COVID-19

By Carlo Caduff (King’s College London) and Yarimar Bonilla (Hunter College, CUNY)

A medical anthropologist and associate professor in global health and social medicine at King’s College London, Carlo Caduff published his first book, The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger, in 2015. The Pandemic Perhaps explored the dramatic ramping-up of preparedness efforts among New York City scientists and public health experts in the run-up to a catastrophic influenza pandemic—a widely expected event that never occurred. In the midst of a current research project on cancer in India, Caduff has become a prominent voice on the ongoing coronavirus pandemic and its response—in India, the United States, and globally—on Twitter and in his forthcoming article in Medical Anthropology Quarterly, “What Went Wrong: Corona and the World after the Full Stop.”

Public Anthropologies editor Yarimar Bonilla, a political anthropologist and public intellectual whose work has focused on social movements and crisis aftermath, spoke with Caduff about the politics of lockdowns, barriers to pandemic preparedness, and affective and critical responses to COVID-19 on May 25, 2020.

Yarimar Bonilla (YB): Thank you so much, Carlo, for making time to talk to us about COVID-19 and the kind of role that anthropologists can play in public debate during this time. You’ve been very active on social media since the pandemic began. How has this period impacted the way you use social media?

Carlo Caduff (CC): Thank you, Yarimar. Actually, I had not been using Twitter much before the pandemic. During this period, I have turned to it as a kind of public notebook, where I could write down thoughts and then publish them and have a record for myself. The tweets were either orientations, diagnostic, or suggestions for another politics of life.

In Twitter, life assumes a particular form of appearance: an ongoing series of events in search of a caption. People are commenting online about things that occur in their life or in the world. The caption that they provide very often takes the form of either opinion or judgment. People bear witness, express themselves, and let other people know whether they agree with something or not—or how they think about it—and that frequently takes the form of an opinion or a judgment. Beyond opinion and judgment, it’s pure expressivity (“Today I baked a lockdown cake”). Similar to other “social” media, Twitter embodies an ideology of publicity that emphasizes expression and circulation over relationality and response.

I think that’s where you can see some of the limits of that kind of communication technology. It reduces critique to the idea of judgment, rather than seeing critique as something that is about conditions of possibility.

Some people were puzzled about my tweets—not quite knowing what to do with them or where I was heading. It was part of an attempt to open up the event and wonder what’s happening around us. Because everything happened so quickly, almost matter-of-factly. Suddenly, half of the world was under lockdown. I tried to slow down and ask questions.

The other thing that’s important to say about Twitter is that it’s a tool for and a territory of strategic disruption. Twitter has become an information battlefield in this civil war that is COVID-19. There’s a deliberate attempt to create instability and confusion—thus preparing the ground for authoritarian longings.

YB: So, do you feel that Twitter has not served as a space for opening up the debate and considering new possibilities?

CC: At the beginning of the pandemic, I saw very few people asking questions. I was sitting here alone in my isolation and watching what was happening in a world I could access only through technology.

I was seeing so many people already knowing what it was all about. People seemed to act as if everything was already settled and there was no alternative.

I was looking for the signal in the noise. I wanted to open up a space where people could again start thinking about what’s happening, rather than assuming that we already know or that the experts should speak and everyone else should be quiet and follow the advice.


YB: What surprised you about the intellectual response, or the critical engagement, with COVID-19? You were very critical early on in your tweets about the nature and terms of the public debate. I wonder if you see any difference now, several months into the pandemic, or if you still see the same trends?

CC: I think things have changed quite a bit. At the beginning of the pandemic there was hardly any political voice, because people were overwhelmed, and then stuck. Many were busy with homeschooling. And then lots of people were scared, so the first responses were either people not saying much, or they were repeating what everyone else was saying, or it was just silence.

Now, I think that has definitely changed. There are more political voices. The views are more diverse. People have gained a better sense of the complexity and the seriousness of the pandemic response and its consequences.

But again, things have taken different shapes in different places. When you look at the politics of the pandemic, very often in the United States, the United Kingdom, and Brazil, it’s left-wing thinkers who are in favor of the lockdown. In countries like India, France, and Italy, it’s the left who’s been concerned about the lockdown.

YB: Can you talk about that a little bit? What does a leftist critique of the lockdown look like? Because I feel like we’ve had such vocal and performative objections to the lockdown from a conservative perspective. What would a radical account look like?

CC: I’m living right now in India, where the lockdown has been devastating for millions of people. It’s been very cruel—especially for the poor, vulnerable, and marginalized. It has been the most stringent lockdown in the world, affecting 1.3 billion people, and has created huge problems in terms of loss of income, access to food, and basic health care. It has put lives and livelihoods in danger. There was police brutality. There was pure desperation.

To be isolated and watch all of this from a distance was hard. It was obvious that millions of people were excluded from the government’s vision of saving and protecting lives.

In India (but also elsewhere), it’s been very difficult for patients to reach hospitals, because there’s no public transportation. People are not allowed to travel. Many cancer hospitals either stopped, or they have had to reduce services. So that just means patients with life-threatening conditions are refused and can’t get essential, basic medical care. Many rural health programs have completely stopped. Doctors have not received salaries for months, and often they work without appropriate personal protective equipment.

In many places, including the United Kingdom, the lockdown has wreaked havoc on oncology. Treatments have stopped and the numbers of referrals and consultations have gone down drastically. There’s a huge backlog now for the whole spectrum of cancer care.

A left account highlights structural issues. It underscores how the lockdown is not a response to the virus but to failing political governance and fragile public infrastructures, defunded over the past two decades. The lockdown created huge costs and consequences, especially for poor, vulnerable, and marginalized people. In India, the lockdown may have slowed down the spread of the virus, but the number of cases continues to increase, and the pandemic is taking a protracted shape—far from the simplistic metaphorical language of “waves” and “peaks.” Now, after three months of complete shutdown, the lockdown has become unsustainable, so restrictions are gradually lifted, while the virus continues to spread slowly. No one knows whether we are at the beginning, in the middle or at the end of the pandemic in India.

YB: I heard you talk about how part of what we need is just basic public health policies: contact tracing, testing, etc. Do you think, if those were in place, we wouldn’t need a lockdown? Or is it just that the lockdown without those in place is cruel and useless?

CC: The lockdown was presented as if there were no alternatives. And that’s simply not true. First of all, you need to understand the history of the idea of the lockdown. Lockdowns only figured in infectious disease modeling. They were basically a theoretical idea that disease modelers used in simulations: What happens if you do this? What happens if you do that? Can you reduce the number of deaths if you do x, y, z? A complete shutdown was never an option that public health professionals considered in their preparedness plans for a pandemic like this.

The lockdown existed in the space of the what-if of disease modeling. It was never implemented before on such a big scale. It was never tested in a real-world context. What were the conditions of possibility for the lockdown to become a solution to this pandemic in the first place? How did this happen?

The second question is a historical/ethnographic question. How did the idea of the lockdown travel across places? A particular version of lockdown was first implemented in China, but in China, the strategy was one of the locked city. China never pursued a locked-country approach. It was only when the Italian government took up the idea of the lockdown that it became a locked-country strategy. That’s something quite different and much more extreme.

And then it took different forms in different places. In the United States, the lockdown was not the same as in the United Kingdom, Switzerland, South Africa, France, Italy, or India. Especially in France, Italy, and India, it took an extremely militarized form and became a curfew, and thus a law-and-order intervention executed by the police. So that’s opening up a range of different questions in terms of how lockdowns worked in different places and what shape they took and what kinds of contestations occurred or didn’t occur.

The main point that you were mentioning is really the point of testing, tracing, and isolating. We know that’s a very classic, efficient, and effective public health strategy. And a couple of countries have used it and have been extremely successful. South Korea and Germany have been very successful and strategic with testing, tracing, and isolating.

Other countries were either unwilling to mount the effort, biopolitically incompetent, or just missed the opportunity to start testing and tracing, or they placed emphasis on the medical response and focused on hospitals. Then it was too late for a proper public health intervention and governments imposed extreme lockdowns to prevent the worst. Last but not least, in the United Kingdom, France, Italy, India, and elsewhere, the lockdown became part of a nationalist discourse—the whole nation united against a common enemy.

YB: You’ve also written about how we need to be attentive to how we’re going to pay for this lockdown and this state of emergency. What do you think we should be concerned with and looking out for?

CC: That’s my biggest concern, because this lockdown strategy has created enormous public debts. When you look at how much money—how many trillions of dollars, pounds, and euros—are being put into the relief bills, it’s just mind-blowing. It’s massively more than during the financial crisis of 2008. And most of the money is not going into making the public health infrastructure stronger. It’s support for businesses and individuals.

That helps them to survive, perhaps. But it won’t change anything in terms of the response for the next pandemic, or in terms of the health-care system in general.

One of the biggest paradoxes of preparedness is the United States, where the investment in public health has gone down over the past two decades. At the same time, hospitals and local public health departments have been asked to do more preparedness for a pandemic. The aim of preparedness in the United States was never to prevent a disaster. It was to mitigate the consequences of disaster. Defunding of public health and investing in pandemic preparedness have been part of the same political strategy. Today we see the consequences of this strategy, crowned in a cruel way by Trump, who keeps celebrating free carelessness as an image of individual sovereignty.

YB: Can you say a little bit more about that? I wonder if the policies implemented after this virus will actually make us even less prepared for future pandemics.

CC: That could very well be. You know, that’s the story of preparedness in the United States over the last twenty years. Part of the problem has also been that a lot of the resources went into biodefense projects in order to prepare for anthrax and smallpox attacks. I have written about this extensively in my book.

After the terrorist attacks on September 11, 2001, there was a massive increase in biodefense labs. But at the same time, it took the United States so many months to set up a decent, systematic testing system for COVID-19. Coronaviruses are common cold viruses—they’re not lethal bio-weapons with a fatality rate of 80 percent. So how come there was no large testing system in place to provide local public health departments with the necessary data to do their job? These are the contradictions of preparedness in the United States. And they’re very visible now. Whether anything will change in terms of the politics of preparedness in the United States, I’m not so sure. 

YB: Can you say a little bit more about the kind of moral panics that have emerged around COVID-19? You had this tweet: “What makes this pandemic unprecedented is not the virus, but the response to it.” Can you tell us what you were thinking about there?

CC: The scale of the response is unprecedented. I think that’s very clear. We’ve never seen anything like this, on such a scale, with confinement at a global level and such massive costs and consequences. The response is definitely historic. And the repercussions are unforeseeable. At the same time, when you look at the virus—the virus has killed many people; it’s dramatic in many ways. But when you look at the numbers, you need to compare this with other kinds of disasters and diseases that are happening every year. We know that tuberculosis kills 1.3 million people every year; HIV/AIDS kills 770,000; malaria kills 400,000. And then there’s dengue. And then there’s diarrhea. Influenza, in a severe season, kills up to 500,000 people. In 1968, there was an influenza pandemic that killed between 2 and 4 million people. We don’t see these numbers of TB, HIV/AIDS, and malaria deaths displayed on TV on a daily basis.

So that, then, raises the question: Why are we responding in such a huge, massive way for COVID-19, but when it comes to TB or AIDS or malaria or even influenza, we’re not mobilizing as many resources?

Are these deaths acceptable? What’s the politics of acceptability? Why is it acceptable that so many people are dying from TB or malaria each year? These are preventable and treatable conditions. To me, this is a question of justice, equality, and solidarity—a question of understanding how we determine the value of life and the inequalities we find acceptable or not. And then there are the people who will die due to the lockdown, due to lack of food, loss of income, and disruption of ordinary medical care.

These are important problems that we need to highlight in today’s distorted economy of attention where everything has become determined by a certain image of COVID-19.

The catastrophe, in many ways, is in the ordinary. The fragile infrastructures of support have always been there—it’s just now that many realize how fragile and uneven they are. Today’s response—let’s all stay at home until the virus has disappeared—is not a long-term solution. And it hurts those at the margins of society and the economy most.

YB: Absolutely. So, what do you think it was about this disease that captured the imagination in the way that it did?

CC: First of all, it’s a “new” disease. I think that made a huge difference. Even though there are four other human coronaviruses that have been infecting and killing people for decades. The emergence of a new coronavirus is not unprecedented. It has happened before.

The second thing is, it’s a disease that’s infectious and that seems to be a threat for everyone—or at least, that’s how it’s framed. We know that the risk really depends on a number of factors. It depends on age and comorbidity, in addition to class and race. We know that it has affected marginalized and vulnerable populations with lack of access to health care much more. But it has always been presented as a disease that is eventually going to spread for everyone to be potentially at risk of death. Then the middle and upper classes got scared and started calling for drastic measures.

And then it was spreading fast, and the media was reporting about it, and then everyone got obsessed with the numbers—and then got even more scared. Some of these models predicted that the virus would kill millions of people. I saw one prediction suggesting 200 million people could die from COVID-19 in India. There’s a whole politics around numbers, which we could discuss in detail, because that’s another disaster in terms of the response to this pandemic.

YB: Especially how people have embraced modeling almost as a kind of numerical truth, when it’s all about projections and “perhapses,” no?

CC: Everything is now a perhaps. Everything now seems perhaps possible. And the ruling elites will not wait. For them, the crisis is an opportunity.

YB: One thing that has driven me crazy has been the way in which so much of the burden has been placed on individuals. Especially here in Puerto Rico, where we can’t count on the state at all. The burden of preparedness, protection, and care has been placed on individuals and communities. To what extent is COVID-19 a particularly neoliberal pandemic, or to what extent does it just show what was happening in health care for years?

CC: This is not the “first modern pandemic,” as Bill Gates suggested, but the second neoliberal pandemic, the first one being HIV/AIDS under Reagan and Thatcher in the 1980s. It’s a neoliberal pandemic because you can see that in the most neoliberalized countries in the world, the United States and the United Kingdom, significantly more people have died due to COVID-19. And it’s precisely due to the kind of fragile health-care infrastructures and sidelining of public health that neoliberal policies have created. Italy’s northern regions is another case in point, in addition to Brazil. Bolsonaro has made it very clear that he cares about power, but not about the pandemic.

It’s also a neoliberal pandemic because of precisely what you were saying: because of the idea that citizens need to be responsible; it’s your duty to protect yourself and society at large; it’s not the state’s duty to provide protection. Suddenly, citizens were asked to stay at home and protect the health-care system (the NHS in the United Kingdom). It wasn’t the health-care system that’s protecting citizens. This just shows how fragility is being normalized, how negative effects are redistributed to the margins, how accountability is displaced and deferred, and how a logic of public sacrifice is mobilized in a nationalistic discourse.

The kind of responsabilization that’s been at the center of neoliberal policies for the last two decades has been very strong. Neoliberal defunding made health-care systems so fragile that citizens now need to protect it from falling apart during a pandemic. And all of this is accompanied by nationalist sentiments with people engaging in symbolic clapping to support “corona warriors.” The aim of all of this is to obscure political questions about structural vulnerability and democratic accountability. The idea of the dangerous virus as an external biological threat is politically very useful.

YB: It’s great that health care is being valorized in this moment, but it’s concerning that in other labor sectors folks are forced to go to work without proper protection, because the PPE is reserved exclusively for the health-care sector. Supermarket workers, bank tellers, sanitation workers, etcetera, are all categorized as “essential workers.” But really, they are “expendable workers,” because they’re not given any protective gear. If they were essential, they would be protected. I wonder to what extent the neoliberal pandemic also involves defining who is essential, who is expendable, who must be protected, and how to reorganize the labor pool in relation to these new risks.

CC: I completely agree. Privileged people can work at home and have a salary (if still employed) and enjoy the lockdown as an unexpected holiday from 24/7 capitalism (but not 24/7 communication-technology use), as long as there is no daycare and/or homeschooling. Other people lose their jobs, have no access to medical care, and are living in slums, where a lockdown is just catastrophic, because it intensifies conditions that are already extremely dense and prone to the spread of disease.

The lockdown is a political mechanism for the redistribution of negative effects. It moves negative effects away from spaces of public attention to spaces where those effects are less visible. This is how the state reclaims its legitimacy and escapes accountability.

YB: A lot of folks are really desperate to find a lesson in all of this. There is a collective search for hope and optimism. What do you think about this desire for hope? And what other affects should we be paying attention to?

CC: I would be in favor of a whole different range of affects. I found Veena Das’s idea of neither hope nor despair helpful. I think and write from the position of depressive realism.

It’s important to keep in mind how affect is mobilized in this pandemic. But we need to distinguish between affect conceived of as emotional state and affect as activity and force that you can relate to because it’s in the room, so to speak, or enacted. When you go and see a horror movie, you’re not necessarily scared—or, you’re not just scared. You also enjoy the pleasure of seeing something that’s horrible. So it’s a very ambivalent kind of affective setting where affective activity and emotional state are not necessarily in a mimetic relationship.

I think the same is happening in the context of the pandemic. It’s exciting to be in this historical moment. It’s exciting to witness history in the making. There’s a lot of enjoyment in this pandemic.

The doctors in hospitals are not just afraid and fearful. It’s also a big moment for them. And yet they are exposed and at risk. And so it’s a very ambivalent affective setting. To understand this ambivalence is important, because an object is not just something that exists in the world, but it’s also something that’s invested. Reducing affective investments in the pandemic to the notion of fear is a very limited kind of understanding of what’s going on.

YB: I don’t like horror films, and I don’t know why people like them. But I would speculate that perhaps part of what’s exciting is that ultimately you know that you’re going to be OK. You’re not the one in the film. I wonder to what extent there can be pleasure in knowing that you can be OK—that you can stock up on toilet paper, that you can take care of your family, and watch the horror film of the pandemic unfold with a certain degree of detachment. I wonder if tapping into some of that voyeuristic pleasure might be worth thinking through.

CC: And, as I was saying at the beginning of our conversation, to open up the event, to not assume we know what’s going on, to find a new language to talk about it. A lot of today’s language is driven by control fantasies and the desire for sovereignty—to find new words, to find new stories, to find new narratives. To explore things in a more open way, to shake things up, to say what we don’t want to hear, to face things we don’t want to encounter. And to understand to what extent violence, inequality, suffering, pain, and exploitative social and economic systems are systemic and structural, and not just the result of an external biological threat that suddenly fell on us from the sky. As Canguilhem once said, societies have the death rate they deserve.

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