COVID Roundtable

Kavita Sivaramakrishnan: We convened this roundtable conversation in February 2021 as an informal dialogue among leading scholars, thinking about the current COVID-19 pandemic as a moment of historical convergences. This pandemic reveals persistent, historical asymmetries and inequities rooted in specific histories of mobility and immobility—migration and displacement, capitalism and globalization, colonialism and decolonization. The roundtable emerged from an editorial the CSSAAME editorial board wrote in May 2020 that reflected on the effects of COVID-19. That editorial noted that the effects of COVID were evident in “the intersecting crises of state violence and economic collapse—along with the multiplex failures of governing institutions” that were evident in all the regions that are addressed by CSSAAME's intellectual project.1 The pandemic and its multiple, complex manifestations brought “into relief a moment of history characterized by both global interconnection and deep ambivalence about it” and COVID's flattening, universal epidemiology masked and reinforced “systems of exploitation and brutalization that structure our world.”2The conversation that we have captured here reflects the nuanced and thought-provoking ideas and scholarship of the participants—Banu Subramaniam, Julie Livingston, Omar Dewachi, and Sunil Amrith—who all study the body and biopolitics. Their approaches range across global histories of medicine and science, anthropology, and feminist studies of science, environmental and transnational histories of migration, and studies of war and humanitarianism, but they share a broad interest in the shifting power of the state and in consequences of capitalism. Their discussion and lively debate affirms, questions, and speaks to new directions for research and analysis that emerge from this moment racked by deep moral dilemmas and historical reckoning. At a time when the body is at the heart of debates about controlling, containing, and reframing its viral exposures and epidemiological vulnerability, we see that debates about controlling access to therapeutics and immunity, sustaining rapid economic growth, and investing in productive populations are now more open than ever before.To begin, we posed several broad questions to initiate a discussion among our participants, and to suggest a common perspective, viewing COVID as having specific stages and developments. Imagining it as having a “lifecourse” links complex biological and social phenomena, but also reveals how virality is politically perceived and linked to social and historical conditions.Our questions were: How might we consider the link between epidemic and endemic crises, especially drawing from experiences of metabolic risks, embodied pain, toxicity, violence, and stigma that have long and persistent afterlives?Epidemics have also long been associated with moments of dramatic, transformative rupture and of social discontinuities. Yet they can also be viewed as generating impulses toward reconstitution and reorientation, as in the case of the HIV/AIDS crisis and the moral, political, and public health debates it generated and reframed. How might we reconsider this binary between notions of rupture and of reconstitution today in the case of COVID? In other words, how do shifts in notions of a continuous historical timeline also create new possibilities for the future, or of collective forms of futurity themselves? What moral reworkings and realignments may emerge from this pandemic?Finally, there has been a deepening of global biopolitics, international and national surveillance mechanisms, and health-security-focused laws that have implications for mobility, migration, privacy, and safety as legal, moral, and biological justifications have often been conflated. How do we understand these shifts now, as well as past and present responses and resistance in the face of such deepening interventions?In addition to our participants, we warmly thank our observers, Devon Cheney Golaszewski and Valentina Parisi, who joined us and engaged closely, refining, clarifying, and articulating crucial threads of this roundtable. Their support and input were indispensable.• • •Banu Subramaniam: Pandemics reveal layers of racialized bodies and dichotomies of biology/culture. I come to this discussion as a biologist and see the unfolding global life of the virus SARS CoV-2 as yet another lesson about our impoverished accounts of the natural world. Coming from feminist Science and Technology Studies (STS), I see yet another moment of a reinscription of an abstract binary of nature and culture, rather than understanding the unfolding pandemic as an instantiation of racialized nature-cultures. The pandemic reveals rich and layered sedimentations of race: racialized bodies, racial Others—virus and human alike. From the vantage point of feminist STS, the virus is not “evil,” “Chinese,” or “foreign.” It is a single strand of RNA. Planet Earth in 2020 proved fertile ground because of the world created by some human actions, including the increased colonization of the wild, opening new pathways of viruses into human worlds; globalization hubs that transmit goods and people everywhere; and an impoverished health-care system that renders the virus lethal to some. The pandemic is a racialized nature-culture object par excellence.In particular, xenophobia and Orientalist discourses have dominated our narratives of the virus and its origins in China. Through the language of “yellow perils” and “yellow alerts” in keeping with Orientalist rhetoric, the virus has been rendered “sneaky,” “cunning,” as “an assailant,” “shifty like a chameleon,” “an invisible enemy that is pure evil,” and called “the Chinese virus,” “the Wuhan virus,” “the kung flu,” and “the anti-Muslim virus.”3 In India, early during the pandemic, there was an international gathering of the Tablighi Jamaat in a mosque in South Delhi. Despite similar gatherings of Hindu groups, this event generated great publicity as a “super spreader” event. It fed already rising anti-Muslim violence, and claims of a “Talibani crime” and jihad. The leader and some others were charged with manslaughter. A year later, some are still awaiting trial.4The idea of the virus as enemy has sanctioned militaristic models of immunity: to fight, battle, combat, attack, tackle, defeat, and defend. Coming from a long history of an antagonistic model, the immune system has been considered military central, commanding a hierarchical organizational structure with weapons of offense (e.g., PPE as “armor,” hospitals as “war zones”), medicines as “ammunition ready for deployment,” and “frontline” workers. These concepts represent a racially stratified militarized force of health workers that is “ready for anything.” These metaphors frame our conception of infection and immunity. Responses have also built on these militarized models, though lockdown, quarantine, and armies of scientists. This is based on a self-other model of immunity that renders the virus as the enemy and humans as victims. In fact, in severe cases of COVID, the immune system overreacts and kills, rather than the virus itself. Something more complex is afoot. I feel like we have taken a step back from the flexible bodies discussed by the anthropologist Emily Martin during the HIV/AIDS pandemic to an older model of conceptions of antagonistic immunity/immune systems.5I also want to talk about how zoonotic diseases are not only ubiquitous, but transformative too.I am struck by how zoonosis—when a disease moves from animals to human—has been represented as an unusual, dangerous event caused by primitive people living too close to nature and eating weird food. In fact, zoonotics are ubiquitous, and three-quarters of infectious diseases are zoonotic spillovers. Zoonotic vectors, like viruses and bacteria, carry genes across species allowing for lateral gene transfer. Evolutionary biologists have long shown that such events have profoundly shaped the evolution of life on earth, including transferring novel and beneficial adaptations across species.The same biological populations do not present the same mortality/morbidity in the West (e.g., Black and Indigenous populations). Black and Indigenous populations in the West have been hardest hit. The same biological populations in other parts of the world have not shown the same mortality (for example individuals from South Asia and countries in Africa during the first wave have been said to show lower mortality in their home countries than in diasporic populations in the West). Social and national contexts, rather than population or biology, seem to be the key factor.Further, race emerges as a biopolitical strategy of obfuscation. Some deaths are seen as inevitable and medical languages naturalize and biologize the deaths of marginalized populations in abstract language of “comorbidities,” “biological propensity,” and “genetic predisposition.” This is the repetition of a racialized script during yet another health crisis, while we see little change to health infrastructures between crises.The language we have used during the pandemic is neither obvious nor inevitable. There are other ways to represent this point: The terminology of physical distancing/cocooning/social distancing have been offered as alternate vocabularies for “pandemic safety.” The continued insistence of alienating language of “social distance,” “lockdown,” and other vocabularies of the pandemic represents an impoverished political leadership, where “physical distancing” became “social distancing.” A robust body politic could have promoted sociality without physicality. This aligns with policy (e.g., bars are open, but schools are closed).Our focus should not be on the virus, but on systemic issues and oppressive systems that enable pandemics of various kinds. We cannot blame the virus—this misunderstands the role of viruses and bacteria on Earth. Rather, humanity creates a way of life that can render epidemic- and pandemic-prone diseases effective or can help avoid them in the future.Julie Livingston: I want to address the introductory questions that were a starting point that Kavita posed for us and want to begin by exploring the link between epidemic and endemic crisis in three different ways.First, the virus helps surface the burden of endemic disease, that is the extant burden of debility and suffering that we accept as the normal “cost of doing business” from the scarred lungs of factory workers and miners to diabetes, heart disease, and hypertension. We know that these underlying burdens of disease map onto political and economic fault lines. This pandemic crisis event shows us an acceleration of “business as usual” in a way that suddenly can't be ignored. That potentially opens political possibility as well as shuts it down, depending on how it's framed.Second, we observe how epidemics produce effects across a wider field of disease in ways both predictable and not. I believe strongly that we need to move beyond “case” and “mortality” metrics with which we are obsessed. The AIDS epidemic is my model—the one I've seen up close in southern Africa. What I saw in Botswana was that the AIDS epidemic rebirthed the TB epidemic (although TB had never gone away, but it took on a whole new life as it attached to the AIDS epidemic). The afterlife of the AIDS epidemic helped birth the cancer epidemic. It's true that some of that cancer epidemic would have happened anyway, but it was given new life through its attachment to the AIDS epidemic. While this is shorthand for complex epidemiological and biological processes, what I want to emphasize is that beyond the surfacing of an extant burden of disease, we also see engines of combination/proliferation of disease, even if we do not know exactly where they are leading.Third, we can already see this through the rhetoric surrounding “Long COVID.” People have survived COVID with brand-new cases of diabetes, damage to heart muscle, loss of hearing, with many other forms of cascading and prolonged symptomatology. This reveals the impoverishment of our health systems. They are simply not designed around the forms of care and mutuality that are required for well-being by people who are grappling with long-term debility. It also helps reframe the relationship between the economic and the biological. For example, our current systems are predicated on the “worthy” versus “unworthy” in relationship to labor, and we find this problem being faced very squarely. We have a long future to come even once infection and hospitalization rates subside.History (and biopolitics 101) tells us the obvious: the economy and population health are two sides of the same coin, not opposing forces, even though they have been rendered that way in the policy and rhetoric around this pandemic. This rendering is purposeful and instrumentalized; it is a convenient political way to manage opposing forces who have different claims on the state—when you have, as we did in the US, a state that decided under the last administration that it was not going to attend to the pandemic at all. Not surprisingly, in the “not tending to it,” some people made a huge pile of money, even as so many others struggled to eat. We have to pay attention to the dramatic upward-sucking of wealth that this produces; it is not accidental. If we are going to have a large population grappling with the sequelae of the virus, some people will also make bank off of their needs. We need to understand those economic interests.With COVID, we see how industrial practices are productive of this pandemic, just like they have been for many epidemics that have come before it. For example, if we look historically, we can see that gold mining in South Africa produced a massive tuberculosis (TB) epidemic, which is still plaguing the southern zone of the continent.6 If we look at those industrial relationships under COVID, we can see that the conditions of the possibility are ongoing. Public health needs to be more focused on the upstream causes of these pandemics, including how human action transforms and harms the environment in dramatic ways. We created the conditions of possibility for this pandemic through our industrial practices, which combined the enclosure of some of the last wild places, the evisceration of wild forests, and broad-based industrial agriculture. There are long histories of this—such as sleeping sickness in the Congo in the early twentieth century, when people were driven at the point of a gun or machete to collect wild rubber in environments that they knew were unsafe.7 There are many other cases. Remaining wild habitats are complex and under pressure; they house potential zoonotic pathogens, and when agribusiness cuts the forest, it allows those pathogens to move into closer proximity to humans and domestic animals. We saw that with the fruit bats associated with Ebola, where multinational corporations are undertaking a massive land grab in the Mano River region. This dispossesses the people who held customary tenure, but it is also terraforming in ways that pressure wild habitat.Parallel to that, when pathogens enter our industrial meat industry, this also reflects transformation potential for epidemic/pandemic-prone disease because of the fact that animals are bred to be genetically similar, with an eye toward market preferences. This is dangerous to us as well as to the chickens being bred to have more breast meat for sale. In agribusiness, we manage those effects through pharmaceuticals and chemicals, which feeds back into the problem, while also creating an incentive within biotech. So, you get a market for the materials that can tend to the problem caused by agribusiness in the first place. We are encased in a profit cycle. If we look at flows of wealth, we see elements of the profit cycle. I am not saying I see someone behind a curtain directly trying to create a disaster for profit. But these systems are built with internal contradictions and great money and power, leading them to develop patterns that are hard for any one person to break.Public health needs to move upstream and “name” this system and not allow what Banu pointed to—the obfuscation of this system by an attention to rhetoric, much of it racist models (such as exoticized attention to “wet markets”). A similar process of racialized obfuscation occurred with the “cut hunter” thesis around HIV in West Africa. These are easy to turn to because we are saturated with the racial models of causation, but public health must resist this. My own name for the system is self-devouring growth.8Finally, on the subject of rupture and continuity/possibility. It is hard to tell. I think that the National Health Service (NHS) in the UK might have been saved by this; we see with the NHS, that if you have a public health system, you can actually possibly accomplish some things, but that you cannot with the piecemeal privatized system that exists in the US. We have seen though that citizens in the US got a basic income grant—that was surprising for this country. The existence of a non-labor tied basic income grant, albeit it temporary, was a political occurrence that was quite surprising. We see all kinds of new possibilities out of the pandemic—just as we do out of the Black Lives Matter movement, or in Nigeria, the protests against the Special Anti-Robbery Squad (SARS). But we also see the hardening of borders, intensification of limits on migrants, a looming food crisis, and new forms of police brutality for the management of the pandemic in Johannesburg, Nairobi, and elsewhere, and we also see the upward sucking of wealth.We also do not see a vaccine commons, but instead are yet again governed by a private property/secret knowledge model of the vaccine. This contributes to competition over supply, vaccines shortages, etc. It's really bad public health. Really bad. And yet the US and Europe just doubled down and refused the TRIPS waiver to allow generic manufacture of the vaccines for distribution to low and middle-income countries.Omar Dewachi: To address this discussion, I am going to offer more of a local and regional perspective, mainly from my work and research on medicine and public health in conflict settings in the Middle East. Over the past decade, I have been documenting the “unraveling” of biopolitics in the Eastern Mediterranean states through documenting the human experience of health care, displacement and state breakdown under protracted conflicts, and the transformations of what we could call “local biologies” of these interconnected geographies. While there has been a lot of attention to how the pandemic has reinforced forms of surveillance and biopolitical models, I see, in this region, the unraveling of biopolitics and potentials for surveillance. Increasingly, the body politic has become more and more ungoverned.With this perspective, one of the things I see in the region is a continuation of a “biology of history” in tandem with the breakdown of health-care infrastructure.9 For example, the rise of antibiotic resistance in different warzones/conflict areas in Iraq, Syria, Lebanon, Yemen, and Libya. What is really disturbing is the way that COVID-19 has sped up antimicrobial resistance processes in these areas contributing to seeing intertwined epidemics. We've seen in the context of war and political instability “anarchy” in terms of antibiotic use and breakdown of sanitation inside hospitals. This is accelerating under COVID, mainly because ICU units are becoming clogged with patients and there is considerable and haphazard use of antibiotics and antimicrobial agents. Thus, the clinic has become increasingly toxic.Before COVID, there was considerable movement of patients seeking health care across national borders and therapeutic hubs as patients dealt with collapsed health care systems in their home countries.10 Iraqi patients would go to India, or Iran, or Turkey for common medical and surgical procedures and to seek medical care in a stable health-care environment. Now COVID has limited that movement of patients. At the same time, there is widespread death linked to antimicrobial resistance inside hospitals dealing with the COVID crises. When I investigate these deaths, I get the impression that the majority are dying from complications from hospitalization, mainly from septicemia, or blood infection with antimicrobial resistant bacteria. This problem varies from one place to the other and depends on the layout of the country's health-care systems. One interesting example is the comparison between Lebanon and Jordan. Jordan has a health-care system that depends on small-clinic systems, rather than big hospitals. In the case of COVID doctors also provided medical service to patients in their homes. In Lebanon, hospitals are the main care facilities, and this is where you see more cases of death resulting from a dependence on a failed and toxic hospital-based care system. All of this is compounded by the financial crises and the environmental toxicities that have contributed to increasing rates of cancer, which are affecting younger populations more aggressively than before.11With regards to the second question, one of the things that happened before COVID was multiple social uprisings in places like Beirut and Baghdad (not to mention the fact that the Syrian conflict has been going on for nearly a decade). When the virus erupted, these protests were in full gear.In Iraq, COVID has been dwarfed by broader political misery and violence.12 Since October 2019, six hundred people have been reportedly killed and between 9,000 and 25,000 injured in one year of nationwide protests.13 Assassinations and kidnappings are ongoing and recently there has been a return of suicide bombs. Protesters in the street through their chants and slogans equated the pandemic to the deeply seated “political corruption” under decades of post-occupation militia rule. In fact, demonstrations are articulated as biopolitical demands for the state to better regulate “life” (provide health care, clean water, electricity, and a clean environment, for example). In this context, a laissez-faire attitude has emerged regarding virus control/management (although the country was one of the first to close the borders). Religious events are continually happening, because the state cannot control religious militia parties that draw support from these events.Where do we go from here? I think the Middle East in general is going to be facing a bit of an existential question over health systems that were built over decades of the solidification of the nation-state. What we've been witnessing since the 1980s and 1990s is the implosion and collapse of these infrastructures. I am not very optimistic of where things are going, and I am also trying not to project or speculate into the future—a phenomenon that has become accentuated in political and scientific discourses about the pandemic with all kinds of modeling exercises. But we really don't know—there is so much unruliness and confusion as the “contagion” unfolds as a biosocial artifact. Having said that, in the Eastern Mediterranean, there needs to be a serious biopolitical reckoning through the restoration of the body politic and newfound respect for humans and the environment.Sunil Amrith: On the life course of epidemics, I was struck by how this pandemic was simultaneously utterly predictable and shocking. At least in a small way it has torn a hole in the sense of insulation among the privileged in the world, who have viewed themselves as “immune” to such risks, and the rest of nature. Of course, there are many, a majority, for whom such insulation has never been an imaginable possibility. So much of the commentary in the US—but also among the privileged sections of countries across the global South—has been, “How could this happen to us?” I have been sitting with that, and what it makes visible. What it ought to make visible is the “endemic epidemics,” or the tentacular “epidemic of environmental risk” (as Kavita and Julie have noted). What has been made visible instead is what Banu spoke about: a predictable “geography of blame” with fault lines around migration and the racialization of public life.What is unprecedented here is maybe the response. There was an interesting intervention by Adam Tooze early on in the lockdown,14 arguing that this pandemic has blown up our basic expectation that the interests of the economy would always trump everything else; or the fact, as Julie mentioned, that for three months Americans had a guaranteed basic income, which would have been very hard to predict. Although it may be more complicated than that—as Julie noted, we have still seen the transfer of wealth to the very wealthy despite what appeared to be a series of health measures that struck at the heart of certainly many corporations' business. How do we account for the nature of the responses we have seen?On the subject of transformative rupture that Kavita posed to us, as a historian of South and Southeast Asia, the parallel for me is not to a past epidemic, but to the Great Depression in Asia. That's the last time in Asia that you see sudden and total transformations (even reversals) in migration flows between South and East Asia.15 The depression ended the expected normality of circular migration to and within Southeast Asia for the next generation. After a period of fifty years (starting in the 1870s), when the number of new arrivals from India and China to Southeast Asia always exceeded the number who left, migrants were deported, or chose to go home, because the conditions on which they had built their migratory lives were no longer tenable. The long-term consequences of that were not foreseeable, but for a generation, the patterns of migration, attitudes toward migration, and the possibility of migration were transformed. I wonder if we will see any change in attitudes toward and practice of migration following this pandemic. In the 1930s, the Great Depression shifted attitudes in the countries of migrants’ origin as much as in their destinations. Until the 1970s, for example, the Indian government was very hostile toward overseas migration.Then there is biopolitics and surveillance, and I think Singapore provides a good instance of some of the dilemmas at work. Singapore appears exemplary at first glance in terms of pandemic control—and in many ways, it has been. But in Singapore, probably more than any other place I know, the concentration of the suffering in the lives of migrant workers has been so extreme. There have been very few cases outside the migrant labor community, but within it has been hit very, very hard. In April 2020, 40 percent of migrant workers were testing positive, at a moment in which there were very few cases overall.16 In Singapore, the very rhetoric of “community cases” excludes migrant workers. They are not considered part of the “community” despite the fact that there are close to a million of them resident in Singapore. Additionally, these migrants continue to live in isolation, while for others, things are opening up. Migrant workers can leave state-sanctioned dormitories only under strict conditions—they must get permission to leave their dorms for just a matter of hours to undertake errands. While Singapore did not deport these workers like other countries did, the state increased its surveillance of this population. There has been a big debate about this: it has also led to a powerful critique from civil society groups in Singapore of how migrants have been treated, and—at best—has created new spaces of solidarity and empathy.I am also struck by the geography of the pandemic. The countries that “did well” are almost entirely in East and Southeast Asia (with New Zealand as rather an exception). This is not about democracy vs. authoritarianism—as it has often been portrayed in the Western media—but rather about different relationships between states and citizens (Julia Adeney Thomas has made this point well17), and higher levels of trust in both the state and expertise. This is where what Omar said struck me, perhaps it explains it. I think we are looking at the contrast between those countries where biopolitics is unraveling—including the US—and those where biopolitics is inscribed in everything. This is not about democracy versus authoritarianism, but different historical trajectories. Countries that have done very well, like Taiwan or Korea, all had their moments of economic growth at the moment of the birth of neoliberalism, but they are also shaped by longer historical trajectories, such as histories of Japanese colonization and forms of colonial medicine and health surveillance (compared with say the British in India).OD: It is interesting that there is a current shift in global health discourse around health-care systems with an emphasis on universal health care as opposed to decentralization. This has become tied to conversations about which states are succeeding and which are failing in response to the pandemic. These questions have critical histories and genealogies. Health care became a central problem for state building in Iraq during the twentieth century under the British mandate.18 At first, the British goal to create a unified health system was resisted by a call for decentralization, but then the Health Directorate, under Iraqi-British doctors, used the cholera epidemic of 1923 as a political opportunity to argue for a more centralized universal health system and a platform for state building. Even during moments of crisis, such as the 1980s Iran-Iraq war, state biopolitics became consolidated, with decreases in infant and maternal mortality during the longest conventional war of the twentieth century. However, since the 1990s, during the Gulf War an