By Pamela J. Downe, University of Saskatchewan

COVID-19 is dominating the headlines. Incidence rates, death counts, public health actions and risk factors are being updated at an unprecedented pace. Most anthropologists in Canada are witnessing the rapid evolution of the pandemic across many settings, such as workplaces, care residences and research communities. We must adapt our practices to physical-distancing measures, make more room for virtual exchanges and face growing anxiety. As anthropologists, we already know very well the complex character of COVID-19. Infectious diseases are not, and never have been, purely biological phenomena (although that is certainly an important aspect of any disease). The burden of disease and infection, which is never distributed equally, is borne and managed by families and communities. Communities made vulnerable by poverty, colonialism and repeated displacement, by homelessness, incarceration, war and political abjection will suffer, and are already suffering, the worst consequences of COVID-19. Families already struggling with chronic hunger, social ostracism, racism, violence and abuse will suffer even more as their daily networks shrink, their expenses rise and their savings evaporate. COVID-19 is, in other words, a syndemic. In each community, the novel coronavirus interacts synergistically with other illnesses and health problems, thereby exacerbating their risks and combined effects.

Over the past 14 years, I have collaborated with AIDS Saskatoon on several major projects. The people served by this organization (people living with AIDS, or PLWAs) are often affected by substance abuse, hepatitis C virus (HCV), human immunodeficiency virus (HIV) and type 2 diabetes. Homelessness, stigma and food insecurity are realities that PLWAs face every day. Because the majority of PLWAs at AIDS Saskatoon are Indigenous, they also live with the heavy legacy left by the Canadian residential school system and contend with the ongoing reality of child removal from the family home as well as discrimination when it comes time to find housing or receive health care or social services. COVID-19 does not evolve separately from these other issues: the virus is drawn into them, making their cumulative effects even more deadly.

The syndemic does not only affect individuals. It causes an accumulation of risks and health problems that splash across extended families. Parents, grandparents and other caregivers help one another care for children, a task they accomplish while continuing to encourage each other to stay on methadone treatment for substance use, to receive antiretroviral therapy for HIV and anti-HCV treatment, and to obtain some food from a food bank whose reserves have already dwindled. The physical-distancing protocols prescribed in response to rising coronavirus infection rates simply cannot be respected by those who live at the heart of such a syndemic. The collective provision of care (collective care) is the ethos of survival among the PLWAs served by AIDS Saskatoon. These people look out for one another. The call for physical distancing is therefore totally incomprehensible for this population affected by the HIV epidemic in Saskatchewan.

Paradoxically, today it is these same daily interactions and social networks that PLWAs rely on to survive that expose them more to COVID-19. This is a serious problem that has no simple solution. However, it is a problem that can be traced and communicated. Because of the long-standing relationship of trust we have with our interlocutors, as anthropologists we are in a better position than most public health and emergency service professionals to determine how syndemics manifest day to day and how individual burdens pile up and transform into collective distress. Moreover, we wield a vocabulary that allows us to contribute to public discourse and debate in a way that is not available to everyone. We can speak and write about the notion of « pluralea » politics, namely the many risks that neoliberal governments have engendered through privatization, deregulation and the erosion of public health services. Just as our analysis of syndemics highlights the synergies between medical conditions, anthropological models of pluralea reveal to us how political decisions, priorities, actions and individual inactions interact to then exacerbate social inequalities and community vulnerability.

Medical anthropologists have a particular expertise when it comes to the ethnography of epidemics. Under good management — as demonstrated by Rob Lorway, Janice Graham, Sylvia Abonyi, Vinay Kamat, Mark Nichter and Charles Briggs (among many others) — notions of epidemic curves, flattening the curve or calculating the basic reproduction number (R0) of the infection do not take precedence over those of syndemic dynamics and pluralea politics. The ethnography of epidemics adds an understanding of the community perspective on the implications and risks posed by COVID-19, which should be considered within the actions and interventions of public health authorities. In doing so, we contribute directly to municipal and regional efforts deployed to address situations of vulnerability that are so poorly and superficially described in journalistic coverage. We have a role to play in this crisis. It's up to us.