Lessons learned from AIDS could improve COVID-19 response | Opinion
Former Philadelphia Health Commissioner Stuart Shapiro shares suggestions for the city's response to coronavirus.
As the former Philadelphia Health Commissioner who led the city’s response to the AIDS crisis in the 1980s, and with nearly five decades in crisis management, including time as Massachusetts’ Deputy Secretary of Health reacting to the radiation release from Three Mile Island, I understand the need for decisive action, truthful and prompt communication, and strong leadership in a public health crisis.
Over the last two months, I have remained publicly silent, offering private counsel to those responding, and keeping my own notes for an “after-action” report once cases of COVID-19 begin to decline. But I cannot stay silent any longer as this crisis has many similarities to the sudden emergence of AIDS and how we responded may inform and improve the response at the local, state and federal levels.
AIDS exploded early in Philadelphia, along with San Francisco and New York. It was deadly, there were no diagnostic tests, the methods of spread were little understood, treatments were elusive, and citizens and healthcare workers were scared. Some hospitals were overwhelmed with cases.
The good news was that leadership at the local level, where the sick were located, responded and collectively demanded state and federal action … and they did respond.
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The City Health Department immediately brought together scientists and physicians from Philadelphia’s finest hospitals and medical schools to begin to deal with the epidemiology. We built a team of disease trackers to trace contacts of those with the early symptoms of AIDS as there were no tests. Other cities did the same thing and we compared results. This informed our communications, and we continued to track, track, track. This greatly reduced spread. We were the first city to distribute condoms widely and set up programs to inform the public of the dangers of needle sharing. As soon as a rudimentary diagnostic test was available, we figured out how to prioritize its use. Eventually, we helped set up programs where anyone who wanted a test could get one.
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By 1985, thousands of non-monogamous heterosexuals were regularly testing. We systematically and quickly implemented safety protocols for EMS, police, and other first responders, directly addressed the sexual activity in our local jails, and made sure all healthcare providers knew what they should do to protect themselves. With early, honest, and frequent communications, we reduced panic and reduced spread.
Given that experience, Philadelphia should be acting more proactively, and with greater urgency, in the following areas:
Disease/contact tracing should dramatically increase in Philadelphia. Use restaurant inspectors and other Health Department personnel to ramp up this effort.
The homeless: It should be Code Blue right now, just as it would be a freezing night. No homeless should be on the streets of Philadelphia.
EMS protocols should be developed and announced on how first responders will be protected and how they will screen patients from a distance before even thinking of transporting. EMS has always been over used by Philly citizens.
Philadelphia should develop contracts with private ambulance providers so that they are ready to respond when the need arrives.
The city jails have been slow to develop social distancing and the correctional officers are not well protected. This will lead to greater spread in both the jails and in the city. First steps: Spread out meals throughout the day so prisoners have some space while they eat. Move prisoner to single cells now. Many are empty, and protect employees.
And, the federal government must do its part. Bobbing and weaving at press conferences is no substitute for distributing life-saving supplies, organizing a national testing and disease tracking effort, and following sound scientific advice. Americans are strong and can handle the truth.
Stuart H. Shapiro, M.D. is the former Philadelphia Health Commissioner, Massachusetts Deputy Health Secretary, and Senior Staff Member of the U.S. Senate Committee on Health and Scientific Research. He currently is a strategic healthcare consultant. shapirostu@gmail.com