The Trump administration’s botched coronavirus response

German Lopez
vox.com
Updated 25 March 20

Here is an excerpt:

It’s also something that the federal government has done well before — recently, with H1N1 and Zika. “It’s been surprising to me that the administration’s had a hard time executing on some of these things,” Ashish Jha, director of the Harvard Global Health Institute, previously told me.

But it’s the kind of thing that the Trump administration has screwed up, while instead trying to downplay the threat of Covid-19. Trump himself has tweeted comparisons of Covid-19 to the common flu — which Jha describes as “really unhelpful,” because the novel coronavirus appears to be much worse. Trump also called concerns about the virus a “hoax.” He said on national television that, based on nothing more than a self-admitted “hunch,” the death rate of the disease is much lower than public health officials projected.

And Trump has rejected any accountability for the botched testing process: “I don’t take responsibility at all,” he said this month.

Jha described the Trump administration’s messaging so far as “deeply disturbing,” adding that it’s “left the country far less prepared than it needs to be for what is a very substantial challenge ahead.”

Even as the Trump administration has tried to escalate its efforts to combat the pandemic, Trump has continued to downplay concerns. Recently, he’s suggested that social distancing measures — asking people to stay home and keep their physical distance from one another — could be lifted within weeks, instead of the months experts say is likely necessary. “What a great timeline that would be,” Trump said.

The info is here.

The race to develop coronavirus treatments pushes the ethics of clinical trials

Olivia Goldhill
Quartz.com
Originally posted 28 March 20

Here is an excerpt:

But others are more pragmatic. Arthur Caplan, director of NYU Langone’s Division of Medical Ethics says that when doctors are faced with suffering patients, it’s ethical for them to use drugs that have been approved for other health conditions as treatments. This happened with Ebola, swine flu, Zika, and now coronavirus, he says.

Some of the first coronavirus patients in China, for example, were experimentally given the HIV treatment lopinavir–ritonavir and the rheumatoid arthritis drug Actemra. Now, as the virus continues its rampage around the globe, doctors are eyeballing an increasing number of treatment possibilities—and dealing with the challenging ethics of testing their efficacy while making the safest choices for their patients.

Controlled trials—with caveats

When choosing to use an experimental treatment, doctors have to be as methodical as possible—taking careful note of how sick patients are when given treatment, the dose and timing of medication, and how they fared. “It’s not a study, not controlled, but you want observations to be systematic,” says Caplan.

If, after a couple of weeks and 10 or 20 patients the drug doesn’t seem to cause active harm, Caplan says scientists can quickly move to the first stage of clinical research.

Many of the current coronavirus clinical trials are based on those early experimental treatments. Early research on lopinavir–ritonavir suggests that the drug is not effective, though as the first study was small, researchers plan to investigate further. There are also ongoing trials into arthritis medication Actemra,  antimalarial chloroquine, and Japanese flu drug favipiravir.

While clinical trials typically take months to years to get started, Li believes the current coronavirus trials will set records for speed: “I don’t think they could go any faster,” she says. It helps that there are a lot of coronavirus patients, so it’s easy to quickly enroll study participants.

The info is here.

Who gets the ventilator in the coronavirus pandemic?

Julian Savulescu & Dominic Wilkinson
abc.net.au
Updated on 17 March 20

Here is an excerpt:

4. Flatten the curve: the 'too little, too late' approach

There are two wishful-thinking approaches that try to make the problem go away.

The first is that we need more liberty to impose restrictions on the movement of citizens in an effort to "flatten the curve", reduce the number of coronavirus cases and pressure on hospitals, and allow everyone who needs a ventilator to get one.

That may have been possible early on (Singapore and Taiwan adopted severe liberty restriction and seemed to have controlled the epidemic).

However, that horse has bolted and it is now inevitable that there will be a shortage of life-saving medical supplies, as there is in Italy.

This approach is a case of too little, too late.

5. Paternalism: the 'greater harm' myth

The second wishful-thinking approach is that some people try to argue that it is harmful to ventilate older patients, or patients with a poorer prognosis.

One intensive care consultant wrote an open letter to older patients claiming that he and his colleagues would not discriminate against them:

"But we won't use the things that won't work. We won't use machines that can cause harm."

But all medical treatments can cause harm. It is simply incorrect that intensive care "would not work" in a patient with COVID-19 who is older than 60, or who has comorbidities.

Is a 1/1,000 chance of survival worth the discomfort of a month on a ventilator? That is a complex value judgement and people may reasonably differ. I would take the chance.

The claim that intensive care doctors will only withhold treatment that is harmful is either paternalistic or it is confused.

If the doctor claims that they will withhold ventilation when it is harmful, this is a paternalistic value judgement. Where a ventilator has some chance of saving a person's life, it is largely up to that person to decide whether it is a harm or a benefit to take that chance.

Instead, this statement is obscuring the necessary resource allocation decision. It is sanitising rationing by pretending that intensive care doctors are only doing what is best for every patient. That is simply false.

The info is here.

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Ariana Eunjung Cha

The Washington Post
Originally posted 25 March 20

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators would have to ask Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

The info is here.

Coronavirus and ethics: 'Act so that most people survive'

Georg Marckmann
dw.com
Originally posted 24 March 20

Here is an excerpt:

Triage, a word used in military medicine, means classification. What groups do you classify the patients into?

There are several categories. Critically-ill patients are treated immediately, the treatment of seriously-ill patients is delayed, and patients who are slightly ill are treated later. Patients with no chance of survival receive purely palliative care.

The crucial element of situations involving a large number of sick people that we can no longer care for adequately is that we have to switch from a patient-centered approach to a group- or population-oriented approach. In a patient-centered approach, we try to adjust treatment as best we can to ensure the well-being of the individual patient and accommodate their wishes.

In a group-centered approach, we try to ensure that the incidence of illness and death within a population group is as low as possible. This places a strain on those making these decisions, because they're not used to it.

As a basic rule, we try to act in such a way that the largest number of people survive, because that is in the public interest.

The info is here.

Human Trafficking Survivor Settles Lawsuit Against Motel Where She Was Held Captive

Todd Bookman
npr.org
Originally posted 20 Feb 20

Here is an excerpt:

Legal experts and anti-trafficking groups say her 2015 case was the first filed against a hotel or motel for its role in a trafficking crime.

"It is not that any hotel is liable just because trafficking occurred on their premises," explains Cindy Vreeland, a partner at the firm WilmerHale, which handled Ricchio's case pro bono. "The question is whether the company that's been sued knew or should have known about the trafficking."

After a number of appeals and delays, the case finally settled in December 2019 with Ricchio receiving an undisclosed monetary award. Owners of the Shangri-La Motel didn't respond to a request for comment.

"I never thought it would be, like, an eight-year process," Ricchio says. "Anything in the court system seems to take forever."

That slow process isn't deterring other survivors of trafficking from bringing their own suits.

According to the Human Trafficking Institute, there were at least 25 new cases filed nationwide against hotels and motels last year under the TVPA.

Some of the named defendants include major chains such as Hilton, Marriott and Red Roof Inn.

"You can't just let anything happen on your property, turn a blind eye and say, 'Too bad, so sad, I didn't do it, so I'm not responsible,' " says Paul Pennock with the firm Weitz & Luxenberg.

The info is here.

Respirators, our rights, right and wrong: Medical ethics in an age of coronavirus

Dan Sulmasy

nydailynews.com

Originally posted 22 March 20

The coronavirus pandemic is upon us. This novel virus has disrupted lives, killed people, and wreaked havoc with our economy. COVID-19 has also raised novel ethical questions and generated ethical duties for the public, health professionals and the government. Just as our health system has been caught off guard, so have our ethics.

The general principles that guide care for individual patients are the duty to help the sick and respect their autonomy. The general principles that guide public health ethics are concern for the common good and justice. In the current crisis, these principles all come into play. We are in this together. Even if the personal risk for an individual is not great, the risk to the common good is immense. But the measures taken to mitigate the effects of the virus must be just and fair.

The duties for the general public are not arbitrary. They might seem mundane, but they are important and ought to be considered truly ethical duties. Obey the rules: We owe this to each other. Wash your hands. Keep six feet away from strangers. Don’t shake hands with, kiss or hug strangers or acquaintances. Disinfect surfaces where the coronavirus might linger. Self-quarantine if you become sick. Call or email your doctor through an encrypted system or telemedicine connection.

Unless you are experiencing life-threatening distress, don’t rush to the emergency room where you could infect people having heart attacks or complications of cancer. Don’t hoard food, disinfectant wipes, or toilet paper. Don’t spread false and alarming rumors on social media.

The info is here.

Italian nurse with coronavirus dies by suicide over fear of infecting others

Yaron Steinbuch
nypost.com
Originally published 25 March 20

A 34-year-old Italian nurse working on the front lines of the coronavirus pandemic took her own life after testing positive for the illness and was terrified that she had infected others, according to a report.

Daniela Trezzi had been suffering “heavy stress” amid fears she was spreading the deadly bug while treating patients at the San Gerardo Hospital in Monza in the hard-hit region of Lombardy, the Daily Mail reported.

She was working in the intensive care unit while under quarantine after being diagnosed with COVID-19, according to the UK news site.

The National Federation of Nurses of Italy expressed its “pain and dismay” over Trezzi’s death, which came as the country’s mounting death toll surged with 743 additional fatalities Tuesday.

“Each of us has chosen this profession for good and, unfortunately, also for bad: we are nurses,” the federation said.

The info is here.

COVID-19 and the Impossibility of Morality

John Danaher
philosophical disquisitions
Originally published 16 March 20

The stories coming out of Italy over the past two weeks have been chilling. With their healthcare system overwhelmed by COVID-19 cases, Italian doctors are facing tragic triage decisions on a daily basis. In severe cases of COVID-19 patients need ventilators to survive. But there are only so many ventilators to go around. What if you don’t have enough? Who should you save? The 80 year old with COPD and other medical complications or the slightly healthier 50 year old without them? The 45 year old mother of two or the 55 year old single man? The 29 year old healthcare worker or the 38 year old diabetes patient?

Questions like these might sound like thought experiments cooked up in a first year ethics class, but they are not. Indeed, decision-making of this sort is not uncommon in crisis situations. For example, infamous tales are told about what happened at the Memorial Medical Center in New Orleans during Hurricane Katrina in 2005. With rising flood waters, no electricity and several critically ill patients who could not be evacuated, medical workers at Memorial had to make some tough decisions: abandon patients and leave them die in agony or administer euthanizing drugs to end their suffering more quickly? The suspicion is that many chose the latter course of action.

And medical decisions are just the tip of the iceberg. As we are all now being asked to isolate ourselves for the common good, many of us will find ourselves confronting similar, albeit less high stakes decisions. Which is more important: my duty to care for my elderly parents or my duty to protect them (and others) from potential transmission of disease? My duty to work to ensure that other people have the essential services they need or my duty to myself and my family to protect them from illness? We may not like to ask these questions, but we cannot avoid them.

But what are the answers? What should people do in cases like this? I don't know that I have much in the way of specific guidance to offer, but I do have a point that I think is worth making. It's at times like this that the essentially tragic nature of much moral decision-making reveals itself. This tragedy lurks in the background most of the time, but it is brought into sharp relief at times like this. Once we are aware of this ineluctable tragedy we might be inclined to change some of our common moral practices. We might be less inclined to blame others for the choices they make; and we might be more conscious of the pain of moral regret.

The info is here.