S1E67 / Past Is Prologue: Epidemics & Anti-Asian Xenophobia / Toby Chow, Merlin Chowkwanyun, David Randall

I think a lot of people don't understand how fearful Chinese Americans and other Asian Americans are in this moment.

How we respond to disease is in fact a mirror and a microcosm of what is going on in the larger society.

You're listening to Epidemic, the podcast about the science, public health, and social impacts of the coronavirus pandemic. I'm your host, Dr. Celine Gounder.

Turn to some, some tragic news. The deadly shootings in Atlanta killing at least 8 people. A suspect is in custody this morning, and police across the country are on alert this morning as well, fearing the attacks may have targeted the Asian community.

The shooting spree began around 5 PM Monday at Young's Asian Massage Parlor in Cherokee County, 30 miles north of Atlanta.

Authorities are now trying to determine a motive and whether race played a role.

Last week, a gunman in Georgia shot and killed 8 people. 7 of the 8 killed were women. 6 were of Asian descent. This mass shooting is just the latest in what has been a year of harassment and violence against the Asian American and Pacific Islander community.

Too many Asian Americans have been walking up and down the streets and worrying, waking up each morning the past year feeling their safety and the safety of their loved ones are at stake.

These shootings are among some 3,800 acts of anti-Asian hate incidents reported since March 2020. Throughout the pandemic, former President Trump repeatedly framed SARS-CoV-2 as a quote-unquote "China virus." This and other racialized descriptions of the virus at the beginning of the pandemic set the stage for anti-Asian violence. At the beginning of the pandemic, we spoke with Toby Chow about the threats Asians and Asian Americans were facing in the U.S. He leads a group called Justices Global.

When the COVID-19 crisis hit and we saw this spike in racist harassment and assault, it seemed like we needed to pivot to that. So this is a big part of my work right now.

Toby's originally from Canada, but he's been living in Chicago for 15 years. Before the coronavirus was even declared a pandemic, Back in February 2020, Toby was walking in downtown Chicago one day.

I was walking by an Asian woman. It turned out she was in fact Chinese American, and she was a professor at one of the universities here in Chicago. A man came up to her and started yelling at her and then spat right in her face. Like, he got right in her face and then spat directly into her face. And then I and some bystanders, like, pushed him off of her. And then, you know, just sort of stood with her and consoled her as best as we could. But that was a really shocking moment.

The woman told Toby she'd lived in Chicago for more than a decade. Nothing like that had ever happened to her before.

The woman was crying so hard she had trouble explaining what had happened, but she was certain that it was related to the coronavirus. That was her opinion. I sort of had a sense in that, in that very early moment, that things were going to get much, much worse.

The shooting in Atlanta made it disturbingly clear that these attacks have only gotten worse. In 2020, anti-Asian hate crimes were up 150% in the United States. That's according to a report from the Center for the Study of Hate and Extremism at California State University, San Bernardino. But the coronavirus pandemic is not the first time people of Asian descent have been stigmatized because of a disease. In this episode, we'll look back at what happened in San Francisco during the California Gold Rush, when an outbreak of the plague was blamed on Chinese immigrants. We'll find out what happened.

It was probably one of the most important medical crises in our country's history. And it was only because of a small team of doctors that millions of people didn't die.

How these same prejudices are flaring up now.

This is the first time that I have felt just afraid of my fellow Chicagoans. It's really just a devastating feeling.

And how a new approach helped save the city.

It really took facing that kind of racial bigotry in the face to save the country.

Today on Epidemic, a look back at the history of anti-Asian prejudice and pandemics. Public health and medicine have a long history of discrimination, but for this story, we're going to focus on one school of thought in particular: the sanitary movement.

Sanitary movement really arises out of a couple things, but it's kind of larger social anxieties about what to do with what you might call surplus populations.

This is Merlin Chow Kwan Yin. He's a historian of public health at Columbia University.

So these are populations that are either out of work, that they depend heavily on government, or they're influxes of mostly poor working-class people, many of them immigrants in the United States. And you need to do something about them and figure out how to manage them.

The sanitary movement started in Great Britain in the 19th century and soon came to the United States.

And so this is an idea that is actually very embedded in all of our minds, even to the present. We really take for granted a lot of the things that the sanitarians emphasized.

Things like washing hands, good ventilation, building sewers, and clean water. These are all positive things that prevented a lot of disease, especially in urban areas. So what's the problem?

Well, the problem is that sanitarians at the same time tended to cast poor people, and particularly immigrants and racial minorities, in the United States as those who are much more likely to generate filth and dirt, usually because of how they supposedly behave.

During this time, there was a belief that some races were more prone to disease than others.

It's kind of this notion that you have people, whether they're Chinese, Mexicans, African Americans, they're just sort of different from a quote unquote normal white person.

Another was that these non-white cultures practiced behaviors and habits that promoted disease.

Often these are described in very exoticizing ways, living in crowded housing, not cleaning up, eating strange things, being dirty, and so on and so forth. So these images of depravity start to become very linked to immigrants.

Traditionally, stories about mass migration to the United States focus on the experience along the East Coast. Places like Ellis Island are synonymous with 19th century immigration, especially from Europe.

But on the West Coast, particularly in California, California and San Francisco, I think people forget that there was a massive stream of immigration from China.

Chinese immigration to the United States started during the California Gold Rush of 1849. Afterwards, immigrants from China helped to do the difficult and dangerous work of building railroads and other undesirable jobs. Merlin says this influx of Chinese labor set off nativist fears. Some thought immigrants were stealing jobs from U.S.-born workers. Others feared Chinese labor would drive down wages.

So there are all these kinds of stereotypes that, that arise around the Chinese, and I think it's very much rooted in these broader 19th-century anxieties over foreign labor and the threats that they pose to U.S.-born labor. So in some ways, when you kind of look at it, it's remarkably similar to some of the nativist discourse that's had kind of this disturbing resurgence in the past few years in the United States.

United States. So this is where economic anxieties about foreign-born workers met a racist vision of public health. This environment bred a lot of stereotypes and slander against Chinese immigrants, including some that associated people of Asian descent with disease, diseases like the bubonic plague. The Black Death that most people associate with medieval Europe was actually the second plague pandemic. By the late 1800s, a third plague pandemic was spreading in places like India and China. And by 1900, the plague reached San Francisco.

So the first known patient was a man named Won Cha King, and he lived in the Globe Hotel in Chinatown.

This is David Randall. He's a senior reporter at Reuters and the author of the book Black Death at the Golden Gate.

The health inspector knew what he was seeing, and he was terrified. He calls the police, and they started enacting a quarantine of Chinatown right away. They start, you know, roping it off in the middle of the night.

The man who would lead the effort to control the outbreak was Joseph Kenyon. He was running a quarantine station on Angel Island off the coast of San Francisco.

So Dr. Joseph Kenyon is one of those heroes of medicine that many people have never heard of. He was the founder of a laboratory which is now considered the start of the National Institutes of Health. He was somebody who prevented a cholera outbreak in New York City. And he was, you know, essentially a superstar of American medicine.

Plague posed a serious threat to the city, but Kinyoun's approach to quarantine and other public health measures unfairly targeted Chinatown's residents.

You know, people in Chinatown itself, the Chinese Americans, don't want any association with themselves and plague because it seems to confirm every negative stereotype about themselves.

Initial quarantines only affected Chinese-owned businesses. White residents and business owners were exempt. A federal judge would later throw out the quarantine order, but chaos erupted in the meantime.

You know, the Chinese who were living in Chinatown wondered, how long are we going to be here? You know, it almost felt like they were jailed. They had no provisions. People started climbing into the sewers. They started climbing across rooftops. Anything they could do to get out of the quarantine zone itself.

Soon, residents of Chinatown started calling Ken Yun the Wolf Doctor.

The main person who was called Wolf Doctor was Ken Yun himself because he was very aggressive. You know, Chinese Americans who were living in Chinatown, they did not trust Ken Yun at all. And this was for good reason. Doctors and other authorities who were going into Chinatown would use it as an excuse to steal from people's apartments. They were using an excuse to essentially to remind people where their place was in the racial hierarchy.

Another extreme measure was forced vaccination. At this time, there was no cure for plague, but there was a vaccine of sorts that had been developed called the Haffkine serum. It had questionable safety, and its efficacy has never been proven.

And it had very strong side effects. You know, it, it'd make your whole body turn flush. You get this high fever, you get chills. You get nauseous. So many people thought, you know, this cure is worse than the disease. Kinyoun had this plan to forcibly inoculate everybody in Chinatown. He tried to go through each apartment building, you know, knocking down doors and forcibly injecting people. This caused riots.

At one point, Kinyoun tried to forcibly remove the entire population of Chinatown and quarantine them on a nearby island. Tensions between public health authorities and the residents of Chinatown were escalating.

People would pull up the cobblestones from the street and smash the windows of people who were thought to be collaborating with Kenyon or with any white authorities.

The city was a powder keg. So how did public health authorities stop the spread? We'll find out after the break. Before the break, San Francisco was in the middle of a plague epidemic. Dr. Joseph Kinyoun was right about the threat posed by plague, but his aggressive, racist approach alienated the people he was supposed to be helping.

He too fell victim to this idea of bigotry.

Kinyoun's approach to the plague outbreak in San Francisco wasn't just racist, it was ineffectual.

That is one of the big tragedies of Kinyoun. He was this, you know, brilliant man, and he probably could have saved more lives if he had been able to move his own social ideas and social understanding of other cultures and people forward as well.

But Kenyon kept ratcheting up the response.

And he continued to become more and more adamant that he had to put more and more draconian measures in place in order to stop anything. He briefly quarantined the entire state of California, and that was the last straw.

Kenyon was replaced with another public health leader, someone with a very different approach: Dr. Rupert Blue.

One of the first things Blue did was he opened up an office in Chinatown itself. He hired Chinese translators on his team and he treated them like full members of the team. He paid them equally, which was a radical step at the time as well. And slowly he started to build up trust with people in Chinatown, and he was able to start tracing the spread of the disease in a way that Kinney never was.

Blue also reached out to other groups in the city to get them on board.

Ladies groups, he would talk to longshoremen, he would talk to business leaders, you could talk to anybody and saying that, you know, this is how we have to stop the spread of plague, which was essentially instituting all these types of sanitation measures that we now take for granted.

Blue was able to convince leaders to support hygiene measures like rat-proof trash cans, street sweeping, and concrete sidewalks and streets.

This was really the start of public hygiene in the U.S. was because of this fight against plague.

And this outreach revealed something else: while the plague had been framed as a so-called Chinese disease, it could be found throughout the city.

When plague did emerge in San Francisco, there was this idea that, you know, it's only a Chinese disease or it's only an Asian disease, so therefore the broad city doesn't need to worry about it. And it tied in all these other, you know, Asian bigotries that, you know, it's only some— it's only disease that can affect somebody who eats rice. You know, and if you're an American who eats meat, then somehow you're not going to be susceptible to this.

This, of course, is not how disease works. Viruses and bacteria are ruthlessly colorblind. They don't care where someone is from or how they look.

But many doctors refused to believe that it was plague, and they came up with all these other diagnoses. So, you know, the disease went by so many other names because simply people didn't want to admit that that they could have the quote-unquote Chinese disease.

All the while, the disease spread through the city. Once again, these prejudices led to worse outcomes for everyone. Eventually, after several years, the plague subsided in San Francisco. Efforts to control the plague and other infectious diseases would have a big impact on what cities look like. But as we've seen during this pandemic, what's past is prologue.

"Well, one thing historians love to do is say that nothing has changed." Here's Merlin Chow Kwan Yin again. "But some of these tropes do endure. You certainly see this today, questions about whether Chinese people in the United States are more likely to spread coronavirus, rhetoric of blame against Chinese people writ large rather than the Chinese government specifically." Merlin says that over the last several years, the political climate in the U.S.

has been rife with anti-immigrant sentiment.

That, I think, certainly has heightened fear of outsiders, and you see that kind of manifest in conversations about disease.

But for many of the Asian American and Pacific Islanders experiencing harassment or even violence motivated by the pandemic, they aren't outsiders. They're Americans. This is something Toby Chow says he experienced in a visceral way.

The Chinese side of my family hasn't lived in China for over 100 years. And yet, you know, I walk around in the street and I feel like the average person in the US is going to still identify me with a country that my family hasn't lived in for over a century.

While other immigrant groups from Europe, like the Irish or Italians, eventually came to be seen as part of mainstream white America, Asian American and Pacific Islanders continue to be seen as other despite their deep roots here. Violence begins with othering and marginalizing, and the pandemic has exposed how resilient these racist ideas are.

I think a lot of people don't understand how fearful Chinese Americans and other Asian Americans are in this moment, and the fact that, like, we're hearing stories from each other And we are following news stories of harassment and even violent assaults causing injury, and we are anxious and afraid.

Hi, I'm Annabelle Chen. I'm one of the interns at Just Human Productions. Like many of you, we're angry and disturbed by the shootings in Atlanta that targeted Asian women. So we wanted to highlight two organizations that you should consider supporting. They are the Asian American Pacific Islander Civic Engagement Fund at aapifund.org and Asian American Advancing Justice Atlanta at advancingjustice-atlanta.org. You can find links to their websites in the show description. Thanks.

Epidemic is brought to you by Just Human Productions. We're funded in part by listeners like you. We're powered and distributed by Simplecast. Today's episode was produced by Zack Dyer and me. Our music is by The Blue Dot Sessions. Our production and research associate is Temitayo Fagbenle. Our interns are Annabel Chen, Brian Chen, Julie Levy, and Sophie Varma. If you enjoy the show, please tell a friend about it today. And if you haven't already done so, leave us a review on Apple Podcasts. It helps more people find out about the show. Follow Epidemic on Twitter and Just Human Productions on Instagram to learn more about the characters and big ideas you hear on the podcast. We love providing this and our other podcasts to the public for free. But producing a podcast costs money, and we've got to pay our staff. So please make a donation to help us keep this going. Just Human Productions is a 501(c)(3) nonprofit organization, so your donations to support our podcasts are tax deductible. Go to justhumanproductions.org/donate to make a donation. That's justhumanproductions.org/donate. And if you like the storytelling you hear on Epidemic, check out our sister podcast, American Diagnosis. On American Diagnosis, we cover some of the biggest public health challenges affecting the nation today. Past seasons cover topics like youth and mental health, the opioid overdose crisis, and gun violence in America. I'm Dr. Celine Gounder. Thanks for listening to Epidemic.