COVID-19: Can We Have Our Cake and Eat It, Too?

Dr. David Holland is the Chief Clinical Officer of Medical & Preventive Services at the Fulton County Board of Health. 

As we enter the year 2021, there is an almost universal sense of relief that 2020 is over — but that’s about all we can agree on. Divisions over politics, economics, and a vast array of other topics literally threaten a repeat of the Civil War, but nowhere is our division more apparent than in our response to COVID-19.

In one corner is a group of people who see it as a global existential threat capable of killing hundreds of thousands of vulnerable Americans and overwhelming health care systems even in the richest parts of our country. In the other is a group that sees an overall low mortality rate and finds it hard to justify the extreme measures needed to control it when the vast majority of people who get it recover just fine.

Among gay men, this division has been growing steadily since the summer, when case rates first spiked. With waiting lists for hospital and ICU beds, the hospital system is now teetering on the verge of collapse, but large-scale events continue to be held both at local gay clubs and international destinations. Health care workers are being driven to the brink of exhaustion, so it seems inevitable that some people will want to lash out at what appears to be complete social irresponsibility among the revelers.

The situation has now erupted into a social media cold war, with the Instagram groups @gaysovercovid, @gaysovergaysovercovid_, and @gaysovergaysovergaysovercovid leading us into a sort of COVID-19 shaming Inception.

It seems hard to believe, but there will be a day when COVID-19 will no longer pose a mortal threat to a significant portion of our population. We have multiple vaccines being rolled out that will eventually return us to our regularly scheduled programming, so despite the anger and vitriol being swapped on virtual platforms now, it seems likely that many of us will end up at the same parties at some point in the future.

It would be nice if we didn’t have to show up armed.

Fortunately, science shows us that there is a path to a middle ground. To get there, we need to acknowledge two important points.

First, COVID-19 is a problem. While risk among younger people is quite low, infectious diseases are, in fact, infectious, so spread among low-risk groups will eventually find its way to high-risk groups. Furthermore, calls to allow for unchecked spread to reach herd immunity ignore both the enormous number of additional COVID-19 related deaths we will suffer to get there as well as the vast racial disparities in mortality. We simply cannot throw people under the bus just because our lives are being inconvenienced.

Second, we must accept that people are going to do what they are going to do. We know from multiple studies that abstinence-only education doesn’t work to prevent HIV, and the data showing the negative impact of stigmatizing behavior on prevention efforts could fill this column.

So, how do we reconcile these two points? It isn’t hard. We already know that complete cessation of fun isn’t necessary: We didn’t stop having sex in the 1980s and were still able to manage a dramatic decrease in HIV incidence once we realized what the problem was.

Of course, HIV transmission requires (in essentially all cases) consent between everyone at risk of acquiring or transmitting the infection, whereas COVID-19 can be passed along to innocent bystanders, but there are still parallels in a harm reduction approach. Some suggestions:

• Take it outside. Harder to do in winter, but transmission is less likely outside.

• Make it smaller. The risk of transmission and the number of people potentially infected increases with the size of the party.

Acknowledge the risk. Accepting that everyone at a large gathering is at risk of carrying the disease into the community (yes, even if you have had it before) and taking extra precautions to limit contact with other people for the next 10–14 days could limit spread to those at high risk of serious disease.

And finally, we need to emphasize that the global spread of COVID-19 isn’t being driven by gay parties — plenty of other groups are doing exactly what we are doing. In truth, failure to develop a coherent national strategy in one of the richest countries on the planet is universally to blame for our current predicament. Still, given our history, I think we have an opportunity to use our experiences and show everyone else how we can have fun and keep other people safe. We can have our cake and eat it, too.