What the US (and the world) should learn from AIDS denialism

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On the 31st of December 2019, a cluster of pneumonia cases was reported in Wuhan, China. A novel coronavirus strain, which we now know as SARS-CoV-2, was eventually identified as the agent causing these pneumonia cases: a respiratory disease we now know as COVID-19. With a new disease comes new questions: What is the disease course? Do we have a working vaccine? What can we use to cure it?

Yet one thing about the SARS-CoV-2 quickly became apparent: its lipid envelope is no match for alcohol based sanitisers. Initial reports also speculated that the sun and higher temperatures inactivate SARS-CoV-2 particles. Perhaps these observations, coupled with an urge to answer some of these unknowns and provide leadership to a country with 3.5 million confirmed COVID-19 cases, propelled United States President Donald Trump to suggest the use of disinfectants and UV lights to combat SARS-CoV-2 infection. He can be quoted as contending:

“Supposing we hit the body with a tremendous, whether it’s ultraviolet or just very powerful light, and I think you said that hasn’t been checked but you’re going to test it,”

“And then I see the disinfectant. Where it knocks it out in a minute, one minute and is there a way we can do something like that by injections inside or almost a cleaning, cause you see it gets on the lungs and it does a tremendous number on the lungs.”

Whilst numerous health officials have had to caution the public against ingesting disinfectants, this is not the first time in history the use of disinfecting and industrial agents has been suggested to thwart a viral disease. We have a lot to learn from our handling of the HIV/AIDS epidemic, as well as the multitude of disinfectant agents peddled as possible cures during that time.

VIRODENE

Virodene was a prospective HIV/AIDS drug developed in South Africa, but rejected by the scientific community. Controversy surrounded the safety and efficacy of the drug itself, of which the main ingredient is the industrial solvent dimethylformamide. Dimethylformamide is an industrial solvent used in the production of acylic fibers, plastics, pesticides, synthetic leathers and adhesives. It was discovered by Michelle Olga Patricia Visser, who claimed to have noted the properties of the drug while conducting experiments to freeze animal hearts using this substance.

Visser went on to administer the drug to 11 patients without approval, an action that was later condemed by the South African Medicines Control Council. This council went on to comment that it would be more likely the agent killed patients with AIDS than the disease itself.

However, in 1997, researchers working on this drug were given the opportunity to make presentations to the South African cabinet, where they recieved support from then Deputy President Thabo Mbeki, and then health minister Nkosazana Dlamini-Zuma. Commenting on the rejection of human trials by the Medicines Control Council, Mbeki wrote the following:

Two thirds of those affected world-wide are in Sub-Saharan Africa, including a 2,8 million strong South African contingent. Often I have wondered whether those who have generated sand storms with the greatest enthusiasm, did not, in fact, seek to achieve precisely this result!

By writing the above, Former President Thabo Mbeki meant to suggest that those who rejected Virodene were intent on creating an AIDS outbreak.

Not only is the story of Virodene a cautionary tale against the use of industrial solvents in medicines, but it also serves to caution us against the politicisation of disease. Trump has repeatedly labelled Coronavirus Disease 2019 as a ‘Chinese disease’, and is rumoured to have begun the process of withdrawing the United States from the World Health Organisation (WHO), even though the details of this are not yet clear. History, such as research ventures into agents such as Virodene or Oxytherapy, tells us that rejecting global and scientific consensus, whilst suggesting the use of industrial solvents, does not work well.

Additionally, masks have become politicised as well. Numerous news outlets have documented instances of Trump’s refusal to wear a mask in public. According to a CNN article, Trump can be quoted as saying ‘I didn’t want to give the press the pleasure of seeing it,’ in reference to wearing his mask backstage before removing it for a tour of a Ford plant in Michigan. While there was an initial confusion about the benefits of wearing masks, especially because they needed to be put aside for frontline medical workers, it has become clear that they are pivotal for the prevention of Coronavirus transmission. Yet their politicisation rings a familiar bell for South Africans who lived through the early years of the HIV/AIDS epidemic, where the government refused to provide Highly Active Antiretroviral Therapy (HAART) until constitutionally compelled to do so by the courts. According to Nicoli Nattrass, various nostrums and traditional medicines were pushed to the forefront, and even administered to those with CD4 counts of 2 (i.e. extremely immunosuppresed). Nicoli Nattrass writes:

When the opposition Democratic Alliance (DA) complained about the manufacture of ‘fake cures’ such as ubhejane by what it called ‘backyard chemists’, the Department of Health retorted that the DA was simply perpetuating racist stereotypes (DOH, 2006). The DA responded by investigating the matter further and laying charges of fraud and of contravening the Medicines and Related Substances Control Act against the manufacturer of ubhejane.

Where this matter became politicised are the ideals it is believed informed the government actions around this period of time. Nicoli Nattras again states:

One answer to this question is that it was part of his [Thabo Mbeki’s]broader ‘African Renaissance’ agenda to recast the image of Africa in more positive terms, and to strengthen Africa’s capacity to address domestic problems (Mbali, 2004; Cameron, 2005). In terms of this perspective, the conventional approach to AIDS would have undermined Mbeki’s project in two ways: firstly by appearing to judge Africans negatively for the fact that AIDS spread so rapidly (i.e. by pointing to the African origins of the AIDS epidemic and to the sexual promiscuity that underpinned its spread); and secondly by placing Africa in the demeaning position of having to rely, once again, on outside assistance and on Western biomedical advances, to combat it.

…The first issue was imbued with the politics of race and identity. There is evidence that Mbeki, like Richard and Rosalind Chirimuuta (1987) before him, saw the scientific search for the origins of HIV in human-primate interaction as an attempt to ‘blame’ AIDS on Africa and as demonstrating the world’s profoundly racist views of the continent. (Van der Vliet, 2004: 82–3 — Mbali, 2004: 113–114). Such a view reflects very closely the view of AIDS denialists who argue that immune deficiency in Africa can be blamed on poverty (not AIDS) and that those who suggest that HIV is sexually transmitted are merely repeating colonial racist stereo-types about African sexuality (see e.g. Lauer, 2006).

From this is is thus clear that scientific integrity should not be undermined by political agenda, even though there have been instances in history where scientific enquiry has been used to justify widely held societal constructs.

What was also shown by the Virodene scandal was the need for a leader who can seperate the criticism from the personal attack, something that Trump often does not do well. In his repeated comments on the mechanisms through which America should be made great again, and even in his personal attacks to leaders such as New Zealand Prime Minister Jacinda Ardern, what is clear is that Trump interprets the unhappiness of the public with his leadership as a personal attack on his values and personality. To his defence, the media also have not spared him from critcisms on his mental health status and narcisstic tendency, with Tom Nichols of The Atlantic opining that exposure to these personality traits with each presidential briefing makes us worse people. Nicoli Nattrass again provides insight into South Africa’s previous leadership:

Other commentators chose instead to focus on what they saw to be key character flaws. For example, Van der Vliet argues that Mbeki’s: ‘hypersensitivity to criticism, especially where he believes there is a racist dimension to the comment, and his suspicions, some say paranoia, concerning the pharmaceutical industry, the media and conspiracies aimed at him and his government, make it particularly difficult for him to deal effectively with AIDS…. As time passes, Mbeki comes more and more to bear the hallmarks of the classic tragic hero — a man so driven by a vision that, combined with a fatal dose of hubris, he is unable to heed the warnings all around him, and destroys himself’ (2004: 88).

With our current pandemic, we should be, as democratic constituents, weary of our leaders and their motives.

OXYTHERAPY

In 1998, the BMJ ran a piece by Pat Sidley in which clinics offering oxytherapy are discussed. Also situated in South Africa, these clinics were injecting ozone into AIDS patients without the supervision of a medical doctor and without ethical approval. However, research has been done on this by Kenyan researcher Basil Wainwright. Wainwright invented ‘polyatomic aphaeresis’ which involves injecting ozone into AIDS patients and he claimed to have cured 371 them, yet he is also a man who served prison terms for fraud in both the US and Britain, and has been called ‘a conman of the highest order’ by then Kenyan director of medical services Richard Muga. He was permitted a license from the Kenyan government as he was providing his services on charitable terms but was actually charging thousands of pounds for treatment.

What is especially interesting is that Ozone is a disinfectant, and so the research and intentions surrounding it’s usage do not stray too far from Donald Trump’s claims that a disinfecting or industrial agent can be used to treat the coronavirus. A post on Nanobble claims that ozone is used to disinfectant vegetables and seafood. Furthermore, a Medical News Today article makes mention of Ozone being touted yet again as a possible treatment for fighting arthritis, fighting viral diseases, disinfecting wounds, activating the immune system, treating ischaemic heart disease, macular degeneration, and cancer. This is in line with a claim made in a 2011 paper by Elvis and Ekta:

Ozone therapy has been utilized and heavily studied for more than a century. Its effects are proven, consistent, safe and with minimal and preventable side effects. Medical O3 is used to disinfect and treat disease. Mechanism of actions is by inactivation of bacteria, viruses, fungi, yeast and protozoa, stimulation of oxygen metabolism, activation of the immune system.

Yet in 2019, the FDA warned against using ozone therapy due to the lack of evidence available to conclude that it is effective or safe for medical use. The same (aforementioned) Medical News Today article claims that usage of ozone therapy in an inappropriate manner can lead to lung damage or death. This is yet another striking similarity between the ozone hype and recent disinfectant claims, as ozone has only been proven to kill such viruses outside the body. It’s worth mentioning that it can also be a harmful pollutant, resulting in air embolism, blood borne infections, and bilateral visual field loss.

Lockdown and the economy

Many have contended that hard lockdowns extending for too long will cause debilitating damage to the economies of various countries, and they’re right. BusinessTech recently reported:

The key finding was that approximately three million people lost their jobs over the lockdown period [in South Africa], representing an 18% decline in employment from 17 million people employed in February, to 14 million people employed in April 2020.

But what then do we make of arguments that countries should ‘open up’ for the sake of economic livelihoods? Whilst a valid one, it does have it’s limits. One cannot forget Trump’s promise that America would be open by Easter despite the chokehold Coronavirus held over much of the world. Looking again to South Africa’s previous handling of the AIDS epidemic, a lesson in economic considerations reveals itself. Nicoli Nattrass writes:

In short, the argument requires that government lacked any policy flexibility with regard to the economic challenges, and that Mbeki and the government were prepared to sacrifice the lives of children and adults in a cynical pursuit of fiscal discipline, which they had to disguise in a cloak of AIDS denialist mythology.

Therefore, we should not reopen either too quickly or without the necessary precautions in the name of fiscal necessity, as lives can be lost.

What do your leaders say?

Former South African president Jacob Zuma once made headlines for claiming that taking a shower after sexual intercourse would prevent HIV infection. Recently, President Donald Trump made claims of a simolar controversial nature. He claimed at his Tulsa rally that testing be slowed down to prevent a rapid increase in statistics. He later said it was meant as a joke, but the same concept was once discussed in South African policy making circles. Nicoli Nattrass writes:

…the dissidents argued “AIDS would disappear instantaneously if all HIV testing was outlawed and the use of antiretroviral drugs was terminated” (ibid: 15). The result was total non agreement between the dissident and orthodox scientists.

The solution is never to run away from defining the extent of your problem, and Trump’s rally statement, even if intended as a joke, remind South Africans of a dark time in history when such excuses prevented some from receiving the medical attention they needed.

A lesson in research ethics

The testing of Virodene presented an ethical problem: the drug was administered to patients without approval. Whilst similar reports have not emerged about Coronavirus research, hydroxychloquine studies that concluded the malaria drug was inefficient when treating COVID-19 patients has since been retracted. According to WebMD:

The study was withdrawn because the company that provided data would not provide full access to the information for a third-party peer review, saying to do so would violate client agreements and confidentiality requirements, The Lancet said in a statement.

“Based on this development, we can no longer vouch for the veracity of the primary data sources. Due to this unfortunate development, the authors request that the paper be retracted,” The Lancet said in a statement.

This serves to prove that regardless of how far along the world has come in it’s research endeavours, it still has the tendency of forgetting that ethics are what underpin the public’s trust in scientific conclusions, and so the veracity of our scientific reports is necessary now more than ever. We can not afford to foster a culture of mistrust during this pandemic.

Can we compare these two outbreaks?

When discussing the current Coronavirus pandemic, the default is to compare it to other Coronavirus outbreaks such as SARS or MERS, or viral outbreaks that are transmitted in a similar manner, such as the Spanish Flu outbreak. Not only does comparing HIV/AIDS outbreaks and responses make for opportune lessons in history, but to address the semantics, these diseases share similar features: we know a lot about HIV/AIDS, but a lot is still left unknown. This is the same with Coronavirus. Furthermore, according to a recent Forbes article:

A few recent studies on the effects of HIV and SARS-CoV-2 indicate that they do have some similarities. Shanghai-based researchers provided evidence that SARS-CoV-2 can infect T lymphocytes, the same cells targeted by HIV. Other researchers have documented that individuals with severe COVID-19 may exhibit lymphopenia, or an atypically low number of lymphocytes in the blood. Likewise, HIV infection results in this abnormality, eventually causing the immunosuppression associated with AIDS. But these findings should not cause us to assume that SARS-CoV-2 is like HIV.

To wrap it up

The lessons presented to us from South Africa’s response to the HIV/AIDS outbreak present valid reflections for this point in history. Aside from acknowledging what our leaders say, it teaches us to be critical. Furthermore, it overtly teaches us that perhaps disinfectants and industrial solvents don’t make for the best anti-virals for use in humans. Lastly, not only should we respect scientific integrity, we should viciously guard it too. These are the only ways we can forge a new path in the midst of a pandemic disease we know little about.

Your neighbourhood physician-politician. 2nd year medicine. Instagram: @asandevilane

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