Is it ethical to get a booster shot when so many people in the world can't even access their first dose?

The same week that Rochelle Walensky, the director of the Centers for Disease Control and Prevention, gave the green light to booster shots for Pfizer vaccine recipients over age 65, the World Health Organization reported that only 2.2% of people in the world’s low-income countries had received even one dose of a Covid vaccine.

That means millions of Americans will receive a third vaccine dose while billions around the world have not had their first.

That stark contrast of U.S. haves and global have-nots prompted one of my clinic patients to ask me, “Is it immoral for me to get a booster?”

My response is in my new article at Boston Globe’s STAT news: https://www.statnews.com/2021/10/15/feeling-guilty-about-getting-covid-booster-shot-do-this/

Scientific transparency - like vaccines - has short-term side effects but they are worth the massive long-term benefits

I recently met hundreds of COVID-19 vaccines at the door of Vermont's large public vaccination drive, shepherding each one to meet the nurses who would perform the vaccination.

I screened each for symptoms of active disease, commented on the lovely spring weather, and asked if they had any concerns.

One nattily dressed Black woman in her mid-forties admitted she was nervous as we walked toward her chair.

"I hate needles," she said, visibly shaking. "Are these vaccines safe?"

We paused. I listened. I said I was glad she had come. I reassured her that I believe, as a physician, that COVID-19 vaccination will make her much safer than she was before.

In Europe, recent reports of extremely rare clotting complications of the AstraZeneca vaccine made European vaccine recipients markedly more nervousabout vaccine safety. Many public health authorities worried public safety fears could hurt efforts to vaccinate past a fourth wave of COVID-19 deaths.

I think it’s worth it, though, ,to be transparent. Like vaccines, scientific transparency has real short-term side effects but they are well-worth the mammoth long-term benefits.

To read more, check out my new post about how scientific transparency, like vaccines, has short-term side effects up at MedPage TODAY.

The Bottom of the Health Care Rationing Iceberg

A stink filled the room as my patient eased coal-black toes out of his shoes. After spending winter nights in a tattered sleeping bag behind a local grocery store, he had developed frostbite and then gangrene.

In the hospital, we gave him intravenous antibiotics and debrided the dead tissue from his toes. Soon he felt better. He was enjoying regular meals and the kind at- tention of his nurses. Each day, a new crayon portrait of his life on the street went up on the walls, scary scenes depicted in bright colors and childlike simplicity.

When the hospitalist said he was getting ready to discharge him, the patient’s nurse shook her head and crossed her arms. “How is he supposed to heal if he goes right back out to the streets?” she asked.

She wasn’t wrong. More than one in four discharged homeless patients is readmitted within 30 days, according to a recent study by a team from the Boston Health Care for the Homeless Program.

The hospitalist noted that the patient would have been dis- charged much earlier if he hadn’t been homeless. “But is hospitalization really the cure for home- lessness?”he asked, as he ran a finger down a list of emergency department patients waiting for a hospital bed. “Don’t we owe them something, too?”

There it is, I thought: the bottom of the health care rationing iceberg.

To read more, including about the contrast between our careful efforts to allocate mechanical ventilators amid the COVID-19 pandemic and the haphazard way we leave the homeless and others out of health care resource allocation on ordinary days, check out my new essay up at The New England Journal of Medicine.

How should parents make tough decisions about returning their kids to school this fall?

One of the most challenging and divisive decisions of the coronavirus pandemic is whether and how to reopen schools this fall.

We heard the same thing from a dozen nationally prominent psychologists, parenting experts and authors with whom we met by Zoom recently. One after another admitted that they, too, were unsure what they will do for their own children.

“We want our children to return to school for a variety of reasons, but safety is our top priority right now,” says Katie Hurley, a child and adolescent psychotherapist.

If experts aren’t sure what to do, how should parents decide?

In a new story in The Washington Post, co-written with the esteemed (and I would say beloved) parenting author Jessica Lahey, we summarize the data pro and con returning kids to school and provide a decision-making checklist to help parents make the right call for their own families.

The quick summary is that there is no one-size-fits-all answer, and parents and schools need to individualize decisions based on local epidemiology, family health issues, and how seriously schools take science-based prevention. Here’s a tweetorial.

Cutting corners on a coronavirus vaccine could cost lives

In the desperation to save lives in the coronavirus pandemic, we have already begun to relax scientific standards in the hope of finding a treatment without waiting to prove that it works.

Bioethicists have proposed risky human-challenge trials — which expose volunteers to the virus — to speed coronavirus vaccine development, and the Trump administration has already let one vaccine maker skip the usual requirement for animal safety trials before injecting an unproven vaccine into the arms of human volunteers.

The World Health Organization has funded a trial of new drug therapies that shockingly has no placebo-control arm.

And, of course, the experimental and potentially dangerous use of hydroxychloroquine in Covid-19 patients already boasts the presidential seal of approval and has become commonplace in American hospitals.

The next scientific corner to cut is clear.

Influential authors from the Coalition for Epidemic Preparedness Innovations recently wrote in The New England Journal of Medicine that “in a high-mortality situation, populations may not accept randomized, controlled trials with placebo groups.” While placebo-controlled multivaccine trials may be one solution, they wrote, another would be to skip the placebo.

This wouldn’t be the first time doctors took a chance on an unproven vaccine on a mammoth scale.

Read more in my new article at The New York Times.

How ordinary lives have changed in the age of COVID-19

All of our lives have changed in some way. Whether we are hard at work getting ready for a surge of cases or managing stir-crazy kids at home, the basic rhythms of the day have changed.

I’ve been talking a lot with the media to make sure the general public has the information they need to make good decisions. I won’t post all the links here but was really proud to be quoted by Jodi Kantor in The New York Times in her great story, “No Longer Just a Walk in the Park.“ Beyond the thrill of being quoted in the paper I read every day, Jodi was incredibly charming and bright.

Hey general public - check out my new COVID-19 Facebook live post and FAQ!

(N.B. This Facebook Live and the accompanying Q&A came out while evidence regarding COVID-19 was first emerging. As an example, at the time this was published epidemiological studies showing that face masks help control the pandemic had not yet been released so many experts were skeptical the approach would help. Also, face mask were in short supply so there were concerns that widespread public use would deprive at-risk frontline clinical workers from protection they needed during high risk work. Fortunately scientists made new discoveries, and the supply chain improved, so we changed our approach as a result. That’s what reasonable people do.)

It was a quiet sunny Saturday in Vermont. Perfect for taking a break from the COVID-19 trenches.

So, because I’m a massive geek, I decided to get the word out the general public about COVID-19. To over 100,000 viewers to date on cross-posting platforms, I took on some core questions like:

1. Do you have to stay home? (Yes, and I explain why.)

2. Why shouldn’t I get tested? (Probably not.)

3. How can I stay safe? (Stay home. Wash your hands. Don’t believe the hype.)

4. Should I take that wonder drug Elon Musk was all excited about? (No, duh, and don’t buy an electric car that I built!)

But wait, there’s more, including quirky questions about dogs, lettuce, playdates, takeout food and so much more.

To get there, we went all Facebook live, harnessing my wife Jessica Lahey’s prodigious social media connections. Thanks to outstanding websites like MomsRising, EverydayHealth and Grown & Flown who cross-posted the video, and threw gasoline on my geek fire!

Check it out!

Oh, yeah, and if you want the FAQ that we made in lieu of a transcript, go crazy, here it is.

Be well.

Life in the time of COVID

A few days ago I held the COVID-19 “pager” for my hospital. I couldn’t keep up. For every call I answered, 3 more showed up. In my 21 years as a physician there have been quick emergencies during which I couldn’t keep up with calls. But nothing close to this.

As our hospital, which serves over a million people in Vermont and surrounding states, gets reads for COVID-19 to hit hard, I’ve worked incredible hard, and been inspired every day. The way our hospital and our entire health network works has been entirely changed. Whole hospital floors retooled. Thousands of elective surgeries cancelled. Buildings commandeered. Entire clinical processes and teams fully made a new over and again.

I direct our ethics program, and a cascade of questions have kept me busy. If we run out of hospital beds or PPE or mechanical ventilator, how should we apportion them wisely? Should we resuscitate someone with COVID-19 even if it could infect their caregivers and the next patients those caregivers see? Should we save the lives of children over older adults? Is it ethical to consider disability in resource allocation schemes?

Even as we address hard ethical and scientific questions, one of the biggest challenges of the COVID-19 epidemic has been getting trustable information out to the general public. Questions abound, from should I stay home (yes), to should I get tested (not if you are stable), to should I take hydroxychloroquine (probably not) . Oh, yeah, and is the grocery store totally safe? (No, but nowhere is).

Here is one example of a PSA put out through the magic of our hardworking communications team. I hope you like it. More to follow, and today I’m going to try my first Facebook live Q&A about the novel coronavirus to see if that is helpful.

When the best medicine means asking parents to leave the room

I struggled to get the burly 20-year-old construction worker to talk about his fatigue.

Was he sleeping okay? “Yep.”

How was his mood? “Fine.”

At this point the patient’s mother, sitting in the chair beside him, broke in. “What he’s trying to say,” the mother said, giving the patient a playful punch to the deltoid, “is that he …”

After that, the patient’s mother talked more than he did. She provided articulate descriptions of her son’s symptoms, occasionally interrupting him to do so.

“He hasn’t told you this,” the mother said at one point, “but on weekends he drinks a lot with his friends and … well … I wonder if that relates to what’s going on?”

I had wondered the same thing. Also, I needed to get the patient’s mother out of the room.

For more on how to support young adult autonomy and self-advocacy, check out my new article at the Washington Post.

Did you know hospitals hire "secret shoppers" to understand the patient experience of care?

A nurse walked in with a loaded syringe. “Can you lift your gown?” she asked.

The woman on the gurney held the scratchy emergency room blanket closer to her chin. “What’s in the syringe?” she asked.

The nurse frowned. “Don’t you want the medicine your doctor ordered?”

The woman took a deep breath and kept asking questions. She had more than just self-interest on the line.

She was a “secret shopper,” a consultant pretending to be a patient in order to evaluate the quality and culture of care in a hospital.

TO learn more, check out my article at The New York Times.