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Covid-19 and AIDS: Parallels

MATTHEW EDLUND, MD, MOH
Guest Columnist
Edlund@lbknews.com

The past is never past. As I wrote two months ago, the bungled political response to Covid-19 eerily paralleled the first American responses to AIDS.

The present parallels between Covid-19 and AIDS continue to increase:

Both diseases are nasty and lethal in unexpected ways

With AIDS, originally GRIDS (Gay-Related Immune Deficiency Syndrome), many of the first cases were identified via Kaposi’s sarcoma, a formerly very rare tumor. Others rapidly died from pneumocystis jiroveci, a  fungus that hitherto infrequently affected people.

Covid-19 causes a series of presently poorly understood syndromes like happy hypoxia, where folks are bantering on their cellphones with oxygen saturations that should leave them stuporous on the floor; inflammatory vasculitis particularly afflicting children, like the weird Kawasaki syndrome, where without rapid treatment many may die; autoimmune pneumonias occurring several weeks after the original Covid infective pneumonia; sudden blood clots almost anywhere, often weeks after asymptomatic infection.

 

Both hit the immune system hard

AIDS attacks the heart of our prolific, multifocal immune system, actively destroying T cells and other immune fighters. Covid-19 causes interleukin 10 levels to go haywire, fouling immune responses. It also now appears to rapidly destroy T cells, and cause acute disseminated encephalomyelitis https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408, even with mild infections.

Destroying immune function is much like incapacitating a military defending against overwhelming invasion.

Though they kill many, these viruses disable many more.

AIDS, even when effectively treated, often leaves its victims with a shadow life of weakness, tiredness,  and multiple chronic illnesses. Though Covid-19 has only officially been with us since November it leaves many starving for breath, incapably weak, and suffering from chronic fatigue, brain fog, and occupational incapacity. We have no good idea yet just how much long term disability this illness will cause, but it may prove a major impediment to our health and economic renewal.

 

The viruses go everywhere on the planet

Every country on earth is susceptible to AIDS and Covid-19. All you need to propagate Covid-19 is breathing; talking appears to be probably the most effective means of spread. As humans must and will talk, this highlights the importance of masks. Though sex and blood are how AIDS infects, it has gone all over the globe, still producing 1.7 million new cases a year.

As condoms stop AIDS, so masks help prevent Covid-19.

Different populations are selectively susceptible

Covid-19 kills older people much more effectively than toddlers or the young. In the original clinical outbreaks, people over 80 had death rates between 8-20%. Seniors should be wary of any claims this disease is “99% harmless.” Latinx and African Americans have suffered much higher death rates than other groups. The reasons for this selectivity are many and an active arena of research.

AIDS was originally so selective in its lethality it was called “GRIDS,” though with time the majority of cases became heterosexual.

The Political response is often denial  and active ignorance

AIDS was killing hundreds of Americans by 1981. In 1982, Lester Kinsolving brought up the matter at a White House press conference, was treated with derision, and asked if he was gay. President Reagen did not even mention the disease until 1985.

On January 18th, HHS secretary Alex Azar told President Trump the coronovirus required a major increase in pandemic preparedness. The subject was ignored. On January 26h, White House Advisor and Director of Trade and Manufacturing Policy Peter Navarro sent the president a report stating the coronovirus could easily kill half a million Americans. The subject was ignored. When Dr. Nancy Messonnier, Director, National Center for Immunization and Respiratory Diseases, made public statements February 24th-25th to Congress and the White House that a major pandemic might occur, coordinated messaging across the administration declared that simply would not happen. Soon to be White House press secretary Kayleigh McEnany said “We will not see diseases like coronavirus come here” https://www.businessinsider.com/kayleigh-mcenany-said-coronavirus-wouldnt-come-to-the-us-2020-4)

As of last week, with 50,000 cases tallied daily, the President once again repeated the virus will “go away.”

Viruses are notoriously unresponsive to political directives telling them how to behave.

 

Bottom Line

We have been here before.   AIDS and Covid-19 are global pandemics causing dramatic political, economic, and social upheaval. AIDS changed the way we had sex; Covid-19 changes how we consider breathing and talking. Both viruses use human social engagement to spread and create a reservoir of infectees. In a global economy that leaves virtually everyone on the planet at risk.

As has been true for centuries, standard public health measures like testing, tracing, tracking, isolation, and support can control viral epidemics. Taiwan has had .3 per million deaths from Covid-19; the United States 408, and rising.

We know what to do. National coordinated programs are effective. The U.S. lacks one. International programs are required to control a global disease, including multinational development of treatments and vaccines. The U.S. is now planning to leave the World Health Organization, where such global coordination often takes place.

The past is a great teacher, and it’s past time to learn.

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