All posts filed under: Health

COVID-19 and the College Football Debate

Why should we have to go to class if we come here to play FOOTBALL, we ain’t come to play SCHOOL, classes are POINTLESS. ~Ohio State University football quarterback Cardale Jones, October 2012 tweet Last week, the question of whether or not the American college football season would start on time in the early fall got complicated. Some schools (with enrollments of up to about 50,000 students in total) had already opened for voluntary workouts. Now, the National Collegiate Athletic Association (NCAA) has approved a six-week plan that would allow student athletes to return to campus for pre-season workouts, and so testing for COVID-19 has begun. The results so far have been stark. Clemson University had 23 players test positive. There were 13 players with COVID-19 at the University of Texas in Austin. Ten athletes at Iowa State tested positive. The University of Alabama had eight, as did Kansas State University. University of Houston had six, Texas A&M had five, and Mississippi State had four. The list went on and on with more schools reporting …

Rethinking Health Disparities

In the last few decades, the proliferation of diversity, inclusivity, and equity literature throughout the medical profession has become institutionalized. Medical organizations such as the World Health Organization (WHO), the National Institute of Health (NIH), and the American College of Cardiology (ACC) have embraced this ideology and its accompanying bureaucracies and web-based material, and have called for cultural changes in some of our most important fields of study. Reforms are ostensibly intended to address healthcare disparities between groups, and new initiatives are frequently justified with reference to what the Sullivan Commission called the “ghosts of discrimination.” 1 The authors of reports like these will invariably go on to talk about implicit bias, the need for diversity in the healthcare workforce, and an examination of structural forces and power distributions that shape group disparities in health outcomes. In January 2020, the ACC published a cover story stating that healthcare group disparities and the lack of diversity in healthcare were a “national emergency” and strongly promoted the use of the Implicit Association Test (IAT).2 Even as late as …

Reassessing the Guidance on Face Masks

The efficacy of face masks for limiting the spread of SARS-CoV-2 remains uncertain and hotly contested. Recommendations vary between countries as do the reasons given. In Norway, where I live, masks are not considered necessary because very few people are infected, and efforts to contain the spread of the virus have been quite successful without mandating their use by the general public. But the debate about whether or not masks “work” is complicated and requires attention to numerous variables and contingencies. Even if we can agree that masks do help limit the spread of the virus to some degree, the conditions under which they are most effective can differ enormously, and recommendations to wear masks “in public” can actually mislead more than they illuminate and even cause some harm. We now know more than we did even a few weeks ago about how the virus spreads. In a blog post inspired by a Quillette essay analysing superspreader events, immunologist Erin Bromage delineates the salient principle as “Successful Infection = Exposure to Virus x Time.” Exposure …

Moving Away from Meat Means Welcoming the New ‘Flexitarians’

Author and animal-rights activist Jonathan Safran Foer recently argued in a New York Times essay that the COVID-19 pandemic represents a turning point in society’s attitude to eating meat. “Animal agriculture is now recognized as a leading cause of global warming,” writes Foer. “A quarter of Americans between the ages of 25 and 34 say they are vegetarians or vegans, which is perhaps one reason sales of plant-based ‘meats’ have skyrocketed… Our hand has been reaching for the doorknob for the last few years. Covid-19 has kicked open the door.” I agree the pandemic presents the best opportunity in a generation for animal-rights advocates to win over skeptics. But if and when vegetarian and vegan diets become truly mainstream, it will not be for the reasons Foer emphasizes. Foer provides three main rationales for rejecting meat: (1) “We cannot protect our environment while continuing to eat meat regularly,” (2) we can live “longer, healthier lives” without animal protein, and (3) many forms of animal farming are both cruel and unhygienic. These are valid arguments that …

How New Zealand Is Beating COVID-19

Things are getting back to normal in New Zealand. In the past two months, every time I have been to my local supermarket the rules have changed. At the start of Lockdown Level 4, a two-meter spaced queue had been marked out and a long tent had been erected to accommodate it. There was a “one trolley, one person” rule, an insistence on a single “designated shopper” per household, and a ban on bringing recyclable bags into the supermarket. Contactless payment was preferred and cash was discouraged. Customers were required to maintain two meters distance from the person in front of them at the checkout. All staff wore some kind of PPE, and some wore face visors. Perspex barriers appeared at the deli counter and the checkout. There were shortages of baking products, yeast was for some reason unobtainable, customers could purchase no more than two packets of pasta or tins of tomatoes, and messages were broadcast over the Tannoy system instructing customers to shop normally. In response to the sudden outbreak of the COVID-19 …

After the Virus: The Way We Live Next

How will we live, or be forced to live, after the pandemic? “I don’t know” is—according to Paul Collier, the famed development economist—the most honest answer to this question and others related to the cause, rise, treatment, and decline of the current pandemic. This is, after all, an unprecedented disease of rare speed and communicability, for which there is no cure and no agreed political and social response. Yet, contradicting himself within weeks, Collier wrote a similarly powerful essay in which he argued that centralisation had failed, and devolution from those who pronounce from on high to those who practice on the ground is necessary. Perhaps he was merely demonstrating that, in this maelstrom of conflicting arguments, no-one, no matter how distinguished, can wholly know his own mind from day to day. In any case, agnosticism is as unwelcome to journalism as it is to governance. And journalists, who operate under fewer constraints than governments, can at least consider some likely alternatives, while remaining alive to the possibility that unknown unknowns will continue to turn up, …

The Case for a Mandatory COVID-19 App

COVID-19 offers governments no attractive policy options. Those in power are in a no-win situation. The choice is not between good and bad, nor even between bad and worse, but between grim and catastrophic. On one hand, there is the “butcher’s bill” of death that results from inaction or inadequate action in the face of the virus. On the other, there is the “banker’s bill” of bail-out and bankruptcy that results from quarantine measures. The “butcher’s bill” that results from delay or inaction in the face of the virus is grim. The butcher bills fortnightly. Two weeks of inaction or delay in the face of COVID-19 can kill thousands. The banker moves at a more leisurely pace, billing quarterly. Most businesses can survive without revenue for a fortnight. Fewer can survive one quarter let alone three or four without income. “Stay home: Save lives” is the message promoted by New Zealand’s prime minister Jacinda Ardern, the Western leader whose response to COVID-19 has been among the most successful. The secret of this success? Ardern also …

Risk, Uncertainty, and COVID-19 Strategies

Former World Bank President Jim Yong Kim recently argued that “[n]o one in the field of infectious disease or public health can say they are surprised about a pandemic.” And yet, the COVID-19 outbreak did take most policymakers very much by surprise. From their perspective, the situation was still one characterized by the kind of radical uncertainty highlighted by economists such as Frank Knight and George Shackle: Policymakers were simply unable to assess the possible consequences of action and inaction, and this made informed cost-benefit analyses of alternative (probabilistically assessed) outcomes impossible. One thing was, however, clear: The consequences of a runaway pandemic could be disastrous. In such a situation, the precautionary principle tends to apply. As a prominent member of the Danish parliament told us in mid-March: “This is a natural disaster in slow motion. We basically know nothing. The only rational thing to do is to shut down entirely.” That was six weeks ago. At the time of writing, we are already in a very different situation. Now that many more data points …

Human Challenge Trials—A Coronavirus Taboo

The idea is as simple as it is apparently repulsive: allow human challenge trials (HCTs) under which “low risk” and healthy young adult volunteers in double-blind studies would be given trial vaccines (or a placebo) and then intentionally exposed to the novel coronavirus. This would accelerate the assessment of the trial vaccine’s safety and efficacy and more generally expand our understanding of this virus in a controlled setting. According to the World Health Organization (WHO), more than 70 vaccines are currently under development, five of which are already moving to clinical trials. Notwithstanding these Herculean efforts, the earliest we can realistically expect a readily available vaccine is in 12 to 18 months. This is in large part due to constraints imposed by traditional vaccine validation methods, which rely on large test groups and chance exposure to the virus by participants to assess the vaccine’s safety and efficacy. HCTs, using a relatively small low-risk group of volunteer participants, could potentially accelerate the release of a safe and effective vaccine by many months. While conducting coronavirus HCTs …

Italy and the EU: The Hard and Stony Road Ahead

“Too many,” said European Commission President Ursula von der Leyen on April 16th, “were not there on time when Italy needed a helping hand at the very beginning. And yes, for that it is right that Europe as a whole offers a heartfelt apology.” And heartfelt the apology probably was. For weeks, von der Leyen and her colleagues had been receiving frantic pleas for assistance from the Italian government, and little had been forthcoming. By mid-April, Italy was at last beginning to pull out of the dire circumstances that had placed it at the top of the world’s league of COVID-related death: At its grisly peak at the end of March, nearly 1,000 Italians a day were perishing from the virus, a terrible figure that will, as in other countries, almost certainly turn out to be an underestimate. It was still in great need of help—from the EU, above all—but it was no longer the worst place in the world. It was time for the EU to display some public contrition. But, for several reasons, …