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May 2020

April 2020

Do we open the country, or do we stay safe? Whose rights triumph?

I have interacted with and read about a LOT of people who want to assert their constitutional rights to free assembly, etc. and do whatever they want to do in the face of this viral pandemic. In my State of Wisconsin, we have had some protests on this, and various talking heads opine about the Governor's restrictions and how they deny people their rights.

But, I know that in Wisconsin, the Governor has temporary extra-legal powers during a crisis and I suspect that many other states also give their guvs similar temporary totalitarian powers in order to deal with crises. We, as a country, have exerted extra-legal government authority many times since the Civil War and courts have not stepped up to prevent emergency measures in any significant way.

Sure it hurts people, but so does disease and war. My right to be protected from you infecting me is as important as your right to go about your business. In times of crisis, rights often conflict and sometimes my rights, or, for example, the right of the military to have shoes to prosecute a war takes precedence over your rights to go to a bar or to buy new shoes (that happened in WWII). THAT is why state constitutions often give guvs temporary totalitarian powers and why courts have not told them they cannot do that.

Conflicting rights are messy and dealing with the mess will always make someone unhappy. That is a given. But, it is flat wrong to say that your right to do whatever you want always trumps my right to remain safe and healthy.

My $0.02.

Promising preliminary CoV-2 vaccine results

The University of Oxford is leading the way in developing a SARS-CoV-2 vaccine. They tested their vax on six rhesus monkeys and all remained virus free after 28 days of sustained exposure to the virus. The monkey experiment was carried out in late March by US vscientists at the Rocky Mountain Laboratory in Hamilton, Montana as reported by the New York Times Monday 4/28.

In this pre-clinical trial, Six rhesus macaques received a vaccine produced by the Jenner Institute and the Oxford Vaccine Group. They were then exposed to heavy levels of the coronavirus that previously sickened other monkeys. The vaccinated monkeys suffered no ill effects and remained healthy at least 28 days later. Safety trials for the vax have begun in humans as a prelude to efficacy trials in a large number of people.

These are encouraging, but very preliminary results. One concern when trying to develop a vax to a new virus is that the immune response generated by the vax might actually be detrimental to the patient. For example, the infectiveness of Dengue virus can actually increase due to an immune response to the virus. A consortium of EU and US health agencies recently formed and met virtually to oversee the numerous vax trials underway or soon to be launched, and they pointed out that a deleterious immune response to CoV-2 was one of the first things they needed to understand.

However, if this Oxford study holds up, it could go a long way to minimizing the fear that an immune response could actually exacerbate COVID-19. That would represent a significant hurdle surmounted.

NYC ED doc on frontlines of the pandemic commits suicide: was it due to stress from COVID-19 or something else?

Sunday and Monday were among the few nice days this month in this Great White North. I gather the weather was similar on Sunday in Charlottesville where Dr. Lorna Breen took her own life. Dr. Breen was the medical director of the emergency department in a NYC hospital which has been particularly hard hit with the coronavirus. She was the ultimate COVID-19 responder and saved many lives. She was very close to her sister and mother in Charlottesville, according to news accounts, yet no one caught that depth of despair in her. What demons did she wrestle that caused her to end a very productive, helpful life? She did catch COVID-19 and recently recovered from it, but it emotionally crushed her. She was admitted to an in-patient psych unit and then went home to her sister and mother. At her sister's house, she shot herself in the head. Was her suicide due to stress of dealing with so much morbidity and mortality? Or was it a sequelae of the infection? We know that some infected people lose smell and taste, which suggests there might be neurological involvement in at least some people. Could it have affected her emotional state?

Docs can wear PPE to protect them from pathogens. But no armor can protect anyone from the Legion that can haunt an otherwise sane person. There is no PPE for despair. There is no vaccine for it. This is a truth that is revealed in times like this and a truth for which we are all vulnerable. It is the cold hard elegance of a nature that doesn’t care. We can see beauty in nature, but it can still grind us down with pathogens and despair. Sometimes both. We marvel at the beauty of flowers that attract both us and the pollinators who feed the queen, who then makes more pollinators. But, that beautiful nature is no different from the cold, mechanical nature that lets CoV-2 to attach to your respiratory and gut epithelium and even to your heart cells. That is not so beautiful.

Yet we plow on, believing, hoping that this too shall pass; believing that we will triumph over COVID like Ulysses triumphed over the Sirens by lashing himself to the ship's mast like a mythological version of PPE. And we must, for Lorna and the rest of us.