As concern over the coronavirus mounts in the United States, it's understandable to be paranoid about what might happen, and LGBTQ people and people with HIV are in a unique place with regard to this. It's unclear at this point what the specific impact of the coronavirus will be on our communities, but we can go into this battle armed with what we do know, and this post shares insight from health professionals, HIV media, and LGBTQ advocacy groups.

The National LGBT Cancer Network has some helpful advice and information. It also issued an open letter signed by dozens of LGBTQ advocacy groups that expands on their advice, which you can read in full at the end of this post. Also at the end of this post, a list of additional essential reads.

They offer a few reasons why LGBTQ people are at greater risk: “Lesbian, gay, bisexual, transgender, queer, plus (LGBTQ+) people are at particular risk for Coronavirus disease 2019 (or COVID-19) as a result of several factors: We use tobacco at rates that are 50% higher than the general population. Coronavirus 2019 is a respiratory illness that has proven particularly harmful to smokers. Higher rates of HIV and cancer among LGBTQ+ individuals mean that a greater number of us may have compromised immunity, leaving us more vulnerable to Coronavirus infection.”

They note as well that LGBTQ experience health disparities: “Access to care barriers leaves us less likely to get medical care, and existing health disparities mean more of us live in a state of compromised health.”

As far as special precautions LGBTQ people should take, they write: “If an LGBTQ+ person has cancer, smokes, is HIV+, is over 65 years old, or has any other fragile health condition, consider taking additional measures to avoid risk of infection. This could include more vigilance about staying away from symptomatic people, it could include avoiding larger gatherings of people, and should definitely include practicing excellent epidemic hygiene, like frequent hand washing and breaking habits of face-touching. All smokers should know they can access free cessation services by calling or visiting 1-800-QUIT NOW.”

The LGBT Cancer Network adds: “In addition, there are more than 3 million LGBTQ+ older people living in the United States. LGBTQ+ elders are already less likely than their heterosexual and cisgender peers to reach out to health and aging providers, like senior centers, meal programs, and other programs designed to ensure their health and wellness, because they fear discrimination and harassment. The devastating impact of COVID-19 on older people – the current mortality rate is at 15 percent for this population – makes this a huge issue for the LGBTQ+ communities as well.”

They also offer a few resources:

If you do not have a health provider you are comfortable with, there are several options for finding LGBTQ+ welcoming providers.

GLMA has a directory of welcoming providers here.
Human Rights Campaign lists welcoming hospitals and medical centers here.
Federal Qualified Health Centers have been receiving guidance on how to be LGBTQ+ welcoming (and offer care for low income/uninsured persons). Find a local one here.
The National LGBT Cancer Network has online directories for welcoming cancer screening and care providers. Find them hereand here.

Steve Pergam, MD, MPH, of the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center, told POZ: “When you look at who's been most profoundly ill, it tends to be people who are older, in their 60s, 70s and 80s. As you get older, your immune system doesn't function as well. It's all based on level of immune suppression. For an HIV patient who is on stable antiretroviral therapy and has a normal CD4 count, their risk may be slightly increased. People often lump HIV patients with other immunosuppressed patients, but HIV is a different disease than it was years ago. For people who have a reconstituted immune system because of treatment, I think the risk is not going to be tremendously different.”

Pergam also said the risk will likely be more severe for cancer patients on chemotherapy and solid organ and bone marrow transplant patients as well as those who use high-dose steroids for auto-immune diseases.

Pergam added: “People with a weakened immune system may be unable to fight off the virus, or they may develop an excessive inflammatory immune response known as a cytokine storm. Paradoxically, immune suppression can sometimes mean fewer or milder early symptoms, such as fever, even as the virus and the body's response to it ravage the lungs and other organs. The symptoms may be more subtle, so we have to have more awareness. Oftentimes their initial symptoms may be less prominent, but the level of complex disease may be more severe.”

Write s the Institiute of Tropical Medicine in Antwerp, Belgium: “We can only derive information from our experience with other viral infections, such as the seasonal flu caused by the influenza virus. People with a stable HIV infection (i.e. normal CD4 content and undetectable viral load) do not seem to be more susceptible to infections with the influenza virus. However, if an HIV-infected person has low CD4 levels (or other underlying diseases), an influenza infection may be more severe. Finally, the viral load may temporarily increase during a viral infection, especially if the patient is not on HIV inhibitors. Some antiviral agents used to treat an HIV infection appear to have an effect on SARS-CoV-2 under laboratory conditions. However, we do not yet know what the impact of this finding will be on patients. If you are infected with HIV, we recommend that you adhere strictly to the preventive measures.”

RESEARCH.

Testing of various treatments is underway, some related to antiretroviral medicines currently used to treat HIV.

Pharmaceutical technology writes: “AbbVie has announced plans to evaluate HIV medicine Kaletra / Aluvia (lopinavir / ritonavir) as Covid-19 treatment. The company entered into partnerships with health authorities and institutions in various countries to investigate the efficacy and antiviral activity of the medication. Furthermore, the company is aiding in clinical studies and basic research of lopinavir / ritonavir.”

Adds Poz: “Researchers are hard at work to develop treatments for COVID-19 and a vaccine for SARS-CoV-2. Certain HIV medications have shown activity against the coronavirus. Clinical trials of Gilead Sciences' antiviral drug remdesivir are currently underway in China and at the University of Nebraska Medical Center in Omaha—home of the CDC's largest biocontainment unit—where some people who contracted the virus overseas are being treated. A vaccine from Moderna Therapeutics has been sent to the National Institute of Allergy and Infectious Diseases for the first Phase I study. However, human trials are expected to last at least a year before a vaccine is ready for widespread use.”

Nature writes: “China's biotech companies have been gearing up to repurpose existing drugs, approved in the West for other viruses, as treatments for the coronavirus outbreak originating in Wuhan. Last month, Hangzhou-based Ascletis Pharma applied to the Chinese authorities to test two HIV protease inhibitors (ritonavir and ASC09) in clinical trials to treat COVID-19, the illness caused by the new coronavirus (Table 1). And Suzhou-based BrightGene Bio-Medical Technology announced in early February that it would begin to manufacture Gilead Sciences' remdesivir (GS-5734), a broad-spectrum investigational antiviral, as a treatment for coronavirus infection. Remdesivir, originally developed to treat Ebola virus and then dropped, will also be tested by Gilead in partnership with Chinese health authorities in randomized, controlled trials. “The general genomic layout and the general replication kinetics and the biology of the MERS, SARS and [SARS-CoV-2] viruses are very similar, so testing drugs which target relatively generic parts of these coronaviruses is a logical step,” says Vincent Munster, chief, Viral Ecology Unit, US National Institute of Health. Testing therapies approved for other indications also makes senses, as these drugs are already mass produced and available on a large scale.”

PREVENTIVE MEASURES.

Wash or disinfect your hands regularly and especially:

After a visit to the toilet.
Before eating.
After you have touched a possibly contaminated object like a door handle or a shared keyboard.

Wash hands with soap and water for at least 20 seconds or use a disinfectant containing at least 60% to 95% alcohol. If your hands are visibly dirty, wash them with soap and water.

Do not touch your eyes, nose or mouth with unwashed hands.

Stay away from sick people and make sure no one coughs or sneezes in your face.

Stay away from animals and their waste products. Do not visit animal markets.

Do not eat undercooked meat and non pasteurised milk products.

Wearing a mouth mask is not recommended because it does not provide good protection.

Wearing an FFP-2 mouth mask is only useful during the care of patients with COVID-19. In that case, make sure that the mask is firmly pressed against your face. Touching your face beneath the mask renders it useless.

No vaccine is available.

OPEN LETTER FROM The National LGBT Cancer Network and Health Professionals Advancing LGBTQ Equality revealing why COVID-19 may pose an increased risk to the LGBTQ population and steps to minimize disparity:

As the spread of the novel coronavirus a.k.a. COVID-19 increases, many LGBTQ+ people are understandably concerned about how this virus may affect us and our communities. The undersigned want to remind all parties handling COVID-19 surveillance, response, treatment, and media coverage that LGBTQ+ communities are among those who are particularly vulnerable to the negative health effects of this virus.
Our increased vulnerability is a direct result of three factors:
1. The LGBTQ+ population uses tobacco at rates that are 50% higher than the general population . COVID-19 is a respiratory illness that has proven particularly harmful to smokers.
2. The LGBTQ+ population has higher rates of HIV and cancer, which means a greater number of us may have compromised immune systems, leaving us more vulnerable to COVID-19 infections.
3. LGBTQ+ people continue to experience discrimination, unwelcoming attitudes, and lack of understanding from providers and staff in many health care settings, and as a result, many are reluctant to seek medical care except in situations that feel urgent – and perhaps not even then.
In addition, there are more than 3 million LGBTQ+ older people living in the United States.
LGBTQ+ elders are already less likely than their heterosexual and cisgender peers to reach out to health and aging providers, like senior centers, meal programs, and other programs designed to ensure their health and wellness, because they fear discrimination and harassment. The devastating impact of COVID-19 on older people – the current mortality rate is at 15 percent for this population – makes this a huge issue for the LGBTQ+ communities as well.
LGBTQ+ communities are very familiar with the phenomena of stigma and epidemics. We want to urge people involved with the COVID-19 response to ensure that LGBTQ+ communities are adequately served during this outbreak. Depending on your role, appropriately serving our communities could involve any of the following actions:
● Ensuring that media coverage notes the particular vulnerabilities of any person with pre-existing respiratory illnesses, compromised immune systems or who uses tobacco products. While populations – like LGBTQ+ communities – can be at increased risk, it is important to note the overall state of health that contributes to any person's increased vulnerability to contracting COVID-19.
● Ensuring health messaging includes information tailored to communities at increased risk for COVID-19, including LGBTQ+ populations. An example of such tailored messaging is including imagery of LGBTQ+ persons in any graphic ads.
● Providing LGBTQ+ individuals resources to find welcoming providers, such as the ones provided here , if they are experiencing symptoms like a cough or fever and need to seek medical attention.
● Ensuring funding to community health centers is distributed in a fashion that accounts for the additional burden anticipated by LGBTQ-identified health centers.
● Whenever possible ensuring health agencies partner with community-based organizations to get messaging out through channels we trust.
● Ensuring surveillance efforts capture sexual orientation and gender identity as part of routine demographics.
● Ensuring health workers are directed to provide equal care to all regardless of their actual or perceived sexual orientation, gender identity/presentation, ability, age, national origin, immigration status, race, or ethnicity.
● Ensuring that all COVID-19 responses take into account exceptionally vulnerable members of the LGBTQ+ communities, including our elders, bi people, and black and brown trans and gender nonconforming/nonbinary people.
● Since xenophobic responses are heavily impacting the Asian American communities, ensuring all communications and responses related to COVID-19 attempt to counter any such xenophobic responses, avoid racial profiling, and discourage the public from doing so as well.
● Ensuring LGBTQ+ health leadership, along with all providers and health care centers, are provided with timely and accurate information to disseminate.
As LGBTQ+ community and health leadership, the undersigned organizations offer to stand shoulder to shoulder with the mainstream health leadership to make sure we learn from history and do not allow any population to be disproportionately impacted or further stigmatized by a virus.
Initial signers:
National LGBT Cancer Network
GLMA: Health Professionals Advancing
LGBTQ Equality
Whitman-Walker Health
SAGE
New York Transgender Advocacy Group
National Queer Asian Pacific Islander Alliance
Additional Signers:
Advocates for Youth
Advocating Opportunity
Alder Health Services
Antioch University MFA Program
Athlete Ally
Atlanta Pride Committee
BiNet USA
Black Lives Matter Houston
Bradbury-Sullivan LGBT Community Center
California LGBTQ Health and Human Services Network
Callen-Lorde Community Health Center
CARES
Center on Halsted
CenterLink: The Community of LGBT Centers
Compass LGBTQ Community Center
Corktown Health Center
Counter Narrative Project
CreakyJoints & Global Healthy Living Foundation
CrescentCare
Darker Sister Center
Deaf Queer Resource Center
Desert AIDS Project
Desi Queer Diaspora
Equality California
Equality Federation
Equality North Carolina
Erie Gay News
Family Equality
Fenway Health
GALAEI
Gay City: Seattle's LGBTQ Center
Gender Equality New York, Inc. (GENY)
Gender Justice League (Washington State)
Georgia Equality
GLAAD
GLBT Alliance of Santa Cruz
Greater Erie Alliance for Equality
Greater Palm Springs Pride
Harvey Milk Foundation
Hetrick-Martin Institute
HIV AIDS Alliance of Michigan
HIV Medicine Association
Horizons Foundation
Howard Brown Health
Human Rights Campaign
Independence Business Alliance
Indiana Youth Group
Infectious Diseases Society of America
Inside Out Youth Services
InterPride
Keystone Business Alliance
Lambda Legal
Lansing Area AIDS Network (LAAN)
Lansing Association for Human Rights
Legacy Community Health
LGBT Center of Greater Reading
LGBT Center of Raleigh
LGBT Elder Initiative
LGBTQ Center OC
MassEquality
Matthew Shepard Foundation
Milwaukee LGBT Community Center
Minority Veterans of America
National Center for Lesbian Rights
National Center for Transgender Equality
National Coalition for LGBT Health
National Equality Action Team
National LGBTQ Task Force
Newburgh LGBTQ+ Center
No Justice No Pride
Oasis Legal Services
Oklahomans for Equality
Our Family Coalition
Out Alliance
Out And Equal
Out Boulder County
OutCenter of Southwest Michigan
OutFront Kalamazoo
OutRight International
Pennsylvania Youth Congress
Persad Center, Inc.
PFund Foundation
Pizza Klatch
Positive Women's Network
Pride Center of the Capital Region
Pride Center Of Vermont
Princess Janae Place Inc
Rainbow Community Center of Contra Costa County
Rockland County Pride Center
San Francisco AIDS Foundation
SAVE – Safeguarding American Values for Everyone
SERO Project
SF LGBT Community Center
SisTers PGH
St. James Infirmary
Still Bisexual
The LGBTQ Center Long Beach
The LOFT LGBT Community Services Center
The Montrose Center
The Social Impact Center
The Source LGBT+ Center
The Trevor Project
Thomas Judd Care Center
Thundermist Health Center
Transgender Education Network of Texas (TENT)
Transgender Legal Defense & Education Fund
Triangle Community Center
Trillium Health
TriVersity Center for Gender and Sexual Diversity
UNIFIED-HIV Health and Beyond
U.S. People Living with HIV Caucus
Wellness AIDS Services
William Way LGBT Community Center