46 International The EconomistAugust 29th 2020
2 dnasamples after admitting sending pho-
tos of the bodies to relatives on WhatsApp
may have led to misidentification.
Guayaquil, a tropical business hub of
2.7m people, is still counting the dead.
They may top 10,000, which would give it
one of the highest death rates of any big
city. Yet it disappeared from headlines in
April and has had to deal with its trauma
alone. Most family members have received
no psychological support. This points to
yet another important characteristic of co-
vid-19—its mental-health burden falls un-
equally in different parts of the world.
This exacerbates suffering in areas that
failed to implement lessons from prior
traumas. Parts of New Orleans where black
people died of covid-19 at rates two to three
times higher than white people were the
same areas ravaged by Hurricane Katrina in- Then, racist housing policies had
herded minorities into low-lying areas.
Now, a higher share of minorities work in
front-line jobs cleaning hospitals or stock-
ing shelves. They also have more underly-
ing health problems like diabetes, often
caused by poor access to primary care.
The remains of the pain
Good leadership can bring people together
in a crisis. Polarising leadership has the op-
posite effect. In Brazil President Jair Bolso-
naro has echoed his American counter-
part’s claim that the economic fallout of
covid-19 is a greater trauma than the death
toll. In both countries social distancing is a
political statement. Even when hospitals
were full in Manaus, less than half of peo-
ple stayed at home. The local governor tried
to cast himself as responsible, but people
stopped trusting him after his health secre-
tary was arrested on charges of embezzle-
ment tied to a fake respirator company,
which she denies. Corruption was more
blatantinGuayaquil.Theombudsman’sof-fice is investigating reports that morgue
staffers demanded $700 from relatives to
return bodies, though most family mem-
bers are too traumatised to sue.
Chaos at the top makes it harder to grap-
ple with a harsh reality. Some stop believ-
ing altogether. Psychologists who set up a
hotline in Manaus were surprised to dis-
cover that even callers who had lost rela-
tives downplayed the virus’s role, claiming
other ailments ultimately killed them.
Many believe online conspiracy theories,
such as one claiming the state had exagger-
ated the death toll to receive more federal
money and another alleging that the cof-
fins buried in mass graves were filled with
rocks. Sônia Lemos, who ran the hotline,
said locals were going through collective
denial. “It’s a defence mechanism that
saves people from feeling responsible.”
There is a danger that political divi-
sions, social distancing and economic
woes will over time lead to a loss of togeth-
erness in the same way that displacement
after the Buffalo Creek flood gave “a degree
of permanence to what might otherwise
have been a transitional state of shock”, in
the words of Mr Erikson. Communities
cannot grieve together because the disaster
is ongoing and the threat has yet to disap-
pear, says Judith Lewis Herman, a psychia-
try professor at Harvard Medical School.
She describes three stages of healing: re-es-
tablishing safety, remembrance and
mourning, and reconnecting with others.
Social distancing complicates all of them.
And so like the pandemic itself, the psy-
chological fallout will require assessment
and adaptation. Many doctors are still fo-
cused on saving lives, but governments
and mental-health professionals should
start thinking about “psycho-social” inter-
ventions. In France “medical and psycho-
logical emergency units” offer one model.
Theywerelaunched torespondtomental-health concerns after a terrorist attack in- People are offered psychological sup-
port immediately, near the scene, just as
they would be offered paramedical ser-
vices. Four years after 86 people were killed
in Nice in a terrorist attack, the city has
broadly returned to normal, says Frédéric
Jover, the psychiatrist then running the
unit. But empty streets this spring brought
back ghastly memories. Nice reactivated its
unit to help people struggling with be-
reavement, anxiety and isolation.
The fact that covid-19 is slower than a
bomb or a flood gives governments and
ngos an opportunity to identify and deal
with mental-health issues before it is too
late. Fuelled by national protests against
racism and police violence, advocacy
groups in Louisiana are proposing policies
for a “racially and economically equitable”
covid-19 recovery. New York City’s health
department is hosting virtual town-hall
meetings for African-Americans, includ-
ing webinars about bereavement.
But it will not be easy to sustain the re-
cent surge in community organising and
mutual-aid networks (such as WhatsApp
groups to bring groceries to old people)
that have sprung up across the country. Fa-
tigue and forgetting can lead social net-
works to deteriorate, says Sarah Lowe of the
Yale School of Public Health. “Often people
are still recovering when resources are cut
off.” One of her studies found that a year
after Hurricane Sandy, which hit New York
City in 2012, mental-health outcomes were
similar across demographic groups. But
two years on, the poor were faring worse.
Poor countries spend much less on
mental-health services and their citizens
have fewer resources to get help. So healing
will have to come from the ground up. This
will require the creation of spaces—physi-
cal or virtual—for people to come together.
In Parque das Tribos Ms Baré organised a
WhatsApp group to distribute food bas-
kets. A local nurse used her free time to go
door-to-door checking on covid-19 cases
and eventually persuaded the city to send a
mobile-health station. Mr Kokama’s family
petitioned the courts for permission to
bring his body back for a 30-minute,
closed-coffin ceremony.
His friends and neighbours gathered on
a recent Sunday, the first time since the fu-
neral, settling into lawn chairs to watch lo-
cal dance groups perform to raise money
on Facebook Live. “This is still a cry for
help,” said Luciana Vasconcelos as she
painted her friend’s face red and black. She
added that Parque das Tribos owes its exis-
tence to a kind of collective trauma: indige-
nous people leaving the forest for the city
in search of a better life. A speaker boomed
out traditional lyrics with modern beats,
and a mobile phone on a tripod filmed the
dancers, some in t-shirts, others in beads,
Standing united in New Orleans all beaming with a stubborn sort of hope. 7