Photo: Names Project Foundation

If you, like me, were born in the seventies you remember the eighties. Looking back, I remember my own HIV/AIDS learning process starting with hearing whispered rumors. Many of these rumors turned out to be wrong (#FakeNews). It took years for me, and many, to gradually comprehend the mainstream science. If only we would’ve had ‘The Internet’ back then… Seeing the AIDS Memorial Quilt on TV in 1987 made a huge impact on many, including me…a sexually active young man. I was also privileged. I had a progressive mom who took sexual education of her kids very seriously and was very open and frank about the subject of sexuality.

Maybe my memories are conflated but, in general, I believe that it has taken years for the general public to more accurately understand the general science of HIV/AIDS. And I believe that, to this day, many people:

  • Still don’t fully understand the science or;
  • Don’t care enough about the science or;
  • Incorrectly believe: “It won’t happen to me” or;
  • Can’t afford to follow the science’s guidelines.

The (combination) of the above can be summarized as a lack of ‘Awareness‘. I list these without any judgement. But I believe that the consequence is that, now 40 years later, guidelines are still not followed enough to allow for the eradication of HIV/AIDS. For example: Why the use of PrEP hasn’t gone mainstream eludes me. The argument that it could lead to promiscuity is, to me, absurd. And driven by ideology not science and fact. I bet some of you haven’t even heard about PrEP.

I believe that the lack of ‘Awareness‘ is a challenge that we face with the fight against most diseases. Generally speaking: Increased awareness leads to increased adherence. People are less inclined to ‘follow the rules’ if they don’t understand them. I am hopeful that now, 40 years later, a majority of people understand the principles of HIV transmission and what measures exist and why they exist. I would like to contribute to the fight against respiratory viruses: Influenza (Flu) and SARS-CoV-2 (COVID-19) by using an HIV/AIDS analogy, in the hopes of helping with our ‘Awareness‘.

If we educate the masses about the science of viral transmission, people’s awareness will increase and infections will decrease

HIV Transmission Recap

According to Wikipedia: “In most cases, HIV is a sexually transmitted infection and occurs by contact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids“. So if you can avoid the transfer of these bodily fluids from one person to the next, you eliminate the risk of infections with HIV. At the risk of being conceived as arrogant, this sentence on Wikipedia I find a little misleading. I believe it should read: “HIV is a virus that is transmitted by contact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids. In most cases it transfers via sex, because humans engage in sexual activity. A lot if you compare it to other behaviors” 😉

At the same time I recommend reading the story of Kimberly Bergalis. Ever wonder why your dentist wears latex Gloves? If you study the case of Kimberly Bergalis you’ll notice that it took years for ‘Government Experts’ to overcome their own ‘Expert-blindness’. And I fear that history is repeating itself….

A list of measures against HIV infection

Please note: This list is not exhaustive or complete and should not be construed as me giving any advise on this topic. It’s purpose is solely to explain the analogy of this blogpost.

  • Adapting our natural behavior completely. Abstinence and/or isolation. Not fun, but effective;
  • Adapting our natural behavior somewhat. Example: ‘self-service’ or a ‘handjob’ are relatively risk-free.
    Slightly more fun than abstinence;
  • Preventing transfer. A condom’s goal is to prevent transfer of specific bodily fluids.
    Slightly more fun than ‘self-service’ or a ‘handjob’;
  • Direct Mitigation. Example: An antiviral drug, such as PrEP.
    Its goal is to avoid infection, after transfer of these bodily fluids.
    One could argue: More fun than a condom (although it has some side-effects, including risk of other STD’s);
  • Indirect Mitigation. Example: An HIV/STD Test.
    If you are infected you can take your responsibility to not infect others.
    You might have had a lot of fun the night before, but you took a bigger risk.

The point here is that there is a balance between behavior and risk. And that ‘prevention’ and ‘mitigation’ go hand-in-hand and are not competitors. At least, they shouldn’t be. You can use the same principles for the fight against respiratory viruses; Influenza and SARS-CoV-2.

A list of measures against Respiratory Virus Infection

Please note: This list is not exhaustive or complete and should not be construed as me giving any advise on this topic. It’s purpose is solely to explain the analogy of this blogpost. But I must tell you that, based on scientific findings, I believe that the coronavirus spreads predominantly through the air. It isn’t called a respiratory virus for nothing. The list below is based on this premise.

  • Lock-downs and/or Curfews.
    Not fun and that’s obviously an understatement. But it’s effective;
  • Adapting our behavior somewhat. Example: ‘Social Distancing‘ and a ‘Sanitizing‘.
    Slightly more fun than Lock-downs and Curfews;
  • Preventing Airborne transfer. A COVID CONDOM!
    A. I am a major proponent of Increasing Humidity.
    Its goal is to prevent Airborne transfer of the virus. A Specific Humidity (above 8 gr/kg, which is a relative humidity of 50% at room temperature) reduces the amount of Airborne particles (ie. the droplets evaporate less). In the condom analogy you should realize that increased Humidity also acts as a ‘spermicide’. A higher humidity (i) de-activates the virus more quickly and (ii) strengthens our Mucosa (which is our bodies’ natural ‘Firewall’ against viruses);

    B. I am also a supporter of Faceshields and Facemasks. Just like condoms, you get them in different shapes, colors and sizes. And there are differences in effectiveness between all of them. Proper use also has a major effect on their effectiveness. Regardless of the effectiveness, the principle is the same: preventing Airborne transfer;

    Both A and B are a lot more fun than Lock-downs and/or Curfews;
  • Direct Mitigation. On top of humidity, (i) Air Purification (Airpurifiers, either through UV Purification, HEPA Filters and/or Ionization) and (ii) Ventilation are my second favorite measures. Their goal is to mitigate infection, after the virus is released into the air. A third mitigating measure, just like PrEP, is a Vaccine.
    A lot more fun than Lock-downs and/or Curfews;
  • A PCR Test. If you are infected you can take your responsibility to not infect others. You might have had a lot of fun before, but you took a risk.

What I would like you to take away from this…

Allow me to finish this blogpost in a Typically-Direct-Dutch-Fashion. 🙂
One of the riskiest behaviors related to HIV is engaging in an orgie without any protection and without getting tested (beforehand). Like the commercial below, used in AIDS Awareness campaigns, explains: when you do this, you are basically having sex with every bedpartner your bedpartner(s) has/have ever had. During this activity, that many consider to be quite enjoyable (no personal experience myself), the risk even increases with the level of exertion.

Here is the point…
In terms of COVID-19, you are engaged in an orgie every time you enter a communal area, that has people breathing in it or even had people (aerosols linger in the air). Even exertion plays a role. Heavy breathing actually creates more aerosols and you inhale more deeply when exerting (like singing, shouting or screaming) yourself.

Don’t panic when you read this. But be aware. The latter is my point.

This animation is also available in Spanish, Dutch and my native language; Papiamento. A language spoken on the tiny island of Curacao and a vacation spot I highly recommend. An island in desperate need because tourism has collapsed, despite a low prevalence of the virus. This due to a high humidity and a lot of sunlight. 😉

My conclusions

Abstinence and/or isolation are not sustainable solutions. Not only do they go against our most basic and natural instincts, they undermine the very fabric of our society. I would even dare state that they would – ultimately – lead to the collapse of our species. I believe that the civil unrest we are witnessing across the world is a direct result of our increased and sustained isolation. We must stop these measures at our earliest possible convenience. Currently they are doing more harm than good. I say this in the context of the other measures (ie. a condom did wonders), at our disposal. This should always be a last resort, not the first thing you go for.

‘Social Distancing’ and a ‘Sanitizing’ are not sustainable solutions. These should be temporary measures. And frankly, their effectiveness is also related to Humidity. The risk vs. rewards fails during a period with low humidity because aerosols linger. We should be honest about this. Just like we should state honestly that ‘Social Distancing’ does have an effect inside. Less warm bodies inside, less aerosols, less evaporation, even less aerosols, less infections. But explain this to the public! Only a handful of scientist understand this.

A curfew does have an effect, when you don’t implement humidifiers. Because, at night, risk of infection increases because (a) there is no sunlight to de-activate viruses more quickly and (b) the risk of infection increases because of the length of exposure. But if you have a condom on, you should be allowed to have sex. And that is exactly what a humidifier and facemasks are: Condoms for Covid.

Our highest priority should be prevention. And prevention is achieved through education. As scientists we have a moral responsibility to call a spade a spade.

SARS-CoV-2 is a Respiratory Virus that predominantly spreads through the air, because the water droplets contained in our breath evaporate, depending on the humidity. Which people inhale. If if we inhale enough, we get sick. Full stop. End of discussion

Anything less is misleading and undermines our ability to fight this disease. And the scientific community has a responsibility here that can not be overstated…

Because I started with HIV/AIDS and Kimberly Bergalis. Kimberly was a virgin that got infected with HIV because her dentist, who was HIV Positive, did not wear gloves. He didn’t wear gloves because, for years, people thought HIV only got transmitted through sex. It took the US CDC MANY YEARS to change course. The Bergalis case itself took more then 3 years. She died, many thinking this virgin had been a slut. To me she was, like hundreds of thousands of people, the victim of a lack of awareness and ‘expert blindness’. I hope we learn from earlier mistakes.

Let’s honor Kimberly Bergalis’ legacy, who passed away 30 years ago.
Please join me in spreading #CondomsForCovid. Thank you.