Doctor: Pandemic shares similarities with AIDS epidemic
NORWALK — In the early 1980s, Dr. David Rubin was a second-year medical student at Cornell Medical College in New York City. He was taking a course on physical diagnosis when the class was presented with a new case: A patient with a seemingly rare cancer which presented with lesions on the face, body and organs.
That “cancer” turned out to be one of the early cases of AIDS.
“That was a seminal event,” said Rubin, who is now the medical director of Circle Care Center in Norwalk. “From that it took off and we realized this thing was everywhere.”
Many describe the COVID-19 pandemic as a oncein-a-lifetime event or the first pandemic seen in over 100 years. This is only true for those who were not touched by the AIDS epidemic of the 1980s and 1990s, a crisis that affected more marginalized groups like the gay community and thus took longer to see a response.
Rubin realized the severity of the AIDS epidemic in 1982, when Dr. James Curran, who was leading a Centers for Disease Control and Prevention task force determining the causes behind HIV/AIDS, addressed a few hundred medical professionals in New York City, many of whom were gay. Curran told the group not much was understood about the virus yet, but based on early data, AIDS was set to spread “everywhere” among sexually active gay men.
The moment would go down in history. It was referenced in “And The Band Played On,” a definitive account of the epidemic written by San Francisco Chronicle reporter Randy Shilts. It also shaped Rubin’s career as he spent his early years practicing medicine responding to the crisis. He became a certified HIV specialist and helped start the New York State Department of Health AIDS-Designated Center at the Salvation Army’s Booth Memorial Hospital in 1991.
The 1982 conference was similar to what many experienced back in March when COVID-19 cases began cropping up in the United States. For Rubin, who has a background in epidemiology as well as public health, he saw the writing on the wall even sooner.
“My aha moment was in middle to late February when I saw what was going on in Italy and how it was spreading,” Rubin said. “I followed it very closely early. What made me nervous was seeing the initial reaction of the government ... about getting this info out.”
Comparing the coronavirus to the AIDS epidemic is like comparing apples and oranges, whereas AIDS only affected specific, often marginalized groups, COVID-19 has affected virtually everyone globally; Rubin said the situation now is a “negative mirror image” of what happened then.
“When I was talking to some of my patients about this, I’d make a comment like dealing with a pandemic like this is not something new to me because (of ) the AIDS crisis,” he said. “But on the other hand, they’re very different in that if you were outside very specific communities, you didn’t know anything was going on where here this thing is touching every corner of the world. It’s very hard to compare them.”
Despite the politicization of AIDS, Rubin said what happened then is nothing compared to what’s happened now with COVID.
“It became politicized from the very beginning which was the wrong thing to do,” Rubin said. “AIDS was very politicized, but it was wrapped up in the politics of the moment. There was a lot of homophobia and the religious right was coming into its own at the time. ... Whereas now, this got tangled up in the political splintering of the country ... between right and left and Republican and Democrat. It got silly.”
Like Dr. Anthony Fauci has been a leader of the government’s COVID response, Rubin said, thenSurgeon General C. Everett Koop sounded the alarm on HIV/AIDS when President Ronald Reagan took the stance that the crisis was a personal issue with which the government shouldn’t be involved. Koop rooted for sex education and giving people the knowledge to protect themselves.
Unlike the AIDS epidemic, the country is seeing an immediate response to COVID, which Rubin said makes sense. There are about 18 million cases of COVID in the U.S., according to Johns Hopkins COVID dashboard, versus 1.7 million Americans the government reports as living with HIV. HIV is transmitted through fluid exchange, while anyone is at risk from COVID when face-to-face with another human being. And while HIV can take up to two years to manifest after transmission, COVID shows up in a matter of days.
Based on these factors, Rubin said there wasn’t much of a response to the AIDS epidemic until six or seven years in after pressure from activists and the gay rights community.
“Considering the disease was such an unknown in the ’80s, the scientific breakthroughs and benefits of modern pharmaceutical industry really got this thing under control and ultimately contained it,” Rubin said. “It’s a very controllable illness now and that’s through all the research that happened and a lot of that was pushed by activists, and that’s because again society at large wasn’t that focused on it.”
By comparison, the first COVID vaccines just hit the U.S. about nine months after the virus arrived here. But both viruses have led to similar discussions about personal liberties: Just as many have resisted and questioned the effectiveness of masks, some had the same concerns when told wearing condoms would prevent HIV spread.
“It had the same feel with what were seeing now with people refusing to use masks,” Rubin said. “Gay men having sex using condoms came out later. That wasn’t something anyone thought about during the ’80s. It’s very interesting how that parallel is there. ... Here we know masks are helpful and stop this from spreading. Just as now you have people who don’t want to wear masks, it’s the same thing where condoms were reacted against back then. But then with time, it made a lot of sense.”
And there’s a similar sense of fear now as there was then.
“One of the issues back in the ’80s is you never knew if you were going to get sick or not,” he said. “There was always this underlying anxiety of am I next? It created almost a PTSD-like situation in some people where it was very difficult to deal with it. COVID has a lot of similar characterizations, but for different reasons. In COVID, you have the whole population isolated with the same (question of) how do people know if they’ve been exposed? The main risk is walking out of your house. It’s similar in that respect.”