Test 2 Study Guide

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Test 2 Study Guide Human Challenge Trials 1. What is a human challenge trial?  Infect Patient with virus and then directly observe them with or without the vaccine. 2. When and where was the first human challenge trial for COVID-19 conducted?  In the United Kingdom, in the year 2021. 36 adults ranging from 18-29. 3. Bramble lists 3 common reasons for allowing volunteers for COVID-19 human challenge trials. a. What’s Bramble’s response to the first one (best interests of high-risk volunteers)?  They already should have the access to the best medical care. They don’t have a choice to isolate themselves. The government should be doing their jobs. So these people aren’t taken advantage of. b. What’s Bramble’s response to the second one (fully-informed volunteers)?  They can’t really be fully informed as we do not know the risk. Young and healthy people make these kinds of decisions because they think they’re invincible and they don’t know how their death can affect family and friends. c. What’s Bramble’s response to the third one (analogies with other professions)?  We have vaccine trials instead of having people volunteer. Other professionals are needed in our society or else we would collapse. 4. According to Bramble, when would it be okay to conduct human challenge trials for COVID-19?  When there is not enough of the virus circulating to make a vaccine normally. People not following the protocols designed to protect all of us. 5. Chappell and Singer argue that pandemics need new research rules. What do they say the goals of these rules should be?  Allowing volunteers for human and challenge trials. It speeds up research and doesn’t exploit people. Only can happen under pandemic circumstances. 6. What do Chappell and Singer say about young participants making fully-informed decisions?  We can make informed decisions without knowing all the risks. We allow young people to sign up for high risk things even with their lack of experience. 7. What do Chappell and Singer say about incentives and messages when prohibiting COVID-19 human challenge trials?  Allowing: respects autonomy and produces vaccine faster.  Prohibiting: encourages anti beneficent paternalism. 8. According to Chappell and Singer, what are the supposed benefits of human challenge trials?  Save many lives and could help even more livelihoods like things like job loss and eviction. Rationing Scarce Resources 1. In 2020, Ranny et. al. estimated that we had 60,000 – 160,000 ventilators. How many did they estimate we need?  Several Hundred Thousand to a Million

2. How many times more likely were health care workers to become infected with COVID-19 compared to the general public?  3 times as likely 3. According to Ezekiel et. al., what are the 4 fundamental values in allocating scarce medical resources during the COVID-19 pandemic?  Maximize Benefits – Save most individual lives or the most life years  Treat People Equally- Wealth gives no priority. First come or first serve, or random selection.  Promote and Reward Instrumental Value- Give priority to those who can or have saved others  Give Priority to the worst off- The sickest or have the most to lose. 4. According to Ezekiel et. al., what is the most important value in a pandemic?  Maximizing benefits is the most important value. 5. What are Ezekiel et. al.’s 6 policy recommendations for allocating scarce resources during the COVID-19 pandemic?  Maximize number of patients that survive treatment with reasonable life expectancy. People who are sick but could recover with treatment.  Give scarce resources to essential workers first.  For patients with similar prognoses, use random allocations instead of first come, first serve.  Prioritization guidelines should depend on the particular intervention and on the available scientific evidence.  Volunteers in medical research to combat the pandemic should receive priority for covid-19, but only serve as a tie breaker.  DO NOT prioritize patients with covid over other patients. 6. According to Ezekiel et. al., what strategies should be used to implement their rationing policies?  We Need to balance 4 values for different interventions in different contexts.  Need fair and consistent allocation procedures that include affected parties  Employ triage officers, physicians, and or committees to help make decisions when individual physicians are forced to improvise  Procedures must be transparent to ensure public trust. 7. According to Bramble’s point system, each expected year remaining in a patient’s 20s counts for more than each expected year remaining in a patient’s 90s. According to Bramble, why is that?  One’s younger years typically contribute more to one’s ultimate level of well being. 8. Under Bramble’s point system, who gets extra points?  Essential Workers, so it discourages them from quitting.  Parents with Dependent children.  Socio- Economically Disadvantage patients 9. Under Bramble’s point system, who takes care of calculating points and ranking individuals based on their point totals?

 Largely Triage Officers  Doctors and Nurses will be needed to calculate some numbers 10. According to Bramble, who should decide if/when to remove a ventilator?  Leave it to health care professionals to decide.

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