Welcome to Part II of my conversation with Dr. Celine Gounder, epidemiologist, infectious disease specialist, and member of the Biden-Harris Transition COVID-19 Advisory Board. Dr. Gounder is also the host and producer of two vital podcasts: “American Diagnosis,” on health and social justice, and “Epidemic,” on infectious disease epidemics and pandemics.
Read Part I of our conversation here.
Follow Dr. Gounder on Twitter at: @celinegounder.
[Note: this interview was edited for clarity and length]
Caroline Light (CL): You’ve recently been addressing the complexities and justice implications of COVID-19 through your podcast series “Epidemic.” How are you seeing the coronavirus pandemic overlap or intersect with the gun violence epidemic?
Celine Gounder (CG): Let’s start with white supremacy. If you look at who has been at risk for disease, death, and disability from COVID, that risk is very much concentrated among Black, Latinx, and Indigenous communities. And we see a similar pattern with gun-related homicide and injury. Women are actually at slightly lower risk of having severe COVID and dying from it, but they are at increased risk for “long haul” COVID, relative to men. We don’t entirely understand why, but we do know women are immunologically different from men. So it’s not entirely surprising to see that differential, but setting aside biological differences, women have it really hard socio-culturally.
For example, caregivers and people in education professions are predominantly women. And nurses, particularly those who work in long-term care facilities, nursing homes, and the like, are largely women of color. Once you factor out doctors, who are about 50-50 male-female, depending on the specialty, the healthcare profession skews female. As you descend the hierarchy of jobs, things skew increasingly person of color.
CL: can you tell us more about the gender and race implications of “long-haul” COVID?
CG: A study out of the UK looked at long haulers, and risk factors included being female, being of lower socioeconomic status, and working in healthcare professions. Workers with less prestige and lower pay, like medical assistants and personal health aides, are performing essential, hands-on care: bathing patients, changing diapers, and emptying urinals. These vital jobs are often performed by women of color, who are thus more likely to become infected because they come into such close contact with their patients. They also tend to be paid poorly and to lack health insurance, especially in the long-term care facility setting.
I think, more generally, in the context of receiving healthcare, women have experienced profound paternalism, where their health concerns are not taken seriously. For example chronic fatigue syndrome tends to be more often experienced by women, similar to many other autoimmune, rheumatologic, and post viral syndromes. Long COVID is likely to be another one in that group, where women are told they’re crazy, that what they’re feeling is not real.
This is one potential benefit of long COVID, the fact that men as well as women are experiencing these symptoms, which in turn may increase the amount of research being done in this space, perhaps helping change some of those perceptions. But for a long time, women who came forward with those kinds of complaints have been dismissed or ignored.
For example, consider women’s gynecological complaints, for example the pelvic pain often related to endometriosis. A recent piece in the New York Times addresses how the words for women’s anatomy are rooted in shame and silencing. How can we as medical practitioners remove this shaming language from female anatomy?
CL: This reminds me of how “hysteria” derives from the Greek word for uterus, hystera, so the language used to refer to female anatomy helps reinforce beliefs in irrationality as a feminine trait.
In addition to these deeply embedded gendered habits of mind, barriers to equitable medicine and health care dovetail with gendered and racialized care supply chains, and the failure of state and federal governments to protect our most vulnerable and essential workers. What do you make of the contemporary correlation of public protest and the pandemic?
CG: The demand for Black lives to matter applies to COVID, as well as measures to protect vulnerable populations from infection. Much resistance to measures like social distancing and sheltering in place are related to a general unwillingness to make sacrifices on behalf of the populations most vulnerable to exposure, especially Black, Brown, and Indigenous peoples. If you don’t value those peoples’ lives, you’re not going to make those sacrifices, like wearing a mask and practicing social distancing. If you view certain people as disposable, which I think we as a nation do when it comes to minoritized populations, you don’t really care what happens to them as long as there are more workers to replace them.
CL: What do you say to the people who insist these issues are not about race, to those who claim, “I just don’t want to wear a mask. It’s my choice. My body, my choice.”
CG: As Tom Frieden said, “your choice ends at the tip of your nose.” When your behavior affects me, it is not just about your freedom anymore. And yet, comparing this issue to opioid addiction, there are many instances where the “My body, my choice” argument doesn’t hold. Many don’t agree with the idea that “If they want to use opioids in their own home, and they harm themselves, why should I care?”
CL: How can we apply this logic to gun violence?
CG: Opioids harm those who misuse them. Suicides constitute the majority of gun deaths. And yet we seem more willing to police and regulate opioid self-harm than gun violence self-harm, and for that matter, gun violence harm to others. Your freedom has limits determined by how your behavior affects other people, and your exercise of freedom should not imperil or restrict the freedom of others. If your actions are making other people unsafe, in their workplaces and communities, that’s not freedom. Nor is living in fear.
CL: How do COVID-19, white supremacy, and gun violence converge in this moment?
CG: We clearly prioritize the rights and freedoms of some people over the rights and freedoms of others; those of white men are sacrosanct while the rights and freedoms of women and people of color are often expendable. I feel like it’s rooted in white male fragility. There are gender and race implications for the uneven ways our laws get applied.
A recent example is a video that went viral on “Black Twitter” of an older white guy on an airplane, flipping his mask up and down, angry about being asked to wear a mask. Black and Brown people are so used to being told to comply, while being accused of not being law-abiding. But when you ask some white people to follow basic public health and safety rules, some behave like they are above the law.
CL: This gets me thinking about the uneven ways government protections get applied. We can consider, for example, the labor standards and protections that originated in the 1930s as part of the New Deal, and the construction of a federal safety net. But some of the resulting policies, like the Fair Labor Standards Act of 1938, excluded certain categories of workers – like domestic workers and agricultural workers – from governmental protections. This exclusion disproportionately harmed Black and Brown workers. How does this history influence our present moment?
CG: We should consider “carve-outs” in the labor context, where the state carved out certain populations, certain categories of workers in terms of governmental protections, including labor, health, and safety protections.
In the gun context, we might ask who can really exercise their Second Amendment rights? And in terms of “stand your ground” laws, which tend not to protect Black and Brown people and women regardless of race. These exclusions parallel the way that women and people of color are generally less protected in terms of labor, health, and safety. Women and people of color – especially women of color – are less protected when exercising their Second Amendment rights. And if they try to exercise them, then they’re far more likely to end up in prison. So can we really refer to these as universal rights when they leave so many people out?
CL: I appreciate the way you frame it as a “carve out” because the exclusions and loopholes are not accidental. Labor policies were created to exclude certain populations of workers. With the FLSA, Southern congressmen insisted on the exclusion of agricultural and domestic workers from federal protection. The logic was to keep marginal populations governed by the states and to ensure that they would not be protected under minimum wage or maximum hour standards. So these essential elements of our social safety net were literally carved out for the most vulnerable workers, reserved for a select few.
You discuss these intersections of race, gender, and unprotected labor in the context of the pandemic in one of your “Epidemic” podcast episodes, which addresses the mass shooting in Atlanta in March 2021 that killed eight people, including six Asian-American women. In this episode, you also discuss the history of anti-Asian racism in the context of an outbreak of the bubonic plague in San Francisco in the eighteen-nineties. I thought it was a powerful way to link the past with our current moment where a minoritized group is scapegoated and blamed for the spread of a virus. Are we seeing history repeat itself?
CG: Xenophobia is a common pattern when a new infectious disease emerges, and many blame it on an out-group, just as COVID-19 has been blamed on Chinese people. In the shooting in Atlanta, with Asian women working at these spas, the white male perpetrator was acting on sexualizing stereotypes of East Asian women. It turns out that the killer was an “incel,” and he specifically objectified and targeted these women even though mainstream media coverage was slow to acknowledge the racial implications of the attack.
Work and class identity are relevant here too. Why is it that women of East Asian descent are concentrated in spa work and aesthetic professions? We need to ask ourselves why many of these relatively low-paying and low protection jobs are gendered and racialized in the way they are, just as we ask how and why women of color are more likely to be targeted by violence more generally.