Masks off: The lessons we didn't learn from COVID

When the SARS-CoV-2 virus first began spreading across the globe five years ago, some predicted that it could take five years for things to recover. Now that we've reached this seemingly impossible point, it seems some of those warnings were correct. Though infections are at a relative low these days, we're still dealing with COVID-19, which kills hundreds of Americans per week and disables countless others.

To date, the death toll from COVID is approximately 1.2 million Americans, the most deaths of any country, across two administrations. The fact that this was essentially allowed to happen, and that Americans were at greater risk than we could have imagined, is an eye-opener. So too is the fact that there has been no accountability. And that people continue to die from, and be disabled by, SARS-CoV-2 infection without any movement to change the situation. 

But it’s not just our life expectancy at birth that COVID has changed, or our probable risk of dementia. The pandemic has been a broader un-masker as well. Since perhaps FDR's New Deal and World War II, the interests of the average American have been understood to be inseparable from U.S. democratic capitalism. But since the pandemic, those interests have diverged sharply from the interests of the leaders and power-brokers of that system, regardless of whether they are Democrats or Republicans. (In other countries there's been a similar divergence between a wealthy minority and the majority most negatively affected by the pandemic.)

Of course, the arrival of COVID five years ago merely accelerated and facilitated existing trends of inequality, commodification and ownership consolidation of housing and agriculture (and everything else). It spurred massive geopolitical shifts, a class of increasingly precarious workers drawn from what was once a heartier middle class, the rise of tech authoritarianism and proto-fascism along with old-fashioned xenophobia, and the decline in public health and the scientific literacy, interest, trust and funding that support it. Perhaps most of all, these trends include acceptance of mass death, and of huge suffering among one identifiable group after another.

An interest in keeping us well

In the wake of COVID, existing trends in the spread and re-emergence of almost-forgotten diseases — trends mostly reflective of an increase in poverty, inequality and global travel, as well as in the alliance of so-called alternative medicine with the political far right — have been exacerbated.

A rise in syphilis cases in many countries over roughly the decade preceding the pandemic, for example, has accelerated since 2020, with congenital syphilis, where a mother passes the disease on to her child during pregnancy, rising 30% between 2021 and 2022 in the United States. University of Toronto infectious diseases researcher Ian Bogoch told the BBC that “a lot of this is reflective of a breakdown in public health care.” 

Indeed, a letter in the journal Science last week argued that preparing for an H5N1 pandemic is urgent, requires global cooperation, and must focus on equitable public health response funded by the government in collaboration with other sectors. Six years ago this might have read as a serious and realistic call for action. Now, it sounds more like a utopian incantation: read it aloud three times on a hill under moonlight and perhaps it will come true. Because the odds of such a serious, urgent, equitable and cooperative public health response being realized in the current reality seem incredibly unlikely. 

Syphilis is not a complicated disease to treat: it just needs penicillin. During the early phases of the pandemic, testing and treatment were delayed, and so rates of reported syphilis, like tuberculosis rates in this period, were artificially high for a while once testing began to catch up. But that issue has largely passed, without public health care returning to what it was. And syphilis is far from the only sign of a terribly sick health care system.

Even as funding for necessary health care vanishes, essential data is removed from the public eye, and programs are forbidden from focusing on where they’re most needed, ordinary people are losing faith in the system, contributing to the problem by refusing simple, self-protective public health measures like wearing masks in indoor spaces or vaccination. Of course, not all groups are affected equally by these disparities.

“When we think about racial disparities in vaccination, it’s really important to get to the heart of why they exist and continue to persist,” Dr. Maimuna Majumder, a computational epidemiologist and faculty member at Harvard Medical School and Boston Children’s Hospital, told Salon in an email in relation to declines in measles vaccination fuelling the current outbreak of the disease.  

“Ultimately, under-vaccination has many causes. For example, in educated white folks, it’s often because of [factors like] lack of direct experience with [measles] itself; confidence in knowing the needs of their children, driven by their own education attainment; and so on. But in marginalized groups, the reasons can be completely different,” Majumder said, going on to note that a primary reason she’s seen in her own work is a lack of trust in the authorities that have themselves been responsible for their marginalization.

An interest in us believing our own eyes

We all saw the images of body bags stored in refrigerated trucks, and if we were in New York or another major city, we might viscerally remember the sirens. All this has faded awfully fast from our mass cultural memory. Could we really have lived through a situation in which, in that city alone, hospitals had to move bodies by forklift into makeshift truck morgues, in which bodies were stored in funeral home viewing rooms and chapels, in which four crematoria worked around the clock and bodies were buried in the same potter's field that has taken in the victims of past yellow fever, tuberculosis, HIV and influenza victims?

When we hit 100,000 American lives lost to COVID in May 2020, the New York Times published a moving tribute with detailed memorials to victims of the disease. When the figure reached one million the following year, the Times waited two weeks before representing all one million Americans as dots in a nonetheless valuable investigation of disparities in death rates. Thankfully, deaths have declined sharply from their peak during the Omicron surge, thanks to vaccination and acquired immunity from previous infections, which can make it feel like the virus is in the rearview.

But COVID — no longer subject to the precautions and policies of a national public health emergency or mandatory reporting of the disease — is still very much with us. Between 23 and 39 thousand Americans died directly of COVID in just the past six months, but their faces are no longer memorialized on the New York Times' front pages.

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In several years of writing about the opioid painkillers, the intersection of drug use and homelessness, and speaking with low-income people who used street drugs like illicit fentanyl or methamphetamine, I was struck by how often my interlocutors used the word "genocide." War on drugs policies that increase the unreliability of the underground drug market, combined with policies that criminalize poverty, were resulting in the regular deaths of the people around them. When they described it as a genocide, they were alluding to what they couldn’t help suspect was a concerted government policy to kill off drug users and the poor. The fact that the intersection of those two categories more often than not went along with one or more of being Native American, Black, disabled or queer only exacerbated these fears.

Conspiracy thinking in the absence of evidence is not helpful in understanding either COVID or toxic drug supply. But my respondents were accurately identifying a phenomenon of mass social abandonment. In their case, it began — or perhaps accelerated — as the impact of housing-commodifying policies of the 1990s coincided with the rise of illicit opioids, producing a class of extremely poor people with very little hope of emerging from desperate poverty. Addiction was really beside the point. 

Drivers wait in a long line of cars for a COVID-19 test at a drive-through test site on December 9, 2020 in Riverside, California. (Gina Ferazzi / Los Angeles Times via Getty Images)So for two decades there has been mass death and displacement without any substantial ripples in the rest of society or significant policy changes to stop it. Rather, victims were increasingly criminalized. Attending funeral after funeral until it feels like an emergency, but seeing society continue as if nothing is going on is, for these people, a kind of gaslighting by policy.

Drug overdoses escalated from the start of the pandemic. While the rate has slowed, deaths have yet to decline back to where they were before COVID — a possibly significant drop just this year may be attributable to incomplete data, the CDC notes. 

Meanwhile, the sense of a crisis of mass death that society ignores as a whole, and policymakers in particular, has gone on to hit more and more identifiable groups. We stopped keeping track of COVID deaths almost altogether sometime in 2023, and given the lack of testing, there are no longer published death rates that can be said to accurately reflect actual deaths. There is evidence to suggest that some deaths attributed to natural causes, such as strokes, pneumonia or organ failure, during the first 30 months of the pandemic actually resulted from COVID. And now? All we know is that COVID, as a vascular disease, can have long-term effects on virtually every system of the body, worsening existing health conditions and creating new ones. But when someone dies of a heart attack now, or pneumonia, it is even less likely to be attributed to COVID. So we really don't know how many people are being killed as a result of past or current infection with SARS-CoV-2. But — as the National Organization for Women pointed out earlier in the pandemic — “Black, Hispanic, Latinx, Native American and Alaskan Native populations [are] suffering much higher rates of exposure, hospitalizations, and deaths.” 

These disparities are unlikely to have changed for the better. But those rates are no longer recorded.

For many of us, this all feels anything but normal. The continuing toll of the coronavirus is officially unrecognized while being exacerbated by official policies that suppress the signs of a pandemic — without suppressing the virus itself. Immunocompromised and disabled patients are told that unmasked hospital waiting rooms are safe when we know they are not. Or that we must send our kids to crowded classrooms, but are not allowed to even donate an air filter to reduce our risk of life-changing infection. 

Those living with postacute sequelae of COVID (PASC, or long COVID) are routinely gaslit about their symptoms by medical professionals. Rates of numerous conditions for which there is a clear association with SARS-CoV-2 infection and even a demonstrated mechanism seem to be on the rise — heart disease and strokes or new onset type 2 diabetes, for example — but we are told that it has nothing to do with ongoing high wastewater rates of the virus. Patients go into hospital for surgery and come out with COVID. Or, sometimes, they don’t come out.

The same president who was the single largest driver of misinformation about COVID — as Cornell University researchers concluded in a 2020 study that looked at 38 million pieces of English-language content that year — has returned to power, vigorously pursuing the agenda that was briefly interrupted by the Biden administration. 

And then, of course, since Oct. 2023 we have watched war crimes livestreamed on our screens, even as the students protesting it and calling for ceasefire in Gaza have been treated as criminals. It's not just a war, it's also a public health crisis that, a couple of months of ceasefire aside, bridged the change in administration, assuring us that the cross-partisan tendency to gaslighting remains constant in regards to global geopolitics, as in regards to the pandemic. Jewish students holding open Shabbat dinners at encampments in support of Palestine, even, have been slandered as antisemitic. It’s enough of an inversion of truth, expected adherence to international law, the values that supposedly guided Western sympathy toward Ukraine, and basic compassion to give you whiplash. 

It all likely contributed to the return of Donald Trump, whose disregard for the Democratic tendency to use social justice rhetoric to mask billionaire-benefiting policy, and whose naked use of the president’s office as a profit-making, land-grabbing opportunity, takes unmasking of priorities to a whole other level.

The current administration’s attempts to visually and then literally wipe out concepts like racial disparities in health care outcomes, or health impacts of climate change, pollution and wildfires, or the vulnerability of groups like those over 60 or under 5 to infectious disease, fit right into the environment that’s been created: one in which one’s own experience is at odds with the official line. 

At which point, we’re told by friends, doctors, pundits and our political leaders that we’re clinically anxious, paranoid or even dangerous for the very logical skepticism and mistrust that result.

“As a Muslim scientist, a good deal of my community engagement involves reassuring my ummah that the government isn’t trying to chip us every time we get a vaccine — but I want to stress that this fear is not unfounded and does not deserve the ridicule it tends to receive,” Majumder explained, pointing out that Muslim Americans are extremely over-surveilled. "Many of us have first-hand experiences with inexcusable governmental infringements on our right to privacy."

"And sadly, we are not at all alone in this struggle, either; after all, our country has a long-standing history of government-financed eugenics programs that have targeted American minorities,” Majumder went on. "It’s extremely important from a health communications perspective to treat well-founded fears from a place of respect and empathy; that’s the only way marginalized communities — that are rightfully distrustful of the authorities — can be reached."

An interest in keeping us alive

Very early in the pandemic it became clear that, as is common for pretty much all diseases, the impact of SARS-CoV-2 infection is not evenly distributed across the population. Some groups have higher infection rates: like children under five, despite early and even continuing pronouncements about kids not getting COVID; Black people versus white, Hispanic versus non-Hispanic; men versus women. 

Others get more severe COVID if they get infected, and are more likely to be hospitalized or die (men; younger people with disabilities; older age groups.) Others are more vulnerable to long-term effects (women, people over 65, people with autoimmune diseases.) Still others live in areas or come from groups that have worse access to life-saving health care, or are less able to afford personal protection — everything from N95 masks to driving a private car instead of cramming into a packed subway car. 

Study after study has revealed differential risk of death, likelihood of positive tests, or ability to isolate from family members to prevent spread of infection. The obvious course of action, once we learned that, for example, people with diabetes were at higher risk of dying due to infection, was to increase protection for people with diabetes. At the start, that meant giving them greater access to personal protective equipment and quick testing, and increasing their ability to get food delivered and to work from home. 

Later, the ways to protect what came to be generalized as "vulnerable people" included treatment with monoclonal antibodies and antivirals; and universal masking so that the amount of potential pathogen in any indoor space was reduced.  

“You do expect the state to save capitalism from its own worst instincts to some degree, in order to preserve social stability,” John Clarke, a long-time anti-poverty organizer who now teaches the history and practice of social struggle in Toronto, told Salon by email. He observed two ostensibly different responses play out around the globe — the Trump-style denialists, and leaders like Biden who purported to be responsible, but whose response was weak and inadequate, still put corporate profit over public health in reopening prematurely and without adequate mitigation. In practical terms, both approaches hung workers and those at risk of infection out to dry. In large part for this reason, more people ultimately died of COVID under Biden than Trump, as former Surgeon General Jerome Adams, who held this role under the first Trump administration, reminded Salon in December. 

That said, if we hadn't reopened as early as we did (Trump issued his reopening plan in April of 2020, a month after everything closed, while Georgia, Alaska, and Oklahoma began to reopen against public health advice April 24th), it's possible that the less infectious original strain of SARS-CoV-2 would have eventually fizzled out for lack of transmission, like SARS-1 and MERS, other coronaviruses with pandemic potential. Instead, mitigation was uneven and half-hearted, stoking frustration without effectively preventing spread of the disease, and paving the way for the backlash that followed.

“What was striking about the pandemic was how weak that limited restraining influence proved to be,” Clarke said. "In the face of a terrible virus that could have been even worse, measures of public health and social protection took a back seat to the needs of short-term profit in country after country. Lockdowns were too late and too little and temporarily improved income support and tenant protections were cast aside as rapidly as possible."

A registered nurse administers the COVID-19 vaccine into the arm of a woman at the Corona High School gymnasium in the Riverside County city of Corona, California on January 15, 2021. (FREDERIC J. BROWN/AFP via Getty Images)

While we often heard about people’s vaccine fatigue or pandemic fatigue or masking fatigue, rarely did the media cover a far more entrenched structural issue: labor rights fatigue. Majumder told Salon that the second primary reason for low vaccination rates within marginalized communities is the lack of worker protections that would make it easier to get vaccinated. The majority of Americans consider themselves middle class, whether or not their lived reality or ability to afford housing or share of aggregate income reflect what we used to consider middle class. Thus they may not see themselves as marginalized. Still, if we’re considering who lacks worker protections, the term marginalized communities must refer to an amorphous but increasingly populated group that includes restaurant workers, daycare staff, delivery drivers, personal support workers — anyone who has trouble taking time off or who has an unpredictable work schedule and wages that are low in comparison to the cost of necessities. 

Such a group overlaps notably with that of workers who have difficulty voting because they can’t get the time off work: low-wage, more likely to be women, people of color, and working parents with young children. This is the group that needs daycare and good health insurance but is less likely to have it; that commutes large distances because they can’t afford rent near their workplace; that was disabled by COVID but lacks long-term disability insurance; and that was pushed back to in-person work most quickly and insistently, and before COVID rates justified it in epidemiological terms. This is often the group that were lauded as essential workers or heroes. Within this broad group, researchers have identified multiple identities that were hit with higher death rates than outside it.

An interest in real estate  — over workers

The move to remote work had its downsides, for sure. But for many people, the change represented a significant improvement in their work-life balance and quality of life, and allowed for workforce participation among people with disabilities, including those newly disabled from COVID. It also reduced workers' risk of new COVID infection, disability and death. A 2021 study based on a survey of one million Americans, for example, found that non-health care front-line workers experienced a sustained higher risk of testing positive for SARS-CoV-2 compared to non-frontline workers from Sept. 2020 to March 2021. These days, we’re all less likely to know if we are infected, so this kind of data is harder to collect. But we know that people continue to die of COVID, and they are largely not the CEOs who are pushing people back to in-person work or arguing against mitigations such as sick leave provisions or improving indoor ventilation and filtration in these workplaces. While there are strong cases to be made for hybrid or flexible workspaces that allow workers to spend time in person with colleagues, to get out of the house, and to interact with clients or customers in person, the push to return to in-person work has been imposed very definitely from above.

It’s not even because workers are more productive when they’re in an office workplace. They’re not. The U.S. Bureau of Labor Statistics demonstrates that what they call total factor productivity growth, a concept that tries to account for different ways of measuring productivity, rose along with the rise in proportion of remote workers across 61 private sector industries between 2019 and 2022. This holds even after you account for pre-pandemic productivity trends. The authors of the Bureau report dryly note: “productivity gains accrued to businesses, however, did not result in increased compensation to workers.” 

Despite the advantage to many businesses of reducing non-labor costs by remote work, the commercial real estate sector has needs. A 2023 McKinsey Global Institute report on remote work estimated $800 billion of commercial real estate value was at stake by 2030 across nine major world cities. Then there's the twitchy desire to maintain control over employees’ time. Together, these factors seem to have motivated the push to get low-wage workers back to in-person work in unmitigated environments, while white-collar workers and high-level decision makers continue to enjoy hybrid or work-from-home arrangements and the resulting lower risk of SARS-CoV-2 infection and death. One of Donald Trump's first executive orders was to send the entire federal workforce back to the office.

Majumder noted another way in which public health outcomes relate to worker protections, or lack of them: “It’s important to remember that many unvaccinated folks actually aren’t vaccine-hesitant; rather, they simply don’t have adequate accessibility to vaccination (i.e., easy access), driven in no small part by poor worker protections.” Some of her early pandemic research looked at the importance of paid sick leave in being responsive to public health interventions. 

“Vaccines are an excellent example of a situation where paid sick leave can be essential, especially if folks are worried about (minor, albeit disruptive) side effects. Moreover, it can be tough to even make it to the vaccine clinic — whether it be for yourself or for your kids — if you work a job where you can’t get time off for this essential public health activity,” Majumder told Salon. 

In effect, reports that emphasize vaccine hesitancy or talk about pandemic fatigue may conflate policymakers' goals of pushing people back into the workplace and of maximizing productivity at the expense of well-being with workers’ sheer exhaustion and barriers that make it hard for us to take part in protecting our own interests, whether through votes or vaccines.

So who is all of this for?

As documented in A Poor People’s Pandemic Report, “after its first wave, COVID-19 became largely a ‘poor people’s pandemic,’ with poor communities grieving nearly two times the losses of richer communities.” As this became evident, the “we’re all in this together” slogans petered out. Media and politicians began declaring the pandemic over, well before the epidemiological indicators bore this out in any way.

“The international reopening consensus that emerged as the pandemic ground on represented, in my view, a de facto consensus on social abandonment,” Clarke said. “There is no plan to deal more effectively with any future pandemic and the same is true of climate impacts. The cost of living crisis that followed the pandemic saw austerity intensified, wage demands resisted and an even more naked effort to deal with all social and economic crises in ways that served the needs of the vested interests. In conditions of 'polycrisis,' governments are more determined than ever to shape public policy in ways that favor the few at the expense of the many.”

Following the pandemic, homelessness skyrocketed. And the homelessness crisis that hit wealthy cities like San Francisco was by no means confined to people who used illicit drugs, or to the unemployed. 

This is the context in which the pandemic accustomed the rest of us to mass death, mass amnesia about that death, and criminalization of those who refuse to forget.

While U.S. politics have been dominated by the wealthy for as long as any of us can remember, and while Republican and Democrat representatives send their children to the same Ivy League schools where they will make the connections that lead to the same corporate boards, and while the dramatic concentration of wealth that results in inequality levels that would shock Marie Antoinette began ramping up in the '90s, the fallout of the pandemic has been such that the U.S. now have a government committed to avoiding any gestures towards the 99%.

The concentration of wealth has escalated through and since COVID. By the time the Omicron strain first turned up in South Africa in Nov. 2021, its current most famous son, Elon Musk, was already $293.7 billion richer than at the start of the pandemic. Collectively, America’s billionaires gained $1.8 trillion over that same interval, even as rents skyrocketed and 28.2% of lower-income adults lost their jobs, compared to just 7.8% of upper-income workers. They often ended up with more precarious positions or, as was the case for working women with children and people disabled by the pandemic, being pushed out of the workforce. And changes made in the wake of the pandemic have married wealth to power and governance as never before. 

Essentially, the world — including the majority of Americans — are being held hostage by a tiny group of people of unimaginable wealth. Just 36 fossil fuel companies are responsible for half of the world’s CO2 emissions. A majority of Americans have, since two weeks after Oct. 7, 2023, expressed support for restrictions on or reductions in weapons sent to Israel, and for a ceasefire in Gaza. But U.S. policy under Biden and under Trump has involved sending ever-greater amounts of money and weaponry that are then used to flatten or dismember Palestinian children. 

And we are asked to see the "vulnerable" as a small number of whiny people on death’s door anyway. It’s a straight-out lie — after all, being over 65, being overweight or obese, suffering from depression, having ADHD or having either type of diabetes are just a few of the all-too-common factors that put you on the CDC’s at increased risk list — but it’s been an enormously successful one. Its success during the pandemic, as a million Americans died of COVID-19 within a year, has emboldened those who steal the world’s resources and exploit our labor while putting us at risk we would never have tolerated decades ago, when it seemed that a rising tide was lifting all boats. Risk of disease. Risk of unemployment and homelessness. Risk of global climate collapse and constant disaster, for which we can no longer find insurance to help rebuild nor expect government support to do so.

And resistance will be criminalized

Authoritarianism has been a hallmark of the post-pandemic world. Human Rights Watch described, four years ago now, how at least 83 governments around the world had already used the COVID pandemic to justify attacks on free speech and peaceful assembly. In the wake of the pandemic in the U.S., we've seen a sharp increase in authoritarian response to social movements. This is despite initial successes of the Black Lives Movement and protests of police killings of unarmed Ahmaud Arbery, Breonna Taylor, and George Floyd during the pandemic. Protests of Floyd's murder were perhaps "the largest, broadest and most covered political protests in American history." But establishment and corporate support for changes to structures of systemic racism and racist policing proved short lived. 

As sociologists Deanna Rohlinger and David Meyer argued, "movements may have difficulty working with partners whose financial interests are likely to supersede political goals." Indeed, responses to exercise of the democratic right to protest have, especially in the case of student-led demonstrations against the U.S.-funded siege and bombardment of Gaza, been characterized by excessive use of police force that has been criticized by the American Civil Liberties Union, Amnesty International, Human Rights Watch, the Inter-American Commission on Human Rights, the U.N. High Commissioner for Human Rights, and U.N. experts, including the U.N. special rapporteur on the right to education.

Meanwhile, over the first two years of the pandemic, policing in Houston, Texas shifted from reactive to proactive, relying on increased police presence and targeting of perceived sources of disorder or violence as a way to prevent crime before it happens and avoid accusations of police brutality. However, in practice this might mean clearing encampments of homeless people, surveilling student activists, or targeting specific ethnic or income-defined neighborhoods. 

Harassment of mask-wearing individuals, followed by outright mask bans, has been a feature of this post-pandemic life, with even personal ways to attempt self-protection perceived first as an affront, and then as evidence of suspicious intentions, and even as a crime. At the same time, mask bans fulfill the authoritarian purpose of ensuring individual protesters can be identified by authorities in a climate that is ever more punitive of people exercising their rights to free assembly and freedom of expression.

Perhaps, perhaps, the pandemic sowed the seeds of future resistance by revealing to more and more of us that the world we live in isn't designed with most of our best interests (or the planet's) in mind. There are certain inflection points in history where you can imagine how things might have gone differently. If Martin Luther King Jr. hadn’t been assassinated, might he have succeeded at marrying his anti-war and economic inequality work with the civil rights advocacy for which he remains famous? Might we now all enjoy affordable housing and fair working conditions thanks to his economic bill of rights, rather than preparing for the world’s first trillionaires? If Al Gore had become President, would we now be wondering why climate change indicators are veering towards the worst case scenarios, or whether we’ll perish by water or fire?

And if it hadn’t been for that spiky little virus, would we all be one happy family? Or might we just still think we are?