Coming Home

The nation has become gripped with fear, a healthy fear, of the Ebola virus and how easily it might spread out of control in our crowded urban centers. The fear has not yet turned to panic, and one can feel the struggle of our public health personnel as they try mightily to prevent panic and still do what must be done to prevent a full blown outbreak here at home. Naturally, people wonder if the government is telling us the truth about the minimal danger it claims Ebola poses.

So, are we being told the truth about Ebola? Is the government lying to us simply in order to prevent a panic?

It all depends on how one defines terms such as truth and lying. There is the unvarnished truth, therapeutic doses of truth (which contains lying by omission), etc. We do well to stop and consider the full dimensionality of the moment we are in, and consider the historical lessons from the beginning of the AIDS pandemic. Critiques offered here are not political, and indeed there is plenty of bipartisan criticism to go around. We are not in a political moment. We are in an American moment, facing an indiscriminate killer. Sound public policy will require rising above petty politics and sniping, while seriously evaluating current and historic national policies that will drive this crisis one way or the other. We must leave politics behind, as we are at the water’s edge.

Currently we have an administration in Washington that sees no need to restrict air travel from the endemic areas in Africa, has committed 3,000 troops to fight the epidemic in Africa (with no detailed articulation of what that mission might be), and has no articulated plan for how to bring them all back safely.

At this writing, we have in Dallas a Liberian who lied on his immigration papers regarding contact with an infected person at home. He reported to a hospital in Dallas when he felt ill, was misdiagnosed, and sent home with antibiotics. As his illness progressed he called an ambulance, vomited in the parking lot of his complex, and has exposed at least 100 people who are now under surveillance, and many under quarantine. Further, many parents are keeping their children home from school, as some of the exposed are children.

There are no quarantine stations to which people are being sent to wait out the 21 days it can take Ebola to manifest itself. Indeed, some of the people being monitored have attempted to leave their homes. These policies and lapses have the makings of an outbreak of unprecedented magnitude. They can also generate a panic which could cripple the national economy if people begin to lock themselves up at home. So, what to do?

First, we do well to remember some history from the AIDS pandemic. In the early days of the pandemic, we were told that this virus could only be contracted through transmission of bodily fluids such as semen, vaginal secretions, and blood. All true, but incomplete. We were told that there was no evidence that HIV could be transmitted by oral sex, and that was an early, deadly error. Many lesser authorities would extrapolate from this that stomach acid would kill any virus swallowed during oral sex.

“No evidence,” in science does not translate into, “Impossible.” It simply means that there is not a study establishing the behavior as a risk factor. It turns out that the lining of the esophagus contains a great many cells that are a part of the mucosal immune system. They transport viruses and bacteria across to waiting immune system cells, the very cells HIV attacks. So in those early days, in the absence of definitive proscriptions on sexual behavior, and before condoms and dental dams were recommended for use during oral sex, many may well have contracted the virus through that transmission vector.

Then there was the disparity between what the CDC was saying and what the AIDS activist (read homosexual) community was advocating with condom use. This is a key piece of history that shows what happens when political and ideological issues run up hard against scientific truth, and the blind spots in the extant data that well-informed scientific and medical judgement can fill in. The following is from a series I wrote five years ago dealing with the condom issue as it related at the time to AIDS activists excoriating Cardinal O’Connor for not giving church approval for their use in combating HIV. What is striking is the very different posture assumed by the NIH and CDC. From the article:

Certainly Cardinal O’Connor and the Bishops knew all too well the rise in promiscuity following widespread access to the pill in 1968. They knew the CDC data linked here which show the steady rise in STD rates. (Click on “all slides”). Fast-forwarding to today for a moment, Research out of Harvard agrees with the Church that Condoms can make HIV worse in Africa, among other places.

In the mid-80’s, the New York Times, the self-styled ‘paper of record’ carried several articles which cast a long shadow over the absolutist claims of condom safety by AIDS activists.

On August 24, 1987 the Times reported “20% of Condom Batches Fail”.

On May 12, 1988 the Times reported that 33 million condoms had been recalled in 1987 with a failure rate of 4/1000. The paper failed to reconcile those numbers with the 20% failure rate reported in August of the previous year. The paper did report that the 4/1000 was an improvement over the 4.8/1000 rate in 1986. These rates for domestic condoms were better than the 6.5/1000 in 1987 and 7.3/1000 in 1986 for imported condoms.

On August 18, 1987 the Times ran a major article entitled “Condoms: Experts Fear False Sense Of Security”. From the Article:

“MANY health officials have begun to voice concern that the campaign to encourage condom use to curb the spread of AIDS may be misunderstood, creating a false sense of security in people whose behavior continues to put them in danger.

“Experts say condoms should minimize the spread of the AIDS virus among the heterosexual population, especially when used with spermicides containing nonoxynol-9, which has been found to kill the virus in test tubes. The experts say this justifies recent campaigns promoting the devices.

“But they stress that it is unknown just how much protection condoms offer. The officials note that condoms have been widely rejected as a method of birth control because they frequently fail, and say the devices may be no better – in fact, may be worse – at curtailing AIDS. They warn that sexually active men and women should not assume that they are protected simply because they use prophylactics.”

The article is filled with notable quotes from experts, all expressing doubts.

It was an interesting time. Because the spermicide nonoxynol-9 was found to have killed HIV at high concentrations in test tubes, it was added as a lubricant and fail-safe against condom tearing or slipping. In recent years we have learned two devastating truths.

1. Nonoxynol-9 in the low concentration on condoms is ineffective against HIV.

2. Nonoxynol-9 in the low concentration on condoms causes ulcerations in the vaginas of women who use them frequently, such as sex workers. This means that N-9 does not kill the virus when condoms tear, and facilitates infection by compromising the vaginal and rectal epithelia.

Finally, a week after the desecration of Saint Patrick’s Cathedral by ACT-UP (reported in Part I), the Times reported that The National Women’s Health Network requested the FDA to remove approval for two new condoms:

“A public-interest health group said today that it had petitioned the Food and Drug Administration to withdraw marketing clearance for two new types of condoms because neither had been tested for effectiveness in preventing pregnancy or protecting against disease.

“The National Women’s Health Network, a nonprofit group based in Washington, charged that the Federal agency had erred in approving the devices under a legal provision that waives testing requirements if a new device is substantially like one already approved.”

It was an interesting time. Anti-retroviral medications were being hastened to market. New condoms were being hastened to market all in a desperate attempt to throw the entire arsenal at this virus. But desperate measures can have unintended consequences.

In time, what will be most remembered is the stubborn insistence of so many to having sex outside of a life’s commitment to mutual monogamy with ONE individual in the face of a disease that is so devastating.

Where were the AIDS activists when these reports were being published by the Times?

A candid and sober reflection on those early missteps in assessing HIV and its spread, what we thought was safe, and how wrong many of those assurances were should temper and guide our steps with an overabundance of caution with a far deadlier virus that threatens to erupt into a full-blown pandemic.

In part II we’ll consider the missteps being made with Ebola, and how to correct them while there is still time.