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Lessons of HIV/AIDS help San Francisco battle today’s pandemic

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A doctor with the Haight Ashbury Free Clinic passes encouraging graffiti on his way to warn homeless people about the coronavirus.

A doctor with the Haight Ashbury Free Clinic passes encouraging graffiti on his way to warn homeless people about the coronavirus. Josh Edelson/AFP via Getty Images

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Dec. 1 is designated as a day to focus on and honor the millions of people who have grappled with, researched, suffered from and in some cases died from a global pandemic. Not COVID-19. This one arrived nearly 40 years ago — HIV/AIDS. 

Among the first cities in the U.S. to be overwhelmed by and battle against that disease was San Francisco, with its large LGBTQ population and, eventually, its public-health and patient-advocacy communities. 

Many public health experts who helped fight that pandemic are working now to contain COVID-19. Back in the middle of March, as COVID-19 was spreading across the U.S., San Francisco Mayor London Breed announced aggressive public health measures, including one of the nation’s first stay-at-home orders.

“Making a decision to shelter in place is not one that was taken lightly. It was taken at the direction of some of the most incredible public health experts anywhere in the world,” Breed said.

Standing at her side was one of those experts — city health director Dr. Grant Colfax. Decades earlier, Colfax, along with others fighting COVID-19, had been through the crucible of HIV/AIDS. 

“Early aggressive action — very, very important,” Colfax said.

Early in this crisis, Colfax said, he kept several lessons in mind.

“There was no place in terms of the COVID-19 pandemic where a jurisdiction was saying, ‘Oh, we reacted too quickly. We overdid it.’ In every case at that point, early action paid off,” he said.

Also, Colfax said, you need everyone working together, from academic hospitals and neighborhood clinics to community leaders.

And finally, Colfax said he remembers how isolated and stigmatized San Francisco felt, along with parts of the LGBTQ community that were severely impacted by AIDS.

“We could not wait for a federal response to take our local action. Again, I think that was built into our institutional memory in terms of the HIV response,” he said.

So how has San Francisco been doing with COVID? Well, the city is facing a new surge, like the rest of the West Coast. 

But Dr. Robert Wachter, director of medicine at the University of California, San Francisco, said the city’s still in better shape than most of the country. 

“We’ve had since this thing started 158 deaths in the city of San Francisco from COVID. And if you extrapolated that — in other words, if the country had San Francisco’s death rate, we’d have about 70,000 people who would have died rather than 260,000. So we’ve done better than any of the 20 largest cities in the country,” he said.

One effect of HIV/AIDS took decades to play out, as activists pushed the Food and Drug Administration to change its drug protocols, said NYU bioethicist Arthur Caplan.

“We see that today, as people try to enroll in COVID studies, there’s more willingness to think about emergency use and expanded use for drugs and vaccines,” Caplan said.

And that, he said, is another important legacy of what HIV/AIDS patients fought for. 

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