Myth-Making in the Age of Science: Costa Rica’s COVID-19 Narrative
By: Ken Morris
Tags: Coronavirus, Public Health, Covid 19, Costa Rica, Social Anthropology

Myth-Making in the Age of Science: Costa Rica’s COVID-19 Narrative

Photo by Jose Pablo Garcia on Unsplash

Introduction

The novel coronavirus that causes COVID-19 is just a virus. It has no mind of its own, tells no stories, and creates no cultures. It only does what viruses do, namely infect hosts and replicate.

But humans, who are among the main victims of COVID-19, do have minds of our own, tell stories, and create cultures. We therefore respond to the virus by using our minds to tell stories that fit the virus into our cultures.

Unfortunately, the facts about COVID-19 aren’t making accurate storytelling easy. We still don’t know why it kills some but produces only mild symptoms in others. Neither do we know why treatments succeed with some patients but fail with others. We don’t even know who is infected and who isn’t — or sometimes if we ourselves are infected. COVID-19 is invisible to us, undetectable without lab tests, but the results of the lab tests aren’t always conclusive. All we really know is that mysterious killer virus is circulating among us.

The situation is ripe for humans to what we have done for eons, namely construct myths. No one would be surprised, after all, to hear of a far-off primitive tribe concocting a myth involving sorcerers and warring spirits to explain the ravages of COVID-19. Although we moderns wouldn’t construct a myth like this, we are no less motivated to construct explanatory COVID-19 stories consistent with our cultures.

We’re all also aware of modern COVID-19 myths. Usually we don’t call these outlandish stories myths. (We’re not primitives, after all). Instead, we call them conspiracy theories. But there’s not much functional difference between modern conspiracy theories and primitive myths. Instead of faulting sorcerers conjuring up evil spirits for COVID-19, conspiracy theorists usually fault a cabal of elites bent on dominating us. It’s the same basic story; the mythical villain has just received a modern update.

The question then becomes to what extent modern science-driven stories about COVID-19 are functionally myths too. Those who create and believe these stories, of course, deny that there is anything mythical about them. They insist that their stories are fact-based explanations, not fanciful myths. But this insistence betrays a misunderstanding of both science and myth.

Science isn’t quite the storehouse of facts some assume it is. Especially in areas such as infectious diseases, scientific findings are more apt to take the form of statistical tendencies than solid facts. Of course, statistical tendencies are facts too, but when coupled with the methodological criticisms most scientific studies invite, statistical tendencies provide leeway for different interpretations. As a result, many who claim to be “following the scientists” in their construction of COVID-19 narratives find themselves inserting the modifier “reputable” before the word “scientists.” By doing so, they concede that they are privileging the interpretations of scientists with good reputations over the interpretations of those who lack establishment prestige. This may be a prudent choice, but it isn’t a scientific one. It’s a social choice.

More importantly, nothing in science tells anyone which facts to look for, how much weight different facts deserve, or how facts should be assembled into explanations. The process of selecting, weighting, and arranging the facts is pure narrative construction. In science, these narratives are called theories (although when theories are broadened into more generalized explanatory frameworks they can be called paradigms). And this process occurs within science. When scientific explanations are disseminated through the popular media or used to shape public policies, all kinds of other facts, values, and assumptions become grafted onto them. The result can start looking a lot like myth.

The main misunderstanding of myth is that it is woven out of false facts. Traditional myths, of course, do usually include a fair number of false facts. (It’s highly unlikely that spirit-conjuring sorcerers are responsible for COVID-19.) But myths don’t have to be based on false facts. The defining feature of myth is that it tells a story about the tellers at the same time it tells a story about its subject matter. Factual narratives can do this. When the facts are selected, weighted, and arranged in ways that tell about the tellers, we are in the realm of myth, whether or not those facts are false.

Everyone who followed the debate over masks in the United States is familiar with an example of how science morphs into myth during a pandemic. Although there is scientific evidence for the protective benefits of masks, that evidence is subject to interpretation. There are no double-blind studies, the usual methodological standard for medical research, demonstrating the effectiveness of masks in reducing the spread of COVID-19 in the real world. Instead, there are studies of coughing mannequins, of instances in which mask-wearing has been combined with other public health protocols, of the protective benefits of masks for other infectious diseases, and so on. Although most experts conclude that masks reduce the transmission of COVID-19, even they don’t know by how much. Other experts examining the same data are less persuaded.

But of course the debate over masks in the United States quickly escaped the confines of science and became a political debate. One subset of the population used the evidence of the benefits of masks to justify government mask mandates; another objected that mandates violate their liberty. Although to some extent the rival groups also debated the benefits of masks, the main debate was between competing political ideologies. Sadly, some who favored mandates continued to insist that they were merely following the science, refusing to recognize that mandates are a political preference rather than a scientific fact, while some who objected to mask mandates minimized the scientific support for masks to their own peril. In both cases, although many believed that the debate was over science, it was more fundamentally a debate between rival political myths superimposed on the science.

While the debate over masks in the United States invites further attention to the ways that modern myth-making affected that country’s management of the pandemic, I prefer to turn my attention to the process as it unfolded in Costa Rica. Unlike larger and more diverse countries, where different myths compete for dominance, Costa Rica is small and cohesive enough to have seemingly created a consensus COVID-19 narrative. This makes examining the myth-making process in Costa Rica easier than it might be in countries where there are competing myths. At the same time, Costa Rica’s COVID-19 myth is solidly anchored in science. Costa Rica’s scientists and public health experts are every bit as competent as those anywhere else in the world. This is therefore not an interpretation of some primitive tribe, but of a scientifically sophisticated country. Despite this, it is a country that wove mythical elements into its COVID-19 narrative.

But first, some general background on the concept of culture and the challenges cultures pose is in order.

Cultures and Their Boundaries

To speak of culture in the easy way I have been using the term is sometimes considered a mistake. The argument is that this usage implies more homogeneity and consensus within cultures than exists, even as it often privileges the beliefs, values, attitudes, and customs of a culture’s dominant members. In reality, runs the thinking, cultural beliefs, values, attitudes, and customs are constantly contested by the diverse groups that comprise a culture.

Although this criticism has merit, it can be pressed too far. It’s rare, for example, for the diversity within cultures to lead to separatist or secessionist movements. These occasionally appear, and when they do it might be misleading to refer to the culture as a unified entity. However, it’s more common for the different groups in a culture to try to steer the culture as a whole in the directions that they prefer. These attempts by subgroups influence the common culture betray their allegiance to it, however fierce their criticisms of it may be. A similar allegiance to a common culture across the culture’s diversities is often apparent when cultures as a whole are threatened, for instance by external invasion. In these times, such as occurred in the United States in the aftermath of the 9/11 terrorist attacks, competing factions tend to temporarily set aside their differences and join together shared expressions of patriot sentiment. If it’s misleading to speak of cultures as if they are singular consensual entities, it’s also misleading to speak of cultures as if they are aggregates of conflicting factions bereft of common congealing forces.

Because cultures are characterized by both diversity and cohesion, cultures must constantly struggle to balance the two. Especially in the modern world where cultures are for the most part coextensive with large and diverse nation-states, most cultures permit a good deal of diversity. Yet at the same time, they strive to maintain a coherent national identity, lest their culture become indistinguishable from others. To some extent, modern nation-states maintain their cultural identities by managing their own internal political and economic affairs. To an additional extent, modern nation-states pursue nation-building initiatives, such as implementing common social studies curricula in schools, erecting national monuments, commissioning flags, approving national anthems, and establishing national holidays.

But these methods of maintaining a common cultural identity amid diversity are only applied within a culture. The question often becomes what the borders of a culture are that separate it from other cultures. Borders, in turn, take three forms: territorial, legal, and cultural. Nation-states have territorial borders that separate them from others, legal borders defined by citizenship or legal residency status that distinguish members from nonmembers, and cultural borders that further help to distinguish members from nonmembers. Although using cultural criteria to distinguish members from nonmembers can threaten the value of diversity and is therefore often denounced as prejudicial or xenophobic, people use them anyway. Sometimes even nation-states use them, such was when there is a state religion or national language.

No modern nation-state finds balancing diversity with cultural cohesion easy, and most struggle with it. The recent debates over immigration in the United States, Europe, and elsewhere are examples of the struggle, as also was the protracted debate over Brexit in Britain. But some countries struggle with it more than others. Costa Rica is one of them.

Costa Rica’s Struggle for Cultural Identity

There is a joke in Costa Rica that when Hitler wanted to invade, a fly landed on top of Costa Rica on the map Hitler was consulting. Since Hitler couldn’t find the country on a map, he couldn’t invade it. Thus, Costa Rica was spared a Nazi invasion.

Although only a joke, this story underscores the reality that Costa Rica is a tiny country by world standards. With a population of only slightly more than 5 million on a land mass of under 20,000 square miles, Costa Rica ranks about 120th in the world in population size and 126th in the size of its territory. In rankings of nominal GDP, Costa Rica does a little better, but it still only comes in at about 77th.

While Costa Rica’s small size may or may not protect it from foreign invasions, it does deprive it of the autonomy many larger countries enjoy in managing their own political and economic affairs. Yes, Costa Rica generally governs itself as it sees fit, while it also establishes its own economic policies. But it is not large or powerful enough to resist outside influences in either area.

Politically, Costa Rica is internationalist in outlook. It is a committed member of the United Nations, signs onto most international covenants, adheres to the standards of international human rights, abides by the terms of the various treaties it has agreed to, and so on. To some extent, this is a matter of principle. But to a further extent, it is practical policy. Costa Rica realizes that it’s too small and weak to go it alone in the world. It needs the protection of the international community. The trade-off for that protection is to subordinate its own laws to those of the international community.

Thus, for example, Costa Rica approved same-sex marriage after the Inter-American Court of Human Rights ruled that it must. Many in Costa Rica were none too happy with this ruling, and the second-place finisher in the 2018 presidential election, Fabricio Alvarado, campaigned against abiding by it. But the victorious candidate, Carlos Alvarado, accepted it and eventually same-sex marriage was allowed. Even so, many Costa Ricans winced over their powerlessness to determine their own marriage policies.

Costa Rica’s economy is also largely directed by outsiders. As a former banana republic, albeit with interludes when small fortunes were made by a few in the coffee business and a tradition of small farmers, Costa Rica’s economy has always been dependent on outsiders. It still is. Actually, it still exports bananas. Its rise from banana republic status, though, was fueled by the development of a tourism industry. This industry, in turn, is dependent for its success on pleasing foreign visitors, as well as to some extent on attracting foreign capital investments. To augment its tourism industry, Costa Rica turned to wooing multinational corporations to the country’s proliferating free-trade zones. Today there are hundreds of multinational corporations in Costa Rica providing tens of thousands of jobs. By contrast, there are scant few Costa Rican companies that are globally competitive. The result is that many of the best jobs in Costa Rica require working for foreigners in foreign-owned companies.

And what’s true of the private sector is true of the public sector. Costa Rica’s government is financed by high levels of international indebtedness. This leaves the country at the mercy of bond-rating agencies like Moody’s, which periodically conclude that Costa Rica’s bonds deserve a junk bond rating. And economic dependency can augment political dependency. In order to attract foreign investments, Costa Rica must enact policies that are attractive to foreign investors. In order to join alliances such as the Organization for Economic Cooperation and Development, in which Costa Rica’s membership is pending, the country has had to reform myriad local laws to conform to the requirements of the OECD. And so on.

In part because of its comparative economic success, Costa Rica’s population isn’t entirely Costa Rican. The multinational corporations send managers to Costa Rica to run their companies, while owner/investors in the tourism industry tend to live in the country. During peak tourism season, the country’s population can swell by 10 percent with foreign visitors. In main tourism locations, the foreigners can outnumber Costa Ricans. Some tourists either don’t leave or return so frequently that for all practical purposes they live in the country. Estimates vary, but perhaps 200,000 of those living in Costa Rica are from North America or Europe.

Another 400,000 or so residents of Costa Rica are Nicaraguans. Costa Rica’s rising economy relative to Nicaragua’s has created a labor market in which many of the menial jobs, such as maids, construction workers, and farm laborers, are filled by Nicaraguans. As often happens to disproportionately poor immigrant laboring groups, Nicaraguans are periodically the objects of prejudice and discrimination. It’s not unusual, for example, to see graffiti saying “Nicaraguans go home” or for landlords to refuse to rent to them.

To this economically-fueled immigrant diversity can be added the existing diversity of Costa Rica’s population. About seven percent of Costa Rica’s population is of Afro-Caribbean descent, not the Spanish descent usually thought characteristic of the country. There are also indigenous groups, a smattering of Asians, Dominicans, Colombians, and so on. Meanwhile, as part of its internationalist outlook, Costa Rica tries to provide refuge for people seeking political asylum. Most refugees come from Nicaragua, though some come from Venezuela and elsewhere. Costa Rica did recently resist accepting refugees from Syria on the grounds that it didn’t have the resources to accommodate them, but a few refugees from Nigeria have managed to settle successfully in the country.

As the influx of Nicaraguan laborers illustrates, Costa Rica’s territorial borders are quite porous. Although most Nicaraguans in Costa Rica hold one or another form of legal residency (more than a few are citizens), some are undocumented. There are so many clandestine border crossings that controlling the border is impossible. Costa Rica’s southern border with Panama is less porous, owing to more treacherous terrain, but it too is permeated by numerous migrants crossing illegally. This is because it’s a land route to the United States commonly taken by distant migrants hoping to make their way there. Meanwhile, as the number of former tourists from North America and Europe who for most practical purposes live in Costa Rica illustrates, Costa Rica’s air borders can be porous too. Although technological improvements are reducing the number who arrive by air and manage to use false passports and the like, there are few mechanisms available to ensure that the supposed tourists leave when their visas expire. Some don’t. Most of these manage to keep their tourist visas current by making quick visits to either Nicaragua or Panama every 90 days in order to renew them. This practice is so common that the unofficial residency category of “perpetual tourist” has arisen to describe it.

Costa Rica is also frequently engaged in disputes over its territorial borders. There are, for example, periodic disputes over maritime borders, usually involving fishing rights or oil exploration. But Costa Rica’s main border disputes are with Nicaragua. Every few years, Costa Rica insists that Nicaragua has “invaded,” the two countries march off the International Court of Justice in The Hague to do legal battle, and a mixed verdict is eventually delivered. Sometimes Nicaragua rubs salt into the wound by threatening to annex one of Costa Rica’s provinces, Guanacaste, on the grounds that the 1824 referendum by which the territory joined Costa Rica was unfair. The threat isn’t serious, but it adds to the anxiety some in Costa Rica experience over tensions between it and Nicaragua over their shared border.

Citizenship is the usual marker of full legal membership in a nation-state, and is in Costa Rica too. However, citizenship can be a nebulous marker for cultural inclusion. By allowing birthright citizenship, Costa Rica grants citizenship to a fair number of Nicaraguans with family connections to a child born in the country. By granted citizenship through marriage, a small but noticeable number of perpetual tourists end up with citizenship, sometimes without even speaking Spanish. Others abuse the right to citizenship through marriage by contracting bogus marriages for a fee. Although there are earnest naturalized citizens who qualified by passing the required exams in Spanish on the history and the culture of the country, these naturalized citizens would seem the exception rather than the rule.

Flanking citizenship are then dozens of categories of legal residency. The closest of these to citizenship is permanent residency. This is roughly equivalent to the “green card” in the United States. It entitles the holders to live and work in Costa Rica indefinitely, and the only restriction is that they can’t vote or hold elective office. Many long-term residents of Costa Rica hold permanent residency; some are so indistinguishable from citizens that their friends don’t realize that they lack citizenship. Beneath permanent residency are then a variety of categories of temporary residency. Sometimes the government even invents new categories of residency on the fly. Recently, for example, a new category of residency was created for political refugees whose applications were denied. The reasoning seemed to be that these unsuccessful applicants aren’t likely to leave and the government doesn’t have the resources to deport them, so they might as well be granted some form of legal residency. In the end, possessing legal residency in Costa Rica doesn’t in itself indicate that a person is a member of Costa Rican culture, although some are.

Left then are the cultural criteria for inclusion in Costa Rica, but it’s hard to identify any of these that are especially salient. As noted, race or ethnicity isn’t always a reliable marker of Costa Rican identity. Although Costa Rica is officially Roman Catholic, so also are all its neighbors. Meanwhile, about a quarter of Costa Ricans don’t identify as Catholics (while more aren’t practicing Catholics). Costa Rica does have a few unique national holidays, but it shares its Independence Day with the rest of Central America. There is a national anthem, as well as a national symphony, but conductors tend to be recruited from abroad. The same is true of Costa Rica’s national soccer team. Players and sometimes even coaches aren’t always Costa Rican.

Neither can Costa Rica easily distinguish itself from other cultures based upon the smaller cultural traits that help define a culture. Nearly all of Costa Rica’s typical foods, for instance, including the beans and rice breakfast staple, gallo pinto, originated elsewhere. (Gallo pinto comes from Nicaragua, although Costa Ricans like to flavor it with a locally-manufactured brand of Worcestershire sauce.) The country’s informal national slogan, pura vida (pure life), was appropriated from a B-movie made in Mexico during the 1950s. Its Spanish accent is somewhat distinct, but even Costa Ricans sometimes remark about how readily their countrymen adopt the accents of others when traveling.

Yet, it would appear that Costa Ricans believe that something distinguishes them from others. What this is, though, remains unknown. National historians and others sometimes speak of Costa Rican “exceptionalism,” but none has ever been able to identify anything exceptional about Costa Rica — except the collective belief that it is exceptional.

When COVID-19 hit, the country understandably sought to protect itself by circling its wagons. In doing so, facts were arranged into a narrative that emphasized the coherence of the culture, when that coherence is elusive under the best of circumstances.

COVID-19 as a Foreign Threat

The first case of COVID-19 in Costa Rica was detected on March 6th in a tourist from New York. This surprised no one and prompted little animosity toward tourists. Everyone expected that COVID-19 would eventually enter the country, New York was then a main site of infections, and it made sense for COVID-19 to arrive with a tourist from New York.

The reporting of the second case the next day was a little odder. This case was brought in by a Costa Rican doctor who arrived from Panama accompanied by a Cuban relative. Once again, the public wasn’t surprised that the virus had entered from abroad (this time from either Panama or Cuba), but it was odd for the doctor himself to be described as Cuban. What this meant was never made clear. Since the doctor was employed in public healthcare system, he was at least a legal resident with the right to work and probably a citizen. Reporting the doctor’s nationality or ancestry didn’t further the public’s understand of how COVID-19 entered the country, and may have even violated his privacy rights. Yet both the Ministry of Health and the press evidently believed that identifying the doctor as Cuban was in the public interest, even though neither bothered to explain whether it meant Cuban citizenship or Cuban ancestry.

As cases began to multiply (unfortunately, the doctor turned out to be a super spreader), it quickly became apparent that distinguishing between Costa Ricans and foreigners would be a permanent feature of Costa Rica’s pandemic management. Everyday the Ministry of Health reported the number of new infections, and everyday it distinguished between the number of nationals and foreigners infected. It never, however, explained the criteria it was using to distinguish between nationals and foreigners.

The initial impression was that the infected foreigners were entrants from other countries who brought the virus in with them. This is how many Costa Ricans understood the reports. But it was soon obvious that this wasn’t the correct interpretation. Instead, the Ministry of Health was simply listing everyone diagnosed with COVID-19 who lacked formal citizenship as a foreigner. This information was of course useless for managing the pandemic. The count of infected foreigners was mainly a count of people with legal residency who live in Costa Rica, making their country of citizenship irrelevant. Moreover, insofar as identifying foreigners by country of origin might have helped the public understand where the virus was entering from, this information was omitted. All infected foreigners were simply lumped together in the count of infected foreigners with no mention of where the foreigners were from.

Two weeks after the first case arrived in the country, Costa Rica took the drastic step of closing its borders. But it added an unusual twist to the closure by decreeing that any legal resident who leaves will have their residency revoked and be prohibited from returning. There was a practical public health justification for this decree. This was discourage Nicaraguan residents from visiting their families in Nicaragua over the Easter holiday, which tens of thousands do in a typical year. Because Nicaragua was then managing the pandemic more poorly than Costa Rica, officials in Costa Rica rightly worried about importing cases from Nicaragua. Even so, it was a harsh policy that deprived Costa Rica’s legal resident population of rights they had previously enjoyed. It was also a harsh policy that remained in force for many months after Easter and into a period when COVID-19 cases were probably higher in Costa Rica than they were in Nicaragua.

If Costa Rica’s early response to the pandemic included circling its wagons around citizens and excluding foreign residents, it was in no way overtly xenophobic. Rather, the opposite was the case. When a public health clinic was found to have refused treatment to Nicaraguans, the Ministry of Health immediately intervened to end that. When public prejudice surfaced against infected Nicaraguans, officials were quick to respond that most were legal residents. Even so, the government itself had set the stage for the rise of xenophobic sentiments. The practical tensions that arose from policing the border, such as a rebellion among truck drivers required to test free of the virus before they could enter, helped fuel these sentiments. It didn’t help quell the xenophobia when officials openly said that the country’s main problem was its border with Nicaragua, and even that building a wall might be a good idea.

But instead of emphasizing the separation between themselves and others, Costa Ricans early on joined with their foreign resident neighbors to battle the pandemic collectively. The government leveled fairly strict restrictions on everyone, including limiting the days an hours people could drive, closing schools, shutting down bars and nightclubs, and so on. There was also a nine-day country-wide lockdown over Easter week. The results were sensational. Although it wasn’t enjoying the same favorable global press coverage, Costa Rica was managing its pandemic better than New Zealand. Costa Ricans swelled with deserved national pride. Unsurprisingly, an April survey showed that over 90 percent of the public supported the government’s pandemic management while President Alvarado enjoyed an approval rating of two-thirds. Someone even manufactured a doll in the likeness of the Minister of Health, Daniel Solis, whose daily press conferences that mixed data with encouragements and sometimes scoldings catapulted him to rock star status.

It was not though to last. In June, Costa Rica’s infection rate started to soar. There was no mystery about its source, either. Rather, there were outbreaks in the agricultural processing plants, where the workers are disproportionately Nicaraguans. These outbreaks spread geographically to the shantytowns and boarding houses populated by the poor, who are again disproportionately Nicaraguans. There were also outbreaks among construction workers, also disproportionately Nicaraguans. Meanwhile, the daily case counts that distinguished nationals from foreigners kept showing that foreigners were disproportionately infected. On some days, nearly half of the new cases reported were among foreigners, even though foreigners make up only about ten percent of the population.

Of course, except for the handful of infected Nicaraguans who entered the country illegally, foreign nationality had nothing to do with the high rate of infections among foreigners. The explanation for the high infection rate is simply poverty. Around the world the poor have suffered the most from COVID-19 because of their crowded working and living conditions. It just so happens that a disproportionate number of the poor in Costa Rica are immigrants who lack formal citizenship. With infection rates presented by citizenship status rather than by economic circumstance, it appeared that foreigners were at fault for spreading COVID-19.

Government officials did their best to combat the spread of COVID-19 among the foreign-born poor, but some in the public were not supportive. Arsonists set fire to a shelter the government established to house some of the infected poor, for example. Other expressions of xenophobic sentiment periodically surfaced. When in late June a high-ranking official in the Ministry of Health was found to have spent his day off boating with friends in violation of the Ministry’s public health restrictions, he publicly apologized and resigned. Social media posts pointed out that the official was born in Cuba and is only a naturalized citizen of Costa Rica. One added that we don’t need any foreigners in our Ministry of Health anyway.

The Narrative Unravels

July through September was a dour time for Costa Rica. The rate of COVID-19 infections rose from a troubling two or three hundred a day to over a thousand. Costa Rica went from one of the best countries in managing the pandemic to one of worst. Simultaneously, the country was paying a heavy social and economic price for its unsuccessful pandemic control. Public health restrictions prevented people from enjoying their normal social lives even as they decimated the economy. GDP was falling while the unemployment rate exceeded 20 percent. By September, it was no longer even plausible to fault foreigners for the infections. The daily case counts among them declined to about their proportion of the population. COVID-19 was raging through the citizen population at an alarming rate.

There were strained attempts to stimulate national pride. One was to point to Costa Rica’s comparatively low COVID-19 death rate. Although the implication was that Costa Rica was caring for its COVID-19 patients better than comparable countries, this inference wasn’t warranted. Costa Rica had no access to treatments superior to those available elsewhere in the world. The comparatively low death rate could more plausibly be explained by the lower average age of the patients in Costa Rica as well as the paucity of nursing homes.

A related attempt to extract national pride from the dismal situation was to note that the country’s public health system was holding firm despite concerns about its impending collapse. This too was a misinterpretation. A report during these months showed that more COVID-19 patients were dying in hospital wards than in intensive care units. This, coupled with the relatively low rate of COVID-19 hospitalizations to begin with, indicated that the public health system was in effect already rationing care. Meanwhile, thousands of non-COVID-19 medical procedures were canceled. A shift to telemedicine resulted in many patients calling phones that nobody answered and leaving messages that nobody returned.

Special pride was taken in the development of a polyclonal antibody treatment derived from equine (horse) plasma by the Clodomiro Picado Institute at the University of Costa Rica. Lab tests showed this to be a promising treatment for COVID-19. Unfortunately, a preliminary trial of the equine plasma in human COVID-19 patients failed to demonstrate effectiveness. Another more ambitious trial once again showed disappointing results.

Demographers at the University of Costa Rica’s Centro Centroamericano de Población, who were among the experts tracking the course of the pandemic in the country, did their best to spin the dour data positively. By September, their data allowed them to suggest that Costa Rica had probably reached its peak infection rate and to forecast that the situation wouldn’t likely get worse. Their evidence was the tendency of comparable countries to reach a similar peak only to see the rate slowly decline. Excluded from the comparable countries, though, were those like Uruguay that were controlling the pandemic better. Costa Rica was being compared only to the countries that had managed the pandemic poorly, and then the best that could be said was that Costa Rica wasn’t doing any worse.

Some Costa Ricans surely clung to whatever optimistic interpretations they could find, but even among them frustration was the dominant experience. Nothing, it seemed, was working. Many began to resent the public health restrictions. In their opinions, these not only weren’t helping but were also penalizing the wrong people. Restrictions on driving, for example, were widely resented. In a country where only about a third of the population drives (generally the most affluent third) and a pandemic spreading primarily among the foreign-born poor, how do driving restrictions help control the pandemic? (The public health rationale is that driving restrictions reduce the number of large social gatherings and thereby limit contagion.) Although attitudes like this show that class as well as nationalistic interests were surfacing, at least the class interests never led to class conflict. This is because the working class and poor were the hardest hit economically by the public health restrictions. The lower economic strata therefore allied with the upper economic strata in exasperation over public health restrictions.

In July and August, the belief that the public health restrictions were failing was becoming a self-fulfilling prophecy. Cellphone tracking data showed minimal compliance with a partial lockdown ordered by the government in July, and no compliance at all with another one ordered in August. Since the public had already concluded that lockdowns didn’t work, it made sure they didn’t by refusing to comply.

The government was therefore popularly blamed for the out-of-control pandemic. Protests were organized outside the president’s house and a handful of mayors ordered their local police forces not to enforce the countrywide public health protocols. Representatives of the tourism industry insisted on the need to reopen the air borders to allow tourists to return. Many legislators sided with those who opposed the government, whether out of conviction or because they sensed an opportunity to gain political advantage.

Nowhere was this anti-government sentiment on more vivid display than in the public standing of the health minister, Dr. Salas. In August, Dr. Salas’ father was admitted to the hospital for a heart condition, where he contracted COVID-19 and died. Some insensitively said that if Dr. Salas can’t even protect his own father, he surely can’t be trusted to protect the country. For his part, Dr. Salas took time off to be with his father, and then more time off to quarantine. He never really returned to his former role as chief pandemic informer, much less a beloved one. Instead, he usually turned the daily press conferences over to subordinates, and before long the press conferences were limited to twice a week. The health minister who had previously enjoyed rock star celebrity was just another functionary in a government the public opposed.

Some say that President Alvarado had no alternative except to cave into the demands of the opposition. By August his approval rating dropped to 26 percent, down from the two-thirds where it had stood in April. He simply lacked the popular support necessary to continue trying to combat the pandemic. In September, he therefore announced a new pandemic policy under the slogan, “Costa Ricans work and protect themselves.” In other words, the economy would basically reopen, many of the public health restrictions would be lifted, and it would be up to the people themselves to control the pandemic. True, mask-wearing was mandated (although unlike the United States there was little opposition to masks), bars had to close early, and various other restrictions remained in place. But in the main, the government simply agreed to stop trying to control the pandemic.

Instead of fighting the pandemic, President Alvarado turned his attention to two other challenges. One was to secure vaccines for the country. Costa Rica joined COVAX, the United Nations program for allowing lower income countries to access vaccines at prices they could afford, while President Alvarado struck a separate deal with Pfizer and BioNTech for their vaccine. (Later he negotiated another deal with AstraZeneca and the University of Oxford.) The second challenge President Alvarado took up was saving the economy. The decline in tax revenues coupled with the increase in government expenditures during the pandemic put Costa Rica’s already fragile public financing in a dangerous tailspin. Drastic action was required to save the economy.

National Rescue

Ideologically, President Alvarado can probably be described as center-left. As the former Minister of Labor, he leans in favor of workers over management. More generally, he is among the last people anyone would describe as a neoliberal. At the same time, he’s well-informed about economics. He received a scholarship from the British government for graduate studies at the University of Sussex in developmental economics, for instance. President Alvarado is therefore pretty realistic about the economic policies Costa Rica needs. As a result, when in September he negotiated a loan at a favorable interest rate from the International Monetary Fund, he knew what he was doing. More importantly, he knew that the alternative of not receiving such a loan would be economic calamity.

Instead of being appreciative, many Costa Ricans were enraged. The very mention of the International Monetary Fund recalled Latin America’s economic devastation during the 1980s, which the neoliberal economic policies of the International Monetary Fund then are popularly blamed for. At the same time, the loan President Alvarado negotiated required raising taxes. Although it’s reasonable for a creditor to expect a debtor to have the means to repay a loan and the tax increases were minor, temporary, and progressive, the threat of tax increases smacked of the hated “austerity measures” the International Monetary Fund is infamous for imposing.

October therefore proved to be an ugly month in Costa Rica. In addition to a raging pandemic, protests erupted. The protests weren’t always peaceful, either. Over a hundred police officers were injured by protesters, for example, who also cost the country tens of millions of dollars.

The opponents of the loan from the International Monetary Fund were drawn from diverse groups. As often happens, they were united more by what they opposed than what they were for. Business interests, which quickly withdrew from the protests themselves because of their destructive effects on the economy and society, still stood firm against the loan. They objected to the new taxes, and preferred cutting public expenditures instead. Joining them in opposing the loan, and to some extent protesting it, were many of the public employees’ unions. Since public employees in Costa Rica often earn two or three times the amount their peers in the private sector earn, it’s common knowledge that the main area in which public expenditures need to be cut is the compensation for public employees. Yet the public employees claim the real problem is that the wealthy (most of them businesspersons) don’t pay their fair share of taxes. Clearly, business interests and public employees’ unions made for strange bedfellows.

In addition to these two otherwise ideologically opposed groups, pretty much everyone who didn’t like the government joined in the protests. And this was pretty much everyone. Those who actively protested, or in some cases more accurately rioted, were probably disproportionately drawn from the ranks of the diffusely disaffected. More unsavory elements were attracted to the protests too. These included some members of drug trafficking gangs, who used the roadblocks erected by protesters as an opportunity to extort money from motorists.

But while those who opposed the loan from the International Monetary Fund were an amalgamation of diverse and conflicting interests, a unifying theme was evident. The self-styled group that organized the protests called itself National Rescue. In fact, among the few planks of the movement was the promise to protect the homeland. What the movement was protecting the homeland from was never specified, but in context it can be inferred that a loan from the International Monetary Fund was perceived to be a threat to the homeland.

Whatever the thinking of the opposition, President Alvarado once again had little choice. He withdrew the loan proposal from the legislature and called instead for a months-long dialogue with the opposition. Many of the opposition groups didn’t bother to send representatives to the dialogue, while others that did produced so many different policy recommendations that no consensus was on the horizon. Realistically, while President Alvarado was open to suggestions, he didn’t believe that there was an alternative to working with the International Monetary Fund. His strategy was to hope that the dialogue would allow some in the opposition to educate themselves about the issues and otherwise diffuse their anger. He knew, as he admitted in December, that he was going to return to the International Monetary Fund and either accept the original deal or negotiate a similar one.

Interestingly, the opposition knew this too. This is probably why many didn’t bother to participate in the dialogue. Those who did sometimes complained that the dialogue was just a charade to disguise the reality that the loan from the International Monetary Fund was going to be approved eventually anyway. In fact, some seemed privately to understand that accepting the loan was the only viable economic option for the country.

But if even the members of the opposition realized that accepting a loan from the International Monetary Fund was a foregone conclusion, why did they so stridently oppose it? To some extent, the answer is just that the anxiety of the pandemic made acting out about anything appealing, while the ability to bring the government to its knees created an exhilarating feeling of empowerment. But the opposition wasn’t acting out about just anything, it was objecting to a specific thing. Apparently, the loan from the International Monetary Fund was chosen because it represented another instance of perceived foreign encroachment on Costa Rica. By opposing it, Costa Ricans were able to reweave their tattered pandemic myth, which from the outset had asserted national cohesion against foreigner intrusions.

Myth, Science, and Public Health

Sickness and death are almost always accompanied by stories that transcend scientific facts. After a former classmate died, for example, her obituary explained that God called her home. As a nurse, I’m sure my classmate knew the medical explanations for her sickness and death. But as a person of faith, my classmate probably agreed that the ultimate explanation involved the doings of God. Her obituary told us about her and her faith, not what was written on her death certificate.

Pandemics threaten entire cultures with sickness and death. The narrative response to them is therefore collective. These collective narrative responses are myths, again regardless of whether the details out of which they are constructed are true or false.

Pandemic myths can obviously be dangerous. Certainly Costa Rica’s tendency to fault foreigners was. If Costa Ricans had simply continued in the public health solidarity they displayed during the first months of the pandemic, the country would have continued to enjoy low rates of infection and death. By separating themselves from foreigners, Costa Ricans excused their own weakening commitment to complying with public health restrictions by blaming the pandemic on others. The result was that COVID-19 spread savagely everywhere. Nationalistic opposition to the loan from the International Monetary Fund then caused immediate (and likely long-term) damage to the economy, while it also deflected attention away from a pandemic that continued to rage uncontrolled.

Public health experts are well aware of the dangers pandemic myths pose. This is why the first rule of public health management is to keep the public accurately informed of the scientific facts. The theory is that facts are the surest corrective to myths. This is also why a subsidiary rule of public health management allows for marketing strategies to counter myths. When a portion of a population erroneously believes a vaccine is dangerous and refuses to take it, for example, public health experts sometimes recruit respected members of the recalcitrant community and ask them to serve as role models by taking the vaccine publicly. Here the theory isn’t that facts counter myths, but that the scientifically informed are obligated to combat myths by deploying marketing strategies for the well-being a public.

In both instances, public health experts can be criticized. The first criticism is to ask how the public health experts can be certain that they too aren’t beholden to myths. If or insofar as they are, their denial that they are may make their myths more resistant to correction. Another criticism is to ask with what authority public health experts combat myths with marketing strategies. Although they may be more scientifically sophisticated than the myth-believing public, nothing in science entitles even scientists to manipulate the public. If the dissemination of the scientific facts doesn’t persuade the public, it’s frankly game over for the scientists. To proceed to market scientific facts to a recalcitrant public may be morally justified, but it’s not justified by science.

The truth is therefore that public health is ultimately a moral endeavor. Yes, it is rooted in science and deferential toward it, but at the end of the day it is not directed by science. It is directed by a moral aim, which probably many would agree can be summarized as “saving lives.” This may well be good, even noble, but our admiration for the field shouldn’t prevent us from suspecting that it might be infiltrated by the same kinds of dubious concepts and assumptions that encroach on every other moral philosophy.

Mentioned is the disparaging attitude toward myth common among public health experts. But there may be a more fundamental aspect of their outlook that needs to be recognized. This is their anemic concept of the public.

Public health experts rarely bother to define what they mean by the public. When they use the term, they appear to regard the public as essentially an aggregate of individuals. From this, they proceed to consider a problem a public health concern when a lot of people either suffer from it or might suffer from it. Continuing to reason this way, the experts apply the utilitarian ethical maxim of “the greatest good for the greatest number” to public health management. The result is usually a proposal for corrective measures that impose the least costs possible on everyone while benefiting the most people possible. For example, masks are currently favored by public health experts not because masks are the most effective strategies for combating COVID-19 (hazmat suits would be more effective) but because masks are cheap, easy to use, and not terribly inconvenient. In the end, it’s almost as if public health experts create algebraic formulas to manage pandemics, and assume these formulas represent the public good.

A misunderstanding of myth follows from this orientation. There is no room in the orientation for the collective stories that can properly be called myths because there’s no concept of anything collective in the orientation. Everything is rather broken down into bits. Even the public is reduced to an aggregate of the individuals that comprise it. Since myths are by definition properties of groups rather than individuals, it’s no wonder that they appear to the public health experts as irrational beliefs that need to be overcome, not as stories essential for binding people together into a culture.

But there is another way to think about the public in public health. This is to understand the public as a culture, a congealing thing that transcends its individual members, almost an organism in its own right. When the public is understood this way, the standard of public health success isn’t only saving the most lives possible at the lowest costs, but of saving cultures.

Myths save cultures. This is their primary purpose. True, they can sacrifice individual lives in the process. But this isn’t unusual when cultural survival is at stake. Warfare may be the most extreme example, though there are more common examples, such as the risks individual healthcare workers, first responders, and others take to protect the rest of us. We honor these people as heroes; we don’t dismiss them as so irrational that they lack the sense to protect themselves. Why would we esteem them this highly if we didn’t also prioritize the survival of our culture over individual survival? Indeed, everyone knows that they won’t live forever. Everyone therefore wants to attach their individual lives to something larger and more enduring than themselves. This larger and more enduring entity is their culture, as they understand it.

Of course, saving as many individual lives as possible at the lowest cost is a worthy goal too. Costa Rica could have done better at this. But if it had done better at saving individual lives, it’s possible that the fragile coherence of its culture would have dissolved into a nothingness more frightening than death.