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2022 m. vasario 17 d., ketvirtadienis

Covid Patients May Have Increased Risk of Developing Mental Health Problems

"A new, large study found that in the year after getting Covid, people were significantly more likely to be diagnosed with psychiatric disorders they hadn’t had than people who didn’t get infected.Top of FormBottom of Form

 Social isolation, economic stress, loss of loved ones and other struggles during the pandemic have contributed to rising mental health issues like anxiety and depression

But can having Covid itself increase the risk of developing mental health problems? A large new study suggests it can.

The study, published Wednesday in the journal The BMJ, analyzed records of nearly 154,000 Covid patients in the Veterans Health Administration system and compared their experience in the year after they recovered from their initial infection with that of a similar group of people who did not contract the virus.

The study included only patients who had no mental health diagnoses or treatment for at least two years before becoming infected with the coronavirus, allowing researchers to focus on psychiatric diagnoses and treatment that occurred after coronavirus infection.

People who had Covid were 39 percent more likely to be diagnosed with depression and 35 percent more likely to be diagnosed with anxiety over the months following infection than people without Covid during the same period, the study found. Covid patients were 38 percent more likely to be diagnosed with stress and adjustment disorders and 41 percent more likely to be diagnosed with sleep disorders than uninfected people.

“There appears to be a clear excess of mental health diagnoses in the months after Covid,” said Dr. Paul Harrison, a professor of psychiatry at the University of Oxford, who was not involved in the study. He said the results echoed the emerging picture from other research, including a 2021 study on which he was an author, and “it strengthens the case that there is something about Covid that is leaving people at greater risk of common mental health conditions.”

The data does not suggest that most Covid patients will develop mental health symptoms. Only between 4.4 percent and 5.6 percent of those in the study received diagnoses of depression, anxiety or stress and adjustment disorders.

“It’s not an epidemic of anxiety and depression, fortunately,” Dr. Harrison said. “But it’s not trivial.”

Researchers also found that Covid patients were 80 percent more likely to develop cognitive problems like brain fog, confusion and forgetfulness than those who didn’t have Covid. They were 34 percent more likely to develop opioid use disorders, possibly from drugs prescribed for pain, and 20 percent more likely to develop non-opioid substance use disorders including alcoholism, the study reported.

After having Covid, people were 55 percent more likely to be taking prescribed antidepressants and 65 percent more likely to be taking prescribed anti-anxiety medications than contemporaries without Covid, the study found.

Overall, more than 18 percent of the Covid patients received a diagnosis of or prescription for a neuropsychiatric issue in the following year, compared with less than 12 percent of the non-Covid group. Covid patients were 60 percent more likely to fall into those categories than people who didn’t have Covid, the study found.

The study found that patients hospitalized for Covid were more likely to be diagnosed with mental health issues than those with less serious coronavirus infections. But people with mild initial infections were still at greater risk than people without Covid.

“Some people always argue that ‘Oh, well, maybe people are depressed because they needed to go to the hospital and they spent like a week in the I.C.U.,’” said the senior author of the study, Dr. Ziyad Al-Aly, chief of research and development at the V.A. St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis. “In people who weren’t hospitalized for Covid-19, the risk was lower but certainly significant. And most people don’t need to be hospitalized, so that is really the group that’s representative of most people with Covid-19.”

The team also compared mental health diagnoses for people hospitalized for Covid with those hospitalized for any other reason. “Whether people were hospitalized for heart attacks or chemotherapy or whatever other conditions, the Covid-19 group exhibited a higher risk,” Dr. Al-Aly said.

The study involved electronic medical records of 153,848 adults who tested positive for the coronavirus between March 1, 2020, and Jan. 15, 2021, and survived for at least 30 days. Because it was early in the pandemic, very few were vaccinated before infection. The patients were followed until Nov. 30, 2021. Dr. Al-Aly said his team was planning to analyze whether subsequent vaccination modified people’s mental health symptoms, as well as other post-Covid medical issues the group has studied.

The Covid patients were compared with more than 5.6 million patients in the Veterans system who did not test positive for the coronavirus and more than 5.8 million patients from before the pandemic, in the period spanning March 2018 through January 2019. To try to gauge the mental health impact of Covid-19 against that of another virus, the patients were also compared with about 72,000 patients who had the flu during the two and a half years before the pandemic. (Dr. Al-Aly said there were too few flu cases during the pandemic to provide a contemporaneous comparison.)

The researchers tried to minimize differences between groups by adjusting for many demographic characteristics, pre-Covid health conditions, residence in nursing homes and other variables.

In the year after their infection, the Covid patients had higher rates of mental health diagnoses than the other groups.

“It’s not really surprising to me because we’ve been seeing this,” said Dr. Maura Boldrini, an associate professor of psychiatry at NewYork-Presbyterian Columbia University Medical Center. “It’s striking to me how many times we’ve seen people with these new symptoms with no previous psychiatric history.”

Most veterans in the study were men, three-quarters were white and their average age was 63, so the findings may not apply to all Americans. Still, the study included over 1.3 million women and 2.1 million Black patients, and Dr. Al-Aly said “we found evidence of increased risk regardless of age, race or gender.”

There are several possible reasons for the increase in mental health diagnoses, Dr. Al-Aly and outside experts said. Dr. Boldrini said she believed the symptoms were most likely influenced by both biological factors and the psychological stresses associated with having an illness.

“In psychiatry, it almost always is an interplay,” she said.

Research, including brain autopsies of patients who died of Covid-19, has found evidence that Covid infection can generate inflammation or tiny blood clots in the brain, and can cause small and large strokes, said Dr. Boldrini, who has conducted some of these studies. In some people, the immune response that is activated to fight against a coronavirus infection may not shut down effectively once the infection is gone, which can fuel inflammation, she said.

“Inflammatory markers can disrupt the ability of the brain to function in many ways, including the ability of the brain to make serotonin, which is fundamental for mood and sleep,” Dr. Boldrini said.

By themselves, such brain changes may or may not cause psychological problems. But, if someone is experiencing stress from having felt physically ill or because having Covid disrupted their lives and routines, she said, “you may be more prone to not being able to cope because your brain is not functioning 100 percent.”

Dr. Harrison, who has conducted other studies with large electronic medical databases, noted that such analyses can miss more granular information about patients. He also said that some people in the comparison groups might have had Covid and not been tested to confirm it, and that some Covid patients might have been more likely to receive diagnoses because they were more worried about their health after Covid or because doctors were quicker to identify psychological symptoms.

“There’s no one analysis that tells you the whole story,” Dr. Al-Aly said. “Maybe all of us or most of us experienced some sort of an emotional distress or mental health stress or some sleep problem,” he added. “But people with Covid did worse.”"


Viduramžių Europoje pandemija visam laikui pakeitė darbą. Ar tai gali pasikartoti?

  " Po niokojančios pandemijos žuvo milijonai žmonių, o dar daugiau jų gyveno blogai. Daugelis tų, kurie išgyveno, pavargę nuo beprasmiško darbo jausmo ir neįveikiamo atotrūkio tarp turtingųjų ir visų kitų, atsisako grįžti į senus darbus arba masiškai išeina iš darbo. Pavargę nuo pervargimo ir nepakankamo atlyginimo, jie jautėsi nusipelnę geresnio gyvenimo.

Tai galėtų būti istorija apie šiandieną, tačiau tai taip pat yra modelis, kuris atsirado visoje Europoje po vienos mirtingiausių pandemijų istorijoje – Juodosios mirties.

Kovos dėl atlyginimų ir darbo vertės, nulėmusios metus po maro, tam tikra prasme buvo tokios pat dramatiškos, kaip ir pati pandemija. Galiausiai Europa įsiveržė į smurtą. Atsižvelgiant į tai, kur šiuo metu esame, verta atkreipti dėmesį į įvykių grandinę, kuri lėmė grandis nuo pandemijos iki panikos iki kruvino sukilimo.

Juodoji mirtis, kaip mes ją dabar vadiname, siautėjo Eurazijos žemyne ​​nuo 1347 iki 1351 m. Arabų istorikas Ibn Khaldunas su siaubu prisiminė: „Ir Rytų, ir Vakarų civilizaciją aplankė destruktyvus maras, nusiaubęs tautas ir sukėlęs populiacijos išnykimą. Jis prarijo daug civilizacijos gerų dalykų ir juos išnaikino.

Ypač sunkiai nukentėjusi Europa prarado maždaug trečdalį savo gyventojų (nors istorikai vis dar ginčija šį skaičių). „Daug žemių ir miestų buvo apleistos“, – 1348 m. rašė italų istorikas Giovanni Villani. „Ir šis maras tęsėsi iki _____. Jis niekada neįrašė pabaigos datos. Jis mirė nuo maro, nespėjęs įrašyti.

Kai galvojame apie Juodąją mirtį, mes linkę galvoti apie šiurpias scenas, pasakojančias apie ligą miestuose: sukrautus lavonus, apkasus, į kuriuos buvo mėtomi kūnai, negedėti. Tačiau amžininkams baisu atrodė tai, ką jie matė kaime – ne naikinimo scenas, o gausos ir užaugimo vizijas. Subrendusių javų laukai, tušti laukiantys po saule. Vynmedžiai sunkūs vynuogėmis. Šie vaizdai kėlė nerimą, nes leido manyti, kad nebeliko nė vieno gyvo, kuris galėtų atvežti derlių.

 „Daug puikaus, kilnaus dvaro / Nedirba be tų, kurie jį dirbtų“, – rašė poetas ir kompozitorius Guillaume'as de Machaut, atlaikęs marą, slėpdamasis uždarytas savo bokšte. Jo eilėraštis tęsiasi:

Galvijai guli

Laukai visiškai apleisti

Ganosi kukurūzuose ir tarp vynuogių

Visur, kur jiems patinka

Ir jie neturi nei šeimininko, nei piemens

Nėra žmogaus, kuris juos surinktų

Po demografinio žlugimo labai trūko darbo jėgos. Taigi po pirminio šoko, kaip prognozuotų šiuolaikiniai ekonomistai, darbo jėgos kaina pakilo į viršų. Machaut rašė:

Nė vienas žmogus nebuvo suaręs laukų

Jo grūdai nepasėti arba vynmedžiai  neprižiūrimi

Nors jis būtų mokėjęs trigubą atlyginimą

Ne, tikrai, net ne už 20 kartų didesnį tarifą

Nes tiek daug mirė

Įvairių rūšių darbininkai – ūkio darbininkai, amatininkai miestuose, net neturtingi parapijų kunigai, turėję patarnauti mirštantiems – pandemijai atlėkus, pažvelgė į savo gyvenimą ir iš naujo įvertino, ko jie verti. Jie pamatė sistemą, kuri buvo neįmanomai prieš juos pakrypusi.

Pavyzdžiui, Anglijoje maždaug pusė gyventojų buvo teisėtai pririšti prie žemės ir buvo priversti dirbti savo vietiniam šeimininkui. Tačiau staiga atrodė, kad šie darbuotojai turėjo tam tikrą derybinę galią. Jie nebebuvo įpareigoti taikstytis su nepagrįstais reikalavimais. Jų darbdaviai nebegalėjo jų laikyti savaime suprantamu dalyku.

Viena vertus, jiems reikėjo didesnių atlyginimų, kad galėtų susidoroti su bėgančia infliacija, kilusia po maro: Anglijoje, nepaisant kai kurių pagrindinių prekių, pavyzdžiui, grūdų, kainų kritimo, bendros vartojimo prekių kainos pakilo maždaug 27 procentais nuo 1348 iki 1350 m. Darbininkai skundėsi, kad negali sau leisti būtiniausių dalykų – ir jei jiems nebuvo sumokėta, ko jie reikalavo, jie nuėjo nuo plūgo, pabėgo iš savo šeimininkų kaimų ir išvyko ieškoti geresnio pasiūlymo.

Per Covid nepatyrėme tokio žiauraus demografinio smūgio, bet vis tiek amerikiečiai darbuotojai iš naujo įvertino, ką reiškia dirbti ir ko vertas jų darbas – ir rekordiškai daug žmonių paliko savo darbus per pastaruosius kelis mėnesius Didžiojo atsistatydinimo metais. Darbo departamentas pranešė, kad vien lapkritį iš darbo pasitraukė apie 3 procentai visos JAV darbo jėgos. Rugsėjo mėnesį atliktos apklausos duomenimis, 46 procentai visą darbo dieną dirbančių darbuotojų svarstė arba aktyviai ieškojo naujo darbo.

Mažai apmokamas pradinio lygio darbo vietas tapo ypač sunku užpildyti, o socialiniuose tinkluose gausu piktų diskusijų apie tai, kaip vidutiniame mieste reikia dviejų ar net trijų darbo atlyginimų, norint sumokėti vidutinį nuomos mokestį.

Per pastaruosius kelis mėnesius įvyko keli didelio atgarsio streikai, kai darbuotojai reikalavo teisingos kompensacijos, o „Kellogg's“ ir „Deere“ profesinės sąjungos buvo sėkmingos. Šia prasme matome situacijos po Juodosios mirties atgarsius, kai darbuotojai atsisako grįžti į ikipandemines sąlygas ir iš naujo įvertina savo poreikius bei vertę. Per pastaruosius dvejus metus pasikeitė per daug. Pasaulis kitoks.

Kaip pereiname prie naujos eros po pandemijos, 14-ojo amžiaus įtampa darbo rinkoje gali ką nors išmokyti apie būsimą sumaištį.

Keletą metų po maro visoje Europoje dvarininkai ir bajorai iš pradžių pasipiktinę, o paskui įsiutę stebėjo, kaip žmonės ėjo iš darbo ir ieškojo geresnio gyvenimo. Vėliau kilo isteriška teisės aktų banga, kuri bandė grąžinti ekonomiką ten, kur ji buvo prieš marą. Įstatai ir potvarkiai įšaldė atlyginimus prieš marą; jie padarė neteisėtu veiksmu palikti šeimininko žemę, neteisėtu veiksmu bėgti; iš tikrųjų jie patį nedarbą padarė neteisėtu.

Anglijos darbininkų statutas pasmerkė valstiečius, kurie pabėgo nuo savo dvaro sutarčių, kad ant kaktos būtų pažymėtas „F“ ženklu, už „klaidingumą“, palikęs šeimininko ūkį galėtų būti teisiamas, kaip sukilėlis – gali būti tempiamas gatvėmis įkaitusiomis grandinėmis ir palaidotas gyvas.

Spaudimas ir toliau augo: viena vertus, naujai įsidrąsinusi darbo jėga reikalavo pragyvenimo atlyginimo, galimybės klestėti; kita vertus, karaliai ir tarybos, viešpačiai ir turtingi bendrininkai buvo pasiryžę, kad niekas nesikeis.

Galiausiai spaudimas tapo per didelis. Antroje amžiaus pusėje visoje Europoje kilo smurtas. Didžiųjų miestų gatvėmis knibždėte knibždėjo darbininkai. Jie sudegino dvarų įrašus ir darbo sutartis. Jie sunaikino visus savo tarnybos ir ryšių su žeme įrodymus.

Vienas sukrėstas metraštininkas Prancūzijoje 1358 m. rašė, kad pasipiktinę valstiečiai „be gailesčio išžudė visus bajorus, kuriuos tik galėjo rasti, net ir savo viešpačius. Ne tik tai: jie sulygino su žeme didikų namus ir tvirtoves.

Bajorai savo ruožtu pradėjo deginti kaimus ir skersti darbininkus. Tas pats prancūzų metraštininkas aprašo, kaip jie puola „ne tik tuos, kurie, jų manymu, jiems padarė žalos, bet ir visus, ką rado savo namuose, net dirbančius vynuogynuose ar laukuose“.

Anglijoje liaudiškas pasipiktinimas dėl mokesčių ir erzinančios nelygybės per 1381 m. Didįjį sukilimą peraugo į vandalizmą ir smurtą. Minia įvykdė mirties bausmę kancleriui ir pakėlė jo netvarkingai nukirstą galvą ant Londono tilto. Jie reikalavo viešpatystės pabaigos ir nepripažino jokios valdžios, tik karaliaus.

Žinoma, yra daug svarbių skirtumų tarp mūsų finansinės ir politinės padėties ir padėties dešimtmečiais po maro. Tačiau didėjantis nusivylimo jausmas tarp mūsų šalies dirbančių gyventojų sieja mus su tais viduramžių valstiečiais ir amatininkais, kurie atmetė elito lūkesčius, kad ieškoti geresnio gyvenimo.

Per pastaruosius keturis dešimtmečius daugumos amerikiečių darbo užmokestis sumažėjo, palyginti su pragyvenimo išlaidomis. Ir mes, kaip ir viduramžių valstiečiai, esame apsupti turtingų asmenų reginio ir jų brangaus avantiūrizmo. Amerikos milijardierių turtai per pandemiją išaugo 70 procentų – ir, kaip sužinojome šią vasarą, kai kurie nuolat nieko arba beveik nemoka mokesčių.

Turtingieji ima mus likusius pasivažinėti sistemoje, kuri yra prieš mus nukreipta. Kairė ir dešinė ją formuluoja skirtingai, bet mes visi žinome apie tą spragą.

Šalies nuotaikos tamsios ir iš esmės suskaldytos. Jei matome smurto spazmus, manau, jie mažiau panašūs į viduramžių sukilimų revoliucinę politiką, nei į beatodairiškus, neracionalius žiaurumus, kurie dažnai vykdavo tų sukilimų šešėlyje, kai minios taikėsi į išorines grupes: žydus, apkaltintus dėl šulinių apnuodijimo; flamandus, apkaltintus anglų darbo vietų vogimu, kai kurie iš jų buvo sumedžioti gatvėse ir nužudyti.

Taigi, kaip mes galime kovoti su gilia nelygybe ir išvengti pasipiktinimo?

Amerikos rinkėjams reikia bendros istorijos, kuri atitiktų faktus be atpirkimo ožių ar konspiracinės paranojos. Ši akimirka yra subrendusi veiksmui būtent todėl, kad dalijamės kai kuriais istorijos fragmentais: nuovargiu ir atsargumu; jausmu, kad negalime prasibrauti; pasipiktinimu, kad galingieji niekada neatsakingi.

Didieji viduramžių sukilimai subūrė žmones iš įvairių visuomenės sluoksnių, kaimo ir miesto: ne tik valstiečius, bet ir amatininkus, statybininkus, smulkius pirklius ir net dvasininkus. Kolektyvinis darbo judėjimas šiandien galėtų padaryti kažką panašaus mums.

Pastarųjų poros mėnesių profesinių sąjungų pergalės yra puikus pavyzdys, kaip darbuotojai gali susiburti ir pasinaudoti šiuo nesutarimo momentu – ir pavyzdys, kaip elitas gali sustiprinti darbuotojų lojalumą didelės kaitos metu.

Taip pat turime aktyviau aptarti didėjantį pajamų nelygybės skirtumą, kuris pažymėjo šį naują šimtmetį. Šiuo metu 1 procentui daugiausiai uždirbančiųjų priklauso beveik trečdalis viso šalies turto, o mažiausia 50 procentų uždirbančių – tik apie 2,5 procento turto. Mes žinojome jau seniai, kad tokia stipri nelygybė slopina ekonomikos augimą – ir tai yra istorija, kurią turime nuolat pasakoti.

Tačiau atsakymus taip pat turi pateikti mūsų pačių valdantysis elitas. Amerikos įstatymų leidėjai turi sumažinti didžiulį ir potencialiai smurtinį spaudimą, imdamiesi veiksmų, kuriais būtų sprendžiami dalykai, kurie prisideda prie mūsų nacionalinio beprasmiškumo jausmo: minimalaus atlyginimo didinimas, pagalba skolinimui, mokesčių kodekso subalansavimas, kad turtingieji sumokėtų teisingą dalį, sukurti tvirtas infrastruktūros darbo vietas, aprūpinti vaikų ir sveikatos priežiūros paslaugas amerikiečių darbuotojams (šis žingsnis taip pat padėtų mažiems darbdaviams).

Užuot bejėgiškai matę susiskaldymą, galėtume siekti gerovės ir galimybių visiems mūsų kolegoms amerikiečiams. Įsivaizduokite galimą pasididžiavimo jausmą ir bendrą tikslą. Tokios vartotojus remiančios priemonės pumpuotų pinigus į sistemą jos bazėje. Visa ekonomika tampa stabilesnė, kai yra daug žmonių, kurie turi pinigų. Politiškai šalis būtų mažiau linkusi į išsiveržimus. Jaunuoliai netgi gali jausti viltį.

Tačiau tai retas elito atstovas, kuris nori mąstyti ilgalaikėje perspektyvoje. Dauguma, kaip ir visoje Europoje po maro, nusprendžia tvirčiau laikytis to, ką turi, stengtis uždengti dangtį ant bendros kitų gerovės – ir viską suėmę į save, galiausiai stumia jų tautas, taip patenka į krizę ir lieka tik riaušės, gedulas, baimė, liepsna ir kančia.

M. T. Andersonas yra knygų „Šaros“ ir „Peizažas nematoma ranka“ autorius."

Su tokiais skausmais gimė Vakarų Europos kapitalizmas. O kas gimsta dabar?


In Medieval Europe, a Pandemic Changed Work Forever. Can It Happen Again?

 "In the wake of a devastating pandemic, millions of people are dead and many more have had their lives upended. Many of those who survive, worn down by a sense of futility in their work and by the impassable gap between the wealthy and everyone else, refuse to return to their old jobs or quit en masse. Tired of being overworked and underpaid, they feel they deserve a better life.

This could be a story about today, but it is also the pattern that emerged across Europe in the aftermath of one of the deadliest pandemics in recorded history, the Black Death.

The struggles over wages and the value of labor that defined the post-plague years were in some ways as dramatic as the pandemic itself. Eventually, Europe erupted into violence. Given where we are right now, it’s worth paying attention to the chain of events that led, link by link, from pandemic to panic to bloody uprising.

The Black Death, as we now call it, burned its way across the Eurasian continent from 1347 to 1351. Arab historian Ibn Khaldun recalled with horror, “Civilization both in the East and the West was visited by a destructive plague which devastated nations and caused populations to vanish. It swallowed up many of the good things of civilization and wiped them out.’’

Europe, particularly hard-hit, lost somewhere between a third and a half of its population (though historians still dispute the figure). “Many lands and cities were made desolate,” the Italian historian Giovanni Villani wrote in 1348. “And this plague lasted till _____.” He never filled in the end date. He had died of the plague before he could.

When we think of the Black Death, we tend to think of the gruesome scenes reported in the cities: the heaped corpses, the trenches where bodies were hurled, unmourned. What contemporaries also found eerie, however, was what they saw in the countryside — not scenes of destruction, but visions of bounty and overgrowth. Fields of ripe grain sitting under the sun. Vines heavy with grapes. These sights were unsettling because they suggested there was no one left alive to bring in the harvests.

 “Many a fine, noble estate / Lay idle without those to work it,” wrote the poet and composer Guillaume de Machaut, who weathered the plague by hiding locked up in his tower. His poem goes on:

The cattle lay about
The fields completely abandoned
Grazing in the corn and among the grapes
Anywhere at all they liked
And they had no master, no cowherd
No man at all to round them up

Following the demographic collapse, there was a severe shortage of labor. And so, after the initial shock, as modern economists would predict, the price of labor skyrocketed. Machaut wrote:

No man had his fields plowed
His grain sowed, or his vines tended
Though he’d have paid out triple wages
No, surely, not even for 20 times the rate
Because so many had died

Workers of all kinds — farm laborers, artisans in the cities, even poor parish priests who’d had to minister to the dying — looked at their lives once the pandemic had eased and reassessed what they were worth. They saw a system that was tilted impossibly against them.

In England, for example, around half the population was legally tied to the land in serfdom, forced to labor for their local landlord. But suddenly, these workers seemed to have some bargaining power. No longer were they obligated to put up with unreasonable demands. No longer were their employers able to take them for granted.

They needed higher wages, for one thing, to deal with the runaway inflation that followed the plague: In England, despite the drop in the cost of some basic commodities like grain, overall prices for consumer goods rose about 27 percent from 1348 to 1350. Laborers complained they couldn’t afford the bare necessities — and if they weren’t paid what they demanded, they walked away from the plow, fled their landlords’ villages, and went off in search of a better deal.

We have not suffered as brutal a demographic blow during Covid, but still American workers have reassessed what it means to work and what their labor is worth — and record numbers have left their jobs in the Great Resignation of the past several months. About 3 percent of the total U.S. work force quit in November alone, the Labor Department reported. According to a September poll, 46 percent of full-time employees were either considering or actively looking for a new job.

Low-paying entry-level jobs have become particularly hard to fill, while social media is full of angry discussions about how two or even three jobs are necessary to pay the average rent in the average city.

The past few months have seen several high-profile strikes as workers demand fair compensation, with notable union successes at Kellogg’s and Deere. In this sense, we are seeing echoes of the situation following the Black Death, as workers refuse to return to prepandemic conditions and as they re-evaluate their needs and their value. Too much has changed in the last two years. The world is different.

As we move toward a new, post-pandemic era, the tensions in the labor market of the 14th century may have something to teach us about turmoil to come.

In the years after the plague, all across Europe, landowners and noblemen watched, first in outrage, then in fury, as people walked away from their jobs and went in search of a better life. What followed was a hysterical wave of legislation that tried to return the economy to where it had been before the plague. Statutes and ordinances froze wages at pre-plague levels; they made it illegal to leave a master’s land, illegal to flee; they, in effect, made unemployment itself illegal.

The English Statute of Laborers condemned peasants who fled their manorial contracts to have an ‘F’ branded on their foreheads, for ‘Falsity.’ In Italy, Florence’s new labor laws, openly called “Against Rural Laborers,” declared that those who neglected their master’s farm could be tried as rebels — liable to be dragged through the streets in red-hot chains and buried alive.

Pressure continued to build: On one side, a newly emboldened work force demanded a living wage, a chance to flourish; on the other, kings and councils, lords and wealthy commons, were determined that nothing change.

Eventually, the pressure became too great. In the second half of the century, violence erupted across Europe. Workers swarmed through the streets of the great towns. They burned manorial records and labor contracts. They destroyed any evidence of their service and their ties to the land.

One shocked chronicler in France in 1358 wrote that outraged peasants “killed, slaughtered and massacred without mercy all the nobles whom they could find, even their own lords. Not only this: They leveled the houses and fortresses of the nobles to the ground.”

Nobles, in turn, began burning villages and slaughtering laborers. The same French chronicler describes them attacking “not merely those they believed to have done them harm, but all they found, whether in their houses or digging in the vineyards or in the fields.”

In England, popular resentment about taxation and outrageous inequities burst into vandalism and violence in the Great Rising of 1381. Mobs executed the chancellor and mounted his messily severed head up on London Bridge. They demanded the end of lordship and recognized no authority but the king’s.

Of course, there are many important differences between our financial and political situation and those in the decades after the plague. But the growing sense of frustration among the vast working population of our country connects us to those medieval peasants and artisans who bucked elite expectations to seek a better life for themselves.

Over the past four decades, most Americans have seen wages stagnate against the cost of living. The Trump-era tax laws of 2017 legislated breaks that disproportionately benefited the rich. And we, like the medieval peasantry, are surrounded by the spectacle of high net worth individuals and their expensive adventurism. The fortunes of American billionaires grew by 70 percent in the pandemic — and as we learned this summer, some regularly pay nothing or next to nothing in taxes.

The wealthy are taking the rest of us for a ride in a system that is slanted against us. Left and right formulate it differently — but we’re all aware of that gap.

The mood of the country is dark and fundamentally splintered. If we do see spasms of violence, I predict they are less likely to resemble the revolutionary politics of the medieval uprisings than the feckless, irrational atrocities that often went on in the shadows of those uprisings, when mobs targeted out-groups: Jews, accused of poisoning wells; the Flemish, accused of stealing English jobs, some of whom were hunted down in the streets and killed on sight.

How, then, do we address the cavernous inequities and avoid the violence of resentment?

The American electorate needs a shared story that fits the facts without scapegoating or conspiratorial paranoia. This is a moment ripe for action precisely because we do share some fragments of a story: a weariness and wariness; a sense that we can’t get ahead; an outrage that the powerful are never held accountable.

The major medieval uprisings brought together people from many different walks of life, rural and urban: not just peasants but artisans, builders, small-time merchants and even the clergy. A collective labor movement could do something similar for us today.

The union victories of the past couple of months are a great example of how workers can come together and take advantage of this moment of dissent — and an example of how C-suite elites can strengthen employee loyalty in a time of high turnover.

We also need to more proactively discuss the broadening gap of income inequality that has marked this new century. At this point, the top 1 percent of earners own nearly a third of all wealth in the country, while the bottom 50 percent of earners own about 2.5 percent. We have known for a long time that such steeply pitched inequality stifles economic growth — and that’s a story we need to keep telling.

But answers also need to lie with our own ruling elite. America’s legislators must ease the tremendous — and potentially violent — pressure building up with actions that address the things that contribute to our national feeling of futility: raising the minimum wage, assisting with debt, balancing the tax code so the wealthy pay their fair share, creating solid infrastructure jobs, providing child care and health care coverage for American workers (a move that would also help small employers).

Instead of helplessly witnessing division, we could seek prosperity and opportunity for all our fellow Americans. Imagine the sense of pride and shared purpose that are possible. Such measures supporting consumers would pump money into the system at its base. The economy as a whole becomes more stable when there’s a broad base of people who have cash to spend. Politically, the country would be less prone to eruptions. The young might even feel hope.

But it is a rare elite that is willing to think in the long term. Most, like those all across Europe in the aftermath of the plague, instead choose to hold more tightly to what they have, to try to keep a lid clamped on the shared prosperity of others — and by clutching everything to themselves, in the end push their nations into crisis, and be left with nothing but riot, mourning, fear, flame and misery.

M. T. Anderson is the author of “Feed” and “Landscape With Invisible Hand.”"

Western capitalism was born with such pains. And what is arriving now?