Tag Archives: public health

Love in the Time of Coronavirus

21 Mar

My sixth-grade teacher pulled down the United States map. “This is New York, and this is Washington,” she told the class, on what could only have been our second or third week of middle school. “Not to take anything away from any of the other cities, but they’re probably the two most important cities in the country.” Airplanes had hit several buildings in them, she explained, and our lives were about to change.

I was eleven, and it was my first brush with a global crisis. Even for a hyper-aware kid, one who has a strong enough memory to still retain snippets of news clips about Bosnian Serbs while I played with toys on the floor at three or four at our house in Wisconsin, this was the first time the world had come close to me. Roger Angell’s snippet from the New Yorker that week, discovered years later, still rings true. No longer was history something that happened somewhere else.

But was it really, though? In New York, maybe; for an 11-year-old in northern Minnesota, life mostly just went on. Airport lines got longer (not that I can really remember what came before), and I recall a few some stray episodes of hysteria from others around me; 9/11 certainly informed my geopolitical conscience, but not my day-to-day life in any way. After that, there were snippets, mild crises of inconvenience that were mostly just cause for a little shared fun, like the Snowpocalypse that shut down Washington, D.C. my sophomore year, or the stray brush with a hurricane two years later. Any northern Minnesotan is accustomed to the occasional weather-driven shutdown, a snowstorm that pins us down and then brings out a burst of communal activity as we all shovel out together and then get on with our lives. The most recent, this past November’s snowstorm that ruined my Thanksgiving travel plans, is about as extreme as it’s been. I hardly expect much sympathy.

The arrival of the coronavirus, then, is my first direct brush with any sort of collective national crisis. A holding pattern of dread takes hold. Our sprawling and convoluted healthcare apparatus strains to its limits, and in Washington, at least some people seem to grasp the gravity of the moment and look to escape their regular state of sclerosis. But there’s nothing you or I can do besides wash our hands and lock ourselves in our homes. Perhaps the dread has less to do with the virus itself than the sudden reality of that sense of urgency that I preach to myself every week but have always forgotten by Thursday afternoon. We don’t know what we have until we lose it.

If this is to be my generation’s sacrifice, the postponement of a planned vacation down the East Coast next month is a small burden to bear compared to so many who came before, to say nothing of the scores who are now out of work. Still, it’s hard not to dwell, at least a bit: quarantine takes from me so many of the things that give me joy on this earth, sports and travel and dinner parties and game nights and the freedom to rove and revel and delight in the new. It threatens to leave me with more of the things that do not: devotion to screens, an already bad trend exacerbated; phone calls, which I irrationally hate; correspondence that slowly loses meaning over distance. I am among the world’s most incompetent introverts; or, perhaps, to borrow a phrase from a friend, maybe this sliding scale of introversion and extroversion isn’t worth much to us at all. I live for people, and I will interact with precious few of them in a meaningful way over the coming weeks, maybe months.

I’m still left with a few creature comforts in my 740-square-foot cell. I can see if TV has produced anything good since I stopped paying attention to it a few years ago, and I can delve into a stack of books I have at hand. Being stuck at home may force me to cook, an undertaking I always enjoy but am terrible at making time to do. I have a stash of booze and am learning the merits of the virtual happy hour. I may just have timed my entry into the homebuyers’ market perfectly. My athletic pursuits these days are of a solitary sort, and unless we go into total lockdown, I can still enjoy a good run or hike or ski if the snow should return. Color me torn: should I be pleased this has all come about during Duluth’s least pleasant season, a hope of full enjoyment of the summer ahead, or does staring out windows at drab grayness and fresh dustings just make it all worse? Excuse me while I go pop some more Vitamin D.

I become a creature of habit. Get up at the same time every morning, though I have no commute; just read things until eight, then log in and start my day. Meander the apartment and work in different positions. My normal work-related frustrations feel trivial now, especially for one whose job can go along with relatively little disruption. My tea water comes from a kettle instead of a water cooler and the coffee table holds less mess than my desk, and the company is poorer, too. But I can still plow through and learn how to manage a meeting on Zoom. Run, or at least walk, about the neighborhood after it’s time to sign off. If the routine gets stale, try something new, a midday break, maybe just a drive around for the sake of driving around. I switch it up: park in Denfeld and struggle up hills in Lincoln Park one day, head out to Stoney Point later in the week and scoot up to Knife River and back, take a moment to lose my eyes in the deep aquamarine of a Superior lake.

I tour my city at a safe distance to see how it’s coping. Runners and dog-walkers seem more eager to share a greeting, a glimpse of normalcy. Someone could run a good sociological experiment visiting the various Super Ones across town to see what different neighborhoods choose to horde. Downtown Duluth is dead now, though the people who stand on the corners and fight loudly with one another are somehow still there when I raid my office for a second monitor. I guess it’s reassuring that the Duluthians least likely to heed public health warnings are also among the least likely to interact with people who are jetting off to the global cities that have been the points of embarkation for this virus; I’m not sure if our status as an out of the way city might spare us the worst of this or leave us waiting for the damn thing to show up for another month after other places have recovered and moved on.

My reading choice for the first week of confinement has been Joan Didion, an apt muse for an era of societal reckoning, a literary voice infused with a quiet despair who nevertheless dispenses with the easy nihilisms of her era. She undermines the premises of unlimited freedom, whether Californian American Dreamers or a hippie generation and its offshoots in open rebellion against it, all while pushing to it herself with her omniscience. She’s striving toward something as a writer, some unseen truth behind the veneers, some logic that she, with her authorial power, can bring to bear on a world that would otherwise resist it. It is a Sisyphean task.

To be a witness to quarantine is to be a witness to the deeper chambers of one’s own mind. The process takes its toll: for all her blasé scrutiny of her world, Didion struggled mightily with her mental health. My own peaks and valleys are not so severe, though the topography seems a bit more accentuated from this single vantage point I now enjoy from my apartment windows. It’s harder to leave bed when the commute is just ten feet; harder to communicate with people who don’t always express themselves well in writing. I wake with a start at 3 AM one night and struggle from there, endure inconsistent heat and the croak of a lone crow and some inconsequential hockey revelation coupled with some weird childhood dream, a labyrinth of thought whose exit is hidden but still there for me. I retreat to my fictions to lull myself back toward peace.

Crises force us to find new founts of creativity, new ways to take stock of where we are. I was waiting for a bit of deliverance in Georgetown and Savannah and Key West; instead, I may have to find it right here in an apartment I’d thought I’d outgrown. I don’t know what my world will look like after the coronavirus, but I will take one bit of sage advice from those who have seen real disruption before: some things won’t ever be the same. As for what that new beginning looks like, well, that is a story I still have to write.

A Floor for the Stool to Stand On

1 Apr

Last Monday, I attend committee of the whole meeting, a soiree in which the Duluth city councilors all gather together to hear a presentation, often from a city staffer or some contracted party. Monday’s topic was the recent spate of heroin-related deaths, overdoses, and arrests in Duluth. (Though city officials use it, I am going to shy away from using the term “epidemic,” for reasons I will explain later.) It showed a proactive city response, one that has already heard Mayor Emily Larson’s call to fight back.  Duluth is basically doing everything right. And yet it still may not matter.

Mike Tusken, the city’s Chief of Police, gave the presentation. Duluth is lucky to have Tusken, who is on the forefront of tackling issues like opioids, and has worked with many partners to develop a comprehensive strategy. He continues a long tradition of creative, community-minded policing in this city. He repeated himself several times: Duluth cannot arrest its way out of this problem.

Not that it can’t try. The city has been remarkably proactive to date. Its arrest and seizure rates far exceed other parts of the state, even when accounting for the higher addiction rates. They’ve overheard arrested dealers saying they have no desire to ever return to Duluth, as the police are all over them here.  Paradoxically,  with a crackdown on the supply and no change in demand, the price only rises, and increases the incentives for dealers to try their hand in this market. Without a change in demand, there will always be a reason for people to try to match the supply and make money off of it.

Tusken spoke of a three-legged stool necessary to combat the opiod surge, and spent plenty of time on the second leg, treatment. The opioid task force has an embedded social worker on hand to help with outreach. Needle exchanges, methadone clinics, drug court, treatment programs: there are a wide range of options available to people at various stages of addiction recovery, though in some cases, long wait times leads to people slipping through the cracks. When these programs are effective, expanding them only makes sense, and the police appear to be doing a good job of tracking data.

Finally, there is an education component, and once again, Duluth is staying as close to the cutting edge as it can in making sure the education leg of the stool relies on serious research and study. The city dropped its old DARE program for fifth graders because studies found it ineffective; now, with a new curriculum that has shown some initial promise, DPD is ramping it up again, recognizing that middle school health class is often too late to make this connection.

In short, combatting opioids requires a comprehensive strategy, and Duluth has built a comprehensive strategy. And yet I still find myself taking a skeptical bent. The opioid crisis is much more than a public health issue. Hence my misgivings over the word “epidemic,” which makes it sound like an outbreak of some virus. Treating it as such misses out on yet another element at play, and may mistake the symptoms for the disease.

Chief Tusken was at pains to emphasize how opioids affect everyone. Yes, at times these addictions can hit people who’ve been on them for, say, a sports injury. And yes, as with any drug, there are no doubt plenty of people from wealthier backgrounds who end up on them, whether due to peer pressure or ennui or an effort to escape dysfunction in some less material sphere of life. But let’s not bury the lede here: this particular crisis grew out of a particular class of people. Those who are toward the bottom of the economic ladder, even if they do not necessarily use drugs more than those toward the top, are much more likely to suffer its negative effects. The increase in middle-aged white mortality in the United States—a stunning reversal in recent years, one that runs counter to trends in other first-world countries and even other racial and ethnic groups in this one—is among the non-college educated.

This implies that the problem is socioeconomic, which in turn implies a need for socioeconomic solutions. Better education, more reliable careers for those who don’t have an education: we’ve heard all of these before, and it adds up to the fourth leg of a stool. The stories from later that evening make it clear how declining economic station can lead to feedback loops and greater struggles. This sort of crisis is a call to find solutions, and this is, I suppose, why I work in economic development. We have a lot to learn about how to adapt to an economy that looks drastically different from the one that made Duluth a powerhouse of the industrial era. Even with this city’s relative success when compared to many of its Rust Belt brethren, there are a lot of people who don’t have obvious long-term roles to play in the economy. Regardless, stable incomes and meaningful work are part of the solution.

But for all these pieces coming together, for all the scholarly rigor in making sure they work, this approach can’t quite go all the way. Take it from the pioneers of the first study to document the dying white non-college-grad trend have just come out and said it: the crisis goes much deeper than opioids.  Call it psychological, moral, spiritual: without an underlying belief system that informs a conception of what a complete human life looks like, all the policy tools in the book can’t turn the tide. Perhaps we can learn a thing or two from the Mormons; whatever one may think of their faith, they’re keeping the American Dream alive better than anyone else out there. Perhaps we just need to do a much better job of thinking holistically, especially when it comes to an honest accounting of the more troubled portions of individuals’ minds that we can’t just legislate away. People who have fought addictions and won know this better than anyone. Without a solid floor to stand on, it doesn’t matter how many legs there are on a stool.