Like HIV, Covid-19 affecting most marginalised, says leading consultant

Much like the HIV/Aids pandemic of the 1980s, Covid-19 is hitting the most marginalised and vulnerable in society the hardest, one of Ireland’s leading authorities on infectious disease has said.

However, according to Prof Mary Horgan, consultant at Cork University Hospital and president of the Royal College of Physicians of Ireland, society's response this time has been far faster due to the widespread reach of the virus.

“They are on a different scale, the two pandemics, but it is the power of the people that makes the difference” in each, she said.

As a 26-year-old eager to specialise in infectious disease, Prof Horgan went to work at the Barnes Hospital in St Louis, Missouri, part of the renowned Washington University School of Medicine.

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You built up relationships with all of the patients you cared for and the vast majority of them died

In 1990 the US was in the middle of the HIV/Aids crisis – people were dying in their thousands from a highly stigmatised illness for which there was no treatment or cure. Forty years on, many comparisons are drawn with Covid-19, widely considered the greatest threat to public health since then.

Although HIV had been quietly circulating for years, the first Aids case in the US only came to attention in about 1980, and the first reported cases the following year.

Key differences

Prof Horgan pointed out key differences in scientific responses between both pandemics. It took two years to identify HIV as the cause of Aids, while identifying coronavirus as the cause of Covid-19 took just 10 days. Doctors faced with the HIV/Aids outbreak had to wait four years before an approved test was rolled out in 1985. In the meantime the death toll mounted.

“I came into an era where there was essentially no effective treatment and all you could do was treat the infections the virus caused. So it was fairly doom and gloom,” she said of her time in St Louis. “You built up relationships with all of the patients you cared for and the vast majority of them died.”

She saw hundreds perish, but the case that springs to mind was a young African-American mother who had acquired a brain infection.

“It stood out how sick she was and how unlikely she was to get better. And she had a young family to look after. Those were the home truths of what was happening.”

Drawing some comparison between the 1980s and now, Prof Horgan noted that Aids particularly hit gay people, poor urban African-American communities and intravenous drug users, the more marginalised corners of society. Covid-19 is similarly affecting the most vulnerable people in society.

While the mortality rate was far higher among Aids victims, it did not have anything like the same reach. In fighting and understanding Covid-19, Prof Horgan stressed how crucial it is the same stigma not be allowed to take hold.

“People [with HIV] were often afraid to tell their families or their friends in case they may have been ostracised, which often happened.

“Sometimes I think they didn’t worry about dying. I think they worried about people finding out they had HIV/Aids, I think that was more of the worry.”

Misinformation

There is of course similar misinformation or “folklore” around the new illness, Prof Horgan pointed out, but she noted a more positive repetition in community response, both socially and scientifically.

“In HIV/Aids in a different sense communities came together but they would be the gay advocacy groups and were hugely important in pushing the whole research agenda.”

Although the political response was slower in the 1980s (US president Ronald Reagan would not use the term Aids publicly until 1985 when more than 5,000 people had died )as was sufficient research funding, the stepped-up response in 2020 is largely considered to be a reflection of how widespread the crisis has become.

“There was no crash in the global economy with HIV/Aids,” Dr Hogan said. “That is a probably a marker of how everybody can be potentially touched by this [Covid-19 pandemic].”