Politics, People, and COVID-19: The Band Plays On – Again

As COVID-19 has continued its unchecked spread across the United States, journalists and scholars have drawn many apt comparisons with pandemics of the past century. The 1918 influenza outbreak has certainly made for a useful example, but it comes from a period when the United States’ public health infrastructure was only in its infancy. Conversely, the more recent H1N1 and Ebola scares illustrate how a science-driven, collaborative approach can effectively contain a deadly contagion while reducing its threat to the general population. In a number of ways, the technologies available to public health today far outpace what was possible in the 1980s, when HIV/AIDS was discovered. But to understand how COVID-19 has managed to penetrate the general population with such ruthless efficiency and thoroughness, I believe the political handling of the early HIV pandemic merits strong reconsideration. 

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In 1987, Randy Shilts, a trailblazing gay journalist who covered AIDS extensively for the San Francisco Chronicle, exposed the weaknesses of that political system in his bestseller, And the Band Played On: Politics, People and the AIDS Epidemic. While researching Shilts’s life, I’ve mostly regarded Band as cautionary, but reflective of when he wrote it, with a legacy that’s complicated and admittedly less than perfect. However, I’m eerily reminded today of how some of its broader themes have managed to endure. 

First, scientific evidence shows us what to do, but personal stories show us why we should care. While the mainstream press covered AIDS mainly as a medical issue, Band made the pandemic intimate and relatable by depicting how political gamesmanship could impact the lives of ordinary Americans. Shilts documented how AIDS was initially treated as a political inconvenience by the Reagan Administration’s budget officials, who stymied efforts within the Centers for Disease Control and Prevention to mount a full-fledged effort even as doctors, epidemiologists, members of Congress, and activists were clamoring for resources to battle this deadly new disease. Within his narrative, Shilts helped familiarize the general public with figures like Larry Kramer, the tenacious and sometimes inflammatory author and activist, whose fury targeted not only gay men who still downplayed the existential threat they were facing, but also leading officials like Ed Koch, Mario Cuomo, and Ronald Reagan, who initially failed to reckon with the disease as a serious public concern. 

Of course, the story that still haunts Shilts’s career is that of Gaetan Dugas, a French-Canadian flight attendant who turned up in numerous early contact traces and reportedly refused to change behaviors that put his sexual partners at risk. While Shilts stopped short of calling Dugas “the man who brought AIDS to North America,” a headline in the New York Post did just that, catapulting the book to bestselling status. Among Shilts’s backers, Dugas (who died in 1984) remains an example of how one person’s disregard for preventive measures can expose a wider population to heightened risk for infection. To critics, the story reeked of tabloid journalism, which stigmatized people with HIV and legitimized efforts to isolate and blame a solitary source for every new disease outbreak.

Despite its limitations, the case of Gaetan Dugas illustrates how difficult it can be to change our behaviors, especially those we associate with longstanding patterns and customs. The alternative, however, is still deadly. Faced with evidence that our everyday habits may endanger ourselves and others, many people respond by taking the necessary precautions. Others will try to mitigate, but not completely eliminate their risk. Some, however, react by doubling down on the harmful behaviors, essentially saying, “You can’t make me.” As in the early AIDS crisis, those in this last category today are a small minority whose lived experiences defy simple explanation, who nonetheless represent a magnified potential for contamination. That risk potential is amplified by the fact that COVID-19 spreads freely and indiscriminately, while HIV is primarily spread through unprotected sex and sharing syringes.

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Finally, Shilts knew that all leaders, political or otherwise, come with their flaws and limitations. Whenever possible, however, he tried to balance his criticism by examining their intentions. For example, while Dianne Feinstein, who at the time served as San Francisco’s Mayor, had generally been considered prudish and hostile to the more public aspects of a liberated gay sexuality, Randy noted how she dedicated substantial city funding to AIDS research and care efforts at a time when the Reagan Administration was failing to commit the necessary resources. 

In Band, Shilts also drew attention to how Dr. Anthony Fauci, who is rightfully lauded for his leading work on infectious diseases, once made a cringeworthy mistake by publicly speculating that AIDS might be spread through close household contact, due to the discovery of cases among patients’ children. Scientists quickly refuted this, but the misstep sparked some unfortunate overreactions toward AIDS patients by anti-gay conservatives, the mainstream news media, and members of the general public. Over time, however, Fauci, who eventually became lifelong friends with Kramer, has demonstrated his ability to receive new information, correct his mistakes, and speak truth to power when called upon.

Over fifteen long years, those who were affected by the early AIDS crisis had to adjust to the dispiriting interruption of life as they had known it. The pandemic claimed nearly half a million Americans by the year 2000 (including Shilts himself), and instead of life returning to normal, that disruption became the new normal. In the present day, And the Band Played On remains an imperfect yet compelling story that’s still in need of a definitive ending. Good science and the dogged activism of ordinary citizens have substantially improved the outlook, but HIV still affects far too many people both domestically and abroad. If scientists’ predictions hold true, it appears that in the years ahead, so will COVID-19. 

Each successive day of the COVID-19 pandemic has forced us to reckon with the reality of overlapping crises, each with its own far-reaching and long-lasting consequences. At the very minimum, the push to forego containment and prematurely reopen the economy has resulted in a stomach-churning rate of new infections, an overwhelmed and resource-starved healthcare system, and an ever-climbing death toll, to say nothing of the potential long-term consequences for those who survive their infection. As many of us sit waiting for life to return to normal, we’re faced with an uncomfortable reflection on how the society we’ve imagined – the return to normal for which we yearn – still exposes its most disadvantaged members to the cruelest possible outcomes. Were Randy Shilts alive today, I think he’d point out how scientific leaders seem to be using the lessons of HIV to fight COVID-19. Scientists, however, aren’t the ones responsible for setting our government’s COVID-19 policy. Americans may be alarmed by the tune that’s being played, but it will only change when the leaders of the band are held accountable for their actions.