Readers Write: Puzzles, defying COVID restrictions, human challenge trials, laughter

I noted the Saturday Variety piece on jigsaw puzzles ("Puzzling together for prizes and a cause," Dec. 12). Like many during the pandemic, I've taken up jigsaw puzzles to pass my housebound days. But I was having a hard time finding a word to express a new feeling such puzzle-making has induced. It's the slight sadness that occurs soon after the joy of triumphantly placing the last piece in the puzzle — the realization that after days of effort, the next step is to destroy one's creation and return its pieces to the box.

German seems to be a better language than English for such abstract feelings. Schadenfreude, for example, is a word also used in English to express happiness over the misfortune of others. I asked a professor friend and German speaker if a word exists to capture my new pandemic-induced feeling. Alas, no, but she created one for me: endepuzzlefreudenschade.

As we enter a long winter and tackle many more jigsaw puzzles, we now have a word to empathize with one another and express a feeling so many of us are now having. As you put that last piece in your jigsaw puzzle, I can honestly say that I feel your endepuzzlefreudenschade.

We have been living with the coronavirus way too long to believe that persuasion regarding state health guidelines is going to work, but I believe behavior in defiance of state health guidelines should be named for what it is. In "Defying the law, paying the price" (front page, Dec. 17), the owner of the Alibi Drinkery in Lakeville asserted that "she has a right to be in business and let her customers decide if they feel safe enough to come out for a bite to eat and a beverage." This, of course, completely misunderstands how the virus works. This would hold true if her patrons were themselves the persons who were incurring the risk. The people photographed looked like young adults who are correctly assessing that even if they are infected, the risk of serious illness or death for themselves is quite low. The people who are put at risk by their behavior are very likely to be someone infected by them or by someone they infected.

If, say, reliable information was obtained that a terrorist group had planted a land mine on a golf course and the owner of the course chose to stay open despite state officials ordering the course closed until the mine was found, one might logically say that those who chose to golf anyway had a right to choose to incur that risk. It would be bad ethics, but at least the risk would fall on the person choosing the behavior.

Opening or patronizing a bar during the coronavirus is something else. It is as if state authorities learned that an even more insidious terror group had planted a device on a golf course that would detonate a bomb somewhere else. The person at risk is not the person choosing the behavior. The owner of the Alibi Drinkery's statement is akin to the owner of that golf course claiming that she has a right to be in business and let her customers decide if they want to behave in a way that could cause illness or death to someone else. This, at the very least, is not an admirable point of view.

The Star Tribune could do its readers a great service by printing the names of any and all businesses that are defying the governor's reopening ban, so that we know which businesses do not deserve our future patronage.

Looking at the front-page photo showing maskless bar patrons makes me wonder if the Alibi Drinkery in Lakeville posted a sign outside warning, "No masks allowed in these premises." As a retired physician, I think the disregard for the health and safety of fellow Americans will go down in the annals of American history as a real head-scratcher. Given the constant warnings from Dr. Anthony Fauci, Gov. Tim Walz, state Health Commissioner Jan Malcolm, epidemiologist Mike Osterholm and countless others to practice safe measures during the pandemic, it is abundantly clear that a lack of a clear message from our federal government has emboldened many to see this as an infringement on their constitutional rights. We now have over 300,000 deaths to show for this while we watch many countries take the necessary steps to safeguard their citizens and open up larger parts of their economy.

I sincerely hope that the rigorous work on the part of health professionals and science will continue to keep us healthy. Would anyone facing surgery insist that it is unpatriotic for the operating room staff to wear masks and gloves and wash their hands? Our brilliant scientists have rolled out vaccinations at an unprecedented pace so all Americans can look forward to normalcy in the near future. Let's hope that we all take advantage of the vaccination for the good of ourselves, our families, our friends and the country.

A Monday letter writer raised the question of whether we could have arrived at a successful vaccine more quickly by using human challenge trials. This is a good question, but the answer is not obvious. We now have multiple vaccines with enough data for an emergency authorization, but this was not known in March. Indeed, many researchers were skeptical that it was even possible based on the fact there were no extant vaccines for any coronavirus.

Second, human challenge trials involve deliberate exposure to the pathogen. It is assumed that such trials are easy to implement, but even the preliminary step of how to systematically expose participants to the pathogen (how much, how long, by what mechanism) is non-trivial. Failure in experimental design could make the results unusable. For a novel pathogen, such as the virus that causes COVID-19, the general mechanisms of exposure were not known, i.e., whether it is transmitted by exposure to contaminated surfaces, droplets or aerosols.

The ethics of such a trial are also a serious challenge. There is no known treatment for the disease. Furthermore, there is the possibility that the vaccine doesn't work at all. Exposing a person to a pathogen that causes possibly fatal disease while having only a placebo or ineffective vaccines is a violation of the principle "first, do no harm." Finally, and crucially, the vaccine is meant to be used in and to protect the general population. The smaller size of a challenge trial is posed as feature; however, the size of the trial is in fact one of the limitations. Small trials are not designed to look at adverse side-effects. General use requires sufficient data to ensure there are no rare but serious side-effects. General use also requires sufficient data in important subgroups, particularly older people, those with serious comorbidity or disability, and those in disadvantaged communities. The main ethical issues of challenge trials are compounded in these communities, but exclusion from the trials would mean there would be no information on the risk/benefit, exposing these populations to potential further harm.

In short, challenge trials are not a quick answer to getting a safe vaccine for everybody.

The writer is an epidemiologist.

Last Saturday I was in a long line of distanced, masked individuals at a St. Paul Post Office. One woman had several large packages. It was suggested she leave them rather that lugging them all through the line, and they would be watched. Someone said, "Is there anything good in them?" which brought laughter. Another person said, "If they disappear I know who took them," to louder laughter. The response, "Yes, the person wearing the mask," resulted in the entire room laughing. I couldn't see the smiles due to the masks but bodies were shaking with laughter. It was a nice moment shared by total strangers.

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