FOREWORD
In Breughel’s Icarus, for instance: how everything turns away
Quite leisurely from the disaster; the ploughman may
Have heard the splash, the forsaken cry,
But for him it was not an important failure; the sun shone
As it had to on the white legs disappearing into the green
Water, and the expensive delicate ship that must have seen
Something amazing, a boy falling out of the sky,
Had somewhere to get to and sailed calmly on.
—W. H. Auden, Musée des Beaux Arts
Catastrophes are curious things. Earthquakes, hurricanes, fires, and floods have persistent meaning for those who directly experience them. For others, they are a fleeting news item glanced upon while flipping through cable news stations, heard about while scanning for their favorite radio station while driving to work, or perhaps seen in today’s headline but not tomorrow’s, where the story shows up on a page deep inside the newspaper, already fading. Catastrophes are forgettable.
But what to make of COVID-19, a catastrophe that is global in nature? Millions dead, millions more grieving for those gone, millions of lives and livelihoods disrupted, many still living with the lingering symptoms of long COVID. While the virus is still with us, killing thousands a month in late 2023, in early 2024 in the United States alone nearly everyone has seemed to move on.
This is the conventional wisdom, adopted as policy since most pandemic programs sponsored by the US government have faded away and by ordinary people who go about their business unbothered by the pathogen in their midst. Now and then you’ll walk into a shop where those tending the till are masked up, see a scattering of people on the train similarly attired, hear someone remark that they tested before going to a conference or seeing relatives, or note a lone air purifier in someone’s office humming quietly away. These are artifacts, the signal traces of the catastrophe—what is left behind.
What are COVID studies but a reclamation, a retrieval from the ash heap, a talisman against collective amnesia, a memorial against forgetting? The editors of this volume and the authors herein are thus rescuing us from ourselves. There were many in-the-moment hot takes on the pandemic over the past four years, which were about trying to explain the present to those living in it. This volume tries to explain what we are living through now and into the future.
This is vital. I know what it is to forget. It is over forty-two years since the first mention of AIDS in the United States. Since then 40.4 million have died from the disease around the globe. Because this now-old pandemic started off in the United States among gay men, people who use drugs, sex workers, and other marginalized populations, no one took notice. Everyone, in the words of W. H. Auden in the poem “Musée des Beaux Arts,” turned “away quite leisurely from the disaster” as they turned the pages of their newspapers, glancing at the occasional story about what was happening. In the White House, Acting Press Secretary Larry Speakes made homophobic jokes as reporters asked him about the new disease. President Ronald Reagan didn’t mention AIDS in a speech until 1987, six years after the crisis began. It is easy to ignore other people’s suffering as a political and personal choice, particularly when it is happening to what the writer and AIDS activist Larry Kramer called “disposable people.”
This is forgetting in the present tense. It’s putting a catastrophe to the side, in a place out of sight, out of mind. It’s what we do now with COVID: ignore the thousands of deaths currently happening each month because it isn’t happening to us, people who matter. This active, present-tense forgetting started soon after the COVID pandemic began as politicians, pundits, even some in clinical medicine and public health decided after the first year or so that their own risk was manageable, as they had “the tools” to protect themselves and their families. They devolved the response to the pandemic to a “you-do-you” lifestyle choice, crafting specious rationales (e.g., the Omicron variant of SARSCOV2 was “mild”) to justify their personal predilections. This was a stark reminder that for all the performative solidarity of the first few weeks and months of the pandemic, class interests have predominated throughout the past few years. Some people were disposable again.
But then there is forgetting as history rolls out before us and weeks become months, months become years, and years become decades. By the end of the 1980s, largely due to the activism of people living with HIV, the world took notice of this plague. Social movements emerged that grabbed the attention of politicians and dragged decision-makers into action. By the middle of the 1990s another shift occurred, also instructive in our current moment. With the advent of highly active antiretroviral therapy, a combination of inhibitors of the HIV protease and reverse transcriptase enzymes, the disease now had a treatment that could keep people from dying. While not a cure, these drugs would show themselves to be able to suppress HIV replication for years and decades. This promise was apparent early on in the drugs’ short-term early potency. And it led some commentators, some gay, living with the disease to declare the pandemic over (e.g., “When Plagues End” appeared in the New York Times in 1996). Of course, the AIDS epidemic was not over, but again, it was over for those who mattered. Contributions to AIDS service organizations slumped, activism waned, and HIV was slipping out of public consciousness once again.
This is forgetting as an ongoing practice, something that must be cultivated through repetition. Of course, the AIDS epidemic had not ended; it was moving along the fractures of American social geography, from gay white men in large urban areas to men who have sex with men (whether they identified as gay or not) among the African-American and Latino communities, into the rural South, into poor communities more generally. Even in the 2000s, after activists from around the world demanded access to the AIDS drugs available in rich countries and with great success in getting initiatives such as the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria established, you could see the world’s attention draining away year by year, with the COVID pandemic knocking these three diseases off the radar, probably for good. Contributions to the Global Fund to Fight AIDS simply do not match need, and congressional Republicans want to gut the President’s Emergency Plan for AIDS Relief, established by President George W. Bush, one of their own. Now COVID has succumbed to a similar fate as HIV, slipping away as a priority for anyone even faster than its predecessor in the public imagination.
This is the history of infectious diseases and epidemics. It always matters whose lives are at stake. We can write plagues out of history when we don’t recognize the humanity of others—such is the case for the smallpox epidemic among freed slaves during and after the American Civil War when at least sixty thousand people died between 1862 and 1870, but the event was simply erased from memory, appearing nowhere in the literature until recently. One can look for artifacts, signal traces of how forgetting happens over time for other diseases. Travel to other countries such as Brazil, and you’ll find private foundations established over a century ago when tuberculosis was ravaging all segments of the population but now is a disease of the poor in favelas and rural communities and is easy to forget in the privileged enclaves across the country. There are entire categories of pathogens that we euphemistically call “neglected tropical diseases.” Neglected by whom? Not by those who suffer and die. As with AIDS in the 1980s, no one who matters cares about the illnesses of the poor, particularly those separated from us by oceans and thousands of miles.
Infectious diseases will always be with us; epidemics are human creations. We create the environment for diseases to emerge and flourish, then create conditions for them to persist except in the most rare cases such as smallpox. Forgetting is a tool, a weapon. It buries the past, submerges the present below the water line. Tuberculosis, AIDS, and COVID are all still with us. And all are major killers. But we wish to forget, and we will forget. This book refuses that denial. It is a testament, a bearing witness, in deep detail of what we suffered and are suffering, about how we got here, what we did to try to survive and help others to do so, and an examination of our deepest failures.
The COVID pandemic laid bare what those of us who work in infectious diseases, particularly those diseases that face the poor and marginalized, already knew: this would end badly. Revisionism is now on the march, with some, such as the former director of the National Institutes of Health, suggesting that we overreacted to SARSCOV2, that even with over a million dead in the United States, our efforts were too much given the nature of the threat. Meanwhile, public institutions are eager to give the people who matter politically what they want, with the Centers for Disease Control and Prevention suggesting in early 2024 that people can go back to work after one day without a fever, which means that many people will be mingling with their colleagues still shedding virus, still infectious. What will we tell those who come after us about this kind of surrender and abdication in face of a deadly virus? This book will be one answer.