Vaccines, Masks, and Routine Disruptions during COVID-19
COVID-19 has forever changed the world and our lives. As of the beginning of July, the total COVID-19 cases around the world is approaching 11 million. At nearly 2.7 COVID-19 cases and nearly 130,000 deaths, the United States represents 25% of the world’s cases and deaths despite being less than 5% of the world’s total population.
With the simple request of wearing a mask turning into a political issue rather than an essential public health issue, it is clear that the United States has failed to properly handle this global pandemic. COVID-19 is making a resurgence in the United States and wreaking havoc on southern states including Florida, Texas, and Arizona.
Contexts Magazine: Sociology for the Public has aimed to provide cutting-edge, scholarly, and research-based commentaries on the pandemic. We continue this work with our latest installment. Jennifer Reich provides an important commentary about vaccines, who may refuse them, why, and what the implications of the refusal may mean for the country moving forward. Simón E. Weffer-Elizondo discusses the complications of masks at work for essential workers. Cinthya Guzman’s essay illuminates the stress and strain of disruptions to normal routines and the “new normal” that Canadians and people around the world are facing.
-Rashawn Ray and Fabio Rojas
“Routine Disruption during COVID-19” by Cinthya Guzman
“The pandemic hit like a shock – it is not a change. A change is expecting Winter after Spring. This is like getting hit with a blizzard during Summer – you do not immediately know how to proceed.”
A year ago, I conducted research on 100 Canadians. I wanted to learn about the contexts that shape routines and emotional experiences, like boredom. The study used a 10-day experience sampling method (ESM) and interviews to provide a window into daily lives. Some had very routinized lives, others less so. Habits, I found, led to divergent experiences of boredom. People who constantly kept busy did not struggle with lulls; rather, they relished the opportunity to always find something new to do. Those who did not have similar habits often struggled to find purpose in activities outside of their routines.
Given the dramatic social impact of the Covid-19 pandemic, I followed up with the participants. This time, I sought to capture the impact of social distancing measures on our daily lives. These measures, while absolutely necessary for public health, have dramatically altered interaction and time-use patterns. We are physically constrained in ways never experienced before. As one participant put it, our social lives have become ‘smaller.’ But there are also opportunities to expand our social worlds in new and creative ways. The crisis, as the participant expressed, has completely shifted the forms of social contact. This has led to clear impacts on the self – namely, our routines, habits, interactions, and emotions. In highlighting these, I want to suggest ways in which people’s lives have changed from a year ago.
Radical disruptions to routines
The pandemic has caused incredible disruptions to daily routines and lives. Last year, the majority of participants were either employed, seeking employment, or retired. Now, many participants are unemployed or employed but absent from work.
Many participants now crave the normalcy of work life – independent of the economic security it brings. Although they feel far less rushed compared to a year ago, they are now more bored, anxious, and stressed. They feel that they lost the central organizing axis in their lives. The pandemic, they feel, has disrupted their sense of control. Leisure activities have also become far less pleasurable. Boredom, under these conditions, is a constant reminder that their time no longer earns them a living and is therefore less productive. Time, they emphasize, now moves painstakingly slow.
For those who are able to work from home, there are added stressors in having to juggle between work and family life in the same physical space. The ESM and interview data tell two stories: for some, time is now divorced from the pressure of productivity and performance. Boredom now invites new experiences and opportunities. Compared to a year ago, this first group of people talk far more about finding time for activities they always intended to do, like doing woodwork and growing gardens.
For others, disruption of work routines limits opportunities for the self. The second group talked more about needing to adapt to other’s schedules and routines. One participant, for example, spoke about her very routinized life at home while taking care of the children. The crisis, however, has completely changed that. She is now on her husband’s schedule and mimics his routine. There are also no divisions between the spaces they share in their home. Where once there were clear boundaries, there are none. She expresses that it has caused enormous stress, since she no longer feels that she can find time for the daily activities that used to bring her pleasure. In losing her daily routines, her sense of self has been affected.
As social beings, it is difficult to imagine a life with little to no face-to-face human interaction. But the pandemic made it a reality. In practicing social distance, many now feel disoriented. We need to interact with others to get a better sense of who we are as individuals.
A common thread in the data is a strong sense of discomfort in regard to limited social contact. In a society where we often resort to short-lived, low opportunity cost activities like scrolling through social media and texting, people are forced to find new ways to socially connect with others. For instance, participants report joining online community workout classes, mommy groups, and online binge parties – all of which they were not doing a year ago.
Participants now talk far more about the urge to reach out to others in their social circles. As one participant put it, we crave connection because we look for reassurance – much like Mead aimed to detail through his theory of the social self. For Mead, without the Other reacting to our actions, we cannot form a solid sense of our self. In moments of isolation, feelings of loneliness are not just reactions to our current condition; they are also a reflection of our fragile sense of selves.
ESM data details how the distortion of social contact caused by the pandemic has deeply felt impacts on the self. There are far more reports of being alone associated with generally negative emotional states. The interviews also point to a noticeable tonal shift compared to a year ago. Anxiety and worry loom heavy. Now, contact with others is for many a way to ‘hold on’. One participant, for example, spoke about daily check-ins with her close friends and family. She knows that they too are lonely – but she also wants to make sure that they are ‘still there’.
The social distance we are experiencing is unprecedented. It has brought to light that social connections provide much needed structure and contact. Ultimately, people are looking to instill new routines and maintain connections during these unsettled times.
Cinthya Guzman is a Doctoral Candidate of Sociology at the University of Toronto.
“COVID-19 Vaccine Refusal” by Jennifer A. Reich
The past few months have provided a peek into a future where a COVID vaccine is made and produced, and when a small but animated minority refuses it, claiming personal or religious freedom. In some cases, coordinated protestsaround the country have shown citizens holding signs insisting their freedoms have been violated by social distancing orders aimed at containing the current COVID-19 pandemic. In others, individuals have challenged requests that they wear masks to protect others around them. Though small, they signal what is likely to come as communities grapple with how to move forward, particularly if a vaccine against SARS-CoV-2, the virus causing the pandemic, becomes available. Despite broad enthusiasm for a vaccine, we will have to face hard questions of what to do with those who do not want it. For more than a decade, I have been studying vaccine refusal and the ways individual rights and community responsibilities are bound together and are sometimes in conflict. Now, as we face new questions about the COVID-19 pandemic and state responses, these issues are of critical importance.
Outside of the military, the U.S. does not have any existing laws to mandate vaccination and what laws do exist are enforced at the state or local level. All states require childhood vaccines as a condition for accessing schools or childcare settings, though states allow exemptions for medical reasons and sometimes non-medical ones. Although a range of vaccines for adults are available, they are typically encouraged, not mandated. The exception is for healthcare workers and students who face greater risk of becoming infected and spreading infection, particularly to those who might be most vulnerable to the worst outcomes of infection.
Childhood vaccines are recorded in state-run vaccine registries. These databases merge records from multiple health providers and allow families to more easily access their children’s vaccine records when needed. Registries also help states and local governments identify where pockets with low immunity exist and to act quickly to contain outbreaks. Although these systems are secure and allow individuals to opt out, they nonetheless raise concerns about what parents I spoke with referenced as “womb to tomb tracking.”
Even in places where parents are legally entitled to opt out of vaccines, states have the power during a disease outbreak to quarantine or otherwise limit freedoms of the unvaccinated. This right was affirmed in 1905 when the U.S. Supreme Court heard a challenge to a law that required residents to be vaccinated against smallpox or to pay a fine. The court ruled in that case, Jacobson v MA, that governments are entitled to limit individual freedoms for the good of the community, arguing that, “Society based on the rule that each one is a law unto himself would soon be confronted with disorder and anarchy. Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own… regardless of the injury that may be done to others.”
State powers are not absolute. Public agents must demonstrate necessity and cannot exercise power in “an arbitrary, unreasonable manner” or go “beyond what was reasonably required for the safety of the public.” There must be a clear relationship between the intervention and the legitimate public health goal it seeks to accomplish.
Since this 1905 decision, we have seen challenges to these state powers, which inform our current and future responses to COVID-19. In 2019, with measles outbreaks around the country, many cities worked to immunize those who were unvaccinated and enacted quarantines for those who refused. Rockland County for example, restricted the movement of people who lived in areas with high rates of infection, barring them from school until a threshold level of immunity was reached and blocking unvaccinated children from gatherings of more than 10 people. New York City went further and identified four Brooklyn zip codes with high rates of unimmunized children and measles infections and ordered anyone over six months of age who lived, worked, or attended school there to be immunized or face a fine.
When it comes to children, there is strong consensus on vaccines. Some advocates insist that access to vaccines is a core human right consistent with the United Nations Convention on the Rights of the Child, which promises children “special protection,” and opportunities to “develop physically, morally, spiritually and socially in a healthy and normal manner.” (Those who oppose vaccines make the same assertion.) With adults, these issues are more complicated, since adults’ rights to refuse healthcare, even when life sustaining, are well established and generally accepted.
Any vaccine to prevent COVID will have to face these issues. Should one prove safe and effective, there will likely be strong demand for it, as there has been for vaccines against other diseases. Even without a vaccine available, half of all Americans and 67 percent of those over age 60 say they plan to get the vaccine when it becomes available. When the polio vaccine was first licensed, there was more demand than supply and arguments ensued over whether it should be first given to those who could pay for it or to those at greatest risk, and who should decide. The response to one of the last outbreaks of smallpox—New York in 1947—also suffered from inadequate supply. Recent vaccine shortages have forceddecisions on how best to ration them. People generally want vaccines and see them as beneficial, but governments must strategize distributing them in ways that are just. Should priority go to older people who are most likely to be hospitalized or die if infected? Should vaccines go to essential workers first, and if so, which workers are essential? How should the vaccine be priced and should there be public financial support for it? How priorities are set, and by whom, will matter in building trust in vaccine distribution systems.
The harder questions are what to do with those who don’t want a vaccine. We already face challenges in finding ways to contain infection as cities, businesses, and travel systems are reopening. Arguments about a containment strategy less invasive than a vaccine, like whether to require a mask in stores or on flights, suggest this may be difficult to solve. Questions about how to handle vaccine refusal will become increasingly significant, particularly if evidence of immunity becomes required for participation in civil society. What limitations, we must ask, should be reasonably placed on adults who don’t want the vaccine and don’t have immunity from infection? State law may drive policies on this, but corporations and private entities may also be able to make vaccination a condition of employment or service.
During other outbreaks, employees in particular industries are often required to show evidence of vaccination or immunity to continue working. For example, hospitals typically require workers who refuse flu vaccines to wear masks and stickers on their badges to denote their unimmunized status or simply terminate their employment. Based on precedent set in the historic case of smallpox, states would likely be able to require COVID immunizations or exclude individuals without immunity from work. States could also force unimmunized workers to take heavy precautions to prevent them from infecting others, so long as scientific consensus exists. Yet, the state’s ability to “keep in view the welfare, comfort and safety of the many, and not permit the interests of the many to be subordinated to the wishes or convenience of the few,” as the Jacobson decision suggests, will not be easy.
Prior to COVID-19, we faced a social landscape marred by disputes over what constitutes fact, knowledge, authority, and the appropriate role of the state. COVID-19 did not create these disputes, but magnified them. The success of any public health intervention will rest on the public’s perceptions of the reasonableness of the proposed interventions. That may not be forthcoming.
In the past few months, many organizations have condemned potential future efforts to require vaccines, to track immunization records, or to make employment decisions based on vaccine status. In Colorado, one resolution additionally called on the Colorado Republican Party to affirm “the rights of citizens to live free of tracking and discrimination (medical tyranny).” Texans passed a resolution insisting that “healthcare decisions, including routine preventative care such as immunizations, should be between a patient and healthcare professional and should be protected from government intrusion.” Other states, including Wyoming and New Jersey, have organized efforts to limit vaccine usage or mandates. These resolutions, actions, and recent protests suggest that states’ ability to place community above individual preference will likely be challenging and challenged.
Vaccines are an important tool in promoting public health and have saved lives. Nonetheless, questioning state power remains important. In addition to controlling disease, the Jacobson decision was cited in 1927 to defend state-ordered sterilization to purportedly protect the “health of the patient and the welfare of society” by preventing the state from being “swamped with incompetence.” Just this spring, the fifth U.S. Circuit Court of Appeals used the case to validate Texas’s order to stop physicians from performing abortions during the COVID-19 pandemic. Balancing individual rights and community interests is complex and requires thoughtful policy makers and clear communication. The public also has a role to play in ensuring that state power is not used against those who are already vulnerable. This might indeed result in more protests but also essential conversations on how states can account for their efforts to protect everyone in the community.
Jennifer A. Reich is Professor of Sociology at the University of Colorado Denver and author of Calling the Shots: Why Parents Reject Vaccines.
“Sheltering in Masks at Work” by Simón E. Weffer-Elizondo
Mid-March, 2020 seems eons ago. On March 13th, I saw chaos as people tried to push their way into a Costco with a line that circled the entire building. I saw first hand a Trader Joe’s Frozen food section cleared out save for a few boxes of cod, and mainstream grocery stores with shelves cleared of pastas, paper goods, and cleaning supplies. While the Asian market near us was better, with only a run initially on rice and cleaning supplies. Mind you this is happening before Governor Pritzker closed the schools, and a full week before issuing the shelter-in-place order. I will never forget the images of hoarding sent to me by a friend who braved the Costco that morning: people with 5 packages of Costco toilet paper (with 30 rolls each), or a dozen gallons of milk, or 6 12-packs of macaroni and cheese.
As my colleagues discussed in earlier articles here at Contexts, there are tremendous disparities between who is “essential” versus those that can work at home (Pangborn and Rea), inequity around who can social distance (Higuera), and structural inequalities, not a lack of changed behaviors, that have resulted in the differences in testing positive and mortality for communities of color (Sanchez, Dominguez, and Vargas). Particularly in light of Higuera’s work, I want to discuss some conversations I’ve had with my neighbors here in Chicago. My family and I are lucky to live in one of the most diverse parts of Chicago. Albany Park, on the city’s Northwest side, is a collection of Latinx, Asian (though mostly Korean), White, as well as a predominantly East African group of Muslim diasporic nationalities because of one of the largest mosques and community centers in the Chicago area. Walking down Lawrence Avenue I pass taquerias, halal groceries, and Korean BBQ restaurants. In my 10 minute walk to the El, I can grab shwarma, kebab, pan dulce, or bulgogi. So as the COVID-19 virus spread, I couldn’t help but become an ethnographer, observing my community, and comparing it to the rest of Chicago.
I know quite a few of our neighbors both up and down our block, and in the wider neighborhood. I’m friendly with a group of Latinx men, a group of between 8-10 from Mexico, El Salvador or Guatemala, as well as a few Korean and Filipino neighbors. These Latinx men are a mix of day laborers, grocery store employees, cleaners, and restaurant workers, while the Koreans and Filipinas all work at local Aisan grocery stores. They are exactly the “essential” workers that most of America hears of, but doesn’t know. And in the past few weeks, we’ve communicated across our front stoops, from the safe distance of our front yard fence lines, or a Latinx version of the backyard conversations between neighbors on the 90’s sitcom Home Improvement. Where before our conversations usually revolved around fútbol, DIY projects, and what’s happening on our block/neighborhood, it should come as no surprise our conversations since mid-March have been around COVID-19.
One of the topics that we often discuss is the shelter-in-place order. While they will tease me that it must be maddening to be stuck in a house full of women (with my wife and 4 daughters), or ask my medical opinion (because as a Profe I must know medicine!), we also discuss the situation they’re in. Ignacio and Juan Carlos, work as the cooks at two neighborhood restaurants. Of all the men, their jobs have been impacted the least. While the hours have been shifted, they still fundamentally do what they’ve been doing ever since beginning at their respective restaurants: prep work and cooking. Ignacio actually isn’t worried at all.
I get there early in the mornings, and now the streets are empty. I’m just in the kitchen all day. Just me and the other cook, and then the owner in the restaurant. Just the three of us. Most of the time a driver from Grubhub or wherever picks up the food, that we leave on a table by the front door. Or the owner takes it to a car. That’s the only time any of us wear a mask, and it’s really only him. If I don’t talk to anybody, why should I worry?
Juan Carlos feels the opposite. If he could, he would stay at home. However, he knows he cannot afford it, in no small part because he sends between a third and half of his earnings back to Mexico.
I don’t like being around the other people at my restaurant. I don’t know where they’ve been. And my boss, he wears a mask, will wear gloves every time he gives someone an order. But he doesn’t give me anything. He says that since I’m in the back, and I don’t talk to no one, what do I need it for. But I figure, he’s talking to all these people, then takes of his mask and talks to me, how do I know I won’t get infected? [SWE: Would you like my wife to make you a mask? It’s no problem.] No, paisan, I think I’m just going to start wearing a bandana, if he likes it or not. He’s not going to pay for me if I get in the hospital.
I think Juan Carlos’ situation encapsulates the experiences of so many Latinx and Asian immigrant working in these “essential” jobs. They often support not only themselves, but the remittances are a huge part of their motivation. And Juan Carlos recognizes that only he can operate in his own best interest, his employer won’t.
Of the men I know, no one’s ability to work has been more impacted than Ferdinand has. He and his wife, along with a few other Salvadorans, had a business cleaning homes and businesses. Initially, there was an uptick in work for them, as more people wanted their homes cleaned and disinfected. Since shelter in place through, their residential cleaning has completely disappeared, as has the work they did at a few smaller Christian parishes and two synagogues.
It’s hard Profe, I mean, no one wants you in their homes. And I understand. And some are very nice. Apologizing. Promising to bring us back after, in the summer. But that doesn’t help us now. So know I’m out with the guys, trying to do some construction, which I did when I first got here. [SWE: Have you found any work.] Yes, Pedro (another neighbor) has helped me. He knows a guy who calls us. We’ve been doing roofing, and concrete work and some other stuff a couple days a week. But it’s not regular. Not secure. Hopefully when the weather gets better I’ll be able to do more. But who knows? The only good thing is my wife can stay with the kids.
We then talked quite a bit about being on work sites, if people were six feet away, had masks, or any other of the recommended actions. He just said simply “No” to each question, but didn’t want to talk about it more. I could see on his face that it bothered him, but that he also didn’t want to talk about it more. Perhaps because he understood the risk not only he was taking, but exposing his wife and kids to as well.
The Korean and Filipina women expressed the most anxiety of my neighbors about doing their jobs, do doubt because they work in supermarkets. Hayoon, a middle-aged Korean woman, has been wearing a mask around the neighborhood since early March, well before the shelter-in-place order. When I ran into her one evening back then while walking my dogs, I asked if she was sick, and her response was “Everything I hear from home (outside of Busan) is about how bad the corona is. I want to be safe now.” More recently, seeing her again while walking the dogs in the evening, she voiced her frustrations when I asked her about working at the market.
All these Americans, they love Korean food, want bulgogi or japchae or kimchi but they don’t see we all wear masks? All workers? All shoppers? Don’t they understand? Even with shield (a sneeze-guard most super markets have installed), I’m worried. I always clean extra after they come to my line. They young. Think they can’t get sick. Why can’t they be like Korean people? Asian people? Wear masks? They going to make me and all of us sick. Then what?
Hayoon here expresses the frustration that I’m sure many “essential” workers have, that while they (and their employers) insist on certain protocols, there is no guarantee that any of the shoppers would do the same—though she clearly drew a line between Americans (which I read as White) and Asian shoppers. Grace, one of the Filipinas in the neighborhood who works at the local Filipino market, expressed some of the same anxieties, though more targeted towards the younger, and US born, Asian shoppers, whom she thought were being unsafe, but also buying impractical things—lots of sweets and chips, and not enough staples, like rice. Though she was also very shocked at the panic purchasing, that came a few days later then what I described at the top—which saw her markets rice, pasta, cleaning and paper supplies sold out, though most of the rest of the store in good shape.
At the end of the day, these stories of my neighbors reinforce the inequality my colleagues discussed, as well as the concerns that these “essential” workers have. We know because of their social position in the labor force, they will be more likely to be exposed. But sadly they also seem resigned to it, because where else could they work? What else could they do? While the zeitgeist may be that they are essential, the reality is society, in its actions, make them utterly dispensable.
Simón E. Weffer-Elizondo is an Associate Professor of Sociology at Northern Illinois University.