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Tag: public-health measures

  • The Pandemic’s ‘Ghost Architecture’ Is Still Haunting Us

    The Pandemic’s ‘Ghost Architecture’ Is Still Haunting Us

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    Last Friday, in a bathroom at the Newark airport, I encountered a phrase I hadn’t seen in a long time: Stop the spread. It accompanied an automatic hand-sanitizing station, which groaned weakly when I passed my hand beneath it, dispensing nothing. Presumably set up in the early pandemic, the sign and dispenser had long ago become relics. Basically everyone seemed to ignore them. Elsewhere in the terminal, I spotted prompts to maintain a safe distance and reduce overcrowding, while maskless passengers sat elbow-to-elbow in waiting areas and mobbed the gates.

    Beginning in 2020, COVID signage and equipment were everywhere. Stickers indicated how to stand six feet apart. Arrows on the grocery-store floor directed shopping-cart traffic. Plastic barriers enforced distancing. Masks required signs dotted store windows, before they were eventually replaced by softer pronouncements such as masks recommended and masks welcome. Such messages—some more helpful than others—became an unavoidable part of navigating pandemic life.

    Four years later, the coronavirus has not disappeared—but the health measures are gone, and so is most daily concern about the pandemic. Yet much of this COVID signage remains, impossible to miss even if the messages are ignored or outdated. In New York, where I live, notices linger in the doorways of apartment buildings and stores. A colleague in Woburn, Massachusetts, sent me a photo of a sign reminding park-goers to gather in groups of 10 or less; another, in Washington, D.C., showed me stickers on the floors of a bookstore and pier bearing faded reminders to stay six feet apart. “These are artifacts from another moment that none of us want to return to,” Eric Klinenberg, a sociologist at NYU and the author of 2020: One City, Seven People, and the Year Everything Changed, told me. All these fliers, signs, and stickers make up the “ghost architecture” of the pandemic, and they are still haunting America today.

    That some COVID signage persists makes sense, considering how much of it once existed. According to the COVID-19 Signage Archive, one store in Key West had a reminder to mask up during the initial Omicron wave: Do not wear it above chin or below nose. In the summer of 2021, a placard at a Houston grocery store indicated that the shopping carts had been “sanitizd.” And in November 2020, you could have stepped on a customized welcome mat in Washington, D.C., that read Thank you for practicing 6 ft social distancing. Eli Fessler, a software engineer who launched the crowdsourced archive in December 2020, wanted “to preserve some aspect of [COVID signage] because it felt so ephemeral,” he told me. The gallery now comprises nearly 4,000 photos of signs around the world, including submissions he received as recently as this past October: a keep safe distance sign in Incheon, South Korea.

    No doubt certain instances of ghost architecture can be attributed to forgetfulness, laziness, or apathy. Remnants of social-distancing stickers on some New York City sidewalks appear too tattered to bother scraping away; outdoor-dining sheds, elaborately constructed but now barely used, are a hassle to dismantle. A faded decal posted at a restaurant near my home in Manhattan depicts social-distancing guidelines for ordering takeout alcohol that haven’t been relevant since 2020. “There’s a very human side to this,” Fessler said. “We forget to take things down. We forget to update signs.”

    But not all of it can be chalked up to negligence. Signs taped to a door can be removed as easily as they are posted; plastic barriers can be taken down. Apart from the ease, ghost architecture should have disappeared by now because spotting it is never pleasant. Even in passing, the signs can awaken uncomfortable memories of the early pandemic. The country’s overarching response to the pandemic is what Klinenberg calls the “will not to know”—a conscious denial that COVID changed life in any meaningful way. Surely, then, some examples are left there on purpose, even if they evoke bad memories.

    When I recently encountered the masks required sign that’s still in the doorway of my local pizza shop, my mind flashed back to more distressing times: Remember when that was a thing? The sign awakened a nagging voice in my brain reminding me that I used to mask up and encourage others to do the same, filling me with guilt that I no longer do so. Perhaps the shop owner has felt something similar. Though uncomfortable, the signs may persist because taking them down requires engaging with their messages head-on, prompting a round of fraught self-examination: Do I no longer believe in masking? Why not? “We have to consciously and purposely say we no longer need this,” Klinenberg told me.

    Outdated signs are likely more prevalent in places that embraced public-health measures to begin with, namely bluer areas. “I would be surprised to see the same level of ghost architecture in Florida, Texas, or Alabama,” Klinenberg said. But ghost architecture seems to persist everywhere. A colleague sent a photo of a floor sticker in a Boise, Idaho, restaurant that continues to thank diners for practicing social distancing. These COVID callbacks are sometimes even virtual: An outdated website for a Miami Beach spa still encourages guests to physically distance and to “swipe your own credit card.”

    Most of all, the persistence of ghost architecture directly reflects the failure of public-health messaging to clearly state what measures were needed, and when. Much of the signage grew out of garbled communication in the first place: “Six feet” directives, for example, far outlasted the point when public-health experts knew it was a faulty benchmark for stopping transmission.

    The rollback of public-health precautions has been just as chaotic. Masking policy has vacillated wildly since the arrival of vaccines; although the federal COVID emergency declaration officially ended last May, there was no corresponding call to end public-health measures across the country. Instead, individual policies lapsed at different times in different states, and in some cases were setting-specific: California didn’t end its mask requirement for high-risk environments such as nursing homes until last April. Most people still don’t know how to think about COVID, Klinenberg said, and it’s easier to just leave things as they are.

    If these signs are the result of confusing COVID messaging, they are also adding to the problem. Prompts to wash or sanitize your hands are generally harmless. In other situations, however, ghost architecture can perpetuate misguided beliefs, such as thinking that keeping six feet apart is protective in a room full of unmasked people, or that masks alone are foolproof against COVID. To people who must still take precautions for health reasons, the fact that signs are still up, only to be ignored, can feel like a slap in the face. The downside to letting ghost architecture persist is that it sustains uncertainty about how to behave, during a pandemic or otherwise.

    The contradiction inherent in ghost architecture is that it both calls to mind the pandemic and reflects a widespread indifference to it. Maybe people don’t bother to take the signs down because they assume that nobody will follow them anyway, Fessler said. Avoidance and apathy are keeping them in place, and there’s not much reason to think that will change. At this rate, COVID’s ghost signage may follow the same trajectory as the defunct Cold War–era nuclear-fallout-shelter signs that lingered on New York City buildings for more than half a century, at once misleading observers and reminding them that the nuclear threat, though diminished, is still present.

    The signs I saw at the Newark airport seemed to me hopelessly obsolete, yet they still stoked unease about how little I think about COVID now, even though the virus is still far deadlier than the flu and other common respiratory illnesses. Passing another stop the spread hand-sanitizing station, I put my palm under the dispenser, expecting nothing. But this time, a dollop of gel squirted into my hand.

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    Yasmin Tayag

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  • The Pandemic’s Legacy Is Already Clear

    The Pandemic’s Legacy Is Already Clear

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    Recently, after a week in which 2,789 Americans died of COVID-19, President Joe Biden proclaimed that “the pandemic is over.” Anthony Fauci described the controversy around the proclamation as a matter of “semantics,” but the facts we are living with can speak for themselves. COVID still kills roughly as many Americans every week as died on 9/11. It is on track to kill at least 100,000 a year—triple the typical toll of the flu. Despite gross undercounting, more than 50,000 infections are being recorded every day. The CDC estimates that 19 million adults have long COVID. Things have undoubtedly improved since the peak of the crisis, but calling the pandemic “over” is like calling a fight “finished” because your opponent is punching you in the ribs instead of the face.

    American leaders and pundits have been trying to call an end to the pandemic since its beginning, only to be faced with new surges or variants. This mindset not only compromises the nation’s ability to manage COVID, but also leaves it vulnerable to other outbreaks. Future pandemics aren’t hypothetical; they’re inevitable and imminent. New infectious diseases have regularly emerged throughout recent decades, and climate change is quickening the pace of such events. As rising temperatures force animals to relocate, species that have never coexisted will meet, allowing the viruses within them to find new hosts—humans included. Dealing with all of this again is a matter of when, not if.

    In 2018, I wrote an article in The Atlantic warning that the U.S. was not prepared for a pandemic. That diagnosis remains unchanged; if anything, I was too optimistic. America was ranked as the world’s most prepared country in 2019—and, bafflingly, again in 2021—but accounts for 16 percent of global COVID deaths despite having just 4 percent of the global population. It spends more on medical care than any other wealthy country, but its hospitals were nonetheless overwhelmed. It helped create vaccines in record time, but is 67th in the world in full vaccinations. (This trend cannot solely be attributed to political division; even the most heavily vaccinated blue state—Rhode Island—still lags behind 21 nations.) America experienced the largest life-expectancy decline of any wealthy country in 2020 and, unlike its peers, continued declining in 2021. If it had fared as well as just the average peer nation, 1.1 million people who died last year—a third of all American deaths—would still be alive.

    America’s superlatively poor performance cannot solely be blamed on either the Trump or Biden administrations, although both have made egregious errors. Rather, the new coronavirus exploited the country’s many failing systems: its overstuffed prisons and understaffed nursing homes; its chronically underfunded public-health system; its reliance on convoluted supply chains and a just-in-time economy; its for-profit health-care system, whose workers were already burned out; its decades-long project of unweaving social safety nets; and its legacy of racism and segregation that had already left Black and Indigenous communities and other communities of color disproportionately burdened with health problems. Even in the pre-COVID years, the U.S. was still losing about 626,000 people more than expected for a nation of its size and resources. COVID simply toppled an edifice whose foundations were already rotten.

    In furiously racing to rebuild on this same foundation, America sets itself up to collapse once more. Experience is reputedly the best teacher, and yet the U.S. repeated mistakes from the early pandemic when faced with the Delta and Omicron variants. It got early global access to vaccines, and nonetheless lost almost half a million people after all adults became eligible for the shots. It has struggled to control monkeypox—a slower-spreading virus for which there is already a vaccine. Its right-wing legislators have passed laws and rulings that curtail the possibility of important public-health measures like quarantines and vaccine mandates. It has made none of the broad changes that would protect its population against future pathogens, such as better ventilation or universal paid sick leave. Its choices virtually guarantee that everything that’s happened in the past three years will happen again.

    The U.S. will continue to struggle against infectious diseases in part because some of its most deeply held values are antithetical to the task of besting a virus. Since its founding, the country has prized a strain of rugged individualism that prioritizes individual freedom and valorizes self-reliance. According to this ethos, people are responsible for their own well-being, physical and moral strength are equated, social vulnerability results from personal weakness rather than policy failure, and handouts or advice from the government are unwelcome. Such ideals are disastrous when handling a pandemic, for two major reasons.

    First, diseases spread. Each person’s choices inextricably affect their community, and the threat to the collective always exceeds that to the individual. The original Omicron variant, for example, posed slightly less risk to each infected person than the variants that preceded it, but spread so quickly that it inundated hospitals, greatly magnifying COVID’s societal costs. To handle such threats, collective action is necessary. Governments need policies, such as vaccine requirements or, yes, mask mandates, that protect the health of entire populations, while individuals have to consider their contribution to everyone else’s risk alongside their own personal stakes. And yet, since the spring of 2021, pundits have mocked people who continue to think this way for being irrational and overcautious, and government officials have consistently framed COVID as a matter of personal responsibility.

    Second, a person’s circumstances always constrain their choices. Low-income and minority groups find it harder to avoid infections or isolate when sick because they’re more likely to live in crowded homes and hold hourly-wage jobs without paid leave or the option to work remotely. Places such as prisons and nursing homes, whose residents have little autonomy, became hot spots for the worst outbreaks. Treating a pandemic as an individualist free-for-all ignores how difficult it is for many Americans to protect themselves. It also leaves people with vulnerabilities that last across successive pathogens: The groups that suffered most during the H1N1 influenza pandemic of 2009 were the same ones that took the brunt of COVID, a decade later.

    America’s individualist bent has also shaped its entire health-care system, which ties health to wealth and employment. That system is organized around treating sick people at great and wasteful expense, instead of preventing communities from falling sick in the first place. The latter is the remit of public health rather than medicine, and has long been underfunded and undervalued. Even the CDC—the nation’s top public-health agency—changed its guidelines in February to prioritize hospitalizations over cases, implicitly tolerating infections as long as hospitals are stable. But such a strategy practically ensures that emergency rooms will be overwhelmed by a fast-spreading virus; that, consequently, health-care workers will quit; and that waves of chronically ill long-haulers who are disabled by their infections will seek care and receive nothing. All of that has happened and will happen again. America’s pandemic individualism means that it’s your job to protect yourself from infection; if you get sick, your treatment may be unaffordable, and if you don’t get better, you will struggle to find help, or even anyone who believes you.

    In the late 19th century, many scholars realized that epidemics were social problems, whose spread and toll are influenced by poverty, inequality, overcrowding, hazardous working conditions, poor sanitation, and political negligence. But after the advent of germ theory, this social model was displaced by a biomedical and militaristic one, in which diseases were simple battles between hosts and pathogens, playing out within individual bodies. This paradigm conveniently allowed people to ignore the social context of disease. Instead of tackling intractable social problems, scientists focused on fighting microscopic enemies with drugs, vaccines, and other products of scientific research—an approach that sat easily with America’s abiding fixation on technology as a panacea.

    The allure of biomedical panaceas is still strong. For more than a year, the Biden administration and its advisers have reassured Americans that, with vaccines and antivirals, “we have the tools” to control the pandemic. These tools are indeed effective, but their efficacy is limited if people can’t access them or don’t want to, and if the government doesn’t create policies that shift that dynamic. A profoundly unequal society was always going to struggle with access: People with low incomes, food insecurity, eviction risk, and no health insurance struggled to make or attend vaccine appointments, even after shots were widely available. A profoundly mistrustful society was always going to struggle with hesitancy, made worse by political polarization and rampantly spreading misinformation. The result is that just 72 percent of Americans have completed their initial course of shots and just half have gotten the first of the boosters necessary to protect against current variants. At the same time, almost all other protections have been stripped away, and COVID funding is evaporating. And yet the White House’s recent pandemic-preparedness strategy still focuses heavily on biomedical magic bullets, paying scant attention to the social conditions that could turn those bullets into duds.

    Technological solutions also tend to rise into society’s penthouses, while epidemics seep into its cracks. Cures, vaccines, and diagnostics first go to people with power, wealth, and education, who then move on, leaving the communities most affected by diseases to continue shouldering their burden. This dynamic explains why the same health inequities linger across the decades even as pathogens come and go, and why the U.S. has now normalized an appalling level of COVID death and disability. Such suffering is concentrated among elderly, immunocompromised, working-class, and minority communities—groups that are underrepresented among political decision makers and the media, who get to declare the pandemic over. Even when inequities are highlighted, knowledge seems to suppress action: In one study, white Americans felt less empathy for vulnerable communities and were less supportive of safety precautions after learning about COVID’s racial disparities. This attitude is self-destructive and limits the advantage that even the most privileged Americans enjoy. Measures that would flatten social inequities, such as universal health care and better ventilation, would benefit everyone—and their absence harms everyone, too. In 2021, young white Americans died at lower rates than Black and Indigenous Americans, but still at three times the rate of their counterparts in other wealthy countries.

    By failing to address its social weaknesses, the U.S. accumulates more of them. An estimated 9 million Americans have lost close loved ones to COVID; about 10 percent will likely experience prolonged grief, which the country’s meager mental-health services will struggle to address. Because of brain fog, fatigue, and other debilitating symptoms, long COVID is keeping the equivalent of 2 million to 4 million Americans out of work; between lost earnings and increased medical costs, it could cost the economy $2.6 trillion a year. The exodus of health-care workers, especially experienced veterans, has left hospitals with a shortfall of staff and know-how. Levels of trust—one of the most important predictors of a country’s success at controlling COVID—have fallen, making pandemic interventions harder to deploy, while creating fertile ground in which misinformation can germinate. This is the cost of accepting the unacceptable: an even weaker foundation that the next disease will assail.

    In the spring of 2020, I wrote that the pandemic would last for years, and that the U.S. would need long-term strategies to control it. But America’s leaders consistently acted as if they were fighting a skirmish rather than a siege, lifting protective measures too early, and then reenacting them too slowly. They have skirted the responsibility of articulating what it would actually look like for the pandemic to be over, which has meant that whenever citizens managed to flatten the curve, the time they bought was wasted. Endemicity was equated with inaction rather than active management. This attitude removed any incentive or will to make the sort of long-term changes that would curtail the current disaster and prevent future ones. And so America has little chance of effectively countering the inevitable pandemics of the future; it cannot even focus on the one that’s ongoing.

    If change happens, it will likely occur slowly and from the ground up. In the vein of ACT UP—the extraordinarily successful activist group that changed the world’s approach to AIDS—grassroots organizations of long–haulers, grievers, immunocompromised people, and others disproportionately harmed by the pandemic have formed, creating the kind of vocal constituency that public health has long lacked.

    More pandemics will happen, and the U.S. has spectacularly failed to contain the current one. But it cannot afford the luxury of nihilism. It still has time to address its bedrocks of individualism and inequality, to create a health system that effectively prevents sickness instead of merely struggling to treat it, and to enact policies that rightfully prioritize the needs of disabled and vulnerable communities. Such changes seem unrealistic given the relentless disappointments of the past three years, but substantial social progress always seems unfeasible until it is actually achieved. Normal led to this. It is not too late to fashion a better normal.

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    Ed Yong

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