Covid-19 Overview by Mark Nichter, UPDATED 3/31/20

Dr. Mark Nichter is an experienced  medical anthropologist actively engaged in global health research and outreach. This slide show is intended for a general educated audience, university professors wanting to educate their students  and engaged social scientists. This presentation was originally created during  the week of  March 12-18th and will be updated weekly.

UPDATE MARCH 31, 2020

Information on Covid-19 is changing rapidly. Many thanks to Mark Nichter for his work on integrating new information into this resource.

Photo by Ylanite Koppens on Pexels.com

If you are interested in writing a blog for our community, please contact me, Liz Cartwright, carteliz@isu.edu. It would be great to hear from all of you out there. What is happening in your communities around the Covid-19 pandemic? What are your theoretical ideas on ways to better understand cultural interactions, treatments, forms of personal protection, and the larger issues of power abuses, biosocialities, vulnerable populations, etc.?

Elizabeth Cartwright, RN PhD, is a medical and visual anthropologist who works in Latin America–mostly. Her work is focuses on environmental health, social justice and anthropology with an applied focus; she is a professor at Idaho State University in the lovely Rocky Mountains.

Visualizing the Pandemic by Jerome Crowder, PhD

Crowder is a medical and visual anthropologist. His research focuses on the conceptualization of illness and help seeking behavior among urban migrants. Crowder’s books, articles and exhibits explore how migrants define and maintain community; he is currently the president of the Society for Visual Anthropology.

Visualizing Covid-19

As Covid-19 wreaks havoc across the globe and close to home, one of the virus’ features that makes its spread so disconcerting is our inability to SEE it. Knowing its molecular structure or viewing its image from an electron microscope doesn’t help us avoid contracting it. How can we visualize Covid-19 in a way that is meaningful? 

First, we can see it’s impact on our society by viewing our preparation for its arrival and our reaction to its infection. These are material manifestations of the virus, which are culturally informed and expressed. They are different everywhere.

Covid-19 offers us a unique opportunity to reflect on our cultural assumptions and expectations about infectious disease. I immediately conjure up images from The End of Polio by Sebastião Salgado (2003), dramatic black and white images documenting the final stages in the eradication of that virus… what new images will Covid-19 bring us?

Early in the outbreak I was mesmerized by television images from the Chinese response to Covid-19, images of building temporary hospitals, people walking down the streets wearing face masks, gloves and smocks, empty roads, packed clinics. I also thought about the images we don’t get to see, the faces of the health care workers skillfully attending to their patients, families huddled together worried about a relative in quarantine, or public health officials in heated conversations with politicians obsessed with keeping the status quo. Over time, images will emerge that tell the stories we have not heard, they will help shape new facets in our understanding of what Covid-19 means.

As Covid-19 spreads, the images we see show how cultures respond to it. Even though the virus was discovered in South Korea and the USA on the same day (January 20, 2020), reviewing images from the news reveals a decidedly different approach to the rapidly spreading infection. Images from S. Korea show lines of people waiting to be tested, health care workers wrapped head to foot in disposable gowns with masks assisting patients on hermetically sealed gurneys, and teams of white-coat clad individuals with pump-sprayers walking in single file spraying the nooks, crannies, and surfaces where Covid-19 may reside. 

Meanwhile images published in the US show a president rebuking Covid-19’s danger, streets, parks, and malls heavily congested with people, and sign-clad residents in San Antonio protesting the arrival of Americans from China evacuated to US bases for quarantine and observation. And of course, the cruise ships not allowed to dock so infected travelers and well persons could disembark and seek appropriate attention.

As the infection spread to Italy and Iran, images depicting their plight revealed mask-wearing clerics, empty street markets and quarantined families standing in windows singing across to each other. The images are as strikingly different. By reviewing these images we get a taste for how Covid-19 is being conceptualized and addressed. Granted popular images published in magazines and newspapers have political intentions, but check out images posted on social media to really understand what is important about Covid-19 for people to share with others.

While medical anthropology’s eye is trained on people’s understanding of the outbreak and its potential ramifications to community health, my visual anthropology eye searches for scenes that reflect that understanding (or lack thereof). 

Escaping Houston’s urban center a couple weeks ago for Galveston Island, I was astonished to see the beaches filled with friends and families enjoying themselves for spring break. The Gulf side parking along the seawall was as full as were the cantinas across the street.  That’s an image burned into my mind’s eye, as three days later the County asked all guests and visitors to leave the island, residents were asked to practice social distancing and restaurants became take-out portals. Immediately, signs appeared in the windows indicating new hours of operation, reminding patrons to keep 6’ between themselves, and stores listed items they no longer had in stock (mostly TP, water, eggs, milk and pasta). 

Walking through the grocery I noted which aisles and shelves were bare and which remained well-stocked. While I couldn’t find rice, there was plenty of quinoa and couscous. What do these bare shelves tell us about our dietary preferences and cuisine? Upon entering a restaurant, I note the hostess was replaced with signs indicating which bags were for takeout or Grubhub/Doordash pickup, the lighting was cut back and the chairs were stacked on tables. 

While we all endure the trajectory of Covid-19, keep in mind its visual manifestations in your own community; what’s a unique response and what’s more general to your region or state? Keeping our eyes open for subtle changes in visual expression to the virus help us peel back the layers to better understand what Covid-19 really looks like and how we visualize the experience that will forever affect our society.

Jerome Crowder, PhD is a medical and visual anthropologist who has conducted fieldwork in the Bolivian and Peruvian Andes, east Houston, and most recently in Galveston, Texas. His primary research interest focuses on the conceptualization of illness and help seeking behavior among urban migrants.Crowder’s books, articles and exhibits explore how migrants define and maintain community; he is currently the president of the Society for Visual Anthropology.

Recent Book: Anthropological Data in the Digital Age (Palgrave 2020)

Articles:

Optimizing Community Bioethics Dialogues (Narrative Inquiry in Bioethics)

A Journey through Chronic Illness (Medicine Anthropology Theory)

Visualizing Tensions in an Ethnographic Moment (Medical Anthropology)

Covid-19 Overview by Mark Nichter, PhD, MPH

Dr. Mark Nichter is an experienced  medical anthropologist actively engaged in global health research and outreach. This slide show is intended for a general educated audience, university professors wanting to educate their students  and engaged social scientists. It was created during  the week of  March 12-18th and will be updated weekly.

March 23, 2020 UPDATE

Thanks to Mark Nichter, PhD, Professor Emeritus, University of Arizona for this great resource powerpoint. The presentation covers Covid-19 disease etiology, anthropological insights and future directions for research. Please pay attention to dates and recognize that information is changing very rapidly.

Guest blogs and information are welcome! Email me at carteliz@isu.edu if your are interested in contributing information, research ideas or perspectives from your fieldsites in the US and in other countries.

Eco-risks and Covid-19

NOTE: Please contact me at carteliz@isu.edu if you’d like to do a guest post on this blog. !!

Photo by Arun Kr on Pexels.com

“Everyone was trying to be pleasant… but the faces of the old people were scared. They’ve been around, and today at the grocery store, they were scared.” Small town, Idaho, March 18, 2020.

How do humans understand danger? This is perhaps the most enduring question that I’ve brought to my work in medical anthropology. What makes us afraid? What makes us change our behaviors or seek the help of experts? How do we protect ourselves from dangers large and small?

Covid-19 is our current danger. For some it is a fearsome specter, a death-bringer. For others, it is an inconvenience, a nuisance. The world is focused on this virus with an intensity that is unprecedented.

As an anthropologist I want to understand the processes of how cultures come to grips with a new menace. In past writings, I coined the term eco-risk to explain how cultures try to understand, control, and hopefully vanquish dangers that emanate from the environment. [1]

I use the term “eco-risk” to highlight how individuals and groups  react to dangers that they perceive as coming from their environment (Cartwright 2013). Eco-risk highlights how we create multi-level understandings of risk and danger in three inter-related processes: 1) the process of culturally recognizing and naming the environmental danger; 2) the recognition that is based upon available technologies of perception (pace Foucault), instruments, divination, microscopes and various kinds of ‘tests’ and 3) the articulation of these two things within the legal systems. What counts as evidence?

1) In the case of Covid-19 we have just begun to recognize the danger. As the virus has spread across the map, ideas and information changes. The threat has become more and more real. One by one, cultures are recognizing what this virus can do to individuals, institutions and societies.

2) Our technologies of perception are still faltering. Testing labs, equipment and supplies are inadequate and our protocols are reflecting this weakness. We still can’t see our foe, only those individuals presenting with the most critical symptoms are being tested. The vectors, those individuals with no or less serious symptoms are still untested. The ramifications of testing status, stigma, access to care and to services is another pressing topic for anthropologists to work on.

3) Legal ramifications will come in the kinds of rules we’ll set up for mandating vaccinations (or not), the punishments that we will create for breaking the rules, whatever they will be and the power structures that are established in the wake of this outbreak. 

These three processes play out over time, in ways that reflects cultural values, norms and aspirations.

Environmental threats come in all sizes as Covid-19 demonstrates. We are just getting a glimpse of how our lives are being changed forever by this wee virus that has come out of our environment to confront us.


[1] Cartwright, Elizabeth. 2013. “Eco-Risk and the Case of Fracking.” In Cultures of Energy, edited by Sarah Strauss, Stephanie Rupp, and Thomas Love, 201–12. Walnut Creek, CA: Left Coast Press

Elizabeth Cartwright, RN PhD, is a medical and visual anthropologist who works in Latin America–mostly. Her work is focuses on environmental health, social justice and anthropology with an applied focus; she is a professor at Idaho State University in the lovely Rocky Mountains.

Covid-19 is diagnosing Mother Earth

If we could but look at our lovely planet earth from afar we’d see that iconic blue marble. If we could look more closely, we could see that it is blanketed in lots of microbes; a veritable robe of virus covers her lovely blue roundness. 

And if we could see hot spots, places where the virus break out of their usual routine lives of happily reproducing in their weirdly parasitic way, we could see the places that Mother Earth is calling our attention to. 

I’m a medical anthropologist, I look for patterns both cultural and biological. I see layers and layers of environmental affronts to the earth, of air pollution so bad it is the cause of millions of deaths each year and I see overlaying that pollution, heavy smoking patterns, exceptionally high for men in China and I see lungs that are susceptible to viral infections. Lungs so damaged by years of inhaling filthy air and cigarette smoke that they no longer can mount an effective immune response; they can no longer clean out the garbage from their distal spaces. These lungs will drown once hit with the coronavirus. 

This situation is a good example of what the medical historian Mirko Grmek called pathocenosis.

“By pathocenosis, I mean the qualitatively and quantitatively defined group of pathological states present in a given population at a given time. The frequency and the distribution of each disease depend not only on endogenous—infectivity, virulence, route of infection, vector—and ecological factors—climate, urbanization, promiscuity—but also on frequency and distribution of all the other diseases within the same population” (Grmek, 1969). 

As Gonzalez et al continue, in their recent application of this concept, “Thus, for the first time in the history of medicine—beyond a nosological framework that encloses diseases in a frozen disciplinary framework (e.g., respiratory diseases, arboviral diseases, sexually transmitted diseases)—Grmek offered a temporal and spatial approach to understand the dynamics of infectious diseases and their interdependency.” Ecohealth. 2010 Jun; 7(2): 237–241. 

Published online 2010 Jul 1. doi: 10.1007/s10393-010-0326-x

Viral spread is largely about density of people— Asia has the highest density in the world, then Africa (perhaps, the coming storm) and then Europe. Asia and Europe are the hardest hit now, we will see how it will move forward. The African continent is located between Asia and Europe, it is linked economically and socially and I would think it is only a matter of time before the Covid-19 makes an appearance there. 

Oh, and then there are the cruise ships. Talk about population density! 

Weaknesses show up at many levels. The weaknesses of the institutionalized elderly in the US, (density) and yes, ‘underlying causes’ –weakened immune systems, chronic illnesses and immobility, oh and not so very much social distance at all. 

And not just the elderly, it is the institutions themselves that are weak, nursing homes and hospitals with only the bare necessities and only minimal staffing. In the event of an increase of 10% in the in-patient load many would collapse for lack of staff, lack of supplies, lack of equipment, lack of planning and resources. This article on biosecurity and what hospitals would need to do to effectively respond to an outbreak is from John’s Hopkins; it is very informative. 

What is it that our earth is trying to tell us? If we could see the places on the blue marble most affected, if they lit up brightly, what could we learn? We are in a syndemic, not just of coronavirus, but of multiple levels of pathological states and behaviors.

This virus will surge and it will wane, we will wash our hands, and we will need to be better prepared next time. 

Elizabeth Cartwright, RN PhD, is a medical and visual anthropologist who works in Latin America–mostly. Her work is focuses on environmental health, social justice and anthropology with an applied focus; she is a professor at Idaho State University in the lovely Rocky Mountains.

March 5, 2020

Today in the news there are many instances of people, nations and organizations working together to better understand and combat the Covid-19 virus. There are also instances of people and communities being targeted in negative ways because of fear and racism. 

Blame, fear and conspiracies result in groups of individuals being stigmatized as dangerous, dirty and the sources of the disease. Stigma is negative stereotyping without understanding the underlying complexities of the situation and the harmful effects on the individuals who are labeled in this way. 

Erving Goffman’s work Stigma:
Notes
 on
 the
 management
 of
 spoiled
 identity.

New
York: Prentice‐Hall,
1963,  highlights the process of how people acquire and manage stigmas. How do people live with stigmatized conditions? How do they conceal/reveal them,  to whom do they reveal and why? These questions are just for starters, but point the direction for questions specific to the Covid-19 outbreak. 

How do the patterns of stigma associated with Covid-19 create social contexts where individuals:

  1. might try to hide their symptoms (pharmaceuticals), 
  2. could be afraid of going out in their communities/visiting their providers, 
  3. might be using non-biomedical treatments in lieu of biomedicine?

Here are some great resources on stigma that give us some ways of thinking through how it is playing out in the current moment in this pandemic. 

The first is a refresher on how stigma affects people and what we can do to stop it. Words matter—the pdf you can download from this site has some communication tips. 

The WHO has a good list of Myths about Covid-19 and how to BUST them! Information is power and is an important step forward to combatting stigma.

How is this affecting you as a practitioner? What are educators doing to get the word out to their students. (My students got this post for their discussion next week). Thoughts? Other resources?  If you put them in the comments, I’ll add them into the post.  

March 2, 2020

Monday, March 2, 2020

France has closed the Louvre and the Domincan Republic was infected by an Italian tourist. An entire nursing home in Washington was infected and many will die–facilities like this one will be epicenters of mortality.

This is a virus that will test our ability to be compassionate, to put ourselves (as privileged healthy people) into the shoes of the elderly and the sick, the workers who need to be at their jobs and can’t work remotely and the populations of poor countries that don’t have ventilators and support medical equipment and staff. 

We healthy, potential vectors, need to step up and take responsibility for curtailing the spread of the virus.

This virus is reminding us to think of others. We’ve grown complacent with the same message from the flu. Will we listen to this one?

March 1, 2020

Thought for the day: Start right now to be prepared. Buy extra supplies of the things you already eat and stock up your pantries. Go over your needed medications and don’t forget your pets!

…and know how to shelter in your home for a couple of weeks…

Analysis: Here’s a thoughtful article by medical anthropologist Roberta Rafaeta called, “From Italy: anthropological reflections on coronavirus, COVID-19”

We will be posting information here on the evolving pandemic of COVID-19. Our intent is to gather the most informative information in one place for our colleagues and our students.

We encourage a thoughtful exchange of ideas. We take a critical approach to understanding health and we forefront the structural vulnerabilities of those who are facing this situation with few resources. Our goal is to advance understanding in a timely and responsive fashion and to learn from this difficult situation as it unfolds.