Community health leaders talk coronavirus prevention for those living with HIV

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On the heels of Philadelphia’s first reported case of coronavirus on March 10, Mayor Jim Kenney called for the temporary closure of all nonessential businesses in Philadelphia to prevent further spread of coronavirus. Nine newly found coronavirus cases were confirmed in Philadelphia on Tuesday, out of 99 returned tests, bringing the total number of Philadelphia cases to 18, according to officials. 

Local and regional medical professionals talked to PGN about best precautionary practices for those living with chronic illnesses such as HIV, as well as universal precautions that everyone should take to help flatten the curve. 

“The good news is that 80 percent of people who caught this viral infection have had mild to moderate symptoms,” said Dr. Karam Mounzer via a webinar produced by Philadelphia Health Training Alliance, a program of Philadelphia FIGHT. “Fifteen percent had a severe course, and 4-5 percent had a critical course to their disease.The average time from exposure to onset of symptoms was five to six days.” 

Individuals living with HIV, whose CD4 counts are normal, are not necessarily at higher risk of contracting coronavirus, said Dr. Stuart Burstin, infectious disease specialist and medical director of AIDS Healthcare Foundation’s Philadelphia healthcare center “They should be able to handle this virus as well as anyone else. I think we have to think of this as being part of the community and we should do the same thing as everybody else does.” 

However, Burstin pointed out that there is still a lack of data on people living with HIV and whether they have a heightened risk of becoming infected with coronavirus. “It is possible that this, like influenza and some other things, there may be a difference but not a major one,” he said. “We don’t know yet. There’s a lot of questions about how coronavirus has caused illness.” 

José de Marco, ACT UP Philadelphia organizer, told PGN that it’s paramount that people living with HIV make sure they have enough medication, “and if they’re in need of refills to contact [their] health provider now to get them,” he said. 

“I think the best [thing] folks can do is make sure they have enough [HIV] medication to last at least for a few months. Also to make sure they have a line of communication [to their doctors] — some places have online portals so they can reach their doctor. But make sure you have access to your doctor, and maybe [make sure] a partner or someone in your family is able to reach the doctor in the event you’re not able to.”

This falls in line with the Center for Disease Control and Prevention’s recommendations for people living with HIV as related to coronavirus prevention: “ensure ample medical supply (30-days supply at all times,) keep vaccines up to date (influenza, pneumococcal), establish a plan for medical care if isolated or quarantined, maintain a social network, but remotely.” This information comes via a slide in Philadelphia FIGHT’s webinar.   

On a larger scale, Burstin explained that in addition to washing hands and sanitizing surfaces, social distancing is really crucial in stanching the spread of the virus, but acknowledged that it may prove difficult to do. 

“This virus is also transmitted by small aerosoles — that means it’s in the air around anyone positive,” he said. “The most unfortunate thing is that people carry it before they feel sick, as opposed to the SARS agent. Here we have people walking around with it and that means that many people can get infected by any one person. How do you prevent that? Stay away from people as much as possible.” 

JD Davids, who was part of ACT UP Philadelphia for 13 years and pioneered Project TEACH when Philadelphia FIGHT was in its infancy, created and runs the Cranky Queer Guide to Chronic Illness and is working on another group called Chronic Illness Leadership for Emergent Times.    

“Rather than seeking to parse risk or to look for a marker, like lowest ever CD4 counts, or current viral load being barely detectable — instead we could look at this in terms of, ‘What would you do right now if you thought you may have this coronavirus?’ and then do it,” Davids said. 

Davids broke down precautionary measures into two categories: universal precautions, and what he tentatively called “most careful precautions.” 

“Universal on a basic level is, knowing what we know now, what should we do,” he asked rhetorically. “I think we’re going to invent new ways of intimacy including hugging each other from behind. If the idea is to not get things from our hands into our mouths, eyes or nose, that’s what we should be doing.”

Davids also briefly discussed coronavirus prevention in relation to sex education. “I think the primary thing to stop, especially when it comes to sex, is stop kissing,” he said. My new slogan is ‘kink not kissing.’”

Under the category of “most careful precautions,” Davids explained that those living with chronic illnesses, including HIV, who do contract an acute disease, frequently become sick again in the near future.

“It’s not proven from the flu but it’s known that there can be a second wave of illness that happens from having a major illness. When I think about those people living with HIV who may be virally suppressed, but have been living with it for a long time, I think that we have to stay aware that there may be follow-up challenges.”

Burstin and other medical professionals warned of the dangers of overloading U.S. medical systems as people continue to get sick from coronavirus. Although U.S. cities are taking reactive and proactive measures by cancelling events and shutting down non-essential businesses, the virus will continue to spread because it is impossible to quarantine people individually, Burstin explained. He predicts that over the course of time, most people will contract the virus. 

Dr. Mark Watkins, physician at Mazzoni Center, said his biggest concern is about his patients who are on dialysis. “They have to go to their dialysis three times a week,” Watkins said. “That’s going to be a risk in an environment like that. If there’s a healthcare worker with any chronic illness, working in an urgent care center or an emergency room, they are going to be at extra risk.”

In collaborative efforts to ensure the health of their patients, the team at Action Wellness will be calling all of their 2,000 patients to make sure they are following the right prevention procedures, making sure they have the right medication and healthcare, according to Action Wellness executive director Kevin Burns. 

“[We want to make sure they understand that they could be at increased risk of infection with COVID-19 if they have a low CD4 count, if they have an unsuppressed viral load, if they are 60 years of age or older, if there’s any history of heart disease, kidney disease, diabetes or chronic lung disease,” Burns said. “A lot of our clients are older, so we want to focus on those first.”

One Day at a Time on Tuesday opened their food bank specifically for people living with HIV. The recovery and addiction services organization upped the ante on their cleaning efforts and is reducing their hours at the moment. Bebashi Transition to Hope is also open to the public, and has extended the hours of their food pantry from a two-hour window to the entire day in order to avoid crowds of people. 

Burstin underscored that we as a society have adapted to changing conditions in the face of health epidemics, or in this case, a pandemic. However, he cautioned that younger people who may be asymptomatic and who choose to go out to a public place still risk exposing the virus to others, including those with weaker immune systems. 

“Just because you’re younger and are going to do well, is absolutely no reason not to worry about being infected, because that’s how it spreads,” he said. “Isolate even if you’re young and healthy.”

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