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  2023-05-14

  Pandemics are Not "Great Equalizers" - Comparing COVID-19 to the Bubonic Plague Outbreak of 1870-1905

  With the designation of COVID-19 as a "public health emergency" by the Centers for Disease Control and Prevention (CDC) ending as of May 11, 2023, public healthcare facilities throughout the US are rolling back protections they once employed to try to keep people safer during this ongoing pandemic. So, as this unit asks of us students, are pandemics the “great equalizers” in terms of social inequalities, and is there more equality now that the "emergency" has been deemed to be over? I argue that this is not the case, as immune compromised and disabled people have been more or less left for dead. A huge swath of healthcare facilities have removed mask mandates for care providers and hospital visitors, which leaves vulnerable and immune compromised people at a much higher risk of getting COVID-19 while receiving the medical care that is necessary for them to manage their conditions. In response, people and organizations, such as the Massachusetts Coalition for Health Equity in the tweet above, have begun to mobilize in favor of maintaining COVID-19 protections in healthcare settings by organizing strikes, protests, petitions, and phone banks to public officials. The reasons for maintaining COVID precuations such as mask mandates, access to COVID tests, and enhanced filtration in healthcare settings are clear. As the Massachusetts Coalition for Health Equity describes in their petition titled "Patient Strike Authorization Vote," the CDC "advises immunocompromised people to avoid crowded indoor settings, which now includes all healthcare institutions without universal masking," essentially maintaining that COVID is dangerous to immune compromised people while giving them no option but to risk exposure if they want to receive their necessary healthcare (Patient Strike Authorization Vote). The petition text explains that "[n]ational leaders in hospital epidemiology argue that universal masking should become the new standard of care, as gloves became with HIV" in order to keep people with compromised immune systems such as young children and elders safe (Patient Strike Authorization Vote). Currently, disabled and immune compromised people "are being locked out of safe healthcare" and are facing discrimination that makes them unwelcome and unsafe in healthcare settings (Massachusetts Coalition for Health Equity). In order to relate this modern COVID-19 pandemic to our course materials and demonstrate that discriminatory treatment during times of disease is not new, I will compare the above post to points from the text "The Chinese as Medical Scapegoats In San Francisco, 1870-1905" by Joan B. Trauner. This text discusses the discrimination against Chinese and other East Asian people living in San Francisco's Chinatown during a bubonic plague outbreak in the late nineteenth century. Sinophobic and anti-Asian sentiments, similar to those that arose during the epidemic Trauner details, have also been evident throughout the COVID-19 pandemic, so much so that even US President Donald Trump referred to COVID-19 as the "China virus." Ableism has also been prevalent throughout the COVID pandemic, as many people no longer care about the effects of the virus, because it harms disabled and immune compromised people most, especially people who also face racial discrimination in healthcare. Trauner explains that, because white people in the US believed the plague primarily affected Chinese and other Asian people, and because plagues were bad for business,"[t]he governor of California, Henry T. Gage, and executives of big business and of the large railroads, in conjunction with the San Francisco Board of Trade, the San Francisco Chamber of Commerce, and the Merchants Association, were all determined to prove that the plague did not exist in San Francisco" (78). The author of the Patient Strike Authorization Vote argues that today, we see a similar pro-business sentiment that comes at the expense of immune compromised people who are more likely to get sick with and die from COVID-19, writing: "Hospitals that remove masks and surveillance testing are making a value judgement about our lives, because they want to preserve their profit margins" (Patient Strike Authorization Vote). The CDC's ending of the COVID-19 public health emergency designation and the resulting halt of COVID mitigation procedures indicate that people are ignoring the needs of immune compromised people so that everyone can feel more comfortable going "back to normal" and maintaining consumption habits that are desired by businesses. Additionally, in both the past plague outbreak and the current pandemic, public health officials have shown hesitancy to give people vital information, which has led to harm. As Trauner explains, during the bubonic plague epidemic, "San Francisco Mayor Eugene Schmitz refused to approve the printing of health reports and vital statistics and even attempted to remove from office four members of the Board of Health who persisted in stating that plague existed in San Francisco" (79). Today, because the public health emergency designation ended on May 11th, 2023, the CDC is "no longer reporting aggregate cases and deaths, COVID-19 Community Levels, COVID-19 Community Transmission Levels, or COVID-19 Electronic Laboratory Reporting (CELR) data," all of which have been used to determine the severity of the situation throughout the pandemic (COVID Data Tracker). Meanwhile, over one thousand people are dying of COVID every single week, but COVID transmission levels are not being tracked, so people cannot know how many COVID positive cases there are in their county and how likely they are to contract the virus by going out in public (COVID Data Tracker). Another similarity between the COVID-19 pandemic and the bubonic plague outbreak of the late nineteenth century lies in the responses of the people facing discriminatory treatment in public health settings during these respective disease outbreaks. Trauner writes that before, during, and after the bubonic plague outbreak, Chinese businesses and health practitioners constructed and operated their own hospitals that would treat the people of Chinatown, because they were not welcome at other hospitals due to racial discrimination (81). Trauner explains that "[e]arly Chinese immigrants realized the necessity of banding together and providing for their own health care needs," in light of the government abandoning their health needs (81). Activists and organizations like the Massachusetts Coalition for Health Equity are currently banding together and fighting to get better and safer care for immune compromised people during the COVID-19 outbreak, as they are also facing discrimination at hospitals rolling back COVID precautions, because these spaces are not safe for them. The organizing they are doing to try to make healthcare settings safer for immune compromised people looks different, as no one is proposing the creation of immunocompromised-specific hospitals. They are fighting for better treatment, still, using slogans like "We Do Not Consent to Get COVID at the Doctor," and urging people that "[w]e must take collective action to prevent this mass violation of our human rights and federal rights to safe care," as stipulated under the Americans with Disabilities Act (Massachusetts Coalition for Health Equity). In both disease outbreaks, it has been the duty of those being discriminated against to take care of and advocate for themselves. So, in fact, pandemics are not "great equalizers"; in reality, they not only make pre-existing inequities even more visible, but exacerbate them even further. As Trauner argues, "Health policy [...] manifests not only the state of the medical sciences, but the expectations and the value system of society-at-large," and as such, if society-at-large is racist and ableist, then the health policies put into place will reflect these discriminatory values (70). These governmental measures come at a cost to everyone, and especially those facing racist and ableist discrimination. Had the nineteenth-century bubonic plague outbreak been determined an emergency and treated as a serious threat in spite of sinophobic and anti-Asian sentiments, perhaps more research could have been carried out sooner, and more lives could have been saved. If people in the US continue to take the COVID-19 pandemic seriously and not dismiss the pleas of immune compromised and disabled people to continue precautions, perhaps loss of life and further disablement from COVID infection can be mitigated.