37 North America: Medical Geography I

COVID-19

Derrick Willis

 

The circumstances of COVID-19 are anthropologically and geographically striking now in early June 2020.  Spread of the disease has not produced a randomized pattern, but instead has affected Americans differently based on location and on social, racial, and ethnic patterns.

Throughout the country, governors issued stay at home restrictions and other strategies of mitigation, including public health responses that involve testing and contact tracing, quarantining, and treating the infected. Significantly, there has not been a national testing and contact tracing strategy for addressing COVID-19, even though over 100,000 Americans have died from this pandemic. It is shocking to know that we have had more Americans die in a little over two months than we lost in Viet Nam (58,000) and the Korean War (36,000) combined. Columbia University issued a report that if the US had closed one week earlier and began mitigation, then 36,000 American lives could have been saved. Over 40 million jobs were lost in the US by May 28, 2020.

Due to the ease of infection in places of high population density, early hot spots were Los Angeles, San Francisco, and Seattle on the west coast and New York City, New Jersey, and Boston on the east coast. New Orleans became a hot spot after the Mardi Gras festival. Detroit and Chicago were hot spots in the Midwest. Approximately half the country still has uncontrolled cases of COVID-19 but all the states have entered some phase of reopening the state and economy.

 

The strength in the US response has been its governors and local leaders across most of the nation.  New York (Governor Chris Cuomo), California (Gavin Newsom), Washington (Jay Inslee), Michigan (Gretchen Whitmer), and Illinois (J. B. Pritzker) are but a few examples of governors and local leaders who let science be the primary reference when addressing their constituents.

 

Other states have taken less scientific approaches. Officials in Georgia manipulated statistics to fraudulently report improvement in COVD-19 cases over time.  Federal leadership also chose to avoid science when it contradicted their personal hopes for better news. President Trump fired the Health and Human Services Inspector General Christi Grimm after she issued a report observing the shortage of protective personal equipment (PPE) to properly respond to this pandemic. Scientist Dr. Nancy Messonnier of CDC was demoted after alerting the public that the upcoming pandemic would disrupt our lives. Whistle-blower scientist Dr. Rick Bright who headed BARDA, the division in CDC responsible for developing vaccines, was demoted after he would not recommend hydroxychloroquine, as otherwise touted by President Trump for treating COVID-19. Silencing and ignoring the advice of Dr. Anthony Fauci, Dr. Deborah Birx, and the CDC left the public with misleading and incomplete information.

The impact of the virus socially, demographically, and economically has varied.  African Americans, Latinx, and Native Americans have been the hardest impacted communities. They are more likely to live in urban centers or where there is considerable dense population, thus in settings where this virus more easily spreads. They are at increased risk for being underinsured and malnourished than white Americans are. This impact is tied to the socio-economic inequalities that exist within these communities. Health disparities among these minority populations, such as greater rates of pre-existing conditions like high blood pressure, heart disease, diabetes and obesity, put these populations at increased risk of experiencing complications from COVID-19.  Individuals who are 65 and older are among the groups with the highest rates of mortality from the virus.

 

Photography of COVID-19 sign in Arlington County, Virginia.
COVID-19 sign in Arlington County, Virginia. Photo by dmbosstone on Flickr.

Economically we find that African Americans, Latinx, and Native Americans are more likely to be defined as essential workers who are not allowed to work remotely from their homes, but need to work on site. These workers are disproportionately people of color and immigrants. Smithfield Foods in Sioux Falls, South Dakota, is one such meat factory that had a noteworthy outbreak of COVID-19.  Concerned about maintaining the supply of meat across America, on April 29, 2020, President Trump issued an executive order citing the Defense Act of 1950 to keep meat processing plants open to delay possible shortages of beef, pork, chicken and other meats. Oddly, President Trump did not use this act to increase production of personal protective equipment (PPE) for essential workers.

 

Working on the disassembly-line these workers are in close quarters, practically shoulder to shoulder from each other preventing them from socially distancing. Needed masks would be hard to wear for long periods given the strenuous fast-paced nature of their work. Consequently, meat processing plants have been among the main vectors for transmitting the COVID-19 virus.

 

The close proximity in which individuals live and work can easily prompt the spread of COVID-19.  A number of nursing homes across the country have reported numerous deaths, while prisons, such as in Marion, Ohio, and in Pine Bluff, Arkansas, face challenges to halt the virus.  For a look at which jobs place workers at greater risks, examine the excellent diagram at https://www.visualcapitalist.com/wp-content/uploads/2020/04/covid-19-occupational-risk-scores.html

Federal, state, and local governments continue to search for ways to balance the health and economic challenges.  For instance, many hotels that are no longer booking rooms could serve as places to isolate/quarantine individuals who test positive or who have had contact with someone who is positive when they live in with others. Hotel rooms could serve as places for first responders to live temporarily, otherwise worried about bringing the virus home to their families. The government could pay a per diem for these services, thus generating income for the hospitality industry that has been so gravely impacted by the shutdown of the national economy.

International comparisons are interesting and perhaps a topic for an additional essay.  Countries that are effectively controlling the COVID-19 threat have done so be demonstrating strong political leadership that stresses science in response to this pandemic.  Examples include New Zealand – Prime Minister Jacinda Ardern – population of 4.8 million, Germany – Chancellor Angela Merkel – 83.0 million, South Korea – President Moon Jae-in – 51.6 million, and Taiwan – Tsai Ing-wen – 23.7 million.

 

Did You Know?

Other countries, including the United States, have done poorly in containing the virus.  The seven countries hardest hit, measured by per capita cases, are Singapore, Ireland, Spain, Belgium, the United States, Italy, and the United Kingdom.

Hot off the Press

The hard copy edition of The Atlantic for September 2020 has an excellent and lengthy article that examines the spread of COVID-19 in America.

Yong, Ed. 2020. “Anatomy of an American Failure: How the Virus Won.” The Atlantic, September 2020.

 

Cited and additional bibliography:

Armstrong, Martin. 2020. “Infographic: COVID-19 Cases per Million Inhabitants: A Comparison.” Statista Infographics. May 18, 2020. https://www.statista.com/chart/21176/covid-19-infection-density-in-countries-most-total-cases/.

Baird, Robert P. 2020. “What It Means to Contain and Mitigate the Coronavirus.” The New Yorker. March 11, 2020. https://www.newyorker.com/news/news-desk/what-it-means-to-contain-and-mitigate-the-coronavirus.

“COVID-19 May Not Discriminate Based on Race — but U.S. Health Care Does.” 2020. YouTube Video. YouTube. https://www.youtube.com/watch?v=U5QdRwflM9I&t=1s.

dmbosstone. 2020. COVID-19 Sign in Arlington County, Virginia. https://tinyurl.com/covidarlington. Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0).Laa, Jose Manuel de. n.d. Coronavirus by José Manuel de Laá from the Noun Project. Accessed May 30, 2020. https://thenounproject.com/search/?q=covid-19&i=3349759.

Lussenhop, Jessica. 2020. “The Untold Story behind America’s Biggest Outbreak.” BBC News, April 17, 2020, sec. US & Canada. https://www.bbc.com/news/world-us-canada-52311877.

Martin, Rachel. 2020. “Labor Reps Worry About Meatpackers Safety After Plants Ordered To Reopen.” NPR.Org. April 29, 2020. https://www.npr.org/2020/04/29/847732023/labor-reps-worry-about-meatpackers-safety-after-plants-ordered-to-reopen.

McCarthy, Ryan, and Sam Daniel. 2020. “Map: COVID-19 Meat Plant Closures.” Www.Meatpoultry.Com. May 28, 2020. https://www.meatpoultry.com/articles/22993-covid-19-meat-plant-map.

Molteni, Megan. 2020. “Why Meatpacking Plants Have Become Covid-19 Hot Spots.” Wired. May 7, 2020. https://www.wired.com/story/why-meatpacking-plants-have-become-covid-19-hot-spots/.

Press, Associated. 2020. “Georgia, Florida Accused of Fudging or Bungling COVID-19 Testing Data to Make State Look Better.” Www.Mywebtimes.Com. May 19, 2020. https://www.mywebtimes.com/2020/05/19/georgia-florida-accused-of-fudging-or-bungling-covid-19-testing-data-to-make-state-look-better/afix7zf/.

Rosner, David. 2010. “Spanish Flu or Whatever It Is …”: The Paradox of Public Health in a Time of Crisis.” Public Health Reports 125 (S3): 37–38.

Singer, Merrill. 1995. “Beyond the Ivory Tower: Critical Praxis in Medical Anthropology.” Medical Anthropology Quarterly 9 (1): 80–106.

“The Dangerous Global Flood of Misinformation Surrounding COVID-19.” 2020. YouTube Video. YouTube. https://www.youtube.com/watch?v=Xl9zgDGko5U.

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