Unnatural Disasters: On the Pandemics We Make For Ourselves

SINCE 1961, we’ve been witnessing a slow-rolling cholera pandemic. Unlike earlier ones, it began in Indonesia, not India, and moved across Asia and the Middle East. It reached Africa by 1971 and Italy by 1973. By 1991, it was in South America, where cholera had been eradicated a hundred years earlier. It killed at least three thousand people in Peru. In 1994, it reached the Rwandan refugee camps in the Democratic Republic of Congo. Then it moved on to the earthquake victims in Haiti. In 2008, it reached Zimbabwe, then wracked by a political crisis.

Until recently, it’s been easy to forget, sitting in Brooklyn or Chicago or Denver, that this is how many diseases work: cholera finds the hobbled, the dysfunctional, the disbelieving, the exposed, the weakened, the neglected, the forgotten. It’s a disease we have lived with since at least the fourth or fifth century BCE. It spreads by way of bacteria, not a virus, and the bacteria thrives in sewage, polluted water, mud, poverty, and crisis. It inflicts diarrhea, vomiting, and leg cramps, until the body is dehydrated. Most healthy people survive cholera; dehydration, septic shock, and death—sometimes within hours—come for the rest. Mortality rates increase sharply in any population that has suffered malnutrition, poverty, displacement, or other health risks.

Cholera still kills around ninety-five thousand people a year, a majority of them in Africa, South America, and Asia, where urbanization—not population density, necessarily, but the absence of sanitation and clean water that result from mismanaged urbanization—threatens to increase the death rate. Cholera travels through human and animal feces into the water supply. “To put it bluntly,” the World Health Organization wrote in 2018, “cholera spreads when people have no choice but to eat food or drink water that contain feces.” In 2018, more than two billion people used water sources with fecal contamination; 2.4 billion lacked basic sanitation services. Which is to say that cholera is a killer only when it finds the right environment. “Spread by the faeco-oral route, the disease affects poor people and the most vulnerable,” The Lancet notes.

The most vulnerable. Reporting on frontline workers during the early months of the Covid-19 pandemic caused me to look deeper at parallels between the outbreak in America and the long history of disease and empire. You might think from today’s American reactions that, as Donald Trump put it in mid-March, “We have a problem that a month ago nobody ever thought about.” The American memory is notoriously short, John Dewey warned us. Even the worst of the previous domestic influenza outbreaks are barely remembered. The experiences of disease in India and Africa and Latin America, of course, are well beyond the scope of most American media, which have long struggled to think clearly about the country’s influence abroad. We manufacture our own “progressive” projects, including endless wars and imposed “aid,” even as we court authoritarians in service of our bellicose empire. Some can see this now more clearly in the Trump era, but few have articulated what will end our long-gestating crisis. Like cholera and poverty, Covid-19 is not the crisis; it’s a disease that feeds on our racialized inequalities.