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Accountability and "the America virus"

In 1743, when worms ravaged crops in Northampton, Massachusetts, the Puritan minister Jonathan Edwards interpreted the tragedy as divine retribution, casting blame squarely on the townspeople themselves. Their sin? They had failed to do “justice” to the poor. In a sermon (Malachi 3:10-11), he affirmed that “Christian people are to give to others not only so as to lift [them] above extremity but liberally to furnish [them].” Charity was not optional. It was a duty, with the spiritual and material fate of the wealthy fastened to the fate of the poor.

Over a hundred years later, in 1861, Abraham Lincoln approved recommendations from Congress to observe a national “Day of Fasting” to repent for the beginning of the Civil War, declaring it "fit and becoming in all people, at all confess and deplore their sins and transgressions." As a legal document, the language is uncharacteristically moving in its contrition. Through the lens of the 21st century, it is also matter-of-factly disorienting. "In sorrowful remembrance of our own faults and crimes as a nation and as individuals,” the United States proclaimed that it must pray to “be spared further punishment, though most justly deserved.”

Two years later, in 1863, when the awful calamity of the war had carried on in ways that made 1861 appear naïve, the federal government set aside yet another “Day of Fasting and Humility,” propounding that "We have been the recipients of the choicest bounties of Heaven. We have been preserved, these many years, in peace and prosperity. We have grown in numbers, wealth and power.... Intoxicated with unbroken success, we have become too self-sufficient to feel the necessity of redeeming and preserving grace."

To be clear, I mention these passages not to suggest that our current viral pestilence is a manifestation of the wrath of God, though we do seem to be living in Biblical times, with catastrophic floods, locusts, and hail. My own personal belief, which I don’t mind sharing on the Internet, is that God’s will is inscrutable – that what we perceive as curses may later appear to have been blessings – and that this mystery is cause enough for humility and hope. Assertions by a rabbi, a far-right pastor, and the founder of a religious media outlet that SARS-CoV-2 is God’s punishment for homosexuality seem overly specific for a global health crisis. (Pride and avarice seem like better candidates for a reckoning to me, but I’m not exactly looking to debate what I feel is the unknowable will of an unprovable entity, at least not right now.)

Instead, I want to highlight that we have a choice in how we react to crises, that history – even our own history – affords us models, and that there is something particularly "fit and becoming" about the model in which we look inward instead of outward for blame and improvement. To look inward is to assume personal responsibility, which anyone with integrity would see as an opportunity to institute reforms, at the risk of one's reputation. (Note that though the US in the 1860s acknowledged its “dependence upon the overruling power of God,” it still assumed culpability for its actions.) To exclusively look outward for blame is to shirk accountability, which shows both an unwillingness and an inability to improve. And in practically any scenario, to deny room for improvement is simply unrealistic.

In academic hospitals across the country, medical specialties make a ritual of reviewing their errors in weekly or monthly “Morbidity and Mortality” (or “M. & M.”) conferences. In doing so, some residency programs assign independent analysts (residents not personally involved in the care) to audit the cases, while others ask the responsible parties to do the job on their own, in front of their peers and faculty, in what can become a sort of public mea culpa. In my third and fourth years of medical school, I had the privilege of attending about two dozen of these, and there is much to be learned in them about nearly every aspect of medicine – from the fundamentals of anatomy, physiology, and pharmacology, to less strictly medical topics like systems analysis, team dynamics, effective communication, and error analysis. But there is also an underlying drama to these sessions: how plainly will the presenters give voice to the blame that the audience is currently formulating? Will they embarrass their colleagues, or will they admit their own faults? If so, will the admission be proportionate to the error, if such a thing is even possible?

At my medical school, which has a reputation for an idiosyncratic didactic approach in its first two years, my classmates and I learned aspects of the core scientific curriculum in groups of nine, two hours at a time, three days a week. The last twenty minutes of each two-hour block were devoted to “reflection,” in which, one by one, around in a circle, we evaluated our group’s conduct that day and touched on our individual performances. Did we interrupt too much? Were we too passive? How was the group’s leadership and focus? These deliberations happened for a total of one hour each week, for one hundred weeks. Time is precious in medical school, and by devoting so much of it to contemplation, the administration was signaling that the skills we would develop from this new habit of thought were as important as the knowledge we could have gained in the same amount of time – namely, one hundred hours of study. The implication was also that without reflection and mindfulness, there is limited personal or institutional growth. In a sense, our school was preparing us for the M. & M. presentations we are all someday destined to lead. And appropriately, in our self-reflections, my classmates and I often erred on the side of self-criticism than self-congratulation. In most cases, it seemed more "fit and becoming" to be too hard on ourselves than to be too self-satisfied.

But there were only nine of us at a time, and the stakes were low. By contrast, to watch physician residents admit an error that may have adversely affected patient care, and to watch them do it on stage in front of dozens of their colleagues – to watch them attempt to reconcile their sense of accountability with an uncomfortable self-forgiveness – I’ll just come out and say it. It’s beautiful. After all, we are talking about minutiae of medical care, usually in a Powerpoint format, but there is a soul up there trying to come to a decision about itself. It is a drama of conscience. M. & M.s are weekly meetings, but their subtext, at least to me, is always about justice versus mercy.

Which brings me to the current political environment. There has been an outcry, especially from more liberal outlets, regarding our president's use of "the China virus" to describe the novel coronavirus. I have to admit that, for better or worse, when I initially heard this phrase, my reaction was neutral. I had read very early reports in respected journals that had referred to it as “the Wuhan virus,” and it is not unusual for viruses to take on geographical nomenclature, as they did in the Spanish flu, the West Nile virus, Ebola, Zika, hantaviruses, Rocky Mountain Spotted Fever, Middle East Respiratory Syndrome, and Lyme disease, many of which no longer adhere to their initial place associations.

But when the scientific consensus solidified around calling the novel coronavirus SARS-CoV-2, the cause of COVID-19, and these terms entered into common parlance, our president's continued use of “the China virus” appeared more deliberate and less incidental. Call me naïve (and I actually won’t argue with you), but at that point, I interpreted his use of “the China virus” less as a racist overture than as a deliberate attempt to shunt blame away from our botched domestic response and onto its purported source. I saw it as political gamesmanship, and again, to be frankly honest, I still did not entirely fault him for it.

We ought to hold governments accountable for their public health interventions. That means that we have to give them credit for their successes as much as we blame them for their failures. It also means that if you criticize another country, you open yourself up to similar scrutiny. To be more specific, if China’s lax enforcement of sanitary conditions in its local wet markets and poor surveillance of wild bird populations lead to cross-species contamination and newer, deadlier strains of avian influenza, those are worth noting. But fairness demands that you also commend the Chinese government for increasing life expectancy by 30 years since 1949, reducing infant mortality, and eliminating smallpox years ahead of countries with comparable economies. By the same token, is the US prepared to answer for E. coli O157:H7, which, as a result of our vast domestic feedlots and centralization of food processing, has led to outbreaks linked to apple cider, produce, and contaminated water supplies? The fatal bacterial strain was first discovered in Oregon and Michigan in 1982 but has since spread globally. Should we call it “The America bacteria?”

The initial response among local and federal Chinese officials is reprehensible and well-documented. Its later attempts at correcting its missteps through global outreach (and suppression of criticism) are also well-known. And to be sure, the blame game is not just a political matter. It is also financial. The US government has spent over $2 trillion to save its economy from a virus that originated in a country that has pledged $2 billion to the W.H.O. Does that pledge come anywhere close to a sufficient reparation? It depends on how much accountability each government is willing to accept for its own response. And here is the rub: it’s fine to blame the Chinese government for its initial cover-up, but it is unfit and unbecoming of our own government to admit no fault in its own response, especially now that the virus is firmly ensconced on our own shores.

Despite being wealthier and less populous than China, and despite having more time to prepare, the US has seen more cases and more deaths from the coronavirus than China or anywhere else in the world, at the time of writing. If our federal and local governments are unable or unwilling to institute and enforce basic safety measures to limit the spread of this disease, it may be permanently added to the human species. And if American society is unable or unwilling to adapt to new social norms to prevent the deaths of its most vulnerable neighbors, to the point where America becomes a global nidus of contagion, we will own this virus. It will be “the America virus.”

Viruses expose our connectedness and, by extension, our accountability to each other. In a globalized world, novel diseases that spring up anywhere run the risk of spreading everywhere. As Eula Biss writes in On Immunity, "our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies. We are, bodily, both independent and dependent." Like it or not, we are our brothers' keepers. Anti-lockdown protestors are understandably chafing under this uncomfortable truth, which clashes with American individualism (no doubt, they are also suffering under the personal and economic tolls of this pandemic, amplified by a deep skepticism of government control). We may be a "free country," but we are not free from our reliance on each other. If we shirk responsibility for our neighbors, we cannot avoid the consequences for long. Here in the United States, COVID-19 is disproportionately affecting the poor and the working class, but it is by no means confined to them. If Jonathan Edwards justified his claim on religious grounds, his point was just as valid from a scientific and pragmatic standpoint: our destinies - not only spiritual or material, but also bodily - are tied to the destinies of the most vulnerable among us. It is a humbling truth, but with enough humility, we may find the mercy we need.


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