Lectures

Memorializing Death in an Age of Mass Mortality: Keywords of Covid-19

How do we remember death when it constitutes our landscape? In an age of ubiquitous mortality—not only pandemic deaths, but also deaths from meteorological disasters, deaths of migrants seeking refuge from their war-torn homes, and the more banal declines in life expectancy in broad swaths of the United States—what kinds of death do we memorialize, and what kinds do we disappear, either actively or through habituation or an atrophy of memory? This essay explores some of the meanings of death, commemoration, and differential valuations of life in the era of Covid-19. It also historicizes these concepts through links to important tendencies in disaster epidemiology, death investigation, and their inherent rhetorical violence. One of this project’s central goals is to examine the anonymization of certain categories of death in a pervasively mortal present.

Discrepancies abound in communal responses to deaths from disasters and other human tragedies. While some disasters, such as Hurricanes Sandy and Katrina, have led to the construction of memorials, others—typically more diffuse and chronic disasters—have not. There is no monument, for example, to the 15,000 who died during the devastating heat wave of August 2003 in France: the nearest thing to a memorial to these victims was a ceremony in which President Jacques Chirac attended the burial of sixty-odd unclaimed bodies in a cemetery on the outskirts of Paris. The following day, their names appeared in Le Parisien. This list of the dead presaged the New York Times’ famous publication of the names of 1,000 people who died from Covid-19 on May 24, 2020 in commemoration of the first hundred thousand American deaths in the pandemic, which it described as an “incalculable loss.”

These are important acknowledgments of death, but they are not memorials. They are ephemeral, consigned to the recycling bin or the expiration of digital recording. They lack the solidity of memorials to other kinds of disasters. I argue that this ephemerality marks an active process of forgetting through which we consign uncomfortable deaths to the past. This process not only helps to obscure these deaths by eliding broad public memory of them, but also helps to obscure the structural vulnerabilities that shaped the lives and influenced the deaths of the forgotten. The deaths of Covid-19 patients, which disproportionately strike the economically marginalized, offer a stark reminder of the sheer numbers of people living in conditions of wrenching vulnerability. In a process that mirrors the individuation of the pandemic in the United States, the dead are left to be grieved privately by their loved ones but ignored by a wider public. This forgetting is far from benign neglect. There are material and rhetorical processes involved in the erasure of mass mortality, the recognition of which would prevent what many hope will be a return to “normal.” At a material level, political decisions to cease data collection and publication about Covid incidence and death, the halting of contact tracing in schools, and the phasing out of mask mandates amount to a concealment of the pandemic’s ongoing toll as well as a refusal of remembrance. And the very vocabulary that drives this refusal trivializes the disease as a means of obscuring its broad impact. Yet as Amy Sodaro has argued, writing of memorialization and violence, memory “is necessary for coming to terms with and righting the wrongs of the past.” To produce and reproduce the invisibility of precarious populations in an era of mass death is to reinforce the conditions that exacerbate their vulnerability. As I have argued elsewhere, it is easy to valorize certain kinds of sacrifice. But it is more difficult to recognize the dead who are reminders of uncomfortable truths, particularly those truths that uphold a system marked by devastating inequality.

Keywords of Covid-19

As with similar epidemics and disasters that disproportionately strike vulnerable populations, the Covid-19 pandemic has witnessed a multilayered process of erasure that cloaks its victims in invisibility. Three keywords closely tied to the pandemic’s evolution illuminate this process by demonstrating the rhetorical mechanisms that minimize the severity of the disease and thereby discount the experiences and deaths of its victims. The first of these, and the most recent to echo around social media, is endemicity. Endemic diseases are those that exist as a part of normal life in a given population and follow predictable patterns. Examples of endemic disease include infections such as the common cold and influenza. With the arrival of the Omicron variant, politicians, pundits, social media influencers, and even some physicians and epidemiologists have given the term a significant boost, arguing that we need to learn to live with Covid-19 as a “new normal.” Omicron’s high infectiousness as well as its allegedly milder effects have led many to argue that the variant will spur widespread immunity, and that Covid will simply become another endemic disease like flu.

Endemicity

It is easy to see why the label of endemicity is a tempting one. It serves dual and critical rhetorical purposes. In the usage its proponents have adopted, the term is palliative: it allays the force of the virus by rendering it familiar. It also neutralizes the horror of death by recasting staggering curves of mortality as somehow anticipated. Yet there are significant problems with this framing of the disease. As the virologist Aris Katzourakis has recently argued in Nature, “the word ‘endemic’ has become one of the most misused of the pandemic.” Endemic diseases are those with “static”—if seasonal—rates of infection. It is true that some endemic diseases are largely benign. But others are far more dangerous, even if expected. Malaria is an endemic disease, killing hundreds of thousands of people (mostly children) each year. More disturbing, smallpox was an endemic disease until the nineteenth century, when vaccination began to bring it to heel. Populations worldwide had learned to live with smallpox, but they had also learned how to die with it. In Europe, where smallpox killed as many as one in seven every year, families would often not name children until they had survived an infection. And, as Eleanor Murray has argued, what is labelled endemicity is fixed to time and place: “something can be endemic today and epidemic tomorrow.”

Another problem with considering Covid-19 an endemic disease is that the pandemic’s infection, hospitalization, and death rates are far from “static,” as much of the world reels from the Omicron surge. There is also no indication that Omicron’s alleged mildness foretells a waning of Covid-19’s virulence—there is no reason to assume a disease will evolve toward relative harmlessness. First, while Omicron may appear more benign than earlier variants, hospitalization and death rates should caution against optimism, especially as the milder effects of Omicron are confounded with wider vaccination rates, summer in the Southern hemisphere, and poor record keeping as a function of both bureaucratic incapacity (in some countries) and an abandonment of contact tracing (in others). Second, a surging disease is at least as likely to lead to the emergence of new variants as it is to lead to widespread immunity.

What, then, explains why “endemicity” is the “epidemiological term du jour,” to cite the medical historian Monica Green? Some—including Katzourakis—have argued that the term derives from an unrealistic optimism, while others contend that it represents what Jacob Steere-Williams calls “endemic fatalism”: the notion that “we’re all going to get it,” so herd immunity should be our collective goal. Such a notion encourages a kind of apathy and offers an excuse to halt extreme public health interventions. As Steere-Williams argues, striving for endemicity is “at best … a neoliberal apology” for a broad failure to manage the pandemic; at worst, it is a “neodarwinian fatalism.”

Both kinds of acceptance of Covid’s eventuality—optimism and fatalism—are rooted in a deep trivialization of the disease and a profound failure of empathy born of the dehumanization of the dying. The notion that we should be “done with Covid” and simply move on and accept that we’ll all fall ill with it and then reach herd immunity is not only an epidemiological fallacy—there is strong evidence against the effectiveness of natural or acquired immunity—but it is also directly in line with claims that the disease is no worse than the flu (which also does not leave much in the way of acquired immunity). The idea that states should drop mitigation measures and return to normal depends on a minimization of the disease, whereby infections are mild, with few real health consequences.

Comorbidity

Beyond this trivialization is a deep lack of compassion for those who are at risk of severe Covid, as well as the risk of creating what Steven Thrasher has called a “viral underclass.” The idea of mild infection, that Covid is no more dangerous than the flu, entails the explicit disregard for comorbidity, the second keyword facilitating the erasure of Covid mortality’s significance. Many of those who have sought to minimize the impact of the disease have pointed to the significantly higher death toll among those with comorbidities, or other chronic illnesses. Recently, CDC director Rochelle Walensky provoked outrage when ABC released a highly edited statement regarding the evolution of the pandemic. Speaking of Covid mortality among the vaccinated, Walensky stated that it was “really encouraging news” that “the overwhelming number of deaths—over 75 percent—occurred in people who had at least four comorbidities. So really, these are people who were unwell to begin with.” The statement relied on accurate data, but the framing of the deaths of those with multiple comorbidities as “really encouraging news” prompted a powerful backlash, particularly among people with disabilities. Walensky and the CDC immediately backpedaled, claiming that the edited statement removed the broader context for her remarks. As a preface to her comments on mortality, Walensky had stated that a study of more than a million vaccinated people found that only .0003 percent had died from infections; of that number, most had “underlying health conditions.” The “encouraging news” was thus that vaccines appeared to be highly effective.

Regardless of this broader context, Walensky’s statement still shows a powerful disregard for the deaths of those with comorbidities. Her positive framing of the study’s results suggests that death with multiple causes is the exception rather than the rule—that Americans should rejoice at the knowledge that those with no underlying health conditions are in little danger of dying from Covid. Yet for decades, two-thirds to four-fifths of all deaths in North America have had multiple causes. This means that comorbidity is a general condition rather than an exceptional one. Two-thirds of Americans are overweight or obese. Nearly fifteen percent are diabetic. Roughly half of Americans have hypertension. Seven percent have coronary artery disease, forty percent will be diagnosed with cancer in their lifetimes, fifteen percent have chronic kidney disease, more than ten percent have chronic lung disease. Three percent take immunosuppressant drugs. Why, then, does comorbidity apparently devalue life, if it is a basic condition of existence? Rather than be reassured that only those with comorbidities have something to fear from Covid, we should be sobered by the sheer prevalence of comorbidity in America.

From Covid or With Covid

As the death toll from Covid-19 began to rise in the United States in spring 2020, pundits who sought to minimize the disease’s significance as well as its mortality rate drew constant attention to comorbidity. The question, “from Covid or with Covid,” the third keyword I want to invoke here, gained significant traction as a general refrain on networks such as Fox News. With climbing mortality linked to the pandemic, conservative critics argued that the death rate was overinflated, claiming that health providers labeled every death occurring in someone who had tested positive as a Covid death. This led to a series of memes with captions such as “Skydiver who forgot to wear a parachute dies of coronavirus” or “Man eaten by alligator dies of coronavirus.” According to this logic, physicians and death investigators were labeling deaths more properly attributed to cancer, heart disease, COPD, or other causes as Covid deaths. One particularly toxic explanation for this phenomenon—and a popular one among elected Republicans in 2020, including the president, was the falsehood that hospitals were claiming excessive death rates from Covid-19 in order to receive higher insurance reimbursements.[1]

Yet far from inflated, the Covid-19 death toll is likely significantly undercounted. As of December 2021, the United States had experienced roughly a million excess deaths since the start of the pandemic, but only about 800,000 of them were officially counted as Covid-19 deaths. At the same time, in some parts of the country, deaths from conditions that are often complications of Covid-19 have exploded in the same period. Deaths from hypertensive heart disease have doubled in some areas without explanation, for example. Such leaps “point to a substantial undercount of the pandemic’s toll,” according to Boston University professor Andrew Stokes. Other accounts point to a general excess death rate of over twenty percent since the beginning of the pandemic, indicating a significant undercounting of Covid deaths.

This is in part an artifact of the material processes of measuring mortality and their politicization in contemporary America. Excess death measurements are a critical epidemiological and demographic tool for measuring the impact of an epidemic or disaster. They are somewhat simple and blunt: they subtract average mortality for a given period in a given place from the observed mortality. Take, for example, a cholera outbreak in July 2021 in country X. If that country averages 5,000 deaths from all causes every July, but observes 15,000 deaths during the cholera outbreak of July 2021, the excess mortality would be 10,000. Even without accurate testing, the death toll attributable to cholera would be roughly the same, absent other major novel causes of death.

Excess death tolls above the known rates of Covid mortality indicate that the impact of the pandemic is higher than the grim statistics suggest. Those tolls include indirect deaths linked to Covid-19—for example, those that occurred among those who avoided hospitals for fear of infection, or among those who were turned away from overcrowded clinics. But they also include those who may well have died from Covid-19 before being tested. Moreover, some causes of death declined precipitously during the pandemic: for example, traffic fatalities declined during lockdowns, and Covid prevention measures led to a nearly non-existent flu season in 2020-2021. The excess death toll during the pandemic is therefore even worse than it appears, as deaths in other categories have more than offset these declines.

Despite these high excess death measurements, the notion that deaths tied to comorbidity are somehow less concerning than those among healthy adults has persisted. This idea has deep intellectual roots in the epidemiological and demographic concept of “mortality displacement” or the “harvesting effect.” The idea behind the harvesting effect is that certain extreme events—including pandemics, but also extreme weather phenomena such as heat waves, cold snaps, and high pollution events, do not so much cause excess mortality as they hasten mortality for those already in poor health. The populations who die during these events are typically fragile ones: they are the elderly, the chronically ill, the homeless, and the mentally ill. The harvesting effect concept considers these deaths to be the product of a forward displacement of mortality. If a given phenomenon causes excess mortality, the theory argues, then the weeks or months immediately following the event will experience a concomitant drop in mortality, indicating that the deaths associated with the event represent an advanced, rather than a truly increased mortality.

There are several critical problems with the harvesting effect concept. First, it is extremely difficult to measure. Just as multiple factors can explain elevated mortality levels, they can also explain low mortality levels. Covid-19 may cause significant deaths among the elderly, but mild flu seasons might cause fewer deaths than expected in the coming years, leading to the conclusion that Covid merely killed those who would have died the following year in any event. Second, there are no clear criteria for how to measure displaced mortality. If someone dies tomorrow, they cannot die in the future. But when do we consider that death “displaced” rather than “caused”? If it advances death by a week? A month? A year?

The idea of a harvesting effect provides an important epistemological register for the race toward endemicity, the notion that comorbidity renders death less important, that a death with Covid is less consequential than one from Covid. The harvesting effect operates in a complex and dehumanizing ethics. As I have argued elsewhere, calling a death “displaced”—like attributing it to underlying health conditions—implies that it is somehow less real because of its inevitability. Yet all of our deaths are of course inevitable. To ascribe a death to harvesting or displacement or comorbidity—which is an essential element of reaching the stage of endemicity—is to devalue certain kinds of life and to trivialize death by indicating that those living in such conditions were already dead, or at least living lives outside of full legitimacy.

There are important institutional and political factors behind both the undercounting and discounting of Covid deaths in America. As Stefan Timmermans has argued, death investigation in the United States remains a fraught enterprise, meaning there is significant uncertainty over exact causes of death and even the rates at which deaths are occurring. Part of this has to do with the slow process of death reporting. Death certificates typically originate with funeral directors. Treating physicians or death investigators sign the certificates and then send them to the county health department, where they are then reviewed before they are directed to the state health department. Only then do state authorities send death reports—including both the fact and cause of death—to federal authorities, a process that can take up to a year even in times of full staffing. But many factors can slow this process or distort its accuracy. Chronic underfunding of medical examiners’ offices is one factor: autopsies can take months, dramatically slowing the reporting process. Periods of unusually high mortality—including environmental disasters and epidemics—add to the burden, not only slowing the process but also introducing errors in death reporting as beleaguered medical examiners struggle to keep pace with the flow of bodies.

A further—and more political—complicating factor is that many states have preserved the outdated coroner system for death investigation. Whereas medical examiners are almost exclusively board-certified forensic pathologists, coroners are usually elected officials required only to be 18 years of age and without a felony record. The coroner system, a British import to colonial America, is legal rather than medical, and is subject to extraordinary politicization, with most candidates running for office on partisan platforms. Coroners are notorious for their close ties to police and corrections organizations, often ruling to exonerate them from culpability for suspicious deaths. It is unsurprising to see that they have played a critical role in the undercounting of Covid-19 deaths. As Wavis Jordan, a pastor and Republican coroner for Cape Girardeau County, Missouri, put it to a journalist recently, he “doesn’t do Covid deaths.” The county has not noted a single Covid death in 2021. Jordan—who has no medical experience and who had no experience with death investigation before his election—noted that his office does not test the dead for the disease, and will only include it on a death certificate at the family’s request. Given the political leanings of the county, such requests are rare. Another coroner in Louisiana told reporters that he deferred to family members’ wishes when attributing cause of death during the pandemic, stating that “getting Covid … was a scarlet letter.” Such responses broadly characterize areas where conservative coroners lead death investigations, in which deaths from conditions that are often complications of Covid-19 have exploded while Covid goes overlooked. This leads to the opposite phenomenon of what right-wing critics predicted in 2020. Rather than a dramatic overcounting of Covid deaths as a result of counting deaths “with Covid” as deaths “from Covid,” there has been a significant undercounting of Covid deaths by virtue of a political refusal to acknowledge the disease.

The erasure of the legitimacy of deaths with comorbidity amounts to a shaming of comorbidity, reinforcing the discounting of disability, old age, and compromised health. This message is constantly reiterated. As a guest on the New York Times podcast The Daily on 26 January 2022, journalist David Leonhardt encapsulated this problem when he argued that excessive concern for others is irrational, given that Covid-19 only presents serious risk for those with underlying health issues:

“Omicron looks a lot like other, common respiratory illnesses. As we’ve said, it is usually mild but can be rough on elderly or immunocompromised people. So the question becomes: if Covid is starting to look like a regular respiratory virus, is it rational to treat it like something completely different – to disrupt our lives in all these big and consequential ways?”

It is difficult not to see the eugenicist slant in these arguments, where concern over the deaths of the elderly or immunocompromised is not “rational.” As Ed Yong has noted in The Atlantic, most Americans would probably find eugenics “reprehensible,” yet “when a society acts as if the deaths of vulnerable people are unavoidable, and does little to lessen their risks, it is still implicitly assigning lower value to certain lives.” Such suffering and loss are in this formulation inconsequential, not worth disruption to ordinary life. As with the idea of a harvesting effect that simply advances the inevitability of death, the dismissal of Covid deaths among those with underlying health concerns contributes to the dehumanization of the dying. As with qualifying a death as “displaced” rather than “caused,” to say that it is not worth disruption is to deny its full significance, and therefore the significance of life lost.

These deaths resemble those that Judith Butler has called “ungrievable.” Writing in the context of the War on Terror, Butler argues that the lives of entire populations simply do not “count,” that they are not what she calls “grievable” in their death. Butler here points to a phenomenon of dehumanization with complex yet inextricable links to violence. While the lives of American soldiers and the victims of the World Trade Center attacks are grievable, those of not only terrorists but also the civilian victims of American bombing campaigns suffer a double violence: the violence of their deaths, to be sure, but also that of the “derealization” that precludes their grievability. They are anonymous figures at the fringes of life, incapable of assimilation into our imaginative experience. As a consequence of their dehumanization, violence against them “leaves a mark that is no mark,” because there is no easy identification with the victim.

The Covid-19 pandemic and other episodes of mass mortality from disease or disaster are radically different contexts from the War on Terror. But this logic of grievability, derealization, and dehumanization has an important relevance for the ways in which these deaths are so commonly dismissed. The description of death as so inevitable as to not merit precaution or concern underscores a life’s insignificance and its unimportance—indeed, its unassimilability to lived experience, and ultimately, its inhumanity. The dismissal of disability, old age, and chronic illness effects a violence of derealization that precedes and preordains their deaths as unimportant, for which the pandemic is less a cause than a catalyst. To speak of their deaths in terms of their inevitability both highlights and extends the effacement and denominalization that attends both their lives and deaths.

Small wonder, then, that there are so few memorials to pandemic deaths. In addition to the New York Times front page of 24 May 2020 listing the names of a thousand people who had died from Covid-19, MSNBC ran a series of biographical vignettes memorializing coronavirus deaths on Nicolle Wallace’s Deadline: White House in 2020 and 2021. When 400,000 had died, on the eve of his inauguration, President-elect Biden offered remarks in Washington, D.C. in commemoration. There have been sporadic and short-lived flag displays in Washington as well, with seas of flags each representing a Covid death. But pandemic memorials have been notable mostly in their absence.

This is not unusual. Although the AIDS quilt, one of the most prominent and evolving commemorations of pandemic death, originated with a newspaper story similar to that published in the New York Times—in this case, a 1985 San Francisco Chronicle headline announcing that a thousand San Franciscans had died of AIDS—memorial tributes to those who have died in epidemics are rare. There are a handful of memorial plaques designating mass burial sites of cholera victims from the nineteenth century, including those at Duffy’s Cut, Pennsylvania; the Cefn Golau cemetery in Wales; and the Cholera Monument in Sheffield, England. But more often monuments to disease herald saviors rather than the dead. There is a statue of Balto, the sled dog who led a team carrying diphtheria antitoxin to Nome, Alaska, in 1925, to halt an outbreak of the disease among children. In London, there is a statue of a water pump with a missing handle in Broad Street that commemorates the epidemiologist John Snow’s role in ending cholera in that city: he famously surmised that contaminated well water was the cause of the outbreak, and ordered the pump’s handle removed, abruptly stopping the spread of disease. There is a statue of Edward Jenner, who discovered the smallpox vaccine, in London’s Kensington Gardens. Vienna’s famous Plague Column celebrates not the victims of plague, but the Holy Trinity: Emperor Leopold I vowed to build the monument if God drove plague from the city during a 1679 outbreak. After its apparent success, similar columns, modeled on those used by flagellants seeking to end plague epidemics through the “reenactment of Christ’s flogging,” multiplied throughout central and eastern Europe. Covid-19 has continued this trend: in spring 2020, the artist Jorge Rodríguez-Gerada painted a 20,000 square foot portrait of a doctor wearing a mask in the parking lot of the Queens Museum in New York as a tribute to front-line health workers.

Nods to heroism in the face of deadly disease are important. Yet the absence of those to the dead is stunning. Where they exist, they are often private rather than public endeavors. Westminster Abbey has an inscription commemorating its own monks who died during the Black Death. The defunct Human BSE Foundation in London mounted a plaque in tribute to those who died of bovine spongiform encephalopathy in the 1990s. In 2018, a Vermont restaurateur built a monument to those who died in the 1918 influenza pandemic. Perhaps the only public memorial to that pandemic is a plaque mounted near a war memorial in 2019 in Wellington, New Zealand—notably, one of the countries with the most effective Covid-19 response to date.

The absence of monuments to disease is one component that manufactures the invisibility of these deaths. It is not merely the anonymity of these deaths that accounts for their disappearance; war memorials to unknown soldiers are ubiquitous. Instead, I argue, it is a broad refusal to identify with those sacrificed to disease that accounts in part for this absence. The portrait of the subject who is at risk for death from Covid-19 is a composite of multiple orders of marginalization: old age, disability, dementia, chronic illness, and mental illness are some of its many layers. Those with such conditions exist on the margins of social citizenship and elicit little public empathy. This is not merely a problem with Covid-19: as Jason De Léon has so eloquently argued in The Land of Open Graves (2015) every year the “killing machine” that is American immigration policy condemns thousands of migrants to anonymous death in the Sonoran Desert. In the aftermath of the 2003 heat wave in France, epidemiologists and media crafted a risk profile suggesting that those with the most to fear during extreme heat episodes were poor, elderly, urban women with disabilities. The following year, when French cities opened telephone networks designed to aid those at risk during heat waves, very few registered for them: it was simply too difficult to identify one’s self with the desperate portrait of vulnerability the state and media had created.

Likewise, epidemiological tools are by their very design incapable of sustaining the visibility of these deaths. The case of heat deaths in a period of climate change offers an important cautionary example. If excess death measurements are the essential tool for gauging the magnitude of a disaster, what happens when repeated, annual heat episodes constantly elevate the death toll from extreme heat? France recorded devastating heat and associated high mortality every year from 2015 to 2019, with July 2019 shattering temperature records in the country. But how can one cast high mortality in relief when comparing it to already exceptional average levels during the four preceding years?

Premature claims of Covid endemicity—in a moment when daily deaths average above 2,000 in the United States—are part of a broad national process of inuring ourselves to mass death. As excess deaths mount month after month, year after year, they are no longer excess but instead part of the mean. Covid-19 loses its exceptional and excessive status, and starts to be merely another cause of death, like gun violence, overdose, extreme heat death, heart disease, and smoking. And as with those other, largely preventable causes of death, it becomes increasingly associated with behavioral choice and individual responsibility, and therefore increasingly invisible.

In May 2020, I was asked to predict the future of the pandemic by two different venues. I told David Wahlberg of the Wisconsin State Journal that I thought we were headed in a direction where with the relaxation of restrictions, we would “see a pushing of the pandemic out of sight, out of mind.” To elaborate, in a forum on “Pandemic Narratives and the Historian” in the Los Angeles Review of Books, I argued when asked what the end of the pandemic would look like, that “the pandemic’s continuation will be baked into the local social worlds of those least able to withstand the additional blow” with concentrations “in the Global South, but also in significant pockets of the United States and Europe.” Surges in Covid mortality in unvaccinated, poor, rural populations in the US have become a reality, where they underscore a trend in declining life expectancy linked to economic marginalization. In the same forum, the historian and ethnographer Julie Livingston made a similar point, but more eloquently. Livingston argued that any return to normalcy meant a return to “one characterized by high rates of cancer, diabetes, heart disease, and other chronic illnesses that COVID-19 has surfaced.” More important, Livingston noted that “those epidemics will continue, as accepted side effects of our economic and political systems, collateral damage that disproportionately affects the black, brown, and poor.” Finally, she foretold the profound forgetting that would mark what was then called a return to normal, but what now characterizes the rush to endemicity: “The collective urgency we now feel will dissipate back into individuated narratives of misfortune.”

Perhaps this is what is truly at the root of the erasure of Covid-19’s toll in a background of mass mortality. As with HIV-AIDS, Covid-19 is losing its emergent status and heading toward a broader condition of marginality. It will move out of the headlines, but will remain a central lived experience and an evolving tragedy in much of the world, the US included. It will exacerbate and prey on the burdens of chronic illness and premature death precisely in the populations that can least afford it, much like the conditions of addiction, diabetes, renal disease, heart disease, and cancer that preceded it and will remain comorbid with it.


Richard C. Keller is Professor in the Departments of Medical History and Bioethics and History at the University of Wisconsin-Madison. He is the author of Fatal Isolation: The Devastating Paris Heat Wave of 2003 (Chicago, 2015) and Colonial Madness: Psychiatry in French North Africa (Chicago, 2007), and is co-editor of Unconscious Dominions: Psychoanalysis, Colonial Trauma, and Global Sovereignties (Duke, 2011), Enregistrer les morts, identifier les surmortalités. Une comparaison Angleterre, Etats-Unis et France (Presses de l’EHESP, 2010), and a special issue of South Atlantic Quarterly, “Life after Biopolitics” (2016). He is currently writing a global history of the environment, which is under contract with Oxford University Press. He is the winner of the 2013 William Koren, Jr. Prize from the Society for French Historical Studies. His work has been supported by the National Science Foundation, the Andrew W. Mellon Foundation, the French Ministry of Health, and the City of Paris.

This project is funded in part by a Research Forward Award from the Office of the Vice Chancellor for Research and Graduate Education at the University of Wisconsin-Madison: “Resilience, Recognition, and Ritual: Human Engagement with Disease, Death, and Dying.”


Notes

[1] Although the CARES act did include a 20% premium for Medicare patients who were diagnosed with Covid-19, this is only a fraction of patients. Moreover, the funds the premium provided—designed to offset increased cost of care of Covid-19 patients—were dwarfed by actual costs of PPE, ventilators, and the suspension of elective procedures, leading to hospital bankruptcies in some cases. See, e.g., “American Hospital Association, Fact Sheet: COVID-19 Pandemic Results in Bankruptcies or Closures for Some Hospitals,” https://www.aha.org/fact-sheets/2020-11-09-fact-sheet-covid-19-pandemic-results-bankruptcies-or-closures-some-hospitals?fbclid=IwAR3XQ7dgAK3d89pobGWohcQg6pQWN2bpHkjLrq0YpLruoP9ssrF-vYH0NPI, accessed 25 January 2022.



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