Time Out: Monkeypox, Temporal Quarantine, and Queer Social Life
Time is not on our side.
It’s Vital Sign, summer edition: hallo from Berlin, where I’m parked for a bit to visit friends, eat lots of bread, build some collaborations for a new project on public health negligence, and just…sit still? I’m trying to exhale a bit before the launch of my book in a couple months (you can pre-order the book and read the Intro here!).
Being still is not easy for me. I’m turning to the signs in my neighborhood to keep me on the path.
Today’s newsletter is about monkeypox, and specifically, monkeypox and the problem of time. Here’s the gist: the convergence of the disease itself and the state response to the disease has pulled people out of social time, and into what I’ll describe as temporal quarantine.
Here we are, again
First, a rewind.
I wrote about monkeypox almost six weeks back to try and think about eventedness.
Six weeks later, things feel decisively different: monkeypox is very much present now, more intimate and close, immersive almost. We’ve gone from “yeah I saw one guy post a firsthand account of it on Tiktok" to “🐒💉” circulating on the socials as a self-identifier of the vaccinated self, marking the rollout of vaccines in urban centers in the US, UK, and Europe.
Discursively, we’ve gone from the important opinion pieces demanding vaccine access a month ago to queer folks in metropoles chatting everyday about knowing several people who have it, if not themselves. It’s not delimited to an op-ed. It’s in (some) bodies. And vaccines aren’t the only answer. Prevention and treatment both need acceleration. As Jay Varma and Joseph Osmundson argue, there must be a better, faster, and more comprehensive rollout of therapeutics. In the US, access to ticoviramat (aka TPOXX), an antiviral therapeutic, remains stymied by bureaucratic hurdles and delays because prescriptions must be routed through the Strategic National Stockpile.
It feels all so Groundhog Day, doesn’t it? Experts do their expert thing, and tell news outlets that the time window to manage a potential mass outbreak is closing. There are bureaucratic trip-ups and hiccups and naps by those in power utterly failing to file paperwork or inspect vaccine production facilities promptly.1 For monkeypox, add to the stew a moral panic promulgated by milquetoast homophobic conservative commentators mocking lines of people waiting for vaccines for their presumed sexual promiscuity. Abstinence-only messages fly around. Boring, venal, and utterly predictable. The pleasure police do not want you having contact, any contact at all.
But there’s something else going on here, something that makes the delayed and inadequate structural response even more venal, and something that makes the homophobic reactions to monkeypox even more distressing. That something is the time factor of both monkeypox and the response to it. Not just one, but both. I’m an ethnographer of medicine, so allow me to explain via the thing that connects anthropologists to physicians: a case study.
Rush to Wait
Picture it: Berlin, July 2022.2 It is Berlin Pride week, aka CSD week, and there are rainbow flags a-flying. There are parties and flyers for the “official” parade and flyers for the parades denouncing the colonial occupation and racism of the official one. There are drag shows in parks, and extra-long queues at bars and clubs. And, also, there is monkeypox (do check out this FAQ from Deutsche Aidshilfe on CSD week and monkeypox).
On a Thursday afternoon, I see an Instagram a post from a friend about one particular doctor’s office that seems to be offering the monkeypox vaccine to people who are not the doctor’s clients. This is novel: distribution of vaccine doses has been tightly controlled here, with only a set number of centers (such as municipal public health centers and community-based organizations) offering mass distribution and the remainder going to physicians who can offer it to their clients. And this matters: folks who are immunocompromised have been able to begin getting vaccine access, so I’m glad to know that, for instance, docs who practice HIV medicine can get (some) vaccines directly to their clients who need it. This is triage, people. We live in triage times.
I have put my own name on several waitlists, often after waiting hours on hold only to speak to a kind person who apologies that things are not moving more quickly.
But today, this tip seems promising. So the hubby and I, along with our close friend, immediately jump on the U-Bahn and head to said doctor’s office.
We find a sign on the door saying that all the doses for the day have been distributed; please come back tomorrow at 9am.
And we do. Friday morning, we arrive at 8am. There is campy dance music playing and at first I think: oh, this doctor knows what’s up. My sleepyhead takes another minute to register that the music is actually coming from the elevator repair guys in the lift.
There are already at least twenty people in a line that snakes up a curvy marble staircase for several flights. People see friends. It’s a decisively social space, one of nerves and also a little bit of hope, maybe?
Behind me, two guys are talking about monkeypox. And what one says sticks with me.
“I just don’t think I can emotionally deal with the possibility of being at home for three weeks,” he says.
He’s referring to the quarantine period imposed on those infected. The other agrees: this would be impossible. And, also, that he couldn’t bear infecting someone else.3
I want to turn and ask more about this, but the line starts moving, fast. Five people at a time. It turns out that this line is to put your name and phone number on a small post-it note, to be collected by a practitioner. She apologies profusely and passionately to everyone: it’s clear she’s frustrated. “I’m so sorry,” she explains. There just isn’t enough supply and they’ve already allotted today’s appointments. She’ll take our names and numbers and call us, maybe next week? She’s not sure when or if it will happen.
What is going on in this scene?
Temporal Quarantine
One might look at the scene from (at least two) different angles.
One is the structural angle — the basic fact that there is not enough vaccine, which creates a state of triage, and public health works itself out through waiting. What is waiting, exactly? The anthropologist Ghassan Hage describes waiting as
a conservative governmentality that aims at de-legitimising impatience and the desire to disrupt ‘the queue’ even in the face of disaster.4
For Hage, waiting is a deligitmising force. You need only look at the line to see this: we have a line of people who are actively working to protect the health of themselves and others and the line disrupts it. They are getting up disturbingly early to wait in a line to get a vaccine that is not a line to get a vaccine but a line to maybe get a vaccine later. There is absolutely NO vaccine hesitancy here. Most queer people I know are taking active measures to reduce the risk of infection and illness. This is a line of the willing, and the queue’s infrastructure is one of desire to not be sick. So on one hand, we have monkeypox as the interface between bodies who desire contact with others (sexual and otherwise), are doing all the things they can to avoid getting sick from that contact, and are inserted into a queue as a result.
But, also, there is a second desire: the desire to avert temporal quarantine.
It’s a desire best articulated by the person behind me in line: one hellbent on not winding up sick at home for three weeks, here three weeks to the 21-day mandatory quarantine that is required if one tests positive for monkeypox. The actual quarantine length is determined by states in the US. Germany’s Robert Koch Institute recommends a 21-day quarantine from the onset of clinical symptoms. It may be longer if there are still lesions whose scabs have not fallen off: the disappearance of rash and the resolution of lesions is the endpoint.
This isn’t any old quarantine, one of those CDC-mandated five-days-you’re-good things for Covid. This is almost a month. And a month during summer, and during Pride season. A month during the time of pleasures and gatherings and contacts and intimacies, particularly in places that actually have managed Covid decently, such that this summer is a summer of possibility.
Temporal quarantine has two sources here.
The first source is the clinical specificity of monkeypox itself. The disease may take weeks to present as symptomatic in any one body (although symptoms can emerge days after exposure according to some accounts — again, bodies are all different and this is both beautiful and complicated!). The symptoms themselves have a time horizon. There can be flu-like symptoms such as fever and swollen glands. There often can be a rash, and the development of lesions that can be incredibly painful. The rash then resolves, after some time, and the lesions heal, scab over, and the scabs fall off. This can take weeks.5
The second source is the structure of delay and deferral built into the vaccine and therapy distribution apparatus, described above.
We have a disease with protracted forms of exposure, symptom, and resolution. We have a structure to manage that disease with protracted forms of procurement, distribution, and access.
We have a time problem, friends.
Time May Tell
There’s something telling about the convergence of monkeypox and Pride…not just the debate of “is this a gay disease or not” but something deeper, something about the degree to which monkeypox is a queer disease because of its temporal qualities.
Queer studies scholars such as Elizabeth Freeman have posed the notion of “queer time” — a way of inhabiting time that does not accord with ordinal, heteronormative, state-imposed forms of progress-oriented life projects that Freeman terms “chrononormativity.” I won’t detail Freeman’s deeply complex ideas at length here. I simply want to note how she parses a distinction between temporalities.
What I see happening with the temporal quarantine is this: quarantine pulls someone out of queer sociality and isolates them at home for weeks. It pulls them out of queer time.
But it doesn’t push them into chrononormativity. It’s not as if those diagnosed with monkeypox and quarantined are pulled out of queer social worlds and thrust instead into the demands of a heteronormative, productive lifeworld. No: those in quarantine are in quarantine, out of time, and in an impasse of sorts.
And this is what I see as the venal, neglectful, and destructive force of the monkeypox response thus far. Every day that vaccine doses sit in freezers for sign-off paperwork by negligent bureaucrats (yes, this is happening in many places), every day that passes before governments realize that they need far more doses, every day that passes as arrangements get made on how to distribute and pay for those doses, every hour it takes for a provider to deal with paperwork to procure vaccine or antiviral doses…these delays are widening and deepening the risk we face.
It is more than a risk of disease.
That alone is terrible enough, painful enough: no one should suffer this.
It is also, tragically, the risk of being pulled out of time. A time-out from summer’s pleasures: Bodies touching. Connections forming. What-if’s unfolding. Social worlds cohering.
The very connections that sustain us.
I know this sounds like a hot take and maybe it is, but I worked in public health, and I know what rapid response can be, and this is not rapid.
Sophia Petrillo as ethnographic storyteller: discuss.
One might read this part as complicity in the liberal project of “no one is safe until everyone is safe.” I think it’s more complicated and will save that thought for another day.
Ghassan Hage, Waiting. Melbourne: Melbourne University Publishing, 2009.
This is all predicated on getting a test, one, and getting the test results, two. These are not fast matters right now. It can be devastatingly difficult to get tested, and there are time lags in the delivery of results. So, diagnosis itself has a time pressure that pushes the experience of disease further down the line.
It is painful indeed, as a medical person myself, to see preventive medicine being practiced the world over with a special brand of cretinism.