Happy Summer Folks

Summer has Arrived, and It's Time to Update Our Blog

Special Edition: Living During the Coronavirus or COVID-19 Pandemic

             Like all of you – the near constant attention to Coronavirus, is endless at IDA, and we are all working tirelessly to stay on top of every piece of data that comes our way.  As you know, we cover nine area hospitals, and, each hospital has its own criteria to consider, thus , this means an exceptional amount of work for our doctors and many considerations.  Most importantly, we’re on top if it!

            I’d like to share some current thoughts.  For anyone old enough to remember 1981 and the first announcement of HIV, it’s Déjà vu now with Coronavirus,  at least in my view, it feels that way.  In a little over two months, June 5, 2020, will mark the 39th anniversary of the first article about the human immunodeficiency virus (HIV) in the medical literature (Gottlieb, 1981). It’s hard to believe but we are nearing 4 decades of HIV care.  Early on, there was fighting about what this new virus would be called.  However, on June 5, 1981, Dr. Michael Gottlieb and a team of scientists from the University of California at Los Angeles reported in Morbidity and Mortality Weekly Report the first known case of Pneumocystis carinii pneumonia (PCP) in previously healthy young gay men (Gottlieb, 1981).  This report characterized PCP as a rare opportunistic infection often found in patients with a compromised immune system.  That same year, in 1981, eight young gay men in New York City received the diagnosis of Kaposi’s sarcoma (KS). This was a form of cancer, as rare as PCP, especially in young people (Hymes et al., 1981).  Unexplained illness and death were suddenly and rapidly infiltrating the gay community; yet not until 2 years later, in 1983, was HIV isolated from a patient and shown to be the causative agent of acquired immunodeficiency syndrome (AIDS) (Barré-Sinoussi et al., 1983). That rate of death should never be forgotten!

           On a positive note, over the past 39 years, HIV has transformed from a rare, obscure, and unexplainable disease into a universally known and successfully managed disease.  The time has passed when gay men died at alarming rates due to HIV.  The fear and mystery surrounding what was initially called the “gay plague” (Greene, 2007, p. S94) has given way to significant advances in the identification, treatment, and prevention of HIV.  

          You may wonder why it’s Déjà vu.  Well, that’s simple.  It’s because like HIV in 1981, nowadays with Coronavirus – now called COVID-19, there are more questions than answers and so many unknowns.  Also, there is even a level of stigma and finger pointing being wrapped around this because of its origins from China.  Calling it a Chinese virus is no different than calling HIV a gay disease.   At that time, the words HIV and AIDS where not even invented, and until just recently, COVID-19 wasn’t invented either.  Our first look at the mysterious illness began with the first major news story to cover emerging HIV was full of gloom and levels of hysteria, doesn’t this sound familiar? Decades later, it’s a fascinating glimpse into the early days of AIDS.  History is repeating itself with COVID-19. There is the same fear, stigma, and ignorance that defined the world circa 1981-1985.  Strictly from the medical lens, I see no difference now with COVID-19.  And, from a virologist perspective, it’s never a matter of “if,” but instead always a question of “when”. 

          Some differences of course are the young versus the old, and now with COVID-19, the focus is switching from the young and otherwise healthy, to the elder, maybe frail, with any number of diseases that come with the aging process.  And of course, we cannot overlook the natural tendency to have decreased immunity as part of the natural aging process.  Those early announcements came to be known as the harbingers of AIDS.  And this current brief glimpse of our past with HIV is nowadays announcing and signaling similar signals of finding our way through COVID-19.  It’s mind-boggling.

         Nowadays it seems COVID-19 is causing much the same hysteria.  Worse, yet, is the power of social media to perpetuate rumors, and in a short amount of time, the flood gates have opened.  Trying to calm the fears, logical or otherwise, takes great work and conviction and trust, especially when there is much we do not know, and, we learn as we go day-by-day.   Yes, COVID-19 is a novel virus, but, it’s a virus.  And all viruses do have some common tendencies, their own life cycle for example, which we aim to break through current mitigation ideas and our newest strategy of “social distancing.” a phrase that has become identified with COVID-19.

         What we know so far:  a 3000-mile gap between Washington and New York states is mind blowing. How did that happen?  It’s sci-fi on some levels and spreading with remarkable speed.  Our first glimpse of COVID-19’s deadly consequences is a poignant situation yet a reminder of how misinformation, or missing information, leads the rumor mill now, just like the power of misinformation in 1919.  It’s like a tsunami of mistruth, wives’ tales, hysteria, and insanity. Also just like HIV in 1981, that lead to bizarre behavior.  For example, how in the heck did COVID -19 lead to a toilet paper shortage?  What makes folks buy 3-5 times more toilet paper than normal purchasing?  Human behavior is clearly a complex process with little to no simple explanations.

         Another idea comes to mind.  The Great Influenza Pandemic of 1918-1920 that had the same global reach as COVID-19.  Not that I remember this, but, history tells a tale of similar tragedy.   At that time, it was thought the returning soldiers from World War I, introduced this virus.  The pandemic, which lasted from 1918-20, is estimated to have caused 39 million deaths, equivalent to 2% of the world's population at that time.  Something different though, is that those suffering from COVID-19, from what we have seen so far, it the opposite of the Great Influenza Pandemic that resulted in high mortality among young adults without pre-existing medical conditions.  Just like COVID-19 now, and HIV in 1981, and the Great Influenza Pandemic in 1918, a common theme is the consequences of the unknown.  Let’s now turn to what we do know and let’s get back to COVID-19 and living with HIV.

          If you happen to live with HIV, it can get tricky if your virus is not controlled and your CD4 count is low. If you live with AIDS, you certainly need to take very special consideration and precautions.  If your CD4 is high, in the ranges of 800-900-1000 and the virus is undetectable, HIV is not a relevant consideration.  COVID-19 manifests like the flu and typically abates after a few weeks as far as we know currently—although it can lead to more severe respiratory symptoms and even death, in some people.  But we mustn’t forget that the CDC estimates that equal to or more than 50% of people with HIV are over 50 years old, part of the COVID-19 risk profile so they conclude that all people with HIV should take precautions against this new virus.  The risk of getting very sick is greatest in people with a low CD4 cell count and people not on HIV treatment.  It’s simple: people who are taking antiretroviral medications to treat HIV or prevent HIV (for example, with PrEP) should stick to their treatment plan, continue taking their medicine consistently, and follow our advice.  Call us with any questions. But most importantly, do not let yourself fall out of care!

        Just like the 1980’s and early 1990’s, our commitment to the HIV community then, is exactly our commitment to understanding and treating COVID-19.  We were on the frontline then, and you’ll find us there again.  It’s the very oath we took when entering medicine as a profession, that keeps us doing what we do.  We will get ahead of this pandemic! HIV care providers are uniquely prepared for this moment. Those who lived and worked through the early years of the HIV epidemic can help remind others, both patients and the public at large, that stigma is one of the greatest enemies of public health.  We are uniquely positioned to overcome stigma and gossip.

         According to the World Health Organization - one of the biggest challenges in the HIV response has remained unchanged for 30 years: HIV disproportionally affects people in vulnerable populations that are often highly marginalized and stigmatized.  In some way, sounds like COVID-19 to me!  Now, more rumors perpetuate stigma, the Asian population has been inappropriately targeted and stigmatized due to the novel virus’ origins in China.

        In the end, of course, the scale of this pandemic remains unknown.   If we model the pathway of COVID-19 like history, we can find an element of hope. Never stop believing you can make a difference! Nothing else matters! Take care of yourself, your loved ones, and do the simplest of things.  Stay at home! Maintain “Social Distancing,”  which means maintain a six “6” foot distance between yourself and others.

       Final Considerations

For people living with HIV and us, as your providers, this means:

• Having at least a 30-day supply of HIV medicine available.
• Avoiding close contact with people who are sick.
• Practicing good hand washing.
• Cleaning and disinfecting frequently used surfaces
• Avoiding large crowds and gatherings.
• Avoiding cruises and non-essential air travel.
• Following recommendations made by local public health officials.
• Establishing a clinical care plan to communicate with health care providers online (Telehealth appointments) or by phone.

Essentially, to summarize here: Persons with HIV should follow all applicable recommendations of the U.S. Centers for Disease Control and Prevention (CDC) to prevent COVID-19, such as social distancing and proper hand hygiene.

These recommendations are updated regularly! Be sure to visit: (https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0)

Regardless of HIV, wash or disinfect your hands regularly and especially:

• After a visit to the toilet.
• Before eating.
• After you have touched a possibly contaminated object like a door handle or a shared keyboard.
• Wash hands with soap and water for at least 20 seconds or use a disinfectant containing at least 60% to 95% alcohol. If your hands are visibly dirty, wash them with soap and water. (A good trick for a 20 second count is to sing “Happy Birthday to You” twice).
• Do not touch your eyes, nose or mouth with unwashed hands.

Stay away from sick people and make sure no one coughs or sneezes in your face.

Animals

Stay away from animals and their waste products. Do not visit animal markets.

Food and drinks

Do not eat undercooked meat and non-pasteurized milk products.

Face masks (This is critical)****

      Wear a mask which covers your mouth and nose. Do NOT touch your face beneath the mask as renders the mask useless. Persons who are (possibly) infected can wear a mouth mask to protect others.

Social Distancing (This is critical)****

     It is recommended that everyone should maintain a distance of 6 feet.

And finally - The Interim Guidance for COVID-19 and Persons with HIV is now available on the AIDSinfo website- please visit:  https://aidsinfo.nih.gov/guidelines

      So, remember, we are here for you.  Our practice is not closed.  Our doctors are prepared for telemedicine! All you have to do is call to schedule a Telehealth Appointment.”  

      We need to do everything in our power to make certain your surveillance remains up to date including your labs.  We also need to hear from you to ensure your appointments can be scheduled, and, your medications remained ordered.

      I leave you with this.  Recently, a Capuchin Franciscan (Richard Hendrick) living in Ireland, penned a lovely poem titled Lockdown.  This can easily be found in the Internet. In part, he writes:

Wake to the choices you make as to how to live now.
Today, breathe.
Listen, behind the factory noises of your panic
The birds are singing again
The sky is clearing,
Spring is coming,
And we are always encompassed by Love.
Open the windows of your soul
And though you may not be able
to touch across the empty square,
Sing.

To all of you and in solidarity, we remain committed to you! We are all human!

Looking forward to seeing you all soon.

Dr. Tom

Dr. Loveless' next Blog will be published soon.