COVID-19

By Veronica Gomez-Temesio (University of Copenhagen)

As an anthropologist with kin interests in epidemics, I have been following the situation in China since media started talking about a “new coronavirus” emerging from Wuhan in early January. Nevertheless, my proper first encounter with COVID-19 happened a few weeks later when my partner and I got to the pediatric emergency ward in Geneva’s main public hospital with our feverish daughter, who was only a few days old. At the triage room, the nurse asked us if we had recently traveled to China. She seemed to ask this as a joke—why would parents of a newborn be traveling the world?—but still, she was wearing a mask. It is because of the flu, she explained. During these weeks, COVID-19 seemed to be a remote threat. People called it la grippette (the little flu), implying that the actual flu was killing more people every year. Furthermore, the news insisted that the virus was killing only the elderly and the already sick. There was nothing to be worried about so far.

But yet, a few weeks later, drastic changes were made all over Europe. Massive top-down state interventions took place in almost every country during March. Schools and public places were shut down; people were locked down at home and borders were closed. These drastic decisions were made after the failure of the Italian public health system to cope with the epidemic. On the news, Italian doctors urged neighboring countries to get ready to face the threat: Don’t be like us, they said. Exponential curves attested that European countries were barely ten days behind Italy. You have to flatten the curve, they said. The public message had to be changed. The virus was killing massively. Yes, it affected mainly the elderly and the already sick, but if the curve was not flattened, then we wouldn’t have enough beds in intensive care. An eminent Swiss doctor filmed a viral YouTube video explaining that we should not fear the disease itself most. The fatality rate could be reduced if every patient who needed it was intubated. What we had to fear as a community was the collapse of the common values of public health. If too many people became sick at the same time, we wouldn’t be able to save everybody; we would have to choose and let people die. Some people would die not because they were fated to but because we could not save them. It seemed Europe discovered—or rediscovered—the horror of triage. Anxiety was growing on social networks. On Facebook, you could now emblazon your profile picture with a STAYATHOME message. On social networks, people took pictures of others relaxing in parks and said, Don’t be so selfish, what if it was your mother, your grandfather? People refused to choose between lives.

School closure. Geneva, Switzerland, 2020. (Courtesy of author)

These few weeks of collective panic echoed deeply my past ethnographic experiences studying Ebola response in Guinea. Triage is a medical routine that has become a chore in humanitarian practice. Some lives can be saved while others can’t. During my fieldwork in an Ebola treatment unit in Guinea in 2015, nevertheless, triage appeared as a mechanism unfolding way behind medical practice. Some lives were valued enough to be cared for while others were just taken care of. People sick with Ebola were left to die in quarantine camps. People suspected to have contracted Ebola were quarantined with already-sick people, were contaminated, and were then left to die. Children were quarantined with no parents and no one to feed and rehydrate them. They were left to die as well. In short, humanitarian aid was not sent to Guinea to save Guinean lives. It was “our” lives, the lives of people living in the Global North, that were saved. The quarantine camps were not made to cure Guinean citizens from Ebola. They were made to quarantine a deadly virus and make the Global North a safe place again. The outbreak revealed the rise of zombies: people standing at the border of biological life and political existence. Black lives were treated as already dead and confined in quarantine camps although they were still very much alive. This was the idea enrolled in my article “Outliving Death: Ebola, Zombies, and the Politics of Saving Lives” (2018). Almost every time I explained some version of this idea in front of a public or academic audience, some people raised their hands to give pretty much the same comment: In a deadly epidemic, you cannot expect human rights to be endorsed. If you are contaminated, you become a casualty, and it is only normal that you are isolated and ultimately left to die. People apparently felt okay to say this out loud. After all, this was the intrigue of most epidemic movies. You have to sacrifice some secondary characters to save the human community.

But then came COVID-19, and European governments, one after the other, threatened the economy and the livelihoods of millions of people to save the most vulnerable of our people: the elderly and the already sick. These measures were strongly supported by the population. In most cases, people obediently locked themselves down at home. In doing so, they delivered a different message from the one I heard during my lectures: Everybody has to live, even the sick, even the elderly and even those who threaten to contaminate the rest of the society. Triage is not a medical routine but a political act that is enacted through the moral economy of the society in which it takes place. As such, all epidemics have their moral narratives. COVID-19 is not about the fear of African people contaminating the Global North. It is about the good people of Europe standing as one to defend the most vulnerable members of their societies. Don’t get me wrong: I do think it is our common responsibility to care for the most vulnerable people, to protect the exposed and to endure this crisis in solidarity. But I want to highlight how, following Ann Stoler (2016), duress “is not a faint scent from the past.” In Europe, we seemed to refuse triage, but as the experience of Ebola teaches us, there are always zombies wandering in the shadowy corners of our postcolonial societies. From Ebola to COVID-19, epidemics tell the same story: how we fail, as a society, to ensure social justice for all.

Quarantine. Wonkifong Ebola Treatment Unit, Guinea, 2015. (Courtesy of author)

COVID-19 is not only about the shortage of public health all around the world—how to protect health-care workers, how to ensure enough beds in intensive care for all. We tried to avoid triage of lives. But this is the trick of triage as a political mechanism: valued lives are always saved. It is the invisible ones that are left behind. Triage is the manifestation of a politics of life that values some lives and not others (Fassin 2018). Triage manifests, for example, as a condition prior to COVID-19. It is about access to medical care and conditions of living. In this sense, cities constitute particular territories of exclusion from care. In the beginning of April, it was reported that Seine-Saint-Denis, the poorest département of France, was experiencing an exceptional excess of mortality due to COVID-19.[1] In many cases, people there relied on the care economy to care for kids, the sick, and the elderly. They had to work while others could enjoy the safety of working from home. With the mandatory closure of outdoor markets, there were also few places to shop for food once COVID-19 was raging. In Bondy Nord, for example, one supermarket was available for 21,000 inhabitants. In Seine-Saint-Denis, there are also three-times fewer doctors than in Paris, with a population of only 500,000 fewer inhabitants.

In the same vein, access to medical care in Guinea was not the refined war on respirators and masks unfolding between rich countries in Europe. It was the well-known lack of access to medical care—an exclusion that was born of colonial times, as colonial medicine was about protecting the colonizer through architecture. The most important infrastructures were centralized in segregated spaces constituted of large streets where air could circulate easily and as such disperse local germs. As a consequence, today Conakry’s main hospitals are still all located at the top of the peninsula, where the capital is situated. Due to both the cost of transportation and the cost of medical care, most of its inhabitants never get access to these infrastructures. As Canguilhem (1966) reminds us, life expectancy is not a translation of the duration of biological life. Some lives are extended with ventilators, clinical trials, and medical technology while others are simply exposed. The fatality rate of the epidemic of COVID-19 is not a direct translation of the deadly properties of the virus. It is not about the number of places of intensive care in every country. It is about who has the luxury to be locked down, who has access to places of medical care, who is recognized as a life that has to be cared for.

Triage operates not only on those who are going to be saved and those who are left to die but between those who can tell their story and are recognized as playing an essential role in the epidemic narrative and those who have to remain silent. Triage is then a form of belonging to the world. It dictates the access to the public sphere of different groups of people. Writing on pro patria mori, Kantorowicz (1951) reminds us that the sacrifice for the homeland always appeals for a counter-gift, the political recognition of the value of the sacrificial individual.

Protecting health-care workers. Wonkifong Ebola Treatment Unit, Guinea, 2015. (Courtesy of author)

In almost every European city between mid-March and April, people started clapping their hands every day at a defined time to thank health workers risking their lives. It seemed then that only doctors and nurses were working while the rest of the population was safely locked down at home. Nevertheless, a lot of people were still working—for example, cashiers. In French, cashier translates into caissière, an almost exclusive female word, as most of the people performing this job are foreign women. These women continued working without masks or gloves, counting people at the entrance of supermarkets, refilling the shelves, and cashing out shoppers. At the same time, magazines covered doctors and nurses working at the front line.

Appearance, according to Hannah Arendt (1998), constitutes reality. Technologies of public appearance are linked to processes of political recognition. They disclose segregation in terms of gender, race, and class. Locked-down cities in Europe became haunting places in the sense described by Avery Gordon (2008). To the enthusiasm of the claps, we have to oppose the violence of the fatality rate among the invisible ones. Catastrophes, like the Ebola outbreak, like Hurricane Katrina, and like the current COVID-19 pandemic, are never good news for those whose lives are already unacknowledged in the moral economy of the society in which they live and die.

Recently, I have been contacted by journalists and asked more or less the same question: How big the magnitude of the catastrophe could we expect in Africa? Not how to avoid it. As I was interviewed by the national Swiss channel, I stated that there was only one respirator for twelve million inhabitants in Guinea. In a region where the majority of people work as daily wage laborers, lockdown measures equal starving for most of them. Moreover, by April, the rate of attendance at local health-care institutions had dramatically dropped.[2] People remembered Ebola. They were afraid to be screened as positive for COVID-19, as the quarantine units had left a terrible memory. A difficult situation seemed to be on the road. Still, after one week, my interview wasn’t yet on air. As the journalist excused himself: with all that was happening in Switzerland and Europe right now, he had a hard time imposing an international case on the news.

Inhabitants of Conakry, inhabitants of Seine-Saint-Denis, low-wage female cashiers all around Europe—all share the same structural fate as a global triage operates around class, race, and gender. COVID-19, as Ebola, did not create this situation, but enlightens it. Following Alia al Saji (2013) and Fratz Fanon (1952), these recent outbreaks epitomized the “lateness” that characterizes racialized, gendered, and other invisible lives—born into a world where there are no possibilities because all of them have been allocated already to more-valuable lives. Today, European countries are slowly reopening. Most governments said that we avoided the catastrophe. But do we all?

REFERENCES CITED
Arendt, Hannah. (1958) 1998. The Human Condition. Chicago: Chicago University Press.

Canguilhem, Georges. 1966. Le normal et le pathologique. Paris: Presses Universitaires de France.

Fassin, Didier. 2018. Life: A Critical User’s Manual. Hoboken: John Wiley & Sons.

Gomez‐Temesio, Veronica. 2018. “Outliving Death: Ebola, Zombies, and the Politics of Saving Lives.” American Anthropologist 120 (4): 738–51.

Gordon, Avery. (1997) 2008. Ghostly Matters: Haunting and the Sociological Imagination. Minneapolis: University of Minnesota Press.

Kantorowicz, Ernst H. 1951. “Pro Patria Mori in Medieval Political Thought.” The American Historical Review 56 (3): 472–92.

Stoler, Ann Laura. 2016. Duress: Imperial Durabilities in Our Times. Durham, NC: Duke University Press.

NOTES
[1] See: https://www.lemonde.fr/planete/article/2020/04/04/coronavirus-la-seine-saint-denis-confrontee-a-une-inquietante-surmortalite_6035555_3244.html.

[2] These rough figures were given to me by my colleague Frédéric Le Marcis, Ecole Normale Supérieure de Lyon and Institut de Recherche pour le Développement, France. He is currently conducting fieldwork in Guinea.

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