The Danger of a Single Threat

Photo by Sharon Sinclair.

In a well-known public talk, the Nigerian novelist Chimamanda Ngozi Adichie details the danger of letting a single story define a world. Collective experience defies such reduction; as she eloquently reminds us, our lives resist becoming iterations of the same, even when united by a cultural language or scarred by a shared event. This insight grows harder to recall whenever a sense of crisis narrows the horizon. Crisis invokes an imperative mood, along with moral demands and calls for decisive action. Like cancer, it can consume and spread, occupying attention and devouring imagination. A crisis becomes all the more seductive, and thus conceptually hazardous, when life is at stake and the threat existentially real.

This pandemic moment has certainly inspired an outbreak of crisis commentary. Between orders to shelter in place and anxious demands for information, it comes as no surprise that people traffic in frenetic updates and insights, rumors and theories. Facing a potential threat, who would not want a recipe for safety? At the same time, fragmentary data and the evolving storyline of a novel pathogen undermine quick conclusions. Beneath expert pronouncements, charts and graphs, things remain partly predictable and yet discomfortingly uncertain. Prescriptions for action and potential critique abound, not always in sync.

One striking exhortation came my way at the end of March, in the form of a viral video broadcast to a university list by a prominent academic, a critical theorist no less. It featured an earnest family physician from Michigan, demonstrating how to import hospital protocol into a suburban American kitchen. With moving sincerity and step by step precision, the doctor transforms the mundane action of unpacking groceries into a high ritual of separation and sterilization—quarantining bags outside for three days, washing packages and fruit, dumping takeout food directly onto a plate. Adopting such procedures, he suggests, will allow consumers to eat safely during the outbreak. Like many injunctions of the moment, the video’s moral force stemmed from the urgency of saving lives. This message found a ready audience; over the course of barely a month, it racked up some twenty-six million views, more than Adichie’s talk had received in a decade. It also inspired sequels, related advisories, and pushback by food safety experts.

From the perspective of combating a dangerous virus, the doctor’s advice would seem a potentially sage, if elaborate precaution, particularly for those in the direct shadow of transmission. According to current findings, SARS-CoV-2 appears impressively contagious and hardy, leaping readily between people and lingering on surfaces outside the inviting body of a host. The actual risk of bags and packaging may remain minute for most consumers, but difficult to dismiss entirely. Likewise, the mortality rate of Covid-19—however uncertain, however modest compared to smallpox, bubonic plague, or Ebola—is nothing to ignore. Infection clearly represents a serious threat for many, particularly for those with worn bodies, health complications, or raw deals in life due to racial discrimination or poverty. Deaths add up, each a singular tragedy. In sufficient numbers they threaten to overwhelm already strained, defunded health care systems, the fear that haunts much policy.

There are other perspectives, however, and other things to worry about. Without leaving the confines of contemporary biology and human health, we might recall expanding research on the microbiome, and all the inner ecosystems that may affect our sense of personhood, in addition to well-being. Not that long ago, knowledgeable people cautioned about the overuse of hand sanitizer and considered the value of fecal transplants. What else might be wiped away, while cleansing vigorously for one specific virus? Watching the good doctor’s video, I could only marvel at speed with which this coronavirus has reanimated a spirit of total hygiene, one that once extended as far as the fumigation of immigrants and racial purification. Along with innumerable exhortations to wash hands at every opportunity, sanitized shopping offers some semblance of control and safety when confronting contagion, purity in the face of perceived danger. Handwashing remains a bedrock practice of all public health, along with identifying potential vectors of transmission. Both are surely all the more vital during a pandemic. But the magic of cleanliness also has its limits and ecological tensions, as well as its colonizing history. Obsessive sanitation affects many things, not all of which we see or realize. It can promote illusions and compulsions as well as safety. And along with the virus, it can wash away recognition of plural, interconnected worlds, in which borders are ever porous, nothing travels in isolation and life remains mortal.

Put more bluntly and less reassuringly, there are always many things that can kill you. People will continue to die from multiple causes during a pandemic, both quickly and slowly. Years of tracking medical humanitarianism impressed on me one humbling, simple realization: health care is never a singular proposition. Amid the most exceptional emergencies, people still have all manner of ordinary problems and complicating conditions—fractures, cancer, dementia, malnutrition. Even within orthodox biomedicine, timelines of engagement and treatment protocols vary considerably. A trauma surgeon’s perspective differs from that of a psychiatrist; HIV/AIDS presents different quandaries than cholera, let alone depression or a car crash. Clinical practice routinely involves rival concerns and trade-offs as well as multiple opinions. At times it confronts questions of limits and potential sacrifice. All of this remains painfully clear in places defined as resource poor, where the injustice of global distribution means that people routinely die from treatable conditions—“stupid deaths” in the memorable phrase popularized by Paul Farmer. Taken in aggregate such problems converge into the most consistent theme of public health: those worse off inevitably suffer more. Every now and then, a crisis offers a glimpse of this larger scarcity in unexpected places, such as media anxiety about triage in northern Italy, France, and New York City instead of the Global South, or the astonishing shortage of masks in the strategic national stockpile of a supposedly well-prepared country like the United States. But focusing only on exceptions risks continued myopia about the rule. Is concern for “saving lives” restricted to one disease alone?

The danger of any crisis proves ultimately imaginary, in the sense that it concentrates concern around a singular threat. Veteran aid workers know that global media can only recognize one emergency at a time. As a consequence, today’s outbreak eclipses both yesterday’s continuing drought and tomorrow’s potential famine; the cameras that relentlessly expose some moments of suffering effectively obscure others. Once questions of health and safety refract through the presence or absence of a specific infection, it becomes that much harder to perceive anything else, even a longer build up or extended consequences. Once framed by selective metaphors of war, a public health campaign grows into a full-fledged moral struggle, in which ventilators and PPE signify life itself, rather than cumbersome and highly imperfect technologies. One story becomes the only story, a single virus the only threat—one threat to rule them all.

As Adichie stresses, there are always other narratives, a point that holds also in war and medicine. Actual combat involves casualties and collateral damage, weapons that misfire or exact a terrible price. The immune system proves delicate and erratic in practice, sometimes turning against the very body it protects, including, it appears, some patients with Covid-19. So too quarantine and isolation, time-worn techniques to sanitize a social body in hope of immunity, sometimes with debatable rationales or deadly violence. A pandemic carries many stories, only some of which involve the virus. But recalling such things requires retaining critical imagination, a capacity to reflect while acting, and an ability to listen as well as hear.