POST 179. July 16, 2021. CORONAVIRUS. “It, therefore, follows that the “harm principle” (“first, do no harm.”) can be used to justify compulsory vaccination programs in specific instances where the community interests or benefits are deemed to be significant.”

“The only pandemic we have is among the unvaccinated.”… “If you have been lucky enough to escape infection previously and you’re not vaccinated, your luck is about to run out”…“That raises a question…What ethical duties will we have, if any, to those who refuse to be vaccinated?”

“Los Angeles County will reinstate indoor mask requirements in public spaces for all this weekend, regardless of vaccination status, amid an alarming rise in Covid-19 cases driven by the Delta variant.”

In POST 162, May 20th – “My Take: It is easy to UNMASK but it will be impossible to REMASK!”

for links to POSTS 1-180 in chronological order, highlight and click on


“Over the past two decades, much activity has been directed toward the goal of defining the ethical principles relevant to public health. There is some consensus, as put forth by Childress et al. in 2002, that the most relevant of these principles (which they label moral considerations) are: 1) producing benefits; 2) avoiding, preventing, and removing harms; 3) producing the maximal balance of benefits over harms and other costs (i.e., utility); 4) distributing benefits and burdens fairly (distributive justice) and ensuring public participation, including the participation of affected parties (procedural justice); 5) respecting autonomous choices and actions, including liberty of action; 6) protecting privacy and confidentiality; 7) keeping promises and commitments; 8) disclosing information as well as speaking honestly and truthfully (i.e., transparency); and 9) building and maintaining trust.4 (O) CONTINUED AT THE END OF THIS POST!

“President Biden on Friday said that social media companies that allow coronavirus misinformation to spread on their platforms are “killing people,” escalating a fight with Facebook and other companies as the White House warns about the spread of inaccurate information about COVID-19 vaccines.

Psaki criticizes ‘loaded and inaccurate’ question from Fox’s Doocy

Surgeon general says social media companies have ‘enabled…

Biden was asked by reporters at the White House Friday afternoon what his message is to social media platforms on coronavirus misinformation.

“They’re killing people. The only pandemic we have is among the unvaccinated. And they’re killing people,” Biden said.” (A)

The head of the Centers for Disease Control and Prevention on Friday warned that COVID-19 is becoming a “pandemic of the unvaccinated.”

CDC Director Rochelle Walensky said that cases, hospitalizations and deaths from the coronavirus are increasing nationwide, adding that over 97% of new hospitalizations are in patients who are unvaccinated.

“There is a clear message that is coming through,” Walensky said at a press briefing. “This is becoming a pandemic of the unvaccinated. We are seeing outbreaks of cases in parts of the country that have low vaccination coverage because unvaccinated people are at risk, and communities that are fully vaccinated are generally faring well.”

The five states with the highest infection rates are Arkansas, Florida, Louisiana, Missouri and Nevada. Florida alone accounted for one in five of all new cases in the past week. But those states are also seeing a higher rate of new vaccinations compared to the national average, according to Jeff Zients, the White House COVID-19 response coordinator/

Zients said that as the now-dominant delta variant spreads, cases are expected to increase in the coming weeks.

“As the more transmissible delta variant continues to spread across the country, we will likely continue to experience an increase in [COVID-19] cases in the weeks ahead with these cases concentrated in communities with lower vaccination rates,” Zients said.” (B)

“Just as health experts predicted, the combination of unvaccinated people and the more contagious Delta strain of coronavirus has led to new Covid-19 surges.

In 46 states, the rates of new cases this past week are at least 10% higher than the rates of new cases the previous week, according to data from Johns Hopkins University.

In 31 states, new cases this past week are at least 50% higher than new cases the previous week.” (C)

“The number of new coronavirus cases is increasing in every state, setting off a growing sense of concern from health officials who are warning that the pandemic in the United States is far from over, even though the national outlook is far better than during previous upticks.

The 160 million people across the country who are fully vaccinated are largely protected from the virus, including the highly contagious Delta variant, scientists say. In the Upper Midwest, the Northeast and on the West Coast — including in Chicago, Boston and San Francisco — coronavirus infections remain relatively low.

But the picture is different in pockets of the country where residents are vaccinated at lower rates. Hot spots have emerged in recent weeks in parts of Missouri, Arkansas and Nevada, among other states, leaving hospital workers strained as they care for an influx of coronavirus patients. Less than a month after reports of new cases nationally bottomed out at around 11,000 a day, virus cases overall are increasing again, with about 26,000 new cases a day, and hospitalizations are on the rise.” (M)

“While infection numbers in the U.S. are much lower than they were during the worst peaks of the pandemic, the country is still seeing an uptick in cases. The seven-day average of new infections is over 21,000, which is the highest reported since late May, according to data from the Centers for Disease Control and Prevention.

“These numbers and what we are seeing across the country reveal two truths about the current state of the pandemic,” CDC Director Rochelle Walensky said during a press conference last week. “On the one hand, we have seen the successes of our vaccination program over the last eight months, with cases, hospitalizations, and deaths far lower than the peaks we saw in January. And yet, on the other hand, we are starting to see some new and concerning trends. Simply put, in areas of low vaccination coverage, cases and hospitalizations are up.”

States seeing some of the highest increases include Louisiana, Tennessee, Alabama, California, Kansas, Florida, Arkansas, Nevada and Georgia, according to data from Johns Hopkins University.

The delta variant, which is now the dominant strain in the U.S., makes up nearly 52% of total new cases, according to CDC’s latest estimate. However, in the Midwest and Upper Mountain states it could be responsible for about 80% of new cases, Walensky said. The strain is believed to be the most transmissible identified thus far and “is currently surging in pockets of the country with low vaccination rates,” according to Walensky.” (D)

“Los Angeles County will reinstate indoor mask requirements in public spaces for all this weekend, regardless of vaccination status, amid an alarming rise in Covid-19 cases driven by the Delta variant.

Thursday’s announcement by the nation’s largest county sent a chill through the state just one month into California’s long-awaited reopening. And it could prompt other local health officials to follow suit, complicating the post-pandemic recovery narrative of Gov. Gavin Newsom as he faces a September recall election.

Los Angeles County just over two weeks ago recommended that people wear masks indoors, a step that Sacramento County health officials also took on Thursday and that Yolo County initiated a day earlier.

The rise of the Delta variant has caused case rates to double nationwide over the past three weeks. On Thursday the state reported 3,622 new cases as part of a startling trend in the wake of the state’s June 15 reopening.

While California started from a relatively low level, the trajectory and speed at which the more transmissible Delta variant has spread is sounding alarms and causing public health officials to rethink their infection-control strategies.

“Across the state we are seeing increases in cases,” said Marin County Public Health Officer Matt Willis, who is considering a recommendation for indoor masking, but not a mandate. “All of us right now — public health officers — are sharing the same challenge: What is the next step for us to reduce transmission?”

A steep rise has pushed Los Angeles County’s case rate to 7.1 per 100,000 residents, which puts the region in the “substantial” category of spread, according to the U.S. Centers for Disease Control and Prevention. That would also have put the county in the second-most restrictive tier under the state’s now-retired reopening blueprint.

The new order will go into effect late Saturday, just before midnight.

“It is clear that the Delta variant is here and spreading rapidly, overwhelmingly in our unvaccinated communities, and we need to take action now before we see uncontrollable spread,” Los Angeles County Board of Supervisors Chair Hilda Solis said on Twitter.

Solis called the move “only a temporary action, until we can lower our cases and continue getting more people the doses they need.”” (E)

“Driven by the rise of the ultra-contagious Delta variant and pockets of low vaccination, the announcement, which affects more than 10 million Californians, led a wave of heightened health warnings in a state of 40 million people. It also reflected concern nationally that vaccine defiance, disinformation and the variant have been responsible for significant increases in coronavirus cases in Arkansas, Louisiana and elsewhere…

Los Angeles County’s new rules came Thursday as the University of California’s 10-campus system announced that most faculty, staff and students will be barred from its campuses this fall if they show up without vaccinations. Health authorities in Sacramento, Fresno and Yolo Counties also recommended, but did not yet require, that residents return to indoor masking, a move that was followed on Friday by Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara and Sonoma Counties in the Bay Area.

The new local and institutional health rules also sowed confusion.

The C.D.C. as well as the state’s Department of Public Health have said fully vaccinated people do not need to wear masks indoors in most situations. However, Los Angeles has been among the more cautious jurisdictions throughout its response to the pandemic, and California’s guidance gives counties the option to impose tighter restrictions locally.

Officials in Los Angeles stressed that they were acting out of an abundance of caution, in an effort to pre-empt the sort of case numbers that have rapidly increased in other parts of the country. Every state has reported an increase in the number of new virus cases in recent days.

California’s figures have nearly tripled over the past month, largely because of San Bernardino and Los Angeles, but the current rate of 3,000 new cases a day is a blip compared to the winter peak, when there were more than 44,000. California is doing slightly better than the national per capita average and far better than in hot spots around the country. In parts of Missouri, hospitals have been stretched thin by an influx of coronavirus patients…

“If you have been lucky enough to escape infection previously and you’re not vaccinated, your luck is about to run out,” Dr. Hotez said….

On Friday, the C.D.C. director noted that local authorities could adapt masking guidance to reflect the trajectory of the virus in their communities.

“If you have areas of low vaccination and high case rates, then I would say local policymakers might consider whether masking at that point would be something that would be helpful for their community,” said Dr. Walensky, warning that the number of new virus cases is likely to increase in the coming weeks, particularly in areas with low vaccine coverage.

Hours later, 10 Kansas City-area hospitals and health officials issued a joint advisory for indoor and crowded outdoor settings, recommending masks.”   (N)

“Fueled by the Delta variant, daily coronavirus case counts in New York City have begun climbing in recent days, even as the city seems determined to turn the page on the pandemic.

Just a few weeks ago, there were only 200 new cases a day across the city on average, the lowest level since the early days of the pandemic. But the city has now had a streak of days with 400 or more cases. And the test positivity rate has doubled: from below 0.6 percent on average to about 1.3 percent.

Those numbers are still low, but the increase has been swift, surprising some epidemiologists and public health officials who had not expected to see cases jump so quickly after remaining level throughout June.

Still, with some 64 percent of adults in the city fully vaccinated, epidemiologists said it was unlikely that the Delta variant would create conditions anywhere near as devastating as the past two waves of Covid-19.

“Alarming is not the right word” to describe the recent uptick in cases, said Denis Nash, an epidemiologist at the CUNY Graduate School of Public Health and Health Policy. “I would say concerning.”….

“The metrics to keep a close eye on are hospitalizations and deaths,” said Dr. Wafaa El-Sadr, a professor of epidemiology at Columbia University.

So far, those metrics have remained stable in New York City. The seven-day average number of daily hospitalizations this week has remained under 20. The city has recently seen four or five Covid-related deaths a day on average…

In interviews in recent weeks, some epidemiologists said they were expecting a calm summer followed by an uptick of cases around the time students returned to school and Manhattan office workers migrated back to the office.

But in the last week of June, the number of people testing positive suddenly jumped, crossing 300 on June 30. A four-day streak of 400-plus cases followed last week…

So far, the Delta variant has not led the city to drastically change its public health guidance or virus-related restrictions. Nor has it affected the plans of many large companies to get workers back to their desks in Manhattan, according to Kathryn Wylde, president of the Partnership for New York City, a leading business association.

“It would have been prudent for our elected officials to have specified in advance if, when and under what circumstances they would walk back certain components of opening up,” Professor Nash said.

For now, the city’s main strategy against Delta is to continue urging the unvaccinated to get vaccinated. But in recent months, the number of doses administered has fallen precipitously.

While vaccination rates are high in the lower half of Manhattan, much of Queens, and parts of Brooklyn, they lag behind elsewhere, especially in Black and ultra-Orthodox Jewish neighborhoods…”

The city is scrambling to figure out how to raise vaccination rates, offering in-home vaccinations and other incentives. But Mr. de Blasio has shown little interest in mandating vaccinations or pressuring people through testing requirements or other inconveniences. He has not mandated vaccinations for the city government’s 400,000-person work force, as San Francisco has.” (F)

“Dr. Sergio Segarra says when Covid-19 patient numbers in the Miami hospital he works in dipped below 20 last month, he began feeling optimistic.

“I remember seeing articles in the news about hospitals in California with empty Covid units and I longed for that experience,” Segarra, the chief medical officer with Baptist Health’s Baptist Hospital, said. “It’s an experience we were working our way towards that unfortunately has taken a rather sad turn.”

In the weeks since, the hospital’s Covid-19 patient numbers have more than tripled, and staff are now treating more than 70 people, an “exponential growth,” he said, that they were not expecting. To accommodate the climbing patient numbers, the hospital recently reopened two units that were previously shut down.

The overwhelming majority of those coming in sick with Covid are unvaccinated, Segarra said. Many are young — people in their 20s and 30s who are getting “extremely, extremely sick” and some of whom are dying.

Roughly 45% of people in Florida are fully vaccinated, according to state data. The low vaccination rates, along with a dangerous coronavirus variant that’s now the dominant strain in the United States and the relaxed Covid-19 guidelines, are what Segarra said he thinks have led to the increase.

“It’s very sad to see as a health care professional, to see that this is generally an avoidable and preventable disease and to see so many people dying from a preventable illness,” he said. “It’s heartbreaking.”…

“We haven’t made the progress that we wish in terms of treating Covid, we don’t have that magic bullet in terms of treating Covid, but boy, we’ve come pretty close to having that magic bullet to avoid it — and to see it not being used is very frustrating,” he said.” (G)

“Dr. Alan Jones, associate vice chancellor for clinical affairs at the University of Mississippi Medical Center in Jackson, told ABC News Wednesday that his facility was seeing a “significant increase” in pediatric patients over the last several weeks.

The medical center is currently treating five children with confirmed COVID-19 cases, two of whom are in the ICU. Two other children at the hospital are being investigated for potential COVID-19 infections, he said.

The children, who are in stable condition, range from infants to teenagers, Jones said. He could not share any further details about the cases but said that many patients within his hospital who are currently in the ICU do have some chronic, underlying comorbidity diseases that would put them at a higher risk of having a more severe illness associated with COVID-19.

The state has been seeing a “pretty alarming” increase in the number of COVID-19 cases and hospitalizations, Dobbs said during a press briefing last Friday, as the highly contagious delta variant, which was initially identified in India, has quickly become the dominant variant in the state.

“We have seen pretty much an entire takeover of the delta variant for our transmission,” Dobbs said during the briefing, noting that the current cases in the state are “pretty much all delta.”

Between June 15 and July 9, the delta variant accounted for 80% of all specimens sequenced in the state, according to Dobbs.

Hospital systems are not currently overwhelmed, but Dobbs said there are “concerns about it going forward, as has been seen in other states” due to delta, which has become the dominant variant nationwide.

Mississippi’s daily COVID-19 case average has more than doubled in the last three weeks. Less than three weeks ago, there were under 100 patients receiving care for COVID-19 in Mississippi. As of July 11, there were nearly 200. Hospital admissions have also increased by 26.7% in the last week.

The state has seen an increase in COVID-19 outbreaks as well, particularly among youth, in summer activities and nursing homes, Dobbs said.

Jones said his hospital’s pediatric patients seem to be more symptomatic than the children who became ill earlier in the pandemic, which he attributed to the delta variant.

“These seem to be more classic COVID symptoms — fever, cough, respiratory illness,” he said. “I suspect that’s probably because this delta variant is importing a little more severe illness in the pediatric population than those earlier strains that were circulating.”

The delta variant is surging as Mississippi has the second-lowest vaccination rate in the country, with approximately one-third of the state’s total population fully vaccinated, according to the CDC. The “vast majority” of cases, hospitalizations and deaths in the state now are in unvaccinated people, Dobbs said.

Due to the low vaccination rate, the state health department advised Friday that those who are ages 65 and older or have chronic medical conditions avoid mass indoor gatherings for several weeks.

“Our collective under-vaccination in the state has put us all at risk, especially the most vulnerable,” Dobbs said.” (H)

“Northwest Arkansas and River Valley doctors and healthcare leaders said hospitals are feeling the strain associated with the more virulent delta variant, as active COVID-19 cases and hospitalizations increase in Arkansas.

“Our COVID ICU unit is full and the majority of the patients are on ventilators right now. Our COVID unit upstairs, which is our med surge COVID unit, is also full right now,” said Debbie Hewett, R.N. and director of critical care services at Mercy Fort Smith. “Our patients here in the ICU are just so incredibly ill and that’s COVID and non-COVID patients.”

Hewett said the hospital is not yet seeing record numbers of COVID-19 patients, but they are much more sick than in previous months and when combined with non-COVID-19 patients and limited nurses, it is a stress for the health care system.

“They’re deteriorating much faster. We could predict last go around how long from the time they came in and hit a certain amount of oxygen before we had to intubate them and that would be, on average three to four days, now it’s hours,” she said.

“We’re very concerned of what could be coming,” said Dr. Jason McKinney, ICU medical director for Mercy NWA in Rogers.

Dr. McKinney said the COVID-19 unit is currently full and that hospital staff are moving to open a second unit to help care for patients. He’s worried that the current surge of sickness could surpass previous spikes in active COVID-19 cases and hospitalizations.

“What we’re seeing in south Missouri is that it tends to be worse and that’s kind of where we’re heading now,” McKinney said. “Common sense tells you that when you have this huge population of super sick patients in a hospital, that’s going to strain the system and it’s going to push it again. It was strained last year and it’s going to be strained again.”

“Almost 100% of the cases we are seeing in the hospital are unvaccinated individuals,” said Dr. Raed Khairy, infectious disease consultant for Baptist Health Fort Smith.

Khairy said the hospital has also seen increases in COVID-19 patients, but said the hospital has not yet had to expand capacity.

“Certainly, this may create a stress on any health care system. If we have more cases, then we will have less beds to admit other regular cases and other regular admissions. But, at Baptist Health we are ready for that kind of situation,” Khairy said.” (I)

“The Springfield, Missouri, health department is requesting funding for an alternate COVID-19 care site in response to a spike in infections and hospitalizations in recent weeks, health officials announced Wednesday.

Several local health facilities and hospitals jointly requested the alternative care site funding, which would include money for more beds, staff and antibody testing. One of those facilities was Springfield-based Mercy Hospital, which had so many hospitalized COVID patients last week that it had to call in backup ventilators from other hospitals in its network when it ran out.

The increase in severe illness is taxing the health system and sick patients are expected to outpace hospital capacity, according to the Springfield-Greene County Health Department.

Of the 231 patients currently being treated in Greene County hospitals, 104 are in critical care and 61 are on ventilators, the health department said.

Healthcare workers in the emergency room at Cox Medical Center South in Springfield, Missouri…Read More

“The Springfield-Greene County Health Department continues to urge anyone not fully vaccinated continue to take precautions to prevent the spread of COVID-19, including wearing a mask,” Aaron Schekorra, a spokesperson for the health department, told ABC News. “Businesses and organizations are encouraged to implement policies in order to protect their staff, clients, and guests, such as requiring masking for all.”

The spike in Springfield is part of a larger wave of COVID in the state that has top health officials worried.

“Missouri is at the top of our list,” Dr. Francis Collins, director of the National Institute of Health, said during an interview with ABC News Kansas City affiliate KMBC, in reference to concerning COVID hotspots. “It seems to be now expanding more and more (to other areas) of Missouri,” Collins added.” (J)

“With about a third of adults in the U.S. still completely unvaccinated, and cases of COVID-19 on the rise, the U.S. surgeon general is calling for a war against “health misinformation.”

On Thursday, Dr. Vivek Murthy released the first surgeon general’s advisory of his time serving in the Biden administration, describing the “urgent threat” posed by the rise of false information around COVID-19 — one that continues to put “lives at risk” and prolong the pandemic.

Murthy says Americans must do their part to fight misinformation.

“COVID has really brought into sharp focus the full extent of damage that health misinformation is doing,” Murthy told NPR in an exclusive interview ahead of the advisory’s release. Surgeon general’s advisories are reserved for significant public health challenges that demand immediate attention…

Rates of COVID-19 are rising nationwide, driven in large part by the spread of the highly transmissible delta variant. A recent analysis by NPR shows that cases are highest in places where vaccination rates lag. Multiple factors, including inadequate access to vaccines, can keep vaccination rates low in some communities, but Murthy says fear about possible side effects or extremely rare adverse events are also a powerful driver of vaccine hesitancy.

In many cases, false information about the vaccines feeds that hesitancy. According to polling from the Kaiser Family Foundation, two-thirds of unvaccinated adults either believe vaccine myths or are unsure about whether they are true. Murthy says that means misinformation is literally putting lives at risk…

In his advisory, he puts pressure on big tech companies to play a bigger role in combating health misinformation on their platforms. He wants to see algorithms tweaked to further demote bad information and companies to share more data with outside researchers and the government.”  (K)

“….What ethical duties will we have, if any, to those who refuse to be vaccinated?…

We will once again face a choice, individually and collectively, between saving lives and preserving freedoms. Only, for many, the tables will be turned. Individuals who reject public health measures, including vaccines, in the name of liberty will soon face an ongoing risk of fatal disease as those who are vaccinated assert their own rights to gather and travel. The only difference is that, unlike with masks or social distancing, the unvaccinated will be able to protect themselves fully with a shot that is both safe and free. In fact, the willfully unvaccinated may continue to threaten the health of the vaccinated by requiring hospital space for COVID-19 care, as well as health care resources that might be spent otherwise….” (L)


Childress et al. suggest that three of these moral considerations—benefiting others, preventing and removing harms, and utility—are critical to the goal of public health while three others—justice, respect for autonomy, and privacy—are most likely to limit public health activities.4

In addition to defining the ethical issues relevant to public health, we must also acknowledge that there are often instances in the practice of public health decision-making and program implementation where the above noted considerations may come into conflict, provoking a need to choose or assign a greater weight to one of these moral considerations over another. Childress et al. proposed five “justificatory conditions” to help determine when the moral considerations critical to public health (benefiting others, preventing and removing harms, and utility) can take precedence over the other goals during specific public health activities.4

These “conditions” are: effectiveness of the activity, proportionality of the activity (the probable public health benefits outweigh the “infringed” other moral considerations), necessity of the activity, the extent to which the activity represents the least infringement of the other moral considerations, and lastly, the ability to publicly justify the activity in a transparent manner. Because vaccination activities are a key component of many public health programs, we suggest that they fall within this ethical framework. Diekema and Marcuse, however, have put forth a more direct approach for evaluating and resolving ethical issues around mandatory vaccination programs.5

Their approach is based upon the often cited medical maxim commonly translated as: “first, do no harm.” When applied to vaccination activities, this maxim has the following implications: the vaccination should be of benefit to the subject being vaccinated; care should be taken to prevent any harm that might accrue from the vaccination; compared to other procedures for addressing the same issue, the vaccination should be the best opportunity for successfully preventing disease as compared to the risk for harm; and if harm does result from the vaccination, the benefit of vaccination to the subject should at least compensate for the harm incurred.5

Because vaccination provides not only a direct benefit (immunity to disease) to the person being vaccinated but also provides a benefit to others in the community via herd immunity, Diekema and Marcuse remind us that unvaccinated persons can be viewed as “harming” the community.5 It, therefore, follows that for serious and highly communicable diseases, there is a role for compulsory vaccination programs. Diekema and Marcuse cite the utilitarian philosopher John Stuart Mill who held that: “The only purpose for which power can rightfully be exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.”5

This principle, known as the “harm principle,” can be used to expand the application of the maxim: first, do no harm” to the community interests that result from vaccination programs.5

It, therefore, follows that the “harm principle” (“first, do no harm.”) can be used to justify compulsory vaccination programs in specific instances where the community interests or benefits are deemed to be significant. Often, the issue is in determining what is considered significant. Finally, the “precautionary principle” has been put forth by Gostin and colleagues as being critical in public health’s response to potential infectious disease emergencies.6

This principle was initially defined as being relevant to environmental health emergencies and asserts that public health is obligated “…to protect populations against reasonably foreseeable threats, even under conditions of uncertainty… Given the potential costs of inaction, it is the failure to implement preventive measures that requires justification…”6” (O)


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