A TALE OF TWO PANDEMICS

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“It was the best of times, it was the worst of times, it was the age of foolishness , it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness…”

In A Tale of Two Cities by Charles Dickens, opens with the following iconic statement:

 

“It was the best of times, it was the worst of times, it was the age of foolishness , it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness…”

 

And it is with these words that my tale of two pandemics can begin.

 

 

1983, for a young white South African male was an amazing time to be Gay and alive. I was 18 years old, just finishing Matric, I was out and I was hitting Johannesburgs Gay scene. Disco was alive and well and I was a party boy hanging out at the Dungeon, Idols, Zipps and later on Scants and Heaven. These were discos that were of a  world class standard. For the younger readers, drugs were not really part of the scene, poppers and the occasional joint were for the main part the drugs we used. The sexual revolution that epitomised the 60’s and 70’s was still very much in play and it was a time of one nightstands, random pick ups and deep meaningful relationships that lasted maybe a week or two. To meet people you went to bars and clubs, and of course there were bathhouses or sex-clubs as well. Hook ups were plentiful and random and the town buzzed with sexual energy.

 

It was around this time that in our Gay Press and buried deep in mainstream newspapers that we first heard about this new disease called GRID (Gay Related Immune Disease) which soon became known as AIDS was killing young gay men in the US and Europe. Back home in South Africa 1983 also saw the first confirmed cases of AIDS and the first deaths in the same year.

 

Towards the latter part of the 80’s HIV/AIDS as we now call it was decimating the Gay population the world over. Caught up in the clubbing world as I was at the time, we saw pretty boys wasting away before our eyes, the haunted look and frailty of old men caught in the bodies of the young. Putting a brave face on it we saw these sad humans trying to maintain a semblance of normality, propping up a bar or listlessly trying to dance one week and gone the next. If you asked about them somebody would whisper the words “Aunty Aida came to visit” and we knew that he had passed. Memorials became the new cruising grounds, which would often take on the air of a garden party, with the victims (yes we still called them that) family members looking on with shocked disbelief.

 

Away from the “scene” a committed group of medical professionals, lawyers and citizens were trying to make sense of the growing epidemic in our Country. The AIDS Consortium came into being under the forceful guidance of Edwin Cameron housed at the Centre for Applied Legal Studies at Wits. Bringing together the organisations that were fighting the good fight to combat this disease. Hospices for Gay men sprang up, starting with the Guesthouse Project in Houghton, Friends For Life, that provided counselling and home-based care. Essellin Street Clinic that provided counselling, training and testing. ACT-UP the International AIDS Activism organisation staged “Die Ins” protesting Governments inaction and big Pharma’s greed. The TAC or Treat Action Campaign, worked tirelessly to get free Anti-Retroviral Treatment for people living with HIV/AIDS. There were many more organisations set up, all trying to make sense out of the senseless and provide aid and succour to those infected and their families and loved ones.

 

The backdrop to this fight of course was the huge societal changes we were going through as a Nation, starting with the unbanning of the ANC and the inevitable change to a Democratic South Africa in 1994.

 

As the Apartheid Government was in its final throws, the lives of Gay men, haemophiliacs and the increasing number of black heterosexual cases of HIV/AIDS were of little or no consequence.In fact there was almost an active lack of state care given especially since the number of cases and the demographics were changing and Mother to Child Transmission and heterosexual black males became part of our lexicon. Southern Africa became the epicentre world wide for AIDS and the new and the old Governments did the bare minimum to contain the disease. This of course was not only a South African phenomenon, the world over Governments failed to respond to the crisis in a meaningful way. We saw  Western film stars and pop idols die, and Princesses highlighting the cause, but on the ground the people were failed by those in charge. The public education programs were hit and miss and often failed miserably.

 

To-date an estimated 32 million people have died from AIDS related illnesses. In 2018, 71000 people died from AIDS in South Africa, 30 years into the epidemic. The difference being that for people with access to medication, free or bought, HIV/AIDS is now a chronic manageable disease the world over. The sad reality however is that numbers of infections are rising again, as the next generations are not seeing the deaths and the destruction caused by this disease and they have become complacent in the knowledge that it is treatable and not the death sentence it was originally.

 

Role on 2020, and the world is hit by another Pandemic, the second of the two that I want to talk about in this article. Towards the end of 2019 we heard about an obscure city Wuhan in China that had a new flu. COVID-19 soon became a household name. Forward thinking Nations reacted quickly, heeded the calls of scientists and soon a new, rather dystopian reality had taken hold. As the number of cases rose around the globe, Countries began shutting down. Words like “lockdown” and “Self Isolation” became common place. Karin on Facebook became an epidemiology expert overnight. Italy became the hardest hit Nation with others following quickly. We locked down, and have remained locked down for months now. By and large citizens across the globe have responded and have been compliant. Every night, people gather to make a noise to honour the essential workers that are at the forefront of this epidemic. As I write this on the live stats counter 3,523,355 people are infected the world over with 246,394 people having succumbed to COVID-19.

 

The flip side of this of course is that these numbers appear to be relatively low with a smallish mortality rate. With the lockdown of Nations, has come huge economic losses and intense financial hardships for billions of people across the world. Civil Society is starting to rebel as the reality of the economic devastation dawns, whilst some Governments have become more authoritarian.

 

Has there been an overreaction to this threat? Have we overestimated the suffering that this disease can cause? Do the economic realities outweigh the cost of human life?

 

 

We need to look at the similarities and differences of the two diseases and the responses to them in order to try and answer if possible the questions I have just posed.

 

Both are viruses. The one HIV, is body fluid borne, whereas COVID-19 is airborne. Therein lies the first and possibly the most dangerous differentiation. Being airborne COVID has the ability to infect far more people in a very short space of time. HIV needs the specific person to person transmission of the virus through one infected persons body fluid entering the body of another. It takes a deliberate act in order for this to happen, and added to this, the virus itself is very unstable and cannot live outside its host fluid for more than a few seconds. COVID-19 on the other hand being airborne is able to transmit far more easily borne through the air from an infected person sneezing or coughing. It is also a robust virus and can remain on surfaces for hours post said sneeze or cough, with the ability to infect. Both viruses can present in asymptomatic carriers and as such we are unable to visually detect who is infected or not.

 

Another similarity between HIV and COVID-19 is that they both are particularly dangerous to people with underlying health problems. Lifestyle diseases and especially those that are respiratory based are huge cofactors in the severity and ultimately the morbidity of both diseases.

 

With COVID-19 the argument often arises that the common flu is just as deadly and kills more people annually (to-date) than COVID has. However the difference is that there is a vaccine for the  common flu, it has been around in various mutations for hundreds of years, and as such we generally have a baseline immunity against the common flu. A hundred years ago the Spanish Flu became a Pandemic, in 1918/19, 500 million people became infected, with an estimated 50 million people succumbing to the disease before it was brought under control. During that time the world also experienced lockdown and isolation, and without the medical advances we have today millions more people suffered and died than perhaps we will experience today. In just over four months worldwide 3,4 million people have the Corona Virus, of which 1,1 million have recovered and 244 thousand people have died.

 

But to what do we attribute these lower numbers. Would it be the fast reaction of Nations shutting down, aided and abetted by faster communication techniques and better medical knowledge than both the Spanish Flu and HIV? Perhaps that is the answer. However if we look at two different responses form two very disparate Countries. I am talking about the USA and South Africa. Vastly different population numbers, demographics and styles of Government.

 

In the USA there was a long period of denialism by the President regarding the threat of CORONA-19 to his country. Based on very little evidence and not listening to his advisors regarding the threat and impact of the disease. He had dismantled his White House Pandemic team, and had withdrawn the CDC (Centre for Disease Control) Official stationed in China to monitor disease breakouts. He has until very recently downplayed or ignored the impact, and has posited his own non factual beliefs as truths. He also did not start preparing for the onslaught in time  and is subsequently failing to catch up with the backlog.

 

In South Africa, our President took control immediately and acted decisively, by announcing a lockdown in order to contain the spread and to give the government a chance to build up supplies of much needed PPE and medical equipment. He also listened to our highly specialised outbreak control task force and virologists and made informed decisions around the way forward. This must be seen in the light of the fact that this period of extended lockdown will not necessarily stop the spread, but may flatten the curve whilst allowing time for a vaccine or for us to ready ourselves for greater numbers of infections and deaths. Of course this also has given us the ability to test, monitor and map the hotspots of the disease, the people infected and the people they have likely infected as well. The quick response is exactly what is needed especially as we have a large number of immune compromised people with the cofactors that exacerbate the morbidity of this disease.

 

 

Whilst infections and deaths are running rampant in the USA making them the hardest hit country at the moment, with the death rate exceeding the number of American Soldiers killed in the Vietnam war and quickly catching up to the deaths of Americans in WW2. In South Africa, although the figures of infection and mortality are climbing slowly we have succeeded with huge international approval to flatten the curve to a large extent. With winter on the horizon we will see a marked increase in infections, but the difference is in South Africas ability to cope with the pandemic.

 

In the USA President Trump has expounded the virtues of many untested and often dangerous cures for COVID-19. I could not help but liken them to the Mbeki/Tshabalala-Msimang AIDS denialist years where they promoted remedies such as beetroot, garlic, lemon and African Potato as cures as apposed to ARV’s. According to a Harvard study these actions caused the premature deaths of 330000 South Africans. My sense that injecting bleach and taking untested drugs and shining UV lights may add to the death toll in the USA.

 

In the USA federal government under Trump is pushing to reopen their States from lockdown. He is threatening those States who do not abide with legal action, even though their Constitution specifically gives each State the right to self determination. Fanned by the Presidents tweets, many civil organisations are taking on their States laws, holding mass meetings and storming their State Government offices. On the one hand this is understandable, people are not coping financially, there is little in the way of subsidies and this is also fuelled by the misguided sense of the individuals rights trumping those of the collective.

 

These sentiments are being echoed by big and small business, political parties, economists and civil society in South Africa. As I see it we are on a knifes edge as a society. Many of us have been compliant, we have endured lockdown and have had the ability to keep the wolf from the door. However living in one of the most unequal societies in the world today, societal tensions, the lack of basic infrastructure and limited access to opportunity has on the one hand sown the seeds for revolt. On the other hand the limited tax base who has historically been compliant and who have worked under a system that promotes the interests of one sector of society above those of their own, have now been excluded from any financial assistance offered by the State for CORONA-19 . Despite being the major contributors to the funds and being large scale employers across the demographic spectrum. So what we have is a very angry populace, who despite the geniality and calm wisdom of the President, have been cajoled, threatened and generally dismissed by his ill informed, technocrats. These said technocrats seem to be using this crisis to only further their own agendas and who have shown up the vast disjunct in the ruling party. Petty unthought out laws that go against conventional wisdom and facts, are made laws. The security apparatus have literally become a law unto themselves having declared martial law on the populace shooting and killing citizens and  arresting people with no legal basis. There is a growing sense that the President has lost control and that there is a coup underway in the ruling party.

 

This does not bode well for us. What South Africa needs now is strong leadership through sound economic policies, based on facts not bias and above all phasing us all back into the economy to be able to regrow and mitigate the losses we have all faced. The alternative is economic meltdown (some say we are there already) as well as a civil war fighting against the downward spiral into economic and societal ruin.

 

So in conclusion, where do we stand, is it at the epoch of darkness or light? Do we continue with the lockdown and restrictions imposed on us? My take is that we need to, with major adjustments to how we get the country working again. Using a much better thought out plan to aid us back to economic and societal stability, that encompasses and encourages a social compact between Government and the civil society. A plan where we are working towards the goal of stabilising our economy and our society. The other route we can follow is the route followed by previous governments and administrations. We can ignore the science, the virology and the social impact that this disease causes. We can return to “normal” and allow the disease to run rampant as we did with HIV/AIDS  which has led to our country being the epicentre of the Pandemic with the impact on the economy and lives. We can continue to allow ill-informed Ministers to countermand the wishes of the President and Finance Minister, purely to follow their own self serving agendas.

 

As Gay people we need to use our powerful voice to add to the roar that is shouting for change, whilst abiding to the temporary rules and regulations that define our reality at this moment. Through advocacy we can make a difference, but it starts with each one of us standing up for what we believe is right, not right for now, but right in the long term to stabilise our Country.

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