This article was originally published on ProPublica, a Pulitzer Prize-winning investigative newsroom.
WASHINGTON — Last week, when he decided to protest, William Smith, 27, used a red marker to write a message on the back of a flattened cardboard box: “Kill Racism, Not Me.”
As he stood alone, somber, he thought about George Floyd, a fellow black man whom he’d watched die on video as a Minneapolis cop kneeled on his neck eight days earlier. “Seeing the life leave his body was finally the last straw that broke the camel’s back for me,” he said.
But he also thought about people he knew, a handful of them, who died after catching the new coronavirus. “They were living in impoverished areas. Couldn’t get proper treatment. Lived in crowded conditions, so social distancing was hard to do. And they were still forced to go to work and be put in harm’s way.”
When speaking out against the loss of black lives, it is tough to separate those who die at the hands of police from those who die in a pandemic that has laid bare the structural racism baked into the American health system. Floyd himself had tested positive for the coronavirus. Eighteen black protesters interviewed by ProPublica were well aware that black lives were being lost to the virus at more than twice the rate of others, and that societal barriers have compounded for generations to put them at higher risk.
It was fueling their desire to protest and their anxiety about joining the crowd. But they flocked to the White House on Tuesday afternoon, one day after peaceful protesters there were tear-gassed so that President Donald Trump could hold up a bible for a photo op at St. John’s Episcopal Church. There were tanks on the streets, along with a battalion of federal agents, military troops and police. Many of the protesters said they were willing to sacrifice their bodies, either to violence or the virus, to be heard.
In front of the White House stood Caleb Jordan, who turns 21 on Saturday. He showed up with an overstuffed backpack to make sure his 62-year-old grandmother, Carolyn Jackson, had enough water to drink and a hoodie to protect her arms in case of violence. “I don’t know what I would do if anything happened to her,” he said. Some people had on masks. Some did not. Some pulled their masks down to talk or breathe. “I’m not comfortable with that,” he said. She’s got a chronic lung condition, and he had been so worried about her catching the coronavirus in the past few months that he wouldn’t hug her. But then she mentioned that she drove by the protests on Sunday, and immediately he asked, “Why didn’t you take me?”
He had been losing sleep over what he was seeing in social media and on TV, having nightmares in which he was fighting a “real-Jim-Crow-looking white guy in a white button-down shirt, black tie, sleeves rolled up.” His mom told him he was fighting racism. “It’s like obstacle after obstacle,” he said. “If it’s not police beating us up, it’s us dying in a hospital from the pandemic. I’m tired of being tired. I’m so tired, I can’t sleep.” It was something he continued thinking about until he couldn’t help himself, sending a text at 3 a.m. asking his grandmother if they could attend together. “I thought about it and said, ‘This is a teachable moment,’ ” she recalled.
So Jackson took the day off from her job as an accountant at a hospice organization and put on some peace sign earrings and a T-shirt from the 20th anniversary of the Million Man March. On the car ride into the city, her grandson asked about her struggles with race. She explained what it’s like being a professional black woman with over 30 years experience who still feels overlooked for opportunities because of questions about her qualifications. Her awareness of being treated differently dates back to how her white paternal grandmother favored her lighter-skinned cousins. She found solace in her black maternal grandmother, who would comb her hair while she sat between her legs. Jackson wants her grandson to feel that kind of comfort from her.
That desire extends to her mission to help the black community understand palliative care is an option that can offer dignity and support at the end of life. “Because when people hear hospice, their hands go up and they say, ‘I don’t want to hear it.’” She’s also heard that resistance when it comes to getting tested for the coronavirus; she has gotten tested twice and plans to get tested again. She feared being exposed on Tuesday, but being here with her grandson was too important to miss. “We internalized a lot with my generation,” she said, “but I think it’s important for him to see this.”
N.W.A.’s “Fuck Tha Police” blared from a nearby speaker outside St. John’s Episcopal Church until an interfaith group of men and women bowed their heads and began to pray. Among them was Timothy Freeman, pastor at Trinity African Methodist Episcopal Zion Church, who wore a brightly colored kente cloth-inspired mask, its vibrant yellows and reds standing in stark contrast to his ministerial black suit and white clerical collar.
Freeman, 42, knows eight people who have been diagnosed with the virus; one died. For two weeks, a sick friend had a fever and could barely move from fatigue but refused to get tested, running through all the scenarios of what might happen if he had it: What if he wound up isolated in an ICU with no one to advocate at his bedside? Another sick friend worried an ambulance would take him to a hospital that he didn’t trust. These conversations, the pastor said, are always infused with an awareness of the medical system’s record of neglect and abuse of black people, from dismissing their pain to using their bodies for research without consent. The virus has forced this all top of mind.
A licensed occupational therapist for 19 years who spent a decade managing a skilled rehab facility, Freeman said he has seen racial disparities in health care firsthand and that access to adequate insurance coverage is crucial. “I have seen diagnostic tests not performed … and hospitalizations cut extremely short — or not happen at all — because of insurance.” COVID-19 is affecting black and brown people in disproportionate numbers, “and not just because we’re black and brown, but because of the social and economic conditions people are forced to live in,” he said.
“All of it comes together. What happened with George Floyd publicized to the world the experience that we live,” he said. “It’s a conglomeration of everything.”
A block away from the prayer group, Elizabeth Tsehai, 53, drove slowly in her BMW SUV, honking her horn, as federal agents in riot gear began to march past the crowd just behind her. She had a Black Lives Matter T-shirt displayed on the dashboard and a bike rack on the top of her car that she joked made her look like the “caricature of a soccer mom.”
She stopped her car on the road and remained there as protesters to her left took a knee. There was some heckling from the crowd but no one was in anybody’s face. A Secret Service agent warned her to move. Her response: “Arrest me. I can’t breathe!” Agents then pulled her from her car and to the ground and handcuffed her. “I didn’t resist because I know they just arrest you for resisting arrest,” she said. “But the minute they pulled me up on my feet, I was talking all kinds of trash.”
Her car was left unlocked in the middle of the street, where it was protected by protesters. She was questioned and released. She said agents told her they were afraid she was going to hit protesters because people have been using their cars as weapons. They told her to move it and leave. The Secret Service did not respond to questions about this incident.
“Ordinarily, I would not get involved,” Tsehai said. But George Floyd’s death was enraging, as were “all of the things that came before it.”
All of the things.
How a white nurse looked her up and down when she arrived at the hospital to give birth to her son and sneered, “Can we help you?”
How her brothers, who live in Minneapolis, recount being pulled over by police for driving while black.
How a black man couldn’t watch birds in Central Park last week without having the police called on him.
“The pandemic is hitting black people hard and exposing these structural inequalities,” she said. “Then on top of that, you get Amy Cooper … weaponizing her white privilege at a time when he might end up in jail, where infection is rife.
“But when they manhandled protesters who were peaceful, that was a bridge too far,” said Tsehai, who grew up in Ethiopia under an authoritarian regime during a period known as Red Terror. She didn’t know life without a curfew until she moved to the United States to attend Georgetown University 35 years ago.
“Moments like this are quite unusual,” she said. They can also inspire change, a message she shared with her children, ages 12 and 14, when recounting her ordeal with them. “I want these children to live in a different world. It’s not enough to read about it and get outraged and talk about it at the dinner table. Silence makes you complicit.”
To fight the spread of coronavirus, government officials have asked Americans to swallow a hard pill: Stay away from each other.
In times of societal stress, such a demand runs counter to what evolution has hard-wired people to do: Seek out and support each other as families, friends and communities. We yearn to huddle together. The warmth of our breath and bodies, of holding hands and hugging, of talking and listening, is a primary source of soothing. These connections are pivotal for responding to and maximizing our survival in times of stress.
But as with any pill, there are side effects. As psychologicalscientists at the University of Washington’s Center for the Science of Social Connection, our lab studies social connectedness, why it is important and how to maximize its benefits. Our clinical and research experiences help us understand the side effects of social distancing and suggest strategies for addressing them.
For those who must be quarantined because they are infected with the virus, this research has one important implication: Depriving the sick of social connection and physical closeness unfortunately may make it harder for them to defeat infection. For example, lonely college students respond more weakly to influenza vaccinations than do non-lonely students.
There are other costs. Loneliness makes people feel more vulnerable and anxious in social interactions. An official mandate to socially distance and isolate may increase what psychologists call intergroup anxiety, the natural threat and distrust people feel when interacting with those who are different.
While social distancing and isolation are in effect, there are things everyone can do to mitigate their downsides.
Now is the time to reach out to friends and family and connect with them however you can. Let people know how much you care about them. While live human connection is best, a phone call, with a real voice, is better than text, and a videochat is better than a phone call.
We believe such social technology-faciliated connections will aid all of us in staying as healthy as possible during this time. Although research on this is not comprehensive, we think it’s valuable to use social technology to mitigate the effects of loneliness and isolation for those who are sick.
What you say when connecting also matters. If you are stressed and upset, talking about your feelings can help. You may or may not feel better, but you will feel less alone. If you’re on the receiving end of this kind of sharing, resist the impulse to dismiss, debate or tell the other person not to worry. Your task is to listen and convey that you understand their feelings and accept them. This process – one person sharing something vulnerable, and the other responding with understanding and care – is the basic dance step of good, close relationships.
Human touch is also vital for well-being. If you are distancing with people who are close to you and healthy, don’t forget the positive impact of a gentle hug, or holding someone’s hand. Safe, mutually consenting physical touch leads to the release of oxytocin. Sometimes called the “love hormone,” oxytocin helps regulate your fight or flight system and calms your body in times of stress.
Other actions can help boost your and others’ well-being as you’re adapting to a world of social distancing.
Embrace others, figuratively. Be aware of your tendency to circle the wagons around your group. Importantly, even though it doesn’t always feel this way, you’re not born with a fixed group that you trust and fixed groups that you distrust. These feelings and associations are flexible and change with context. Imagine, for example, who feels safe and familiar to you when at work versus at a family dinner versus at a football game. Now is the time to expand how you define your group identities. This is a global pandemic. Human beings are in, the coronavirus is out.
Be generous. The practical side of this idea of expanding your identities is an encouragement to be generous, broadly speaking. Giving to others in times of need not only helps the recipient, it enhances the giver’s well-being, too. If you feel compelled to go to the grocery store to stock up on toilet paper, consider checking in with people you know who are more vulnerable and see what they might need. Give them some of that toilet paper. Help others around you, including neighbors you may not know well, people with whom you don’t usually feel a sense of kinship and people experiencing homelessness. Doing so combats the impulse to build walls. It puts you in touch with the better angels of your nature, and gives these angels voice and purpose.
Finally, remember to breathe. In this moment, with all the stress and anxiety, many people feel overwhelmed and disconnected. But you’re still here and those around you are in this chaos with you, too. A few conscious, gentle breaths can restore that connection, slow your mind and give you clarity, at least for a moment or two.
This coronavirus crisis may not end soon. Things may get worse. As people hunker down, the negative side effects of social distancing and isolation will shift and evolve. What feels manageable today may not feel manageable tomorrow.
As psychologists, we are concerned that the lack of social connections, increased stress, disruptions and losses of livelihoods and routines will tip some people toward depression. We are concerned about increased family conflict as people are forced to navigate unusual amounts of time together, many in confined spaces.
Flexibility is adaptive. Building a foundation of healthy coping, maintaining awareness of the side effects of our necessary societal changes, and staying connected to our values and to each other are imperative. Human beings have great capacity for empathy and caring in times of suffering. Maintaining social distance doesn’t need to change that.
Being healthy is pretty simple, but most people in the United States find it pretty hard. And for an African American, it’s over-the-top hard. Not only is the struggle of getting healthy and maintaining a healthy lifestyle embedded in the culture, but there are sometimes actual physical and financial obstacles to overall health.
There are many things in life that are simple and hard. Like staying committed to your spouse. It’s simple. Just stay faithful to one person for the rest of your life. It’s hard because there are all kinds of ups and downs you go through.
Alongside various temptations, you will also lose that euphoric feeling you had when you first met. That’s what makes it hard for the long haul.
Following Jesus seems simple. Jesus is to be the Ruler and number one priority in your life.
Sounds simple, right? It is but it’s also hard to do it. It means you have to deny yourself. Who wants to do that?
It means that you have to trust someone you cannot see. That’s a pretty high expectation, and if you have ever tried it, it’s extremely difficult.
Application is Key
The simple part about being healthy is summed up in a maxim from Michael Pollan, the author of TheOmnivore’s Dilemma andFood Rules: “Eat [real] food, not too much, mostly plants.” It can also be summed up in the overall guideline of staying active. That seems simple enough but even in the overall culture, it is a tall order. Folks who try often get buried in a mountain of guilt over late-night binges and how that occasional donut in the morning becomes habitual.
There seems to be no end to the people telling us that we need to eat better and stay active. The problem is not more information but application.
Usually where application fails is when we try to break ourselves from our normal routine. It’s all about habits. Habits are what shape our lives.
In his book the Power of Habit, Charles Duhigg says that habits can be broken down into three basic steps.
First, there is a cue or the trigger that tells our brains that we need to do something. The next step is the routine, which is the behavior that leads to the reward. The next step is the reward that reinforces the habit.
This is something he has labeled the habit loop.
Breaking Old Habits
It seems simple to break a habit then. All we need to do is recognize our cues. Then we can choose alternate behaviors that lead to a different reward.
The problem comes when your whole culture is made up of cues that go against the habit you are trying to break. That’s when the mountain of unhealthiness seems insurmountable.
At that point, you have to choose between your cultural identity and your personal well-being. What do I mean by that?
It’s Sunday afternoon at Big Mama’s house and everyone is famished after spending hours at church. Big Mama’s table is full of all kinds of things that are detrimental to your health: creamy mac and cheese. Fried chicken. Chocolate cake.
The only thing that’s decent is the collared greens and those have been overcooked with ham hocks. So the health factor is reduced.
What do you do? Do you skip the meal? You’re hungry and after all, you don’t want to disappoint Big Mama. Plus your family has been eating this way for years.
Besides that not only has your family been eating this way but millions of African American families have been eating this way. It’s embedded in your culture.
You begin to remember that time when your unusual cousin from California came and ate a salad the whole week and everyone ridiculed her and said she had been hanging around white folks too much.
You don’t want to be thought of as betraying your race. So you reach for the fried chicken. It’s only right.
Limited Time and Resources
How about the many African Americans who are single moms? You don’t have time to cook healthy meals for the kids. You are just trying to make it through the day and get some peace once they are finally put to bed.
So what do you do? You give them the quickest and easiest thing.
Most of the time the quickest and easiest thing is also the unhealthiest. It is loaded with sodium and sugar. It is targeted to parents and children and has been tested and refined to produce a bliss point.
I learned about this concept from the book by Michael Moss titled Salt Sugar Fat
The bliss point is the perfect combination of salt, sugar, and fat that will get people craving for more. You don’t want to hear this but you’ve been had.
The food companies are deliberately making you unhealthy so they can make a profit from your lack of time to cook healthy meals for your family.
What if you did choose to live healthy in spite of the inconvenience of cultural identity and time? You still may face other challenges.
Let’s say you decided to follow Michael Pollan’s food maxim of eating real food and mostly plants. The economics are against you. Real food just costs more.
When you’re faced with feeding your family with the amount of money for food in your budget you have to make some choices. If it doesn’t add up you will buy the junk. And then you’re pulled back into the cycle.
There is also the existence of food deserts that totally trump eating healthy. A food desert is a swath of a usually urban community that does not have a grocery store.
There is no access to healthy food and families resort to buying food from the corner store which is usually processed and packaged. No fresh fruits or vegetables in sight.
If you are part of the 23.5 million people (mostly African American and Latino) in the United States who live in a food desert, this is a huge obstacle.
Let’s Talk Money
How about if you said that you wanted to stay active? You want to get a gym membership. That’s going to cost. You also have a family to take care of and a job to go to. You have to find time to squeeze it in.
Not only that but when most of your friends are not active then you won’t be active. Jim Rohn, the popular self-help guru, is often quoted as saying “You are the average of the five people you most spend time with.”
When it comes to being active, most black people don’t hang around other active black people. Watching sports on TV doesn’t count.
This is the essence of the struggle many black people face when it comes to health. On the surface, it seems like the struggle that anyone who wants to make a major change faces.
In many ways it is. What makes it unique is the cultural factors surrounding health.
For most African Americans eating processed, cheap, nutrient-absent foods and sitting on the couch watching reality shows has become a way of life.
Gathering around the table to consume salt, sugar, and fat in copious amounts has become the symbol of what it means to be family.
History of Soul Food
Don’t get me wrong. I love soul food. I think that the distinct flavor of the cuisine that we grew up with is worth having once in a while but I also believe that some of the ingredients have gone the way of just wowing the taste buds instead of delivering the sustenance we need.
He recalls the meals that his Ma’ Dear made in Tennessee and how they were organic and contained ingredients from the garden. It is important to note that we didn’t always eat like this.
So what happened? Corporate America happened. Concern for profit became more important than concern for humans.
In the 1960s, Soul Food became a hit and the recipes became more dangerous to our health. We have come to equate soul food with the fare showcased in the episode of the Boondocks about the “itis.”
You know, that feeling you get after a big meal and you just want to fall over and go to sleep.
TV or play video games on the couch are not what we are designed to do.
It’s a way of life I’ve seen played out in too many homes. Personally, I’ve tried to break away from it. I do it in fits and starts.
Some leafy greens here. Some HIIT workouts there. Then sooner or later the holidays come. That’s when the temptation levels are the highest.
My mind has two thoughts battling each other. The first thought is to not give in and pursue my highest ideals. The second one is that I’m not only missing out on the stimulation of my taste buds but the community that I’m a part of.
Most African Americans are a part of the church. It would seem that this makes things even worse. When church people get together, they eat.
And they don’t just eat but they eat good (or bad depending on your point of view). Treating our bodies as temples of the Holy Spirit seems to only apply to sex, smoking, and drinking in the church world. Packaged foods and large meals get a free pass.
I can remember when I was a strict vegan for six months in college. I was filled with energy and it was mostly from the food that I was eating and not eating.
I felt like I was lighter than air. My mind was clear and I didn’t have any illnesses. Why did I stop? Family telling me I was eating rabbit food.
To put it simply I had no community to support me. And when it comes to food and many other lifestyle choices, the community always wins. That’s why for most African Americans, eating healthy is simple and hard at the same time.
Just last week, it seemed OK to have lunch out or maybe meet up with friends for a game of pickup soccer.
Now, in the fast-moving world of the coronavirus response, that’s no longer the case. More and better social distancing is required. But what’s still acceptable?
We reached out to public health experts, who, admittedly, vary in their recommendations. But their main message remains: The better individuals are now at social distancing to slow transmission of the virus, the better off we’ll all be eventually.
Already, California has told people 65 and older to stay at home. In the San Francisco Bay Area, where community spread is a growing concern, just about everyone else has been ordered to do so, too. California is also among the states that have ordered restaurants, gyms and other facilities to close. And the Trump administration has instructed Americans to avoid gatherings of more than 10 people for the next 15 days and avoid sit-down meals in bars, restaurants and food courts. More restrictions from states, localities and the federal government could follow.
In the coming days, those rules and recommendations may expand as federal, state and local health officials weigh conditions on the ground. So what to do now?
“We ought to make risk-based decisions,” said Dr. Georges Benjamin, executive director of the American Public Health Association.
Expect change. Maybe daily. But also take a deep breath. Some things are still all right.
“At the end of the day, we have to take care of our kids, our family, we have to eat,” said Benjamin. “What people ought to do is think about how best to reduce risk and do as many less risky things as they can.”
So what about walking around the neighborhood?
“Yes, but not in groups,” said Benjamin, who added that he would wave at his neighbors while out for a stroll but “would not have a long conversation.”
If you do chat outside, maintain 6 feet of separation.
Dinner parties? Food for those shut in their homes?
“Inviting people over depends on whether or not they have symptoms, whether they have traveled overseas,” Benjamin suggested. “I would not have a BBQ on my deck with a bunch of people.”
If you bring food to a shut-in or a neighbor, “leave it on the porch,” he said, and always, always make sure you wash your hands before preparing the meal.
In a blog post titled “Social distancing: This is not a snow day,” Dr. Asaf Bitton, an assistant professor at the T.H. Chan School of Public Health at Harvard, takes a hard line, recommending no play dates or sleepovers for children. No sharing of toys with other families. Even playing outside with other kids is a no-go “if that means direct physical contact” such as in basketball or soccer.
Limit trips to stores. Cooking food at home, he wrote, is less risky than takeout. Don’t have other families over for dinner.
School closings won’t slow transmission if parents allow close play dates, or even activity on playgrounds, said Elizabeth Stuart, a professor of mental health, biostatistics and health policy at Johns Hopkins Bloomberg School of Public Health, in an interview with KHN.
Playgrounds are a problem because they put children, and their watching parents, in close proximity. There is also a chance the virus could remain on surfaces.
But some people need more flexible guidelines, especially those with young children or those who can’t work from home, such as health care workers.
For them, a “closed-network strategy” might work, Stuart, two epidemiologists and a health policy expert wrote in a piece that ran in USA Today.
That means a small, trusted circle can continue to interact while creating social distance from outsiders. If any member of an individual family within that circle, however, exhibits symptoms, the entire family should isolate — and let everyone else in their circle know.
“The ideal situation is everyone stays home, but that’s just not a reality for a lot of people,” Stuart said in an interview with KHN.
She said friends have asked what to do in specific situations, such as deciding whether a teenager should babysit for another family.
The key, she said, “is to think of the number of unique people you come in contact with.”
Each case involves a judgment call — and an element of risk. Maybe two families share child care, or a teenager babysits for one family. But the teen does not sit for 10 families, she said.
Bitton, in his column, took a tougher stance.
“Even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent,” he wrote.
Do get outside every day, he wrote, as “it will be important during these strange times,” but “stay physically away from others.”
Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, agreed.
“We encourage people to go out and exercise, but in a solitary way. Your pickup soccer game, because of a lot of close contact, no. But maybe tennis because there’s a big distance from you and another player,” he said.
Maintain that 6-foot distance, whether outside or if you invite someone into your home, he said. If people come over, wipe down surfaces after they leave. And always wash your hands.
These recommendations — and the stricter ones being imposed in some cities, like San Francisco — are vitally important, Plescia said.
“Social distancing works. If we do it, we can keep the spread from going up. We can get ahead of this and slow it down,” he said.
For the past eight years, she’s been washing her hands pretty much every time she passes a sink. When she’s near a bottle of antibacterial gel, she uses it. She makes a point of avoiding people with contagious illnesses, even though it can be uncomfortable to ask to work from home or miss a date with friends. And she makes sure she gets plenty of sleep, not always easy at age 25.
Amelse was diagnosed in 2012 with lupus, an autoimmune disease that makes her vulnerable to infections. She’s since developed pulmonary arterial hypertension, a condition that requires intravenous therapy via a central line to her heart. Both illnesses place her at heightened risk for viral and bacterial illnesses. So, she has adapted as a matter of survival, taking to heart long-standing axioms on what constitutes good hygiene.
As the highly contagious new coronavirus continues its spread through the U.S., the general public could learn a thing or two from Amelse and the millions of other Americans with weakened immune systems who already live by rules of infection control. Whether it’s people who had recent organ transplants, people undergoing chemotherapy or people with chronic diseases, America has a broad community of immunosuppressed residents who long ago adopted the lifestyle changes public officials now tout as a means of avoiding contagion: Wash your hands, and wash them often. Don’t touch your face. Avoid that handshake. Keep your distance from people who cough and sneeze.
Amelse doesn’t follow the advice perfectly — of course she touches her face sometimes. “You do these things unknowingly, so forcing yourself to break these habits can be challenging,” she said. But the incentive to keep getting better is there. “If you get a cold and you give me that same cold, you might get it for a week. I’ll get it for a month.”
Even with her dedication, COVID-19 is proving a daunting prospect to face. And she has a stake in Americans adopting these habits because, while the disease is relatively minor for many people who get it, it can be life-threatening for people with preexisting conditions.
Amelse works at a health literacy startup in Minneapolis that helps patients with complicated diseases learn about their illness. She knows a lot about health and how to prevent infection. Still, the threat of COVID-19 is unnerving, for her and her doctors.
With a virus so new, official guidance on what people at heightened risk should do to steer clear of COVID-19 is limited. But the Centers for Disease Control and Prevention recently said the virus seems to hit hardest in people 60 and older with underlying health concerns. There is also concern for younger people with limited immune systems or complex diseases.
Health officials are asking those at risk to stockpile two-week supplies of essential groceries and medicines in case they need to shelter at home; to avoid crowds and heavily trafficked areas; to defer nonessential travel; and to track what’s going on in their community, so they know how strictly to follow this advice.
Infection control always follows a similar set of principles, said Dr. Jay Fishman, director of the Transplant Infectious Disease and Compromised Host Program at Massachusetts General Hospital and a professor at Harvard Medical School. The most important things for people to do right now are the things he always recommends to his organ transplant and cancer patients. Again, think hand-washing and avoiding spaces where sick people congregate.
Still, the recommendations aren’t one-size-fits-all. Some people are born with stronger immune systems, and immune deficits exist on a spectrum, said Fishman. How strict people need to be to prevent illness can vary depending on how susceptible they are.
Recommendations also need to take into account what people can and will do, he said. Children, for example, are among the greatest germ vectors of all time, but Fishman doesn’t ask his patients with grandchildren to stay away from their young family members. “We did the transplant so you can see your grandchildren,” he might tell them.
Similarly, avoiding crowds and staying away from sick people is easy for some but can be all but impossible if you work in food service, for example. Find ways to avoid the risks and reduce them where possible.
Though there isn’t great research on how well transplant patients and others manage to prevent infection, Fishman said many of his patients don’t get sick any more frequently than the general population, despite their vulnerabilities. But when they do, the illnesses tend to last longer, be more severe and put people at higher risk for additional infections. He counsels patients to be vigilant, but also to live their lives and not be ruled by fear.
Dr. Deborah Adey, a transplant nephrologist for UCSF Health, echoed Fishman, saying she likes to find ways to help her patients carry on with their lives. A patient recently asked if it was OK to fly to Salt Lake City, and she suggested they drive instead.
Gauging the risks can be tough. Amelse was relieved when a major health conference she was scheduled to attend recently in Florida was canceled at the last minute. She wasn’t sure it was safe to travel, but it also was unclear how to categorize an important work trip: Was this essential? Nonessential?
Adey conducts follow-up appointments via teleconferencing where possible, to keep her patients out of medical facilities. Hospitals are, by design, places for the sick, and people with compromised immune systems are generally advised to avoid them and the viruses and bacteria potentially inside.
That matches advice from officials in California and other states, asking people to stay out of emergency rooms unless absolutely necessary. They are asking people, when possible, to call ahead to their doctors and stay home unless an illness is serious.
And, similar to what public officials are advising the general population, Adey does not recommend that her patients wear face masks when out in public or even at the clinic. “The only people I would recommend is if they’ve got a lot of close contact with the general public, and they can’t afford to be off work.”
While much has been made of the hoarding sprees for face masks, the empty hand sanitizer shelves are equally frustrating for Amelse. Every 48 hours, she has to mix and administer drugs she places in an IV that goes into her heart. Everything must be sanitized, and she typically gets monthly shipments of antibacterial wipes and sanitizer. If suppliers run out, she’s worried she’ll have to go to a hospital to have the drugs administered — exactly where her doctors don’t want her to be.
Officials are desperately working on a vaccine for the coronavirus for use in as little as 12 to 18 months. But many vaccines are made from live viruses and can’t be given to some immunosuppressed people.
Given the risk COVID-19 poses for people with compromised immune systems, the government needs to stress how important it is for everyone to follow good hygiene protocols, said Fishman. “The worst thing we can do is downplay it.”
And for those just getting up to speed on preventing infections, Amelse has advice: “Viruses don’t pick and choose; they will latch on anywhere,” she said. Even if it’s not a serious illness for you, “there are people in your life that you can infect. You have the obligation and the responsibility to take care of your loved ones.”
With coronavirus cases exploding in China, the U.S. is once again responding to a global epidemic. Five years ago, when the Ebola virus infected more than 28,000 people in 10 countries, many people were surprised to learn that four of these cases were diagnosed on U.S. soil.
Based on research I conducted for a book about the Ebola crisis and prejudice against certain groups of people associated with it, I fear that Americans might make immigrants the villain instead of the virus during the coronavirus epidemic.
If the U.S.‘ experience with epidemics tell us anything, it is that these events will be followed by increased public attention aimed at immigrants from China. This is because during epidemics, attention is typically focused on groups from countries where they started. And, this attention is rarely accompanied by an understanding of immigrants’ complicated experiences.
This does not imply that the Ebola virus and the new coronavirus are similar. Yet, there are important facets of African immigrants’ experiences during the Ebola crisis that can inform how Americans think about the current experiences of Chinese immigrants.
Some immigrants experience the devastation firsthand, because they had traveled to their countries of origin when the outbreak occurred. During the 2014 Ebola epidemic, for example, African immigrants visiting West Africa when the outbreak began lived through the ensuing social disorder, witnessed the rising death toll and feared infection from the deadly virus.
More often, however, immigrants experience outbreaks from afar. During the Ebola epidemic, my research shows that immigrants who remained in the U.S. were not spared from these emotional experiences. While advances in global travel and communications technology have helped immigrants maintain connections with these countries, they also provide channels through which the consequences of disease outbreaks abroad are experienced.
News of the mounting deaths of family members created a paralyzing feeling for immigrants in the U.S. who knew that they couldn’t risk traveling to the endemic countries abroad. At the same time, they felt being guilty about their inability to participate in customary burial rites.
But worst of all, blame
In addition to fear and guilt, however, immigrants often experience a great deal of blame. During the Ebola crisis, negative responses from Americans who used caricatures of immigrants’ ethnicity to stigmatize them as carriers of disease only worsened immigrants’ stress and fear. For example, many heard racist tropes about Africans’ presumed penchant for kissing corpses and their habit of consuming exotic beasts.
Stigmatizing immigrants does nothing to contribute to the fight against epidemics. Instead, such actions are usually counterproductive because they fail to incorporate immigrants into broader efforts to combat the spread of disease.
How immigrant communities help
Immigrant communities provide a critical line of defense for detecting, monitoring and preventing the spread of the disease, as I discuss in my book. With Ebola, these included the development of strategies to prevent the spread of the virus and improve public health by African immigrants after the first case of Ebola was discovered in the U.S.
Accordingly, African immigrant communities promoted initiatives to discourage travel to affected countries. They also helped develop systems for ensuring that Africans returning from these countries abide by quarantine period required by the Centers for Disease Control and Prevention.
Beyond these actions, West African immigrants took other practical steps to reduce person-to-person transmissions of Ebola, while also supporting efforts to address the consequences of the disease abroad. In addition, these immigrants promoted the practice of frequent hand-washing with chlorine-based solutions and discouraged social norms of hand-shaking withing their communities. These actions were complemented by efforts to assist in contact tracing, the identification of people who may have come in contact with infected persons.
Building on these initiatives, they also collaborated with local businesses and other mainstream institutions to care for families affected by Ebola and assisted humanitarian organizations working to combat the spread of disease in West Africa.
When a nation responds to epidemics by stigmatizing immigrants, it misses opportunities to build strategic coalitions for preventing the spread of viruses. Now that the first person-to-person transmission of the coronavirus has been confirmed in the U.S., the need for such coalitions has become more urgent.
In my view, our nation’s response to Chinese immigrant communities should be based on actions informed by facts and not fear. Without such actions, we risk failure in our attempts to build the resilient communities needed to prevent the occurrence of a greater public health emergency within our borders.