Unvaccinated should get priority for an effective early covid-19 treatment, some officials say
I am horrified at the notion that voluntarily unvaccinated people in distress from covid19 should move ahead of vaccinated people who need the treatment too. Personal responsibility is the clarion call for Conservatives. Seems like that isn’t so important to them when the bill for their irresponsible behavior comes due. Am I letting politics overrule ethics in being outraged by this? I do not think voluntarily unvaccinated people should ever displace other people in getting scarce treatment.
The Hippocratic Oath, and particularly the “Lasagna version” explicitly rejecting therapeutic nihilism, avers restraining treatment because of lifestyle, political, or moral choices, including the decision to reject vaccination. That being said, in the situation in which care has to be rationed, physicians and nurses have to make the election of what effort and treatment is best likely to result in a positive outcome, and what is likely to be a futile waste that condemns other, potentially treatable patients to death. In such cases, it is clear that the vaccinated patient is generally more likely to benefit from care.
Regardless of the ethics of who “should” get treatment on some theoretical ethical basis, remember the medical workers who have to make such life and death decisions, and the angst and trauma they face at the loss of every patient.
While I’m pretty sure I agree with you, I do see the point: if you are vaccinated, and get a breakthrough infection, you’re still a lot less likely to die than an unvaccinated individual of the same general health. So, in the tradition of triage, you give your limited treatments to those who are likely going to be able to be saved, rather than those who are likely to recover on their own.
Doesn’t mean that in my darkest moments (many these past year + and more since vaccines were made available in the US) feel just as you do - let them reap the responsibility of their choices.
(For people not in the know, Dr. Louis Lasagna of Tufts University wrote the modern oath. This is not a joke on how seriously doctors take the Hippocratic Oath)
Is this a typo? Where care = monoclonal antibody therapy.
I am very personally frustrated by those who have rejected vaccination, either based upon some adherence to an absurdist political dogma, clinging to baseless conspiracy theories for which counterevidence is abundant, or those claiming “religious exemption” even though no major religion–even the Christian Scientists, for fuck’s sake–are telling members that they cannot be vaccinated. It has become a particular thorn in my side occupationally for reasons I won’t go into, and of course the resultant overwhelming of medical facilities is a tragedy for not only those affected and the medical personnel who have to care for them but also the others denied needed care for lack of hospital space and labor. But I don’t wish the disease upon anyone; I just wish they’d get the perspicacity to get a fucking shot.
No, even in the case of vaccinated patients, those whose immune response is not prompt or very effective still benefit from monoclonal antibodies, which attack the virus directly even if the immune system is not. Of course, to be effective, monoclonal antibodies have to be applied early in the infection before viral replication peaks, so hospitals and doctors who are taking a “wait and see who does worse” approach to conserve limited supplies aren’t helping anyone. I would like to see more work done on theraputics specifically to protect immune-compromised people because even booster shots (which, despite all of the rambling deliberation by the CDC and FDA, are going to be needed for the vaccinated population and especially vulnerable people) aren’t going to provoke sufficient immunogenicity for those with weakened immune systems, and this virus is too transmissible for normal protective measures to be effective.
Also, Louis Lasagna is a great name for a cornball comedian or child’s show host, and a terrible name for a doctor. The ribbing that guy must have gotten. “Paging Dr. Lasagna…please report to the OR for an emergency asiagectomy.”
This is why I brought up earlier what “rationing care” actually means. It’s triage, meaning that you give it to those that it’s most likely to help, which is not necessarily those who would be the worst off without it.
Sure, if you give it to someone who was going to be just fine without it, that’s a waste. But it’s also considered a waste to give it to someone who winds up dying anyways. Hence why, @Max_S, it can be possible that giving treatment to vaccinated people would be more beneficial due to the unvaxxed being more likely to die even if they do get it.
Now, whether this is actually the case, I do not know. I suspect that a proper guide would need more data. The main thing I know right now is that, if your state is in crisis care mode (like Idaho), then the policy is that they just will not attempt resuscitation in case of heart or lung failure in adults. That is one treatment considered unlikely to help.
Okay, so the priority wouldn’t be vaccinated patients, it would be vaccinated patients who are also immunocompromised. As I understand it half of breakthrough hospitalizations are immunocompromised, and breakthrough hospitalizations make up about a fifth of all hospitalizations; so roughly one tenth of hospitalized COVID-19 patients would be in this priority group.
The problem with the unvaccinated is that they typically don’t come in for treatment early on in their disease. Monoclonal antibodies are not as useful once you’ve been sick for a while.
So you don’t want a highly researched product in your body tested on many millions of people - unless it costs ten thousand times more than the vaccine.
“And no practical definition of freedom would be complete without the freedom to take the consequences. Indeed, it is the freedom upon which all the others are based.”
I hope they’re not planning on doing that because it’s a complete waste of money. Once you’re that sick, monoclonal antibodies ain’t gonna do much good.
They also better not be giving scarce, expensive treatment as a prophylactic to the unvaccinated* unless those motherfuckers pay out of pocket. No insurance for them!
*unless someone has serious allergies or something that prevents them from being vaccinated.
Yeah, the monoclonal antibody only works while the virus is building up in the system, which for most patients is early in their presentation. Once viral replication has peaked and the symptoms are due to secondary effects of the infection, antibodies do nothing. Unfortunately, there are still reports of doctors giving monoclonal antibody treatments to late sequence patients out of desperation because other treatments aren’t working because like any other profession some doctors are well-informed about treatment protocols and efficacy and some are just waving their arms in the dark for something that works.
Having to actively deal with an anti-vax situation currently, I’m just at a loss to understand the objections on any rational basis. The mRNA vaccines in particular went through the standard three-phase vaccine trials prior to receiving an EUA, and at this point are some of the most widely distributed vaccines in the history of pharmacological medicine with a virtually negligible rate of serious reactions (literally less than reactions to over-the-counter medicines like asperin and acetaminophen). They are demonstrably not made using pluripotent stem cells from aborted fetuses and no major religion has any ethical objection to them. There is unequivocal evidence of their efficacy from objective sources independent of the manufacturers, they don’t have “microchips” or make you ferromagnetic. There aren’t really even many reasons for medical exemptions unless you are demonstrably prone to pericarditis or myocarditis, and even then it is a better gamble taking the risk of vaccine reactions under controlled conditions versus the near certainty of getting the natural infection. I understand skepticism in “Big Pharma”, the medical community that has done a poor job of inclusion in research and treatment, and the government as a whole, but none of these sources have a vested interest in selling you on a vaccine that doesn’t really work. Even the manufacturers are essentially getting paid regardless of whether the injection goes into your arm, expires in a freezer, or gets shipped to Africa. Just…WTF?
I don’t believe in vaccines. I do not want some new medical gimmick forced into my body due to my respect of individual liberties and understanding of constitutional case law. Unless it is… you know… prestigious and I can brag about it. And if it is not called a vaccine. (cough cough)
Am I the only one who thinks some of the vaccine names are silly? Cominaty? Spikevax? Maybe people would think them doubleplusgood if they were called WealthFlow, SexNeedle or $ucce$$Jab?
Since I really strongly support vaccines, though, I do not really support expensive alternatives in the absence of a bona fide medical reason for essentially healthy people. If they might help a patient at high risk who cannot be vaccinated so be it. If they might help sicker patients they should be reserved for this, but much depends on what specific antibody is being discussed since they differ.
For the same reason that raging alcoholics can’t generally get liver transplants, anti-vaxers shouldn’t get a hospital bed, let alone this scarce and expensive experimental treatment.
Then why have my keys been sticking to my side since June?
I’ve been fighting with anti-vaxers all day on Facebook. No, VAERS does not show 50,000 deaths. No, it’s not the second coming of Nazism. No, the vaccines don’t cause variants. No, the vaccines are not sterilizing which is why getting EVERYONE vaccinated provides more protection.
At this point we are at 85+% of eligible people vaccinated. We are pushing since a vaccine passport went into effect today and apparently playing bingo, going to the gym, or eating in a restaurant is enough to push another 5% or so. Screw the rest at this point. You made your own bed.