Nobody Gets Out of Here Alive

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Gay pneumonia, pneumocystis carinii, or PCP, was a formerly slow-moving, easily treated lung infection largely associated with World War II concentration-camp survivors whose immune systems had been depleted by long periods of abysmal living conditions. Now doctors were seeing a version that was very aggressive -- suffocating -- and didn't respond well to treatment. And it was attacking what appeared to be healthy young men -- American men who ate and lived well. Such diseases would not usually have had a chance of gaining a foothold, much less causing death, in someone whose immune system was operating normally.

A big clue that these patients' immune systems were screwed up was the fact that they had low white-cell counts -- counts that should have been elevated to deal with infections. That led doctors to the discovery that the patients had low, or non-existent, T-cell counts (named for their shape, T-cells are considered the "sentinels" in the bloodstream that recognize the presence of a foreign invader and mobilize the rest of the immune system to deal with it). The "opportunistic infections" like Kaposi's and PCP flourished because no sentinels were available to wake up the immune troops.

But what was destroying the T-cells?

Some members of the medical community speculated that rampant drug use in the fast-lane gay community might be suppressing immune systems by destroying T-cells. Others speculated it might be a form of bacteria, like syphilis. Others, including a handful of epidemiology researchers at the Centers for Disease Control, wondered if it might be some new strain of virus. That notion sent a shudder through the medical community.

Ever since the advent of antibiotics, the bacterial infections that had plagued humankind had taken a beating. The discovery of penicillin had saved millions of lives; millions more had been saved by the wide array of antibiotics that had followed. But viruses were another story: They're not really living organisms and are therefore difficult to "kill"; a virus is a parasitic piece of genetic material that takes over the machinery of a cell and can mutate when it makes a "mistake" when replicating itself, producing a new version that may be resistant to drugs.

Whether it was the common cold or genital herpes (which to that point was the most-feared sexually transmitted disease), there were still no cures for many viruses, despite decades of funding and scientific research. But researchers had learned that the best way to defeat a virus was to contain it through the use of vaccines. By 1980, scourges like polio, as well as smallpox, measles and mumps, had all but been eliminated from the United States and other developed countries; the diseases existed only in developing countries and remote areas where vaccines were either unheard of or there was no medical infrastructure to get them delivered.

Denver physician Frank Judson and his team had played a major role in developing a vaccine against hepatitis B in 1979. In this, he was aided by the cooperation of Denver's gay community.

Unlike hepatitis A, which could be transmitted by drinking polluted water or coming into contact with human feces (such as when a restaurant worker doesn't wash his hands), hepatitis B was blood-borne. It was easily transmitted through sexual contact or shared needles -- even something as simple as using someone else's razor to shave -- and hardy enough to live for a period of time outside the human body. It caused cirrhosis and liver cancer and was thought to be responsible for thousands of deaths every year. The hepatitis B epidemic in the gay community made gay people the perfect group to test the effectiveness of the vaccine, and gay men volunteered to participate in the studies.

Now, as new cases of immune-system collapses popped up with increasing frequency, particularly in areas with large gay populations, speculation grew that a virus was the culprit. It seemed to be following the same route of transmission and was affecting the same initial populations -- gays and intravenous drug users -- as hepatitis B. That meant the virus could be in the nation's blood supply and blood products, putting hemophiliacs and people who received blood transfusions at risk. And if, like hepatitis B, it was sexually transmitted, then it would infect women as well.

The first "official" case of the gay plague was recorded in 1981 in New York. Doctors in other parts of the country, especially those involved in infectious diseases and epidemiology, held their breath, waiting to see if the contagion would spread. Those aware of the coast-to-coast bathhouse scene feared the worst.

Among them was a young infectious-diseases doctor named David Cohn, who arrived at DGH in 1981. Cohn had been turned toward infectious diseases as a medical student at the University of Illinois by an instructor named George Jackson. It was Jackson who'd pointed out that throughout history, infectious diseases had killed more people than any other medical ailments.

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Steve Jackson