Tag Archives: COVID-19

What Anthropology Teaches Us about COVID-19, Part 4: A Conversation with Physician-Anthropologist, Dr. Bjørn Westgard

Recently, I checked in with Dr. Bjørn Westgard, to see how he was doing.

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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, a Level 1 Trauma Center in Minneapolis that sees 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.

Over the years, Bjørn has researched heart disease among Somalis in Minneapolis (with support from the National Institute for Health); has specialized in hyperbaric oxygen therapy for certain medical conditions; and has helped create an innovative program finding housing and lifestyle amelioration for homeless people in Minneapolis.

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 Westgard here and his LinkedIn page here.)

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 a hemoglobinopathy.  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 for cytokine 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 to syndemic 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. 

Photo by MEGAN JELINGER via Getty Images
A local militia group is seen at a rally to protest the stay-at-home order amid the Coronavirus pandemic in Columbus, Ohio, on April 20. For the third time that week, hundreds of protesters gathered at the Ohio State House to protest the stay home order that was in effect until May 1.
Source here.

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 do case-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 in mobilizing 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, maybe Atmosphere, but not many others in the national mediasphere.

Senegalese group, Y’en a Marre, in a new music video (singing in Wolof) advocating safety measures to protect against COVID-19
Source here

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 a user-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

What Anthropology Teaches Us about COVID-19, Part 3: A Few Thoughts about Culture, and What We Can Learn from Artists . . . and the Homeless

What is “culture”?

Early generations of anthropologists offered all sorts of definitions. No matter what their specifics, the various definitions inevitably shared one feature: “culture” is identifiable. Above all, it encompasses a set of beliefs and behaviors that, together, are premised on an enduring set of values.

Or something like that.

And, as such, culture (it was thought) offers a source of stability. It occupies broad swaths of time and space: associated with a delimited place, and occupying long patches of history. For these reasons, culture makes for a certain level of predictability in the lives of community members.

Source here.

Or does it?

Starting in the 1960s, anthropologists started questioning those assumptions. Marxists pointed out that ever since, oh, the advent of capitalism, or feudalism, or agriculture (pick your favorite starting point), “culture” has been perpetuated by the ruling class. Once the poor get fed up enough, they protest; eventually, they revolt. Then, suddenly, what passed for an enduring model of “culture” turns into a set of values to be challenged, and “culture” — or, one particular version of it — doesn’t seem so reliable or inevitable.

This “Occupy Everything” poster featured on Day 14 of the Occupy Wall Street movement of 2011 summed up a great deal of diverse social justice perspectives that sheltered under the umbrella of the global social movement. Source here.

Around the same time, feminists began pointing out that “culture” has been perpetuated by men-in-power. Once women get fed up enough, they protest; eventually, they revolt. See above.

One can repeat similar arguments focusing on many other oppressed groups: racialized minorities, religious minorities, ethnic minorities, citizenship minorities, language minorities . . .

Nor is oppression the only reason for change. “Culture” also mutates when people from different backgrounds meet up, live near each other, work with each other, eat each other’s foods, dance with each other at street fairs, marry each other, have children with each other.

This ethnic-restaurant map of Queens, NY–an area of 109 square miles/52 square kilometers–hints at the extent to which large numbers of people from diverse cultural backgrounds (21,000 of whom live in every square mile) encounter each other daily.
Source here.

You get the point. “Culture” turns out to be way less permanent, less bounded, less intractable than early anthropologists claimed.

Unlikely neighbors enjoy dancing together at a street fair in the Mountain View section of Anchorage, Alaska — which is currently America’s most ethnically diverse neighborhood. Source here.

Not that the idea of culture is worthless. Contra some serious critics (Lila Abu-Lughod famously urged anthropologists to “write against culture“), I still find plenty of value in the notion. That’s because I see a lot of space between worthless and intractable. Culture can be malleable, adaptable, dynamic, while still remaining rooted in something. And, although the values that buttress culture can change, while they are active, they are powerful. They lie behind many (perhaps, for the privileged few, most) of our decisions.

Still, in pop culture, the current generation of anthropologists’ critiques of what culture is, and isn’t, hasn’t taken hold. Instead, in texts ranging from newspaper articles to corporations’ reports, we easily read disturbingly essentializing claims about “the Chinese” and “the French” and “the Muslims” as if all Chinese people, all French people, and all Muslims were easily interchangeable, eagerly sharing all values and forever speaking with one voice.

Or we read simplistic assertions about “corporate culture” in the halls of this or that company, as if all employees endorsed and enacted daily the corporation’s stated idealistic goals.

Along comes COVID-19.

The maddening “organism at the edge of life” (as virologist E. P. Rybicki describes viruses) that is far too dangerous to appear this beautiful

Of course, the most poignant takeaway of COVID-19 is the tragic demise of its most vulnerable targets.

But alongside the wrenching announcement of the day’s latest mortality statistics, as a cultural anthropologist, I find myself fascinated to read “culture” changing before our eyes — weekly, daily, even hourly. What we took as immutable practices grounded in deep-seated values are turning out to be far more pliable than most of us imagined.

Take the case of exercise. For the first few days of their local “lockdown,” people who got their workout in gyms despaired. How could they stay fit with health clubs closed?

Enter human ingenuity. Gyms have figured out ways to run “live” classes online. The acronym du jour — WFH for work from home — is expanded by some clubs to WFHBT: work from home better together. Buttressing that conceptual adaption is a simple technical one. Don’t have weights at home? How about using any heavy-ish household item you have lying around that you can hold? Say, pasta sauce jars, six-packs . . . or suitcases.

Coach Andrew Samuels of New York’s Mile High Run Club models creativity in suggesting the “suitcase squat.” Source here.

In such cases, people substitute one space for another. The exercise formerly done in the gym is now done in one’s living room.

But for some urbanites, studios may prove way too tiny to offer space for exercise. City-dwelling coaches are undaunted. Some suggest finding new purpose in a balcony.

Coach Marni W. of New York’s Mile High Run Club demonstrates lunges on her tiny balcony. Source here.

For fitness enthusiasts, daily habits of organizing one’s life around outings to the gym morph into organizing one’s life around coaches’ new online classes. That may entail switching work and sleep schedules to accommodate new class times. But the stable source, here, remains the commitment to “fitness,” no matter where, when, and how. That part of local culture and its underlying values remains stable.

But, for a stronger challenge to “culture,” let’s look at a different physical practice common to most of us: that of ordinary walking. For those who learn to walk competently some time in the second year of life, walking becomes a rote activity by the third year. As adults, we rarely contemplate our gait, pace, or stride. No matter where in the world we live, we have a sense of exactly how much distance we should put between us and the next person in order to avoid being judged creepy or reported as criminal. In a New York City subway, that space might be just an inch or two; in rural Sweden, it might be quite a few feet.

Whatever the interpersonal space bubble that feels “natural” to us while out in the world, we must all now confront our unconscious body awareness as we constantly re-calibrate distance. Keeping six feet from the nearest person may now require crossing the street to avoid being too close to the person approaching you on a narrow sidewalk.

Previously, such an action might have seemed, at best, rude; in some contexts, it could have been deemed racist. (As a short film by Cydney Cort called “Passing” once suggested, even speeding up while walking on the same side of the sidewalk can be motivated by racialized fear). Now, not crossing the street to avoid someone approaching you might be assessed as thoughtless, selfish, even potentially murderous.

Normally, producing such a 180-degree turn in what constitutes proper etiquette doesn’t happen overnight. Anthropologists and sociologists from Erving Goffman on have chronicled the deep-seated values that lie behind bodily practices as basic as walking styles. Those values tend to make somatic habits relatively resistant to quick or arbitrary changes.

French sociologist Pierre Bourdieu termed such practices, habitus. He spent much of his celebrated career studying how we experience and embody entrenched assumptions about the world and our place in it, and how these assumptions shape everything from architectural styles to taste in dinnerware.

But with COVID-19, much of what heretofore passed for habitus has suddenly become its evil twin. An attempt at a friendly hug might as well be a curse.

If maintaining a span of two meters from the nearest human may require doing a sort of dance down the sidewalk, suddenly, we are all turning into novice choreographers, performing an awkward solo tango across the street. What was heretofore a routine somatic movement becomes a basis for uncomfortable improvisation.

Perhaps the professional dancer, actor, and jazz musician can teach us a thing or two. All these artists learn the art of improvisation as part of their training. It may seem odd to think of improvisation as something to be learned. But improvisation is actually a discipline that students practice in dance, theater, and music classes. Ironically, it turns out that the art of improvisation is, indeed, a teachable skill, and the rest of us non-artists are suddenly being required to master it. If you’ve got an artist friend or relative, ask them for some tips.

Gwendolyn Baum is one of many dancers now offering online classes — including how to plan for a dance audition. Source here.

Artists are now designing striking face masks, teaching us to find beauty in even this new health requirement while enjoining others to do the same.

Abiquiú, NM-based artist, Suzie Fowler-Tutt, showing off her hand-sewn face mask color-coordinated with her hair adornments. Source here.

Powerful new works of art, such as this one by performance artist, Miles Greenberg, may speak to how many people feel these days — alone, awkward, defenseless, shackled.

This short but moving work of performance art by Miles Greenberg is part of a COVID-19-themed series for Document Journal. Source and video here.

But artists no longer have a monopoly on improvising new ways to cope with unprecedented challenges. Many who never considered themselves especially creative are finding themselves inventing new ways to cope with challenges and celebrate what remains noteworthy.

Neighborhoods are now organizing weekly shout-outs to thank those who risk their own health daily to care for the sick.

Every Friday night at 7 pm, residents up and down the street of this suburban neighborhood in RI stand outside their houses to clap, bellow, and bang their gratitude for local health care workers. Source here.

And those whose jobs put them daily in harm’s way are, themselves, figuring out the life-saving art of improvisation. In the U.S., thanks to an infuriating two months of inattention to the looming pandemic on the part of the Trump administration, medical professionals at risk of infection because of inadequate supplies are actually making their own masks.

In the U.S., lack of preparation for COVID-19 by the Trump administration propels hospital workers to sew masks. Unsurprisingly, this is feminized labor. Source here.

Workers in plenty of private businesses are also digging deep to find new modalities.

Distilleries that otherwise produce vodka have found a new use for excess alcohol: they are re-purposing that newly-hyper-valued substance into one of the rarest commodities of the day, sanitizing wipes.

Source with video clip here.

Inside supermarkets, managers are getting creative about indicating six-foot intervals delimiting where people should wait on the checkout line.

Meanwhile, gig-economy musicians position themselves outside those supermarkets, where they entertain customers awaiting their turn to enter at safely-spaced intervals.

With all this creativity occurring in the economy, I find all the more reason for us to take another look at the homeless.

And, no, I don’t mean because they are especially vulnerable. They are, but we already know that. We’ve known that for a long time. Too many books have been written about their vulnerability, with not nearly enough done to address it. Here, I’d like to point out something we rarely think about when we consider the situation of those who live on the streets.

By necessity, the homeless are masters of improvisation. From whatever tragedies led to their plight, they must scrounge anew for food and safe spaces daily. As if that weren’t enough, they must often manage these demanding tasks while being stigmatized, mocked, even arrested or assaulted. Although the homeless are more frequently the object of derision than admiration, their life skills in the face of almost unimaginable obstacles are extraordinary. Along with artists, they, too, could teach the rest of us some important life lessons.

As an anthropologist who researches the lives of homeless people in Leipzig, Germany, Luisa Schneider writes in a new poem:

while you wait it out at home

part of an expanding digital universe

connected to those you love

millions of us

have no doors to close behind us

or doors behind which

violence waits

or loneliness

or emptiness

or fear

(Source here.)

Even as many in the middle class (and beyond) are now coming to appreciate for the first time the low-paid workers who (often, invisibly) make their privileged world work — producing payroll checks, bagging groceries, cooking restaurant meals, packing and delivering packages, cleaning houses, teaching children — the one group that remains invisible for their life skills is the homeless. When this COVID-19 state of emergency finally passes, might this moment of global reflection produce new policies of compassion for helping the homeless to find new living quarters, while also helping them adapt their formidable survival skills to new careers?

What levels of grit and ingenuity are required to amass and transport daily this collection of necessary life goods as an impoverished, homeless urban nomad across the streets of NYC? Source here.

*

At the biomedical level, the most urgent lesson of this COVID-19 moment, of course, remains: isolate, isolate, isolate. For understanding the epidemiological challenges of this infectious disease emergency, we can turn to readable digests and thoughtful analyses of the week’s scientific COVID-19 findings such as this one, by the brilliant infectious disease specialist, Dr. Bill Rodriguez.

But that biomedical level has its counterpart in sociological factors — inevitably, given that humans are, above all, a social species.

The new catch-phrase guiding our lives is “social distancing.” For some, the required new habits of isolation are causing great loneliness and worse. For others, the phrase couldn’t be more of a misnomer, as people with access to advanced technology forge ingenious ways to stay in touch with those they hold near and dear. In the global North, Zoom is making geeks of technophobes.

I do not mean to underplay the suffering that the most vulnerable are enduring. Of course, that group includes not just the homeless but also the incarcerated and the medically compromised — the elderly, and those with the now-famous list of “underlying medical conditions” that, especially, stress the heart (diabetes, cancer, obesity, serious organ issues) as well as the lungs (asthma and respiratory conditions).

But it also includes the sociologically most vulnerable — the poor. And, in most parts of the world, that means, especially — for historical reasons having everything to do with the past half-millenium of European colonial expansion — people of color. Maps plotting those five groups — the homeless, the incarcerated, the medically vulnerable, the poor, and Black and Brown populations — are disturbingly close to isomorphic.

In a future post, I will explore these sorts of social vulnerabilities in this COVID-19 moment. Here, I want to end on a different note.

COVID-19 is forcing us to do no less than not only reinvent ourselves as individuals, but reinvent components of who we are as communities. For those who fear change but recognize the suddenly urgent need to embrace it, artists and the homeless alike offer powerful models of inspiration.

The transformations now occurring at every level of society will offer anthropologists research topics for years to come — starting with reëvaluating some unexpected benefits of what we might have formerly dismissed as fragility, and what we mean by “culture.”

Source here.

What Anthropology Teaches Us about COVID-19, Part 1-Early Thoughts

Lesson 1:

Like the ducks and brants my husband and I see congregating regularly by the dozens along the shore’s edge of Narraganssett Bay near our coastal home, we humans are a social species.  (Audobon’s description of the Brant: “Feeds in flocks at most times of year”),

Whether indoors or out, whether in small numbers or large, whether in person, online, or at a distance, we crave others.  And not only for emotional needs.  Also, for economic and survival reasons.  With precious few exceptions, we modern humans haven’t survived the past ~100,000 years as hermits.

So, it’s no surprise that, when the bizarre daily habitus of “social distancing” becomes the “new normal,” we suffer.  We were meant to.

Lesson 2:

Like the Leonardo da Vincis or Zora Neale Hurstons we read about in chronicles of our most creative ancestors, we humans are a clever species.

Okay, so, we’re not all Albert Einstein or Sappho.  But, whether working at an easel or a computer, whether laboring alone or in a team, whether doing work of the mind, heart, or body, we specialize in problem solving.  We haven’t survived the past 100,000 years as modern humans by walking over cliffs en masse as lemmings do when they run out of choices. 

Yes, life and society have apportioned privileges unequally, contributing to unequal doses of resiliency at the individual level.  That is a heavy burden that psychologists specialize thoughtfully in addressing, even as our politicians ignore their responsibility in producing the structural inequalities that create such unequal apportioning. Once we emerge from this global crisis, even our most heartless politicians should have greater awareness of what it takes at the structural level to sustain a compassionate community.

For now, it’s important for all of us to remember that, collectively, we are a resilient lot.  Unlike every other species, we’ve figured out brilliantly how to safely move through, and even inhabit, every environment on earth, from sky to water, from arctics to tropics. 

Now is not a time for despair. The tiny creatures underlying today’s global crisis will not defeat us.

Lesson 3:

The bad news:

Coping with COVID-19 won’t be fun.  Some among us will suffer more than most—financially, emotionally, logistically. 

Those who survive on daily coffee and lunch dates, and weekly dinner parties or movie outings, may become especially frustrated and depressed.

A very small number of those among the most vulnerable of us–especially the elderly, those with compromised immune systems, and those in both categories–will not survive a viral attack.

That is a potential source of collective tragedy we must all work hard to mitigate.

The good news:

We are learning to thoughtfully prioritize scarce resources, with the greater good in mind.

Face masks are for front-line health workers, and for those with disease symptoms, to prevent them from spreading disease when they must go out and about.

Some stores are limiting the amount of COVID-related items they’ll allow shoppers to buy. Hoarders of masks and toilet paper are being shamed in cartoons, and warned everywhere to change their behavior.

Individuals aren’t the only ones being monitored. Stores are, too.

New York City has already issued $275,000 in fines to stores that have charged more than 10% higher-than-usual prices on hand sanitizers, disinfectant wipes, and face masks. The fines will apply for at least two months.

The community spirit being promoted by this pandemic has other positive effects. For those with Internet access at home, social media offer us amazing alternatives for remaining in touch with those near and dear to us. They also help us find our way to many new communities that can offer solace.

In the U.S., for those with limited Internet and data access, new options are emerging daily to provide access. Companies are actually offering expanded smartphone data at no charge, creating new Wi-fi hot spots, and offering free international phone calls.

No doubt, these profit-oriented corporations will return to greedy practices once the pandemic subsides.

But for now, at least some of them are actually being part of the solution. Their unusual pivot reminds us that, as a species, we will survive this challenge, as we survived all known pandemics—the Black Death, HIV-AIDS, Ebola and others.

Not only that, but if we live up to our vaunted cleverness, we may actually emerge stronger.

The moment will produce many heroes.  

Front-line health staff will bravely reduce the suffering of patients. 

Humane politicians will offer financial supports.  Germany has “promised companies ‘unlimited’ credit to keep them afloat” in an economic package . . . worth at least 550 billion euros ($614 billion) initially — the biggest in Germany’s post-war history.” Politics will even make strange bedfellows. Mitt Romney has just endorsed Andrew Yang’s proposal (at last for now) for a universal basic income.

Brilliant infectious disease specialists will analyze all available data and translate statistical and arcane knowledge into readable syntheses for ordinary readers.

Medical researchers will eventually create a vaccine.  The EU has already invested an emergency $89.4 million into the project.

And those are only the headline heroes.  We will have far more heroes who will never make the headlines.

On my neighborhood list-serv, someone who loves to cook has offered to bake a loaf of bread, and personally deliver it on foot, to any elderly or quarantined neighbor who requests one.  To be realistic, she clarified the approximate radius of how far she might walk to deliver samples of her kitchen’s output. Another neighbor soon magnified the offer: he’ll drive to pick up the loaves and deliver them by car to anyone farther than the generous baker’s walkable zone.

And that was only Day Two since my state’s governor declared first steps of “social distancing.”

Not convinced of our species’ capacity for creative and even limitless commitment to one another, no matter how far the physical distance required?  Check in soon for more encouraging ethnography, large and small.

Meanwhile, remember: As a species, we’ve got this.