AIDS: You Haven't Heard Anything Yet

It was A.D. 1348, one year after the bubonic plague, or black death, had begun its devastating rampage through Europe. In a famous medical treatise French Surgeon Guy de Chauliac of Avignon recalled his impressions of the horror around him: "The father did not visit the son nor the son the father. Charity was dead and hope abandoned . . . For self-preservation there was nothing better than to flee the region before becoming infected."

Guy's patients died within five days of falling ill. Cities were decimated in a matter of months. The scourge was so contagious that, according to Guy, "no one could approach or even see a patient without taking the disease." By the time the epidemic subsided a few years later, at least a quarter to a third of all Europeans -- perhaps 25 million people -- had perished.

Today's plague is a very different beast. AIDS works its way through a population slowly, over a period of years and even decades. It also tends to kill slowly, laying waste the immune system so that patients fall prey to a debilitating succession of infections. Unlike the plague of Guy's era, it is spread only through the most intimate forms of human contact: sexual intercourse, childbearing, the sharing of contaminated blood or needles.

Yet as the AIDS death toll climbs and statisticians project its probable course into the next decade, comparisons with history's greatest killers begin to make sense. "If we can't make progress, we face the dreadful prospect of a worldwide death toll in the tens of millions a decade from now," warned Health and Human Services Secretary Otis Bowen at a recent gathering of the National Press Club. Such earlier epidemics as typhus, smallpox and even the black death will "look very pale by comparison," he continued. "You haven't read or heard of anything yet."

The projections, if accurate, would bear him out:

-- Cases of AIDS have been reported in 85 countries, though the World Health Organization suspects that the disease has actually struck as many as 100 nations. WHO officials estimate that between 5 million and 10 million people around the world now carry the AIDS virus, and that as many as 100 million will become infected during the next ten years.

-- In the U.S., more than 30,000 cases have been reported, and another 1.5 million people are thought to be carriers. If the epidemic continues to spread at its current rate, the Centers for Disease Control (CDC) in Atlanta predicts, the total number of cases will reach 270,000 over the next five years, while total AIDS deaths will rise to 179,000. Fearsome as that count is, it falls short of the tolls taken by the influenza epidemic of 1918-19 (500,000 U.S. deaths) and by polio in the mid-'40s to mid-'50s (360,000 cases with 20,000 deaths). But then again, AIDS is still gathering steam.

-- In Africa, as many as 2 million to 5 million may already be infected, and in ten years, predicts Epidemiologist B. Frank Polk, of Johns Hopkins University, "some countries could lose 25% of their population." The loss in terms of the economy and social structure could well equal the black death's ruination of medieval Europe.