I have spent every Tuesday night for the last five weeks in childbirth class. Like many of my male classmates, I dreaded having to ask anxious questions about the physical experience of pregnancy. On our last night, the guest pediatrician also fielded questions about vaccinations. This welcomed change of subject opened a flood of questions by all sexes regarding their access to the H1N1 vaccine. I understood this to mean that everyone else also assumed they would be exposed to this flu strain, and therefore, anxiety over access to the coming vaccine mattered more than the coming winter season spread of H1N1.
I now knew that H1N1 fears would be part of our rite of passage into parenthood.
As a historian of medicine, a Latino Studies specialist and a one-time epidemiologist, I was already fascinated and appalled at the easy way in which news outlets connected Mexicans in the United States to the sudden appearance of a difficult to treat respiratory illness in Mexico City. In fact, the news of quarantine rendered the existence of Mexican communities in China, the Southern Cone and France visible to North Americans like me. Our concern with the vaccine in childbirth class meant, to me, that anxiety over domestic public policy was complicating the existing concern over the promiscuous ways flu viruses make their way across national borders.
Now, concern with access will not subsume the existing fears of contagion. News coverage in the last two weeks of April provided an object lesson in medicalized nativism - the use of medical language to justify the exclusion of a minority population in the United States based on their alleged ties to another country. Michael Savage surmised publicly that H1N1 could be part of a Mexican terrorist plot to destroy the United States, and Rush Limbaugh blamed H1N1 on the national health system in Mexico. Even The New York Times followed this racial framing, titling its discussion of the first confirmed death in the United States "Mexican Child Visiting U.S. 1st to Die Here Of Swine Flu."
News of a potentially pandemic flu in Mexico arrived in a country already debating the meager distribution of health resources, the status of public schools, the rate of job loss as well as the relative place of ethnic minorities in the political order. The fears of the flu will be a temporarily prominent part of a tradition in American culture that still has problems recognizing the long presence of Mexican Americans in the United States.
It is pretty clear that fears of outside contagion will be used to justify the exclusion and mistreatment of ethnic minorities already present in the United States. In the 1848 cholera epidemic, many Americans held the Irish responsible for the ongoing presence of cholera. In 1886, anti-Chinese activists used the rumor of venereal disease among Chinese women in California to give the Chinese Exclusion Act a medical underpinning, and this racial exclusion lasted past World War II. The presence of typhus among Jewish families in the Lower East Side of New York City provided a rallying cry to pass the 1892 Immigration act in order to cut the number of Eastern European Jews living in urban areas. In 1917, the United States Public Health Service started placing Mexican workers crossing into El Paso and Laredo in gasoline and vinegar baths to prevent the presence of lice and typhus in the United States, a policy that lasted through the 1930s. This vivid spectacle probably helped city authorities in El Paso justify separate Mexican and (white) American field hospitals to treat people suffering from the "Spanish" flu. Even domestically, separate black and white tuberculosis wards during the Progressive Era are another reminder that unequal public policies will shape the experience of illness in this country.
Since the promised supply of the H1N1 vaccine will not match the need or the demand, access to the vaccine and recovery from H1N1 seems far less amenable to short-term policy proposals and far more dependent on previous urban and social policy decisions.
The early symptoms of H1N1 are indistinguishable from other variants of the flu. Getting treatment for this flu will depend on each person and each family's willingness and the ability to find transportation to get to their family practitioner, if they have one. Successful treatment will depend on each clinic's ready access to Tamiflu, if federal mandates have made it readily available. In addition to the quality of medical intervention, recovery will also depend on the general health and immediate social networks of each patient.
I fear that urban mortality rates will follow the deadly geography of death that emerged in Chicago's 1995 heat wave, where few people and fewer city officials stepped in to offer a helping hand to older more vulnerable people in poorer, less politically-connected neighborhoods with very little street-life or everyday contact. Lurid comparisons with the vast number of people who died during the 1918 flu pandemic will probably be part of our experience of this epidemic. Paradoxically, our early exposure to the flu and our survival from the flu will probably depend on the same mundane factor: the quality of contacts we have built to connect us to other people.
John McKiernan-González is an assistant professor in the Department of History who researches the intersection of public health, civil rights and transnational social movements, along with American public health policies at the Mexican border, race and cross-border labor politics, and Latino public history.