Author Interviews, COVID -19 Coronavirus, JAMA, Pediatrics / 05.08.2020

MedicalResearch.com Interview with: Taylor Heald-Sargent, M.D., Ph.D. Ann & Robert H. Lurie Children’s Hospital Chicago MedicalResearch.com: What is the background for this study? Response: Given the ongoing debate around the ability of children to transmit SARS-CoV-2, we noticed that our clinical data could address one of the prevalent assumptions.  Some people postulated that the reason children have less severe infections with SARS-CoV-2 is because they are not able to replicate virus as much as adults and therefore may not transmit as readily.  (more…)
Author Interviews, COVID -19 Coronavirus / 05.08.2020

MedicalResearch.com Interview with: Pranay Sinha, MD Research Fellow Section of Infectious Diseases Boston University School of Medicine  MedicalResearch.com: What is the background for this study? Response: In the early days of the COVID-19  pandemic there were no evidence-based treatments for severely ill patients infected with this virus. We formed an interdisciplinary group of physicians from departments of adult and pediatric infectious diseases, rheumatology, and pulmonary/critical care as well as clinical pharmacy specialists. Given some promising data from China, we instituted treatment with off-label IL-6 receptor inhibitors (tocilizumab and sarilumab). The rationale was to mitigate the exuberant immune response observed in some patients infected with SARS-CoV-2 (also called cytokine storm or cytokine release syndrome). Quite quickly, we started noticing that giving the drug to our sickest patients wasn’t eliciting dramatic improvement. We reasoned that by the time patients were severely ill and requiring ventilators, the damage to their lungs from the cytokine storm had already taken place. It was like closing the barn door after the horse had already bolted. (more…)
Author Interviews, Cancer Research, COVID -19 Coronavirus, JAMA / 04.08.2020

MedicalResearch.com Interview with: Harvey W. Kaufman, MD, MBA, FCAP Senior Medical Director, Medical Informatics Quest Diagnostics Needham, MA  MedicalResearch.com: What is the background for this study? Response: The COVID-19 pandemic has disrupted routine healthcare and in particular cancer screenings.  We documented the impact on patients who were newly identified by cancer in the early months of the pandemic by analysis of Quest Diagnostics data. MedicalResearch.com: What are the main findings?  Response: We saw a 46% decline in newly identified patients with six common types of cancer.  In accordance to healthcare recommendations, many patients didn’t receive mammograms, colonoscopies, low-dose CT scans, and avoided physician visits for minor complaints.  When these patients return, some will present with more advanced stages of cancer than they would have without the disruption of the pandemic.  (more…)
Author Interviews, COVID -19 Coronavirus / 26.07.2020

MedicalResearch.com Interview with: Jonathan Li, MD MMSc Assistant Professor of Medicine Harvard Medical School Division of Infectious Diseases Brigham and Women’s Hospital  MedicalResearch.com: Why did you do this study? Response: The accurate diagnosis of COVID-19 is critical for our patients in order to receive appropriate care, and for infection control and public health. In the US, the gold standard for COVID diagnosis is sampling through a nasopharyngeal swab (NP)  but is that really the best way to diagnose COVID?  As many of your viewers may have experienced first hand, nasopharyngeal swabs require inserting a long swab into the back of the nose, which is incredibly uncomfortable for the patient, technically-challenging for the health care worker, and requires equipment and reagents that are in short supply. There are also alternative sampling methods for COVID diagnosis. In Asia, oropharyngeal sampling(OP), or swabbing the back of the mouth, are commonly used and in my hospital, the Brigham and Women’s Hospital, we frequently test sputum as well for inpatients.  But there’s a lot of confusion in the field about which of these methods is the most sensitive? We undertook this study to try to bring some clarity to this question of what is the most sensitive way to diagnose COVID and detect SARS-CoV-2? (more…)
Author Interviews, Biomarkers, COVID -19 Coronavirus / 21.07.2020

MedicalResearch.com Interview with: Gil Garnier PhD Director and Professor Bioresource Processing Research Institute of Australia (BioPRIA) PALS ARC Industry Transformation Research Hub Department of Chemical Engineering Monash University MedicalResearch.com: What is the background for this study? Response: We wanted to develop a test that would be: 1) Reliable and fast to perform, 2) Easy and fast to manufacture, 3) Easy and fast to distribute and be adopted by the Health care community. We also wanted to capitalize on our vast expertise and experience from developing novel blood typing tests. Our strategy was to develop a serology COVID test using the current Gel card technology available in most hospital and blood laboratories throughout the world. Equipment and expertise are already available from point of care setting to high throughput/automated systems measuring 100-200 test/ h. Also, these cards are currently produced by many companies all over and these can be shipped all international. (more…)
Author Interviews, COVID -19 Coronavirus / 17.07.2020

MedicalResearch.com Interview with: Rajan K. Chakrabarty, Ph.D. Associate Professor, Department of Energy, Environmental and Chemical Engineering Washington University in Saint Louis MedicalResearch.com: What is the background for this study? Response: At the onset of COVID-19, we developed a state-of-the-art epidemic progression model involving the susceptible, exposed, infected, and recovered (SEIR) dynamics, the age-stratified disease transmissibility, and the possible large-scale undocumented asymptomatic transmission of COVID-19 taking place in the US states. By informing our model with using epidemiological COVID-19 data for the US between March 19 and 28 – a period corresponding to the early stage of the epidemic when the impacts of social distancing on disease progression were yet to manifest – we investigated: “What is the medical cost benefit of implementing social distancing as the “only” non-pharmaceutical intervention policy to combat COVID-19 in the US?” As part of this study, we investigated three social distancing strategies – indefinite, finite-duration, and intermittent – on age-stratified US population and benchmark its effectiveness in reducing the burden on hospital beds. (more…)
Author Interviews, COVID -19 Coronavirus, Dermatology, Environmental Risks, JAMA / 26.06.2020

MedicalResearch.com Interview with: Dr Herman Anne MD Service de Dermatologie Cliniques Universitaires Saint-Luc   MedicalResearch.com: What is the background for this study? Response: In the context of the COVID-19 pandemic, several cases of acro-located lesions (on foot or hands) suggestive of chilblains have been reported and were possibly related to COVID-19. We wanted to determine if chilblains, observed in many patients recently referred to our department, are indicative of COVID-19. MedicalResearch.com: Would you briefly explain what is meant by chilblains? Response: Chilblains are frequent cold induced inflammatory lesions. Chilblains are typically seen in winter and occur after repeated exposure to cold temperatures. Clinical presentation includes erythema and swelling on toes and/or digits followed by red-purple macules or patches. However, given the large number of patients affected, and the exceptionally high outdoor temperatures for the spring season over the past month and at the time of case-observation, cold-exposure seemed unlikely. These lesions were, therefore, suspected to be associated with COVID-19. However, to date, no study has proven a pathological link between these lesions and COVID-19. (more…)
Author Interviews, COVID -19 Coronavirus, Weight Research / 11.06.2020

MedicalResearch.com Interview with: Sarah Messiah, PhD, MPH Professor of epidemiology, human genetics, and environmental sciences UTHealth School of Public Health Dallas MedicalResearch.com: What is the background for this study? Response: Given that obesity is a prevalent, serious, complex, chronic, and relapsing disease, and severe obesity is a deepening crisis, it is important to pay special attention to these challenges during the COVID-19 pandemic. This will avoid placing an even greater burden on individuals, health systems, and society in the post-COVID-19 recovery phase. Thus, it is critically important to document, in real time, how socioecological determinants of health are impacting behaviors among those with obesity. Before our study, how the COVID-19 pandemic is impacting weight management, health behaviors, and psychosocial health in particular among people with obesity was unknown. (more…)
Author Interviews, COVID -19 Coronavirus / 02.06.2020

MedicalResearch.com Interview with: Margaret A. Turk, MD Vice-Chairman, PM&R Distinguished Service Professor Departments of Physical Medicine & Rehabilitation, Pediatrics, Public Health & Preventive Medicine SUNY Upstate Medical University All authors contributed to these responses. (Margaret A. Turk MD, Scott D. Landes PhD, Margaret K. Formica PhD, Katherine D. Goss MPH) MedicalResearch.com: What is the background for this study? Response: Throughout this pandemic, there have been published reports related to vulnerable populations and severity of disease with COVID-19, however disability populations have not been studied. People with disabilities in fact report many of the risk factors for severe outcomes from this virus, usually at younger ages. One such population is people with intellectual and developmental disability (IDD), with estimates of  2.6 to 4 million people living in the US – and also with reported high prevalence of hypertension, diabetes, and pulmonary conditions. These comorbid health conditions are reported as common risk factors for severe outcomes with COVID-19, along with older age. (more…)
Author Interviews, Nutrition, Weight Research / 01.06.2020

MedicalResearch.com Interview with: Zachary Zeigler PhD College of Science, Engineering, and Technology Grand Canyon University. Phoenix, AZ  MedicalResearch.com: What is the background for this study? Response: We already know that during the COVID-19 pandemic, children alter eating, sleep, and activity behaviors in a manner that promotes weight gain.  Additionally, the unprecedented self-quarantine mandate during the COVID-19 pandemic has led to widespread concern that adults may gain weight during the current pandemic. (more…)
Author Interviews, COVID -19 Coronavirus, JAMA / 28.05.2020

MedicalResearch.com Interview with: Soumya Sen PhD McKnight Presidential Fellow Mary & Jim Lawrence Fellow of Carlson School Director of Research, MIS Research Center Associate Professor, Information & Decision Sciences Carlson School of Management University of Minnesota, Minneapolis, MN MedicalResearch.com: What is the background for this study? Response: As the Covid-19 pandemic unfolded across the United States, one of the greatest barriers to understanding the extent of the problem was the lack of reliable and consistent data. Some of the metrics being reported, such as case count and death, are insufficient for hospital capacity planning. Case count is a conservative estimate of the actual number of infected individuals in the absence of community-wide serologic testing, while death count is a lagging metric and insufficient for proactive hospital capacity planning. A more valuable metric for assessing the effects of public health interventions on the health care infrastructure is hospitalizations. Therefore, the Medical Industry Leadership Institute (MILI) and the Management Information Systems Research Center (MISRC) at the Carlson School of Management launched the COVID-19 hospitalization tracking project in March to consistently track and report daily hospitalizations from all reporting states. Tracking daily hospitalization data is a major step forward in quantifying the current impact on local hospital systems, modeling and  forecasting future utilization needs, and tracking the rate of change in the disease severity. It is also useful for understanding the role of health policy interventions in slowing or reducing the impact of the pandemic. (more…)
Author Interviews, COVID -19 Coronavirus / 12.05.2020

MedicalResearch.com Interview with: Peter Jüni, MD, FESC Director, Applied Health Research Centre Li Ka Shing Knowledge Institute of St Michael's Hospital Department of Medicine University of Toronto, Ontario  MedicalResearch.com: What is the background for this study? Response: It is unclear whether seasonal changes, school closures or other public health interventions will result in a slowdown of the current coronavirus disease 2019 (COVID-19) pandemic. We studied 144 geopolitical areas around the world with more than 375,000 COVID-19 cases by March 27 to determine whether epidemic growth is globally associated with climate or public health interventions intended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (more…)
Author Interviews, COVID -19 Coronavirus, Lancet, Rheumatology / 08.05.2020

MedicalResearch.com Interview with: Dr. Giulio Cavalli MD PhD & Prof. Lorenzo Dagna MD FACP Ospedale San Raffaele and Vita-Salute San Raffaele University Milan, Italy     MedicalResearch.com: What is the background for this study? Response: Upon encountering pathogens, our immune system produces pro-inflammatory mediators, called cytokines. Cytokines activate cells from the immune system. In most people, production of cytokines is an appropriate and protective response to infection. However, some individuals develop excessive and detrimental inflammatory responses, which are even more harmful than the pathogen itself to the host organism. We hypothesized that some patients with COVID-19 might develop excessive and detrimental inflammation, and that treatment with anti-inflammatory agents might be beneficial in this population. Anakinra is an inhibitor of the pro-inflammatory molecule interleukin 1 (IL-1). It was originally marketed for the treatment of rheumatoid arthritis, but is now mostly used to treat a variety of pediatric inflammatory diseases. (more…)
Author Interviews, COVID -19 Coronavirus / 08.05.2020

MedicalResearch.com Interview with: Anirban Basu, Ph.D. Stergachis Family Endowed Director and Professor The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute University of Washington, Seattle MedicalResearch.com: What is the background for this study? What are the main findings? Response: The infection fatality ratio (IFR) of Covid19 infections is a key parameter to model the future burden of this pandemic. Case fatality rates at any point in time provide a biased estimate of IFR because of the undercounting in both the reported number of covid deaths (numerator) and the reported number of Covid19 cases (denominator). Instead, this study looked at the temporality or time trend of the CFRs within specific counties in the US (where data were deemed to be mature) to understand the underlying IFRs that these trends allude to. It estimates county-specific IFR to range from 0.5% to 3.6%, with a population average for the US at 1.3% (95% CCI: 0.6% - 2.1%).  (more…)
Author Interviews, COVID -19 Coronavirus / 27.04.2020

MedicalResearch.com Interview with: Mark Czeisler MPhil -2020 Fulbright Future Scholar Australian-American Fulbright Commission Funded by the Kinghorn Family Foundation -Honorary Research Fellow, Institute for Breathing and Sleep Austin Health -Master’s candidate School of Psychological Sciences and Turner Institute for Brain and Mental Health Monash University   MedicalResearch.com: What is the background for this study? Response:  Recognizing the difficult decisions of when and how to manage stringent COVID-19 mitigation strategies faced by health officials and policymakers, researchers at Brigham and Women’s Hospital and Monash University sought to assess public compliance with and support for the current mitigation strategies (e.g., quarantine, stay-at-home orders). We also assessed the life impact of such stringent tactics. We acquired nationally demographically representative samples from one nation and city with large numbers of COVID-19 infections and deaths (US and New York City) and one nation and city with comparatively small numbers of COVID-19 infections and deaths (Australia and Los Angeles). (more…)
Author Interviews, COVID -19 Coronavirus, Weight Research / 24.04.2020

MedicalResearch.com Interview with: Univ.-Prof. Norbert Stefan, MD -Heisenberg Professorship for Clinical and Experimental Diabetology Internal Medicine IV, University of Tübingen -Head of the Department of Pathophysiology of Prediabetes at the Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich -Visiting Professor Harvard Medical School, Boston, USA  MedicalResearch.com: What is the background for this study? Response: Working in the field of obesity and cardiometabolic diseases my colleagues and I were very surprised that most of the articles reporting data about comorbid conditions, which may be associated with increased risk of severe COVID-19, did not provide data about body fat mass. Because increased fat mass, and more so higher upper-body fat mass, are known to strongly predict an increased risk of cardiometabolic disease, pneumonia and mortality, we hypothesized that they may also predict a more severe course of COVID-19. (more…)
Author Interviews, COVID -19 Coronavirus / 23.04.2020

MedicalResearch.com Interview with: David B. Douglas, M.D., M.P.H. Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? Response: Health care workers are facing the major threat of catching COVID-19 through their eyes, yet currently available eye protection is inadequate. Specifically, the use of open-type eye protection allows airborne viruses to float over the top, around the sides or under the bottom of the lenses and contact the eyes. Additionally, eye protection is well known to fog up, which limits usability by making even the most basic tasks challenging. In fact, fogged goggles is a major barrier to use. (more…)
Author Interviews, Emergency Care, Heart Disease, JAMA, UT Southwestern / 22.04.2020

MedicalResearch.com Interview with: Rebecca Vigen, MD, MSCS Assistant Professor of Internal Medicine UT Southwestern MedicalResearch.com: What is the background for this study? Response: Emergency department overcrowding is an urgent health priority and chest pain is a common reason for emergency department visits.  We developed a new protocol that uses high sensitivity cardiac troponin testing with a risk assessment tool that guides decisions on discharge and stress testing for patients presenting with chest pain. The protocol allows us to rule out heart attacks more quickly than the protocols utilizing an older troponin assay. (more…)
COVID -19 Coronavirus, FDA / 21.04.2020

'The U.S. Food and Drug Administration authorized the first diagnostic test with a home collection option for COVID-19. Specifically, the FDA re-issued the emergency use authorization (EUA) for the Laboratory Corporation of America (LabCorp) COVID-19 RT-PCR Test to permit testing of samples self-collected by patients at home using LabCorp’s Pixel by LabCorp COVID-19 Test home collection kit. “Throughout this pandemic we have been facilitating test development to ensure patients access to accurate diagnostics, which includes supporting the development of reliable and accurate at-home sample collection options,” said FDA Commissioner Stephen M. Hahn, M.D. “The FDA’s around-the-clock work since this outbreak began has resulted in the authorization of more than 50 diagnostic tests and engagement with over 350 test developers. Specifically, for tests that include home sample collection, we worked with LabCorp to ensure the data demonstrated from at-home patient sample collection is as safe and accurate as sample collection at a doctor’s office, hospital or other testing site. With this action, there is now a convenient and reliable option for patient sample collection from the comfort and safety of their home.” (more…)
Annals Internal Medicine, Author Interviews, COVID -19 Coronavirus / 18.04.2020

MedicalResearch.com Interview with: Nathan Stall, MD, FRCPC Geriatrics and Internal Medicine (Clinical Associate) Sinai Health System and the University Health Network Hospitals PhD Candidate, Clinical Epidemiology & Health Care Research Institute of Health Policy, Management and Evaluation Eliot Phillipson Clinician-Scientist Training Program
Vasily Giannakeas, MPH Epidemiologist/ Dedicated ICES Analyst Women's College Hospital Toronto, Ontario, Canada   MedicalResearch.com: What is the background for this study? Response: As some health care systems approach collapse, a pressing need exists for tools modeling the capacity of acute and critical care systems during the COVID-19 pandemic. We developed an online tool to estimate the maximum number of COVID-19 cases that could be managed per day within the catchment area served by a health care system, given acute and critical care resource availability. The COVID-19 Acute and Intensive Care Resource Tool (CAIC-RT) is open access and available at https://caic-rt.shinyapps.io/CAIC-RT. (more…)
Author Interviews, COVID -19 Coronavirus, ENT / 15.04.2020

MedicalResearch.com Interview with: Ahmad R. Sedaghat, MD, PhD, FACS Associate Professor Department of Otolaryngology - Head and Neck Surgery University of Cincinnati College of Medicine Cincinnati, OH, USA   MedicalResearch.com: What is the background for this study? Response: The novel coronavirus, SARS-CoV-2, which causes COVID-19 infects the respiratory tract.  As a rhinologist, I am an expert in diseases of the nose and paranasal sinuses, and as the nose and paranasal sinuses (sinonasal cavities) are a major component of the upper airway, we decided to do a systematic review of the scientific literature on the role of the sinonasal cavities in COVID-19. (more…)
Abuse and Neglect, Author Interviews, COVID -19 Coronavirus / 14.04.2020

MedicalResearch.com Interview with: Dr. Naveen Vankadari PhD Research Fellow Monash University, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: The recent outbreak of pneumonia-causing COVID-19 pandemic is an urgent global public health issue. It is critical to understand and unravel the key difference of COVID-19 or SARS-CoV-2 with the previous coronavirus (SARS and MERS) infections. Specifically, structural and molecular dynamics which underline the mechanism of viral infection. The study first addresses the structure of COVID-19 spike glycoprotein in both closed (ligand-free) and open (ligand-bound) conformation, which open the arena in understating the viral attachment to the host cell. The study also provides the first and complete sequence alignment of spike glycol protein from COVID19 and SARA-1, showing novel insertions and deletions that highlights the uniqueness of COVID19 and underlies the differential interaction mode. The study also unravels how this new coronavirus camouflages in humans through its unique glycosylation of spike glycoprotein, which makes the most of neutralizing antibodies useless. Furthermore, In addition to known ACE2 receptor in human, the study discovers the human CD26 as another potential receptor of COVID-19 for host adhesion and hijacking.  (more…)
Author Interviews, COVID -19 Coronavirus / 12.04.2020

MedicalResearch.com Interview with: Bart van Straten, Tim Horeman and John van den Dobbelsteen Research team TU Delft, Delft University of Technology, Dpt. of BioMechanical Engineering The Netherlands  MedicalResearch.com: What is the background for this study? Response: The background for this study was the urgent shortages of mouth masks in several hospitals. Franciscus Hospital, Rotterdam, The Netherland requested on 17 March if face masks could be sterilized since they were facing these shortages. The COVID-19 pandemic and its rapid spread has led to imminent shortages of these masks. (more…)
Author Interviews, COVID -19 Coronavirus, Infections, University of Michigan / 08.04.2020

MedicalResearch.com Interview with: Arnold S. Monto, M.D. Professor, Epidemiology Professor, Global Public Health Thomas Francis, Jr. Collegiate Professor of Public Health University of Michigan  MedicalResearch.com: What is the background for this study? Response: This is part of a continuing study in families first designed to examine how influenza vaccine is working in the community  We have expanded it to look broadly at all respiratory viruses There are 4 coronaviruses which are known to cause respiratory illnesses each year and we had these data ready to go when the pandemic started. (more…)
Author Interviews, COVID -19 Coronavirus, Vaccine Studies / 07.04.2020

MedicalResearch.com Interview with: Paul B. McCray, Jr., M.D. Professor of Pediatrics, Microbiology, and Internal Medicine Executive Vice Chair of Pediatrics Associate Director: Center for Gene Therapy Roy J. Carver Chair in Pulmonary Medicine Pappajohn Biomedical Institute Carver College of Medicine University of Iowa, Iowa City, IA  52242 MedicalResearch.com: What is the background for this study? Response: In the face of the COVID-19 pandemic, there is great interest in developing a vaccine that could help protect people from infection with SARS-CoV-2.  Over the last 15 years, my laboratory has helped develop small animal models of the severe coronavirus diseases SARS and MERS to study disease pathogenesis and to test treatments.  In this study, we used a mouse model of the MERS coronavirus to test a vaccine idea in collaboration with Dr. Biao He at the University of Georgia. (more…)
Author Interviews, COVID -19 Coronavirus / 02.04.2020

MedicalResearch.com Interview with: Hongcui Cao, M.D. State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases National Clinical Research Center for Infectious Diseases The First Affiliated Hospital College of Medicine, Zhejiang University Hangzhou, China MedicalResearch.com: What is the background for this study? Response: The proportion of severe novel coronavirus disease (COVID-19) cases has dropped significantly. Specifically, this number has decreased from 32.4% on January 28 to 21.6% in Wuhan and to 7.2% in other provinces of China on February. Measures such as strengthened medical support and centralized isolation greatly contributed to the improved circumstances, and laid a solid foundation for further enhancing the cure rate and reducing the mortality rate. However, there are still hundreds of severe patients dying every day. It is extremely important to make timely and efficient diagnosis and initiate treatment for severe patients. (more…)
Author Interviews, COVID -19 Coronavirus / 31.03.2020

MedicalResearch.com Interview with: Professor Carl Coleman, JD Professor of Law Seton Hall Law School MedicalResearch.com: Do health care workers have an ethical and/or legal obligation to provide treatment during an infectious disease outbreak? Are there exceptions such as pregnancy, if the health care worker is her/himself immunocompromised or have young children at home?   Response: As a legal matter, health care workers can generally be required to fulfill pre-existing employment or contractual obligations during an infectious disease outbreak.  For example, an emergency room nurse who refuses to come to work during a pandemic can be disciplined or fired; a physician who breaches a contractual obligation to provide on-call services during an outbreak can be held liable for damages.  In addition to loss of employment and contractual damages, other potential consequences for failing to honor pre-existing commitments during a pandemic could include professional discipline for patient abandonment and, for physicians with on-call responsibilities in hospital emergency departments, civil fines under the federal Emergency Medical Treatment and Active Labor Act. This does not mean that health care workers are obligated to show up for work during a pandemic regardless of the circumstances.  For example, under the Americans with Disabilities Act, health care workers who are immunocompromised can ask for a "reasonable accommodation," such as the right to work remotely (if possible) or to take leave.  Under the Family and Medical Leave Act, employers with more than 50 employees must give workers up to 12 weeks of unpaid time off to care for a seriously ill immediate family member.  In addition, federal labor laws allow employees to refuse to work under "abnormally dangerous conditions," which might apply in situations where an employer fails to provide necessary protective equipment.  However, assuming protective equipment is available, it is not clear that an outbreak itself would be considered "abnormally dangerous," particularly in fields like emergency medicine, where exposure to contagious disease is always a foreseeable risk. In most states, health care workers without pre-existing employment or contractual obligations cannot be compelled to treat patients during a pandemic.  However, a few states have laws that authorize public health authorities to require health care professionals to work during public health emergencies.  I am not aware of any state that has invoked this authority so far. As for ethical obligations, in 2004, the American Medical Association (AMA) declared that "individual physicians have an obligation to provide urgent medical care during disasters," and that "this ethical obligation holds even in the face of greater than usual risks to their own safety, health or life."  Some academic ethicists have expressed similar views.  Common justifications for this position are that physicians "assumed the risk" of exposure to infectious diseases when they voluntarily committed themselves to the healing professions; that a "social contract" requires physicians to assume risks in exchange for their social status and privileges; and that individuals who are uniquely capable of providing life-saving care have an obligation to do so. However, I am not persuaded that all physicians -- let alone health care workers more generally -- have an ethical obligation to provide treatment when doing so involves significant risk.  A willingness to accept risk is not a condition of obtaining a medical license, nor is it part of the oaths that students commonly take at medical school graduation.  While I agree that physicians have ethical obligations to contribute to society, there are many ways they can fulfill these obligations without assuming personal health risks.  And even assuming that individuals who are in a unique position to provide life-saving care should normally do so, we generally do not expect people to rescue others from danger at significant risk to themselves.  (more…)