As anthropologists who research and write about death and trauma, we are troubled by accounts of pandemic-related deaths that fail to account for the intimacies of dying at home or in the hospital. By all accounts, Covid-19 compels a lonely death. The dying person is someone’s parent, or child, or friend, but if they are positive for Covid-19 they are also deemed a hazard. Death is not simply a singular event here, and the cessation of the life of one body. Instead, death presents the possibility of viral exposure, and therefore the possibility of more death. Our recent fieldwork experiences make us deeply familiar with all of the labor and logistics it takes to ensure that dying does not happen alone. Dying is relational, and it is the narrowing of that relational capacity that makes dying in a pandemic a critical site of reflection.1
Harris: I study traumatic injuries from traffic accidents in a public hospital emergency ward in Mumbai, India. Often, these injuries are lethal. And often, families are unable to be traced and the patients remain “Unknown.” “We found him dead outside a pharmacy,” a cop says one evening as an old man’s body is wheeled in. Procedures unfold: The man is wheeled into the back area of the room. An EKG machine is wheeled over next to him. The in-charge doctor shows the interns fresh out of medical school how to apply the electrodes, how to work the machine. It doesn’t work the first few times. The doctor tries again. This time the flatline is clear, and she calls it: he is dead. I follow the course of the body. Orderlies wheel him into the waiting area, filled with patients. They tape a thick strip of sticky bandage tape to his chest, mottling the white chest hair. They write: “UNKNOWN MALE” on the tape. And there he lies, until another orderly wheels him over to the morgue, where I’m told they will try and find his family, but that’s unlikely. Maybe, the morgue attendant says, he’ll become one of those news-worthy cases where the police perform last rites of cremation for unclaimed bodies in the morgue. Those hero stories run in the papers from time to time. The morgue is freezing; there’s a giant skull and crossbones painted on the outside warning of danger.
There is solitude in those chambers of cold storage. But writing it now, here, I can’t help but think about photos and stories of freezer trucks backing into hospital loading bays in New York City, and wonder what the circumstances of each of those bodies might have been.
Mara: I study medical aid-in-dying (also known as assisted suicide) in the United States. While the circumstances are very different (terminal illness vs. trauma), the deaths I study are in many ways critically framed against the lonely hospital deaths Harris describes. Those who seek a medically assisted death are often trying to avoid the perceived indignities of a technologically mediated death and the anonymity of dying in hospital. When given the opportunity to choose the time and place of one’s death, most people pursuing this option choose to die at home, surrounded by family and friends, cultivating a type of death that intensifies sociality even as social bonds are being dissolved. One of these people was an artist in her sixties dying of metastatic cancer, a self-described curmudgeon who had never married nor had children. While this was a great source of sorrow, she was surrounded by friends in her death. Friends built her casket, friends piled onto her bed and encircled her when she took the lethal medication, and friends carefully washed and anointed her body after she died. Her thoughtfulness about planning for death—finding a home for her dog, gifting her artwork—deepened social ties throughout the dying process.
Dying of Covid-19, in contrast, admits only the barest forms of sociality. Even as palliative care providers strive to shore up institutional capacities for offering the “least worst” death possible, those dying of coronavirus in the hospital must do so in relative isolation, attended to by masked healthcare workers covered head to toe in PPE—assuming those workers are lucky. Here, the very gear necessary to protect caregivers from viral transmission also diminishes possibilities for social interaction. The less porous the boundary against the virus, the less potential for human sociality. What is it like to die without recalling the last time you saw the flesh of a real human face?
There is, of course, still so much that we don’t know. First, we don’t know much about those who are dying at home before even making it to the hospital. These deaths are not being counted in official mortality counts. We do not know who dies alone. Stories are only now beginning to circulate about healthcare workers dying at home from Covid-19, likely transmitted through care work.
Second, we know too little about the social connections and forms of care that surround death from Covid-19. As anthropologists, we need to be listening for these accounts. Epidemiologists and news outlets reckon these figures at city, state, and national levels. However, amid these attempts at localization and generalization of data, we hope to differentiate between what Vincanne Adams (2016) has called “incidence” and “incidents.” The former, a standard mark of epidemiological knowledge, counts the number of occurrences in question, captured as a ratio. The latter are events of illness or injury, and beg for ethnographic inquiry. If a death has occured, what were its circumstances? What forms of care preceded it, and with what reckoning of risk? And were others present to witness it?
We all are living unequally through regimes of social distancing. In death, Covid-19 makes the tension between proximity and distance ever more urgent.
1. Our thinking about death and dying is guided by several scholars, including Vincanne Adams (2016), Anne Allison (2015), Margaret Pabst Battin (1994), Jason Danely (2019), and Robert Desjarlais (2016).
Adams, Vincanne, ed. 2016. Metrics: What Counts in Global Health. Durham, N.C.: Duke University Press.
Allison, Anne. 2015. “Lonely Death: Possibilities for a Not-Yet Sociality.” In Living and Dying in the Contemporary World: A Compendium, edited by Veena Das and Clara Han, 662–74. Berkeley: University of California Press.
Battin, Margaret Pabst. 1994. The Least Worst Death: Essays in Bioethics on the End of Life. Oxford: Oxford University Press.
Danely, Jason. 2019. “The Limits of Dwelling and the Unwitnessed Death.” Cultural Anthropology 34, no. 2: 213–39.
Desjarlais, Robert. 2016. Subject to Death: Life and Loss in a Buddhist World. Chicago: University of Chicago Press.