22

GRID

In August 1980, at Denver General Hospital, medical student Mark Brunvand was sent up to the ninth floor, critical care, a regular rotation for a third-year student. Years later, Dr. Brunvand would be Jason’s cancer doctor. Now, in med school, he was forming the philosophy that would guide him in his career. His world view, like that of other doctors and researchers at the time, was being formed by a strange new disease and the havoc it wreaked.

On that August day, on the ninth floor, Dr. Brunvand went into the room of a patient who had come in with an unidentified illness. The man now lay in bed, hooked to a ventilator, unable to talk. Dr. Brunvand felt the man was trying to communicate through sad and terrified eyes.

Another med student told Mark: Nice guy. We don’t know what’s going on. He’s probably going to die. Looks like pneumonia, and he’s gay.

In a way, this is part of medical training; students take the labs and babysit the terminal patients. The labs in this case didn’t make sense.

“Everybody was baffled. Nothing cultured out,” Dr. Brunvand reflected. Then it looked like a parasite. “But we didn’t get any confirmation.”

They looked for reasons. What was unusual about this guy? Nothing to explain this. “We don’t know if this guy has been smoking crack, has been exposed to toxic gas or other guys in the neighborhood.”

Dr. Brunvand remembered looking at the guy and feeling completely helpless.

It was the kind of story unfolding all around the country.

June 5, 1981. The CDC put out case studies of five patients in Los Angeles. They were treated for pneumocystis carinii pneumonia. Two died. All were labeled “active homosexual.” A lab at UCLA reported the cases. It’s a novel place, this lab; it has been set up to combine clinical work with immunology. The researchers at UCLA discovered that the patients had “profoundly depressed numbers of T lymphocytes.” T cells.

On July 3, a second CDC report came out reporting twenty-six cases in Los Angeles, New York City, and San Francisco.

Here’s a snapshot of the kind of patient who showed up, baffling doctors.

At a bedside in Memorial Sloan Kettering Cancer Center in New York City, that same month, July 1981, a greenhorn physician, Dr. Mike McCune, looked at the racked body of a twenty-four-year-old man whose symptoms made no sense.

“His lungs were concrete,” Dr. McCune said, reflecting back.

He’d been moved from Cornell, where they couldn’t find a cause. He was surviving thanks to what McCune called a “super-duper ventilator” that managed to get air into his failing lungs. The patient was African American and had a history of intravenous drug use. In medicine the term differential diagnosis basically means: What’s the likeliest cause among a list of probable causes?

“Cancer, cancer, cancer. What else could be causing it? An infection? But what kind of infection?” Dr. McCune said. “We put a tube down his throat and brought stuff up, and looked under a microscope. And what did we see?

“Not cancer. Not bacteria.”

It was a parasite called pneumocystis carinii. Under the microscope, this looks like round clumps. The lungs of McCune’s patient were swarming with these things.

The thing is, ordinarily they’re not that dangerous. “You probably have them growing in you right now,” McCune told me. “But your immune system is keeping them down.”

Dr. McCune was transfixed. “I went back to the lab and thought: What’s this guy got?”

The man held on for weeks, and then he died.

They were all dying.

Not Bob Hoff.

Bob’s phone rang in mid-1982. The caller was Michael Ward. He was a good friend of Bob’s and an undertaker at Fort Lincoln Cemetery. He’d been a lover of Ron Resio, a man Bob had had sex with too. Michael was calling with bad news and with a request. The news was that Ron had been admitted to Building 10 at the National Institutes of Health with an unusual illness. The request was that the NIH wanted to take the blood of Bob and four other men whom Ron had been with.

By now, there was a term for a new kind of STD showing up in the gay community. The illness was called GRID, gay-related immunodeficiency. Bob Hoff read about it in The Blade, a newspaper for and about the gay community in Washington, D.C.

The five men showed up at the NIH. They were met by a team heading up a small, elite research group that had been set up by Dr. Tony Fauci. Team members included two accomplished physician-scientists, Dr. Cliff Lane and Dr. Henry Masur. Dr. Fauci was baffled, concerned—and fascinated.

“I looked at this and said, ‘Oh my God, I don’t have any idea what’s causing this,’ but when we look at the immune system, it’s completely messed up. It’s a disaster,” Dr. Fauci said.

These guys started showing up who couldn’t fight off basic infections, the kinds of viruses and parasites that the rest of us kick as a matter of course. The human defense system had been breached.

“Holy shit, if there ever was a disease I should be studying, this was it. This has to be an infection, but I didn’t know what it was,” Dr. Fauci said. “It’s clearly attacking the immune system. It’s an unbelievable situation where a virus is attacking the immune system. We’ve never had that before. We didn’t know what the hell we were dealing with.

“I stopped everything else I was doing.”

Fauci had found his dragon. Or was it really a windmill? Could it be fought or was it so elusive as to be practically illusory?

When Bob Hoff and four other men showed up at the request of the NIH to see their good friend Ron Resio, they were first asked to give blood in the auditorium at Building 10. Bob Hoff’s blood test was a near disaster. The doctor, in search of a vein, nicked an artery.

“Blood spewed all over this doctor,” Bob recalled. “He was scared to death.”

The blood draw was something of a shot in the dark. Fauci and his team didn’t know what they were looking for, maybe something in the blood, anything that might tell them what they were dealing with. At the very least, Dr. Fauci said, “we wanted to store their blood for future study.”

After the blood draw, the men went to see Ron in the critical care ward. This once long-haired behemoth looked emaciated; he was covered with purple lesions, and tubes protruded from all over his body. Beyond the mystery illness, Ron was very interesting to Dr. Fauci because Ron had a twin brother. Might his twin shed light on what the hell was going on inside Ron’s immune system?

That day, Ron’s friends and lovers stared at him, shocked. They tried not to cry, because as Bob put it: “That would’ve made it about us, when this was about him.”

After the men left the room, they let their emotions go. “Then we went to Glenn’s house and we all had sex,” Bob said.

You read that correctly. The group of men, having seen the first of their friends dying of something terrible, went to one of their homes and had an orgy.

Bob put it to me just as plainly as I’ve shared it with you. I asked what prompted such a response, and he said, “Well, we practiced safe sex.” But there was more to his answer than that, and it was another instructive moment for me in the conversation about how we define ourselves in terms of self and other, just as the immune system seeks to do. Bob and his friends had one another, and they had sex as a defining characteristic and a sign they were not as alien as they’d felt growing up.

Plus, Bob told me, many of these men were part of Washington, D.C.’s elite in-crowd. One of them in the orgy that day had been a campaign manager for a presidential candidate. Many others in that inner circle—just not there that day—were part of the “upper echelon of the Republican Party,” Bob told me. He’d been a Republican too for many years. They hewed to what let them feel safe and as if they belonged, one another and sex.

That was how the day ended for Bob, in catharsis. “For me, it was the last time I’d see a lot of those guys.”

On September 24, 1982, the Centers for Disease Control and Prevention put out a report saying it had received 593 cases of what is now called acquired immune deficiency syndrome (AIDS). The condition that Dr. Brunvand had seen in Denver and Dr. McCune had observed in New York now had a name. Of the reported cases, 41 percent had died. Many of them had the parasite pneumocystis carinii; others had Kaposi’s sarcoma or another opportunistic disease that was ultimately proven to have a viral basis. These were viruses that took advantage of a suppressed immune system. In many of us, such infections would be held in check and certainly wouldn’t kill us.

There is a telling sentence in the CDC note: “The CDC defines a case of AIDS as a disease, at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for diminished resistance to that disease.”

To repeat: occurring in a person with no known cause for diminished resistance to that disease.

Less than 1,000 cases had been reported. Still, the medical community took notice. The immune systems of these patients were so befuddled that they were failing to hold in check viruses and other pathologies that ordinarily caused no problem. And not just one pathology, but multiple ones. In other words, some new thing was unraveling our most basic and elegant defenses.

Fourteenth-century Florence in the grip of the Black Death. (Wellcome Collection)

It is not an understatement to say that some big thinkers saw this as an end-of-days scenario. “We were in a full-blown panic. It was the plague,” one immunologist told me. “We thought everyone would die.”

At this point, I’d like to take a moment to show proper respect for some other plagues.

Bubonic plague in the lab. (Pete Seidel)

The 1918 flu pandemic killed up to 50 million people worldwide, according to the Centers for Disease Control, nearly 700,000 in the United States. The CDC says that it is still not totally clear what made this flu so deadly. It has been hard to study in part because it is deadly to even deal with. But one important theory is that what made it so deadly is that the flu virus in humans—to which we’d adapted some immunity—had combined with a genetic variant from birds. What this meant was that many human beings did not have an antibody to combat the flu, even among the massive pantheon of antibodies we all get born with. This is what the CDC says: “Influenza experts believe that a pandemic is most likely to be caused by an influenza subtype to which there is little, or no, preexisting immunity in the human population. There is evidence that some residual immunity to the 1918 virus, or a similar virus, is present in at least a portion of the human population.”

But not everybody died. That’s because some people could mount an immunity. Some people did have the right antibody somewhere in their infinity machine. All hail the value of diversity!

Another big daddy of a plague was the Black Death, a killer of millions of people, including, at one point, as much as half the world’s population in the fourteenth century. The Smithsonian magazine describes three different ways the plague attacks: through the skin, attacking lymph nodes (bubonic); through the blood; through the lungs. The deadly nature of the plague owed to several mutations in the bacteria that made it elusive to the immune system and easy to transfer. Our immune system, in the case of the lung version, was virtually helpless.

And a quick but important word about the bird flu that scared the living daylights out of infectious disease specialists in 1997. A three-year-old boy died in Hong Kong, and then seventeen more people died, struck down by a terrible virus found in birds. The idea was completely heretical when Dr. Keiji Fukuda, an influenza specialist from the Centers for Disease Control, landed in Hong Kong to do the forensics, but it turned out to be true—and all the live birds in the local markets were killed to avoid further contamination.

There is a key aspect to that flu that is consistent with other deadly viruses. The people who died weren’t overcome by the flu itself but by their immune system’s response to the flu. The immune system went into hyperdrive to stop what it perceived as an extraordinary foe. Massive inflammation followed.

“It was a cytokine storm,” Dr. Fukuda said. “People were dying from having an overwhelming response.”

But by the early 1980s, we’d seen flu before. GRID, or AIDS, or whatever the hell it was called, was something new. If you prefer your cup half full, there was a bit of good news. This potential pandemic happened as science had begun to get a handle on the immune system.

A massive machinery had started whirring that would change everything about how cancer was treated. It was all because of AIDS.

“AIDS was the 9/11 of immunology,” a developmental biologist told me. “We suddenly got this panic and everybody started throwing money at immunology.”