Curious Bioethics: August 14-20, 2023

💉 British neonatal nurse convicted; RSV vaccines; Public Health Ethics 101

Aug 20, 2023

🗞️Bioethics News: British nurse convicted; California Covid numbers; Fall RSV vaccines
📚Recommended Reading: Medicine robs physicians of their fertility
🦉Educational Opportunities: Basics of Public Health Ethics

Hey there, Curious Human!

This week’s roundup touches on one of my interests - illegal behavior by clinicians. I’m not generally into the true crime genre, but I am interested in crimes committed by clinicians using their unique power and access to patients.

Despite efforts in regulation and self-regulation, physicians and nurses can be so protected that few cases are ever exposed to the public. I plan to write more about these cases for you all in the future.

🗞️ Bioethics in the News

British nurse found guilty of murdering seven babies in her care

“In her hands, innocuous substances like air, milk, fluids – or medication like insulin – would become lethal. She perverted her learning and weaponised her craft to inflict harm, grief and death.”

Neonatal nurse Lucy Letby, 33, has been found guilty of murdering seven babies and attempting to kill six others between 2015 and 2016. Prosecutors argued she killed the infants using methods that could be confused with exacerbations of a child’s underlying illness.

When physicians raised the red flag, they were forced to apologize to her.

Police found a trove of handwritten notes while searching Letby’s house during their investigation, including one that read: “I am evil I did this.”

California & Covid

The Omicron Eg.5 variant, or Eris, is becoming the dominant Covid strain in the US, including in California. (To nerd out on recent variants, the CDC has an interactive variant tracker and projector.) In July, the California Department of Public Health redefined an “outbreak,” easing the requirements for employers to meet additional obligations to employees. This means it takes more infections for employers to be required to offer additional support like testing, requiring masks, improving ventilation, and reporting to public health agencies.

Covid cases and hospitalizations are rising in Los Angeles. The SAG/AFTRA strike may keep cases down since Hollywood production is at a standstill, but schools are heading back. We’ll see what happens. We didn't have a summer surge to fuel fall cases.

The recent City of LA Recovery Plan report shows that nearly two-thirds of the city’s $1.3 billion in COVID relief funds went to cops and firefighters, while zero went to building housing. Unfortunately, this was encouraged by the federal administration, rather than thinking more holistically about ways to reduce risk in the most vulnerable populations, like those without secure housing.

Covid outbreaks in four of seven Santa Cruz County nursing homes, show how wide variability of masking and vaccination of residents and staff alike can contribute to infections:

“75% of all nursing home residents in the county are up to date on their COVID-19 vaccinations, but that figure for individual facilities ranges from as low as 54% to as high as 89%…
An even larger disparity exists among nursing home staff, where 66% of all employees are up to date with vaccinations, with a low of 14% in one facility and a high of 100% in another.”

You’re reading Curious Bioethics: Curated Bioethics for Curious Humans! I hope you’ll share it with your curious friends.

RSV vaccinations to Reduce Hospitalizations and Deaths for Adults and Babies

Each year, roughly 177,000 Americans are hospitalized and 14,000 die from an RSV infection. For those over 65, between 6,000 and 10,000 die per year.

This fall, both older adults and infants can be vaccinated against RSV. While RSV may look like a cold, it can be unpredictable, causing severe lung infections, hospitalizations, and death. For babies who need hospitalization in the first year of life, RSV is a leading cause of death.

Nirsevimab for Babies

Nirsevimab, a long-acting monoclonal antibody, could save lives and prevent thousands of infants from being hospitalized with severe illness.

“The American Academy of Pediatrics recommends that all infants -- and especially those at high risk --receive the new preventive antibody, nirsevimab, to protect against severe disease caused by respiratory syncytial virus (RSV), which is common, highly contagious and sometimes deadly.”

Recommendations include

All infants younger than 8 months born during or entering their first RSV season.

Infants and children aged 8 through 19 months who are at increased risk of severe RSV disease and entering their second RSV season.

Arvexy for Grown Ups

This fall, Americans 60 and older adults can be vaccinated against RSV for the first time. GSK’s vaccine Arvexy has already shipped to US pharmacies. Thanks to the Inflation Reduction Act, Medicare Part D patients will pay no out-of-pocket expenses for the shot.

📚 Recommended Reading

Medicine robs physicians of their fertility. Here’s how to fix it

My colleagues Morgan S. Levy, Vineet Arora, and Arghavan Salles write on how medical training interrupts physicians’ prime fertility years, adding additional emotional impacts for those hoping to build a family.

Their team recently published a powerful research letter in JAMA Internal Medicine on the psychosocial burdens of family planning among physicians and medical students.

“Although we know many physicians utilize ART to build their families, our study is the first to show they are six times more likely to report relationship strain and four times more likely to go to therapy to cope with family-building stress. This is consistent with previous evidence showing that infertility patients experience elevated levels of depression and anxiety. Even if you have a clinically “good” outcome, the wounds sustained in this process often turn into permanent scars.”

🦉Educational Opportunities

No registration is required! Just go straight to YouTube for this on-demand bioethics education.

Public Health Ethics. Thinking about bioethics, human rights, justice and moral responsibility

In this video, Greg Martin provides a framework for thinking about public health ethics. “It explores bioethics, human rights, justice and moral responsibility. Ethics is the philosophy of how we should live and can be applied to public health and global health to help make moral and fair decisions. Public health focuses on the health at a population level uses tools like epidemiology and health economics to plan and implement interventions to improve the lives of groups of people. In this video we take a look at deontological and utilitarian ethics developed by Kant and Bentham respectively.”