Pile of envelopes with overdue utility bills on the floor.

The Unfurling Crisis of Unfunded Isolation, Testing, and Treatment of Infectious Disease in the US

By Steven W. Thrasher

For many politicians in the United States, the summer of 2022 was a time of trying not to think about the coronavirus pandemic—though, if they were concerned about the risk that they, their neighbors, and their constituents were facing, they should have been paying very close attention. By August, there were about 500 to 600 COVID deaths a day, accounting for more than a “9/11’s worth” every week, a level of death twice what it had been in the summer of 2021.

But for gay men in the United States, the summer of 2022 was a time of worrying about a whole new viral epidemic: monkeypox. The variant of the MPX orthopoxvirus circulating globally in 2022 has behaved very differently than it had in previous outbreak, acting as a sexually transmitted infection and moving almost exclusively through the bodies of gay men.

And when it did, people who were infected were told to isolate for up to a month, or more. Disastrously, they were expected to do so with no guaranteed pay by their job or the government. There is no federally-mandated sick pay in the United States, and even after the World Health Organization, and the Biden administration declared monkeypox to be a public health emergency, Congress has failed to even consider legislation to financially support people isolating with MPX infection.

Gay Americans are more likely to work in food-service related retail jobs than non-gay people, the kind of work that cannot be done from home. We are also more likely to be poor. And so, for gay people who do face-to-face work to be told they must stay home for a month is not just a medical disaster, but an economic and moral disaster, too. This is but one way infection in this country can force people into (or deeper into) a viral underclass.

Research has long shown that two-thirds of people living in the U.S. cannot afford a $400 medical emergency. Even working at the paltry federal wage of $7.25 means a full-time worker would lose much more than that — $580 during two weeks of isolation, $1,160 in a month. The vast majority of workers earning their living in ways that can’t be done remotely could not afford to lose a month’s earnings.

And yet, the U.S. government is mandating people with MPX stay home and not work, without mandating any financial support. Even though the person is being isolated not to protect their own health, but everyone else’s.

This manufactured crisis has an easy, well-documented solution, as Gabe Rosenberg, an historian of animals, gender and sexuality, has written: Pay people who are infected with easily transmissible disease more than they normally earn to stay home. The United States is the wealthiest country on earth; while the financial impact of MPX isolation for any one person might be devastating to them, helping the tens of thousands of people who may be isolated would not hamper the wealth generating ability of the U.S. at all.

But the stinginess of the U.S. approach to MPX (the Biden administration had 300,000 doses of a vaccine it could have used while many of us were screaming at them to act quickly, but chose to take a wait-and-see approach instead) mirrors a neoliberal shifting of responsibility from the society onto the individual that has recently accelerated with the COVID pandemic response.

In March, Democrats in Congress removed $15 billion from a spending bill that had coupled pandemic relief with the war in Ukraine. The Ukraine part passed; in fact, by the late summer, the United States sent almost $60 billion to Ukraine. Meanwhile, the Democrats failed to pass any more COVID money. The result is that the government no longer pays for the tens of millions of people who don’t have insurance to be tested or treated for COVID. Tests can cost hundreds of dollars, and treatment can cost tens or hundreds of thousands of dollars; hence, people who are uninsured often just aren’t getting tested and treated, even though research has found people without insurance are the most likely to contract, become seriously ill from, and die of COVID.

Whether it’s monkeypox potentially affecting several million people in the United States, or COVID affecting hundreds of millions, our nation is moving in the wrong direction in terms of creating networks of care to deal with pandemics. Viruses prove to us how interconnected we are; they repeatedly disprove notions of hard boundaries and show how porous perceived barriers between us are. Public health approaches need to be similarly porous, building out frameworks of interdependence to facilitate mutual aid and collective well-being. Public health strategies that seek to protect only the ruling class, while locking a viral underclass into a perpetual state of suffering, are as guaranteed to cause harm as is mandating someone with monkeypox not work for a month, without financial support.

Steven W. Thrasher is the author of The Viral Underclass: The Human Toll When Inequality and Disease Collide. He holds the Daniel H. Renberg Chair at the Medill School of Journalism, the first journalism professorship in the world to focus on LGBTQ research, and is on the faculty of the Institute of Sexual and Gender Minority Health and Wellbeing at Northwestern University. Twitter: @thrasherxy

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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