A few years after receiving the Nobel Prize for Literature in 1982, the Colombian writer Gabriel García Márquez published his novel Love in the Time of Cholera. Years earlier, the Swedish doctor Axel Munthe, who came to Naples in 1884 to treat the victims of a cholera epidemic, wrote his Letters From A Mourning City. In both cases, an epidemic caused by the bacterium Vibrio cholerae is the background for deeply human stories (imaginary in Márquez’s novel and real in Munthe’s letters). Márquez and Munthe invite us to contemplate how it is possible to live “in the time” of an epidemic, as involuntary witnesses of human suffering, eager to help the most needy and aware of the risks of contagion.
In addition to these two books, literature has not failed to offer exemplary material that helps us understand how people live during epidemics, and how much they suffer. Among the many works, above all, is The Betrothed by Alessandro Manzoni (1827), about the plague that afflicted the north of the Italian peninsula in the years 1629-31, which was one of the last outbreaks of the centuries-old plague pandemic – the Black Death – that had its climax on the European continent around 1350.
Secondly, in his novel The Plague (1947), Albert Camus plunges us into the drama, based on plague that overwhelmed the Algerian city of Oran in 1849, inviting us to question the nature and fate of the fragile human condition. In times of cholera or plague, we ask ourselves who we are, how we are to live, what causes all this and where is our God when we suffer. As we search for answers, what emerges is the urgent need for care, with a special focus on the poorest and most vulnerable.
In a more recent book, the medical doctor and anthropologist Paul Farmer states that in the time of cholera there is also a need to critically question all the social, cultural and political conditions that characterize people’s lives and so should be an integral part of any intervention aimed at promoting health on the ground. Echoing the biblical and spiritual tradition, the author calls for a conversion that is personal and social, inner and structural. In the times of cholera and of every other pathology that afflict humanity, it is necessary to consider all the multiple dynamics that affect health, and promote living conditions that favor citizens, while strengthening health systems and offering specific health care services that are capable of responding to the health needs of people in the different contexts in which they live on our planet. The assumption is that every social factor affects health: from violence to education, work and housing, social infrastructure (roads, sewers, water and electricity networks).
Promoting health in the coronavirus period therefore requires focusing primarily on the relationship between healthcare professionals and patients, on containing the infection and mitigating its effects. Secondly, it is necessary to intervene on the ground with public health measures, aimed, again, at containing and, if this is not possible or not effective enough, mitigating the spread of the infection and the severity of its consequences. Two-week quarantine – chosen independently or imposed – as well as reduced travel, cancellation of flights and events and the isolation of cities and regions are examples of public health interventions to deal with the emergency. Thirdly, as shown by the progressive spread of the pandemic, global protective interventions are needed to deal with the health emergency.
Living in the time of coronavirus requires us to think critically about how we are promoting the health of individuals, humanity and the planet. On a global scale, we are living what many people have lived and are living as a personal experience due to pandemics (such as AIDS, caused by the HIV virus, seasonal flu, tuberculosis or malaria) or epidemics (such as those caused in recent years by various viruses: avian or bird flu, swine flu, Ebola, Zika, SARs and MERS) from which they suffer or have suffered.
It is estimated that, in 2019, 37.9 million people worldwide had the HIV virus. If we consider the overall estimates since the beginning of the pandemic, there are 74.9 million people found to be HIV positive, with 32 million deaths from opportunistic infections due to AIDS.
It is estimated that, in 2018, 3.2 billion people lived in areas at risk of malaria transmission in 92 countries worldwide (mainly in sub-Saharan Africa), with 219 million clinical cases and 435,000 deaths, of which 61% were children under 5 years of age.
According to the World Health Organization, 10 million people worldwide fell ill with tuberculosis in 2018, with more than 1.2 million deaths, 11% of them among children and young people under 15 years of age.
These data are staggering and reveal the dramatic scale of the suffering caused by infectious diseases for which we have treatments – as in the case of tuberculosis and malaria – or which, thanks to available therapies, have become chronic, such as AIDS.
Probably none of these pathologies affect us directly and we consider them infections that afflict other people far from us who live in unknown places or those we do not frequent. Nevertheless, millions of people around the world suffer the consequences.
The only exception is the flu, the viral infection that becomes pandemic every winter in the northern hemisphere. At the beginning of the flu season, international monitoring makes it possible to identify the specific influenza virus and, by sharing the information, a vaccine is prepared ad hoc and distributed in every country in the world. Together with the vaccine, the antibiotic therapy we have available allows us to treat secondary bacterial infections that may be associated with influenza infections. Nevertheless, it is estimated that between 290,000 and 650,000 people die from the influenza virus worldwide. In the United States, in the current influenza season, the Centers for Disease Control and Prevention (CDC) indicate that, as of January 18, 2020, there were 15 million cases of influenza (out of a population of 327.2 million), 140,000 hospitalizations and 8,200 deaths.
Surprising though these estimates are, they pale in comparison with what appears to have been the most serious recent influenza pandemic, the Spanish Flu of 1918-19. The virus spread throughout the world. It is estimated that around 500 million people – a third of the world’s population – were infected by the virus, with at least 50 million deaths due to its high mortality rate. Without vaccine and without antibiotics to protect against associated bacterial infections, the only ways in which it was possible to try to contain and mitigate the spread of the pandemic were isolation, quarantine, good personal hygiene, the use of disinfectants and reductions in public events, which is what we are doing now at the time of coronavirus.
What we are currently experiencing does not yet have the tragic proportions of such infections, past or present. Scientists and clinicians are studying whether the coronavirus has the same virulence and mortality as the seasonal flu virus, how long it can survive in the external environment, how it spreads and infects us, what we can do to protect ourselves. Noting how quickly the virus has spread around the world in recent weeks, we cannot rule out the possibility that today, tomorrow or in the next few days each of us may test positive for it. In the absence of a reliable vaccine, even though there are already experimental vaccines whose effectiveness is being tested, and in the absence of targeted therapies, health measures to contain the spread of the infection are what we now have throughout the world.
We are all at risk. We can contract the infection and spread it to other people, living the double role of victims and spreaders of the infection. Diseases and epidemics seem to shorten and even eliminate distances and differences between people, while separating and isolating individuals from each other. When people are affected by the same pathology – infectious or not – the distinction between one individual and another person fades. We discover an experiential closeness, a closeness caused by the disease, an intimacy in sharing the need for healing. We know very well, even too well, what the other person lives, suffers, desires and hopes. It is a solidarity that is neither sought after, nor wanted, but it is lived. In the common, unchosen path, in which the infection unites us, we accompany each other, even if only on an interior and spiritual level.
Unfortunately, the opposite is also possible. By continuing to believe that we are different, special and better, we avoid recognizing our shared humanity, that we are sick of the same disease, with the anxiety and worry that accompany every effort to cope. Instead of finding ourselves together and close to each other in a suffering that makes no distinctions, it is separation that reigns (“we are not like them”), further isolating and compromising the possibilities of solidarity and support.
In the time of the coronavirus
The current global pandemic, which continues to spread within affected nations and to infect people in new states, asks us to pay attention to the way in which, in the time of coronavirus, our lives, both personally and collectively, in their most ordinary dimensions, are changing.
Our behavior is influenced, modified and regulated differently: life takes its patterns, its timing, from the virus. It is the virus, with its ways of contagion, that determines how we interact with family members, work colleagues, neighbors and the faithful in religious celebrations; how we avoid touching our face, shaking hands and kissing; how we stay at a safe distance from those around us and rush to wash our hands and face if someone coughs or sneezes near us; how we limit our movements by bus, train, ship and plane; how we move or cancel conferences, matches, concerts, trips, business meetings, dinners, cruise holidays, cinema outings, and even classes in schools and universities, preferring virtual ways of meeting and teaching.
Even the way we contaminate the environment is also changing. If, on the one hand, satellite images reveal a resounding drop in environmental pollution in China, due to measures to contain or mitigate the spread of the infection (factories and schools closed, quarantine, ban on circulation), on the other hand, tons of used masks are accumulating in the country. Since they are contaminated sanitary waste, specific facilities are needed to dispose of them, with the existing ones insufficient.
The two-week quarantine – chosen spontaneously or forced – is emblematic of how the coronavirus affects the way we manage our time, taking control of our days, at least for two weeks. At the end of the quarantine, we regain a measure of control over our time and how we live it. You may wonder, however, if you need to repeat quarantine if you are exposed to a second possible infection. And after the second quarantine? How many more quarantines are necessary? Until we are able to vaccinate ourselves effectively against the virus, the hope is that we do not have to ask the question.
Authentic questions and false answers
In the time of coronavirus, our experience, expressed directly from personal stories, or mediated by literary works, or articulated by scientific knowledge, is dominated by uncertainty and impotence. Uncertain, we question ourselves. A first series of questions concerns the spread of the infection: How long will it last in the countries where it is spreading? How many countries will be involved? How many citizens will be infected, and how many will die? When will the infection cease?
In addition to these questions, there is uncertainty about the ability to cope with the pandemic. Will every person showing symptoms of respiratory infection caused by the coronavirus be able to have a test – laboratory and X-ray – in any country in the world, regardless of whether they can pay for it? Are health containment measures and measures to mitigate the spread of the infection – which require isolating people, towns, cities and regions – effective, justified and proportionate? When can they be reduced? Will we have an effective vaccine in the short term? Who will be vaccinated?
Furthermore, what will be the social costs of compromising production and transport activities, and the national, global, economic and financial consequences? What are the consequences for temporary workers and their families, who depend on weekly pay, when they cannot work because they are sick or because productive activity cannot take place?
Uncertainty paralyses many because it reduces and inhibits the ability to control and act. Uncertain, one becomes powerless. For them, ethical commitment requires certainties. Without certainties one cannot act. A similar difficulty is experienced in another serious global emergency, where environmental sustainability is at stake and living conditions on the planet are threatened, not by a virus, but by our way of life, how we produce energy, how we consume and pollute. Even in the case of caring for our common home, there are those who take refuge behind apparent or real uncertainties, justifying inaction.
On the contrary, ethical commitment depends on uncertainty and knows impotence, but both of these demotivate, leaving people resigned and hopeless. Paradoxically, uncertainty and helplessness fuel ethical commitment, stimulate inventiveness, calling for greater competence in dealing with complex situations, seeking solutions that are not easy. What appear to be moral shortcuts, generated by the will to control and by fear, are seductive. But while they propose strategies to solve moral discomfort, these shortcuts actually deceive and betray. Examples of this are attempts to hide the real extent of the infection in some countries, or measures which, in the name of health interventions, aim to take away social freedoms and hard-won rights, using public health measures to disguise police regimes.
When there is a lack of certainties, in looking for them you risk augmenting them, either by creating an imaginary culprit, distracting from the real causes, or by generating fake conspiracies (claiming that the virus was intentionally produced in a laboratory), spreading false news, feeding stigma (blaming immigrants and minorities), generalizing (for example, proclaiming that all the inhabitants of the most populous nation in the world are infected), promoting the “therapeutic” approaches of dangerous charlatans, turning a global health emergency into a hunt for the enemy.
Throughout history, human beings have continued to question themselves, seeking to understand, know and explain. Identifying the cause of how we live and who is responsible for it is part of this search for meaning. We wait for answers from scientific research and look for the scapegoat, as the historian, philosopher and literary critic René Girard (1923-2015) strongly pointed out. “The other,” the different, becomes responsible in an exclusive way. “We” are the victims. The opposition between “guilty” and “victim,” which echoes the oversimplified distinction between “bad” and “good”, so popular in films, has a falsely cathartic effect. Since the “others” are the cause of what we suffer, by eliminating and marginalizing them, we believe we can remove all evil from us, concentrating what is negative in them, in those we have turned into scapegoats and are ready to sacrifice for our own good.
The logic of the scapegoat shows how the human thirst for knowledge can be perverted, turning and reducing itself into a false attribution of guilt. In the suffering caused by the infection or illness that one shares, the possibility of renewed existential solidarity is supplanted by the emotional shortcut that identifies in the other, in those who are not like me – be it for political, cultural, religious, racial, ethnic or linguistic reasons – the responsible and the guilty. The tragic irony of infectious diseases is that the one who is infected becomes the one who infects, showing the falsity of any simplification that aims at assigning blame to the other.
On a personal and social level, infectious diseases make our common vulnerability clear and should foster awareness of the need for shared solidarity: in our diversity, we are all equal, with the same predisposition to be infected and sick. If there are responsibilities – for example, related to our lifestyle, how we treat animals, how we encourage the passage of viral infections from animals to human beings – they must be identified so that we can intervene by changing the way we act and live.
Furthermore, since structural realities in the world that depend on injustice and poverty prevent access to basic diagnostic and health services, we must intervene by changing any unjust structure. As Paul Farmer reminds us, knowledge makes conversion and change possible on a relational and structural level.
In tackling any complex and difficult problem such as the coronavirus pandemic, an ethical commitment aims to promote concrete projects that open possibilities for moral action and encourage change. Concretely, the ethical tradition considers health as a precious, indispensable and essential good for individuals and for the whole of humanity. Consequently, everything that protects and preserves the health of citizens and the environment is an ethical priority and requires appropriate and proportionate commitments and investments. Investing in what promotes health is to focus on the future, whether it is to develop basic health facilities that provide primary care, or to foster advanced scientific research capable of developing new forms of prevention, diagnosis and therapy for multiple diseases.
Good “health” is – at the same time and inseparably – a good that is personal and social, individual and collective, local and global. Collaborations and solidarity commitments, aimed at preventing, diagnosing and treating, are for the benefit of each and everyone. The common good of health is vulnerable and requires protection and vigilance. We cannot fail to take care of the health of others, even if we are so focused on ourselves in an elitist and exclusive way, convinced that what counts and what we care about is only our individual health. Asking for the gift of a profound conversion of heart and mind can help us to become people of good will, capable of sharing the responsibility of promoting health as a personal and social good.
The Christian faith reinforces the urgency of ethical commitment to promote health as a personal and social good for everyone on the planet, for the current generation and for future generations. Moreover, an authentic Gospel experience rejects any attempt to find explanations, falsely considered “religious,” that attribute to God the responsibility for the bad things that are happening in the world. God does not send viral infections and pandemics as punishments for our wickedness and sin – be it personal, social or structural. The biblical God we profess is Emmanuel, God with us, the compassionate God who accompanies us in every aspect of our lives, who takes all our sins upon himself, who – as creator and re-creator – is at work to promote, heal and liberate creation and creatures, respecting both human freedom and that of the whole of nature and of the universe.
In the time of coronavirus, conversion also concerns the idolatrous images of God that continue to deceive us with false projections of a so-called “divine justice”, made in our image and likeness, instead of inviting us to contemplate Jesus Christ who died and rose again for the love of everyone and the whole world, and to live ahead of time in the light of the grace of the resurrection and divine salvation, which guide and accompany us from now and forever.
DOI: La Civiltà Cattolica, En. Ed. Vol. 4, no. 04 art. 6, 0420: 10.32009/22072446.0420.6
. G. G. Márquez, El amor en los tiempos del cólera, Barcelona, Bruguera.
. The letters were published in Swedish in 1885 and as a book in English in 1887. The Italian edition appeared in 1910.
. Paul Farmer is co-founder of the non-profit organization, Partners in Health, which aims to promote health for the poorest in various contexts around the world: see www.pih.org.
. P. Farmer, “Conversion in the Time of Cholera: A Reflection on Structural Violence and Social Change” in M. Griffin – J. Weiss Block (eds), In the Company of the Poor: Conversations between Dr. Paul Farmer and Father Gustavo Gutiérrez, Maryknoll (NY), Orbis Books, 2013, 95-145.
. At the time of writing (March 16, 2020), out of 195 countries the infection is present in 148. World cases have exceeded 169,387, with 6,513 people dead and over 77,000 cured. For real-time data, see https://arcg.is/0fHmTX/ See also E. Dong – H. Du – L. Gardner, “An interactive web-based dashboard to track COVID-19 in real time” in The Lancet Infectious Diseases: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30119-5/fulltext/ February 19, 2020.
. The Human Immunodeficiency Virus (HIV) compromises the immune system and causes Acquired Immune Deficiency Syndrome : see www.unaids.org/en/resources/documents/2019/2019-UNAIDS-data.
. See www.who.int/malaria/data/en
. See www.who.int/tb/data/en
 . Cf. J. Paget et Al., “Global mortality associated with seasonal influenza epidemics. New burden estimates and predictors from the GLaMOR Project” in Journal of Global Health 9 (2019/20) 1-12 (cf. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815659/).
. Centers for Disease Control and Prevention (CDC), Influenza (Flu): cf. www.cdc.gov/flu/about/burden/index.html
. The virus was type H1N1, with some avian influenza genes.
. The disease (Covid-19, from: COronaVIrus Disease-2019) is caused by Sars-CoV-2 virus. The acronym (Severe Acute Respiratory Syndrome CoronaVirus 2) indicates the severe acute respiratory syndrome caused by the virus. In both cases, the official names and acronyms were chosen by the World Health Organization.
. S. Jiangtao – W. Zheng, “Coronavirus: China struggling to deal with mountain of medical waste created by epidemic” in South China Morning Post, March 5, 2020: cf. www.scmp.com/news/china/society/article/3065049/coronavirus-china-struggling-deal-mountain-medical-waste-created
. Cf. M. Fisher, “A Guide to Worrying About the Coronavirus” in The New York Times, March 7, 2020: cf. www.nytimes.com/2020/03/05/world/coronavirus-interpreter.html
. Cf. W. Jenkins, The Future of Ethics: Sustainability, Social Justice, and Religious Creativity, Washington (DC), Georgetown University Press, 2013, 18.
. Cf. A. Spadaro, “The policy of the coronavirus. Activating the antibodies of Catholicism” in Civ. Catt. 2020 I 365-367.
. Cf. R. Girard, Le bouc émissaire, Paris, Grasset, 1982 (in English, The Scapegoat, Baltimore, The Johns Hopkins University Press, 1986).