Javier Sethness: Communal Tears and Needed Repairs: On the COVID Syndemic in Los Angeles

Originally published by Ideas & Action, February 19, 2021

The collision between the novel coronavirus (COVID-19) and class society has proven devastating over the past year—especially here in Los Angeles, California. So far, across the globe, COVID-19 has infected over 100 million people and caused more than 2 million deaths. The U.S., which accounts for over 400,000 fatalities, is the world’s worst-affected country. More people have died from COVID-19 in the U.S. than did U.S. Americans during World War II, and life expectancy has dropped by a year. The coronavirus is second only to heart disease and cancer as the leading cause of mortality in the U.S. Grimly, a Kaiser study from September 2020 finds that “Black, Hispanic, and Asian patients [have] had significantly higher rates of infection, hospitalization, and death [from COVID-19] compared to their White counterparts.”

Though the experience with COVID-19 is usually referred to in the media as a “pandemic,” as opposed to a local or regional epidemic, so as to emphasize its global reach, it might be more honest and fruitful to consider this a “syndemic.” Such a shift in framing might parallel the  “medical model” being displaced by the biopsychosocial model favored in nursing. As The Lancet editor Richard Horton writes, “Syndemics are characterised by biological and social interactions between conditions and states, interactions that increase a person’s susceptibility to harm or worsen their health outcomes.” Professor Emily Mendenhall agrees, asserting that “syndemics allow us to recognise how political and social factors drive, perpetuate, or worsen the emergence and clustering of diseases.” Let us explore how this biopsychosocial or “syndemic” framework might be applied to the United States and Los Angeles in particular.

The COVID syndemic has vastly upset the normal functioning of the capitalist economy, both logistically speaking, as in the minds of many, who have begun to consider a syndicalist renewal through labor organizing. In light of the stark vulnerabilities faced by all workers, especially non-unionized ones, workers at Google and Amazon alike have taken the momentous step of organizing union drives. SEIU and the National Nurses Union (NNU) have been expanding their reach and negotiating life-saving protections for their members. Without a doubt, collective efforts to reevaluate and reorganize power at the workplace are urgent.

The International Labor Organization (ILO) recently estimated that the working class has lost at least $3.7 trillion in wages since the onset of COVID, and that more than 114 million workers have lost their jobs during this time. According to the ILO’s findings, women and young laborers have experienced the greatest setbacks in these terms. In Japan, where hospitals face collapse, COVID-19 has led to an increased suicide rate, including among women and children. As a primary-care provider with experience on a COVID isolation ward, I can confirm the negative psychosocial effects of the closures and losses on the development and mental health of patients, children and adult alike, and workers in the industry, myself included. The syndemic has disrupted human sociality and sexuality alike, exacerbating loneliness, frustration, and mental-health crises on the one hand, and resulting in resistant strains of sexually transmitted infections amidst reduced access to healthcare services on the other. Furthermore, bosses are taking advantage of syndemic conditions to union bust and ensure the persistence of proprietor despotism, otherwise known as “private government.”

Geographically speaking, Southern California and Los Angeles County are now considered the global epicenter for the COVID-19 syndemic. 3 million California residents have tested positive, and at least 33,000 have perished from viral infection. It will overtake New York for the state with the most COVID deaths this month of February 2021. Data from the census suggest that Californians, almost half of whom rent, owe $3.7 billion to their landlords. Intensive Care Unit (ICU) capacity in Southern California—which accounts for half of the state’s population—remains at 0%, and around 1 million Angelenos have tested positive so far. It is therefore difficult to fathom that Governor Gavin Newsom should reverse the state-wide stay-at-home order, as he suddenly did at the end of January. While many healthcare workers and public-health experts find this move disturbing, business owners have welcomed it.

In a demonstration of the hellish nature of capitalism, L.A.’s Air Quality Management District recently suspended pollution regulations governing the rate of cremation. Many of those who have died locally from COVID have been elders, “essential workers,” and/or people with other co-morbidities, especially diabetes, heart disease, cancer, respiratory conditions, and/or obesity. 

Reflecting the intersections of poverty, racism, historical and ongoing trauma, labor precarity, and caste-like oppression due to the combinations of capitalism, white supremacy, and borders, Black and Latino communities in L.A. have suffered disproportionately in the syndemic. Black people face a risk of mortality from COVID-19 that is three times higher than it is for whites. Black and Latin communities are receiving disproportionately fewer vaccinations against COVID, compared to wealthier, white communities. Latino workers, concentrated in the agricultural, transport, construction, healthcare, and domestic labor industries, often must reside in crowded living conditions to survive on L.A.’s expensive housing market, and so are highly exposed to the airborne virus. Accordingly, Latinos in the city—not just workers, but also their partners and family members—are now dying at a rate ten times higher than they were in November 2020.

COVID-19 mortality rate in Los Angeles County in early January 2021, by race/ethnicity; the yellow line corresponds to the Latino community, the green to the Black community.
COVID-19 mortality rate in Los Angeles County in early January 2021, by area poverty; the orange and yellow lines correspond to the poorest regions.

Politically, of course, the dethroned, wannabe fascist Trump regime bears much of the responsibility for this ocean of death. In early 2020, Jared Kushner scuttled a proposal for a massive federal testing program, when it became clear that such a program would have benefited the “blue states,” people of color, and immigrant communities whom the virus would affect the most. In his book Rage, journalist Bob Woodward reveals how Trump privately understood the real danger of COVID-19 as early as February 2020, all the while actively “playing it down” in public and scapegoating China, in an attempt to deny responsibility, reassure investors, and promote himself in the re-election battle, in keeping with the dogma of the “capitalist-realist” WASP ethos. Especially disgracefully, Trump promoted the use of hydroxychloroquine to treat COVID-19, despite many studies concluding the drug has no benefit for hospitalized COVID patients, and may even have fatal effects on the heart. He also advocated the injection of bleach, which can result in liver failure and death. 

After having lost to Joe Biden in November 2020, Trump became consumed with electoral conspiracies, and gave up what little responsibility he had accepted for addressing the pandemic. He fumbled on the distribution of the Pfizer and Moderna vaccines, once they first became available, needlessly causing more avoidable deaths. Up to 20 million of these vaccines, shipped by the Trump administration to the states, have mysteriously gone missing.

Being a truly sadistic, necrophilic figure who—like the Baron Harkonnen from the Dune universe—reveals the utter folly of capitalism and the State, the former president effectively called on his audiences to kill themselves and others, whether through denial of the reality of the virus, encouraging non-compliance with face-masks, avowing the injection of bleach or use of “hydroxy,” or inciting the storming of the Capitol and the elimination of his political rivals. Conspiracists even tried disrupting COVID vaccine distribution at Dodger Stadium at the end of January. These Trumpist and QAnon storm-troopers—overwhelmingly resentful white men, many of them business owners, backed by GOP billionaires—mean to uphold the racialized division of labor in the U.S. in spite of the great challenges raised against it lately by Black Lives Matter and the younger generations. In this way, the mob repeats the fascist backlashes against Reconstruction (1863-1877) and the twentieth-century Civil Rights Movement. In this sense, inflamed by white supremacy, the COVID syndemic is “the continuation of a trauma that has [long, if not] always been.”

Yet, even in the depths of a capitalist, racist hell, we can imagine intersectional communist heavens. L.A.’s cityscape has changed since the onset of the coronavirus, becoming even more dystopian than before. Many vital aspects of life have been abandoned, recalling the bleakness of films like Children of Men and Blade Runner 2049. The world is almost totally fragmented, and evidently upside down; it must be repaired. Though COVID-19 has not destroyed L.A. so totally as the Great Fire of Moscow did in 1812, as earthquakes wrecked San Francisco and Mexico City in 1906 and 1985, or as Hurricane Katrina despoiled New Orleans in 2005, it is still proving very disastrous. This is especially true for “essential workers” and their families, people of color, LGBTQIA individuals and communities, the unhoused, people with chronic diseases and/or disabilities, elders, and minors, among other vulnerable populations.

If we could only engage for a moment in “social daydreaming,” we Angelenos could empower ourselves in the face of the devastating COVID-19 syndemic by recreating the Paris Commune, a radical experiment in communal self-management which began, amidst a war with Germany, 150 years ago in March. Combining political and social revolution, the Commune sought to realize the egalitarian promise of the French Revolution of 1789, even as it was besieged and bombarded by the combined forces of the German army and the reformist French government. In the face of COVID-19, we could collectively and cooperatively renegotiate and restructure wages, rent, health, social protections, and urban planning, seeking to protect life, promote open common space, improve health, and maximize freedom.  More effectively than either Trump’s disastrous incompetence or the reformist measures favored today by Biden and Newsom, a revolutionary “L.A. Commune”—being at once local and international—could serve as a newfound, popular model for addressing the various social crises induced and exacerbated by COVID. Overcoming isolation and resonating regionally and across the globe, an “L.A. Commune” might avoid the tragic fate both of the present reality, as of the Paris Commune and the other radical experiments it would inspire, including the Kronstadt uprising (1921), which were crushed by the French State and the pseudo-revolutionary Bolsheviks, respectively. 

Short of such a dramatic recreation of some of the best aspects of modern history on a higher level, unionization and steps toward the collective self-management of housing, food, transit, and healthcare will be important measures for the treatment and prevention of the COVID-19 virus and its numerous associated traumas.

Javier Sethness is a primary care provider, author, and WSA member