COVID-19

In December 2019, a new virus similar to the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) that caused the 2003 SARS outbreak, emerged from Wuhan, China. The new virus, SARS-CoV-2, is responsible for the coronavirus disease (COVID-19) outbreak, which quickly reached the level of a global pandemic in only a few months (Wang et al., 2020). In response to the rapidly increasing rates of infection and deaths, governments implemented shelter-in-place orders, and school and work moved to online platforms. COVID-19 has caused an immense amount of uncertainty and essentially has upended people’s lives, forcing people to adapt to the abrupt change. As of June 7, 2020, there have been over 1,920,904 confirmed cases and over 109,901 deaths in the U.S. alone (Centers for Disease Control and Prevention, 2020).

Due to this sudden change and unpredictable circumstances, there has been an indisputable increase in psychological distress (Bao et al., 2020). A recent review of existing literature suggested that some of the most common mental health issues experienced during the pandemic are anxiety and depressive symptoms, reported at sixteen to twenty-eight percent, and perceived stress, reported at eight percent (Rajkumar, 2020). This issue raises questions regarding the lasting effects this pandemic may have on people’s lives, especially for high school and college students. The sudden shift to online coursework has led to a general loss of motivation and a pause in school until the pandemic ends or at least until in-person classes resume. Moreover, graduating college students are confronted with an even more difficult task of looking for employment or applying to graduate and professional schools in the midst of a pandemic. Because of this, it is important to investigate the psychological effects of the pandemic, particularly in relation to personal characteristics such as goal orientation, self-efficacy, and future orientation.

Goal orientation is linked to one’s motivation to fulfill tasks and their perceived self-efficacy (Elliott & Story, 2017). A previous study of 606 high school students in Shiraz, Iran examined the relationship between goal orientation and academic resilience by having the students complete the Achievement Goals Questionnaire and Youth Development Module Scale then assessing the associations between variables and looking at achievement goal orientation as a predictor of academic resilience (Jowkar et al., 2014). They found that goal orientation as a personal characteristic was not only crucial for academic achievement, but also for better life satisfaction as those who had higher goal orientation reported fewer anxiety and depressive symptoms (Jowkar et al., 2014).

Self-efficacy was found to be positively associated with academic resilience, measured as students’ responses to academic adversity from the Academic Resilience Scale-30, in a study of 435 British undergraduate students who were presented with a case vignette that was either a direct or indirect account of academic difficulties (Cassidy, 2015). This study revealed that the most resilient students were more self-efficacious, persistent, and had low anxiety (Cassidy, 2015). This is not surprising, since self-efficacy refers to an individual’s belief that they can overcome challenges and confidence in their ability to perform well in various conditions (Bandura, 1986).

Future orientation is a person’s natural tendency to make plans for the future and is related to their optimism about the future (Lindstrom Johnson et al., 2014). It is said to be closely tied to one’s identity and its development, as thinking about the future involves introspection and integration of different possible futures with the present self (Lindstrom Johnson et al., 2014). In addition, it is the ability to visualize multiple futures involving family, friendships, relationships, educational goals, and career goals (Lindstrom Johnson et al., 2014).

Future orientation can have a positive or negative effect on anxiety. On one hand, future orientation can be positive when a person’s future orientation makes them more likely to be prepared for the future and to handle unexpected events. Something as simple as planning classes to ensure a smooth enrollment process or looking into career prospects can lessen one’s stress and anxiety. On the other hand, future orientation has deleterious effects when a person incessantly worries about the future to the point that it interferes with their life and they become neurotic. Another related problem is when a person daydreams excessively about the future and imagines different scenarios rather than actually taking steps to reach a particular goal. This imaginative fixation could eventually lead to impaired functioning and increased distress when the worries are of little to no importance to the present (Miloyan et al., 2017).

These are important to consider especially since the world is in a state of uncertainty that could exaggerate one’s judgment of threat, as was the case during the H1N1 crisis when unpredictability led to an increase in anxiety (Garfin et al., 2020). Studying the role of goal orientation, self-efficacy, and future orientation is essential to understanding how best to cope with abrupt changes due to COVID-19. There is a tremendous amount of existing research that shows that these three personal characteristics—particularly goal orientation and self-efficacy, and perhaps future orientation when managed—may be useful in the face of adversity. These characteristics are not innate but can be formed over time, so having a good grasp on these concepts may translate into better coping during adversity. ■

Julieanne Cabang is a recent graduate of the University of California, Los Angeles (‘20), from

Los Angeles, California, USA. She can be contacted at jucabang@ucla.edu.

References

Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology, 4. https://doi.org/10.1521/jscp.1986.4.3.359

Bao, Y., Sun, Y., Meng, S., Shi, J., & Lu, L. (2020). 2019-nCoV epidemic: Address mental health care to empower society. The Lancet, 395(10224), e37–e38. https://doi.org/10.1016/S0140-6736(20)30309-3

Cassidy, S. (2015). Resilience building in students: The role of academic self-efficacy. Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01781

Centers for Disease Control and Prevention. (2020). Cases in the U.S. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Elliott, C. N., & Story, P. A. (2017). Motivational effects of goal orientation. The Kennesaw Journal of Undergraduate Research, 5. https://doi.org/10.32727/25.2019.18

Garfin, D. R., Silver, R. C., & Holman, E. A. (2020). The novel coronavirus (COVID-19) outbreak: Amplification of public health consequences by media exposure. Society for Health Psychology, 39(5), 355-357. http://dx.doi.org/10.1037/hea0000875

Jowkar, B., Kojuri, J., Kohoulat, N., & Hayat, A. A. (2014). Academic resilience in education: The role of achievement goal orientations. Journal of Advances in Medical Education and Professionalism, 2(1), 33-38. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235534/

Lindstrom Johnson, S., Blum, R. W., & Cheng, T. L. (2014). Future orientation: A construct with implications for adolescent health and wellbeing. International Journal of Adolescent Medicine and Health, 26(4). https://doi.org/10.1515/ijamh-2013-0333

Miloyan, B., Pachana, N. A., & Suddendorf, T. (2017). Future-oriented thought patterns associated with anxiety and depression in later life: The intriguing prospects of prospection. The Gerontological Society of America, 57(4), 619-625. https://dx.doi.org/10.1093/geront/gnv695

Rajkumar, R. P. (2020). COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry, 52, 102066. https://doi.org/10.1016/j.ajp.2020.102066

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17. doi:10.3390/ijerph17051729

“The body is a biopolitical reality; medicine is a biopolitical strategy”

–Foucault, The Birth of Social Medicine (1974)

In the midst of a global pandemic, waves of protests against racialized police violence has indicted the uncanny sense of ordinariness that has long veiled rampage violence against coloured communities in America and around the world. The assertion of “Black Lives Matter” articulates the precarity and disposability of Black and coloured lives in America and condemns intersecting powers of nationalism, xenophobia, and capitalism. These powers produce and perpetuate the discursive and systemic discrimination of ethnic minorities on the domestic and global level. The global turn to the right—in India, Philippines, Britain, Hungary, Brazil, France, and many other countries—and recent political events surrounding repressive and racialised regimes worldwide demand our attention to the continuities of history and humanity, through which conditions of neglect, precarity, and lethality subject coloured bodies to bare forms of social existence between life and death (Agamben, 1998; Mbembe & Meintjes, 2003).

The racial disparity in COVID-19 infection and mortality rates has brought to the forefront the differential exposure of ethnic minorities to health and social risks, and their subordinate position in the neoliberal economy. Through this position, ethnic minorities are subject to a specific form of racial biopolitics that is reconfigured globally—ethno-nationalist governance that simultaneously demands for the unceasing flow of capital from the labour extraction of coloured bodies and their parallel social ostracization through fortified borders and racial exclusivity (McIntyre & Nast, 2011; Melamed, 2015). As strategies of racial vilification and scapegoating (re)deploy and (re)produce the racial marginalisation of ethnic minorities to define the threshold of citizenry, the focus of sovereign and penal power has shifted from social morality and integration to immobilisation and expulsion from the polity. Such a shift traps coloured bodies in a carceral continuum between immigration detention and mass incarceration, thus making clear the fragility of rights, identity, and membership in contemporary society (Bosworth et al., 2018; Wacquant, 2001).

The racial and identity politics of the pandemic is felt acutely by the Asian diaspora, whose bodies are ontologically pathologized to be of pestilence and, therefore, risk contaminating the sanctified public space. Trump’s xenophobic diagnosis of COVID-19 as “Kung Flu” and a “Chinese virus” is an example of the binding of pathology to race, deployed in the service of political expediency. Since the outbreak of COVID-19 in Wuhan, China in January 2020, globally, people of Asian descent have overwhelmingly been the target of discrimination and social exclusion (Human Rights Watch, 2020). From verbal abuse to violent attacks on the street, on public transport, in grocery aisles, and on school campuses, the fear of Eastern contamination has latched onto the social imagination of the public and has normalised anti-Asian sentiments in America and abroad.

The stigmatisation of the Chinese as an abstraction of disease, deviance, and degeneracy in public discourse is not new to the current pandemic. In 19^th century San Francisco, following a virulent outbreak of smallpox, epidemiological investigations of infectious diseases in Chinatown seized upon the unsanitary space as evidence of the deviant and diseased nature of the Chinese immigrant community. An investigative report of the sanitary conditions of Chinatown conducted by the mayor, a microbiologist, and a city health official in 1880 denounced the Chinese—“this infamous race”—for the “diabolical disregard of our sanitary laws” and condemned Chinatown as a “nuisance” (Workingmen’s Party of California, 1880, p. 6, emphasis added). The American government construed the impoverished Chinese community as malicious in their intentional disregard of the city’s welfare, and pathologized the site of Chinatown as a diseased and demoralised space that incubates epidemics and breeds vices such as opium smoking, gambling, and prostitution—all of which could lead to the physical and moral destruction of young, white Americans (Craddock, 2008).

By 1885, in a government sponsored public health survey of Chinatown, the racist sentiment that the Chinese lived in depravation by cultural and genetic proclivity rather than by economic necessity concretised an order of differences between Chinese and white Americans as biological and preordained. The 1885 public health investigation report explained the exceptionalism of Chinatown beyond the general categorisation of slums:

Here it may be truly said that human beings exist under conditions (as regards their mode of life and the air they breathe) scarcely one degree above those which the rats of our water-front and other vermin live, breathe and have their being. And this order of things seems inseparable from the very nature of the Chinese race. (Farwell, 1885, p. 33)

The report emphasised the indifference of the Chinese to human comforts and compared the impoverished living conditions of the Chinese to those of pests. This comparison not only dehumanised the Chinese as ontologically inferior but insinuated that the Chinese has an instinct for crowded, dilapidated, and filthy environments that destine the race to diseases and degeneracy. In the racial imagination of the white government officials, disease was conceived as organic to the Chinese living space and symptomatic of the ontological defect of the Chinese. Essentially, the spatial hygiene of Chinatown became a metonym for the social hygiene of the Chinese.

Departing from a prejudiced position that pathologized the Chinese as a contagion within the contaminated Chinatown, anti-Chinese policies started prioritizing the segregation of spatial and social bodies of the Chinese and white community. The ideologically neutral epidemiological guise of sanitation reforms sanitised the racially discriminatory impulse to contain the Chinese within a spatial boundary and to control contact between Chinese and white Americans (Shah, 1995). Two centuries later, in 2020, the pathologisation of the Chinese––and other coloured bodies who, racially profiled, share their physiognomy––as contagious carriers of COVID-19 who contracted the virus through their cultural proclivities reveals that stigmas of disease, deviancy, and depravity continue to locate Chinese bodies as the site of infectious emanation.

Burdened by images of shame, disease, and depravity, the bodies and spaces of the Asian diaspora and ethnic minorities have long been inscribed with the ideological rendering of discursive regimes. The racial health disparity of ethnic minorities in the current climate of COVID-19 reveals that racial logic, colonialism, and health sciences are interlocking systems of power that have justified and have continued to perpetuate exploitative institutions through ideas of biological racial differences and metonymic representation of coloured bodies as diseased and deviant. The biopolitical violence against coloured bodies unsurfaced in the midst of COVID-19 and the Black Lives Matter movement emphasises that it is the pathogens of segregation, neglect, and institutional discrimination that plague ethnic minority communities and create systemic challenges that increase their risk of infliction and mortality. In the face of an epidemiological pandemic of disease and a moral pandemic of racism, we need to confront the current hierarchy of human-ness that justifies the uneven distribution of life and death, and to question who is ‘human’ and deserving of ‘rights’ in society? ■

Genevieve Ding is an undergraduate student from Singapore, currently studying at Yale-NUS College.

References

Agamben, G. (1998). Homo sacer: Sovereign power and bare life. Stanford University Press.

Bosworth, M., Franko, K., & Pickering, S. (2018). Punishment, globalization and migration control: ‘Get them the hell out of here.’ Punishment & Society, 20(1), 34–53.

Craddock, S. (1999), Embodying Place: Pathologizing Chinese and Chinatown in Nineteenth‐Century San Francisco. Antipode, 31: 351-371.

Farwell, Willard B. (1885). The Chinese at Home and Abroad, Together with the Report of the Special Committee of the Board of Supervisors of San Francisco on the Condition of the Chinese Quarter of that City. A. L. Bancroft & Company, San Francisco. Available at: Adam Matthew, Marlborough, Migration to New Worlds, http://www.migration.amdigital.co.uk.libproxy1.nus.edu.sg/Documents/Details/CHS_325-251-F25

Human Rights Watch. (2020) Covid-19 Fueling Anti-Asian Racism and Xenophobia Worldwide. Available at: https://www.hrw.org/news/2020/05/12/covid-19-fueling-anti-asian-racism-and-xenophobia-worldwide#

Mbembe, J. A. and Meintjes, L. (2003). Necropolitics. Public culture, 15(1), 11-40.

McIntyre, M. & Nast, H.J. (2011), Bio(necro)polis: Marx, Surplus Populations, and the Spatial Dialectics of Re production and “Race”1. Antipode, 43: 1465-1488.

Melamed, J. (2015). Racial Capitalism. Critical Ethnic Studies, 1(1), 76-85.

Shah, N. B. (1995). San Francisco's "Chinatown": Race and the cultural politics of public health, 1854-1952 (Order No. 9530798). Available from ProQuest Dissertations & Theses Global. (304266922).

Wacquant, L. (2001) Deadly Symbiosis: When Ghetto and Prison Meet and Mesh. Punishment & Society, 3(1), 95–133.

Workingmen’s Party of California. (1880). Chinatown Declared a Nuisance! Available at: Adam Matthew, Marlborough, Migration to New Worlds, http://www.migration.amdigital.co.uk.libproxy1.nus.edu.sg/Documents/Details/CHS_PAM_3328

Our return to normality is contingent upon one thing: a widely available vaccine. Estimates on how long this may take vary. The Trump administration is pushing for a few hundred million doses by the end of 2020 (Weiland & Sanger, 2020), but Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease, warns of a minimum timeline of twelve to eighteen months (“This is why,” 2020).

Though a vaccine may seem a long way away, the speed at which development is happening is unprecedented. The current record for bringing a vaccine to market is four years, and there has never been a vaccine for a coronavirus (Smith, 2020). Even as we accelerate the process, barriers still remain to the successful design, testing, production, distribution, and implementation of a COVID-19 vaccine.

Why do we need a vaccine?

Your body does everything it can to keep invaders out. Your skin, the largest organ in your body, prevents pathogens from entering into the bloodstream. The mucus lining your nose, mouth, and intestines traps microbes before they can access your cells. Chemicals in your tears, sweat, and saliva break down bacteria. But, sometimes, an invader sneaks past these barriers.

The pathogen is then confronted with the next line of defense: the innate immune system. Inflammation kicks in—blood and cells rush to the area. These cells then begin to surround, engulf, and digest the pathogen within hours of exposure.

As days pass, the immune system rises to the challenge, training specialized cells that are specific to this unique invader. B cells produce antibodies that neutralize invaders in the bloodstream, and T cells attack cells that have been infected. After the invader is gone, antibodies and memory cells stick around, ready for the pathogen to attack again.

A vaccine works by triggering this response, protecting you from becoming dangerously ill from the COVID-19 virus if exposed. Since a modified form of the invader is injected, a vaccine does not produce the severe symptoms that the invader would normally produce but still produces the same antibodies and memory cells (Nania, 2020).

The most effective vaccine we have is for measles, which is ninety-seven to ninety-eight percent effective (Cohen, 2020). In contrast, the flu vaccine ranges between thirty and fifty percent effective from year to year (Chen, 2020). Since the COVID-19 vaccine is being produced as quickly as possible, the FDA bar for effectiveness is set at fifty percent (Smith, 2020).

Design

More than a hundred groups are joining the effort to bring a COVID-19 vaccine to market, a process that usually takes ten to fifteen years and billions of dollars (Burns, 2020). The goal is to have one—or even multiple—vaccines that prevent infection, limit severity, or shorten recovery time. Different vaccines may prove to be useful for different demographics. For instance, the injectable high-dose flu vaccine is recommended for adults older than sixty-five years old, while the nasal spray is recommended for those ages two through forty-nine (Nania, 2020).

The vaccine could take many different forms. It may be a weakened or inactivated version of the virus. Or it may be a piece of its genetic material (Chen, 2020).

We have produced vaccines based on modified forms of a virus for decades. Weakened viruses lead to lifelong immunity (but can be dangerous to those unable to mount a strong enough immune response), while inactivated viruses usually require booster shorts (Burns, 2020). Both methods require work with a potentially infective virus, and there are very few manufacturing facilities with the proper protective equipment to manufacture enough doses (Khamsi, 2020).

As a result, companies are turning to novel RNA and DNA based vaccines that instruct our cells to make COVID-19 proteins. While these vaccines are simpler to produce and can be scaled up faster, no vaccine of this type has been previously approved for use in humans (Rosenbaum, 2020).

Testing

Though many vaccine candidates will be introduced into early trials in animals, an estimated six percent will make it through all three rounds of human testing (Smith, 2020). Phase I trials establish safety: does the vaccine cause dangerous side effects upon injection? Phase II trials establish efficacy: does the vaccine provide a protective immune response? Phase III trials expand upon previous results, testing thousands of people over a longer period of time (Kommenda & Hulley-Jones, 2020).

As of July 2020, 140 COVID-19 vaccine candidates were in preclinical testing, nineteen were in Phase I, eleven were in Phase 2, and three were in Phase III (Kommenda & Hulley-Jones, 2020). These clinical trials will focus on recruitment of those over the age of fifty-five, one of the most important demographics to vaccinate. Children and pregnant women will not be included (Chen, 2020). Phase I and Phase II trials are being accelerated once safety is indicated, but Phase III trials are limited by scientific restraints on length and breadth (“This is why,” 2020).

Although it is technically legal, it would be unethical to vaccinate participants and then expose them to COVID-19 when there is no approved treatment (Chen, 2020). Instead, participants are vaccinated with the drug or with a placebo, then live their everyday lives, and researchers record whether they become ill (Palca, 2020).

Even if thousands are vaccinated, only a few may actually be exposed to COVID-19 on any given day. Phase III trials must last long enough that enough people in the unvaccinated group become infected that it can be determined that the vaccinated group performs better. Phase III trials also must be broad enough to reveal any rare side effects (Nania, 2020).

Production

Once a vaccine is confirmed to be safe and effective in large populations, the next barrier is production. We do not know if we will need to grow cells, synthesize RNA or DNA, produce immune-stimulating ingredients that usually accompany a vaccine (known as adjuvants), or even grow plants (Khamsi, 2020).

To account for this uncertainty, the Trump administration has allocated almost ten billion dollars towards a project known as “Operation Warp Speed” that will ramp up manufacturing of facilities that may never be used (Weise & Weintraub, 2020). The administration has selected five companies (Moderna, Oxford University and AstraZeneca, Johnson & Johnson, Merck, and Pfizer) to receive additional funding and assistance (Weiland & Sanger, 2020).

Moderna’s mRNA-based vaccine has been a front-runner from the beginning. Its design was developed in forty-eight hours following the sequencing of the COVID-19 genome, injected into volunteers in March, and tested in Phase II trials beginning in May (Rosenbaum, 2020). Though Moderna expected to begin Phase III trials in July, its start date has been delayed over trial protocol conflicts with the FDA (Garde, 2020).

Another current leader in the field is Oxford and AstraZeneca’s vaccine. It is composed of a harmless virus genetically engineered to express the same surface proteins as COVID-19 (Kommenda & Hulley-Jones, 2020). This vaccine candidate entered Phase III trials on July 1 (Smith, 2020) and has an estimated eighty percent chance of success (Baker, 2020).

Ideally, once a strong candidate is identified, manufacturing would be able to begin immediately in the pre-built facilities.

Distribution

At least eight billion doses will be needed to protect everyone on the planet. These doses will not be all available at once, so decisions will have to be made about who will be vaccinated first. Healthcare and essential workers are likely to receive priority, along with those at risk of severe complications if infected, such as the elderly and people with pre-existing conditions (Nania, 2020).

COVID-19 knows no borders but its vaccine may. Many countries have laws in place that allow the government to force manufacturers to sell domestically before exporting abroad. In the 2009 H1NI influenza pandemic, Australia was one of the first countries to produce a vaccine and shared the vaccine with its citizens before allowing exportation (Khamsi, 2020). Even if the vaccine is available for purchase by all countries, not all countries will have the resources to procure enough dosages for themselves and will have to rely on the support of donors.

In the United States, where Black and brown communities have been disproportionately affected by COVID-19 infection and mortality, experts worry about equitable distribution. In all age groups, the death rates among Black and Hispanic/Latinx populations exceed those of white populations (“COVID-19 in Racial and Ethnic Minority Groups”, 2020). In New York City, the original epicenter of the disease, the death rate of Black and Latino populations is twice that of the general population. In Los Angeles, a newer COVID-19 epicenter, the death rate of those in low-income neighborhoods is three times that of those in wealthier areas (Jauhar, 2020).

Though these disparities have yet to be fully unpacked, it is suspected that poor access to health care, lack of health insurance, and unstable housing, as well as essential jobs that require work outside of the home, have made these populations vulnerable not only to COVID-19 but also to preexisting conditions that worsen its effects (Jauhar, 2020). It is essential that the vaccine is made available to these communities, with special attention placed on equitable distribution as some may lack transportation.

Implementation

Even if a vaccine becomes widely available, the possibility remains that not everyone would seek out vaccination. Recent polls indicate only half of Americans plan to become vaccinated, with a quarter of Americans wavering on the matter (Cornwall, 2020).

Some may be unable to be vaccinated through no fault of their own. Children, those with weak immune systems, and autoimmune and cancer patients may not be able to be vaccinated if their bodies are not strong enough to build adequate defenses against the pathogen.

To protect these vulnerable populations, enough of the population has to acquire immunity that the disease cannot travel easily from person to person. Public health efforts need to begin now to encourage vaccination of at least seventy percent of the population, the percentage necessary for herd immunity against COVID-19 (Cornwall, 2020).

Next Steps

Even with vaccine development progressing faster than ever before, there is still much to learn. We are not sure how long immunity to COVID-19 remains after infection (Chen, 2020). It is possible that immunity could be less than a year or even less than a few months, as is typical for immunity to the common cold (McFall-Johnsen, 2020).

A vaccine may need to be given repeatedly, with the first dose priming the immune system and the second dose strengthening the response (Ellis, 2020). Even those previously infected may need booster shots (Chen, 2020). Luckily, it is not likely that a new vaccine will be needed every year, like the flu vaccine, as COVID-19 does not appear to mutate rapidly (Chen, 2020).

The road to a vaccine has many roadblocks, from design to testing to production to distribution to implementation. It has been half a year since the first outbreak of COVID-19, and experts estimate that we are about one-third of the way towards a widely available vaccine (Weise & Weintraub, 2020).

We will have to face the remaining roadblocks together, with collaboration between government officials, pharmaceutical companies, public health experts, manufacturers, and the general population. The road to a vaccine is one that must be walked—or, in this case, sprinted—together. ■

Kelly Farley is an undergraduate student from Chicago, Illinois, USA, currently studying at Yale University.

References

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In early April, doctors in Wuhan, China, reported that mildly ill coronavirus patients treated with the anti-malaria drug hydroxychloroquine saw symptoms disappear faster than most patients (Chen et al, 2020). What followed was a whirlwind of media coverage, a few questionable scientific studies, and considerable political lobbying, all of which tried to answer the question: have we found a cure for the coronavirus?

Most likely not, it seems. Despite the initial reticence of the Chinese doctors and most media outlets, widely emphasizing that “more research was needed,” scientists had stirred up hope that a quick and effective treatment for the virus that was ravaging the country had been found (Grady 2020). The Wuhan study was posted in medRxiv, a preprint server for research results that are awaiting or undergoing peer review, before they are formally published. Despite its small sample size (sixty-two patients) and lack of peer review, it became the pillar for research related to the use of the drug for coronavirus treatment.

When did it start?

Hydroxychloroquine, known commercially as Plaquenil, is a disease-modifying anti-rheumatic drug (DMARD) (American College of Rheumatology, 2020). It is used to prevent and treat malaria, and to alleviate the symptoms of rheumatoid arthritis, lupus, and other autoimmune diseases. Hydroxychloroquine’s effect on the body is not yet known, however scientists believe it prevents the body from activating an immune response against itself. It also affects production of cytokines, which are signaling chemicals secreted by cells in the immune system (Sinha, 2020). The drug was first used in the treatment of autoimmune diseases in 1955, and became FDA-approved for large-scale use in 1956 (Lupus.org, n.d.). There are several worrisome side-effects, including irreversible retina damage and heart complications (Sinha, 2020).

A French study published at the end of April described the use of hydroxychloroquine as a treatment combined with the antibiotic Azithromycin (AZT), this time in a larger sample of patients (1061 cases). The researchers concluded that the drug combination was “associated with a very low fatality rate in patients.” (Million et. al, 2020). Following these studies, The National Institute of Allergy and Infectious Diseases (NIAID) began a clinical trial on the combined hydroxychloroquine and AZT treatment on adults with mild to moderate COVID-19 symptoms (NIH, 2020). Including the placebo group, this study involved over two thousand adults.

Early supporters

After preliminary scientific evidence became known, many politicians, including U.S. president Donald Trump, pointed to hydroxychloroquine as a saving grace and expressed optimism for its use in treatment. This led to a surge in the stockpiling of hydroxychloroquine, leaving many autoimmune disease patients without their necessary prescriptions (Grady, 2020). There were soon reports of people self-administering the drug as a preventative measure — President Trump himself acknowledged doing so (Hickok, 2020). Other politicians around the world, including Brazilian President Jair Bolsonaro, embraced the supposed cure and encouraged its citizens to self-medicate (Benke, 2020). In an effort to support Brazil’s failing response to the pandemic, the US government shipped two million doses of hydroxychloroquine in the beginning of June, even as the country’s own health agencies began disputing the scientific evidence supporting the drug’s use (Togoh, 2020).

The doubters

These moves prompted a swift response from the scientific community, who expressed their concern over the increased, unregulated use of the drug. The Federal Drug Administration “cautioned against the use of hydroxychloroquine … due to risk of heart rhythm problems,” and also revoked the emergency use authorization (EUA) of the drug for treatment of COVID-19 outside of a clinical trial (FDA, 2020). The aforementioned NIH clinical trial was halted at the beginning of June, when not enough patients had signed up to participate and the agency decided that the drug “was unlikely to be effective.” (Thomas, 2020) RECOVERY was a large-scale UK clinical trial designed to test the effectiveness of the drug as a treatment for the coronavirus. It published its results on June 5^th, announcing that there had been “no clinical benefit from use of hydroxychloroquine in hospitalized patients with COVID-19.” (Horby & Landray, 2020) A University of Connecticut study, published in the Annals of Internal Medicine, summarized the results of 23 studies, and concluded that the “evidence on the benefits and harms of using hydroxychloroquine or chloroquine to treat COVID-19 is very weak and conflicting.” (Hernandez et. al, 2020) These negative results led to a growing wariness towards the use of the drug.

Despite the evidence against it, there is still relative controversy surrounding the drug. Much like many aspects of the coronavirus prevention, symptom management and treatment, the accelerated timeline and lack of information leads to conflicting reports. A study published by doctors at the Harvard Medical School in The Lancet, one of the world’s most prestigious medical journals, claimed that the use of hydroxychloroquine (or its sister drug chloroquine) led to an increase in in-hospital deaths (Mehdra et. al, 2020). Based on the results of the study, many institutions including the World Health Organization moved to suspend their clinical trials involving hydroxychloroquine. The study was redacted by The Lancet when over 100 scientists and doctors questioned the validity of Surgisphere, the database used as the basis for the study analysis (Rabin, 2020). In an open letter to the journal, the signatories called for a review of the study’s methods, citing many instances where the recorded data seemed unlikely to be true. One example was that the data from Australian hospitals included “more in-hospital deaths than had occurred in the entire country during the study period” (Rabin, 2020). With even more confusion in the field over hydroxychloroquine’s plausible benefits and harms in the treatment of the coronavirus, scientists seem unwilling to give any definitive answers on the subject.

Where do we go from here?

The short-lived fame of hydroxychloroquine serves as a warning to researchers, the media, and the general population. Many have now started to wonder if rushing to find a cure, speeding up review processes for published articles, and endorsing unproven cures will do more harm than good in the long run. Was it wise to direct funding and resources into hydroxychloroquine research? Would it be imprudent, on the other hand, to halt all related studies? Experts in the field seem to have found a possible compromise. The World Health Organization has resumed its study on the use of hydroxychloroquine to treat the coronavirus, but health officials are neither encouraging nor defending the administration of the drug in hospitals or by patients themselves (Park, 2020). Scientists are also cautioning against the drive to speed up the peer-review process in order to produce quick knowledge about the coronavirus, which could lead to misguided data collection methods and an incentive to find results where there may be none. The hydroxychloroquine saga has made plain the scale of the challenge that COVID-19 poses to the scientific apparatus at large—when our understanding of a disease is only inchoate, but when human lives are widely at stake, scientists must plough on with whatever correlations they find, even if the data are only promising and not definitive. It falls onto the lay audience and the media to acknowledge the complexity of such pursuits, instead of jumping to their own conclusions.

Experts remain in a race against the clock to find a cure for COVID-19. Many are still disagreeing on key aspects, but one thing they all agree on is: the rush to find a cure without proper information and reliable evidence could end up harming patients more than helping them. The case of hydroxychloroquine shines a light on the importance of separating politics from science, as well as the confounding incentives that drive research in a time of crisis. Ongoing research on hydroxychloroquine can serve as an opportunity to improve the way we test drugs, change the incentives behind research, and teach us how we can provide better healthcare in the future in times of crisis. ■

Beatriz Horta is an undergraduate student from Rio de Janeiro, State of Rio de Janeiro, Brazil, currently studying at Yale University.

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In December 2019, no one could have foreseen the rapid political, social, and health changes the world would undergo as a response to COVID-19. Six months later, the virus has spread from Wuhan, China, to all corners of the globe. The rapid course of the spread forced country leaders to quickly enact policies that they believed could best control the situation. These high-pressure decisions may determine the fate of the community, both economically and socially. Apart from research and vaccine mobilization, many policymakers throughout the world enacted various non-pharmaceutical interventions (NPIs) to reduce the public transmission of the virus. These unprecedented interventions range from enforcing social distancing to closing non-essential businesses and schools.

Europe has recently seen a significant decrease in COVID-19 cases, and many countries have plans to reopen their borders to a select number of countries that have managed to contain the virus (Stewart 2020). Keeping an eye on case numbers, these countries are slowly returning to normal. Across the Atlantic in the U.S., on the other hand, cases have begun to increase (New York Times database). What did the U.S. do wrong? And what can we learn from Europe on how to effectively stop the spread of COVID-19?

Responses to COVID-19 across the United States varied widely from state to state. Some states imposed strict stay-at-home orders and closures for nonessential businesses, while other states remained mostly open, even as case numbers began to rise. Many argued that the economic consequences of implementing NPIs outweighed the benefits; however, the World Bank reports that early implementation results in improved economic and health outcomes as compared to delayed and reactionary policies (Demirguc-Kunt 2020) . This strongly-endorsed preventive approach, which includes more proactive tracing, testing, and isolating of cases, was more commonly adopted in Europe than in the United States. A thorough analysis of public health interventions in Europe could help better inform policymakers of the practical strategies for overcoming a pandemic.

The Imperial College COVID-19 Response Team, assembled to advise COVID-19 policies in the United Kingdom, aimed to do just that. They created a microsimulation to model and predict the effects of various NPIs in the UK and the US. They concluded that only enacting one NPI is fairly ineffective. Rather, the combination of multiple NPIs substantially lowers infection rates (Ferguson 2020). Additionally, they distinguished between two types of policies: mitigation and suppression. Mitigation policies aim at mitigating the spread of the virus, whereas suppression policies seek to stop the spread completely. They found that even the best mitigation strategy resulted in “hundreds of thousands of deaths and health care systems being overwhelmed many times over” (Ferguson 2020). On the other hand, the best suppression policies, which included universal social distancing, home quarantining of potential carriers, and possible school and university closures, seemed to drastically reduce death numbers. The downside of these policies, however, is that they would have to be maintained until an effective vaccine is released to prevent another peak of cases (Ferguson 2020).

According to the model in which no NPIs are enacted, eighty-one percent of the population becomes infected, leading to at least 510,000 deaths in the U.K. and 2.2 million in the U.S. within a couple of months (Ferguson 2020). But, because of the NPIs implemented in Europe, researchers estimate more than three million lives were saved. The reproductive number, Rt, of the infection has also decreased. This value represents the average number of people to whom an infected individual spreads the virus. To efficiently suppress virus transmission, the Rt has to remain less than one. Data has shown that, since NPIs have been put in place, the Rt has been reduced by eighty-two percent in Europe, with a current and promising value of 0.66 (Flaxman 2020). These values help us understand the importance of NPI policy, even though we cannot physically see it. But there are limitations to modeling such a novel and variable situation.

Since many NPIs were implemented at once, it is almost possible to attribute changes to any one NPI. Furthermore, it is difficult to take into account the two-to-three week lag of hospital case results that emerge following a new NPI (Demirguc-Kunt 2020). There is also uncertainty in true case numbers, as many cases are asymptomatic and/or unconfirmed. Additionally, results can vary based on region and population, and community compliance is equally important as the NPIs themselves. As we learn more about COVID-19, the figures presented in this article may begin to shift and new conclusions may be drawn.

Beyond the scientific community, all eyes are on Europe, as many European countries are cautiously opening businesses and borders. Some of these countries have banned entry of travelers from specific high-risk countries, such as the US, while other countries require travelers to quarantine for two weeks immediately upon arrival. Some countries are even establishing travel bubbles, where a group of countries, usually neighboring, selectively open their borders to each other (McClanahan, 2020). According to Manuel Muñiz, the Secretary of State for Global Spain, the success of these so-called exit strategies are contingent on the countries’ ability to meet four criteria: “Track the virus’s spread; test anyone with symptoms; trace the contacts of those who test positive; and treat those who fall ill” (McClanahan, 2020). These rules establish clear guidelines for current and future policies, but just as we could not have predicted the global effects of a spreading virus in Wuhan back in December, we cannot truly predict what the next six months will look like. But with collaborative effort from all aspects of society, from governments, to the scientific community, to citizens, we can begin to combat the virus that has taken over the world. ■

Anmei Little is an undergraduate student from Nashville, Tennessee, USA, currently studying at Yale University.

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You wake up to a throbbing migraine. You try to get up but can barely stand without losing your balance. Even though it takes longer than usual, you eventually manage to stagger towards the bathroom. As you brush your teeth, you are alarmed that you can neither smell nor taste the tang of peppermint in your toothpaste. You look through your window and see a lion walking inside your neighbor's apartment. "That's weird," you think to yourself. Maybe something isn't right.

Headaches. Dizziness. Loss of smell and taste. Hallucinations.

While these manifestations are common to a host of neurological diseases, they have also been reported by patients infected with the novel coronavirus (Reinberg, 2020). The similarity in symptoms, however, represents more than mere coincidence. A growing body of evidence suggests that SARS-CoV-2 affects the nervous system in more ways than initially assumed (Molteni, 2020).

The first report of neurological manifestations among hospitalized COVID-19 patients was published on the preprint server medRxiv in February. Within the cohort of two hundred and fourteen patients examined in Wuhan, the disease's first epicenter, approximately thirty-six percent had symptoms affecting either the brain, the spinal cord, the peripheral nerves, or the skeletal muscles. As described in the paper, these symptoms often appeared early in the disease, within a median time of one to two days (Mao et al., 2020).

Similarly, a letter published in the New England Journal of Medicine in June reported that eighty-four percent of COVID-19 patients admitted to a hospital in Starsbourg, France, exhibited neurological symptoms, with one-third of them demonstrating some level of disorientation upon discharge (Helms, 2020).

A multi-system condition

Although COVID-19 was first described as a pneumonia-like disease, it is becoming clear to scientists and physicians that it is more appropriate to think of it as a multi-system condition. As it turns out, the coronavirus can assail not only the lungs but also other organs, including the heart, the intestines and the brain (Wadman, 2020). For this reason, understanding the long-term impacts of the virus, both on the neurological front and in other systems within the body, has become a priority for researchers around the world.

When looking at the brain and the spinal cord, the challenge of unpacking the coronavirus’s enigmatic effects is compounded by the complexity of the nervous system. It makes sense, then, for neurological symptoms associated with the coronavirus to produce just as much intrigue as terror. With this in mind, researchers have been using symptoms as clues to unveil elusive mechanisms underlying the effects of COVID-19 on the nervous system.

Headaches

In February, a twenty-four-year-old man went to see a doctor in Japan about a headache that had been bothering him. He felt tired and had a fever. After having been prescribed some medication, he headed back home––but his symptoms got worse. A stronger headache and a sore throat brought him to a clinic, but all tests came back negative. Days later, he was unconscious in a pool of his own vomit. Inside the ambulance, he had multiple seizures (Molteni, 2020). Clearly this was more serious than a mild case of the flu.

When he arrived at the hospital, he was assigned a Glasgow coma scale of 6, which often corresponds to severe brain injury. It was only after doctors performed a brain MRI that indicated swelling and detected viral RNA in his cerebrospinal fluid that it became clear that the patient had COVID-19 (Moriguchi et al., 2020). The coronavirus, it seemed, had trespassed into his nervous system (Molteni, 2020). His doctors described his case as meningitis and encephalitis, or brain inflammation, associated with SARS-CoV-2 infection (Moriguchi et al., 2020).

Some people attribute coronavirus-related headaches to the discomfort of sinus congestion and constant coughing. For that reason, the symptom has often been mistaken as indicative of other conditions. But even though it’s true that either of those nuisances could give anyone a migraine, case reports like this one suggest that, when associated to COVID-19, the origin of these symptoms could be more complicated than that.

Inflammation

When speaking of immune responses to the coronavirus, many scientists refer to "cytokine storms"––unfettered immune reactions promoted by small proteins called cytokines. While these proteins normally help the immune system, when in excess, they can kindle the inflammation of tissues (George, 2020). If these cytokines were to travel towards the brain through the cerebrospinal fluid, they could cause localized swelling, which could in turn trigger symptoms including headaches and even seizures (Loewen, 2020).

Recent observations have raised questions surrounding whether the coronavirus could infiltrate nerve cells directly or cause indirect damage through cytokine storms (Moyer, 2020). Even though it is known that the coronavirus invades human cells by using spike proteins to latch onto ACE2 receptors, which in turn act as the molecular entry point for viral infiltration into the host, no one knows whether neurological COVID-19 symptoms can be explained by how this could happen in the brain and spinal cord. To better understand how the virus could affect the nervous system, researchers have studied the distribution of ACE2 receptors in different structures in the brain. Using genetic information retrieved from transcriptome databases, the group mapped out brain regions with significant expression of ACE2 receptors. Among other findings, they reported that the choroid plexus, which produces cerebrospinal fluid, seems to be a site of high ACE2 expression (Chen et al., 2020). Nevertheless, further analysis needs to be conducted to validate and explore the significance of this distribution.

Strokes

While compelling evidence suggests that the coronavirus provokes generalized inflammation, this idea is still being debated when it comes to localized impacts in the brain. A letter published in the New England Journal of Medicine reported that, in the brains of eighteen deceased patients who had been infected by the coronavirus, researchers did not see signs of inflammation. They did, however, observe the death of neurons in the cerebral cortex and other areas, which indicated oxygen deprivation (Solomon et al., 2020). Some experts argue, though, that these observations will only translate into significant meaning when more samples are examined to add to a larger body of evidence.

Similarly, the possibility of deadly ischemic strokes in coronavirus patients is also a growing concern. This type of stroke occurs when clots occlude vessels carrying blood to the brain, which often results in the death of brain cells. But while studies have linked the coronavirus with coagulopathies (Iba et al., 2020), which make the blood more prone to clotting, others, including researchers at Weill Cornell Medicine, have suggested that the risk of strokes associated to COVID-19 is not significantly higher than for other viral respiratory infections (Merkler et al., 2020).

Anosmia and Ageusia

Among several unknowns that lie within the connection between COVID-19 and the nervous system is one of the most puzzling yet common symptoms associated with the coronavirus: anosmia, or the loss of the sense of smell. Not only does anosmia seem to have a neurological motivation, but it is also often accompanied by ageusia, the loss of taste. A preprint study published in May on medRxiv reported that the average loss of the sense of smell among COVID-19 patients was of approximately eighty percent, while the average loss of the sense of taste was of roughly sixty-nine percent (Kay, 2020).

The initially inscrutable nature of these phenomena sparked the interest of many researchers, eliciting multiple hypotheses. Could it have something to do with the structures inside the nose? Or are the roots of these symptoms concealed deep within the folds of the brain?

Some scientists have been investigating whether the virus could invade the olfactory bulbs, while others suggest that the often short-term duration of the loss of sense of smell implies that the cause for this symptom occurs outside of the brain (Kay, 2020). The million-dollar question of how the virus could find its way to the nervous system is one that has yet to be definitively answered.

Many unanswered questions, one clear truth

Due to a combination of insufficient evidence and an often-mysterious presentation, the causal link between neurological symptoms and the coronavirus still cannot be completely explained. While scientists are trying to understand why some patients develop neurological complications, as well as how exactly COVID-19 impacts our brains in the long-term, it is now clear that this virus can wreak havoc on neurological territory.

But this havoc isn’t always obvious. Or even a havoc at all, in many cases. Not every patient will see jungle creatures traipsing around urban apartments. Some might feel nothing more than a mundane headache. But findings reported thus far suggest that special attention must be dedicated to unpacking veiled connections between the virus and the body’s most complex organ system. If SARS-CoV-2 was powerful enough to upend our world, it could also be powerful enough to get inside our heads. Quite literally. ■

Maria Fernancda Pacheco is an undergraduate student at Yale University ('23) and alumni of The British School of Rio de Janeiro ('18) and is from Rio de Janeiro, Brazil.

References:

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When then-US President Barack Obama was awarded the Nobel Peace Prize in 2009, he recognised the controversy surrounding his award 1, emphasising in his speech: “We can acknowledge that oppression will always be with us, and still strive for justice…. Clear-eyed, we can understand that there will be war, and still strive for peace. We can do that—for that is the story of human progress; that is the hope of all the world” (The Nobel Prize, 2009). In a complex world where ideals often conflict with reality, he called for the courage to persevere in the pursuit of our ideals, while accepting and dealing with events as they really are.

Today, as world leaders attempt to lead their countries out of the pandemic, a conflict has emerged between the widely recognised ideal of promoting and protecting the values of democracy, and the reality of a public health crisis that requires a level of efficiency that democracies struggle to offer. Governments worldwide recognised the need for decisive measures to prevent the spread of the highly contagious coronavirus disease; by the first week of April, more than half of all humanity—more than 3.9 billion people—were placed on some form of lockdown or curfew by their governments (Sandford, 2020). To quickly track and isolate suspected and confirmed patients of COVID-19, governments began developing and experimenting with technologies that would scale up contact-tracing, prompting widespread concerns regarding the trade-off between privacy and public safety (Marr, 2020). These developments invited much discussion and criticism of democratic governments, which have had to give up some of the democratic values that they should have been upholding (Dunst, 2020), such as the freedom of assembly and the human right to privacy (United Nations, n.d.). As it becomes clear that governments that quickly implemented such measures have outperformed those unwilling or unable to do the same (Bremmer, 2020; Buchanan, 2020), many have understandably started to question if democracy should continue to be promoted universally as the ideal form of government (Commission on Human Rights, 2002; Goncharenko, 2020).

1 The controversy was that even though the prize was awarded to those who have done the most to promote world peace, Obama was, in his own words, “the Commander-in-Chief of the military of a nation in the midst of two wars” (The Nobel Prize, 2009).

However, it would be premature to conclude that the success of authoritarian measures has undermined the legitimacy of democracy. Although heavy-handed approaches may be effective during the crisis, they are not sustainable for democratic governments if other democratic values are not protected. When democratic governments use authoritarian measures as a short-term solution, they are tapping into the reserve of public trust built up over the years (Diamond, 2020). This trust greatly determines the effectiveness of policies during a public health crisis (Giuliano & Rasul, 2020)—a trend that was also seen during the Spanish Flu of 1918–1920, the last time humanity battled a pandemic (Siegreist & Zingg, 2014). Measures such as lockdowns and widespread contact tracing require the sacrifice of individual freedoms and the right to privacy. However, to prevent the reserve of public trust from depleting, governments must preserve as much as possible other aspects of democracy. They can do so by, for example, maintaining transparency and accountability, doing their best to protect human dignity, and accessing power in accordance with the rule of law (United Nations, n.d.). Failure to do so could quickly erode public trust and support in the government. In the US, the pandemic hit as public trust in the federal government was at a historic low of just 17%. The Vietnam War, Watergate scandal, and 2008 financial crisis contributed to decades of increasing political polarisation, and an erosion of confidence in the federal government on both sides of the political spectrum (Pew Research Center, 2020; Tavernise, 2020). This polarisation has contributed to a highly bipartisan divide in the public’s response to the pandemic. According to Pew Research Centre (2020), only 44% of Republicans believe that their actions affect the spread of the virus “a great deal,” compared to 73% of Democrats. As a result, greatly inconsistent measures and behaviours between the two groups have contributed to the ongoing difficulty of getting the virus under control. In Singapore, public trust in the government has always been relatively high—in 2019, 67% of the people surveyed said that they trusted the government to do what is right (Edelman, 2019). However, during the pandemic, the government faced repeated episodes of public uproar—two significant ones being caused by the perceived lack of transparency and accountability regarding the outbreak in migrant worker dorms (Vadaketh, 2020), and privacy and transparency concerns regarding the TraceTogether token 2 (Chew, 2020). These episodes contributed greatly to an unusually high level of distrust and dissatisfaction toward the government, which contributed substantially to a ten-point drop in votes for the incumbent People’s Action Party in the nationwide elections of July 10, 2020, as compared to the previous elections five years ago (Beech, 2020).

2 The TraceTogether token is a small wearable device that works like the app, exchanging information with other apps and devices for the purpose of contact-tracing. As clarified by the government, it does not track locations (Chew, 2020).

Instead of losing their legitimacy when authoritarian measures like lockdowns are used, a government that is able to uphold other democratic values while making the necessary trade-offs can earn the respect and support of its citizens. For example, while New Zealanders were one of the first to go into strict lockdown, Prime Minister Jacinda Ardern’s leadership, which prioritised compassion, authenticity and transparency (Luscombe, 2020), resulted in 88% of New Zealanders trusting in their government’s future decision-making based on their response to the pandemic (Manhire, 2020). In South Korea, a high level of social trust allowed the successful implementation of measures that were relatively more intrusive on privacy, such as publicising through mobile apps the hour-by-hour, and sometimes even minute-by-minute, movements of infected people (Fisher & Choe, 2020). Without relying on threats of harsh punishment, such as those seen in China (Greitens & Gewirtz, 2020) and the Philippines (The Economist, 2020), governments that protect democratic values can tap on the trust that they have built to convince their citizens to make the necessary short-term sacrifices during the crisis.

The challenge of trying to reconcile the legitimacy of democracy with the perceived need for a more centralised and efficient approach during a crisis is not new. In ancient democratic Rome, the Senate could convene to appoint a dictator for no more than six months, if the republic is facing an immediate and unexpected threat (Silverstein, 2020). In recent decades, democratic theorists have been discussing a provision for expanded powers for modern democracies: Clinton Rossiter, an American historian and political scientist, introduced the idea of a “Constitutional Dictatorship”—a legitimate constitutional provision that would provide the head of state with expanded power to resolve an emergency (Genovese, 1979). To safeguard the provision from abuse, there should be specific provisions that even a temporary dictator cannot override—for instance, the length of rule allowed before the government or its citizens must convene again to vote on the next course of action. The Constitutional Dictator should also be held accountable by law for the consequences of their decisions once the emergency has ended. These discussions invite the possibility of a democracy tapping on authoritarian measures during a crisis while retaining its legitimacy.

It is not naïve to continue to hope and to fight for the values of democracy in times of crisis. Instead, we must remain steadfast in our beliefs while being realistic about the challenges that we face and the adaptations that we need to make. As Obama emphasised in his speech, the constraints of reality should not deter us from striving to achieve our ideals. Even in this pandemic, leaders have the choice to maintain transparency and accountability, and continue to be a champion for human rights and dignity. In this sense, this pandemic has provided democratic governments worldwide with an opportunity to renew our hopes in the pursuit of a more just and peaceful humanity. ■

Ning Yiran is a rising sophomore from Yale-NUS College in Singapore. She hopes to pursue a major in Global Affairs and is interested in issues related to international conflicts and human rights.

References

Beech, H. (2020, July 10). In Singapore, an Orderly Election and a (Somewhat) Surprising Result. The New York Times. https://www.nytimes.com/2020/07/10/world/asia/singapore-election-results.html.

Bremmer, I. (2020, June 12). The Best Global Responses to COVID-19 Pandemic. Time. https://time.com/5851633/best-global-responses-covid-19/.

Buchanan, M. (2020, June 4). Are Covid-19 Lockdowns Slowing Infection Rates? Science Says Yes. Bloomberg.com. https://www.bloomberg.com/opinion/articles/2020-06-04/are-covid-19-lockdowns-slowing-infection-rates-science-says-yes.

Chew, S. (2020, June 13). Are Our Fears About The TraceTogether Token Justified? We Asked A Data Privacy Expert. Rice. https://www.ricemedia.co/current-affairs-features-tracetogether-token-data-privacy-expert-interview/.

Diamond, L. (2020, April 16). America's COVID-19 Disaster Is a Setback for Democracy. The Atlantic. https://www.theatlantic.com/ideas/archive/2020/04/americas-covid-19-disaster-setback-democracy/610102/.

Dunst, C. (2020, May 1). Western democracy's problem with authority makes it more vulnerable to Covid-19. Quartz. https://qz.com/1847421/why-most-western-democracies-cant-contain-coronavirus/.

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Fisher, M., & Choe, S. (2020, March 23). How South Korea Flattened the Curve. The New York Times. https://www.nytimes.com/2020/03/23/world/asia/coronavirus-south-korea-flatten-curve.html.

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Giuliano, P., & Rasul, I. (2020, June 18). Compliance with social distancing during the Covid-19 crisis. VOX, CEPR Policy Portal. https://voxeu.org/article/compliance-social-distancing-during-covid-19-crisis.

Goncharenko, O. (2020, April 6). Coronavirus crisis could spark authoritarian revival. Atlantic Council. https://www.atlanticcouncil.org/blogs/ukrainealert/coronavirus-crisis-could-spark-authoritarian-revival/.

Greitens, S. C., & Gewirtz, J. (2020, July 10). China's Troubling Vision for the Future of Public Health. Foreign Affairs. https://www.foreignaffairs.com/articles/china/2020-07-10/chinas-troubling-vision-future-public-health.

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Luscombe, B. (2020, June 12). Will New Zealand's COVID-19 Success Re-Elect Jacinda Ardern? Time. https://time.com/5852567/new-zealand-coronavirus-jacinda-ardern-election/.

Manhire, T. (2020, April 9). Almost 90% of New Zealanders back Ardern government on Covid-19 – poll. The Spinoff. https://thespinoff.co.nz/politics/08-04-2020/almost-90-of-new-zealanders-back-ardern-government-on-covid-19-poll/.

Marr, B. (2020, June 1). Why Contact Tracing Apps Will Be The Biggest Test Yet Of Data Privacy Versus Public Safety. Forbes. https://www.forbes.com/sites/bernardmarr/2020/06/01/why-contact-tracing-apps-will-be-the-biggest-test-yet-of-data-privacy-versus-public-safety/.

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Sandford, A. (2020, April 3). Coronavirus: Half of humanity on lockdown in 90 countries. Euronews. https://www.euronews.com/2020/04/02/coronavirus-in-europe-spain-s-death-toll-hits-10-000-after-record-950-new-deaths-in-24-hou.

Siegrist, M., & Zingg, A. (2014). The Role of Public Trust During Pandemics. European Psychologist, 19(1), 23–32. https://doi.org/10.1027/1016-9040/a000169.

Silverstein, G. (2020, February 27). Emergency powers. Encyclopædia Britannica. https://www.britannica.com/topic/emergency-powers.

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Vadaketh, S. T. (2020, May 5). Is pandemic politicking to blame for Singapore's shaky Covid-19 response? South China Morning Post. https://www.scmp.com/week-asia/opinion/article/3082733/coronavirus-electioneering-blame-singapores-teetering-pandemic.

Many Asian Americans are entering the medical field. According to the Association of American Medical Colleges, in 2018, 17.1 percent of all active physicians were Asian American (Association of American Medical Colleges, 2019). By comparison, the US Census Bureau estimates that in 2018, the US population was about six percent Asian, Native Hawaiian, and/or Pacific Islander (United States Census Bureau, 2019). Of course, data disaggregation proves that “Asian American” is too broad of a term and that there are many Asian American subgroups underrepresented in the physician profession. In spite of this, both sociocultural perceptions and racial demographic data suggest that Asian American community and identity are often associated with some involvement in the medical field.

Becoming a physician ties closely with the “model minority” myth: achieving financial success for one’s immigrant parents and using the supposed meritocracy to increase one’s social standing. These are all narratives largely prevalent in Asian American history. However, the arrival of the coronavirus disease (COVID-19) pandemic complicates this vision. Not only are physicians working long shifts in which they are risking their lives (often without adequate personal protective equipment), but many Asian American physicians are facing discrimination from patients who snarl at being treated by someone they suspect might carry COVID-19. For many East Asian Americans in general, COVID-19 has brought them their first personal experiences with racial discrimination, cementing the idea of Asian Americans as perpetual foreigners. However, it is insufficient to simply lead awareness campaigns of anti-Asian racism. It is also insufficient to uphold a healthcare system that proves itself unstable and harmful specifically to marginalized communities. Asian American physicians, who hold a large space in the physician community compared to other racial minorities, must look beyond their immediate work and finally connect their pain and struggle to those of other marginalized individuals in the United States. It is time for the widespread rise of the Asian American physician-activist.

Lawyer and activist Betty Hung describes movement lawyering as a pathway for lawyers to advance social change by considering the “intersectional humanity of the whole person and entire communities in order to build movements together” (2017). She calls upon movement lawyers “to practice courage and be willing to relinquish our privileges in order to act and stand up for justice.” Much like lawyers, physicians also hold high status and privilege due to their profession, and a conscious effort must be made to advance social change.

The COVID-19 pandemic only highlights how many interlocking systems impact health. Tying healthcare to employment becomes a problem when hundreds of thousands of individuals are unemployed due to the pandemic. Although statistics remain incomplete, analyses show that Black and Latinx Americans—especially Black Americans—have disproportionately high rates of mortality from COVID-19 (Centers for Disease Control and Prevention, 2020). This is due to systemic marginalization that increases the likelihood for Black and Latinx Americans to work on the frontlines, lack access to health insurance, and live in low-income neighborhoods that lack resources. It was always the case, but in 2020 especially, healthcare has been inextricably linked to sociopolitical systems that unambiguously impact society’s most vulnerable.

Physicians must advocate for the welfare and long-term health of the patients they serve. “Helping people” encompasses everything from working with patients on a treatment plan that takes their intersectional experiences into account, to advocating for better governmental healthcare policies. According to Hung (2017), advancing social change also involves risk and relinquishing privileges. Such risk-taking could involve supporting healthcare policies that might lower physician benefits but increase healthcare access, such as universal healthcare proposals or applying pressure to hospitals that participate in discriminatory practices against patients or staff. Relinquishing privileges includes stepping aside to let Black and Latinx physicians lead. After all, “by centering the leadership of those directly impacted… and having the courage to do what is just and necessary even when we are fearful and may suffer, we can model the world that we seek and does not yet exist” (Hung, 2017). One of the most important actions that a physician can do in a position of power is uplift the voices of those who are most vulnerable.

Becoming a physician-activist is relevant to any physician, but what does it mean for Asian American physicians in particular? The Asian American community as a whole navigates a tenuous relationship with race, struggling with both white adjacency and a history of discrimination often shared with Black and Brown communities. Asian Americans, occupying a “racial middle,” as lawyer and activist Mari Matsuda (1996) calls it, are called upon to evaluate their allegiances. “The [racial] middle can dismantle white supremacy if it refuses to be the middle, if it refuses to buy into racial hierarchy, and if it refuses to abandon communities of Black and Brown people, choosing instead to forge alliances with them,” Matsuda argues (1996). It should not take Asian Americans experiencing racism themselves for them to feel sympathetic to the lifelong struggles of Black and Brown individuals. The aggressions that the Asian American community faces during the COVID-19 pandemic represent only a fraction of the racism and oppression that has devastated Black, Brown, and Indigenous communities throughout America’s history. The Black Lives Matter movement exposes the violence and anti-Blackness that the United States is built upon. This anti-Blackness permeates all systems, including the healthcare system. Thus, it is the responsibility of the Asian American physician to build interracial coalitions and to actively reject white supremacy in all its forms. As Black and Brown individuals disproportionately suffer from COVID-19, the Asian American physician must treat them with care adapted to their backgrounds, as well as advocate for policies and movements that will increase health access, safe homes, and just lives. In addition, the Asian American physician must learn how to call out racism, classism, sexism, homophobia, and other oppressions whenever they occur.

Social justice is central to a physician’s duties, and Grace Lee Boggs (2011) provides a beautiful vision of social change in her book The Next American Revolution: Sustainable Activism for the 21^st Century. One of the book’s most prominent theses is that despite overwhelming, oppressive structures such as racism and classism, one of the most powerful forms of activism involves building meaningful relationships on a personal and local level. “Dramatic and systemic change always begins with critical connections,” Boggs writes (2011). In addition, “struggle doesn’t always have to be confrontational but can take the form of reaching out to find common ground with the many ‘others’ in our society” (Boggs, 2011). This thought is extremely relevant to physicians because the one-on-one, personal physician-patient relationship lies at the center of a physician’s responsibilities. Successful physicians connect with their patients, gain their patients’ trust, and provide personalized care and treatment. Thus, the physician-patient relationship is a crucial site for social change and leading “the next American revolution.”

As a recent college graduate hoping to enter medical school in the future, I am aware that if I do not actively lead efforts for social justice, I am simply participating in a hierarchical system that preys on the socioeconomically disadvantaged. I pursue this career path because I believe that physicians can be valuable and powerful activists. As the COVID-19 pandemic continues to disrupt communities around the world, revealing vast social injustices and political shortcomings, becoming a “movement physician” is unavoidable if one wishes to truly help others. The COVID-19 pandemic presents a crucial turning point for Asian American physicians. I hope it is a chance for Asian Americans to de-emphasize individual desire for money and power, to unite against injustices, and to ally with marginalized groups. Activists in the United States have fought for rights based on their visions for a more just, equal, and loving future. As we dream of a better, post-COVID world, it is up to us to continue that activist legacy. ■

Sarah Tran is a recent graduate of Pomona College (’20), with a major in Neuroscience and a minor in Asian American Studies. She currently lives in southern California, USA.

Sources

Association of American Medical Colleges. (2019). Figure 18. Percentage of All Active Physicians by Race/Ethnicity, 2018. Retrieved from https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018.

Boggs, G.L., & Kurashige, S. (2011). The Next American Revolution: Sustainable Activism for the Twenty-First Century. University of California Press.

Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019 (COVID-19). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html

Hung, B. (2017). Movement Lawyering as Rebellious Lawyering: Advocating with Humility, Love and Courage. Clinical Law Review, 23, 663–69.

Matsuda, M.J. (1996). Where Is Your Body?: And Other Essays on Race, Gender, and the Law. Beacon Press.

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In mid-March, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic, and since then, the typical functionality of our world has come to an unprecedented halt. Healthcare professionals have united in an attempt to alleviate the countless stressors that have been evolving since the virus has begun spreading uncontrollably. Witnessed through a multitude of media outlets, medical centers and hospitals have been at capacity for a while, with medical personnel risking their lives to save others (Farmer, 2020). Experts deem the most effective way to stop the spread of the virus is to comply with public health guidelines and not take these recommendations lightly.

As stated by the California Department of Public Health, there is still no vaccine that has been developed for COVID-19; thus, the best way to prevent illness is to avoid exposure by following current health measures (“COVID-19 Updates”, 2020). After many states began to lift lockdown restrictions and stay-at-home orders in late May, almost all states in the U.S. either urged or required residents to wear face masks in public spaces while following social distancing protocols. There are several strands of evidence that accurately prove the efficacy of face masks. A particular case comes from a laboratory that studies the nature of airborne droplets and the ability of certain masks to block them. High-speed video recordings found that saying a simple sentence or phrase expelled hundreds of droplets, ranging from twenty to five hundred micrometers in size, from the mouths of individuals; however, properly wearing a mask successfully blocked nearly all or most of these droplets (Bai, 2020).

Per the Centers for Disease Control and Prevention’s (CDC’s) recommendations, people who are two years of age and older should wear a face covering in public settings or when they are around others who do not live in their household (“COVID-19: Considerations”, 2020). Since COVID-19 could be spread by asymptomatic people or people who do not know that they are infected, it is vital to wear face coverings in public. According to the same recommendations by the CDC, the only people who are exempt from wearing face coverings are children who are younger than two years of age, anyone who has noticeable difficulty with breathing, and anyone who is unable to remove their face covering without assistance. Although all distinguished health organizations and public health experts continue to strongly advise individuals to wear face coverings in public, a few residents of the U.S. surprisingly fail to comply with guidelines, comparing the health and safety of others to their freedom and rights.

Certain social media platforms, such as Twitter, do a considerable job in portraying important news both locally and globally, and since many news organizations have their own social media accounts, they aim to utilize their platforms to spread awareness of current issues to general audiences. A progressive, social-media-focused news organization known as “NowThis News,” frequently posts about popular stories. On June 11, 2020, NowThis News posted a three-minute video in which more than one hundred people showed up to an Orange County Board of Supervisors meeting to speak out against the mask-wearing orders. Of the many comments opposing masks, one that stood out stated:

Making our children wear masks is contrary to medical experts and is fundamentally wrong. They need to be exposed to bacteria in the air...kids need sunlight, exercise, interaction, and youth sports without masks. If you deny them that, in twenty years, you are going to have a population of immunosuppressed, antisocial adults who can only interact via Zoom and FaceTime and need gloves to shake your hand (NowThis, 2020).

Some residents also showed no remorse for the board of supervisors: “I don’t know if you guys are robots or whatnot, so please stop imposing Chinese communism tactics—this is America. We need our essential breath” (NowThis, 2020). There is no known evidence to scientifically support either of these comments; they are disrespectful and deviate from the main concerns of the pandemic.

When examining statistics about COVID-19 through the CDC and WHO within the past few months, cases continue to exponentially rise in many states, with California, Florida, and Texas being the top three powerhouses of the virus due to noncompliance of health safety measures (Axelrod, 2020). It is clear that many of these residents’ arguments are counterintuitive and heavily conflict with public health guidelines. TikTok, an entertaining application, allows people to create minute-long videos, and there are many controversial posts that convey how some people outrightly disregard wearing a face mask in public while inappropriately criticizing health officials.

A viral TikTok posted by “NowThisPolitics” shows a video from the Palm Beach County Commission’s meeting in Florida as a group of individuals state their personal reasons for not wearing a mask. During the meeting, these anti-maskers ludicrously argued their opinions:

If we have a second wave, I believe that it will be due to masking healthy citizens. It literally is killing people—we the people are waking up, and we know what citizens arrest is, because citizens' arrests are already happening; every single one of you that is obeying the devil's laws are going to be arrested (NowThis Politics, 2020).

In the same video, one individual compared wearing a mask to the Holocaust: “I am also the daughter of someone who lived through Germany—you’re forcing people to wear masks, they were forced to wear a star” (NowThis Politics, 2020). In response to these comments, COVID-19 has caused almost all stores to require customers to wear face coverings and to practice social distancing, and people who wish to shop in public must comply in order to protect others. If individuals have serious health conditions, they are encouraged to stay home and to keep themselves safe. Many online services, such as online shopping and food delivery, are readily available for safety and convenience.

Lastly, a TikTok video of Emily Lyoness went viral after Dr. Christian Assad, an interventional cardiologist, responded to her video on the application to publicly validate and justify her statements regarding face coverings. In her video, Emily states that she has moderate to severe asthma given the time of the year, which she controls with two medications and a rescue inhaler when necessary. She announces that she owns a pulse oximeter for her own safety and measures her oximetry rate, resulting in 99% with no face mask on. She then proceeds to show a cloth mask covering her face, which she wears twelve to fourteen hours a day at her bartending job. She checks her oximetry rate while wearing the mask, and it is still 99%. She then wears a KN95 mask, and a P100 level mask, showing that in all cases, her oximetry rate stays constant at 99%. She ends the video with an insightful statement: “If someone like me with a breathing problem can wear all three of these masks throughout the day and have the same oximetry rate, then somebody without breathing problems has no other excuse not to wear a mask other than their own selfish motivation” (Assad, 2020).

It is apparent that some individuals create preposterous reasons as to why they refuse to wear masks. Despite constant recommendations from world-renowned health experts and epidemiologists, people still choose to ignore health guidelines and endanger others by potentially spreading the virus. Since governors began lifting lockdown restrictions, people failed to realize that they must follow strict and instructive ordinances to help our society return to normal. As witnessed, a few states have unfortunately backtracked in their efforts to slow the spread of the virus, and lockdowns have begun once again. Public health guidelines exist for a reason—if there are definitive studies conducted which show that face coverings greatly decrease the spread of the virus, responsible and compliant individuals should take the situation seriously and not risk the health of others. ■

Shant Voskanian is an undergraduate student from Los Angeles, California, USA, currently studying at the University of California, Los Angeles. ℅ ‘21.

References

Assad, C. [@christianassadmd]. (2020, June 27). #facemasks #socialdistancing #COVID19

[Video]. TikTok. https://vm.tiktok.com/JL9uGEP/

Axelrod, T. (2020, June 13). Texas, Florida, California hit highs for COVID-19 infections in last two weeks.

https://thehill.com/homenews/coronavirus-report/502588-texas-florida-california-have-all-hit-highs-for-covid-19

Bai, N. (2020, July 10). Still Confused About Masks? Here's the Science Behind How Face Masks Prevent Coronavirus.

https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks- prevent

COVID-19: Considerations for Wearing Cloth Face Coverings. (2020, June 28).

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting- sick/cloth-face-cover-guidance.html

COVID-19 Updates. California Department of Public Health. (2020, July 12).

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx

Farmer, B. (2020, April 15). At Least 9,000 U.S. Health Care Workers Sickened With COVID-19,CDC Data Shows.

https://www.npr.org/sections/health-shots/2020/04/15/834920016/at-least-9-000-u-s-health-care-workers-sickened-with-covid-19-cdc-data-shows

NowThis. [@nowthisnews]. (2020, June 11). More than 100 people showed up to this Orange County Board of Supervisors meeting to speak out against face mask regulations [Tweet].

https://twitter.com/nowthisnews/status/1271203807712575489?s=21

[@nowthispolitics]. (2020, June 25). ‘Masks ‘throw God’s wonderful breathing system out the door.’

[Video]. TikTok. https://vm.tiktok.com/JLxCrcE/

I am no stranger to the Dance of the Public Restroom. It begins as I balance on my left leg and my right foot brushes past my left knee through développé. My right leg now positioned parallel to the floor, I plié and flick the knob of the toilet with my right foot to flush. Depending on the restroom, I usually have half of an eight-count to shimmy out of the stall before the water in the bowl swirls fast enough to generate an invisible plume of peril that might spew pathogens into the cubicle. Next comes the hand jive at the sink, as I swipe my palms beneath the soap dispenser and the faucet, waiting for something, anything, to come out. For the finale of this Ode de Germaphobe, I strike the button on the hand dryer with my elbow and wait for the gust of lukewarm air. I read once in a University of Connecticut study that a hot-air hand dryer takes in microbes from the bathroom air and expels them back out through its cacophonous mouth (though these particles are usually harmless, there is the occasional exception of Staphylococcus aureus bacteria). So, with my arms outstretched, I keep my shoulders back, my neck elongated, and my chin cocked over my right shoulder to avoid inhaling any infectious aerosols. It is in this position that I resemble a ballet dancer standing in the wings, waiting for her cue to join the show.

With the emergence of COVID-19, the entire world seemed to have turned into one giant public restroom. This is to say, things went to sh*t.

By March in the United States, “college dorms,” “office spaces,” and “neighborhood parks” all became synonyms to “petri dish.” The lines outside the local Costco on a Tuesday grew longer than a queue of groupies waiting in 2018 to see Billie Eilish perform live. Headlines like “coronavirus cases spike” became as commonplace on the nightly news as the logos of the broadcast stations themselves. As I watched businesses, schools, and daycares close—as I watched the world retreat—Rod Serling’s voice echoed eerily in the back of my mind: “you just crossed over… into the Twilight Zone.”

Yet I had no idea that the beginning of quarantine would be the easiest part of the pandemic for me. I could heed the pleas of hospital staff and first responders: “I stayed at work for you, you stay at home for us.” The instructions from public health officials were more or less clear. Avoid leaving the house unless you are an essential worker, wear a mask in public, and maintain a physical distance of six feet from those who are not a part of your household unit. It was a tangible checklist that I could recite when the future looked grim and fatalities continued to climb.

Then our sleep-deprived teen of a nation slowly rolled out of bed and into restaurants, summer camps, and shopping malls. My hometown in California made it to “Phase 3” of reopening; nail salons, tattoo parlors, and other non-essential businesses began to open their doors. Though the government’s guidelines called for a gradual reopening, I watched on social media as people I knew immediately flouted physical distancing guidelines, partied in large groups, and burned masks at beach bonfires to show that they were “over this whole pandemic thing.”

But we are not “over this whole pandemic thing.” As I write this, The Washington Post just reported that seven states had their highest rates of coronavirus hospitalizations since March. So my movements began to more closely mimic those I had grown accustomed to in the ladies’ room. I started meticulously scrubbing my groceries with a sanitized toothbrush. My can of Lysol spray became my most valuable possession as I followed perhaps the worst “treasure” map of all—a trail of germs that I imagined glowing green on every doorknob, handle, and counter in my house. I compulsively scrubbed my hands with the strongest dish detergent I could find until my fingers were numb, the skin on my palms became raw, and my nail beds cracked or bled.

With reopening came constant and encumbering questions. What is an acceptable risk for me to take in a global pandemic? What is my obligation to others? Will I make a mistake that will harm my immunocompromised, elderly parents? As with any newfound freedom, there came an increase in responsibilities, the most prominent of which was the responsibility to make safe decisions.

Yesterday, I decided to walk my dog. Equipped with Purell in my pocket and a face mask looped around my ears, I set out to explore a different neighborhood for a change of scenery. As I turned a corner, a man, not wearing a mask, approached me and started shouting.

“Enough with the masks already. What are you afraid of, huh? What would happen if I got closer? What would happen if I…?” He lunged forward, close enough so that I could smell the sandalwood scent of his cologne, and coughed in my face.

I was appalled. Nauseous. Numb. He walked away laughing as I sat down on the hot asphalt of the street and ripped off my mask. What just happened? All of those hours I spent frantically cleaning and a stranger walked up just to cough in my face?

I traced my fingers over the stitches on the mask, searching the threads for answers. Then, another strange feeling, almost an empathy for the man, emerged. Though we reacted on two extreme sides of the spectrum to this pandemic, we were both fearful because we felt powerless. With every breath I took underneath my mask, the stale, sticky air pulsing against my face was a reminder of my constant danger. For the stranger, it was terrifying to look at a world where the smiles of other humans were covered—where what could have been a pleasant interaction between neighbors was now a possibly life-threatening exchange.

However, there is a middle ground between my histrionics when it comes to germs and the stranger’s blatant disregard for safety. Public health guidelines still serve as a checklist for minimizing risks even as the economy reopens. Though these rules vary by state, I can use them to calmly contemplate the pandemic rather than constantly catastrophize it. The first step is to put down my toothbrush and to stop suffocating myself with Lysol spray. Meanwhile, the stranger can actively consider the issue of coronavirus rather than operate in denial. The first step for him is to put on a mask. Most of all, we can both use those guidelines to recognize that we are not powerless in this pandemic. Every family gathering we sacrifice, every party we forgo, and every hug we save for later mark a little victory toward a larger cause. We can act, not out of a fear of dying, but out of the courage to help save lives. ■

Sydney Gray is an undergraduate student from San Diego, California, USA, currently studying at Yale University (‘23). She is also a staff reporter for the Science & Technology Desk at the Yale Daily News.

I never imagined my first introduction to providing medical care would be during a pandemic (or an epidemic for that matter). I am a child: a rising college junior on the pre-med track, majoring in Ethnicity, Race, and Migration. Yet, from mid-April to the end of May, I volunteered at Jamaica Hospital Medical Center in Queens, New York City, as a certified Emergency Medical Technician. During that time, I followed the effects of the coronavirus disease (COVID-19) as they snaked throughout the hospital’s departments, first helping out in the Emergency Department, then the COVID-19 Intensive Care Units (ICUs)—which, in reality, meant helping out in all the ICUs—and on the floors, some of which had also been turned into COVID-19 ICUs. During that time, I lived alone in my brother’s Brooklyn apartment, finished my spring semester finals, and turned twenty-one. I also learned how to breathe through numerous layers of personal protective equipment and decontaminate myself when I returned home. More than anything, I had the privilege to work alongside a team of extraordinarily kindhearted, hardworking, and brave people. However, I also learned about pain, loss, death, and underdiscussed lasting effects of COVID-19. This context illuminated my abilities as well as my fears, ignorance, and understanding of my own mortality. It drastically shaped how I will approach school, medicine, and life going forward, yet, in many ways, I am not yet quite sure how.

Certain moments cemented the complexity and gravity of this experience for me. One late May afternoon, I was surprised by what should have been a routine experience in a non-ICU setting: a patient standing and speaking to me without difficulty. In the ICUs, practically all patients were intubated and heavily sedated; most of the patients also had some form of external oxygenation and were not physically able to move themselves. I was so used to seeing people in that state that when I saw this patient standing and speaking without assistance, I was shocked and frightened. Although he was stable, I feared that at any moment he would fall. That should not have been my expectation of a patient’s behavior. This man reminded me of the most fundamental aspect of medicine: patients are people.

One of my greatest lessons from this experience was coming to understand how a disease does not only ravage patients’ bodies, but also a hospital, critically affecting patient health and outcomes. When most people imagine the impacts of COVID-19, they think primarily about the respiratory system, failing to realize the interconnected effects of the disease across the entire body. For example, under normal conditions in which patients can safely receive proper attention and do not have such extended hospital stays, bed sores or hospital-induced pressure ulcers are highly unusual and preventable. Before COVID-19, not a single patient had developed bed sores from their hospital stay in hundreds of days (there was an ongoing count). Yet in April, they became shockingly common. Not only are they incredibly painful, bed sores can also lead to further health complications, including sepsis. This extraordinary experience opened my eyes to the impacts of a disease’s context, cementing my commitment to preventative care.

People want to “go back to normal,” but that’s not possible for me. When I walk around and see someone without a face covering, I become enraged; when I see photos of busy Florida beaches, I slump over; when I think about eating in a restaurant, I am disgusted; and when I consider college parties, I am genuinely terrified. No one is returning to a “normal” college experience; it will be predominantly online, bereft of social activities, and, frankly, quite isolating. However, I fear that it will, more than anything, seem simply inane to me. Because, in reality, writing a great lab report felt a bit pointless when the next day I performed compressions on a coding patient. I want to apply the many lessons I learned but am distressed when I think about how long it will be before I am able to do so fully. When the current crises—both COVID-19 and the Black Lives Matter movement—seem so much more urgent and important to me, will I be able to convince myself of the significance of learning so that, in the long run, I will be adequately equipped to provide comprehensive care? ■

Alie Brussel Faria is an undergraduate student from New York City, New York, USA, currently studying Ethnicity, Race and Migration at Yale University (’22).

Today we say our goodbyes to the ones we once knew. No longer being able to see their physical form, you desperately try to remember the last time you saw them. The last moment they were at your sight, if you knew what you know now, you would have held on tighter during your last embrace. You would look them in the eyes and say you lived your life right and that it was an honor to have them in your life. Their lives were taken too soon. The news said that high risk folks were the ones sixty and up, so why was it that the ones that lost their battle were barely reaching the peak of their life. Never to see their kids grow up, never again to see the light of day.

People laugh and gawk at the idea of wearing a mask, yelling, “It’s a hoax, don’t be a sheep!” Funny how they also thought this in the beginning, yet it’s sickening that they paid with their lives for not believing. It’s a privilege to learn of these stories through papers instead of through phone calls, and even worse to have to relay this information to your other family.

Family. It was a family affair. The eldest daughter, a first-grade teacher, was exposed during a brief hospital visit and soon found she had tested positive. Across town, her brother embraced his son of seven years who unknowingly exposed him, and soon the brother exposed his mother who then exposed the father. As fast as it came, it ferociously attacked, knocking them all down. The battle centered in their lungs; everyone was desperate for oxygen tanks, but there weren’t enough to go around. Unable to move or speak, the daughter and brother’s lungs were both in trouble, bedridden in different hospitals without the knowledge that they both were at war for their lives. Access to ventilators were waitlisted and his lungs were extremely low in oxygen. He left behind his son of seven years; they never got the ventilator to him. The middle child then sacrificed her life and home with her two children and husband and went to live with her parents. She knew they were weak, knew they needed help, knew that she too would meet the virus face to face. One week later, overcome with sadness and sickness, the father’s heart gives, and he meets his son. The prayers of loved ones filled the air. The eldest daughter in critical condition had tubes inserted into her body in hopes that it would keep her alive; she didn’t know that her brother and father had passed, didn’t know her mom was sick, didn't know the sacrifice her sister had made. The mother and middle daughter embraced in fear. They felt helpless and angry, for death was near their doors, but desperately hopeful that the remaining would survive. Two weeks later. . . she dies, the daughter in the hospital fighting so courageously for almost two months felt her heart give out. As she gasped for her last bits of air, she thought of her children and husband that were waiting for her to come home. She knew she would be with them in their hearts as she joined in the arms of her father and brother.

The sun rises the next day without her, and the song of mourning joins in unison, for a family was torn apart by the virus. The mother cries and screams that the virus nearly ended her family. She questions in anger why she was the lone survivor, why was she chosen to live when those she loves died. She embraces her only child left, together knowing they must spend the rest of their lives caring for the children left behind.

It takes one day. One day for the hospitals to cremate and to deliver the ashes to you. One day for you to see a small container arrive at your door. One day to hold onto a cold, small, quiet container. Today you say hello to the ones you once knew. No longer being able to see their physical form, you desperately try to remember the last time you saw them. The last moment they were in your sights, if you knew what you know now, you would have held on tighter during your last embrace. You would look them in the eyes and say you lived your life right and that it was an honor to have them in your life.

In Memory of:

Breshnev Pérez Jiménez

1981- 2020

Rodolfo Pérez de la O

1946- 2020

Ana Karenina Pérez Jiménez

1975- 2020

“Death doesn't discriminate

Between the sinners and the saints

It takes and it takes and it takes

And we keep living anyway.

We rise and we fall and we break

And we make our mistakes.

And if there's a reason I'm still alive

When everyone who loves me has died”

Wait for it. Booklet. Hamilton. Atlantic Records, 2015 ■

Houyee Chow is a community member from San Jose, California, USA.

New York is a city of stimuli. There are taxis, skateboards, and pigeons that don’t fly away until you step right in front of them. Trucks honk, high heels hit the pavement, and deep bass notes reverberate from open car windows. But none of these sounds can overcome the slamming of a jackhammer, which is to New York’s soundscape what the Empire State building is to its skyline.

It’s hard to find silence anywhere, not just in the city. Outside of the city, there are birds and crickets, squirrels and frogs (although the latter two are much less romanticized than the former). Some would say that these sounds are preferable to those of the city, but I say they’re one and the same. Anywhere that there is life, there is noise.

One would be quite concerned if the birds stopped tweeting or the crickets stopped chirping. That’s how I felt when New York became quiet. First, taxis were banned, leaving the streets without their accompanying whistles, shouts, and honks. Then, people were banned too. Skateboarders did their last kickflips, and businesswomen left their shoes at the door. The jackhammers ceased their sunrise crescendo, and I realized I needed to set an alarm. Eventually, even the Manhattan traffic faded away.

The only sounds left are the church bells and the sirens, but the melodic tolling seems empty without a congregation to call to prayer and the sirens even louder without the usual background blanket of sound. I don’t notice any more ambulances than usual, but according to the news, I’m wrong.

We haven’t been outside in weeks, so before dinner, my family and I take turns sticking our heads out of our kitchen window for fresh air, looking down Tenth Street and over to University Place and Broadway. The air is heavy with spring. Our neighborhood looks the same as it always has, except for the nasty new high-rise they are building across the street. My dad shakes his fist in the air, gesturing towards the building, but what’s shocking is not the construction of new luxury condos; that’s commonplace in New York. What’s shocking is that the streets are empty. I can’t see from my eighth-floor apartment, but I imagine that, without anyone to scare them as they walked past, the pigeons and sparrows are taking over the sidewalks.

We sit down for dinner and begin to eat. My mom switches the radio from the news to music. We don’t want to talk about the news, so we eat in silence. But then we hear a noise. It’s a clanking of some sort, then shouting, then clapping. We again go to the window, looking out onto the street to see who is out there making all this noise despite our governor’s and mayor’s orders to stay inside. There is no one there. Instead, our neighbors, who we’ve only ever glimpsed through their windows, are leaning out of their apartments, banging pots and pans, clapping, and shouting. One person even has an airhorn. At first, we are confused, but then we realize that it is exactly seven o’clock. We Google “NYC seven PM screaming,” and a headline comes up: “NYC Honors Healthcare Workers with Citywide Applause.” We smile and join in.

My dad points to someone on the street below. There’s no traffic, so he walks down the middle of the street, wearing a black hood and a white mask, like a modern-day grim reaper. He holds the hand of a little girl wearing a silver dress, and I can’t decide if it’s comforting or concerning. Is he guarding or taking her? But then, the two of them raise their hands and begin to clap. The Grim Reaper would have come silently, but this man joins us in our New York City noise. ■

Laura Michael is a recent graduate of Yale University (‘20) from New York City, New York, USA.

Long before the outbreak started, Alan was hired to turn the city lamps on and off by hand. Every day, he would take out his ladder into the post-sunset purple and twist the lightbulb in each lamppost until every street was lit up in his fake sunlight. Even after people started venturing outside less and staying in their houses more, he would not stop until he was told to. From their windows, kids would watch him weave between houses on his bicycle, ladder propped on his shoulder, lighting up vacant block after vacant block, only so he could turn them off the next morning.

Once the situation deteriorated, Alan was tasked with turning off all the other lights around town. First came the music hall, then the theater and the schools, and soon, there was no light in any cafe, grocery store, or library in the city. Soon, not even the city lamps were allowed to be turned on anymore. City officials thought the enforced darkness would dissuade people from leaving their homes. They did not know that the light Alan brought was the only thing that tethered the people to the city, and without it, countless families would disappear into the night, some willingly, others taken, and that by time daylight arrived and they saw all the broken glass and parting graffiti, there would be no one left.

After this undetected mass exodus, the officials too abandoned the city. Before leaving, however, they turned to Alan and asked him to turn off the lights in people’s homes. Think of the planet, they said as they boarded their jets. Think of the waste. Alan agreed. He no longer had anywhere to leave to or anyone to leave for. And so he spent the next two weeks, for the city was not very large, going from house to house to apartment and doing exactly as they had asked.

Some of the houses, he found, were unbelievably tidy, like their inhabitants had spent their entire quarantine straightening the place. Others were angry. In one he found the same phrase written over and over on the walls. You can only kill so much time before it starts killing you too.You can only kill so much time before it starts killing you too. You can only- it was written in every room. But most of them just looked lived in: there were used cereal bowls in sinks, unmade beds, towels left to dry on chairs and hampers. Abandonment did not cling to the walls of these houses. Alan could not help but feel like he had just come at the wrong time, and if he came later he would find people, and people in abundance. ■

Ana Paula Padilla Castellanos is an undergraduate student from New Haven, Connecticut, USA, who will matriculate at Yale University (’24).

Our breath dribbles up into open air, and fat water droplets fall steadily onto the windshield. I hesitate; Clara Montgumery’s hand is gasping for air, jellyfishing opened and closed on her armrest, asking me to hold it. It’s like there’s a grace period between when I put the truck in park and when we can talk to each other again. As if in prayer, she closes her eyes and breaths in time with the rumble of the engine. I’ve lost count of the number of times we’ve been in this same moment; her fingers outstretched, my arms resting at the bottom of the steering wheel, sitting in a second-hand truck in the flooded beach parking lot on the southern edge of town. We bake in our silence, in the static of the wind pressing against the car hood. I shift in my seat while she picks at her face in the rear-view mirror. Through the passenger’s side window, I see the pooling water and the nearby trees: distinctly oversaturated, leafless, and mute. I might be in love. Clara Montgomery is asking me to hold her hand, and I can’t will myself to reach over and to grab it.

She sighs into the polyester. Spring of this year, across the whole planet, it started raining. It’s nearing the end of summer now, and the rain hasn't stopped. Sussex County, where we live, will be the first place to go full blue in Delaware. Those who haven't left yet are still salvaging what they can from the time before the water started to swallow their homes and their people. Clara fiddles with the radio, and it hums alive, sputtering quietly: “Harold, here, your reliable, single, suave, weatherman. Our forecast today calls for rain and rain and rain in a city starved of sky.”

We glance at the clock. “Any of you bold bachelorettes can catch me at the singles’ mixer down at the community hall tonight. There’s now a makeshift ramp leading to the roof entrance for easy access. Please come! If we lose any more people, we’ll have to cancel these types of events, and well, Nancy, the florist? She’s the only woman ever there, and she isn't getting any younger.”

Clara covers her mouth with her hands, bursting out into laughter, “What a dog, what a dumb, drooling dog!”

There is another piece to this ritual: the beach. I ask her if she’s ready, and she nods. We slip from our clothing, revealing the bathing suits underneath.

***

There’s something about the grey, and the salt, and the way her hair falls in The Sound. When she pulls herself out of the water, she’s all blue and shivering.

I say, “Aren’t you cold?”

And she says, “Yes.”

“Sand is almost gone,” she coos, “and the fog is so deep.”

“Looks like it.”

“Jog out down the beach,” she points, “and I’ll yell when I can’t see you anymore.”

Her cheeks crinkle when she smiles, and in this moment I would do anything. If she told me my hair looked better shorter, I would cut it. I think I would follow her off a cliff if she asked me to. If she paddled all the way to Europe, I would follow her. The flat of the water around us, despite its roughness, and the thick air, makes me think that in this moment I would do anything.

***

We finally make our way back to the truck. We climb in, and I turn it on. Water drips from my hair. The radio blinks and murmurs: “Hello, and good afternoon. It’s Harold, your weather man. If you didn’t catch my segment this morning, we have officially cancelled the singles’ mixer. The florist, Nancy, has disappeared under ‘mysterious circumstances.’ And we can’t have just guys at the mixer. We’re not into that kind of thing.”

I say something about dicks and self-esteem, and Clara laughs into my side. We start heading for Angola, where Clara lives, because her mom wants her home before dark. When we pull into her driveway, I kiss her on the cheek as a goodbye, and I think that gesture was right to do.

The storm picked up, so the drive home was tiring. Many back roads were blocked off because of flooding, mudslides, or erosion. It turned a thirty-minute commute into an hour-long one, and I thought I would be angry, but I wasn’t.

The next day I woke up with what I had fallen asleep with the night before: the girl in Angola. The house swayed with the storm, and I lay with it for a bit. The wind swelled, and I held my breath along with it; I think we were all holding our breaths along with it. ■

Tirion Rodger is a community member from Madison, Connecticut, USA, who graduated from Daniel Hand High School (‘20) and the Educational Center for the Arts (‘20).

I was only seventeen when Death and I had our first battle. She crept through the emergency room doors near the corner of the stretcher. I was young, so she passed by my inexperienced eyes undetected. I noticed her only after she left, like a letter on the kitchen counter or a post-it note on the fridge. But instead of a note, she left a body.

I was eighteen when she danced around my patient’s stretcher for the second time, but I was still oblivious to her presence. Usually, I’m too busy pressing down on my patient’s chest (trying to coax their heart into helping out) to notice anything, but after her departing message, I began to see a pattern. The texture, smells, and sounds were all the same, and I learned that the signs she left had names. Algor mortis (“coldness of death”), rigor mortis (“stiffness of death”), and finally livor mortis (“blue-ish color of death”). There are more, but usually only morticians, pathologists, and cemetery workers can see them.

Now, equipped with the knowledge of these signs, I thought I could catch Death as she placed each one down.

When I was nineteen, while working during the COVID-19 pandemic, she formally introduced herself to me face-to-face. Since I had two patients at the beginning of my first shift, our meeting was quite long. As if she had been waiting to talk to me, she divulged intimate details about herself. I looked her dead in the eyes. I noted the length and color of her hair; the shape of her ears, nose, and chin; the way she smelled, talked, walked, laughed. All the physical details that didn’t necessarily apply to her, but I used to make a manifestation of her likeness. But the one feature that felt real was her smile. I caught a glimpse of it as she left the room. She started off our second encounter that day smiling as she crept in, prompting my patient’s parted blue lips to fall into a grin as we intubated. She didn’t say a word. All I could do was watch her; never with my eyes but with my heart. Like Mike Tyson’s Brooklyn-made uppercuts, the realization struck me—she was happy, but for the dying patient.

The way she entered with a toothy smile, switching to a reminiscent grin, then back to the smile as she left sent a bead of sweat down my face-shield into my mask. I made sure to focus on that almost loving smile the next time I saw her, and what I had felt made me question every preconception I had of Death. She was holding the patient’s hand the entire time. Like a loving mother, she caressed their heads back and shut their eyes. She loved them. At first, I thought my emotions were just messing with me, but I felt it again and again. There was no more denying it. She really loved them. It didn’t make sense to me, but I didn’t have the time to sit down and to ponder the philosophy of the situation.

My mind was blank for a while. I robotically replaced the oxygen tanks, running back and forth between the trauma room and supply closet, then cleared the ER floor of needles and miscellaneous packaging. But the ER nurse’s words—“We have a delivery incoming”—brought me back to reality. Somewhere in Queens, an ambulance was racing towards us with a woman giving birth. It took me a while to remember that a hospital isn't just for COVID-19 patients. It also took me a while to remember how to handle childbirth; I’d only ever delivered a plastic baby from a plastic woman. As we prepped the neonatal isolation chamber, my mind switched to a mental textbook review of obstetrics. I was glad to get a break from all this gloom and confusion, but then the thought of losing the mother and child plagued my mind. Soon, the sirens flooded the ER, and I knocked on the wooden door as I left to receive the patient. She had delivered in the ambulance, and the ER was uncharacteristically empty. It was just the mother, her baby, and me. But, as our two new patients arrived, I got a familiar feeling in my chest. My first thought was, So that’s birth. But when I recognized that feeling, I saw it—that same loving grin, Death holding onto the baby’s hand. Beckoning her into this world. I was perplexed. I didn’t see any signs of Death. The baby looked healthy and pink and was crying as normal. So why was she here? Amid my inquiry, the two were quickly stabilized and sent off to an isolated portion of the hospital.

But what I thought was Death still lingered in the room. Taking a seat, still smiling and waiting. She felt the same, but something was off. As I tried to make sense of the situation, another code 99 rang on the intercom. The call for another resuscitation brought us back to attention and brought her to her feet. She rushed to the patient's side before the trauma team and I could, and with the same smile, took their hand. After an hour of back-and-forth success and relapse, she caressed our patient’s head back, shut their eyes, and left. At that moment something clicked, and all I could imagine was a room with two doors on opposite sides. All this time, I had focused on the exit leading to the world after this one. I never thought she was the same guide coming through the entrance, bringing someone new into this world from the last. I was wrong to call her Death. ■

Justin Yazdi is an undergraduate student and EMT from Franklin Lakes, New Jersey, USA, currently studying at Yale University (‘23).

When a friend first gifted my family and I our clivia miniata plant, it was but a sprout. We tucked it into an ivory-colored ceramic bowl of loosened earth, where it unfurled four delicate wings of deep green into the rays of the sun.

Clivia miniata, also known as the Natal lily or bush lily, flowers but once per year—from a tall stem burst forth clusters of blossoms, six-petaled trumpet heads of vibrant yellow and intense orange.

One year of growth later, our clivia flowers bloom for the first time. It’s mid-August, approximately one week before I leave home for my first semester of college. I cup a flower head in my right hand and inhale, exhale its sweet perfume, imagining the change to come. But I could never have imagined this.

I could never have imagined this cutting short: of the stresses and anxieties accompanying a second semester of classes. Of the JAW and TEETH performances that had yet to be experienced. Of the early-morning East Rock treks, us giddy from the crispness of the morning air. Of the late-night Popeyes runs, us giddy from the tea to be spilled over chicken tenders and between mouthfuls of mashed potatoes (they ran out of fries), eyes glinting with a hunger for drama and comfort food only arising at 2 a.m. So we indulge.

I could never have imagined this cutting short of adventure. Of ordeal. And of connection.

The agent of our collective cutting short was, of course, the ongoing COVID-19 pandemic: a global health crisis threatening the lives of millions and the livelihoods of millions more. The pandemic shut down our schools and our economies; exposed and exacerbated racial and socioeconomic divides; jeopardized our sanity; uprooted our every perception of ‘normal.’

The pandemic necessitates our mutual physical separation. We now reach for each other through pixelated screens, the live video freezing intermittently. We protect ourselves from each other and the very air we breathe in, breathe out—hide our hands beneath coverings of blue latex, hide our noses and mouths behind layers of plastic fiber.

It’s an extraordinary moment in history, I am told. A once-in-two-hundred-years crisis. But it sure feels less fascinating and more crappy when I’m living through it, the uncertainty heightened and undeniable and real. Bound at home by an order to shelter in place, the time passes in alternating periods of restlessness and calm. The rhythms of our lives have taken an unexpected time out—still, day cycles into night cycles into day.

One mid-May afternoon, I sit on my bedroom floor and lift my gaze to the sky outside of my window. It’s blue today, the color of forget-me-nots, strewn with strands of wispy cotton. An invisible breeze plucks at the clouds, tugging them across my frame of view. I cloud-gaze, finding one leaping dolphin, one swirling maple leaf.

But my plane of vision is framed, cropped, selected—before long, both dolphin and leaf are borne into oblivion. I sit in silence as the clouds shift steadily across my window to the outdoors. Perceptions of movement are sharpened by stillness.

I have interacted with COVID-19 from a sheltered vantage point. I feel the effects of our global pandemic via the summer opportunities delayed, then cancelled; the disposable masks I wear to the grocery store and the rounds of hand sanitizer I apply after a post office run; the never-ending barrage of news coverage that brings the nightmare and struggle of COVID-19 to the family room television screen. I feel stillness in that I am detached from the true pain of the crisis; I feel stillness in that I am anchored to the mundanities of quarantine life, the mundanities that permeate my quiet suburban neighborhood.

The tranquility is unsettling. And the increasing everyday-ness of my everyday life is stifling. The world shouts, yet, when I look about myself, I barely hear a whisper.

Later in the day, I pause as I pass our clivia miniata plant on my way to the living room. Kneeling down beside the ivory-colored ceramic bowl of loosened dirt, I realize that the flowers have, once again, begun to blossom. Two orange buds yawn subtly, mouths half-open. A small movement. I count nine months since they last bloomed—they have arrived three months early, their year-long cycle of life accelerated and cut short.

In an era of stagnation, they are an apt reminder of renewal. Of change. And of new beginnings. ■

Julia Zheng is an undergraduate student from Bethlehem, Pennsylvania, USA, currently studying at Yale University.

oh how close I feel to u dear stranger

as we realize we are jogging toward the same point

and change our course to keep the 6 ft distance.

I know u are worried for someone and I am too.

one way or another six feet distance:

between us or above us, now or later,

grandmother or friend or cousin who

-in New York

-with Crohns

-on immunosuppressants

has not called me back yet so we zigzag

through this city getting and giving distance

and holding our breath. ■

Daniel Blokh is an undergraduate student from Birmingham, Alabama, USA, currently studying at Yale University (‘23) after attending the Alabama School of Fine Arts (‘18).

Four months into quarantine, Ronald Kirk was the last thought on anyone’s mind. Ronald who drank tequila like water, Ronald whose rickety laugh had lit the background of so many freshmen’s nights, Ronald whose flailing-stomping style of dance had spun him across every dancefloor of every party, was forgotten. With the whole world trapped at home and slowly losing their desire for anything, the man who embodied celebration faded from everyone’s mind.

But finally, the virus ebbed. An email arrived announcing the date of the presumed return to campus, and the universe of dormitory beds and dining-hall nachos and sprints to class with one’s coffee in hand, which had begun to seem like a wonderful collective fever dream, was confirmed as real and coming closer every day. One night, with only a month to go until their return, Tom, tossing and turning in bed from the eagerness to feel his body hurtling around the makeshift dance floor of somebody’s dorm, remembered the evening he and Ronald had gone shot-for-shot and danced the polka on their good friend Lily’s common room table.

He was too restless to fall asleep anyway, so he turned over and plucked his phone from the bedside table. U heard anything about Ronald? he texted Lily. Been a while since I talked to him.

A few minutes later: no. no posts on ig either Tom: Hope he’s ok.. Lily: me 2 Tom: Know any friends of his u could ask? Lily left Tom “on read” for ten minutes, still feeling a little hurt by the memory of the common room table incident, which—Tom always forgot this part—had broken under Tom and Ronald’s weight. Still, as bitter as she felt about paying $112 for an incident that wasn’t even her fault, she was a bit concerned to realize that she hadn’t heard from Ronald since the quarantine began. Her mind immediately went to the worst option; though no, she thought, he couldn’t have passed away—the college would have made an announcement. But why was he so absent from social media? The boy infamous for his nightly party Snapchats, which made everyone else angry at him for being so intoxicated with life and angry at themselves for not having as much fun, hadn’t shared a single selfie or video in four months.

Lily had bonded about Ronald’s obnoxious Snapchats with Aidan, a kid who talked shit mostly about people he was close with, and had talked a lot of shit about Ronald. Indeed, they were closer than most people knew—once, after a party, he ended up in Ronald’s suite, made out with him, and started undressing when Ronald decided he wanted to go back out and dance more. Aidan walked home that night wondering how he’d managed to fall for such a weird kid, a guy who moved through parties like a whirlwind, managing to dance with every single person there, catching the interest of half of them, emptying a six pack, and then vanishing out the front door—a guy all surface, composed entirely of desire. But they’d flirted on and off for the next month anyway, and Aidan had even texted him a month into the quarantine asking for song recommendations, but he never got an answer back, and he, too, slowly forgot Ronald existed.

i texted him two months ago but no answer, he told Lily. Abbreviating his feelings, he added, kinda hurt. glad it wasn’t just me

Lily: lol kinda worried though do u know anyone who might know where he’s at? When he’d gone to Ronald’s suite that night, Aidan had bumped into Ronald’s roommate, Trenton, who was finishing his physics homework in the common room. From how comfortably he reacted to the ordeal, Aidan got the impression that Trenton was a much sweeter, more sensible person to have feelings for, but quickly forgot about him when Trenton slipped out of the room to finish his homework in the library.

Aidan: i met his roommate once. kinda cute. i’ll dm him Lily: sure i can’t text him for you? ;) Trenton, too, had succumbed to the plague of amnesia following Ronald. He’d considered messaging him in the first weeks of quarantine but couldn’t quite figure out what to say. When Ronald’s home state of California went on lockdown, he drafted and redrafted a message, trying unsuccessfully to avoid writing the by-then tired cliches of “hope you’re alright in these terrifying times” and “hope you and yours are safe and have enough toilet paper” and ultimately settled on an Instagram story post announcing his outpouring of love to everyone in Cali.

All things told, Trenton had never gotten very close to Ronald and wasn’t sure how to approach him. He’d tried to foster a friendship, but Ronald was simply never there. Sometimes he purposefully did his homework in the common room hoping Ronald might stop by and want to chat, but even on the rare occasions Ronald came in, he was rushing: dashing in to throw something down and to grab something else and already leaving the moment he entered. When rooming plans spontaneously generated between Trenton and some of his Lightweight Crew friends, he’d been very relieved.

Now, though, with the guilt of having forgotten about his roommate pushing Trenton, he called Ronald hundreds of times and reached out to everyone who might be in touch with him. In a few days, the Inquiry into Ronald’s Whereabouts expanded greatly both in participants and urgency. From bits and pieces he recalled from conversations with his roommate, Trenton remembered the names of several of Ronald’s drinking buddies, some classmates and fellow club members he’d gotten close with, and a few friends from his home state. One day Trenton received a text reading:

Hi, I’m Delilah. Mary looped me into this Search for Ronald thing. I used to live not too far from him and we went to elementary school together. I’m not sure what’s happened to him, but I can tell you he’s not dead. I searched obituaries and the records they’re keeping of people who’ve passed, and he’s not there. Also my mom checked his mom’s facebook. She’s posting about the new Twilight Zone on Netflix and asking for book recommendations but nothing about her son.

Trenton wrote back: Thank you so much, Delilah. This is comforting to hear but I’m still concerned. Do you happen to know his mother’s phone number?

Delilah: I do.

Mrs. Kirk was finishing an episode of the Twilight Zone—what an apt show to remake right now! she thought—when her phone began to ring. Ordinarily, she would have picked up right away, but after months of isolation she’d reached the level of detachment necessary to let the phone ring while she finished whatever she was up to.

But she was not detached enough to continue watching the episode when the phone rang a second time, displaying the same number. Annoyed, she picked up and said, “Can I help you?”

“Mrs. Kirk? I’m Trenton. Ronald’s roommate.”

“Oh, yes! Trenton! Hi, how are you?”

“I’m alright, Mrs. Kirk, all things considered. But I haven’t heard from Ronald in a while and I’m a bit worried. How is he doing?”

Mrs. Kirk paused for a moment and scratched her head. “You know... hm. It’s the damnedest thing...” Ronald. Ronald. The name meant something to her, but she couldn’t put her finger on it. Like some city whose name one recognizes as very important but can’t recall why. Little by little, his shape emerged from the fog of her mind: a tall guy, with young, brown curly hair like Mr. Kirk and a button nose like Mrs. Kirk’s... Yes, Ronald was their son! Now she remembered. But when had she last seen him? “I guess I haven’t checked on him in a while. I don’t know. He locked himself in his room and after a month passed he just... slipped my mind...”

She felt the same horror she experienced whenever she felt for her phone in her purse and felt only an awful emptiness in its place. She ran into the kitchen, where her husband was stirring the dough for banana bread.

“William...”

“Yes, honey?”

“Have you checked on Ronny recently?” Hesitation. Then, “Shit. No... I totally forgot.”

The parents sprinted up the stairs and sped around the corner of the hallway, but when they came to the door to Ronald’s room, they froze. There was no glow in the gap beneath the door and the floor, meaning no light was on inside. There was no music, no sound at all. The small, shiny gold door knob was so easy to turn, but neither of them wanted to touch it. They waited for the other to work up the courage, but instead, with every second standing at the brink of what they feared to find out, the fear only deepened and deepened until both of them knew they couldn’t overtake it.

Finally, the parents went out into the street and offered the first person they found (a twelve-year-old boy walking his golden retriever) $100 to open the door for them.

The barking of the dog leashed to the fence outside was barely heard by Mr. and Mrs. Kirk as they hovered, barely breathing, and watched the boy turn the handle. The door slowly creaked open, and the room came into view.

Nothing? It seemed to be. No one sat at the desk; no one was in the bed. Mrs. Kirk clutched Mr. Kirk’s arm in horror: “Oh my god, honey, he must have run away.”

But as they searched the room, that didn’t turn out to be true. There was, in fact, a single pebble that Mr. Kirk found tucked under the blankets. Perhaps a fluke, some dirt Ronald had tracked in, they theorized, but then Mr. Kirk shook the pebble in his hands and it said, “Let me be.”

“What?” Mr. Kirk asked.

“Let me be, I say,” the pebble said. “I’m tired.”

“Oh my god, oh my god,” Mrs. Kirk exclaimed. “My boy. My sunshine, Ronald, Ronny, is that you?”

“Leave me alone.”

“Don’t speak to your mother like that, Ronald,” Mr. Kirk barked.

“We only want to help you, Ronny,” Mrs. Kirk pleaded. “Oh, our poor boy. You must have been so lonely here. We’re so sorry we forgot about you. Do you want something? Let’s order in. Let’s rent a movie. We’ll buy a bottle of wine, do you want a bottle of wine? We’ll do anything you want, Ronny. Whatever you want.”

“I don’t want anything. I stopped wanting anything. I don’t want ANYTHING,” the pebble bellowed, and the house’s foundation shook. “Now let me be.”

The mother and the father kept on pleading, but the rock would speak no more. The kid stood awkwardly and waited, hearing the dog whining from outside. He could just leave, sure, but he wanted his hundred bucks. Finally, as the father bellowed at the pebble and the mother ran out of the room in tears, he worked up the courage to go after her.

She was sitting at the kitchen table, sobbing, when he found her and tapped her on the shoulder. “Excuse me, ma’am,” he said feebly. “I was wondering, could I have my $100?”

She turned and glared at him, then began to cry again. “Oh, you look just like him. Just a boy like him. Always going somewhere, always on the go--he was practically born running... oh, my poor boy. All his life millions of friends, millions of girlfriends, boyfriends, swimming practice, tutoring, piano lessons, National Merit Scholar, I can’t even remember all of it... and then in that room all alone. I can’t even imagine, I can’t imagine...” With a deep breath she straightened herself out, and then she opened the kitchen cabinet and extracted five $20 bills. “Here you go, honey. Thank you. You take care. You buy yourself something nice and then go tell your mom and dad you love them.”

As soon as he felt the weight of the five bills in his hand, he turned away from Mrs. Kirk and dashed out of the house while she began to sob again behind him. By then the restaurants and food trucks were reopening, and there was a hot dog stand on the street corner. Six chili cheese dogs, he rehearsed in his mind as he untied his dog, with extra slaw. As they ran, the bills in the boy’s fingers and the golden retriever’s tongue flapped identically behind them in the wind. ■

Daniel Blokh is an undergraduate student from Birmingham, Alabama, USA, currently studying at Yale University (‘23) after attending the Alabama School of Fine Arts (‘18).

Oh, before, when feelings were a wild

rain—I sat and shivered, and the torrent

soaked me to the bone.

Nowadays, the downpour dwindles,

but I feel the water’s promise

in the humid air, and when wind stirs

the trees, drops dislodge

from leaves and trickle

down my forehead. ■

Daniel Blokh is an undergraduate student from Birmingham, Alabama, USA, currently studying at Yale University (‘23) after attending the Alabama School of Fine Arts (‘18).

The recluse up the road purchases a Winnebago and a 4-wheel drive truck.

Like us, he’s afraid of ticks, falling trees—now this. Someone I don’t remember

friends me. Our neighbor, a pharmacist, stands in the road to wish us good morning

and to share survival tips. He pauses, then warns: Mail-order drugs invite theft.

Three homemade surgical masks arrive in the mail—one black-eyed Susan, one dotted

with moose, one navy blue. Another kind neighbor—her mom’s business card

tucked inside. Fishing season opens early: mid-April and the Fenton’s empty

of trout. When fishermen trespass on our land, we let them. A red fox risks a run

from the river up the Turnpike in broad daylight. In its mouth, something dead.

We imagine her den in the woods. I close doors on my family to attend virtual meetings

in our living room. An irate colleague is asked to mute himself. Like everyone,

I think about the spread and pay attention to the soap disappearing from its dish.

After a trip to the grocery store, my friend breaks down: People’s faces—they look at me

and look away. She confesses she has too many clothes—vows she’ll never shop again.

My husband orders pullets and seeds online. He grows a flat of cold-weather greens

on a windowsill. I join an organic wine club in California, a vineyard at the headwaters

of the Russian River in the Red River Valley. We buy one son a new laptop, the other

a home gym. At night, watch the news, eat cheddar bunnies, chocolate pudding,

and stream every Scorsese film we can find. A FedEx package—too large

to carry alone—arrives at the end of our driveway, addressed to someone

we don’t know. We plan to deliver the box from Cacaoholics.com to our mystery neighbor

across the river. Who knew we shared a passion? On the drive over,

I fantasize about gourmet chocolate—dark, ganache-filled truffles, bittersweet

bark, raw cocoa-dusted confections—and consider, for a moment, keeping the goods. ■

Denise Abercrombie (Wesleyan, '95) is a featured poet and the director of Fine Arts at E.O. Smith High School in Storrs, Connecticut, USA. In addition to performing and directing works with Stage Left Ensemble, she helps coordinate Curbstone Foundation's Poetry in the Julia de Burgos Park series in Willimantic, Connecticut, USA.

One hawk, then another, swoop into the meadow, and perch on fence posts.

We walk a new path on Horsebarn Hill as a couple passes with their teenage daughter.

A parent, who once called the principal to complain about my politics, greets us

and jokes, Let’s keep our distance. I suppose we share a deep love of this place

since we meet so many nights on the slope. A father and his sons fly kites: a rainbow

and a stained-glass bat tangle in midair. Back home, a friend invites us to a virtual party

for her camera-shy husband. So many faces fill the screen, his birthday song’s staccato.

Still she displays, then cuts his homemade cake covered with fifty-some-odd candles.

Our older son studies slave manifests from the Colonial era and calls to say

he’s growing cabbages in his Madison apartment. Soon he’ll forage for fiddleheads

and morels. An estranged buddy calls about his daughter’s fourth grade teacher

just to hear the sound of my husband’s voice. A colleague who ignores me at work

texts me at home: Just wanted to touch base and see how you’re doing. For years

we’ve been cliquey and buried beneath stacks of uncorrected papers. One morning,

three kits come out from hiding under the barn floor to wrestle in the grass. As we

struggle to take good pictures through our dirty kitchen window, our younger—

recently evacuated from college—observes how they blend in with the fallen leaves.

At night, he builds a fire in the front yard pit and invites us in. We step away

from our online lives. Witness the blaze. Sit as close as we possibly can to him. ■

Denise Abercrombie (Wesleyan, '95) is a featured poet and the director of Fine Arts at E.O. Smith High School in Storrs, Connecticut, USA. In addition to performing and directing works with Stage Left Ensemble, she helps coordinate Curbstone Foundation's Poetry in the Julia deBurgos Park series in Willimantic, Connecticut, USA.

there is nightshade in the air

and my people are dying

it is soft and fragrant

on the vine

but now some burn

it in the night

it seeps through doors

and pores

killing us a bit by morning

much like hate

once charred it cannot be

stopped from its killing spree

I have no more sacred stones

to soothe me

so I count small porcelain dogs

first the little spaniel from Jamaica

all the way to the mastiff

from the mountains in Tibet

they are so very cold and still

but for small comfort

are adequate

for a night that’s waning

when the scent of deadly

nightshade fills the air. ■

Donald T. Gray (Yale University ’70) is a community member from Del Mar, California, USA, and was previously a Carnegie Teaching Fellow at Yale University.

I watch each known horizon crumble like blue cheese.

An acquired taste, for sick shipmen and pioneers;

I prefer to sail clear of uncertain times like these.

The sky is dolloped with eggshell white, yet with so much hell below.

My laugh tastes like bitter mold; some forget,

or perhaps don’t know, that the clenching depths do freeze

beneath the fathoms. We’ve had but months of solitude;

the captain has yet to grow enormous wings,

but I’m heartsick at the prow; pale innards drown in milk-black seas.

The brimming stores are rotting; we now have fewer mouths to feed.

Old assumptions decay in the brig, and though the maggots

never tell, the smell of their clotting carries on the breeze.

No blurred mirages promise land. I’ve half a mind to tumble over,

but something bolder condemns swimming toward a damp surrender.

I feel the captain at my shoulder. A heavy palm, a bracing squeeze.

This vessel was built for pandemonium, for cannon-fire

and maelstrom weather. Though the pulleys creak, she’s loathe to sink,

and the rudder’s fixed for imminent shores. She’s eaten hurricanes before.

This, too, shall not end her. ■

Alina Martel is an undergraduate student from Waconia, Minnesota, USA, currently studying at Yale University (’23). She hopes to create opportunities for emotional experience and connection through her poetry, and more of her work can be found at https://www.martelpoetry.com/.

In this informative science comic, Neko and Dumble introduce the reader to the details surrounding the COVID-19 pandemic. Together, the two bring light to issues associated with the disease. ■

Huang Huanyan and Richard Shim Jo are undergraduate students currently studying at Yale-NUS College (‘23 and ‘22, respectively).

Drawn in memory of the healthcare workers who have passed away during the fight against the COVID-19 pandemic. As a healthcare worker myself, it has been particularly hard to deal with the losses within the healthcare community. ■

Sonia Lai is a community member from San Francisco, California, USA.

This was drawn as a reflection of my thoughts and feelings as a healthcare worker and primary care provider during the COVID-19 pandemic. ■

Sonia Lai is a community member from San Francisco, California, USA.

COVID-19 has quickly spread around the world, causing many countries to enact a range of non-pharmaceutical interventions (NPIs) to reduce the virus' impact. In July, Europe saw a significant decrease in COVID-19 cases while the United States witnessed a record number of new cases. What can we learn from Europe on how to effectively stop the spread of COVID-19? ■

AnMei Little is an undergraduate student from Nashville, Tennessee, USA, currently studying at Yale University (‘22).

We have known each other online longer than we have in person. Some of us spend days alone, others in full households. None of us ever thought that a Zoom call would be the most stable part of our week. I am grateful for my friends, our conversations, and Saturday nights. ■

Anasthasia Shilov is an undergraduate student from Hinsdale, Illinois, USA, currently studying at Yale University (‘23).

An illustration of two David statues practicing physical distancing. With the distance created, the nature around them has started to bloom. ■

Maxine Tanjutco is a community member from Muntinlupa, Metro Manila, Philippines.

This watercolor piece navigates the mood changes and mental health shifts that accompany a self-isolated life. Waiting for Camellias alludes to the (currently-forecasted) months during which the pandemic will continue to keep us inside. ■

Sophia Zhao is an undergraduate student from Newark, Delaware, USA, currently studying at Yale University (‘23).

This illustration highlights our healthcare heroes and their incessant efforts to fight against and protect us from the COVID-19 pandemic. ■

Sophia Zhao is an undergraduate student from Newark, Delaware, USA, currently studying at Yale University (‘23).