In His Second Epidemic, a Doctor Recalls His First
Gay leader of New York City Health and Hospitals treated patients during AIDS crisis
BY DUNCAN OSBORNE
As COVID-19 loomed just over a year
ago, Mayor Bill de Blasio told Dr.
Mitchell Katz, the out gay head of
New York City Health and Hospitals
Corporation, that he was about to do “the hardest
thing you have ever done.”
The pandemic quickly overwhelmed the
city’s public and private hospitals. Supplies of
protective equipment that would keep doctors,
nurses, and other medical staff safe from the
virus dwindled. As the city shut down, homes
became workplaces for many New Yorkers. The
noise of traffi c, planes overhead, and all of the
sounds that are usually part of daily life in the
city went silent, only to be replaced by ambulance
sirens that were carrying sick people to
hospitals that had no room for them.
“I thought, ‘I’m sure I’ve done something harder,’”
said Katz who completed his medical training
in San Francisco in 1989 during the worst years
of the AIDS epidemic and joined the city health
department there in 1991. “My fi rst thought was
nothing could be harder than that.”
It took COVID-19 about a year to kill more
than 500,000 people in the US. That death toll
was aided by a Trump administration that refused
to support, and even opposed in some
cases, common sense measures to slow the
spread of the virus, such as masks, social distancing,
and closing public venues where the
virus spreads easily. Trump also promoted bogus
cures and treatments.
HIV was fi rst noted in 1981 and deaths attributable
to that virus began to approach a half
million by 2000, but anti-HIV drugs had already
begun to keep people with HIV healthy and living
longer and longer. Before those drugs appeared,
HIV killed far more of those it infected compared
to COVID-19, though a COVID-19 infection can
be serious with effects that are long lasting.
“The biggest difference is…all of my patients
died usually within nine months,” Katz said of
his time in San Francisco treating people with
AIDS. “With AIDS, I never felt like my system
Katz, who was raised in Brooklyn, would go
on to run San Francisco’s health department
from 1997 to 2010. He headed the Los Angeles
County health department beginning in 2010.
In 2018, he was recruited to lead Health and
Hospitals, which employs 45,000 people and
operates the city’s 11 public hospitals, skilled
nursing facilities, and dozens of community
health centers across the city. It also runs
MetroPlus, a health insurance plan.
Katz was an early proponent of herd immunity,
the notion that with enough people infected
Mitchell Katz, who leads the New York City Health and Hospitals Corporation, worked in the San Francisco health department during the
height of the AIDS crisis.
who have recovered, the virus will have nowhere
to spread. He also opposed widespread closures
of businesses, public venues, and schools. The
city quickly abandoned that position as it became
apparent that if COVID-19 was left unchecked,
it would be a disaster.
In contrast to Trump, in the early years of the
AIDS epidemic, Ronald Reagan, the president
at the time, was not openly obstructing efforts
to curtail the spread of HIV, though Reagan’s
disinterest in aiding the populations affected by
HIV — especially gay man and injecting drug
users — was palpable.
“We didn’t actually have him telling people not
to wear condoms, not to protect themselves,” Katz
Still, instead of promoting the use of condoms
for safe sex, Reagan urged individuals to
take the unrealistic approach of practicing abstinence
to avoid contracting HIV.
What is true of both outbreaks is that bias
was a central feature. Trump and his allies took
to calling COVID-19 the “China virus,” which
was an effort to shift blame from Trump’s failed
response to China and to infl ame his base
against an enemy. The COVID-19 outbreak in
the US has been accompanied by a signifi cant
increase in anti-Asian violence.
With AIDS, gay men and injecting drug users
were the early targets. They were vilifi ed in the
conservative press and refused service in hospitals
and other public accommodations. After their
deaths, families and friends found that many funeral
homes would refuse to bury them.
“My last general comment is in both cases was
how prejudice came out,” said Katz who noted
the rise in anti-Asian bias. “It reminded me of all
ED REED/OFFICE OF MAYOR BILL DE BLASIO
the prejudice in the early part of the AIDS epidemic
about gay men, about drug users.”
What the COVID-19 outbreak has in abundance
and the AIDS epidemic largely did not
have is many Americans following Trump’s
lead and denying that COVID-19 is a dangerous
pathogen, refusing to wear masks and engage
in social distancing, and espousing a general
view that COVID-19 is not a serious threat.
In San Francisco, Katz and other health department
staffers were subject to protests by a
small group of activists who charged that HIV
was not the cause of AIDS and that it was the anti
HIV drugs that were killing people. While those
protests eventually became suffi ciently threatening
that Katz and other health department staff
brought criminal charges, the protests were never
widespread. He also battled with activists over
keeping sex clubs open in San Francisco.
And deaths were common to both outbreaks.
At a January press conference with de Blasio,
Katz recalled that “most of my friends and colleagues
were infected and…funerals were a
The high number of COVID-19 deaths hides the
reality that doctors have been successful in saving
many people who were infected with that virus.
“It brings tears to my eyes to think of the
people who don’t have to go through the horrible
pain that I saw among my friends and patients
in the 1980s,” Katz said during the press
conference. “It’s amazing work and New York
City should be so proud.”
But the deaths still take their toll.
“Losses are cumulative,” he said. “I lost a lot
of people I loved during the AIDS years. It does
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