40 years of AIDS taught us epidemiologic humility. We need to apply that lesson in fighting Covid-19 STAT

 

I am just finishing "And the Band Played On" (1987) about the beginning of AIDS.  It mentions that before AIDS came along the Red Cross cartel controlling blood products had a tremendous hepatitis problem that they refused to do anything about.  Their solution was to have Congress grant them immunity from liability lawsuits involving blood transfusions. (Similar to what Congress did for makers of the new RNA vaccines.) Just saying.

 

BTW, the usual comparisons between the rapid gov't response to Legionnaire’s Disease (veterans) and Toxic Shock Syndrome (women) vs. AIDS (homophobia) are misleading, because those earlier diseases were too easy. Bureaucracies are not prepared to deal with hard new problems.

The long average latency period of HIV - more than 5 years - made it impossible to eliminate without costing lots of money (e.g., testing donated blood for hepatitis antibodies and T-cell ratios). It was always easier to minimize the threat, for example by comparing the small number of existing AIDS cases with the large total number of blood units given each year, or the large total number of people in the US. Picking the denominator of a risk-ratio is an art in public health. Half way through the book, it becomes obvious that experts would have lied about AIDS anyway.

The overriding concerns of most policy makers are: Don’t panic the horses, and don’t raise the cost of business or government. So they lied freely and without remorse until something controversial became undeniable. Regarding a blood transfusion that had obviously caused AIDS in a baby, published in Morbidity and Mortality Weekly Report (not peer reviewed) to get it out fast:

“Nothing exists in the peer-reviewed medical literature — not one case! said Bove. “…Evidence for such blood transmission is lacking.” Years later, when it was clear that hundreds were dying because the blood industry and federal regulators at the FDA heeded the calls of people like Joseph Bove, the doctor would pull a copy of his speech from his shelf at Yale to show that his 1983 presentation at NYC was, technically, accurate. “I wrote ‘evidence is minimal,’ ” said Bove. “I was extremely cautious about my choice of words. I didn’t want to go on the record either way. I was smart enough not to say it wasn’t there. Technically, I was not inaccurate.”

Smart enough to teach at Yale anyway..