Coronavirus Files: Life-and-death decisions, a disability perspective and COVID-19's toll on black communities

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April 13, 2020
 
 
 

By Lindzi Wessel 

The Center for Health Journalism has begun offering a special newsletter geared to journalists as they report on one of the biggest and most complex stories of our times. Each Monday, while the pandemic runs its course, The Coronavirus Files will provide tips and resources and highlight exemplary work to help you with your work. The Center for Health Journalism’s Coronavirus Files Monday newsletter is curated and reported by science writer Lindzi Wessel. Have a suggestion or a request? Write us at editor@centerforhealthjournalism.org.
 
Subscribe to our twice weekly newsletter.
 
Sign-Up for our Upcoming Webinar: Covering The Crisis: Life and Death Decisions, April 15, from 10 to 11 a.m. PT / 1-2 p.m. ET: Some health systems across the country have already made unprecedented decisions about who gets care and whether patients on the brink of death should be resuscitated. In this webinar, we’ll discuss what questions journalists should ask providers and health systems to understand hard calls on rationing care. But it’s not just hospitals who hold the keys. Often overlooked in public debate on scarce resources is whether patients benefit from the most aggressive interventions. We’ll discuss with Dr. Sunita Puri, a palliative care specialist and author, how patients and their families might weigh the survivability of being put on a ventilator, and whether a “good death” at home might be another option.
 
COVID-19 Reporting Tips, Our Health Divide & Disability Perspectives 
 
Tips from the Front Lines
 
This week, ace science journalist Lisa Krieger of The San Jose Mercury News appeared as a guest in the Center for Health Journalism’s “Covering Coronavirus” Webinar Series. Krieger shared tips for staying afloat amid the constant flood of COVID-19 updates, explained the most important science and policy facts you’ll need to follow those updates, and suggested practical ways to find stories within your own communities.
 
“We use stories to convey information,” she reminds us. “To the extent that you can find people — real people, real lives — to tell your story, the more readers will engage.”
 
Krieger’s calm, smart and thorough overview will make covering this rapidly changing landscape feel doable even for those of us who are a bit overwhelmed and not used to covering medicine and health. Check out the webinar video, slides and suggested resources below! 
 
And make sure to sign up for these coming webinars:
The Health Divide
 
Newly available demographic data reveals a striking pattern: The pandemic is slamming black communities across the United States. Long-standing inequality in health care access, higher rates of chronic disease, and an overrepresentation in high-risk jobs like nursing aids, grocery store clerks and emergency dispatchers are all likely contributors to the high death rates in many black communities. In anAssociated Press analysis of more than 52,000 COVID-19 cases from around the country that were published with racial demographic data, black Americans made up 42% of deaths in areas where they only accounted for about 21% of the total population.
 
“Time and again, a state or county releases racial data. Time and again, those numbers reveal a sizable racial disparity,” writes Ibram X. Kendi, director of The Antiracist Research and Policy Center at American University, who, in opinion pieces for The Atlantic, has been calling for the release of racial demographicsof coronavirus patients. There is a “racial pandemic within the viral pandemic,” he writes.
 
State and local leaders, like Los Angeles County Supervisor Mark Ridley-Thomas, have also called for more collection of demographic data, to help “fully understand the depth of the unique challenges it presents to each of our diverse communities.”
 
And as medical rationing becomes the norm, the disabled community could be another group at high risk, writes Alice Wong for Vox. Wong is a disabled activist who uses a wheelchair and requires a non-invasive ventilator to breathe. “The ethical frameworks for rationing often put people like me at the bottom of the list,” she writes. “Even the notion of ‘quality of life’ as a measurable standard is based on assumptions that a ‘good’ healthy life is one without disability, pain, and suffering.”
 
Tell Me Why
 
COVID-19 is killing men at higher rates than women and no one knows why. For Vox, Katherine Harmon Courage explores the various explanations scientists are considering. Some researchers think that women might mount stronger immune responses in general because they have two X chromosomes, which harbor a high number of immune-related genes. Others suggest the difference might come from behavioral norms: Men are more likely to be smokers and are less likely to seek medical care early. Still others say sex hormones could be important in modulating the immune response. The difference prompted White House coronavirus response coordinator Deborah Birx to urge men to take their health seriously at a press briefing on Thursday.
 
How COVID Kills
 
One of the reasons coronavirus has spread so rapidly is that the vast majority of cases are mild. Carriers who think they have a typical cold or flu or even show no symptoms at all can still pass on the virus to someone who has a very different outcome — some estimates suggest up to 80% of cases could be mild or asymptomatic. When people are hospitalized or die it’s almost always because the infection progresses to a condition called acute respiratory distress syndrome, or ARDS, which leaves patients gasping for air.
 
The key to understanding ARDS lies in the air sacs at the ends of our lungs that allow for air exchange in the body, according to a New York Times video explainer that shows how ARDS incapacitates the lungs. To be circulated through our bodies, the air we breathe must cross the thin walls of those air sacs to escape into the bloodstream. But in patients with ARDS, it’s as if “a thick layer of mold” now coats the once infinitesimally thin walls of air sacs. Oxygen passage becomes almost impossible, blood oxygen levels drop dramatically, and people begin to suffocate.
 
No one knows why some people escape COVID-19 unscathed while others develop ARDS. But there’s some evidence it could have to do with a runaway immune response referred to as a “cytokine storm,” writes Geoff Brumfiel for National Public Radio. Cytokines are immune molecules that help fight infection, but when too many stay active too long it can cause damage. While experts are still debating this explanation, some doctors have already begun treating patients with powerful anti-inflammatory drugs to try to mitigate an out of control cytokine response.
 
Ventilator Debates
 
When patients can’t breath, doctors often turn to ventilators, which pump oxygen into the lungs. But as doctors are learning more about how COVID-19 patients respond to treatment, some question if ventilators are being overused or employed too quickly. “What’s driving this reassessment is a baffling observation about COVID-19,” writes Sharon Begley for STAT. “Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen.”
 
This could mean doctors have more time to talk to patients before turning to ventilators, which require sedation, writes Lydia Ramsey for Business Insider. It also suggests patients might do just as well or better on less invasive and more widely available breathing therapies like repositioning or sleep apnea masks. This could be good news in places where ventilators are in short supply, pushing desperate hospitals to consider the risky practice of ventilator sharing.
 
Viral Rumors
 
A widely circulating computer simulation has left many in doubt over the safety of running or biking in public. But when Jason Koebler looked into the origins of the simulation for Vice, he found the research might not hold water. The simulation claims to track “the ‘spread droplets’ and ‘slipstream’ of the exhalations, coughs, and sneezes of people who are running, walking, or cycling,” and is being used by its creators to advise staying up to 65 feet away from others while doing these kinds of activities, writes Koebler. That requirement, which far surpasses the the Centers for Disease Control and Prevention’s recommended six feet, could make outdoor exercise impossible in densely populated cities. The problem, Koebler says, is that the lead researcher “took the extraordinary step of speaking to the media about his research before publishing anything about it,” making it impossible for other experts to evaluate and comment on the validity of his work.
 
Since Vice’s article came out last Thursday, the research team has published a short preprint describing their methods, which involve computations based, in part, on measurements made from a stationary, quarter-scale model of a runner in a wind tunnel. However, the paper still has yet to be peer-reviewed. Despite that, the hasty release and media attention means the simulation has already taken root in public discussion, serving as the basis for meritless accusations of recklessness towards those who are exercising outdoors. It’s a cautionary tale for journalists as we seek to balance the impulse to publish findings with a need for ensuring evidence-based approaches. 
 
More Resources
 
● In her CHJ webinar appearance, Lisa Krieger suggests tapping into public grand rounds or town halls to get an idea of how medical centers are mobilizing to tackle COVID-19. Check out grand rounds from Stanford University or Massachusetts General Hospital or look for the equivalent in your community.
 
●  Keep abreast of case counts and surges by visiting the Centers for Disease Control and Prevention’s update page each morning. Situation reports from the World Health Organization provide global numbers.  The University of Washington’s Institute for Health Metrics and Evaluation’s much-discussed COVID-19 model projects where we may be headed.
 
●  Because of the urgency of the coronavirus crisis, some scientists are publishing their research in preprints, skipping the peer review process for now to get data out as fast as possible. You can access many of those preprints here. But be careful how you interpret the findings, cautions Krieger. “One preprint does not a scientific truth make!”
 
Giving Back
 
Help us continue to serve journalists and policy leaders with new content we are developing on COVID-19. Your tax-deductible contribution to the Center for Health Journalism will advance our mission of helping journalists investigate health challenges and solutions in their communities –serving as a catalyst for change.
 
You can donate through the USC web portal at this link: https://bit.ly/3c8d4xs
 
Pressed for time? You can also text to donate! No amount is too small; just send a text to 41-444 and type the message CHJ for further instructions.