Covid Chronicles (8)

In Covid19 discussions, SARS, MERS, Ebola and Nipah are often mentioned, the common thread linking them being their zoonotic origins. The shared origin story has informed our discourse on possible future mutation of Covid19, vaccines etc so far.

For lateral thinking – and to look past the recency bias mentioned above – I often delve into what we have learnt from and about HIV, which was originally zoonotic (simian to be precise) in origin but whose contagion is now mainly human-to-human via both sexual and non-sexual routes.

***

Over four decades since the discovery of HIV, we don’t have a preventive vaccine. This is not for the lack of trying. Indeed in 1997, Bill Clinton promised a safe and effective vaccine within 10 years (that would be by 2007). In 2019, a Phase III vaccine trial, named HVTN 706 or Mosaico, was announced. It targets more strains of the virus than any other before it.

Over four decades since the discovery of HIV, we do not have a therapeutic vaccine either and none has reached Phase III trial.

Over four decades since the discovery of HIV, we do not have a “treatment” or “cure” for HIV/ AIDS. What we do have is anti-retrovirals that slow the progression of the virus and extend the QALY for HIV/ AIDS patients who can go on to have ordinary, regular lives with near-normal life spans.

Over four decades since the discovery of HIV however, we have a solid understanding of how it is transmitted and how it could therefore be prevented, and that is valuable.

Over four decades since the discovery of HIV, many countries, aided most ably by focused charities and other organised efforts, have built public health awareness and education campaigns that centre on prevention, testing guidelines and frequent testing infrastructure, and robust surveillance regimes.  I have mostly linked to UK specific organisations and guidelines here, some active since the very early days of HIV discovery. But similar information can be found for many other countries.

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It is over four decades since HIV was discovered.

We have not even completed the first year of Covid19.

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We are pinning hopes on Covid19 preventive vaccines, keeping eyes peeled for the vaccines entering advanced stage trials and sometimes not dwelling enough on risks. Nor is it clear that trials involve enough participants of the groups (read: minorities) that are disproportionately affected by Covid19.

We talk about Covid19 “cure” with scant evidence so far beyond dexamethisone or convalescent plasma.

The discussion about “long Covid” — long term health impairments in otherwise healthy people with no pre-existing conditions — is evolving. The latter reminds me of Kaposi’s Sarcoma which affected young healthy men affected by HIV.

Our public health messaging (at least in the UK) — on the use of masks, on risks, on safe return to work, on safe return to schools, on communal responsibility — is, to put it politely, a mess.

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What is possible if we take a cue from HIV/ AIDS, while remembering Covid19 is a probably more contagious respiratory virus that can affect anyone?

We could learn to practise actively the basic rules of prevention through good personal and hand hygiene, good ventilation, use of masks (“masks – the condoms of Covid19” could be a great tagline!).

We could — crucially — get tested more frequently, which will then enable public health surveillance of the prevalence and spread.

We could humbly accept “long Covid” as an evolving area of knowledge. Meanwhile we could work on building the cost of its impact into our national health budgets and healthcare provisioning infrastructure, dynamically fine-tuning our knowledge and our numbers through learning more as we go along over the next few years.

The recovery of our battered economies and our unhappy communities and societies may well rely on the acceptance that we have to learn with live with Covid19 amongst us.

That does require clear messaging on risk of contagion namely who is at risk, in which situations, over what duration of exposure, and how they could mitigate the risks.

The indecision is bugging us all (with apologies to The Clash)

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