In His Second Epidemic, a Doctor Recalls His First

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Mitchell Katz, who now leads the New York city Health and Hospitals Corporation, worked in the San Francisco health department during the height of the AIDS crisis.
Ed Reed/Office of Mayor Bill de Blasio

As COVID-19 loomed just over a year ago, Mayor Bill de Blasio told Dr. Mitchell Katz, the out gay head of New York City Health and Hospitals Corporation, that he was about to do “the hardest thing you have ever done.”

The pandemic quickly overwhelmed the city’s public and private hospitals. Supplies of protective equipment that would keep doctors, nurses, and other medical staff safe from the virus dwindled. As the city shut down, homes became workplaces for many New Yorkers. The noise of traffic, planes overhead, and all of the sounds that are usually part of daily life in the city went silent, only to be replaced by ambulance sirens that were carrying sick people to hospitals that had no room for them.

“I thought, ‘I’m sure I’ve done something harder,’” said Katz who completed his medical training in San Francisco in 1989 during the worst years of the AIDS epidemic and joined the city health department there in 1991. “My first thought was nothing could be harder than that.”

It took COVID-19 about a year to kill more than 500,000 people in the US. That death toll was aided by a Trump administration that refused to support, and even opposed in some cases, common sense measures to slow the spread of the virus, such as masks, social distancing, and closing public venues where the virus spreads easily. Trump also promoted bogus cures and treatments.

HIV was first noted in 1981 and deaths attributable to that virus began to approach a half million by 2000, but anti-HIV drugs had already begun to keep people with HIV healthy and living longer and longer. Before those drugs appeared, HIV killed far more of those it infected compared to COVID-19, though a COVID-19 infection can be serious with effects that are long lasting.

“The biggest difference is…all of my patients died usually within nine months,” Katz said of his time in San Francisco treating people with AIDS. “With AIDS, I never felt like my system was overwhelmed.”

Katz, who was raised in Brooklyn, would go on to run San Francisco’s health department from 1997 to 2010. He headed the Los Angeles County health department beginning in 2010. In 2018, he was recruited to lead Health and Hospitals, which employs 45,000 people and operates the city’s 11 public hospitals, skilled nursing facilities, and dozens of community health centers across the city. It also runs MetroPlus, a health insurance plan.

Katz was an early proponent of herd immunity, the notion that with enough people infected who have recovered, the virus will have nowhere to spread. He also opposed widespread closures of businesses, public venues, and schools. The city quickly abandoned that position as it became apparent that if COVID-19 was left unchecked, it would be a disaster.

In contrast to Trump, in the early years of the AIDS epidemic, Ronald Reagan, the president at the time, was not openly obstructing efforts to curtail the spread of HIV, though Reagan’s disinterest in aiding the populations affected by HIV — especially gay man and injecting drug users — was palpable.

“We didn’t actually have him telling people not to wear condoms, not to protect themselves,” Katz said.

Still, instead of promoting the use of condoms for safe sex, Reagan urged individuals to take the unrealistic approach of practicing abstinence to avoid contracting HIV.

What is true of both outbreaks is that bias was a central feature. Trump and his allies took to calling COVID-19 the “China virus,” which was an effort to shift blame from Trump’s failed response to China and to inflame his base against an enemy. The COVID-19 outbreak in the US has been accompanied by a significant increase in anti-Asian violence.

With AIDS, gay men and injecting drug users were the early targets. They were vilified in the conservative press and refused service in hospitals and other public accommodations. After their deaths, families and friends found that many funeral homes would refuse to bury them.

“My last general comment is in both cases was how prejudice came out,” said Katz who noted the rise in anti-Asian bias. “It reminded me of all the prejudice in the early part of the AIDS epidemic about gay men, about drug users.”

What the COVID-19 outbreak has in abundance and the AIDS epidemic largely did not have is many Americans following Trump’s lead and denying that COVID-19 is a dangerous pathogen, refusing to wear masks and engage in social distancing, and espousing a general view that COVID-19 is not a serious threat.

In San Francisco, Katz and other health department staffers were subject to protests by a small group of activists who charged that HIV was not the cause of AIDS and that it was the anti-HIV drugs that were killing people. While those protests eventually became sufficiently threatening that Katz and other health department staff brought criminal charges, the protests were never widespread. He also battled with activists over keeping sex clubs open in San Francisco.

And deaths were common to both outbreaks. At a January press conference with de Blasio, Katz recalled that “most of my friends and colleagues were infected and…funerals were a weekly occurrence.”

The high number of COVID-19 deaths hides the reality that doctors have been successful in saving many people who were infected with that virus.

“[I]t brings tears to my eyes to think of the people who don’t have to go through the horrible pain that I saw among my friends and patients in the 1980s,” Katz said during the press conference. “It’s amazing work and New York City should be so proud.”

But the deaths still take their toll.

“Losses are cumulative,” he told Gay City News. “I lost a lot of people I loved during the AIDS years. It does become harder.”

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