With mask mandates being overturned and numerous places going back to “normal,” COVID is becoming more of a subconscious thought. Now, this is not a true statement for the entire population, since there are people who are looking at the effects of the pandemic and the virus itself.
I attended a poster presentation for the “The Pandemic Divide” event hosted here at Duke by the Samuel Dubois Cook Center on Social Equity. To me, all the poster boards conveyed the theme of how COVID-19 had affected our lives in more ways than just our health. One connection that particularly caught my eye would be the one between American Education and COVID.
As a student who lived through COVID while attending high school, I can safely say that the pandemic has affected education. However, based on the posters I saw, it is important to know that education, too, has a strong and impactful impact on COVID-19.
The first evidence I saw was from Donald J. Alcendor, an associate professor of microbiology and immunology at Meharry Medical College in Nashville. His poster was about the hesitancy surrounding COVID-19 vaccines. One way he and his team figured out to lessen the hesitance from the public was to improve the public’s trust. To achieve this, Alcendor and his team sent trusted messengers into the community. One of the types of messengers they provided was scientists who studied COVID-19. These scientists were able to bring factual information about the disease, how it spreads, and the best course of action to act against it. Alcendor and his research team also brought in “vaccine ambassadors” to the community and a mobile unit to help give the community vaccines. He noted that this was accomplished with support from the Bloomberg Foundation’s Greenwood Initiative, which addresses Black health issues.
With this mobile unit, Alcendor and his team were able to reach people and help those who were otherwise unable to receive help for themselves because of their lack of transportation. They provided people from all backgrounds with help and valuable information.
Alcindor said he and his team planned pop-up events based on where the community they were trying to reach congregates. With the African American community, he planned pop-up events at churches and schools. Then for the Latino community, he planned pop-events where families tend to gather, and he held events in Latin0 neighborhoods. In addition, he made sure that the information was available in Spanish at all levels, from the flyers and the surveys, to the vaccinators themselves.
All of these amenities that he and his group provided were able to educate the community about COVID-19 and improve their trust in the scientists working on the disease. Alcendor and his team were able to impact COVID-19 through education, and by going to the event, it was evident to me that he was not the only one who accomplished this.
Colin Cannonier, an associate professor of economics at Belmont University in Nashville, asked and answered the question, “does education have an impact on COVID? Specifically, does it change health and wellbeing?” To answer this question, he researched how education about COVID can affect a person. He discovered that when a person is more educated about COVID, how it is spread, and its symptoms, they are more likely to keep the pandemic in check through their behavior. He came to this conclusion because he realized that when higher educated people know more about COVID, they exhibit behaviors to remain healthy, meaning that they would follow the health protocols given by the health officials.
While this may seem like common sense that the more educated a person is, the more they make smart choices pertaining to COVID, this shows how important education is and how deadly ignorance is. Cannonier’s research gave tangible evidence to show that education is a weapon against diseases. Unfortunately, it is evident that some officials did not believe in educating the public about the virus or the virus itself, and that proved to be extremely deadly.
To fully capture the relationship between COVID and education, one must also talk about how COVID-19 affected education.
Stacey Akines, a history graduate student at Carnegie Mellon University, studied how education was changed by the pandemic.
First, she realized that COVID schooling crossed over with homeschooling. Then she uncovered that more Black people started to research and teach their children about Black history. This desire to teach youth more about their history caused an increase in the number of Black homeschoolers. In fact, the number of Black homeschoolers doubled during the fall of 2020. While to some, this change to homeschooling may have a negative impact on one’s life, it actually gives the student more opportunities to learn things.
It is no secret that there are many books being banned here in the U.S., and there are many state curriculums that are changing to erase much of Black history. Homeschooling a child gives the parent an opportunity to ensure that the education they receive is true to and tells their history
Unlike me, where during high school, education felt lackluster and limited because of COVID, some parents saw an opportunity to better their child’s education.
I hope that it is clear that the relationship between COVID and education is a complex one. Both can greatly impact each other, whether it’s for the better or for the worse. COVID thrives when we are uneducated, and it very nearly destroyed education too, but for the efforts of some dedicated educators.
March 2020. The subsequent blur of months. Of spring into summer, fall into winter, a year into another and likely into the next. Like millions of humans around the world, 2020 itself feels infected, as if wrapped up with yellow caution tape. Virus dominatesthe current zeitgeist; pandemic won Merriam-Webster’s 2020 word of the year; vaccine in 2021.
We are all proto-virologists, sludging through the constant slew of “viral” media: novel variants, outbreaks, booster shots, mutations (a jargon in which we’re collectively fluent).
In the somewhat-receding wake of COVID-19, like floodwater, viral fear recently surged again when the World Health Organization began reporting monkeypox (MPX) outbreaks in Europe and North America. The stigmatization of MPX patients as “disease-spreaders” (in the media, on the internet, in conversation, etc.) suggests these individuals have a kind of authority over the virulent strands of DNA in their bodies. This belief aligns with the etymology of “virus” from the Latin “poison,” a word that functions as both noun and verb. Passive and active. Culpable.
I’m reminded of Jude Law’s fear-mongering character in Contagion, Alan Krumewiede, the conspiracy theorist who conjectured MEV-1, the film’s fictional virus, was“Godzilla, King Kong, Frankenstein, all in one.”
Of course, this sentiment did not bud from MPX or COVID-19 like a novel variant. No, it has existed in the United States for decades, if not longer, and it has not been dormant.
Dr. Stephen Thrasher, a scholar of the criminalization of HIV/AIDS at Northwestern University, stood in Duke’s anthropology lecture hall this month and drew parallels between the recent MPX/COVID-19 epidemics and that of HIV/AIDS in the 1980s-90s and stretching into the new millennium. He asked us to raise our hands if we personally knew someone with HIV/AIDS. A few did. If we knew someone who had died from HIV-related causes. A few less. What about COVID? The entire audience raised hands as if to signal the new era of viral infection.
As Thrasher historicized, the stigma that encapsulated HIV/AIDS significantly delayed life-saving interventions on the local and national scale. Prejudice hindered research funding, drug distribution, and government health agency mobilization. The rising tide of the HIV/AIDS epidemic was concurrent with increased violence towards the LGBTQ community, and gay men in particular, analogous to a king tide flooding the coastline.
Thrasher exemplified this taboo through the “patient zero” misconception, which was propagated by the media during the epidemic and embedded like a splinter in pop culture’s thumb (i.e. the film Patient Zero with Matt Smith, Stanley Tucci, and Natalie Dormer).
Gaëtan Dugas, a Québécois Canadian flight attendant, was inappropriately labeled “patient zero” of the HIV/AIDS epidemic in America. As Thrasher and other researchers have debunked, Dugas was, in fact, not the first person to bring HIV to the United States. Further, Dugas was not even included in the early infection group. And Dugas was Patient O (like oh), not zero, for Out-of-State. Yet, this contextualization of the virus endures despite being disproved. Upon diagnosis, many infected individuals will experience shame.
In the 1980s and 90s, HIV/AIDS was characterized as the “gay plague,” setting ablaze a moral panic in America comparable to that of the Satanic Panic, rock ‘n’ roll, and fear of razor blades stuffed into gooey 3 Musketeers bars at Halloween (and there’s an interesting overlap in the timing of these hysterias in the collective American consciousness). And just two months ago even, many people were characterizing MPX in the same accusatory and morally dubious way.
Like with the AIDS epidemic, Thrasher said the US government failed to mobilize public health initiatives early enough to proactively stifle MPX outbreaks in spite of the disease’s well-documented diffusion across Europe and into neighboring Canada.
“We could’ve tapped the Strategic National Stockpile,” he argued. Thrasher listed multiple public health interventions that could have and should have been implemented with the first faint smoke signals of MPX in the United States (as they were in the past for meningitis and polio outbreaks).
For context, the Strategic National Stockpile (SNS) is a cache of medicines, antibiotics, and vaccines that the government started to accumulate just prior to 9/11 in 2001 and, seemingly, in an exponential manner after — almost like doomsday preppers hoarding freeze-dried beef stroganoff and cans of beans in their underground bunkers. Born from the smoking rubble and smoke of New York City following the terrorist attack, fear of biological warfare, especially the weaponization of smallpox, paralyzed the US (i.e. the Anthrax scare).
The SNS was tapped after 9/11, for 12 major hurricanes, COVID-19, and the swine flu (to name a few), but not for monkeypox.
As historically evidenced, mass vaccination and herd immunity effectively prevent the spread of viral infections, especially for slow-mutating viruses like MPX.
“We should have quickly vaccinated queer men and transmasc people,” Thrasher said, “building on a very historic anomaly which is that adults have been socialized to take vaccines en masse in a way that has not happened in many decades.” And because MPX and smallpox are closely related viruses, a rollout of the stockpile’s smallpox vaccine could have nipped the outbreak in the bud.
A large focus of Thrasher’s research is on who is affected by viruses, and how, and why. Nearing 6.6 million COVID-19 deaths worldwide, many would argue that viruses — these ancient, non-life forms — are Earth’s “great equalizers,” as acknowledged by Thrasher in multiple publications. Evolution has pushed them to infect, replicate, and spread: machine-like and non-discriminatory.
But, he added, viruses are not great equalizers. Infection is inherently unequal. Again, we must ask the question who?
Viral infections disproportionately burden marginalized bodies and communities, a concept Thrasher framed as the viral underclass (coined by activist Sean Strub and reshaped by Thrasher to describe this phenomenon). Writing in his book of the same name, “… the viral underclass can help us think about how and why marginalized populations are subjected to increased harms of viral transmission, exposure, replication, and death.”
Let’s return to the MPX vaccine. The Biden administration did not tap the SNS for mass vaccination. Instead, it rolled out meager health interventions at a snail’s pace (like Sisyphus pushing his stone up the hill). Still, many at-risk individuals, in particular men who have sex with men, opted to receive a two-shot regimen to protect themselves from the virus. Considering the viral underclass, Thrasher posed the following questions:
Who is disproportionately burdened by MPX in the US? He answered, “Black and Latino men who have sex with men.”
And his years of HIV research corroborate this trend.
He spoke (and wrote in The Viral Underclass) about his time reporting the Michael Johnson court case in St. Louis, Missouri. Michael Johnson, a black, gay, former college wrestler, was sentenced to 30 years in prison after failing to disclose his HIV status to his sexual partners — a criminal offense. The prosecution had sought a maximum 60.5 years, practically a life sentence.
For context, in the state of North Carolina, the maximum sentence for voluntary manslaughter is a little under five and a half years. In the courtroom, Thrasher was privy to the prosecution’s smoking gun: Johnson had previously signed a legally-binding acknowledgment of his HIV diagnosis. With the flick of a pen, nondisclosure was a criminal offense.
In his interviews, however, Thrasher found that Michael Johnson was semi-illiterate and had not been properly informed of the legal implications of the document he had signed. Nor had he been informed of the consequences of breaking the legal contract. Nor had he been counseled or given any legal advice prior to being charged.
Michael Johnson was released from prison 25 years early after his ruling was overturned. His is a body in the viral underclass.
Concluding his lecture, Thrasher quoted AIDS activist Vito Russo’s Why We Fight speech from the 1988 ACT UP Demonstration at the Department of Health and Human Services. In reading the entire transcript, I found that Russo was aware of the viral underclass, as Thrasher theorized, despite the term not yet existing in the academic ethos. He said in his address:
“If I’m dying from anything — I’m dying from the fact that not enough rich, white, heterosexual men have gotten AIDS…. Living with AIDS in this country is like living in the twilight zone. Living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you’ve lost more of your friends, but nobody else notices. It isn’t happening to them.”
Is it possible to ever resolve the viral underclass in the US? As long as systemic inequities continue to exist, no. This may seem pessimistic or even cynical, but Thrasher concluded his lecture (and his book) with reserved optimism. “Let’s get to work,” he implored.
If we can identify and actively dismantle the systems that disproportionately burden certain populations with viruses and diseases, like a spool of yarn, we can begin to unravel the viral underclass in America.
Yes, infections should be treated with accessible and affordable medicine. Yes, healthcare should be expanded. Yes, we should continue to improve the efficacy of drugs and diagnostics. But, health interventions alone do not cure communities of disease.
Thrasher found that marginalized bodies will continue to be infected, in spite of medicinal intervention, if the inequities from which the viral underclass emerge are not concurrently cured. Let’s get to work.
The list of professions that have been pushed to the brink during the pandemic is ever-expanding. However, the sea change that swept over nursing in the past three years rivals that of almost any occupation, said panelists in a Sept. 28 event hosted by Duke University School of Nursing.
Already one of the most overworked professions, the pandemic only seemed to magnify nursing’s enduring problems, according to panelist and journalist Lauren Hilgers. A few months into the pandemic, nurses around the country began quitting in droves due to both burnout and undervaluation by their employers. As the front lines dwindled, hospitals working at full capacity needed to meet patient demand by any means necessary.
Enter travel nursing agencies, independent staffing organizations that matched nurses from across the country with hospitals dealing with acute labor shortages. Already increasing in popularity in the lead-up to the pandemic, demand for travel nurses in recent times has exploded. As this fundamental change in the make-up of the nursing labor pool occurred, people started to take notice.
In February of 2022, an article was published in the New York Times titled “Nurses Have Finally Learned What They’re Worth”. In the piece, Hilgers chronicles the major trends in the nursing workforce over the past three years. Hilgers describes the unique proposition facing the nurses who chose not to quit: remain as a staff nurse on their current salaries or sign up with a traveling agency and uproot their lives, albeit for higher pay. And the pay bump was substantial. Certain travel nurse jobs paid up to $10,000 a week, many times what staff nurses were earning. These nurses would often stay at a hospital anywhere from a couple of weeks to months, providing much-needed relief to healthcare systems. However, as the practice spread, questions soon began to emerge about the disparities in pay between staff and travel nurses, the sustainability of travel nurse programs, and, moreover, how the American healthcare system enabled travel nursing to rise to such prominence in the first place?
“Nursing is the largest segment of the healthcare workforce…yet what we contribute to the health and wellbeing of our country is invisible,” mentioned Dean Ramos at the discussion’s outset.
Smalheer agreed, adding that nurses today are contributing to patient care in ways that were vastly outside of their scope of practice just twenty years ago. A unique combination of technical proficiency, aptitude during crisis response, and ability to provide feelings of care and comfort, Hilgers describes nursing as one of, if not the only, profession in healthcare that considers the “entirety of a patient.”
A frequently cited statistic during the panel presentation referenced results from a Gallup poll indicating that nursing was rated as the most trusted profession for the 20th year in a row. While nurses were always aware of their influence and worth, getting healthcare systems to agree proved to be a much larger effort, one that only grew in importance as COVID-19 progressed.
“The pandemic has hardened us,” explains Smallheer. No longer were nurses willing to tolerate slights against their treatment as a profession. And they had tolerated plenty. Barraza, one of the protagonists of Hilgers’ piece, described the relentless search for purpose amidst constant burnout, especially during the pandemic’s heaviest waves. From finding efficient triage methods during a surge of cases to celebrating patient discharges, Barraza actively sought out ways to be “consistent when there was no consistency.” A charge nurse located in a region with severe labor shortages, Barraza had seen the influx of travel nurses firsthand every week. What ultimately kept him from traveling across the country in the pursuit of a more lucrative job, however, was the relationships he had forged within the hospital. Nurses, students, patients-they had all left an indelible mark on Barraza and enabled him to push through the long and grueling hours. Tennyson reinforced Barraza’s story by claiming that “you can be burnt out and still find value in a profession.” This seemingly contradictory duality may have proved sufficient to retain nurses during the pandemic, but as for long-term solutions, the panelists agree that significant change must occur at a systemic level.
One of the central tensions of Hilgers’ article is that between the hospital and the worker. The explosion of travel nursing during the pandemic was but a manifestation of decades of undervaluation by hospitals of nurses. In order to undo this narrative and enact concrete change, Tennyson argues that nurses must be represented in more interdisciplinary professional spaces, from healthcare administration to policy to business. Hilgers restates this idea more broadly, saying that nurses “need to have a seat at the table” in reshaping the healthcare system post-COVID-19.
Much of this work begins at the level of the educational institution. Smallheer and Tennyson spoke at length about how nurses can better be prepared to navigate the ever-changing healthcare workforce. They both highlighted a few of the Duke School of Nursing’s novel instructional methods, including early exposure to complicated patient cases, extensive practice with end-of-life scenarios, and recognition of overstimulation points in the field. Also important for nurses-in-training and existing nurses, according to all panelists, was collective action. Through supporting state and national nursing associations, writing to local politicians, and speaking to healthcare administrators, they argued that nurses will be better equipped to voice their demands.
As the panel reached its closing stages, one of the main talking points centered around changing the narrative of nursing as solely a burnout profession. Hilgers in particular remains critical of the portrayal of nurses, and more broadly those involved in care work, in popular media. She strongly advocates for authentic storytelling that including the voices of actual nurses, nurses such as Barraza. Ramos describes Barraza as someone who “represent[s] the best in nursing,” and the panelists maintained a strong desire to see such stories of resilience and passion spotlighted more frequently.
There is no simple formula to reform the nursing profession in the United States. However, through a combination of effective storytelling, more current educational standards, greater interdisciplinary involvement, and collective action, the panelists of the Dean’s Lecture Series firmly believe that lasting change is possible.
In February of 2020, no one could have fathomed that the very next month would usher in the COVID-19 pandemic – an era of global history that has (to date) resulted in 5 million deaths, 240 million cases, trillions of dollars lost, and the worsening of every inequality imaginable.
And while scientists and governments have worked together to make incredible advances in vaccine technology, access, and distribution, it goes without saying that there is more work to be done to finally put the pieces of an exhausted global society back together. On Tuesday, October 12th, the Duke Global Health Institute (DGHI) brought together three leaders in global health to discuss what those next steps should be.
Dr. Lindstrand began by setting the stage and highlighting what are undoubted successes on a global level. 6.5 billion doses of the vaccine have been administered around the world, and the vaccines have impressive effectiveness given the speed with which they were developed. Yet undergirding all of this is the elephant in the room that, sitting in a 1st-world country, we don’t think about: high-income countries have administered 32 times more doses per inhabitant compared to low-income countries.
This vaccine inequity has been exacerbated by already weak health security systems, vaccine nationalism, and lackluster political commitment. And while the WHO is slated to enormously ramp up supplies of vaccines in Q4 of 2021 and Q1 of 2022, it doesn’t mitigate the damage to the socioeconomic welfare of people that COVID-19 has already had. Dr. Lindstrand outlines the three waves of socioeconomic impact we will see, but expressed concern that “we’re already beginning to see the first wave pan out.”
Dr. Alakija took this discussion a step further, asserting that COVID-19 is poised to become the disease of low-income countries. “If you’re living in the US or EU,” she remarked, “You’re heading into the ‘Roaring 20s’. If you live in the Global South, COVID-19 is going to become your future.”
To this point, Dr. Alakija emphasized that the only reason this is the status quo is because in her eyes, the world failed to do what was right when it should have. In her home country of Nigeria, she highlighted that out of a population of 210 million people, 5.1 million people have received the vaccine – and of those 5.1 million, just 2 million — one percent — have been double-vaccinated. “It really is a case of keeping those down further down, while giving booster doses to those that have already been vaccinated,” she said. “We don’t have diagnostic data, so people are slipping underwater and the world has no idea.”
It’s worth noting that Nigeria houses some of the megacities of the world, not just in the African continent. So according to Dr. Alakija, “we don’t solve this with a medical lens, we solve this with a whole-of-society lens.” We must, she argued, because in an interconnected world, no one exists in isolation.
Alberto Valenzuela’s work is a great example of this. In 2019, his team led organizing efforts for the Pan American Games in Lima, relying on extensive partnerships between public organizations and corporations. In 2020, though, as the world shifted, the government called on the team to transition into something much different – COVID-19 relief efforts in the country.
The results are staggering. In just 5 weeks, the Pan American and Parapan American Games Legacy Project built 10 hospitals in 5 regions of the country. The implementation of 31 vaccination centers throughout the country resulted in a tripling of the number of people vaccinated per day in Lima. To him, this work “proves what’s possible when private and public sectors merge.” In other words, remarkable things happen when all of society tackles a societal issue.
So where do we go from here? Perhaps the biggest thing that stood out was the need to empower low-income countries to make decisions that are best for them. In Dr. Alakija’s words, “we need to lose the charity model in favor of a partnership model.” Dr. Lindstrand pointed out that there’s a deep know-how in the Global South of how to roll out mass-vaccination efforts – but only when we “lay down our organizational hats” can we move to what Dr. Lindstrand termed “more coordination and less confusion.” Valenzuela emphasized the need to integrate many sectors, not just healthcare, to mobilize the COVID-19 response in countries. But above all, Dr. Alakija said, “there will be no endgame until we have equity, inclusion, and health justice.”