News from Bioethics.com

An Ethicist on How to Make Impossible Decisions

18 hours 29 min

(The Atlantic) – The question of who gets a ventilator and who does not, when two people are both in real need, is a question of justice of the sort doctors are not trained to adjudicate. But others are, and this is the moment they’ve been training for. On this episode of the Social Distance podcast, Katherine Wells, the executive producer of Atlantic podcasts, and I talk with medical ethicist Arthur Caplan, head of the division of Medical Ethics at the NYU Grossman School of Medicine. What follows is a transcript of our conversation, edited and condensed for clarity. You can also listen to the full episode of Social Distance here.

Coronavirus ‘Could Devastate’ Indigenous Communities

18 hours 38 min

(SciDevNet) – Indigenous communities around the globe are closing borders in an effort to avoid a potentially devastating coronavirus outbreak in their territories. Without medical services, many indigenous communities in remote areas have already taken steps to isolate themselves. But this brings fears that food insecurity could be exacerbated in vulnerable communities who maintain immune system health through diet.

FDA Orders Zantac Removed from Market Due to NDMA Contamination

18 hours 52 min

(UPI) – The U.S. Food and Drug Administration on Wednesday ordered drugmakers to remove all prescription and over-the-counter products containing the agent ranitidine from the market immediately as the agency continues to investigate possible contamination. Ranitidine is the key ingredient in a number of prescription and over-the-counter drugs used to treat heartburn and acid reflux. The popular product Zantac is one of many that uses ranitidine, the FDA noted. 

Federal Inmates to Be Locked in Cells for 14 Days Amid Virus

18 hours 57 min

(ABC News) – The federal Bureau of Prisons is locking all its 146,000 inmates in their cells for the next two weeks in an unparalleled effort to slow the spread of the coronavirus, as the focus shifts to a Louisiana compound, where two inmates have died and nearly 20 others remain hospitalized.  The compound, known as FCC Oakdale, has emerged as ground zero in the federal prison system’s struggle to contain coronavirus behind bars. The situation there is so dire that the local health department told the federal government there was no need to test inmates anymore for the coronavirus. Those showing symptoms should be presumed to have it.

Some Coronavirus Patients Show Signs of Brain Ailments

19 hours 2 min

(The New York Times) – Neurologists around the world say that a small subset of patients with Covid-19 are developing serious impairments of the brain. Although fever, cough and difficulty breathing are the typical hallmarks of infection with the new coronavirus, some patients exhibit altered mental status, or encephalopathy, a catchall term for brain disease or dysfunction that can have many underlying causes, as well as other serious conditions. These neurological syndromes join other unusual symptoms, such as diminished sense of smell and taste as well as heart ailments.

Online Coronavirus Tests Are Just the Latest Iffy Products Marketed to Anxious Consumers

19 hours 22 min

(Kaiser Health News) – The kits were touted as a way for consumers to manage this difficult situation themselves. No struggle to see the doctor. No calls to the health department. No waiting in line at a drive-thru test site. Instead, consumers could collect their own samples, by either swabbing the throat or cheek or spitting into a cup. The samples would then be mailed back to the companies’ partner laboratories, which would test for the coronavirus. Prices ranged from $135 to $181. But criticism was swift. At-home tests could be skimming the resources needed for lab-based tests. There is also the possibility of people collecting their samples incorrectly and questions about follow-up care.

The Grim Ethical Dilemma of Rationing Medical Care, Explained

19 hours 25 min

(Vox) – With medical experts and politicians now predicting that coronavirus cases will dramatically exceed the capacities of hospitals across America, doctors and nurses face the prospect of picking which patients to prioritize for treatment. Though the term “triage” may conjure images of rough battlefield medicine and crude estimates of patients’ survival odds, excruciating decisions on whom to treat already confront doctors in some places and will likely soon be necessary in America.

With Surgeries Delayed, Patients Wait with Anxiety–Some in Pain–as Hospitals Make Way for Coroanvirus Cases

1 day 18 hours

(Medical Xpress) – “I actually burst into tears and started crying,” Rayburn said. “I really wanted that cancer out … I felt like I was being sacrificed … for the good of the people.” Rayburn is one of many Americans whose surgical procedures, tests and examinations have been canceled as part of the broader response to the rapidly unfolding crisis. These disruptions represent a huge but largely hidden toll of the pandemic, which has slashed services available to patients and inflicted a major economic blow on hospitals and health care workers, one intended to be softened with $100 billion from the stimulus package approved by Congress last week.

A New Covid-19 Problem: Shortages of Medicines Needed for Placing Patients on Ventilators

1 day 18 hours

(STAT News) – On top of the overwhelming shortages of medical equipment required to combat Covid-19, there are now signs that medicines needed for patients who are placed on ventilators are also in short supply. The medicines include more than a dozen sedatives, anesthetics, painkillers, and muscle relaxants, and the shortages raise the possibility that it could become more difficult for health care providers to place these patients on ventilators. This is because the drugs are used to help manage patient pain and comfort levels so they can benefit from mechanical ventilation.

America’s Other Heroes

1 day 18 hours

(The Atlantic) – They flew in on short notice. They left their homes all across America; rushed to Lackland Air Force Base, in Texas, and other military installations; and got to work. They are not elite commandos or rapid-response troops, or at least not the kind you might imagine serving in our military. They are the civilian medical personnel of the National Disaster Medical System and the officers of the U.S. Public Health Service—doctors, nurses, medical technicians. And they always respond, parachuting into hot spots of disease and suffering in the wake of every kind of human trauma imaginable.

Coronavirus: US Navy Captain Pleads for Help Over Outbreak

1 day 18 hours

(BBC) – The captain of a US aircraft carrier carrying more than 4,000 crew has called for urgent help to halt a coronavirus outbreak on his ship. Scores of people on board the Theodore Roosevelt have tested positive for the infection. The carrier is currently docked in Guam. “We are not at war. Sailors do not need to die,” Captain Brett Crozier wrote in a letter to the Pentagon.

U.S. Records 700 Coronavirus Deaths in a Single Day for First Time

1 day 18 hours

(Reuters) – The U.S. government raced to build hundreds of makeshift hospitals to ease the strain on overwhelmed healthcare systems as the United States marked 700 deaths in a single day from COVID-19 for the first time on Tuesday.  That is the equivalent of a person dying every two minutes.

Relaxation of UK Abortion Rules Welcomed by Experts

1 day 18 hours

(The Guardian) – Leading UK healthcare providers have welcomed the government’s decision to allow women to take abortion pills at home without travelling to a clinic. A spokesperson for the Department of Health and Social Care confirmed the government was updating its guidance to help women who need an abortion, but cannot access a clinic because of measures put in place to stem the spread of coronavirus. The move will be made on a temporary basis, limited for two years or until the coronavirus crisis is over, and applies for medical abortions up to the tenth week of pregnancy.

Halting COVID-19: The Benefits and Risks of Digital Contact Tracing

2 days 19 hours

(IEEE Spectrum) – As COVID-19 sweeps through the planet, a number of researchers have advocated the use of digital contact tracing to reduce the spread of the disease. The controversial technique can be effective, but can have disastrous consequences if not implemented with proper privacy checks and encryption. Ramesh Raskar, an associate professor at MIT Media Lab, and his team have developed an app called Private Kit: Safe Paths that they say can do the job while protecting privacy. The software could get integrated into a new, official WHO app touted as the “Waze  for COVID-19.” IEEE Spectrum spoke with Raskar to better understand the risks and benefits of digital contact tracing.

Where to Find Ethical Guidance in a Pandemic

2 days 19 hours

(AMA) – The COVID-19 pandemic has demanded of U.S. physicians, medical educators and policymakers to ask many difficult ethical questions. Among them: What is the physician’s duty to show up for work during a deadly outbreak? When is it appropriate to prescribe drugs that haven’t been approved to treat COVID-19? And when the supply of life sustaining equipment like ventilators is severely limited, which patients should get priority? The AMA has created an ethics resource, “AMA Code of Medical Ethics: Guidance in a pandemic,” that offers guidance to these questions and others relevant to the unfolding public health emergency. Drawing on numerous opinions from the Code, this resource includes discussions of ethical challenges particular to the COVID-19 response.

How Sick Will the Coronavirus Make You? The Answer May Be in Your Genes

2 days 20 hours

(Science) – COVID-19, caused by the new pandemic coronavirus, is strangely—and tragically—selective. Only some infected people get sick, and although most of the critically ill are elderly or have complicating problems such as heart disease, some killed by the disease are previously healthy and even relatively young. Researchers are now gearing up to scour the patients’ genomes for DNA variations that explain this mystery. The findings could be used to identify those most at risk of serious illness and those who might be protected, and they might also guide the search for new treatments.

Solo Childbirth, Halted Fertility Treatments: Women’s Healthcare Takes Hit from Coronavirus

2 days 20 hours

(Reuters) – In New York, a mother-to-be faces childbirth without her husband. In Texas, hundreds of women seeking abortions are turned away. Across the country, women are facing postponed mammograms and suspended fertility treatments. The global coronavirus pandemic has infected at least 73,000 people and killed more than 1,000 in the United States as of Thursday afternoon. As U.S. authorities have told residents to remain at home and limited all but essential healthcare, the directives aimed at saving lives have hit women particularly hard, healthcare providers and patients said.

Hospitals Consider Changes to Do-Not-Resuscitate Situations Amid Coronavirus Pandemic

5 days 23 hours

(CNN) – As the coronavirus pandemic continues to sweep the United States, some hospitals are considering whether to make changes to policies and practices when it comes to do-not-resuscitate situations. Such conversations come as hospitals brace for a surge of patients, despite dwindling supplies of personal protective equipment for doctors and ventilators for seriously ill patients.

Telemedicine Surges, Fueled by Coronavirus Fears and Shift in Payment Rules

5 days 23 hours

(Kaiser Health News) – Getting heath care by phone or video conferencing has been around for several decades, but the outbreak of coronavirus has led to an increase in telemedicine use as never seen before, according to health systems and provider groups across the country. Millions of Americans are seeking care by connecting with a doctor electronically, many for the first time. Health systems, insurers and physician groups said it allows people to practice social distancing while reducing the spread of the disease and protecting health workers.

Some Kenyan Nurses Refuse Coronavirus Patients in Protest Over Shortages: Union

6 days 6 min

(Reuters) – Nurses in Kenya’s capital and at least two towns have launched protests or refused to treat suspected coronavirus patients because the government has not given them enough protective gear or training, a medical union chief said. Only a fraction of Kenya’s estimated 100,000 healthcare workers had received any instruction in how to protect themselves, Seth Panyako, the secretary general of the Kenya National Union of Nurses, told Reuters.

When Dementia Meets the Coronavirus Crisis

6 days 9 min

(The New York Times) – While the disease itself does not necessarily place patients at high risk for contracting the virus, they and their caregivers face a range of special challenges. Dementia patients are typically very sensitive to changes in routine and often require a great deal of hands-on care, both factors that are hard to manage now. Family members who usually rely on day care programs or visiting caregivers may be finding themselves with full-time responsibilities, while others whose loved ones are in facilities are unable to visit them now.

In Desperation, Hospitals May Double Up Patients on Ventilators

6 days 29 min

(Undark) – A ventilator is designed and can be set for only one patient at a time. Since two patients are unlikely to require oxygen at the same amount and pressure, one might get too little oxygen while the other receives too much, injuring their lungs either way. Also, the air tubes might distribute contaminants between patients. Reflecting these concerns, one major ventilator manufacturer and the American Association for Respiratory Care both discourage hospitals from connecting machines to multiple patients. Some hospitals are reluctant to try it under any circumstances and are looking for other backup plans.

Should Scientists Infect Healthy People with the Coronavirus to Test Vaccines?

6 days 19 hours

(Nature) – As hundreds of millions of people, maybe billions, avoid social contact to spare themselves and their communities from coronavirus, researchers are discussing a dramatic approach to research that could help end the pandemic: infecting a handful of healthy volunteers with the virus to rapidly test a vaccine. Many scientists see a vaccine as the only solution to the pandemic. Clinical safety trials began this month for one candidate vaccine, and others will soon follow. But one of the biggest hurdles will be showing that a vaccine works. Typically, this is done through large phase III studies, in which thousands to tens of thousands of people receive either a vaccine or a placebo, and researchers track who becomes infected in the course of their daily lives.

Blood Plasma from Survivors Will Be Given to Coronavirus Patients

6 days 19 hours

(The New York Times) – Can blood from coronavirus survivors help other people fight the illness? Doctors in New York will soon be testing the idea in hospitalized patients who are seriously ill. Blood from people who have recovered can be a rich source of antibodies, proteins made by the immune system to attack the virus. The part of the blood that contains antibodies, so-called convalescent plasma, has been used for decades to treat infectious diseases, including Ebola and influenza.

Who Should Be Saved First? Experts Offer Ethical Guidance

1 week 20 hours

(New York Times) – How do doctors and hospitals decide who gets potentially lifesaving treatment and who doesn’t? A lot of thought has been given to just such a predicament, well before critical shortages from the coronavirus pandemic. “It would be irresponsible at this point not to get ready to make tragic decisions about who lives and who dies,” said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado.

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