Dr. Merle A. Sande, a leading infectious-diseases expert whose foresight of the threat posed by AIDS led to the development of basic patient handling protocols, died on Nov. 14 at his home in Seattle. He was 68.
The cause was multiple myeloma, his family said.
In 1981, while chief of medical services at San Francisco General Hospital, Dr. Sande (pronounced SAN-dee) and his colleagues began to note an ominous incidence of young men being admitted with pneumonia, cancers and other serious illnesses, some of which defied easy diagnosis.
One patient, a young gay man, had contracted a lethal case of toxoplasmosis, a parasitic disease sometimes passed from cats to humans but unusual in a patient with a healthy immune system. Dr. Sande and others then noted the appearance of pneumocystis — a form of pneumonia more commonly found in malnourished children or patients with weakened immune systems — in a group of gay male patients in Los Angeles.
Facing an influx of similarly distressed patients, Dr. Sande realized that San Francisco was in the opening stages of an epidemic, the health crisis now known as AIDS, or acquired immune deficiency syndrome. He began to pose fundamental questions about effective practices for care of the sick and protection of medical staffs. In 1983, he argued successfully for the opening of a ward in San Francisco General for AIDS patients and also helped found an outpatient AIDS clinic there.
With Dr. Julie L. Gerberding, Dr. Paul A. Volberding and others, Dr. Sande developed what became known as the “San Francisco model” for AIDS treatments. It was “a comprehensive and rational approach on how care is delivered that contrasted greatly with the fear and paranoia that prevailed at the time,” said Dr. Warner C. Greene, a professor of medicine, microbiology and immunology who was a colleague of Dr. Sande at the University of California, San Francisco.
Dr. Greene, who is also director of the Gladstone Institute of Virology and Immunology, a leading AIDS research center affiliated with the university, said the model addressed a need for infection-control guidelines, clinical studies and research financing. It became a template for AIDS centers nationwide.
Dr. Sande himself advised San Francisco officials and the California Department of Health Services on controlling the disease and helped direct $100 million in public money earmarked for AIDS research.
He helped found the Gladstone Institute in 1992 and contributed throughout the 1990s to national panels evaluating pharmaceutical AIDS therapies like the use of AZT in the early stages of infection. He also advised public health officials on the potential of an AIDS prevention vaccine, which has yet to be developed.
A consuming interest became the treatment of the disease in Africa, where he helped to found the Infectious Diseases Institute at the Makerere College of Health Sciences in Kampala, Uganda. The institute, which opened in 2004, trains doctors and nurses from 26 African countries and operates a clinic that treats about 10,000 AIDS patients, Dr. Greene said.
Merle Alden Sande was born in Mount Vernon, Wash., north of Seattle, and received his medical degree from the University of Washington in 1965.
From 1971 to 1980, he taught at the University of Virginia, where he was a professor of internal medicine. He then moved to San Francisco as a professor of medicine, remained there until 1996 and was appointed chairman of the department of medicine at the University of Utah later that year. He returned to the University of Washington, as a professor of medicine, in 2005.
With Dr. Volberding, he edited a highly influential textbook, “The Medical Management of AIDS.” He also helped to edit a widely read medical reference, “The Sanford Guide to Antimicrobial Therapy,” work that reflected his earlier research in treatments for bacterial meningitis. At the outset of his career, at Virginia, he had studied the genesis of meningitis in mice and evaluated antibiotic and steroidal treatments of the disease.
He was a former president of the Infectious Diseases Society of America.
Dr. Sande is survived by his wife, Jenny Lo. A previous marriage ended in divorce.
He is also survived by a son, Eric, of Alameda, Calif.; three daughters, Cathleen Collins of Lake Stevens, Wash.; Sarah Sande of Glen Ellen, Calif.; and Suzanne Mrlik of San Francisco; a sister, Carolyn Nielsen of Williamsburg, Va.; and eight grandchildren.