Losing dozens of friends in your 20s and 30s and then getting diagnosed with a deadly virus yourself when you’re young really fucks you up. I’ve lost more people than I care to count to AIDS since the late 1980s—and many of those who survived still bear the scars of those years. Some, like my old friend Spencer Cox, made it through to see the advent of treatment for HIV infection, but stopped taking his drugs a little less than a decade ago, and died. He just couldn’t find a way to live with the aftermath of what we all saw.

I spent most of 2020 high on adrenaline. As an infectious disease epidemiologist and someone living with HIV, pandemics strike visceral fear into me even as I try to focus my thoughts, logically, scientifically, on what needs to get done. At the end of 2020, with no holiday celebrations, with instructions to my research group not to do any work between Christmas and New Year, my world was quieter for a few days. And the grief, sadness, terror of 2020 just welled up. I looked in the mirror and could see what this struggle has done to me, physically, emotionally, psychologically.

I say all this not in the spirit of over-sharing, but to acknowledge that this pandemic has wrecked us. Even those with the means to stay at home, to maintain some of the trappings of our old lives, we’ve been put through the wringer. And we have it good.

Twenty twenty-one is here. We greet it with a Democrat soon to be in the White House, and both the Senate and the House in Democratic control. This is our last best chance to finally vanquish Covid-19. We cannot screw it up. The ability to cope, to make our way through the pandemic relatively unscathed, ended a long time ago for some, but for even the die-hards like me, it’s getting tough to think how we can all bear much more of this.

Yes, there are challenges ahead no matter what. But there are things that have to happen immediately that are simply a matter of political will. The first order of business is a massive pandemic relief bill, which dwarfs what has been appropriated to date. What do we need all this money for?

First, we need to underwrite a massive production effort to scale up the two mRNA vaccines now in use—but with not enough to go around. We should not be in the situation where we have to triage access so drastically that millions of us in the United States will still wait months to get vaccinated—and if we’re in the Global South, will be unlikely to see a vaccine this year. The NY-based Covid-19 Working Group and PrEP4All have called for a President’s Emergency Plan for Vaccine Access and Relief—modeled on the massive effort embarked upon by President Bush to get antiretroviral therapy for HIV out to millions around the world—to scale up mRNA vaccine production, not just for Americans but for everyone. It needs to happen now.

Second, we need to subsidize mass vaccination clinics, some fixed, some mobile—not just rely on CVS and Walgreens alone to retail us out of the pandemic. Relying solely on the private sector isn’t going to get us to where we need to go. We need a military-style mobilization for vaccination across the country—yesterday. This means setting up that infrastructure, getting people quickly trained to do the work in every US state and territory. President-elect Biden has said he’s going to do this, but it really has to be something on the massive scale we saw during the campaign to eradicate polio—with national coordination, not leaving the states on their own to do this. My father caught polio when he was 2 years old. No child now has to worry about that here in the United States. We should be able to make that the same claim for Covid, too, soon enough. That also needs to happen now.

Third, as Michael Mina from the Harvard School of Public Health has urged for months, we have to scale up antigen-based tests for SARSCOV2 for active surveillance in our communities. These tests are different than the PCR-based ones that are used for diagnosis in clinical settings, which are exquisitely sensitive to even the lowest amount of virus circulating in your body. Antigen tests aren’t great at detecting low levels of SARSCOV2. What they can do is detect people who have lots of virus on board—these are the most infectious people and therefore most likely to transmit disease. These faster, less accurate tests are exactly what we need right now—so we can scale up testing efforts to identify infectious cases, particularly as we start to see community spread ebb with vaccination. Contact tracing and isolation then follow. That’s been impossible to do with so many cases out there—but it can be done moving forward if we put our money where our mouth is. This will allow us to mop up new clusters of virus spread through the rest of the year as vaccination continues to roll out. That too needs to happen now.

Fourth, as for social distancing and isolation—for the well and the sick? Two-thousand-dollar checks just don’t cut it. We need to subsidize people’s day-to-day lives if they are unemployed, under-employed, struggling to make ends meet, and not play games with sums that most families will burn through in a few weeks. Social distancing and isolation can’t be a luxury of the upper-middle class, work-from-home crowd. They have to be made possible for everyone, with “pandemic pay” that allows people to do the right thing, to stay home in comfort. If the departure of Mitch McConnell as chief of the “just say no” to real pandemic relief caucus is only met by the ascension of Democrat Joe Manchin of West Virginia to the leadership of the naysayers, we are going to see the pandemic drag on and on. Message to Manchin: Your fiscal conservatism is going to get people killed. People need real relief. Now.

Fifth, the previous pandemic packages were largely corporate welfare, with big business feeding at the trough while small businessmen and women suffered. We cannot sacrifice small business to the pandemic response; the new pandemic relief bill has to subsidize small businesses as a priority while putting strict rules in place to keep big corporations from gaming the system as they did in 2020. Again, this shouldn’t be a performative, one-time , too-small-to-do-much-good handout that won’t allow businesses to reopen or stay afloat. It has to be real relief and it, too, has to happen now.

This is the start of the list—but there are other items that belong here. There will be Republicans—and, sadly, some Democrats—who say we can’t afford something like this. We can’t afford not to. This is a national moment of reckoning.

Bob Rafsky made a speech in November 1992 at a political funeral for AIDS activist Mark Fisher on the eve of the Presidential Election that year. Bob himself was dead a few months later. His target then? President George Bush. But just replace the names now with those who have the power to end this current epidemic, Republicans and Democrats alike. All our leaders should heed Bob’s warning to politicians who always seem to find reasons to let the carnage continue:

George Bush, we believe you’ll be defeated tomorrow because we believe there’s still justice left in the universe, and some compassion left in the American people. But whether or not you are—here and now—standing by Mark’s body, we put this curse on you. Mark’s spirit will haunt you until the end of your days. So that, in the moment of your defeat—you’ll remember our defeats, and in the moment of your death—you’ll remember our deaths.

As for Mark, when the living can no longer speak, the dead may speak for them. Mark’s voice is here with us, as is the voice of Pericles, who two millennia ago mourned the Athenian soldiers who didn’t have to die and in whose death he was complicit, but who had the nobility to say that their memorial was the whole earth.

Let the whole earth hear us now: We beg, we pray, we DEMAND that this epidemic END.
Not just so that we may live, but so that Mark’s soul may rest in peace at last.
In anger and in grief, this fight is not over ‘til all of us are safe.

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