Alondra Nelson on Pandemics, Inequality, and the #CoronavirusSyllabus

Joanne Lipman: What’s the purpose of a “Coronavirus Syllabus”?

Alonda Nelson: You might recall there was a “Ferguson Syllabus” (see sidebar), a prior social media endeavor by other scholars a few years ago intended to help the general public understand the broader social and historical context for the wave of U.S. protests about police violence.

Like that time, this is a moment of shock and disorientation. But scholars have this unique vantage: this exact thing hasn’t happened before, but something not dissimilar has happened before. These are some resources to help you contextualize this moment even if it is in some ways unprecedented.

JL: How did you decide to create the syllabus?

AN: One unexpected consequence of “social distancing” is that there’s quite a lot of writing about COVID-19, but it is quick writing about the contemporary moment. A mentor and friend on Twitter said, “People should be teaching the virus.” And I thought well, why don’t we start a syllabus that provides more depth and context? My areas of research are in the sociology of science and technology, and also the sociology of race. So I knew that there was a lot of scholarly literature to help us contextualize this time.

There can be a comfort in taking a step back to remember that we had to deal with quarantines and the social implications of infectious disease in the past. It helps to make sense of the world.

JL: Is it for a general audience, or for an academic audience?

AN: It is intended for a lay audience. We’ve really gone out of our way to make sure there are items on the syllabus that are open access. This is a crowdsourced effort.

JL: How can people find the syllabus?

AN: It’s a living, growing, Google doc. There is also a #coronavirussyllabus hashtag that you can follow on Twitter.

JL: What are your top picks from the syllabus?

AN: Some of the art and culture pieces, which I didn’t expect. There are hip-hop artists creating songs about what coronavirus means in their communities. There’s a fascinating video by police in Kerala, India, doing a dance to pop music to show people how to wash their hands properly. It’s an interesting intersection of public health information and popular culture.

Another favorite is Susan Sontag’s classic book on Illness as Metaphor. This work offers a way for us to think about why it becomes easy to slip into the language of militarization to talk about coronavirus. We’ve turned quickly to the language of a war. Sontag is so insightful about how we use familiar metaphors to make sense of things that feel unprecedented.

Another is a book called Epidemics in Society from the Black Death to the Present, published a few years ago by a former Yale colleague, Frank Snowden. It’s this wonderful magnum opus that brings to bear a forty-year career, by a very learned historian of medicine, who knows the social history of plagues very well.

Also Rebecca Solnit’s book, A Paradise Built in Hell: The Extraordinary Communities that Arise in Disaster, is a stunning work about how common purpose and new social norms may be built in the wake of tragedy and disaster.

And the historian Vanessa Northington Gamble published an article on the experience of African-Americans during the 1918 influenza epidemic in Public Health Reports several years ago. She found that African-Americans were less likely than people of European descent to be reported to be infected with the 1918 flu. Her theory is that there may have been an earlier wave of the flu that impacted African-Americans disproportionately, so these communities had already been ravaged by the disease months prior and this earlier wave was underreported.

JL: As you think about the syllabus, what are some of the major themes we should be addressing now?

AN: The big issue for me is racial health disparities. COVID-19 is a symptom of the institutional discrimination in health and medicine, and in the workforce. These health disparities are the outcome of marginalized communities not having access to medical care and health insurance. The truism is that pandemics and disasters always exacerbate disparities.

We have tried piecemeal ways to address all of these things, like cultural competency training or implicit bias testing. But fundamentally we need to think about a reimagination of the public health system that goes from the medical education piece to the diagnostic piece to the research piece. A wholesale reimagining of healthcare as one of our most important social systems.

JL: Do you expect other enduring structural changes as a result of the pandemic?

AN: Yes, there will be enduring social changes. The question is what they will be and how we want to shape them. The markets are in tumult, some theories say that we will be living with this for one fiscal quarter, others for three fiscal quarters. We don’t know. Millions of people, and potentially tens of millions of people in the US, will no longer be employed.

Many of these workers are coming out of the gig economy, which gives flexibility to consumers, but without any social safety net for workers. We don’t have the basic structure for any kind of social welfare for them. There is a question of their eligibility for even the most threadbare resources of the 2020 CARES Act. I think our perspective on the benefits and risks of the gig economy will be forever changed. My hope would be that we introduce a baseline of new benefits for these and all workers.

There’s been an ongoing struggle in the US to get to a $15-an-hour minimum wage. One can imagine that there will now be a lot more support for that. Many people simply aren’t making enough money and they’re a week, a month, maybe two months away from being homeless, from being impoverished. So I would hope that some socially beneficial policies would emerge out of this moment.

JL: Will we see structural changes in healthcare?

AN: I’ve been thinking quite a lot about this. You know, how do we imagine anew as we rebuild? There can be wonderful opportunities. How do we think about rebuilding in such a way that the deprivation we are seeing in this country will not happen again?

How do we put policies in place that say, don’t come to work if you’re ill, and we would rather pay you $15 an hour not to endanger yourself and others? We need mandatory sick pay and medical leave for all workers.

There was a national protest last week by fast food workers who are not being given gloves and masks at the workplace. The fact that we have people in our communities who don’t have access to the resources they need to work safely is unethical. It’s inhumane. We have an opportunity to build something better.

JL: You also have talked about the problem of allocating scarce medical resources.

AN: I wrote a grant proposal recently with a colleague at UC Santa Cruz on “the sociology of bioethics.” As part of this work, we’re now hoping to address the ethical issues—the decisions that individual health professionals are being asked to make—about access to ventilators and other scarce resources. These issues are being talked about in the public sphere in a quite philosophical and detached sense. And this is my frustration with bioethics, this detachment when these are really issues about policy decisions, about power, about government incompetence, about a lack of federal coordination.

It comes down to one person’s decision about what life is worth living. But wouldn’t it be so much better if a country this wealthy and this well-resourced had been able to provide people everything that they could possibly need to foster health, to make those life-and-death decisions as rare as possible?

JL: Some people call the coronavirus a “great leveler.” Would you agree?

AN: Definitely not. The coronavirus has proven itself to be quite formidable, but I’m not sure that it’s formidable enough to undo decades and generations of inequality.

For those who are proud of this idea of American exceptionalism—this idea that we are this shining beacon on the hill—that’s really been disproven by this moment. But I think this moment is also a challenge for people who hold that ideal to be willing to do what it takes to make it true. To make that true would mean that you don’t have a pandemic in which people are unprotected and left to go it alone.

This moment is shining a light on inequality. But it’s also, more hopefully, shining a light on how important it is that we rely on one another. The symbolism of the face masks that we’re now required to wear is this: it protects others from you. When everyone is working in the best interest of other people, that’s how you “flatten the curve.” This is an instrumental public health insight, but it is also a profound insight about how we need to learn to live together in the world.