âWeâre all in this togetherâ. This hopeful mantra, widely expressed by the media, political leaders, and scientific experts in the early stages of the COVID-19 pandemic, was meant to generate a sense of security suggesting that through collaborative efforts the world would quickly overcome this historic global disaster. The reality is turning out quite differently. The COVID-19 pandemic, like other global catastrophes, reveals the many deep-rooted and far-reaching inequalities throughout the world affecting vulnerability, treating and containing the virus among individuals, communities, and nations. While some of these inequalities are related to biological factors such as age, sex, and prior medical conditions, the disproportionate impacts of COVID-19 are based on the seldom acknowledged and often suppressed inequities rooted in structural differences such as national economic development, minority group status, sex and gender, class divisions, working conditions, citizenship status, geography, political ideologies, and widespread discrimination.
The spread of the virus on a global level has undoubtedly been exponential rather than arithmetic (see Ryan 2021h and Ryan 2021i for an early timeline of the pandemic). For example, the third week of April 2021 alone witnessed more confirmed cases globally than the entire first five months of the pandemic. In other words, rather than a steady increase in the number of cases and deaths, we have witnessed increasing rates as contagion begot more contagion. We have also witnessed a unique realization of global interconnectedness as countries responded with a breadth, and depth, of measures to combat a unifying global health crisis that had not been witnessed in more than a century. Thus, this book will take as a central theme the importance of connectedness. In a territorial sense, the current pandemic has highlighted both the magnitude and the diversity/variety of transglobal connections. Environmentalists and anti-nuclear activists have been making this claim for decades, but the COVID-19 pandemic, and its rapid global spread, has made that claim all the more difficult to ignore. It has also highlighted the interconnectedness between various social systems, on local, regional, national, and global levels.
The impact of the virus has spread well beyond the realm of the medical, also heavily impacting social, cultural, economic, political, and the everyday ways of living for nearly every human being on the planet. It has impacted not just the way we live today, but also the ways we will be able to live tomorrow. In sum, the virus is a medical issue, but one that has had profound impacts on the connected areas of education, housing, employment, discrimination, food security, and religion, to name just a few.
Ryan (2021c) notes that âA pandemic is a moment in which the overlap of the cultural and natural dimensions of reality becomes visibleâ (6). Further, Astorino and Nicola (2021) utilize the concept of a viral cloud to better understand how the SARS-CoV-2 virus has been transformed into an active cultural agent. They define a viral cloud as representing, âthe entanglement of virus, host, and humans (and culture), which allows the virus to become visible (Lowe 2010). This includes media narratives of the impact of infectious agents on public health. It also includes the material practices in response to an emergence eventâ (185, emphasis in original). Thus, they argue that, âThe viral cloud can make the virus visible, in relation to cultureâ (193).
Indeed, it is important to understand the ways in which the virus, its host (be it human or not), and society interact with relation to viral entities. Viruses have social impacts and society impacts viruses. For example, the rapid spread of the SARS-CoV-2 virus has clearly led to tremendous impacts across a realm of social indicators. On the other side, social forces â including cramped crowding conditions, underfunded medical systems, and certain political and religious beliefs â have also allowed the virus to spread more easily. The relationship between virus and society is two-way, interconnected, and, in many ways, interdependent.
In this book, we will examine not just the biological and medical impact of the virus but also the social, cultural, economic, political, and other human dimensions of the pandemic. The virus has infected bodies while the pandemic has impacted societies. This book thus aims to provide insights into the relationship between the medical and the social, the virus and the pandemic, the impacts and the consequences, and the disparities and the opportunities created by this world-changing global event.
This chapter will begin with an exploration of the important difference between impacts of the SARS-CoV-2 virus and the COVID-19 pandemic. We also introduce the value of metaphors in understanding the pandemic as well as the necessity of understanding pandemic impacts in concrete material terms. The chapter concludes with an introduction to each of the chapters in the rest of the book.
The SARS-CoV-2 virus and the COVID-19 pandemic
It is important from the outset to distinguish between the SARS-CoV-2 virus, the virus responsible for causing the disease more commonly labeled as COVID-19, and broader references to the COVID-19 pandemic (Ryan 2021e; Ryan 2021f). A virus is an entity (whether it is alive or not is still highly debated â see Astorino and Nicola 2021) that infects living organisms. It requires a host to survive and reproduce. The term âpandemicâ, on the other hand, refers to the outbreak, occurrence, and spread of a particular disease. In that sense, it has a much more prominent social connotation. There is a clear overlap but there are also important distinctions. Medical doctors, for example, are primarily responding to the SARS-CoV-2 virus, while politicians, economists, and social scientists are primarily responding to the COVID-19 pandemic.
One way of better understanding the relationship between medical and social factors is to understand the difference between contagion issues and systemic issues. Contagion refers to how likely something is to spread, how easily it spreads, and how quickly it spreads. We can think of the SARS-CoV-2 virus as something that is contagious. A systemic issue refers to something that is an underlying factor in how societies operate, is widespread, and is part of a broader system. We can think of issues of inequality and discrimination as systemic. However, one thing that the COVID-19 pandemic has made clear is that these are not separate issues. In fact, we have clear evidence that systemic issues have directly informed many aspects of contagion â for example, how closely together people live, the type of employment one is/was engaged in, access to information and medical care (whose own unique relationship to each other has also become increasingly clear), and oneâs racial and ethnic heritage have all become predictors of oneâs likelihood of contracting, and spreading, and dying from, the virus. While medical doctors have historically focused primarily on issues of contagion, social scientists have historically focused primarily on more systemic issues. The COVID-19 pandemic has highlighted the value of both areas of focus, as well as the need for a conversation between the two.
The tenuous differentiation between health and society has perhaps never been so fraught and the importance of understanding their inextricable relationship so clear. One conceptual response to the blending of medical and social issues is the notion of a âsyndemicâ. A syndemic analysis implies examining not only the health consequences of disease interactions but also how they interact with the social, cultural, economic, political, and environmental factors that promote, and worsen, disease. In short, a syndemic is the meeting point of understanding how the medical impacts the social and how the social impacts the medical. Thus, although for reasons of conventional language we will use the terminology of âpandemicâ throughout this book, we wish to highlight that many of the issues we will be exploring are perhaps better thought of as syndemic in nature.
Conceptualizing the virus: Metaphors we live (and die) by
The human eye is incapable of seeing the SARS-CoV-2 virus on its own. Knowledge of viral infections is reliant on confirmation through expert testing or assumptions made on the basis of physical manifestations (headaches, fevers, even death). In other ways, however, knowledge of, and discussion about, a virus is reliant on more social phenomenon, including media stories and cultural metaphors. Thus, while a purely medical perspective emphasizes working out the biological compositions of viruses, when considering a social perspective to a biological entity, it is also important to consider how viruses are conceptualized.
Modern society is rife with âepidemicsâ. In many ways, âepidemicâ has become one of the buzzwords of the 21st century, whether in reference to obesity, opioid addictions, crime, misinformation, social media, tourism, or a litany of other potential social ills. In short, the term âepidemicâ has been socialized to refer beyond the medical realm to anything viewed as widespread and harmful to society.
In a similar vein, the term âviralâ has gone, well, viral. Rather than refer to the transmission of an infectious agent, âviralâ is more commonly used to refer to the rapid widespread dissemination of a social or cultural artifact. Thus, videos on YouTube, memes on Facebook, and social blunders are often more frequently referred to as having gone âviralâ than viruses themselves.
One consistent theme throughout the pandemic has been the use of metaphors to think of ways to understand, communicate, and mitigate the virus. While useful, metaphors, however, also run the risk of demedicalizing, and, in many cases, politicizing the virus. For example, Trumpâs declaration of war on the virus and arguing that he was a war-time president, both presented images of the virus as something to combat in militaristic fashion. As a metaphor, the utility of this is itself debatable. As a practical response, it is most certainly useless. The virus has no friends or enemies, it has no intentions, it doesnât even have weapons. It is simply an organism which, like most other organisms on the planet, is seeking ways to thrive and reproduce. Thus, while perhaps useful for conceptualizing the virus, the declaration of war against an organism that lacks intent, direction, or affiliation is not a particularly productive way to stop its spread.
The virus has also been given a level of metaphorical agency that in biological reality it does not have. For example, we often speak of the virus âravagingâ populations, âdestroyingâ lives, and âkillingâ economies. We will, in fact, use such metaphors throughout this book. The reality, however, is that the virus itself only seeks out hosts to survive and reproduce. It does not seek to ravage, destroy, or kill â only to survive. Thus, while useful, and as we will do, utilizable, it is important to remember that these conceptualizations of viral agency are metaphorical rather than literal. As Astorino and Nicola (2021) note, âDebate about viruses is a debate about human society because biology and culture come together through the processes these microbes enactâ (193).
Metaphors can also sometimes be dangerous. For example, during his presidency, and even through to the time of writing, Trump frequently refers to the SARS-CoV-2 virus as the âChina virusâ, among other racially charged names. While it is largely accepted that the virus first spread to human beings within the geographic confines of the Chinese state, this does not make the virus itself Chinese. What this means is that the first reported (emphasis on reported) case of the virus entering the human population occurred in a particular country for reasons potentially linked to the cultural, physical, geographic, temporal, economic, and a range of other social factors related to that country. In other words, the association of a virus with a nationality (a trend that has sadly continued with the multiple variants of the SARS-CoV-2 virus) is a politically charged way of communicating a pathogen that has no knowledge of, or interest in, manmade geographic perimeters.
The above criticisms in place, metaphors can also serve positive functions in pandemic conceptualizations. New Zealand, for example, implemented the now viral, if you will forgive the pun, metaphor of âthe bubbleâ to help communicate lockdown and stay-at-home measures. Trnka and Graham Davies (2021) have defined the metaphor of the bubble as âan exclusive social unit whose members are allowed physical contact amongst themselves but not with othersâ (167). In many ways, the bubble has served as a useful metaphor for thinking about social distancing (itself a problematic metaphor perhaps better thought of as âphysical distancingâ) and other socially enacted preventative measures. For example, thinking about existing within a bubble is generally less threatening than thinking about living under âlockdownâ. Bubbles are also seen as soft, playful, and non-threatening. In short, bubbles are good. That said, even the bubble metaphor proved a bit problematic in the end as not all bubbles are created equal. For example, those living in households with domestic abuse, with flatmates who provided no real sense of kinship or support, or in other precarious situations did not benefit from the security implied by a bubble metaphor. Thus, while useful, even the metaphor of the bubble is itself a bit problematic (see Trnka and Graham Davies 2021 for an extended discussion on the bubble metaphor, including ways to potentially improve it).
In sum, the ways in which we socially conceptualize the virus perhaps have as much to offer to the ways in which we understand it, its spread, and its impact as the ways in which the virus itself acts as an infectious entity. Thus, in line with another central premise of this book, biology and society cannot, and should not, be separated.
Pandemic inequalities
The COVID-19 pandemic has laid bare and exacerbated the underlying weaknesses of every society it has touched: vast economic inequalities, overdependence on global production and trading chains, disastrously weak medical systems, national inequalities regarding testing capacity, access to medically necessary protective gear and technology to treat and contain the virus, corrupt and self- serving politicians, racism, particularly against those appearing to be of Asian descent, and widespread cultural denial.
Keeanga-Yamahtta Taylor (cited in Hannah-Jones 2020) has pointedly stated that the COVID-19 pandemic has âpulled what is hidden and buried on the bottom to the surface so that it canât be ignored. It is a radicalizing factor because conditions that have been so dire, now combined with revolts in the street, might lead one to believe that not only is the society unraveling, but it might cause you to question what foundation it was built upon in the first placeâ (53). Indeed, the unequal social impact of a virus that is blind to social difference can tell us much about the ways in which our societies are constructed. Diseases do not distinguish their hosts by race, class, gender, or sexuality, but pandemics unearth just how much human beings do.
An understanding of structural violence provides an important framework for analyzing the social implications of the COVID-19 pandemic. Mungo (2021) defines structural violence as âa direct result of the maintenance of the social and economic structure of society that preserves the dividing line that separates the weak from the powerful, the poor from the rich, and the inferior from the superior, while wreaking havoc and harm on those who cannot afford to pay or lack the ability to earn their way up the social mobility ladderâ (245). In short, a structural violence framework takes account of the ways in which existing social constructs, institutions, and ideologies create, and re-create, existing inequalities.
Structural violence, however, is an especially challenging culprit to pin down since, âUnlike physical violence, which can be observed and often has an apparent perpetrator and victim, structural violence is difficult to see and assigning blame to one individual is challenging. It is camouflaged in social practices, policies, safety guidelines, and prevention recommendations that distribute power, access, and opportunity unequally, harming many victims simultaneouslyâ (Mungo 2021, 245). Structural violence is, in many ways, invisible because it is often deeply embedded in the very structures of societies. Thus, it often goes unnoticed because it is written off as the result of âordinary difficultiesâ that individuals encounter (Lee 2016, 110). In short, we often excuse structural violence because we see its victims as having personal problems, rather than being the victims of larger public issues.
Our analysis here recognizes the importance of structural violence and its role in unveiling the unequal impact of the COVID-19 pandemic on individuals, communities, and nations, a fact often suppressed or invisible. For example, we will highlight how economic inequality between and within nations significantly contributes to the chances of contracting and dying from the virus. We will also acknowledge how nations with weak health care systems, workers whose jobs cannot be performed remotely, the differences between those with and without access to soap and water to wash their hands, and the ability to practice physical distancing, also account for the unequal impact of the virus. We will also acknowledge how racial and ethnic minorities experience higher death rates from COVID-19, which has also unequally affected indigenous peoples and urban and foreign migrants around the world. Finally, we will call attention to the ways in which inequality is also embedded in international responses to COVID-19, as giving and receiving aid is often impacted by inequalities of national power and influence, resulting in global competition rather than the collaboration needed to end the pandemic.
Perhaps more insightful of our status as a global human community than the reported numbers of cases and deaths has been the extreme variation in ways that individuals, communities, and nations have responded to the crisis. In addition to being a global medical pandemic, COVID-19 has done much to lay bare the ways in which we as human beings sharing a single planet view ourselves in terms of nation-states, races, ages, institutions, political ideologies, social classes, and, indeed, members of a shared humanity. While the pandemic has brought humanity together in some noteworthy ways, it has also laid bare many of the systemic inequalities that lay at the foundation of our global society.
Layout of the book
The design of this book is such that chapters can be read in any particular order. Although a chapter by chapter read will help highlight the building nature of our overall argument â namely the unequal impact of the pandemic â interested readers can skip back and forth between chapters without a substantial loss in understanding. That said, we obviously encourage readers to not skip any pages as another of our central arguments is to understand the ways in which the various topics we will address are all inextricably interconnected.
In Chapter 2, âPandemic numbers, consequences, and contradictionsâ, we will examine some of the quantitative aspects of the pandemic, including a closer look at reported infection and death toll counts. We will also explore how these numbers compare to those of other global kill...
