The World Health Organization has declared a global health emergency over the new coronavirus, which has infected over 40,000 people and killed over 1,000. The response should be to strengthen public health and improve social determinants of health, to make everyone safe from this and other infections. But instead there is racist scapegoating of Asians, and a focus on border controls and quarantine rather than healthcare and paid sick days.
Nearly 10,000 people signed a petition addressed to schools in York region. Declaring that Chinese New Year “tremendously increases the chance of infection” by the “Coronavirus of China”, and that families returning to Canada “will definitely bring the virus into our country”, the petition demands returning students and their family report to schools and quarantine themselves, and that all others wear masks. While no public health recommendations support any part of this, the petition claims that “we cannot be overly cautious in protecting our children”, because “York region has a large Chinese-Canadian population.”
There’s a broader context to this online vitriol. The media continue to use the term “Wuhan coronavirus”—encouraging racist assumptions that there’s something specifically Chinese to the emergence and spread of this infection—while governments are imposing quarantines and border controls in the name of public health. But throughout history, the strategy of naming, blaming and containing specific populations has failed to prevent or treat disease, and only encouraged racism to go viral. As coronavirus continues to spread, we need to be clear: this is not a Chinese virus, it is not spread by Asians, and quarantine or border controls are not the answer.
Naming
History is full of examples of xenophobic responses to infectious diseases. The sexually transmitted infectious syphilis was called the “French disease” in Italy, the “Italian disease” in France, the “Spanish disease” in Holland, the “Polish disease” in Russia, and the “Christian disease” in Turkey.
Even if a disease is first identified in a particular area, naming it after that region implies there’s something specific to its inhabitants that produce and spread disease—which takes infections out of context and creates a scapegoat. Cholera, the deadly diarrhea, swept the world in the 19th century in the context of colonization and lack of sanitation—accompanying the British occupations of India and Ireland, Russia’s invasion of Poland, and the US war against Chief Black Hawk. As medical historian Erwin Ackernecht explained, “troops have always played a major role in the spreading of cholera…The second pandemic originated in India in 1840. That was the year Great Britain sent an army from India to China, in order to impress on the Chinese government the importance of opium. As a gift, this army carried the cholera to China.” But it wasn’t called “colonial cholera”, it was called “Asiatic cholera”.
The 1918 influenza pandemic accompanied the destruction, displacement and malnutrition of WWI, and its mortality rate varied with poverty rates. But it was not called “world war flu” but instead “Spanish flu.” The 2009 influenza epidemic emerged in the context of factory farms, as evolutionary biologist Robert Wallace explained, “Although considerable attention is being paid to the role of a particular company in the emergence of the new influenza, and rightfully so, we might better focus on the deregulation that allowed such porcinopolies to grow to the point that whole human communities are pushed off the land pigs now occupy. So if we are to impart responsibility where it should lay, North America’s new influenza would be better called the NAFTA flu.” But instead Conservative Prime Minister Stephen Harper called it “Mexican flu.”
Now a new coronavirus has emerged. As Wallace explained, “Spreading factory farms meanwhile may force increasingly corporatized wild foods companies to trawl deeper into the forest, increasing the likelihood of picking up a new pathogen, while reducing the kind of environmental complexity with which the forest disrupts transmission chains… This is no Chinese exceptionalism, however. The U.S. and Europe have served as ground zeros for new influenzas as well, recently H5N2 and H5Nx, and their multinationals and neocolonial proxies drove the emergence of Ebola in West Africa and Zika in Brazil. U.S. public health officials covered for agribusiness during the H1N1 (2009) and H5N2 outbreaks.” These epidemics weren’t called “American flu”, so the current epidemic should not be called “Wuhan coronavirus” or “Chinese coronavirus.”
Blaming
Rather than trying to understand the complex interplay of historical, social, economic and environmental conditions that destabilize the microbial ecosystem and make people vulnerable to infection—from colonization and war to industrial production and ecological crisis—naming an infection after specific group of people implies there’s something inherent to their culture, behavior or genetics that threatens others.
In the 19th century, fear of “Asiatic cholera” led European governments to blame Hindu and Muslim pilgrimages as “the most powerful of all the causes which conduce to the development and propagation of cholera epidemics,” while US authorities blamed Irish drinking or Jewish migration. In the early 20th century the high rates of the respiratory infection tuberculosis among Black and Indigenous people—a result of poverty and inadequate housing, the legacy of colonization and slavery—were blamed on Indigenous culture and Black racial characteristics. A report to Canadian Indian Agents claimed that “Consumption [the older term for tuberculosis] in its various forms is the scourge of the Indians…the unnecessary frequenting of, and more especially holding of gatherings for dancing or other purposes in houses in which there is consumption should be carefully avoided.”
Meanwhile the statistician Frederick Hoffman claimed that tuberculosis was a “racial trait” of African Americans, which insurance companies used to deny coverage or charge higher premiums. But as Black scholar WEB Dubois responded, “The undeniable fact is, then, that in certain diseases the Negroes have a much higher rate than the whites, and especially in consumption, pneumonia and infantile diseases. The question is: is this racial? Mr. Hoffman would lead us to say yes, and to infer that it means that Negroes are inherently inferior in physique to whites. But the difference in Philadelphia can be explained on other grounds than upon race. The high death rate of Philadelphia Negroes is yet lower than the whites of Savannah, Charleston, New Orleans and Atlanta. If the population were divided as to social and economic condition the matter of race would be almost entirely eliminated…Even in consumption all the evidence goes to show that it is not a racial disease but a social disease.”
A century later, naming and blaming continued. AIDS was first called “Gay Related Immune Disease”, as though it was the natural consequence of homosexuality, and then it was labelled a “Haitian virus” and blamed on voodoo. As an article in medical journal The Lancet explained, “The American media, with the help of some of our colleagues, seems intent on establishing a connection between Haitians and acquired immune deficiency syndrome (AIDS), even though none may exist…Being Haitian is not itself a risk factor. However, Haitian Americans have already begun to pay the price for the stigma given them by the media. ‘Boat people’ have been housed in makeshift prisons, and Haitians who have migrated legally are housed in a different ‘prison’ in our ghettos. Some have already lost desperately needed jobs and others are beginning to experience the prejudice of their neighbours who see them not only as black and poor and different but, now, also as contaminated by disease.”
In 2003, SARS was portrayed as a virus spread by Asians. As Carienne Leung explained in the report Yellow Peril Revisited, “Chinese and Southeast/East Asian communities were doubly burdened, fearing for their own health and well-being, and bearing the stigma of this disease on themselves and their communities.” This included reports of discrimination in public transportation, workplaces, schools, public spaces, housing, and small businesses. The response to “Wuhan coronavirus” has repeated these racist myths—blaming lunar year celebrations or Chinese food. The result has been reports of school bullying, harassment on public transportation, and workers being sent home for “coughing while Asian.”
Containing
Quarantine emerged as a response to the plague in 14th century Europe, but was primarily motivated by maintaining public order rather than public health. It was a bureaucratic tool developed by rising Italian city states, both to police their borders and to protect the property of elites who temporarily fled. This was 500 years before the germ theory of disease, so quarantines were not motivated by an understanding of infections; the 40 day duration they are named after was not based on any science, and it was obviously ineffective as the plague killed a third of Europe’s population. It’s for these reasons that there was opposition to widespread quarantine to deal with cholera in the 1800s: the emerging medical community objected to it as a medieval strategy without scientific basis, and the British objected to it as a barrier to free trade.
But quarantines were applied selectively to contain marginalized groups who were blamed for spreading infection. In New York in the 1890s Russian Jews were accused of bringing cholera and their ships were quarantined—which did nothing to improve sanitation or prevent cholera, and was only enforced on the poorer passengers below deck. As a medical historian Howard Markel summarized, “the gravest problem with the New York quarantine effort were a too-ready acceptance of Eastern European Jews as the source of cholera, inadequate medical care for detained immigrants, and the elaboration of policies that were based far more upon considerations of class and scapegoating than upon deterministic principles of bacteriological or physician diagnosis.”
While Canadian colonization created the conditions for epidemics to flourish, the Canadian state repeatedly imposed quarantines on First Nation reserves—and in 1914 the Indian Act was revised to add “prevention or mitigation of disease” as a justification for enforcement.
When plague appeared in San Francisco’s Chinatown in 1900 it was named as an “Oriental disease” and blamed on “rice eaters”. Rather than improving the wages and housing conditions to make everyone healthier, the city launched a militaristic “disinfection” campaign including home demolition, closing of businesses, and quarantine backed by armed guards. When plague killed white residents seven years later, none of this was repeated.
SARS spread in Ontario in the context of healthcare cuts, as former Conservative health minister Tony Clement now admits: “Complacency about public health by successive governments – including my own – contributed to the challenge of containing SARS.” Quarantine was credited with containing SARS in Toronto, but did it? According to Richard Schabas, Ontario’s former chief medical officer of health, “Toronto quarantined at least 25 times more people than was appropriate. Concerns about this inefficiency were raised quite early in the outbreak. The Toronto quarantine was clearly ineffective in identifying potential SARS patients. At least the first 50 cases in the second phase of the outbreak were not quarantined. Compliance with the Toronto quarantine was poor. Only 57% of people quarantined were ‘compliant’, according to Toronto officials…I think the evidence is now overwhelming that quarantine played little or no role in controlling SARS. Furthermore, mass quarantine, as practiced in Toronto, did considerable harm by sapping public health resources and fueling public anxiety…Case identification and isolation in hospitals is what controlled SARS. Quarantine, as such, played no role.” These same public health measures—without quarantine—have identified all coronavirus cases in Canada so far.
Despite its ineffectiveness in fighting disease and proven track record in causing harm, governments around the world are turning to quarantine measures for coronavirus. But often aggressive quarantine measures are pursued by the same governments who are hostile to basic preventive measures. China has imposed the biggest quarantine in history, over a region of 50 million people, which has caused a lack of food and medicine that will make this and other infections worse. As a government official stated, “During these wartime conditions, there must be no deserters, or they will be nailed to the pillar of historical shame forever.” But this is the same government that forced Li Wenliang, the doctor who first called attention to coronavirus (and has since died of the infection), to recant his warnings.
Meanwhile outside China, quarantine is becoming another justification for racist border control. After his Muslim travel ban, Trump has banned Chinese citizens as part of his trade war (coronavirus “will help to accelerate the return of jobs to North America,” said his commerce secretary), and is quarantining returning Americans on a military base. But this is the same government that continues to deny Medicare for all and paid sick days, two campaigns that would do far more to prevent coronavirus and other infections than any quarantine. Indeed, during the H1N1 epidemic, the lack of paid sick days led 8 million workers to go to work sick across the US, which contributed to an additional 7 million cases of the flu.
In the UK the government is now allowing forcible quarantine for anyone who doesn’t follow voluntary self-isolation (even though there have been no such cases), with the Health Secretary saying “I will do everything in my power to keep people in this country safe” and that “we are taking every possible step to control the outbreak of coronavirus.” But this doesn’t include restoring funding to the National Health Service.
Australia has banned travel from Chinese citizens, and is repatriating their own citizens to quarantine on Christmas Island, a notorious compound used a migrant detention centre and which is still indefinitely detaining a Tamil family. As one person in quarantine asked, “Are we getting this kind of treatment because we’re not Caucasian Australian? Because we’re Chinese Australian?” Canada also has indefinite detention for migrants, and is using a military base to quarantine those returning from Wuhan. As one infectious specialist noted, “It won’t work. It feels good, it looks good. It’s political theatre.”
Reframing
Cholera was not controlled by restricting pilgrimages but by providing safe drinking water, and it continues where basic infrastructure is destroyed–from Iraqi under US occupation, Haiti under UN occupation, and Yemen under Saudi war. TB rates were not reduced by blaming racial traits or policing ceremonies but by better housing and medication, and persist where these are denied. HIV infections is not reduced by border control but by accessible medication, safe injection sites and safe sex, and continues where these are denied.
Naming and blaming Chinese communities for coronavirus won’t stop it, and Chinese around the world have spoken out against racism, including using the hashtag #IamNotAVirus. The York Region School Board quickly responded to the petition, with an answer based on public health and grounded in anti-racism: “The advice of Medical Officers of Health is consistent for all our students and families: Wash hands; Cover your mouth and nose when you cough or sneeze, if you don’t have a tissue, sneeze or cough into your sleeve or arm; Stay home if you are ill…While the virus can be traced to a province in China, we have to be cautious that this not be seen as a Chinese virus. Those who are afflicted or are potential transmitters are not just people of Chinese origin…Situations such as these can regrettably give rise to discrimination based on perceptions, stereotypes and hate. Individuals who make assumptions, even with positive intentions of safety, about the risk of others, request or demand quarantine can be seen as demonstrating bias and racism.”
Forcibly containing people is not the answer, and empowering people to stay home when they are sick is far more effective. More than 175 Ontario health workers have signed an open letter demanding paid sick days and an end to sick notes: “In the context of recent concerns with the novel coronavirus in Ontario, we consider the current provincial labour laws to be a serious threat to the health and safety of Ontarians. In September 2019, the federal government implemented 5 PEL days for all federally-regulated workers, 3 of which are paid. In Quebec, a similar policy exists, providing workers with 5 days of PEL, 2 of which are paid. Our patients in Ontario must also be able to stay at home and recuperate from new and existing infectious threats. They will be unable to do so unless they have paid sick days. Employment standards in Ontario provide workers with no paid sick days, only 3 days of job-protected leave for personal illness, and workers can be required to provide a sick note in order to access this leave. These provisions do not meet the health needs of Ontarians and create a direct individual and public health risk to Ontarians. We call on the provincial government to reinstate 10 days of flexible Personal Emergency Leave days, 7 of which need to be paid, and an end to mandatory sick notes.
To begin to understand epidemics, we need to vaccinate ourselves against racist explanations. Infectious disease—by its very nature—spreads, and tying an epidemic to a country or region (“Asiatic cholera”, “Haitian virus”, “Mexican flu”, “Wuhan coronavirus”) falsely equates disease with specific people. This has led to the medicalization of racism, where previously marginalized groups are accused of spreading disease through normal behavior—praying while Brown, breathing while Black, dancing while Indigenous, drinking while Irish, traveling while Jewish, or eating while Asian. These do nothing to explain infections, but instead target racialized people—through immigration control, restrictions on cultural practices, and monitoring of students. This also distracts from the real social and economic conditions that drive infections. It’s only by addressing these conditions through collective solutions—like clean water, good housing, access to medication, and paid sick days—that we can stop epidemics.
As UofT student Frank Ye said, “when we peddle racist ideas, when we peddle xenophobia, that isn’t going to protect you from the virus. Proper public health procedures and precautions will protect you from the virus. Racism won’t.”
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