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.