There comes a time in every pandemic when those in power feel sufficiently protected from the infection and sufficiently burdened by public health that they push for life to go back to “normal” even as the pandemic rages.
Just a few months into COVID-19 we’ve already come to this point: major Canadian grocers stopped pandemic pay and the Canadian government is trying to restrict financial relief. Meanwhile, the Ontario government is pushing ahead with privatizing long-term homes despite their death toll, empowering landlords to evict tenants in the middle of housing crisis, and allowing agribusinesses to work migrant workers with COVID to death. Pandemics are public health crises. But they can also produce a social crisis if they threaten the personal safety, economic profitability or political stability of those in power. The first response is often a xenophobic exercise in naming, blaming and containing the infection to communities accused of originating and spreading the infection.
When that fails, the next strategy is narrow technical, behavioural or biomedical interventions while preserving the economy and restoring political stability. Life can then go back to “normal”, with ongoing infections normalized as expressions of deviant behaviour while the conditions that breed pandemics go unchallenged. But from cholera to HIV/AIDS and COVID-19, pandemic response has also included movements with an expanded vision of health that can convert social crisis into social change.
Cholera and the sanitary “revolution”
When cholera pandemics erupted in in the 19th century in the context of the British colonialism it was named “Asiatic cholera,” blaming those living under occupation and containing their movements. But this didn’t stop its spread to Europe, where cholera thrived in conditions of poverty, poor housing and polluted water. The public health crisis of cholera then became social crisis. Before bacteria were discovered and before cholera was traced to contaminated water, it appeared that nobody was safe and that it might spread from the slums of London to the homes of the rich. Debates about quarantine to stop the spread of cholera threatened the profitability of the British empire built on “free trade,” and cholera epidemics coincided with the political instability of the 1848 revolution.
The European ruling class had to act to protect themselves while preserving their profitability and defending their political order. As Edwin Chadwich explained, “the sullen resentment of the neglected workers might organize itself behind the trade union leaders…if a Chartist millenium were to be averted, the governing classes must free the governed from the sharp spur of their misery by improving the physical conditions of their lives.” So the goal was to narrowly improve the physical conditions of workers—without improving their social, economic or political conditions.
Chadwick started his career reforming the Poor Laws, making relief as painful as possible to drive people to work. He then turned his sights to diseases which struck the poor, which he blamed on filth rather than poverty. The Public Heath Act of 1848 provided a technical fix to water-borne diseases like cholera by providing drainage and sewers—without raising wages, improving nutrition and housing, expanding democracy, questioning the private ownership of the water supply, or proposing revolutionary alternatives. The goal was to contain cholera while maintaining conditions of poverty and exploitation.
As explained in Public Health and Social Justice in the Age of Chadwick, “Chadwick had made the case that his reforms were the key to preventing revolution. He damned Chartists, damned all manifestations of democracy, in favor of a sanitary technology. Far from representing any kind of radicalism it was thoroughly conservative in seeking to solve a problem through minimal changes maximally acceptable to established interests.”
While sanitation helped, it was only when working class struggle raised wages and improved nutrition and housing that the multiple epidemics of the industrial capitalism, from cholera to tuberculosis, were brought under control in the global north. Now water-borne diseases have been normalized as diseases of personal hygiene without addressing the conditions that contaminate water–from the denial of clean water in Indigenous communities, to wars and occupations from Haiti to Yemen (both supported by Canada).
HIV/AIDS: deviant behaviour or violent conditions?
Whereas cholera became normalized after decades, AIDS was normalized immediately. When it emerged in 1981 it was greeted with stifling silence because it was first reported in gay men. In the context of rampant homophobia, it was not even considered infectious but instead an immunological consequence of homosexuality: in the medical literature AIDS was first called GRID, Gay Related Immune Deficiency.
Those in power felt safe, it did not threaten their profitability, and did not weaken their political order. On the contrary, they used the epidemic to reverse the gains of the gay rights movement. LGBT activists had fought to eliminate homosexuality from the list of psychiatric disorders, and now it was being relabeled as a terminal illness. As right-wing ideologue Pat Buchanan claimed in 1983, “the sexual revolution has begun to devour its children. And among the revolutionary vanguard, the Gay Rights activists, the mortality rate is highest and climbing.”
When it was clear that AIDS was not isolated to gay men or an expression of homosexuality, the strategy of blaming and containing broadened to others in the “H club”: hemophiliacs, heroin users, Haitians, and hookers. These were labelled as deviant “risk groups” and accused of being inherent vectors of disease that threatened the “general population”. This resulted in further stigmatization and criminalization of oppressed groups rather than addressing conditions that put them at risk of infection.
AIDS was only considered a public health crisis when people with AIDS made it one, through marches and demonstrations raising the slogan “silence = death.” Far from being “risk groups”, those blamed for AIDS led initiatives to reduce risk. The LGBT community pioneered the first preventive measures of safe sex and pushed reluctant governments to develop the first treatments, drug users organized for safe injection sites and sex workers for safer conditions, hemophiliacs demanded a safe blood supply, and Haitians fought against the anti-Black and anti-migrant discrimination that labeled an entire country as a disease vector.
AIDS was finally recognized as a public health crisis, but as it deepened internationally it was increasingly seen as an economic opportunity. Pharmaceutical companies who were late to developing medications then prevented access by charging exorbitant prices. It took a global movement of AIDS activists to make medications more accessible for the majority of people with AIDS, linked to movements against oppression. South Africa’s Treatment Action Campaign (TAC), emerging from the country’s anti-apartheid and LGBT movements, broke the stranglehold that BigPharma had on AIDS treatments. As TAC founder Zachie Achmat explained, “Our lives matter. The five million people in South Africa with HIV matter, and the millions of people throughout the world already infected with HIV matter…Just because we are poor, just because we are black, just because we live in environments and continents that are far from you does not mean that our lives should be valued any less.”
It’s thanks to people with AIDS that we know how to prevent HIV and have medication to treat HIV/AIDS. This was always part of movements for broader change, and the ongoing pandemic is an expression of this unfinished social, economic and sexual revolution. But as with the start of the pandemic, AIDS has been normalized as a disease of “risky behaviour” even though this its disproportionate impact reflects racialized poverty: with 12% of the population, Black people in the US account for nearly half of new HIV infections; with 5% of the population, Black people in Canada account for a quarter of new HIV infections. As the book Anti-Black Racism and the AIDS Epidemic explains:
“The color of AIDS in America is black…From structured impoverishment to racial segregation, and from mass incarceration to the ‘political death’ meted out to former prisoners, the state has structured the ways in which black Americans have been made vulnerable to HIV exposure and infection far beyond the capacity of any individual or community mitigation or control…The AIDS epidemic is structured not by the deviant behaviors of relations that people engage in, but by the unequal and violent conditions in which they are forced to live and that are embodied as ill-health and vulnerability to disease.”
COVID-19: wash your hands of the police
COVID-19 was first named “Chinese coronavirus”, an echo of “Asiatic cholera” of the 19th century. It was blamed on people in China while hoping the Chinese state or Western border control could contain it. But it spread rapidly around the world, overwhelming healthcare systems from Italy to New York. It reached the rich and powerful—from Tom Hanks to Prince Charles, and from Sophie Trudeau to Boris Johnson—spurring slogans that the “virus doesn’t discriminate”. It became the last straw that triggered an economic crisis, provoking calls that “we’re all in this together.” But this about face only fuelled political instability. Years of neoliberal cuts to hospitals were laid bare, and governments preaching austerity suddenly had billions of dollars to stabilize the economy. Years of opposition to a $15/hr minimum wage for “unskilled workers” suddenly became applause and pandemic pay for the front-line heroes who prevented the economy from collapsing.
This social crisis created space for longstanding movements to gain a wide audience. To effectively “stay home when sick”, there needs to be housing justice, decarceration, paid sick days, and status for migrant workers. This democratic response to achieve health for all can’t succeed without addressing the economic order based on inequality and the political order imposed by force—and in the context of COVID-19, a resurgence of Black Lives Matter crystallized this context. As with HIV/AIDS, the colour of COVID-19 is Black, Indigenous and racialized: racialized communities are 52% of Toronto’s population but 83% of COVID-19 cases, and this has nothing to do with biology or individual behaviour.
The disproportionate mortality of personal support workers and migrant farm workers is part and parcel of the disproportionate incarceration and policing of Black, Indigenous and racialized communities. Black Lives Matter has exposed the centuries-long oppression that is embodied as ill-health and vulnerability to disease, and the apparatus of state repression that enforces capitalist rule—sparking widespread calls to disarm, defund and abolish the police.
It’s no wonder there are calls for a return to “normal”. It’s clear that while the virus itself doesn’t discriminate, the conditions that drive the pandemic do. The 1% are already socially distanced and now feel personally safe from COVID-19. They can now drop the call that “we’re all in this together” and get back to maintaining economic distancing. Like Chadwick the federal Liberals and Tories are trying to restrict CERB, grocery store billionaires are cutting pandemic pay, and the Ford government is empowering landlords to evict tenants during a pandemic.
This is part of the process of normalizing COVID mortality—including privatizing long-term homes despite their excess mortality rates, and forcing migrant workers with COVID-19 to keep working if they are initially asymptomatic. As Syed Hussan, Executive Director of the Migrant Workers Alliance for Change, explained: “Ontario has responded to three farmworker deaths by signing a death warrant for more migrant workers. COVID-19 positive workers will be forced to keep working as they get sicker, keep infecting others, and more will die.” This is the future of the COVID-19 pandemic if life goes back to “normal.”
Normalizing COVID mortality is the outcome of restricting public health to the minimal changes maximally acceptable to Loblaws and Amazon, agribusinesses and for-profit care homes. It’s about damning Black lives and damning paid sick days in favour of technical suggestions to wear masks and behavioural advice stay home when sick. Deviants who don’t follow this advice can then be blamed as “covidiots,” rather that addressing the social and economic conditions driving the pandemic.
Resisting the normalization of COVID-19 mortality, by challenging the unequal and violent conditions that create vulnerability to disease, helps maintain an expanded vision of health. From cholera to HIV/AIDS, effective pandemic response combines technical and biomedical advances with social transformation. For COVID-19 this means universal access to PPE and an eventual vaccine while empowering people to safely distance at work and to have safe homes and communities—through housing justice and decarceration, defunding the police and investing in communities, status and paid sick days for all.
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