Tag Archives: public health

Resident Perspective: Volunteering at a Testing Site

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

 

With my office hours consolidated and no longer attending morning and noon teaching conferences, I find myself wanting to get back in the action. During my self-isolation I signed up for the Philadelphia Medical Reserve Corps. I signed up to be a “swabber” (obtaining samples from the back of the throat) at the South Philly screening site in the parking lot of Citizen’s Bank Park. I have Phillies tickets for a game that was supposed to take place this weekend. But instead I arrive at the stadium parking lot to see swathes of asphalt without cars. Instead they’re filled with tents, traffic cones, and people gowned from head to toe in PPE rather than tailgaters. This screening site is a joint venture between the Philly Department of Health, the Commonwealth of Pennsylvania, and the Federal Emergency Management Agency (FEMA). There is plenty of PPE to go around and I suspect this is due to FEMA’s presence because right now nobody seems to be overly concerned about limiting volunteer access to equipment.

Testing Site

I’m interested to see who comprises the volunteer corps because there is a wide variety of people in the Delaware Valley that suddenly have nothing to do. There are retired physicians, nurses, medical students (suddenly without any clinical duties), as well as people not at all involved in medicine who just want to help. Everyone is eager and energetic. You couldn’t tell there was a pandemic about to make its way to Philadelphia and the people that are most concerned they have an infection are driving to your current location.

There are multiple large white tents set up to receive cars to drive through. Each tent has the capacity to test about 100 people per day. The decision on how many tents to open each day is dictated by the number of volunteers available and the weather. On my first day it’s windy—very windy in South Philly. So windy in fact if you dropped a glove or a face shield you better start running because it would be 10 yards away before it hit the ground. Mornings start with huddles of teams where we begin the process of assigning volunteers to different stations and assign roles for the day. A woman in a vague military ensemble and standing up perfectly straight, presumably from FEMA, calls our medical director over after our huddle. There is a line of about 30 cars waiting for the entrance gate to the parking lot to be lifted to signal we’re ready to start testing. We typically start at 1pm on the dot but today things are dragging along. The Medical Director slowly walks back to the “swabbers” tent, facemask in hand, and dejectedly says that we have to close the operation today due to high winds which are anticipated to become worse as the day wears on. This is because the specimens may blow over and be scattered in the wind, putting Philly on the map as the first city to accidentally infect its own citizens with coronavirus. We have to go car by car to notify the inhabitants that if they are truly sick they should go to the nearest ED or come back at a future date. Demoralizing indeed.

Our positive rates with the nasal swab at the testing site are between 25% to 30%. If we had tested only 200 people that day, that’s still at least 50 people we would have identified as being COVID-19 positive. Who knows how many had to take off from work to come in or might not get the chance to come in tomorrow. The volunteers are pretty disappointed.

The screening site is a well-oiled machine by the time I arrive in late March. Through intake, data collection, verification, swabbing, etc. it takes about 8 to 10 volunteers to run one “lane” of cars. Ultimately the car completes its journey at our site in the swabbing tent where the specimen is collected. The more volunteers present, the more tents and lanes can be open,  which will greatly decrease wait time for the public to get screened—therefore enticing more people to receive testing. There are times when I volunteer and only two tents are open due to staffing issues. Additionally, I’m told by the Medical Director at the site that samples are now taking closer to 10 days to process, not the 5 to 7 that we had been telling the patients. Lastly, something that I find somewhat incomprehensible is that the FEMA guidelines for eligible patients to get tested do not align with those of the Philadelphia Department of Health. This leads to some people being taken out of line by FEMA representatives even though they’re eligible for testing according to the Department of Health. It never occurred to me that things like this can affect an overall city’s number of cases. Closing or decreasing screening capacity as well as delays in reporting can make numbers artificially lower.

I’m trying to find silver linings to come from the pandemic. Some are that the people being screened are overwhelmingly appreciative of our efforts. Local restaurants provide free lunch and dinner to the volunteers so it very much feels like a community coming together. I’m fortunate to observe the way people are supporting one another during these stressful times. Philadelphians are responding positively—for now. It likely won’t stay like this for the entirety of the pandemic as economic and other life-changes will exacerbate the anxiety that many people are feeling. I take comfort in knowing that there is potential for a lot to change in our society as we emerge from the pandemic.

It won’t be a surprise that our lives will be markedly different in the coming months and most likely years. For the foreseeable future,  society will no longer run as “business as usual” following the first wave of the pandemic. The way our healthcare system functions is something I’m most looking forward to seeing evolve as people realize that our employer-based model leaves millions behind is not equipped for delivering the most care to the most people. A new awareness of what we find important in life will also develop. This may entail rethinking the significance of the local community and each person’s role. We’ll be forced into introspection – things like where we get our food how we view work, and how we spend our free time will require reflection and evaluation – whether we like it or not.

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Resident Perspective: My Biggest Fear

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Monday, April 6th

Aside from the very real concerns over lack of personal protective equipment (PPE), ICU beds, and ventilators, I believe that the biggest cause for anxiety among healthcare professionals is not having answers. Traditionally, the public has turned to physicians during public health scares as they purportedly know how to approach all ailments. This virus is demonstrating that given all of our progress in the medical field from state-of-the-art imaging modalities to treatments utilizing personal genetic properties, we still can’t answer many basic questions about this new disease.

Philadelphia has a geographic advantage over many other regions in relation to the viral spread. We have an up-close view of the damage that the virus has wrought in New York without having nearly the number of cases or hospital burden at this time. The delay it takes for the virus to move westward globally and down I-95 not only allows us to stock up on PPE, prepare the hospitals, and practice social distancing, it also gives us the opportunity to analyze the studies that have come out of places like China and Italy. Although hospital beds in Philadelphia are now filling up with COVID-19 patients, it’s the barrage of images in the media of trashbag-wearing nurses, overflooded hallways and pleas from staff urging more supplies or more assistance that make this even more terrifying. The answers to our questions will come, but during the quarantine when each day feels like a week, data collection isn’t necessarily the issue — interpreting the data is.

As the pandemic ramps up in our region, the ever-present fear of not knowing which patients entering the hospital with upper respiratory infection symptoms are positive is anxiety-producing, not only because these patients can become sick quickly, but because it’s easy to let your guard down. When you know your patient is infected you know to be extra cautious. Also, determining whom to test prior to admission, given the tests’ continued scarcity, remains an issue, even as our own institutions’ guidelines continuously evolve.

In an ideal world we’d screen everyone and it would be an accurate test. However, right now we cannot screen everyone and we know the test has a high rate of false-negatives. Let’s say we do identify a COVID-19 patient through testing but who doesn’t require hospitalization. Our guideline for duration of self-isolation is just a recommendation as we simply don’t know if they are still infectious post-isolation. We can’t even tell patients that tested positive whether or not they are susceptible to getting re-infected, and if it will return in autumn; we can only posit given what we know about other viruses in these situations. Lastly, we don’t even have a proven treatment plan, only what experts surmise is the best approach given the information we have. Hydroxychloroquine, among many other proposed treatments, is still in the nascent stages of evaluation but the public wants answers quickly. This is not typically how the peer-review process works in academia as it often takes months to years to evaluate therapies. In this case public expectations need to be grounded to a reality in which even when expedited, implementation of new practices moves at a seemingly-glacial pace.

Residents get daily updates regarding our own institutional policies as well as new relevant findings that could be practice-changing. It’s amazing seeing the sausage being made, but it’s also terrifying because the Attendings and veteran physicians that we as trainees look to for answers are now looking to each other for answers and opening the floor to all ideas.

The good news is that while we don’t have the answers yet (and we may never have all the answers), we can take comfort in knowing that we are in the golden age of data- and knowledge-sharing. Pooling the resources of physicians, epidemiologists, researchers, and statisticians internationally has allowed us to make great strides in our understanding of COVID-19 in a relatively short time, and work toward mitigating our greatest fear – the unknown.

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Resident Perspective: waiting for test results

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Sunday, March 29th

Although I’m a resident and I’m able to access my own medical chart through the electronic medical record, I’m not allowed, per hospital policy. I’m relegated to waiting for my results once “released” to me. While waiting for results in self-isolation, at a certain point you don’t really care whether it’s positive or negative, you just want to know something. Unfortunately, we still don’t know if being coronavirus positive prevents you from getting infected again so I’m not at the point where I would prefer to be positive just to get it over with.

Finally, five days after having the back of my throat swabbed I get an email saying my results are back: SARS CoV-2—undetected. Whew, negative. I was able to isolate for 5 days while my wife worked and took care of our baby simultaneously. Many other households aren’t that fortunate and either the other parent would have to take unpaid time off from their job (if they are able) or the person in quarantine would have to watch the kids and therefore expose the entire family to coronavirus. This is problematic for many obvious reasons.

Screen Shot 2020-04-06 at 7.54.26 PM

A picture of me and Jack at the tail-end of my quarantine. I still smiled under the mask for some reason.

The responsiveness from the government to obtaining and manufacturing tests was bungled from the very beginning. Quick turnaround time for testing is beneficial for giving patients a diagnosis promptly and is beneficial for epidemiologic prediction models that guide how much a region will be impacted and which locations that will be hit hardest next.

There are two main testing locations. In-patient testing for those that are hospitalized, where the test is performed in the hospital’s own microbiology labs (“in-house”) which have continuously improving turnaround times. Once the tests became available to hospital labs across the country, waiting times went from 48 hours down to about 4 or 5 hours (and in some hospitals turnaround is under an hour). The other main testing sites are commercial labs (LabCorp, Quest Diagnostic, etc.), where your test would be performed if your outpatient doc sent in a referral or if you went to a screening center. Unfortunately wait times are getting much longer as the public demand goes up for testing, and along with it, any part of the supply chain that is lacking—from swabs to reagents to protective gear for the providers—will back up everything.

The answer to better prediction models and better care isn’t just faster turnaround time for tests. The media has really honed in on getting quick results as a major issue in the epidemic because the news can show a long queue waiting to be swabbed or interview people frustrated by the lack of knowing their status. Arguably just as important is the accuracy of these tests. Swabs of the nose and throat are analyzed by something called polymerase chain reaction (PCR), which is designed to multiply the virus genetic material—RNA in the case of coronavirus—and detect the presence of the virus itself. A couple of problems arise from PCR as there have been reports of high rates of false negatives—meaning getting an inaccurate “undetected” reading when in fact, one is coronavirus positive. This is called low sensitivity in a test.

Because PCR looks for the virus itself from the swab, there have been studies in which essentially, if you go lower down the trachea (“wind pipe”) and obtain a sample closer to the lungs there are higher concentrations of virus located there so you will get a better sample and potentially provide more RNA material to amplify and detect with PCR. The issue with going down the trachea, in addition to being very unpleasant, can cause more of the virus to be coughed up during the procedure potentially infecting more people. So it seems not only possible, but likely that the swab going to the back of the throat either by way of mouth or nose just doesn’t pick up enough virus to be amenable to detection in many instances.

A blood test was recently approved by the FDA under Emergency Use Authorization which will test for antibodies (our own immune system response to the virus). These tests are already in use in China and other countries and can return results in under an hour. The benefit is that these tests aren’t dependent on obtaining an adequate swab and they could potentially tell us if someone’s been exposed in the past. It will also lead to more data regarding immunity to future infections with SARS CoV-2. The downside is that the test may not be accurate either and potentially detect non-COVID-causing coronavirus like CoV-1. There also arises questions like: is it better to know with 80% accuracy with one method vs 70% accuracy with another but it takes half the time to get the results back? There are no clear-cut answers because there are pros and cons to both.

The good news amongst all of this is that there is high “specificity” with these tests, meaning that if you get a positive result then you almost certainly have COVID, however comforting that may be. Keep in mind, for the time being these only apply to people that are having symptoms. I haven’t even touched upon the messed up screening guidelines and how they’ve morphed over the past few weeks. All of this is really to say we don’t know how many people are SARS CoV-2 positive currently for lots of reasons, and looking at the current positive cases on the news only tells part of the story.

At our institution there have been patients that we’ve been so sure are COVID positive that we’ve performed multiple PCR tests yet have all returned negative. Unfortunately, the answer to those that are so sure they are positive with coronavirus but have received negative testing is to assume the test is wrong. Given the rapidity with which this is all developing there just isn’t enough data regarding how accurate these tests are and how they should be employed.

I finally received a call from occupational health telling me the test results and to go back to work. Typically I’d be starting on outpatient weeks at this time, meaning I would be seeing patients in the office and go to morning and afternoon conferences with other residents. The pandemic has disfigured outpatient life for a resident, so now I start with telemedicine appointments and we’re given strict instructions to stay away from the hospital until it is our turn again—I’ll gladly oblige.

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Resident Perspective

I was encouraged by my wife to keep a journal for thoughts and feelings surrounding the developing coronavirus pandemic because I may be able to offer a unique perspective as a resident in medicine who is also a new parent and attempting to overcome fear of the unknown and what’s to come. I will try to update as frequently as I am able.

Monday March 23rd 2020

I found out that the Attending Physician I had been working with all last week and who was coughing during rounds was getting tested for coronavirus last night in the emergency department. I can convince myself I’m having symptoms of fatigue, sore throat and maybe a headache but I’ve also been working in the hospital for almost four weeks straight and this could just be general exhaustion mixed with a touch of seasonal allergies. I try not to think about it too much.

I haven’t been wearing any masks or other personal protective equipment around the hospital yet. At this point I feel like we are still in the nascent stages of the impending unknown so wearing a mask right now seems premature. The practice isn’t mandatory but I see more and more random staff in the hallways with facemasks on, many of whom aren’t clinicians which is a greater indication that I should probably get on board. Every now and then I’ll check a supply closet or outside a patient’s room to see what the surgical mask inventory is like. There are constant rumors floating around that, like the N95 facemasks, other equipment will be locked up and parsed out by a charge nurse on an “as needed basis”. If a run-on-the-banks situation were to occur, I want to make sure I hit the sweet spot where I don’t contribute too much to the hysteria but ensure I’ve got a mask without having to fight for scraps. I’ll continue to assess the situation.

Meanwhile, I observe more PAPRs (Powered Air-Purifying Respirator—special protective equipment) next to rooms on the wards, awaiting their donning by newly trained hands. They’ll be used for all COVID patients but since there aren’t any confirmed as of yet in our hospital, the purpose is to be used by all COVID “rule-outs” for now–those that are being tested and don’t have results back. We have a three to five day turnaround for test results right now, meaning we simply don’t know if the virus is already in our presence. The increasing numbers of PAPRs seen daily act as a surrogate for the proximity of the disease to Philadelphia and as a gauge for the level of concern amongst residents.

Over the last several days quite literally every discussion between residents in the hospital is about the coronavirus. Either discussing potential treatments; rumors as to what’s going on in China, Italy, or New York; sending memes or chatting about our trepidation and general anxiety that has gripped the entire hospital. Even when seeing my patients, every TV seems to be tuned into the news, all of which are giving up-to-the-minute global figures alternating between death tolls and economic indices. Patients ask questions for which I don’t have answers. No families or visitors are allowed in the premises. No students or “non-essential personnel” permitted to the hospital. Residents are instructed to follow social distancing protocols and there are to be no gatherings of more than five.

I went to a stroke alert today at a patient’s room for a patient that I wasn’t directly taking care of, I just happened to be nearby. The patient was in a designated “rule-out” room meaning all personnel involved need to treat the patient with extreme caution, and to limit those in contact with the patient to only those “essential.” Two nurses and a tech were in the cramped room already while the neurology resident was outside the room, not wanting to unnecessarily expose herself, miming the actions for a neurologic exam to one of the nurses. She gave instructions through the patient’s door window and into a speakerphone in a patient’s room a mere 4 or 5 feet away. The nurse and the tech cautiously proceeded to ask the patient to perform the maneuvers coached by the neurologist. It was an odd scene as clearly the patient could hear the instructions from the hallway through the door as well as the speakerphone but was polite enough to not mention that to the nurse directly in front of him. The nurse dutifully relayed the commands, “can you follow my finger with your eyes and keep your head still?” and the patient dutifully followed them. It would be funny if it weren’t so bizarre. Turns out he wasn’t having a stroke but it was good to have the opportunity to work out kinks regarding the protocol for patient emergencies. Residents are instructed to make note of instances in which normal protocols can’t be followed given the extra necessary precautions we now have to take. No doubt there will be plenty.

The hospital is both quiet but buzzing lately. Most of the services only have a few patients on each team and I walk down the wards and can find four-five-six! rooms in a row without any occupants. I’ve never seen more than two consecutive empty beds during my years here. The hospital policy is to discharge as many patients as possible with the impending influx of COVID cases to come. No elective surgeries and if you don’t absolutely need to be hospitalized you’d be safer at home. The atmosphere was akin to the episode of Game of Thrones just prior to the final battle in the last season. Nervous and anxious, we have no overflowing wine to keep us preoccupied and stumbling about. The morale is low and the silence in the hallways and in the former resident-gathering areas from our lounge to the cafeteria forces it to reverberate. Philadelphia has the temporary advantage of being able to watch from the shore as the tidal wave from China picks up steam as it makes its way across Europe, to New York City and crashing down I-95.

That night at home I continued to mentally scan my body for any possible symptoms. I hardly ever get sick so I don’t know if I’m short of breath at the top of the stairs because I’m out of shape or because I have a deadly infection. Best to push it to the back of my mind as there’s nothing I can do about it at this moment.

Bedtime routine completed. I get a text message at 10:00pm from a co-worker saying that the Attending I had been working with came back positive for coronavirus.

Image from Getty Images.

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Governor Wolf and the Courts Must Act Now to Mitigate Public Health Threat

On Monday morning, the ACLU of Pennsylvania filed an emergency request to the state Supreme Court to order county courts to release vulnerable populations from city jails. Philadelphia activists amplified the call to action through an organized social distancing caravan targeted at key decisionmakers. These actions follow the first confirmed cases of COVID-19 in Philadelphia prisons and jails, which were reported last Friday.

For weeks, the ACLU, local activists, community organizations, the Defender Association of Philadelphia, and the Philadelphia District Attorney’s office have been urging the release of vulnerable populations from conditions where social distancing is impossible. The First Judicial District (FJD) courts and Governor Wolf, however, still refuse to step up to inhibit the rapid and fatal spread of COVID-19. Two weeks into the alarm being raised on coronavirus in Philadelphia, the FJD has released minimal numbers of immunocompromised and elderly individuals, far fewer than the hundreds or thousands that have been released in other jurisdictions across the country and world. The courts have also rejected emergency release petitions based on public health concerns for those detained on probation or parole violations, barring many youth and adults who pose no threat to society from returning safely home.

Despite a foreboding history of communicable disease outbreaks inside detention centers, Governor Wolf has also declined to proactively save lives by closing inhumane facilities and exercising his gubernatorial powers of compassionate release. People awaiting immigration cases in York County Prison are on hunger strike to protest insufficient measures for their safety. The Berks County Immigration Detention Facility in Leesport, PA, one of the nation’s three immigration detention centers for families seeking asylum, lost its state license to operate in 2016 due to dangerous conditions and ongoing human rights abuses of residents, including infants. Yet Governor Wolf’s administration reiterated last week that they would not issue an emergency removal order unless there is a serious threat to public health inside the walls, an irony not lost on advocates and immigrant families currently fearing for their lives at the prospect of COVID-19 entering the unsanitary facility.

Jails and prisons as institutions pose a greater public safety risk than any individual they cage. This was true before the pandemic began and is an even more urgent truth as the virus enters jails, prisons, and detention centers. These overcrowded facilities lack access to soap, sinks, paper towels, and hand sanitizer and put both those who are incarcerated and those who enter these facilities for their work at risk, as recently seen on a large scale in New York City’s infamous Rikers Island Jail. The FJD and Governor Wolf could immediately reduce overcrowding and mitigate this risk without any threat to public safety. Governor Wolf could enact massive compassionate release with just the stroke of a pen, which would free any elderly or immunocompromised person at increased risk for contracting and dying from the disease. He could also order the release of community members detained by Immigration and Customs Enforcement (ICE) who are held for no crime other than lacking documentation while they otherwise contribute robustly to our communities. The FJD could supplement these efforts by releasing all those charged on low-level offenses from county jails and discontinuing arbitrary bail amounts. There’s no good justification for wealth-based detention in general and it is particularly indefensible during a pandemic. The courts and the governor also have the power to extend compassionate release to individuals who are up for parole review, individuals within six months of their release date, pregnant individuals, and youth in county and state detention facilities – many of whom are medically vulnerable and in conditions violating the federal ban on solitary confinement of youth because of facilities’ attempts to follow social distancing.

Community members are anxious to welcome children, parents, siblings, aunts, uncles, grandchildren, grandparents, partners, and friends home, people they have often traveled thousands of miles and spent thousands of dollars in travel expenses and private prison phone company bills to stay connected to during the months, years, or decades of their incarceration. Precautionary measures for COVID-19 now forbid most visits to jails and prisons. Most facilities have not replaced those visits with video conferencing alternatives or lowered costs per phone call minutes to talk with lawyers and families. This strains already obstacle-ridden bonds between those behind barbed wire and those in the outside world. If and when our loved ones are connected to the basic resources and support systems they need to survive, they are less likely to commit crime and more likely to contribute positively to society when they come home, as so many returning citizens do. In the midst of this deadly pandemic, allowing them to sustain those bonds through early release also grants them access to health-sustaining resources and the ability to social distance, preventative measures mandated by the governor himself to ward off and slow the spread of the novel coronavirus.

Governor Wolf and the FJD must take immediate action before they risk condoning hundreds if not thousands of preventable deaths in the state. Government inaction on continued overcrowding of carceral facilities has already resulted in chaos and deaths in places such as Italy and Colombia. Our city and state have an opportunity to instead follow the example of neighboring states, to embrace humanity and public health common sense in mitigating the disastrous effects mass incarceration will lend to COVID-19’s rapid spread.

Hannah

About the Author: Hannah Prativa Spielberg is currently pursuing a Master of Social Work at the University of Pennsylvania. She worked for four years as a social service advocate for the Defender Association of Philadelphia. Hannah is inspired by the leadership and love-based activism of community members and friends who have experienced life from the inside of prisons, jails, and detention facilities, who moved her to write this piece.

Hannah recommends following @YASP2, @aclupa, @powerinterfaith, @DecarceratePA, @Closethecreek, @Phillybailout, @phillybailfund, @mediamobilizing, @BBworkers, @BLMPhilly, @LILACPhilly, @JustLeadersUSA, @AmistadLaw, and/or @reclaimphila for updates and ways to get involved in the fight.

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The FDA Modifies Gay Blood Ban But Continues to Disregard Facts

Just before Christmas, the FDA accepted the recommendation of a Department of Health and Human Services panel and announced its plan to modify its ban on gay blood donation. Instead of barring gay (and bisexual) men from donation for life, as the policy has up to this point, the FDA plans to accept blood from gay men who have been celibate for at least one year.

While this shift would represent nominally better policy, however, it would preserve the ban’s core problem: that the FDA is targeting a high-risk group (men who have sex with men) instead of high-risk behavior (unprotected sex, especially receptive anal sex, with multiple partners – regardless of the gender of those involved). Not only is the ban unjust, but statistics from the Centers for Disease Control and Prevention (CDC) also indicate that the policy is scientifically baseless.

The FDA’s blood donation guidelines apply to questionnaires used by the Red Cross and other blood collection agencies. Prospective donors respond to survey questions that ask about their travel history, drug usage, and other risk factors associated with disease transmission. People with certain responses are asked to disqualify themselves from donation.

Because it highlights activities that increase the risk of disease, this practice should function as an important educational tool. But by suggesting that gay and bisexual men are at risk and straight people aren’t, the FDA’s guidelines misinform the public. To the extent that it contributes to ignorance of the risks associated with certain types of heterosexual sex, the FDA’s policy, even in its revised form, actually presents a public health concern.

The FDA’s insistence on outdated, unscientific guidelines for blood donor deferral also undermines its credibility more generally. Diminished credibility could have significant ramifications; for example, it may be harder to debunk the myth that vaccinations cause autism without high levels of public confidence in the FDA. Most of the FDA’s recommendations about food and drug safety are surely legitimate, but critics of these recommendations can now point to a clear instance – blood donor eligibility criteria – in which the organization has disregarded the facts.

Some people might contend that the one-year ban is an improvement, albeit a very small one, to the lifetime ban. As minimal progress can be considered better than no progress at all, this argument isn’t necessarily wrong. But organizations also sometimes adopt nominally better policy to pacify opposition and avert or postpone more sweeping changes.

Regardless of the FDA’s motives in this case, their proposal remains backwards. In addition to inappropriately stigmatizing gay men, the blood ban spreads misinformation about public health and harms the FDA’s credibility. It is therefore imperative that activists apply pressure until the FDA embraces science and adopts the focus on actual high-risk behavior that has worked in Italy for the past thirteen years.

Note: A version of this article originally appeared in The Huffington Post.

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