It’s hard to believe that this month marks my one-year anniversary of joining Northern Virginia Family Practice. I want to thank everyone – colleagues and patients alike – who have made me feel so welcome here. This was a big transition for me, but I was ready to make a change allowing me to move towards a model of practice where I could be more engaged with my patients and elevate the level of care for them. Little did I know that my first year at NVFP would also bring about the worst pandemic that the world has seen in years. We often compare the COVID-19 pandemic to the Spanish Flu pandemic of 1918, but I think that it’s also very relevant to remember the HIV/AIDS epidemic that we first encountered in the 1980’s. In fact, our home of Washington, DC currently has one of the nation’s highest rates of total HIV infections at 46.3 per 100,000 people (Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017). This virus continues to impact us today though it rarely makes the news anymore.
Much like what COVID-19 is doing to our global community in 2020, the Human Immunodeficiency Virus (HIV) similarly turned our world upside-down when infections started showing up in the early 1980’s. Though I was still far away from medical school at that time, others do recall what it was like to care for those affected with HIV/AIDS early in the epidemic. Imagine having HIV/AIDS before the advent of medications to treat it. You were sick and alone in a hospital room. The phlebotomist team would be too afraid to draw your blood. Even the nutrition staff wouldn’t come into your room, and instead would leave your food outside the door.
Sadly, COVID-19 has in some ways similarly isolated us. Without good treatments or immunity (in the form of a vaccine and/or herd immunity protection), Social distancing has become a very necessary yet heart-breaking way to control the spread of this virus. And for those who do get hospitalized with COVID-19, the isolation seems even worse when unrecognizable health care workers in layers of Personal Protective Equipment (PPE) care of you, friends/family are not allowed to visit and comfort you, and tragically some people do die alone without having their loved ones nearby.
Another striking similarity between HIV/AIDS and COVID-19 in the U.S. is that people of color are being affected by this virus disproportionately. The reasons are probably similar and reside in the fact that this population is more affected by poverty and reduced access to healthcare where testing and treatment can be offered. Also, in the case of COVID-19, social distancing is sometimes less possible for people of color who frequently work in the “essential” service industry (think grocery workers, delivery workers, factory workers, and even health care staff). Staying in your home is not an option. Staying at home also assumes that you have a home. Homelessness and financial instability are both factors that prevent access to healthcare and therefore lead to worse outcomes.
Something unique to the HIV/AIDS epidemic is that it has also affected gay men disproportionately in the U.S. As we enter June and Pride Month, it’s important to also recognize the painful stigma this has brought to this community, despite the fact that we are all at risk for HIV. Thankfully with new prevention strategies, such as PreP (or pre-exposure prophylaxis) medications, the incidence of HIV among the gay and bisexual male population are finally starting to level off.
With COVID-19, we are waiting for the same to happen to our community at large. Prevention will be key to controlling this pandemic, which is why social distancing, face masks, hand washing, and eventually a vaccine are such important aspects to controlling the COVID-19 pandemic of 2020. Once thought to be a virus far away from our U.S. shores, we quickly learned that we are all at risk. COVID-19, like HIV, does not discriminate.
So what does this mean to me? What have I learned in this past year since transitioning to a Concierge Medicine model of practicing? Simply, the Power of Prevention.
This, above all, is what is driving our survival right now. The way I practice medicine now allows for a deeper level of commitment to helping patients, physically and emotionally. Those I don’t touch with my hands, I hope my voice and actions can reach them.
The pandemic, disruptive as it has been to our personal and professional lives, has offered us an opportunity to step outside our overscheduled lives and refocus, to reset, and to maybe (for me) to recommit to a mindset that allows one to move towards a more affirming healthcare system for all. That’s also what I think of when I recognize Pride Month – the hope that kindness towards the human race as a whole will get us through. We are, after all, all in this together. It’s been a long road to understanding HIV, and the science is moving even faster with COVID-19, but let’s not forget the many lessons we have learned along the way and come out stronger, kinder, and more compassionate than where we started.
“Healing in Kindness & Acting for Change”
Cecily Dvorak Havert, MD
Northern Virginia Family Practice