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The virus persists in the bloodstream for years, often spanning generations. The warning signs aren’t always obvious and don’t follow the traditional path for how an infection progresses in humans. Even so, it exerts its sinister effects on the individuals infected and everyone around them.

Some with the community-acquired form of this illness demonstrate moderate to severe symptoms: A profound sense of entitlement. Panicked calls to 911 using histrionic language. Irrational acting out and murderous rage. Hunting down and executing joggers. Breaking, entering, and murdering without identifying yourself. Applying pressure with a knee on the neck to the point of asphyxiation, disguised as “protect and serve.”


The justified outrage among medical communities in reaction to this acute outbreak has been swift. Health care workers joining communities in unity and protest. Calls for social justice from medical and public health officials on social media. Official statements denouncing the structural nature of this pandemic from national and international medical organizations.

But if you look closely, medical systems and personnel have been struggling with the same disease for decades, albeit with different clinical manifestations: Withholding appropriate pain medication from patients who needed it. Avoiding medically necessary curative interventions. Discharging patients to their homes instead of testing and admitting them to the hospital. Bias when prescribing biomedical HIV prevention options. Selectively choosing social apathy over established clinical guidelines.

Some health care workers who demonstrate milder subclinical findings are often mistaken as asymptomatic — these comprise the majority of cases. Symptoms may include: Lecturing patients about not doing the very same things they do in their personal lives. Perpetuating inequities in academic promotional advancement. Diagnosing subjects with anxiety or depression before initiating a proper medical work up. Vocal disregard for human life. Choosing silence when a colleague exhibits severe manifestations of the affliction toward a co-worker or patient.


People of no color are disproportionately affected but suffer none of the resulting health inequities.

As a Black man in a white coat, I represent about 5% of currently active physicians. I have encountered enough people afflicted with this disorder that I deserve a special board certification in the field. They have mistaken me for a parking attendant or hotel van driver when I was wearing a suit for my medical residency interviews. They advised me not to apply to the top-rated residency programs and instead focus on local “community” programs. Some even questioned my training, experience, and expertise, suggesting I wasn’t really a doctor.

I have experienced this both as a member of the community and as a member of the medical establishment — and I am not an isolated case. The expression of this ailment varies but represents different points along the same clinical continuum.

Testing and contact tracing for this contagion are limited, as many don’t perceive themselves to be at risk. Exposure to and demonstration against the disease doesn’t guarantee immunity, and certainly doesn’t produce antibodies. Various treatments have been proposed, but none of them curative. And there is no vaccine. The only current accepted management involves rigorous self-reflection and introspection, but most are reluctant to adopt this inconvenient intervention.

Many health care workers suffering with this infection don’t think they have it because their symptoms don’t reflect the more severe cases highlighted in media reports. But they do, and they represent walking statistics in a centuries-old pandemic, transmitting the virus to susceptible colleagues, students, trainees, and vulnerable patients at every turn.

The only difference is that the deaths stemming from their version of the illness are enacted in a slower, quieter, and less public fashion than a knee to the airway. But they are no less deadly or devastating.

David Malebranche is an internal medicine physician specializing in sexual health and the prevention and treatment of HIV and other sexually transmitted infections, and is an associate professor of medicine at Morehouse School of Medicine in Atlanta. The opinions expressed here are his and do not necessarily reflect those of his employer.

  • Terrible, Horrific events do happen ( and should not) but when one looks objectively at the whole system, one finds that these are aberrations not evidence of a systemic problem. Heather MacDonald assesses and puts forth the studies and data transparently for all to see; you have to have an open mind( without an agenda)to see it. Don’t believe me, read it for yourself

    • My friend Steve, there is abundant evidence, overwhelming evidence, in the news, in scholarly research, in scientific data, in personal experience, and in virtually every instance when this issue comes up, that American society has systematically and violently violated the rights of African Americans, denied them opportunity, denied them justice, in every aspect of their lives and in every aspect of our society, and continues to do so every day. When one looks objectively at the whole system, the truth is unmistakable. I appreciate your respect for the importance of having an open mind, but we are far, far beyond any shadow of a doubt that insidious, violent racism is a fundamental, omnipresent, core constituent and product of our society and has been every day and in every age for the past 401 years. I have not read Heather MacDonald’s book, but there are mountains of books that document the truth about racism in the United States. I would invite you to broaden your reading a bit. I have an open mind about nearly everything. But if you told me that aliens from outer space had taken over the White House and the government of our country, and that no one knew about it but you, I would not have an open mind. If you told me that the sky is red every day and bright blue every night, I would not have an open mind. If you told me that Hitler never existed and the Holocaust was a fiction invented by liberals, or that President Kennedy’s assassination was staged and never happened, I would not be willing to read a book to evaluate the evidence. Nor do I not have an open mind about the truth that systematic racism, which is on display in plain view every day for anyone (with an open mind) willing to scratch the surface to see, is an inescapable reality in America and has been from the time the very first Africans were kidnapped, chained, brought to this country, and enslaved until this very day, when the President of the United States orders the national police of our country, and the military, our military, to take over the streets of our cities, fire tear gas, rubber bullets, and stun grenades at Americans peacefully exercising their Constitutional right to protest, in outrage over the daily, unwarranted, unjust, unprovoked, and illegal use of violence against innocent, peaceful, unarmed African American citizens of our country, killing them nearly every day.

  • Nicely articulated. But I disagree that there is no effective management. Leadership is critical. Surveillance of the disease and of its effects on the daily experience of people of color, research, extensive and probing, with reporting of the findings and appropriate attention (in schools, in the media, in public discourse, in the scientific literature) to the findings, to trends, to aggravating and ameliorating factors, to potential solutions. Words like “respect” and “dignity” need to become as commonplace as words like “fake news” (much more common, actually). Talking about race and racism needs to become so common that white people are no longer afraid of it. Talking, and listening. Respectful airing of grievances from every sector is needed to expect listening to be possible. Above all, the truth, about history and about the present, needs to be told. Ignorance about race and racism among people is rampant — shocking ignorance. The truth is simply never spoken of. The story is never told. People don’t know it happened, so they don’t believe it did. It needs to be told, by whites, to whites, so it will not be dismissed. There is much that can be done. It just has to be done.

  • It appears that David has been infected with another illness more severe than the make-believe one he discusses above. Its symptoms are feelings of grandiosity from a sham political movement that civil right leader Robert Woodson of the Woodson center refers to as” using race as a ruse”. The ruse in his opinion and many other astute observers is using one terrible event to create/promote a socialist/leftist agenda by creating the “fake systemic police racism” narrative to delegitimize the police and the country. this take the attention off the failure of the left over 5o years running these cities that have the same problems today! He ( and others) calls them’ race hustlers’ and agree ” poor people are being hustled”. Well your high and mighty article show it isn’t just the poor !(well unless.. the hustlers know what they are doing)

    • Please read Heather MacDonalds new book on “The war on cops” and her Wallstreet Journal Editorial just a day ago which show the statistics on why there is NO systemic problem; “A police officer is 18.5 times more likely to be killed by a black male than an unarmed black male is to be killed by a police officer.” “Police shootings are not the reason that blacks die of homicide at 8 times the rate of whites and Hispanics combined: criminal violence is.”

    • So, what are you saying? It’s ok for cops to rip a person peacefully sitting in their car out of their car, throw them to the ground, handcuff them, and then kneel on their neck until they die? Which part of that is a ruse? Does the number of police killed by black people mean it’s ok for police to pull unarmed, peaceful people who are driving while black over, unprovoked, and shoot them dead? Does criminal violence against black people mean it’s ok for police to shoot unarmed people with their hands in the air? To shoot unarmed, peaceful people in the back? What exactly are you thinking?

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