This is another field, along with human challenge trials and the vaccination of young children, where the current fixation in medical ethics on not causing harm to an individual might be mistaken. Less clear cut, but still up for discussion. I can think of two areas where slowing viral evolution to greater deadliness might be a policy aim, although in the second alongside the aim of slowing transmission more generally:
1.Should we be using treatments on a small number of the critically ill that are likely to extend their lives, but risk causing the emergence of more deadly variants? I believe there’s a real possibility that variants have emerged as a result of patients being treated with monoclonal antibodies and as a result of lengthy infections in the immunocompromised (I would post links to the papers I’ve just googled, but I’m not sure if the spam filter would let them through and to be honest I can’t evaluate them beyond having heard of the journal they’re published in). If this becomes the consensus, should we be limiting the use of monoclonal antibodies, and reducing any previously prescribed immunosuppressants, in Covid patients, even where this increases the risk of the individual patient dying?
2. In a future epidemic, should it be policy that patients with a serious infection of the novel disease shouldn’t be taken to hospital even where doing so is likely to extend their lives? We’re getting pretty close to nailing up the doors of the sick territory, so surely not unless things are really desperate. But should we have a policy setting out what really desperate means here? And potentially create a list of volunteers who would agree to go to look after the sick in such circumstances, with the understanding that they would be agreeing to isolate with the sick patient in their home throughout the course of the infection and for 30 days afterwards? Or have ambulance staff wear hazmat suits, and transport the potentially infected to repurposed sports halls or other large buildings in the community for basic care by volunteers who agree not to leave the building, with the understanding that these patients are more likely to die than if they went to hospital? A number of countries constructed covid hospitals very rapidly, but I’m not sure anywhere had a policy of moving the infected to places that weren’t hospitals where the volunteer staff would isolate along with the patients.
I’m sure there are other possibilities. As an aside, looking at stuff for this comment I realised that I’d never thought about where the word quarantine comes from. For those similarly ignorant and incurious, quarentena is medieval Venetian for “forty days”, a quarantine period they first imposed as a result of the Black Death.
This is another field, along with human challenge trials and the vaccination of young children, where the current fixation in medical ethics on not causing harm to an individual might be mistaken. Less clear cut, but still up for discussion. I can think of two areas where slowing viral evolution to greater deadliness might be a policy aim, although in the second alongside the aim of slowing transmission more generally:
1.Should we be using treatments on a small number of the critically ill that are likely to extend their lives, but risk causing the emergence of more deadly variants? I believe there’s a real possibility that variants have emerged as a result of patients being treated with monoclonal antibodies and as a result of lengthy infections in the immunocompromised (I would post links to the papers I’ve just googled, but I’m not sure if the spam filter would let them through and to be honest I can’t evaluate them beyond having heard of the journal they’re published in). If this becomes the consensus, should we be limiting the use of monoclonal antibodies, and reducing any previously prescribed immunosuppressants, in Covid patients, even where this increases the risk of the individual patient dying?
2. In a future epidemic, should it be policy that patients with a serious infection of the novel disease shouldn’t be taken to hospital even where doing so is likely to extend their lives? We’re getting pretty close to nailing up the doors of the sick territory, so surely not unless things are really desperate. But should we have a policy setting out what really desperate means here? And potentially create a list of volunteers who would agree to go to look after the sick in such circumstances, with the understanding that they would be agreeing to isolate with the sick patient in their home throughout the course of the infection and for 30 days afterwards? Or have ambulance staff wear hazmat suits, and transport the potentially infected to repurposed sports halls or other large buildings in the community for basic care by volunteers who agree not to leave the building, with the understanding that these patients are more likely to die than if they went to hospital? A number of countries constructed covid hospitals very rapidly, but I’m not sure anywhere had a policy of moving the infected to places that weren’t hospitals where the volunteer staff would isolate along with the patients.
I’m sure there are other possibilities. As an aside, looking at stuff for this comment I realised that I’d never thought about where the word quarantine comes from. For those similarly ignorant and incurious, quarentena is medieval Venetian for “forty days”, a quarantine period they first imposed as a result of the Black Death.