Going into the summer, for many of us, means even more changes in an increasingly turbulent pandemic. Coronavirus hotspots are shifting, and those who are left on campus will soon be returning to their hometowns, for better or worse. As Michigan continues to see increasingly deadly days, it is vital that we keep in mind the groups at highest risk, including LGBTQ+ people.
Just about everyone is struggling in some form or another because of self-isolation and stay-at-home orders, but queer people are especially predisposed to loneliness and depression, as my fellow columnist Owen Stecco wrote recently. As many as 60 percent of LGBTQ+ people struggle with depression or anxiety, both of which are easily exacerbated by this pandemic. Stay-at-home orders also worsen issues common among queer people regarding family environments. Only a quarter of LGBTQ+ youth reported having supportive families, and just under half of openly queer youths were made to feel bad about their orientation by their families. The University of Michigan, like many other universities, urged students to leave campus if at all possible, but just because students are physically capable of going home doesn’t mean they should — not that it will matter when the semester ends in a few weeks and they have to go home anyway. This doesn’t even address the students who don’t have a home to go back to, as 40 percent of homeless youth are LGBTQ+.
In truth, returning to the closet and/or going back to a bigoted family is the safest option for many LGBTQ+ people, provided they have the option. While it is true that young people are less likely to die from a case of COVID-19, age is far from the only survivability factor — things like preexisting conditions and access to medical care matter just as much, if not more. Gay and bisexual men and transgender people are drastically more likely than other Americans to have HIV and, therefore, a compromised immune system. More than one in five transgender adults have a chronic condition (diabetes, asthma, etc.), a major risk factor for coronavirus patients. The same trend can be seen in LGB adults. To complicate things further, those who are LGBTQ+ are less likely to have health insurance than those who are not. This serves to worsen the severity of said chronic conditions and deter individuals from seeking care if and when they contract COVID-19, despite their heightened risk of death.
Perhaps the greatest risk factor for queer people during this pandemic is respiratory issues. Breathing trouble is a key symptom of COVID-19, hence the desperate need for respirators. LGBTQ+ people have enough trouble breathing as it is — and it’s not just the prevalence of chronic conditions that sometimes happen to be respiratory. A lesser-known fact is that LGBTQ+ people are roughly twice as likely to smoke as their cisgender and heterosexual counterparts. Smoking increases the chance of both contracting the virus (due to higher risk of chest infections and frequent hand-to-mouth contact) and experiencing complications once sick. Breathing issues virtually exclusive to the LGBTQ+ community are those related to chest binding, a practice used by many transgender men, nonbinary people and sometimes butch lesbians to flatten their chests. One of the many potential health problems caused by frequent binding is shortness of breath.
These and many other medical needs of the community are being put on the back burner as states order the indefinite postponement of “nonessential” health care services. Michigan’s order dictates — as the bare minimum that must be postponed — joint replacements, bariatric surgeries and any dental care that does not “relieve pain or infection”; in Texas and many others, this has been made to include abortion despite its time-sensitive nature. With these procedures constituting the minimum for cancellation, it comes as no surprise that transgender health care makes the list as well. Gender-affirming surgeries, which already have a long wait period due to the small number of surgeons doing them, are being delayed even further because of COVID-19. These procedures are often vital to the health and safety of transgender people, who see decreases in anxiety, depression and suicidal behavior as well as a decreased likelihood to smoke or abuse drugs — factors that are more important than ever during this pandemic. This quarantine period would be ideal for recovering from surgery if only people could get them, and forget about trying to start hormone therapy.
If LGBTQ+ people are more likely to be hospitalized over a case of COVID-19, what happens to them once they get there? As overwhelmed hospitals begin to ration life-saving equipment, prospects are bleak. One rationing method is to give lower priority to patients with underlying conditions, which would disproportionately affect minorities, particularly Black people, but also queer people. No matter what method is used, though, they all hinge on prioritizing those most likely to survive short-term and long-term. As if the heightened suicide risk in the LGBTQ+ community wasn’t bad enough on its own, it could very well become a deciding factor in denying people life-saving resources because it compromises the odds of long-term survival. Even if this could be controlled for, doctors have strong implicit biases against queer people, making them unlikely to prioritize gay and transgender patients regardless of how resources are officially allotted.
Now more than ever is the time to think of others. The vast majority of us personally know someone who is LGBTQ+. Keep them in mind when you debate going out or wonder if you really need to wear that mask. Wash your hands, keep your distance and stay home unless absolutely necessary — and, of course, have the best summer you can, no matter who you are.
Ray Ajemian can be reached at rajemian@umich.edu.