The Viral Underclass: The Human Toll When Inequality and Disease Collide

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for

Syed Ali, Eli Pollard,

Tanya McKinnon,

Christopher Statton,

and

Matt Mager

The world is one big petri dish.

—ALICE WONG (王美華)

FOREWORD

The sirens with which Steven Thrasher opens this tragic, beautiful, erudite book announced what seemed at the time to be a common threat to shared humanity.

It was late March 2020. He was in Brooklyn, as was I. The world as we knew it was upside down. The novel coronavirus had sickened and killed people in places like China and Italy. Now it was here, among us, in our air.

Those early days of the COVID-19 pandemic saw a range of responses in New York and then elsewhere that in many ways presaged what was to come. Denial was chief among them. For many people, viral pandemics happened overseas or over there, places with mosquitoes or dirty water, or where people ate or did the wrong things. Surely America was protected by the nature of our capitalist spirit, our resolve, our scientific advances. People who felt this cast the response to the pandemic as overblown—this thing will be gone in two weeks, it’s no worse than the flu—and went on with their daily lives.

At the other end of the spectrum sat terrified doomsayers, people glued to their news feeds for developments or information who left their apartments only long enough to rush to bodegas or supermarkets to load up on ever more toilet paper, Clorox wipes, boxes of pasta, and other everyday items whose utility they had never fully appreciated until now.

In the middle were the confused, the I-don’t-care-ers, the what’s-going-on-ers, and those who felt that whatever was coming down the pike was inevitable.

This range surely represents the gamut of responses to many tragedies, from wars to 9/11, and the vastly different ways people process threats. But the sirens put an end to all that. The sirens, inescapable and penetrating in those early days, weeks, and months, piercingly announced that social psychology was irrelevant to the new apex predator in our city. It didn’t care how you felt, who you were, what sports team you liked, or what you ate for lunch that day. It just wanted to infect humans.

The sirens announced that the virus, and not human minds, would set the narrative. And for one brief moment COVID seemed an equalizer. No one was safe until everyone was safe. Infection anywhere was a threat to people everywhere.

But just as quickly, that moment was gone. More sirens, then even more. The crescendo of it all revealed that though we were all equally vulnerable to the novel pathogen by nature of our earthly humanity, some people were more vulnerable than others by nature of preexisting fault lines, not of biology but of society.

As the virus traveled down streets and into subways and then through towns and communities, its suffering tracked along layers of disparity. It quickly became clear that illness and death reflected existing, mutually reinforcing systems of discriminatory housing, education, employment, earnings, health care, and criminal justice. Paths of COVID suffering and loss illuminated centuries of support systems that America did not build, investments it did not make, opportunities it did not allow.

As but one example, it was soon evident that early rates of COVID death in cities like New York mapped onto socioeconomic neighborhoods, leaving white populations with higher income and wealth relatively unscathed while decimating neighborhoods with lower-income and lower-wealth Black and Latinx populations. And the sirens that blared through days and nights topped ambulances that disproportionately carried people who already suffered from housing insecurity, or lived in multifamily or multigenerational housing where social distancing was not an option, or worked essential jobs that exposed them to the virus without necessary protective equipment. Many of these people did not even make it into ambulances at all. Among the din, they died in silence.

The sirens, in other words, portended not just doom but decision for people in cities like New York and in countries like the United States. Did we, the safely distanced, hear the noise and think we were dying? We, humans. We, citizens. We, neighbors, workers, parents, friends of friends. Or did we breathe relief and autonomically think they are dying? They, the deserving. They, the disposable. They, the viral underclass.

The former response is what should have happened. If we were at risk, then we could have taken collective action to seriously address inequity, build vibrant common structures, and create ever more of the kinds of social capital or social cohesion through which healthy societies survive in pandemics. Building social capital based on common ground, in turn, would move us closer to what economist Amartya Sen calls better societies, which can emerge from moments of crisis—in which peril sparks appreciation of our shared humanity and a renewed drive toward building mutually beneficial infrastructures that persist well after the crisis has subsided. National health care systems, for instance. Or reformed police, more vibrant food distribution networks, protected climates, and closed wealth gaps. Or wider roads. As Sen explains it, societies that react to moments of crisis by democratizing access to resources, health, and decision-making power come out ahead in the long run.

Instead, despite profound individual moments of bravery and heroism, we as a nation responded to the sirens via the latter reflex, and in the ways that Steven Thrasher powerfully exposes in this remarkable book. As he rightly puts it, we responded, as so many others have responded in the global instances he also tracks, by magnifying

the divisions already present in our world. In 2020, it quickly became apparent in the United States that the novel coronavirus may not consciously discriminate, because viruses have no consciousness. Similarly, water and fire do not discriminate; they also have no sentience. Yet their effects do discriminate against the bodies of the underclass, because those bodies have been placed in proximity to danger by the structural design of powerful humans.

The cracks in our society widened, as Thrasher rightly describes it. We failed to expand Medicaid or access to quality masks or information, or to build better bridges and repair historic wounds. We failed to become structurally competent. Some people got filthy rich off of the instability of it all (a report by the Swiss bank UBS found the world’s billionaires’ wealth soared to upward of ten trillion dollars. This has given militaries and governments cover to enforce borders and police populations more harshly), while others were cast into ever more precariousness and instability. And thus the pandemic, like so many before it, highlighted the effects of what sociologist Whitney Pirtle, adopting a term from Cedric Robinson, calls racial capitalism, a system that constructs the harmful social conditions that fundamentally shape biologies, diseases, and pandemic patterns.

This searing book, this forever book, forces us to look and hear and feel the human costs of our decisions and indecisions and indifferences. With power, empathy, and deep insight, Thrasher tells the stories of people left to fend for themselves, people we made vulnerable long before the virus arrived. People who thought their country, their leaders, or their ideologies would save them. These are stories of people whose vulnerability is manufactured, and stories of how such exposure spreads through society more broadly—with the economy, media, and law acting as potent modes of transmission for the infection of inequality. And they are stories of resilience and compassion, of survival, of love in the time of cholera and the time of COVID-19.

Listen to these stories. Pay deep attention to the masterful way Steven Thrasher tells them. Then think, again, about your place in it all, about what you have done and what more you can do. About how, despite the veneer, risk at the end of the day is communal, and safety the same.

And, hopefully, you will never listen to a siren the same way again.

Jonathan M. Metzl

Nashville, Tennessee

I’m revising my position on viruses living in bodies;

they live briefly in spaces where bodies interface,

making the war against the virus also a

war against moments and spaces of connections.

—ADIA BENTON

AN INVITATION

Sirens, Silence, Standby

In the waning days of March 2020, it felt like the sirens in Brooklyn would never stop.

At first, the noticeable uptick in their frequency had felt worrisome. But perhaps, I tried to convince myself, I was hearing sirens so often only because there wasn’t much else to hear. After the mayor and the governor ordered everyone indoors, much of the foot and vehicular traffic of Bed-Stuy had disappeared. An eerie silence descended upon the neighborhood I’d long imagined to be bustling years before I ever lived there, from its depiction in Spike Lee films like Crooklyn and Do the Right Thing, which I’d watched repeatedly on VHS tapes as a teenager in Oxnard, California.

Absent from the Brooklyn soundscape were the sounds you’d normally hear during the spring thaw: of motorcycle mufflers and SUV horns, of music blasting from stoops and basketballs bouncing on pavement. Instead, in the middle of a sunny day, it was so uncharacteristically quiet on Malcolm X Boulevard that you could hear birds chirping—until, that is, the birdsong began to be drowned out by the screeches of the sirens piercing the unsettling urban quiet with their urgent cries.

Like the Greek mythical figures for whom they are named—who lured sailors away from safety so that their ships would crash on rocks as they approached the shore—the sirens began wailing hourly in Brooklyn and then many times each hour. Occasionally, they belonged to fire trucks, but usually they almost undeniably belonged to ambulances and (strangely, for such a policed neighborhood) almost never to cop cruisers.

Given the reduction in traffic and the subsequent drop in calls to 911 about automobile, bicycle, and pedestrian collisions, there should have been fewer sirens, not more. And yet the sound of sirens increased, as many people worried they would after hearing news reports from Wuhan, China, and the Lombardy region of Italy. Day by day, hour by hour, their wails increased until they formed one overlapping, screaming, inescapable dirge around the clock. It didn’t matter how much you might have wanted to escape thinking for just one moment about the horror unfolding nearby. The sirens would not let you avoid the crisis.

Though gentrifiers had been moving in for years, our corner of Bed-Stuy was still largely composed of working-class Black people. As during three-day holiday weekends of years past in the neighborhoods of brownstone Brooklyn, Bed-Stuy had become almost entirely Black and brown again by late March 2020. The white gentrifiers had largely skipped town. But unlike during those idyllic summer weekends of yesteryear, the white people hadn’t left the city to summer as a verb. Rather, they’d fled to second homes that were not even meant to be inhabited in the winter. Or to their suburban families of origin. Or to suddenly very expensive country rentals—all to try to avoid a pandemic that was rapidly taking on and taking over the bodies of the New Yorkers who weren’t allowed or able to work from home.

While many white Brooklynites fled the city in this moment—perhaps afraid of the rationing of medical care, the possibility of social unrest, decreasing accessibility to certain foods, an inability to hoard toilet paper, or the epiphany that they’d have to start scrubbing their own toilets as they no longer felt safe with the help coming into their homes—I had just returned.

New York City had been my home for a quarter century since I moved to the Village when I was seventeen in 1995. But in 2019, I’d moved to Chicago to become a professor of journalism, public health, and queer studies. And yet, I had returned to New York City in early March 2020 because of another virus, one I had been studying for a long time: the human immunodeficiency virus (HIV). I was staying in Bed-Stuy, in the very brownstone that had been my last New York home, with dear friends.

Over the course of a single week, I was supposed to present field research I had recently completed in Greece to a philanthropic foundation in New York. Then I was supposed to travel to Boston by train to attend the annual Conference on Retroviral and Opportunistic Infections (CROI) to learn about the newest research on HIV. Finally, I was supposed to travel back to New York by train to present my research to another philanthropic foundation, before flying back to Chicago.

But I made only the first of these three dates. The organizers of CROI retrofitted the event to primarily become an emergency conference about the one and only virus that was suddenly on everyone’s mind: severe acute respiratory virus (SARS-CoV-2), or the dreaded novel coronavirus. Then CROI moved online entirely. I never made it to Boston, and my second foundation presentation in New York City was canceled—along with all the basketball games at Madison Square Garden, performances at the Metropolitan Opera, and shows on Broadway. As the world began to shut down, stalked by a virus moving rapidly and microscopically through societies around the globe, I had to decide whether I would stay in New York with my friends or return to Chicago, where I’d be isolated and alone in a new apartment, in a city I didn’t yet know well.

If I remained in New York, I could help create and receive care within my well-established mutual aid network. But I didn’t know when, or even if, I would be allowed to leave again.

I decided to stay. Somewhat by accident, I had become obsessed with viruses years before. As the writer Sarah Schulman first taught me, you can’t understand the history of the United States without understanding how viruses shaped the development of this country in general or how HIV shaped the last forty years of American politics specifically. By the time coronavirus disease 2019 (COVID-19) deaths began overwhelming New York City’s hospitals, I’d been studying HIV and the acquired immunodeficiency disease syndrome (AIDS) in the city for a decade. I could sense that, in New York, there was going to be another big moment in American viral history that would be worth seeing up close. And as I had lost my father, birth mother, and stepmother in my twenties, before losing one of my sisters in my thirties, I had come to appreciate how, while painful, witnessing death can be a blessing. Even when there is nothing to be done to stop or postpone death, just being with someone in the last moments of their life can be very meaningful—for the person left behind holding the deceased’s hand and, I suspect, for the person leaving the land of the living.

Besides, New York City had been one of the truest loves of my life. I had breathed its deadly smoke on September 11, 2001; ridden its financial crash in 2008; and weathered Hurricane Sandy in 2012. Many of the people I loved most lived in the Big Apple’s five boroughs. And even though the sights of a U.S. Navy hospital ship pulling into New York Harbor and a field hospital going up in Central Park were alarming, the resources were flowing toward New York, not from it. If I was going to get sick, I had as good a shot in that city as in any.

I didn’t yet know that by the end of the summer, more than 33,000 New Yorkers would be dead, including people I loved—a similar loss to the city as the one wrought by the influenza pandemic of 1918 and the equivalent of eleven 9/11s. I didn’t know if I would be among them.

If I am going to die, I thought, I’d rather die in New York.

I think it was my friend Stephen Molldrem, a scholar of critical HIV data, who pointed out to me that we were experiencing the first viral pandemic also to be experienced via viral stories on social media. These viral stories about viruses created a kind of squared virality.

I learned of the first COVID-19 death in my extended social circle on Twitter on March 30, 2020. It would be the first of many instances in which I learned via social media about the death of people who were loved by someone I loved. The friend of a friend who died had lived near a jail and a hospital in New York that were both epicenters of this new epidemic. Look at the map of COVID-19 rates, our mutual friend had tweeted. It is a map of poverty, racism and overpolicing. People are dying in jail and because they have been to jail.

They were articulating something I had been working through for a few days: people were getting sick from this new virus because of where they lived, and they were dying disproportionately from it because of the bodies they had been living in their whole lives. Their bodies had repeatedly been pushed into contact with danger.

I’d done much of my reporting and research over the years in St. Louis. And so, when I read that of the first dozen confirmed coronavirus deaths in St. Louis, all twelve of them were of Black people, I was sad but not at all surprised. All over the United States, early data showed that Black people were dying of COVID-19 at alarmingly high rates. Research was also showing that Latinx people and Native Americans were dying disproportionately from the disease, as well.

And as the maps began to emerge showing where in New York the people being infected by and dying from the novel coronavirus lived, I realized that they were very familiar maps to me. The maps showing where people were most likely to become HIV positive (and to be harassed by police, or be killed by police, or be incarcerated, or have their HIV progress to an AIDS diagnosis, or have their AIDS diagnosis proceed to death) were maps of the same spaces where people were most likely to get the coronavirus and die of COVID-19.

When we follow the virus—any virus, really—we follow the fault lines of our culture. Like all pathogens, the novel coronavirus was not a great equalizer, as some initially called it, but a magnifier of the divisions already present in our world. In 2020, it quickly became apparent in the United States that the novel coronavirus may not consciously discriminate, because viruses have no consciousness. Similarly, water and fire do not discriminate; they also have no sentience. Yet their effects do discriminate against the bodies of the underclass, because those bodies have been placed in proximity to danger by the structural design of powerful humans. In a hurricane, water drowns the underclass not because two molecules of hydrogen and one of oxygen discriminate by income or race. Rather, the inequitable drownings happen because the built environment of society makes it so water will physically be kept away from the rich, while stormwaters will flow through the cracks in flimsy barriers to flood the poor.

Similarly, viruses show us where the cracks in our society are; they offer a stark revelation of inequality. In times of mass crisis, those cracks get wider and more people fall into them. For instance, within months of the first coronavirus case in the United States being confirmed, more than 40 million people had lost their jobs (ironically, including nearly a million and a half health care workers). Meanwhile, approximately 27 million people lost their health insurance. All these people were then at higher risk for a host of disasters, including eviction, which, researchers soon discovered, alarmingly increased the likelihood of novel coronavirus infection and COVID-19 death.

For the poor, this precariousness and instability affect people’s financial, spiritual, mental, and biological health. The people living in these valleys are dwelling in the kinds of metaphysical spaces the ancient Greeks might have referred to as Hades or the underworld. Get Out filmmaker Jordan Peele might describe the psychological and physiological dimensions of this domain as the sunken place.

I call it the viral underclass.

I did not come up with this phrase, but first heard it in the summer of 2018. I was at a conference called the HIV Is Not a Crime National Training Academy, in Indianapolis, Indiana, where activists from around the United States and other countries had gathered to strategize about repealing laws that criminalize HIV transmission. Some activists did not like that efforts were underway to reform but not abolish HIV laws. They argued that people who had access to HIV medication that made their viral loads undetectable, and thus unable to be transmitted to others, should not be liable under HIV laws, while people who had detectable viral loads should still be vulnerable to prosecution.

What the activists recognized was that people living with HIV who have detectable viral loads are disproportionately Black and unhoused and often can’t get access to the medication needed for viral suppression. Leaving these people behind, the activists argued, created a viral divide, with a privileged white set above it and a Black underclass below—a viral underclass.

Sean Strub, a white man and one of the main organizers behind the training conference, had coined the term viral underclass with a slightly different emphasis in 2011, writing, Nothing drives stigma more powerfully than when government sanctions it through the enshrinement of discriminatory practices in the law or its application. That is what has happened with HIV, resulting in the creation of a viral underclass of persons with rights inferior to others, especially in regard to their sexual expression. After nearly 30 years of the AIDS epidemic, people who have tested positive for HIV continue to experience punishment, exclusion from services, and a presumption of guilt or wrongdoing in a host of settings and for a host of practices that are, for those who have not tested positive for HIV, unremarkable.

I have built on Sean’s phrase to develop a theory of the viral underclass. Like all theories, this one doesn’t definitively prove only one outcome, nor is it meant to shut down conversation or prevent further inquiry. Rather, theories are helpful for thinking about our world. They are helpful for finding better ways to understand the social, physical, biological, and cultural forces around us. They can help us identify and interrogate a dynamic.

If we were to look through a powerful microscope, physics and biology might help us to see subcutaneous viruses inside a group of disadvantaged people. But a theory of the viral underclass can help us think about how and why marginalized populations are subjected to increased harms of viral transmission, exposure, replication, and death. And it can help us to understand not only why viruses reside where they do, and in whom they do, but also why the underclass has formed in the first place. It can help us to understand that the dynamic works in both directions: that just as marginalized people are made vulnerable to viruses, viruses are also used as justification for the policies and systems that marginalize people in the first place.

Just as Naomi Klein’s shock doctrine and Michelle Alexander’s use of the concept of a new Jim Crow have done, a theory of the viral underclass can serve as a framework for understanding how vulnerability is manufactured for certain kinds of people and how it spreads through society more broadly—with the economy, media, and law acting as potent modes of transmission for the infection of inequality.

The COVID-19 pandemic has made both the capital held by the world’s wealthiest and the number of people in the viral underclass expand dramatically. Globally, the World Bank has estimated that as many as one hundred and fifty million people were pushed into extreme poverty by the COVID-19 pandemic by 2021. At the same time, a report by the Swiss bank UBS found, the world’s billionaires’ wealth soared to upward of ten trillion dollars. This has given militaries and governments cover to enforce borders and police populations more harshly. As climate change compels more interactions between humans and microscopic pathogens, these dynamics will likely grow more severe in the coming decades.

How can we survive in such an underclass, or maybe even shrink its scope, if we don’t learn to recognize it and think about it communally? Viruses are all around us. Biologists estimate that 380 trillion viruses are living on and inside your body right now—10 times the number of bacteria, infectious disease pathologist David Pride wrote in Scientific American. We humans are vastly outnumbered by them (though we are going to consider what it means to think about us and them on our journey in this book). This creates thorny difficulties when it comes to fighting viruses—which brings me to an additional dynamic we’ll explore. As my colleague, anthropologist Adia Benton, has written, viruses live briefly in spaces where bodies interface, making the war against the virus also a war against moments and spaces of connections. The fear of such connections is that viruses expose how the social divisions imposed upon humanity (nationalism, race making, capitalism) by hard wars or softer ones (like policing) are fictions. The truths that viruses reveal could topple the systems meant to divide us. We, the people, are connected to one another—and so, war metaphors are not helpful ways to think about public health.

Like airplanes dropping bombs on residents too poor to flee the city that the pilots are ostensibly liberating, waging war on viruses will often kill humans in the viral underclass, but not only them. For viruses are wherever any of us meet—and how can we declare war on where we meet? Hug? Make love? Where our lips touch and our hearts beat? Where we sing, dance, laugh, and pray together?

Without romanticizing them too much, viruses have been some of my greatest teachers. Even in avoiding them, we find them pulling our consciousnesses down out of our minds, don’t we? (There’s cloth over my mouth! Ow—a needle in my arm! Rubber on my genitals?!) They’ve forced me to learn and unlearn not just with my brain, but with my heart, my lungs, my skin, and with my embodied relationship with others. They have led me to seek out and better know some of the people I most dearly love on this planet and some I never would have known otherwise. They have continuously shown me how dangerous vulnerability is and how necessary it is to the very meaning of our lives as social animals. And in the ways they’ve drawn me around the world and even taken human lives, they’ve taught me that I could love (and mourn) more deeply than I ever knew was possible.

Around a half million people died of COVID-19 in the United States alone over the first year of this pandemic, ten times the number who ever died of AIDS in a single year (about fifty thousand in 1995, some fifteen years into that pandemic). Before the second year of American life under COVID was over, the death toll reached seven hundred thousand—surpassing more than forty years of AIDS deaths in the United States of America.

But this book is not a story of numbers, at least not primarily. It is mostly a story about just a few of the people in the viral underclass I’ve gotten to know over a decade of reporting on viral epidemics—in person or as ghosts, sometimes up close, sometimes from afar—and of the people who loved them in various ways.

This book is also a story of the guides I’ve learned from as I’ve traveled through the viral underclass on five continents: of the doctors, condom-mongers, syringe-exchange volunteers, lovers, librarians, colleagues, boyfriends, sex workers, journalists, bathhouse attendants, friends, activists, bartenders, maps, movies, dogs, doulas, and drag queens who have pointed me in the right direction. By hearing a few of their stories, we will learn together about the structures that ensnare most of us who live in what the late anthropologist David Graeber first called the ninety-nine percent.

And while these stories will be narrated by me, an American trying to make sense of the particular cruelties of the American empire, the viral underclass is a global phenomenon. This is not a book about or for only the United States of America.

While we will follow, on our journey, people in the viral underclass encountering or negotiating life around a number of pathogens, such as hepatitis B (HBV), hepatitis C (HCV), West Nile virus (WNV), influenza, and smallpox, we will see them dealing mostly with two viruses: HIV and SARS-CoV-2, the novel coronavirus.

We will follow these two viruses for several reasons. First, even though there are effective medications for HIV and good vaccines for SARS-CoV-2, both these viruses still power two of the world’s most dangerous ongoing pandemics. They are both also likely viruses that humans will not be eradicating anytime soon and will probably be living with for a good long while. The risks of both of these viruses can be mitigated with simple prophylactic barriers (masks for the novel coronavirus, condoms for HIV)—both of which have spawned intense international culture wars—but also, more conceptual forms of prophylaxis (like access to safe housing, stable employment, and the collective medication of populations) can protect against both. This broader idea of prophylaxis, and the elusiveness of these measures for many, reflects a commitment to care that many societies persistently resist; adopting them would mean changing the notions of inequality, manufactured scarcity, and hoarded abundance that currently organize our world.

This brings us to the main reason we will mostly be following these particular pathogens’ dance with humanity. Despite the fact that these are very different viruses, with very different properties, lifespans, and modes of transmission, they afflict alarmingly alike populations, especially in the United States: Black people, Native Americans, Latinx people, queer and trans people, migrants, poor people, and people who are unhoused or incarcerated. Viruses impact a disturbingly similar group regardless of the properties of any particular pathogen.

And while virology plays a role in all human interactions with viruses, a viral underclass is produced by all the isms: racism, ableism, sexism, heterosexism, cisheterosexism, nativism, anti-Semitism, and the biggest social vector of them all, capitalism.

In his 1943 book, Being and Nothingness, existentialist philosopher Jean-Paul Sartre wrote about mauvaise foi, or bad faith. This occurs, as a viral YouTube video explains it, when we lie to ourselves, in order to spare ourselves short-term pain, but thereby suffer from long-term psychological impoverishment. Viruses offer us the opportunity not to engage in this collective delusion of bad faith. Because they are not merely cerebral ideas but, rather, inseparable components of our anatomy, viruses can push us toward reckoning with an embodied honesty that can’t be ignored. They are so intimately a part of us—altering our DNA, even—that they can force us to deal, in some way, with short-term pain we might want to avoid in order to create long-term societal health and well-being.

Viruses demand something more of us than the bad-faith argument of going back to normal—as if normal were not itself plagued by social ills. They invite—no, command, really—that when we interrogate our relationship with them honestly, we can clearly see an equation:

(HIV) [or (SARS-CoV-2) or (HBV) or (HCV) or (H1N1)]

+ racism [or ableism, or sexism, or heterosexism, or capitalism]

= a viral underclass

In other words, viruses interact with the power structures already at play in our society so that those who are already marginalized are left even more susceptible to danger, exacerbating existing social divides. But more important, of the variables in this equation, it is social structures that are the drivers, while viruses merely amplify. If we remove the viruses without dealing with the isms in a population, the underclass will remain, plaguing the people whom public health campaigns purportedly want to help and leaving conditions intact for future viral outbreaks.

Some reductive public health and economic approaches to epidemics see humans only as hosts of viruses. But it is whole human beings, in all our wonderful complexity, whom we want to keep in mind. If a society tells someone with cancer, You’re on your own to deal with it, and tells the same person, You’re on your own if you get evicted, that person might not respond well if they’re also told, You must get vaccinated to protect others in society.

A theory of the viral underclass acknowledges the people most susceptible to viruses not as hosts, but as whole people. It can help us understand that if we care about people, we need to care about them as much when they face cancer or eviction as we do when they pose a viral risk to more privileged members of society. And it can help us to understand that if we eliminated the conditions of the underclass as a whole (viral or otherwise), the health of the society overall would be so much better. Vectors of transmission for viruses could be mitigated before those viruses even had the chance to reproduce and cause harm.

A viral underclass is produced through twelve major related social vectors that enable the relationship between viruses and marginalization. Sometimes, these vectors produce the material conditions for unequal viral transmission; sometimes, they turn the presence of viruses into discrimination or economic ruin, leading to compounding harms. These social vectors are:

Racism

Individualized shame

Capitalism

The law

Austerity

Borders

The liberal carceral state

Unequal prophylaxis

Ableism

Speciesism

The myth of white immunity

Collective punishment

The twelve chapters of this book will dramatize, mostly through the stories of people, how each of these dozen vectors operates. All the vectors are interconnected: racism is tied up with the courts and with access to prophylaxis; austerity is tied up with ableism and shame; policing bolsters many of them. And these vectors are intrinsically connected to other social ills, such as homophobia, sexism, and transphobia. So, in chapters foregrounding one of the vectors, we’ll see shades of others, for these conditions, like our identities, are always intertwined.

Viruses don’t move across time and space in neat, predictable lines. But they do move in patterns, and following their trajectories can often reveal fascinating (if depressing) echoes and rhymes. In this book, I have broken these beats into four waves of understanding.

The story of Michael Tiger Mandingo Johnson and his prosecution for transmitting HIV is the main story we will keep returning to, as it was through reporting it that I came to understand the tenets of