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Another pandemic??

April 16, 2020

Humans, 

A few letters back, I mentioned COVID was the third-worst pandemic we have encountered behind the Plague and the Spanish Flu (which didn’t originate in Spain). In retrospect, not totally true. Many of us have lived through another pandemic. One that killed 10’s of millions (32 million to date) and continues to kill. 

Yep, I’m talking about the HIV/AIDS pandemic. 

And, it's still raging. There were 770,000 people who died from it in 2018. I was as shocked by that statistic as I am sure you are. 

Here are some of the big differences…

One started before the information age… One started in the internet era  
One is spread via blood… One is spread via respiratory droplets
One (initially) hit minority groups... One hits basically anyone 
One kills you slowly (months to years)… One kills you quickly (days to weeks)
One is hard to get if you don’t practice certain behaviors (or unless you needed a blood transfusion in the early years)... One is easy to get unless you drastically change your social interactions

I had an email exchange from a grizzled old ER doc that was practicing during the early years of HIV/AIDS. Here was his muse (I took the liberty of some minor edits to make it more appropriate for a wider audience) 

LOL.  I love being the grizzled, old, wise doc from the past. Let’s see, HIV discovery and pandemic.
There was no internet, no instantaneous and voluminous flood of information. It was a different time.  It really took almost a decade to realize it's danger. I have condensed the first 10 years + on an AIDS timeline below.  You can see that information and realization of the pandemic was much slower than the present, and with a lot more prejudice because the disease first manifested itself in the gay community. And then it was manifested in the black population and we know what kind of discrimination and prejudice they have endured. Personally, as a medical student and surgery resident during the early days (81-85) I didn't think much of AIDS because the early information was so sketchy and I was preoccupied mainly with not being embarrassed in the lecture hall, trying to tie suture knots correctly, and not killing someone in the ED.  Also, AIDS was a disease confined to the gay community - so I was OK. I do remember working in a clinic at Parkland for a month working with a high-risk population and wondering whether my risk factors for this new disease were increased. All the while I was spraying fomites of blood every which way in the OR and ER with not so much as a care in the world. After all, the title of my Senior Film at Southwestern was - "Real Men Don't Wear Gloves". It was a different time. Then later in the 1980's, it came out that HIV was also a heterosexual disease. Now that's when everybody started to worry. I mean this AIDS stuff made herpes, our only previous worry, look like your sweet, benevolent elderly grandmother. I'd have to say though, ignoring the prejudices of an earlier age, it’s the internet, CNN, Fox News, etc. that has made public reaction to Covid 19 so much different than HIV.  

Here is the timeline which he referenced. Here is another way to look at the timeline. Below the postscripts are the highlights from the timeline he referenced. If you don’t study the timeline from the links, definitely go down below and peek at the entries he highlighted. They are fascinating and are basically a great crib sheet. 

On a slightly COVID topic, here is a great site someone sent me while writing this. It’s good stuff if you live in San Antonio.

Stay emotionally connected and physically distant,

Greg

Excerpts from the timeline.

1981-

June 5: The U.S. Center for Disease Control (CDC) publishes an article in its Morbidity and Mortality Weekly Report (MMWR): Pneumocystis Pneumonia—Los Angeles. The article describes cases of a rare lung infection, Pneumocystis carinii pneumonia(PCP), in five young, white, previously healthy gay men in Los Angeles. Los Angeles immunologist Dr. Michael Gottlieb, CDC’s Dr. Wayne Shandera, and their colleagues report that all the men have other unusual infections as well, indicating that their immune systems are not working. Two have already died by the time the report is published and the others will die soon after. This edition of the MMWR marks the first official reporting of what will later become known as the AIDS (Acquired Immunodeficiency Syndrome) epidemic.

  1. June 5: The same day that the MMWR is published, New York dermatologist Dr. Alvin Friedman-Kien calls CDC to report a cluster of cases of a rare and unusually aggressive cancer—Kaposi’s Sarcoma (KS)—among gay men in New York and California. Like PCP, KS is associated with people who have weakened immune systems.

  2. June 5-6: The Associated Press, the Los Angeles Times, and the San Francisco Chronicle report on the MMWR article. Within days, CDC receives reports from around the nation of similar cases of PCP, KS, and other opportunistic infections among gay men.

  3. June 8: In response to these reports, CDC establishes the Task Force on Kaposi’s Sarcoma and Opportunistic Infections to identify risk factors and to develop a case definition for the as-yet-unnamed syndrome so that CDC can begin national surveillance  of new cases.,,

  4. July 3: CDC releases another MMWR, “ Kaposi's Sarcoma and Pneumocystis Pneumonia Among Homosexual Men — New York City and California,” with information on KS and PCP among 26 gay men (25 white and one black). On the same day, the New York Times publishes an article entitled “Rare Cancer Seen in 41 Homosexuals .” At this point, the term “gay cancer ” enters the public lexicon.

1982-

September 24: CDC uses the term “AIDS” (Acquired Immune Deficiency Syndrome) for the first time in a new MMWR, and releases the first case definition for AIDS: “A disease at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for diminished resistance to that disease.”

December 10: CDC’s “Epidemiologic Notes and Reports Possible Transfusion-Associated Acquired Immune Deficiency Syndrome (AIDS) -- California” notes that a 20-month-old white infant who required multiple blood transfusions at birth has developed unexplained cellular immunodeficiency and opportunistic infections. Donor tracing reveals that one of the baby’s blood donors died of AIDS in August.

1983-

May 25: The New York Times publishes its first front-page story on AIDS: “Health Chief Calls AIDS Battle ‘No. 1 Priority’.” The article reports on the federal response to the growing AIDS epidemic. By the time it is published, 1,450 cases of AIDS have been reported and 558 of those individuals have died.

September 30: After New York City physician Joseph Sonnabend is threatened with eviction from his office building for treating patients with AIDS, the state’s Attorney General and Lambda Legal join together to file the first AIDS discrimination awsuit .

1984-

April 23: U.S. Department of Health and Human Services Secretary Margaret Heckler announces that Dr. Robert Gallo and his colleagues at the National Cancer Institute have found the cause of AIS, a retrovirus they have labeled HTLV-III. Heckler also announces the development of a diagnostic blood test to identify HTLV-III and expresses hope that a vaccine against AIDS will be produced within two years.

  1. October 9: The New York Times reports that new scientific evidence has raised the possibility that AIDS may be transmissible through saliva. It will be another two years before proof emerges that this is not the case.

  2. October 10: San Francisco public health officials order bathhouses closed due to high-risk sexual activity occurring in these venues.


1985-

March 2: The U.S Food and Drug Administration licenses the first commercial blood testELISA, to detect HIV. Blood banks begin screening the U.S. blood supply.

October 2: Rock Hudson dies of AIDS-related illness at age 59. In his will, Hudson leaves $250,000 to help set up the American Foundation for AIDS Research  (amfAR). Actress Elizabeth Taylor serves as the organization’s founding National Chairman.

1986-

January 16: The U.S. Center for Disease Control (CDC) reports that more people were diagnosed with AIDS in 1985 than in all earlier years combined. The 1985 figures show an 89% increase in new AIDS cases compared with 1984. Of all AIDS cases to date, 51% of adults and 59% of children have died. 

May 1: The International Committee on the Taxonomy of Viruses announces that the virus that causes AIDS will officially be known as “Human Immunodeficiency Virus ” (HIV).

October 22: The Surgeon General issues the Surgeon General’s Report on AIDS [PDF, 1.98MB]. The report makes it clear that HIV cannot be spread casually and calls for: a nationwide education campaign (including early sex education in schools); increased use of condoms; and voluntary HIV testing.

1986-

January 16: The U.S. Center for Disease Control (CDC) reports that more people were diagnosed with AIDS in 1985 than in all earlier years combined. The 1985 figures show an 89% increase in new AIDS cases compared with 1984. Of all AIDS cases to date, 51% of adults and 59% of children have died. The new report shows that, on average, AIDS patients die about 15 months after the disease is diagnosed. Public health experts predict twice as many new AIDS cases in 1986.

1987-

February 4: Emmy-award winning pianist Liberace dies at his home in California at age 67. His doctor claims that Liberace died of a heart attack, caused by an underlying brain infection. But the county coroner orders an autopsy, which proves that the entertainer died of AIDS-related illness. The case demonstrates the powerful stigma of AIDS and leads to a national discussion about the rights of people living with AIDS to privacy, both before and after death.

April 19: Princess Diana makes international headlines when she is photographed shaking the hand of an HIV-positive patient in a London hospital. She goes on to become a passionate advocate for people living with HIV and to speak forcefully against HIV/AIDS-related stigma and discrimination.

  1. July 23: The U.S. Food and Drug Administration (FDA) announces that it will allow the importation of small quantities of unapproved drugs for people with life-threatening illnesses, including HIV/AIDS.

1989

Reported AIDS cases reaches 100,000

https://www.cdc.gov/mmwr/preview/mmwrhtml/00001442.htm

  1. 1990-

  2. On May 21, ACT UP (AIDS Coalition to Unleash Power)  protests at the National Institutes of Health (NIH), demanding more HIV treatments and the expansion of clinical trials to include more women and people of color.

  3. The 8th International AIDS Conference is originally scheduled to be held in Boston, but is moved to Amsterdam due to U.S. immigration restrictions on people living with HIV/AIDS.

On October 26, the U.S. Food and Drug Administration (FDA) approves use of zidovudine (AZT) for pediatric AIDS.

  1. 1991-

  2. On November 7, American basketball star Earvin “Magic” Johnson  announces that he is HIV-positive.

  3. On November 24, Freddie Mercury, lead singer/ songwriter of the rock band Queen, dies of bronchial pneumonia resulting from AIDS .

  4. 1992-

  5. AIDS becomes #1 cause of death for men aged 22-44 https://www.cdc.gov/mmwr/preview/mmwrhtml/00022174.htm

  6. Florida teenager Ricky Ray dies of AIDS-related illness on December 13. The 15-year-old hemophiliac and his two younger brothers sparked a national conversation on AIDS after their court battle to attend school led to boycotts by local residents and the torching of their home

  7. 1996-

  8. The number of new AIDS cases diagnosed in the U.S. declines for the first time since the beginning of the epidemic.

  9. AIDS is no longer leading cause of death for all Americans ages 25-44, although it remains the leading cause of death for African Americans in this age group.

  10. 1997-

  11. The U.S. Centers for Disease Control and Prevention (CDC) report the first substantial decline in AIDS deaths in the United States. Due largely to the use of HAART, AIDS-related deaths in the U.S. decline by 47% compared with the previous year.

  12. 98-The U.S. Centers for Disease Control and Prevention (CDC) report that African Americans account for 49% of U.S. AIDS-related deaths. AIDS-related mortality for African Americans is almost 10 times that of Whites and three times that of Hispanics.