Harris Solomon, Associate Professor of Cultural Anthropology and Global Health
COVID-19 is contagious and deadly; we know this. What we have not had the time to grapple with, yet, is that it is turning people into patients, and patients on ventilators specifically.
Much of the public discourse on the clinical aspects COVID-19 revolves around mechanical ventilators, generally in terms of supply (diminished) and demand (outsized). Will people build their own prototypes, in hack-a-thon-like sessions? Will people buy their own, privatizing the air? The ventilator is a lifesaving piece of equipment, to be sure, but what else is entailed in its use? In my own research in intensive care units in India, I study how ventilators are always rationed. From this vantage point, several things are clear:
First: Securing more ventilators is essential, but the machine is only part of the story. It takes trained health workers to intubate, to calibrate the ventilator, and to monitor patients on the machine. Care workers make constant and nuanced calculations to ensure that patients are getting the breathing support they require. COVID-19 presents an additional challenge: how to support breathing while also minimizing viral transmission through aerosolized droplets (this is why personal protective equipment is so essential).
Second: The ventilator is not the same thing as the patient, but it can seem like it is. In critical care situations, it can seem like a patient suddenly has a co-pilot, in the machine that lies next to their bed. I have put photos of family members, of saints, of gurus, and of favorite things on top of ventilators in the Mumbai trauma ward for families hoping that the person in the bed does not fear the machine’s dominion over their life. Perhaps it’s a comfort measure for the healthy, too: a way of familiarizing this juggernaut of medicine that makes the symbolic and real difference between the critical and the stable.
But I have also seen the ventilator become perhaps *too* familiar. Medical anthropologists who study the ways technology is deeply entwined in social life have demonstrated how technologies like ventilators anchor quandaries about end-of-life care. “Once intubated, the ventilator becomes the CPU for patients,” a physician in the Mumbai ward tells me, a shift of life’s controls from analog to digital and from being located within a person to being located outside them. In an instant, with both the ventilator and good intentions flowing, families and providers can begin to think about the patient largely in terms of the machine.
This cyborg relationship is something we must grow accustomed to. As the nation itself becomes the site of intensive care, ventilators reveal our interdependence and show that breathing itself is social. In times of crisis such as this one, even breath itself must be borrowed and shared.