Five lessons from the AIDS epidemic on how to cope with COVID-19
Without masks and a vaccine, we could reach Herd Immunity from COVID-19, but deaths would skyrocket. We break down the science of it. USA TODAY
We need humility, flexibility and tests, tests and more tests. The only way to stop a pandemic, be it AIDS or COVID, is to know exactly who is infected.
A novel infection, an unknown history, and a race to learn how it spread, how to contain it and how to treat it. This was HIV, the Human Immunodeficiency Virus that caused the AIDS epidemic. Over several decades, we made monumental strides against AIDS — transforming it from a death sentence to a chronic disease. On Tuesday, World AIDS Day, here are five important lessons from that experience and how they can help us better navigate the coronavirus pandemic now.
First, universal precautions are of utmost importance — especially for health care workers. Multiple papers show that in the early 1980s, when the Acquired Immune Deficiency Syndrome epidemic began, health care personnel were at increased risk of HIV acquisition via non-intact skin exposure. Part of this increased risk came from the fact that the route of transmission (bloodborne) was not entirely clear for AIDS, and thus, proper precautions were not instituted.
We learned from this that for any unknown pathogen, it is better to be over-protective than under-protective. For COVID-19, the disease caused by the coronavirus, early research has suggested that its route of transmission is via respiratory droplets. Based on this knowledge, appropriate health care measures should include routine use of masks by patients and providers, disinfection of shared equipment, prompt testing of symptomatic patients, and isolation precautions when the disease is confirmed.
Be humble and don't stigmatize
Second, for any new disease, a little humility goes a long way. This is of utmost importance because even a small outbreak has the potential to become a pandemic. In the case of AIDS, Dr. Anthony Fauci noted that it started with: “Five gay men, then 26 gay men, and then it's only a gay man's disease… And then fast forward a few decades. You have 78 million people who have been infected.”
COVID-19 has shown similar skyrocketing numbers in the last year and requires us to balance the fear of uncertainty with the need to act. However, in taking actions, we must not resort to desperation. Rather, each action should be based on ethically sound data as it becomes available. Much like with AIDS, we need to respect the constraints of our knowledge and recognize that we may need to change our guidelines as new information emerges.
Third, stigma runs counter to public health. Stigma was a significant contributor to the AIDS pandemic as it often prevented patients from taking the very actions needed to curb the pandemic — like getting tested and using protection during intercourse. Similar themes have resurfaced during the COVID-19 pandemic, where individuals who test positive are often subject to social stigma. Nevertheless, if there’s one thing we saw with the AIDS pandemic, it was that stigma only made outcomes worse. Those who test positive for COVID-19 need to be encouraged and supported in sharing this information without fear of judgment.
Lasting mental toll: recent reports from the Centers for Disease Control and Prevention estimate that these asymptomatic carriers are responsible for more than 50% of transmissions. Identifying these asymptomatic carriers is a critical lever to limiting transmission and this makes widespread testing a top priority — even for those who exhibit no symptoms.
And, finally, diseases do discriminate. For both AIDS and COVID-19, the risk of disease is higher in communities of color and those that are under-resourced. For COVID-19, these vulnerable populations additionally include the elderly (75+) and those with preexisting chronic conditions such as diabetes, kidney disease and obstructive pulmonary disease.
Pay people to get vaccinated: @Pjuthani) is a student at the Yale School of Medicine and Yale School of Management. Dr. Howard P. Forman (@thehowie) is a Professor of Management, Radiology, Public Health, and Economics at Yale University.