Viewpoints: Discussing Health Priorities With Seriously Ill Patients Is Vitally Important Now; Rationing Care Forces Hard Decisions

Editorial pages focus on these health care topics and others.

Boston Globe:
In The Midst Of The Coronavirus Pandemic, We Must Have Those Serious Illness Conversations 

The COVID-19 crisis is forcing a lot of uncomfortable conversations, often ones that should have happened long ago but that we’ve put off for one reason or another. Among those is a difficult conversation you may need to have with your doctor — and soon. The medical term is “serious illness conversation”: A patient with a chronic or life-shortening condition talks with their clinician about their understanding of their illness and prognosis as well as their hopes, fears, and values. The goal is for both parties to arrive at a shared understanding of patients’ priorities for living and how those priorities might change when they become more sick. (Daniel M. Horn and Juliet Jacobsen, 4/1)

If Rationing Occurs, Doctors Shouldn’t Have To Decide For Their Patients

Medical school didn’t teach me how to decide which of my patients should live and which should die if it becomes rationing of medical equipment or treatment becomes necessary. But I’ve spent most of my time recently planning for the possibility that my colleagues and I may need to make precisely that decision. (Kelly Michelson, 4/2)

The Ethical Minefield Of Prioritizing Health Care For Some With Covid-19  

“We are at war with a virus that threatens to tear us apart,” the World Health Organization Director-General, Tedros Adhanom Ghebreyesus, told world leaders in a virtual summit on the coronavirus pandemic Thursday. Such dramatic phrasing as “the war against Covid-19” and “physicians are on the front lines of battle” is heard everywhere today — in the media, and from politicians and health care workers around the globe. (Ira Bedzow and Lila Kagedan, 4/1)

The Washington Post:
If You Could See My Hospital, You Would Know The Horror Of Covid-19

My patient dialed his wife on the cracked iPhone he barely knew how to use. I grabbed the phone from the 74-year-old’s shaking hands as it rang, keeping one eye on his mouth, chest and face and the other on the monitor as his oxygen saturation dropped.“Hi, I’m Dr. Stansky,” I said. “I am with your husband.” My stomach turned as I tried to find the right words. How do you tell someone over the phone that this might be the last time they ever speak to their spouse? (Danielle Stansky, 4/1)

The New York Times:
In A Pandemic, Do Doctors Still Have A Duty To Treat?

It is a question being asked in hospitals across the country: What is the duty to treat in a viral pandemic, particularly one in which health workers are getting infected and there is a dearth of personal protective equipment? The question could be glibly dismissed. Medicine is a humanitarian profession, the argument would go. Health care workers have a duty to care for the sick. By freely entering into the profession, we have implicitly agreed to accept the risks. (Sandeep Jauhar, 4/2)

The Wall Street Journal:
Got Coronavirus Antibodies? 

One of the great uncertainties in the coronavirus pandemic is how many people have been infected without knowing it or showing symptoms. Fortunately, there are now tests for that, and broadly deploying them will be critical to saving lives and getting Americans back to work. Dozens of commercial and public health labs around the world are rolling out antibody tests that can show if an individual was recently infected with the virus and has developed immunity. When fighting a pathogen, the immune system produces proteins known as antibodies that bind to specific molecules known as antigens on the invader’s surface like a lock and key. (4/1)

The New York Times:
Why Are So Many More Men Dying From Coronavirus? 

As coronavirus continues its spread across borders, oceans and continents, there is a perplexing piece of data that has so far evaded a proper explanation: It’s still early, but in almost every country that we have numbers for, more men than women are dying from the virus. Most attempts to explain this discrepancy have focused primarily on behavior, some of which are almost certainly valid. Higher rates of tobacco consumption, a reluctance to seek proper and timely medical care and even lower rates of hand-washing absolutely do play a role in who will be hit hardest. (Sharon Moalem, 4/2)

Masks-For-All For COVID-19 Not Based On Sound Data

In response to the stream of misinformation and misunderstanding about the nature and role of masks and respirators as source control or personal protective equipment (PPE), we critically review the topic to inform ongoing COVID-19 decision-making that relies on science-based data and professional expertise. (Lisa M. Brosseau, 4/1)

Modern Healthcare:
Address Needs Of Homeless As COVID Spreads To Protect Us All

The health of our nation and our unsheltered population are inseparably linked. The ripple effects of a COVID-19 outbreak among the homeless in our communities will impact each of us and the health systems already stretched so thin. Across the country, 500,000 people are without a home, with thousands of workers on the front lines serving this population in shelters, encampments and social service agencies. (Bechara Choucair, 4/1)

The New York Times:
These Coronavirus Exposures Might Be The Most Dangerous 

Li Wenliang, the doctor in China who raised early awareness of the new coronavirus, died of the virus in February at 34. His death was shocking not only because of his role in publicizing the developing epidemic but also — given that young people do not have a high risk of dying from Covid-19 — because of his age. Is it possible that Dr. Li died because as a doctor who spent a lot of time around severely ill Covid-19 patients, he was infected with such a high dose? After all, though he was one of the first young health care workers to die after being exposed up close and frequently to the virus, he was unfortunately not the last. (Joshua D. Rabinowitz and Caroline R. Bartman, 4/1)

The Way The U.S. Beat TB Could Be A Boon In Battling Coronavirus 

Current efforts to battle COVID-19 focus largely on reducing transmission by quarantine and physical distancing and by providing hospital care for the severely ill. But as scientists discovered with TB, the secret is not to put the everyday life of the community on indefinite hold, but rather to make it progressively safer. (Salmaan Keshavjee, Aaron Shakow and Tom Nicholson, 4/1)

The Problem With Shutting Down Outpatient Care  

My mother still needs her mammogram. My colleague with a family history of melanoma needs that suspicious mole examined. My elderly friend who struggles with glaucoma and cataracts still needs to see her ophthalmologist. All of these conditions require outpatient care — a suddenly scarce resource in the setting of Covid-19. (Vance Vanier, 4/1)

Will Bayh-Dole Be Needed To Get Affordable Covid-19 Treatments? 

As the Covid-19 pandemic strains the capacity of the U.S. health care system, attention is being focused on developing new drugs and therapies to fight it. Pharmaceutical company Moderna, for example, began clinical trials in Seattle for a new vaccine, providing welcome news to many. But what few Americans realize is just how much of their taxpayer dollars went into the development of these drugs long before Covid-19 emerged. (Mathur, 4/2)

The Hill:
Health Care Professionals Must Also Be Experts In Public Health

As the U.S. now leads the world in COVID-19 cases, health care in this country has transformed swiftly — in some cases overnight — with thousands of American hospitals responding to the pandemic’s urgent and dire demands. It is a new normal. It would be a perilous mistake not to radically change the health care academy — the medical, nursing, health professional and health science colleges — as well. (Dr. Sherine Gabriel, 4/1)

The Washington Post:
How To Think About Time Management In The Age Of The Coronavirus

Time looks different than it did a month ago. Long commutes are gone, freeing up hours on weekdays. Saturdays are no longer consumed by Little League and Chuck E. Cheese birthday parties. In this era of social distancing, any type of calendar entry — from a retirement dinner to a March Madness marathon — has been canceled. (Laura Vanderkam, 4/1)

With Covid-19, We’ve Made It To The Life Raft. Dry Land Is Far Away 

Imagine you are in a small boat far, far from shore. A surprise storm capsizes the boat and tosses you into the sea. You try to tame your panic, somehow find the boat’s flimsy but still floating life raft, and struggle into it. You catch your breath, look around, and try to think what to do next. Thinking clearly is hard to do after a near-drowning experience. (Marc Lipsitch and Yonatan Grad, 4/1)

Louisville Courier-Journal:
Coronavirus Testing: Louisville Could Lead Fight Against Pandemic

As data from South Korea shows, the key to curtailing the pandemic is testing. While the initial missteps and delays in rolling out widespread testing are unpardonable, it is likely that we may soon have adequate kits to test at least those who most need testing — the vulnerable, the sick and health care workers. But even in optimistic scenarios, it is unlikely that there will be enough kits to test everyone. This is all the more reason that we must organize public testing rigorously, scientifically and systematically. (Aruni Bhatnagar, 4/2)

Lexington Herald Leader:
A 1918 KY Funeral Home Ledger Shows How Pandemic History Repeats Itself

It’s hard for Virginia Kerr Zoller to tell grieving families that only 10 mourners can come to a funeral at Kerr Brothers on Main Street these days. But if she needs a reminder of why these quarantine restrictions and distancing rules for COVID-19 are in place, all she has to do is look at the black leather ledger that holds records of everyone Kerr Brothers buried in 1918. Nearly every yellowed page between the fall of 1918 and spring of 1919 records the pandemic of Spanish flu and resulting pneumonia that gripped the world. …The 1918 ledger is bigger than the others; it records a time when Lexington, and the rest of Kentucky, was in a similar lockdown as we are today. Nearly 15,000 people died statewide, according to historian Nancy Baird. (Linda Blackford, 4/1)

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