Loss, Responsibility and Cura
So much personal loss, empty chairs at dinner tables, and so much waste and material squander in this terrible year of the pestilence, 2020. Lives cut short by a disease that should not have caught us by surprise. Preventable deaths, not because medical knowledge had an available cure for patients becoming critically ill — we still do not have it-, but because non-medical-interventions could have stopped the outbreak, and were readily available. Initially those measures were perhaps not well understood, but after a few weeks it became pretty obvious. Nations that adopted timely controls on personal movement, universal mask wearing, contact tracing, and a unified public messaging strategy, all relatively simple public health interventions, contained the pandemic. Those that did not are still paying with the loss of thousands of lives prematurely cut short. A political failure is what prevented timely measures from being deployed over vast territories of the world where the disease is still spreading. With the notable exceptions of Canada, Cuba and Uruguay, the worst performance was in the Americas. Our governments in the Western Hemisphere overwhelmingly failed in their response to COVID–19.
The failure was political because the governance of our polis, our towns and cities, our Republics, and our active role as citizens within them, revealed that Latin America, the Caribbean and the United States did not respond with the solidarity and the swift decisive action needed to ensure that the life of someone else, an anonymous other, could be spared. If you believe that disease will not strike your loved ones, your mother, your grandfather, your brother or your daughter, you are likely to resist public health measures aimed to protect the common good. Solidarity with strangers is in short supply in the Americas. Our societies failed because most people believed that SARS-COV–2 would happen to someone else, not to them personally. The virus seemed to come from far away lands, spreading in distant hospitals or nursing homes, not in our family gatherings, our friendly meet ups or our community activities. After months of tentative and partially enforced containment measures, citizens are fatigued. The human losses have disproportionately impacted the poor, those unable to work remotely or who have underlying health conditions, making them more vulnerable to complications from the infection.
Citizens, politicians and public health officials were not able to recognize the imperative of saving lives -no matter the cost. Initial explicit cost benefit calculations turned out to be wrong, since the economic cost of the pandemic continued and was even reinforced as countries failed to save lives: the calculus of pandemic economics was not about whether to retain jobs and manufacturing activity while letting a few vulnerable individuals die. There was no trade off. In some countries political responses were clearly negligent, basing public health policies an the assumption that the disease was not that serious, or that it would eventually go away, without causing much harm. Perhaps in some exceptional cases the incapacity of governments to coordinate resources effectively became a limiting factor, even when there was a political desire to act or respond. But I doubt government capacity was the main stumbling block. The African response, drawing from the public health lessons learned from Ebola and other previous epidemic risks, shows that even ill equipped countries with limited health resources could contain the epidemic when their leaders took early action.
Scientists understood from the very beginning the risks of the threat and its potential for catastrophic consequences. But our societies responded in various ways to such common knowledge. Our political failure is also a spiritual failure in terms of the way our shared humanity and ethics were put to test. The shortcomings of social solidarity in the Americas became painfully evident. In our deeply divided societies, by class, race, ethnicity or income, it was not possible to mount an effective response to the pandemic. From a purely medical perspective, our societies were not ill prepared. The problem was not a lack of epidemiological knowledge or medical resources, but that our mechanisms of social choice failed to produce the collective decisions and enforcement of those decisions that would save lives. This story is not new: it is the same experience lived throughout other pandemics in human history. Ever since the knowledge of how to mount effective public health responses to disease emerged in Italian cities in the 14th century, societies have differed in their use of those available public health responses.
So if responses are possible, where does responsibility lie? Who is to blame for so much loss? One might argue that a genetic mutation that leads to the emergence of new virus was an act of nature, so that there was no human agency in this pandemic. That is wrong. Although the virus is the immediate cause of death, it is not the explanation for those deaths. This is similar to the problem of explaining the death of a person by a wound from a firearm. While the bullet that tears the flesh hitting a vital organ may be the cause of death, it does not explain the homicide, nor does it allocate responsibility. The responsibility for a murder is to be found in the human action, for example, of a person that pulls the trigger. Perhaps the death was an accident, an involuntary manslaughter, provoked by the irresponsible actions of a gun owner that did not keep the weapon out of the hands of a child or an inexperienced user. But someone is still responsible for the death. The responsibility might even be shared with the gun manufacturer or the politicians who have decided that a society can allowed to have firearms widely available among the population. One could even attribute responsibility to the failure of a police force to control the availability of guns by criminals, which in turn may lead civilians to want to protect themselves.
Our legal codes have usually found ways to structure and attribute responsibility for preventable deaths, such as murders. But in the case of deaths from infectious disease, we do not have a similar codification of responsibility, because human agency remains somehow diffuse. Is there a way to think about an analogous accountability for the death of a human being from COVID–19? Clearly nurses and doctors that fight to save the patient lives should not to be held responsible for the failure to prevent an eventual death. But when a hospital is overrun by patients due to poor planning, a doctor does not follow the required protocols of care, or a ventilator or ICU is not used when it was available, we may start shifting into a world of responsibility. If budgets for public health systems are cut by governments, or an epidemiological surveillance system is neglected, there is some insight into the failure in the response to an epidemic, and some sense of public accountability.
Any of these potential shortcomings in public health responses are, nonetheless, minor contributors compared to the larger issue of how political leaders in the Western Hemisphere downplayed the danger facing society. The most important role of leaders in a pandemic is a coordination role: their public announcements create common knowledge. Several presidents in the Americas, particularly Donald Trump in the US, Jair Bolsonaro in Brazil, and Andres Manuel Lopez Obrador in Mexico, are directly responsible for the death of hundreds of thousands. This is not a minor issue. As executives in their federal countries, they knowingly behaved in ways that produced deaths. They downplayed the risk of exposure and the severity of the disease. They were unwilling to wear face coverings in public and therefore, through their example, doomed the most straightforward protective measure from the very beginning. But most importantly, they failed as political leaders in coordinating other political actors within fragmented systems of policy making on a common goal. In the case of deaths from infectious disease, in contrast to intentional injuries, we do not have a codified system of justice that will allow us to prosecute and bring these men to trial in a public court. But in my mind their decisions and behavior were not just unethical and inmoral, but criminal. At the very least, if citizens were truly aware of their responsibility, their political careers should be over.
In the past months I have been able to read and think a lot about the epidemics that decimated the Americas during the colonial period. What strikes me most, beyond the tremendous human suffering, is the overall indifference of the colonial rulers. Since the times of the Black Death in Europe, autonomous cities (Republics) had already learned basic public health measures that could be adopted to save countless lives. But in the colonial possessions of the Americas, those measures were simply not considered. It was the colonizers that often brought the diseases, and the pathogens were responsible for the deaths. But most crucially it was colonial rule that did nothing to prevent “una gran mortandad de indios” (as the Telleriano-Remensis codex written by indigenous scholars attests), an unimaginable level of mortality, just like the one we are witnessing today.
There is no true translation in English of the Latin word cura. In its original version it means something well beyond a medical therapy, instead reflecting the common trust that emerges from being attentive and caring. The word “accuracy” is related to cure, due to its relationship with paying attention. The person that has cura for someone else is also a guardian, and becomes responsible for the wellbeing of those under his or her care (in the Romance languages, this is the etymology for both the Procurador, the public prosecutor, as well as the Cura, the priest in charge of a Parish). The proto-indoeuropean root of coera may have been related to the heart (cor), but more modern filologísts suggest that coera is related to the same root as the act of observing, knowing and paying attention. When there is cura, it is possible not just to heal (in Spanish a curandero, or healer is also related to cure) but to acknowledge and make a person whole. The missing ingredient in the response to COVID–19 in Latin America, the Caribbean and the United States was an ethics of cure.
Some Latin American nations have a current debate regarding whether it should be possible or not to purchase vaccines through the private sector, in such way that the rich may be able to have priority over the poor in the quest towards collective immunity. Such debate summarizes quite well how much of this ethics of cure is actually absent in Latin America. The way in which politicians in the Americas were able to displace the public discussion of the human imperative of saving lives, no matter the cost, to the ambiguity of contestable perspectives regarding how much of the economy would need to be slowed down, the extent to which individual freedoms were being curtailed by the public health measures, or the frankly disturbing controversy on facial coverings and mask wearing also reveal this absence. That a society is not able to care, to cure each other through the simple inconvenience of having everyone, from the President to a young child, wearing a mask, is a clear signal of the dimension of a collective failure.
Citizens throughout the Americas and the world have been waiting for a cure for the SARS-CoV–2 virus. Therapeutic treatments have not been developed at the incredible pace with which vaccines are being designed, developed and mass produced to be brought to the world. Doctors and nurses have learned how to use various medical interventions to keep seriously ill patients alive, and reduce the mortality rate of COVID–19, but this remains a deadly disease. There is still no medicine that can be administered countervailing an infection from the SARS-CoV–2 virus.
The promise of containment comes from immunity through vaccination (not herd immunity, which would imply unacceptable mortality even in societies that have revealed themselves quite tolerant to death). Vaccines hinge on the scientific promise of finding suitable strategies to trigger our own bodies self defense systems, and to achieve enough prevalence of the immunity among the host population so that the transmission of the virus is no longer viable. The success of this strategy depends on citizens adopting vaccines. How long that immunity through vaccination may last is still an open question. And whether the virus may adapt through its evolutionary biology to the new conditions, is an ever present possibility.
We have not cured the disease. Maybe we cannot cure it, at least in the foreseeable future. But what we must strive for is to bring cura to each other. To bring our societies to a new shared sense of solidarity with strangers. To reject any leader that is not willing to build a common future based on such solidarity. To make each other whole, by acknowledging our common humanity.