Benjamin Thompson
Welcome to Coronapod.
Noah Baker
In this show, we’re going to bring you Nature’s take on the latest COVID-19 developments.
Benjamin Thompson
And we’ll be speaking to experts around the world about research during the pandemic.
Amy Maxmen
I really don’t know how this plays out. We also don’t know a ton about this virus, so there’s so many open questions. I just have a really hard time making predictions because I don’t know how the outbreak is going to change.
Noah Baker
Hello, and welcome to the twelfth episode of Coronapod. We’re three months into the show now, and joining me this week is features editor Richard Van Noorden and a new voice that you won’t have heard before, senior reporter Nidhi Subbaraman who’s based in Washington DC. Now, the past week has been difficult to say the least. The killing of George Floyd, an unarmed Black man, at the hands of the police in Minnesota has led to a wave of justified anger that has swept through societies, including academic institutions and research centres. Protests under the Black Lives Matter banner have erupted across the world, few of which are more prominent than those in Washington DC, and Nidhi, that’s where you are. Tell us about the last week.
Nidhi Subbaraman
It’s certainly been surreal, I’ll say that. We’ve already been kind of under odd circumstances at home pretty much since the middle of March, but starting at the weekend, we’ve begun to see people back on the streets in masks, marching for the Black Lives Matter movement against police brutality and just people coming out in sheer numbers that I haven’t seen like since the inauguration and every march that followed in the city since.
Noah Baker
I mean it’s a pretty extreme thing to see anyway, and it’s a very, very emotionally testing time for people, but somehow it almost feels like it’s even more extreme because we’ve had this long period of not seeing people gathering outside. It’s almost adding more power to it.
Nidhi Subbaraman
More than a couple of times this week, I’ve been home and working on stories and I’ll stop to go step out on the balcony and people are marching down 14th Street and stopping and kneeling and raising their arms and chanting the names of people who have died in incidents related to police violence, and it’s just incredibly moving and it’s a very strong moment. While I had been to protests and marches in the past as a reporter, because my primary work here hasn’t been to cover the movement itself, I haven’t participated in any because that’s the practice for journalists in the US. I’ve stayed sort of at an arm’s distance but tried to follow it in every way possible just because it’s such a huge, huge moment at this time.
Richard Van Noorden
So, Nidhi, I’ve been seeing also that you are watching how scientists are responding to this. A huge amount of commentary on how this movement should be responded to by scientists and scientific societies and journalists, and there’s been some really striking statements made.
Nidhi Subbaraman
Yes, I think what we’re seeing is that people are really grieving George Floyd’s death in Minneapolis in particular but sort of stating it in the context of Black people, African Americans, being killed or disproportionately targeted by police violence time and time again. Scientists on Twitter are being unusually candid about how these social events are impacting their ability to do work in the lab on a day-to-day basis just because of the weight of this event and the news each time. In addition, they’re pointing out that science itself has been, in some ways, hostile to minorities – women, people of colour, Black scientists in particular – and this altogether is a very hard time. There’s loads of suggestions about how people could first take note or acknowledge that there are these inequities socially and, in particular, in science, and lots of people are talking about how they could be supported better by the institutions and by their colleagues.
Noah Baker
Inequities in science and inequities in the world are very much front and centre in a lot of our minds, and rightly so at the moment, and as we live through this pandemic which is still ongoing, it’s something that applies there as well. You’ve been reporting on this as well, Nidhi, about the disproportionate way that the coronavirus has impacted people of colour. Just yesterday – that’s Wednesday in the UK because we’re recording on a Thursday – a report was released from Public Health England which has demonstrated that people of colour had been up to two times more likely to die from coronavirus infections, and that is something that’s been reflected in various studies around the world. Nidhi, tell us about what you’ve been reporting on.
Nidhi Subbaraman
So, this was something that I covered for Nature a couple of weeks ago, and like all aspects of the pandemic, the exact snapshot shifts week to week, but this theme seems to have persisted in some capacity or the other, which is that, from the beginning, as soon as people realised that this virus was going to go big, experts expected that it would affect people of colour worse. I’ve been hearing that past epidemics, from HIV to the diphtheria outbreak in New York, the small and the big ones, have had this sort of unequal impact and people were saying it’s just a matter of time. And sure enough, in early April, a couple of weeks into when the major lockdowns went into place in the US, the first numbers began to emerge in Louisiana, in Michigan, in Milwaukee, Wisconsin. Places that where a third or a quarter of the population African-American or Black were seeing absurdly high rates of infection and fatalities. The frustrating thing was that, like in many aspects of this pandemic, the data was hard to come by. In the US, we’ve heard that we’ve had trouble finding numbers for how many tests have been done and how many deaths there have been and early on, not many people were reporting the ethnic and racial breakdown of deaths and infections due to coronavirus in the US. And it really required, in some cases, lawsuits, in some cases, letters from experts, in some cases, FOIA requests, to force municipalities and states to count these numbers and report them. I believe the CDC – the national public health organisation here – wasn’t reporting breakdowns of the case numbers until late into April, and even so, just about a quarter of the total number of cases that they were reporting were broken down by race and ethnicity.
Noah Baker
Given that, as you mentioned, there was an expectation that this would disproportionately hit people of colour, it strikes me as shocking that these data were not being gathered and reported from the beginning. But is that perhaps unsurprising based on the way that organisations like this work?
Nidhi Subbaraman
That’s a great question that I haven’t had a satisfactory answer for. I’ve asked everybody I’ve spoken to why hasn’t this data been gathered. Is it because it was sort of an ad hoc exercise just dealing with this pandemic and noting who was being affected by it, or is it because people don’t want to know, or is it because there isn’t a system in place that acknowledges that we need to know and funnels that into the machine in a way that is efficient and fast. I really haven’t had a good answer to this. I guess that part of the story is that the system in the US at least is extremely decentralised and state public health departments typically have the power in collecting data and reporting it to the CDC, and so, again, as in all aspects of this response, it has varied state to state how fast people have been and how effective they have been in getting this information.
Richard Van Noorden
In one way, it’s very well known why these health disparities exist. As you wrote, they’re systemic. Black people are getting infected more in America because they’re exposed more and less protected, Camara Phyllis Jones said, and there are these socioeconomic and health disparities. But at least in the UK analysis that was released yesterday, there’s some attempt to sort of unpick this and say, ‘Is it related more to chronic conditions like diabetes, obesity and cardiovascular disease that have a higher incidence in some groups? Is it related to the low-paid professions, the jobs that people do like staffing grocery stores or driving buses?’ And trying to sort of unpick the strands of all of this. It feels to me like that might be really hard to do and perhaps a never-ending task, which in the end maybe is not get us any closer to sort of what’s staring us in the face. I don’t know whether researchers, Nidhi, feel that this can be unpicked and all of this can be broken down and controlled for and we might come up with a surprising finding about the biggest contributor to this inequity, or whether this kind of research is in the end, academic, once the initial data has been gathered.
Nidhi Subbaraman
That’s a really interesting question that I discussed with a researcher in the UK while I was reporting this piece. She was pointing to the way the disease was playing out among South Asian groups in the UK, and perhaps the study addressed this – you guys have taken a look closer than I have – but she was saying that some South Asian groups are socially and economically better off than others. Indians tend to be more affluent than Bangladeshis, for example, while sharing the history of migration and a propensity to certain underlying conditions in a way, so looking at these Asian populations in the UK might be an opportunity to tease apart some of what’s really a muddled set of factors.
Richard Van Noorden
Right, the British analysis hasn’t accounted for factors like obesity or the jobs done by the people who’ve died. It tried to account for the effect of social deprivation and age and sex and region, but there’s a lot of factors that it hasn’t controlled for, so it is quite tricky to tangle it out and figure out, when you take these things into account, whether there’s other differences. It seems, on the face of it, perhaps unlikely that there should be any biological difference. It does seem to me that it probably does all come down to socioeconomic factors and the jobs people do and systemic racism that’s still in societies and how that plays out in this pandemic, but it’s going to be interesting to see the figures. I expect we won’t know for a long time what the key drivers of these disparities are.
Noah Baker
It’s interesting that you mentioned biology there because this is something that I remember having a conversation with Amy Maxmen, which Coronapod listeners will know, about this in the past, and she said this is something that people will often jump to very quickly when there is these disparities, which are very, very common in outbreaks that she’s covered in the past. Very quickly people see these disparities and they’ll jump to, ‘There must be some biological reason that people of colour are perhaps more susceptible than others.’ She says that’s a really dangerous thing to jump to because there are these multitude of factors and the reality is that making that assumption is a very, very dangerous one because it can lead to people not looking into those multitude of interconnecting factors and the systemic racism which could potentially be the true cause of this.
Richard Van Noorden
Right, I think it would be the last thing really one would think of. One would think that issues of societal inequity would be the major drivers here. We’ll have to see as more data comes in, but that does seem to be kind of the obvious explanation.
Nidhi Subbaraman
I’d agree, and it’s interesting that it manifests in a few different ways depending on the communities you look at, the social factors, in particular. I’d heard from experts that part of why the infection rates may be higher in Latino and African-American populations in the US had to do with a general mistrust of the health system and a reluctance to seek medical care and or heed public health messaging early on about mask wearing and social distancing, and I’ve seen two different reasons for that. The African-American community pointed to a history of exploitation and a deep-rooted kind of distrust of the system from that community because of those reasons, and among Latinos in the US it is a large immigrant population, and immigrants, depending on their status, tend to be reluctant to seek healthcare because they worry about compromising their status. So, again, there is a distrust but rooted in sort of a different social and cultural reason. But, of course, regardless, if public health messaging isn’t reaching communities, that’s going to make things harder and it’s going to make it difficult to control and know the extent of the disease there.
Noah Baker
With all of these really complex, interconnected factors that it’s hard to pick apart, you can’t get away from the fact that the very stark reality of this disproportionate effect is there and that it’s happening right now. What do we do about it? If it’s difficult to work out exactly what the cause could be, is there at least some kind of suggestion from researchers about how we could tackle that problem? What are the recommendations?
Nidhi Subbaraman
Yeah, I think there was a strong push for just recognising the problem and collecting the data, and we’ve seen leaps and bounds of improvement in that. It’s not perfect, but people have recognised it as a problem. There have been laws passed requiring hospitals to report such data, so there’s improvement there. I think, since the pandemic is sadly ongoing, there is a stress on some certain fundamentals. Again, make sure messages are reaching communities. Make sure your testing capacities are reaching communities who may not come to you. So, in Louisiana, for example, certain hospitals were sending out testing teams to communities that they knew would have a hard time getting into cars and driving to their facility. So, that sort of acknowledgement of circumstances, while not surprising, is definitely relevant to helping shut down the pandemic. One sort of radical seeming idea was a national commission in the US to focus on COVID-19 among people of colour because, as we’ve seen, there has been a lack of national coordination and because of how decentralised and uneven things are, the experts I spoke to said, ‘If we have a unified voice sort of at the centre making recommendations, providing guidance and prioritising these groups, we might see a more uniform and more consistent flow of resources, flow of information and, now that we know that this is a gap, be better positioned to support these groups.’
Noah Baker
Absolutely.
Nidhi Subbaraman
One thing I didn’t quite get to in my story, but if we’re talking about the US it would be remiss if we didn’t mention, this disease has hit Native American communities really hard, and I didn’t mention it in the piece because the factors that go into that are so unique. But essentially, Navajo Nation surpassed New York as having the highest rate of infections earlier last month. It’s such a horrifying betrayal of that community. The way the healthcare system works, the federal government has an obligation, a treaty obligation, to provide healthcare to Native American tribes, and they have documentedly been failing in this promise for decades, for hundreds of years, and it makes things harder when the lands are vast and people live far away from each other and don’t have a culture of social distancing amongst themselves, but the rates of infection in Native American communities has been remarkable and the lack of response there has been stunning.
Noah Baker
Is there anyone that’s trying to tackle this problem of the increased infections amongst these indigenous communities?
Nidhi Subbaraman
I’ve seen local NGOs spring into action. I’ve seen the president of Navajo Nation and the local community really take this very seriously and do their utmost to pay attention to World Health Organization guidelines and be transparent to a degree about the numbers coming out and the response that they’ve been able to make so far. It hasn’t gone away, so I imagine we’ll keep hearing more of it. I think Doctors Without Borders sent a team to Navajo Nation to help with the response in the absence of a federal response.
Noah Baker
Well, at this point in the show, we would usually transition to our segment called one good thing, but this week, we’re not going to do that. Not because there aren’t many good things still in the world but because I think that we all feel that particularly this week, when on top of the challenges of the pandemic, the world and the scientific community is grieving, that this isn’t really a time for frivolity. It’s a time for reflection. Instead, Richard, I know that you have brought with you one thing that people may want to listen to or could perhaps act as food for thought for them, or at least focus their attention in these trying times.
Richard Van Noorden
Well, it’s not exactly recent, but I’ve been listening to George the Poet, who UK listeners might know very well because he’s won lots of awards for his podcast, but I don’t know if his fame has reached the United States. He is a British poet and rapper and podcast host of Ugandan heritage, and his podcasts have just been amazing explorations of what it’s like to grow up Black in Britain, and takes you into his world and the world of the people he knows and reflects on Britain’s role in the oppression of Black people in an incredibly involving and thoughtful way. He’s been on television this week talking about racism and some of the parallels between the United Kingdom and the United States, but his whole back catalogue on his podcast is just incredible and I’d highly recommend that people check it out this week.
Noah Baker
I wholeheartedly second that recommendation. If people haven’t come across George the Poet, he is incredible. Well, that bring us to the end of this part of the show. Stay with us for a dive into the history of past pandemics. But before that, I’ll let Nidhi and Richard go. Nidhi, Richard, thank you both so much for taking the time to talk to me today.
Richard Van Nooden
Thank you.
Nidhi Subbaraman
Thank you.
Noah Baker
For the second half of the show this week, reporter Nick Howe has been looking into the history of past pandemics. In particular, he’s been asking are there lessons to be drawn from the outbreaks of the past? To find out, Nick spoke to Frank M. Snowden, a historian of medicine who’s written a book about the impact of epidemics on society. Nick started off by asking Frank how diseases have shaped humanity.
Frank M. Snowden
First, and perhaps most obvious, is the emergence of public health. Public health began as a discipline with bubonic plague in the 14th and 15th centuries, especially in the Italian cities like Florence and Venice. Those entities began to organise methods of public health with quarantine, with plague hospitals. All of those were a public health body known as the health magistrates. We now know them instead as boards of health or departments of health. Another feature very closely related to it is that epidemic diseases are one of the factors that went along with the emergence and moulding of the modern state. That is to say that these smaller entities in the Italian peninsular and then across Europe, in order to deal with bubonic plague, it was necessary to have military means. It was necessary to have taxation and the establishment of funding for the response efforts to create these health magistrates. So, we see that leading to an enormous increase in powers of the state.
Nick Howe
And so, considering the history of epidemics across the world, do you see similar things playing out to what has happened in the past, or are things different this time?
Frank M. Snowden
So, the coronavirus is not just like another disease in the past. It will have its own history and its own impact. But what we can learn from epidemic diseases is that they’re so profound that they immediately raise the question of what we believe in most profoundly. We have a recurring tendency to pose the question of who’s to blame for outbreaks like this and therefore to have witch hunting. In the time of the Black Death, there was the hunting down of Jews held to be responsible for the plague, or there were outbursts of xenophobia. This happened again and again through a wave of other epidemic diseases. Once can see a lot of these themes recurring in different ways, however, with the coronavirus. As many diseases in the past, it again is leading to scapegoating. There is also the fact this has an enormous impact on the economy, and the bubonic plague ravaged the economy of the period. Trade stopped. Production stopped. Agriculture was in disarray. Now, this, I’m fairly, certain, will be nothing in terms of the scale of the bubonic plague, but we even see already that it doesn’t have to be in order to throw the global economy into disarray, so this is a disease that once again is showing that epidemics have the capacity, really, to cause human societies and economies to be under enormous stress and to begin to unravel.
Nick Howe
I mean the last chapter of your book, if I remember correctly, is called Dress Rehearsals for the Twenty-First Century: SARS and Ebola. It seems almost like an ominous prescient thing to write at the time for what we’re now facing. Could you speak a little bit about what you meant there when you were talking about SARS and Ebola?
Frank M. Snowden
I was taking on board what a public health officials have been saying since 1997 – that it is inevitable that we will face increasing challenges from pulmonary viruses and also other emerging diseases. After each of these emergencies, for example, SARS, there have been enormous attempts to galvanise the world and individual countries into preparedness to face the next emergency. After each test, like SARS, there has been a flare up of preparedness, of plans being drafted, funds allocated, so that we can cope. But after very soon, that willingness and commitment seem to dissolve. There’s a kind of collective amnesia. The funds dry up and preparedness withers.
Nick Howe
So, do you think then that history is just sort of doomed to repeat itself or do you hope that we might learn something from this latest outbreak?
Frank M. Snowden
My greatest hope is that this time will be different. In a sense, one of the horrible aspects is that this epidemic of coronavirus is going to shake the world in very, very fundamental ways. I think all of those things reveal that we really have to change if we don’t intend to go through this again and again, perhaps in even much worse ways.
Noah Baker
That was Frank M. Snowden from Yale University. If you want to know more about the history epidemics then Frank’s book is called Epidemics and Society, and we’ll put a link to a review of the book in the show notes. And that takes us to the end of this week’s episode of Coronapod. I want to thank Nidhi Subbaraman and Richard Van Nooden for chatting to me earlier and to Nick for his interview with Frank Snowden. For more information on everything we’ve talked about, do check out the show notes. I’ll put links to everything I can in there. And if you’re being affected by anything we’ve discussed in this show, we’d love to hear from you. You can get in touch on Twitter – @NaturePodcast – or via email – podcast@nature.com. Remember that there’s a coronavirus-free episode of the Nature Podcast coming out every Wednesday. You can find that wherever you found this. And until next week, thank you very much. Stay safe and solidarity.