By Gordon Hull
As of this writing, approximately 421,000 people in the United States have officially died of Covid-19. We also know that this number is fewer than the number that have actually died of Covid for a variety of reasons. For example, early in the pandemic, there was nowhere near enough testing, and so many people who died of Covid-19 never received an official diagnosis. For that sort of reason, measuring “excess deaths” during a given period is one way to try to get a handle on how many people actually died of Covid-19. If n more people die during a given period this year than last year and/or typically, that number can be a useful indicator for how many deaths can be attributed to the pandemic.
Some of these will of course be indirect: people who didn’t go to the ER over a heart attack because they were afraid of contracting Covid, for example. The isolation of Covid may be driving an increase in opioid overdose deaths. Others will be direct, deaths where Covid was the underlying cause. STAT News is now reporting on the results of a recent study that takes a dive into this question, concluding that the overall direct Covid death toll is 31% higher than official figures. That’s the top line, and it means that the national number of Covid deaths is approaching 550,000. What should surprise no one (but is surprising, because deaths are so much more reliable for understanding infection rates than reported cases) is that the mortality data is deeply shaped by politics: excess deaths are a window into the sociology of the pandemic.
As the STAT News report noted, “the researchers found that unattributed Covid-19 deaths were significantly higher in rural areas than urban; in the South compared to other regions; and in areas with lower levels of education.” But the data is not just sociopolitical in the broad sense; it also appears to be political in the more narrow sense:
“Preliminary research by [Andrew] Stokes, [one of the authors,] which isn’t part of the broader study, explicitly examined the political correlations and found that excess deaths unattributed to Covid-19 are far more common in the most Trump-supporting counties, based on both 2020 and 2016 presidential election results, than in the least. In total across the country, there were 44 excess deaths that weren’t officially recognized as Covid-19 for every 100 official Covid-19 deaths. But the uncounted deaths are far higher in the 25% of counties with the most Trump voters in 2020, with 163 excess deaths for every 100 Covid-19 deaths. In comparison, there were just 18 excess deaths per 100 Covid-19 deaths in the bottom quarter of these counties.”
One of the mechanisms Stokes points to is around the politics of death certificates. Someone who never got tested for Covid – recall Trump said testing should be avoided because more testing would mean more cases – is less likely to have Covid recorded on their death certificate:
“In areas where the pandemic is downplayed or seen as a myth, the death reporting process leaves room for those who don’t take Covid-19 seriously to leave the virus off death certificates. Covid-19 is typically the underlying cause of death, leading to conditions such as pneumonia or a heart attack that is the more direct cause. In cases where someone hasn’t been tested, coroners are free to attribute a death to the more direct condition, and leave Covid-19 out entirely.”
The role of coroners turns out to be crucial. When someone dies at home – say because they refused to believe that they had Covid – their death is recorded not by a doctor but by a coroner or a medical examiner. “The study led by Stokes found that counties that used coroners, who are elected and can be laypeople, had higher rates of excess Covid-19 deaths than counties with medical examiners, who are appointed medical officials.” Leave aside the question of why we should elect lay people to be coroners! Elected coroners are subject to both political pressure (especially in regions with small numbers of voters) and pressure from family members who don’t want to admit that relatives died of a disease they are determined to believe is a hoax. Although tests can be given post-mortem, coroners may not do that, even if there’s no pressure – if nothing else, the testing can be expensive, and may have to come from the coroner’s own budget.
The article reports on other ways that death certificates can end up inaccurate, but it’s worth recalling Judith Butler’s work on the politics of obituaries here. In Precarious Life, Butler argues that we “have to ask, again and again, how the obituary functions as the instrument by which grievability is publicly distributed” and that “we have to consider the obituary as an act of nation-building” (34). She relates the following story:
“A Palestinian citizen of the United States recently submitted to the San Francisco Chronicle obituaries for two Palestinian families who had been killed by Israeli troops, only to be told that the obituaries could not be accepted without proof of death. The staff of the Chronicle said that statements ‘in memoriam’ could, however, be accepted, and so the obituaries were rewritten and resubmitted in the form of memorials. These memorials were then rejected, with the explanation that the newspaper did not wish to offend anyone” (35).
Butler underscores the political valence of refusing to mourn the Palestinians. The example also reminds us that obituaries depend on death certificates, and so the grievability of lives lost depends on the micropolitical practices of inscribing death on official paperwork. The result is a constitutive minimizing of Covid. The effect is not precisely the disavowal of loss, rather it’s an effort to channel loss, and define its meaning. You can and should grieve and mourn, but the meaning of your bereavement is constrained in advance. Your loved one died of “pneumonia,” and so avowal of your loss requires the disavowal of its cause.
Trump, of course, refused to make any meaningful public gesture of mourning for those lost to Covid; this is part of why it was so striking when Biden acknowledged them not just in a vigil the night before the inauguration, but during his inaugural address. Biden’s memorialization works to create a counter to Trump’s, and should be read as an effort to reconstitute the national community. As Butler writes:
“The prohibition on certain forms of public grieving itself constitutes the public sphere on the basis of such a prohibition. The public will be created on the condition that certain images do not appear in the media, certain names of the dead are not utterable, certain losses are not avowed as losses, and violence is derealized and diffused. Such prohibitions not only shore up a nationalism based on its military aims and practices, but they also suppress any internal dissent that would expose the concrete, human effects of its violence” (37-8).
Butler is writing about the grievability of the many thousands of lives American imperialism destroyed in the aftermath of the 9/11 attacks. But the point generalizes: if “each of us is constituted politically in part by virtue of the social vulnerability of our bodies” (20), a point forcefully underlined by the disproportionate impact of Covid on black and brown bodies, the politics of Covid death certificates both denies our vulnerability to a virus (an injustice to those whose lives it has ended) and inhibits a less violent politics that is premised on the recognition of it.
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