Transcriber: Amanda Chu Reviewer: Rhonda Jacobs
It was 1981, in the fall.
I was a new infectious disease fellow,
just showed up at UCLA to start my fellowship.
It was grand rounds,
and grand rounds are when very interesting or rare cases
are discussed by experts.
I actually had no idea
how pivotal that grand rounds was really going to be for me.
It was about young gay men from Hollywood
who had shown up with a very unusual infection
called pneumocystis.
We were familiar with pneumocystis
but only in the setting of profound immune deficiency.
These were young, healthy men.
What the heck happened?
We didn't know.
Was it something toxic?
Were they exposed, all together, to some sort of event?
Was this an infection?
It was totally not known.
There was a lot of conversation about that.
Not long after,
there were reports from Florida,
and then there were reports from New York,
and then there were reports from San Francisco.
These gay men,
who were getting not only pneumocystis
but herpes,
all sorts of opportunistic infections.
We didn't know why,
but clearly,
this appeared to be something far greater than a local outbreak.
After that, it was Europe,
then it was Asia, then it was Africa -
this was a pandemic.
We thought it was an infection.
In fact, as the information started to come out
from the Centers for Disease Control,
they noted there was a striking pattern:
This infection appeared to be sexually transmitted.
It appeared to be transmitted in blood.
People who used intravenous drugs,
who shared needles, who shared syringes,
were also getting these same symptoms and signs.
And then it was hemophiliacs who received blood,
and then it was babies
who were born to mothers who were infected.
This was exactly like hepatitis B.
We knew a lot about hepatitis B.
Suddenly, we had a pathway forward.
This was not all unknown.
This was acting exactly like a virus that we were familiar with.
We knew about interventions.
We knew about how to prevent.
What we didn't know was how to treat.
It was so sad.
It became real to me the first time I saw an AIDS patient.
I was still in my fellowship.
We were studying acyclovir for herpes.
And I walked into a room
where the note on the door said this man was only 30 years old.
He looked 60.
He was emaciated.
He had the worst herpes infection I had ever seen.
He was in pain.
I was studying acyclovir;
I had to get a detailed history.
It was so sad to listen to this story.
It was sadder yet to realize
that all I could provide was some comfort care -
we could not cure.
But I could provide compassion and care,
and ask questions that made them think I really did care about them,
and I did.
About the same time,
we started to see another pandemic develop.
This one was all about stigma and fear and discrimination.
It was terrible to watch.
My colleagues in the hospital refused to take care of patients with AIDS.
They were fearful of being infected.
They were aghast
when I walked in the room without gloves,
without a mask, without a gown.
Because I knew that's not how this virus was transmitted.
I was able to touch my patients,
which gave them comfort and let them know I cared about them.
And I didn't care that they were infected.
Their families had thrown him out.
They lost their jobs;
they lost their apartments;
they lost their friends.
So not only were they infected with a deadly disease
but they lost everything in their lives.
I was their doctor.
I was there to take care of them.
Did I have apprehensions because there was so much [unknown]?
We didn't even know for years later that this was caused by HIV,
human immunodeficiency virus.
We didn't even have any good medications
until the mid-'90s.
We didn't have the right combination
until 2010 -
very, very slow progress.
But through it all,
even though there were so many unknowns,
I knew how that virus was transmitted.
So let's fast-forward.
It's now December ...
2019.
China - Wuhan, China -
reports an outbreak of pneumonia,
infectious pneumonia, it appears.
It spread rapidly.
By the time we heard that news,
Chinese scientists,
because of all the advances in science,
already knew what caused that pneumonia.
It was coronavirus.
The Chinese people already knew about coronavirus.
It causes SARS,
it causes MERS -
deadly, deadly infections.
But this coronavirus was different.
We call it COVID-19.
How was it different?
It wasn't as deadly,
but it was highly transmissible.
Clearly in crowded areas, it was spreading rapidly.
So where did COVID come from?
Well, COVID came
because humans and animals interact with each other,
and animals get coronaviruses,
and it's a highly mutable agent -
it mutates all the time.
So what happened is this animal virus mutated
so it could infect humans.
And so in that market in Wuhan,
it was able to transmit to a variety of people,
who then took it home,
who then took it to their friends.
By the time we heard about this in the United States,
we already knew that.
We're way ahead of where we were with HIV.
We knew how it was spread:
it was transmissible through the air.
We knew because we'd been working with another virus
very much like this for years:
influenza.
We had planning for influenza, so even though it was horrifying -
And here's what was horrifying about COVID-19:
Number one, it was a new virus.
Number two,
everybody in the world was susceptible -
there was no immunity.
And so, it was clear
that this was not going to be just Wuhan, China.
It did not take long;
in fact, instead of years, as it took for HIV,
it was weeks before we started seeing the cases all over the world,
imported with travelers,
and then easily transmitted in crowded settings.
Was I scared?
I remember HIV,
and I remember that feeling,
that "Oh my god, this is a deadly virus.
Can I do this work?"
I knew, however, how it was spread,
and I was careful with needles and blood,
and so I was able to take care of patients with some confidence,
although I couldn't really treat them appropriately
for many, many years - 20, to be precise.
But with coronavirus?
This transmissible?
This was a scary thought.
How were we going to really respond to this?
And then I remembered what it was like for me with HIV.
I'd learned to do it sort of in a trial-and-error process,
but I trusted my science, I trusted my colleagues,
I trusted my experience.
I learned slowly to always be able to deal with what is unknown
because I couldn't move forward in a predictable fashion.
So for coronavirus, what do we know?
We do know it's highly transmissible and it goes through the air.
Talking, breathing, coughing, laughing, sneezing,
all of those things propel this virus out.
Do we know how to stop that one?
Because we don't have a cure, we don't have a medication,
we don't have a vaccine.
Oh yeah, we know how to stop this one.
Because the science from way back when -
five decades ago, at least -
tells us how to do this.
You isolate.
You interrupt that flow of virus from one person to the other.
We know how to do this.
We know that you can put on a mask
or you can distance yourself from that virus being spewed out
and not get infected.
So what happened when COVID hit the US?
There was another pandemic that we saw:
People of Asian descent
were getting ugly messages -
not only in social media, but on the street and in stores.
They were being blamed because this virus was new.
There were a lot of things that we didn't know about this virus.
So it was blamed.
There was fear: What if ...
What if this was manufactured?
What if somebody's trying to kill us all off?
There was fear.
There was a lot of "We don't know anything."
"We don't know anything.
What are we going to do?"
Although the pandemic is scary for me,
I remembered about how knowledge comes forward
and how we deal with what we know how to do.
This was difficult this time.
We didn't have Facebook, we didn't have social media
when HIV first came around,
so the transfer of knowledge was not this rapid.
We didn't have people
setting themselves up as self-proclaimed experts
and confusing people with messages.
But also, people want clear answers.
And when we don't have them, I think it is frightening.
So for me, that part of the pandemic,
the dis- and mis-information is almost as scary.
But we know a lot.
And so I don't think we should be confused.
Just because we don't know everything
doesn't mean we don't know something.
We know something,
and the something that we know
can directly affect how we move through COVID-19.
When I go out,
I wear my mask,
and I stay away from people,
and I'm respectful of that distance
because I want to live through this
so that I can see the knowledge come about
that makes us safe from COVID for the foreseeable future.