Dartmouth College, Hanover, NH, USA
Covid-19 or coronavirus is the first major infectious disease outbreak to threaten a wide segment of the population in the US since the emergence of HIV/AIDS and of neoliberalism. As such, it raises a number of questions about inequality, racism, and the results of a hollowed-out state public health infrastructure. In this context, we examine what coronavirus can teach us about how to enact a politics of care in crisis in the age of Trump.
While questions of care emerge with urgency in the midst of a crisis, attending to vulnerability as a collective response has long been central to literature on the ethics of care (Held 2006). At root, care ethics offers a response to neoliberalism’s ideological constructs of individualism, self-responsibilzation, and “boot strapping”. Instead, insisting upon an ontological relationality in which life rests on our entangled relationships (Green and Lawson 2011). While neoliberal capitalism posits the limits of responsibility to “individuals and their families” (as Margaret Thatcher put it), the coronavirus outbreak (and other public health emergencies) make plain the multi-scalar uncaringness of neoliberal policies and the ideologies that underpin them.
The Covid-19 outbreak reminds us that bodies are vulnerable and require care throughout the life course, even as not all bodies experience heightened vulnerability equally (Folbre 2014). In the midst of this growing crisis, the intimate entanglements of individuals, communities, and the nation highlight multi-scalar modes of vulnerability and care. In charting a path for critical medical anthropology, Nancy Scheper-Hughes and Margaret Lock (1987) offered three interconnected bodies for study – the individual body, the social body, and the body politic. We use this framework as a jumping off point in this Intervention to think about what coronavirus can teach us about care at multiple scales.
Coronavirus and the Individual Body
On 3 March 2020, North Carolina announced its first case of Covid-19, a person who had been visiting and caring for a relative at the Kirkland, Washington skilled nursing facility, which was the first epicenter of the virus in the United States. As more and more people have been infected and affected by Covid-19, stories emerge of family members caring for or trying to care for individuals who are sick and who are stuck in quarantine without loved ones. These stories and experiences raise questions about care in an epidemic in which the main public health response is to isolate the individual body to cut it off from the social body.
Since 2016, Trump has made it his mission to walk back every single major achievement of the Obama administration in a petulant tirade of retribution. He has also brought anti-science sentiment to all aspects of the US government. These two pillars of his approach come together in the context of coronavirus as the administration clashes with its own scientific experts and as increasing numbers of people are either uninsured or underinsured (thanks to efforts to gut the Affordable Care Act) with limited access to healthcare. All of this makes it harder to treat and protect the individual body.
As the first medical bills begin to arrive for people who have been tested and/or quarantined, the unevenness of access to affordable healthcare is clear. For the 27.9 million uninsured and 29 million underinsured (the vast majority of whom are low income families with at least one full time worker), the choice to seek treatment or testing may come down to not just medical costs, but also potential lost income for being diagnosed and compelled into quarantine. This choice between protecting the health of the public and protecting one’s economic health lays bare the neoliberal logics that underpin the unfolding crisis in the United States: shrinking government spending and cuts to social welfare programs make the most vulnerable the least able to cope.
Coronavirus and the Social Body
As the virus spreads throughout the country – 35 states and Washington, DC as of 9 March – and as numbers of cases grow, health care workers have begun to raise alarm bells about training, supplies, and exposure (The New York Times 2020). Feminist scholars have long attended to the raced, classed, and gendered dimensions of care labors, both in the home and in the public sphere (England and Dyck 2012; Henry 2015).
In the US, nurses spend more time interacting with patients than any other health care professionals. Roughly 91 percent of nurses are women and according to the 2017 National Nursing Workforce Survey (Smiley et al. 2018), 19.2 percent of registered nurses (RNs) and 29 percent of licensed practical nurses (LPNs) identified as racial or ethnic minorities. Further, foreign born nurses make up between 15 and 22 percent of the workforce, depending on the sector, even as foreign born people make up only 13 percent of the US population (Hohn et al. 2016). As these numbers make clear, the majority of the people who will make up the frontline of medical care during the Covid-19 outbreak are disproportionately women of color, many of whom live with uncertainty in the country’s anti-immigrant climate.
Nurses aren’t the only workers tasked with keeping the social body healthy. Low-paid workers like airport screeners, cruise ship employees, janitors, and others are putting their health on the line as they labor to keep the social body healthy. Already, two airport medical screeners at Los Angeles’s International Airport have tested positive for coronavirus in the past week, despite reports that they had “all the right protective equipment while on the job” (KTLA 2002). First in Japan and now in San Francisco, California, cruise ships have sat unable to dock as the virus has infected huge numbers of passengers and crew members (700 on the Diamond Princess in Japan). Of the 21 people who have tested positive on the Grand Princess cruise ship in the San Francisco Bay, 19 are cruise ship employees.
The impact of the burden of maintaining the social body will not be evenly distributed. Women, the poor and working class, those in precarious positions are being and will be called on to do the work – most of it unpaid or under-paid – to ensure that the social body will continue.
Coronavirus and the Body Politic
An August 2017 a Vanity Fair article, titled “The Enablers”, included a tag line that asked: “If Trump is the political equivalent of a pathogen, just doing what’s in his nature, who’s responsible for letting him wreak havoc in the national bloodstream?” What was intended as a rhetorical question based on a biomedical metaphor has taken on the troubling salience of a multi-modal pathogenesis. His “nature” begins from the premise that all relations are (or at least should be) economic relations – a decidedly neoliberal logic that is quietly unmaking democracy as we know it (Brown 2015). This neoliberal logic has extended to a roll back of public health funding intended to protect the body politic from infectious diseases.
Trump’s 2021 budget proposal, released on 10 February, included $3 billion in cuts to critical federal agencies and global health programs, and in 2018 Trump ordered the National Security Council’s global health security unit be dismantled, dissolved the Department of Homeland Security’s epidemic response team, and recalled $252 million from the emergency funds for rapid response to outbreaks. All of which have left not only the US but the global community more vulnerable to infectious disease outbreaks such as this one.
Conservative pundits, along with Trump and his political allies, argue that the Democrats are “politicizing the coronavirus”, and, in the extreme, that they “hope millions will die”. This orientation reveals a refusal to acknowledge that some people actually do care and that to care is a political act. Moreover, in moments of crisis like this one, most people hope that their government will care for them. Indeed, we will all need care some time in our lives (Lawson 2007), and right now we face the possibility that many more of us will require unprecedented amounts of care abruptly and unexpectedly at a global scale. What is needed instead is a broad-based politics of care that takes seriously our global interdependency and that pushes against the masculinist realism that so regularly underpins international relations (Robinson 2018).
Through the unfolding public health crisis in which we now live, the division between private and public life is rapidly being reconfigured through a wide range of responses. School closures, event cancellations, and work-from-home policies coupled with the constant reminders to wash your hands (for 20 seconds!), cover your cough (with a tissue, not your elbow!), and stay home if you have the sniffles, reflect a growing recognition of our social ontology of relationality, and by extension, our responsibility to each other. They are also reminders that the individual body, social body, and body politic are and always have been entangled. At the same time, it offers an opportunity to think more broadly about the ways in which neoliberal capitalism, and its underlying ideologies in individual freedom and individual responsibility, have failed us. For those of us who have been arguing this for years, this is nothing new. But for the millions (billions?) of people who are waking up to this crisis, thinking relationally may seem new, even as it has always been part of their lived experiences. What we have sought to do in this brief Intervention is to layout a care ethical response that takes seriously the multiple scales of the body all at once – to bring into focus the multi- and inter-scalar impacts of living in an uncaring democracy. Indeed, as Joan Tronto (2013: ix) argues, “despite the voluminous discussions about the nature of democratic theory, politics, and life, nothing will get better until societies figure out how to put responsibilities for caring at the center of their democratic political agendas”.
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