In the spring of my first year in my master’s program, I interned at the DeKalb County Medical Examiner’s Office. This opportunity was easily one of the most influential experiences I’ve had, and one that has informed who I want to be in the field of public health. I had anticipated just doing data analysis work using their mortality data, but ended up also shadowing and assisting in autopsies, taking photos of scenes for the forensic investigators, and assisting in taking the decedent from the scene to the lab. As heartbreaking as that job often was for me, it fundamentally changed my view on public health. Public health and policy is often taught and talked about in a very high-level, theoretical manner, but talking with families and being witness to the most vulnerable moments of human life, loss, and grief, transformed public health into something deeply personal and connected for me.

I bring this up because of the Silverlake documentary we watched today. The scene of Mark filming Tom right after his passing was so emotional, raw, and heartbreaking. It hit me really hard because I’ve had similar experiences going to scenes while the families were still there. Like Mark talks about in the documentary, even when you know what is coming, the finality of death and loss hits you like a train. That is something that I think notably distinguishes the COVID-19 pandemic from the HIV/AIDS crisis of the 80s. For HIV/AIDS back then, a diagnosis was essentially a death sentence. Mark and Tom spoke about feeling like they were watching themselves die for years before they eventually passed; it was impending, incremental, and anticipated. With COVID-19, many people have dismissed it as being just like the flu, and probably not all that dangerous if you’re young. But I witnessed a lot of COVID-19 deaths; from children and teenagers to parents and grandparents. Death from COVID-19 blindsides people. There are no winners either way; knowing or not knowing death is coming doesn’t make its arrival any less devastating, but I think it tells us a lot about how people understood these two different viruses. We’ve talked about this a lot with health communication and education, but I think this demonstrates the importance of putting people at the front of public health. I think people who may have ostracized those living with AIDS or demonized/moralized the virus could not have watched that documentary without having their entire perception of the virus and people’s experience with it change. Similarly, I think witnessing so much loss and pain that families experienced when a loved one passed from COVID left a lasting impact on me, and gave different weight to the virus.

We’ve spent several weeks in this course discussing the ways in which COVID-19 and HIV are comparable and distinct. While history has repeated itself in a number of ways, I think a notable similarity between these two pandemics is the power that touch (or a lack thereof) has had on either stigmatizing or isolating us.

When the HIV/AIDS epidemic swept across the United States in the 1980s, a variety of misconceptions about the virus came with it. President Reagan’s refusal to acknowledge the epidemic emboldened the stigmatization of the virus. Not only did blatant homophobia play a role in stigmatizing the virus, but misinformation about how it could be transmitted made many fear touching or kissing someone who had it. We’ve discussed in our classes how hospitals didn’t want patients with HIV/AIDS both out of fear for themselves and because they thought other patients would be too afraid to go to a hospital that treated people with HIV. I think we often think of stigma as what people say to disparage others; but the absence of touch, of human connection, can ostracize people just as much. In the early years, people not only had to experience the pain of finding out they had an incurable, and, at the time, life-ending disease, but they also had to face apathy and disgust at every turn. To be treated as if you were contagious by touch is incredibly isolating, stigmatizing, and dehumanizing. This was such a notable aspect of HIV/AIDS that activism surrounding touch became prevalent: for example, Princess Diana was very outspoken about the epidemic, stating, “HIV does not make people dangerous to know. You can shake their hands and give them a hug. Heaven knows they need it. What’s more, you can share their homes, their workplaces, and their playgrounds and toys.”

In 2020, COVID-19 spread throughout the globe, triggering sweeping lockdowns and social distancing mandates. Especially in the early days of COVID, many people were completely isolated within their homes, unable to see or hug their loved ones for months. While touch may not have contributed to stigma the way it did with HIV, it did play a significant role in the isolation and mental health issues many faced during the COVID pandemic. During this time, the US Surgeon General described the US as also experiencing an epidemic of loneliness; combined with the fear of the pandemic, isolation impacted many people’s mental health and ability to cope with uncertainty. I think we all saw how reliant we became on technology during the pandemic, desperately searching for connection, disassociation, or maybe both in social media, television, news, anything. For me, my increased use of technology did nothing to fill the gap of real, human connection. I think something as simple as a hug, a kiss, or a touch reminds us of our humanity, our connection to one another. These pandemics, each in their own way, highlight how important something so seemingly simple is in keeping us going.

Stephen Thrasher gave an excellent lecture last week on all of the vectors that interact to create the Viral Underclass. Essentially, these 12 components are all pieces to the puzzle of unequal transmission – those most marginalized are most at risk. The Viral Underclass has always existed, but was especially illuminated in these past two years by government response and rhetoric surrounding the COVID-19 pandemic, and something I especially noticed was how COVID-19 is discussed as it relates to ableism.

Thrasher writes, “In other words, viruses interact with power structures already at play in our society so that those who are already marginalized are left even more susceptible to danger, exacerbating existing social divides.” He goes to write a chapter on ableism astutely titled “Disability as Disposability.” We have seen the ways in which the world has been created to empower the lives and success of able-bodied people. Being left out of the discussion is a common facet of marginalizing groups, and this has been demonstrated time and time again when discussion surrounding COVID-19 response and perception has left out those most impacted by it’s spread.

A common line that I heard throughout the pandemic was something along the lines of, “Well, it’s only killing people with comorbidities,” as if those lives are somehow of less value and importance. We can balk at the COVID protocols because it doesn’t impact us, accept that COVID is only hurting those groups. I think there is an implied dismissal of life, specifically for people who are immunocompromised or disabled, sending the message that their lives are not worth following protocols for.

I think there is something deeper here, and it’s what Thrasher describes in his book. The common rhetoric of COVID-19 and it’s impact on people with disabilities was accepting, expected, and seemed to be of little concern on the national level. But people with disabilities are 3 times more at risk for death for COVID-19, and that’s not including common intersections like living in poverty or experiencing unemployment. I don’t think people with disabilities faced higher death rates simply because they may have been immunocompromised or had comorbidities; I think unequal and poor quality health access, a societal unwillingness to follow protocols to prevent transmission, and a rhetoric that dismisses the loss of life from your community in the first place put people living with disabilities at such a high risk. To ignore or accept how the pandemic has specifically targeted people with disabilities is to deny them of their humanity, and ultimately, it creates a negative feedback loop of continued marginalization, ostracism, and worse health outcomes.

When COVID-19 began it’s sweep across the globe, we bore witness to some incredible missteps by our country. We’ve discussed in detail how and why that happened; leadership that doesn’t value science or unity breeds mistrust. How could we have built more trust in public health in the United States during COVID? More importantly, how could we have communicated science, vaccines, public health, and empathy more effectively? In class, we saw an inspiring example of that kind of communication with New Zealand’s Prime Minister, Jacinda Ardern.

. PM Ardern has delivered inspiring speeches that demonstrate strength under pressure, empathy, accountability, foresight, and a dedication to science. She has worked hard to sow trust in public health within her country: while they have experienced spikes recently, New Zealand had faced some of the lowest COVID rates in the world. PM Ardern has been a crucial figure in the effort to stop the spread, her communication being one of her greatest strengths.

That being said, communication should be followed with action, and this does demonstrate a short coming of the PM. Despite Ardern’s effective elimination strategy, it is important to look at what populations were left out of the conversation. The Māori population faced disparities in vaccination access and hospitalization rates, illustrating that when programs are developed on a broad, general scale – even if these programs are strong and scientifically backed – they often overlook the needs and inequities of health for marginalized groups. While PM Ardern’s communication is often inclusive and intentional with the Māori population, her actions that follow do little for health equity for indigenous people.

There is much to be learned from PM Ardern and New Zealand’s response, but like the United States, they too uphold systems of oppression when it comes to their indigenous populations. While I hope to see the United States take a similar science-led, consistent, and reliable approach, I think the pandemic has highlighted health inequity specifically for indigenous and marginalized populations around the world. Health communication is only as effective as the action that follows.

NPR has a fascinating article titled, “40 Years Later: The Denialism That Shaped The AIDS Epidemic.” It describes how fear funneled misinterpreted theories in a time of panic and confusion, and how this was ultimately exacerbated by politicians’ dismissal of the issue. Reagan’s refusal to say the word “AIDS” until 4 years into the epidemic, Senator Helms trying to block education that would encourage or condone homosexuality: these are just a few examples of how the silence of powerful political actors can cost thousands of lives. It is chilling the way history repeats itself, as 40 years later we find ourselves in similar waters.

Denialism is two-fold in it’s impact; misinformation or misinterpretation stokes the fire of disbelieving scientists altogether and it makes blatantly clear which communities we as a society have left behind. When Reagan won’t say the word AIDS or Trump blocks scientists and officials from the CDC from speaking to the media about COVID-19, misinformation spreads like wildfire. Not only does a lack of accurate information lead to distrust, but it encourages many to mirror the rhetoric of their elected leaders and, ultimately, undercut the true impact of the disease. Injustice in health has been present in both pandemics, as both of these diseases have been the most rampant and fatal in marginalized communities. In the 1980’s and 90’s, black men who had sex with men saw some of the highest rates of infection and fatality. Today, indigenous people, Latinx people, and African Americans are two times more likely to die from COVID than white Americans, people with disabilities have a 3 times higher risk for death from COVID, and people living in extreme poverty grew by 115 million in 2021 due to the effects of COVID-19.

Government response has played a key role in both the AIDS and COVID-19 pandemics; their silence was loud, catastrophic, and fatal. I was especially inspired by Sandra Thurman’s concept that attaching stories to our data can make all the difference. Discussions surrounding COVID so often deal in percentages – like fatality or hospitalization rates – and I think such a clinical approach has made many feel detached from the humanity and gravity of COVID’s destruction. One million people have died in the United States. One million. Six million people have died globally. Disproportionately, these deaths have been people from marginalized, impoverished, or under-resourced communities. We have looked back on the AIDS crisis in shock of how much loss could have been prevented had political actors advocated for science and destigmatization, and I believe we will find ourselves in a similar position in 40 years, reflecting on COVID. As stated by Noel King in the NPR article, “Expertise tells us a virus doesn’t care who you have sex with or how, what drugs you use or whether you think it’s real. A virus doesn’t want you to get a vaccine or wear a mask. It wants to live. To live, it needs to spread. And with every denial, we send it on out into the world to live.”