Past is Prologue: Applying Lessons from HIV to COVID

Shakespeare said it in The Tempest: What’s past is prologue.

Here’s the story.

One of my medical residents at Strong in the late 1970s, Dr. Michael Gottlieb, went on to describe the first cases on the planet of what we could come to know as AIDS.

It was June 5, 1981. The Centers for Disease Control and Prevention (CDC) printed a weekly public health report, and this one had a description of five cases of a disease in men in Los Angeles area that had never been described before and had no name. These otherwise healthy men came down with a type of pneumonia called Pneumocystis (pronounced: new-mo-cyts-is). Two of them died.

The first description of what we know as AIDS was in a CDC publication on June 5, 1981. The disease was yet to be named, and Dr. Valenti filed it under ‘Infectious Disease Other”. Provided by Dr. Bill Valenti

I read through the cases and there was something unsettling. I just didn’t feel right about what I was reading.

I noticed at the end that the article had been submitted by Mike, who was at UCLA. So I called the UCLA switchboard and tracked him down.

I asked him what he thought was going on. He thought it might be a virus that was destroying the immune system, but he didn’t have any solid information. What he did know was that after the article came out, he received hundreds of calls from around the world who told him about similar cases.

I said we hadn’t seen anything like that here. He said, “Then if I were you, I’d get ready.”

About a month later, we had our first case. Things were never the same.

I bring that up because of COVID.

Four years ago, we were hearing a lot from China about a respiratory virus that was killing people. This is a respiratory virus, different from the spread of HIV through sex, blood and needles.

As I was reading about those cases in China, there was something unsettling. It was as though I was rereading the first cases of AIDS from 1981.

One day shortly after the reports of this respiratory virus started coming out, we were having a meeting at Trillium with some people from Buffalo. They asked what we thought was going on. When one person said they hadn’t seen anything like that in Buffalo, I recalled Mike Gottlieb from 40 years ago.

I said, ‘Yeah, we haven’t seen anything here yet, but we need to get ready.”

Within a matter of months, there was the first case on the West Coast and then we all know what happened here.

Shakespeare’s famous line works in the world of an infectious disease doctor. We look at events, look at signals and think about how what we’re seeing ties into what we know and what we’ve already done.

In recognizing and then addressing pandemics and epidemics, past certainly can be prologue.