Dr. Jeffrey Klausner, a primary care physician in Los Angeles, has treated gay men for decades. Since the start of the coronavirus pandemic, he said, many patients have so dramatically changed their sexual behavior that they shrug off the need for routine screenings for sexually transmitted diseases.
“They say, ‘I haven’t had any contact since I saw you last, so there’s no need to do any STD tests,’” said Klausner, an adjunct professor of epidemiology and infectious diseases at UCLA.
But attitudes among these patients are shifting, Klausner has noticed, now that California and other states are loosening policies on social distancing. “People are starting to think about a return to engaging [in sex],” he said, “and are asking me, are there ways they can remain safe” from COVID-19?
Concerns about sexual intimacy during an epidemic are universal and not limited to gay men, of course. Public health experts, including those long involved in HIV prevention, recognize that a proportion of all people are likely to ignore or reject categorical mandates about sexual behavior — whether they involve using condoms or limiting contact because of social distancing norms.Don't Miss A Story
Subscribe to KHN’s free Weekly Edition newsletter, delivered every Friday.Sign Up Please confirm your email address below: Sign Up
“It didn’t work when we had to deal with HIV, and it won’t work in dealing with COVID,” said Pierre-Cédric Crouch, a clinical nurse researcher at the University of California-San Francisco, and an expert in HIV prevention.
The coronavirus is known to spread through oral and nasal secretions but not specifically through sexual intercourse. In New York City, the health department issued sex and coronavirus guidelines that counsel against sex with those outside your household but advise those who choose otherwise to “have as few partners as possible.”
The guidelines, which note that “kissing can easily pass the virus,” suggest that people “make it [sex] a little kinky” by being “creative with sexual positions and physical barriers, like walls, that allow sexual contact while preventing close face to face contact.” In the Netherlands, the government has advised single people considering sex to find a symptom-free sexual partner.
For many gay men, especially in urban areas, sexual exploration with multiple partners is a way of life, whether single or not. Many committed male couples maintain open relationships.
Research supports the notion that gay men tend to have more sexual partners than do heterosexuals. A 2012 review of surveys among adults ages 18 to 39 noted that men who have sex with men (a phrase often used in scientific studies that focus on sexual behavior rather than sexual identity) “reported significantly more lifetime partners than heterosexual men and women at all ages.” In the 35-39 age group, the median lifetime number of sexual partners reported by men who have sex with men was 67, compared with 10 for heterosexuals, according to the study.
Damon Jacobs, a therapist with many gay clients, lives alone in Brooklyn and remained celibate for the first month of the lockdown. At that point, he said, he reached out to a regular and trusted sexual partner.
“He’d also been alone for four weeks except for going outside for groceries, and he also had zero symptoms,” said Jacobs, 49.
“So we got together and started hanging out again,” Jacobs added. More recently, he has met up with several other partners after asking about their social distancing practices. He has also found many of his clients dealing with similar issues after months of being on their own.
“Human beings can cope with certain levels of pain and suffering for a specific amount of time if they perceive an ending,” said Jacobs. After more than two months, he added, people who have been physically isolated are “starved for touch.”
A mid-April survey of more than 1,000 men who have sex with men provided a snapshot of how the coronavirus had affected sexual behavior. While about half reported fewer sexual partners than before the pandemic, only 1% reported more, with 48% reporting no change. (The survey did not ask about the number of partners or whether sex was with a household member.)
Many gay men remain cautious. Lewis Nightingale, a retired graphic designer in San Francisco who lived in New York during the early years of the AIDS epidemic, said he had spent much more time using online apps such as Grindr and Scruff to flirt and sext with other men.
He has received, and turned down, occasional invitations to meet up in person, he said. As an older man, he knows he is in a higher risk group for coronavirus complications. But refraining has been challenging, he said, since expressing himself sexually has played such a big part in his life. “For a lot of gay men, sex is pretty essential for a feeling of connection, for excitement, for validation,” said Nightingale, who has been in a relationship for 16 years.
Last month, Eric, a 42-year-old male escort in Manhattan who asked that his last name not be used, began weighing when and how to return to work. A former occupational therapist whose husband is a physician, he shut down business in mid-March and finally started seeing clients again earlier this month.
For now, he plans to limit scheduled appointments. He intends to see only those he knows well enough to believe they are truthful about routinely wearing masks and being symptom-free. And he is meeting people at his home rather than in a hotel room or their place. “I figure if I have people coming here, I’m only exposed to that person’s germs,” he said.
Eric also plans for now to avoid clients who have attended recent protests against police brutality. “I support the protests 1,000%, but I think they are probably pretty good breeding ground for the virus,” he said. “I don’t want to take that risk.”
In advising his gay patients about sexual activity, Klausner, the Los Angeles physician, said he tries to put the risk in context. The majority of coronavirus cases, he noted, have emerged from workplace and residential settings, such as meatpacking plants and nursing homes, as well as big indoor gatherings, such as concerts and religious services. Although the virus can be transmitted one-to-one in more intimate contexts, he said, “individual risk is really driven by people’s potential exposure to these crowded settings.”
A common misperception — that actions can be clearly defined as risky or not risky — can hamper understanding of other people’s actions, said Julia Marcus, a Harvard epidemiologist and HIV prevention expert. As restrictions on social distancing relax, she said, almost everyone will be making choices and engaging in activities that involve some level of risk — yet will likely be judged by various standards.
“There are very few zero-risk situations,” she said. Unfortunately, she added, “the gay guys are going to be shamed for hooking up, while the straight people having dinner together are less likely to be shamed.”
The sample was collected on July 1 near the town of Orange in Franklin County, the Massachusetts Department of Public Health said in a statement released Friday.
While nursing homes have been in the spotlight during the pandemic, a "parallel crisis" has festered in assisted living residences.
A FEMA administration for the New England states talks about how the federal agency is supporting citizens throughout the pandemic and the challenges it is facing.
This week at CBPP, we focused on health, state budgets and taxes, federal taxes, the economy, and family income support.
El CTC estima que entre el 10% y el 15% de los casos solicitan asistencia
As federal policymakers consider another package to address the deep economic downturn, one of the most effective steps would be to provide substantial federal grants to help states address their huge revenue shortfalls, as the House-passed Heroes Act would do. That would help states and localities avoid cuts in services and investments that would worsen racial inequities — as my colleague Nick Johnson recently wrote.
The Fourth of July is a perfect time to read the Declaration of Independence that not only heralded the American Revolution, but also provided the most powerful and enduring formulation of the American aspirations for freedom and equality. Take a moment to visit the Library’s Declaration of Independence web guide, and explore Thomas Jefferson’s draft of the Declaration at the Library of Congress.
But, you might ask yourself, what did the British think of the Declaration at the time? Not a whole lot. In the British press, the publications that discussed the Declaration generally reacted with contempt toward the ideology expressed by its preamble, and anger at the ingratitude showed by the colonists toward their king. Some voices expressed sympathy. There are two responses in particular that are worth highlighting.
The first is King George III’s brief response written by Lord North. The reply scolds Americans for their Declaration of Independence, and is more or less a call for Americans to go to back to their rooms and think about what they’ve done, lest they suffer the consequences.
The most entertaining response comes from the famous Utilitarian philospher, Jeremy Bentham. Bentham ghostwrote a section by section rejoinder to the Declaration in John Lind’s Answer to the Declaration of the American Congress.
Even if you haven’t read the Declaration in a while, no doubt you’ll recall from memory the preamble where Jefferson writes that,
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
So what did Bentham think of these stirring words?
Of the preamble I have taken little or no notice. The truth is, little or none does it deserve. The opinions of the modern Americans on Government, like those of their good ancestors on witchcraft, would be too ridiculous to deserve any notice, if like them too, contemptible and extravagant as they be, they had not led to the most serious evils.
You can read the entirety of Bentham’s response here. It concludes,
How this Declaration may strike others, I know not. To me, I own, it appears that it cannot fail — to use the words of a great Orator— “of doing us Knight’s service.” The mouth of faction, we may reasonably presume, will be closed; the eyes of those who saw not, or would not see, that the Americans were long since aspiring at independence, will be opened; the nation will unite as one man, and teach this rebellious people, that it is one thing for them to say, the connection, which bound them to us, is dissolved, another to dissolve it; that to accomplish their independence is not quite so easy as to declare it: that there is no peace with them, but the peace of the King: no war with them, but that war, which offended justice wages against criminals. — We too, I hope, shall acquiesce in the necessity of submitting to whatever burdens, of making whatever efforts may be necessary, to bring this ungrateful and rebellious people back to that allegiance they have long had it in contemplation to renounce, and have now at last so daringly renounced.
Bentham’s views on the United States independence later softened, though he continued to reject the claim of natural rights that underpin the Declaration. Oddly enough, you can visit Jeremy Bentham. After Bentham died, he requested that his body be turned into an auto-icon: his skeleton was dressed in his clothes, a wax head was added, and then this figure was put on display at the University College London. This has led to a myth that he is wheeled out Weekend at Bernie’s style to attend meetings of College Council. While Bentham’s auto-icon is permanently on display in London, he actually went on tour in 2018, visiting the rebellious colonies he once chastised, when Bentham was placed on display at the Met Breuer museum in New York City.
I hope that you are doing well. As we enter into July, it is hard to believe the many changes and challenges we’ve had to face in our world in just the past few months. The upcoming July 4th holiday is another reminder of the ways we’ve all had to adjust and rework communal celebrations and gatherings in the age of COVID-19.
Many of you have celebrated birthdays and graduations virtually, and have come up with creative ways to stay in touch with family and friends from a distance. The Library of Congress is no different, and we continue to adapt to stay connected with you even as our doors remain closed. This is especially important as we strive to offer a safe place to have difficult conversations about the challenges facing our nation today with regard to race, inequality and social justice.
To that end, below you will find information on some of our upcoming virtual events including today’s conversation with new Kluge Prize winner, Danielle Allen, who will take on the hard questions about democracy and public life. Our online series, “Hear You, Hear Me”: Conversations on Race in America, also continues this month.
You can also learn more about the major collections work we are undertaking to document the pandemic in an informative new blog post, “How Will We Remember COVID-19?”
And, as we prepare to celebrate Independence Day, it must be noted that the Library of Congress is home to the original rough draft of the Declaration of Independence. It is one of the institution’s top treasures. View it online here, https://www.loc.gov/exhibits/treasures/tr00.html, and discover other resources related to our nation’s independence below.
Have a safe holiday weekend.
Carla Hayden, Librarian of Congress
[Detail] Currier & Ives print showing the signing of the Declaration of Independence.
American Treasures of the Library of Congress: Declaration of Independence
Thomas Jefferson Papers Collection
TODAY: Kluge Prize Winner Danielle Allen
Librarian of Congress Carla Hayden announced last week that Danielle Allen, director of the Edmond J. Safra Center for Ethics and the James Bryant Conant University Professor at Harvard University, will receive the 2020 John W. Kluge Prize for Achievement in the Study of Humanity. Allen will work with the Library to share her expertise on justice, citizenship and democracy with a wide audience.
Today at 7 p.m. ET join Allen and Kluge Center Director John Haskell for a virtual event: “Danielle Allen Takes on the Hard Questions about Democracy and Public Life.” This presentation will premiere with closed captions on both the Library's Facebook page and the Library's YouTube site and be available afterwards on the Library's video page.
Kluge Prize Announcement: loc.gov/item/prn-20-043/
Homegrown at Home Concert Series
The American Folklife Center at the Library of Congress is presenting traditional music and dance from a variety of folk cultures thriving in the United States and around the world in a new online concert series each Wednesday through September. Tune in to “Homegrown at Home” Wednesdays at noon ET on the American Folklife Center Facebook page, and replay performances anytime on the Library of Congress YouTube channel and on the Library's video page.
Series info & schedule: loc.gov/item/prn-20-045/
"Hear You, Hear Me": Conversations on Race in America
This online series continues featuring Librarian of Congress Carla Hayden in conversation with some of the nation’s great literary figures, and will highlight what poetry and literature can offer the nation as it contends with foundational issues of social justice.
- Joy Harjo and Tracy K. Smith - Thursday, July 9, 2020, 7-8 p.m. ET
- Colson Whitehead - Thursday, July 16, 2020, 7-8 p.m. ET
Event details & videos: loc.gov/programs/national-book-festival/national-book-festival-presents/
[Detail] Life during the pandemic. Photo: Camilo Vergara. Prints and Photographs Division.
How Will We Remember COVID-19?
The Library is amassing a vast collection of materials that document the COVID-19 pandemic, including the award-winning photography of Camilo Vergara. These photographs are among the very first items the Library acquired documenting the COVID-19 coronavirus pandemic. And they will be far from the last: The Library anticipates a collecting effort that exceeds its coverage of the Sept. 11, 2001, terrorist attacks — which was huge.
Read the full blog post: blogs.loc.gov/loc/2020/06/how-will-we-remember-covid-19/
Support the Library
We are more grateful than ever for all that you do to keep us strong. Whether you support the Library with a gift or simply by spreading the word about what we do, you help us in our mission to connect millions of people around the world with the stories of our collective past, present, and future.
If you haven't yet had a chance to give and you're in a position to donate, please consider making a gift at loc.gov/donate/.
During this time of physical distancing and stay-at-home recommendations, presumably like many of our readers, I have been cooking at home almost exclusively. I love cooking, but after a couple months of teleworking, I grew bored with making the same recipes on loop. For inspiration, I went through my cook book collection and stumbled across a book that my grandparents gave me years ago titled The Congressional Club Cook Book. The book not only gives an interesting insight into food culture in America in the 1960s (countless Jell-O salads), but is also an opportunity to learn about the Congressional Club and former government officials.
The Congressional Club was founded in 1908, with the goal of building a network for socializing and friendships among spouses of senators and representatives. The organization still exists today, although it is now referred to as The Congressional Club Museum and Foundation. According to its website, “the Club’s primary focus has shifted to serving its community and the Nation with not-for-profit partners. Together with its partners, the Club supports causes across the country with a particular focus on entities that support members of our military and their families.” The organization also publishes the above cookbook, which primarily contains recipes submitted by spouses of representatives, senators, presidents, Supreme Court justices, and ambassadors. The Congressional Club continues to print updated editions of The Congressional Club Cook Book, many of which are held in the Library of Congress’s collections.
While skimming the index of contributors, I came across one of the few female elected officials listed in my edition of the book, Margaret Chase Smith. Smith served terms in both the House and Senate between 1940 and 1973, representing Maine. She was the first woman from Maine to serve in Congress, and the first woman to win elections for seats in both chambers of Congress. Smith also ran for president in 1964 and was the first woman to have her name listed for presidential nomination by a major political party.
In addition to her impressive background, Smith is remembered for a speech she gave on the Senate floor that is referred to as “A Declaration of Conscience.” In that speech (beginning on page 7894), she spoke about free speech principles, including: “The right to criticize. The right to hold unpopular beliefs. The right to protest. The right of independent thought.” To commemorate Smith’s speech, a Senate resolution designated June 1, 2010, the 60th anniversary of the speech, as “Declaration of Conscience Day.” Smith passed away in 1995. In her home state of Maine, a congressional research library, federal building, and commuter ferry are named after her.
In learning about Smith it became evident that she was proud of her home state, and that is reflected in her recipes, which included a lobster dish and “Maine Baked Beans.” Smith’s other contributions to the book included recipes for French salad dressing and a lime and cucumber gelatin salad.
I hope this post inspires an interest in both congressional history and trying new recipes!
In Massachusetts, people who have tested positive for the coronavirus or been exposed to COVID-19 get help with everything from groceries to legal assistance, whatever it takes so they can stay put and avoid infecting anyone else.
Pero a pesar de las protestas, de que los restaurantes comenzaron a admitir comensales en sus locales, y la lenta resurrección de las compras y otras actividades, los temores de un nuevo aumento en los casos de coronavirus hasta ahora no se han materializado.
On this day 20 years ago, Denmark and Sweden inaugurated the Oresund Bridge (Danish: Øresundsbroen, Swedish: Öresundsbron). The bridge is almost 8 km (about 5 miles) long and, together with a 4 km (2.5 mile) long tunnel and a large, 1.3 km square man-made island, connects the Copenhagen region of Denmark with the Malmö region of Sweden. A contract (available in Prop. 1990/91:158 at 27) was signed between the two countries in 1991, and in 1995 the building began. Globally it may be most famously known from the TV-series the Bridge (Broen), where cross-border and cross-jurisdictional issues were presented by a woman found dead on the middle of the bridge.
History of the Oresund Region
The Bridge connects the two countries across the seemingly natural land barrier of Oresund strait. Here, private boats once carried Jews from occupied Denmark to neutral Sweden during World War II. But the history of the strait goes back even further. The battle for the strait was hard-won. In fact, Swedish Skåne (also known as Scania) was part of Denmark until 1658, when it became part of Sweden as part of the Treaty of Roskilde.
For hundreds of years the strait was also heavily taxed, in the form of a “Sound Fee” or “Sound Toll” (Øresundstolden). The Danish King Erik of Pomernia initiated the tolls in the 1400s. In fact, the creation of Göta Canal was in part envisioned because of the strait. By connecting the port of Gothenburg with the port of Stockholm via a domestic canal, the Swedes could avoid the tolls paid to the Danes for passing through the Danish controlled strait. The Sound Fees were abolished in 1857, but the old documents have been preserved in a digital format in The Soundtoll Registers Online, which includes a list of products in different languages.
The Oresund Area Today
Today, the strait is still associated with fees or road tolls paid to finance the building of the bridge and its maintenance. But the tolls are not as hefty and have not hampered transportation. Products move freely between the two countries, and, until recently, the only official controls conducted at the bridge were done to ensure that Swedes were not bringing in too a great quantity of alcohol from (lower taxed) Denmark. However, differences in alcohol tax are not the only difference in policy on the two sides of the strait. In 2015, Denmark and Sweden took sharply different approaches to the refugee crisis, resulting in the imposition of Swedish ID-controls at the border.
On a normal day thousands of people cross the bridge, which takes 10 minutes by car or 30 minutes by train. But these are not normal times, and the Swedes and Danes are divided once more, this time in their response to COVID-19. Denmark was quick to close its borders to contain the spread of COVID-19. The Swedish borders meanwhile remained open to all European Union (EU) member (and Schengen) states. Reports have claimed that some EU citizens have headed there to have their hair done. When Denmark opened its borders, it originally did not welcome Swedes, then it made exceptions for Swedes from southern Sweden (Skåne, Halland, and Blekinge). As of today, July 1, 2020, Swedes coming to Denmark from southern Sweden as tourists must show a certificate of a negative COVID-19 test .
Even without the pandemic to account for, both Denmark and Sweden, at present, still maintain border controls between their two countries unrelated to COVID-19. Although the Schengen Area allows border-free travel, Sweden and Denmark have used its exceptions to maintain border controls across their respective borders. Sweden cites terrorist threats and shortcomings at the external border, and Denmark cites terrorist threats and organized criminality in Sweden.
In a few weeks, the Oresund region has another milestone to celebrate. It will be 100 years since Robert Svendsen, on July 17, 1910, was the first person to cross the Oresund strait in an airplane.
Unless federal policymakers provide enough aid to states, localities, territories, and tribal governments to offset all or nearly all of their massive revenue losses due to the pandemic, the longstanding inequities from historic and ongoing racism and discrimination — which have left Black and brown communities most harmed by COVID-19 and the economic crisis — will only worsen from the deep cuts in public services that these governments might have to make.
Federal policymakers should substantially increase the federal share of Medicaid costs to help prevent states from cutting payments to health care providers, which would likely hurt Medicaid patients and could threaten the sustainability of the health care workforce during the public health and economic crises.
This triggered increase in federal Medicaid assistance would go a long way toward closing the large recession-related gaps emerging in state budgets and reduce the need for harmful program cuts and tax increases.
The Law Library of Congress is proud to present the report, Regulating Electronic Means to Fight the Spread of COVID-19
Countries have to find ways to control and mitigate the spread of COVID-19 in order to break the chain of human-to-human transmission, such as case identification, isolation, testing, contact tracing, quarantine, and location tracking. Many governments have turned to electronic measures to provide information to individuals about the COVID-19 pandemic, check symptoms, trace contacts and alert persons who have been in proximity to an infected person, identify “hot spots,” and track compliance with confinement measures and stay-at-home orders. Most of the surveyed jurisdictions have developed one or several dedicated coronavirus apps with different functionalities, such as general information and advice about COVID-19, symptom checkers, and contact tracing and warning. This report surveys the regulation of electronic means to fight the spread of this infectious disease in 23 selected jurisdictions around the globe.
This report is one of many prepared by the Law Library of Congress. Visit the Comprehensive Index of Legal Reports page for a complete listing of reports and the Current Legal Topics page for our highlighted and newer reports.
July 1 is a big day in medical education. It’s traditionally the day newly minted doctors start their first year of residency. But this year is different. Getting from here to there — from medical school to residency training sites — has been complicated by the coronavirus.
“We were all really freaking out,” said Dr. Christine Petrin, who just graduated from medical school at Tulane University in New Orleans and is starting a combined residency in internal medicine and pediatrics at MedStar Georgetown University Hospital in Washington, D.C. Students “matched” — the term for finding out where they will spend their next several years training — in March, just as everything was shutting down because of the pandemic.
After getting the news of their placements, Petrin said, some of her friends were worried about being able to enter states that were closing their borders. They “just rapidly picked up and moved. Found an apartment, packed up the car, and went.”Email Sign-Up
Subscribe to KHN’s free Morning Briefing.Sign Up Please confirm your email address below: Sign Up
Petrin said she was lucky. Although she shopped apartments online, her sister, who lives in Washington, could check them out in person. Dr. Erin Fredrickson was not as fortunate. She graduated in May from Campbell University School of Osteopathic Medicine near Raleigh, North Carolina, and matched in a family practice residency at the University of Washington in Seattle.
She and her partner were already planning to drive across the country with their dog, but the trip turned out to be much different than the leisurely journey they had envisioned. “We were going to visit friends in different places along the way,” she said. “We were going to camp, but a lot of places to camp were closed. We ended up staying in Airbnb guest houses” in an effort to minimize contact with anyone else.
Meanwhile, she said, she was forced to pick out housing remotely. “I did a lot of FaceTime tours of apartments” in Seattle, she said.
Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges, agreed this has been a year like no other. “It’s been really messy,” she said. “But it looks like it’s coming together.”
Among other things, graduates traveling from states that are or have been hot spots are being asked to quarantine for 14 days upon arrival. That has required more flexibility than usual from administrators used to starting programs at an exact time.
“Everyone is pretty much going to start July 1 — or a little after,” she said.
In some instances, the medical students graduating this year — some of whom graduated early to help in the hospitals attached to their medical schools — have it easier than students directly behind them.
Almost from the start of the outbreak, third- and fourth-year students who would typically spend much or all of their time in the hospital were shut out to avoid being exposed to the coronavirus. Even the newly graduated doctors were generally kept away from COVID-19 patients.
The restrictions were intended not only for their own safety, said Orlowski, but also to help protect patients. “If you have a COVID patient, you don’t need 14 people marching into the room,” she said. “We wanted to decrease the team size.” And shortages of personal protective equipment made smaller care teams necessary.
For most of the graduating seniors, required rotations were generally finished by the time the virus had upset their plans. Those that were not could be made up.
But for third-year students, the time out of the hospital will be more difficult to recoup as the pandemic drags on — and continues to spread. For the moment, most students are also barred from rotations at hospitals other than their own. (Students frequently work at hospitals that have programs their home hospital does not offer.)
At the same time, those soon-to-be fourth-year students who normally would be traveling around the country to interview for residencies will be limited to online visits only. That’s a real shame, said Petrin, because being on-site in some cases “changed my perception for better or worse.”
But right now it’s about safety, Orlowski said. “We’re trying to cut down on any travel,” she said. “But we’re also trying to make it fair. We don’t want some students to have in-person interviews and others not.”
For those starting residency this week, one of the hardest things, said Fredrickson, is getting through all the errands she won’t have time for later. “I moved to a new state and I need a new driver’s license and license plates,” she said. “And the DMV is still closed.”
Dr. Nadia Abuelezam, infectious disease expert and assistant professor at Boston College Connell School of Nursing, joined WBUR's Morning Edition to explain how Massachusetts' approach has been successful so far.