Coronavirus: “Man bites dog” or “Dog bites man”? (Hidden Figures I)

Journalists have often emphasized to me the difference between news and not-news by comparing, “Man bites dog” which is news, to “Dog bites man” which is not.  So the growing number of headlines about disproportionate death from Covid-19 among African Americans strikes me as not-news.  This is perhaps because I started to do AIDS research in 1986 looking at the question, “Why was there excess risk for AIDS among Blacks and Hispanics in the United States?”  After some years of work, I could confidently say that the answer lay in the dismantling of the communities of color, a process that was vicious then and has not stopped since.  While gentrification has been temporarily driven out of the headlines, it is the latest form that this disruption has taken. 

In fact, even if you don’t know about serial forced displacement and deindustrialization – the prime movers of excess risk for anything – it’s obvious from the simple observations of who can get out of the way of infection and who can’t, who can pay the rent for some months without work, and who can’t, who can get prompt access to excellent medical care and who can’t.  Those are the people who are at greatest risk, and Blacks, Hispanics and immigrants are over-represented among them.  That they are likely to die in outrageous numbers is a foregone conclusion.  We can parse the disparities among those at highest risk, if we need to.  Many immigrants, for example, are younger and in excellent health, even if terribly poor.  They are in better shape to survive than the African American population, which includes older people and people with a high rate of chronic illness from “weathering,” as Arline Geronimus styles it.  While some are saying that the issue is a desperate lack of data, I am reminded of my colleague Dr. Jennifer Stevens Dickson, who, at the end of her dissertation on the failure of AIDS care to reach poor women of color, declared, “No further research is needed.”

That was stunning.  That was news. 

Dickson broke with tradition, which always says more research is needed.  She concluded that the patterns were too entrenched to need more study.  What we needed was sound policy to address the underlying structural causes.  That our society did not do that – in fact, the trends of serial forced displacement and concentration of wealth have made things worse – brings us to this moment and the “discovery” that Black people are at excess risk for death from coronavirus.  As a scholar who has been writing about this for decades, I can only shake my head.

Paul Krugman has said of this moment that we have put our economy into a medically-induced coma, and what we need is disaster relief, particularly for those most at risk. This is hampered by neoliberal policies that have dismantled much of the safety net and left us all inadequately sheltered from this storm.  Still we must try to fill the gaps, such as opening access to health care for all, supporting weak health systems, getting money in the hands of all the poor – not just some – and protecting the vulnerable from eviction.  The call in Britain to support the National Health System brought out hundreds of thousands of volunteers.  We could do the same.  Many are willing to deliver food to the housebound, raise money so the poor can eat, and carry out other tasks that make it possible for those at most risk to get the help they need. 

We could do this.  The question is not, “What is the data?” The question is, “Will we act?”

Coronavirus: Managed Retreat

Some years ago, after Hurricane Sandy, I was a consultant to Rebuild by Design, a project to get architects, engineers and designers to think how to build back in the best manner.  One of the other consultants, Dr, Klaus Hans Jacob, talked about the need for "managed retreat" from the shore in the face of rising sea levels.  As I was a consultant on the psychiatry of displacement, I argued that such shifts were very difficult, and likely to fall unequally on the poor.  In my post today I want to talk about managed retreat and tomorrow I'll turn to inequality.

In situation analysis, which is a method for assessing the current state of affairs, it is essential to "name the moment."  In the face of a highly infectious and fatal virus for which there is no vaccine and no cure, public health leaders have clearly stated that we must retreat, shelter in place, until the rate of infection tapers off.  We are now in the process of "managed retreat."  The key here, as Dr. Jacobs explained to the Rebuild by Design teams, is that it must be managed, and need not be feared.

To manage a retreat of this magnitude, several processes are essential.

First, we must ensure that all people have the fundamental requirements for supporting human life, for those familiar with Maslow's hierarchy this are the foundation for life.

Health care must be in place for the 20% of those infected who will have serious illness.  As the potential numbers will overwhelm the US health care system, it is essential that excess temporary capacity be created. Tents and temporary hospitals will be key to managing this part of the retreat. 

It is also essential that everyone with a mild illness weather it out at home with as good a plan as possible.  I was lucky, when I was ill with an undefined illness that did not include cough or fever, that my brother, Josh Thompson, gave me sound advice on vitamin supplements (Vitamin C every couple of hours, Vitamin D 4000 IU, zinc tabs often for a few days than once a day, and Zarbee's elberberry cough medicine).  These and other symptomatic aids can help -- it has been advised to keep your cell phone handy in case it gets worse.  Lots and lots of fluids, recommended every doctor I consulted. 

Food has to be provided.  Delivery should be expanded.  Free food must be made easily accessible for people who need it.  And supermarkets have to be stocked to the best of our ability. 

Money has to continue to flow. Over the second half of the 20th century, Big Business did its best to destroy the wages, protections and benefits of workers, leaving half the work force at the mercy of gig employment, scraping along with no cushion.  That half of the workforce is likely to be un- or underemployed in the next period of time.  This is a grave part of the retreat that we must manage.  Extending unemployment benefits to all would be a sound first step.  Suspending utility cut-offfs (and reconnecting those who've been disconnected) and evictions are also essential protections. 

Housing is essential.  Governor Gavin Newsome of California was reportedly buying hotels to house the homeless -- there are 30,000 or so in the state.

Second, there is one other element of managed retreat that I think is also foundational, confidence, or morale, as social psychiatrists like me like to say.

Confidence is essential: we must have faith in ourselves.  We are retreating so that we can come back and fight another day.  My father, Ernest Thompson, was forced to retreat from his civil rights organizing during the McCarthy Era in the 1950s.  He and his colleagues vowed to "retreat to the ghetto and come back strong,"  They did -- building powerful political movements around the US.  We must support the morale of the population.  Demoralization can kill as surely as a virus can.  

Naming the moment "managed retreat" is to distinguish it sharply from "recession" or "depression."  This is a temporary situation.  Epidemics rise and fall -- we have to wait out the worst of the storm.  Our economy is large, Paul Krugman says, and vital (I highly recommend his NYT column and newsletter).  The economy will bounce back when we can return to the streets.  For one thing, having sat in our houses for days, if you're anything like me, we will all have a list of things to be improved or fixed.  I'm off to Valley Hardware first thing.