By Mark Chataway, Co-Founder of Bairds CMC and Hyderus
I was in charge of communications for the largest HIV services group in the USA in 1983. I started work just after most Americans first heard about AIDS. The novel Coronavirus is not HIV, but I have noticed similarities in the panic surrounding the two.
Healthcare systems couldn’t keep up in the early days of the HIV panic. There were relatively few patients, but doctors and emergency rooms were deluged with the worried well who had seen terrifying pictures on TV of people with disfiguring cancers or incurable pneumonia. Last night I watched a video of a young Spanish doctor almost screaming at people with colds to stay away from his COVID-19-hit institution. Most of the Italian patients stumbling between tents on TV look suspiciously ambulatory.
Triage may be the key to managing this crisis, but the challenge is that doctors in many countries have spent years insisting that patients come through them for everything from repeat prescriptions to cholesterol checks to flu jabs. All could be done more efficiently on line or through self-care, but undoing this network of protectionism will take time and political will.
As HIV spread through the affected communities, there was a clamour for action to stop transmission. To my boss’s irritation, I was a big supporter of closing down New York’s swingers’ clubs and bathhouses and in cracking down on the shooting galleries where IV drug users met. I used to plot against the sex club owners with Randy Shilts, who eventually wrote a book attacking San Francisco’s business-as-usual attitude to containing AIDS. We now know that places made no difference; it was change to behaviour that limited the spread. Closing things may have sent a useful temporary signal about the seriousness of the risk, but it did not change that risk and it made people at risk harder to reach.
The analogies are limited: COVID-19 appears to be spread by droplets while HIV was spread by shared body fluids; it’s much easier to share a sneeze than blood. However, we need to think about changing social norms, rather than closing pubs. With AIDS, we discovered that most communications about behaviour change was, at best, a waste of time and, at worst counter-productive. The British tombstone ads scared people into denial while Sweden’s dancing condoms just didn’t have an impact. The campaigns that worked best were practical advice to meet real world situations: how do you avoid shaking hands without looking rude; what happens when you don’t have a tissue or sanitising gel to hand?
The epidemiology in the early days of AIDS was often misleading. The small town of Belle Glade in the Florida Everglades had the highest per capita rate of AIDS in the nation. Could mosquitoes be involved? What about the water supply? Maybe whatever caused AIDS needed heat. Years later, we discovered that Belle Glade just had the usual aggravating factors of poverty, poor education and poor overall health. Coronaviruses are much less of a mystery than HIV was and we should be very sceptical about claims that dogs transmit it or that it can live for months in gyms.
After French scientists identified the virus responsible for AIDS, deaths were reported based on whether people were HIV positive when they died. For young gay men who had lived in the gym, HIV was usually the clear cause; for heroin users with multiple infections and violent lives, it was often less clear. We need to remember that, worldwide, thousands of people a day die of pneumonia and other respiratory conditions. Most are elderly and in poor health. An increasing number will test positive for COVID-19.
In 1984, the then-Secretary of Health & Human Services promised that HIV vaccine trials would start within two years. Dr Anthony Fauci was appointed head of the National Institutes of Allergy and Infectious Diseases. Thirty-five years and about $15 billion later, there is a vaccine that protects monkeys well — sadly it does nothing for humans. A coronavirus vaccine is a simpler task than an HIV one, but it is unlikely to come before most of us have been exposed and developed antibodies which will protect us, at least in the short term.
Once we knew that HIV caused AIDS, we knew that those who tested positive would be the victims of discrimination. With COVID-19, it may work the other way: imagine the premium that employers may be tempted to place on those who can show they have protective antibodies and can travel at will, without endangering themselves or others?
Mark Chataway helps run two health policy and communications consulting firms, hyderus.eu and bairdscmc.com.