Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
Giving Convalescent Plasma a Shot
Used to effectively treat mumps, measles, and even the so-called Spanish flu in 1918, convalescent plasma may not be a silver bullet, but it still has the potential to play an important role in helping some patients recover from COVID-19 (“5 Things to Know About Convalescent Blood Plasma,” Aug. 27).
To support its recent decision, the Food and Drug Administration used data from previous use cases of convalescent plasma for other respiratory coronaviruses, results of early safety and efficacy trials in animal models, and published studies on the safety and efficacy of convalescent plasma before issuing Emergency Use Authorization (EUA). The agency also pointed to a Mayo Clinic preliminary analysis of 56,000 patients who were given high or low titer units of blood plasma.
The EUA also specifies that donor blood can be released only to hospitals and patients after it is tested with a currently available antibody test that accurately detects the right type of antibodies to neutralize the virus and confirms that the blood contains sufficient levels of these antibodies for treatment purposes. This means that less accurate, less specific tests that are more susceptible to false positives will not be used to identify COVID-19 convalescent plasma — something that should give patients higher confidence that the plasma they receive meets scientific and quality standards.
— Dr. Fernando Chaves, a board-certified hematopathologist who serves as Global Head of Medical and Scientific Affairs at Ortho Clinical Diagnostics, Raritan, New Jersey
I’m quoted here saying what everybody already knows: if we want to know if plasma works, we need a trial.
This isn’t academic for me: I want to know if I should be using plasma in my patients with severe COVID-19. This fiasco was preventable. https://t.co/MjS2DXbYUX
— Adam W Gaffney (@awgaffney) August 28, 2020
— Dr. Andrew Gaffney, Boston
Vaccination and Prognostication
Both assertions that seniors will drive 800 miles or come home from an assisted living or skilled nursing facility to live with families are dubious (“What Seniors Can Expect as Their New Normal in a Post-Vaccine World,” Aug. 3). The latter are need-based moves (think dementia, wandering). The former makes sense for those who won’t tolerate the physical strain of long car rides — think Florida to D.C.
— Laurie Orlov, Aging and Health Technology Watch, Port St. Lucie, Florida
I wonder if many of these predictions are more likely to be true among those who have personal experience with COVID-19, either through personal experience with illness or loss of family or friends. https://t.co/uRZnuSfFLf via @khnews
— Rosemary Wright, PhD (@rwrightphd) August 3, 2020
— Rosemary Wright, Wichita, Kansas
I don’t want these precautions to last forever. I want there to be a time where we can all give each other hugs and high fives again. We were built to be together and celebrations bring us so much joy. I want there to be a time when we can all be in fun crowds again. I want to be able to smile out in public again and not have to cover my face. What do you think about all of this?
— Christopher DeCarlo, Oyster Bay, New York
We won’t go back to “the way things were” even after a vaccine for #COVID19 has been invented. This experience has been an opportunity to innovate and do better. Here are some changes you’re likely to see in #healthcare and beyond. https://t.co/l4x50qVxvM
— Tony Slonim MD, DrPH (@RenownCEOTonyMD) August 8, 2020
— Dr. Tony Slonim, Reno, Nevada
Humans as Guinea Pigs for the Sake of Corporate Piggy Banks?
We assume that this vaccine works, but how do we know (“They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma,” Aug. 25)? The public is not some testing animal. I would not take this vaccine, especially since the back-and-forth is over money and not public health. No government should give any money to a business without a deal that protects the public as investors. We are not a source of free money; just as they make no concessions, we also should make no concessions without a deal. And the deal is public health.
There was no vaccine during the 1918-19 influenza, not until 1940. Our immune system needs to be considered as part of a cure. Is that not the theory behind flu shots? So, if we are exposed to the virus and allow our bodies to fight it off, that defense is greater than any vaccine. Those who cannot fight off the infection are the ones who need to be considered for medical attention — and not just some shot hopefully manufactured by a company that does not prioritize money over health.
There are times when profit is important, but since businesses are being subsidized, this is not one of those times. The world economy has been seriously affected, and printing money we do not have is not a sound idea. What good are medicine and doctors and medical research? Seems we should consider those old grandma medications, such as the hot toddy … whiskey and hot coffee and a good night to sweat it out under many covers. That cured my grandfather of influenza long before there was a vaccine.
Medical science doesn’t have all the answers. If soap can kill this coronavirus, then there must be a common household solution to eradicate it that is medically safe for humans. Perhaps technology students would do better to help the world instead of these money-hungry corporations.
— Tom Berger, Suffolk County, New York
Volunteers risk their lives in clinical trials, and the Oxford converted vaccine from public good to profitable commodity? …
— Amar Jesani (@amarjesani) August 31, 2020
— Amar Jesani, Mumbai, India
On COVID Tests and Risk
I have worked in a clean lab for many decades. I know how to behave and how to take advantage of and handle PPE, for the purpose of achieving very low contamination levels. The article “Analysis: When Is a Coronavirus Test Not a Coronavirus Test?” (July 29) presents a false option. It is not about accepting a level of risk, it is about doing everything possible to reduce the risk.
In my labs, I had the ability to require adherence to careful procedures and the option to fire anyone who would not follow approved procedures. I don’t have that option with those who refuse to follow the simple instructions for COVID-19, including the “religious” wearing of a mask, the same way that women cover their heads when entering a Catholic church and Jewish men wear a yarmulke in a temple.
And when the president irresponsibly and criminally refuses to follow and to mandate simple instructions by medical experts, then I am unable to calculate the risk. I don’t think Ms. Rosenthal can calculate the level of risk she suggests we accept.
— Dimitri Papanastassiou, Pasadena, California
I enjoyed your piece, but I regret that you said so little about therapies that may emerge to help us. Vaccines are not the only hope. I think a disservice is being done by indicating that our only options are to live with it or wait for a vaccine.
— John Van Drie, North Andover, Massachusetts
Great article by @ahartreports. I too cringed initially at likening #covid19 to war but couldn’t agree more that we need to treat our #PublicHealthOfficials with respect and be grateful for their sacrifices https://t.co/rr9NT4tNlB via @khnews
— Meghan McGinty, PhD (@Breukelen299) September 1, 2020
— Meghan McGinty, Brooklyn, New York
The Hydroxy Paradox
Wouldn’t it be refreshing, instead of slamming other doctors’ practical experience with hydroxychloroquine at low dosages and supplemented with zinc, etc. at the first sign of the infection, to at least let them make fools of themselves (“Don’t Fall for This Video: Hydroxychloroquine Is Not a COVID-19 Cure,” July 31)? What is the harm?
Aren’t “we all in this together”? Why are we afraid of a difference in opinion? What if it really works using the protocols as stated? Let it play out. Pretty sure no one has died when prescribed “hydroxy” in low dosages by doctors in actual practice, unlike the deaths that occurred when given in massive dosages late in the infection.
Why make fun of doctors who are trying their best to help us all? That seems narrow-minded to me.
— Larry Koch, Agoura Hills, California
Reported this tweet. You are encouraging the use of a medication a. Without a license b. Without citing sources and c. Every double blind study has shown and increase in death.https://t.co/iN7eionH03https://t.co/eSPDwPz9V6
— Tara Tisch🦓🍀🎨🏴☠️ (@TaraTisch) August 22, 2020
— Tara Tisch, Peoria, Illinois
I know you disagree with Dr. Stella Immanuel, and that’s OK. The problem I have is that no one has done the clinical trials to prove that hydroxychloroquine doesn’t work. She said she has 350 patients who have had success with her prescriptions; the doctor from Dallas said she uses it with her own little concoction. If, in fact, what they are doing is working, then why don’t people visit these doctors to see if it is true — and, if it is, then try collaborating with them to keep people from dying, for crying out loud.
That is one of the problems here: Everyone is against one another instead of trying to support one another. We are Americans and, as in years past, we have stuck together for the betterment of the country. If we would stop trying to take care of America with money and start taking care of America with information, then America would live and thrive.
I am a first-year respiratory therapy student and spent 20 years in the Marine Corps, and back in the ’80s we took chloroquine, and I have no side effects and neither do the guys I stay in contact with. Keep in mind that the reports of the side effects are not in every patient and if hydroxychloroquine is offered to a patient and the patient is told, “This is going to make you better but there could be side effects later, but if you don’t take this you will get worse and we don’t know if you will die or not,” what do you think they will say? No one wants to die.
C’mon, let’s just be people trying to keep other people alive no matter the cost, no matter who is right or wrong — we can sort that out later.
— Jim Tumlinson, Canyon Lake, Texas
Editor’s note: A recent report from the Centers for Disease Control and Prevention expressed caution and concern that hydroxychloroquine was potentially being misused to treat COVID-19 and affecting supplies of the medication to treat rheumatoid arthritis, lupus and other conditions. “Current data on treatment and pre- or postexposure prophylaxis for COVID-19 indicate that the potential benefits of these drugs do not appear to outweigh their risks,” it said.
Yoga for All
I appreciate your article (“Namaste Noir: Yoga Co-Op Seeks to Diversify Yoga to Heal Racialized Trauma,” July 30) but have a hard time with “people of color” being repeated over and over. Yoga benefits all people, and until we start thinking as one and not labeling everything we will always have racial issues. We need to think all lives matter, not just a specific color. Thank you for your writings.
— Susan Ferguson, Cypress, California
— Eli Imadali (@eliimadaliphoto) August 9, 2020
— Eli Imadali, Denver
— Jimmy Etheredge (@JimmyEtheredge) August 14, 2020
— Jimmy Etheredge, Atlanta
Words That Carry Weight
Thank you for calling attention to the challenges people with obesity face regarding risks of COVID-19 infections and the potential that vaccines may not be effective (“America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine,” Aug. 6). I would like to comment on how you refer to people with obesity. The Obesity Action Coalition, and other organizations focused on obesity, recommend using people-first language. An article about cancer does not refer to cancer people, nor does one on cardiovascular disease label individuals as heart disease people. The terms “obese people” and “morbid obesity” are stigmatizing. It is better to utilize people-first language as Dr. Timothy Garvey did at the end of the article. As a member of the Obesity Medicine Association as well as an obesity medicine specialist and educator, I work diligently with patients to overcome the bias and stigma that society imposes. Please be considerate of the use of language when referring to people with obesity.
— Dr. Nicholas Pennings, Raleigh, North Carolina
It is becoming more & more obvious that we would‘ve “saved” FAR more lives here if we had put all the mask shaming energy into getting people to lose weight. But that would be un-PC.
America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine https://t.co/wfbUz9JSB9
— John Ziegler (@Zigmanfreud) August 10, 2020
— John Ziegler, Los Angeles
As a sociologist researching weight stigma, I am appalled by the article by Sarah Varney suggesting obesity will undermine vaccine effectiveness. The article is full of stereotypes and misinformation. In the first place, it is Big Pharma’s fault vaccines aren’t made for fat people. It is beyond incompetence that any vaccine drugmakers come up with would be less effective for half the population. In the second place, many of the diseases fat folk allegedly have are caused by yoyo dieting and stigma. And there is no proof weight loss would make any vaccines more effective as most fat people are biochemically different than thin ones. This is a tone-deaf, fat-phobic article that serves only corporate interests.
— Sherie Sanders, Springfield, Illinois
My life and those of others are being put in danger by the San Bernardino County Sheriff’s Department (“COVID Runs Amok in 3 Detroit-Area Jails, Killing At Least 2 Doctors,” July 23). I’m in jail with health issues: asthma, prediabetes, vitamin D deficiency, high blood pressure, and may have a cancerous tumor and peripheral neuropathy. I’ve already been put on quarantine two times, once because a deputy who tested positive for COVID-19 had direct contact with me and the other because they put someone in the cell with me who was symptomatic for COVID-19. When being transported anywhere, they put chains on us that have been on many people and have not been cleaned. Then they chain multiple people together, not even knowing if a person has or is a carrier of the coronavirus. The social distancing was put in effect to protect the lives of people. The sheriff’s department is violating it, putting lives in danger and will continue to do so until they are stopped. To top it off, I am state property and not even supposed to be here. I don’t want to die or see anyone else die for being in jail and catching COVID-19. So can someone please help us all.
— LeAire Moore Sr., Adelanto, California
Lots of people ask me why I stay home most of the time, mask up, wash my hands, socially distance.
Why should I? I’m young. I’m healthy. I work out and eat right.
But, I have a mother.
This is why. ⬇️https://t.co/IlKPXmTu65
— Samuel Cook, III | CPT, CNC, USAW (@samueljcookiii) September 6, 2020
— Samuel Cook III, New Orleans
Correcting the Record on the Navajo Language
The article “Two Navajo Sisters Who Were Inseparable Died of COVID Just Weeks Apart” (Aug. 26) is incorrect. The Navajo language is most certainly “written down” and is taught in schools and universities.
— Randy Truman, Albuquerque
Editor’s note: Thanks for helping us clarify that point. The article has been updated.
Medicaid Expansion in the Age of COVID
The COVID-19 pandemic has shown us that Americans are in desperate need of health insurance, including publicly financed health insurance programs such as Medicaid. The time is now for some policymakers in America to reshape how they think of Medicaid as more than a government handout that makes us worse and not better.
Medicaid is a health insurance program that is jointly funded by the state and federal government. This program provides low-cost insurance to adults with low income, both young and elderly, pregnant women, the disabled and children through the Children’s Health Insurance Program, commonly known as the CHIP program.
The Affordable Care Act provided an opportunity for states to expand coverage to individuals at 138% of the federal poverty level. As an added incentive, the federal government pledged to pay 100% of the costs to expand, a share that would be reduced to 90% by 2020. In recent months, states such as Oklahoma and Missouri through the ballot box have expanded Medicaid. This leaves only 12 states to not expand, but millions more in need of affordable health insurance.
The argument by some policymakers against the Medicaid program is the fear of incentivizing Americans to not work. Contrary to this belief, in 2017, it was reported that more than 63% of Medicaid recipients are already in the workforce while only 7% were not working for various reasons.
Finally, since the beginning of the pandemic, one study estimated that nearly 27 million Americans could lose their employer-sponsored insurance this year. Of those 27 million, nearly 13 million would be eligible for Medicaid.
The American people deserve to have affordable health insurance. Therefore, policymakers have an obligation to expand it and not contract.
— Reginald Parson, Portland, Maine
This is happening right now throughout our system and its utterly disgusting and unacceptable.
— Stephen Ferrara, DNP (@StephenNP) August 6, 2020
— Stephen Ferrara, New York City