Pharma drew a line in the sand over Covid-19 vaccine readiness, because someone had to

Ed Silverman
statnews.com
Originally posted 7 Sept 20

Here is an excerpt:

The vaccine makers that are signing this pledge — Pfizer, Merck, AstraZeneca, Sanofi, GlaxoSmithKline, BioNTech, Johnson & Johnson, Moderna, and Novavax — are rushing to complete clinical trials. But only Pfizer has indicated it may have late-stage results in October, and that’s not a given.

Yet any move by the FDA to green light a Covid-19 vaccine without late-stage results will be interpreted as an effort to boost Trump — and rightly so.

Consider Trump’s erratic and selfish remarks. He recently accused the FDA of slowing the vaccine approval process and being part of a “deep state.” No wonder there is concern he may lean on Hahn to authorize emergency use prematurely. For his part, Hahn has insisted he won’t buckle to political pressure, but he also said emergency use may be authorized based on preliminary data.

“It’s unprecedented in my experience that industry would do something like this,” said Ira Loss of Washington Analysis, who tracks pharmaceutical regulatory and legislative matters for investors. “But we’ve experienced unprecedented events since the beginning of Covid-19, starting with the FDA, where the commissioner has proven to be malleable, to be kind, at the foot of the president.”

Remember, we’ve seen this movie before.

Amid criticism of his handling of the pandemic, Trump touted hydroxychloroquine, a decades-old malaria tablet, as a salve and the FDA authorized emergency use. Two weeks ago, he touted convalescent blood plasma as a medical breakthrough, but evidence of its effectiveness against the coronavirus is inconclusive. And Hahn initially overstated study results.

Most Americans seem to be catching on. A STAT-Harris poll released last week found that 78% of the public believes the vaccine approval process is driven by politics, not science. This goes for a majority of Democrats and Republicans.

The info is here.

Poll: Most Americans believe the Covid-19 vaccine approval process is driven by politics, not science

Ed Silverman
statnews.com
Originally published 31 August 20

Seventy-eight percent of Americans worry the Covid-19 vaccine approval process is being driven more by politics than science, according to a new survey from STAT and the Harris Poll, a reflection of concern that the Trump administration may give the green light to a vaccine prematurely.

The response was largely bipartisan, with 72% of Republicans and 82% of Democrats expressing such worries, according to the poll, which was conducted last week and surveyed 2,067 American adults.

The sentiment underscores rising speculation that President Trump may pressure the Food and Drug Administration to approve or authorize emergency use of at least one Covid-19 vaccine prior to the Nov. 3 election, but before testing has been fully completed.

Concerns intensified in recent days after Trump suggested in a tweet that the FDA is part of a “deep state” conspiracy to sabotage his reelection bid. In a speech Thursday night at the Republican National Convention, he pledged that the administration “will produce a vaccine before the end of the year, or maybe even sooner.”

The info is here.

Please see top line: 80% of Americans surveyed worry that approving vaccine too quickly would worry about safety.  The implication is that fewer people would choose the vaccine if safety is an issue.

Every Decision Is A Risk. Every Risk Is A Decision.

Maggie Koerth
fivethirtyeight.com
Originally posted 21 July 20

Here is an excerpt:

In general, research has shown that indoors is riskier than outside, long visits riskier than short ones, crowds riskier than individuals — and, look, just avoid situations where you’re being sneezed, yelled, coughed or sung at.

But the trouble with the muddy middle is that a general idea of what is riskier isn’t the same thing as a clear delineation between right and wrong. These charts — even the best ones — aren’t absolute arbiters of safety: They’re the result of surveying experts. In the case of Popescu’s chart, the risk categorizations were assigned based on discussions among herself, Emanuel and Dr. James P. Phillips, the chief of disaster medicine at George Washington University Emergency Medicine. They each independently assigned a risk level to each activity, and then hashed out the ones on which they disagreed.

Take golf. How safe is it to go out to the links? Initially, the three experts had different risk levels assigned to this activity because they were all making different assumptions about what a game of golf naturally involved, Popescu said. “Are people doing it alone? If not, how many people are in a cart? Are they wearing masks? Are they drinking? …. those little variables that can increase the risk,” she told me.

Golf isn’t just golf. It’s how you golf that matters.

Those variables and assumptions aren’t trivial to calculating risk. Nor are they static. There’s different muck under your boggy feet in different parts of the country, at different times. For instance, how safe is it to eat outdoors with friends? Popescu’s chart ranks “outdoor picnic or porch dining” with people outside your household as low risk — a very validating categorization, personally. But a chart produced by the Texas Medical Association, based on a survey of its 53,000 physician members, rates “attending a backyard barbeque” as a moderate risk, a 5 on a scale in which 9 is the stuff most of us have no problem eschewing.

The info is here.

San Quentin’s coronavirus outbreak shows why ‘herd immunity’ could mean disaster

Rong-Gong Lin II and Kim Christensen
The Los Angeles Times
Originally published 11 August 20

Here are two excerpts:

San Quentin is an imperfect setting to help understand when herd immunity might be achieved. Prisons are crowded settings that will promote coronavirus transmission more so than among people in other settings, like those who live in single-family homes.

But the San Quentin experience — as well as other data — does show that, in the absence of a vaccine, “in order to get to something that approaches herd immunity, we’re going to have to get something well on the far side of 50% of people infected,” Rutherford said. “Which comes with a resultant large cost in mortality and severe morbidity.

“If you believe the San Quentin stuff, you got to get up to way-up-there before you start seeing slowing of transmission,” Rutherford said.

Dr. Anthony Fauci, the U.S. government’s top infectious diseases expert, last week guessed it will probably require 50% to 75% of a population to be immune before achieving herd immunity — a goal that should be achieved not just through infected people recovering but also through vaccination.

California has a long way to go before the vast majority of residents have been infected.

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Sweden famously pursued a herd immunity strategy when it decided not to impose a severe lockdown.

But now, Sweden has among the highest mortality rates among European countries, and has a worse rate than that of the United States.

The info is here.

Mental Health and Clinical Psychological Science in the Time of COVID-19: Challenges, Opportunities, and a Call to Action

June Gruber et al.
American Psychologist. 
Advance online publication.
http://dx.doi.org/10.1037/amp0000707

Abstract

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond.

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Concluding Comments

Clinical psychological science is needed more than ever in response to both the acute and enduring psychological effects of COVID-19 (Adhanom Ghebreyesus, 2020). This article is intended to inspire dialogue surrounding the challenges the field faces and how it must adapt to meet the mental health demands of a rapidly evolving psychological landscape. Of course, sustained change will require strong advocacy to ensure that mental health research funding is available to understand and address mental health challenges following COVID-19. To secure a leadership role, clinical psychological scientists must be prepared to raise their voices not only within scientific outlets, but also in public discussions on the airwaves (radio, cable news), alongside colleagues in other scientific fields. Sustained effort, collaboration with other disciplines, and unity within psychology will be necessary to address the multifaceted impacts of COVID-19 on humanity.

What is herd immunity?

Joshua Krisch
Live Science
Originally published July 2020

Here is an excerpt:

Herd immunity doesn't always work

The ingredients for achieving herd immunity naturally are well understood. "You want a disease that is guaranteed to produce robust immunity with largely asymptomatic spread, and have a low R0," Altmann told Live Science. But even if the R0 is relatively high and most patients are symptomatic, herd immunity is still possible with an effective vaccine, and a vaccine program that immunizes the population en masse. "Think of our big, public-health vaccination success-stories: Smallpox and polio, both entirely due to massive, sustained vaccine programs with simple, highly effective vaccines," he said.

Robust immunity is necessary to ensure that those who become immune stay that way long enough for the pathogen to die out. Asymptomatic spread helps, because it means that fewer people are likely to die while the population waits for herd immunity to take hold — and increases the likelihood that there will be enough survivors to affect herd immunity in the first place. A low R0, of course, lowers the bar for how many individuals need to be immune before we see the infection rate flatten and decline.

Nonetheless, some diseases that are seemingly strong candidates for herd immunity never quite achieve it. Despite widespread infection and vaccination, chicken pox, for instance, has never been entirely eradicated from the population. That's because the virus that causes chicken pox remains latent in the nerve roots of those who are infected by it, even after they recover and acquire immunity to the disease. As once-infected individuals grow older their immune systems weaken and the virus can reactivate, causing shingles, which can, in turn, cause chicken pox.

"You might have eradicated chicken pox in a small island community, but then somebody's granny gets an attack of shingles and, over a matter of weeks, every kid on the island gets chicken pox," Hunter said. "You've achieved herd immunity, and [it appears] the virus has died out, but it's actually waiting to come out." Similar phenomena have been observed with tuberculosis, according to the WHO.

Vaccine-induced herd immunity can also fail when a vaccine results in only short-lived immunity within a population. Pertussis and mumps recently reappeared long after vaccine programs were assumed to have eradicated these diseases, and studies suggest that, while vaccine noncompliance played a role, the outbreaks were in part due to the vaccines losing effectiveness over time. "In the past few years we've had both pertussis and mumps outbreaks, and those have primarily resulted from waning immunity over time," Poland said.

The info is here.

Hydroxychloroquine RCTs: 'Ethically, the Choice Is Clear'

F. Perry Wilson
medscape.com
Originally poste 5 August 20

Here is an excerpt:

I am not going to say that HCQ has no effect on COVID-19. We can never be 100% sure of that. But I am sure that if it has an effect, it is quite small. Think of a world where HCQ was a miracle cure for COVID-19. Think how different all of these randomized trials would look. It would be immediately obvious.

Straight talk: HCQ is unlikely to kill you. It will kill someone (rare cases of torsades de pointes occur), but it is unlikely to be you or your patients. It really is a relatively well-tolerated drug. But there are adverse effects, as all of these trials show. And given that, our ethical obligation to "first, do no harm" is paramount here. There simply is not good evidence that HCQ has a robust effect, and there is evidence of at least moderate harm. Ethically, the choice is clear.

A few final caveats. Yes, only one of these trials reported on the use of zinc with HCQ (no effect, by the way). But two things on that particular issue: First, we know that many individuals take zinc supplements, so if, as the argument goes, HCQ is a miracle cure when given with zinc, you'd still see a benefit in an HCQ trial because a subset of people — maybe 25% — are taking zinc.

The zinc issue falls into this "no true Scotsman" land of HCQ studies. Any negative study can be dismissed: "Oh, you didn't give it early enough, or late enough, or with zinc, or with azithromycin, or on Sunday," or whatever. That's not how science works. I'm not saying that any of these studies are perfect, just that they are the best evidence we have right now. The burden of proof is to show that the drug works. Though I'm sure that pharma would be stoked to be able to argue that their latest negative trial can be ignored because their billion-dollar drug wasn't given in concert with vitamin C or whatever.

Yes, I know that another Yale professor is saying that HCQ can save lives.

And to those of you who have pointed out that he is a full professor while I am a mere associate professor, you really know how to hurt a guy. I have no idea why he wrote that article and didn't mention any of the randomized trials. But I embrace the academic freedom that he and I both have to present our best interpretation of the data.

The info is here.

The Role of Cognitive Dissonance in the Pandemic

Elliot Aronson and Carol Tavris
The Atlantic
Originally published 12 July 20

Here is an excerpt:

Because of the intense polarization in our country, a great many Americans now see the life-and-death decisions of the coronavirus as political choices rather than medical ones. In the absence of a unifying narrative and competent national leadership, Americans have to choose whom to believe as they make decisions about how to live: the scientists and the public-health experts, whose advice will necessarily change as they learn more about the virus, treatment, and risks? Or President Donald Trump and his acolytes, who suggest that masks and social distancing are unnecessary or “optional”?

The cognition I want to go back to work or I want to go to my favorite bar to hang out with my friends is dissonant with any information that suggests these actions might be dangerous—if not to individuals themselves, then to others with whom they interact.

How to resolve this dissonance? People could avoid the crowds, parties, and bars and wear a mask. Or they could jump back into their former ways. But to preserve their belief that they are smart and competent and would never do anything foolish to risk their lives, they will need some self-justifications: Claim that masks impair their breathing, deny that the pandemic is serious, or protest that their “freedom” to do what they want is paramount. “You’re removing our freedoms and stomping on our constitutional rights by these Communist-dictatorship orders,” a woman at a Palm Beach County commissioners’ hearing said. “Masks are literally killing people,” said another. South Dakota Governor Kristi Noem, referring to masks and any other government interventions, said, “More freedom, not more government, is the answer.” Vice President Mike Pence added his own justification for encouraging people to gather in unsafe crowds for a Trump rally: “The right to peacefully assemble is enshrined in the First Amendment of the Constitution.”

The info is here.

America’s Schools Are a Moral and Medical Catastrophe

Laurie Garrett
foreignpolicy.com
Originally posted 24 July 20

After U.S. President Donald Trump demanded last week that schools nationwide reopen this fall, regardless of the status of their community’s COVID-19 epidemic status, his Secretary of Education Betsy DeVos was asked how this could safely be accomplished. She offered no guidelines, nor financial support to strapped school districts. Her reply was that school districts nationwide needed to create their own safety schemes and realize that the federal government will cut off funds if schools fail to reopen. “I think the go-to needs to be kids in school, in person, in the classroom,” she said in an interview on CNN on July 12.

This is nothing short of moral bankruptcy. The Trump administration is effectively demanding schools bend to its will, without offering a hint of expert guidance on how to do so safely, much less the necessary financing.

I can’t correct for the latter failure, of course. But here’s some information that will be of use to the many rightfully concerned parents and educators across the United States.

1. Should a national-scale school reopening be considered, at all?

Emphatically, no. The state of Florida’s data shows that 13 percent of children who have been tested for the novel coronavirus were found to be infected, and there’s a gradient of infection downward with age: Only 16 percent of these positive cases are in children 1 to 4 years old, whereas 29 percent are in those 15 to 17 years old. In Nueces County, Texas, 85 children under age 2 have tested positive for the coronavirus since March, killing one of them. The infections were likely caught from parents or older siblings. A South Korean government survey of 60,000 households discovered that adults living in households that had an infected child aged 10 to 19 years had the highest rate of catching the coronavirus—more so than when an infected adult was present. Nearly 19 percent of people living with an infected teenager went on to test positive for the virus within 10 days. A Kaiser Family Foundation study says some 3.3 million adults over 65 in the United States live in a home with at least one school-aged child, putting the elders at special risk.

The info is here.

“Feeling superior is a bipartisan issue: Extremity (not direction) of political views predicts perceived belief superiority”

Harris, E. A., & Van Bavel, J. J. (2020, May 20).
PsyArXiv
https://doi.org/10.31234/osf.io/hfuas

Abstract

There is currently a debate in political psychology about whether dogmatism and belief superiority are symmetric or asymmetric across the ideological spectrum. One study found that dogmatism was higher amongst conservatives than liberals, but both conservatives and liberals with extreme attitudes reported higher perceived superiority of beliefs (Toner et al., 2013). In the current study, we conducted a pre-registered direct and conceptual replication of this previous research using a large nationally representative sample. Consistent with prior research, we found that conservatives had higher dogmatism scores than liberals while both conservative and liberal extreme attitudes were associated with higher belief superiority compared to more moderate attitudes. As in the prior research we also found that whether conservative or liberal attitudes were associated with higher belief superiority was topic dependent. Different from prior research, we found that ideologically extreme individuals had higher dogmatism. Implications of these results for theoretical debates in political psychology are discussed.

Conclusion

The current work provides further evidence that conservatives have higher dogmatism scores than liberals while both conservative and liberal extreme attitudes are associated with higher belief superiority (and dogmatism). However, ideological differences in belief superiority vary by topic. Therefore, to assess general differences between liberals and conservatives it is necessary to look across many diverse topics and model the data appropriately. If scholars instead choose to study one topic at a time, any ideological differences they find may say more about the topic than about innate differences between liberals and conservatives.

Collective narcissism predicts the belief and dissemination of conspiracy theories during the COVID-19 pandemic.

Sternisko, A., Cichocka, A., Cislak, A.,
& Van Bavel, J. J. (2020, May 21).
PsyArXiv
https://doi.org/10.31234/osf.io/4c6av

Abstract

While COVID-19 was quietly spreading across the globe, conspiracy theories were finding loud voices on the internet. What contributes to the spread of these theories? In two national surveys (NTotal = 950) conducted in the United States and the United Kingdom, we identified national narcissism – a belief in the greatness of one’s nation that others do not appreciate – as a risk factor for the spread of conspiracy theories during the COVID-19 pandemic. We found that national narcissism was strongly associated with the proneness to believe and disseminate conspiracy theories related to COVID-19, accounting for up to 22% of the variance. Further, we found preliminary evidence that belief in COVID-19 conspiracy theories and national narcissism was linked to health-related behaviors and attitudes towards public policies to mitigate the spread of COVID-19. Our study expands previous work by illustrating the importance of identity processes in the spread of conspiracy theories during pandemics.

Conclusion

Ultimately, we hope that our studies are not only relevant for researchers but also for practitioners.Yet, little is known about how to increase or decrease the link between collective narcissism and conspiracy theories. Therefore, we urge future research to examine if focusing on the protection of the national image influences the spread of COVID-19 conspiracy theories, and the implications of these associations for public-health communication. For instance, underscoring that the national in-group is in some way disadvantaged in fighting the pandemic might increase the need to assert the image of the group and further fuel conspiracy theories.  Conversely, public-health messages might benefit from stressing that the adherence to health guidelines and policies also helps protect the nation’s image. Exploring such and other interventions could help limit the current ‘infodemic'.

Physicians united: Here’s why pulling out of WHO is a big mistake

Andis Robeznieks
American Medical Association
Originally published 8 July 20

Here is an excerpt:

The joint statement builds on a previous response from the AMA made back in May after the administration announced its intention to withdraw from the WHO.

Withdrawal served “no logical purpose,” made finding a solution to the pandemic more challenging and could have harmful repercussions in worldwide efforts to develop a vaccine and effective COVID-19 treatments, then-AMA President Patrice A. Harris, MD, MA, said at the time.

Defeating COVID-19 “requires the entire world working together,” Dr. Harris added.

In April, Dr. Harris said withdrawing from the WHO would be “a dangerous step in the wrong direction, and noted that “fighting a global pandemic requires international cooperation “

“Cutting funding to the WHO—rather than focusing on solutions—is a dangerous move at a precarious moment for the world,” she added

The message regarding the need for a unified international effort was echoed in the statement from the physician leaders.

"As our nation and the rest of the world face a global health pandemic, a worldwide, coordinated response is more vital than ever,” they said. “This dangerous withdrawal not only impacts the global response against COVID-19, but also undermines efforts to address other major public health threats.”

The info is here.

Making Decisions in a COVID-19 World

Baruch Fischoff
JAMA. 2020;324(2):139-140.
doi:10.1001/jama.2020.10178

Here are two excerpts:

Individuals must answer complementary questions. When is it safe enough to visit a physician’s office, get a dental check-up, shop for clothing, ride the bus, visit an aging or incarcerated relative, or go to the gym? What does it mean that some places are open but not others and in one state, but not in a bordering one? How do individuals make sense of conflicting advice about face masks, fomites, and foodstuffs?

Risk analysis translates technical knowledge into terms that people can use. Done to a publication standard, risk analysis requires advanced training and substantial resources. However, even back-of-the-envelope calculations can help individuals make sense of otherwise bewildering choices. Combined with behavioral research, risk analysis can help explain why reasonable people sometimes make different decisions. Why do some people wear face masks and crowd on the beach, while others do not? Do they perceive the risks differently or are they concerned about different risks?

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Second, risk analyses are needed to apply that knowledge. However solid the science on basic physical, biological, and behavioral processes, applying it requires knowledge of specific settings. How do air and people circulate? What objects and surfaces do people and viruses touch? How sustainable are physical barriers and behavioral practices? Risk analysts derive such estimates by consulting with scientists who know the processes and decision makers who know the settings.3 Boundary organizations are needed to bring the relevant parties together in each sector (medicine, sports, schools, movie production, etc) to produce estimates informed by the science and by people who know how that sector works.

The info is here.

Immunity to Covid-19 could be lost in months, UK study suggests

Ian Sample
The Guardian
Originally posted 12 July 20

People who have recovered from Covid-19 may lose their immunity to the disease within months, according to research suggesting the virus could reinfect people year after year, like common colds.

In the first longitudinal study of its kind, scientists analysed the immune response of more than 90 patients and healthcare workers at Guy’s and St Thomas’ NHS foundation trust and found levels of antibodies that can destroy the virus peaked about three weeks after the onset of symptoms then swiftly declined.

Blood tests revealed that while 60% of people marshalled a “potent” antibody response at the height of their battle with the virus, only 17% retained the same potency three months later. Antibody levels fell as much as 23-fold over the period. In some cases, they became undetectable.

“People are producing a reasonable antibody response to the virus, but it’s waning over a short period of time and depending on how high your peak is, that determines how long the antibodies are staying around,” said Dr Katie Doores, lead author on the study at King’s College London.

The study has implications for the development of a vaccine, and for the pursuit of “herd immunity” in the community over time.

The immune system has multiple ways to fight the coronavirus but if antibodies are the main line of defence, the findings suggested people could become reinfected in seasonal waves and that vaccines may not protect them for long.

The info is here.

Cognitive Bias and Public Health Policy During the COVID-19 Pandemic

Halpern SD, Truog RD, and Miller FG.
JAMA. 
Published online June 29, 2020.
doi:10.1001/jama.2020.11623

Here is an excerpt:

These cognitive errors, which distract leaders from optimal policy making and citizens from taking steps to promote their own and others’ interests, cannot merely be ascribed to repudiations of science. Rather, these biases are pervasive and may have been evolutionarily selected. Even at academic medical centers, where a premium is placed on having science guide policy, COVID-19 action plans prioritized expanding critical care capacity at the outset, and many clinicians treated seriously ill patients with drugs with little evidence of effectiveness, often before these institutions and clinicians enacted strategies to prevent spread of disease.

Identifiable Lives and Optimism Bias

The first error that thwarts effective policy making during crises stems from what economists have called the “identifiable victim effect.” Humans respond more aggressively to threats to identifiable lives, ie, those that an individual can easily imagine being their own or belonging to people they care about (such as family members) or care for (such as a clinician’s patients) than to the hidden, “statistical” deaths reported in accounts of the population-level tolls of the crisis. Similarly, psychologists have described efforts to rescue endangered lives as an inviolable goal, such that immediate efforts to save visible lives cannot be abandoned even if more lives would be saved through alternative responses.

Some may view the focus on saving immediately threatened lives as rational because doing so entails less uncertainty than policies designed to save invisible lives that are not yet imminently threatened. Individuals who harbor such instincts may feel vindicated knowing that during the present pandemic, few if any patients in the US who could have benefited from a ventilator were denied one.

Yet such views represent a second reason for the broad endorsement of policies that prioritize saving visible, immediately jeopardized lives: that humans are imbued with a strong and neurally mediated3 tendency to predict outcomes that are systematically more optimistic than observed outcomes. Early pandemic prediction models provided best-case, worst-case, and most-likely estimates, fully depicting the intrinsic uncertainty.4 Sound policy would have attempted to minimize mortality by doing everything possible to prevent the worst case, but human optimism bias led many to act as if the best case was in fact the most likely.

The info is here.

COVID-19 is more than a public health challenge: it's a moral test

Thomas Reese
religionnews.com
Originally published 10 July 20

The time is already past to admit that the coronavirus pandemic in the United States is a moral crisis, not simply a public health and economic crisis.

While a certain amount of confusion back in February at the beginning of the crisis is understandable, today it is unforgivable. Bad leadership has cost thousands of lives and millions of jobs.

A large part of the failure has been in separating the economic crisis from the public health crisis when in fact they are intimately related. Until consumers and workers feel safe, the economy cannot revive. Nor should we take the stock market as the key measure of the country’s health, rather than the lives of ordinary people.

It can be difficult to see this as a moral crisis because what is needed is not heroic action, but simple acts that everyone must do. People simply need to wear masks, keep social distance and wash their hands. Employers need to provide working conditions where that is possible.

These are practices that public health experts have taught for decades. Too many in the United States have ignored them. Warnings about masks, for example, have been ignored.

For its part, government needs to enforce these measures, expand testing on a massive scale, do contact tracing and help people isolate themselves if they test positive. Instead, government, especially at the federal level, has failed. Businesses, especially bars, restaurants and entertainment venues, have remained open or been reopened too soon.

That it is possible to do the right thing and control the virus is obvious from the examples of South Korea, Thailand, New Zealand, China, Vietnam, most of Europe, New York, Massachusetts and Connecticut.

There is also the sin of presumption of those who trust in God to protect them from the virus while doing nothing themselves. Those who left it to the Lord forgot that “God helps those who help themselves.” There is also an arrogance in seeing ourselves as different from other mortals like us. Areas where people insisted they were somehow immune to this “blue” big-city virus have now been hit with comparable or worse infection rates.

The info is here.

The Pandemic Experts Are Not Okay

Ed Yong
The Atlantic
Originally posted 7 July 20

Here is an excerpt:

The field of public health demands a particular way of thinking. Unlike medicine, which is about saving individual patients, public health is about protecting the well-being of entire communities. Its problems, from malnutrition to addiction to epidemics, are broader in scope. Its successes come incrementally, slowly, and through the sustained efforts of large groups of people. As Natalie Dean, a biostatistician at the University of Florida, told me, “The pandemic is a huge problem, but I’m not afraid of huge problems.”

The more successful public health is, however, the more people take it for granted. Funding has dwindled since the 2008 recession. Many jobs have disappeared. Now that the entire country needs public-health advice, there aren’t enough people qualified to offer it. The number of epidemiologists who specialize in pandemic-level infectious threats is small enough that “I think I know them all,” says Caitlin Rivers, who studies outbreaks at the Johns Hopkins Center for Health Security.

The people doing this work have had to recalibrate their lives. From March to May, Colin Carlson, a research professor at Georgetown University who specializes in infectious diseases, spent most of his time traversing the short gap between his bed and his desk. He worked relentlessly and knocked back coffee, even though it exacerbates his severe anxiety: The cost was worth it, he felt, when the United States still seemed to have a chance of controlling COVID-19.

The info is here.

Our Minds Aren’t Equipped for This Kind of Reopening

TessWilkinson-Ryan
The Atlantic
Originally published 6 July 20

Here is the conclusion:

At the least, government agencies must promulgate clear, explicit norms and rules to facilitate cooperative choices. Most people congregating in tight spaces are telling themselves a story about why what they are doing is okay. Such stories flourish under confusing or ambivalent norms. People are not irrevocably chaotic decision makers; the level of clarity in human thinking depends on how hard a problem is. I know with certainty whether I’m staying home, but the confidence interval around “I am being careful” is really wide. Concrete guidance makes challenges easier to resolve. If masks work, states and communities should require them unequivocally. Cognitive biases are the reason to mark off six-foot spaces on the supermarket floor or circles in the grass at a park.

For social-distancing shaming to be a valuable public-health tool, average citizens should reserve it for overt defiance of clear official directives—failure to wear a mask when one is required—rather than mere cases of flawed judgment. In the meantime, money and power are located in public and private institutions that have access to public-health experts and the ability to propose specific behavioral norms. The bad judgments that really deserve shaming include the failure to facilitate testing, failure to protect essential workers, failure to release larger numbers of prisoners from facilities that have become COVID-19 hot spots, and failure to create the material conditions that permit strict isolation. America’s half-hearted reopening is a psychological morass, a setup for defeat that will be easy to blame on irresponsible individuals while culpable institutions evade scrutiny.

The info is here.

Can COVID-19 re-invigorate ethics?

Louise Campbell
BMJ Blogs
Originally posted 26 May 20

The COVID-19 pandemic has catapulted ethics into the spotlight.  Questions previously deliberated about by small numbers of people interested in or affected by particular issues are now being posed with an unprecedented urgency right across the public domain.  One of the interesting facets of this development is the way in which the questions we are asking now draw attention, not just to the importance of ethics in public life, but to the very nature of ethics as practice, namely ethics as it is applied to specific societal and environmental concerns.

Some of these questions which have captured the public imagination were originally debated specifically within healthcare circles and at the level of health policy: what measures must be taken to prevent hospitals from becoming overwhelmed if there is a surge in the number of people requiring hospitalisation?  How will critical care resources such as ventilators be prioritised if need outstrips supply?  In a crisis situation, will older people or people with disabilities have the same opportunities to access scarce resources, even though they may have less chance of survival than people without age-related conditions or disabilities?  What level of risk should healthcare workers be expected to assume when treating patients in situations in which personal protective equipment may be inadequate or unavailable?   Have the rights of patients with chronic conditions been traded off against the need to prepare the health service to meet a demand which to date has not arisen?  Will the response to COVID-19 based on current evidence compromise the capacity of the health system to provide routine outpatient and non-emergency care to patients in the near future?

Other questions relate more broadly to the intersection between health and society: how do we calculate the harms of compelling entire populations to isolate themselves from loved ones and from their communities?  How do we balance these harms against the risks of giving people more autonomy to act responsibly?  What consideration is given to the fact that, in an unequal society, restrictions on liberty will affect certain social groups in disproportionate ways?  What does the catastrophic impact of COVID-19 on residents of nursing homes say about our priorities as a society and to what extent is their plight our collective responsibility?  What steps have been taken to protect marginalised communities who are at greater risk from an outbreak of infectious disease: for example, people who have no choice but to coexist in close proximity with one another in direct provision centres, in prison settings and on halting sites?

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Utilitarianism and the pandemic

J. Savulescu, I. Persson, & D. Wilkinson
Bioethics
Originally published 20 May 20

Abstract

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay.

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