Reorganization and Remarriage

Please choose one of the following questions for discussion – (c.) Read Families Are Not Structurally Prepared for Covid 19
(Links to an external site.) and discuss the following —
What does the author mean by “not structurally prepared??”
What is cultural health capital??
What are the microadvantages discussed by Gengler?? Have you experienced either the benefit of a microadvantage — or not benefitted from a microadvantage — during the pandemic to date??
covid-19 is a make or break moment for u.s. experts by gil eyal
On February 25, Nancy Messonnier, Director of the CDC’s National Center for Immunization and Respiratory Diseases told reporters that the question no longer is if the Coronavirus epidemic will spread to the US, but “It’s more of a question of exactly when this will happen.” Soon after, the Washington Post reported a whistleblower complaint that US personnel interacting with quarantined evacuees lacked proper training and protective gear. In the following days, As the epidemic spread in the US, it also became evident that the CDC botched the development and distribution of a test for Coronavirus. And all along, viewers of White House press conferences have been treated to a new spectacle, repeated almost every night: The President and the nation’s foremost public health expert, Anthony Fauci, the longtime Director of the National Institute of Allergy and Infectious Diseases, sparring and contradicting each other. It has become clear that the Covid-19 epidemic is not only a global disaster, a collective and personal ordeal. It is also a make or break moment for the nation’s phalanx of public health experts. After years of declining levels of trust in experts, this could be one more heavy nail in their coffin or the tipping point from which will begin a restoration of the public’s trust in experts and expertise.
It is no secret that the Trump Administration distrusted experts from day one. The Federal Agencies where they work were gutted and muzzled. Many experts were sidelined or replaced by lobbyists and cronies. Inexcusably, the National Security Council’s Directorate for Global Health Security and Biodefense, entrusted with monitoring and providing early warning about emerging new pathogens, was disbanded by the Administration. None of this was surprising. I have studied the politics of expertise for over two decades and in multiple national contexts. Invariably, Populists do not like experts. They call them “elitists” and “globalists” and imply that they cannot be trusted. The irony of this moment is that the legitimacy of politicians now depends on the professionalism and technical competence of the very experts they denounced.
Yet, the problems that beset expertise are deeper and predate the Trump Administration. Surveys show that trust in the FDA, for example, declined from 80% in the 1970s to 36% in 2006. The EPA, OSHA and the CDC do not fare much better. Many people, including leading politicians from both sides of the aisle, reject or doubt the assessments of experts, even when they are supported by solid scientific consensus, regarding climate change, environmental pollution, GMOs, mammograms or vaccines. There is a systemic crisis of mistrust in experts. It can be traced to the combination and interaction between two factors: first, experts are called upon to provide advice on matters that are politically contested and create winners and losers.
Determining which illnesses count as industrial accidents, for example, may provide relief to one group of workers and deny it to others; while putting new financial burdens on one group of employers, and protecting the bottom line of others. Second, unlike the exploratory nature of basic scientific research, regulatory science is tasked with formulating binding rules like a vaccination schedule or “acceptable levels” of a pollutant. These rules are formulated by expert committees that take into account the state of scientific knowledge at a given moment, but they also take into account other considerations such as cost, timing and coverage. For example, the vaccination schedule arrived at by the experts combines many shots together to reduce the cost of multiple doctor visits and thereby reduce the burden on poor parents. Yet, as the state of the scientific art changes, the rules can quickly become obsolete or manifestly imprecise (e.g. the recommendations when and how often should women receive mammograms, or men be tested for prostate cancer, have swung wildly over the years). In public perception, the combination of these two factors – decisions that advantage some groups and disadvantage others, which periodically become obsolete and are replaced by new rules – can appear arbitrary, ill-informed and untrustworthy. It can appear as if life and death decisions, rules that decided winners and losers, were taken on the basis of arbitrary cut-offs. Experts can appear bungling and incompetent, or worse, corrupt and callous.
A crisis, however, does not mean the “death” of expertise. To paraphrase Winston Churchill, “expertise may be the worst form of reaching decisions, apart from all the others that have been tried.” Whatever problems beset expertise; the alternatives are worse. In the US, at least, regulatory decisions must demonstrate that they were taken in a reasoned, rational manner, and it is impossible to do so without showing that one has taken into account empirical evidence and expert judgment.
An epidemic, however, throws this crisis, the push and pull of contradictory forces, into stark relief. As a result, it can further undermine trust in experts. As more than 10 million Americans filed for unemployment, it is hardly necessary to point out that expert advice creates winners and losers. But the other aspect of the crisis is also on full display. Take as an example the widely reported case of the Washington State patient who was not given a diagnostic test for several days because according to Federal rules, she was not considered high risk (she did not travel back from Wuhan). As a result, precious time was lost to detect and prevent community spread. The rules have changed since then and today she would have been given the test. Before we denounce the rigidity of the rules, we should recognize that this is exactly how decisions should be taken during an epidemic. Errors and mistakes are unavoidable. An epidemic requires allocating scarce resources on the basis of expert assessments of relative risk. If a diagnostic test was given to any coughing, feverish patient that showed up in the emergency room, we would soon have found ourselves with no test kits at all and with no defenses against the epidemic. This means, however, that even when experts are making reasoned decisions based on the best available knowledge, even as they impose on themselves uniform decision rules to avoid subjectivity and partiality, inescapably they will sometimes be wrong and their misjudgments will become public spectacle, further undermining trust. And yet, the alternatives are worse. This is why the crisis of expertise is systemic.
An epidemic, moreover, brings the crisis to a make or break moment. If there is one lesson that we can learn from what happened in China, it is that the response to an epidemic becomes part of the very dynamic of the epidemic itself (witness the much higher death rate at quarantined Wuhan). This is doubly true when it comes to trust. How an epidemic develops depends crucially on people’s trust in public health authorities. You can do all the right things, but if people don’t trust you, they will stockpile face masks and fail to self-quarantine themselves. US public health experts are entering their make or break moment doubly handicapped. First, because the systemic crisis of mistrust in expertise that I have described has already taken a heavy toll on their credibility over the years. Second, because mistrust has an infectious quality (no pun intended). If political institutions are mistrusted, this can spread to the experts as well. Fauci and Trump may spar, but they also need one another (Pierre Bourdieu would have called this “collusion in conflict”) because when one is mistrusted, it may tarnish the credibility of the other.
At the same time, an epidemic may also be a moment when people are predisposed to change their attitude and trust the experts. An epidemic is a cultural frame. It foregrounds, trains attention on what in “normal” times is pushed to the background, namely our utter dependence on far flung and complex expert systems, on the experts who run them, and on the complex calculations that underlie their advice. It is a moment of emergency when we all listen closely to the experts and hope that they know what they are doing. Despite the spectacle of incompetence at the highest levels of the political echelon, it is also evident that there are deep reserves of professionalism, integrity and competence among the ranks of American public health experts, medical administrators and civil servants. It is their make and break moment now, and we should all be rooting for them.
Gil Eyal is Professor of sociology at Columbia University. His book, The Crisis of Expertise, was published by Polity Press in 2019.
Image by Steve Buissinne from Pixabay
families are not structurally prepared for covid-19 by amanda m. gengler
The novel coronavirus that causes COVID19 may not care if we are rich or poor, celebrities, teachers, or warehouse workers. But what happens after we get sick is another story.
In my previous research with families caring for children with life threatening and sometimes rare conditions, I found that even parents who ultimately accessed care for their children at an elite university research hospital were far from equally equipped to navigate the road ahead. As a result, they turned to very different coping and decision-making strategies as they slogged through the treatment, recovery, and sometimes—devastatingly—the death and dying process. As a result, they had very unequal experiences seeking help, coping with the experience of illness and uncertainty, and carrying the weight of grief.
Though young children thankfully do not seem to become severely ill from this virus, the experience of those who may become caregivers for a loved one of any age who has or may become critically ill with COVID 19 will likely mirror the one I observed in my study. Some patients and caregivers will be able to savvily communicate with healthcare providers. They may even do so through online portals they are already set up with and comfortable using. They are likely to have friends, or friends-of-friends, who are medical professionals. These connections may provide invaluable medical advice and guidance, help them interpret symptom severity, call in prescriptions, or otherwise pull strings so they can leap over the bureaucratic hoops they would otherwise have to jump through. Celebrities who have been able to get tested for the virus while tests are in short supply are one example of this. Others may not feel able, or know that they can, do much more than sit through a long emergency room wait to get help from a provider they have no existing relationship with.
Some households will be well-equipped with electronic thermometers, over-the-counter medicines, hand sanitizer, and household disinfectants. Others will not have these basics available to them and may therefore encounter frustration from over-burdened, highly stressed healthcare providers who want to help, but expect patients to be able to manage some elements of basic medical care and surveillance at home.
And some families will have well-stocked fridges, freezers, and pantries filled with comfort foods like chicken soup or ice cream, giving them a tangible way to provide some small bit of relief and succor to those in their home whose suffering—even with more mild cases of the illness—they desperately want to alleviate. Others, especially those who faced food insecurity before the pandemic and its accompanying economic disruptions, will have no cushion to fall back on and lack these basic “home remedies” as the pandemic goes on. This can leave caregivers feeling even more helpless with little to offer as they attempt to provide comfort and “TLC” (tender loving care) as they witness an ill loved ones’ pain.
These and other resources that help us navigate the healthcare system or protect and manage our health are components of what Janet Shim calls cultural health capital, and they can help people garner what I call “microadvantages” throughout the course of illness and treatment. While beneficial in all kinds of health-related situations, microadvantages can be especially meaningful when confronting an acute and alarming medical crisis. In these harrowing situations, these seemingly small advantages can add up to a smoother, or conversely, much rockier, experience. They can go a long way towards easing the physical discomfort those who are sick must endure, and without them, an already harrowing crisis may feel even more distressing and overwhelming.
A microadvantage can be as simple as having a caregiver who feels empowered to speak up and request an extra blanket, ice chips, or a medication adjustment in the often busy and chaotic hospital setting. Whether patient and caregiver self-reports of symptoms or side effects are taken seriously and acted upon quickly by providers, or one is able to comfortably administer medications at home when needed, can also make a real difference in a patient’s illness trajectory. Beyond the tangible physical benefits that may result, a caregiver’s ability to feel efficacious—in other words, that they’ve done something to directly alleviate their loved one’s suffering—can lessen the emotional burden they bear. This is perhaps rarely more important than when patients die, and caregivers are left wondering if they, or the institution of “medicine” overall, did everything possible to save them, or at least deliver the absolute best care available.
It is, in fact, in these end-of-life cases that microadvantages may be most deeply felt.
This is where COVID19, as experienced during this global pandemic, is even more profoundly cruel. As hospitals bar visitors to contain spread, even as patients may be dying, families will be unable to provide patients with the love and care that can help everyone meet emotional goals even when life-saving goals become unattainable. Families may also be forced to consider “virtual funerals,” or to grieve in solitude while in quarantine themselves. Within a culture that already struggles to incorporate death and dying into the fabric of life, it will be even harder for people to obtain needed social, emotional, and material support in these profound moments.
As families across the globe continue caring for loved ones with serious cases of COVID19, some will be more firmly anchored as they cope with the illness. Paying attention to how inequalities play out in seemingly small, everyday ways even within or secondary to the context of larger, more fundamental inequalities in access to healthcare, is important if we are to understand where families are left at the end of this road. These are deeply traumatic experiences. They will stay with the families who endure them for the rest of their lives. It is easy to underestimate how “huge” a few microadvantages along the way can be. It is vital that we do whatever we can to ensure as many people as possible can obtain them.
Amanda M. Gengler is an Assistant Professor of Sociology at Wake Forest University. She studies medical sociology, inequality and emotions, and is the author of “Save My Kid”: How Families of Critically Ill Children Cope, Hope, and Negotiate an Unequal Healthcare System.
Image by Sabine van Erp from Pixabay

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