Matthew J. Edlund M.D.

The Power of Rest

AIDS and COVID-19: We've Been Here Before

The past gets recycled. But we can learn to do things differently.

Posted May 07, 2020

 WHO
WHO model of SARS-CoV-2.
Source: WHO

History rhymes and chimes, and the past is never truly past. AIDS and SARS-CoV-2 may be very different viruses, but live as historic cousins.

Fresh out of public health school, I began a residency at NYU-Bellevue in the early '80s. That New York, later the epicenter of COVID-19, was then an epicenter of GRIDS—Gay Related Immune Deficiency Disorder, now AIDS.

Men in their late 20s and early 30s arrived in the ER with fevers and were rapidly admitted, ill with a baffling affliction that appeared exclusive to gays. Brain imaging showed tiny seed-like objects in their brains; within a week, many inflated to the size of golfballs. Within a few weeks, virtually all died.

We tried trimethoprim-sulfamethoxazole. We tried pentamidine, attempting to kill the pneumocystis carinii infections their failed immune systems let explode. They just died.

Residents and medical students were terrified. Many refused to talk to the patients or go into their rooms. In those days, medical students and house staff did a lot of the blood drawing. People believed an errant needle stick would kill them.

One of my mentors was dating a real, royal princess who wondered if she would get GRIDS eating salads brought to her by gay waiters. He asked me whether I thought this true.

I told him I was ignorant, but it appeared the disease spread by sex and blood. That was more the province of big DNA viruses like hepatitis B. Probably not much risk in food.

The princess still refused to go to a Greenwich Village restaurant. I did not imagine AIDS was caused by a reverse transcriptase virus.

Her highness’s response was mirrored by the Reagen administration. It’s worth looking at a transcript of White House press secretary Larry Speakes responding to journalist Lester Kinsolving in 1982:

Lester Kinsolving: Does the president have any reaction to the announcement by the Centers for Disease Control in Atlanta that AIDS is now an epidemic in over 600 cases?

Larry Speakes: AIDS? I haven’t got anything on it.

Lester Kinsolving: Over a third of them have died. It’s known as “gay plague.” [Press pool laughter.] No, it is. It’s a pretty serious thing. One in every three people that gets this has died. And I wonder if the president was aware of this.

Larry Speakes: I don’t have it. [Press pool laughter.] Do you?

Lester Kinsolving: You don’t have it? Well, I’m relieved to hear that, Larry! [Press pool laughter.]

The first cases of GRIDS were reported in Morbidity and Mortality Weekly Report on June 5, 1981. President Reagan did not mention the term AIDS until September 1985. In a country where gay marriage is a right, it is painful to recall the horrific, furious prejudice against gays at the time. The silence and deliberate inaction of the administration crystallized in the slogan "Silence = Death."

As the writer Bob Plunkett recalls, “all my friends died.”

In 1984, Secretary of HHS Margaret Heckler declared the virus causing AIDS had been discovered, and forecast a vaccine by 1986.

We’re still waiting.

AIDS and COVID-19

One of the developers of an abortive AIDS vaccine was Dr. Robert Redfield, present director of the CDC. His role in the national lack of early testing of SARS-CoV-2 deserves further investigation. His possible engagement in suppressing research by people like Dr. Rachel Chu, who knew COVID-19 was ravaging Seattle and was told studying it was illegal, requires more analysis. It appears that the administration’s beginning policy was if you don’t count things, they don’t count.

Dr. Tony Fauci was originally vilified by AIDS protesters. They felt the NIH agency he’s now headed for 36 years was simply letting them die. Fauci went on to become a pivotal figure in developing AIDS drugs and President George W. Bush’s PEPFAR program that has saved millions of lives around the world.

Vice President Pence supported funding for conversion therapy of gays rather than new AIDS drug development, and helped bungle the Scott County, Indiana AIDS epidemic through 2015. He is putative head of the national Coronavirus Task Force, recently winking in and out of existence, which includes Fauci.

Then there is President Trump, who famously said the virus will disappear as by a miracle. He has also raised hopes about treatments including hydroxychloroquine (cardiotoxic, so far ineffective); bleach (lethal); and bright light (who believes putting a light bulb down your throat kills the virus?).

Silence, distortion, and denial characterized the response to AIDS. They also characterize the administration’s response to COVID-19.

Getting Better, Bit by Bit

AIDS is still a primer on how we will get out of the COVID-19 disaster. There was no AIDS treatment until AZT appeared in 1987. Though its efficacy so far is weak, it took only months for remdesivir’s approval.

At the beginning, nothing worked to forestall AIDS’ lethal march. Now there are over 40 medications. People with AIDS live lives as long as anyone else. The use of testing, tracing, tracking, and education led to remarkable decreases in the spreads of AIDS.

The same should happen more quickly with COVID-19. Public health measures like those of Taiwan have let a country of 24 million experience six total COVID-19 deaths. Nationally coordinated testing, tracing, and tracking have worked brilliantly in South Korea, Australia, and New Zealand. If initiated, they will work here, too.

Over a hundred SARS-CoV-2 vaccines are now actively being researched. Innovative treatments like BCG and OPV vaccines, plasma and monoclonal antibodies, even llama antibodies, are in the works. The lower incidence of COVID-19 in French smokers is leading to nicotine clinical trials.

The idea that smoking might in any way be good for you provides the tiniest idea of how COVID-19 has upended our lives and ways of thinking.

Silence, distortion, and denial do not destroy epidemics. Active global cooperation does.

"Silence = Death" defined the response to AIDS. Perhaps Your Health = My Health will define our response to SARS-CoV-2.