk is even more acute when they don’t have the proper equipment to protect themselves. In the early stages of the pandemic, nurses would wear garbage bags due to the lack of personal protective equipment. Even now, months in, there are still areas that lack the necessary supplies to properly sustain their workforce.
This induces a staffing shortages as health care workers themselves get sick, especially in places where hospitalizations are increasing. In North Dakota, the nurse staffing situation is at a point that even some of those that get COVID-19 will still be allowed to work with patients. In Pennsylvania, some nurses are going on strike so the hospital can fill staffing to safe levels. All of this causes immense strain on the health care workers as they attempt to care for the community, putting their own health and well-being at risk.
Of course, the toll on healthcare workers isn’t just physical; it’s also psychological. At the height of the pandemic in New York, a large study of health care professionals revealed depressive symptoms, acute stress and insomnia among a majority of them. In this recent Atlantic article, health care workers describe the emotional burnout that comes with treating sick patient after sick patient. As one nurse put it, “You get to the point when you realize that you’ve become a machine. There’s only so many bags you can zip.” Worse still, they describe “societal fatigue” where they watch people deny the reality of the pandemic and receive insults and death threats from trying to do their jobs. And this is the result of downplaying or dismissing the pandemic: it insults the health care workers that put their all on the line to treat the rest of the community.
Ultimately, our response to the COVID-19 pandemic needs to include these groups that are heavily impacted by it. The pandemic affects everyone, but some lives are either affected more than others or are discussed less than others. Their lives matter, and we cannot neglect to acknowledge that.
Part 2 will discuss the impact of the lockdowns and reopenings on people and the treatment of “essential workers”.
Part 2: What It Means to be Essential (coming soon)
Part 3: The Climate Disasters (coming in December)
Part 4: The Police and the People In the Streets (coming in December)
