Biomedical Racism, Queer Theory, and the Monkeypox Epidemic

By the time the Department of Health and Human Services declared a public health emergency in response to monkeypox last week, there were already nearly 7,000 cases in the U.S. Microbiologist Joseph Osmundson joins The Intercept’s Maia Hibbett to discuss the failings of U.S. medical infrastructure in confronting this latest viral epidemic. They also discuss his book “Virology: Essays for the Living, the Dead, and the Small Things in Between,” which uses queer theory to shed a novel light on our understanding of the viruses that shape our lives.

[Deconstructed theme song.]

Maia Hibbett: Welcome to Deconstructed.

I’m Maia Hibbett, an associate editor for The Intercept, filling in for Ryan Grim this week.

On August 4, with monkeypox spreading globally, and with over 26,000 confirmed cases worldwide, U.S. Health and Human Services Secretary Xavier Becerra announced a public health emergency.

Secretary Xavier Becerra: I want to make an announcement today that I will be declaring a public health emergency on monkeypox. And we urge every American to take monkeypox seriously, and to take responsibility to help us tackle this virus.

MH: Coming from a country with more than a quarter of known cases — almost 7,000 by the day of the announcement — the move struck many scientists and observers as too late. Several states had gotten ahead of the federal government, and the World Health Organization declared a global health emergency almost two weeks earlier.

The emergence of the coronavirus that causes Covid — and, long before that, the spread of HIV and AIDS — showed us that what we think of as “hard science” can only go so far in quelling these sorts of public health crises. Even the best tests, treatments, and vaccines are useless if people don’t trust public health leaders enough to take advantage of them — or if they don’t have the opportunity to take advantage of them as a result of interlocking factors like race, wealth, and geography.

The simple truth is that our medical and pharmaceutical systems are more focused on profits than on public health, and many people are treated as low priorities, if not outright abused — furthering distrust in the medical response, or lack thereof.

Joseph Osmundson, a molecular microbiologist, writer, and clinical assistant professor at New York University, knows this well. It’s a focus of his latest book, “Virology: Essays for the Living, the Dead, and the Small Things in Between.” Osmundson’s essays examine the social impact that viruses have on human life, offering digestible introductions to scientific concepts alongside critical readings of queer theorists and literary giants. He reflects on how networks of care and solidarity emerged in gay communities amid the AIDS epidemic and later adjusted to a less deadly present, and how biomedical racism — and a reluctance to name race and whiteness for what they are — has deprived so many people of the care that is possible now.

“The problem wasn’t illness,” Osmundson writes. “The problem is our inability to provide care to all.”

Joe, welcome to Deconstructed.

Joseph Osmundson: Thank you so much for having me. I can’t wait to chat.

MH: So the monkeypox outbreak has suddenly been seizing headlines in recent weeks and has gotten a lot more coverage in the past week or so than it had previously. A lot of the early coverage minimized the severity of the outbreak because it emphasized that it was isolated to a specific community, specifically men who have sex with men. And a lot of the framing has spoken to an audience that presumes is outside that group and says: You’re not at risk, or a lot of people aren’t at risk, because this is isolated to this one community.

So I wanted to start off by touching on what’s wrong with that framing, although it might be obvious, and how that speaks to the media’s kind of gaps in knowledge and in care.

JO: Yeah, I mean, that framing is trying to avoid alarmism. And I will say Covid was a traumatic global experience. People are freaked out [laughs] about pandemics and viruses. It was very odd for those of us who are queer people who grew up in the ’80s and ’90s, or even who were adults already in the ’80s and ’90s, who had been doing viral risk reduction around our behaviors and sexual practices for our whole lives, right? And then all of a sudden mask-wearing was risk reduction for Covid. Every time you went out or went to a party, you had to think about what my risks are, what the pleasure is — is this a choice that I want to take, given my risk/pleasure decision-making? And that has fried people’s brains. [Laughs.] I mean, really. And in the last week, we’ve seen a lot of this alarmism by some bad players in the online space, but also just by well-meaning people who are freaked out about sending their kids to school.

To be very clear, this is not a virus that has ever, epidemiologically, done something like had 1,000 kids in a school all catch it from a toilet. That is just not the situation and we need to be clear that that’s not the situation, because we have limited resources and those resources need to go to where they’re going to actually be helpful in stopping spread.

So that is the meaning of this sort of don’t panic — the risk for most folks is low. At the same time, the WHO literally said, its advisory panel director said: This is not a public health emergency because it’s only affecting gay men in our sexual networks. Folks in Nigeria are pissed. This is not a public health emergency when it’s only affecting Nigerian folks? Right?

We see these patterns of groups of people being ignored, their suffering being normalized and accepted, their suffering being not called an emergency, which not only dehumanizes those groups of people — in this case folks in Nigeria, and queer folks globally — but, of course, infectious diseases show us how connected we all are, right? No infectious disease will ever stay limited to a country or population. So investing in care for all is actually investing in care for everyone.

And that one other thing that I’ll say is that we’re working on an op-ed with a group of queer and trans folks that we don’t love the language “men who have sex with men” — we are trying to shift to “queer people and our sexual networks,” because our sexual networks increasingly include non-binary people, trans women, and, really, the risk has nothing to do with identity, the risk has to do with who is in our social and sexual networks.

MH: Yeah, thank you for clarifying that.

You mentioned also, as you were talking about this, folks in Nigeria, where monkeypox has been spreading for a long time and is firmly within what is commonly called the endemic region. And, as I think many people know, but perhaps not everybody at this point, monkeypox has been spreading among humans in parts of Central and Western Africa for over 50 years now. And we’ve had vaccines and treatments that work against it.

So as you mentioned that a disease never stays within one country, would you say that the current outbreak worldwide is the product of global inequality and biomedical racism?

JO: [Laughs.] You took the words right out of my mouth.

So, to do a little history: monkeypox is discovered in laboratory animals in 1958, in humans in 1970; at the time. Between 1970 and 1980, the immunity of the world was high against monkeypox, because vaccination against smallpox also protects against monkeypox. And the WHO, with partner countries, was trying to eradicate smallpox from the face of the planet using vaccination.

So everywhere, including in the Congo, and Nigeria, and Ghana, levels of immunity for monkeypox were high; the virus is endemic there in rodents that commonly come into contact with humans, so it would pop into the human population every so often, but the outbreaks would be what we call self-limiting, largely because the immunity was high, right? So it might infect a household, maybe two, but then the virus by itself would eradicate itself essentially, right? It would go back, leave the human population.

That has shifted, because when the WHO decides that smallpox was eradicated — and it is — they stopped vaccinating, even though vaccination could prevent monkeypox suffering and death. And we also are talking about this as though it is a virus without deaths, right? It is not a virus without deaths. We now are starting to see deaths outside of the endemic region. We knew that would happen. This virus has been killing people in Congo and Nigeria for many years. And there was a shift because of the waning immunity from the smallpox vaccination. It was, from my mind, a matter of time.

This also tended to be a disease that was more common in rural areas where people would come into contact with animals. No longer. In 2017 to 2018, you see continued human-to-human spread in urban centers. And, at that point, it’s like pretending that you’re not going to see flights from Lagos to London or Lagos to New York, it’s just a matter of time before — the way humans move, also — everywhere humans move, so to will move any virus. This was an epidemic of choice. The U.S. government let 28 million doses of the Jynneos vaccine, the modern vaccine, the very safe one, expire in its national stockpile. It did not even consider using expired doses of an American vaccine for people in need in the endemic region.

I did a panel with the head of the Nigerian CDC three weeks ago now, and I asked him specifically: What countermeasures do you have in Nigeria of vaccination and treatment? They have none. Right? So again, speaking about alarmism in the American context, there are folks who are saying that we need to vaccinate like all Americans. I do not want a white woman in Kansas with very low risk to get a vaccine before a person in Nigeria where this virus spreads much more commonly, right? We need to think globally to consider everyone suffering.

Unfortunately, because of late capitalism, the vaccine is scarce right now. That we can work on changing. It will take huge political motivation and will, but it is possible. And everyone’s suffering should be met with the world’s best biomedicine, no matter what country they reside in. I mean it’s remarkable you would even have to say that, but it’s actually quite a radical stance, if you think about making that happen in practice.

MH: Yeah, absolutely. And just as a point of history connecting, you mentioned when those 28 million doses expired in 2017, there was also, at the time, a massive monkeypox outbreak happening in Nigeria that very year, right?

JO: That is the same year. Yeah. Another point of history that folks might find interesting: this has never not been on the radar of global public health. monkeypox and smallpox are very similar viruses and the presentation can look quite similar. One of the last places that the WHO looks in terms of smallpox eradication, at the time, every single monkeypox outbreak that happened in the endemic region, the WHO had to go there and make sure that it was monkeypox, not smallpox, right? So it was like, heading to hundreds of local epidemics at that time. But then once smallpox is listed as eradicated, that level of care and consideration completely dissipates.

MH: Yeah. And again, all of this very clearly relates to biomedical racism and access worldwide. And on that topic, here in the United States, when we talk about vaccine hesitancy, and quote anti-vaxxers, often people assume that that hesitancy is rooted in partisanship, conspiratorial thinking, and just flagrantly wrong information. And of course, in many cases, it often is. But, as you outlined in your book, there are a lot of past crimes of biomedical racism by the scientific establishment that have led a lot of people, particularly Black and Indigenous people to have very reasonable fears of new medical procedures and the way they’re developed.

So could you speak to that history a little bit and how well-meaning scientists who genuinely want to support public health might seek to regain trust or kind of correct those past actions?

JO: Yeah. When I was in my PhD program, we had one little 30-minute seminar on bioethics and we talked about Tuskegee, right? The government experiment where care was withheld from men with syphilis. They were lied to about whether or not they had syphilis. They were used as human incubators. This was a decade-long experiment. It’s viewed as a blemish on an otherwise ethical project of biomedicine in America. And the argument that I and scholars like Harriet A. Washington make in her book “Medical Apartheid,” is that this is not a blemish on the biomedical project in America. This is, from start to finish, emblematic of structural racism that gets baked into every American institution, including biomedicine.

And one of the many experiments that I detail is from the ’90s, where a researcher at Columbia was giving fen-phen to 12-year-old boys whose brothers had interaction with the the system of incarceration in the city. Her hypothesis was that there might be some —

MH: Can you define fen-phen for listeners?

JO: Oh my god. It’s fenfluramine/phentermine. It’s a mood-altering drug that relates to systems of aggression that was also used as a diet fad drug in the ’90s, if you remember, if anyone was alive then. It’s a pretty gnarly drug to give to 12 year olds, mood-altering. Her hypothesis was that they were inherently aggressive because of their older brothers’ interaction with the systems of mass incarceration.

Right? This was the ’90s, this was Columbia, this was research approved by an IRB happening at a major research institution. In other work, I write about a researcher who literally, in the aughts, was treating lesbianism in utero. There’s a genetic mutation that relates to intersex folks, and a lot of the folks with that mutation become lesbians — and that’s awesome, because queerness is great! But this woman was having mothers take drugs to treat the in-utero person so that they would be less likely to be both intersex and lesbian.

I mean, we’re just talking about a history of experimentation that harms folks with all sorts of identity markers that are not WASP-y, cis, straight white men. Still, to this day, clinical trials have way more men than women, typically.

And, again: I am an anti-capitalist. Pharma is fucking evil. I am not out here saying Pfizer is awesome. As a matter of fact, in Covid-19, I was on the street in front of Pfizer protesting for global access to what was very good biomedicine. We have to understand that — I can’t remember which post-Marxist talked about this, but capitalism can develop good tools. Capitalism is evil, and can also develop tools that are useful for working people, and we should be allowed access to those inventions that make our lives better, all while also trying to completely deconstruct capitalism, because it’s an evil system.

And I don’t trust pharma. Fucking pharma sucks, man. But I can tell you that the data on the Covid mRNA vaccines — I cried the first time I saw it. Because the data was so clear: it was incredible biomedical intervention. And before the evolution of variants, it was very effective, even at preventing infection. And I did not think that was going to be possible. And then the virus had some tricks up its own sleeve, vaccines are still an incredibly helpful but not perfect tool.

It’s sort of holding these two ideas in mind. Biomedicine is racist and fucked up; capitalism means that all pharma companies are not trying to save your lives, they’re trying to profit. That is their goal. Their goal is to profit. If they happen to save your life, that might be a nice, little offshoot of that, but primarily it is profit. At the same time, when a good biomedical tool exists, folks should take it if they have access. And we should fight for everyone to have access.

There’s sort of those points of advocacy and activism where we actually have had wins. We’ve had wins on global HIV med access in the 2000s. We lost, basically, on Covid-19 global vaccine access. We are now fighting very hard for global monkeypox biomedicine access. It sucks that this is only on our radar now, that’s a way that we — me and a bunch of other folks — were not advocating for folks in Nigeria to get access to the 20 million doses of vaccine as they expired because it was not on our radar, because of biomedical racism.

[Musical interlude.]

MH: So you mentioned the HIV drugs that people have fought to get distributed globally. And also, returning to your book, you have an essay on HIV and Truvada, in which you lay out not only the scientific functioning of both pre- and post-exposure, antiretrovirals, but also kind of the social transformation that made people begin to trust the drugs and understand that they truly worked.

Can you envision something like that happening now amid the monkeypox outbreak, when people are so scared, and there’s so little access, that we might have a similar outcome in the future?

JO: Hmmm. [Sighs.] It’s a really tough question. The HIV situation is almost — I want to say unique in the history of biomedicine; I don’t know that that’s true. But those of us who came of age in the ’80s and ’90s are a unique generation, in that we didn’t lose a lot of our friends and lovers. But we also never knew sex without the fear of HIV; did not — not once in my life — have I ever had sex without considering HIV risk all through the act.

And I think Truvada, which is a pill that you can take as an HIV-negative person that is essentially 99.9 to 99.6 percent effective at preventing you from getting HIV, it’s also the intervention that we understood through science that someone who’s HIV positive but undetectable is the safest sex partner you can have in terms of HIV risk. So it’s this whole — what I would say queering — of the HIV-positive, HIV-negative binary, right? You have people who are HIV positive on meds, who have no virus in their blood or semen; you have people who are HIV negative on meds who have no virus in their blood and semen, and that the sex between those people doesn’t have to use a condom for HIV risk prevention. And that fried a lot of brains in a good way. Because — to be real with you — I sometimes stayed in bad relationships, because I could have sex without condoms with minimal risk of worry for HIV, and that sucks, man. It is not ideal to be in a relationship to feel like that’s the way to prevent getting HIV.

And so being able to feel that if you’re using condoms and they break — which they do sometimes, that’s happened to me before prep. Not fun! Not fun to have a condom break before prep. And so it really, for those of us who grew up in the specter of HIV/AIDS, allowed some of our trauma brains to heal, is what I argue. At least that’s what I feel. And I know many other people feel that way as well.

The question is: Is this on the horizon for monkeypox? We have so many questions open: How effective are the vaccines at preventing infection for this virus in the context of this epidemic? They are an incredible tool. It’s so lucky that we have vaccines already for this virus. We don’t yet know how well they work. And really, for the answer to this specific question, I think we would have to ask Nigerians and queer Nigerians who have actually been living with the fear — you know, I have a Nigerian friend, and he was traveling in the U.S. and the monkeypox thing was blowing up and I was like: Hey, girl, what’s going on with this monkeypox thing? And he’s like: Oh, we’ve been dealing with that since forever [laughs.] He’s like: This is not new to me. It’s new to you.

And I think, if good biomedicine and global access actually changes things for folks in Nigeria. I think that I would love to ask them that question in five years and I hope that we end up in that situation.

MH: That makes complete sense. And I guess I should have noted also in, in my question, that, of course, Truvada, like so many other drugs in the U.S. is, of course, very expensive and not available for equal access for all. So it’s not like it’s truly, totally rosy.

JO: No — and I worry, there is a huge political activation right now amongst queer folks. Because everyone I know knows someone with monkeypox. This is not something that is theoretical to us. This is something like: We’ve had it, we know people who’ve had it, you have to isolate for four weeks, it can be incredibly painful. So there’s a huge political activation, because we’re in a crisis, and people are being withheld from the treatment that they need from access to testing and vaccination that they need.

I really worry that this is a largely privileged group that is politically activated, and they’re going to get their little shots and go on about their little lives, and leave everyone else behind and that everyone else, as always, will include folks in America. Only 25 percent of the people who are indicated for PrEP actually are on it. Some of that is people who maybe just don’t want to be, but certainly some of that is issues with access. That number goes down to 9 percent if we’re considering Black folks — 9 percent, right? So we know who we leave behind in biomedical access in this country. And when you know, when the Fire Island white gays get their little shots and go on about their little lives, is that political activation going to go away? And once again leave folks in the rural south and folks in the endemic region completely behind? That’s my real worry. And I really hope we can all push against that.

MH: Yeah. That’s an excellent point.

And it calls to mind also, you mentioned in your book that Lawrence v. Texas enshrined the gay right to privacy —

JO: Mhmm.

MH: — to have your sex life be your business and not the government’s. But, of course, as we’ve seen, recently, in the wake of the Dobbs decision, which took away the constitutional right to abortion, that precedent is now also under threat.

Do you think that the activist networks you’re talking about right now are also going to engage on that front? I know, also, we’re kind of getting on a tangent here.

JO: No, not at all. I do see a lot of queer anger not just among people who can get pregnant about the abortion ruling.

I think in the face of fascist backsliding, which we are definitely seeing [laughs], there is real solidarity and political activation. I don’t yet know that we have all the right strategies, but certainly queer people and not just people who can get pregnant, we are on the streets for the right to abortion. And not just because we’re worried about the rights of gay marriage and the rights of privacy, but because people in our community have need and solidarity means showing up when people are being harmed. And people are being harmed.

MH: And returning to monkeypox strategies and prevention, you’ve also pointed out what should be an obvious point, that telling people just not to have sex doesn’t work.

JO: [Laughs.] Mhmm.

MH: And it’s also unhealthy. But there are certain temporary, safer sex recommendations that might help reduce the spread until we see some better solutions from public institutions that could actually provide vaccine and treatment.

So just quickly, what are some of those recommendations? And how should people think realistically about risky activities, whether they be sex or other kind of high contact, high touch —?

JO: Yeah, I mean, if anyone out there is on a college wrestling team, just be aware that this is something that could affect you, right? Any high-touch activity: sex work, massage parlors, certain sports, places where people are taking on an awful lot of clothes, including theatres, high school drama, marching band uniforms, right? So not to be alarmed, it’s just for this to be on people’s radars.

So this has bubbled up from community: I’ve been in conversation with a lot of people who host nightlife and sex parties about whether to cancel. Right now all the New York City sex parties are canceled, voluntarily. And that is because so many people in that community were sick. And I was talking to a friend last night about how like obsessed straight people are with gay sex, that they’re like always just like: [puts on a tone of exaggerated surprise] A sex party, wha?! A bath house, y’all still do that?!

You know, it’s kind of like finger wagging, but also, like: That sounds kind of fun! There’s something in the stomach where they’re like [puts on a tone of exaggerated surprise]: Oh! They’re so liberated. The communities who go to places like that are largely voluntarily saying: We just need to wait for more vaccines. I think, if I remember the epi correctly, around 30 percent of cases the person thought themselves that it was linked to a sauna, or a sex party, places where people meet for sex, basically. And out of love for those spaces, and for the people who attend and not wanting them to suffer and not trying to have to get medication that they probably won’t get, it’s probably not a bad idea to wait till you get at least one shot of vaccine, if not two, and that is coming up from the community, that is not coming down from public health officials who correctly are very reticent to finger-wag about particular behaviors.

What I’ve been saying is that gay sex is like the wind, right? Gay sex is like the earth. It is like a mountain; it’s like the ocean. It is a fact of life. You will not stop it. Decades of HIV work shows us this. You need to show up where people are and offer risk reduction and biomedical intervention. Calling for an anal autumn instead of a slutty summer.

MH: [Laughs.]

JO: Hoping that the 800,000 doses of vaccine that should come online before September actually get people protected.

MH: [Laughs.] It’s a good phrase.

And since you mentioned those 800,000 doses of vaccine for anyone who missed this story last week — or maybe when they hear this — two weeks ago, what happened with those? There are about 300,000 doses —

JO: That’s right.

MH: — I believe in Denmark? What happened there?

JO: Yeah, this is reporting from the New York Times. The Feds fucked up. The Feds fucked up. And they were hearing from the community how bad the situation was on the ground. I think, two, three years ago, if I had said this, it wouldn’t make sense to anyone, but when you have cases of a virus popping up, that are not linked to one another, or to travel, that has clear epidemiological evidence that you have undetected community spread of that infectious disease. And that was the situation in May, right? We had a very small number of cases, but none of them were linked to each other. And none of them — not none of them, but the majority of them — were not someone who had been out of the country.

So we knew that the situation was much worse than we were monitoring. We started having people in our community directly affected, who were trying to get tested, who knew how bad the testing situation was. And we directly asked partners in the federal government to move as many doses as they could. They counted, in all of their official outreach, the 300,000 doses that were available to be moved immediately were counted as part of the 800,000 doses that were not. They said: We have 76,000 doses, I believe, that can be moved.

And that was the situation where it was — and Pride was coming up! My goodness. This was May into June. We were like: Get the fucking doses in the fucking arms before people come to New York for Pride. A million people are coming to the city, let’s work this out.

And they didn’t. So they were not honest with community members or the public about those 300,000 doses being able to be moved. They were not ordered until the weekend of Pride, actually. And then it took many days to get them in a plane, to get them over to the States. And they arrived in July. And vaccine in a freezer or on a plane is fucking useless. And many people I know, personally, wanted to get a vaccine, did not get a vaccine, and then went on to get monkeypox.

MH: And the logic there was a hypothetical —

JO: It hurts me.

MH: — national security —

JO: It hurts.

MH: — threat, right? [Laughs.] Yeah.

JO: They were afraid of not needing the vaccine. And they were afraid of a theoretical smallpox bioterrorism emergency, and therefore could not respond to an actual monkeypox emergency. Their logic, again, was: Oh, we don’t see that many cases. But that was only because no one could get tested.

And I am so sorry, but if this were affecting a community that wasn’t just queer folks, those doses would have been moved. Like we allow certain groups of people to suffer without taking their suffering seriously. And when Secretary Becerra, HHS Secretary, goes and tells reporters: The federal government has done everything they can do, if you’re having problems, it’s the fault of the cities and states — I just want to, like, my head wants to blow off. Because that is just overtly, objectively false.

MH: Yeah.

JO: [Laughs.] We live in hell!

MH: [Laughs.] Yeah. [Laughs.] It’s true!

And then, also, in terms of access and government gatekeeping, we do have treatments.

JO: Right.

MH: But people are having a lot of difficulty accessing them.

JO: And still.

MH: Yeah. And so what are the treatments available? And why are they so hard for people to get right now?

JO: It’s a great question. You know, this is sort of a story of the power of government, and then the failures of government.

There’s a drug called Tecovirimat, which in the States goes by TPOXX — with two x’s at the end, because it’s a little spicy. The drug was developed through our tax investment, the drug was fully developed, and FDA approved, by the federal government, by different agencies. Initial research was done by the National Institutes of Health to find a small molecule — so a drug — that seemed to be effective against orthopoxviruses, which is the family of viruses that includes both monkeypox and smallpox.

The FDA actually developed a new set of rules, because it’s not really ethical to do a smallpox random clinical trial on a planet where smallpox is eradicated and you’d have to give people smallpox and then test the drug on them — can’t really do that. And because of biomedical racism, no one was like: Hey, let’s invest, let’s spend the money in a clinical trial in the regions of the world where monkeypox does exist, and then ensure access to the drug in those regions. No one thought about that, because of racism. And so the drug was tested on efficacy using animal models, including an animal model for monkeypox shown to be effective, and then safety was tested in a small clinical trial with humans. The drug was FDA approved based on that collection of data. So it’s never had a randomized clinical trial in humans. That is a special class of drugs in the States. And it is completely up to the federal government how that type of drug is actually rolled out. It is not FDA-approved for monkeypox, even though some of the animal data was from monkeypox itself and the drug is approved in the European Union for monkeypox as well.

Because the FDA approves a drug based on this animal-rule situation, the only entity that can buy the drug from the manufacturer is the federal government and the only place it can go is the Strategic National Stockpile, which is the federal government’s sort of emergency, national defense biomedical entity. And there’s only one way to get the drug out of the Strategic National Stockpile. The CDC has made those decisions, and it used to be a 124-page protocol that took clinicians five-plus hours per patient to enroll. The CDC is patting themselves on the back, because it’s now down to a 20-page document that providers still have to do per patient. Obviously, only certain types of providers will be able to handle this paperwork burden. We have providers in New York working 20-plus hour days to enroll as many patients as they can. But there are too many patients, too few providers, there are 1 to 2 million — million — doses of this drug sitting on a shelf. We need to tell patients that the drug is different than other drugs, we don’t know exactly how effective it is, although observational studies show that it may decrease the duration of symptoms, the safety data are more limited than with a typical drug. But patients — and I’m talking to a ton of them, because so many people I know have this virus — they want the pill. They want the intervention. They’re sitting at home, isolating two-plus weeks, four-plus weeks, when a pill sits on a shelf. They know the information that I just told you and they want access to the pill. And that still is so tightly limited just by the number and types of providers who actually can prescribe it.

MH: Yeah. Yeah. I mean, it’s just insane. It seems so painful — like, physically and emotionally — to go through. And people are just waiting.

JO: There’s one thing we know about this virus, that is well-documented in the literature, is the mental health burden of having it. The isolation and the duration of isolation, the pain, the stigma of the lesions, the feeling of the lesions, the stigma post-infection has a huge mental health burden. And right now we’re asking folks to isolate a month. And there is no financial, emotional, or social support for those patients to help them successfully do so with the smallest emotional and mental health burden possible. We don’t have hotel room programs like we did for Covid for people who have roommates or have family members. I have some folks who have kids, and they’re terrified, because kids are high-risk for severe disease. It’s scary for them to figure out what they would do with their kids if they got this virus. So right now, because of the lack of a declaration of public health emergency at the federal level, getting funds to have these basic needs met for patients, it just does not exist.

MH: Yeah. I mean, what about patients who are supposed to go into a physical job, and will not get paid if they don’t show up?

JO: Yeah. And there was an article very early on, in May or early June, about a Canadian performer. And he talks in great detail about not having his next rent check. And the financial cost of having to isolate. It’s a known thing that people are struggling with, and there’s no response whatsoever. Crowdsource!

MH: Yeah. Well, thank you so much for coming on the show. It was great talking to you.

JO: It was a real pleasure. In these trying times, it was a moment of connection. Thank you.

[End credits music.]

MH: Deconstructed is a production of First Look Media and The Intercept. Our producer is Zach Young. Laura Flynn is our supervising producer. The show was mixed by William Stanton. Our theme music was composed by Bart Warshaw. Roger Hodge is The Intercept’s editor in chief.

And I’m Maia Hibbett. If you’d like to support our work, go to theintercept.com/give — your donation, no matter what the amount, makes a real difference.

If you enjoy this podcast, be sure to also check out Intercepted, as well as Murderville, which is now in its second season. If you haven’t already, please subscribe to the show so you can hear it every week. And please go leave us a rating or a review — it helps people find the show. If you want to give us feedback, email us at Podcasts@theintercept.com. Thanks so much.