Not Our First Rodeo

(Photo by Tamba Tudiarsana at Scopio)

It’s hard to remember this isn’t our first pandemic rodeo. Humanity faces plagues more often than we realize. Some fade away. Some stay with us but become no longer as widespread or no longer untreatable or no longer as deadly. Smallpox has been eradicated.

We’ve had plenty of previews for what we’re facing now. It’s just that the here and now of this pandemic seems so big that for many of us, it crowds out any perspective from earlier rounds.

I’ve been hearing too many people saying, in a tone of despair, “We’re never going to be done with this.” They don’t see any way for us to ever get a grip on it. Are they right?

The answer depends on us more than it depends on the virus.

I’ve been thinking about HIV in this context. The 1980s and 1990s were scary, especially for gay men because they happened to be the demographic where it hit first and worst in the USA. Having a new disease start in any group that is low on the power scale or stigmatized guarantees a poor response. My perspective about AIDS is very USA centric because that’s where I lived then.

We botched it. Some of our mishandling was due to ordinary, understandable human responses. Some of it was due to specific key people making decisions or taking actions that impeded progress against the emerging epidemic. If you aren’t familiar with the details, I recommend the superb chronicle And The Band Played On by Randy Shilts. (Disclosure: This is an affiliate link.)

For many people, it’s lived history. It’s survived history. AIDS was a sentence to death by inches. It looked like the only way to fend it off was to change behavior to minimize your risk of getting it. The gay community hadn’t been able to be out and proud for very long, so the concept of giving up the bath houses frequented by gay men, or radically changing behavior, was a bigger loss than straight people would ever understand. Using condoms every time was another big ask.

It wasn’t entirely about sex, either. I may have mentioned my dentist. At one of my appointments, I suggested he and his hygienist should wear medical gloves because I had a sinus infection. That led him to realize they should be wearing gloves, eye shields and disposable gowns with every patient. We were in Houston, a hot spot for the emergence of AIDS. Some other dentists refused to see gay men as patients. My dentist realized the new disease wasn’t going to stay limited to gay men. He didn’t want to turn anyone away. He was one of the first local dentists to start using full PPE and he wouldn’t refuse care to anyone.

With behavioral changes, the spread of HIV slowed dramatically. It did spill over into other demographics where people were slow to recognize that they needed to be careful too.

HIV mutates so fast that it often isn’t even the same virus in one patient after a year. The potency of HIV began to diverge. In Africa, where there was still little impediment to its spread, HIV blossomed. It made people sicker after less time and killed them sooner. In the the USA and Europe, where it was no longer easy for the virus to hop from one person to another, it began taking longer to make people sick and they lived with it longer before dying.

Researchers began coming up with medicines, and then with mixtures of drugs, to slow down the progression of the disease. Today, in the developed world, HIV-positive patients who have access to those drugs can carry on with a relatively normal life for so many years that many people regard it as a manageable chronic condition now.

But it isn’t fully under control. We left it spreading like crazy and not robustly treated in much of Africa. Whenever such a disease is allowed to run amok anywhere, there is a high risk that it will make itself more potent and less manageable. With the ease of modern travel, the breakout strain can find its way into developed countries that had older strains under control.

In February 2022, science journals reported that more transmissible, more damaging variant of HIV is circulating in Europe. It isn’t completely new. It has been there for many years, but Europe is generally in a position to do more to impede the spread of HIV so it hasn’t been able to run wild there.

We have plenty of previews in this history to tell us how we could fare against SARS-CoV-2 and COVID. We also benefited from research about AIDS and HIV. New mRNA vaccine technologies were painstakingly invented over the past 20 years in the quest for a vaccine against HIV. Those technologies were redirected to help the world get at least a partial defense against SARS-CoV-2. Developing and deploying a new vaccine in a year was unimaginable. We got there in large part because of vaccine research against HIV.

We also have a preview of how the world might eventually get a genuine exit from the COVID pandemic. The NHS in the UK sees a path to cutting new HIV cases to zero by 2030, at least in England. Notice that the NHS sees how to accomplish this without having a vaccine against HIV yet.

We can get a grip on the COVID pandemic, but it won’t happen by magic. It requires diligence and patience. We’ve done it before with other pandemics. We can do it again, if we all put in the effort.