Covid-19, mask mandates, and photographs. The US and Vietnam.
How photojournalism and mask mandates can still save lives before the vaccine rollout.
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(CW: Violent and graphic imagery)
“One of the distinguishing features of modern life is that it supplies countless opportunities for regarding (at a distance, through the medium of photography) horrors taking place throughout the world.”
- Susan Sontag, Regarding the Pain Of Others
On February 1st, 1968, on a Saigon street in broad daylight, the police chief of American-allied South Vietnam executed a Vietcong prisoner with a casual, point-blank shot to the head. AP photographer Eddie Adams captured the precise moment of the execution. By the next morning, national newspapers confronted millions of Americans with the violent image of a US ally murdering a handcuffed prisoner, which for many shattered the illusion of a just war.
It wasn’t the only image of its kind. A nine-year-old named Phan Thị Kim Phúc, more commonly known in the west as “Napalm Girl,” was later photographed fleeing a south Vietnamese napalm attack, her clothes completely burned from her body. She would later describe putting out the flames on her body with her hands.
These images shocked a misled society into bringing the political pressure necessary to eventually end a failed war. They may also prove to be a useful template for stoking urgency into what continues to be a lackluster public response to the COVID-19 pandemic in the US. One only has to look to the differences in national pandemic response models between the country these images came from and our own, where individualistic ideologies currently outweigh the ability for centralized action to protect the public.
Vietnam and the US, COVID-19 Responses Compared
52 years after the Saigon street execution, to the day, Vietnam documented its sixth case of the COVID-19 virus. On the other side of the planet, a man returning from Wuhan, China went into isolation in Massachusetts. His was the eighth documented case of COVID-19 in the United States. Both countries had just set up national task forces to combat the virus: Vietnam’s National Steering Committee for COVID-19 was assembled on January 30th, and the US’s Coronavirus Task Force was announced on the 29th.
The then parallel paths of these historically intertwined countries diverged to become two of the most distant points of reference on a broad spectrum of national responses. Vietnam declared a public health emergency over the coronavirus epidemic and enacted one of the most proactive, albeit restrictive approaches to the virus of any nation. Its experience with SARS was still fresh in the population’s collective consciousness, which facilitated swift, centralized action from a strong, more authoritarian state. Vietnam closed schools, accelerated domestic production of protective equipment, funded public service announcements, and enacted mandatory testing for travelers from hotspots, all by February 2nd. And while Vietnam and the US both announced a halt to flights from China (Vietnam on the 1st and the US on the 2nd), over 40,000 people still arrived in the US from China on direct flights in the two months following the supposed ban. Vietnam officially closed the border to China — by any means — on February 15th.
It would be another 40 days and 557 confirmed cases before the US even declared COVID-19 a pandemic, evincing a reactionary strategy based on containment that would fail millions of Americans. The Trump administration maintained through March that the risk to Americans was very low. The consequences of not taking a proactive or potentially even over-reactive response to a novel coronavirus has proved devastating: By at least one estimate, starting lockdowns just a week earlier in the US could have prevented over half of the deaths due to COVID-19, meaning tens of thousands of lives lost unnecessarily in the following months while an exponential extrapolation of deaths likely followed this initial estimate. And now deep into the second wave of the virus’s winter path, the US is repeating the same mistakes.
As of the writing of this piece, shortly before the new year, the US is closing in on 15 million cases and 350,000 deaths, a toll exceeding the dropping of two nuclear bombs on Japan and the nuclear meltdown of Russia’s Chernobyl power plant combined. We now exceed the total deaths from the September 11th attacks every day, and we could see that toll only increase as people continue to travel for the holidays. Yet Vietnam, which shares a 900 mile physical border with China, did not have a single documented death due to COVID-19 until the end of August.
Vice President Mike Pence, the head of the coronavirus task force, declared victory in a June Wall Street Journal op-ed titled, “There Isn’t a Coronavirus ‘Second Wave.’” “Cases have stabilized over the past two weeks, with the daily average case rate across the U.S. dropping to 20,000 — down from 30,000 in April and 25,000 in May,” Pence wrote. In the month after Pence made this assertion, the seven-day average number of cases tripled. Today, the average rate is approaching 200,000 cases per day, ten times the case rate touted by Pence in June.
Vietnam’s numbers, in contrast, appear to be as trustworthy as they are remarkable. Todd Pollack is the director of the Partnership for Health Advancement in Vietnam (HAIVN), a collaboration between Harvard Medical School, Hanoi Medical University, the Ho Chi Minh University of Medicine and Pharmacy, and the Vietnam Ministry of Health. Said Pollack, “I see no reason to mistrust the information coming out of the government at this time. Vietnam’s response was swift and decisive. If the epidemic were much larger than is being officially reported, we would see the evidence in increased emergency room visits and hospital admissions — and we’re not seeing it.”
Professor Guy Thwaites, director of the Oxford University Clinical Research Unit (OUCRU) in Ho Chi Minh City, echoed Pollack’s sentiments. He believes that if there was some effort to sweep cases under the rug that they “would have seen them on the ward — and we haven’t.” He reportedly told the BBC, “[T]here wasn’t a systematic cover up of cases — I am very confident of that.”
But more important than Western academics weighing in on the accuracy of Vietnam’s numbers is recognizing that Vietnam has a well-funded public health system and is considered a world leader in pandemic response. Since the turn of the century, its public health expenditures increased almost 10% a year, on average. Its experiences in the early 2000s with SARS and two instances of the avian flu have provided Vietnam with the necessary expertise to prevent mass death through public faith, helped along by the amplification of PSAs by social media influencers. In a global study of 45 countries with regard to how citizens feel about their government’s response to the pandemic, whether the measures taken are too much or too little, Vietnam was the highest ranking country with 62% of its citizens saying the measures were “just right.” The Goldilocks rating for the US was half of Vietnam’s at 31%, below the average of all measured countries. The US, as one might expect, also rounded out the top five for “the government is doing too much” at 19%. While it is clear that the US has dealt itself repeated and avoidable blows, a paucity of Western coverage of Vietnam and its handling of the disease might have left the general public unaware of Vietnam’s remarkable successes.
Animation of confirmed cases in 2020 through mid July, the US and Vietnam
Vietnam reported its first case on January 23rd, and over the next six months it kept its number of confirmed cases under 500, in addition to avoiding any deaths in the first wave. The US during that same stretch had 4.5 million confirmed cases, or roughly one million percent of the cases in Vietnam. And the latest data shows that this trend has continued into the second wave as countries like the US and Sweden — which have resisted imposing restrictions and mandates — have seen their cases and fatalities skyrocket. Countries with more aggressive, centralized approaches have been able to stamp out smaller outbreaks as they arise. This also means hospital capacity in those countries can remain high, making sure moderate cases don’t become severe and severe cases don’t become fatal. When hospitals are overstretched, their ability to treat the virus is diminished into triage.
Sweden and the US, both countries that employed policies that prioritize personal freedom and the maintenance of economic status quo over slowing the spread of the virus, are far out in front with regard to cases as a proportion of population. Ironically, the countries that sacrificed near-term economic recovery and had meaningful lockdown policies are not only far healthier but far closer to reopening their economies if they aren’t fully open already. Take New Zealand, whose swift and decisive actions have allowed it to eradicate the virus within its borders twice. History long should have reminded of this as an analysis of US cities that engaged in earlier and longer lockdowns during the Spanish Flu epidemic of 1918 had similar results: fewer deaths and no economic trade offs.
It is not entirely fair to assume that the US should or even can now do all of the things that Vietnam has. Vietnam at one point had over 200,000 people in quarantine facilities, something unpalatable to the vast majority of Americans, let alone dyed-in-the-wool conservatives or libertarians who still find seatbelt laws tyrranical. What is fair, however, is trying to understand the advantages that strong centralized responses play in a pandemic as well as the weaknesses of a decentralized democracy. It is important to quantify the real costs of holding individual freedoms above the expense of mass public death.
Masks, and Regarding the (Hidden) Pain of Others
In weighing freedom and safety, one should understand that at the very least, a federal mask mandate is essential policy. However, masks remain one of the most salient symbols of this ideological divide. Mask mandates, despite being policy that holds the best balance between being the least restrictive to personal freedoms and perhaps the most effective way to curb community transmission, remain to many an overstep by the state. Their effectiveness in slowing or even stopping the spread of the disease has been demonstrated empirically, time and time again. Not only do masks work, but — as has been demonstrated through the natural experiment of Kansas’s county-by-county participation — so do mask mandates.
Despite the proven efficacy of masks, getting politicians (and the public that support them) to have the will to enact anything resembling centralized control is something that has proved almost impossible. President Trump and a number of Republican governors have long misled the public with regard to COVID-19’s severity, and even went as far as to censor and suppress photojournalism that covered the epidemic. They have also resisted echoing statements of public health officials and even sought to actively attack health agencies as well as individuals who try to educate the public. Regardless of whether or not such interference was successful, an increasingly partitioned media ecosystem has prevented millions from coming into contact with public health messaging that hasn’t been filtered through social media networks or news empires with particular narrative-based messaging.
What is missing from public debate is a way to bypass these filters into the visceral cruelty of the disease, much like how the photos and film from the Vietnam War brought the true nature of its injustice into view. When the public was finally able to witness the horrors of warfare, it changed the hearts and minds of many Americans. Perhaps that method can also work in our war against COVID-19.
The horrors of COVID-19, unfortunately, are far easier to hide than the atrocities of the Vietnam War, and not only because people can choose media sources that will never confront them with its grim reality. The disease itself is mostly concealed within the body, where it wreaks havoc on internal organs through the vascular system. The people experiencing the visceral pain are often hidden by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the law that defaults to the protection of sensitive health information without consent. They are also hidden within necessary hospital quarantines that keep an eager press at bay who can’t document the tragedy of people saying their final goodbyes to a loved one about to be placed on a ventilator, or the thousands of people dying alone.
People who, in the very best of circumstances, have a nurse in head-to-toe PPE gear available to hold an iPad up to them while their family watches them die remotely via FaceTime. Hospital workers remain our only real witnesses, and they absorb the trauma and the risk for our national negligence.
These nurses and doctors suffer unimaginable emotional tolls as they handhold stranger after stranger on to the next world. Danielle Stansky, an emergency physician in New York City wrote in an emotional plea for the Washington Post that she wishes she could make people “a fly on the wall. Maybe then they would understand this disaster. I am scared for my patients. I am scared for my colleagues. I am scared for my friends and family… I am scared for myself.” And while hospital workers like Dr. Stansky continue to share their experiences with journalists who have, in turn, created powerful stories in newspapers, magazines, and podcasts, they clearly haven’t done the job. These images and stories of haggard, overworked, even suicidal nurses and doctors remain a buffer. They represent the damage absorbed and not the damage itself.
Most people still do not lay witness, instead only viewing images of suffering once removed and thinking of it as confronting the disease, while the real witnesses carry the entire emotional burden of caring for the sick and dying.
Some symptoms of the disease are not so easy to hide, but even with the external physical destruction of limbs, local news media often shies away from the traditional “if it bleeds, it ledes” mantra. For example, COVID’s vascular attacks on the human body often result in the amputation of fingers and toes.
One local news channel took such a story and presented as a rosy survival tale, washed clean of most of its trauma. The survivor spoke of his full recovery, despite the loss of his fingers. When given the opportunity to highlight the gruesome injury, difficult images were blurred and smiling faces accompanied bandaged hands.
This is because local news is often constrained by efforts to avoid the ideological, or political, which means they may view these as politicized images as much as they view it as graphic content not suitable for wide audiences. CNN and MSNBC, the cable news networks most watched by Democrats, have been better about not shying away from the grim details. Rachel Maddow’s show has managed to get camera crews into ICU wards. CNN even aired uncensored footage of a COVID-ravaged hand (below).
But these audiences are not those who need the exposure, and FOX News has failed to similarly rise to the occasion. There was one moment where they came close, when stunned television anchors Dana Perino and Jesse Waters inadvertently reached a critical understanding of the gravity of the pandemic as Trump was about to be taken to Walter Reed for contracting COVID-19.
The hyperconservative pundits on FOX, confronted with the image of Marine One on the South Lawn of the White house, had this exchange:
Jesse Waters: I wonder, Dana, for the president to be affected, like this, millions of Americans have been affected by this… He had an opportunity to potentially document how he’s feeling, how he’s progressing, to the country one way or another through social media, through video, perhaps. I wonder if this does change the way the country feels about the coronavirus depending on how quickly the President can overcome it and get back out there. It could potentially be a very inspiring story for the Ppresident to get better and then show the country this is what we can do and safely recover.
Dana Perino: I think it will renew calls for people to wear masks when they need to, socially distance, wash your hands… do the right thing.
This idea of getting the ideologically driven to confront reality through the use of shocking imagery, as opposed to the simple refutation of misinformation, is not just theory; it is backed up by rigorous science. In a series of studies addressing beliefs that vaccines cause autism, pediatric researchers found that “[r]efuting claims of an MMR/autism link… decreased intent to vaccinate among parents who had the least favorable vaccine attitudes.” That is to say, simply telling someone their facts are wrong and supplying new ones could actually backfire, further entrenching non-believers in their stance. Think of any long Facebook thread or heated discussion at the Thanksgiving table: Were any facts shared really ever that stubborn?
What does work, however, is a technique known as replacement. Instead of countering the belief of autism being linked to vaccines directly, researchers provided anecdotal evidence of the effects of preventable disease together with photos of children suffering from these diseases. Showing pictures of crying children whose bodies were wracked with measles (below) was a far more successful strategy to encourage vaccination, especially among parents for whom these risks hit closer to home.
We have been witness to this kind of replacement and a correlating change of public opinion play out in another context, concurrent with COVID-19. Following the murder of George Floyd, where video captured was one of the most severe and unmistakble exanmples of injustice enacted by everday policing of Black bodies, support for Black Lives Matter protests jumped from 46% to 53%. Support for BLM, too, had been steadily increasing for years, as body cameras and civilian captured footage had also been increasing in proliferation.
And during the violent clashes between police and protestors, thousands of videos capturing the hundreds of instances of uninstigated police violence flooded the internet. T. Gregg Doucett, a former computer scientist criminal defense attorney began cataloging them into a twitter thread with nearly a thousand separate incidents between the end of May and September. (Also available by spreadsheet here.) These photographs and videos appear to communicate better than any other form that the police as counter demonstrators to police violence seemed determined to validate the concerns of BLM protestors nation wide.
Eddie Adams ended up winning the Pulitzer for capturing Nguyen Van Lem’s execution in Saigon, but at the time he thought nothing of it. “I think I got some guy shooting somebody… And, uh, I went to lunch.” It wasn’t until the photograph was published by editors above the fold in major newspapers and framed by the critical words of other journalists’ that it carried the meaning that gave it immediate and lasting impact. In fact, Adams resented the photo that gave him the Pulitzer Prize. He felt that it failed to capture the context of the moment and ruined the life of his friend the executioner, General Nguyen Ngoc Loan. In 1998 Adams wrote in Loan’s eulogy for Time magazine:
Two people died in that photograph: the recipient of the bullet and GENERAL NGUYEN NGOC LOAN. The general killed the Viet Cong; I killed the general with my camera. Still photographs are the most powerful weapon in the world. People believe them, but photographs do lie, even without manipulation. They are only half-truths.
The other half of the truth that Adams refers to is that the executed Viet Cong prisoner, Nguyen Van, had allegedly killed a South Vietnamese officer along with his wife and six children.
This article starts with a few words from Susan Sontag’s Regarding the Pain of Others (2003), a book-length essay about what it meant to view human suffering through photographs in this particular context: war. She reminds us that no photograph exists on its own as some momentary objective truth, as Eddie Adams himself points out. That instead, these photographs are “an invitation to pay attention, to reflect, to learn, to examine the rationalizations for mass suffering offered by established powers.” And while Adams might have chosen to frame his photo in a different way, placing the image in front of readers in a way that highlighted the unspeakable violence, it was able to end the war.
If Sontag or Adams were to live into the 2010s to see the development of YouTube, Facebook, and Twitter into major sources of information as well as de facto public squares, they would see how photographs are framed often for a second or a third time, by online platforms and their users. That in the modern choose-your-own-adventure media ecosystem, the “if it bleeds it ledes” approach gets buried by the more profitable enterprise of creating safe harbor for extreme ideologies, not images. And that this approach keeps US audiences from confronting, en masse and in first person, the hardships of hospitals, overwhelmed nurses, COVID toes, amputations, intubations, and countless people dying alone. And when they do encounter them, they encounter a sanitized version that doesn’t offend a person’s political peculiarities.
Governments too have wised up to the work of embedded photojournalists since the Vietnam War, in bipartisan fashion. Bush censored photographs of flag-draped coffins at Dover Air Force Base. Obama refused to release the Abu Ghraib dossier to the media. One might imagine that today Adams’ photo never would have made it out of Vietnam.
We know what to do. How do we get there?
Countries like Vietnam have demonstrated what centralized planning is required to preserve life and ensure a swift return to normalcy. Stricter measures would also allow us to restart the full economy sooner, even with the delivery of an effective vaccine. We would be lucky to have one fully rolled out this summer let alone this year as current projections have us on pace to be fully vaccinated against COVID-19 by sometime in the year 2030. Many people, including some frontline health care workers, are refusing to take the vaccine.
Our tangled history with Vietnam may provided a guide towards adopting a more complete response. By pulling back the curtain on COVID’s horrors, we might succeed in ushering a reasonable response: mandating masks at least, and with great luck restricting travel and paying people enough to stay home. To bypass the biases of social media platforms and major news networks like FOX that have a financial stake in a narrative of noncompliance, public funds should be used to buy up local advertising spots and online ads on Twitter and Facebook.
Local and state government should fund TV spots that show the process of intubation. Ads should be taken out in newspapers and magazines that reveal the stacks of corpses in refrigeration trucks and mangled extremities. Public platforms should be given to the families of their dying relatives who have to see their loved ones through to the next world via a phone on tablet. Doctors and nurses, who are already asked to do too much, must consider risking even more by leaking images beyond the tragic portrayal of their burdened faces. We must flood the airwaves with death and suffering if we expect anti-maskers to finally take this pandemic seriously and be moved to action. And this needs to be done regardless of network, because for every anti-masker there are just as many people who believe the science but are tired of the restrictions. Liberals alike want to rush to open schools, see their families over holidays, and eat out at restaurants and bars.
Anti-mask advocates will cry foul at “fearmongering” and a great number of people will be resistant, even more will never be reached. But in a pandemic where every case begets three others, convincing even a small percentage of people to wear a mask, or fostering advocacy from a handful of unexpected legislative sources can potentially reduce immeasurable harm. When a successful course of action depends so heavily on buy-in from the public at large, especially from a country as individualistic as the United States, any way to move the needle means less unnecessary death and a quicker return to a life we recognize. So let’s not hold back under the guise of patient privacy or viewer sensitivity. Let’s show this disease for what it truly is: a devastating pandemic that is wholly within our power to control, should we collectively choose to do so.
Juddson Taube is a PhD candidate and interdisciplinary research at Stanford’s Graduate School of Education and an MA student at the Department of Communication studying Democracy in the Digital Era.
