At the point pangolins became infected, the “social” began to take over as a cause of the pandemic. Pangolins are a desired food delicacy in China and sold in Wuhan’s Huanan Seafood Wholesale Market where live wild animals can be purchased for human consumption. Just as the SARS (severe acute respiratory syndrome) pandemic of 2002–3 began in China’s live wild animal “wet” markets, coronavirus apparently took a similar transmission path from bats through animals (pangolins instead of civets and raccoon dogs) to reach humans in a crowded marketplace. Lax health and safety regulations, combined with ineffective local government inspections in such markets, likely made transmission easier. Regardless of where it originated, a human became sick. The first case (the so-called patient “zero”?) was allegedly a 55-year-old Chinese man in Hubei Province where Wuhan is located. He was hospitalized in mid-November 2019 with a previously unknown pneumonia. By December 8, there were more patients.
No public alarm was sounded until December 30, 2019, when Dr. Li Wenliang, a 34-year-old ophthalmologist at Wuhan Central Hospital, began noticing some of his patients had a viral infection. He thought it was a reoccurrence of SARS and began alerting his colleagues through social media. The Wuhan police took Dr. Li into custody the first week of January 2020 for spreading a false rumor. They required him to sign a confession admitting his alleged deception before releasing him. A month later (February 7), he died from the coronavirus after catching it from a patient he was treating for glaucoma, becoming one of the real heroes of the pandemic.
A travel ban to and from Wuhan was issued on January 23, 2020, but by that time, infected Chinese had traveled to cities throughout the country and abroad. The Wuhan Municipal Health Commission informed the World Health Organization on January 31 of an epidemic caused by a new virus that was initially named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). WHO changed the name to COVID-19 on February 12. By mid-February, the coronavirus had erupted into a full-scale epidemic, centered in Wuhan, infecting some 90,000 people and killing at least 4,600 in China while dispersing worldwide through tourism, business travel, and community spread. The Chinese government took Draconian measures to restrict people inside their homes, close whole regions of the country to travel, and mobilize medical resources to test for the virus and treat it as best they could since no cure was available. By mid-March, the situation in China improved.
Yet other countries began having severe problems, especially Iran in the Middle East and Spain and Italy in Europe. The problem in Italy, as it was in China, was a late start in isolating affected areas and restricting movement. The first known patient, a 38-year-old man in the Lombardy region in northern Italy, had not been to China and was thought to have contracted the virus from another European. He refused hospitalization and went home before returning a second time, infecting several people at the hospital and others he visited, conducting an active social life and playing on a soccer team while contagious. The spread of the disease was so quick that in the next 24 hours some 36 additional patients were admitted to the hospital, none of whom had any direct contact with the first patient. Out of some 234,000 confirmed cases in Italy in late spring 2020, more than 34,000 died. Spain had even more cases, nearly 287,000, with fewer than 30,000 deaths. Britain later moved to the top in deaths in Europe and then Russia.
The United States, with its large number of international visitors and travelers, was impacted the most. Nearly 2.5 million people were confirmed as infected by late June with over 126,000 deaths. However, the number of cases changes daily as the pandemic is ongoing and are likely to be even higher by the time this book is published. The coronavirus first appeared on the West coast in the state of Washington, and soon after that, California. The hardest-hit state was New York, with more than 30 percent of all cases nationwide. COVID-19 apparently arrived there by way of a traveler from Europe. By late June, New York’s more than 395,000 confirmed cases were greater than those of most countries except the US as a whole, Brazil, Russia, and India. Males were more likely to be infected than females and older people age 65 and above with pre-existing health problems such as obesity, hypertension, heart disease, diabetes, dementia, atrial fibrillation, and chronic obstructive pulmonary disease (COPD) were especially subject to infection and death. Nursing homes were major sites for infection, with about 20 percent of all deaths nationwide. Fortunately, children were the least affected. One reason Italy had such a high mortality rate was because of its large, disproportionately elderly population. The final story on the 2019–20 coronavirus pandemic has yet to be written at this time, but it serves as an example of the social causation of disease as “social distancing” and “stay at home” measures become the primary means of preventing infection, or conversely, acquiring it through close social proximity.
Smoking
Smoking is associated with more diseases than any other health-related lifestyle practice. Smoking tobacco or using tobacco products in any form harms health (Cockerham 2013b). Autopsies on heavy smokers show lung tissue that transformed from a healthy pink to gray and brownish white in color. Smoking also affects the body in other ways, such as damaging the cardiovascular system, causing back pain, and producing increased risk of loss of cartilage in knee joints through osteoarthritis. The physiological damage caused by smoking cigarettes is due to the irritant and carcinogenic material (“tar”) released by burning tobacco into smoke that is inhaled in the lungs and enters the blood stream where it is spread throughout the body. Persons who die from lung cancer are increasingly less able to breathe and feel suffocated as their lungs lose the capacity to transfer oxygen to the blood.
In Britain, some 114,000 people die annually from smoking. In the United States, with its much larger population, about 480,000 Americans die each year from smoking-related causes, including some 41,000 dying from exposure to second-hand smoke. Smoking promotes heart attacks and strokes, narrows and hardens arteries, damages blood vessels and causes them to rupture (aneurysms), and brings on high blood pressure. Habitual smoking regularly results in premature death, as smokers typically die 10 years earlier than non-smokers in the US. How do social variables enter into this disease pattern in a causal role? At one level it looks like the causal factors are all biology: tar in smoke causes cancer and impairs blood circulation. But tar by itself is not causal. It has to enter the human body to have any effect. What is ultimately causal is the human being – both as a host inhaling the smoke and as a producer of a smoking-prone social environment. There is a social pattern to smoking that indicates tobacco use is not a random, individual decision completely independent of social structural influences.
However, smoking and other risky behaviors have not been viewed in a broad social context by researchers as much as they have been characterized as situations of individual responsibility. If people wish to avoid the negative effects of smoking on their health, it is therefore reasoned that they should not smoke. If they choose to smoke, what happens to them is no one’s fault but their own. This victim-blaming approach does not explain why people, especially those from socially disadvantaged circumstances, are drawn to poor health habits like smoking and the types of social situations that promote this behavior. Today, smoking is highly unusual among persons at the higher and middle levels of society and is concentrated among people toward the bottom of the social ladder. Persons in higher socioeconomic groups were the first to adopt smoking in the early twentieth century and other social classes followed, but growing publicity about the harmful effects of cigarettes in the 1960s led to a shift in smoking patterns over time as better educated and more affluent groups began abandoning the practice (Antunes 2011; Cockerham et al. 2017b; Ho and Fenelon 2015; Narcisse et al. 2009; Pampel 2009). By the early twenty-first century, smoking patterns had drastically changed.
According to Mieke Thomeer and her associates (Thomeer et al. 2019), social connections are key predictors of smoking. Thomeer et al. found that the social connections in one’s life (i.e., parents, peers) were most important in influencing an individual to smoke or, conversely, avoid smoking. For those who quit smoking or relapsed after having stopped, the primary motivation was found to be changing social connections in adulthood (such as finding