11 April 2020 – Saturday – #27

As a survivor of the AIDS epidemic, I marvel at the speed of Covid-19 research. Science during the time of AIDS was agonizingly slow. One of the earliest reports of HIV in the US was a September 1981 Lancet article about eight gay men in New York with Kaposi’s sarcoma. Around the same time, gay men were reported to have Pneumocystis carinii pneumonia in Los Angeles. Gay men were dying from rare diseases. No one knew why and most people didn’t care.

It wasn’t until a year later that the CDC came up with the name Acquired Immune Deficiency Syndrome (AIDS) to describe the outbreak. Imagine if we were still six months away from coming up with just the name for the malady that’s now infected a million people worldwide, something more descriptive than the flu.

It took until 1984 for scientists to discover the virus that caused AIDS, then another year to market the first test for the virus, and still another year after that for scientists to name it. Five years into the AIDS crisis, we had the Human Immunodeficiency Virus (HIV).

It took us years just to agree on the name of what was killing us.

Nine years after the first US AIDS cases, when there were over 100,000 AIDS deaths in the US, when an estimated 8-10 million people were infected with HIV worldwide, and when the US still hadn’t appropriated significant funding for AIDS research or treatment, science delivered the first treatment for AIDS, a re-purposed cancer treatment called AZT. Nine years for a treatment that didn’t work well is beyond agonizing while you’re watching your friends die.

But science delivered a treatment in the absence of any significant government support and, as governments bumble their way through Covid-19, that should give everyone hope. Science goes on in spite of politics.

Not to harp on the US government’s inept response to Covid-19 or anything, but the Trump administration is making the Reagan administration’s response to HIV look genius. The Reagan administration didn’t do anything, but it couldn’t be blamed for having very few ideas about what might work. No one did. The dance between viruses and the human immune system wasn’t well understood then.

The Trump administration, on the other hand, has failed to deliver test kits, ventilators, and protective gear when experts knew these were vital to reducing Covid-19 deaths. Five or six months into the pandemic and Trump himself doesn’t appreciate the difference between bacteria and viruses. That doesn’t keep him from spouting off misinformation.

The president of the United States doesn’t understand the difference between bacteria and viruses.

Scientists learned a lot about viruses and the human immune system during the AIDS crisis. In the thirty years since AZT, science has added a host of significant tools to its virus arsenal including reasonably complete human immune system models, PCR gene amplification, the Internet, and big data.

Today there are over 1-1/2 million Covid-19 cases and about 100,000 deaths. AIDS has a much higher mortality rate than Covid-19, but Covid-19 is much more communicable. In five or six months, Covid-19 has done the damage that took AIDS five or six years.

But in five or six months, science already has identified and sequenced the Covid-19 virus, determined it doesn’t mutate much, identified target treatments, and has vaccines in trials. Unlike the AIDS crisis, governments have allocated trillions of dollars to support research and to prop up the world economy. There are over 400 clinical studies underway and dozens of potential therapies. In other words, the scientific advances the world achieved for HIV / AIDS in 15 years have taken about five or six months for Covid-19.

The speed with which the science community is attacking Covid-19 is breathtaking compared to the days of AIDS. Once again, a virus is changing the way scientists work.

We had our first small meeting on Friday, March 6, where we saw the first 120 human-cell proteins that interact with 10 of the 29 viral proteins. …Quickly after that meeting, we assembled more than 150 scientists … into the QBI Coronavirus Research Group to identify potential drugs that target the host factors the SARS-CoV-2 virus interacts with to potentially repurpose existing drugs to treat patients. Through an amazing crowdsourcing effort, largely on Slack and Zoom over 2 weeks, we identified 69 potential drugs, which our collaborators in New York and Paris are screening in some of the first SARS-CoV-2 replication assays in the world.

Kevan Shokat, Chair, Department of Cellular and Molecular Pharmacology, UCSF

Already Gilead’s HIV anti-retroviral (ARV) drug remdesivir shows some promise in treating Covid-19. In a small trial with 33 patients, remdesivir outcomes for late-stage patients was better than late-stage non-study patients in China. The study is small and has no control group, so this is not definitive news. If further testing shows remdesivir outperforms a control group, but doesn’t resolve Covid-19 in all cases, it may become part of a Covid-19 cocktail, similar to HIV ARV cocktails like Truvada which contain two or more ARVs to keep HIV in check.

Like many, I have assumed that a Covid-19 vaccine will come in 12-18 months. But no one actually knows. I’ve been waiting almost 40 years for an HIV vaccine so I don’t have to worry about infection. By now when a researcher announces an HIV vaccine candidate that looks more promising than any before, I kind of roll my eyes. I hope the researcher is right, but I’ve seen this film too many times. I know how the promising story is likely to end once the candidate vaccine goes to human trials.

A Covid-19 vaccine seems more likely since the virus doesn’t appear to mutate rapidly and scientists have made vaccines for similar viruses. But no one actually knows. There’s evidence in South Korea, for instance, that 100 patients have relapsed. Lots of unknowns in this reporting. It could be testing, but South Korea has more testing experience that many countries. It’s not a large percent of recovered patients who appear to be relapsing, but it looks like a growing percentage over time. If Covid-19 relapses are real, maybe it takes 5 or 10 or 40 years to find a Covid-19 vaccine. The world may have to rethink its response to this virus.

Then there are technological surprises. Yesterday, Apple and Google announced an opt-in app that enables contact tracking. Of course, there are enormous privacy issues with this kind of geolocation data sharing, but it’s a solution that was unimaginable 40 years ago when AIDS started. This app is a harbinger of the ways science and technology might change the Covid-19 outcome without treatments or cures, but by helping humans change our behavior.

During the AIDS crisis, gay men learned how to change their behavior. Before there was AZT, even before HIV had its name, gay men learned that condoms could save their lives. When we knew almost nothing about AIDS but wanted to have sex, we used condoms. It gave us a way to stop the spread and, if we stopped spreading the virus, fewer of us died and we had a path to AIDS eradication.

No one knows how Covid-19 is going to play out. The good news is that we know what works for Covid-19, social distancing and hand washing. Here’s an eloquent 30-second reminder from the state of Ohio.

State of Ohio Covid-19 public health advertisement on social distancing

The viruses that do well in humans are the ones that takes advantage of what we humans like doing most. HIV takes advantage of the human desire to have sex. Covid-19 takes advantage of our desire to be social. I hope in my lifetime there’s not a virus that takes advantage of my desire to love others.

4 thoughts on “11 April 2020 – Saturday – #27

  1. I found this thought provoking. I think the association of AIDS primarily with homosexual sex and drug abuse is a big reason it was initially marginalized as a concern for many people. If you knew that you weren’t at risk, it was easier to ignore. With COVID-19 virtually everyone is at risk, so the political response is predictably different. I also appreciate your point that a vaccine may not be forthcoming quickly. And … not to be too negative the idea that this virus will not mutate significantly during the process of infecting at least a billion people people seems perhaps over-optimistic.

    Just one quibble … we need to stop thinking and talking about the virus as having agency and intention. It doesn’t. We are are the ones with agency and intention. The virus is part of the environment that we live in. We can’t “defeat” the virus, we can live safely in an environment that contains it.


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