I began interviewing authors of fabulous new anthropology books for this space back in 2016. While completing 11 interviews, I also amassed a backlog of more terrific books whose authors I planned to interview. One thing led to another, and my embarrassingly accumulating backlog fell hostage to a pandemic. I’ve finally harnessed my guilt and bundled these beauties into a group. No author interviews this time (who has time for that in a pandemic?), but below, you’ll find capsule descriptions of why I love every entry in this archive.
To be sure, my selection is idiosyncratic. I don’t claim that these books are the only works in anthropology worth reading that were published in the past few years. Yet, individually, each of these books grabbed my attention because of its brilliant analysis of some topic(s) I judge to have critical importance to the world. Plus, the writing in all these books is oh-so-readable. Collectively, they remind us: Anthropology is not only alive and well, the discipline continues to offers unique insights into vexing issues in ways that only long-term immersion can produce.
Acknowledgments: In curating this collection, I’m inspired by Philip Graham‘s “Some Books You May Have Missed” posts for the literary/arts magazine, Ninth Letter, for which he serves as Editor-at-Large. (You can read his latest literary rundown of great new fiction and creative non-fiction here.)
So, here goes.
C. Richard King, Redskins: Insult and Brand (University of Nebraska Press)
In the aftermath of George Floyd’s murder, one of the many critical lessons that at least some of white America has learned is this: Representation matters. In that sense, Richard King‘s brilliant book provided an overdue argument that at least one sports team has finally heard. In 2020, the Washington Redskins at last acknowledged the racist foundation to their team’s name, which they changed (temporarily) to the Washington Football Team (with a new name soon to be announced here). The placeholder name may be boring— but boring is better than offensive. For its part, King’s scholarly exercise in a theoretically and historically informed argument can now be considered a paragon of engaged, critical anthropology. A review in the Chicago Tribune called this a “must-read book.”
Amy Starecheski, Ours to Lose: When Squatters Became Homeowners in New York City(University of Chicago Press)
Over the past two pandemic years, real estate stories have dominated the news, from personal tragedies (eviction stories following job loss) to personal triumphs (the privileged few scooping up “deals” outside major metropolitan areas). Lurking behind those individual tales chronicling the human joys and costs of gentrification lies a broader story of economic trends (falling prices in some markets, skyrocketing prices in others). In that sense, this book by anthropologist/oral historian Amy Starecheski remains more timely than ever. A beautifully crafted narrative balances individual tales of urban squatters’ experiences across three decades of New York City’s increasingly unaffordable housing market with “big-picture” trends of macroeconomic, political, and legal developments in New York and beyond. This book contains so many lessons about where and how to make a livable space for “home.” A “recommended” book by Choice.
Rosa De Jorio, Cultural Heritage in Mali in the Neoliberal Era (University of Illinois Press)
Rosa De Jorio‘s early research in West Africa concerned women’s political participation in Mali. In this book, De Jorio focuses on the same country but has switched gears to focus on cultural heritage. Political scientists rarely pay attention to artistic and cultural performances, while art historians rarely focus on political structures. In a broad sense, this book might be characterized as an engagement of political perspectives with humanistic spaces. As such, I take this work—based on careful field research in urban Mali over the course of 16 years—as a model for how scholars working elsewhere might unpack the questions De Jorio asks here surrounding the politics of culture and the culture of politics. Jean-Loup Amselle calls this book “in the tradition of Michel Foucault’s work.” The title appeared in the Interpretations of Culture in the New Millenium series (now closed), edited by Norman E. Whitten, Jr.
Jane C. Desmond, Human-Animal Relations in Art, Science, and Everyday Life (University of Chicago Press)
Some years ago, I made a case for an anthropology of infancy. In this book, Jane Desmond makes something of a similar case for an anthropology of animals. In both arenas, subjects communicate with us in ways that we adults/humans understand only partially, and with difficulty—as if through a scrim. Of course, the same can be said for all communication among human adults . . . but the barriers appear more extreme and daunting with both human infants and non-human animals. In a provocative set of thematically linked essays (think: pet cemeteries, taxidermy, roadkill), Desmond makes a persuasive case for developing a robust ethnography of non-human animals and, perhaps more broadly for an inter-species ethnography. An NPR review called it “an important and moving book.” The title appears in the terrific new Animal Lives series at Chicago edited by Desmond.
Jennifer Cole and Christian Groes (eds.), Affective Circuits: African Migrations to Europe and the Pursuit of Social Regeneration (University of Chicago Press)
If the predominant narrative of Covid-19 emphasized immobility, that memo didn’t reach African migrants. Over the past two years, refugees fleeing Africa’s multiple postcolonial catastrophes have continued to seek more hospitable living spaces. This rich collection co-edited by Jennifer Cole and Christian Groes thus speaks to continuing hemispheric challenges, even as it centers personal experience. Moving discussions humanize the dehumanizing images, statistics, and political directives that dominate so much discussion of African migrants in Europe. Eleven case studies range from intimate topics such as child fostering, bi-national marriages, and coming-of-age rituals to explorations of the ways that government actors, laws, and policies shape migrants’ lives. As such, this volume serves as a welcome, “bottom-up” corrective to the “top-down” trope of “migrant crisis” that too often frames both government policies and journalists’ stories coming out of the EU. The book won the Most Notable Recent Collection Award from the Council on Anthropology and Reproduction.
Andrew Bank, Pioneers of the Field: South Africa’s Women Anthropologists (CambridgeUniversity Press)
The notion of a “scholarly canon” is a bit of an oxymoron. Do what passed as the great works in any given field in the past still deserve pride of place today? By contrast, in re-reading “the classics” year after year, what hidden treasures might we have overlooked because of unconscious biases surrounding what “counts” as quality scholarship . . . and who “counts” as serious scholars? The brilliant scholars who have become so demonized by the U.S. right of late in promoting critical race theory prompt us to recognize the importance of regularly revisiting “the canon,” to rethink our understanding of history with new eyes and new questions. In Pioneers of the Field, historian of science Andrew Bank has done our discipline a great favor by reminding us of six brilliant women scholars of the early/mid-20th century whose work had a major impact both within and beyond South Africa. If you’re an Africanist up on your early British social anthropology, you might at least have heard of Audrey Richards, Monica Wilson, and Hilda Kuper, but if Winifred Hoernlé, Ellen Hellman, and Eileen Krige weren’t even on your radar, they will be now. Elizabeth Colson called this volume a “major contribution to intellectual history.” No History of Anthropology course should neglect this correct-the-record book.
Ana Mariella Bacigalupo, Thunder Shaman: Making History with Mapuche Spirits in Chile and Patagonia (University of Texas Press)
There’s a good reason this marvelous book received Honorable Mention for the 2017 PROSE Award for Anthropology offered by the Association of American Publishers. Ana Mariella Bacigalupo challenges stereotypical images of shamans as either extinct or anachronistic religious practitioners long left behind by history. Based on extraordinary research that Bacigalupo conducted from 1991 to 2015, the book serves, at once, as a biography of a single Mapuche shaman who accepted the author into her life in a deep, cross-cultural friendship; and an argument for a reëxamination of how we define what counts as “religion” in the modern world.
Naomi Leite, Unorthodox Kin: Portuguese Marranos and the Global Search for Belonging (University of California Press)
When I lived in Lisbon in 2006-07, I found myself shocked and appalled at the extent to which the nation’s long, rich, and traumatic Jewish history had been rendered virtually invisible. In this riveting book, anthropologist Naomi Leite profiles a small group of Portuguese who are actively reclaiming their ancestral Jewish ancestry hidden from them, and from the nation, for centuries. With its beautiful narrative writing allied with a thoughtful analytic engagement linking hyper-local spaces in Lisbon with hyper-global spaces of international Jewish tourists, it’s easy to see why the book won two awards and was a finalist/honorable mention for two more:
Timothy R. Landry, Vodún: Secrecy and the Search for Divine Power (University of Pennsylvania Press)
This intriguing work offers another fascinating look at international religious tourism. In this case, Western tourists travel from the U.S. and Europe to Bénin, homeland of the famed religion of Vodún (a.k.a. “voodoo”), in search of a West African spirituality. Becoming apprenticed to a Vodún priest, Timothy Landryoffers, at once, an outsider’s and insider’s look at Vodún practice from the intertwined perspectives of practitioner, acolyte, seeker, and casual tourist. Along the way, he engages with issues ranging from the challenges inherent in representation of a stigmatized religious tradition to the ethical quandaries inevitably brought on by participant-observation. The book won the Clifford Geertz Prize in the Anthropology of Religion from the Society for the Anthropology of Religion. It appears in the Contemporary Ethnography series that I edit for Penn Press.
Michelle Johnson, Remaking Islam in African Portugal: Lisbon—Mecca—Bissau (Indiana University Press)
Grounded in rich fieldwork in both Guinea-Bissau and Portugal conducted across 20 years, this book is an ethnographer’s dream. Oozing with gorgeous ethnographic details, the book at the same time tackles all the issues one could hope to think about concerning West African Muslims’ lives in Europe. Challenges of racism. Challenges of Islamophobia. Challenges by mainstream Muslims of heterodox practices. All these big-picture issues frame the stories Michelle Johnson exquisitely tells. Those stories center stunning discussions of life-cycle and other rituals—including a never-before-described practice of “writing on the hand” to initiate young students into learning the Qu’ran. Along the way, Johnson explores how immigrant African women and men rethink and adapt rural practices of female genital cutting, pilgrimages to Mecca, and funerals to urban neighborhoods in a European capital. Paul Stoller predicts: “Given the depth of its analytical insights and the grace of its presentation, this is a work that will be read, savored, and debated for many years to come.” This fabulous book appears in Indiana’s Framing the Global series.
Cati Coe, Changes in Care: Aging, Migration, and Social Class in West Africa (Rutgers University Press)
Hot off the press, this new ethnography, like Johnson’s, sings with all that contemporary anthropology can offer. Over the course of 20+ years, Cati Coe has lived and conducted research for long periods both in Ghana, and in the U.S. with Ghanaian migrants. The result is just the sort of rich ethnography that centers global flows, while also remaining deeply grounded in knowledge of intimate practices of the local. A short film accompanies the book, available online here. The book appears in Rutgers’ wonderful Global Perspectives on Aging series, edited by Sarah Lamb.
Recently, I checked in with Dr. Bjørn Westgard, to see how he was doing.
Back in the ‘90s, Bjørn was enrolled in a wildly demanding, combined M.D./Ph.D. program at the University of Illinois, where I had the pleasure of serving as his academic advisor. After completing his medical school coursework, Bjørn conducted doctoral research in cultural anthropology in a small town in northern Senegal, studying the complexities of intersecting local and global medical systems as they sometimes complemented one another and sometimes competed. He intentionally combined “bottom-up” and “top-down” perspectives, interviewing everyone from village-based farmers and healers to biomedically trained nurses and doctors. (From that research, Bjorn is fluent in French and Wolof, the most widely spoken language in Senegal; he also speaks Serer and Mandinka, two linguistically unrelated languages spoken in the region of his research.)
When it came time to choosing a medical specialty in which to pursue his residency, Bjørn surprised me: he decided against his early interest in pediatrics or family medicine and opted instead for emergency medicine.
Initially, I was disappointed: I thought that working in ER rooms would waste Bjørn’s formidable scholarly skills. How could he get to know transient patients and put his extensive training in biomedical cultural sensitivity to work? Of course, Bjørn had already thought through that concern. “There are more return patients than you’d think,” he explained. Bjørn understood what few others in the U.S. yet knew: that many, many uninsured Americans used emergency rooms for routine medical services. That included the poor and the undocumented—for all of whom, Bjørn (with his ample wading into the deep waters of culturally sensitive issues) would have special insights.
Bjørn had an additional reason for selecting emergency medicine that made equally compelling sense. “There’s so much wrong with the American medical system, and a lot of it is encapsulated in ERs,” I remember him explaining. “As an anthropologist, I can start addressing the systemic problems if I have a position working in the belly of the beast.” At the time, no one was talking about this problem in such clear ways–at least, not in public conversations about healthcare policy. I remember being instantly both impressed and persuaded: Bjørn was making the right decision.
Besides, if I thought about everyone I had ever known, Bjørn would have been my first pick for an ER doctor. He has the sort of calm temperament and clear, logical mind that would make him the obvious choice for captaining any sinking ship.
Fast-forward fifteen years, and Bjørn now finds himself working as Research Director and Senior Staff Physician at Regions Hospital, aLevel 1 Trauma Center in Minneapolis thatsees over 90,000 Emergency Center visits every year. A Fellow of the American College of Emergency Physicians, Bjørn holds secondary medical appointments in emergency departments of four other hospitals in Minnesota and Wisconsin.
Clearly, Bjørn has harnessed the wisdom he gained from studying pluralistic health practices in a small town in Senegal to the technical skills he gained in studying medicine. With his incredible combination of scientific and humanistic talents, I was unsurprised to learn that Bjørn is now leading a medical team that is fashioning policy responses to COVID-19 for the state of Minneapolis.
On his home page, Bjørn describes his approach to medicine this way:
My teaching and research have focused on Emergency Department use for preventable conditions among priority populations, “food deserts” and diet-related Emergency Department visits, longitudinal changes in Emergency Department use among the homeless, supportive housing, and reducing health disparities in emergency care.
Who could be more qualified than an ER physician-anthropologist such as Bjørn Westgard to understand the COVID-19 crisis in both scientific and human terms?
(You can read a brief bio of Bjørn Westgardhere and his LinkedIn pagehere.)
Recently I had a conversation with Dr. Bjorn Westgard about this long COVID-19 moment—about what he has learned, and what he can teach the rest of us.
BW = Bjorn Westgard
AG = Alma Gottlieb
AG: An ER doctor in New York, Dr. Cameron Kyle-Sidell, recently claimed that ER doctors around the world may have drastically misjudged the nature of the COVID-19 beast when it enters the lungs, and may have unintentionally harmed patients by keeping them attached to respirators administering too much pressure on fragile lungs. His claims are quite striking and disturbing! If this ER doctor is right, it’s tragic to think of what damage might have already been done by mis-calibrating those respirators. What do you think of his claims, medically? And, why do you suppose he posted this video on YouTube for general consumption?
BW: This has gotten a lot of play. Unfortunately, his understanding of high-altitude pulmonary edema is a little off, and no one has put anything together about his critique that is systematic or peer-reviewed. However, multiple physicians from China, Italy, and New York in particular (on some emergency medicine podcasts and the like) have raised the possibility that treating COVID using ventilator parameters for ARDS [acute respiratory distress syndrome] may be incorrect, at least initially.
The ventilator management of these patients doesn’t sound incompatible with early ARDS, but it is still very controversial. I just got into a heated argument with an intensivist earlier today for even bringing up the above. There is fear among all sorts of health professionals right now, especially among those who tend to “know what they know” with the most certainty. So the idea of managing critical pathophysiology that might be different from what is expected–requiring a veritable,Kuhnian paradigm shift–can be very anxiety- and anger-provoking.
To add further fuel to that fire, there has also been discussion of a possible hemoglobin issue (oxygen carrier in the blood), but there has been nothing other than a pre-press 3D computer modeling paper out of China in the rapid-fire literature to support that idea. However, a group from NYU did use machine learning to predict severe disease, with results that could support the idea of ahemoglobinopathy. I even have colleagues in my other Board specialty, hyperbaric medicine, who are working on a trial to use hyperbaric oxygen to get around the possible hemoglobin issue. I think there’s probably more to the receptor for COVID, which is present in all of the body’s vasculature, which could potentially trigger inflammation and coagulation that way, and that inflammation and small clots, which we’re finding everywhere in coronavirus patients, could be causing diffuse injury.
It’s fascinating to watch the accretions of science and knowledge in the age of the Internet and social media. Already, cranks are hawking conspiracy theories and supplements in response to the “censored” knowledge above.
As an emergency physician and an anthropologist, I’m a bricoleur of the contingent and the emergent, by trade. I’ll consider new ideas if they make pathophysiologic sense, and I have no doubt that someone will examine these ideas further and more systematically, so I’ll keep watching for more evidence. For now, I’ll care for the patient in front of me and adjust their vent settings as needed.
AG: That sounds like a good strategy both for an ethnographer and a doctor. But then, I always thought that all doctors ought to have training in anthropology.
BW: I hope I didn’t give you the impression in my last email that I was resistant to the ideas presented, just that I’m looking for more information, whether from personal, clinical experience or other data. I’m just not generally inclined to change my clinical practice in response to social media. I’m in the middle of our Thursday morning residency conference right now, and we’re discussing initial and ICU ventilator settings, given developing information, and it’s fascinating to hear an intensivist colleague suggest that “we’re all in the same boat here, the attendings [fully credentialed, attending physicians], the fellows, the residents, and the med student . . . we’re all learning together as we go.”
AG: Speaking of combining social and technical approaches, we’ve been reading about efforts to systematically calculate social contacts for COVID-19 patients, to help track the socio-geographic spread of the disease. What do you think of those?
BW: Very cool. I’m trying to get our state to do something similar using an app I’ve worked with a team to develop. I’m arguing with our Department of Health, who have difficulty appreciating how technology might help. But they’re also feeling less pressure to consider novel options, since our state is doing relatively well.
AG: Here’s something else I thought you might have a lot to say about . . . the whole “herd immunity” question strikes me as so interesting for anthropologists. I’ve been reading a lot about this recently. This piece in the Boston Globe really caught my attention.
First, there are the epidemiological questions. How accurate is the concept of “herd immunity” to begin with? As a doctor and scientist, I assume you’ll have much to say about that.
Second, there are the sociological implications. How can your perspective as an anthropologist speak to the epidemiological factors? If the US (and/or other nations) adopts a “herd immunity” approach at some point (before a vaccine is widely available), what sorts of people will be allowed—or even encouraged–to be exposed to the virus? What sorts of people should be allowed, or even encouraged, to be exposed to the virus? Are those two groups of people the same? Or, will socioeconomic disparities intervene, and might large numbers of the wrong people (the most vulnerable) end up being exposed to the virus? I’m thinking about this because, over the past two weeks, many mainstream journalists in the U.S. have begun noting racial disparities in COVID-19 mortality. Of course, that’s no surprise to anthropologists (and some other social scientists), though it seems to be surprising plenty of politicians. Thinking about these social factors, are there new risks to perpetuating racial disparities with a “herd immunity” strategy?
Third, there are the symbolic/conceptual/philosophical implications. As a scholar steeped in sensitivity to discursive implications, what are the ramifications of using a metaphor of (non-human) animal behavior for human behavior, in evoking “herd” immunity?
The maddening “organism at the edge of life” (as virologist E. P. Rybicki describes viruses) that is far too dangerous to appear this beautiful
BW: I haven’t had time until after my shift this evening to get to your questions, but I like them. It prompts me to reflect and consider with a wider lens.
I’m not an expert in infectious disease or epidemiology, but my understanding is that “herd immunity” is primarily a statistically useful concept that expresses the aggregate balance between immune systems and infectious vectors such that there’s enough immunity to prevent ongoing transmission. But when you get into the immune system, things become very complex very quickly. Talking about vaccines and immune medications (like those being discussed as treatments forcytokine storm, for example), the questions pertain not just to the dose of a drug in the volume of an aqueous human, but also to what the most productive triggers are for the bodily machinery churning out the immunity widgets of antibodies. The questions become: What is needed to trigger the production of immunity? How effective is the immunity that is produced? Does it wane, and if so, when?
And all that is without discussing the social patterns of intermixing that we all experience, and which have become the main means by which we are currently intervening upon the spread of this pandemic. I think that’s where the concept of “herd” becomes interesting. Anthropologists and many others are comfortable with the idea of the population as a biopolitical concept generated by a certain kind of governmentality. But how do we, the multitude, deploy that in an effective, self-governing manner?
It seems to me that the concept of the “herd” could allow us to conceive of our collective biology, our animality, in a way that is positive and potentially collectively empowering, rather than biostatistically disempowering. That said, it seems clear that a “herd immunity” strategy that treats the lot of us like chattel (the flip side of the “herd”), positing that we should all “put on our big boy and big girls pants” and accept that a lot of people must die, will undoubtedly do more harm. We’re seeing this in those areas of the country where few or late actions have been taken to mitigate the spread of coronavirus.
It’s my hope that we’ll use available information from around the world to develop better methods that capitalize upon our current collective engagement. It seems like “flatten the curve” has brought the collective back to the biostatistical. Hopefully, well-thought-out approaches to “reopening” and easing social/policy measures could do the same. But the evidence for these measures is thin, and we are all learning about one of my favorite areas or research, complex population models of disease. This is another area where science is being built daily, as the pandemic provides some of the first empirical test cases for these tools.
But it is disheartening that in areas both with and without aggressive measures, we see the impact of racial and socioeconomic disparities. Those disparities are at play in health inequities and inequitable care in the best of times. Now, resources are strained, so it would be almost unthinkable that those factors would not be significantly at play in the pandemic. In areas with less, or late, social and political measures to isolate people, the historic clustering of populations through systemic segregation, with associated increases in population density and decreases in access to resources, lead tosyndemic conditions. In areas with more social and political measures to isolate people, many who work low-end jobs become unemployed, with all the accompanying fears and hardships, while those who keep their low-end jobs–clerks, janitors, service workers, etc.–are left out in public in positions that put them in contact with large numbers of potentially infectious people. So, between the two groups, disparities in rates of infection and adverse outcomes should come as no surprise.
I’ll get back to you with more, as this is the next bit of thinking required. In Minneapolis, the group I’ve assembled between HealthPartners and the University of Minnesota are going to consider how to model this process to provide guidance for the long term of the pandemic.
AG: Yes, racial disparities are emerging with disturbing alacrity and intensity in the US. But, as you say, that’s hardly a surprise, for all the reasons concerning systematic, structural disempowerment that have characterized US society since Europeans set foot on these shores. Those sorts of disparities have begun to be part of a growing national conversation since the Civil Rights movement of the ’60s, and they took on new force more recently with the Black Lives Matter movement. One of the components of the current horrible moment that I’m actually finding most heartening is the extent to which social conditions ARE finding their way to being front and center of many conversations. It strikes me that this moment of national (and global) crisis offers America new opportunities to expand that conversation and really take its lessons seriously in a new way for the first time in US history. And, medical researchers and doctors will be at the forefront of that conversation. Someone like you, with your dual training, is especially well positioned to think systematically about just how to operationalize those lessons in ways that work with public health protocols. That’s why I’m excited about our continuing conversation!
BW: I think it’s very clear that this virus is hitting communities in both indiscriminate ways (with some reportedly healthy individuals going on ventilators or even ECMO life-support machines) and in VERY discriminating ways, hitting poorer communities and those of color. What I haven’t heard exactly is any discussion about ways to focus resources on those communities that are hardest hit, which is disappointing but not unexpected, given the current national leadership.
I actually think race and structural inequalities and violence have very much come to the fore within medical practice. It’s just that our sphere of influence is limited. For example, in Minnesota, our healthcare system has an Equitable Care Committee that has done a lot of great work, although it has vacillated between focusing on equitable care and health equity, depending upon what we think we can actually achieve. Residents and med students, particularly the med students, are very aware of disempowerment, and it’s one of the things I teach about when I’m on shift [teaching residents]. In fact, next week, I’ll be drawing directly from anthropology in giving a talk as part of a panel at our Society for Academic Emergency Medicine national meetings (now online!) about teaching residents to be “structurally competent”—meaning, thinking about larger, structural issues that shape the experiences they see in particular patients.
What’s most difficult is to figure out how to get beyond the clinical domain and affect pathologies upstream, closer to their source. It helps one understand why Paul Farmer long ago advocated for large-scale wealth transfers between north and south, and why we need to do the same in the U.S. That’s actually some of what was achieved by the Affordable Care Act but then was largely undone or undercut by recent tax cuts for the wealthy. So it’s good that these issues are front and center, but I think they could be even more so. And it’s good that we’re thinking communally, as I said before, but the idea that we might differentially focus collective resources upon communities that are hardest hit seems to meet resistance with predictable frequency.
AG: In Rhode Island, where I now live, there’s actually a vigorous initiative (Beat COVID-19) with just that emphasis. Beyond the capital, the two cities hardest hit in Rhode Island are Central Falls and Pawtucket, both of which have large, immigrant communities of color (mostly from Latin America and Cape Verde). The current rate of infection in both those cities currently surpassess that of New York City. Nationally, these two small cities are invisible in news reports, but locally, a multidisciplinary coalition has formed that is forging creative approaches to reach these communities. The coalition includes a normally unlikely set of folks, including a local doctor, representatives from the state’s Department of Health and the two cities’ police departments, marketing specialists, local community organizers and advocates, translators, and even yours truly, as an academic critic. I’ve been heartened to see a far more open-minded approach to reaching these communities than I would have imagined. For example, since many residents of these neighborhoods feel more comfortable speaking either Spanish, Portuguese, or Care Verdean Kriolu, a new COVID-19 hotline in these three languages now welcomes callers, and there are now public service announcements in those three languages that are being promoted online in all sorts of social media spaces where people from these communities are likely to read them. I’m so impressed by what I’m seeing that I’m starting to consider this local initiative a model for communities elsewhere.
Once COVID-19 starts hitting the white heartland–as now seems inevitable–because of resistance both by Republican governors and local residents to maintain social isolation procedures, and insistence to “re-open” the economy prematurely and indiscriminately–it will be interesting to see how those communities respond to the crisis suddenly invading their families. As a physician, I imagine you must feel quite frustrated by those conditions.
BW: Just look at the largely white nationalist forces that have hijacked what began as small-business protests about state efforts to enact social-distancing policies, in an effort to minimize the impact of the COVID surge.
Those folks are having trouble getting on board with just the baseline collective actions needed for public health. Currently, so many folks in the rural parts of the country see this crisis as an urban thing. But if we look back at the influenza pandemic of (supposedly) 1918-19–which actually lasted three years (my grandfather nearly died of it in 1921)–the initial wave hit densely populated areas, but the next waves were largely rural. And today, if you look at rural areas, they’re as disproportionately disadvantaged as are many of the low-income, urban communities from which we’ve divested as a society. In fact, rural America overall is actually less insured, has less access to services, and is more dependent upon government transfers of resources than is most of urban America. So, I’d really like us to be able to see both of those kinds of communities with one gaze.
AG: That makes a lot of sense both politically and intellectually. It will be interesting to see if white conservatives come around to that position, once they are affected.
Since you’re enjoying thinking about epistemological issues raised by COVID, I wonder what you might think of an e-mail I recently received.
A prominent medical school has decided to confer MD degrees a little early, for med students who had completed all their training and were scheduled to receive their degrees within a few months. (The e-mail subject line read: “Emergency Powers Exercised: Approved Early Degree Conferral of 4th Year Medical School Students.”)
That will allow these brand-new medical residents to start practicing in COVID-19 hotspots and help alleviate the hospital crisis in those areas. Seems like a great idea–this is a good time to challenge bureaucracy, right?
But I also saw an online petition on a related question that made me more nervous–to grant “registered nurse” (RN) licenses to “licensed practical nurses” (LPNs), who have quite a bit less training than registered nurses do. That struck me as way riskier. But perhaps I’m being too conservative. Maybe LPNs are actually being asked to do the work of RNs in this crisis, and so they should be credentialed and salaried accordingly. What do you think?
BW: I definitely agree with deploying fourth-year medical students early. It strikes me as a safe move at this time in their training.
However, in areas that are not already seeing surge conditions, I think the country would be best served by deploying medical students to docase-contact tracing.
And I agree with you that granting RN licenses to LPNs is riskier. Credentials are indicators of different kinds of training, and their significance should be maintained, though that’s the professional in me coming out and maintaining boundaries.
As with many things at the moment, one could simply and temporarily alter practice parameters for surge or crisis standards of care.
AG: I recently read another, especially thoughtful piece in the New York Times, about when to “re-open America”—with the intentionally provocative title, “Restarting America Means People Will Die. So When Do We Do It?” A staff writer for The New York Times Magazine moderated a panel discussion with five people with varying backgrounds (a minister, an economist, a global health specialist, a civil rights specialist, and a bioethicist). They raised sociological issues related to those raised in the Boston Globe piece about “herd immunity”–but from broader perspectives, and more critically, I think. Lots of food for anthropological thought here. As a physician-anthropologist, you can, I imagine, bring special perspectives to this emerging national conversation about how we think about risk in “re-opening society.”
BW: There definitely needs to be attention to those who are at higher risk for contracting and dying from COVID-19, and to those communities whose residents don’t have a choice about going back to work. It’s really a matter of whether people are forced to be at risk, or are allowed to be agents of their own risk and that of their loved ones. Are we going to make re-opening businesses opt-in?
Unfortunately, the baseline state of affairs in America is far from a level playing field. Some people will, essentially, be forced to work so that states don’t have to pay them unemployment benefits, and small business owners will be forced to run risk so they can qualify to get loans and other state-funded stimulus funds. Yet, somehow, there’s no national conversation questioning whether oil, airlines, and other large industries should be bailed out.
I think we could consider restarting by focusing on the social and the scientific. I think most of us would be doing better with all of this isolation, quarantine, and lockdown if we had a few more people to connect to. If you look at places that are opening up, or even how we started this all, we could start clustering in smaller groups, 10 people or fewer. Just folks who you would know were sick. And we could get the kids back together. Given the low likelihood of adverse effects in children, the fact that they have been much less symptomatic, but that they are also very good at transmitting disease to each other (just ask any parent of a daycare child), getting them back together would get us started with herd immunity. Bioethicist and oncologist, Zeke (Ezekiel) Emanuel was one of the first to say that we should probably get summer camps up and running. To me, that makes sense. But, again, it’d have to be opt-in, both for those who run the place and those who go to camp.
AG: Scholars and doctors aren’t the only ones talking about how to protect ourselves from this virus. I just discovered a pretty awesome rap video about COVID-19 from Y’en a Marre, a group from Senegal (here). Any thoughts?
BW: Y’en a Marre are a great group. They were instrumental inmobilizing the youth vote to get Wade out of power in Senegal, so I feel like they’re always “au service du peuple et de la nation” [in the service of the people and the nation]. It’s so interesting how hip-hop and other forms of art in a smaller country, fending for its own identity and economy with a smaller media space due to the constraints of language, can be called on–if not officially (like this probably was), then culturally–to serve the body of the nation. In this new video of theirs, I love how they’re all doing scientific activities–looking at charts, microscopes, and blood specimens–instead of just striking stereotypical poses in hazmat suits. It’s a solid video. I can’t imagine many hip-hip artists in the States pulling something similar off with the same tone–in Minnesota, maybeAtmosphere, but not many others in the national mediasphere.
AG: You mentioned that you’ve just co-authored a short piece about COVID-19 that you’ve submitted to a medical journal. Can you talk a bit about the orientation of that article? Were you able to insert an anthropological perspective into an article for a medical journal?
BW: In Minnesota, we’ve just had a huge decline in visits to the emergency department and to the hospital for just about everything. Most of the news outlets have covered it, but no one has published any numbers or more detailed reports of what’s not coming in. I’m fine with a slowish day in the ER, but across the country, particularly in those places not seeing the surge, the changes in patient volume have had devastating effects on clinics, hospitals, and health systems that have to operate at near full capacity and with razor thin margins in normal times just to stay afloat. So, at the same time as we have surge, we’re also seeing mass furloughing and pay cuts for nurses, doctors, and even (gasp) administrators.
So we just pulled the numbers for before and after our great Governor Walz’s announcement of a statewide “peacetime emergency,” comparing volumes and visits to a year ago, and we found a 70% drop off in strokes, and a 50% drop off in heart attacks, but also declines in really painful things like kidney stones, too. And, who’s not coming in? Well, it’s the elderly, children, and those who have insurance through Medicare. Much of this drop is likely prudence on the part of high-risk individuals, but we know there’s also some desire to not burden the health systems with non-COVID related care, as well as some fear of actually contracting coronavirus in healthcare settings.
Similar trends have been seen in China, Taiwan, South Korea, and Europe, as well as in chronic care. In Minnesota, the HealthPartners Institute has a chronic care surveillance group, and they saw visits drop off by 90% in three days after the statewide announcement.
We’re interested in doing follow-up studies, monitoring for the effects of delayed or deferred care, both acute and chronic, and seeing who comes back first, and with what.
AG: That sounds like an important set of considerations I haven’t yet seen anyone talking about in the press. Everyone is so focused on the now of the emergency, and how to extricate ourselves from it, that few I’ve seen are allowing themselves the luxury of imagining ancillary questions such as those you’ve just raised. Again, I imagine your training in anthropology makes it easier for you to keep your eyes focused not only on the big picture, but on seemingly unrelated factors that, in the end, turn out to be deeply related. That’s what we do in anthropology, right?
Well, let’s end on a positive and practical note. Last week, the team you’re leading produced a new app, “SafeDistance,” to provide up-to-date information about COVID-19 incidence in micro-neighborhoods.
Online, the website for the new app describes it this way:
SafeDistance is a free, non-profit app and website that crowdsources symptom data to help detect, predict, and prevent the spread of COVID-19, while assuring your privacy.
· Personalized, social distancing recommendations
· Neighborhood-level COVID-19 risk map
· Privacy assured – no account required, you remain anonymous
Can you talk about what sorts of social knowledge about Minnesotans factored into how you designed the app for ordinary people?
BW: The basics are maintaining privacy while collecting data of actionable utility. So we’re focusing on anonymity–both to allay privacy concerns, and also to make it an easy tool to begin using. Instead of identifying individuals, we’re mapping and doing analytics by neighborhood. This approach allows both individual users, and anyone else who is interested in the data from a more sociogeographic perspective, to have some granularity to what they’re seeing.
If you look at most of the data that’s out there, even the Johns Hopkins and Unacast or SafeGraph data, it’s mostly out there in county form, which is fine if you’re interested in the temperature of the pandemic locally, but it doesn’t tell you the weather and how much caution you should be exercising. Right now, that’s not a huge deal, because we’re all being very cautious with our efforts to self-isolate, mask and the like. But as we open up, and we find that our prior efforts burn out and COVID-19 flares up in different spots, we’ll probably have to dial up and dial down and differentiate our self-protective and collective efforts to deal with the virus. As I said, the “1918” influenza pandemic actually lasted until 1921, so it’s like [epidemiologist] Mike Osterholm has said, we need tools to figure out how we’re going to live WITH this virus, since it’s unlikely that we’ll just out and out defeat it–at least, until an effective vaccine is available globally.
AG: You initially launched the app in and for Minnesota, but it’s now available for anyone across the U.S. via auser-friendly website. Do you imagine it could have equal relevance anywhere in the country?
BW: If all the app does is give users good information and maps that convey the details of the pandemic in their neck of the woods, I’ll be satisfied.
But the detailed neighborhood maps that will be produced in the app from new user data will soon be available nationwide. If the data that are generated can be combined with other datasets to get us to a geospatial SEIR model that would allow us to predict more accurately when and where future outbreaks might occur, that would be a real contribution to fighting this pandemic–as well as to science more generally.
Well, it’ll likely only be the former, but hope springs eternal.
N.B. Another version of this post appears on the website of the anthropology journal, Public Anthropologist. You can find it here.
UPDATE, June 19, 2020: Bjorn has just published a co-authored article analyzing changes in the numbers and kinds of patients arriving at ERs in one large, public Minneapolis hospital. You can request a copy here: https://www.researchgate.net/publication/342111120_An_analysis_of_changes_in_emergency_department_visits_after_a_state_declaration_during_the_time_of_COVID-19