Bioethics Matters: End of Life Decision-Making and Advance Care Planning
End of Life Decision-Making and Advance Care PlanningMoira McQueen, LLB, MDiv, PhD When is it…
CCBI Resources for Covid-19 – March 26, 2021
Dear Friends of CCBI,
Last week we asked whether the predicted ‘third wave’ had arrived. I would think it has, given the rising numbers of cases caused by the variants. One of them, B.1.1.7, was first detected in Britain, and is now the dominant strain in Ontario, just as most public health officials and scientific advisors warned. An article in The Globe points out that, “We haven’t talked about doubling times since the early days of the pandemic last March. And, as we did a year ago, we find ourselves.at a pivotal period in which, if we take our eyes off the ball for even a moment, the numbers could soar.” This, at a time when some politicians are easing restrictions. We all want to ‘ditch’ them (restrictions, not politicians…) but the time has to be right. I’m in the ‘don’t go there’ camp, judging by the rising surge. “For a Few Dollars More” is a movie theme, but it could apply here. Hold on a little longer, or we might put people at even more risk.
In the US, CNCB reports that “Public health officials warn that while roughly 2.5 million people nationwide are receiving shots every day, infection levels have plateaued this month and some states have failed to reduce the number of daily cases.” Their message relates that cases are increasing in 21 states, even as restrictions are being eased in some areas. Dr Fauci, commenting in The New York Times, said that since 2 to 3 million people are being vaccinated in the US per day, “…we can stay ahead of what I would consider a race to vaccinate people and the emergence of variants.” Note: ‘can stay,’ not ‘are staying.’ The rate of infection of some of the variants, then, is so fast that even such a high vaccination rate is still ‘a race’ against infection spread. Hence, the above statement from The Globe in light of the increase in numbers infected in Canada. BC’s leading public health official, Dr Bonnie Henry, said in an article from Canadian Press, “An increasing number of younger people in British Columbia are becoming infected with COVID-19 and some are dying, just as vaccines are protecting older populations.” This is not what was expected previously, nor is the unwelcome news that younger people are experiencing serious illness as a result of contracting COVID-19, and even ‘long COVID,’ a long and distressed period of recovery.
Thanks to a vaccine rollout that concentrated on our elderly citizens in long-term care homes, deaths there have dropped. For example, in the second week of January, Quebec recorded 131 COVID-19 deaths in long term care facilities, while last week, there were 5. ( I wrote ‘only’ five until I remembered that I’m not talking about statistics here, but fellow human beings). It’s the same story in Ontario, which has recorded nine COVID deaths in long term-care in March. Requiescant in pace! This is certainly an improvement, and it was the right use of our scarce vaccines.
Given that our elderly are well on the vaccination path, and given the danger of the variants, the question arises about the fastest way to win the race against the variants. An editorial asks: “Should priority for shots continue to go to people most at risk, which means focusing on the oldest Canadians? Or should priority switch to those most likely to spread the disease?” It referred to a study that concluded: “…when vaccines are highly effective and readily available, it found that the more efficient strategy is to concentrate on vaccinating high-transmission groups in order to more quickly achieve herd immunity – thereby protecting unvaccinated people of all ages and vulnerability.” A further conclusion by some is that perhaps younger people should be given priority, to protect them (often at risk, socially), to prevent or allay virus spread, and to attain societal immunity faster.
PEI has gone ahead on that basis, and CBC reports that “Starting Thursday (March 26), people aged 18-29 who work in any job where they have contact with the public and cannot work from home will become eligible to make vaccine appointments.” There has already been some difficulty in assuring vaccine availability, but the province has decided that young people who must go to work outside the house are not only at risk themselves, but could be virus spreaders, since, understandably at that age, they are more likely to want to socialize. Now that it’s known that the effects of the virus are not as mild in younger people as had been thought, this is another reason for vaccinating that age group ahead of their ‘turn’: they now count as vulnerable for several reasons, despite their age.
A major question: is AstraZeneca reliable? The vaccine has had some bad press over the past few weeks: it was cited as not of great benefit to those over 65; there are questions about causing blood clots; there are questions about dosage; delays in use were declared in several countries for that reason; and there has been a delay in approval by the FDA in the US. Conflicting reports about safety are clearly a cause for concern for potential users. We refer below to a detailed study which looks at these concerns in depth. Regarding the safety issues, one example from it states: “This question loomed large over the past week in Europe, when more than 20 countries paused the roll-out after scattered reports of rare blood-clotting conditions, mostly in women aged 55 or younger. This was despite the vaccine having been approved and rolled out to millions in the United Kingdom, and the WHO continuing to recommend its use, saying that the benefits outweighed the risks.” IF and UNTIL the FDA approves the vaccine, many are reluctant to take it, unfortunately causing delay in reaching immunity status. But safety of individuals must be assured first.
Many scientists affirm the vaccine’s worth, but it seems that AstraZeneca presented some outdated information to the US vaccine evaluators when requesting approval for use. The redoubtable Dr Fauci stated three days ago that “…the clinical trial’s data safety and monitoring board had expressed concern that AstraZeneca had shared “outdated information” when it announced the interim results from the clinical trial.”Official approval from the FDA is expected any day, but at least until midday, March 26, approval has not yet been given for use in the US, which has gathered vast millions of doses of the vaccine.
In an article in Nature, Stephen Evans, a biostatistician at the London School of Hygiene & Tropical Medicine, hopes that the FDA will put the vaccine’s reputation back on track. In contrast to other regulators, the FDA uses raw trial data to conduct its own analysis. “I think the way that the ship will be righted is by having the FDA’s scrutiny,” says Evans, who expects it to eventually authorize the vaccine. There are many who share that hope!
The Vatican COVID-19 Commission is preparing to vaccinate 1200 homeless people during Holy Week – inspiring! The news item says: “The faithful can pay for the vaccine for a person in need via an online donation through the Holy Father’s Charity account, managed by the Office of Papal Charities at www.elemosineria.va.” I tried it – it works!
Our Lady, Health of the Sick, pray for us!
Let us pray that we may experience the sacrament of reconciliation with renewed depth, to taste the infinite mercy of God!
(Pope Francis’ intention for March)
Moira and Bambi
The Globe and Mail
B.C.’s top doctor says COVID-19 infections among younger people rising Dr. Henry says younger patients who are ending up in intensive care units need more time there, in part because of clusters of cases in some communities www.theglobeandmail.com
Opinion: The third wave of the pandemic is here. Now what? – The Globe and Mail The third wave is upon us, and it may prove to be the most challenging one yet. Our actions – or inaction – in the coming days will determine whether this much-unwanted third wave is a ripple … www.theglobeandmail.com
Opinion: The COVID-19 vaccines are starting to roll in. Should the oldest get them first? – The Globe and Mail When COVID-19 vaccines started to trickle into Canada in December, health officials had to decide who should get them first. Given the scarcity of doses, the answer was easy: residents of long-term care and retirement homes. … www.theglobeandmail.com
CNBC
Covid cases are rising in 21 states as health officials warn against reopening too quickly
Fierce Healthcare
Fauci: U.S. needs to boost vaccinations to stay ahead in race against COVID-19 variants | FierceHealthcare Top infectious disease expert Anthony Fauci, M.D., said the challenge the U.S. faces in its fight against COVID-19 is vaccinating enough people to stay ahead of more infectious variants of the … www.fiercehealthcare.com
Vatican News
Homeless people to receive Covid-19 vaccines in the Vatican during Holy Week – Vatican News By Vatican News staff writer. As the world continues to adopt measures to combat the ongoing health emergency, the Office of Papal Charities, in response to Pope Francis’s numerous appeals that no one be excluded from receiving the Covid-19 vaccines, is taking action to accompany the most vulnerable. www.vaticannews.va
The New York Times
More than 40 states say they will meet or beat Biden’s May 1 deadline for vaccine eligibility for all adults. … www.nytimes.com
Nature.com
What scientists do and don’t know about the Oxford–AstraZeneca COVID vaccine Results confirming the vaccine’s strong protection against COVID-19 were welcomed following last week’s pause in roll-outs — but fresh questions have now emerged about the data. www.nature.com