It's over before it starts
Monkeypox, non-events, and the pandemic impasse
Time horizons
Today’s note is about monkeypox. Not the what of it, but the when of it.
Twitter is abuzz with speculations: What would it mean to mobilize a rapid response to monkeypox? There’s much to say here, but one answer struck me as particularly notable:
The premise here is that because current testing protocols involve reporting up the chain of hospital and health department hierarchies, and because this outbreak of monkeypox has some unusually elusive clinical signs, the “event” of monkeypox testing and diagnosis is too complex. Eventedness makes for obstacles and potentially deadly delays.
Testing, Dhillon argues, should be “as much as a non-event as possible.”
What is a non-event? And what would it mean to make disease into one?
The United States of Events
Thinking about disease for me is always situational — the disease I’m thinking about never feels singular. It’s always related to others. So a little on COVID, first.
I started this little newsletter in a moment that feels distant. It was January. Omicron unfurled. Opinions on the unfurling of this latest wave of COVID-19 by anyone with a social media account bounced endlessly.
I wasn’t sure how my own words would bounce in this mess. I felt compelled to prioritize a collaborative project I’ve been working on since 2020: an ethnography of the lives and labors of ICU workers during the pandemic in the US. I began writing a book on the project with my critical care physician colleagues.
There was a little public writing, too: a call for more tests, and some thoughts on the dangers of conflating vaccine hesitancy with vaccine access. And I put the finishing touches on my own book, which comes out in September (you can pre-order now!).
As Spring progressed, I focused on teaching a new course called “The Politics of Pandemics.” More on that in a post, soon.
Meanwhile, everything in the timeline seemed to be event-panic. An everyday person would think an everyday thought along the lines of “The latest pre-print said that the latest variant renders neutralizing antibodies useless!” This was supposed to change everything: how we see the world, vaccines, the public health apparatus writ large, the state and its obligations to bodies. I would see these and ask myself: Why is this an event? I mean, the US is a place that spins on events. Event planning is a profession. You pay someone to make a piece of life event-ful. News breaks into events.
I didn’t ask these questions out of a sense of superiority or dismissal, rendering the concern tweeted or posted or substack’ed invalid or credulous. I asked because of an ongoing sense of profound failure by the many ever-mediated medical experts to educate the public on the very basics of infectious disease — including the odd, fascinating, and terrifying different time horizons of disease. There are so many exceptions, to be sure: wonderful scientists, physicians, and public health professionals whose social media feeds are dedicated to demystification, clarification, and calming. But still: I have a sense that something got skipped over with Covid in terms of laying out the basics once they became known. One of those basics is time.
This is partly why I think people experiencing long Covid have faced such headwinds of credibility: how could something that feels so fast not end, and go on and on?
By Spring, opinions kept bouncing and they converged, at some point, around a perverse question: Is the pandemic over? The answer, from many: Yes. That which remains, live with it. It’s your choice! You’re supposed to live with the end. Even if it sickens or maybe kills you.
I found this very weird and very telling.
First, because it seemed as if for two years (and for many good reasons), Covid’s eventedness was all we could conceive of. And now it’s….over? The event is no longer happening? (And again, what about long Covid?)
The experts asserting the end have, as some have noted, received little pushback for their forceful and incorrect assessments. Some are posing the key question of how Covid is dissipating from the attention of those who traffic in garnering attention: publishers.
These are important concerns to foreground. And they also point to an enduring and complex association of temporality, one in which we are caught in a tussle between disease and endings. The anthropologist Bharat Venkat details this brilliantly in his book At The Limits of Cure.
The issue I’d point to is that with all the disagreement around Covid’s end, there is also a quality of eventedness that still suffuses it. It’s a temporal one. On one hand, we have a perverse and dangerous public consensus of comfort with Covid as an event that lies in the past progressive tense. On the other hand, when this mass disease that is supposedly over and done with does in fact surface in someone’s body, we conjure an event to diagnose it quickly: the event called “rapid testing.”
Cough or sniffle? Get a test, and you’ll know relatively quickly if it’s Covid or not. An event-temporality just out of the corner of one’s eye, sometimes, and ready at hand in others. In the rearview mirror but not out of sight. A sometimes-event.
And then came monkeypox.
Time for Containment
As of June 2, the World Health Organization says that 27 non-endemic countries have reported 780 cases of monkeypox. Several days ago, Gregg Gonsalves titled his moving piece in The Nation "550…and Counting.” The numbers are counting upwards.
These increased cases are new numbers, new cases, but they not by any means the first. This is not a novel disease, precisely (although novelty may indeed lie in its differences from other forms of pox virus outbreaks). Still, as Kai Kupferschmidt points out, there is a risk of ironing out and erasing the very real sickness and death that monkeypox has caused in countries where the virus is endemic. There were warning signs of broader spread, and they were ignored, Sarah Zhang notes.
A rapid iublic health response is happening, in different forms. There are diagnostics rolling out. And in some places, there is vaccination for people at risk.
Is this an event? And for whom?
Given the epidemiological profile of recent infections traced to sexual contact between men, Gonsalves has urged LGBTQ health organizations to take action. As trusted sources of information and services, these organizations could serve as the necessary and nimble actors for tracing and treatment within circuits of transmission. Some argue that a localized response is currently stymied by the limited resources available for testing and treatment and the testing pathways that wind through health departments and the CDC. Yes, you can get information on monkeypox on Grindr, but should you want care, many roads lead back to the CDC for the time being.
There is another wrinkle in time here: the latency period between infections and early symptoms and then between early symptoms and resolution. There can be an incubation period of 7-14 days after infection before a prodromal period begins, and after a rash appears, lesions may take weeks to develop and resolve.
What this entails in practice: there is an infectious disease whose lineage is still coming into view, and whose clinical signs may vary in their severity. The disease can involve a latency period. It is a disease of proximate contact: yes, sex, but also potentially other modes of contact with the virus such as via clothing and linens or toys. There may be bottlenecks in terms of testing and treatment, if resources are not amplified right now.
Amidst these uncertainties, there will be better information that emerges soon. Boghuma Titanji notes that “it is premature to declare that [monkeypox] cannot be contained.” Steven Thrasher points out that slow-moving epidemics can be devastating. In other words, there is much that is unknown, but containment must remain thinkable.
Pandemic Impasse
Back to the non-event. Would framing monkeypox as a non-event help us avoid the pitfalls of the response to Covid?
The challenge as I see it is to be honest about how disease enters into the space of everyday life. Anything less than that honesty will just result in another replay of some scenario designed decades ago. A time when mass disease was something imagined only to affect the Global South, and — here in the US — only to affect those whose value was held in question. In the scenarios played out in public health security courses (I had to take one in public health school twenty years ago), mass disease held together as an event as long as certain amnesias and inequalities held together.
But the utter everydayness of Covid has made life for everyone a series of disease non-events. Disease isn’t evented in the same way at the aggregate level (even as, for anyone who has lost a loved one to Covid, it of course it can feel like an event).
Perhaps we’re experiencing a pandemic impasse.
Covid has rendered our attachment to mass illness one that is anchored both in the past (“Covid is over because it’s mild now”) and in the contracted present (“Test and see if it’s Covid, you’ll learn the answer quickly”). It’s a present that chugs along, one in which we can’t quite shake off the disaster of the past several years, try as some might. It’s a feeling of the historical present, something that we might think of in relation to the ideas of Lauren Berlant’s pivotal text Cruel Optimism. In that book, Berlant explores the idea of the impasse as a way of thinking about the historical present: the impasse refers to the constrained ongoingness that we can feel as we muddle through a suspended now.
For Berlant, an impasse “is a space of time lived without a narrative genre” (CO, 199). There are also different kinds of impasses — “not all stretches of life and time in the present are suspended in the same way,” they note. That is what makes an impasse capacious: it can take on different registers of feeling adrift, of feeling stuck, of feeling dramatic without a given dramatic script. The political importance of the impasse is key for Berlant. Their task in the book is to assess
different styles of managing simultaneous, incoherent narratives of what’s going on and what seems possible and blocked in personal/collective life. We understand nothing about impasses of the political without having an account of the production of the present. (CO, 4)
For Berlant, the point isn’t necessarily to rupture the impasse into a dramatized and dramatizing event. If fact, they argue, the idealization of a dramatized event is precisely the problem: everyday life just isn’t lived that way for most people. If we are to truly confront our attachments to disease — and we have many, many bad attachments to disease right now — we have to own up to the temporality of attachments to disease we’re living with. The impasse is where we’re at, and describing its production is where we must begin.
This means, then, that confronting monkeypox might involve the uncomfortable but necessary engagement with the impasse of COVID. It seems unlikely that mass publics will face a new disease without carrying over attachments to the mass epidemic we are still living through. That sort of division-work, the clean lines of tucking one intimate disaster to bed and then going to check in on the one in the room next door, is a fool’s errand. There may be something worth thinking through in terms of what it means to absorb an intimate bodily threat in one’s everyday world.
Monkeypox is not COVID. It is a viral disease, yes. It has zoonotic links, yes. It can be transmitted between humans, yes. It is a disease of intimate proximity, yes.
Of course it is not the same. There are so many differences, and one of the most critical ones is that it must be confronted with tools both similar to and different from those mobilized for COVID-19. And one of those tools is a temporal one: one grounded in “an account of the production of the present,” as Berlant would have it.
It’s not enough to name the impasse; it’s crucial to describe it.
Even in an impasse, we can still: Name the disease, educate about it not through fear but through timely information (and there are webinars!), prioritize public health techniques tested for decades with other similar infections, remain sensitive to addressing intimacy and bodily proximity, and mobilize existing prevention and treatment regimes for those who want and need them. Frame it as global, which is is, without equating “global” to “inevitable.” Monkeypox is a virus and viruses become global because of mobilities: the transits of capital interests, environmental damage, and bodies, all which defy easy geographical bounds.
The virus does not care about your frameworks. But how we confront and live with the virus — that is something worth caring about. Description and action can go alongside each other.
If there is to be a legacy of the affirmation “Silence = Death,” one of the core lessons of HIV/AIDS, perhaps we might affirm that “Endings = Silence.”
This is part of what it might mean to account for the impasse. To insist that disease isn’t over, and to describe what that feels like, for now.