This Podcast Will Kill You - Special Episode: Dr. Steven Thrasher & The Viral Underclass

Episode Date: June 13, 2023

Are viruses the “great equalizers” that some people claim them to be? Are we all similarly susceptible not only to infection from viruses but also to the consequences from infection? The short answer is no. The longer answer can be found in this week’s book club pick, The Viral Underclass: The Human Toll When Inequality and Disease Collide by Dr. Steven Thrasher. Dr. Thrasher, the inaugural Daniel H. Renberg Chair and Assistant Professor of Journalism at Northwestern University, joins us to discuss how racism, classism, sexism, ableism, stigma, and other forms of oppression intersect to create a viral underclass, a group of individuals that are disproportionately susceptible to and impacted by viruses. Our conversation takes us through several of these vectors of the viral underclass as well as personal stories that illustrate how social and political structures punish certain communities for getting sick while others profit. Part memoir, part academic discussion, part journalism, and entirely groundbreaking, The Viral Underclass is an incredibly timely book that demonstrates the ways that viruses amplify and exacerbate existing inequalities while also underlining how we are truly all in this together. Our interconnectedness means that if one of us is vulnerable to infection, then we all are. See omnystudio.com/listener for privacy information.

This is exactly right. There are already enough things charging your card every month. Dinner should not be one of them, which is exactly why Blue Apron is now subscription-free. You heard that right, Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. Order now at Blue Apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50.

Terms and conditions apply. Visit blue apron.com slash terms for more information. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these quote-unquote fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious.

These are foods that you would want to eat. Not that the babies would ever share. Just Food for Dogs is the number one bet recommended fresh dog food back by over a decade of research. No marketing fluff. My dogs lose their minds at dinner. They run to the bowl, tags wagging, paws tapping, full Broadway performance every single night. So I do care about the food I feed big and smalls. So go to just food for dogs.com for 50% off your first box, no code, no gimmicks, just real fresh food.

My small business used to have me doing a ton of things at once. It felt like playing basketball five on one, and I was the one. Out of bounds. Now QuickBooks on the Intuit platform gives me access to a team of AI agents and trusted experts for the assists I need. so I can outdo anything. Check this out. Nothing but net. Net profit, that is. Val, bad fun. Outdo it with Intuit QuickBooks. Feature availability varies by product. Hi, I'm Aaron Welsh, and this is This Podcast Will Kill You. Thanks for joining me today for this latest installment in the TPWKY Book Club. This season's mini series of bonus episodes where I chat with authors about their excellent popular

science books. If this is your first time tuning into one of these book club episodes, be sure to check out the other ones in the series to learn about why sweating is actually a superpower, how the Vatican deals with rogue flower-eating birds, where some period myths come from, and so much more. If I'm counting correctly, this is the sixth episode in our miniseries, and there will be three more coming out this season for a total of nine. So hopefully your library card or e-reader or bookshelf is getting a workout. And as always, we love hearing from you about how you're liking these episodes, any favorites you have so far, and what other books you'd love to have featured in this miniseries or any future miniseries. One of the most important questions that

comes up in this podcast, in public health, in life, really, is why we get sick. Not how we get sick, like airborne transmission versus mosquito-borne, or what happens when you get sick, like the pathophysiology or symptoms of a disease, but why? Why does one person get sick while someone else does not? Disease does not happen in a vacuum, as we're fond of saying. There are countless factors that determine whether or not an individual is exposed to or develops a disease, from individual-level variables like age or immune system function, to ones operating on a societal level, like unequal access to health care, racism, and poverty. Measuring the many determinants of health and disease and how they interact is foundational

to the field of epidemiology. In theory, if we understand the risk factors for developing a disease or the variables that lead to the spread of a disease, we can use some of the risk. information to prevent disease and improve health. But in practice, what ends up happening all too often, especially here in the U.S., is that public health policies are too narrow, failing to take into account many of the social determinants of health and reinforcing the racism, classism, and abelism that drive health disparities. In the viral underclass, the human toll when inequality and disease collide, author Dr. Steve, Stephen Thrasher explores 12 social vectors that create unequal opportunities for infectious

disease transmission, as well as compound the negative impact of infection on someone's life. Viruses are not the quote-unquote great equalizers that some people claim them to be. Rather, they expose and exacerbate existing structural inequalities. A bout of influenza for one person could mean using paid sick days to recuperate at home for a week before heading back to work. But for someone else, those missed days could be unpaid, forcing them to choose between food or heat or rent, or the missed days could lead to them getting fired. Dr. Thrasher, who is the Daniel H. Renberg Chair of Social Justice in Reporting,

and Assistant Professor of Journalism at Northwestern University, examines these dynamics and impacts of viruses far beyond their biology, creating an essential new framework through which we can study the relationships between viruses and marginalization. But the viral underclass is so much more than a skillful and important academic investigation into these complex systemic issues. The inclusion of personal stories throughout the book brings a sense of humanity and compassion to the analysis of each social vector and serves as a necessary reminder that, like the factors driving, health inequalities, we too are all interconnected, that if one person is vulnerable to disease or the impacts from it, then we all are. I am so excited for the opportunity to chat with Dr. Thrasher about

the viral underclass for today's episode, and just wanted to make a quick note that this interview was recorded all the way back on January 31st of this year, so keep that in mind if you hear references to current events. I already know that there is so much we aren't going to be able to cover in this interview, so make sure you all check out your local library or bookstore for a copy of this exceptional book. Okay, but now I should get to the interview right after this break. Dinner shows up every night, whether you're prepared for it or not.

And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. There, assemble and bake meals, take about five minutes of hands-on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it. And if there's truly no time to cook, dish by Blue Apron meals are fully prepared. Just heat them in the oven or microwave, and dinner is ready. And here's the exciting news.

Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. order now at blue apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50. Terms and conditions apply. Visit blue apron.com slash terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat.

By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh

conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keef's. Just visit O'Keef's Company.com slash this podcast and code this podcast at checkout. A timeless wardrobe starts with pieces that are built well from the beginning. From the fabrics to the fit, everything needs to last beyond one season. And that's how Quince approaches design. Quince has all the staples covered, from 100% organic cotton sweaters to premium denim made with stretch for all-day comfort and luxe cotton cashmere blends, perfect for the changing seasons.

The quality shows in every detail, the stitching, the fit, the fabrics. Every piece is thoughtfully designed to be your new wardrobe essential. And each piece is made with premium materials in ethical trusted factories and priced far below what other luxury brands charge. I recently got a pair of Quince's Bella stretch wide-leg jeans, and they are now in constant rotation. They are so comfortable. The fit is amazing, and they come in a bunch of different washes, so I'm about to go order some more. Refresh your wardrobe with Quince. Go to quince.com slash this podcast to get free shipping on your order and 365-day returns, now available in Canada, too. That's Q-U-I-N-C-E.com slash this podcast to get free shipping and 365-day returns, quince.com slash this podcast. Dr. Thrasher, thank you so much for being here today.

I really enjoyed your book, The Viral Underclass, and how it explores the role of viruses as exposing or amplifying these existing structural inequalities in the U.S. that leave some people much more vulnerable to viral infections like COVID or HIV. Before we get into some of the vectors that you discuss that produce a viral underclass, can you give me a bit of background on how this book came to be? Sure. And thanks so much for having me on. I've been writing about HIV for more than a decade. First, as a staff writer at the village voice, and sort of seeing some of the patterns between HIV and poverty. But for about 10 years, or almost 10 years now, I've been writing about when HIV is prosecuted, when people are charged with HIV transmission, which happened through a

story that I wrote for BuzzFeed. And so I've been seeing these patterns come together between viruses and crime, viruses and race, poverty, and incarceration, particularly for a long time. I spent quite a bit of time reporting on this story about a young man named Michael Johnson, who was arrested for HIV transmission in near St. Louis and in the, county next to St. Louis in the beginning of 2014. And then I ended up going to back to St. Louis to write about Michael Brown. And I asked the HIV activists that I had been working with what I should be looking for in that area because I didn't know what this Ferguson was exactly that town. And they told me that they had recently been in the exact apartment complex where

Michael Brown was killed because there have been some new cases of HIV infections. And the apartment complex in Ferguson had this high rate of AIDS. And so I started thinking about the ways that when you would see concentrations of black poverty, you would also see police violence and police killings, but you would also see viruses and particularly HIV. The social factors that led to criminalized black poverty were also leading to new infections. And so I started thinking about that relationship then. And when COVID-19 broke out in the beginning of 2020 in the United States, I started seeing that the same maps that I worked with, and seeing overlap between police violence and HIV were the same emerging maps for COVID-19. The first 12 deaths that happened in St. Louis were all of black people in the North County,

which is the part of the county where Ferguson is. And similar patterns were emerging in New York City as well. And of course, COVID came to be a virus that affected people all over the world and all of the country. but the concentrations of severe sickness and death, particularly at the beginning of the pandemic, and again now, as we're shifting into what President Biden is calling the endemic stage, we're seeing the same kinds of concentrations of who's getting affected by these viruses. And so the book kind of came out of this reporting. I was trying to figure out the story I wrote about HIV criminalization became the basis for my dissertation.

I was trying to in 2019, early 2020, figure out how I was going to turn that into. to a book after I'd finished graduate school. And that's when COVID happened. And it was my agent, Tony McKinnon, who's really great, who said, let's go back and look at your dissertation again. And she saw the last chapter is called the viral underclass. And she was the one that encouraged me to think about that as an analytic to understand why this very, very different virus. And as you know, SARS-COV-2 is a very different virus by many metrics than HIV. And why was it this very, very different virus was affecting similar populations. And so that's how I started thinking about a theory of a viral underclass and making it into a book. And I was very grateful that my

editors at Seldon Books in McMillan saw the vision for this at a time. I mean, we sold the book in late March, early April of 2020 when nothing was happening business-wise. And I didn't know if I was going to lose my job. I didn't know if there'd still be book publishing. Fortunately, people in book publishing thought that people are going to get tired of watching Netflix and they're going to keep buying books, which is exactly what happened. But that's kind of how the book came to be. Really, for me, the sort of aha moment was trying to understand why these viruses with very different properties were affecting similar populations.

What is the viral underclass? And where did this term come from? The term comes from an activist named Sean Strupe, who I interviewed extensively in the book. and he used it first in 2011 and coined it, and he used it as a way to talk about when HIV was criminalized. And so for your listeners who don't know, in about 70 countries around the world, and it's fallen since I've started researching, it was about 30 or so when I began. It's probably about 24, 25 now. States in the U.S., you can be prosecuted for transmitting HIV. And there are a variety of ways that these prosecutions happen. The most nefarious is somebody

can even be charged for spitting if they have HIV. And this has come up with police cases where they've tried to say that somebody who is arrested who either spits during the arrest or even bleeds during the arrest, who's had their head bashed into the car of a police car against the sidewalk. If they haven't told the officer their HIV positive, the officers can charge them with attempted murder. That's kind of the most nefarious end of it. The most common way is that if people who are living with HIV don't disclose their

status to people who they have sex with or who they're sharing injection needles with, they can be prosecuted for transmitting HIV to them, whether or not the person becomes positive. And it doesn't matter if the person's using a condom. It doesn't matter if they are what's called undetectable, that they're on medication and their viral load is so low that they literally cannot transmit HIV. They still can be prosecuted for this. And it becomes an incentive to not know your status.

And so Sean wrote about how this was creating a viral underclass of laws that apply differently to people with what we call immutable characteristics. So in the U.S., there have been periods of time where people are, where the law is explicitly about immutable characteristics like race, there have been laws in the history that explicitly are written to apply about black people. But for the most part, and this is what critical race theory helps us understand, the law itself is written in a way that's, you know, colorblind. It's not literally saying that things apply only to black people, even when it's more often applied to black people. With these HIV laws, that's not the case. It's explicitly saying if you're living with HIV, you live under a different set of laws and other people for very normative life activities. And the example that Sean uses to illustrate it best is to say that infants that become HIV positive, while still fetuses and they're born as babies with HIV, they're going to be living under a different set of laws their whole life. is second-class citizens. So that's how the term started. I heard activists use it in a different

way when I first heard the term, when they were debating about whether or not to revise or abolish HIV laws. And there's been a fair amount of successful movement and not abolishing these laws. The laws have only been abolished in a couple of U.S. states in Illinois, where I live, and actually in Texas. So it can happen in very blue or very red states. But most states have revised. their laws and said, well, if you're undetectable, if you're on medication, then you shouldn't be able to be prosecuted for these laws. But who is undetectable and who is not? The people who are undetectable are homeless, they are poor, they're disproportionately black, they're people who don't have health insurance and can't stay consistently on medication for a variety of reasons. And so I heard activists

talking about a viral underclass that was produced in that way, that some people could be prosecuted and others would not. And I use it in kind of a third way. I use it as an analytic to think about and understand why is this viral underclass being produced? You know, why is it happening? What are the social factors that are making it happen? And then also, how do viruses themselves produce an underclass? And while in the book, and conceptually, I think that a viral underclass can be used to think about viruses in different countries,

I think that last part is very much a U.S. version of what happens and is very particular to the U.S. That the – because we don't have universal health care, because the majority of bankruptcies come from medical debt, here in the U.S., we are particularly punishing of people who have viruses. And so being infected with something can throw you off an economic cliff, and that can make you fall down the class ladder. So that's kind of the origin of the term and how I think about it. And I've really enjoyed hearing from readers who find it interesting to think about how it can apply in different ways or to think about its limits. In each of 12 chapters of your book, you examine one social vector that plays a role in creating or perpetuating the viral underclass. And I'll briefly list them here.

Racism, individualized shame, capitalism, the law, austerity, borders, the liberal carceral state, unequal profiless, Abelism, speciesism, the myth of white immunity, and collective punishment. And throughout these discussions, you interweave these powerful personal stories that exemplify the structural issue at hand. And before we dive into some of these vectors in a bit more depth, I wanted to ask about how you landed on this format, which I think was really impactful, you know, balancing academic, big picture discussions with grounded stories of individuals who have been deeply affected by being a member of the viral underclass. Thank you. So my background is both as a journalist and now I have a PhD in American Studies, which can be many different things.

And I do like studying the history of the United States. But in my program, in my studies, I did really study kind of medical anthropology and sort of social epidemiology and cultural epidemiology because I ended up studying so much HIV and how it intersects with law and culture. But the journalist in me always likes to tell stories. And I worked as a staff writer for the Village Voice for three years before I went to graduate school. And then I was a writer for the guardian all through graduate school, largely writing about the Black Lives Matter movement as as it was happening. The plan, as I read about in the book, was I was going to write for the guardian and just kind of riff on politics and not do a lot of original reporting. But I ended

up getting sent to Ferguson and traveling around the country and documenting a lot of what was happening with the Black Lives Matter movement. And so I've always found that it's really effective to tell stories because that's the best way to connect with people. But I wanted to write a book that was theoretically rigorous. This is maybe a bit in the weeds, but when one becomes a professor as I became right before I started writing this, you often have to write what's called an academic book for an academic press that's written in a very particular way to get tenure, to have a steady job. I was very relieved when I found out when I started at Northwest of that because my home line was in the journalism program that I could actually write a trade book. So I knew that that was a

possibility, but I still wanted to do something that was theoretically rigorous. And some of my inspirations are people like Naomi Klein, I wrote the shock doctrine, Fast Food Nation, which is a fantastic a book about fast food. That's also one of, I think, one of the best books about economics and how economics and labor play out in the United States. So those are some of my guides. So I wanted to write something that had this combination of stories and theory. And I began with the idea of this viral underclass. And some of the themes in that were very familiar to me. I had written about for years, the connections between racism and disease, how that intersected with sexuality. for me, what felt like the growing edge in this book, in a way, was to go beyond race.

And race is never away from these things. Race is the first vector that I write about. The story of Michael Johnson is actually the only one I really keep coming back to throughout the book. It starts and ends with his story, and I write about it a couple times in the middle. But in Chapter 5, I'm writing about a situation I found in Athens, Greece. and I went, while I was working on my dissertation, I had a writing fellowship in Athens through my university, and I thought I'm just going to get to have a break

from all this police violence in the United States and get to clear my mind and eat feta cheese and eat olives and not have to think about some of these things while I'm doing my writing. But within my, about the first week that I was there, there was a police killing in Athens within a mile of where I was working. And it just happened to be the most prominent HIV activists in the country. And so for me, I started to see the situation that was not connected as so much of my work had been, not only with the contemporary race relations in the United States, but the history of the transatlantic slave trade and sort of the ways that race had been made across different national borders.

I was very much getting to see a situation within Europe that was not connected to the United States that did still have a lot to do with viruses. and with queerness. And this young man, I was thinking about him a lot that the past couple weeks as we've seen these horrific videos out of Memphis, this young man was kicked to death by a mob by several people and four police officers as well who just kicked him until he was dead.

And he was HIV-B positive. And so I started looking into the story of how did he become HIV-positive? And I saw the story of how in Greece they had actually been doing very, very effective HIV work at keeping that virus down through taking sterile syringes to the street and getting them to people who used injection drugs. It wasn't actually even particularly expensive to do so, but they were keeping HIV pretty in check in that way. And when they had their economic crisis and the EU imposed austerity, they cut all those kinds of programs.

They said, you can't pay for those things. And HIV went up 3,000 percent in just a couple of years. And so it was like a very, very similar story that happened outside of the United States. And so that's how I started thinking about, okay, I can write about austerity as one of these vectors in a way that can hopefully create a sense of solidarity between white people in other countries and people in Asia and people in Africa and in the Americas who are having similar things happening that's not only about this dynamic we have with race relations in the United States.

So I started seeing, you know, what are these things? different social vectors that try to explain why certain bodies are put in front of viruses routinely, why they come into contact with them the most, and then why they have very different results in how they'll survive, who's going to become infected, who's going to get seriously sick, and who's going to die. And so I think I started with eight when I proposed the book, and then it became 10, and then I begged my editors for 12, and they were fine with that. night and I think that explains 12 different ways. I've heard readers say there are other ones they've thought of or some resonate more with

them than others, but I hope that they help people think about. These vectors are, they're socially constructed. And I don't know if you struggled with this in your work, but I write about this a little bit in the book. There was a challenge at the beginning of the pandemic that people were using language that typically had only been used by public health people. And there were good things about this. I'm glad that people were wanting to read and wanting to understand this, you know, global phenomenon that was happening. At the same time, it could be very damaging when lay people were using terms like

host or describing individuals as vectors. And so one of the things I wanted to say is the individual is not a vector. You know, somebody like Zach, who became infected with HIV and eventually was killed by police, he became HIV positive in part because the EU stripped the money away from what had been happening in Greece, and then suddenly there was a lot more virus circulating. That's the vector. It's not any one individual person. So that was one of the reasons why I wanted to think about and emphasize that these vectors are beyond our control, which is not to say that we, you know, we don't play a part in them, but no individual is a vector. Viruses don't just develop in a person dropped into them by a stork or anything like that, they're socially connected. And that should be

our focus and understanding how are these vectors operating? What can we do to work with them to minimize the harm that they're doing? Absolutely. And you mentioned one of these vectors, austerity, but let's get into a few others, starting with individualized shame. And I know many listeners of this podcast are likely familiar with the true story of patient zero, but could you take a it and also talk a bit about the ways that we saw scapegoating used during the COVID pandemic. Sure. So the term patient zero is originally, it's just a mistake. Originally, this French Canadian flight attendant at Gaitan Dugard was identified as the quote-unquote patient zero who brought HIV to the United States, to North America, actually, of Canada and the United

States. And there's a fantastic book called A Patient Zero on the Making of the AIDS epidemic by Richard McKay that writes out a lot of this history about how Duga was trying to actually be very helpful with contact tracers and people were trying to understand what was happening with this epidemic. And in talking to one person who was talking to like 40 different people, everyone he'd been talking to was in California. Juga was the one person who was outside of California. And so he noted that he was the patient O is in the letter for outside California. And Randy Schultz, who was a very celebrated and very complicated gay journalists, identified this as the number zero and called impatient zero.

And the marketing by St. Martin's Press really, really focused on that in his book tour and made much more of it than should have been. And so I kind of have some linguistic fun in the book trying to understand the history. of that term, and I think it actually also dovetails with thinking about ground zero and the ways that we broadly, not hopefully you and me and your listeners, but journalists often write about people living with disease as if they're akin to an atom bomb, is like they're a biological bomb waiting to go off in a community. And so there is something I think about that number is zero, but also when people are called by numbers and when anytime an individual is made to feel like

disease is their fault, really bad things happen. So that's one of the reasons why, as I write about in the book, including with somebody that I knew and loved, why you have high rates of suicide with people who are living with HIV. The shame and the isolation that people feel when they need support the most can be a real tragedy. And what we want with any kind of communicable disease, whether it's HIV, COVID-19, as I will write about for the paperback edition, because it happened right after the book was published

with monkeypox as well, we want people to be able to have open, honest communication with one and other and know that they're going to be supported and helped. You know, if you are, this happened with monkeypox quite differently than with early COVID, you know, if somebody gets a diagnosis of monkeypox and they're told you must isolate now for four to six weeks, but you get no money, there's every impetus to lie about it and or to feel shame and isolated and to suffer. And most people, no matter how wealthy in the United States or how middle class they might think they are, most people can't go four to six weeks without their income. And so this can be a really devastating thing.

And the idea of a patient zero, I think, helps corporations and governments enact that kind of shame and austerity to say, you are a bad person, you brought this on yourself, it's your responsibility to keep the rest of the community from getting it. Whereas in reality, if everyone got paid sick leave, you know, they could, they could more effectively be able to stay home and not feel so scared and frightened about coming out to each other and be able to reach out to other people and say, I've been exposed to this, you might want to get tested for it. And I think that the idea of the patient zero just does a lot of work in letting the society broadly off the hook and putting the responsibility on the individual. But the consequences from that can be tragic for the individual, and they can also be

quite bad for the population level public health. One of the stories that you feature in your book and you mentioned earlier is that of Michael Johnson, a young black man who was convicted for allegedly not disclosing his HIV status to his sexual partners. Can you share a little bit more about Michael's story and what affect the criminalization of HIV can have or has had on shame and stigma and seeking care? Sure. So Michael, when I met him, was a young man. It's been almost nine years now, so we're both older than when we first met. He was a college student at Lyndon Wood University in Missouri, and he was almost done. He only had one more year to go, even though he couldn't really read or write very well. This is unfortunately not an uncommon story for some black male students who are very good athletes. He was a fantastic wrestler. And he was accused of having sex with six. different young men and not disclosing his HIV status. Two of the charges were that he had transmitted HIV to them, and the rest were that he had just exposed them to HIV. And the trial

was one of the most disastrous things I've ever seen. I sat through every minute of the trial. It was kind of every disaster of black America and of how we deal with disease and sexuality in this country. And it was initially sentenced to 30 years in prison, of which he served about six before we got him out, partially because of, largely because the prosecutor had engaged in prosecutorial misconduct. But he spent most of his 20s in prison. And it was a disastrous case for him. And it's a good jumping off point to think about how criminalization doesn't work. At the time that Michael was arrested, there were headlines about him all over the world, Australia, Europe, up all over the place. 40 million people were living with HIV at that time. One American

college student who is largely illiterate cannot be held responsible for 40 million people living with HIV. We can't lock up all 40 million people. We can't lock up everyone who infected someone else, nor should we. And as I was saying earlier, what we really want is people to be able to have open communication when they are dealing with sickness. The more stigmatize the sickness, the more we want to support them and being able to have open communication. So this is a real problem with HIV in many ways, much more so than COVID, because HIV's history is largely associated with queer sexuality and injection drug use. Obviously, people are affected for other reasons as well, but that's a lot of the history

and why a lot of shame comes up around it. And so when I started reporting on the story, I immediately heard from the HIV people that I worked with how much harder their work was getting that we knew, I would say within a year of reporting on the story, the CDC came out with a statistic that one out of every two black gay men is projected to become HIV positive in our lifetime. And that has to do with all kinds of different social factors. It actually doesn't have to do with having more sexual partners or using injection drugs more. Black gay men use them a bit less. But it has to do with all these social factors. And so the population that you want to try to support and protect and

prevent from becoming HIV positive, largely, you know, you need to do a lot of work with young black gay men. And the people that I worked with in St. Louis said it is getting harder and harder and harder for us to get people tested because of this case. Because if you see somebody go to prison for HIV and the law says if you know your HIV positive, you could go to prison. And if you don't know, you can't ever be prosecuted, then it becomes even harder to get people tested. And it's just a complete misuse of funds that the government could be spending differently in the county where Michael was arrested. And I think this was, trying to matter what year it was. I think it was shortly before, after he got acquitted, before his sentence was overturned. That county also stopped

having an STI clinic. And so the state was on one hand saying, we want to spend all this money prosecuting someone because he's making people HIV positive, but we're also going to get rid of the clinic. So you want to have the clinics. And there's a lot of the clinics. And There's this relationship. I've been thinking about this a lot since Roe is overturned. There's this relationship you can see between abortion and sexually transmitted infections and who's doing this work. In Indiana, when Mike Pence was governor, the fastest HIV outbreak in the country happened. And a big reason for that was because they had already effectively chased out all the abortion providers who were also the people who were doing STI testing.

So everyone doing HIV testing in the lower half of that state, was no longer doing it when HIV happened, and then no one knew it was circulating until the infection had gotten quite wide. And so I was horrified to see that in the county where Michael was prosecuted, the same set-ups happening. You get rid of the surveillance network to test for STIs, and then you're leaving people vulnerable to becoming infected with them. And something similar now is happening with COVID. As COVID money dries up, as the federal government moves it into the private market, there's going to be less surveillance. and more circulation of the virus.

I've moved a lot, and I've seen a lot of other people move a lot in how they think about criminalization with HIV. I think it should not be criminalized at all for a variety of reasons, but even just at the population-level public health reasoning, nobody should want anything to be criminalized in this way because it's going to affect the kind of people

you might think are doing the quote-unquote wrong thing, but it's really going to affect everybody and have a big effect on everybody. And the more stigma that happens, it does create worse public health levels for the people who receive that stigma the most, but it also just affects the whole population quite badly. Absolutely. All right. We will take a quick break here.

And when we get back, some more questions about the vectors of the viral underclass. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hand. feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions.

Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works.

O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefs. Just visit O'Keefscom. This Podcast and code this podcast at checkout. I'm Austin Hankwitz. And I'm Janice Torres.

Join us for Season 4 of Mind the Business, small business success stories from Ruby Studio and Intuit QuickBooks. We're back and talking to more inspiring small business owners about everything from the changing business landscape to the rise of artificial intelligence and how QuickBooks on the Intuit platform helps you outdo what you're capable of. So Outdo it with Intuit QuickBooks.

Working in QuickBooks just makes it easier to run the business, right? There's so much that you need to do when it comes to running a business, building products, setting up marketing campaigns. And to run a business, you have to make sure that your finances are in order. So it removes my anxiety from one side of it so that I can focus on everything else. Listen to new episodes of Mind the Business, Small Business Success Stories, every other Thursday on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these quote-unquote fresh dog foods in your fridge are not even 100% human grade,

which is why feed your babies just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat. Not that the babies would ever share. Just Food for Dogs is the number one bet recommended fresh dog food back by over a decade of research. No marketing fluff. My dogs lose their minds at dinner.

They run to the bowl, tags wagging, paws tapping, full Broadway performance every single night. So I do care about the food I feed Biggie and Smalls. So go to Just Foodfor Dogs.com for 50% off your first box. No code, no gimmicks. Just real fresh. food. Welcome back, everyone. Let's dive back in. Another chapter in your book deals with borders, both political and social. How do these different types of borders reinforce the viral underclass? So borders, this is one of these terms that I did think about a lot in my PhD program and what

constitute borders. And on the national level, we try to imagine that there are hard borders to the U.S., you know, water or a wall. The Trump administration's been trying to build this wall. But borders are very porous over what is in the U.S. and what isn't in various different ways. And I do this often. I just spoke to a group of about a thousand people last week. And the answer came, as it almost always does. When I asked people, you know, when did Guantanamo Bay start getting used as a site of infinite detention? And people always think it's 9-11. But it was actually a decade before that, when it was activated to put Haitian refugees who were trying to flee Haiti, and the Coast Guard didn't want them to get to Florida. And so they diverted them. They said, where can we send them where the U.S. can control them,

but that they can't make a claim to U.S. law? And they said, well, we have the space in Guantanamo Bay. Let's do that there. So the whole history of having the site of infinite detention is predicated on this in-between zone where where exactly the border is, is not clear. and viruses are used as the justification for it. And we've seen this in all kinds of bad national policy. Right now, again, we're only testing people from China, have to have a test before they come to the United States from no other country for COVID. The virus is used for justification for how we misunderstand how viruses actually move, is if they respect national borders.

And the last China policy with the U.S. requiring testing just from that country is happening, as the virus is allowed to move completely freely within the borders of the U.S. And as we've had among the highest rates of the virus for anyone, so of any country in the world. Something really similar and bad happened with South Africa, with another countries, about a year, a year and a half ago when they first discovered the Omicron variant. Now, Omicron didn't necessarily come from South Africa. South African is a relatively poor country. But because of their experience with AIDS, they have.

have very smartly, and as a great gift to the entire world, put resources into genomic surveillance ever since they've dealt with HIV. And so even though they have modest resources, they still put a lot of effort into understanding what's happening with viruses. So often they're the ones finding variants first, and they're punished for it. They're told, okay, you can't come to the EU or UK or the United States because there's something diseased about you. And then the U.S. has an idea in their mind that the border of Africa is defined by a virus in this way. And so I think a lot about those kind of borders, but also about the borders that are imagined to be between genders. So one of the things I read about in the book, and unfortunately,

I feel like the situation's gotten even worse since I published the book, are how much trans people are in the crosshairs in the United States. And the state and a lot of media and certain elements of science, not other elements of science, are very invested in the idea of creating the idea that there are two distinct genders and there has to be a hard border between them. And that creates all kind of bad health effects, one of which, in very, very direct ways, create viral risk for people who are trans. So if the state will allow you to have trans medical care as most states were allowing until the past couple of years, then some of the state will, someone who's transitioning and taking hormones is going to get sterile syringes, a medication,

the medication they need under the care of a doctor. If they're not getting that, and it's been taken away in Florida, I think Wyoming just passed a really bad bill, Texas as well, if they can't get it from their doctor, they're going to get it from the contraband market. And the more people are using syringes from the contraband market, the more likely they're going to get hepatitis, HIV, any number of other things. And so that's a very direct way. I think the state, is opening up the veins of people and making them more susceptible to viruses. In a very related way, the same happens with education. We've long known that children who get absence-only sex education or no-sex education

are more likely to become pregnant and more likely to get STIs. And so as we see these don't say gay bills, these very draconian bills happening around the country, these classrooms that are having all books taken out of them, you know, you might be in a district where they're not allowing any kind of, of queer knowledge of any kind, but the teacher could, on their own, get a book like Heather has two mommies or something like that. All those books have been taken off classrooms. So in denying young people the ability to know about how to protect their bodies, they're going to become

more susceptible to viruses. And so, like, they're very, very direct ways that this is the literal virus entering people's bodies because of decisions by the state. But as I read about in the book, there's kind of a secondary way this happens as well. with the ways that not getting proper medical care, feeling shame and stigma creates depression, creates barriers to getting care that you need. I write about this wonderful trans-Latin activist named Lorena Borjas in the book who died of COVID.

She was the first person in my social circle to die of COVID. In my outer social circle, I'd only met her once, but she was very close to a number of my friends. And in her final day, she did not want to go to the hospital, before she, when she had COVID, and part of the reason why it was because she was terrified about how badly she had always been treated, both for her language as someone whose first language was not English,

but also for being a trans person. And I write very briefly about an experience I had of being made feel to unwelcome once in a medical setting. And the more times people have that, which happens particularly with people who are undocumented, who are immigrants, who are trans, who are queer, the more likely they're made to feel like they're not, welcome the medical system, the more likely something that maybe could have been dealt with easily

could become a life-threatening situation or take their life. And the hierarchy of borders is why a lot of this happens. When the U.S. has really harsh enforcement of our national borders, that makes people who are undocumented unlikely to seek medical attention. When we have really harsh borders around who is allegedly a male or a female and act like the there's nobody who's intersex or trans or non-binary in between. The hierarchy and the enforcement of those borders drives people out of care that they could be receiving. And the consequences of that are really deadly. And we can see it in very unrefutable ways in looking at viral transmission and who's affected.

Yeah. So I want to shift a bit to talking about capitalism, which is another of the vectors that you discuss in your book. How can we use capitalism as a lens? through which to view some of the large-scale geographic differences in COVID incidents or mortality, especially in the context of this is a part of your book I really enjoyed, of how the U.S. spends money on certain aspects of health care compared to other countries. Capitalism is the driver of so much viral transmission, and it's a very opposite message that most of us get in school and certainly in mass media.

You know, historically, one of the things that I come to in lectures and I write a bit about in the book is understanding the origins of modern capitalism cannot be decoupled from the history of the transatlantic slave trade. Modern capitalism in North America and in Europe is based on the Middle Passage where money came from Europe. It was used to buy human beings in Africa and to convert them into enslaved people. The enslaved people were used to extract raw goods in the Americas, cotton, gold, silver, things of that nature. And then those were sent to Europe for manufacturing and turned into money, and this triangle goes around, around, around. And that's the birth of modern capitalism. It's also the biggest transfer of pathogens in human history, I think, that the slave ship itself is the vector. Again, not the enslaved people, the ship itself where 20, 25% of people could die from the conditions in the crossing.

And then there was this mass movement of bringing together more people than ever been together from different parts of the globe. And then moving those viruses and those pathogens and bacteria to the Americas in that process. So that's the birth of modern capitalism. It was one of great viral transmission and one of enormous racial. pain and suffering and trauma. And coming to modern day times, the point of capitalism is just to extract value. It must extract as much value from as many sources as possible, and people's bodies get moved into the crosshairs when that happens. And so people who were at the higher end of the ladder of capitalism were relatively well protected at the beginning of COVID-19. You know,

if you could stay home, that was the biggest thing that would change. things for you. And then among people who could not work from home, but doctors, you know, certain people who were working in settings where they still had medical gear that were protect them. The huge report that was done out of UC Berkeley Public Health School that looked at California found that the deadliest job in the pandemic was line cook. And line cooks were people who worked in very, very tight spaces with poor ventilation. Many of them are undocumented. Many of them live in intergenerational homes and dense homes. And so if somebody gets sick in that setting, they're not going to be able to really isolate in the rest of their household.

So capitalism is always playing a role in why public health things are playing out as they do. And as the president just said that we will move out of the emergency period of the pandemic on May 11th, when that happens, this is all going to create a much more entrenched viral underclass and ruling class, that the people who don't have insurance are going to lose access to testing treatment and prevention efforts. And they've already been cut off of many of them already, but they'll be completely cut out of all of them. And then people with insurance will get a COVID booster. Pfizer and Madonna look like they're going to charge a lot more for it. They've been charging $25 to $30 a shot to the federal government.

They're going to charge probably $110 to $130 to individuals. Those with insurance, their insurance will go up. But the viral rate will probably be much lower amongst the insured if they can still get shots. And people who don't have insurance are not going to get shots and the viral load is going to be much higher. And this is a pattern. You know, we've seen this with, I've seen this in my research for years with AIDS that in 1995, tens of thousands of people were still dying every year in the U.S. And there was no medication.

Then the medication comes in 96. And it's like a miracle. And people hope that this is going to be the end of AIDS. but the drugs don't go to other countries for another seven years. And in the U.S., they're very, very unequally accessed. And for the most part, 80, 90 percent of white gay men get access to the drugs, and the level goes way, way down. But black people don't really get access to the drugs that much.

And then all these other social factors I've been talking about keep people from getting consistent access to the drugs. So if you don't have insurance, if you're homeless, if you're incarcerated, it makes it really hard to get medication. And so capitalism is kind of the driving force for this. A phrase I really like, the active activists told me while I was reporting the book, is at 96, they knew that science had won the battle, but then capitalism won the war. We know how to keep people from getting HIV. We know how to keep people from dying from AIDS. HIV is such a slow-acting virus that there's no reason why people should die of AIDS, even though the better part of a million people globally do every year.

You have five, ten, maybe 15 years before somebody's going to die from HIV, but bolstering capitalism and keeping profit for the drugs for it, keeps people from getting the care they could have. And I really fear that we're heading into something similar with COVID. We could have, as happened with AIDS, you know, more people could die of COVID after there's medication than before if people aren't actually getting it. and if they're not getting the things that they need to survive this virus.

So one of the things you mentioned just now was this discussion around COVID vaccines. And I want to talk a little bit about anti-vaccine sentiment in the U.S. And this modern anti-vaccine sentiment or vaccine hesitancy can be traced back to discredited former physician Andrew Wakefield, who claim to find a causal link between the MMR vaccine and autism. How does this story illustrate a couple of the vectors in your book, namely ableism and the myth of white immunity? There's vaccine hesitancy in different countries around the world for different reasons. In the U.S. and in England, it very much does trace back to Andrew Wakefield and the idea that the MMR vaccine had three different vaccines together was somehow causing autism. And so the way I grew to think about that in conversation with the city.

activist requires for a moment, I'll keep giving disclaimers, but requires trying to think about the logic that's happening there. And the idea of it is that if a vaccine causes autism, which it does not. But just saying for a moment, the idea that if the vaccine cause autism, that is somehow worse than death. And that's a very ablest idea. I think if my child could become autistic from this thing, I would rather risk their life. I would rather risk the lives of the other children around them, then the idea that my child could be autistic. Again, vaccines don't cause autism. But this logic is what is at play. And so I think that both illustrates the really grotesque nature of disability and ableism, which was one of my growing edges

and understanding this book, as we're talking earlier about kind of how I moved from thinking about race and then also about austerity. Thinking about disabling abelism was a real growing area for me in this book and to see how embedded it is and how it's used as an excuse for not giving care. Zeke Emanuel, who wrote this horrible Atlantic essay, Why I Want to Die at 75, was just tweeting it out in the last week again, saying that, you know, you shouldn't want to be infirm

and have people remember you not being a contribution to society. And so that also dovetails with capitalism. And we often think about people who are disabled, either with something like autism or some kind of physical disability, that, oh, you're not being maximally productive in society and therefore you have no value, which is not true.

But that's a lot of the logic under it. And I end the book, and this chapter took a fair amount of work in my editor. I made it much better, I think, in understanding the myth of white immunity and when white people think they're immune. So four of Michael Johnson's accusers were white. One of the things I saw in that trial was that none of the young men were having open communication about sex. And they seem to think they could just say, are you clean or not? And that was going to protect them. And I think that for a lot of the white accusers, the idea that something bad

could happen to them and sex just didn't come into their mind. And sex is not risk-free. Nothing in life is risk-free, but certainly whenever we're involved in intimate connections with another, viruses show us that there can be transference that happens. People can get pregnant. And of course, pathogens can move between our bodies. And I think that the myth of white immunity speaks to when white people will think, well, you know, this bad thing that happens to black people or happens to queer people, it's not going to happen to me. But of course, it can happen to them. And Jonathan Metzell, who wrote the introduction to my book, his book, Dying of Whiteness, goes deep into how some of these states that have large, poor, white populations will not want

Medicaid expansion because they think, oh, you know, black people could get it too, so I don't one, besides, I'm going to be okay. And I think something similar happens with vaccines, is that, and this was not actually, the class dimensions here, I think, are very interesting, and that vaccine hesitancy came into upper-middle-class America first and upper-class America. The idea that my child is so genetically superior and so hearty and hail, they don't need a vaccine, and that ties not only into abelism, but to a kind of white superiority and the notion that my natural body doesn't need these things. When you step back and look, you can see that one of the greatest advances in human mortality has been vaccination. That's one of the reasons

why. And I didn't get into the book. It's come up a couple times in conversation, but I wish I'd thought to use this in the book because it's a really good illustration. So many, people, I think, believe that humans used to live much shorter lives before the 20th century. And in fact, no, they, I mean, humans have lived, you know, 50, 60, 70, 80 years or so in that range, you know, for some time. The huge difference is child mortality is that children didn't make it out of childhood. And that's why you see, oh, an average lifespan of 30 years or 40 years in certain societies. It's because so many children were dying. The biggest, and one of the biggest things that has changed that for children has been vaccination.

And so it's been really alarming and quite concerning to see how not only has there been low COVID vaccine uptake for children, even though there was a JAMA paper that just came out this last week showing that COVID was the number one killer of people zero to 19 in the United States. That was the most common thing to kill young people the past couple of years. And so there's been very low uptake of the COVID-19 vaccine. But even vaccines for other things are falling now because of so much blowback against this vaccine. And so that's really, really concerning. Do you think that this hesitancy around the SARS-CoV-2 vaccine has similar drivers to this Andrew Wakefield type thing?

Or do you think that the drivers for anti-vaccine sentiment have changed? I think they're related. So there's, I think that the basis of where Wakefield came from, that my child is so hardy they don't need it. I think that's a much more popular idea. I do think that there was like understandable skepticism about how quickly this was moving, not to the extent that people shouldn't take it, but I think that the federal government should have put more effort into explaining what was happening. I think that there is a real problem in understanding collectively how we sort of share one body. And this is a big difference to me and why I, not just as a gay man, as a practicing gay man myself, but also sort of as a queer theorist and understanding that queer people and particularly queer men understand quite well, this is like a shared responsibility. When something like monkey pox happens, nobody wanted to get the pox themselves, but they all.

also understood, and gay men were just lining up waiting for this vaccine, wanted to get as quickly as they could. Because for the past 40 years with HIV, we've understood that this is, like, we all share the responsibility for the virus moving amongst our community. It's not just every individual person on themselves. We have to manage the viral load amongst us. And I'm disappointed that the U.S. has not taken that on more. So I think a lot of adults, like a lot of adults did eventually get vaccinated,

but very few are vaccinating their children because they think that, well, it's only going to hurt old people. One, as just said, it was the biggest killer of children over the past couple years. But also, like, the children's bodies are part of this collective that we all need protected because the children don't live in a vacuum. The children are interacting with their teachers, with their parents, their grandparents, the bus drivers, the lunchroom attendance, everybody. And so that I had hoped that kind of understanding would be much broader coming out of this pandemic or as this pandemic goes on, that we share a collector responsibility. And there's been a lot of rejection for that. And I think a lot of people are rejecting it through their children. The other thing that I do find difficult, but I do give some credence to, and this isn't just about children, but it's come up with relative.

of my own family, I think that in the U.S., we are so bad about telling people you're on your own with medical conditions. And if something like cancer happens to you, like, you're on your own, like, you better take care of that. So then when the government comes along and says, well, you really should take this thing and it's good for you and it'll be good for the rest of the community, there is like a lot of skepticism. And that's not an easy thing to fix.

You know, I think if we had a universal health care system, if people didn't think they were going to go off an economic cliff every time they were sick, there could be a different response. And I certainly saw that, you know, I worked on successfully. I will, I will toot my own horn here, you know, with a couple of people and like trying to understand and explain, okay, what is it? You are afraid of, oh, you are a shift worker and you're afraid you take the vaccine and you might lose a day's work. Okay, you know, I will help you find a place where you can do it Friday afternoon. and then you'll have the weekend to recover. And doing that, like, I found that very effective with two of my friends. That kind of one-on-one care was effective in lots of ways. But also, if we just had a general health care framework where you get sick, you take time off, and you don't go to work, and you get paid, that would make people less anxious in the first place. So I'm probably mixing a little bit of what you were asking about children. But I think that that, of course, affects how people think about it with their children, too.

And I think that there was a lot of worry that, okay, if the child's going to react, I can't take time off from work, who's going to take care of the child? There are all these things that contribute to it as well. But I found the Andrew Wakefield line, which was something my editor actually asked me to add. It was mostly taking things out of the book. But she asked me to kind of look into that and think about that, and I'm glad she did. I think that that gives us a very generative place to understand the general dynamics of ableism. and how we imagine immunity, and there are new challenges that happen, particularly with COVID too. I love the point that you made, and I'm probably paraphrasing here, hopefully not butchering it too much,

about how viruses themselves are not necessarily predictable, yet they do move in predictable ways. How can this framework of the viral underclass help us to prevent disease spread or, at the very least, distribute resources more equitably. Something that I've, and I think I came to this phrasing after I'd finish the book, is that viruses demand a sense of humility. So, like, we can predict them. We try to. And we have long histories with some of them, and we can predict them very well.

But they can mutate and they can change. And I think we need to have a sense of humility about that. This did happen after I finished the book. You know, monkeypox, we'd understood monkeypox for about 70 years. and then five, six years ago, it evolved and started behaving very differently and presenting differently and ending up in a particular population because it seemed to be behaving in a way seemingly from my best understanding now, transferring mostly through unprotected anal intercourse, which had not been the case with how it behaved before.

And that's not a rejection necessarily of the 70 years of research that was done in it. There were things about that research that help understand how to treat it. but they are living evolving things. They evolve much faster than we do as human beings. And so I think that we should always just have a sense of humility about that. And I do think the particulars of viruses are important to understand and to know that the way that this came up for me a lot in doing public health speaking about monkeypox and reassuring people, this is not like COVID.

You know, this is not, we're starting to see like very clearly how it's moving. moving 97, 98, 99% amongst men who have sex with men, which means it's probably not moving through air because otherwise it would be moving to other people too. So these particulars are important to understand. But at the same time, these social vectors, I think, do help us understand where a lot of the risk is going to be. And even within those populations. So within, you know, in monkeypox, we knew, okay, it's primarily moving amongst

the MSM population. But we could pretty quickly see, oh, it's much more moving. doing so through black and Latin men and who's getting the vaccines, white men. Okay, that's something that we need to address. And I think that with any kind of virus or any kind of pathogen or sickness, we know who is most likely to be affected the most and where resources need to be deployed. And often the policy goes counter to that. So research has been pretty clear around the world, not just in the United States, that people

who have access to health insurance fared much better in COVID, people who do. don't have health insurance fared much worse. And some of that's because they're not getting care. It's also reflective in our country. Those are the people who don't have any kind of preventative care in the first place. So if you're the kind of person who doesn't have health insurance, you probably can't work remotely, and you're probably going to lose pay if you miss a day of work. And so we know that the uninsured are the most likely to get COVID, get seriously sick from COVID and die from COVID. And yet, we're taking away the care from them. And that's going to kill them, to be very blunt about it.

But it's also going to let the virus circulate much more throughout the country. And this is, you know, yes, this is true in a very particular way for COVID. One of the reasons why LGBTQ people are more affected by COVID has nothing to do with sex or gender identity, but has everything to do with LGBTQ people being poor and in a very explicit way being overrepresented in retail work. So as people are working in retail and face-to-face work, they're going to be more exposed. But even though this is very, very true with COVID, the same social dynamic is true with HIV, influenza with any number of other pathogens. And so we know what we need to do. We know who we need to protect.

We know who in the society is not being protected. And if you're not being protected in terms of having access to medicine, food, safe shelter, education, the things that make for a quality, and healthy life, if you don't have access to those things, when pathogens come into the picture, you're going to be the most likely to be in their path. And so that's something that I think that we just need to not let go of and keep focusing on. The particularities can change, the situation, why and how transmission happens can change. But that was the kind of the genesis of my book of saying these are very different pathogens that are affecting the same kinds of people. And yes, anyone could in theory be affected by COVID, but the reasons why and who's going to survive are going to create very different odds.

And I think that as COVID came into the U.S., and as we understood it in the United States, and we saw who was affected, who was affected most at the beginning. And then there was this period of socialized medicine, of people being able to show up and get what they needed for this. And then as that dissipates, that same viral underclass is going to really emerge again. see, yeah, it's the poor areas of towns that are getting it the most. And that's the states where people don't even have Medicaid, where people are going to get the sickest. And that's the thing that we need to keep combating. That was absolutely wonderful. Thank you so, so much, Dr. Thrasher for taking the time to chat. It was really great talking with you. And if you listeners enjoyed this conversation as much as I did and want to learn more, check out our website,

this podcast will kill you.com, where I'll post a link to where you can find the viral underclass, the human toll when inequality and disease collide. And don't forget, you can check out our website for all sorts of other cool things, including, but not limited, to transcripts, quarantini and placebo-rita recipes, show notes and references for all of our episodes, links to merch, our Bookshop.org affiliate account, our Goodreads list, a first-hand account form, and music by Bloodmobile. Speaking of which, thank you to Bloodmobile for providing the music for this episode and all of our episodes. Thank you to Leanna Squalachi for our audio mixing. And thanks to you, listeners, for listening. I hope you liked this bonus episode and are loving being part of the TPWKY Book Club.

A special thank you, as always, to our fantastic patrons. We appreciate your support so very much. Well, until next time, keep washing those hands. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these, quote-unquote, fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for you.

your babies, 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat. Not that the babies would ever share. Just Food for Dogs is the number one vet recommended fresh dog food backed by over a decade of research. No marketing fluff. My dogs lose their minds at dinner. They run to the bowl, tags wagging, paws tapping, full Broadway performance every single

night. So I do care about the food I feed Biggie and Smalls. So go to just food for dogs.com for 50% off your first box, no code, no gimmicks, just real fresh food. Military life isn't predictable, but earning your master's degree can be. With American military university's 40 plus flexible online master's programs, you can stay mission ready while you get market ready. Learn anywhere, anytime, with an education built to keep pace, steady, reliable, and always accessible. Plus, military service members, veterans, and their families can save up to 45% on master's tuition.

with AMU's special rates and grants. Learn more at AMU. com.apus.edu. Steady through every mission. Travel smarter, not harder, at America's Best Value In by Senesta with convenient locations from coast to coast and value-packed comfort at every turn.

And when you're a Senesta Travel Pass member, staying at America's best value in means earning points toward free nights, upgrades, and more. Go to senesta.com to book your stay and unlock the best rates with Sanesta Travel Pass. Here today, Rome tomorrow. Join now at senesta.com. Terms and conditions apply.