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| What Are My Obligations if I’m a Doctor Who Is High Risk? | What Are My Obligations if I’m a Doctor Who Is High Risk? |
| (7 days later) | |
| I am a physician in an urgent-care setting in the Pacific Northwest, and thus I am at some risk for exposure to coronavirus even when following appropriate precautions. I am in a category that is considered high risk for complications were I to become ill with the coronavirus. The C.D.C. has recommended as of March 8 that individuals at high risk try to limit their public exposure. | I am a physician in an urgent-care setting in the Pacific Northwest, and thus I am at some risk for exposure to coronavirus even when following appropriate precautions. I am in a category that is considered high risk for complications were I to become ill with the coronavirus. The C.D.C. has recommended as of March 8 that individuals at high risk try to limit their public exposure. |
| What is my ethical obligation to my community, to my colleagues, to my spouse and to my employer in this situation? What is my employer’s ethical obligation to me and to others who may have similar risk factors? Name Withheld | What is my ethical obligation to my community, to my colleagues, to my spouse and to my employer in this situation? What is my employer’s ethical obligation to me and to others who may have similar risk factors? Name Withheld |
| Health care workers around the world are making heroic contributions to fighting the pandemic, which has taken an especially high toll on them. Many people have now heard of Dr. Li Wenliang, the ophthalmologist who tried to warn the medical community in Wuhan as the new coronavirus first started to make its way through the population and was taken into custody by the police for “spreading false rumors.” His death, on Feb. 7, caused an outpouring of anger and grief in China and elsewhere. The disease claimed the lives of at least three other physicians at Li’s hospital alone. | Health care workers around the world are making heroic contributions to fighting the pandemic, which has taken an especially high toll on them. Many people have now heard of Dr. Li Wenliang, the ophthalmologist who tried to warn the medical community in Wuhan as the new coronavirus first started to make its way through the population and was taken into custody by the police for “spreading false rumors.” His death, on Feb. 7, caused an outpouring of anger and grief in China and elsewhere. The disease claimed the lives of at least three other physicians at Li’s hospital alone. |
| On March 18, Dr. Marcello Natali, who helped lead the response in Codogno, the center of the Covid-19 pandemic in Northern Italy, died as well, at a time when health care workers represented a significant proportion of Italians stricken with the disease. Health care workers are a society’s first line of defense, and many have been working long hours with inadequate supplies, while dealing with the stressful possibility of falling ill themselves, of infecting their families or of spreading the virus to their patients. The rest of us owe you and your co-workers a huge debt of gratitude — and a good way for us to show that gratitude is by following the recommendations for social distancing and staying at home whenever possible. | On March 18, Dr. Marcello Natali, who helped lead the response in Codogno, the center of the Covid-19 pandemic in Northern Italy, died as well, at a time when health care workers represented a significant proportion of Italians stricken with the disease. Health care workers are a society’s first line of defense, and many have been working long hours with inadequate supplies, while dealing with the stressful possibility of falling ill themselves, of infecting their families or of spreading the virus to their patients. The rest of us owe you and your co-workers a huge debt of gratitude — and a good way for us to show that gratitude is by following the recommendations for social distancing and staying at home whenever possible. |
| But heroes are not people who take unnecessary risks. They are people who respond intelligently to a challenge, assessing the likelihoods of hazards and benefits, and making a judgment about which chances are worth taking. As Aristotle put it, courage means that you “endure or fear the right things and for the right purpose and in the right manner and at the right time.” | But heroes are not people who take unnecessary risks. They are people who respond intelligently to a challenge, assessing the likelihoods of hazards and benefits, and making a judgment about which chances are worth taking. As Aristotle put it, courage means that you “endure or fear the right things and for the right purpose and in the right manner and at the right time.” |
| So what’s the right purpose and manner for you at this time? Begin with the fact that, as a doctor who has taken the Hippocratic oath, you have assumed an ethically distinctive commitment: You’ve agreed to bear certain risks necessary to the performance of your vocation. But you won’t be of use to anyone if you get seriously ill. And as happened in the early stages of the Wuhan outbreak, health care workers who aren’t properly protected can themselves become significant sources of infection. | So what’s the right purpose and manner for you at this time? Begin with the fact that, as a doctor who has taken the Hippocratic oath, you have assumed an ethically distinctive commitment: You’ve agreed to bear certain risks necessary to the performance of your vocation. But you won’t be of use to anyone if you get seriously ill. And as happened in the early stages of the Wuhan outbreak, health care workers who aren’t properly protected can themselves become significant sources of infection. |
| Hospital systems, working with federal and state health officials, have increasingly taken measures to try to keep staff members safe, including the routine use of basic protection (masks, gloves), hand hygiene, careful distancing and the like; using higher levels of protection when dealing with certain patients or with respiratory procedures; asking health care personnel with symptoms to stay home. Not a few hospitals have been hampered by woefully inadequate supplies. But, I’m assured by a professor at Harvard’s school of public health, these protocols, when implemented, really do seem to work. As always in ethical life, facts matter, and it’s incumbent on responsible people — and organizations — to get the relevant facts right. | Hospital systems, working with federal and state health officials, have increasingly taken measures to try to keep staff members safe, including the routine use of basic protection (masks, gloves), hand hygiene, careful distancing and the like; using higher levels of protection when dealing with certain patients or with respiratory procedures; asking health care personnel with symptoms to stay home. Not a few hospitals have been hampered by woefully inadequate supplies. But, I’m assured by a professor at Harvard’s school of public health, these protocols, when implemented, really do seem to work. As always in ethical life, facts matter, and it’s incumbent on responsible people — and organizations — to get the relevant facts right. |
| So your employers have an obligation to do their best to ensure, first, that you and your colleagues have the resources needed to practice the proper forms of hygiene; and second, that everyone in your system rigorously adheres to the appropriate rules. That won’t bring the chance of your getting ill down to zero, but concerted action and the right equipment can keep it low. In urgent care (which involves cases that need prompt attention but not E.R.-level interventions), you’ll typically have time to approach newly arrived patients after a proper assessment of the risks — a precaution important to their well-being and to yours. | So your employers have an obligation to do their best to ensure, first, that you and your colleagues have the resources needed to practice the proper forms of hygiene; and second, that everyone in your system rigorously adheres to the appropriate rules. That won’t bring the chance of your getting ill down to zero, but concerted action and the right equipment can keep it low. In urgent care (which involves cases that need prompt attention but not E.R.-level interventions), you’ll typically have time to approach newly arrived patients after a proper assessment of the risks — a precaution important to their well-being and to yours. |
| You also have obligations, as you recognize, that are shaped not just by your workplace responsibilities to colleagues and patients but also by your ties to family and friends. That means (to repeat something that bears repeating) observing social distancing and proper hand hygiene away from work too. The real challenge for health care workers, as for the rest of us, may be keeping your guard up over the weeks and months ahead. But you may be able to help your colleagues here — perhaps by letting them know that the stakes for you are higher than for most. | You also have obligations, as you recognize, that are shaped not just by your workplace responsibilities to colleagues and patients but also by your ties to family and friends. That means (to repeat something that bears repeating) observing social distancing and proper hand hygiene away from work too. The real challenge for health care workers, as for the rest of us, may be keeping your guard up over the weeks and months ahead. But you may be able to help your colleagues here — perhaps by letting them know that the stakes for you are higher than for most. |
| I was supposed to have a friend over, but she and her husband were ill, so we rescheduled. Since then she has become very ill with coronavirus-like symptoms. She thinks it’s just the flu but will not see a doctor or explore testing options. Can I move the date again because I do not want to risk infection? The dinner, though casual, is to celebrate my friend’s birthday. Name Withheld | I was supposed to have a friend over, but she and her husband were ill, so we rescheduled. Since then she has become very ill with coronavirus-like symptoms. She thinks it’s just the flu but will not see a doctor or explore testing options. Can I move the date again because I do not want to risk infection? The dinner, though casual, is to celebrate my friend’s birthday. Name Withheld |
| A crisis like this one brings out the ways in which we are all united through a web of connections and thus of mutual responsibilities. In the current circumstances, an untested person with a fever, dry cough or unusual fatigue should assume she’s carrying and shedding the coronavirus and practice self-isolation, as every responsible body of experts has recommended. Even if your friend has the flu, she ought to be concerned to limit its spread. Especially these days, we need to avoid adding to the burden of an already overburdened health care system. | A crisis like this one brings out the ways in which we are all united through a web of connections and thus of mutual responsibilities. In the current circumstances, an untested person with a fever, dry cough or unusual fatigue should assume she’s carrying and shedding the coronavirus and practice self-isolation, as every responsible body of experts has recommended. Even if your friend has the flu, she ought to be concerned to limit its spread. Especially these days, we need to avoid adding to the burden of an already overburdened health care system. |
| Sadly, a majority of Americans failed to get vaccinated by February, a date well into the flu season. If more had done so, we would have had fewer hospitalizations and more resources at our disposal for this new threat. People who don’t suffer much themselves from such infections can spread them to those who do. | Sadly, a majority of Americans failed to get vaccinated by February, a date well into the flu season. If more had done so, we would have had fewer hospitalizations and more resources at our disposal for this new threat. People who don’t suffer much themselves from such infections can spread them to those who do. |
| Tell your friend that, as much as you love her, you think she should be keeping herself away from others and that you’re going to delay the dinner until you can both be sure she’s not contagious. She shouldn’t be socializing with anyone, not just not with you. Help her to understand that. | Tell your friend that, as much as you love her, you think she should be keeping herself away from others and that you’re going to delay the dinner until you can both be sure she’s not contagious. She shouldn’t be socializing with anyone, not just not with you. Help her to understand that. |
| Updated June 22, 2020 | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| After reading about how there’s a blood shortage as a result of coronavirus, I went to a blood drive. It was the first time I’ve donated in a few years, and I immediately remembered why. I’m a healthy 25-year-old with no medical or lifestyle factors that would prevent me from donating, but the donation process takes about twice as long for me as it does for everyone else. The nurse said my blood flow is weaker than average and that my veins are uniquely hard to find. A nurse had to stay by my side, continually readjusting the needle, while a backlog of donors built up in the waiting area. My guess is that at least two other people could have donated in the time I was there. I know that donating blood is critical, especially during national emergencies, and for all I know, the others could ultimately have been disqualified from donating. Do you think the inconvenience of dealing with me outweighs the good I’m doing? Name Withheld | After reading about how there’s a blood shortage as a result of coronavirus, I went to a blood drive. It was the first time I’ve donated in a few years, and I immediately remembered why. I’m a healthy 25-year-old with no medical or lifestyle factors that would prevent me from donating, but the donation process takes about twice as long for me as it does for everyone else. The nurse said my blood flow is weaker than average and that my veins are uniquely hard to find. A nurse had to stay by my side, continually readjusting the needle, while a backlog of donors built up in the waiting area. My guess is that at least two other people could have donated in the time I was there. I know that donating blood is critical, especially during national emergencies, and for all I know, the others could ultimately have been disqualified from donating. Do you think the inconvenience of dealing with me outweighs the good I’m doing? Name Withheld |
| If the time it takes to collect your pint would really have reduced the amount of blood collected at that site — maybe because the station closed with people still waiting in line — you’d have reason to take a pass. You might have asked the nurse or another blood-drive official about this. But if you only created a minor hassle, well, someone has to have the trickiest veins on a given day. Your donation expressed your desire to contribute to the well-being of others. That’s valuable in itself and something to give at least a little weight to. In these individualist times, we should take the opportunity to remember that, as St. Paul put it, we are “members one of another.” So thank you for responding as you did. | If the time it takes to collect your pint would really have reduced the amount of blood collected at that site — maybe because the station closed with people still waiting in line — you’d have reason to take a pass. You might have asked the nurse or another blood-drive official about this. But if you only created a minor hassle, well, someone has to have the trickiest veins on a given day. Your donation expressed your desire to contribute to the well-being of others. That’s valuable in itself and something to give at least a little weight to. In these individualist times, we should take the opportunity to remember that, as St. Paul put it, we are “members one of another.” So thank you for responding as you did. |
| I live in a shared house with three other people. We are all employees or graduate students at the university we graduated from last spring. One of my housemates, with whom I also work, is planning to self-quarantine in our apartment after a vacation to Spain, which she took despite increased warnings about Covid-19 in the media and messages from the university discouraging international travel. | I live in a shared house with three other people. We are all employees or graduate students at the university we graduated from last spring. One of my housemates, with whom I also work, is planning to self-quarantine in our apartment after a vacation to Spain, which she took despite increased warnings about Covid-19 in the media and messages from the university discouraging international travel. |
| I am in my 20s but have struggled with some moderate health issues; my housemates and I also work with professors who are in their 70s. Can I tell my housemate to quarantine elsewhere? Should the university provide housing for one of us? Should I notify our boss? Name Withheld | I am in my 20s but have struggled with some moderate health issues; my housemates and I also work with professors who are in their 70s. Can I tell my housemate to quarantine elsewhere? Should the university provide housing for one of us? Should I notify our boss? Name Withheld |
| Your housemate acted irresponsibly. It’s her obligation to find a place to quarantine herself without imposing risks on you. Ask her to do so. If she can’t or won’t, ask your boss to let you stay out of town, if you can, until she’s out of quarantine, or as you suggest, ask the university to provide accommodations for one of you elsewhere. Either way, you should practice social distancing with those septuagenarian professors. Given their risk profile, they should certainly be grateful — and grateful too that you took the initiative to do so. | Your housemate acted irresponsibly. It’s her obligation to find a place to quarantine herself without imposing risks on you. Ask her to do so. If she can’t or won’t, ask your boss to let you stay out of town, if you can, until she’s out of quarantine, or as you suggest, ask the university to provide accommodations for one of you elsewhere. Either way, you should practice social distancing with those septuagenarian professors. Given their risk profile, they should certainly be grateful — and grateful too that you took the initiative to do so. |