key: cord-0941974-oz1eziy1 authors: Munyikwa, Michelle title: MY COVID‐19 DIARY date: 2020-06-04 journal: Anthropol Today DOI: 10.1111/1467-8322.12575 sha: 39c51cf02dcf33aeabbd7140728520509f651721 doc_id: 941974 cord_uid: oz1eziy1 Written in weekly instalments, Michelle Munyikwa's Covid‐19 diary reflects upon the experience of an unfolding pandemic from her dual role as a medical trainee and anthropologist living in the United States. Her observations centre on everyday encounters with scenes or objects that reflect the growing crisis, from the absence of masks outside patient rooms to emergent forms of care through telemedicine. The diary follows the author as she experiences grief, ambivalence and disorientation in the first weeks of the pandemic. In this narrative, Michelle Munyikwa, an anthropologist and medical doctor-in-training, reflects on developments in the Covid-19 pandemic in the form of a diary from Philadelphia. How do you know when you are living through a crisis? Crisis requires recognition -the point when a dawning awareness settles into an uneasy certainty. It may be the moment when you enter a store and find that the toilet paper or water you had intended to buy has gone -the empty shelf a signifier not only of what is to come, but of what has already happened. For me, that moment came when I could no longer easily don a mask to see patients. Simultaneously reacting to and anticipating public panic, the hospital where I am a medical student had sequestered them in order to prevent theft and regulate use. In order to obtain one, you had to declare your intention to the unit secretary, who would look up the patient you were seeing and hand a mask to you only when she or he had verified you had a use for it. In an instant, the absent mask conveyed the impending change. Over the last two weeks, the United States has undergone a transformation in its appreciation of the threat of Covid-19, the disease caused by the novel coronavirus SARS-CoV-2. We have collectively struggled to make sense of the epidemic. Scrolling social media feeds, one is inundated by reports from other countries, graphs and tables attempting to predict the future, and calls to understand the past of previous epidemics such that we might not repeat our errors. One is also bombarded by assertions that this is merely the flu, a media hoax or an example of the mass hysteria that the 24-hour news cycle can fuel. We live, and make choices, in an affectively saturated, information-rich (and often, truth-poor) environment. This uniquely 21st-century crisis is an object lesson in what it feels like to live through an emerging epidemic during what has often been described as an age of anxiety. How do we navigate unfolding uncertainty in a context where truth is wobbly and misinformation pervasive? I am a doctor-in-training and an anthropologist, currently completing clinical rotations, which means that I work in a different specialty every month. Over my last few days in the hospital, I have watched the crisis unfold. Hospitals are stripping down their staff to essential personnel, planning for the worst. Teams that would normally see patients in large groups are paring down in the hopes of saving personal protective equipment (PPE), like masks and gowns, which are already in short supply. Already, we have suspected cases in Philadelphia, which was all but an eventuality, given the cases in New York. The question on everyone's mind is just how worried we should be. Should we stock up for a doomsday scenario? Or is this merely the flu, coupled with a politically inflected overreaction? I had been tracking the outbreak since its emergence in December. In January, I happened to be on a rotation in infectious diseases. My colleagues regarded the unfolding panic with an air of bemusement, more concerned about quotidian but deadly matters like the flu. Still, I found myself sitting in on meetings where we discussed strategy with a growing sense of dread: how would we ensure that doctors out in the community felt adequately prepared? How many cases could we reasonably handle in our hospitals? Could faster, more local tests be developed? This was before the virus reached other nations, let alone the United States, in significant numbers. Throughout January and February, concern about an American Covid-19 epidemic seemed tepid. Most of my social networks were not talking about it, and I was only able to find communities talking about the virus in the hospital and online. This shifted around Tuesday of last week, as more nations started to report cases and the case number went up substantially. Soon, friends were contacting me about the virus, expressing their concern. The World Health Organization (WHO) recently announced that the worldwide death rate is 3.4 per cent, but all epidemiological evidence suggests that deaths are not evenly distributed. We also know that there is a high rate of nosocomial infection, with large quantities of healthcare workers getting infected. Here in Philadelphia, I am concerned by how our public health infrastructure and significant economic inequality will shape who is affected by the disease and who will die. Philadelphia is often described as the poorest big city in the United States; 24.5 per cent of our resi-dents live below the federal poverty line, the highest rate among the nation's 10 largest cities. 1 While in a period of celebrated growth, the city is still recovering from the decline of manufacturing and its attendant public divestment and suburban flight, and the current landscape of the city is shaped by racialized class inequality and the assaults to public health that these dynamics produce. We also have a serious problem with hospitals; while there are many elite hospitals in Philadelphia, that also means that we have a high concentration of complex, chronically ill patients, precisely those who will be at significant risk were Covid-19 to become a significant public health problem here. Like many American cities, we also lack a public hospital, and few ways to access care without concern for the massive, crushing bills that our specialized care foists upon patients. We will need to worry about the chronically ill and the fact that many American hospitals cannot handle a surge in patients at this time of year. In the best of times, patients can languish in the emergency department for hours while they wait for beds in increasingly crowded hospitals. In this first week, it feels as though there is nothing to do but wait, track the epidemic in other countries and hope the government pulls together a response. Scepticism, anticipation, anxiety and disgust. Other anthropologists have written extensively about the problems this epidemic lays bare, most notably the illumination of cleavages in our social fabric and the truly deadly implications of such divisions across the lines of race, class and national origin. 2 This work has drawn attention to this pandemic's disregard for borders and the xenophobic and racist responses PUBLIC DOMAINA that contagion engenders. It highlights the ongoing negotiations around scientific expertise and practice and the dizzying array of projections and models that shape the daily response to the pandemic, particularly the infamous study from Imperial College London. 3 The situated labour of anthropologists has also drawn attention to the differential unfolding of this pandemic across different spaces and in local communities. As the sense of crisis transforms from a speculative possibility into a reality, I have also been struck by how overwhelming this is, in part because of a deluge of media that urges us to perform an affective reorientation to the present. Affect theory offers us a language for examining the structures of feeling (Williams [1976] 2014) that shape our response to the world. It helps us to understand the sense that we are living through history, situating our experience of the unfolding present (Ahmed 2004; Berlant 2011) . The lens of affect also helps us to understand how efforts to change the course of things necessarily entail attempts to manipulate such structures of feeling. As public opinion about Covid-19 has oscillated between disgust, scepticism and anticipation, so too have the discursive strategies to combat each of these entrenched positions. As we navigate affectively shaped worlds, experts and laypeople alike engage in affective mitigation that tugs on the contours of the affective in order to transform individual sentiments and understanding. In other words, we attempt to transform one another's orientation to the epidemic in order to inform action that mitigates the crisis. Scoffing on Fox news, for example, politicians tug on concerns about immigrant invasions and the peril inherent in progressive politics to simultaneously maximize fear of the other and stoke confusion about the pandemic. Affective mitigation also shapes our use of history, alternately stoking or taming a response through historical analogy: the 1918 flu, for example, or the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) events that never came to pass (Arnett 2020). Our response is characterized by a wild oscillation between scepticism and anticipation. Scepticism has been attributed to members of the political right, whose news sources have projected the message that this epidemic is a fabrication of a panicked, over-anxious media. Anticipation: the left, those plugged into the latest epidemiological models and projections. In the contemporary American moment, we can see that modes of preparation and prevention have failed to produce the desired effects. We find ourselves amidst a crisis that has been not only weeks, but decades in the making, with the sense that normative modes of prediction and anticipation have failed. We are daily negotiating emerging relations to expertise, authority and truth, which have always been at stake in the declaration and management of public health crises. This week, the picture is bleak. Friends working in hospitals across America tell me of critical shortages of masks, sickened col-leagues and stolen equipment. Due to concern about the possibility that medical students, perceived as young and healthy, 4 could serve as asymptomatic vectors, schools around the country cancelled clinical rotations. I amalong with my classmates -at home, watching the pandemic from afar, as friends working in hospitals around the country supply me with a stream of updates. Being away from the hospital, experiencing the pandemic through mediated resources, has shifted my sense of the crisis, making it at once more deeply felt and more distantly understood. Doctors and advocates are organizing to halt detention, protect prisoners, feed and house the homeless and struggle to put together a social safety net hardy enough to withstand social distancing. We have seen beautiful acts of social solidarity, mutual aid and altruism. These acts balance the misery with hope, though they force us to question why they are necessary in the first place. So what does one do in the meantime? What are the stories one tells in dark times? How can a narrative of defeat enable a place for the living or envision an alternative future? (Hartman 2008) We tell ourselves stories in order to live. (Didion 2009) If I'm being honest, I suspect that there are no words that are adequate to the task of describing the slow-moving disaster we are living through. We often characterize this sensation as the ambiguous pleasure-paincuriosity of watching an accident unfold. I am reminded of a time when I was driving down the highway; as I approached, I saw an enormous plume of black smoke. Whizzing by, it took a moment after I passed to realize that the smoke was emerging from an enormous fire in the engine of a car, which had been parked, strangely, in the opposite lane. Only much later did I think to ask: what is a burning car doing on the highway? How did it come to be there? Is everyone okay? There are harbingers of disaster around us: empty streets devoid of their usual traffic; a space on the shelf where your favourite bread normally dwells; cars piled full, mysteriously, with toilet paper; realizing just how often you have come to rely on small conveniences; a bizarre longing for hugs from strangers or quotidian, banal interactions. Things are different. Over the last week, nations around the world have locked down. The borders of the United States have closed; expatriates around the world have been encouraged to return home. Here in Philadelphia, we have continued to prepare for the worst. Medical students, disconnected from clinical rotations, have organized to coordinate food deliveries and babysitting services for frontline providers. Others have started collecting PPE, which is scarce, while still more gather to support local businesses that are suffering in the absence of foot traffic. There are efforts to aid the many people who are without housing and food, and campaigns to transform empty hotels into housing gain traction. Letters circulate, some with thousands of signatures, imploring the ICE (US Immigration and Customs Enforcement) to decrease enforcement and the state to release prisoners. In moments like this, we turn to history (Jones 2020). Many of the articles circulated across my social media feeds encourage us to understand the past to orient our present response. We go clawing into the archive for lessons we wish we had already learned, and attempt to learn them too quickly, all at once. I may have read more about the 1918-1920 influenza pandemic in the last week than ever before in my life, and I am a student of medicine, history and anthropology. And yet, every day, another journalist uncovers these lessons with their moral: take this seriously. Never forget. We, too, are vulnerable. Perhaps one reason we tell ourselves these stories is because they convince us that we will, in fact, survive this. We hope that this means we might surmount the growing threat, for if others have lived to tell the tale of our devastating past, then perhaps there is hope for our future. But there is nothing to say that we are permanent presences on this earth, no reason to believe that we, unlike all other species, are not susceptible to extinction. That is not to say that the end of humanity is likely (however closely environmental collapse hovers, threatening to complete the job). It is, however, to suggest that the world that we have known up to this moment, no longer exists. Returning to that normal ceased to be one of the possibilities many steps ago in this unfolding chain. Its possibility was stifled most proximally by failures of government, but perhaps even more by the choices we made, entrenching rapacious capitalism, greed and immoral incompetence. We might have seen the proverbial smoke from a distance when we elected generations of leaders more invested in enriching the elite than strengthening the poor. When I am thinking about history, politics and its use, I often return to the poetic prose of Saidiya Hartman, whose historical imagination seeks to uncover but not redeem the past. She knows, as we all do, that we change nothing simply by noticing what has happened. After all, 'we all know better. It is much too late for the accounts of death to prevent other deaths; and it is much too early for such scenes of death to halt other crimes' (Hartman 2008) . Saidiya Hartman was speaking, of course, of the not-quite-past of slavery and her repeated visits to the archive of that atrocity, saturated as it is with the tales of the dead whose loss we will never recuperate. As this pandemic visits devastation unevenly upon poor communities, people of colour and immigrants, the body count of racial capitalism mounts and we are left to account for it. If it is the case that we are always hanging in the balance between presence and absence when recounting the injustices of history, then what do we hope for with respect to telling these tales in the present? I want to believe that revisiting the lives that were unnecessarily lost 100 years ago during the 1918 flu pandemic will spur us to do differently. I want to believe that being haunted by the archive of bodies piled in the streets might shift our perspective, such that we will successfully avoid what is to come. I want to think that knowing that this is all wrong may keep us from continuing to do it. I also wonder if by the time it occurs to us to marshal the evidence of the past, it is already too late. I fear that we are like I was: blinking into realization the image of a burning car on the road, long after I could have done anything about it. An image of destruction seared into my consciousness, for nought. When is it time to dream of another country or to embrace other strangers as allies or to make an opening, an overture, where there is none? When is it clear that the old life is over, a new one has begun, and there is no looking back? (Hartman 2008) We're over 100,000 cases here in the United States, as many states have placed shelter in place orders and the economy has come to a grinding halt. Hundreds of thousands have lost their jobs and the threat of economic disaster looms. Politicians and citizens alike worry that our response is an overreaction. Donald Trump, concerned about stock prices, has been at the centre of a push to reopen the economy and loosen restrictions on those communities where disease prevalence is lower or allow lower-risk citizens to work. Rallying around the cry that 'the cure cannot be worse than the disease', people desperate for economic relief suggest that we go back to the way things were, allowing the epidemic to run its course. Perhaps, they suggest, we can merely isolate the 'at risk', allowing the rest of the country to go to work. This, despite the increasingly dire situation in New York and other cities around the country. This week has also seen the spread of Covid-19 throughout Africa, with a reported 2,000+ cases across the continent, likely an underestimate. I am now worried about the spread in these countries, which include my home nation of Zimbabwe, where rumours surrounding our first death suggest that we are woefully underprepared for the task of fighting this pandemic. 5 I worry about my extended family, who remain there, and what they will do if one of them becomes sick. While the conditions in countries with fewer resources will be dire, an abundance of wealth does not seem likely to prevent horrible outcomes in the United States, where we are quickly developing the worst epidemic in the industrialized world. In New York, Massachusetts and Michigan, medical students are being graduated early to help with the crisis. Philadelphia-area doctors warn of an impending ventilator shortage, and the institution prepares guidance for the worst: rationing and the reality of preventable death. We are not there yet in Philadelphia, but the anticipation permeates the entire health system. Every day, hospital leadership sends new projections, attempting to calculate the impact of this pandemic -Do we have enough beds? Enough clinicians? Enough gloves? -each time assuring us that we are ready. However, some projections are more terrifying than others, suggesting a flow of hundreds of patients a day into a hospital with just barely enough space for those patients we anticipate. My best friend, an emergency doctor, texts me news every day. 'Intubated a 40-year-old woman today'; '11 intubations in one shift, there's normally only one'; 6 'We're down to the donated PPE'. The hospital is a ghost town, with elective surgeries cancelled and other patients avoiding care for fear of contracting the virus. We are nowhere near the peak yet, so the hospital is the emptiest it has been in years. This feels like the calm before the storm. Stories of young healthcare workers dying of respiratory failure circulate in my medical social circles. My mother, also a doctor, worries about the impending shortage at her hospital. It becomes clear that healthcare providers will be among those who bear the brunt of this, to say nothing of the poorly paid essential workers across many industries. Hospitals around the country begin trialling hydroxychloroquine as prophylaxis, and as Donald Trump and scientists alike promote the possibility of the drug, we hope they are right. The debate around the drug reveals deep uncertainty about the proper course of treatment, bringing up important concerns about ethics, patient harm and medical responsibility. 29 March-11 April: Time compression, pandemic fatigue and the new normal As I am editing this, the United States has nearly 800,000 cases and over 40,000 deaths. The disease is now the largest cause of death in the country. My experience of the pandemic has transformed from a frenzy into a slow unfolding, each day simultaneously more terrible and mundane than the last. As we round out one month of sheltering in place, my experience of each day becomes more and more rapid, as I blink and 10 days have passed. At the same time, it feels as if this pandemic has lasted a thousand lifetimes. This is in part because the nature of my work has changed so much, from intense labour in the hospital to digitally mediated interactions on video chatting platforms. I spend most of my day in front of a screen, like many of my peers, completing both school and volunteer work digitally. Across the healthcare system, students and providers alike have been repurposed. Psychiatrists and gynaecologists act as frontline providers in areas of the hospital where they usually do not work, while others pivot to telemedicine. As medical students, we have been forbidden from interacting with patients, but we continue to volunteer. Some students participate in grocery delivery programmes, picking up an extra bag of food on their weekly trips and dropping them off for patients in need. Others staff our tele-ICU (intensive care unit), watching over intubated patients with a camera from a safe distance a mile away from the hospital and adjusting vent settings from afar -more a scene from science fiction than real life. I have signed up to a project attempting to address the social needs of patients in our massive healthcare system. A team of medical students and social workers has assembled to intervene in the social fallout from this disease, from unstable housing to domestic violence, health insurance woes to food insecurity. Based on a referral from a doctor, the team calls to perform a screening: Do you feel safe at home? Do you have enough to eat? Are you worried about paying your rent? My first call was to a woman who had lost her job and her insurance due to Covid-19related layoffs, just in time to contract the disease. Or it should have been; I called her all morning, but her phone had already been disconnected. Other patients, COVID-positive and acting as caregivers for family members who were now at risk, needed help with food, making money, surviving. Who will get my groceries if I can't leave my house and everyone who lives with me might also be contagious? Can someone come to take care of my elderly grandmother who has dementia? Can I go back to work? These conversations force Athens airport, 25 February 2020: the Covid-19 virus hell in Italy is just beginning. I arrived in Greece in early February before the chaos started; today, I am heading to Kavála, the field base for my comparative project on the protest movements against the Trans Adriatic Pipeline in Greece and southern Italy. Out of habit, twice, perhaps three times, I say 'grazie' as I navigate airport procedures. It's enough to elicit worried looks and whispered comments among the bystanders. A sudden and uncomfortable feeling grips me. The next day, Greece records its first Covid-19 case, 'imported' from Italy. Ever since that announcement, an invisible wall has arisen between me and my Greek neighbours. Soon, it also affects my fieldwork. 'I don't speak to Italians' I overhear while sitting in the car of one of my informants, as he calls a fellow activist and introduces me. Next day, immediately after he posts a picture of us on Facebook, the warnings fly: 'Be careful! You're not even wearing masks!' Though followed by smiley emojis, such 'joking' remarks are anything but. Then there's the street vendor's inquisitive and concerned look when he places my accent, my neighbour's 'teasing' gesture of shielding himself from me by forming an X with his arms, and the pharmacist who suddenly steps back and denies me the much-requested disinfectant hand gel as it is destined 'only for local customers' -while grunting. In response, I speak as little as possible to avoid making mistakes in Greek and to 'hide' my nationality. This hits me particularly hard as I'm usually warmly received in Greece. I'm a southern Italian who grew up in Salento (Puglia), where a variety of Greek -'Griko' -is still spoken. On this shore of the shared sea, Griko tends to elicit admiration and self-celebratory comments about the durability of Hellenism. Suddenly I'm no longer called i Ellinìda tis kato Italias ('the Greek from southern Italy'). The distinction between purity and danger fills into symbolic -and physical -boundary maintenance, as Mary Douglas observed in her 1966 book Purity and danger. Abruptly, I'm simply Italian and Italian means 'polluted and polluting' -the enemy. Meanwhile, gallows humour circulates via memes: 'Not finding a seat on the bus? No problem. Cough, say Buongiorno a tutti -"Good morning everyone [in Italian]" -and sit wherever you want!' (Facebook, 29 February) . Then again, irony can be a weapon as much as self-irony can be a defence: 'I'd say that if we keep coughing, we'll end up re-conquering the Roman Empire' (Facebook, 3 March) . However, as things in Italy take a catastrophic turn, and as infections climb in Greece, public expressions of concern and closeness towards Italians follow. When the Covid-19 nightmare started in MATRYX / PIXABAY.COM questions of reciprocity, solidarity and obligation. Every patient chart, every documented encounter, is an unflattering look into our devastatingly leaky social safety net. The virus continues to unmask the consequences of our late capitalist social order, which differentially exposes communities to death (Taylor 2020) . In Philadelphia, these are apparent in statistics collected by our public health officials, which reveal that it is easiest to get tested in our affluent neighbourhoods, despite a larger number of cases in poorer communities. To get a test outside of a hospital, you must wait in a drive-through line, leaving those without cars to scramble for other means of testing. Meanwhile, my peers are still collecting PPE. My partner and I, not generally prone to crafting, pull out a long-neglected set of sewing machines to produce masks for ourselves and friends as the recommendations shift and community use of masks is encouraged. We draw on his expertise as an engineer to design and fabricate alternatives to N95 surgical masks, anticipating a day when our doctor and nurse friends will go to work to find protection absent. I'm reminded of a message my mother sent me early in the pandemic, as critical shortages of PPE became apparent and her daily work in the hospital revealed an overwhelming lack of preparedness. The message said simply: 'No gloves. No eyewear. No PPE. Who's [this] s**thole country now?' It has become increasingly difficult to gain the distance from this pandemic that would allow me to make sense of it. At the same time, there has been a veritable boom in social theory since the pandemic began. Every day, advertisements for webinars and digital lectures fill my inbox. Calls for papers have already pivoted around this latest crisis, and I expect to see dozens of COVID-19-related panels at the next big conference. A prominent social theorist has already penned a book about the pandemic. I feel self-conscious about my dulled capacity to distance, to theorize, to make sense of something which is overwhelming and surreal. It is true that as anthropologists, we are precisely in the business of making sense of what is going on around us. Perhaps it is a need for control, the will to know, that impels us to attempt to tame what ultimately can't be tamed. Or It is worth noting that the federal poverty line is only one of the many ways of characterizing widespread precarity in the city of Philadelphia, though it is most often cited. 2. Here, I am thinking especially of some of the compelling contributions to Somatosphere's COVID-19 forum, particularly Adia Benton's elaboration of the racialized geography of blame Also see: MacGregor It is worth noting that it is not always the case that medical students are healthy and that this elides those who are living with chronic illness or are otherwise at risk. 5. I heard rumours before I started to see formal reporting, like Nyoka (2020). Also, a later account describes the family's perspective It is worth noting that the use of invasive ventilation for Covid-19 is contested terrain, with considerable disagreement about when to intubate, the ethics of early intubation and the potential harm to patients of overly aggressive care Affective economies 100 years ago, another epidemic terrorized the city. The Boston Globe Border promiscuity, illicit intimacies, and origin stories: Or what contagion's bookends tell us about new infectious diseases and a racialized geography of blame. Somatosphere (blog) Cruel optimism The white album: Essays Venus in two acts History in a crisis -Lessons for Covid-19 Novelty and uncertainty: Social science contributions to a response to COVID-19 Covid-19-struck family speaks of ordeal. The Standard (blog) Coronavirus: Zimbabwean broadcaster Zororo Makamba died 'alone and scared'. BBC News Counting coronavirus: Delivering diagnostic certainty in a global emergency Reality has endorsed Bernie Sanders. The New Yorker The Pew Charitable Trusts 2020. Philadelphia 2020: State of the city Keywords: A vocabulary of culture and society Mona Lisa protecting her environment from infection by Covid-19