An Evidence-Based Comparison of HIV/AIDS and COVID-19: A Review / Špela Šalamon

I'm joined by Dr. Špela Šalamon, Nuclear Medicine Specialist Physician and biomedical scientist. She has contributed to global efforts in understanding and mitigating the impacts of COVID-19 and published several papers addressing the risks following COVID-19 infections, emphasizing the necessity for proactive health measures. In October of last year, she co-authored and published the AJPM Focus review article, COVID-19 is “Airborne AIDS”: provocative oversimplification, emerging science, or something in between?

The review compares and contrasts “observations of the immunological impacts of COVID-19 and HIV infections […] examining shared and distinct mechanisms, such as immune dysfunction, vulnerability to opportunistic infections, accelerated aging and neurocognitive disorders, […] highlight[ing] critical parallels and their implications.”

Our discussion addresses the key points, including why it was important for Dr. Šalamon and her colleagues to publish this review comparing these very distinct viruses, including the necessities and challenges of carefully drawing these parallels from a public health messaging standpoint.

She elaborates on what we know and can anticipate as the COVID-19 pandemic blows past its sixth-year anniversary, what paths exist for attending to the dire public health implications of its continued spread, and what lessons we can learn from the ongoing HIV/AIDS pandemic.

It’s a difficult needle to thread, but Dr. Šalamon, both in this interview and in the review, manages to do it. Hyperbole is rarely useful, and calling COVID-19 “airborne AIDS” is, at the very least, controversial and, at worst, a hindrance to public understanding and proactive mitigation and treatment. But as she explains, listening to long COVID sufferers and researchers and what the now massive amount of data shows necessitates a reasonable examination of the facts. Dr. Šalamon provides those facts in this interview.

We wanted to provide a scientifically sound and well evidence-based comparison, which would put this comparison into sober perspective. We know that nowadays a lot of misinformation spreads, and if someone says, It's airborne AIDS, it can sound very scary and disorienting. And we wanted to say, people, it's not AIDS, right? But there are a lot of similarities that we have to pay attention to and that have very real consequences, in clinical practice, in public health, and in other places where a lot of people might not be aware that these parallels even exist.

— Dr. Špela Šalamon

Episode Notes:

• Read Dr. Šalamon’s AJPM Focus review article, COVID-19 is “Airborne AIDS”: provocative oversimplification, emerging science, or something in between?

• Read Dr. Šalamon’s work at the World Health Network

• Follow her on X

• The music featured is by Nick Vander, used with permission by the artist

Image adapted from: VMD visualization of a 1-billion-atom aerosolized SARS-CoV-2 virion, rendered using the CPU version of Tachyon on a workstation with 1TB of RAM. This visualization was created from the all-atom models described in the SC'21 Gordon Bell COVID-19 finalist project "#COVIDisAirborne: AI-Enabled Multiscale Computational Microscopy of Delta SARS-CoV-2 in a Respiratory Aerosol", by Dommer et al. / Source: Tachyon john, CC BY-SA 4.0, via WikiCommons

EP 399 / REC 01.04.2026  / REL 02.16.2026

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The following transcript was edited for clarity.

PATRICK FARNSWORTH: Well, we'll just dive in. Dr. Šalamon, thank you very much for being here. I've been really looking forward to having you on the podcast. So just thank you so much for your time today. 

DR. ŠPELA ŠALAMON: You're very welcome. And thank you for your invitation. 

FARNSWORTH: You and your colleagues published in October of last year—now we're in the early days of January of 2026—COVID-19 is “Airborne AIDS”: provocative oversimplification, emerging science, or something in between? I'm sure you had to wrestle with even how to title the review paper a little bit because you are really trying to represent what you're doing in the review. 

So if we could just talk a bit about why it was important for you and your colleagues to put this out there and why comparing HIV and SARS-CoV-2 infections is useful from a public health messaging standpoint?

I think this has been a very controversial issue within Covid advocacy groups, Covid-cautious people, and maybe in the general public as well. So in what ways can we make these kinds of comparisons that are sensitive and nuanced?

ŠALAMON: Yes, absolutely. That is a very big challenge. And we decided to tackle this challenge because we saw, as researchers who pay attention to the community, that this term "airborne AIDS" has been spreading. We have seen it spread on social networks, and we have even seen it referenced in some mainstream or other media or online forums or various places. And we wondered, why are these patients choosing to describe their experience with such a term? 

We also have been reading the literature all these years since the emergence of COVID-19, and we noticed several other groups and authors make the comparison between the virus HIV and the disease AIDS that it eventually causes and SARS-CoV-2, the virus that causes COVID-19, on various levels, from molecular to pathological to neurological to immunological and even societal and political. But we did not see or find any review that would cover all of these parallels and contrasts. Also, we wanted to provide a scientifically sound and evidence-based comparison that would put this comparison into a sober perspective.

We know that nowadays a lot of misinformation spreads, and if someone says "it's airborne AIDS," it can sound very scary and disorienting. And we wanted to say, people, it's not AIDS. But there are a lot of similarities that we have to pay attention to and that have very real consequences in clinical practice, in public health, and in other places where many people might not be aware that these parallels even exist.

We have heard COVID-19 compared to many other diseases, especially diseases that we have very, how should I say, easy experiences with, like the common cold, even influenza. I know that influenza can be serious, but most people experience it as a sort of mild cold-like disease and other viruses like that—we say respiratory viruses, whatever that means. So we will see in the continuation of this interview that SARS-CoV-2 is not really a respiratory virus; it's a respiratory-transmitted virus. 

But we wanted to put this into perspective and to compare it to a disease where comparisons are actually kind of justified to some extent. Of course we have to be very careful because AIDS as a disease and HIV as a virus are very emotional, loaded subjects with a very difficult history. We have to be very sensitive and consider the stigma and the discrimination that these people who have had this disease have faced, and of course the struggle that they have faced to get their disease recognized and treated. 

What we wanted to achieve with this article is to point to this and say we have to learn these lessons from the AIDS pandemic, and we shouldn't repeat these mistakes.

I wrote the main draft of this article, and then the other co-authors, of course, contributed, and if you read the article, you will see it has this sociopolitical part, and it's very hard to publish sociopolitical topics in biomedical papers. They don't want to publish anything that has sociopolitical topics. And so we had to be very selective and resourceful to get this paper published because we had to find a journal that would publish something that is mainly a biomedical article but also has a sociopolitical part. So I think that was a big success, and I insisted and wanted that part in there even if most journals didn't want it.

I think it's so important, and the main message of the paper is that we really have to learn from the AIDS pandemic. And this way, I think we also honor the struggles of the HIV-positive community, and we give them the respect due by learning from what they have achieved and from the mistakes that were made during the ongoing, should I say, AIDS pandemic.

FARNSWORTH: Right. We'll definitely get into that sociopolitical element of it because I think that's actually kind of how it's being discussed most of the time. It's being discussed within that frame. So, yes, we'll talk about that a little more. 

We've been dealing with HIV since, I believe, the 1970s. It really kind of emerged in public consciousness in the 1980s. And so, there was a lot of stigma attached to that, largely because it was mainly gay men in the gay community in particular—speaking as someone from the United States—that seemed most immediately impacted. The amount of stigma that was around that is a cultural and social factor. And this was during the Reagan administration, of course. 

So without getting into all of that, we're now decades past that point. It's been pretty well established, and people basically understand, I think, how HIV is transmitted for the most part. And I think people mostly understand at this point how SARS-CoV-2 is transmitted. But I do think it's important to just lay this out because when we're talking about the comparisons, we probably should define the differences. Could you simply go over what makes these two viruses different?

ŠALAMON: Yes, the biggest differences, of course, begin from their very classification. HIV is an RNA retrovirus, and it transcribes itself into our DNA, and that's the biggest issue, basically. While SARS-CoV-2 is a coronavirus, it does not do that as far as we know—at least one thing it doesn't do, thank God. Because it can do a lot of things. But as far as we know, there has been no evidence of that. It can damage the DNA, but it has not been shown to integrate into it. 

And of course, transmission is completely different. HIV is only transmitted through bodily fluids. So mostly that means either sexually or through blood or organs, or also vertically from mother to child. But either way, it requires bodily fluid contact, and it does not spread through the air. That was one of the big problems at the beginning also of the AIDS pandemic, when people didn't know how the virus was spread, and then they were stigmatizing these people, afraid to touch them and whatnot. But that's not how it spreads.

But I think the second part, the part that everyone should know about, is how SARS-CoV-2 is transmitted. I think a lot of people don't really understand how it's transmitted. Even the policies don't really reflect how it's transmitted. We still hear "Wash your hands" all the time, or "Use disinfectant," or whatever. We know by this point that a very minuscule percentage of cases of COVID-19 are transmitted through any kind of fomite—any kind of touch or whatever contamination from the hands. That is something that probably happens once in a few thousand cases. 

What happens most of the time is airborne transmission. So, when we breathe, or even more if we talk, shout, sing, or do anything else with our mouths that produces sounds and more air and so on, we are always spitting out little droplets of our saliva mucus, like lung mucus, and all the things that are inside of us; they make little droplets. And these are not droplets in the classical sense when we talk about droplet transmission. This is why standing six feet away from someone is not going to help a lot. Because in the beginning of the pandemic, we had this six-foot distancing and all of these things. Of course, if you have people six feet apart, you will have bigger spacing, probably fewer people, and that will mean fewer aerosols in the air. That's good. But just the distance itself is not going to do much because it's like smoke. It's like smoking: if someone's smoking in the room, everyone can smell it, not just the person who is within 2 meters. So it's the same way. 

And I think a lot of policy and recommendations of public health really failed to reflect the way that SARS-CoV-2 and other viruses, also influenza, measles, and tuberculosis—which is not even a virus, it's a bacterium—also spread like this. 

So things that spread airborne through the air are, of course, a completely different story than something that spreads through blood or through sexual contact. This also makes it a much more universal threat and a lot more challenging to control. But it can be controlled.

Both of these diseases have their different but almost equally effective prevention devices and methods. I always say, whatever condoms are to HIV, that is what N95 respirators are to Covid. So if you cover it up, then it's very likely that you're not going to catch it. We have seen that these preventative methods are always the ones with the biggest returns. This is different but the same for both of them. One of them is prevented this way, the other that way. But either way, prevention is very highly effective. 

We have the means. The problem is very often, just like with HIV, that the availability of these devices varies very much across the world. So I'm speaking here from a privileged Western perspective from a country where these things are available. And sadly, in a lot of countries, it is not that easy. There are alternatives, which we can discuss later. 

We are always coming back to the parallels, but we're talking about the differences here, right? And I suppose you have a different question for the differences in terms of disease, or is this the same question?

FARNSWORTH: Yes, I wanted to discuss what's called viral persistence. There have been some breakthroughs over these years, specifically with SARS-CoV-2 and viral persistence. Is this a similar frame that we use to describe HIV as well, that it persists in the body?

ŠALAMON: It is similar but also different.

So with HIV, this is very intrinsic to the pathology. So if you don't have persistence of HIV, then you cannot develop AIDS. It's one-to-one. Everyone who has AIDS has viral persistence of HIV. They have this virus in their DNA, it's replicating, and it's killing their T cells continuously until they collapse. Unless they are treated, which we will arrive at. Which is also a very big difference between these two things.

So with SARS-CoV-2, it does not seem like persistence affects everyone with long Covid. In fact, according to different studies, this is from about 20 or 25% to maybe about 60% in some cases. Chronic inflammatory bowel diseases seem to increase the risk, probably because the lining of the guts is damaged and so it's more likely to harbor the virus. And as far as we know, this viral persistence in the case of SARS-CoV-2 is not related to any kind of DNA integration. But the virus can take residence in certain cells of the body. We have some studies that show us which cells are more likely to harbor it. These are mainly cells of the blood vessels of different organs, of the glands, like the salivary glands, and even the gonads—so different kinds of glands. And then, of course, the gastrointestinal tract is very much a reservoir, like with many other infections.

But there is an important nuance here because viral persistence in the case of SARS-CoV-2 sometimes doesn't seem to involve live replicating viruses but rather just remains of the virus, like various proteins and other complexes that it forms with other substances in the body. And so, the question is, why are we unable to clear these viral remnants?

There are always studies that show us one thing, and then another study shows a different thing. And this is why we write review papers like this to make sense of all these studies that are being published. Because it's very hard even for scientists to really understand an entire area of study in a comprehensive way that connects the dots and puts together all the different evidence from different types of studies. I think this is very important in science in general, to never fixate on just one study or whatever, but to see how the data from different types of methodologies align.

For example, I will take the example of brain pathology or neurocognitive issues in Covid; for example, we have studies that show that the IQ drops. We have studies that show that different performance tests are worse with people after infection. We have studies that show that they drive worse. We have studies that show us structural changes in the brain—that measure, for example, the volume of the brain using MRT or that measure the metabolism in the brain of sugar. We have autopsy studies, and we have functional MRI studies. And all of these studies, regardless of what method is being used, are showing us brain damage, neurocognitive impairment, and so on. And so we can be pretty damn sure that these are real phenomena and not just some kind of methodology issue or whatever.

And the same with these immunology studies in the case of long Covid. So we looked at, is there an increased risk of infections? Is there an increased risk of opportunistic infections? Are there problems with the cell counts? Are there problems with the cell function? What are the inflammation markers? All of these different things. And then once you put all of these things together, you get a puzzle, and you get a complete picture—or at least as complete as it can be—of what is really going on.

And of course, this is always evolving. Some things that we wrote maybe in half a year will have been proven different. But the current state of the science shows us what it shows us, and that's what we try to explain and analyze and compare and contrast in such a way that we make these things a little bit clearer.

FARNSWORTH: I think it just came up for me with just remembering this point, which is with HIV, you get it once, and you have HIV. But with SARS-CoV-2, could you hypothetically clear the virus, or at least enough to recover from an infection? Is that correct?

ŠALAMON: Yes, I think so. Again, I'm not aware of a study that would provide absolutely irrefutable evidence that there are, because this is almost impossible. Physically impossible.

But, as far as we can tell, of course, a lot of people recover from this infection, at least in terms of immune function and daily functioning.

Of course, I also believe, based on all the thousands of studies I have read, that almost no one escapes completely unscathed. It probably leaves a little bit of wear and tear on everyone who gets it. And this is true of almost any disease. But in this case, I think my main concern would be that studies show a slight drop in IQ and brain volume, or in terms of accelerated neurodegeneration and also accelerated aging phenotypes in other areas.

So, yes, you might recover. It might shorten your life a little bit. It might take away a little bit of your cardiopulmonary conditioning, for example. We have seen with people that are very fit, like firefighters, soldiers, and athletes, that they do lose a little bit of VO₂ max, and it doesn't come back all the way. Usually it comes back to some degree, but these degrees are the problem. I think that's the danger because these degrees are pretty small. And so if it happens over the course of several reinfections, you could easily mistake it, probably, for natural aging, being under stress, perimenopause—very popular these days—and so on.

So it's very sneaky. At least up to five years after infection, it doesn't do what HIV does 10 years after infection.

But we do see recovery. For example, even with this immune dysfunction we see in many areas after COVID infection, the immune dysfunction usually develops within a few weeks and lasts a few months, and then it does begin to recover. But the issue I see nowadays is that people are often catching COVID more than once a year. And that would keep you in a permanent state of immune dysfunction, basically, because you just keep adding infections. You may be about to recover from your previous infection, and then you catch another one. It's a cycle. And we don't know how long this can go on before the damage becomes more comparable to something like AIDS.

So we just don't have the data yet. It's been five, six years. We can say five because the data always lags like a year or something before it gets published. I will not discuss the publishing process, but our paper was submitted in February 2025, and it got published in October. That's how it is. So, by the time it comes out, it's already obsolete. And that's how it is with this. So basically that's the difference.

As far as we know, from catching just one COVID infection, few people will develop some kind of progressive immune collapse. We don't see that very much. But there are some people that will get really messed up from one infection in many ways, not just in their immune system. But these don't seem to be the majority. The majority of them are the ones that catch three, four, or five infections, and then they start getting really sick. And it's a different number for everyone.

And I think one of the problems is it affects people in a really crazy, broad spectrum of ways. So some people catch it once, and they are disabled. And other people, they keep catching it, and it looks like everything's okay. But then at some point, something happens, or, very often, it's not long Covid as we know it as this ME/CFS-like chronic fatigue syndrome. It's not that. It's a heart attack, or it's a lung embolism, or it's premature dementia. And doctors don't really connect the dots to Covid. So it's a very evolving area.

We have another paper on, for example, the organ damage in long Covid and the contrast between symptoms and pathology. So just because you feel okay does not mean you are okay. We are creatures that have developed through millions of years of evolution to hide our symptoms from everything, including ourselves. Because the moment you look sick in the wilderness, you are prey. And we still have this coded into our DNA.

So, for example, with heart disease, until your coronary artery is 85% closed, you don't feel any kind of pain in your chest. You don't feel the symptoms. With kidney failure, you can lose two-thirds of your kidney function, and not even your classical kidney tests will be any worse, let alone any symptoms.

So our body is made to compensate, and we can damage our reserve a lot before we decompensate, but once we decompensate, we're usually very sick. So that's a general thing, not just with COVID or whatever.

FARNSWORTH: Right. I'm glad you went over that because what I wanted to really bring up is the reinfections, the fact that people are getting Covid multiple times a year, and other infections as well. We're seeing spikes of other types of viral infections or other types of even fungal infections, things like this, because people's immune systems are suppressed, dysregulated, or compromised. And maybe if they were to get Covid once or maybe several times and then decide, okay, I'm going to take all these preventative measures to avoid infection for, let's say, the next year and see how I feel, then maybe they can recover. Hypothetically. You don't know that because it could be permanent damage.

ŠALAMON: I think everyone should try that. I have said it before. I have done it. I have been doing this for six years now, and I have never felt this good in my entire life. I feel better than I felt when I was 20 years old. It's absolutely miraculous what your body does if you just let it rest from all of these constant infections. It's life-changing.

I really wish that people would try it and experience the steady, reliable, enjoyable existence in a body that's not always recovering from something. It's not comparable. The life quality is absolutely incomparable, even compared to just catching one, two, or three infections per year that people typically catch. I'm never going back.

Even if we get a sterilizing vaccine against Covid, I will keep taking airborne precautions because living without illness is just so awesome. I'm healthy. I'm not even in any kind of "risk group."

But why get sick? It's like drinking sewage. Why would you do that?

FARNSWORTH: Exactly. Well, I feel weird saying it sometimes. I'm glad you're saying this, because I almost don't know how to always bring it up.

I do take precautions. I wear a mask. I do all the things. I've only been sick maybe once in the past six years, and I've never gone through any period of my life where I haven't actually gotten sick. I always assumed, well, maybe it's because I was eating something that made me feel weird, and that does happen, but that's not really what's going on.

I haven't had a cold. I haven't had the flu. I haven't felt really nauseous. Again, everyone's going to be different. But I just want to say, just through personal experience, wearing an N95 everywhere I go, I haven't been sick in about six years. Again, with one exception, because I think something came through during a wave and I may have had Covid at least once that I know of. But I can't prove it because the tests I got were really bad and didn't prove anything.

So anyway, setting all that aside, it is true, and I completely agree with you. We understand how these tools work, and they do work. And I think people who use them consistently and well—learn how to use respirators, air purifiers, take basic precautions, and are consistent—will understand that the things we thought were normal are actually not normal. And unfortunately, the people who are not taking any of these precautions and assuming that this is just fine are getting sick much more frequently throughout the year.

And so that's the point I wanted to just bring up with the repeated infections.

ŠALAMON: Speaking of which, I think it's super important to emphasize something on this at this point. And that is, we have heard a lot from different sources that since Omicron sublineages, this virus has become "less dangerous" or less whatever. It's more infectious. They admit that. But they keep telling us it's milder. Maybe in terms of acute disease I would agree with that because it does have a weaker tropism for the lungs. So it doesn't attack the lungs as much as previous variants, but unfortunately it attacks the blood vessels just as much, and it attacks the brain maybe even more than before. And it has acquired several immunological tricks that we describe in our paper, including enhanced immunosuppression on several different molecular levels, and also, of course, immune evasion, which is the reason that it is more likely to reinfect us.

There is a great study from the journal Nature that we also cite. It shows that, while at the beginning of the pandemic, with strains like Alpha and Delta, if you got infected, you could count on being protected from this infection from having a specific immunity for at least about one year. And this, with Omicron, has completely changed. It has flipped completely. The graph of differential protection almost reaches zero after one year. Which means that, within a year, the chances that you will get reinfected are very high. They just keep getting higher throughout the year.

So, on average, maybe 1.5 times per year, or something like that, is what we can expect. Of course, again, it will vary really wildly. Some people might catch it every few weeks; some people might only catch it once every three years. But on average it's about one and a half, maybe up to two times per year.

And this is why we have two waves. We have the summer wave, we have the winter wave, and we have all the little waves in between because it's always circulating. But, but we usually have two to three big spikes throughout the year. And that is when another variant emerges, usually one that is even better at this, and that can reinfect a larger portion of the population.

But what I'm getting at is I have this hot take that is really unpopular: that post-Omicron variants are more dangerous than previous variants. And I'm not talking about respirators and acute respiratory failure. I'm talking about cumulative damage to your health. Because the more times you catch a Covid infection, the more hits you get—it's a hit to your system. And with each of these hits, your chances of getting health complications are like what I said before. So heart attacks and embolisms and all kinds of thrombotic events and all kinds of organ failures—and that keeps going up. It's cumulative. And it's the same with this chronic fatigue-type syndrome that you can get that we know and love as long Covid. So it's more dangerous. Not acutely more dangerous, but chronically more dangerous.

I think for the majority of people, for the majority of the population, this is a lot more relevant because we know that the acute Covid disease is mostly... and I don't mean by any stretch of the imagination to diminish the value of the lives of older people and chronically ill people. I think they are just as important, and we shouldn't say it only affects old people and that doesn't matter because that's a very, very wrong way of talking about it.

FARNSWORTH: Of course.

ŠALAMON: And unfortunately something we hear often. But for the majority of people, the so-called healthy—which, if you ask me, healthy people almost don't exist anymore with the possible exception of people like you and me who have been taking precautions the whole time—but most people are not even aware that they are a risk group, but they are. They are immunocompromised.

And this is why we are also seeing so many more cases of very severe diseases like the flu or pneumonia, or recently a lot of kids have been affected because kids are the ones that are catching these infections the most. Very sadly, we have failed to protect them. They are always exposed all the time, most of them. And so they are paying for it in their long-term health.

If you look at the graph of influenza, each year after '22, the peak has been higher and the area under the curve has been bigger. So each season just keeps getting progressively worse. And if next season this doesn't happen again, then I suppose we will be able to say, "Dr. Šalamon is a doomsayer, and she is just pessimistic." But I strongly suspect that unless we take some precautions and we do something about it, this trend will continue. So each new season of influenza will be worse. And then people often say something like, "This influenza was so terrible. Covid was nothing compared to this." So that must mean the flu is worse than Covid. But they are not aware that Covid has softened them up for this flu to affect them in this way.

FARNSWORTH: Absolutely. We don't need to get into this too much, but of course, there's the threat of avian influenza, H5N1 or H5NX, as it's been called because there are all these other variants or subvariants of the H5N lineages. So you have this highly pathogenic influenza virus that's circulating among, particularly, animal populations. And we have seen some crossover to humans.

ŠALAMON: We have also not even touched the subject of immunocompromised hosts.

I'm a nuclear medicine doctor, but I'm also a geneticist. And so, one way that viruses evolve, like at a high speed, on super speed, is in immunocompromised hosts because they can replicate, and they can recombine with other viruses, and they can make their little virus babies with each other that are a combination of several different types of viruses. And this is what we have created with the uncontrolled spread of Covid: we have created a subpopulation of immunocompromised hosts for viruses to breed in. And in addition, these same people can also accelerate things like antimicrobial resistance, for example, because they are also an excellent petri dish for something like resistant bacteria. We often see people who are just catching infection after infection. They get a sinus infection, and then they get a urinary tract infection, and then they get an ear infection, an eye infection, and a mouth infection. It just keeps going.

And all of these pathogens, they are not just there causing disease; they are reproducing and mutating. And viruses are especially great at this. People think the viruses will evolve to become milder. They have no reason to do that. They have a reason to become more infectious, they have a reason to become more persistent, and they also have a reason to improve, for example—I'm theorizing—something like host manipulation.

So if a virus has more of a neurocognitive influence, for example, something like risk-taking or sociable behavior that makes it more likely to spread, then that variant is more likely to make the new variants. This is just theoretical, but we see infectivity is getting progressively higher. And all of these immune tricks that we have discussed—immunosuppression, immune evasion—have also been evolving.

Viruses have reasons to become fitter, not to become weaker. No one evolves to become weaker. Everyone evolves to adapt to their environment better. That's how evolution works.

And I mean the logic behind diseases will become milder—there is a logic, but that logic only works if the disease spreads during the time that it should kill. So, for example, if you are actively infectious and you are too sick to spread the disease, you are either dead or you're so sick that you're just lying down and not going anywhere, then of course that will help.

But the problem with something like Covid is no one is dying of Covid in the time when they are the most infectious. Even people who die of Covid usually die like two to three weeks after infection and not in the first week of infection. So there is no evolutionary pressure for the virus to kill you, or a smaller likelihood. Because if it kills you, it will kill you long after you have already spread it as much as you will have spread it.

So that doesn't work in this particular case, with this particular disease. If it's with something like, let's say, smallpox, where you are actively infectious while you have these lesions, then of course it will affect that during evolution. But if it's something that kills weeks after it spreads, then there is no pressure. Evolution only happens when there is a pressure. If there is no selective pressure, then there is no reason for something to evolve.

I think a lot of even virologists and immunologists don't really understand it. I don't know why. As a geneticist, I don't see how they don't understand this. But there is no reason for diseases to get milder just to get milder. They will only get milder if it affects their rate of spread.

FARNSWORTH: Right. Well, this speaks to some of the very human biases that we have. Survivor's bias. So we've all survived the pandemic so far, and a lot of people have died from it as well, but they're gone. They can't really provide their opinions or their insights.

ŠALAMON: Don't get a seat at the table.

FARNSWORTH: Exactly. They really don't. But I think they would say something if they could.

But the idea is that the most vulnerable have died, or they continue to die because people are still dying from Covid. We have this sort of bias that, okay, we're still here, therefore we must have survived, and therefore the virus must be getting milder.

So there are these sort of unfortunate psychological, psychosocial components to these things that make it difficult to kind of break through to people and say, Actually, this is slowly but surely degenerating our collective health.

ŠALAMON: Very true. And I think a very large part of it is also the success of vaccination that people like to overlook. Because a large portion of the population got vaccinated, in some places 2/3 to 3/4, and they don't get as acutely sick anymore for the most part. Because that's something that vaccines are really good at preventing.

Unfortunately, they are not as good at preventing long Covid. They are not as good at preventing these organ damages and all of this stuff that happens in the post-acute phase. To some degree, yes, but not as much.

But what they really have put an end to, more or less—not completely, but they have significantly reduced—is this severe acute respiratory failure kind of Covid that we have seen in the beginning of the pandemic—the 2020 Covid pneumonia. That went away mostly with vaccination.

I shouldn't say "got away" because there are people probably in my hospital right now dying of this.

FARNSWORTH: I know what you mean.

ŠALAMON: It's a trickle; it's not a flood. That's the difference.

FARNSWORTH: Yes, I think the important thing is that quibbling—maybe "quibbling" isn't the right way to say this, but there is something about whether we talk about it being an ongoing pandemic or that we've exited the pandemic phase and are in some other phase. The point of that is that Covid is very much with us. And that maybe the way we experience the pandemic has changed from where we were in 2020-2022. Things are different. But that doesn't mean that we have left the danger zone or that it, in fact, isn't getting more dangerous. It's just that it's almost more stealthy in its danger, which we have been discussing.

ŠALAMON: If we look at the disability statistics, they are rising. If we look at presenteeism and absenteeism—so people working sick and people not working sick—they are increasing. Then all of these infectious diseases that we discussed, their incidences are increasing. The flu seasons are getting worse each year.

So personally, my take is that all in all, the pandemic is slowly getting worse. Not maybe in terms of viral transmission, which is ongoing, but it's not really increasing throughout the years. Which is why some people say it is endemic. But I think it is the wrong expression. Because no one thinks that officially. The WHO has never officially ended the pandemic. They ended the international emergency phase, the PHEIC (public health emergency of international concern). They ended that in '23. But they never ended the pandemic, and for good reason. Because the pandemic is ongoing by every possible criterion. Endemicity criteria demand that a disease have a predictable pattern, which we don't really have. The waves are all over the place. Sometimes summer, sometimes winter. Some places this, some places that. It demands it be limited to some geographic area or present in more areas, but again with predictable patterns.

Of course the problem is that in the case of this disease, especially the pathology, it is not something that we can "live with" in the long term. So we are in an unstable position. We cannot live with this disease the way that we are living right now for several years to come and expect our society to function as it functions now. So, there is nothing that says endemic about this.

It's an ongoing pandemic even by official definition. But it's very popular even in scientific publications. We see it all the time that people use terms like "after the pandemic," "post-pandemic," and "since the pandemic." We really love to past-tense Covid. It even passes peer review. That's the funny thing. Even though it's objectively wrong. Like if it were any other objectively wrong fact, the reviewer would probably be like, Hey, you should check this and that's not correct, and whatever. But this seems to fly under the radar all the time.

I think it's a wishful thinking kind of situation because, of course, we all want the pandemic to be over. I absolutely want this pandemic to be over. And it can be over. We can do that. It's doable, a lot more doable than people think. But unfortunately, the way that we are approaching it right now, it is going to continue, and it is going to keep causing an unsustainable amount of harm.

FARNSWORTH: Yes. Well, let's see if we can do a few more questions and see if I can combine a couple here that I have prepared for this.

So in comparing it to HIV, again, these are different things, and I don't want to say one is worse or not worse, but there are strategies and therapies that have been developed for HIV infections. And we're definitely seeing research being done into long Covid as well. So if you could talk a bit about the parallels or the differences in how these therapies exist for HIV-infected versus those with long Covid, and if we can maybe use these as a model to sort of see where we're going to go with this.

ŠALAMON: So let's start from the beginning again with prevention.

We have a vaccine against Covid. We don't have a vaccine against HIV yet. We do have this one relatively new prophylactic besides PrEP. PrEP has been around for a while, but there's this relatively new six-month injection that can be taken to prevent acquiring HIV. But there is no vaccine in a classical sense.

There are several vaccines against COVID-19, different kinds of COVID-19 vaccines. There are the very hotly discussed mRNA ones, but there are also classical ones like protein vaccines and so on. And these vaccines are pretty good, like we said, at preventing acute disease and death, but they are not quite as good at preventing long Covid. There are some people even who have been trying to use vaccination, like in people with long Covid, and some claim that this causes improvement in more people than not. But it's still an ongoing research area.

The truth is, for HIV, we have PrEP. So we have a therapy that can prevent acquiring it. And then we have the ART, the antiretroviral therapy, which is a chronic therapy. So people have to take these pills much like for any other chronic disease, and they have some side effects. But most people who are treated nowadays for HIV never develop AIDS, and they live a quality of life that is from good to very good. So almost comparable to the general population without disease. They are doing quite well. Not perfect, but okay.

And for people with long Covid, that is unfortunately not the case yet. We do not have any approved therapies for them. We have a lot of trials going on, including trials of drugs like the ones my friends at the PolyBio Research Foundation are trialing, Truvada and Maraviroc, which are very well-known AIDS medications for people with long Covid. There's a very big challenge in identifying the right subpopulations for this because, probably, people who have long Covid but don't have viral persistence are not going to benefit from this and will suffer from side effects. So it will definitely not be a one-size-fits-all kind of therapy, even if these trials turn out to be successful. So, it will be basically only for people who either have SARS-CoV-2 persistence or who suffer from reactivation of other viruses like Epstein-Barr virus, cytomegalovirus, and so on. Which is another thing that happens, of course, with things that suppress your immune system. And that is that.

People with advanced or severe long Covid have a quality of life comparable to people with stage four cancer right now. So it is very bad. These people are suffering big time. And we are working so hard and want so much to come up with something. I'm just one person in this big network, and most people are doing a lot more important work than me. But I'm a little bit updated on everything because I'm part of these groups.

And so, yes, treatments are coming. So if anyone is listening to this and ready to give up and unsure if something will happen in the next years, I am absolutely sure that therapies will be coming and that a lot of people will be able to benefit from them.

But, just like with HIV, prevention is still better. So if you can avoid getting sick, it's a lot better than having to treat it. That will remain. Even if we find some kind of cure, at least in the beginning it will probably be much like with HIV. It will make this chronic disease a little bit more survivable. But definitely it will not be, in the beginning, at least—I don't think so—a silver bullet that will just bring you back to your previous baseline. That would be awesome, and I would be very happy if that happened, but I would not count on it. I would definitely count on improvements on things that will improve the quality of life.

We already have a few things that some people are benefiting from. Something like low-dose naltrexone or anticoagulants, for example. Things that help, help some people, not everyone. But more of this will be coming. So probably more of these therapies that help some people, but not everyone.

Long Covid is just such a complex disease. It has so many faces, and the immune dysfunction is just one of many faces. And so, the solutions will probably have to be just as complex as the problem. I don't expect a silver bullet, but I definitely can tell everyone who's listening that a lot of things are happening in this area, and there is no reason to think that no help is coming. That's not true.

There are definitely studies, but unfortunately a lot of money is still being squandered on things that don't work. I think in the area of long Covid research, there is way too much of this—I have nothing against healthy living and yoga and breathing exercises. But one thing is therapy, and another thing is support and something like psychotherapy. And of course, if you're so sick, eventually you will also get depressed. Reactive depression is a thing. People with cancer also get it. That doesn't mean that they should be treated primarily with antidepressants.

FARNSWORTH: Right.

ŠALAMON: So yes, too much money is going into non-causative or non-science-based therapies—more of these support and lifestyle and that sort of thing, which is all good and well, but not what we have to be investing in primarily.

FARNSWORTH: Absolutely. Everyone's looking for ways to kind of paper over or to put a Band Aid over it when we need serious research funding and treatments that require a lot of expertise and work, things that you're doing and others are doing as well.

But you keep on bringing it back to this important point, which is prevention. The thing is that we're not building "natural immunity" over time from Covid infections. This isn't going to go away. It isn't necessarily, as you've described, going to get milder.

It's like all of these sorts of stories that we have been told and that we've been telling ourselves. I say "we" in the sort of most generalized sense, not you and me necessarily, but as the media has been presenting it—at least based here in the United States, that's how it's described. Voices that have been elevated that have basically been using their credentials and their positions professionally to promote ideas that are detrimental to the long-term health of the population. And just the way in which the pandemic has been framed narratively—that we've reached an ending and then we can move on. And that's mostly just a political project.

We're at this point where we're having whole generations that are being born and raised in the pandemic. We're seeing the consequences of that. And it's actually something I think I've kind of tried to block a little bit because I think trying to survive the pandemic has taken precedence. But now that we're in it for as long as we've been, thinking about people I know, or just in a general sense, knowing young people who are being born and raised right now without any precautions being taken is profoundly disturbing. Seeing entire generations being raised in this sort of context disturbs me.

So prevention right now and making that a widespread thing in the same way that we take for granted in many places, at least, clean water and water treatment—we take that for granted as a commons that we all share. We should also treat air in the same way, making that common, making that infrastructural, and making policy on a wide scale.

So I think, just to harp on that point, it's just prevention.

ŠALAMON: It's essential to adapt in order to survive. This has been the case for the past good three or even four billion years that life has been around on this planet in one way or another.

So we have increased the density of human populations. That was the problem with water sanitation as well. So as long as people lived very dispersed in small villages and farmlands and stuff, they could live without water sanitation because everyone had a little stream where they knew that there was clean water. I'm exaggerating, but you know what I mean. People were obviously dying of cholera and all kinds of things. But for the most part, the human populations could survive without water sanitation until they moved into cities, until they had a bigger density. And then things got unsustainable. People were dying of cholera and all kinds of bowel infections and dysentery and all that. And the story about that also involves a lot of resistance and ridicule of people who tried to push for that, like John Snow. Not the one from Game of Thrones, the other one.

FARNSWORTH: Yes, good to clarify that.

ŠALAMON: The one from the John Snow Project.

FARNSWORTH: Right.

ŠALAMON: So that was that. And now we're at a point where our populations are so dense and our buildings are so airtight, and that was never the case before. And so we have all of this stale air indoors in most places, especially in schools.

That's the biggest—like you said, the new generations, the kids. I, personally, am not someone who would be very enthusiastic about hanging out with kids, but I find it so heartbreaking. Sometimes I feel like I, the most child-free person ever, am way more concerned with the welfare of these kids than their own parents.

And I think that's very, very concerning because if you are exposed to this so early in life, you will basically never know what it's like to be healthy. You will never be able to develop your full potential. Either physically or neurologically. It's just completely crazy that we are exposing kids over and over while there's so much evidence that this is harmful.

It's not just that we wouldn't know or whatever. We know this is very harmful. Maybe in 2021, when they were opening the schools and stuff, we didn't know as much. We already knew a shocking amount of stuff that we know today about COVID, but we didn't know it quite as well and quite as for sure and whatnot. But now we have more than half a million studies showing us what havoc it wreaks throughout the body every time, even if it's asymptomatic and so on.

And so, it's completely unjustified. Honestly, I see this as a mass crime against humanity. I cannot describe it in any other way. And the question is who the perpetrator is, because everyone is the perpetrator for the most part. Of course, the biggest blame lies with the decision makers. But we have to know that we are the ones choosing those decision makers. Ideally, not always.

FARNSWORTH: Yes.

ŠALAMON: But in general.

So I think it's a very difficult thing. Even if we try to face this now, how are we going to phrase this? I think this is the question that politicians might be asking. Oh shit, we have this problem, but how do we say it's this bad? We have been exposing you willy-nilly for the past five years, but here is the truth. That doesn't fly well.

I have no idea what I would say if I were in that position, but it's something that will have to happen. I don't think most people realize how much our current modus operandi, our current state of things, cannot go on. The amount of harm that's happening is just not going to allow us to continue on this course for, let's say, five more years. Maybe for one, two, or three more years—maybe. Things will keep getting worse and have been. If you observe the past two or three years, everything has been getting worse, massively. And all of these trends are going to just continue for as long as we continue our complete lack of management of this pandemic. So it's just going to have to happen at some point that we will do something because otherwise we will just not have functioning health care systems, functioning school systems, functioning anything. Even food delivery, things like that.

FARNSWORTH: Right.

ŠALAMON: At some point you just have to say, okay, now let's do something. And it is happening already because if it was not, why would I be the one in charge of writing the SOPs (standard operating procedure) in Austria, for example?

And I already had this forecast. Basically, I said before, maybe two or three years ago, when everyone was despairing about everything opening and stuff, Well, when things get bad enough, they will come to us for solutions, because we are the ones who know what to do. And this is now slowly but surely beginning to happen. I am sure it's a process that will be happening gradually, but it's only beginning to happen.

This is why I think I am so busy, because everyone wants to hear—nobody wanted to hear this stuff a year ago. Nobody. No one called me for an interview. No one called me for a podcast. No medical chamber was asking for my expertise. And now all of a sudden, everyone wants solutions, and everyone is asking, What do we do? We cannot go on like this.

And like I said, this is starting to happen, but it will take time. It will take a lot of work, and it will take a lot of dedication from people who are not benefiting in any way from this. I'm still happy to be a part of this process, but as long as everything is based on just voluntary and basically charity efforts, we cannot expect a lot of progress. So we will have to mobilize bigger parts of public health and politics and everything to really tackle this problem. Because it is a massive problem, and it is happening all around us.

I don't know how many people you know that didn't get sick during this holiday season. Not very many, probably.

FARNSWORTH: Yes.

ŠALAMON: So at some point, you just have to do something. And I think this point has started coming with the year 2025, and it is going to just slowly, gradually—maybe parallel to the damages that the disease is causing—keep increasing. And I sadly think that by the time that we have really gotten the situation under control, everyone will have been—or not everyone, but a large portion of the population—pretty badly damaged.

And then we have another few years, hopefully, to find out whether these people will recover or not recover or whether we can come up with some kind of therapy that will improve this process.

FARNSWORTH: Right. There are two tracks that seem to be happening at the same time, similar to the nuances of talking about HIV/AIDS and SARS-CoV-2 and the differences between these, but also how we can learn from both. And I think in the same way we can understand that temporally, as we move through this, things are getting worse. I think that's objectively true on multiple levels, as I discuss on this podcast.

But also there's a reckoning that's happening, and at a certain point, people are like, Well, the pain is too much. When are we going to try to alleviate that pain and address the source of it? So there's also this movement that's happening toward building up these means of prevention and a base of knowledge and understanding, which I do think that you are providing. You are part of that process using your skills, your expertise, and your experience as a scientist.

ŠALAMON: Yes. And from my position, I can definitely say the interest is growing for what we are doing.

So I think a lot of people who are Covid competent, cautious, or whatever you want to call it, they have witnessed recently that people have come to them with questions because they keep getting sick, and they're like, Well, how should I stop getting sick? Maybe they have something coming up, and they're like, I cannot afford to get sick. Please tell me what I should do. And usually they don't like the answers. But most of them want a solution.

Like the people with long Covid—very often people with long Covid come to me, and they're like, What should I take to get better? And I'm like, well, I sadly cannot recommend you take anything because we don't have any registered therapies. But what I can recommend to you is to do your darnedest to never catch Covid again. Prevent infection.

And I think if we just did secondary prevention with these people—if we just took everyone who is currently suffering from long Covid and we just made sure, absolutely sure, that they don't catch it again, I am pretty sure—and this is, again, a hypothesis, but I think it's a very strong hypothesis—that the vast majority of these people would get better, and they would probably get better over, let's say, two to three months, up to maybe two to three years. Some people will stay sick or will even keep deteriorating because there's always a bell curve. But most of this bell curve will be on the getting-better part if you just prevent them from catching Covid again.

I always emphasize this: our bodies are not just a machine that runs on whatever settings we give it; it has all kinds of mechanisms that have evolved, just like other things have evolved, to help us recover from everything from injuries, from trauma, from disease, from anything basically that happens to us. And if we can just provide the right environment and the right conditions, then these systems can work for us. And sadly, they don't work the same or just as well in everyone.

But for most people, I am sure that if you just prevent reinfections and if you just give them the right conditions—and in long Covid, that means pacing, that means rest, that means enough time for recovery—that a very large proportion of these patients would get better. Maybe they wouldn't get to their previous baseline, but they would most definitely start recovering, they would start getting better, and they would start being able to do more. And once you can do more, you can get better.

And so I think that is definitely something that everyone can attempt to try. I know that people's situations are very different. Like some people cannot afford to rest, they cannot afford to recover, and they cannot afford to protect themselves. And again, we come to very similar issues as we have had and still have with AIDS. So there are a lot of people still in the world today who are dying of AIDS because they cannot afford the treatments.

FARNSWORTH: Absolutely.

ŠALAMON: That's a different topic altogether.

But, for those of us privileged enough to have access to this option, if people just gave it a try to just really protect themselves—to just really never go anywhere without a fitted mask on, an N95 or better; to avoid crowds; to not receive visits from people who are not taking protective measures; to get a HEPA filter and ventilation and CO2 monitors and everything.... So if you just turn into one of these Coviders—what have we been called recently? Fringe online cult or whatever.

FARNSWORTH: Yes, right.

ŠALAMON: If you just want to become hashtag "one of the two" that are still protecting themselves, then I am pretty sure your chances of recovery should be up there, should be quite good. I cannot promise because with everything in biology, with everything in medicine, there's always going to be a range of responses, and we cannot know. But most people will definitely feel better.

And this even applies to people who don't have long Covid, funny enough. If you just stop catching infections, I think most people would notice a difference. Even if they think they're completely healthy, they will just feel better. They will think clearer, they will have more energy, and they will have fewer nagging symptoms, pains, aches, whatever it is that we have sometimes. I think everyone can benefit from prevention, and especially people with long Covid or other post-infectious syndromes should most definitely have access, first of all, to information about this. And second of all, we should attempt to make it possible. Some places have things like mask blocs, or people who are helping with information and with supplies, and we probably need more of that kind of stuff.

One thing that we have not discussed yet, and I know we're like one and a half hours in, is basically the main comparison.

So I talked about transmission, but I didn't really talk about the comparison between the two diseases. I touched on it. But what I think maybe we should emphasize is that our paper has this graphical abstract everyone can look at, and there are the main comparisons in terms of different areas where these diseases have both differences and similarities.

These are basically the immunological effects and the immunosuppression and increased susceptibility to infections, including opportunistic infections. But this happens in a very different way with HIV. We have a progressive decline of a very specific type of T cell. These are the CD4+T lymphocytes. And this is just one subtype of a lymphocyte. It's one very specific type of immune cell that is attacked by HIV.

In contrast with SARS-CoV-2, which we know can also affect and even infect these same cells, that is by far not the main mechanism by which it causes immune dysfunction. The main mechanism, if I had to pick one with SARS-CoV-2, probably originates from the chronic inflammation that perpetuates this inflammatory response. And this happens mostly because of the issues with linings. For example, blood vessel linings, the blood-brain barrier—this is again a lining—and the lining of your guts. All of these things are damaged, and they have little holes in them. And these little holes leak things that are not supposed to get in your blood or out of your blood. And these are constant irritations for your immune system, keeping it busy.

And at the same time, there is a procoagulative state. So the blood is more likely to form little clots. And these clots are usually very tiny—they are microclots. These microclots usually plug up a very or fairly large proportion of your capillaries—your tiny blood vessels—and this causes blood circulation or blood flow disturbance. A very large part of your immune function depends on how well blood can get to places. This is why, for example, if you get a wound on your foot, it's more likely to take a long time to heal because your foot is the furthest away from your heart and receives the least blood in your body. Things that are close to your heart, like your face and torso, tend to heal a lot faster because they are closer to the heart.

But there is a myriad of ways that COVID-19 affects the immune system, including effects on many kinds of cells in the immune system. Not just the lymphocytes, but macrophages, monocytes, and all kinds of immune cells are involved.

The immune dysfunction is much more broad, much more multifaceted than it is in HIV. But at the same time it's not—as far as we know, in five years—as bad in terms of inevitable immune decline.

So it can recover to some degree in some ways. And it doesn't necessarily keep getting worse without treatment. With some people it remains, and with some people it gets better. But maybe with reinfections that could happen. Maybe in a few years that could happen. But as far as we know, in these five years, things don't necessarily keep getting worse with SARS-CoV-2 after infection in terms of immune function.

But there are other things. For example, there's HAND versus SAND—the HIV-associated neurocognitive disorders versus SARS-CoV-2-associated neurocognitive disorders. Both of these viruses cause a form of premature neurodegeneration, which is similar to something like Alzheimer's or frontotemporal dementia. So it's basically again a circulation issue, mostly in this case of COVID-19, and it's more of the chronic viral reservoir-associated inflammation in the case of HIV, but both diseases do lead to a premature dementia-like syndrome. So they cause neurodegeneration.

Another thing that they both cause, again through slightly varied mechanisms, is the premature aging response. And again with HIV, this takes many years, but once it starts, usually it just keeps getting worse. With SARS-CoV-2, it takes maybe just a few weeks until we can measure things like methylation changes and telomere shortening—things that show us increased biological aging processes. It happens very soon after infection, a very short time compared to HIV, but we don't know yet how this will happen with reinfections, and we still don't have the information on that. But either way, both of these viruses have that effect. So they affect our systems in ways that are similar to what so-called natural aging does, only quite a bit faster.

So again, there are a lot of parallels. But even in parallels, these two diseases are different. They are especially different in terms of how quickly things happen and what happens in terms of progressive worsening, stability, or whatever. But we don't know yet. That's the big deal: we have no idea what happens 10 years after COVID infection, so we cannot draw that comparison yet. And I very sincerely hope that something like AIDS does not happen, at least with most people. But again, not something we can guarantee.

We will just have to wait and see what happens, and hopefully by that time we will also have some medications and some therapies that will be able to prevent the worst outcomes.

But we know it took decades for HIV. And we are in a different place right now in terms of what our science can do. Our science can move a lot faster than it did 40 years ago, but that is only provided that it receives the right conditions, just like our bodies.

FARNSWORTH: Right, exactly.

ŠALAMON: In the current circumstances, I'm afraid they are not very friendly to scientific progress. So I think that's also something that we will have to change if we want to really tackle these issues.

FARNSWORTH: Yes, I know we're in very different places, but in the US this is the political issue. It's getting progressively worse and faster too.

I want to be clear that the Biden administration set this up to lead to—I'm not saying that it was conspiratorial, but just based on their own interests—some very anti-scientific perspectives to take up the dominant position in the United States and just this kind of austerity and also somewhat surgical attacks on funding, research grants, and just generally how the United States has progressed with that.

So yes, the main obstacles seem to be not so much a lack of knowledge or an interest in knowledge, but mainly these sorts of political institutions that are currently being made up the way they are by the people they're being made up by. And also the social complications and complexities that have emerged from the pandemic and our responses to it, and that's still playing out to the present.

So, let me ask just one final question. You brought up how a lot of this is a question of time and what we're going to see over the years. What are some questions that come up for you as far as what you want to find answers to in your research and just a broader sense as the pandemic continues?

ŠALAMON: Well, I'm not going to hammer on about prevention again because we already know that.

I'm going to say what we really need in terms of research are better biomarkers. Because currently we don't really have very good biomarkers for anything. There are some biomarkers that correlate with long Covid as such, but they are not broadly available. They're not available to most people in clinical practice, and we need to make them more available.

But also crucial, and I don't see this discussed nearly enough, is we need biomarkers for Covid viral burden in terms of how many times people have been infected, and it is very important to identify those who have really not been infected yet. So-called naive people—naivety biomarkers—we don't have that. Currently, if you want to be as sure as you can be, you can take these nucleocapsid tests. So that is the nucleus protein of the virus, which is only present in the nucleus and not on the surface. It doesn't show up in people who have been vaccinated, but it shows up in people who have been infected. The problem is these antibodies don't even appear in a lot of people, especially those who have been vaccinated enough times, and they clear the virus so fast that it doesn't create these antibodies, in which case maybe the infection didn't affect you as much, so you could be closer to a "healthy control" anyway, but we are not sure about that yet. And again, this nucleocapsid antibody only stays in the blood for a few months after infection, typically. You would have to take these tests, I don't know, once every three months or something to really rule out, as far as possible, a chance of asymptomatic infection.

Then, of course, we can have similar biomarkers to follow the effectiveness of antiviral treatment. We know we have similar treatments for HIV. We look at these titers in people with HIV, and then we can say, Okay, you're good; you don't have a lot of virus in your system; or, You have too much virus, and we have to give you some more medication or whatever. So, we need that.

Then we also need, of course, speaking of the devil, effective antivirals, which will help people also with long Covid, not just people with acute disease. There are a lot of trials underway, but again, like I said, too much money goes into physical therapy and things that are even harmful, like graded exercise therapy and stuff.

Then, of course, we have to improve the understanding of cumulative impacts of infection. Not among people who study this, because we understand it, but most of the public, and especially most doctors, have no idea about this. They don't know. They don't know what Covid causes.

We need, for example, something like a new cardiovascular risk calculation, which currently has a formula that includes age, sex, cholesterol, and blood pressure. As far as I know. Sorry, I'm not a cardiologist, but it doesn't include Covid; I can tell you that much. Even though, probably if we do the calculations, it is a bigger risk factor than all the others combined, or at least very significant, and definitely deserves to be in this formula.

Then, of course, we need better not just airborne prevention but also better surveillance testing infrastructures, wastewater monitoring, and air monitoring. We also are doing something like that at the WHN (World Health Network). Hopefully we will have air sensors everywhere soon, with which we can detect viruses in the air as soon as they appear.

Then, of course, countries should most definitely support things like isolation and quarantine, even though in many places that's not the case. But it's very important.

And, just like with HIV and with the AIDS pandemic, we should try our best to minimize any inequities and differences in accessibility. Because the thing is, this is an airborne threat, so as long as some of us are spreading it, everyone is at risk.

And I know the rich can kind of sequester themselves and be hashtag "Davos safe" and stuff, but ultimately, if we want to keep this capitalist machine running, we will have to do something about the general population. And I know they want to replace them all with AI, but that's not going to happen because AI has a lot of limitations.

FARNSWORTH: Yes, there's a lot of fantasy in that.

ŠALAMON: There's a lot of hype and not as much—I mean, it's useful. I'm not going to say [it's not]. It's like having an undergrad assistant that really likes to lie about everything.

FARNSWORTH: Yes, right.

ŠALAMON: It's not what it's cracked up to be. And a lot of people have fired their creative teams or their accountants or whatever, and then they were like, Please come back.

FARNSWORTH: Right.

ŠALAMON: So it's not going to go as smoothly as some tech enthusiasts imagine.

So I think we will definitely have to take care of the general population for a while longer, even if we are just looking at sheer benefit for those who are benefiting from their work.

So those are the things. I'm sure I could go on, but I think those are the most important points.

So we need biomarkers, we need to invest in the right kind of research, and we need to take care of the whole systemic management of the disease, not just in terms of direct prevention, but also vigilance, surveillance, support for isolation, and all of these things, which I realize is a problem in terms of short-term profits, but it pays off so much in the long term economically. If you look at the economic analysis by David Cutler, he's been doing it for a few years now. And if you just make politicians look at that, I think they should realize the cost of prevention is just completely negligible compared to the cost of unmitigated disease.

So I think we need to bring this into public and political awareness, and we need to be very loud and annoying and obnoxious and keep hammering it in until everyone gets it. That's my strategy. Maybe someone has a better strategy, but I don't.

FARNSWORTH: Well, thank you for going all over that.

I think the final point would be I've done some collaborative interviews and spoken with Joshua Pribanic, founder of the Long Covid Action Project. We've talked about the kind of activism, the sort of disruptive activism of ACT UP. Many of them were HIV sufferers, not all, but they organized and were really in people's faces. They weren't violent; they were nonviolent technically, but they were very belligerent. In the United States, they really confronted power and said, We're dying; we need something now. And they were even making their own kind of movement forward regarding antiviral therapies and things like this, or at least coming to some sort of place of, Well, we can kind of figure out some stuff here, but we really need the vast resources of the federal government here to move forward on this.

And so, taking that as a model, I agree. This is a problem whether people want to look at it or not, whether people want to acknowledge it's an issue or not. It is happening, it's continuing, and it's going to get worse, and things have to be done.

This is also a global effort, across societies and across different groups. For example, you're in Central Europe, and I'm somewhere here in the western part of what's called the United States. So people all over the world are working through this and trying their best to not only survive the pandemic but also improve the conditions that we're all in.

I really appreciate you online as well. I do like to follow specifically some individuals on X or other social media sites and just keep up with what they're posting. And I think your posts are really informative, and I really appreciate how you approach this, how you spread the word and talk about this. And also, of course, this review that you published with your colleagues is just really impressive, and I think you navigated those nuances, those comparisons, parallels, and also differences between HIV and COVID-19—how they're very different in many specific ways, but also the parallels are worth acknowledging. I think that you and your colleagues navigated that very well.

Final point: what's next for this paper, but also what's next for you, and what can we look forward to as far as your work goes?

ŠALAMON: Well, I think we circled back beautifully to the beginning in terms of lessons and in terms of how we should learn from AIDS activists and how we should also learn from the mistakes that were made and, to some degree, are still being made in the AIDS pandemic around the world.

And what's next? Well, I have like three or four papers in the works right now. I have a lot of stuff coming up from the Austrian Medical Chamber. One of the things that I have been very interested in, and this is just a little bit of a teaser for any fans listening, is that I have been working on one paper about diagnostics in long Covid.

I am a diagnostician by trade. I look at mainly PET CTs. So those are CT scans with the additional information of glucose metabolism in the body, which we use mostly to diagnose cancer and how it spreads, but then also infections, inflammations, and other kinds of diseases in the body, including also dementias and everything. And so I have been writing a paper on that, on how to diagnose people using our technology. Mainly medical imaging, but also some other methods, like clinical tests and, for example, imaging of the capillaries and things like that.

And the other thing that I have been very interested in and working on has been the connection between COVID-19 and cancer. Because that's another thing I do a lot of. I look at people with cancer every day. I look through their bodies from head to toe. It's a large part of my day job. And I have also been following the literature, of course, in this area.

I have been very concerned about the oncogenic properties of SARS-CoV-2, which would be another parallel to HIV that our paper didn't really discuss at length. We mention that there are some case reports showing increased incidences of certain tumors, like Burkitt lymphoma, also included. But one very interesting study, for example, showed a very strong association with HPV-mediated cancers like cervix, throat, anal channel, and so on. And they are increased by from about 70 to about 140% or something like that, which is very significant, after COVID infection. And that has to do probably with viral reactivation or with promotion of viral replication of HPV because these are human papillomaviruses associated with cancers.

I don't expect all cancers to be affected the same way by this infection. I think that the cancers that do have another infectious disease as a component, maybe also something like stomach cancer with Helicobacter pylori or other cancers like some lymphomas like Burkitt lymphoma—maybe also things like that.

So some cancers will probably be more affected by others. But there have already been quite a few papers on different cancer-promoting mechanisms that happen after COVID infection. And I think, according to how many real-world data studies have come out in the past few months, it should be enough for another kind of review paper, where we will discuss, hopefully, how all of this plays into cancer risk and also how all of this plays into cancer prognosis.

I think the biggest issue in this area is not really healthy people developing a new cancer. Of course, the risk will be increased. But the bigger issue is people who already have cancer catch Covid in the hospital, usually, and then their treatment gets delayed, and then their diagnostics get delayed, and their diagnostics get complicated.

Because I do this, this is my day job. I look at these people, and how should I know someone has an infection? It doesn't have to be Covid; whatever it is, there's an infection in the body. And this person has, let's say, lymphoma, and I see that they have activated lymph nodes. And how should I now know if this lymphoma is coming back or if it's just their infection that they're reacting to?

And I cannot give them a so-called Deauville score. It's a score where we say, Aha, there is so much activity in the lymph nodes, or not so much, and then, according to that, we plan the treatment. That can really mess up the treatment even without the disease itself having a detrimental effect on their prognosis, which it does because it messes up the immune system and cannot fight the cancer as well, and so on. But even without all of that, just the way it complicates diagnostics and therapy is a very big issue. And I think this is also going to be a big part of this story.

So it's not just going to be, You have so much more risk of this cancer or that cancer developing in you as a healthy person. But also, if you have cancer and catch Covid, it can cause this and this problem. So, I think it would be absolutely crucial. And whenever I'm on the phone with the referring physicians who send me these patients, I'm like, Listen, you have to keep these people infection-free, otherwise I cannot diagnose them. It's a really big issue, so it's an issue I want to discuss because it's very close to my line of work.

FARNSWORTH: Okay, that makes a lot of sense. Thank you for explaining that, because I think a lot of folks, especially those who are undergoing cancer treatment, are already, I think, often taking a lot of precautions, but I think it needs to really be emphasized that avoiding infection, all infections as much as possible, is really important in the treatment process. So, yes, clarifying that, especially regarding the ongoing pandemic, will be very useful for a lot of folks.

The medical field getting on board is a huge part of this.

ŠALAMON: So it doesn't have to be that patients have to ask them to.

FARNSWORTH: Absolutely.

ŠALAMON: It should be the other way around. And it is where I work. My entire department is masked. We have CO₂ levels usually under 600 parts per million.

FARNSWORTH: That's good.

ŠALAMON: I keep insisting on this even if everyone hates me for it.

FARNSWORTH: Hey, it's making it better for everybody, whether they like it or not.

ŠALAMON: One day they will thank me.

FARNSWORTH: Yes, I hope so. Geez.

Well, again, I'm just a really big appreciator and fan of your work, Dr. Šalamon. I just really appreciate the work you've done, and thank you for going over all of this and explaining everything. I think it's of great service. So, yes, thank you so much. I'm glad that we connected. I'll be sure to direct people towards all of your work in the description of this episode.

ŠALAMON: And thank you for this invitation and for the exposure because we need the exposure. God knows we do.

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