Q&A With Biden Advisor, UCSF Professor Dr. Eric Goosby, Part 3

Synapse: According to Biden, the purpose of the coronavirus advisory board is to “manage the surge of reported infections, ensure that the vaccines are safe, effective, and evenly distributed, and to protect at-risk populations.” However, in your words, what is the importance of having a solid advisory board during a major public health crisis like the COVID-19 pandemic?

Dr. Goosby: You know, when you’re responding to a pandemic or an outbreak where there are inevitably going to be inequities in the response, you can’t respond to everybody at the same time at the same intensity; choices are going to have to be made.

When you’re in that kind of a situation, as a government or as a city or as a university — whatever that institution entity is, you are always better off by being transparent and inclusive. And you want to be able to say to the population that you have accessed true expertise and be transparent about that.

So when you make a policy decision, make a decision that inevitably has those who benefit and those who don’t, you share the responsibility.

That’s the reason to do it. It’s the right thing to do, is the short version of that. But the political reason you do it is to ensure that you have made every effort to be solicitous, inclusive, intellectually honest, and transparent.

Synapse: You have had over 35 years of experience working in the field of HIV/AIDS, including treating patients on the frontline when HIV/AIDS began to emerge in the 1980s. What sorts of similarities, if any, do you see between the AIDS epidemic and the current COVID-19 pandemic?

Dr. Goosby: I would say [that there’s a] complete congruence of events and needs that COVID has presented to the public health system, just as HIV did in 1981.

In 1981, we had the same lack of awareness of HIV until there were enough people who had advanced in their disease far enough to develop opportunistic infections, present to the emergency room, and get admitted to the hospital.

We didn’t see it before that moment. So our first reaction, just as with COVID, was when they hit the ER.

You then go backward into — what is this? With HIV, you have a disease that has a ten-year incubation period in developed worlds. And with COVID, you have a two-day incubation period.

So the awareness of the threat, understanding the natural history of it — it’s a virus, it infects cells, the cells propagate, and then the person becomes infected; and marching out all the time intervals and the relative threats of those different stages in the pathophysiologic development of the virus, and the body’s response to it — create more infectious, less infectious moments, depending on the immune response to the crescendo of virus.

All of those viral dynamics are exactly the same for COVID, as they were for HIV.

Our ability to understand how it infects individuals, seeing the individuals that seem to be more susceptible to infection — people at high risk; the same awareness that this is moving differently through the population, and our ability as a delivery system responding to it — seeing the importance, knowing the importance of understanding those differences of virus movements through populations; allow us to see who has disproportionate impact in disease, and informs us as to where we should put our prevention and treatment interventions in terms of geography and population.

And all of that had been worked out with HIV. We understood the need for that. But instead of it occurring over years in HIV, it occurred over months — over days to months — with COVID.

It took us five years to develop a test for HIV — a blood test. We didn’t have any way to know if you were positive or negative until 1985. And it wasn’t available to the general clinicians out there until ’86. Antiretrovirals were the same way.

We had very ineffective, but effective-enough-better-than-nothing antiretrovirals until 1994, the first one available in ’89. That gave us a window into what we needed to do for COVID — the need to go right to diagnostics, right to therapeutics, and our extraordinary ability to jump over a lot of Phase 1, 2, and 3 studies for vaccine development. And it worked. But we’re still looking for a vaccine for HIV and TB.

So to answer your question, [COVID-19 and HIV] run completely parallel challenges to medical delivery responses. You can see a blueprint of HIV responses that are all needed in responding to COVID.

Our delivery systems all over the world — those that were most responsive — came out of HIV platforms and out of TB platforms, because for those diseases and the people who care for them, we need to develop that prevention effort on contact tracing and case finding skillsets that those diseases still require, and that some other diseases don’t.

The capability in health professionals globally for case finding and contact tracing skills, and for keeping that information into a delivery system so you can mitigate against spread in a population, is low. If those systems aren’t robust, they don’t work, and they don’t have the impact that you need them to have.

And we’re seeing that over and over again with ineffective COVID contact tracing standup efforts.