Project by: Anna, Emily, Lauren
On March 25, 2020, The New York Times published under The Opinion Section a five minute video clip titled: “‘People Are Dying’: 72 Hours Inside a N.Y.C. Hospital Battling Coronavirus. Filmed during the rapid rise of coronavirus cases, the video highlights the perspective of an emergency medicine doctor, Dr. Colleen Smith, at Elmhurst Hospital Center in Queens, NY. The film follows select clips of her experience — B-roll, self-interview, photos — throughout the course of three days, from March 23rd to the end of March 25th. Throughout the film, Dr. Smith uses her experiences to create her own narrative regarding the coronavirus.
Mission & Purpose
Social Mission: to equip consumers of this COVID-19 media piece with the contexts (local, state, national, international) that influence its creation and message.
- What narratives are Dr. Colleen Smith responding to in the video? In other words, what webs of meaning is this video suspended in?
- What other contexts were left out of the video that are important to acknowledge?
- How do these narratives lead to media decisions within the film that try to convey the reality of a situation?
- Can visualizing audio, comparing B roll to interview footage, and analyzing the overall construction of the media lead to a greater understanding of the contexts of COVID-19?
- How can the creation of our own visualizations aid in contextualization? How can our visualizations imbue meaning that is absent in the video?
Ultimately, by watching a video focused on a local context, we can trace and understand the larger forces at play regarding COVID-19. We will attempt to show the contexts that have been left out or referred to in this video in various analyses and visualizations. By contextualizing this video, we can expose the “webs of meaning” that connect the ideas presented by Dr. Smith.
Overview of Our Project
Our project is broken down into two main parts. In both parts of the project, what is key is the unravelling of the layers of COVID-19 context that affect Dr. Smith’s video. Our method of unravelling closely follows Geertz’s idea of conducting ethnography through“thick description” and is exhibited in our Culture, Media, and Data map (above). Our Culture, Media, and Data map was built for our COVID-19 video and aids in visualizing our project’s framework.
In terms of culture, Dr. Smith, the individual of focus, is at the center of our multilayered cultural context. She is embedded within and is constantly shaped by various, layered contexts that are connected and influence each other. We attempt to reveal these context, mainly the intersection of the local/state with the national level. By unraveling these layers of COVID-19 culture, we reveal how these contexts have not only affected the production of Dr. Smith’s video but also in our own consumption of COVID-19 media. We also point out how different contexts of COVID-19 lead to different productions of data by identifying what data is and is not being used to create pandemic narratives.
Part 1: Narrative Identification
In Part I: Narrative Identification, we begin by deconstructing and disentangling three separately yet distinctly related narratives: lack of leadership support, ventilator shortage, and limited understanding of the virus. After identifying these narratives, we point out the contexts in which these narratives are embedded in. After better understanding these contexts, we reconstruct our own version of Dr. Smith’s video.
Narrative #1: Leadership (Emily)
A primary narrative that Dr. Colleen Smith responds to is one espoused by institutions and public leaders: Elmhurst hospital and its doctors have or are going to have the supplies that they need both at this moment in the pandemic and in the future. Therefore, calls and pleas for more ventilators are invalid.
The context for the leadership narrative involves various individuals on a local, state, and national level (see table below).
Notice that most local officials and state representatives all seem to agree with Dr. Smith’s narrative that the coronavirus situation in New York was overwhelming and would continue to exacerbate unless there was some intervention. Thus, who is Dr. Smith mainly responding to?
As acknowledged in the video and evident in the leadership chart, the narrative that Elmhurst is operating perfectly fine is, indeed, supported by the Head of NYC public hospitals. Even though Michael Katz acknowledges that the current situation is unsustainable without federal help, his phrasing implies that currently the needs are being met at all the NYC public hospitals, which includes Elmhurst. It is likely that it is this exact narrative that “things are fine” that prompts Dr. Colleen Smith to weave her own narrative (images above). She explicitly points out what is being said by leaders, confronts those statements with her own experiment, and then provides her own evidence. It is here with her evidence of five ventilators and the image of the morgue truck (provided later in the video) that Dr. Smith uses indexical landscaping as symbols of something larger that is happening outside of the video but is affecting her material environment. She intentionally shows these FIVE ventilators in order to contrast against the imaginable amount of ventilators that are needed for proper treatment (those 30,000-40,000 ventilators) but also statements like the “100” mythical vents that have not manifested at the hospital and the supposed 400 ventilators that were sent by the government. In using the image of the truck, she intentionally invites the audience to think about repercussions of not acknowledging the impending disaster of coronavirus if there are no changes to the amount of physical equipment and emotional support for doctors.
(right image subtitles): “Leaders in various offices, from the President to the Head of Health and Hospitals, saying things like everything is fine, we’re going to be fine. From our perspective, everything is not fine”
Leaders on local and state levels point out, like Dr. Smith (caption above), that there is also additional resistance against their narrative at a federal level. Indeed, the narrative that the Elmhurst hospital and its doctors have all the supplies that it needs seems to be directly tied to the denial of the need for more supplies on the national level. This leads to Dr. Smith’s assertion that “everything is not fine” by contrasting the five ventilators available in her hospital with the 30,000-40,000 ventilators that are needed by NYC yet is being denied.
Yet, it is important to note that at the release of this video, these narratives continue to develop. In particular, the national narrative seemed to be shifting slightly closer towards the reality that Dr. Colleen supports. Trump seemed to acknowledge the situation in broadly New York “I am working very hard to help New York City & State. Dealing with both Mayor & Governor and producing tremendously for them, including four new medical centers and four new hospitals. Fake News that I won’t help them because I don’t like Cuomo (I do). Just sent 4000 ventilators! (Trump 2020).”
Narrative #2: Equipment Shortage (Lauren)
Context
Intro
An additional narrative that is layered with and further complexified by the parallel leadership narrative concerns personal protective and patient equipment during COVID-19. Dr. Colleen Smith responds to this narrative in her opinion piece in the New York Times, stating that there is an equipment shortage in the United States caused by the COVID-19 pandemic. Throughout the video, Dr. Smith leads the audience through the Elmhurst hospital emergency room, points to beds that are occupied with COVID patients, and documents the sights and sounds of the presence of equipment in an emergency department. Her actions and decisions raise questions such as why is it important that sacred or absent equipment be visualized to the audience of this video? Why are some equipment images static while others are in motion? In order to fully grasp the narrative that Dr. Smith is responding to, it is imperative to contextualize her story within the scope of how the PPE and vent shortage in the United States occurred and who is taking action about this issue. This contextualization leads to the intertwining of other narratives, showing that the narrative of PPE shortage is not an isolated entity.
Equipment Context
Conversations surrounding PPE, or personal protective equipment, and life-saving technologies gained a new significance since the onset of the global COVID19 pandemic in 2020.
Narrative #3: Scientific Knowledge of COVID19 (Anna)
Context
The final narrative that we will analyze in the video created by Dr. Colleen Smith in NYC is that of our understanding of the virus at the time. This video was published on March 25th, just over a month after the virus had been officially named. The idea of asymptomatic cases had newly emerged and is acknowledged by Dr. Smith, specifically when she explains that patients with stomach pain are scanned for the source of their pain and inadvertently found to have signs of COVID-19 settling in their lungs. The way that the virus is spread and its manifestations are widely unknown and this uncertainty is a driving force of Dr. Smith’s narrative.
It is important to understand that our knowledge of the virus at this time was highly limited and is still everchanging. Throughout the video, Dr. Smith blames the lack of action by leadership for the impending pandemic but at the same time, there had also been very little known about the virus as a whole and the ways in which it functioned. Dr. Smith goes on to describe how the hospital had taken extra precautions around individuals displaying symptoms of cough and fever while continuing to respond normally to those not exhibiting symptoms and how they are continuing to learn of more symptoms as they go each day.
The lack of knowledge of the virus was highly detrimental for the hospital staff for multiple reasons. One of the most obvious of these reasons is because of the virus spreading to the hospital staff and causing illness to spread within the personal trying to save those affected by the virus in the first place. But, the lack of knowledge of the virus is not only physically detrimental but also emotionally deteriorating. The high anxiety of the unknown and the fear of contracting the disease is crippling to the doctors and nurses who expose themselves to it every day. The volatile and unknown nature of the virus at this time contextualizes the panic and vulnerability that Dr. Smith expresses to her audience.
Further Understanding
On March 11, 2020, the WHO declared the mass outbreak of Coronavirus as a pandemic. At the time of Dr. Smith’s media, our knowledge, which is still ever-changing as of December 2020, was very slim. In doing research, I found that it was around Mid-March that videos about COVID-19 were being published online for the public to consume and understand the virus to the best extent possible, little substantial information had been posted prior. The video that I found to be most informative was by Kurzgesagt- In a Nutshell on youtube that was published on March 19, 2020, less than a week before Dr. Smith’s video was released. This video breaks down what the virus is, how it spreads, and what the public can do to combat the virus. What I found most interesting about this video is that it itself is a visual representation of the virus, distributed to the public on a large scale. I have embedded the video because of the wide range of topics that it covers and the depth in which it describes each of these topics.
Another part of the video that I found intriguing is the lack of narrative on the current situation. It appears to sugarcoat the severity of the situation, much like that of the leader’s response. The representation of the situation of the pandemic in the United States is illustrated much differently than that of Dr. Smith’s telling. This colorful, animated video juxtaposes the raw, emotional footage from Dr. Smith. This is where the realities of the pandemic diverge from the onset of the pandemic in the United States and polarities in the understanding of the virus become very clear.
Timeline: A Visualization of these Intertwining Narratives (All)
One way that we are interrogating and considering the context of the pandemic in relation to Dr. Smith’s situated media is through the creation of a timeline labeled with the current events. This data visualization enables the viewer to understand the context of the pandemic before, during and after Dr. Smith’s video, in the scales of both state/local and national. These news articles and current events are labeled by color to signify the type of narrative they are discussing or responding to. These correlate with the narratives that we identified in Dr. Smith’s video that she is in dialogue with.
Intertwining Narratives: Zoomed in Analysis after Context (Emily & Lauren)
In this section, we further deconstruct several scenes within the video that show the convergence of these three narratives.
The clip begins with a statement: Elmhurst shipment has received a shipment of ventilators. There is no deeper meaning to that statement until it is put into context by the next clip which states that this is the third emergency resupply. Following this layering of context, there is a subsequent, intentional change to eerie and ominous music in the background, indicating a shift in mood after this new understanding that the lack of supplies has been a recurring issue.
The additional contexts of leadership, equipment shortages, and scientific knowledge about the virus all converge in this clip. An image and the sounds of a ventilator are so significant because vents are the scientifically proven machinery that allows a patient to be kept alive while infected. Additionally, the state and national battles for vents show that the hotspots of the COVID19 pandemic cannot get the resources they need. This puts the equipment shortage into perspective: if the hotspots cannot obtain them, then smaller, rural hospitals probably have non-surmountable challenges.
The head of NYC public hospitals clip is followed and further juxtaposed by a clip of Dr. Colleen explicitly pointing out what is at stake for believing one narrative over the other: “You know we now have these five vents, unless people die, I suspect that we will be back begging for ventilators in a day or two.”
The use of the collective “we” here shows how the emergency room physician is no longer defined by their occupation as a physician during the pandemic. Physicians are now machinery, keeping patients alive that do not have vents, and are additionally advocates and fighters for necessary equipment. They are no longer just administering care, but are fighting a broken system in a trying time.
The juxtaposition between two opposing narratives is seen again with these screenshots. This clip follows the same pattern of first stating what other leaders say is happening and then followed by what Dr. Colleen says it is happening. Emphasizing this back and forth dialogue is the change in clips when there is a switch in narratives.
These screenshots also display the convergence of the many narratives that Dr. Smith is responding to: it exposes the tension in the pandemic of “who knows what.” Typically, society turns to the scientists for hard facts and the government for leadership. Dr. Smith is asserting that neither of these systems are fulfilling their duties, and so the physician has additionally stepped into fulfill these roles during the pandemic. Dr. Smith is the first person expert: she has first person understanding through testing and scans of the science of the virus, of the holes in leadership through the lack of vents, and of the equipment shortage as her health is risked everyday through the reusing of PPE.
Part 2: Narrative Re-unification and Analysis (Lauren)
We employed methods of deconstruction and reconstruction of media in our iMovie representation of Dr. Smith’s media. Our visualization shows simultaneous deconstruction and reconstruction; the visualized deconstructed track shows that the narrative was woven with specific editing choices to emphasize content and message. This contrasts to the final video that is playing at the same time in the upper corner.
(Lauren)
Part 3: Deconstructing Dr. Smith’s Statistic (Emily & Lauren)
In Part III: Deconstructing Dr. Smith’s Statistic, the underlying method of unraveling layers of COVID-19 context is still evident. We follow the same process of starting with deconstruction and then ending with reconstruction: we begin with an isolated clip of Dr. Smith and add the missing layers of context via historical context and data visualizations that are missing within that clip.
The Problem
In addition to pointing out the five ventilators, Dr. Smith utilizes numbers only once more throughout her video: “On a regular day my emergency department’s volume is pretty high, it’s about 200 people a day. Now we’re seeing 400 or more people a day.” During this period of coronavirus, there were many data points regarding coronavirus about NYC, but even with these numbers it’s difficult to understand the significance of Dr. Colleen’s statistic.
(Emily)
Taking a look at the visualization of positive coronavirus cases (above), similar to the aggregation of race categories in “Visualizing Diversity: Data Deficiencies and Semiotic Strategies,” this aggregated COVID-19 data gives a large overview of what is happening in New York City but is unable to explain the specific, individualized experiences such as that of Dr. Smith’s. In other words, aggregation privileges the “norm” of NYC, but does not allow us to see how and why specific areas, such as Elmhurst, might be affected. Thus, how might we come to understand what these numbers mean in terms of being overwhelmed as a hospital and how might we convey the significance of these numbers in a way that Dr. Smith was not able to?
In this section of our analysis, we dive into this statistic by unpacking this statistic’s meaning within a local and state context by combining Elmhurst Hospital Center’s history with contextualization using our own COVID-19 data visualizations.
On Elmhurst Hospital
In order to unravel this statistic, it is necessary to understand Elmhurst Hospital Center. How was Elmhurst operating before the pandemic? What was the demographic of the surrounding area of Queens and how did that impact Elmhurst?
Caption: (left) Location of Elmhurst Hospital Center (right) Image of Elmhurst Hospital Center during the rise of coronavirus cases on March 25, 2020
(image source: Google Maps, NYTimes article)
Elmhurst Hospital is located in Queens, New York City. It is one of three major hospitals in the Queens area and is considered a “safety-net hospital” that mainly serves low-income patients. The hospital has also been known to have a history of a shortage of supplies. For example, in 2009, it was reported that there was a significant shortage of mammograms (citation). Given the combination of these three facts — that Elmhurst is a major hospital in Queens, it has a history of shortages of equipment, and mainly serves a population that is known to be affected disproportionately by COVID-19 — when the coronavirus was rapidly increasing in March, it is perhaps these combinations of factors that led Elmhurst Hospital Center to quickly became the epicenter of the epicenter (New York) of the pandemic, exacerbating the already existing conditions of the hospital.
Our project attempts to engage with the material at a variety of levels by understanding that our data visualizations, of mapping cases and beds, all refer to individual human lives. We understand that these individual lives, when aggregated together, form patterns and ideas that we are seeing in the media. However, by disaggregating New York City data, we can gain new insights.
(Emily) Caption: disaggregated New York manipulated zcta.csv data from THE CITY, nonprofit newsroom in New York. Notice the heavily infected areas around Elmhurst Hospital Center. Unlike the aggregated data, we can see the distribution of positive cases relative to the three main hospitals in Queens. Given that Elmhurst seems to closer to more heavily infected areas, this data visualization can help reveal a possible reason the influx from 200 to 400 hospitalizations.
(Lauren) Caption: notice the rise of coronavirus cases during the release of this video on March 25, 2020. As the video was released during the rapid rise of coronavirus, the amount of cases was exponentially increasing, putting additional pressure on hospitals to compensate for hospitalizations numbers never encountered before. Indeed, by March 24th, Elmhurst was already running at more than 125% capacity compared to its typical 80-percent capacity rate (Kaufman Coronavirus Cases).
(Lauren) Caption: notice the discrepancy between ICU beds available and total ICU beds during the release of the video on March 25, 2020. This gap, made visible by the data visualization, can help the audience understand “why” healthcare workers are worried about maxing out their available resources.
On the Creation of Data Visualizations
In general, data visualizations can be used to put into context the numbers surrounding coronavirus. A lot of these numbers, including the one that Dr. Smith has given us, don’t mean anything without the current norm and current cases. By understanding local and state contexts of COVID-19, we can further shape our own understanding of the increase from 200 to 400 hospitalizations.
All of these visualizations present in our project were created through our own subjective perspective. It is important for us to note that Dr. Smith’s media influenced the subject matter of our visualizations in addition to the way that we constructed them; for example, we felt that data on the number of ICU beds available would aid in contextualization of Dr. Smith’s story. Additionally, we contrasted current cases and deaths because Dr. Smith discussed how equipment only becomes available when COVID patients die. In this sense, our data visualizations are subjective in multiple layers, including Dr. Smith’s narrative, our ethnographic perspective, in addition to the mechanisms and categories employed in gathering the data (and what data was chosen to not be gathered). This is our attempt to say that we thought critically about the best way to dissect and present data for this project.
On Missing Data
While the data visualizations we created helped to transform data into thicker descriptions of COVID-19, it is imperative to address the data that are not available to us in addition to those that are. Dr. Smith’s video, characterized by her emotional plea to the public, led us to realize that the data most visible to the public through media channels are categorized by very “hard” topics of cases, positivity rates, and death counts. What we do not see is data on COVID patient optimism, emergency room personnel burn-out rates, or the emotional load required by a doctor or nursing staff to keep a COVID patient alive.
As ethnographers, it is equally as important to acknowledge what kinds of truths we are creating with our representation. First, the positionality of Dr. Smith and ourselves are inherently limited. Dr. Smith only represents a singular perspective in a very specific context regarding the experiences of COVID-19. She cannot represent all physician experiences but can at the very least give us insight into one specific context. Furthermore, as ethnographers we acknowledge that there are holes that we are missing by not being able to conduct a first person ethnography. We are limited to our own interpretations of Dr. Smith’s interpretation. Though, we imbued our own interpretation with other media sources, there is a lack of information and evidence from other individuals that were directly on the ground of Elmhurst Hospital with Dr. Smith.
Summarizing ANT347 Concepts and Applications: (All)
Wrapping Up (All)
Limitations
For this project, we are making our own interpretation on top of Dr. Smith’s interpretation. We are limited in our positionality as ethnographers, as none of us have had the opportunity to speak with Dr. Smith and additionally none of us are currently experiencing the NYC COVID19 crisis. As we addressed beforehand on “missing data,” our media is specifically from a singular perspective: an emergency medicine physician. We realize that Dr. Colleen Smith is only one perspective and therefore offers us only a partial truth of the entire COVID-19 pandemic.
Achievements
We feel that we achieved our purpose for our audience; we gave them the tools and contexts needed in order to understand the truth and order that Dr. Smith creates with her representation of the COVID19 pandemic. We were able to add in data visualizations and use the critical tools learned from our passages to analyze and represent data; we added more complexity onto an already complex thing. We feel that we succeeded in showing that the COVID19 pandemic, while oftentimes represented in a linear video media, is much more complex than a linear narrative. We hope our audience will take some lessons away from our project, such as understanding that media present subjective representations of reality to their viewers and that media needs to be contextualized (with personal narrative or data) in order to avoid incorrect interpretations. These lessons show how malleable media can be, where it can be removed from certain contexts, and applied to others to further one’s argument (this occurs very often in the age of digital media).
Conclusion
Our mission was to give our audience the tools and content needed to understand the contexts in which the methods of truth and order are created with Dr. Smith’s representation. We hope our audience will take some lessons away from our project, such as understanding that media present subjective representations of reality to their viewers and that media needs to be contextualized (with personal narrative or data) in order to avoid incorrect interpretations. These lessons show how malleable media can be. Media can be completely removed from certain contexts and take on new meaning that can be applied to further one’s argument, a process that often occurs in the age of digital media).
Ultimately, in the words of Geertz: “Cultural analysis is intrinsically incomplete. And, worse than that, the more deeply it goes the less complete it is.” (29). Our project is merely a scratch on the surface of better understanding and interpreting the experiences of the pandemic via media. We hope that our work has helped to reveal some of the “turtles all the way down” and has added to the large, existing discourse on COVID-19.
Sources
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