It all happened too fast, so quickly that we didn’t have time to fully understand. The night before we were sipping beer and eating tapas and waiting for spring to come in the warm evening breeze; the following day we were on the sofa consulting the Netflix schedule for the umpteenth time, without finding an entirely satisfactory choice.
That feeling is like after an unexpected accident, with a supernatural aftertaste. It is as if a divine finger had pushed a gigantic ‘STOP’ button, and our swirling swarm on planet Earth had been suspended; crystallized in a drop of time. One after another, the places where we went to disfrutar de la vida, ‘to enjoy life’, closed their shutters, leaving us confused and lost.
For some it was a trauma to be compelled to cook for themselves. Staying indoors in a city that has unbridled sociability as one of its calling cards is difficult, but Barcelona is still trying to maintain its atmosphere despite the lockdown.
Normally in the evenings the lights of buildings are turned off, with people outside. Lately I discovered that the building opposite my own is actually inhabited.
Yesterday I went out to dispose of the trash and do the occasional shopping we are allowed to do. As I left the door from the balconies above I heard a ripple of applause: for a moment I was moved, it seemed to me that I had become the hero in a dystopian film.
I know they weren’t applauding me, it was just a manifestation of unity in this battle, fought with heavy doses of TV series, bored yawning, punctuated by scared, masked bellboys who bring stuff up to your home. I understood these people: even applauding strangers helps fill the empty minutes.
At least to help us stop missing our previous lives, the weather has decided to remain cold, even if the cold of Barcelona is far from the perennial grey nightmare overhead in Dublin, under which I lived for eight years.
Occupying one’s time is difficult, with the bars all closed there is no possibility of drinking red vermouth with friends. I live in Barceloneta, a neighbourhood that is a peninsula kissed by the sea.
Out on the street, the police remind you to stay at home, speaking calmly into megaphones. Someone brings out their dog to take a piss. The most important road, Carrer de la Maquinista, is empty. The most famous restaurant, ‘La Bombeta’, is closed. The buzz of people’s voices is replaced by the singing of birds, unexpected protagonists in neighborhood life, the vida de barrio that we miss so much.
Flags of Catalonia are still draped from the balconies, moved by a gentle wind. At this time, these people should be my enemies on the football field, as my team, Napoli was set to face Barcelona in the UEFA Champions League round of sixteen, but looking at their worried and tired eyes, so similar to my own, I never felt so close to them. There will be time for confrontation, on the field. Now is the time to be close, very close. If not with our bodies, then in our hearts.
We all wonder when we will be able to walk back to the Paseo Joan de Borbò, stopping at one of the many bars to talk about stuffed bombas; or who is the greater footballer between Diego Maradona and Lionel Messi; or to watch that black-eyed chica that turns the cabeza and makes the corazon skip a beat, every time she passes by.
Such a simple thing, like shopping, has become an experience reminiscent of hours spent gaming; at times I feel I am becoming the protagonist of any chapter in the Fallout saga. The neighbourhood is deserted, everything is closed and dark. The only lights on Plaza de la Barceloneta are those emanating from the church of Sant Miquel.
In the supermarket people are afraid even to smile at you. They are not worried about touching you or being too close, they are simply afraid to recognize in you the fragility of the human condition that unites us all. Breathing inside a mask is for me, with my glasses, embarrassing: with each breath the lenses mist up, giving my vision of the surroundings a dreamlike quality.
In the meantime people are dying, the daily bulletins are becoming increasingly distressing; there is a great deal of concern, and prayers, for the situation in Madrid, but more than miracles the patients need respirators and medical personnel. Here in Barcelona, too, cuts to the health budget are being felt.
People have stopped applauding and there is silence around me, so dense and spooky that it is frightening. More than the infection, and what can happen to any of us if we are hospitalized alongside people fighting for their lives.
We are used to fight for our place in the world, but are we prepared to fight for a lifesaving hospital bed? Now we don’t want to think about it. On the sofas where we spend our days we try to feel secure. Less weak.
In the meanwhile, I’m out. I allow myself five minutes to smoke a cigarette sitting on a bench. But my mind is not free. I just cannot relax. My only thought is about how to get home and carefully spread the antibacterial soap between my hands. A little anguish peeps out: what if I caught the virus on this excursion? I already know that for the next two weeks this thought will haunt me.
But I’m not the only one: here we are, stuck between the duty to stay at home and the desire to go out. In the middle of two fires, or, as De Lucia would say, entre dos aguas. But Barcelona no se rinde – ‘Barcelona won’t give up’. It plays the rumba and waits patiently. The day when we will be allowed to leave our thirty-five-square-metre apartments is inching closer.
When I get back home, I close the door behind me. The sofa seems to look at me worriedly: “Where have you been?”, he seems to ask me. Everything is so unreal that I don’t know how to answer.
The total number of deaths attributed to the Coronavirus in Ireland had reached 22 by March 27th, from 2,121 confirmed cases. However, with 14 of those occurring over the previous two day it suggests that number could rise steeply. Indeed, Taoiseach Leo Varadkar has warned that intensive care units may be at capacity ‘within a few days.’ Historically underfunded and mismanaged, the system of public healthcare in Ireland is at full stretch.
Entrance of the Mater Hospital in Dublin on the North Circular rd. on 27 March 2020. Daniele Idini/Cassandra Voices
Nonetheless, a concerted promotion of social distancing and enhanced hygiene, instigated in particular by civil society and the medical profession, and eventually led by an initially hesitant government, offers hope that the trajectory in the rise of the curve of new cases will flatten. This will bring vital breathing space to implement a detailed national action plan.
The provisional success of containment measures came in the wake of doomsday scenarios being painted in the national media. On March 8thThe Sunday Business Post led with a headline quoting a senior health official to the effect that 1.9 million – out of a total population under five million – were likely to catch the virus over a concentrated three-week burst. Collective minds were also focused by the harrowing accounts arriving, especially through social media, from Italy, leading to hording of foodstuffs.
Daniele Idini/Cassanda Voices
But air travel continued unabated to and from countries such as Spain and Italy, from where the first cases were traced from February 29th. At least the annual Six Nations rugby fixture against Italy, scheduled for March 7th in Dublin was cancelled. Nevertheless, ignoring the looming threat, as many as twenty thousand Irish horse racing fans travelled to and from the annual Cheltenham Festival in the U.K., between March 10th and 13th.
Flight Zurich-Dublin, 19 March 2020. Davide Beschi/Cassandra Voices
Importantly, the government announced the closure of schools and universities from March 13th, calming mounting fears and, after a rising volume of complaints on social media, elected to call off the annual St Patrick’s Day parades. This followed the decision of organisers in the small towns of Cobh, Middleton and Youghal to cancel.
Pubs were not shut down until March 15th, however, by which time concerned citizens were uploading videos of crowded venues onto broadsheet.ie.
O’Connell Bridge, 27 March 2020. Daniele Idini/Cassandra Voices
On March 19th the Dáil passed emergency legislation containing financial measures assisting those affected, and permitting the Gardaí to close down mass gatherings and, potentially, to order people to stay in their homes; as well as providing for the detention of a person on foot of a medical recommendation.
On the evening of St. Patrick’s Day, Taoiseach Varadkar, a trained doctor, solemnly addressed the nation. The competence he projected provided reassurance, even to his critics, that the State would henceforth deploy all means necessary to confront the contagion.
An initial two-week lockdown, permitting walks within 2km of a person’s home, was finally announced on March 27th. It remains to be seen whether this delay in taking this course of action will prove costly. More draconian measures, however, bring their own health risks.
Montjoy Square, 27 March 2020. Daniele Idini/Cassandra Voices
One revealing development has been a massive increase in the availability of properties to rent on the Dublin market, especially near the city centre. This suggests these had been reserved for short-term, Airbnb lets, and that the authorities have not been enforcing regulations prohibiting short-term rents in pressure zones.
As of March 24th, Ireland’s testing figures compared favourably with other European countries. The rate of 1,350 tests per million lagged behind Austria and Germany, but was ahead of the U.K. and France. Senior health officials are following WHO guidelines, rather than trialling risky hypotheses, like the flawed ‘herd immunity’ idea, initially floated in the U.K., and elsewhere.
The pandemic has hit Ireland during a period of political instability after a February general election yielded an indecisive result, with Leo Varadkar’s government no longer commanding a Dáil majority. Notwithstanding the challenge of installing a new cabinet under emergency conditions, it sets a dangerous precedent for a caretaker government to be in power for a prolonged period.
The pandemic appears to have increased the prospect of a united Ireland, especially given the U.K.’s mishandling of the pandemic. The Northern Ireland Power-Sharing Executive, containing politicians from both the Unionist and Nationalist communities, has already agreed to heightened cooperation with the Republic.
Ireland suffers from a legacy of poor planning decisions, with sprawling developments and one-off rural housing commonplace, leading to reliance on motor cars. In the peculiar circumstances of a pandemic, however, this may prove advantageous as communal apartment blocks and crowded public transport seems to have exacerbated transmissions elsewhere.
Henry Street, Dublin. 23 March 2020. Daniele Idini/Cassandra Voices
Located on an island, albeit one with a portion under the United Kingdom, and having a comparatively youngand well educatedpopulation, Ireland can control its borders easier than most. A best case scenario sees the virus being excluded in a matter of months.
President Michael D. Higgins, who is almost eighty years of age, wrote a poem called ‘Take Care’ to reassure his people in a period of dread uncertainty. A portion reads:
Belief
requires
that you hold steady.
Bend, if you will,
with the wind.
The tree is your teacher,
roots at once
more firm
from experience
In December 1899 Honolulu-based physicians attributed two deaths to bubonic plague, and a local paper duly announced that the ‘scourge of the Orient’ had arrived.[i] Within months a first plague fatality was reported in continental U.S. as Chinese-American Chick Gin (Wing Chung Ging or Wong Chut King depending on the transliteration) succumbed to the disease in San Francisco. The cause of death was based on a classic plague symptom of swelling around the groin, but was disputed even after rudimentary bacterial analysis. Regardless, political and health authorities were already taking actions that resonate today.
Fearing the economic impact of a dreaded disease, the state governor denied the existence of plague altogether, accusing his own health officials of propagating rumours and ‘injurious opinions’ detrimental to the ‘great and healthful city.’[ii] Conversely, successive quarantines had already been imposed on San Francisco’s Chinatown, excluding non-Asian homes and businesses despite their proximity. Enforced by barbed wire and a heavy police presence, the blockade led to dwindling food supplies and a steep rise in costs. An experimental vaccine with severe side effects, developed in 1897 by bacteriologist Waldemar Haffkine, was made obligatory for any Chinese (and Japanese) wanting to leave the city.
In 1900, Honolulu’s Chinatown was set on fire to in a misdirected effort to control Bubonic plague.
Unsurprisingly, the turn-of-the-century scapegoating of East Asians in California did not occur in a vacuum. Anti-Chinese prejudice had already been formalized in the Chinese Exclusion Act of 1882, banning their immigration for undermining the ‘dignity and wage scale of American workers.’[iii] There were, likewise, widespread perceptions of the Chinese as carriers of disease. If Europeans had been imperilled by the ‘barbaric hordes of Asia’, germs represented ‘a peaceful invasion more dangerous than a warlike attack.’[iv] And while dogma of the day suggested limited danger to the West due to advances in health and civilization, extreme measures might be necessary with plague. In such cases Russia’s ‘heroic methods’ in its Chinese colonies were helpfully referenced, as firing squads for the infected ‘saved trouble and other people’s lives.’[v]
An 1886 advertisement for ‘Magic Washer’ detergent: ‘The Chinese Must Go’.
Old Wine, New Bottle
Associating disease with marginalized groups, minorities and others has hardly been an exclusively American experience. And by today’s standards, persecution over illness is not necessarily as crude, but neither can toxic discourse or indeed violence be excluded. The arrival of a new coronavirus in December 2019 is a case in point. The linking of its presumed place of origin in Wuhan with East Asians generally, and Chinese in particular, did not take long to manifest itself as multiple accounts of discrimination emerged. In Western countries this played on traditional racial tropes such as sordid animal markets and uncleanliness. Reflecting an entirely different experience, namely apprehension over Chinese influence, regional reaction was also alarmist. Both say as much about perceptions of mainland China as of the disease itself.
There is no shortage of recent examples that demonstrate medical scapegoating around a novel or poorly understood disease. In 2010, the lynching of voodoo priests in Haiti originated with rumours of pout kolera (magic cholera powder) deliberately poisoning the water supply. The choice of target was partially reflected in the complex history of voodoo practitioners and the Haitian State. At times associated with resistance to foreign occupation, at others integrated into the personality cults of Haiti’s twentieth century dictatorships, notably that of ‘Papa Doc’ Duvalier. Confusion over the origins of the cholera epidemic ‘fed on feelings of insecurity and fear’, in turn fuelling stigmatization and violence.[vi] More sustained anger eventually shifted towards the unwitting culprits, negligent United Nations peacekeepers that had contaminated the Artibonite river with cholera-infected faeces.
Vodou ceremony, Jacmel, Haiti, 2002. Image: ‘Doron’.
A corollary of medical scapegoating is fear and misinformation. Fundamental weaknesses in the Pakistani health sector, combined with accusations of a fake Hepatitis B campaign orchestrated to locate and kill Osama Bin Laden, has reinforced suspicions of polio vaccinations. With rumours of polio vaccines being either harmful or simply a front for intelligence gathering, health workers have since borne the brunt of attacks by armed groups.[vii] Misunderstandings and distortions around Ebola, both in West Africa in 2014 and more recently in the Democratic Republic of Congo have led directly to the deaths of medical staff. In the latter case, mistrust over the response is rampant, provoked in part by ‘community resentment’ over the focus on Ebola while ignoring underlying problems in the country.[viii]
The targeting of health workers as somehow responsible for bringing illness into a community, and thus the cause or at least the visible manifestation of a terrifying epidemic, is an extreme example of the need to apportion blame. But if sickness has historically been portrayed as a punishment for sin, socially excluded groups and minorities have proven most vulnerable. Whether linked to mortality or fear of the unknown, context is key to understanding the long history of how those on the margins of society have been scapegoated. Much as nineteenth century descriptions of Chinese immigrants as ‘walking time bombs of infection’ cannot be separated from pervasive Sinophobia, the frequent panic associated with novel or misunderstood illness has tended to reinforce pre-existing stereotypes.[ix]
From Tragedy to Farce
The fate of Chick Gin aside, apportioning individual responsibility for epidemics is unusual in that it is difficult to prove. ‘Typhoid Mary’ is likely the most infamous example as she came to be seen as ‘synonymous with the health menace posed by the foreign-born.’[x] An Irish immigrant cook, Mary Mallon was a so-called healthy carrier of typhoid bacteria, unintentionally instigating outbreaks amongst her wealthy employers in New York until she was eventually tracked down in 1906. Vilified in the papers as a ‘walking typhoid fever factory’ or a ‘human culture tube’,[xi] Mallon would end her days in forced isolation.
‘Typhoid’ Mary Mallon in hospital.
On a more grandiose scale, Canadian air steward Gaëtan Dugas was posthumously declared ‘Patient Zero’, accused of intentionally infecting his partners with HIV and provoking the spread of AIDS in North America.[xii] Although later disproved, the fear and exclusion of the five ‘H’s – homosexuals, heroin addicts, haemophiliacs, hookers and Haitians – remained commonplace in the 1980s.
Much like the five ‘H’s, easier to trace is the scapegoating of entire groups, the archetypal example almost certainly being the pogroms and massacres inflicted on European Jews during the Black Death. Rumours of an ‘anti-Christian international conspiracy’ fit snugly with long-standing antisemitism, particularly when mortality rates among Jews were seen as inexplicably low (the fact that sensible hygiene laws laid out in the book of Leviticus had been employed was entirely ignored). Initially directed at medieval lepers and vagrants, Jews came to be accused of poisoning wells, eventually resulting in the extermination of entire communities.[xiii] Six hundred years later hygiene control of typhus, a lice-borne pathogen, became an element of Nazi propaganda intended to justify the mass murder of human carriers during the Holocaust.[xiv]
Representation of a massacre of the Jews in 1349 Antiquitates Flandriae (Royal Library of Belgium).
The transatlantic journey of yellow fever holds particular irony in the history of racial stereotyping over disease. The mosquito-borne virus’s first documented appearance in the New World was in 1647 Barbados. Even if thoroughly misunderstood at the time, much like malaria there was an assumption that black Africans were immune to the disease, all the more so as white Europeans were so highly susceptible (in reality this was largely due to early exposure during childhood). This immunity in turn became one of the justifications on which the Atlantic slave system was built. Brutal conditions on the sugar plantations and corresponding high mortality rates ensured continued new arrivals, often with the same immunity, all the while reinforcing the original racial stereotype. It was only as slavery was gradually abolished in the nineteenth century, a period coinciding with multiple outbreaks of yellow fever in the American South, that former slaves were themselves accused of spreading the disease.[xv]
Skibbereen, west Cork, in 1847 by James Mahony.
Cholera likewise has a special place in the history of medical scapegoating and became highly politicized. Despite having long circulated locally on the Indian subcontinent, it only emerged on the global stage in the early nineteenth century, an appearance closely intertwined with colonial trade policies. As the bacteria must be ingested through contaminated water or food, the poorest and most deprived urban areas proved most vulnerable. And given the profile of its victims, the spread of cholera inevitably took on class connotations that shifted smoothly towards immigrants, even as disease transmission came to be better understood. The Irish migratory experience was strongly marked by outbreaks of cholera, with higher mortality rates used as ‘corroboration that they were carriers of the disease’ rather than a reflection of widespread discrimination and impoverishment.[xvi]
The link between poverty and disease was particularly apparent with venereal disease, more specifically syphilis (and gonorrhoea with which it was often confused). Referred to at times as the ‘secret plague’ given the strong underreporting, symptoms had been recognizable since the late fifteenth century. And while there had long been a feminized connotation as per responsibility, hence the expression ‘one night with Venus and a lifetime with Mercury’, apportioning syphilitic blame took on far more sinister connotations through the later association with underprivileged women. Various incarnations of the Contagious Diseases Act in 1860s Britain essentially allowed the arrest and forced treatment of prostitutes in an attempt to limit venereal disease in the military, and subsequently the broader population.[xvii]
The emergence of syphilis also provoked an unusual example of xenophobic scapegoating, essentially a bizarre etymological battle that took on global proportions. As the disease spread throughout Europe and beyond, rivals were duly named responsible. For the French it was the Neapolitan disease, the Italians vice versa; the Russians blamed the Poles; the Dutch turned towards the Spanish; in Japan it emerged as the ‘Chinese ulcer’; while the Turks were less discerning, simply referring to the Christian disease.[xviii] The 1918 influenza pandemic likewise went through multiple national incarnations before settling on the familiar Spanish flu, a reference to the neutral country that first reported the disease. Both examples border on the farcical and if there are lessons to be learned, at least as far as 1918 is concerned, it is rather the impact of censorship and misinformation in controlling a pandemic.[xix]
Lessons Unlearned
Being reminded of past madness has a purpose, especially as we have a nasty habit of repeating our errors. Our understandable fear of disease sadly has often revealed our basest instincts, further stigmatizing the most vulnerable and endangering the health of all. Barbaric reflexes are never far from the surface. The emergence of a new pandemic has provoked ugly reactions very much reminiscent of the past, and counterproductive to controlling both the disease and the corresponding panic. While there are no rules to the patterns of hate linked to epidemics, just as increased social cohesiveness is also a potential consequence, the choice of scapegoating targets is not random. Facile demonization of the ‘foreign’ remains a perpetual risk, and disease a convenient pretext.
As for Chick Gin, he was merely the first of many plague fatalities in 1900 San Francisco. Over the next eight years at least one-hundred-and-seventy-two others would perish, both Chinese and non-Chinese.
[ix] Quote taken from testimony to Congress in 1876 over the state of Chinese immigration, Mary Roberts Coolidge, Chinese Immigration, Arno Press: New York, 1969 (original 1909), p. 106.
[xi] ‘Woman ‘Typhoid Factory’ Held a Prisoner’, The Evening World, New York, 1 April 1907.
[xii] Charlie Campbell, Scapegoat: A History of Blaming Other People, Duckworth Overlook: London, 2011, p. 161.
[xiii] John Kelly, The Great Mortality: An intimate History of the Black Death, Harper: London, 2006, pp. 232, 248.
[xiv] Samuel K. Cohn, Pandemics: Waves of Disease, Waves of Hate from the Plague of Athens to A.I.D.S., Historical journal (Cambridge, England), 2012 November 1; 85(230): 535-555.
[xv] Sheldon Watts, Epidemics and History: Disease, Power and Imperialism, Yale University Press: London, 1999, pp. 245-246.
[xvi] Philip Alcabes, Dread: How Fear and Fantasy have Fueled Epidemics from the Black Death to Avian Flu, Public Affairs: New York, 2009, pp. 74-75, 77.
My colleagues are working flat out these days. After seeing our list of patients, we are on the phone and email advising people to quarantine, to get tested, or take measures such as social distancing.
What we are trying to do is help ‘flatten the curve’ of the outbreak: to avoid a peak of infections; to slow down the rate of transmission; and have it play out over as long a period as possible.
The frightening reports from doctors in Italy describing an overwhelmed hospital service, dealing with a peak in admissions of potentially fatal bilateral interstitial pneumonia caused by the virus, makes the work ever more urgent.
Many of our patients are elderly, multi-morbid, and therefore vulnerable to the worst effects of the virus.
When I advise our healthy patients about measures they can take, many are blasé, given the symptoms they get will probably be mild. When I explain that these measures are not for their own sake, but rather for the most vulnerable among them – their relatives, friends or neighbours – I can see it sinking in, and a new seriousness emerging.
If there is a silver lining to this crisis it is the revelation of how connected we are to each other, in ways we have almost forgotten. We are a species with special concerns. We cannot afford to operate alone as individuals; to do so is to threaten us all. This realisation is putting into stark relief the way we have organised our societies over the past few decades.
Some private health care clinics in Dublin are now putting up signs saying they will not accept patients with respiratory symptoms, directing them towards their G.P’s. This is in one way understandable as a means of limiting transmission, but while the public service is taking extra measures to distribute information and organise the response, these private clinics are under no compulsion to do so.
In the U.S, Trump’s apparatchiks like Mike Pompeo have sprinkled their public statements with references to the ‘Wuhan corona virus’, pointing the finger abroad to evade criticism of their response to the crisis.
This crisis will abate. It is hard to gauge how many people we will lose to the infection, but when the wave has broken and dissipated, hopefully the realisation will have dawned that the defences we build are only strong enough if we build them together.
Dr Samuel McManus is an Irish G.P. currently working in Norway.
1/ I may be repeating myself, but I want to fight this sense of security that I see outside of the epicenters, as if nothing was going to happen "here". The media in Europe are reassuring, politicians are reassuring, while there's little to be reassured of. #COVID19#coronavirus
