The Pandemic Will Cleave America in Two
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Viruses aren’t picky. They tear through neighborhoods and nations, infecting whomever they can, and the new coronavirus is no exception: The pain of the present pandemic will be felt—is already being felt—by just about everyone in the United States and all over the world, in one way or another. After the pandemic has run its course, no one will be wholly untouched.
At the same time, there will be stark disparities in how certain segments of the American population experience this crisis. Some of these disparities will be the result of luck or coincidence—a matter of where someone happened to travel, what line of work they chose, or what city they live in. But in a country that was highly unequal in so many ways well before it had a confirmed case of COVID-19, other disparities will be sadly predictable, falling along racial and class lines, as well as other fateful divides.
In the coming months and years, there will really be two pandemics in America. One will be disruptive and frightening to its victims, but thanks to their existing advantages and lucky near misses with the virus, they will likely emerge from it relatively stable—physically, psychologically, and financially. The other pandemic, though, will devastate those who survive it, leaving lasting scars and altering life courses.
Which of these two pandemics any given American will experience will be determined by a morbid mix of a sort of demographic predestination—shaped strongly by inequality—and purely random chance.
When someone dies, there are three ways to think about what caused it, according to Scott Frank, a professor at Case Western Reserve University’s School of Medicine. The first is the straightforward, “medical” cause of death—diagnosable things like heart disease or cancer. The second is the “actual” cause of death—that is, the habits and behaviors that over time contributed to the medical cause of death, such as smoking cigarettes or being physically inactive. The third is what Frank refers to as the “actual actual” cause of death—the bigger, society-wide forces that shaped those habits and behaviors.
In of deaths in the U.S. resulting from “social factors” (Frank’s “actual actual” causes), the top culprits were poverty, low levels of education, and racial segregation. “Each of these has been demonstrated to have independent effects on chronic-disease mortality and morbidity,” Frank said. (Morbidity refers to whether someone has a certain disease.) He expects that the same patterns will hold for COVID-19.
