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Cornell University

Pandemics

Transcript

Eleanor Paynter

A pandemic is, in a critical sense, about movement as the virus courses through a body and between bodies, as it brings bodies to a halt, and prompts governments to regulate movements. What has COVID-19 shown us about borders and migration? And what do we learn about pandemics when we consider them in terms of migration and mobility?

Welcome to Migrations: A World on the Move, a series brought to you by Cornell University's Migrations initiative. I'm Eleanor Paynter, postdoctoral associate in Migrations and your host for this podcast that seeks to understand our world through the interconnected movements that shape it. Today, pandemic. It might be hard to remember, but just 12 months ago, we were still debating whether lockdowns and closed borders would be necessary to combat what at the time had just been labeled a global emergency. In late January of 2019, World Health Organization's spokesman Christian Lynn Meier told the press that borders should be kept open and that, “If travel restrictions would be imposed, we hope there are short lived as possible to try to continue the normal flow of life.” The WHO wouldn't declare COVID-19 a pandemic for another month and a half. But of course, borders did close. And around the globe people modified and limited not only international travel, but our local everyday movements.

In this episode, we think with sociologist Tahseen Shams about the relationship between pandemics and human migration in historical terms, and about how something like a pandemic shapes our relationships across borders. Then, with public health researcher Katie Fiorella, we ask what pandemics reveal about our interconnectedness with local ecologies and the various movements that affect our realities from the microscopic to the global.

As we put this episode together, we're still learning the extent of long-term effects of the disease itself. But from early in the COVID-19 pandemic, it was clear that the spread of this disease would have a differential impact across communities, highlighting some of the long-standing divisions, fractures, and gaps in our social fabric. In this episode, I'm joined by Dr. Gunisha Kaur, assistant professor of anesthesiology at Weill Cornell Medical Center and medical director of the Weill Cornell Center for Human Rights. Dr. Kaur is also a colleague of mine with Cornell's Migrations initiative through her role as faculty fellow with the Einaudi Center. Really glad to have her with us for these conversations and also for the perspective she brings from working at a New York City hospital during the pandemic. And of course from her ongoing work with refugees. We wanted first to ground our reflection on pandemics and migrations with historical perspective on this urge to close borders and to blame migrants for disease. We spoke with Dr. Tahseen Shams whose book, Here, There, and Elsewhere: The Making of Immigrant Identities in a Globalized World, takes this up as part of a broader discussion about the construction and lived experience of immigrant identities within and across national borders. Dr. Shams is assistant professor of sociology and the Bissell-Heyd research fellow of the Center for the Study of the United States at the University of Toronto. And her book focuses especially on religious and political aspects of immigrant identity formation, within this broader discussion, we were drawn to her use of public health and pandemics as a really interesting example of what she calls exogenous shocks. 

Tahseen Shams

I conceptualize exogenous shocks as an unexpected event, such as a terror attack or a global pandemic, that has originated from a foreign place outside of a state but has still impacted the society within it by disrupting the larger international order. These moments in the aftermath of exogenous shocks, I show, are important. They reveal how immigrants are vectors of globalization, who both produce and experience the interconnectedness of societies,  and exogenous shocks and their repercussions reveal where exactly the cleavages run between us and them in society, and how both immigrants and non-immigrants navigate those cleavages in their day-to-day lives. These cleavages are amplified by the unrest of these moments and almost always produce xenophobic backlash against immigrants and their descendants, something that I not only trace as they unfold in the context of South Asian Muslim Americans after different religious political conflicts, but also in the context of epidemics throughout U.S. immigration history.

Eleanor Paynter

So could you give us a couple of examples of those epidemics?

Tahseen Shams 

Yes, of course. The United States has, in fact, a long historical precedent in immigrant scaremongering in the face of global epidemics. Immigrants have been associated with diseases and have been perceived to threaten and contaminate the health of the American nation. We see, for instance, in the 1800s that Irish immigrants were blamed for bringing cholera to the United States. Italian immigrants for bringing polio and Jews for tuberculosis. In the 1900s, Chinese immigrants were similarly accused of spreading the bubonic plague. When the influx of Haitian refugees in the 1980s coincided with the AIDS epidemic, we saw that Haitians and Africans were blamed for the disease. Today in the context of the COVID-19 crisis, the coronavirus—having believed to originate in China—is feeding into pre-existing anti-Chinese racism. It's not something that suddenly has emerged because of the COVID-19 pandemic. And this is despite the fact that the virus that actually led to the outbreak in New York, which has had the largest U.S. death toll thus far, actually came from Europe.

During the Zika and Ebola outbreaks as well, that happened not too long ago, many segments of the American public blamed Latinos for Zika and African immigrants for Ebola—regardless of which South American or African countries the immigrants came from. The Zika epidemic had originated in South America and Ebola in Africa, and both these outbreaks produced shockwaves in the international order, the way that I have conceptualized exogenous shocks. And this is reflected by the restraints imposed on cross-border travel between the United States and not just the places where these events had originated. In response to the Zika epidemic, the Center for Disease Control and Prevention or the CDC, strongly advised travelers, especially pregnant women, not to travel to a long list of countries it identified as places of risk. Countries that also included places in South Asia, like Bangladesh, India, and Pakistan. These shockwaves stoke the nativist fears that already percolated against the broad category of migrants. And this is regardless where the migrants came from, when the migrants came, whether before or after the epidemic, for instance, and whether they had actually returned to their homeland while the outbreaks were still ongoing. The U.S. society's response to the Zika and Ebola epidemics highlighted again, as I said, not only the boundary between immigrants and natives, but also the ideological fault line that exists between conservatives and liberals when it comes to the issue of immigration at large.

Eleanor Paynter 

And it sounds like you're saying that some of that rhetoric and some of the even, let's say policy responses to the pandemic, have exacerbated existing anti-immigrant sentiment. Is it fair to say that they have also contributed to increase anti-immigrant racism, backlash against immigrants? I wonder, maybe I could pose this question to both of you Gunisha and Tahseen—Gunisha, I'm wondering also how you've seen some of this play out in your work in New York City during the pandemic? And maybe in your own research.

Gunisha Kaur

I think, yes, as we know, discriminatory narratives exist against immigrants. And we've seen that play out in our healthcare settings where one might be more hesitant to take care of an individual who looks like they're an Asian because especially in the early stages of the pandemic, when testing wasn't widely available, whether you buy into those narratives or not, there is an unconscious bias that gets built into your framework for dealing with individuals. So yes, I think certainly as healthcare providers, we did see that playing out. In terms of policy, it becomes increasingly complicated. Policy is used as a means to discriminate, so we've seen the pandemic used as an excuse to keep immigrants out and to curb migration. Even in categories where there is universal recognition of trauma or where people may be coming from, which is the category of asylum seekers, these public policies, because they're rooted in health concerns and public health concerns, they end up applying to those individuals as well which is something we don't see in really any other time. Asylum seekers are exempt from laws and restrictions that prevent migration, they're seen as a special category.

And in this pandemic, policy has been used to discriminate against them, even though they are the most vulnerable of vulnerable populations. And I think as we collect information and data and we recognize things such as COVID-19, or other communicable diseases, being worse in situations of poverty, or worse in communities that live more tightly together or have multi-generational homes, that data can be used against the population. And we have to be really careful to ensure that that doesn't happen. Because sometimes with the best of intentions, let's say with the purpose of documenting that Black or Latinx communities experience worse morbidity and mortality from COVID-19, we may accidentally be reinforcing discriminatory narratives. And, what we want to really prevent against is the narrative becoming that these are diseases of immigrant populations, or these are diseases of poor individuals, which is so easy to slip into when people have a fear for their own safety, security, and health. It's easier to blame an external force or the other than it is to not.

Eleanor Paynter 

Yeah and Tahseen, in your book, you talk a lot about both how these kinds of narratives affect individual immigrants and immigrant communities, but also how immigrants position themselves and and sort of navigate their own way through these narratives. I wondered if you wanted to say a little bit more about that aspect of your work.

Tahseen Shams 

I want to first preface my answer by highlighting the fact that—and this is in response to Gunisha’s comments as well—that a fact that often gets overlooked is that even for the migrants who are crossing borders, immigrants and refugees generally are relatively static compared to seasonal travelers. Unlike tourists and business travelers, who will travel back and forth across borders on a temporary but regular basis, we see immigrants and refugees who have settled in their adopted countries, their host lands fairly permanently. And often immigrants and asylum seekers, as Gunisha mentioned, are vulnerable populations, and their often limited resources, prevent them from frequently traveling. In contrast, as we have actually seen, in the context of the COVID-19 pandemic that cruise ships sailing for weeks, despite having infected people on board, helped carry the coronavirus around the world contributing to the mounting toll of cases and deaths.

Epidemiologically, and Gunisha you're the expert here you can inform us, but epidemiologically non-immigrant citizens are just as likely to be virus carriers than immigrants. And yet an immediate response from states in the context of epidemics and definitely in the context of the COVID-19 pandemic is to close borders to immigrants, to asylum seekers, and refugees. And those policies send a signal that fuels this perception that immigrants are dangerous, that diseases of any kind are external, they are results of people coming from outside of a state's borders inside and contaminating the national health of the population. This is one dimension of a larger nativist perception that affects immigrants in various ways, in contexts of different exogenous shocks, or in context of different national security crises. Right now, the security crises that we're talking about are not terrorist threats at this moment, but pandemics—a health crises. Yet, we see the same kind of backlash, the same kind of strategies that categorically imply that migrants are dangerous, that somehow the health of migrants are harmful for the national population than citizens. Whereas if we look at it objectively, scientifically, and epidemiologically, that's not the same. We are all likely to be carriers of the coronavirus.

Gunisha Kaur 

I wholeheartedly agree with that. I think there's pretty good data that indicates that immigrants and immigrant populations are healthier than the countries to which they travel. And that health advantage diminishes over decades. So they become more unhealthy as they live amongst populations of developed countries. So it's interesting, there's this fear of immigrants, but I think, in some ways, it's painfully transparent and obvious that public policy is politicized and utilized as a weapon against migrant communities. That while the data do not support that an asylum seeker is likely to bring COVID that those individuals would be turned away. If they are accepted, they would be detained in centers where they're far more likely to get COVID from other detainees than had they been released into an area where they wouldn't be in crowded conditions. So, I think what you're saying epidemiologically is absolutely correct.

Eleanor Paynter 

I love that you brought up the cruise ship example, too. I mean, it makes me think about how, in a moment, like a global pandemic, when the question of borders comes up, when those modes of travel are blocked, they’re talked about more like a temporary inconvenience, but we still kind of hold separate the idea of borders and movements. We keep them these very separate categories. One, the privilege movement of travel and leisure and the other, the borders as a security question—and that's the realm in which the asylum seeker and the refugee might fit.

Tahseen Shams 

I think that, as a migration scholar, what we are seeing in response to this pandemic—if we consider the pandemic as an exogenous shock—is a dialectical tension between globalization and territorialization. In my book, I don't only talk about pandemics and epidemics, but other political exogenous shocks as well as some religious exogenous shocks, and I use religion as a strategic lens to capture some of these false border ties. And with regard to religion and religious practices, a challenge that immigrant religious communities likely face during a pandemic is that religious communities tend to be global and transnational. They are observed and celebrated collectively. For Muslims, the Hajj, or the pilgrimage, is certainly a practice that is observed in massive numbers. The Hajj exemplifies both the transnational aspect of Islam as well as the territorialization aspect of it, and it doesn't have to be a Hajj. It doesn't have to be Islam. It could be generalized to any religious practice, given the structure of religions themselves. All Muslims in this case, regardless of race, gender, class, nationality, are obligated, according to Islam, to perform Hajj once in their lifetime if they can afford it.

But we are now seeing that even for those who can afford it, whether or not they can actually performed the pilgrimage is constrained by the fact that Mecca is inside the territory of Saudi Arabia. The pandemic has highlighted that to an even sharper relief, the borders are closed. So it does not matter if you can afford to do the pilgrimage, you just cannot go if you're not already within Saudi kingdoms territory. For most Muslims, the tangible part of the Hajj to walk, touch, and do the rituals in the same way that the Prophet Muhammad had done is just as meaningful as the spiritual satisfaction of having performed this obligation. The virtual Hajj or the virtual Eid prayers or Friday prayers or any kind of congregation obviously cannot match up to that experience. So, this is another way in which immigrants having been located in the multicentered relational framework at the center of this homeland, host land, elsewhere dyad that, that they are experiencing the effects of the pandemic, just considering the religious aspect.

Eleanor Paynter 

Tahseen’s framing of the pandemic as an exogenous shock, helps us focus on the multiple effects that our current pandemic has had on our perception of borders, who can cross them and when a border is a point of entry versus a barrier. As the COVID-19 pandemic has brought attention to people's movements, it also underscores the significance of global connections in part by interrupting them. I'm thinking of suspended travel for instance. You may have seen the striking photos of an empty Mecca. These are reminders of the global communities that gather there in non-pandemic times and of the connections that bind people across national borders, in diaspora, through religion and through shared practices.

Now, we continue to think about how pandemics exploit or interrupt forms of connectedness, thinking beyond the human. And to do so we turn to the concept of one health, or the idea that our health reflects our interconnectedness with one another, as well as with local ecologies. And so achieving optimal health requires paying attention to the relationships between animals, plants, microbes, and of course, humans at different scales from the microscopic to the global. A one health perspective also gives us a chance to think about the pandemic as itself in transit, and about the many kinds of movements that the spread of a disease can affect. To think about these entanglements, Gunisha and I spoke with Dr. Katie Fiorella.

Katie Fiorella 

I'm Katie Fiorella, an assistant professor at Cornell in the population medicine and diagnostic sciences department and the master of public health program. And so my work really broadly thinks about how environmental change affects human health and well-being. So I look mostly in global fisheries systems and how environmental changes, ranging from climate change to overharvest of fish species, and the governance of these how they affect human livelihoods, food security, and nutrition security. And I also think a good deal about sort of the feedbacks between these, so how do changes and people's well-being effect the ways that they manage resources? And how, by understanding sort of the intersections between human wellbeing and the ecosystems that support them, how can we better manage them and deal with some of these global changes that we're seeing more and more.

 

And so in terms of the COVID-19 pandemic, you've had some interesting opportunities to look specifically at what the implications of that are in, in large part because interrupted some work that was already ongoing. And so around Lake Victoria, where a lot of my work has taken place, we actually just conducted a survey in March, immediately preceding some of the lockdown measures. And so we've been able to continue following up some of those households over time and are looking to try to understand how are they responding to COVID-19? What are the particular concerns they're facing? How is it affecting their food security, their consumption of fish, and their fishing livelihoods? And at the same time, I've also been able to think about some of the some of the ideas that I had thought about in previous senses and in terms of people's livelihoods and their reliance on natural resources and how the pandemic may be shifting those.

And, and in the context of the pandemic, the thing that we're we've been particularly worried about is natural capital and that the changes in some of these other dimensions of people's lives, might particularly put pressure on natural capital to help support people. And so this is a framework that that is used in a lot of times in settings, like the fishing communities, where I work in Kenya to try to understand the complex things that people are sort of making part of their livelihoods.

And so in the context of the pandemic, we have a situation where there's pressure on human capital because of this disease. Then, because of the lockdown measures and the movement restrictions that people are experiencing, to try to very understandably control the disease, their impacts on people's financial capital, lots of job loss. And the worry is that then households will sell down their assets. And we'll be sort of closer to the edge and a lot of senses, we have lots of reports and projections about really frightening increases in food insecurity, and poverty as a result. And then we also see, because of these movement restrictions, as well as limitations on the ways people can engage their social capital, or the physical capital, that's in their context, too.

And so an example and you know, there have been reports in Kenya where people have less access to cooking gas, there's more reliance on charcoal, right? So I can't, I can't access the market that would previously give me this product I need to cook my food. So people might be might be more reliant on charcoal, something that that puts pressure on forests in some settings. And financially another thing that we worry about in fishing communities sometimes as well as sort of the structure by which people can access money if they need to, involves a lot of loans that have really high interest rates and might then might then cause people to sort of fish harder to try to make it up. So there are lots of ways that these sort of interlinking challenges that people face can ultimately put more pressure on the natural system. And the real worry with that, that is sort of a safety net for people in a lot of ways and that then if those resources are degraded, it ultimately hurts the same people kind of first and foremost, who rely on those natural resources for their livelihoods and their well-being.

Eleanor Paynter 

That's such a critical illustration of how a pandemic affects people's movements and their use of resources. Could you say a little bit more about the environmental implications here?

Katie Fiorella 

A while back with a couple of colleagues, we had written a piece that tried to understand how conflict and particularly armed conflict affected wildlife. And it struck us actually that a lot of the things that we had learned in that review of all of the different literature that thought about that topic was pretty applicable to this pandemic as well. And so what has happened in this armed conflict literature is that there have been some really high profile examples of where wildlife have thrived in the wake of armed conflict. And so one example is the demilitarized zone between North and South Korea. Because people aren't going there, this has been a really protected area, and you get reports of really thriving wildlife. That's also something we've seen during the pandemic, you know, people using these spaces less you hear reports about wildlife being present. You hear a lot of reports about greenhouse gas reductions. So these things seem really positive.

What we found in the case of conflict, at least is that is that in a lot of ways, they're an illusion. And the preponderance of effects of conflict on wildlife are really negative. And these are, these are due to a whole host of things, sort of the breakdown of institutions that support wildlife conservation, you know, less people and parks and providing monitoring. The movement of people can also be really hard on wildlife. And in a lot of cases, people who are in a conflict situation are in a bad position and trying to get by maybe much more reliant on wildlife to meet their food needs and or income needs. So you see more use of wildlife in those ways.

And so we sort of used this information also to suggest that the pandemic may really be similar that while we see some short-term effects that seemed positive for the environment, that the medium- to long-term implications are a little bit foreboding in the same ways that, you know, we see the breakdown in institutions that might have a real effect on some of our long-term conservation and wildlife protection goals. The movement of people could be problematic in the same way. We're seeing people moving from urban areas to rural areas, in response to the pandemic right through, you get a lot of people who may be we're working in urban industries that aren't operating at the moment, moving to rural areas, there's potential that there could be more pressure in those regions too that are sort of at some of these more wildlife frontiers. Similarly, alternate livelihoods and economies, potential to really increase people's reliance on some of these ecosystems and wildlife in them—so a really complex set of interplays. And I wish I felt more optimistic about some of the short term gains, but I think unlikely to be the sort of a long-term benefit.

Eleanor Paynter 

That's really fascinating, especially because, I mean, it's making me remember how many conversations people were at least trying to have at the beginning of the pandemic, thinking about these potential benefits—at least we're not driving everywhere, right now, you know, at least, there will be maybe some of these habits we can keep, and they will have a lasting effect. Your points are a little bit sobering in that respect. I wondered if I could ask both of you to talk a little bit about how this idea of “one health” or maybe “planetary health” is a useful concept for understanding your work. Gunisha, I wondered if it's relevant for your work directly in the hospital, or how you see some of what Katie is talking about maybe emerging even in your interactions with patients or in your research at the clinic? And Katie, I wondered if you could talk a little bit also about this, this concept and how it fits or doesn't fit with what you're doing.

Gunisha Kaur 

In terms of one health and how it impacts my clinic population, in terms of who I see with my research and then abroad, I think one of the things that we focus on very closely is the impact of biosocial factors on refugee health. So how does somebody culture or their geographic location or their political history impact their health? And so in that sense, it's not directly related, but in some ways it is. I mean, it's the concept that there are factors that feed into health, an individual's health, into, in my case, rehabilitation of refugees and migrants, that people don't see as a natural fit or people don't think of right away. An example of that might be how somebody's family ties and relationships play into disease transmission. We saw this in the Ebola outbreak in West Africa in 2015. You know, people were told that if a family member is sick, you have no contact with them. You have to stay outside the house in order to prevent disease transmission. And what we saw, and there were beautiful depictions of this really, of mothers hugging their sick toddlers. You're not going to get a mother not to hug her child who is febrile and feeling sick and vomiting, that's, that's not going to happen. And so, in our context, it's really looking at intercepting all of those different components, understanding them, so that we can understand somebody's health and how to best really advance their health in the context of those biosocial factors.

Katie Fiorella 

I think that's so interesting. And your sort of your description of it being about those intersections that really make a big difference, I think, I think actually really encapsulates so sort of this one health idea— that the reason we think about it as one health is that, that the interconnections really matter. And if we and if we don't get those right, then we don't get the health outcomes that we're hoping for in any of the systems separately, either.

So the research that we did tried to examine how people's fishing behavior was affected by their experience of illness from any cause, actually. And so what we found was that when people were sick compared to the periods of time when they were feeling better, they're more likely to be fishing in ways that were illegal and destructive. And I think this really underscores kind of the way the health of people and the ecosystem is intertwined, that they may not be able to attend to these environmental concerns unless their health is also taken care of. And so we really need to think sometimes in ways that aren't intuitive, about the interconnections that affect one or the other of these outcomes that we're worried about.

You know, I guess in in the setting, and Kenya where I work, I don't think that the interconnection between these things is opaque, like people see it as sort of obviously connected. But I think  sometimes in big picture terms, we tend to separate some of these animal wildlife and ecosystem and human health concerns in two separate places. And by bringing them back together we can do a better job, hopefully, and learn some important things about them.

Eleanor Paynter 

In a piece that you wrote for the Lancet in October, you write, and I'm just going to quote the closing of this piece: “In the aftermath of this pandemic, we should invest in robust social and institutional structures that strengthen households’ portfolios of diverse capitals and improve community resilience to all types of shocks. Such investments will help to forestall the feedback loops that erode all types of capital and lead to negative outcomes for health and the environment. If we do not rise to this challenge, natural resources will erode further and downstream effects on health and livelihoods can be expected.”

Katie Fiorella 

Yeah, yeah. I mean, I think that in a lot of ways, there aren't a lot of easy answers, like there aren't quick policies that are going to fix things. I think, sort of really, really thinking about the ways that a lot of households are tied to their natural environment and the ways that they can find more resilience in those systems and in the long term, sort of have safety nets, that mean that they can protect those resources that are really critical for them, will support their health and the health of the environment that we all depend on.

I think one of the things that we've seen, especially in this country, a lot of reports about and my research group and graduate student, Jeanne Coffin-Schmitt, are really investigating now is this question of sort of, how are people changing their behavior to sort of provide some more of this resilience that I think we all realized isn't necessarily in the food system for themselves. And so we've heard a lot of reports of you know, seeds being sold out, of record numbers of hunting licenses being applied for, and we just we just conducted a survey in upstate New York to try to understand how are people changing their reliance on things like hunting and fishing, foraging, gardening, use of backyard chickens? And you know, who is doing that? How does it relate to people's food insecurity, which includes both feelings of worry about the about the food system and not having money and other ways to actually access food? So we're also really thinking about that question and hopefully some of these local structures that that may ultimately be able to provide some more support for our system I think we're all realizing is too fragile.

Eleanor Paynter 

Thanks for listening to Migrations: A World on the Move, a podcast by Global Cornell's Migrations Global Grand Challenge, a multidisciplinary multi-species initiative that studies how the movements of people, animals, microbes, resources, ideas, and more shape our world. You can learn more about the initiative at migrations.cornell.edu, where you can also find relevant links from this episode. Follow us @GlobalCornell and #CornellMigrations. This podcast is hosted by Eleanor Paynter, migrations postdoctoral associate with the Mario Einaudi Center for International Studies and produced by Megan DeMint. Much of the podcast was produced at Cornell University on the traditional homelands of the Cayuga Nation, and we recognize Cayuga Nation’s sovereignty and the indigenous peoples who have lived and continue to live on this land. Our music is “Basically Really” by Steve Fawcett. Migrations: A World on the Move is available on Spotify, Apple Podcasts, Google Podcasts, and Stitcher.