The Inequalities That Death Completes

Effect of socioeconomic inequalities on COVID-19 outcomes. Figure from “Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile” by Mena et al. in Science Magazine.

A BEYOND BORDERS column by David Krakauer, President of the Santa Fe Institute.

In what is widely considered the preeminent biography, The Life of Samuel Johnson, James Boswell declares, “It matters not how a man dies, but how he lives.” Johnson, of course, had more to say on the topic, making his equalizing point: “Disease generally begins that equality which death completes; the distinctions which set one man so much above another are very little perceived in the gloom of a sick chamber…” Johnson: Rambler #48 (September 1, 1750)

If there is one thing we have learned during these months of pandemic, it is that far from being indiscriminate in its actions, COVID-19 has attached itself to the lopsided superstructures of society in such a way as to brutalize some groups and only challenge others. The complex nature of this infection has revealed, through differential stresses, the inadequacy of both our understanding and control of cascading perturbations. And the great diversity of areas affected by the infection are only now being fully revealed.

In a recent analysis of 5,800 small businesses, published in Proceedings of the National Academy of Sciences, Alexander Bartik at the University of Illinois at Urbana-Champaign (with colleagues at Harvard and Chicago), reported that 43% of all businesses in their sample had temporarily closed as a result of COVID-19 and reduced their active employment by 39%. The average firm with monthly expenses over $10,000 had barely enough cash to survive for up to two weeks. In the U.S. alone more than 20 million people have been removed from the workforce.

The impact of the pandemic has been highly uneven sector-by-sector and state-by-state. In Pennsylvania, the Accommodation and Food Services industry lost 29.2% of jobs, Manufacturing 7.0%, and Health Care and Social Assistance employment 5.4%. Idaho experienced the smallest drop in employment at 1.8% of its payroll jobs, followed by Mississippi at 3.0%.

Leisure and Hospitality experienced the largest reduction in employment with the Accommodation and Food Services industry down 22.7% (3.3 million jobs), and the Arts, Entertainment and Recreation industry 35.2% (870,000) jobs as of August. Hawaii — the most remote state from the mass of infections — is down 54.3% (with a loss of 61,600 jobs).

The economic effects of the pandemic have been compounded by challenges to both physical and mental health. In a recent brief on “The Implications of COVID-19 for Mental Health and Substance Use” Nirmita Panchal (a policy analyst for the Health Care Marketplace Project at the Kaiser Family Foundation) and her colleagues found that “More than one in three adults in the U.S. have reported symptoms of anxiety or depressive disorder during the pandemic (weekly average for May: 34.5%; weekly average for June: 36.5%; weekly average for July: 40.1%).” They describe a related study in which 13.3% of adults resort to substance use as a means to manage stress related to the coronavirus.

Health-related concerns are concentrated along ethnic lines. In a recent paper published in Clinical Infectious Diseases, Don Bambino Geno Tai and colleagues at the Mayo Clinic report on “The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States.” They describe recent CDC data in which “21.8% of COVID-19 cases in the United States were African Americans and 33.8% were Latino, despite the fact that these groups comprise only 13% and 18% of the U.S. population, respectively.”

And complex variations in susceptibility and vulnerability are embedded within larger national variations such as those described in a recent Lancet paper by Rabail Chaudry et al. from the University of Toronto in which elevated COVID-19 caseloads were associated with countries with higher obesity, longer delays to lockdown, higher prevalences of smoking, and higher income dispersion.

I describe all of this, however obvious it might seem in retrospect from our improbable quarantine, to make clear the tangible properties and vulnerabilities of networks of adaptive agents that we call complex systems, and the impossibility of treating complex problems as if they were simple and easily modulated by intervening on a single dominant variable — be that mobility, social behavior, or even a vaccine. Few of the vulnerabilities that I have listed above are treated by the vaccine; they are merely obscured for a short period before the next perturbation arrives. The most vital thing we might learn during this period it is that complex crises require thoughtful, factual, ongoing and multiple, corrections. And that these should weighted appropriately — non-uniformly — across the heterogeneous domains that have been hit. Despite our hero-worshiping tendencies, future safety does not lie in the hands of another Edward Jenner or Jonas Salk, but in the concerted effort by society to accept complex connectivity and adopt new pluralistic methods that respect the density and diversity of global life.

From the Fall 2020 edition of the SFI Parallax newsletter. Subscribe here for the monthly email version, or email “news at” to request quarterly home delivery in print.



The Santa Fe Institute is an independent research center exploring the frontiers of complex systems science.

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Santa Fe Institute

The Santa Fe Institute is an independent research center exploring the frontiers of complex systems science.