On symbols and scripts: The politics of the American COVID-19 response

ABSTRACT

The COVID-19 crisis emerged during a divisive time in American politics. We argue that to unravel the American COVID-19 crisis—and to craft effective responses—we need a more sophisticated understanding of the political culture of public health crises. We use data from interviews and online media to examine symbolic representation of public health phenomena (masks; public health institutions) within the first months of the US epidemic. We show how political scripts about pandemic responses are shaped by, and align with, deeply-rooted social values and political cultures. Social processes of meaning-making help explain the evolution of increasingly partisan public health discourse regarding topics like masking and institutional trust. We highlight the lack of memorialization of deaths in America—that has not acquired the same polarized political meaning as other issues—to consider how and why certain issues gain political valence, and what opportunities certain acts of politicization provide in shifting public discourse. The coronavirus pandemic challenged the science of public health strategy, and the legitimacy of its institutions, with devastating consequences. Anticipating and understanding the central role of political cultures, cultural scripts, and meanings in positioning public health measures is essential for more effective responses to COVID-19 and future pandemics.

KEYWORDS:

• Symbols
• COVID-19
• cultural scripts
• masks
• CDC
• WHO
• memorialisation

Introduction

Since the beginning of 2020, Americans have engaged in making and remaking local moral worlds to confront constant viral threat, economic loss, racial injustice, and climate disaster—a confluence of long-simmering crises that have boiled over in the context of the COVID-19 pandemic and the last year of the Trump presidency. Divisive leadership has turned the American COVID-19 response into a polarising contest of entrenched value structures, even as COVID-19 continues to strain economic and social support systems. While much attention has been paid to the political dynamics shaping elite leadership decisions in responding to COVID-19 around the world, far less attention has been paid to everyday political cultures and how these shape citizens’ perceptions of pandemic responses (Gilson et al., 2020). COVID-19 policy measures are refracted through sociocultural prisms, through which citizens inhabiting (sometimes divergent) moral worlds see themselves, their families, and communities (Kleinman, 1988). These contribute to political cultures and scripts that inform how Americans perceive, and respond to, public health measures. This article argues that better assessing the central role of political cultures, cultural scripts, and meanings in our pandemic response can help us understand collective behaviour, and make future public health policymaking more effective.

The idea that cultural and social dynamics are essential to responding to a pandemic is certainly not new (Briggs, 2005), but the pace of this pandemic, and the acute social divisions it has fuelled in many countries, underscore the urgent need for social science approaches to understanding not just the social impacts of this virus, but the social dynamics shaping how it has been greeted by, and integrated into, our societies. Writing from the first and second decades of the AIDS pandemic, Paula Treichler (1999) presciently called for ‘an epidemiology of signification,’ arguing that our understanding of the various meanings and symbols of a pandemic as it moves through societies are as important as our biomedical understandings of how it moves through and among bodies (p. 39). AIDS, Treichler argued, was a ‘provisional and deeply problematic signifier’ (p. 41) of complex political and social realities – its meanings were the result of contested, highly politicised, fights over how the disease would be perceived, historicised, and integrated into collective imaginations. Following Treichler’s example, and recognising the particular challenges inherent in writing about the meaning of COVID-19 as it rapidly unfolds, we attempt to identify and explore some of the most salient and contested symbols of the pandemic so far. This article draws on ethnographic and secondary data to understand how these symbols have been politicised, what they mean to different Americans, and how they came to acquire these meanings.

The study of symbolic representation in politics is also not new. It owes much to the convergence of continental phenomenology and American pragmatism in the twentieth century, which resulted in symbolic interactionism. This sociological perspective operates on three premises: 1) humans act toward things based on the meaning these ascribe to them, 2) meanings come from social interaction with others in society, 3) meanings are accommodated and changed as individuals interpret their own actions (Blumer, 1969). In politics, this perspective has been used to show how political actors assume specific roles by deploying symbols meant to threaten or reassure (Edelman, 1964). As a currency of politics, symbols (any object endowed with meaning, value, or significance) play an important role in political mobilisation, political legitimacy, social differentiation, and conflict definition (Elder & Cobb, 1983). For this reason, we argue that the collective response to COVID-19 in the US is a useful venue to explore how contemporary symbols are politicised in American political life.

The COVID-19 pandemic triggered a profound process of social sensemaking. This is helpful for understanding the sequence of events through which cultural scripts and symbols operate. As an interactive process of enacting plausible explanations for managing disrupted social order, sensemaking is principally concerned with identity formation (Weick, 1995). Enactment occurs by constructing scripts that provide individuals with ways to think, act, and anticipate change. Similarly, people rely on symbols as points of reference that link ideas to broader networks of meaning. Both scripts and symbols serve to reduce complexity and establish a sense of control. Thus, they are primary instruments of organising, which serve as the basis for collective movements (Snow, 2001). As we shall illustrate, three sources of signification–masks, public health agencies, and memorials–show the complex ways in which COVID-19 has accelerated social change in the United States.

This paper focuses on three key symbols of the COVID-19 response in the US during the summer of 2020, drawing from an ethnographic project in a small Midwestern town as well as broader national-level trend data that contextualises this ethnographic data. The project in part demonstrates how conflict thrives in contexts where no (or few) mandates exist, and where communities are left to rely on social relations and collective reasoning to develop their own protocols for prevention. In the small tourist town in which this study was conducted, collective efforts for coronavirus prevention were maintained through April, but they dissolved by early May when the governor released quarantine restrictions and the summer tourist economy took over. This case study demonstrates the fissures that emerged in the US around some contentious issues (masks and public health institutions), while a potentially contentious or emotional concern (memorialisation) had yet to materialise in any substantive way, during the time period of this study.

Methods and context

Our study draws on methods used by anthropologists, sociologists, and historians to understand broad social dynamics in how large phenomena like pandemics acquire symbolic meaning. As described above, we used an interdisciplinary approach for interpreting how specific symbols and scripts of the US pandemic response became highly politicised, while others attracted little notice at all. Beginning in early June 2020, we developed a working list of keywords and symbols that were particularly salient in the US pandemic response and rhetoric. To do this, we followed the models of conceptual history and Raymond Williams’ (1976) keywords approach to cataloguing contemporary culture, which has been replicated and adapted in several different contexts (Bennett et al., 2005; Fleisch & Stephens, 2018; Leary, 2018; Shepherd & Robins, 2008). From this list, we then turned to ethnographic and social media data from existing research projects (described below) to identify key symbols that were particularly resonant or prominent in rhetoric about the pandemic. Discourses about masks and public health institutions were especially common and divisive.

In addition, we developed a list of symbols relevant to the pandemic which seemed notable for not having attracted partisan rhetoric or notable politicisation. While this list narrowed over the following months as more and more symbols of the pandemic were taken up and politicised by politicians and citizens, several symbols continued to attract very little national attention, and in particular, memorials to those who died were conspicuously absent from public discourse. Based on this several months-long process of symbol generation and narrowing, we decided to focus this article on the topics of masks and trust in public health institutions—which faced sustained and evolving politicisation throughout the early months of the pandemic—as well as the frequently overlooked and absent practices of memorialisation.

Our approach to exploring these prominent symbols and the political scripts that inform them draws on site-specific ethnographic data contextualised by broader national discourses across social and traditional media. Ethnographic data were collected in a rural Midwestern community that is largely white (96%), conservative (two in three people voted for Donald Trump in 2020), and Christian (two-thirds, and most are protestant or evangelical). Study participants were local residents of the County with a year-round population of around 17,000 people, although as a tourist destination, the population balloons throughout the summer to a population of 100,000 people. Busy weekends, such as Independence Day celebrations, have attracted a half-million visitors. We interviewed mostly year-round residents and some summer residents from June to September in 2020, quickly assembling the project amidst the biggest outbreak in the town, as cases hiked from eight to 200 within one month (see Koon et al., 2021). We expanded the study after the initial outbreak to better understand people with different political affiliations, income, occupations, and beliefs. The summaries included in this project were drawn from coding 81 formal in-depth 30–90 min ethnographic interviews with 87 community members, business owners, elected officials, public health practitioners, and healthcare providers; and twelve testimonials within two public discussions of the school board. This study was approved by the Institutional Review Board at Georgetown University.

We generated a preliminary codebook based on the symbols selected above; subtopics were expanded through the coding process. Two researchers coded interviews and were in constant discussion about the codes, definitions, and where they were applied. Since the aim of this paper is to explore several particularly salient themes from this broader research process, other data related to additional themes and topics is not reported at length here, but data was coded for many other COVID-19 related topics that arose in interviews. For this project, the third author analysed the extracted codes ‘masks’, ‘trust’, ‘CDC’, ‘WHO’, ‘burials’, and ‘funerals’ and put together analytic compilations and memos that conveyed the tensions among those within the dataset. Death, dying, and memorialising was an infrequent theme in interviews, in part because when the study was initiated no one had died from COVID-19 in the community; although, by the end of the interviews eight people had died. Using an inductive approach, the researchers returned to the data several times, discussing codes and themes, to agree upon a cohesive summary.

Site-specific ethnographic data was paired with data from broader national-level discourses on social and traditional media, in surveys, and across social networks. The aim of these secondary data sources was to contextualise how local discourses and political cultures resonate with, and sometimes diverge from, broader national discourses. Given that so many Americans relied heavily upon news and social media for not only information but also opinions about the pandemic, these sources provide an important source of data on the political discourses taking place across the country. Data sources include publicly-available Twitter, Facebook, and Instagram posts using trending hashtags and keywords related to the three symbolic topics chosen, gathered between June and October 2020. Primary (i.e. ‘masks’) and secondary (i.e. ‘face coverings’) search terms for each topic were developed and used to search and track social media on an ongoing basis; prominent hashtags such as #maskhole were also tracked. Given the volume of media data on these topics, our objective was not to explore every possible post, but to use observation methods to develop a sense of key points of agreement, disagreement, and tension, and common discursive strategies. Google trends searches on keywords helped identify key time points in the public discourses surrounding these topics. Finally, secondary data drawn from national-level public opinion surveys and relevant websites related to COVID-19 memorialisation, grief, and funerary practices were also used to contextualise and elucidate some trends seen on social media.

Conducting research on rapidly evolving cultural symbols and discourses in the context of a fast-moving pandemic and a period of national political crisis presents many challenges, and we have no doubt that some of what we observe here may change in future months. Taking an approach from Treichler as well as ethnographers who have contributed essential knowledge in the midst of ongoing pandemics such as Ebola (Stellmach et al., 2018), we approach this as an ethnographically-informed ‘history of the present’ (Foucault, 2012) that we hope will inform both policymakers and fellow academics as to how we account for political cultures in the midst of pandemic response.

Finally, our study incorporated important checks on rigour to reinforce our interpretation of the data in the context of an ongoing, and complex, pandemic. First, by using multiple sources of data, including peer-reviewed literature, media, in-depth interviews, and direct observations, we have triangulated our findings to develop a robust interpretation of social phenomena. Second, as outlined above, we reflected regularly and consistently throughout the process of data collection and analysis, merging our diverse anthropological, policy, and public health perspectives. Third, we engaged in peer-debriefing by presenting these emerging insights in a workshop of approximately 20 peers as well as through the journal’s peer-review process. In this way, the insight generated here is consistent with the conduct of rigorous interpretive research in the social sciences.

Masking

The politics of masking provides a clear articulation of symbolic representation in the COVID-19 response in rural Iowa. As a material object, the mask doesn’t inherently confer meaning – it’s a piece of fabric covering part of an individual’s face. Yet, even before the emergence of COVID-19, masks often represented a tacit connection to notions of individual autonomy and security. As a form of ‘personal protective equipment (PPE)’ masks are generally understood to protect their users (health personnel, industrial workers, and other technicians) from harm. While still largely assumed to be technical in nature, they can also signify collective well-being, for example, when used by health workers and food processors. Yet, in both of these instances, responsibility for protecting oneself or others resided with a relatively small segment of the labour force and for prescribed duration.

More broadly, masks also resonate with racist notions of who is entitled to conceal their identity in the US. Whereas masking has been used by white supremacist groups like the KKK and the Proud Boys to conceal identities and preserve notions of white decency, Black people wearing masks are all too frequently associated with criminal intent – a dynamic that stoked early fears in the Black community about wearing masks in stores. Following the outbreak of SARS in 2003, residents of many Asian countries became quickly accustomed to routinely and even symbolically wearing masks as a means of protecting others (Friedman, 2020). As COVID-19 emerged, Asian people were often targeted for wearing masks in the US and felt fears about doing so. Within several months, however, particularly in urban areas, social expectations rapidly changed. Masking became normalised in many areas through the combined effects of government mandates and widespread social adoption.

Nevertheless, major lines of fracture persisted in places like rural Iowa where no government mandates were initiated at the national, state, or local levels (despite the local public leadership requesting that the governor instate a mask mandate as cases rose exponentially). Without any policy measures, rapidly spreading discourses about what masks symbolised and how individuals and communities should respond fuelled social chaos. The political symbolism of masks in Iowa became a political fracture between right and left, real and imagined. Notions of liberty, choice, and personal freedoms became imbued in masks, designating political allegiance simply by wearing one. One woman expressed a common feeling that ‘I don’t wanna deal with being judged either way, whether I’m wearing a mask or not wearing a mask.’ So she stayed home.

Masking in rural Iowa caused people to reflect on their morals. Many people did not think masking should be political, such as a 38-year-old nurse who said, ‘COVID-19 should not be political. It is a pandemic and the fact that we have gotten to the point where it has become political has hurt us, it really has.’ Yet, the political arc of the pandemic has greatly influenced how people perceive the pandemic and, as a result, what people do or don’t do to participate in the project of public health prevention—a choice made possible without national, state, or county mandates. On the right as well as the left, we found deep-seated beliefs of moral superiority based on perceptions and practices of masking. This is an inherent conflict between divergent worldviews, centred around collectivism which emphasises social harmony versus individualism which prioritises freedom and autonomy. This divergence undermines social consensus and collective action in the absence of a strong policy direction.

On the one hand, many people described wearing a mask for collective benefits, such as protecting loved ones, or vulnerable neighbours. A 40-year-old working in tourism said: ‘if the employee was wearing a mask I just, I either wouldn’t say anything or I’d say thank you. You know it's not comfortable for them but if they're doing it, they're not doing it for themselves; they’re doing it for you.’ Another community leader exemplified this collective belief, ‘I’ve always looked at it as me choosing to wear a mask openly says that I care about your health and I care about my health and that’s something that I’m I personally in my profession as well as my personal life believe and so those are things that my family does.’ Another small business owner explained, ‘I feel we have gone so far from the general moral of what it is to be human and what it is to live in a community to take care of one another.’ She continued, ‘if you are a person that needs that sense of power then you don’t have that power somewhere else in your life. At least what I’m seeing here, I don’t like to generalize different groups. That is why a lot of people don’t like to wear masks; so, it is a lack of grounding.’

In contrast, others did not think masks mattered, in part because they did not trust data, science, and the media. This reflected a profound acceptance that coronavirus to be a ‘hoax’ that will go away ‘after the election.’ Some aligned the perceived coronavirus fallacy with other things they erroneously perceived as political (and unreal), such as the Black Lives Matter movement and murder hornets. Others simply thought coronavirus risks were overblown. A woman in her mid-thirties, who was openly skeptical of science and government, stated: ‘I don’t think masks matter at all. And I feel like with the facts that the, you know, the survival rate of this coronavirus is so incredibly high with the death percentage of like 2% or less or something like that the last time I checked. And now the numbers are being manipulated you know. You can go in from this time last year, what was the heart attack or deaths in the United States, even people who died from a car accident you know they tested positive for coronavirus they are lumping them in there.’ Young people were particularly individualistic in the ways they thought about masking. A bartender stated, ‘younger people hate the idea that we have to wear masks. And I saw that Walmart came out with the fact that all customers have to wear masks nationwide. And a lot of my friends just think it is super dumb and they think there is no point in it.’ A middle-aged mother and self-professed Trump supporter stated, ‘there’s no mask standard so I just think that people are overdoing it.’

We propose that opposition to masks is what endowed it with significance, turning something material into something political. This likely reflects a growing undercurrent of resentment that came to fruition with the ascendancy of the Trump-led GOP that effectively channelled resentment into rage. The politics of resentment are underpinned by a quest for recognition in the face of social inequality, marginalisation, and powerlessness in American society (Fukuyama, 2018). This is acutely perceived in rural areas. Our data suggest that while many thought that mask-wearing shouldn’t be political, they were also frustrated by the perceived moral superiority of well-educated progressives displaying them in the name of science, but also a conservative elite who flaunted their indifference. While many could readily identify collective benefits, often linking mask-wearing to protecting vulnerable loved ones or frontline workers, views remained coloured by class and gender differences. Thus, masks assumed a symbolic character, particularly as cases began reaching rural areas, and the end of the pandemic became less certain.

There are several responses to ambiguity that served to entrench political significance attached to masks. One is shaming, on both sides. Shaming as a cultural script serves at least two important purposes. It provides group affinity and exercises social control. In the absence of state-wide or county-wide mandates, shaming is a contested enterprise of coercing others to conform to a particular set of beliefs. In rural Iowa, the role of shaming in masking–to mask, or not to mask–was often what people in the community found to be the most frustrating aspect. A middle-aged woman in the health sector said, ‘I will do my best not to judge you. Can we all do the same?’ Another small business owner exemplified this argument, focusing on their right to act in a way that they feel comfortable without being shamed: ‘I want to sit here without a mask, I should be able to. Nobody should be able to judge me. But […] going out and doing stuff like that and then going around children, that’s not very respectful. Because the children don’t have that option to wear a mask or not to wear a mask. But then I’m exposing them.’ A high-ranking conservative elected official agreed, ‘I go to political functions. Like last night I was at a person’s home there were about 30 people there and some were wearing a mask so I don’t know what to say. I’m probably as confused as the next person as far as regarding masks.’ The social pressure around wearing a mask frustrated many people because they believed if masking was recommended, as opposed to mandatory, then they should have the freedom to follow their decisions without shame.

Some have argued that the fragmented nature of political institutions in the US led to a patchwork COVID-19 response, which resulted in inconsistent mask mandates nationwide, amongst other things (Carter & May, 2020). Moreover, in subscribing to a particular belief of the nature of the virus, the act of shaming is a process of social differentiation, which paradoxically enhances intra-group affinity. While this was often expressed with regard to political affiliation, there were also important findings around class and gender dynamics. A small business owner and nurse said that women are more likely to adhere to and enforce masking. She said, ‘When I think about like the people who come into the [sic, store], I mean, it’s always groups of women who are all wearing their masks.’ Other participants noted class differences in masking, stating that members of the upper-class’ actions aligned with a sense of being untouchable. A realtor stated, ‘and then you’ve got you know the upper class, who oddly enough – they’re [sigh] I don’t know, I feel like sometimes they feel a little invincible, but you know, a lot of those individuals I’ve seen are guilty of not wearing masks.’ However, an owner of a nice restaurant stated that entitlement among the wealthy had become particularly apparent amidst the coronavirus threat: ‘it’s that one segment of society that entitled, wealthy person that just wants to … they’re the one, they’re buying everything, so there’s nothing left for anyone else. No masks, just, you know, it’s the ugly American, it’s just that.’

A second response to accommodating uncertainty and managing risk is through avoidance. This is a possible explanation for why some individuals, perhaps fatalistically, relied so heavily on their spiritual orientation to guide their actions. Those who trusted in God felt that masking was unnecessary because they believed in God and lacked fear of illness (and knew where they were going if they died). For example, a couple with three young children stated, ‘We put our trust in God. There’s no fear. I mean, as far as our kids, I think on my part, there was fear. I don’t necessarily want them to get it, but I want them to build the immune system towards it. We are very against … the mass masking, but I will say when, I especially being from a small town. When I go out to Walmart and stuff, I do.’ Many people who connected religious beliefs to masking and building immunity were also hesitant to vaccinate their children and mistrust biomedicine in general. Even so, community pressures within contexts where masking was required caused many to fall in line, even when they vehemently opposed it.

While the strong anti-science and anti-government sentiment within this community predates coronavirus, the importance of disbelief becomes more relevant in the COVID-19 era. This is large because disbelief itself impedes people from wearing masks, and this is reinforced by a powerful sense of individuality and a right to ‘freedom’ from being ‘dictated’ to, as one school board member (and Libertarian) put it. Further, cleavages in collective interpretations of mask-wearing may be accentuated by social stratification due to wealth inequalities and the seasonal influx of tourists and summer residents. Across these conflicting narratives, however, we can see evidence of complex moral struggles negotiated not in isolation but through social interaction with others. Indeed, because masks were an entirely new addition to everyday life as the pandemic spread, they were especially laden with signifiers, meanings, feelings, and ideas about what is right for whom, and what really matters.

Public health institutions

The coronavirus pandemic forced communities to rapidly reconfigure their relationships as citizens to institutions that had rarely prompted much, if any, thought in the past. At the same time, national media and politicians were casting doubt on the decisions and guidance of these institutions, often from both the right and the left. Consistent with previous research on pandemic media coverage, this type of mixed messaging is common in staging a narrative from problem to discovery and resolution (Ungar, 2008). While institutional distrust was perhaps to be expected, what is more striking is the way that evidence communicated by these institutions also became highly contested over the initial months of the pandemic. By July, for example, a national poll showed that nearly a third of Americans did not trust statistics showing the death toll of COVID-19, and felt it was grossly inflated (Durkee, 2020). Posts shared widely on social media routinely called into question how deaths were counted, how test results were recorded, and how causes of COVID-19 deaths were catalogued. Many of these narratives were actively pushed or created by right-leaning media, and fuelled by social media posts by President Trump and his inner circle. Perhaps tacitly understanding the importance of blame in narratives of crisis (Seeger & Sellnow, 2016), President Trump consistently sought to undermine, question, and misrepresent statistics; at one point in May, he claimed, ‘Coronavirus numbers are … going down almost everywhere’ (Paz, 2020). These had a circular effect, both fuelling the disbelief over the impact of the virus (and thus impacting how people perceived risk) and further undermining trust in the institutions responsible for compiling and releasing the data.

This was exemplified by a radical transformation in how people thought about and responded to coronavirus. For instance, some reported not having given much prior thought to the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO). These individuals now found themselves constantly reading about the CDC and WHO in the news, online, and discussing their merits with friends and family. Thus, for many, these institutions were transformed into political objects during the coronavirus pandemic amidst acute ambiguity and uncertainty in the United States. In these conditions, mistrust proliferated in rural Iowa, where a retired educator explained, ‘we don’t have a trusted leadership, both at the federal level, at the state level, and probably even at the local level. Although, I think we trust more local people than we do at the state and federal. We don’t have a trusted source of information.’ This was also in part because national leadership, including President Trump, discredited the leadership and actions within both institutions. This was enabled by the increased polarisation and mistrust of science in the United States, but also the simple fact that the actual science was changing so quickly that many people did not know what to believe.

Science skepticism in the United States was ascendant prior to the emergence of COVID-19. Whether through anti-vaccination campaigns or climate change denial, the legitimacy of scientific institutions such as the CDC had been increasingly questioned on either pole of the political spectrum. While scientific expertise often assumes a performative quality in politics, lending support to pre-determined courses of action (Boswell, 2009), traditionally, stronger science yields stronger political arguments. However, the pace of technological change, inequality, and specialisation mean that its conclusions are increasingly difficult to understand by significant segments of the population (Giddens, 1990). Moreover, international bodies like WHO are victims of retrenched, insular, and nativist views suspicious of its multilateral governance structure. Thus, the guidance of bodies whose mandate is to provide for the social good becomes undermined. Like many political disputes, this is in part tied to the role of government in private affairs.

Many respondents said that there was general mistrust around the CDC and WHO because their messaging was changing so quickly. An elected official said, ‘You know you get the CDC at one point say don’t wear the masks, then the next time they are saying do wear the masks. Then we get the WHO saying don’t wear the mask, then the next time do wear the masks, but cloth masks are ineffective. So, who knows what is the truth and what is not the truth. ‘ Another participant said, ‘I don’t know if it was the WHO, or which health organization it was. But they said, it’s not spread asymptomatically. And then everybody was like, ‘what, what, what?’ And then they were like ‘oops, I spoke wrong.’ A tradesman agreed, ‘From the general consensus of people that I speak with, a primary example is Dr. Fauci. Originally, there's [pause] I don't know what forces are telling him, but originally he says ‘No, there's no need for a mask. We don't need masks.’ Um [pause] that was basically the gist of it: that masks don't do anything. Well, come to find out he's telling a lie. […] And then you know two, three weeks later it’s like, everybody should be wearing a mask. We need to wear a mask, and we’re trying to get masks out. And like the federal government does that [pause] that's very, very frustrating.’ Like this participant, many people did not know what to believe, or who to believe and entrust with their actions in part because they were observing, perhaps for the first time, science-in-the-making.

This was reinforced by people’s observations that what was known and unknown was constantly changing. Although by the time of the interviews, for example, masks were highly recommended and found to help, many people still did not trust this advice. For instance, an older participant said, ‘That phrase, ‘we really don’t know’ really sort of is the balcony phrase for what went on the past three months. We really don’t know. Oh, you should wear a mask, but we really don’t know. Oh, you should um you know, wash all your groceries, clean ‘em all off when you get home, but we really don’t know. Oh, you should maybe let them sit for three hours and make sure that they’re safe, but we really don’t know.’ A nurse exemplified this imbalance, saying, ‘And I know it’s a new pandemic, so even the experts are gonna, you know the CDC, I sometimes hear from other nurses, they’re like, oh wear gloves, don’t wear gloves, wear masks, don’t wear masks, especially in the beginning, you know? Everyone’s figuring it out.’ The confusion and doubt articulated by these participants reflect patterns of sensemaking that reject scientific recommendations in favour of plausible alternatives. This is at least in part created by media narratives of science and prevention that were evolving as the pandemic gathered speed, similar to previous pandemics.

The politics of science skepticism, symbolised by the deteriorating position of the CDC and the WHO, illustrates the destructive power of discourse awash in vapid imagery. Others have argued that the displacement of public policy by symbols and carefully fabricated narratives have created a postmodern presidency (Santis & Zavattaro, 2019). Social media platforms fuel, and also fail to moderate, such discourses. Postmodernism is a destabilising force, as it alters how society views the nature of reality, leading to unstable communicative practices (Aylesworth, 2015). This has led to a situation in which ‘words, symbols, and signs are increasingly divorced from real-world experience’ (Fox, 1996). Coupled with the fragmented authority of federal institutions, the postmodern presidency has been particularly troubling for developing a collective response commensurate with the scale of the COVID-19 threat (Dzhurova, 2020). Moreover, this is manifest in the incomplete scripts individuals in rural Iowa assemble to account for the conflicting array of political symbols.

On the other hand, some participants had a strong faith in the CDC and WHO. One participant said, ‘I’m not gonna listen to her [Republican Governor Kim Reynolds] about how to protect myself from getting coronavirus. I’m gonna listen to the CDC or the World Health Organization.’ An older small businesswoman said, ‘us older people who rely on data and science and research things and read, we were like, ok we’re sacred.’ Paying attention to CDC guidelines seemed especially relevant for business owners, who in the lack of state-wide policy demonstrated that they closely followed CDC guidelines for business practices. A community leader said, ‘we try to follow what the CDC has recommended to us in terms of masking. There are certain spaces where uh you know can we require all of our members and things to wear them that becomes a challenge too of what that looks like.’ The owner of a small childcare centre, for example, said, ‘We do follow the CDC guidelines and also we have a really good resource, child resource and referral. They’ve been very helpful with assisting.’ These cases suggest that even if there was mistrust in part around messaging for individual behaviour, there was some belief in sanctioned guidelines for formal settings.

The COVID-19 response illustrates the limits of science as an explanatory model which is symbolically refracted through negative portrayals of the CDC or WHO. Science is always incomplete, contestable, and subject to interpretation, a point conveyed by many respondents. Ambiguity around metrics, duration, and severity of the pandemic were a palpable source of frustration for many. This was dwarfed, however, by confusion over the efficacy of protection measures such as social distancing, masking, and business/school closures. Instead, public health agencies assumed a symbolic position of government indecisiveness and inadequacy. It is possible that political leadership also seized on the tenuous normative position of public health agencies to amplify doubt and cast blame. Indeed, it has become clearer that not only were public health agencies undermined in terms of their credibility, but their guidance was actively censored by political actors seeking to shape public perceptions. This likely contributed to unstable and unproductive communication channels.

Memorialising

Other aspects of the COVID-19 pandemic have not (yet) been significantly politicised, in contrast to how people have responded to masking and public health institutions. The list of less politicised aspects of the pandemic has notably become shorter, as political rhetoric around the pandemic and partisanship in responding to it have become ever more heightened. But it is still instructive to examine, as a counterpoint, an element of the response that has not merited a great deal of public attention or outcry. Perhaps the most absent element to date is memorialisation efforts for the hundreds of thousands of Americans who have died from COVID-19.

To begin, a short summary may help to construct, for readers, the particular moment in the pandemic from which we write. As we were conceiving of this paper in late May 2020, the US passed 100,000 deaths. While we were drafting this paper in September 2020, the US passed 200,000 deaths. Current projections estimate that cumulative deaths will reach 400,000 within a year of the pandemic’s start (Institute for Health Metrics and Evaluation (IHME), 2020). Accurately capturing the profoundly large scope of these losses is difficult. Deaths from COVID-19 in the US now far exceed those of World War 1, the Vietnam War, and the Korean War (Yan, 2020).

The scope of deaths due to COVID-19 certainly presents challenges for a reckoning. When the death toll hit 100,000, the New York Times printed information about 1,000 people who had died, culled from obituaries published around the US. This effort, though herculean, left out 99% of the victims. On Sunday, September 20, 2020, shortly after the US death toll hit 200,000, the National Cathedral in Washington, DC tolled its bell 200 times. It took nearly 20 min, but each ring only represented .001 deaths. On October 4, activists marked the beginning of a national week of mourning, to be streamed live from Washington, D.C, where 20,000 empty chairs had been set up on the Ellipse near the White House (National COVID-19 Remembrance, 2020). Yet this effort, and media attention to it, was drowned out by President Trump’s own hospitalisation with COVID-19. In fact, at the same time as memorialisation efforts were taking place, President Trump left Walter Reed Hospital to orchestrate his own media stunt, driving past supporters outside the hospital while putting the secret service members and staff accompanying him at risk. Here, ongoing politicisation efforts have drowned out memorialisation efforts. Though some political debates and misinformation campaigns have circulated around death counts and how COVID-19 deaths are recorded, efforts to memorialise have been minimal under the Trump Administration.¹

More localised efforts have attracted limited engagement and recognition. The City of Chicago set up a virtual memorial wall and invited residents to submit stories of those they lost; but only a few dozen stories are posted to the wall as of this writing (City of Chicago, 2020). Local COVID-19 mutual aid networks have provided hubs for grieving and memorialisation, but these have not garnered much attention. Notably, activists have created a national COVID-19 grief network (Covid Grief Network, 2020) but its mission is to provide psychosocial support to those who are grieving, not necessarily to publicise or highlight deaths and grief as a political issue. On social media, activists set up the hashtag #wegrievetogether and initiated a series of live, online memorialisation efforts. While these have gained some traction over time, participation and visibility are limited across platforms. On Twitter, the most popular tweets with the hashtag had only a few dozen retweets, and a Facebook event had less than 20 attendees. On Instagram, we counted fewer than 500 posts using the hashtag. There has also been a general lack of efforts to build monuments or physical objects for collective memorialisation, either temporary or permanent.

While many Americans are aware of the death toll in the country, it is striking that there have been so few efforts to engage meaningfully in practices of mourning, remembrance or memorialisation beyond basic metrics. One explanation for this is that memorialisation, and the collective processing of trauma following a crisis only materialises when a sense of normalcy returns. For example, research on memorial narratives in natural disasters suggests that the significance of catastrophic events depends on its socially determined historical context, which takes time to coalesce (Seeger & Sellnow, 2016). Yet, we argue that COVID-19 stands in stark contrast to other natural disasters due to its long duration and reach. There has been ample time to more substantively memorialise, even if incompletely. Also, as we describe below, similar efforts have been undertaken before amidst the HIV/AIDS pandemic.

Another explanation for the lack of memorialisation is a tacit endorsement of its mobilising influence by political leaders concerned with controlling the narrative. Certainly, President Trump and other Republicans have been at pains to deny, diminish, and distract from these deaths. President Trump never publicly attended a single memorial service for a citizen who died of COVID-19, including for political colleagues and supporters such as Herman Cain, who died of COVID-19 after attending President Trump’s rally in Tulsa, Oklahoma (Joffe-Block, 2020). The President went so far as to block Federal Emergency Management Agency funds from being used to help pay for the costs of burials, a benefit that is often standard in emergency response (Torbati, 2020). In addition to Republican officials’ efforts to distance themselves from deaths and memorializations, several other factors are worth noting: the rapid pace of deaths amid multiple and ongoing crises in the US has made it difficult to find space for a reckoning, and COVID-19 restrictions have made in-person memorials and services much harder to arrange.

These partial explanations overlook a much more fundamental factor of the lack of memorialisation; that is, the profound racial and social inequities among those who most often died from COVID-19. The exponentially higher rates of death in Black, Indigenous, Latinx, and Pacific Islander communities, as well as among migrant and at-risk workers, nursing home residents, and prison populations, likely did far more to influence a lack of memorialisation. Failure to recognise deaths was not so much a matter of how many deaths, but who was dying. Racism, ableism, ageism, and classism, in addition to grotesque necropolitical displays from the Trump Administration, have overshadowed efforts to make COVID-19 deaths matter, even despite consistent efforts by Black Lives Matter activists over the summer to draw attention to the ways that racism fuels both police violence and COVID-19 disparities. The failure to fully recognise, and reckon with, these deaths is rooted in histories of persecution, suppression and inequity that many Americans are reticent to confront.

It is notable that similar patterns of dismissal, downplaying, and lack of memorialisation of deaths played out during the 1918 flu, driven by wartime suppression of the press and a national desire to project strength (Barry, 2004). Worldwide there are almost no memorials commemorating the estimated 50 million lost to the 1918 flu, an absence that testifies to the world’s determination to forget, and the long-term consequences of that amnesia for pandemic preparedness (Segal, 2020). Making death visible can be a powerful political tool, particularly for marginalised political groups whose deaths are overlooked. Nowhere is this clearer than in the HIV/AIDS pandemic, where generations of activists have strategically, meaningfully, and sometimes even irreverently drawn attention to unjust deaths to critique political responses to the pandemic. This includes die-ins as a common form of protest, memorialisation efforts like the AIDS quilt, and threats of self-inflicted death like those made by Zachie Achmat when he refused to take antiretroviral medications until all South Africans had access to them. As Treichler (1999, p. 325) reminds us,

… militancy must not preempt mourning. But subversion of the ‘beautiful death’ tradition [by HIV activists] made possible experimentation and activism in memorializing activities as well. Faced with higher mortality rates than wartime and no offers of aid from Arlington National Cemetery, communities with AIDS had to pioneer new ways of burying their dead. Thus grew a diverse array of rituals, from memorial performances, commemorative videos, and underground musicals to graphic novels, rock albums, and political funerals–and, of course, the AIDS quilt, a dazzling and monumental legacy.

The absence of memorialisation of death during COVID-19 points to both failure and opportunity: it represents the absence of politicisation in exactly the sort of domain where politicisation might enable positive action, rather than further misinformation and partisanship; but on the other hand, its absence offers activists a vacuum in which to engage in strategic, meaningful, creative actions that could hold leaders to account, call for a reckoning, and highlight the full scope of this unique tragedy.

Conclusion

In this article, we have explored how Americans are engaged in a profound process of sensemaking surrounding the country’s coronavirus response. Symbols serve as waypoints, signalling the contours of situated meaning, whereas scripts provide plausible explanations for how to behave. We argue that much of the conflict manifest in partisan rhetoric about COVID-19 can be traced to the contest over these symbolic and encoded sources of meaning. In this light, discordant social behaviour is rendered comprehensible by clashing systems of belief. Moreover, the destructive power of COVID-19 rests not with what it represents, but what it reveals.

COVID-19 has brought into stark relief the relative risks associated with identity and inequity, and public disagreements about which types of risks matter most. As a result, appreciable differences arose in who was to be a higher risk to contract, suffer, and die from infection, as well as those to experience economic collapse. These stressors further laid bare the deep-seated inequities within American society, particularly among Black, Native, and Latinx communities who constitute a large number of frontline workers. Moreover, these inequities are exemplified by those who can choose to stay home, such as flexible and privileged professionals who can work online, zoom, and order in, compared to workers deemed essential (and whose jobs provide little security) who must confront risk in their everyday interactions (Manderson & Levine, 2020). These conceptualizations of risk have been further compromised by risk related to age, where older people (high risk) contrast to younger people (low risk). As time passes, how people conceive of their own risk has changed, as well as how people hear, use, and apply risk in their lives to make behavioural choices. Finally, perceptions of risk are shaped by politics, history, and culture; for example, as Jonathan Metzl (2019) argues, an acute desire to uphold racialized hierarchies causes many white Americans to wilfully expose themselves to acute public health risks, and reframe those risks as central to their cultural identity.

In a recent Sapiens article, Hugh Gusterson (2020) argued that Americans are prone to magical thinking around coronavirus, ‘miming the form of its seeming opposite by deploying the rhetoric of science.’ He argues that the script sowed by Donald Trump challenges science, using Biblical idioms like ‘miracle’ and production of pseudoscience by suggesting erroneous cures such as hydroxychloroquine and bleach. This anti-science leadership, combined with the powerful ‘echo chamber’ effects of social media platforms, has produced a powerful resistance to scientific and public health authority and rampant denialism regarding COVID-19. This is certainly not the first time denialism has become a prominent feature of pandemic response politics – AIDS denialism in both the US and in South Africa, for example, dramatically undermined public health response, and was promulgated by the highest levels of political leadership. As scholars have noted, such denialism often productively serves those in power, providing a moral and epistemological screen for necropolitics (Fassin, 2007; Mbembe, 2019). But too often pandemic denialism is treated as a historical and epistemological anomaly rather than a calculated political maneuver legitimised through its resonance with political cultures. COVID-19 offers an opportunity to better understand how denialism and pseudoscience is not just promulgated by leaders but embraced by citizens because of, rather than in spite of, cultural politics and political scripts.

Divisions over what to believe and how to behave have become deeply contentious within the United States. Social fragmentation has been fuelled by a divisive and poorly regulated media landscape, by the historic weakening of institutions and federal power within the United States over the last several decades, by cultural divides rooted in longstanding class and racial resentment, and by political rhetoric and behaviour that has increasingly trampled customs of fairness and decency (Dzhurova, 2020). Yet we should not take these forces as overly deterministic of individual behaviour; rather this article argues that symbols and cultural scripts have been powerful forces mediating between the broader political landscape and individual views and behaviours. In particular, symbols and scripts provide a powerful way to understand and assess ‘what really matters’ to people under conditions of uncertainty and ambiguity (Kleinman, 1988). As such, they represent convenient opportunities for social differentiation, a dangerous prospect during a pandemic. Elected officials have long used symbols to threaten or reassure (Edelman, 1964): masks exemplify how problematic this becomes when the symbol itself is a shield for individuals to keep themselves and their communities safe.

Public health interventions tend to focus on technical solutions to social problems, and in numerous ways, COVID-19 has revealed the pitfalls of that approach. As an indiscriminate biological agent that stresses the limits of unequal and inefficient service delivery platforms, COVID-19 in the United States demands an unprecedented level of coordination and consensus. This is a social process and as such the public health ethos (linear, problem-solving, and time-consuming) is poorly positioned to adequately manage. While COVID-19 has ushered in a period of reckoning in science and public health with the ways that politics (and political engagement) matters (‘Why Nature needs to cover politics … ’ 2020), we argue that equal attention must also be paid to the ways that culture shapes and mediates the politics of public health. As others have also pointed out, a distinction between politics and partisanship must be made (Grossman et al., 2020; Youde, 2020), and it is at the level of partisanship that symbols and scripts become particularly powerful as a means of divisive communication and influence. The absence of clear national leadership and policymaking on key issues like mask-wearing has created a vacuum that quickly gets filled by cultural squabbles and value-based disputes (Koon et al., 2021). Shaming, blaming, and stigmatisation thrive in these contexts, particularly where clear and non-contradictory evidence fails to be communicated by national leaders.

While all public health is political, a key question for health policymakers going forward is how to keep it from being scarred by partisan symbolism and scripts. As the COVID-19 response progresses in many countries, new policy domains will become highly relevant, and the meaning such ideas acquire within political cultures will be crucial to how they can be translated into implementable policy. These are ethical concerns, which should be carefully mapped to clarify competing beliefs and determine a socially appropriate and culturally nuanced response (Wasserman et al., 2020). Large issues loom on the horizon – vaccination, immunity, resource distribution, recovery efforts – which are key to effective public health responses but also likely to become politically contentious in many places. Anticipating how they will become contentious is important, and requires social science perspectives which recognise the importance of political cultures, both current and historical. This frame of thinking is also important in considering how this pandemic will reshape political landscapes and political cultures well beyond this immediate time period. For example, how the CDC continues to communicate with the public about COVID-19 will impact its future credibility on a range of other public health issues; and how political leaders and parties frame their response to COVID-19 will likely impact their political support as well as the political issues that define party boundaries.

Symbols and scripts offer opportunities, not just limitations, for advancing beneficial and equitable public health policy goals, both by parties and by activists. As histories of memorialisation show, efforts to make injustice not only visible but culturally meaningful can powerfully change how societies think about what matters. Key to these efforts, however, is nuanced, careful research that does not gloss over the complex meanings and values that people draw on to make sense of the pandemic and their place within it. It is important to also recognise that these phenomena may vary significantly by region and sub-region, and we should note that our data is primarily sourced from one part of the US, rural Iowa. Much more research is needed, and quickly, to influence the next stages of pandemic response. Along the way, shifts in political posturing and leadership can make a big difference in how people perceive, experience, and respond to public health measures to mitigate the social and viral consequences of COVID-19.

Acknowledgements

The authors are grateful for the support of Abby Adams, Lori Eich, and Zachary A. Borus who were critical for data collection and discussion of the early research. We also thank Natalie Kim for her assistance in data analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 It is notable that one of Biden’s first acts as president was to host a national memorial ceremony on the eve of his inauguration.