The New York Times - June 5, 1983
Linda Spear

"Public Health has much to learn about AIDS - and very quickly," said Dr. Christine Williams, the county's deputy commissioner of health for disease control. "People have begun to express concern and question the risk to the general population. Even though the vast majority of confirmed cases are among confined groups and their intimate contacts, the malady appears to be infectious and could present some degree of risk to the public - particularly through our nation's blood supply."

The medical community agrees that intimate contact or exposure to blood or blood products is necessary for infection. As a result, several public agencies and private groups have responded to the reports of health officials by developing new policies that attempt to reduce the risk of exposure to general population.

The Greater New York Blood Program, the American Association of Blood Banks, the American Red Cross and Council of Community Blood Centers have issued a joint statement recommending a standard procedure for blood donation and disbursement. The policy is being followed by all Westchester hospitals.

It includes issuing educational materials to potential donors, a donor-screening questionnaire and an arm inspection to detect intravenous drug use, in addition to the existing screening procedures that assess the general health of the donor.

Groups having an increased risk of getting AIDS have been defined by the Public Health Service as including people with symptoms and signs of AIDS, sexually active homosexual or bisexual men and women with multiple partners, Haitian immigrants, past and present users of intravenous drugs and the sexual partners of those called "at increased risk." Although it is assumed that most members of these groups are not carriers, there is no means of detection and no mechanism to identify those few who may be at increased risk.

The new screening questionnaire asks potential blood donors if they have any of the following symptoms: a persistent cough or diarrhea, a history of night sweats, a history of unexplained fevers, an unexplained weight loss, any sign of swollen lymph nodes, purple or pink flat or raised blotches anywhere on the skin or mucous membranes, or exposure to a patient with AIDS. These questions are asked in privacy and direct questions about the potential donor's sexual orientation are avoided.

If any of the answers are positive, they are evaluated by a physician and the donor is deferred. At that time, the donor can choose not to donate blood.

Blood inadvertently collected from suspected AIDS vicitims is considered potentially infectious and is quarantined and destroyed. "Future recipients of blood or blood products, such as those in the general population who anticipate surgery in the near future are being advised to collect 'autologous' blood donations prior to surgery," said Dr. Bruce Heckman, former chairman of the transfusion committee at Phelps Memorial Hospital and Medical Center in North Tarrytown. Autologous refers to the potential patient's ability to provide one's own blood, collected up to one month before the anticipated surgery, and again, two weeks before, to be stored for a transfusion to that very patient in case it becomes necessary.

Such patients are also encouraged to enlist the help of family and friends with compatible blood type to donate as well. This safeguard offers the recipient the utmost degree of protection against exposure to all infectious agents."

Among the most vulnerable blood recipients are the thousands of hemophiliacs who rely on large amounts of plasma, processed into what is termed Factor VIII concentrate. Statistics reveal that AIDS-like illnesses were the second-leading cause of death among hemophiliacs nationwide in the last year.

"There is little doubt that we are dealing with an infectious agent that is transmitted through the blood and through sexual contacts," said Dr. David Sencer, New York City's Health Commissioner."

Each pool of Factor VIII concentrate goes to about 100 patients. For each hemophiliac diagnosed as an AIDS victim, there are 99 who received the same lot of Factor VIII concentrate. The 99 did not contract the illness but might do so. The incubation period for AIDS appears to vary from two months to two years and could strike any one of these 99 blood recipients at any time during that span. Because of the large number of donors who contribute to each pool of plasma, it is not possible to identify the infected donor.

This is one of the problem areas where an attempt is being made to alter the circumstances surrounding this malaldy. A suggestion has been made by a major supplier of commercial plasma products that a pasturization process be used in the production of Factor VIII, which might produce a product free of AIDS and hepatitis as well.

Because of the urgency of the current problem and predictions of as many as 20,000 cases by 1985, health officials expect additional aid from public funds for an all-out attack on this serious public health hazard. It is hoped that supported studies will provide insight into the workings of the immune system as well as into the origin of other fatal diseases.

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