Could the National HIV Strategy Help Guide the Covid Fight?

That could not be more different than the current situation with Covid-19—which, if trends don’t change, will be the third-leading cause of death in the US by the end of the year, behind only heart disease and cancer. Though the federal government is putting effort behind vaccine development with Operation Warp Speed, there is still no comprehensive top-down public health response, no agreed-upon steps to get us out of this, and no targets that would help us judge how well we are doing.

There isn’t even a list of things to avoid because they will make the pandemic worse—which is why, for instance, Florida governor Ron DeSantis could announce Friday that he is fully opening his state’s economy, despite the likelihood that cases will increase. “Unbelievable. This is precisely why we need a nationally coordinated Covid-19 response,” Steffanie Strathdee, a longtime HIV epidemiologist and associate dean of global health at the University of California San Diego School of Medicine, responded in exasperation on Twitter.

She followed up in an email to WIRED: “When the US developed a bipartisan national AIDS strategy, policymakers put their differences aside and realized that we should be fighting the virus instead of each other,” she wrote. “We’re now facing another pandemic that has already infected more than 7 million Americans, and yet we have no national coordinated plan. As a result, states are left to make policy decisions in a vacuum, and it is costing us thousands of lives.”

To date, the closest the US has come to a national plan is one proposed in July by Peter Hotez, a pediatric infectious disease physician and vaccine researcher who is founding dean of the National School of Tropical Medicine at Baylor College of Medicine. His “October Plan” set containment benchmarks, adjusted to local conditions, that would force cases to low enough numbers that contact tracing could become feasible—and which would allow schools and economies to reopen safely by October 1.

It was not adopted.

“The fact that we haven’t had a national strategy is a major reason why we’ve been the epicenter of the pandemic for most of 2020,” Hotez says. “And there’s no end in sight. Now we have 200,000 deaths. We’ll be at 300,000 deaths by the end of the year. We could be at 400,000 deaths by the time of the inauguration.”

Only a top-down national strategy, flexibly administered from within the federal government, can adjust to the variability of the pandemic across the country, he says. That encompasses not just responding to current caseloads, but parcelling out vaccines in response to local epidemics in the near future. “The White House basically left Covid response to the states, and we’ve already seen leaving it to the states doesn’t work,” he points out. ‘They don’t have the epidemiologic horsepower to know how to do this—and also, they don’t have the political cover” that a federally created plan could give them.

To be fair, some states have tried to work together for good. Witness the banding together of three Western states and six Northeastern states in the spring in separate joint agreements over data-sharing and purchasing supplies, or the compact announced earlier this month in which 10 states will collectively buy new rapid Covid tests. All of those actions were proactive and, simultaneously, desperate. They addressed issues that a federal plan might have provided for—except the feds are absent.

There are questions circulating among public health experts over whether the national HIV strategy is the right model for responding to Covid-19. The two are, after all, very different diseases, with different modes of infection and progression of illness. What they have in common is their size—in 2018, the last year tabulated, 770,000 people around the world died as a result of AIDS. And as with HIV/AIDS, Covid-19 overwhelmingly affects minorities and other marginalized groups.

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