5th Dec, 2023

covid

by Sam Friedman and Mary Jirmanus Saba

Mike Haynes’s article “The Left, COVID, and the Roads Not Taken” aims to skewer the Left for its failures during the COVID pandemic.[1] In this article, we first go through his argument and show its weaknesses and one or two strengths. We end by suggesting paths the Left can continue to take to centre the public’s health, including responding to the current, and future pandemics.

What Haynes said

Haynes begins his article by claiming that the pandemic is over, and that the disease is now endemic. We would be delighted if he were correct, in spite of doubts discussed below. Since he never defines “endemic,” we will do so, using a definition from Public Health Ontario:[2]An endemic disease is one that is consistently present throughout a specific region or population. The prevalence of the disease remains stable and its spread is fairly predictable over time.” What Haynes does not discuss, or even mention, is that diseases can be endemic at very different rates of infection, disease, and death. For example, a disease could technically be described as “endemic” if it were reliably and predictably killing 10% of the population of the Earth each year. Luckily, COVID is not even remotely close to this. As of 2 January 2023, the peak of the last wave before we write this—but also, and crucially, a time before already limited reporting systems markedly deteriorated as governments around the world deliberately reduced and degraded their COVID data systems in order to return to “business as usual”—WHO reported a death rate globally of 40 thousand people per week.[3] As we begin to write this piece in September 2023, the world is facing another wave of infections and death. Yet governments worldwide have largely dismantled monitoring systems. According to the US CDC, for example, its reporting on provisional COVID deaths may not represent all deaths, and reporting delays may be 8 weeks or more.”[4] Still, COVID is still the fourth leading cause of death in the US, taking more than 250,000 lives in 2022 in the US alone. And as we discuss below, Haynes totally ignores Long COVID, which, at any given moment, seems to be at least temporarily causing serious health problems in millions of people in the UK, tens of millions in the United States, and far more globally.

To us, these data do not support Haynes’s characterisation of COVID as endemic, although there are many uncertainties about these data and trends. Worrisomely, the rate of viral evolution and the number of circulating variants remain high, which means that the predictability of spread and of death rates is low. (This challenges Haynes’ dismissal of it as endemic.) In any case, these high numbers, and the uncertainties around viral mutation and around Long COVID, belie the apparent complacency of Haynes’ article.

The thrust of Haynes’s argument is a critique of the “lockdown Left” and of the Left in general for failing to confront a number of issues and for having an insufficient presence in the politics of the pandemic. This critique is remarkably unfocused and, to our eyes, seems to be directed at unnamed strawmen. First, he never defines who or what he means by “the Left.” Secondly, he fails to identify who holds many of the views he attacks, with three exceptions: interestingly, in an article directed at criticising the Left in the UK, he mentions the late Mike Davis and Rob Wallace, both Americans, for not showing “any special insight that cannot be found in the many papers about the threat of pandemic disease produced by the thousands of people who work in the huge global disease surveillance networks”. To anyone who knows Wallace’s work or actions during COVID, this is absurd. Wallace’s keen insights into the roots of the pandemic in investment networks and decision-making, in relation to the logic of capital, are not widely presented in the surveillance networks, and Wallace’s practice as part of People’s CDC (which we discuss later) displays insights that Haynes seems not to have considered. The third person he criticises is also an American (who lives and works in the UK), Devi Sridhar, but it is not clear to us whether or why Haynes considers her of the Left.

Haynes is dead on correct in one of his arguments. The Left (at least as we use the term) does not have an adequate understanding of epidemiology or of public health.

Haynes spends considerable effort lambasting those on the Left who go “down the rabbit hole of elimination and the fantasy of zero COVID”. Unfortunately, he does not name anyone who actually held these beliefs. He could have concretised this by discussing what happened in Australia, New Zealand or China, and their varied attempts at COVID suppression. These attempts ultimately failed, in part because a suppression strategy cannot be pursued in one country alone. (In the case of China, certainly, we agree that maintaining public health was in part an excuse for state repression.) It did, however, succeed in holding mortality and illness rates far below those in the UK or the USA for some years.

Haynes argues that the class struggle was abandoned as well as much human interaction. We cannot judge if that was true of the Left in the UK. In the United States, this was decidedly not the case, at least after the last weeks of May 2020. Here, pretty much everyone on the Left was actively in the streets many times as part of the Black Lives Matter movement, for example, and later in the movement opposing hate crimes and stigmatisation directed at Asian Americans. Haynes may have “lived vicariously off a few protests of Black Lives Matter”, but, in the United States, the movement was organised and led to a significant degree by Black members of the Left. (Haynes’s frame here incidentally seems to exclude Black people from the Left). Furthermore, left activists, many of whom had been members of socialist groups similar to the SWP of which Haynes himself was an active member, were deeply involved in health workers’ protests and strikes at the lack of personal protective equipment during this same period of the pandemic (and since).

Haynes claims that “those on the Left who demanded vaccine mandates [should] be ashamed of their inability to make the elementary distinction between a vaccine that reduces the virulence of an infection and one that stops transmission”. Again, this argument fails to name anyone on the Left who was guilty of this, as well as ignoring the involvement of some left scientists in developing and testing the vaccines themselves. Rather, in the US, it is the US administration and its CDC which popularised such confusion (maybe Haynes is counting Rochelle Walensky in his broad sweep of leftists?). In the United States, our discussions of these issues were much more sophisticated. We discussed what the vaccine trials and subsequent research showed at considerable length, including the evidence that vaccination reduced both the probability of infection and that, by reducing the period of active infection, it therefore reduced the probability that an infected person would infect others. Now, it is true that those of us with an understanding of epidemiology were the ones who made these arguments, but we did so both as part of our efforts to teach the Left some of the basics of epidemiology and as a contribution to the politics of the pandemic. (We also note that Haynes does not report on what, if anything, he said on these issues.)

Haynes spends considerable effort attacking the view that mass testing could stop the pandemic. We actually know of no one on the Left who argued that in the US or the UK it would, although this argument was more viable for China and for New Zealand for reasons specific to those countries. Here, Haynes actually did name a name, Devi Sridhar, but does not tie her to the Left (which, admittedly, might not be needed for those readers of HM who live in the UK.) Also interestingly, Sridhar, as a professor of global public health, presumably does know something about epidemiology. We would add that the emphasis on mass testing and tracing in the US, at least, was mainly put forward by the CDC and by state health departments, not by the Left. Those of us in the People’s CDC, for example, have focused on layers of protection (which includes the availability but insufficiency of mass testing as a single tactic).

Haynes discusses risk transfer at some length, but these remarks seem to float in the air, since he does not cite any evidence that anyone on the Left held the views he criticises. Indeed, no one on the Left we know of actually held that the entire world economy should be locked down indefinitely. Nor did capitalists or actual governments do so, beyond the early weeks of the pandemic when the characteristics of COVID were still unclear.

Nevertheless, Haynes focuses on the concept of risk transfer—that wealthier people were protected and could stay at home whereas workers had to risk their lives. However, Haynes also writes, “Now you can, if you want, make an argument that this was necessary, and more lives were saved this way.” The implication is that he did not see it as needed—but he never states his alternative. In particular, he never discusses how workplaces and transportation to and from workplaces could have been made safer, nor does he mention the myriad ways that workers, from Amazon to Fedex to Target struggled for safer workplaces, an effort in which one of the authors of this piece was highly engaged. The same workers warned that bending public health measures for the country’s largest employer would lead to the market consolidation, which we’ve seen since. (We recall vividly a striking Amazon worker in Chicago in March 2020 waving a rubber chicken at a cell phone camera, asking if its purchase was “essential.”)

In addition, as Haynes and we argue, in most countries, many of those who stayed at home (to say nothing of capitalists!) gained in income whereas those who had to work outside of the home or who lost their jobs, lost. This is all true, and something we all opposed. Haynes then tries to make an argument that non-pharmaceutical interventions should have been “trialled” in the rich world. We would suggest that there are severe ethical barriers to doing this—how can you randomise people not to have good ventilation and filtration of air? Not to wear masks in situations where significant viral exposure might occur? Not to have greater spacing and other changes in meat packing factories? Practising public health researchers have long realised that certain interventions have so much face validity that randomised trials are not ethically feasible. In terms of HIV/AIDS, for example, it would have been unethical to exclude people who use drugs from obtaining sterile syringes or people engaging in high-risk sex from using condoms, which would be a necessary part of such a trial. In these circumstances, research has to rely on “natural experiments” and cohort studies, and a large number of these have been conducted for masks.

Haynes does present an alternative course of action for one circumstance: old people in end-of-life private care homes. Such facilities, along with prisons and some other forms of congregate living, were indeed the locations of horrendous and devastating outbreaks. And it was indeed a tragedy and, in some cases, a crime against humanity, that this took place and that people and their relatives were separated in their last days. Haynes proposes a solution to this: mobilising students and faculty as a care army to help out. He fails, however, to show how this would help. Wouldn’t it just mean that students and academics would carry the virus into and out of care homes rather than the staff of these facilities? Wouldn’t such a programme lead the owners of care homes to lay off the low-paid staff members to live on the dole and to rely on the labour of unpaid students and professors? Perhaps—and perhaps not. But Haynes does not seem to think through either the epidemiology or the social impacts of his solution.

Haynes then ends his article with what he called soul-searching questions.

What Haynes failed to discuss

Any article on the Left and the pandemic has to discuss the actual practice of the Left. Haynes does not do that, and we, as leftists living in the United States, do not learn from this article what left activists and researchers have done in relation to COVID. We want to present a few things that left activists have done in the United States, and suggest that members of the British Left probably took part in similar activities, even if Haynes does not mention it.

Before doing so, however, we want to make a caveat. Even more than in the UK, the Left in the United States is very weak, and has not yet fully incorporated analysis of public health and disability politics in the ways necessary to resist an ongoing, disabling pandemic. This is an essential point for reflection and future improvement.

In spite of these weaknesses, the Left took active part in the Black Lives Matter demonstrations and many subsequent related events. Indeed, to a large extent, Black left activists led many such events, as already mentioned.

Left activists took part in many workplace struggles for safer conditions. Most visibly, this was true in the huge healthcare and logistics industries Broad left leaderships of some unions like the Flight Attendants and some health-care unions also were very active in fighting for various mitigation efforts. Left teachers led or were involved in many struggles to force schools to take various mitigation measures before re-opening.

Many members of the US Left took part in safety and unionizing campaigns at work. Some of these were “salters”—that is, left activists who got jobs at a given workplace in order to organise there.

In early 2022, in a context where it was becoming daily more evident that the Biden administration was turning away from a public health approach to the pandemic and towards prioritising the profitability of business and the imperial interests of the United States, a combination of left activists including public health researchers, doctors, nurses, industrial hygienists, and lay leftists came together to form People’s CDC. The authors of this paper are all members, and leaders, of People’s CDC (as is Rob Wallace, whom Haynes criticised). We have emphasized mitigation efforts using “layered protection,” which are pictured in Figure 1.[5]

covid

Figure 1. Layers of protection against SARS-CoV-2/COVID-19

People’s CDC has written and distributed documents criticising CDC’s response to the pandemic, a document on the Urgency of Equity that discussed ways to re-open schools more safely, a number of documents for worker and community groups on how to struggle to implement layers of protection, documents on how to gain access to medical interventions in the context of the US health-care non-system; and weekly issues of “Weather Report” and “COVID This Week” to help others keep abreast of the pandemic, policy towards the pandemic, and selected scientific issues. We have also organised thousands of public comments on health policy decision-making at various government institutions such as Centers for Medicare and Medicaid (CMS), and CDC’s ACIP and HICPAC, among others. Along with a coalition led by healthcare union National Nurses United and representatives from AFL-CIO, we have made progress pushing back on corporate influence on infection control guidance at the CDC’s Healthcare Infection Control Policies Advisory Committee (HICPAC). And we’re just getting started (learn more and get involved at https://peoplescdc.org/.)

The authors of this article have engaged in many other forms of COVID-directed activity. Mary Jirmanus Saba was active in raising  COVID safety demands in the Disability Caucus[6] and in the general strike movement during the weeks-long University of California 48,000 person strike in late 2022, demands which were later taken up, and won, by workers at the University of Michigan. Samuel R. Friedman[7] took part in planning strategies to protect harm reduction workers and people who inject drugs from both the virus and from social harms during the early part of the pandemic, and has written or co-written a number of left analyses including a critique of the left response to the pandemic in the USA, a critique of an establishment book, Lessons from the COVID Wars, an analysis comparing responses to the AIDS and COVID pandemics, and a number of articles in public health and epidemiologic journals.[8]

Haynes’s lack of engagement with active COVID politics shows in other ways as well. He fails to mention the ways in which, both during the clearly pandemic phases and more recently, during what he calls the endemic phase, inadequate mitigation and prevention measures have excluded whole groups of people from social activity in which others can participate. For example, relaxation of mask requirements and other mitigation measures have forced elderly people, disabled people and chronically ill people, as well as others who prefer not to risk Long COVID, to choose between a high risk of becoming infected and forgoing the use of public transportation, public schooling, and now healthcare (since CDC guidance has now led many hospitals systems to remove masking requirements.) Similar policies have essentially excluded many from safe access to their workplaces, and to many public events.

Unforgivably, for someone who touts his supposed epidemiologic expertise, Haynes nowhere mentions Long COVID, which has been described as a mass disabling event. In the United States alone, approximately 40 million people (as of mid-September 2023) have had Long COVID, which is over one ninth of the total population. At the moment, it is estimated that perhaps fifteen million people are suffering from Long COVID, and that many of them may do so for the rest of their lives. At any given time, millions are unable to work as a result. As of approximately the beginning of September 2023, among adults, 18% of women and 12% of men report that they have ever had Long COVID.[9] These startling numbers are likely an underestimate as they exclude people with asymptomatic infections. The UK Office for National Statistics reports that as of 5 March 2023, 1.9 million people living in private households (2.9%) had Long COVID, a number which excludes those in institutional care such as many elderly people, prisoners, and others.[10]

Summary

Haynes’s article gives the impression that COVID is under control and that the Left has played a sordid role throughout the pandemic. We are not so optimistic about the state of COVID. It still is infecting a lot of people, and large numbers of people are being incapacitated to a greater or less degree by Long COVID. Attempting to avoid illness is continuing to exclude large numbers of people from access to public life. Given the coordinated abandonment of mitigation efforts globally, and the continuing high global load of active infections, mutations are taking place at a rapid rate, and at best we can be cautiously optimistic that none of them will unleash another wave of massive death. Although we have not discussed it here, international comparisons of the impact of the pandemic make it clear that political incompetence—which often took the form of prioritising the profitability of capital over the health of the working class—probably is responsible for a sizeable proportion of the seven million deaths that WHO reports have resulted from diagnosed COVID globally (which is an undercount, given the number of excess deaths during this period).[11] All in all, then, the number of unnecessary deaths due to COVID—that is, those due to capitalist politics—are comparable in number to those due to genocides that receive massive attention from the Left. We, in People’s CDC, have attempted to make the politics of pandemics more visible to the international Left, to make the culpability of capitalism and colonialism in these horrors clearer to the public, and thus to strengthen the ranks of those who actively try to erase capital and to build an alternative world. We invite Haynes and others around this world to join us in these efforts.

Haynes fails to give any description of the actual activity of the British Left during the pandemic. We are based in the United States and lack the resources to provide such a description. Based on what the US Left has done in the pandemic, and our scattered communications with people in Britain, we seriously suspect that the Left in Britain has by no means been the abject failure that Haynes reports.

Nonetheless, Haynes’s article does make one important point with which we strongly agree: by and large, the Left has paid too little attention to epidemiology and public health. This is particularly true since the disruptions that climate change is already causing—and these will only increase during the lifetimes of those who read this article—are highly likely to undo whatever control humanity has managed to get over COVID, HIV/AIDS, tuberculosis, a host of other diseases, and perhaps additional emerging pandemics.[12]


[1] Haynes, 2023. https://www.historicalmaterialism.org/blog/left-covid-and-roads-not-taken

[2] https://www.publichealthontario.ca/en/About/News/2022/Endemic (downloaded September 21, 2023)

[3] https://www.theguardian.com/commentisfree/2022/apr/03/peoples-cdc-covid-guidelines

[4] https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_select_00

[5] Taken from https://peoplescdc.org/2022/09/12/layers-of-protection/ downloaded 9/24/2023

[6] https://truthout.org/articles/university-of-california-workers-center-disability-justice-in-union-organizing/

[7] Feldman, Justin; Friedman, Sam. Where is the Left on pandemic politics? Tempest. April 18, 2022. https://www.tempestmag.org/2022/04/where-is-the-left-on-pandemic-politics/

Friedman, S.; Kay, S. Marxism and the US Response to the HIV/AIDS and COVID-19 Pandemics. August 25, 2023. Spectre Journal¸ web edition. https://spectrejournal.com/marxism-and-the-u-s-response-to-the-hiv-aids-and-covid-19-pandemics/

Friedman, S. https://blog.petrieflom.law.harvard.edu/2023/07/05/learning-from-the-covid-war/

Sam Friedman. Fatal abstractions: Disease, death, and capitalist abstraction. Tempest Magazine 2023. https://www.tempestmag.org/2023/03/fatal-abstractions/

Friedman, Samuel R., David C. Perlman, Dimitrios Paraskevis, and Justin Feldman. 2023. Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens. Pathogens 12, no. 8: 1023. https://doi.org/10.3390/pathogens12081023.

Friedman SR, Jordan AE, Perlman DC, Nikolopoulos GK, Mateu-Gelabert P. Emerging Zoonotic Infections, Social Processes and Their Measurement and Enhanced Surveillance to Improve Zoonotic Epidemic Responses: A "Big Events" Perspective. Int J Environ Res Public Health. 2022 Jan 17;19(2):995. https://doi: 10.3390/ijerph19020995. PMID: 35055817; PMCID: PMC8776232.

Frank D, Krawczyk N, Arshonsky J, Bragg MA, Friedman SR, Bunting AM. COVID-19-Related Changes to Drug-Selling Networks and Their Effects on People Who Use Illicit Opioids. J Stud Alcohol Drugs. 2023 Mar;84(2):222-229. PMID: 36971722 DOI: https://10.15288/jsad.21-00438

Walters, S.M., Bolinski, R.S., Almirol, E. et al. Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis. Addict Sci Clin Pract 17, 24 (2022). https://doi.org/10.1186/s13722-022-00303-8

Friedman SR, Mateu-Gelabert P, Nikolopoulos GK, Cerdá M, Rossi D, Jordan AE, Townsend T, Khan MR, Perlman DC. Big Events theory and measures may help explain emerging long-term effects of current crises. Glob Public Health. 2021 Aug-Sep;16(8-9):1167-1186. https://doi: 10.1080/17441692.2021.1903528. Epub 2021 Apr 11. PMID: 33843462; PMCID: PMC8338763.

Friedman, S.R. Environmental change and infectious diseases in the Mediterranean region and the world: an interpretive dialectical analysis. Euro-Mediterr J Environ Integr 6, 5 (2021). https://doi.org/10.1007/s41207-020-00212-9. NIHMSID: NIHMS1637417

Jenkins WD, Bolinski R, Bresett J, Van Ham B; Scott Fletcher; Walters S; Friedman S, Ezell J, Pho M, Schneider J, Ouellet, L. COVID-19 During the Opioid Epidemic – Exacerbation of Stigma and Vulnerabilities. The Journal of Rural Health, 2020. PMID: 32277731 PMCID: PMC7262104. https://doi.org/10.1111/jrh.12442.

Bunting AM, Frank D, Arshonsky J, Bragg MA, Friedman SR, Krawczyk N. Socially-supportive norms and mutual aid of people who use opioids: An analysis of Reddit during the initial COVID-19 pandemic. Drug Alcohol Depend. 2021 May 1;222:108672. https://doi: 10.1016/j.drugalcdep.2021.108672. Epub 2021 Mar 18. PMID: 33757708; PMCID: PMC8057693.

Vasylyeva TI, Smyrnov P, Strathdee S, Friedman SR. Challenges posed by COVID-19 to people who inject drugs and lessons from other outbreaks. J Int AIDS Soc. 2020 Jul;23(7): e25583. https://doi: 10.1002/jia2.25583. PMID: 32697423; PMCID: PMC7375066.

[8]Feldman, Justin; Friedman, Sam. Where is the Left on pandemic politics? Tempest. April 18, 2022. https://www.tempestmag.org/2022/04/where-is-the-left-on-pandemic-politics/

Friedman, S. https://blog.petrieflom.law.harvard.edu/2023/07/05/learning-from-the-covid-war/

Friedman, S.; Kay, S. Marxism and the US Response to the HIV/AIDS and COVID-19 Pandemics. August 25, 2023. Spectre Journal¸web edition. https://spectrejournal.com/marxism-and-the-u-s-response-to-the-hiv-aids-and-covid-19-pandemics/

Friedman, S.R., Smyrnov, P. & Vasylyeva, T.I. Will the Russian war in Ukraine unleash larger epidemics of HIV, TB and associated conditions and diseases in Ukraine?. Harm Reduct J 20, 119 (2023). https://doi.org/10.1186/s12954-023-00855-1

Friedman, Samuel R., David C. Perlman, Dimitrios Paraskevis, and Justin Feldman. 2023. Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens. Pathogens 12, no. 8: 1023. https://doi.org/10.3390/pathogens12081023Sam Friedman.

Friedman SR, Perlman DC, Paraskevis D, Feldman J. Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens. Pathogens. 2023 Aug 8;12(8):1023. https://doi: 10.3390/pathogens12081023. PMID: 37623983; PMCID: PMC10457759.

Friedman SR, Mateu-Gelabert P, Nikolopoulos GK, Cerdá M, Rossi D, Jordan AE, Townsend T, Khan MR, Perlman DC. Big Events theory and measures may help explain emerging long-term effects of current crises. Glob Public Health. 2021 Aug-Sep;16(8-9):1167-1186. https://doi: 10.1080/17441692.2021.1903528. Epub 2021 Apr 11. PMID: 33843462; PMCID: PMC8338763.

Friedman, S.R. Environmental change and infectious diseases in the Mediterranean region and the world: an interpretive dialectical analysis. Euro-Mediterr J Environ Integr 6, 5 (2021). https://doi.org/10.1007/s41207-020-00212-9. NIHMSID: NIHMS1637417.

[9] https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm downloaded 9/24/23

[10]https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023. Downloaded 9/24/23

[11] Friedman, S.; Kay, S. Marxism and the US Response to the HIV/AIDS and COVID-19 Pandemics. August 25, 2023. Spectre Journal¸ web edition. https://spectrejournal.com/marxism-and-the-u-s-response-to-the-hiv-aids-and-covid-19-pandemics/

[12] Friedman, S.R., Smyrnov, P. & Vasylyeva, T.I. Will the Russian war in Ukraine unleash larger epidemics of HIV, TB and associated conditions and diseases in Ukraine?. Harm Reduct J 20, 119 (2023). https://doi.org/10.1186/s12954-023-00855-1

Friedman, Samuel R., David C. Perlman, Dimitrios Paraskevis, and Justin Feldman. 2023. Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens. Pathogens 12, no. 8: 1023. https://doi.org/10.3390/pathogens12081023Sam Friedman.

Friedman SR, Perlman DC, Paraskevis D, Feldman J. Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens. Pathogens. 2023 Aug 8;12(8):1023. https://doi: 10.3390/pathogens12081023. PMID: 37623983; PMCID: PMC10457759.

Friedman SR, Mateu-Gelabert P, Nikolopoulos GK, Cerdá M, Rossi D, Jordan AE, Townsend T, Khan MR, Perlman DC. Big Events theory and measures may help explain emerging long-term effects of current crises. Glob Public Health. 2021 Aug-Sep;16(8-9):1167-1186. https://doi: 10.1080/17441692.2021.1903528. Epub 2021 Apr 11. PMID: 33843462; PMCID: PMC8338763.

Friedman, S.R. Environmental change and infectious diseases in the Mediterranean region and the world: an interpretive dialectical analysis. Euro-Mediterr J Environ Integr 6, 5 (2021). https://doi.org/10.1007/s41207-020-00212-9. NIHMSID: NIHMS1637417.