This chapter reintroduces the U.S. mood in the spring of 2020 when George Floyd’s death and the Covid pandemic launched an uncanny “racial reckoning” based more on awareness of racism than accountability. The focus on one and not the other proved a shortcoming that contributed to a backlash that continues under the Trump presidency. The organization of the book shows that racial reckoning involved three major areas of racial inequality: disparities in policing, wealth and health. Future chapters present evidence that accountability is necessary despite the rise of federal legal and political developments in support of white supremacy and the denial of racial inequality to Blacks. The book ultimately argues that racial reckoning resembles Black wellbeing, which reflects the goals of most Americans and may be most achievable through local democracy.

This chapter examines how Covid-19’s devastating effects on Black people’s health and mortality reflected their overexposure to risk based on socioeconomic inequality, a disproportionate incidence of “underlying health conditions” and a distinct lack of trust in American healthcare. The combination shortens Black lives at all times. Racial reckoning after Covid demands asking why Black people suffer so many racial health disparities in the first place. This critical public health question leads to discoveries about the social determinants of health and the experience of pervasive implicit bias among healthcare professionals. All the underlying conditions associated with dying from Covid are exacerbated by environment and treatment dynamics that weaken trust, produce toxic psychological stresses and, unless reckoned with, put Blacks at heightened risk of the next pandemic.

This chapter reviews the 2020 “racial reckoning”, critiques its unfinished approach, evaluates the backlash against it and chronicles the rise of racial retribution with the second Trump administration. The original protests sought only awareness of racism in policing, wealth inequality and racial health disparities, not the accountability that could bring about structural changes in material inequalities. The Black struggle over inequality required recognizing racial equity as a core American value, something identity-oriented awareness and DEI programs could not establish. Instead, a structural backlash unwound performative support for reckoning and supported a radical inversion of antidiscrimination aligned with both a MAGA Republican political ideology and a Federalist Society legal movement called colorblindness. The country’s cynical pundulation on race undermined reckoning, challenging future progress.

Culture and emotion are two of the fundamental mechanisms for human adaptation to the natural and social environment. Culture provides informational resources that help a human population adapt to environmental regularities, whereas emotion provides informational resources that help adaptation to environmental perturbations. In this chapter, we speculate on micro-to-macro cultural dynamics under societal threats, namely, when a population experiences recurrent large-scale perturbations. We first piece together individual-level micro-cultural dynamics under societal threat – encoding, storage, and transmission of cultural information when a large proportion of a population is threatened with potential adverse effects by natural challenges, such as extreme weather events and pandemics, or by social challenges, such as wars and conflicts. We then speculate how these processes may give rise to macro-level cultural dynamics under recurrent societal threats by transforming cultural scripts to cope with societal challenges.

Infectious diseases are caused by pathogenic agents, such as bacteria, viruses, fungi or parasites. These agents may infect a human directly from contaminated air, water, or food. The agents may also be spread from infected animals or infected humans, called vectors, to a healthy human. An epidemic is a major increase or upswing of an infectious disease in an area that results in a large number of cases, followed then by a decline. Many infections and contagious diseases have become epidemic, including scarlet fever, chicken pox, measles, influenza, and cholera, among others.

Despite the neoliberal wave solidarity capitalism has remained important in Europe. Since it was impossible to tame capitalism globally, promoters of solidarity turned to the European Union, and strove to strengthen its ‘flanking’ welfare state. The early 1990s brought a first peak of international awareness regarding environmental protection and interest in social Europe, but that was shattered by a neoliberal reaction from the mid-1990s to the mid-2010s. Since then, social and environmental policies have been on the rise again, only to be challenged by the Russo-Ukrainian War. Three expressions of solidarity will be examined. The first deals with the legal regulation of globalisation through social legislation and trade regulation. The second involves financial redistribution towards the neediest, with transfers to poor regions (cohesion policy), and later with specific measures during the Covid-19 crisis (2020–21). The third addresses the rising importance of environmental regulation in general (air and water pollution, biodiversity, etc.), especially with regard to climate change (Kyoto Protocol, 2015 Paris Agreement), despite the lobbying of the ‘Merchants of Doubts’.

This case study presents a scenario where a small community hospital faces a surge of patients during the early stages of the SARS-COVID pandemic. The hospital, located near a cruise ship port, has limited resources, including a 10-bed emergency department (ED) and a two-bed ICU. Several patients from a cruise ship, who are all part of the same family, present with worsening respiratory symptoms, including cough, fever, and shortness of breath. As more patients arrive, the ED staff must manage the influx while facing limited ventilators and critical care equipment. The scenario challenges participants to perform emergency triage, prioritize treatment for respiratory distress, manage limited resources, and follow pandemic protocols to prevent the spread of infection. Through these events, healthcare providers must transition from conventional operations to crisis standards of care while managing an overwhelmed system, making difficult decisions regarding resource allocation and patient survival.

While previous chapters have focused on the deaths of Christians under roughly ordinary circumstances, this chapter turns to deaths precipitated by pandemics and natural disaster. The necrosima accordingly features a number of poems that address instances of mass death due to pandemic and pestilence. In both form and context of preservation, these hymns were manifestly part of their communities’ ritual repertoire. At the same time, however, they witness to periods in which ordinary ritual pathways had broken down. In the midst of sickness and bereavement, the hymns suggest, churches stood empty, clergy mourned the loss of their brothers, even burials had ceased in light of death’s relentless onslaught. This chapter examines the madrāshê in question as spaces for reconfiguring communities’ ritual practices. The necrosima’s pandemic hymns and other, roughly contemporaneous liturgical sources thus point to communities’ embrace of lament, petition, and penance as models for engaging the divine.

Post-COVID condition (PCC) describes new or worsening symptoms that develop after initial SARS-CoV-2 infection and are persistent for months without alternative explanations. Common PCC symptoms include post-exertional malaise, fatigue, breathlessness, cough, dizziness, “brain fog,” and gastrointestinal symptoms, and they may occur in upwards of 10% of patients infected with SARS-CoV-2. The physical, cognitive, and mental health sequalae seen in post-intensive care syndrome (PICS) are also common in PCC, particularly in COVID-19 patients that have survived critical illness. The pathophysiology of PCC remains poorly understood. Patients’ symptoms should be managed aggressively; management has significant overlap with the treatment approach to PICS patients. Dedicated PCC clinics or combined PICS/PCC clinics should include specific expertise in the diagnosis and management of symptoms relating to COVID-19, including fatigue, dyspnea, exertional intolerance, GI discomfort, psychological sequelae, and cognitive dysfunction, and actively collaborate with an interdisciplinary team of clinicians and staff with PCC expertise.