Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Pandemic. Show all posts
Showing posts with label Pandemic. Show all posts

Thursday, July 13, 2023

A time for moral actions: Moral identity, morality-as-cooperation and moral circles predict support of collective action to fight the COVID-19 pandemic in an international sample

Boggio, P. S., Nezlek, J. B., et al. (2022).
Journal of Personality and Social Psychology,
122(4), 937-956.


Understanding what factors are linked to public health behavior in a global pandemic is critical to mobilizing an effective public health response. Although public policy and health messages are often framed through the lens of individual benefit, many of the behavioral strategies needed to combat a pandemic require individual sacrifices to benefit the collective welfare. Therefore, we examined the relationship between individuals’ morality and their support for public health measures. In a large-scale study with samples from 68 countries worldwide (Study 1; N = 46,576), we found robust evidence that moral identity, morality-as-cooperation, and moral circles are each positively related to people’s willingness to engage in public health behaviors and policy support. Together, these moral dispositions accounted for 9.8%, 10.2%, and 6.2% of support for limiting contact, improving hygiene, and supporting policy change, respectively. These morality variables (Study 2) and Schwartz’s values dimensions (Study 3) were also associated with behavioral responses across 42 countries in the form of reduced physical mobility during the pandemic. These results suggest that morality may help mobilize citizens to support public health policy.


Here is a summary of this research.  I could not find a free pdf.

The COVID-19 pandemic has had a significant impact on the world, and it has required individuals to make sacrifices for the collective good. The authors of this study were interested in understanding how individuals' moral identities, their beliefs about morality, and their sense of moral community might influence their willingness to support collective action to fight the pandemic.

The authors conducted a study with a sample of over 46,000 people from 68 countries. They found that people who had a strong moral identity, who believed that morality is about cooperation, and who had a broad sense of moral community were more likely to support collective action to fight the pandemic. These findings suggest that individuals' moral identities and beliefs can play an important role in motivating them to take action to benefit the collective good.

The authors conclude that their findings have important implications for public health campaigns. They suggest that public health campaigns should focus on appealing to people's moral identities and beliefs in order to motivate them to take action to fight the pandemic.

Here are some of the key findings of the study:
  • People with a strong moral identity were more likely to support collective action to fight the pandemic.
  • People who believed that morality is about cooperation were more likely to support collective action to fight the pandemic.
  • People who had a broad sense of moral community were more likely to support collective action to fight the pandemic.
These findings suggest that individuals' moral identities and beliefs can play an important role in motivating them to take action to benefit the collective good.

Monday, December 5, 2022

Social isolation and the brain in the pandemic era

Bzdok, D., and Dunbar, R.
Nat Hum Behav 6, 1333–1343 (2022).


Intense sociality has been a catalyst for human culture and civilization, and our social relationships at a personal level play a pivotal role in our health and well-being. These relationships are, however, sensitive to the time we invest in them. To understand how and why this should be, we first outline the evolutionary background in primate sociality from which our human social world has emerged. We then review defining features of that human sociality, putting forward a framework within which one can understand the consequences of mass social isolation during the COVID-19 pandemic, including mental health deterioration, stress, sleep disturbance and substance misuse. We outline recent research on the neural basis of prolonged social isolation, highlighting especially higher-order neural circuits such as the default mode network. Our survey of studies covers the negative effects of prolonged social deprivation and the multifaceted drivers of day-to-day pandemic experiences.


The human social world is deeply rooted in our primate ancestry. This social world is, however, extremely sensitive to the time we invest in it. Enforced social isolation can easily destabilize its delicate equilibrium. Many of the psychological sequalae of COVID-19 lockdowns are readily understood as resulting from the dislocation of these deeply rooted social processes. Indeed, many of these findings could have been anticipated long before the COVID-19 pandemic. For example, almost one in ten Europeans admitted never meeting friends or family outside of their own household in the course of an entire year, with direct consequences for their psychological and physical health. Solitary living made up >50% of households in a growing number of metropolitan cities worldwide and has long been thought to be the cause of increasing levels of depression and psychological dystopia. Indeed, aversive feelings of social isolation probably serve as a biological warning signal that alerts individuals to improve their social relationships.

Three key points emerge from our present assessment. One is that COVID-19 and associated public health restrictions to curb the spread of the virus are likely to have demonstrable mental health and psychosocial ramifications for years to come. This will inevitably place a significant burden on our health systems and societies. The impact may, however, be largely restricted to specific population strata. Older people, for example, are likely to face disproportionately adverse consequences. Worryingly, prolonged social isolation seems to invoke changes in the capacity to visualize internally centred thoughts, especially in younger sub-population. This may presage a switch from an outward to an inward focus that may exacerbate the experience of social isolation in susceptible individuals. The longer-term implications of this are, however, yet to be determined. Second, the experience of undergoing social isolation is known to have significant effects on the structure and function of the hippocampus and default network, long recognized as a primary neural pathway implicated in the pathophysiology of dementia and other major neurodegenerative diseases as well as in effective social function. The fact that these same brain regions turn up in the neuroanatomical consequences of COVID-19 infection is concerning. Our third key point is that social determinants that condition inequality in our societies have strong impacts on lived day-to-day pandemic experiences. This is highlighted by the negative outcomes from COVID-19 for families of lower socio-economic status, single-parent households, and those with racial and ethnic minority backgrounds.

As a note of caution, in our judgement, few datasets or methodological tools exist today to definitively establish causal directionality in many of the population effects we have surveyed in this review. For example, many of the correlative links do not allow us to infer whether loneliness directly causes depression and anxiety, as opposed to already depressed, anxious individuals being more prone to developing loneliness in times of adversity. Similarly, none of the reviewed findings can be used to tease apart whether changes in psychopathology during periods of mass social isolation are the chicken or the egg of the many biological manifestations. To fill knowledge gaps on mediating mechanisms for theoretical models, future research requires carefully designed and controlled longitudinal before-versus-after COVID-19 population investigations.

Wednesday, March 23, 2022

Moral Injury, Traumatic Stress, and Threats to Core Human Needs in Health-Care Workers: The COVID-19 Pandemic as a Dehumanizing Experience

Hagerty, S. L., & Williams, L. M. (2022)
Clinical Psychological Science. 


The pandemic has threatened core human needs. The pandemic provides a context to study psychological injury as it relates to unmet basic human needs and traumatic stressors, including moral incongruence. We surveyed 1,122 health-care workers from across the United States between May 2020 and August 2020. Using a mixed-methods design, we examined moral injury and unmet basic human needs in relation to traumatic stress and suicidality. Nearly one third of respondents reported elevated symptoms of psychological trauma, and the prevalence of suicidal ideation among health-care workers in our sample was roughly 3 times higher than in the general population. Moral injury and loneliness predict greater symptoms of traumatic stress and suicidality. We conclude that dehumanization is a driving force behind the psychological injury resulting from moral incongruence in the context of the pandemic. The pandemic most frequently threatened basic human motivations at the foundational level of safety and security relative to other higher order needs.

From the General Discussion

A subset of respondents added context to their experiences of moral injury in the form of narrative responses. These powerful accounts of the lived experiences of health-care workers provided us with a richer understanding of the construct of moral injury, especially as it relates to the novel context of the pandemic. Although betrayal is a known facet of moral injury from prior work (Bryan et al., 2016), our qualitative analysis suggests that dehumanization may also be a key phenomenon that underlies pandemic-related moral injury. Given our findings, we suggest that it may be important to attend to both betrayal and dehumanization when researching or intervening on the psychological sequelae of the pandemic. Our results support this because experiences of dehumanization in our sample were associated with greater symptoms of traumatic stress.

Another lens through which to view the experiences of health-care workers in the pandemic is through unsatisfied basic human motivations. Given the obvious barriers the pandemic presents to human connection (Hagerty & Williams, 2020), we had an a priori interest in studying loneliness. Our results indeed suggest that need of social connection appears relevant to the mental-health experiences of health-care workers during the pandemic such that loneliness was associated with greater traumatic stress, moral injury, and suicidal ideation. Echoing the importance of this social factor are findings from prior research suggesting that social connectedness buffers the association between moral injury and suicidality (Kelley et al., 2019) and buffers the impact of PTSD symptoms on suicidal behavior (Panagioti et al., 2014). Thus, our work further highlights lack of social connection as possible risk factor among individuals who face moral injury and traumatic stress and demonstrates its relevance to the mental health of health-care workers during the pandemic.

Thursday, November 4, 2021

The AMA needs to declare a national mental health emergency

Susan Hata and Thalia Krakower
Originally published 6 OCT 21

As the pandemic continues to disrupt life across the U.S., a staggering number of Americans are reaching out to their primary care doctors for help with sometimes overwhelming mental health struggles. Yet primary care doctors like us have nowhere to turn when it comes to finding mental health providers for them, and our patients often suffer without the specialty care they need.

It’s time for the American Medical Association to take decisive action and declare a national mental health emergency.

More than 40% of Americans report symptoms of anxiety or depression, and emergency rooms are flooded with patients in psychiatric crises. Untreated, these issues can have devastating consequences. In 2020, an estimated 44,800 Americans lost their lives to suicide; among children ages 10 to 14, suicide is the second leading cause of death.

Finding mental health providers for patients is an uphill climb, in part because there is no centralized process for it. Timely mental health services are astonishingly difficult to obtain even in Massachusetts, where we live and work, which has the most psychologists per capita. Waitlists for therapists can be longer than six months for adults, and even longer for children.


By declaring a mental health emergency, the AMA could galvanize health administrators and drive the innovation needed to improve the existing mental health system. When Covid-19 was named a pandemic, the U.S. health care infrastructure adapted quickly to manage the deluge of infections. Leaders nimbly and creatively mobilized resources. They redeployed staff, built field hospitals and overflow ICUs, and deferred surgeries and routine care to preserve resources and minimize hospital-based transmission of Covid-19. With proper framing and a sense of urgency, similar things can happen for the mental health care system.

To be clear, all of this is the AMA’s lane: In addition to the devastating toll of suicides and overdoses, untreated mental illness worsens cardiac outcomes, increases mortality from Covid-19, and shortens life spans. Adult mental illness also directly affects the health of children, leading to poor health outcomes across generations.

Saturday, October 23, 2021

Decision fatigue: Why it’s so hard to make up your mind these days, and how to make it easier

Stacy Colino
The Washington Post
Originally posted 22 Sept 21

Here is an excerpt:

Decision fatigue is more than just a feeling; it stems in part from changes in brain function. Research using functional magnetic resonance imaging has shown that there’s a sweet spot for brain function when it comes to making choices: When people were asked to choose from sets of six, 12 or 24 items, activity was highest in the striatum and the anterior cingulate cortex — both of which coordinate various aspects of cognition, including decision-making and impulse control — when the people faced 12 choices, which was perceived as “the right amount.”

Decision fatigue may make it harder to exercise self-control when it comes to eating, drinking, exercising or shopping. “Depleted people become more passive, which becomes bad for their decision-making,” says Roy Baumeister, a professor of psychology at the University of Queensland in Australia and author of  “Willpower: Rediscovering the Greatest Human Strength.” “They can be more impulsive. They may feel emotions more strongly. And they’re more susceptible to bias and more likely to postpone decision-making.”

In laboratory studies, researchers asked people to choose from an array of consumer goods or college course options or to simply think about the same options without making choices. They found that the choice-makers later experienced reduced self-control, including less physical stamina, greater procrastination and lower performance on tasks involving math calculations; the choice-contemplators didn’t experience these depletions.

Having insufficient information about the choices at hand may influence people’s susceptibility to decision fatigue. Experiencing high levels of stress and general fatigue can, too, Bufka says. And if you believe that the choices you make say something about who you are as a person, that can ratchet up the pressure, increasing your chances of being vulnerable to decision fatigue.

The suggestions include:

1. Sleep well
2. Make some choice automatic
3. Enlist a choice advisor
4. Given expectations a reality check
5. Pace yourself
6. Pay attention to feelings

Tuesday, September 28, 2021

Moral Injury During the CDOVID-19 Pandemic

Borges LM, Barnes SM,  et al. 
Psychol Trauma. 2020 Aug;12(S1):S138-S140. 
doi: 10.1037/tra0000698. Epub 2020 Jun 4. PMID: 32496101.

Here is an excerpt:

Moral injury in COVID-19 may be related to, but is distinct from: 1) burnout, 2) adjustment disorders, 3)
depression, 4) traumatic stress/PTSD, 5) moral injury in the military, and 6) moral distress. Moral injury
may be a contributing factor to burnout, adjustment disorders, or depression, but they are not equivalent. The diagnosis of PTSD requires a qualifying exposure to a traumatic stressor, whereas experiencing a moral injury does not. Moral injury in the military has been addressed in a different population and particularly after deployment, and its lessons may not be generalizable to moral injury during COVID-19, which we are seeing acutely among healthcare workers. Finally, moral distress may be a precursor to moral injury, but the terms are not interchangeable. Previous literature has noted that moral distress signals a need for systemic change because it is generated by systemic issues. Thus, moral distress can serve as a guide for healthcare improvement, and rapid systemic interventions to address moral distress may help to prevent and mitigate the impact of moral injury.

While not a mental disorder itself, moral injury undermines core capacities for well-being, including a
sense of ongoing value-laden actions, competence to face and meet challenges, and feelings of belonging and meaning. Moral injury is associated with strong feelings of shame and guilt and with intense self-condemnation and a shattered core sense of self. Clinical observations suggest that uncertainty in decision-making may increase the likelihood or intensity of moral injury.

In the context of a public health disaster such as the COVID-19 pandemic, acknowledgement of the need
to transition from ordinary standards of care to crisis standards of care can be both necessary and helpful to 1) provide a framework upon which to make difficult and ethically fraught decisions and 2) alleviate some of moral distress and indeed moral injury that may otherwise be experienced in the absence of such guidance. The pandemic forces us to confront challenging questions for which there are no clear answers, and to make “lose-lose” choices in which no one involved ends up feeling satisfied or even comfortable. 

Friday, August 13, 2021

Moral dilemmas and trust in leaders during a global health crisis

Everett, J.A.C., Colombatto, C., Awad, E. et al. 
Nat Hum Behav (2021). 


Trust in leaders is central to citizen compliance with public policies. One potential determinant of trust is how leaders resolve conflicts between utilitarian and non-utilitarian ethical principles in moral dilemmas. Past research suggests that utilitarian responses to dilemmas can both erode and enhance trust in leaders: sacrificing some people to save many others (‘instrumental harm’) reduces trust, while maximizing the welfare of everyone equally (‘impartial beneficence’) may increase trust. In a multi-site experiment spanning 22 countries on six continents, participants (N = 23,929) completed self-report (N = 17,591) and behavioural (N = 12,638) measures of trust in leaders who endorsed utilitarian or non-utilitarian principles in dilemmas concerning the COVID-19 pandemic. Across both the self-report and behavioural measures, endorsement of instrumental harm decreased trust, while endorsement of impartial beneficence increased trust. These results show how support for different ethical principles can impact trust in leaders, and inform effective public communication during times of global crisis.


The COVID-19 pandemic has raised a number of moral dilemmas that engender conflicts between utilitarian and non-utilitarian ethical principles. Building on past work on utilitarianism and trust, we tested the hypothesis that endorsement of utilitarian solutions to pandemic dilemmas would impact trust in leaders. Specifically, in line with suggestions from previous work and case studies of public communications during the early stages of the pandemic, we predicted that endorsing instrumental harm would decrease trust in leaders, while endorsing impartial beneficence would increase trust.

Sunday, June 27, 2021

On Top of Everything Else, the Pandemic Messed With Our Morals

Jonathan Moens
The Atlantic
Originally posted 8 June 21

Here is an excerpt:

The core features of moral injury are feelings of betrayal by colleagues, leaders, and institutions who forced people into moral quandaries, says Suzanne Shale, a medical ethicist. As a way to minimize exposure for the entire team, Kathleen Turner and other ICU nurses have had to take on multiple roles: cleaning rooms, conducting blood tests, running neurological exams, and standing in for families who can’t keep patients company. Juggling all those tasks has left Turner feeling abandoned and expendable. “It definitely exposes and highlights the power dynamics within health care of who gets to say ‘No, I'm too high risk; I can't go in that patient's room,’” she said. Kate Dupuis, a clinical neuropsychiatrist and researcher at Canada’s Sheridan College, also felt her moral foundations shaken after Ontario’s decision to shut down schools for in-person learning at the start of the pandemic. The closures have left her worrying about the potential mental-health consequences this will have on her children.

For some people dealing with moral injury right now, the future might hold what is known as “post-traumatic growth,” whereby people’s sense of purpose is reinforced during adverse events, says Victoria Williamson, a researcher who studies moral injury at Oxford University and King’s College London. Last spring, Ahmed Ali, an imam in Brooklyn, New York, felt his moral code violated when dead bodies that were sent to him to perform religious rituals were improperly handled and had blood spilling from detached IV tubes. The experience has invigorated his dedication to helping others in the name of God. “That was a spiritual feeling,” he said.

But moral injury may leave other people feeling befuddled and searching for some way to make sense of a very bad year. If moral injury is left unaddressed, Greenberg said, there’s a real risk that people will develop depression, alcohol misuse, and suicidality. People suffering from moral injury risk retreating into isolation, engaging in self-destructive behaviors, and disconnecting from their friends and family. In the U.K., moral injury among military veterans has been linked to a loss of faith in organized religion. The psychological cost of a traumatic event is largely determined by what happens afterward, meaning that a lack of support from family, friends, and experts who can help people process these events—now that some of us are clawing our way out of the pandemic—could have serious mental-health repercussions. “This phase that we’re in now is actually the phase that’s the most important,” Greenberg said.

Friday, April 2, 2021

Neuroscience shows how interconnected we are – even in a time of isolation

Lisa Feldman Barrett
The Guardian
Originally posted 10 Feb 21

Here is an excerpt:

Being the caretakers of each other’s body budgets is challenging when so many of us feel lonely or are physically alone. But social distancing doesn’t have to mean social isolation. Humans have a special power to connect with and regulate each other in another way, even at a distance: with words. If you’ve ever received a text message from a loved one and felt a rush of warmth, or been criticised by your boss and felt like you’d been punched in the gut, you know what I’m talking about. Words are tools for regulating bodies.

In my research lab, we run experiments to demonstrate this power of words. Our participants lie still in a brain scanner and listen to evocative descriptions of different situations. One is about walking into your childhood home and being smothered in hugs and smiles. Another is about awakening to your buzzing alarm clock and finding a sweet note from your significant other. As they listen, we see increased activity in brain regions that control heart rate, breathing, metabolism and the immune system. Yes, the same brain regions that process language also help to run your body budget. Words have power over your biology – your brain wiring guarantees it.

Our participants also had increased activity in brain regions involved in vision and movement, even though they were lying still with their eyes closed. Their brains were changing the firing of their own neurons to simulate sight and motion in their mind’s eye. This same ability can build a sense of connection, from a few seconds of poor-quality mobile phone audio, or from a rectangle of pixels in the shape of a friend’s face. Your brain fills in the gaps – the sense data that you don’t receive through these media – and can ease your body budget deficit in the moment.

In the midst of social distancing, my Zoom friend and I rediscovered the body-budgeting benefits of older means of communication, such as letter writing. The handwriting of someone we care about can have an unexpected emotional impact. A piece of paper becomes a wave of love, a flood of gratitude, a belly-aching laugh.

Saturday, March 27, 2021

Veil-of-ignorance reasoning mitigates self-serving bias in resource allocation during the COVID-19 crisis

Huang, K. et al.
Judgment and Decision Making
Vol. 16, No. 1, pp 1-19.


The COVID-19 crisis has forced healthcare professionals to make tragic decisions concerning which patients to save. Furthermore, The COVID-19 crisis has foregrounded the influence of self-serving bias in debates on how to allocate scarce resources. A utilitarian principle favors allocating scarce resources such as ventilators toward younger patients, as this is expected to save more years of life. Some view this as ageist, instead favoring age-neutral principles, such as “first come, first served”. Which approach is fairer? The “veil of ignorance” is a moral reasoning device designed to promote impartial decision-making by reducing decision-makers’ use of potentially biasing information about who will benefit most or least from the available options. Veil-of-ignorance reasoning was originally applied by philosophers and economists to foundational questions concerning the overall organization of society. Here we apply veil-of-ignorance reasoning to the COVID-19 ventilator dilemma, asking participants which policy they would prefer if they did not know whether they are younger or older. Two studies (pre-registered; online samples; Study 1, N=414; Study 2 replication, N=1,276) show that veil-of-ignorance reasoning shifts preferences toward saving younger patients. The effect on older participants is dramatic, reversing their opposition toward favoring the young, thereby eliminating self-serving bias. These findings provide guidance on how to remove self-serving biases to healthcare policymakers and frontline personnel charged with allocating scarce medical resources during times of crisis.

Thursday, March 4, 2021

‘Pastorally dangerous’: U.S. bishops risk causing confusion about vaccines, ethicists say

Michael J. O’Loughlin
America Magazine
Originally published March 02, 2021

Here is an excerpt:

Anthony Egan, S.J., a Jesuit priest and lecturer in theology in South Africa, said church leaders publishing messages about hypothetical situations during a crisis is “unhelpful” as Catholics navigate life in a pandemic.

“I think it’s pastorally dangerous because people are dealing with all kinds of crises—people are faced with unemployment, people are faced with disease, people are faced with death—and to make this kind of statement just adds to the general feeling of unease, a general feeling of crisis,” Father Egan said, noting that in South Africa, which has been hard hit by a more aggressive variant, the Johnson & Johnson vaccine is the only available option. “I don’t think that’s pastorally helpful.”

The choice about taking a vaccine like Johnson & Johnson’s must come down to individual conscience, he said. “I think it’s irresponsible to make a claim that you must absolutely not or absolutely must take the drug,” he said.

Ms. Fullam agreed, saying modern life is filled with difficult dilemmas stemming from previous injustices and “one of the great things about the Catholic moral tradition is that we recognize the world is a messy place, but we don’t insist Catholics stay away from that messiness.” Catholics, she said, are called “to think about how to make the situation better” rather than retreat in the face of complexity and given the ongoing pandemic, receiving a vaccine with a remote connection to abortion could be the right decision—especially in communities where access to vaccines might be difficult.

Wednesday, January 27, 2021

What One Health System Learned About Providing Digital Services in the Pandemic

Marc Harrison
Harvard Business Review
Originally posted 11 Dec 20

Here are two excerpts:

Lesson 2: Digital care is safer during the pandemic.

A patient who’s tested positive for Covid doesn’t have to go see her doctor or go into an urgent care clinic to discuss her symptoms. Doctors and other caregivers who are providing virtual care for hospitalized Covid patients don’t face increased risk of exposure. They also don’t have to put on personal protective equipment, step into the patient’s room, then step outside and take off their PPE. We need those supplies, and telehealth helps us preserve it.

Intermountain Healthcare’s virtual hospital is especially well-suited for Covid patients. It works like this: In a regular hospital, you come into the ER, and we check you out and think you’re probably going to be okay, but you’re sick enough that we want to monitor you. So, we admit you.

With our virtual hospital — which uses a combination of telemedicine, home health, and remote patient monitoring — we send you home with a technology kit that allows us to check how you’re doing. You’ll be cared for by a virtual team, including a hospitalist who monitors your vital signs around the clock and home health nurses who do routine rounding. That’s working really well: Our clinical outcomes are excellent, our satisfaction scores are through the roof, and it’s less expensive. Plus, it frees up the hospital beds and staff we need to treat our sickest Covid patients.


Lesson 4: Digital tools support the direction health care is headed.

Telehealth supports value-based care, in which hospitals and other care providers are paid based on the health outcomes of their patients, not on the amount of care they provide. The result is a greater emphasis on preventive care — which reduces unsustainable health care costs.

Intermountain serves a large population of at-risk, pre-paid consumers, and the more they use telehealth, the easier it is for them to stay healthy — which reduces costs for them and for us. The pandemic has forced payment systems, including the government’s, to keep up by expanding reimbursements for telehealth services.

This is worth emphasizing: If we can deliver care in lower-cost settings, we can reduce the cost of care. Some examples:
  • The average cost of a virtual encounter at Intermountain is $367 less than the cost of a visit to an urgent care clinic, physician’s office, or emergency department (ED).
  • Our virtual newborn ICU has helped us reduce the number of transports to our large hospitals by 65 a year since 2015. Not counting the clinical and personal benefits, that’s saved $350,000 per year in transportation costs.
  • Our internal study of 150 patients in one rural Utah town showed each patient saved an average of $2,000 in driving expenses and lost wages over a year’s time because he or she was able to receive telehealth care close to home. We also avoided pumping 106,460 kilograms of CO2 into the environment — and (per the following point) the town’s 24-bed hospital earned $1.6 million that otherwise would have shifted to a larger hospital in a bigger town.

Wednesday, December 23, 2020

Beyond burnout: For health care workers, this surge of Covid-19 is bringing burnover

Wendy Dean & Simon G. Talbot
Originally posted 25 Nov 20

Covid-19 is roaring back for a third wave. The first two substantially increased feelings of moral injury and burnout among health care workers. This one is bringing burnover.

Health care systems are scrambling anew. The crises of ICU beds at capacity, shortages of personal protective equipment, emergency rooms turning away ambulances, and staff shortages are happening this time not in isolated hot spots but in almost every state. Clinicians again face work that is risky, heart-rending, physically exhausting, and demoralizing, all the elements of burnout. They have seen this before and are intensely frustrated it is happening again.

Too many of them are leaving health care long before retirement. The disconnect between what health care workers know and how the public is behaving, driven by relentless disinformation, is unbearable. Paraphrasing a colleague, “How can they call us essential and then treat us like we are disposable?”

It is time for leaders of hospitals and health care systems to add another, deeper layer of support for their staff by speaking out publicly and collectively in defense of science, safety, and public health, even if it risks estranging patients and politicians.

Long before the pandemic emerged, the relationships between health care organizations and their staffs were already strained by years of cost-cutting that trimmed staffing levels, supplies, and space to the bone. Driven by changes in health care reimbursement structures, systems were “optimized” to the point that they were continually running at what felt like full capacity, with precious little slack to accommodate minor surges, much less one the magnitude of a global pandemic.

Saturday, August 22, 2020

Immunology Is Where Intuition Goes to Die

Ed Yong
The Atlantic
Originally posted 5 August 20

Here is an excerpt:

Immune responses are inherently violent. Cells are destroyed. Harmful chemicals are unleashed. Ideally, that violence is targeted and restrained; as Metcalf puts it, “Half of the immune system is designed to turn the other half off.” But if an infection is allowed to run amok, the immune system might do the same, causing a lot of collateral damage in its prolonged and flailing attempts to control the virus.

This is apparently what happens in severe cases of COVID-19. “If you can’t clear the virus quickly enough, you’re susceptible to damage from the virus and the immune system,” says Donna Farber, a microbiologist at Columbia. Many people in intensive-care units seem to succumb to the ravages of their own immune cells, even if they eventually beat the virus. Others suffer from lasting lung and heart problems, long after they are discharged. Such immune overreactions also happen in extreme cases of influenza, but they wreak greater damage in COVID-19.

There’s a further twist. Normally, the immune system mobilizes different groups of cells and molecules when fighting three broad groups of pathogens: viruses and microbes that invade cells, bacteria and fungi that stay outside cells, and parasitic worms. Only the first of these programs should activate during a viral infection. But Iwasaki’s team recently showed that all three activate in severe COVID-19 cases. “It seems completely random,” she says. In the worst cases, “the immune system almost seems confused as to what it’s supposed to be making.”

No one yet knows why this happens, and only in some people. Eight months into the pandemic, the variety of COVID-19 experiences remains a vexing mystery. It’s still unclear, for example, why so many “long-haulers” have endured months of debilitating symptoms. Many of them have never been hospitalized, and so aren’t represented in existing studies that have measured antibody and T-cell responses. David Putrino of Mount Sinai tells me that he surveyed 700 long-haulers and a third had tested negative for antibodies, despite having symptoms consistent with COVID-19. It’s unclear if their immune systems are doing anything differently when confronted with the coronavirus.

The info is here.

Monday, August 3, 2020

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.

Saturday, July 25, 2020

America’s Schools Are a Moral and Medical Catastrophe

Laurie Garrett
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.

Thursday, July 16, 2020

At Stake in Reopening Schools: ‘The Future of the Country’

Matt Peterson
Originally posted 10 July 20

Here is an excerpt:

We do have to think about this longer-term. We also have to think about it from an ethics standpoint, acknowledging the following. At least right now, the primary motivation behind closing schools—having children not be educated in school buildings—is because of a belief that keeping schools physically open with children congregating poses a risk to community transmission. Either to teachers directly or back to households and the wider community. Whether it’s bad for kids themselves or how risky it is for kids themselves remains an open question. We’re worried about multisymptom inflammatory syndrome. But at least, right now, the evidence continues to suggest children are not themselves a particularly high risk group for serious Covid disease.

From an ethics point of view, when one group is being burdened primarily to benefit other groups, that puts a very special onus on justifying that it is ethically OK. If we conclude it is the right thing to do ethically because of what’s at stake for the community, we have both to make sure that it’s justified, this disproportionate burden on children, and that we do everything we can to mitigate those burdens.

The info is here.

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

Halpern SD, Truog RD, and Miller FG.
Published online June 29, 2020.

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.

Wednesday, July 15, 2020

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

Thomas Reese
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.

Tuesday, June 30, 2020

Want To See Your Therapist In-Person Mid-Pandemic? Think Again

Todd Essig
Originally posted 27 June 20

Here is an excerpt:

Psychotherapy is built on a promise; you bring your suffering to this private place and I will work with you to keep you safe and help you heal. That promise is changed by necessary viral precautions. First, the possibility of contact tracing weakens the promise of confidentiality. I promise to keep this private changes to a promise to keep it private unless someone gets sick and I need to contact the local health department.

Even more powerful is the fact that a mid-pandemic in-person psychotherapy promise has to include all the ways we will protect each other from very real dangers, hardly the experience of psychological safety. There will even be a promise to pretend we are safe together even when we are doing so many things to remind us we are each the source of a potentially life-altering infection.

When I imagine how my caseload would react were I to begin mid-pandemic in-person work, like I did for a recent webinar for the NYS Psychological Association, I anticipate as many people welcoming the chance to work together on a shared project of viral safety as I do imagining those who would feel devastated or burdened. But even for the first group of willing co-participants, it is important to see that such a joint project of mutual safety is not psychotherapy. No anticipated reaction included the experience of psychological safety on which effective psychotherapy rests.

Rather than feeling safe enough to address the private and dark, patients/clients will each in their own way labor under the burden of keeping themselves, their families, their therapist, other patients, and office staff safe. The vigilance required to remain safe will inevitably reduce the therapeutic benefits one might hope would develop from being back in the office.

The article is here.