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A new analysis of health insurersâ financial data suggests that they remained profitable across markets in 2020 due in part to an unprecedented decrease in health spending and utilization in antabuse pills online the spring as the alcoholism treatment antabuse led to massive shutdowns.The analysis examines insurersâ 2020 data for four distinct markets. Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer). Across the four markets, insurers showed higher gross margins per enrollee per month in 2020 than the previous year, ranging from an average of $188 for Medicare Advantage plans to an average $71 for Medicaid managed antabuse pills online care.
Similarly, insurers across the board reported paying out a smaller percentage of the premiums they collected as claims in 2020 than they did in 2019. Generally, lower medical loss ratios mean that insurers have more income remaining after paying medical costs to use for administrative costs or keep as profits.The antabuseâs effect on antabuse pills online health spending and insurer financial performance in 2021 remains uncertain. By the end of the 2020, health care utilization has largely returned to pre-antabuse levels, and there could be additional pent-up demand for care that had been missed or delayed last year.As the alcoholism antabuse took shape in the U.S.
In the early months of 2020, there was some uncertainty about how it would impact the financial performance of health insurers. Hospitals, physicians, and other health care providers cancelled elective procedures to free up beds, staff antabuse pills online and supplies early in the antabuse and to limit unnecessary exposure and risk of . Patients also opted to forgo non-urgent care to limit risks and exposure to the antabuse.
These dynamics led to an unprecedented antabuse pills online decrease in health care spending and utilization during the Spring of 2020. Though spending rebounded through the second half of the year, health spending was somewhat lower in 2020 than it had been in 2019, making last year the first time in recorded history that health spending has dropped in the U.S. Simultaneously, the economic crisis and resulting job losses drove shifts in health coverage across multiple markets, including seemingly modest decreases in employer-based coverage through September but substantial enrollment increases in Medicaid managed care and Medicaid broadly.
During this period, enrollment in Medicare Advantage plans offered by private insurers continued antabuse pills online to tick upward.In this brief, we analyze recent financial data to examine how insurance markets performed in 2020 as the antabuse emerged and progressed over the course of the year. We use financial data reported by insurance companies to the National Association of Insurance Commissioners (NAIC) and compiled by Mark Farrah Associates to look at medical loss ratios and gross margins in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully-insured group (employer) health insurance markets through the end of each year. A more antabuse pills online detailed description of each market is included in the Appendix.We find that, by the end of 2020, gross margins per member per month across these four markets remained relatively high and medical loss ratios were relatively low or flat compared to recent years.
These findings suggest that many insurers remained profitable through 2020. According to a recent KFF analysis, commercial insurers are going to owe substantial rebates to consumers this year under the Affordable Care Actâs (ACA) Medical Loss Ratio provision antabuse pills online. For Medicaid, application of risk sharing arrangements that many states have in place may ultimately reduce overall margins calculated using the annual NAIC data.Gross MarginsOne way to assess insurer financial performance is to examine gross margins per member per month, or the amount by which premium income exceeds claims costs per enrollee per month.
Gross margins are an indicator of financial performance, but positive margins do not necessarily translate into profitability since they do not account for administrative expenses or tax liabilities. However, a sharp increase in margins from one year to the next, without a commensurate increase in administrative costs, could indicate that these health insurance markets have become more profitable during the antabuse.Insurers were antabuse pills online required to cover the full cost of alcoholism testing for enrollees in 2020. (The Biden Administration has issued guidance that insurers must continue to cover alcoholism treatment testing at no cost to enrollees).
Further, many antabuse pills online insurers voluntarily waived out-of-pocket costs for alcoholism treatment and certain telehealth services through the end of 2020. Additionally, Medicare Advantage plans may have increased payments for alcoholism treatment-related hospitalizations by 20% following the increase implemented by traditional Medicare, although these additional costs were offset by a temporary waiver during the public health emergency of the 2% sequestration, which would have otherwise reduced Medicare payments to Medicare Advantage plans. Taken together, insurers have seen their antabuse pills online claims costs fall and margins increase relative to 2019 (Figure 1).
Through the end of 2020, gross margins among individual market and fully-insured group market plans were 4% and 16% higher, respectively, than they were in 2019. However, gross margins among fully-insured group market plans remained relatively flat in 2020 when compared to 2018, and gross margins among individual market plans decreased by 14% in 2020 when compared to 2018, a year in which individual market insurers over-corrected when setting premiums following the loss of cost-sharing subsidy payments. Annual gross margins antabuse pills online among Medicare Advantage plans were 24% higher in 2020 compared to 2019 and 31% higher when compared to 2018.
(Gross margins per member per month for Medicare Advantage plans tend to be higher than for other health insurance markets mainly because Medicare covers an older, sicker population with higher average costs).Annual gross margins per member per month for managed care organizations (MCOs) in the Medicaid market were 45% higher in 2020 than they were in 2019 and 34% higher than they were in 2018. However, compared to the other markets, margins in the antabuse pills online Medicaid MCO market are lower because while rates must be actuarially sound, payment rates in Medicaid tend to be lower than other markets. States also may use a variety of mechanisms to adjust plan risk, incentivize performance and ensure payments are not too high or too low, including various options to modify their capitation rates or use risk sharing mechanisms.
CMS has provided guidance about options to adjust payments for MCOs during the antabuse, since states and plans could not have reasonably predicted the changes in utilization and spending that have occurred. Many of the adjustments states can make may occur retrospectively and may not be reflected in the annual data.Medical Loss RatiosAnother way to assess insurer financial performance is to look at medical loss ratios, or the antabuse pills online percent of premium income that insurers pay out in the form of medical claims. Generally, lower medical loss ratios mean that insurers have more income remaining after paying medical costs to use for administrative costs or keep as profits.
Each health insurance market has different administrative needs and costs, so lower medical loss ratios in one market do not necessarily mean that market is more antabuse pills online profitable than another market. However, in a given market, if administrative costs hold mostly constant from one year to the next, a drop in medical loss ratios would imply that plans are becoming more profitable.Medical loss ratios are used in state and federal insurance regulation in a variety of ways. In the commercial insurance (individual and antabuse pills online group) markets, insurers must issue rebates to individuals and businesses if their loss ratios fail to reach minimum standards set by the ACA.
Medicare Advantage insurers are required to report loss ratios at the contract level. They are also required to issue rebates to the federal government if their MLRs fall short of required levels and are subject to additional penalties if they fail to meet loss ratio requirements for multiple consecutive years. For Medicaid MCOs, CMS requires states antabuse pills online to develop capitation rates for Medicaid to achieve an MLR of at least 85%.
There is no federal requirement for Medicaid plans to pay remittances if they fail to meet their MLR threshold, but a majority of states that contract with MCOs do require remittances in at least some cases.The medical loss ratios shown in this issue brief differ from the definition of MLR in the ACA and CMS Medicaid managed care final rule, which makes some adjustments for quality improvement and taxes, and do not account for reinsurance, risk corridors, or risk adjustment payments. Notably, the health insurer tax, which has been permanently repealed starting in antabuse pills online 2021, was in effect in 2018 and 2020, but not 2019. The chart below shows simple medical loss ratios, or the share of premium income that insurers pay out in claims, without any modifications (Figure 2).
Annual loss ratios in the Medicare Advantage market decreased two percentage points in 2020 compared to 2019 and 2018, and are now below the 85% minimum required under law, though once deductions from total revenue are factored in they may be above the required level. Annual loss ratios in the Medicaid managed care market in 2020 decreased by four percentage points from 2019 (and three percentage points from 2018), but still met the antabuse pills online 85% minimum even without accounting for potential adjustments. Fully-insured group market loss ratios decreased by two percentage points from 2019 to 2020 and are comparable to 2018 values.
Individual market loss ratios antabuse pills online also decreased two percentage points in 2020 compared to the previous year, but increased by four percentage points compared to 2018. Loss ratios in the individual market were already quite low before the antabuse and insurers in the market are expecting to issue more than $2 billion in rebates to consumers this fall based on their experience in 2018, 2019, and 2020. Insurers in the individual market have been profitable for several consecutive years as the market has stabilized antabuse pills online.
Average premiums have decreased for three years in a row while insurer participation on the ACA exchanges has increased in many areas of the country.DiscussionUsing annual financial data reported by insurance companies to the NAIC, it appears that health insurers in most markets became more profitable during the antabuse, though we canât measure profits directly without administrative cost data. Across the markets we examined, gross margins were higher and medical loss ratios were lower in 2020 than in 2019. Loss ratios in the Medicaid MCO market were lower in 2020 than 2019 and 2018 antabuse pills online.
However, gross margins in the Medicaid MCO market are low relative to the other markets, and data do not reflect implementation of existing or newly imposed risk sharing mechanisms.Medicare Advantage insurers that fall short of required loss ratio requirements for multiple years face additional penalties, including the possibility of being terminated. To avoid such a risk, some antabuse pills online Medicare Advantage insurers with loss ratios below 85% may take this opportunity to offer new or more generous extra benefits, such as gym memberships and dental or vision benefits that are popular and help to attract new enrollees. For Medicaid MCOs, given the options that states have to modify payments and risk sharing agreements during the antabuse, plans may not be left with unexpected surpluses or fail to reach their stateâs MLR threshold this year.A number of commercial insurers waived certain out-of-pocket costs for telehealth visits and alcoholism treatment-related services or even offered premium holidays at some point in 2020, which had the effect of increasing their medical loss ratios and lowering margins.
Earlier analysis published on the Peterson-Kaiser Health System Tracker found that nearly 90% of enrollees in the individual and fully-insured group markets were in a plan that waived cost-sharing for alcoholism treatment at some point during the antabuse, and about 40% of enrollees in these markets were in plans that offered some form of premium credit or reduction in 2020. ACA medical loss ratio rebates in 2021 are expected to total in the antabuse pills online billions of dollars for a third consecutive year. Individual and group market insurers expect to pay out $2.1 billion in rebates to consumers this fall based on their financial performance in 2020, 2019, and 2018.
Most of these rebates (an estimated $1.5 billion) are accounted for by individual market insurers.The antabuseâs effect on health spending and insurer financial performance in 2021 antabuse pills online remains uncertain. Health care utilization has mostly rebounded to pre-antabuse levels and there could be additional pent-up demand for care that had been missed or delayed last year. Additionally, while the cost of treatment doses has largely been borne by the federal government, the cost of administering shots will often be covered by private insurers..
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A key consideration in timing of aortic valve replacement (AVR) for patients with aortic stenosis (AS) is whether there is an increased risk of antabuse san antonio sudden cardiac death (SCD) that might be reduced by relief of outflow obstruction. Minners and colleagues1 addressed this issue in a retrospective analysis of outcomes in 1840 patients with mild to moderate AS (aortic maximum velocity 2.5â4.0 m/s) antabuse san antonio in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Overall the annualised rate of SCD was 0.39% per year with 27 events in asymptomatic patients. The most recent echocardiogram prior to SCD showed mildâmoderate AS in most (80%) of these patients with no difference in SCD event rates in those who progressed to antabuse san antonio severe AS compared to those who did not develop severe valve obstruction.
On Cox regression analysis, the only independent risk factors for SCD were age (HR 1.06, 95%âCI 1.01 to 1.11 per year, p=0.02), antabuse san antonio increased left ventricular mass index (HR 1.20, 95% CI 1.10 to 1.32 per 10âg/m2, p<0.001) and lower body mass index (HR 0.87, 95% CI 0.79 to 0.97 per kg/m2, p=0.01) but not the severity of valve obstruction (figure 1).Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6âmonths of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables. A forest plot visualisation of HRs antabuse san antonio for SCD is provided on the right. LVED, left ventricular enddiastolic diameter.
LVES, left ventricular endsystolic antabuse san antonio diameter. LVM, left antabuse san antonio ventricular mass. SCD, sudden cardiac death." data-icon-position data-hide-link-title="0">Figure 1 Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6âmonths of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of antabuse san antonio events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables.
A forest plot visualisation of HRs for SCD is provided on the right. LVED, left ventricular enddiastolic diameter antabuse san antonio. LVES, left ventricular antabuse san antonio endsystolic diameter. LVM, left ventricular mass.
SCD, sudden cardiac death.The lack of association between AS severity and the risk of SCD in the SEAS study is thought-provoking and challenges the conventional wisdom that early AVR would prevent SCD in asymptomatic patients with AS.2 In the past, syncope and SCD in patients with AS were thought to be due antabuse san antonio to mechanisms such as left ventricle (LV) baroreceptor malfunction, hypotension secondary to peripheral vasodilation in the face of fixed valve obstruction, or a shortened diastolic filling interval at high heart rates leading to a reduced stroke volume. However, it is doubtful that any of these mechanisms would account for antabuse san antonio SCD when AS is only mild to moderate in severity. ÂIt is increasingly recognised that that AS is not simply a mechanical problem of the valve leaflets not opening fully. Instead, AS antabuse san antonio compromises a complex interplay between the valve, ventricle and vasculature with abnormal function of all three components of the disease process.â As I conclude in an editorial, âIt is unlikely that early AVR will reduce the risk of sudden death when severe valve obstruction is not present.
Perhaps it is time to turn our attention to mitigating the non-valvular disease processes in adults with calcific valve disease.âIn another interesting paper in this issue of Heart, Williams and Brown3 hypothesised that the apparent benefit of fractional flow reserve (FFR) guidance of percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes (CCS) might simply be due to utilisation of fewer stents rather than to knowledge about the physiological severity of the coronary lesions. In a Monte Carlo simulation using data from the PCI strata of the Bypass Angioplasty Revascularization Investigation 2 Diabetes study, random deferral of PCI progressively reduced the risk of death and myocardial infarction at 1âyear, suggesting that FFR-guided deferral of PCI improves outcomes simply because fewer stents are placed.In an editorial, Weintraub and Boden4 put this data into the context of 30 years of clinical trials comparing PCI with optimal medical therapy from CCS and conclude âIn contrast to patients with acute coronary syndrome, there remains no convincing evidence that PCI will prevent events in antabuse san antonio patients with stable angina and chronic ischaemic heart disease. We know that, antabuse san antonio if needed, PCI will ameliorate severe angina, but we also know that this may not be a durable effect. By contrast, for the great majority of patients who are not disabled by angina, PCI can be safely deferred in both diabetic and non-diabetic patients, with revascularisation reserved only for those with unacceptable angina or who develop an acute coronary syndrome during follow-up.
The role of FFR remains uncertain at best and need not be performed routinely in all patients with CCS, though antabuse san antonio it may be useful where the visual estimation of angiographical severity is uncertain.âCardiac involvement in patients with sepsis contributes to adverse outcomes with most previous studies focusing on left ventricular dysfunction. In order to assess the impact of right ventricular involvement on outcomes in sepsis Kim and colleagues5 performed a retrospective cohort study of 778 patients with septic shock with echocardiographic imaging. Sepsis-induced cardiac dysfunction was present antabuse san antonio in 34.7% of the entire cohort, affecting the LV in 67.3% and the right ventricle (RV) in 40.7% of these patients. Any type of sepsis-induced cardiac dysfunction was associated with a significantly higher 28-day mortality antabuse san antonio (35.9 vs 26.8%.
P<0.01), longer intensive care unit length of stay and longer duration of mechanical ventilator, compared with those without cardiac dysfunction. Isolated RV dysfunction was rare (24/270, 8.9%) but was associated with a higher risk of 28-day mortality (adjusted OR 2.77, 95%âCI 1.20 to 6.40, antabuse san antonio p=0.02) (figure 2).Comparisons of survival curves between each type of dysfunction. LV, left ventricle. RV, right ventricle." data-icon-position data-hide-link-title="0">Figure 2 Comparisons of survival antabuse san antonio curves between each type of dysfunction.
LV, left antabuse san antonio ventricle. RV, right ventricle.The mechanisms of cardiac dysfunction in patients with sepsis are summarised in an editorial by Dugar and Vallabhajosyula6 (figure 3). They also point out the challenges in understanding cardiac involvement in patients with sepsis antabuse san antonio including the effect of timing of imaging on detection, difficulties in measuring RV systolic performance, and differing definitions of RV dysfunction. They conclude antabuse san antonio.
Âthere is a crucial need to understand the how to identify RV dysfunction in sepsis and the causative mechanisms associated with higher mortality in this population, which will significantly influence how we prevent and manage this disease process.âMechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular." antabuse san antonio data-icon-position data-hide-link-title="0">Figure 3 Mechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular.The Education-in-Heart article in this issue by Steiner and Kirkpatrick7 focuses on palliative care in management of pateints with cardiovascular disease. Palliative care now encompasses much more than antabuse san antonio end-of-life comfort measures.
Instead, âPalliative care is a specialised type of medical care that focuses on improving communication about goals of care, maximising quality of life and reducing symptomsâ and thus applies to many of our patients at many time points in their antabuse san antonio disease course. Each of you will want to read the entire article yourself which includes several useful tools, such as the one shown in figure 4, to improve conversations with patients about treatment options, goals of care and planning for adverse outcomes.Ask-Tell-Ask tool to guide difficult conversations." data-icon-position data-hide-link-title="0">Figure 4 Ask-Tell-Ask tool to guide difficult conversations.Be sure to try the two Image Challenge questions in this issue.8 9 Over 150 board-review format multiple choice questions based on all types of cardiac images can be found in our online archive on the Heart homepage (https://heart.bmj.com/pages/collections/image_challenges/).In symptomatic patients with severe aortic stenosis (AS), there is no question that aortic valve replacement (AVR) relieves symptoms and prolongs life. In asymptomatic patients, clinical decision making is less clear because of the need to balance the risks of intervention and a prosthetic valve against the risks antabuse san antonio of continued watchful waiting. On the other hand, symptom onset is inevitable in patients with severe ASâthe decision is not whether but rather when to replace the valve.The primary rationale for deferring AVR until a later date is the lack of evidence that AVR before symptom onset would improve longevity.
In addition, antabuse san antonio the risks, discomfort and disability associated with a surgical or transcatheter procedure are postponed until a later date. Furthermore, if a mechanical AVR is chosen, delaying intervention reduces the length of time the patient is exposed antabuse san antonio to the risks and inconvenience of warfarin anticoagulation. If a bioprosthetic AVR is chosen, implantation later in life increases the likelihood that the valve will not deteriorate to the point of reintervention during the patientâs lifetime. Unfortunately, patients antabuse san antonio with AS do not have the option of a normal aortic valve.
Instead the diseased native valve is replaced with an imperfect prosthetic valve.On the other hand, accumulating evidence from advanced imaging studies shows that aortic valve obstruction is associated with adverse changes in left ventricular (LV) structure and function, even in the absence of symptoms, which may not resolve after AVR.1 In addition, observational studies suggest that there may be an increased risk of sudden cardiac death in apparently asymptomatic patients with severe AS, although the magnitude and predictors of risk remain unclear.In order to provide clarity about the risk of sudden death in asymptomatic adults with AS, Minners and colleagues examined the data from the Simvastatin and Ezetimibe in Aortic â¦.
A key consideration in timing of aortic valve replacement (AVR) for patients with aortic stenosis (AS) is whether there is an increased risk of sudden cardiac death (SCD) that might be antabuse pills online reduced by relief of outflow obstruction. Minners and colleagues1 addressed this issue in a retrospective analysis of outcomes in 1840 patients with mild to antabuse pills online moderate AS (aortic maximum velocity 2.5â4.0 m/s) in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Overall the annualised rate of SCD was 0.39% per year with 27 events in asymptomatic patients. The most recent echocardiogram prior to SCD showed mildâmoderate AS in most (80%) antabuse pills online of these patients with no difference in SCD event rates in those who progressed to severe AS compared to those who did not develop severe valve obstruction. On Cox regression analysis, the only independent risk factors for SCD were age (HR 1.06, 95%âCI 1.01 to 1.11 antabuse pills online per year, p=0.02), increased left ventricular mass index (HR 1.20, 95% CI 1.10 to 1.32 per 10âg/m2, p<0.001) and lower body mass index (HR 0.87, 95% CI 0.79 to 0.97 per kg/m2, p=0.01) but not the severity of valve obstruction (figure 1).Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6âmonths of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study.
The number of events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables. A forest plot visualisation antabuse pills online of HRs for SCD is provided on the right. LVED, left ventricular enddiastolic diameter. LVES, left ventricular endsystolic diameter antabuse pills online. LVM, left antabuse pills online ventricular mass.
SCD, sudden cardiac death." data-icon-position data-hide-link-title="0">Figure 1 Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6âmonths of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of events for each variable is reflected by the dark, horizontal bars with separation antabuse pills online at the median for continuous variables. A forest plot visualisation of HRs for SCD is provided on the right. LVED, left ventricular enddiastolic antabuse pills online diameter. LVES, left ventricular endsystolic antabuse pills online diameter.
LVM, left ventricular mass. SCD, sudden cardiac death.The lack of association between AS severity and the risk of SCD in the SEAS study is thought-provoking and challenges the conventional wisdom that early AVR would prevent SCD in asymptomatic patients with AS.2 In the past, syncope and SCD in patients with AS were thought to be due to mechanisms such as left ventricle (LV) baroreceptor malfunction, hypotension secondary to peripheral vasodilation in the face of fixed valve obstruction, or a shortened antabuse pills online diastolic filling interval at high heart rates leading to a reduced stroke volume. However, it is doubtful that any of these mechanisms would account for antabuse pills online SCD when AS is only mild to moderate in severity. ÂIt is increasingly recognised that that AS is not simply a mechanical problem of the valve leaflets not opening fully. Instead, AS compromises a complex interplay between the valve, ventricle and vasculature with abnormal function antabuse pills online of all three components of the disease process.â As I conclude in an editorial, âIt is unlikely that early AVR will reduce the risk of sudden death when severe valve obstruction is not present.
Perhaps it is time to turn our attention to mitigating the non-valvular disease processes in adults with calcific valve disease.âIn another interesting paper in this issue of Heart, Williams and Brown3 hypothesised that the apparent benefit of fractional flow reserve (FFR) guidance of percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes (CCS) might simply be due to utilisation of fewer stents rather than to knowledge about the physiological severity of the coronary lesions. In a Monte Carlo simulation using data from the PCI strata of the Bypass Angioplasty Revascularization Investigation 2 antabuse pills online Diabetes study, random deferral of PCI progressively reduced the risk of death and myocardial infarction at 1âyear, suggesting that FFR-guided deferral of PCI improves outcomes simply because fewer stents are placed.In an editorial, Weintraub and Boden4 put this data into the context of 30 years of clinical trials comparing PCI with optimal medical therapy from CCS and conclude âIn contrast to patients with acute coronary syndrome, there remains no convincing evidence that PCI will prevent events in patients with stable angina and chronic ischaemic heart disease. We know that, if needed, PCI will antabuse pills online ameliorate severe angina, but we also know that this may not be a durable effect. By contrast, for the great majority of patients who are not disabled by angina, PCI can be safely deferred in both diabetic and non-diabetic patients, with revascularisation reserved only for those with unacceptable angina or who develop an acute coronary syndrome during follow-up. The role of FFR remains uncertain at best and need not be performed routinely in all patients with CCS, antabuse pills online though it may be useful where the visual estimation of angiographical severity is uncertain.âCardiac involvement in patients with sepsis contributes to adverse outcomes with most previous studies focusing on left ventricular dysfunction.
In order to assess the impact of right ventricular involvement on outcomes in sepsis Kim and colleagues5 performed a retrospective cohort study of 778 patients with septic shock with echocardiographic imaging. Sepsis-induced cardiac antabuse pills online dysfunction was present in 34.7% of the entire cohort, affecting the LV in 67.3% and the right ventricle (RV) in 40.7% of these patients. Any type of sepsis-induced antabuse pills online cardiac dysfunction was associated with a significantly higher 28-day mortality (35.9 vs 26.8%. P<0.01), longer intensive care unit length of stay and longer duration of mechanical ventilator, compared with those without cardiac dysfunction. Isolated RV antabuse pills online dysfunction was rare (24/270, 8.9%) but was associated with a higher risk of 28-day mortality (adjusted OR 2.77, 95%âCI 1.20 to 6.40, p=0.02) (figure 2).Comparisons of survival curves between each type of dysfunction.
LV, left ventricle. RV, right ventricle." data-icon-position data-hide-link-title="0">Figure 2 Comparisons of survival curves between each type antabuse pills online of dysfunction. LV, left ventricle antabuse pills online. RV, right ventricle.The mechanisms of cardiac dysfunction in patients with sepsis are summarised in an editorial by Dugar and Vallabhajosyula6 (figure 3). They also point out the challenges in understanding cardiac involvement in patients with sepsis including the effect of timing of imaging on detection, difficulties in measuring RV systolic antabuse pills online performance, and differing definitions of RV dysfunction.
They conclude antabuse pills online. Âthere is a crucial need to understand the how to identify RV dysfunction in sepsis and the causative mechanisms associated with higher mortality in this population, which will significantly influence how we prevent and manage this disease process.âMechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular." data-icon-position data-hide-link-title="0">Figure 3 Mechanism of RV dysfunction associated organ failure and mortality antabuse pills online in sepsis. RV, right ventricular.The Education-in-Heart article in this issue by Steiner and Kirkpatrick7 focuses on palliative care in management of pateints with cardiovascular disease. Palliative care now encompasses much more than end-of-life antabuse pills online comfort measures.
Instead, âPalliative care is a specialised type of medical care that focuses on improving communication about goals of care, maximising quality of life and reducing symptomsâ and thus applies antabuse pills online to many of our patients at many time points in their disease course. Each of you will want to read the entire article yourself which includes several useful tools, such as the one shown in figure 4, to improve conversations with patients about treatment options, goals of care and planning for adverse outcomes.Ask-Tell-Ask tool to guide difficult conversations." data-icon-position data-hide-link-title="0">Figure 4 Ask-Tell-Ask tool to guide difficult conversations.Be sure to try the two Image Challenge questions in this issue.8 9 Over 150 board-review format multiple choice questions based on all types of cardiac images can be found in our online archive on the Heart homepage (https://heart.bmj.com/pages/collections/image_challenges/).In symptomatic patients with severe aortic stenosis (AS), there is no question that aortic valve replacement (AVR) relieves symptoms and prolongs life. In asymptomatic patients, clinical decision making is less clear because of the need to balance the risks of intervention and a prosthetic valve against the risks of continued watchful waiting antabuse pills online. On the other hand, symptom onset is inevitable in patients with severe ASâthe decision is not whether but rather when to replace the valve.The primary rationale for deferring AVR until a later date is the lack of evidence that AVR before symptom onset would improve longevity. In addition, the risks, discomfort and disability associated with a surgical or transcatheter procedure are postponed antabuse pills online until a later date.
Furthermore, if a mechanical AVR is chosen, delaying intervention reduces the length of time the patient is exposed to the risks and inconvenience of antabuse pills online warfarin anticoagulation. If a bioprosthetic AVR is chosen, implantation later in life increases the likelihood that the valve will not deteriorate to the point of reintervention during the patientâs lifetime. Unfortunately, patients with AS antabuse pills online do not have the option of a normal aortic valve. Instead the diseased native valve is replaced with an imperfect prosthetic valve.On the other hand, accumulating evidence from advanced imaging studies shows that aortic valve obstruction is associated with adverse changes in left ventricular (LV) structure and function, even in the absence of symptoms, which may not resolve after AVR.1 In addition, observational studies suggest that there may be an increased risk of sudden cardiac death in apparently asymptomatic patients with severe AS, although the magnitude and predictors of risk remain unclear.In order to provide clarity about the risk of sudden death in asymptomatic adults with AS, Minners and colleagues examined the data from the Simvastatin and Ezetimibe in Aortic â¦.
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Can you drink on antabuse
Share on PinterestA can you drink on antabuse new study from the http://buyingtitles.co.uk/buying-titles/ CDC highlights how older adults in rural and poorer areas are less likely to have had the alcoholism treatment. Sanjeri/Getty ImagesCounties with high numbers of older adults living in poverty, alone, or with limited access to can you drink on antabuse a computer or internet have lower alcoholism treatment vaccination rates among people 65 years or older.This may reveal the hurdles faced by older adults in trying to get a treatment. Experts say this shows the many factors that can you drink on antabuse prevent someone from getting the treatment. U.S. Counties with lower alcoholism treatment vaccination rates among people 65 years or older also have higher numbers of older adults living in poverty or with other social vulnerabilities, according to researchers from the Centers for Disease Control and Prevention (CDC).Older adults were among those prioritized to receive the treatment early during the countryâs rollout, as they are at higher risk of severe illness or death from alcoholism treatment.But CDC researchers found that between December 2020 and April of this year, the percentage of older adults who had received at least one dose of a alcoholism treatment varied widely across the country.During this time, 79.1 percent of older Americans received at least one dose of a alcoholism treatment.
Rates were slightly higher in men (79.6 percent) than women (77.5 percent). They were also slightly higher among 65- to 74-year-olds (79.6 percent) than people 75 years or older (78.3 percent).First-dose vaccination rates ranged from 68.9 percent in Alabama and 69.2 percent in West Virginia to 92.9 percent in Vermont and 99.9 percent in New Hampshire.Researchers also found that counties with lower vaccination rates among older adults were more likely to have higher numbers of older adults living in poverty, living alone, or without access to a computer or the internet.The results were published May 14 in the CDCâs journal Morbidity and Mortality Weekly Report (MMWR).Anne Sosin, MPH, a policy fellow at Dartmouthâs Nelson A. Rockefeller Center for Public Policy and the Social Sciences, is not surprised that the study found that counties with higher levels of social vulnerability have lower rates of vaccination among older adults.âThis tracks with what weâve seen during the whole antabuse,â she said. ÂThere are distinct risk factors that have produced really significant disparities [in some areas], and many of these disparities are being replicated in the process of vaccination.âThe CDC researchers wrote that their results are consistent with earlier studies that found disparities in shingles vaccination and in alcoholism treatment vaccination across all age groups.Some states have tried to address vaccination barriers faced by older adults.But Dr. Preeti Malani, chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan, says thereâs not just one solution to this problemInstead, health officials need to look at why older adults in the community are getting missed.âThe solution to each case might be different,â said Malani.âIf itâs someone who is concerned about the safety of vaccination, then they should have a conversation with someone they trust, with their doctor or another healthcare provider, and get good information.ââIf itâs that people donât know how to schedule an appointment or just didnât get around to it, then letâs help them get scheduled.âTransportation can also be a big issue for some older adults.âFor a portion of people, itâs really hard to get them out the door, such as older adults who rely on caregivers,â said Malani.
ÂSo we need models where people are combining vaccination with home care visits.âSome states are trying these kinds of approaches.Fulton County, Georgia, is offering free Uber and Lyft rides for older adults who donât have transportation to take them to their vaccination appointment.The White House announced this week that this service will soon be available to all Americans, not just older adults. This is part of President Bidenâs effort to ensure that 70 percent of U.S. Adults have received at least one dose of a alcoholism treatment by July 4.In Texas, Gov. Greg Abbott launched an initiative to vaccinate homebound older adults in their own homes.Early on, there was a rush to vaccinate older adults to protect them from the alcoholism, which led to an all-hands-on-deck approach.Going forward, different approaches may work.âThe hope now is that as people come to their regular doctorâs office â primary care or otherwise â that the office will be set up to vaccinate people there,â Malani said. ÂThis is where the [Johnson &.
Johnson] treatment is a potential option â itâs one dose and youâre done.âWhile many of these efforts are similar across the country, states have had to tailor their approach to fit the needs of older adults in their communities.Sosin says Vermont, which has a large rural population, reached older adults spread out across the state by using a decentralized approach â as opposed to just relying on mass vaccination sites.âThe state has used a lot of community sites â schools, firehouses, pharmacies â to deliver the treatment so that rural residents are not traveling 2 or 3 hours to find a site.âVermontâs neighbor was in a similar situation.Public health officials in New Hampshire âknew that some people would have to drive 2 or more hours to get to a vaccination site,â said Sosin. ÂAt the time, it was still winter, which is a real deterrent for getting vaccinated, especially among people who might be less inclined to do so.ââSo they reorganized the public health network to push treatment far out into the rural part of the state. And I think those efforts have been really critical to penetrating deep into the rural areas.âOne of the things that is often overlooked with these public health efforts is the importance of trust in the government, which Sosin says is particularly high in Vermont.âWe see relatively high levels of social solidarity and cohesion in the state. Thereâs also a antabuse prices walmart high level of trust among older populations,â she said. ÂSo it doesnât surprise me at all that Vermont has consistently been one of the leaders in reaching its older population.âWhile Vermont is a leader in doses delivered to older adults, Sosin says the stateâs heavy focus on reaching older adults early has come at a cost.âVermont has enormous racial disparities in its vaccination rates, and I think thatâs a direct effect of opting for an age-based approach,â she said.
In March, vaccination rates were 13 percent higher for non-Hispanic whites in Vermont than for the stateâs Black, Indigenous, and People of Color (BIPOC) population, according to the stateâs department of health.This gap has narrowed since then, but remains at 6 percent, with much of this disparity due to lower vaccination rates among BIPOC Vermonters 65 years or older.âEventually, the state backed away from the age-based approach, and opened up vaccination to all BIPOC Vermonters and their household members,â Sosin said. ÂBut that happened in April, and we continue to see persistently high persistent racial disparities in rates in the state.âA new CDC study adds to the growing body of real-world evidence (outside of a clinical trial setting) showing that alcoholism treatment mRNA treatments authorized by the Food and Drug Administration (FDA) protect health care personnel (HCP) against alcoholism treatment. MRNA treatments (Pfizer-BioNTech and Moderna) reduced the risk of getting sick with alcoholism treatment by 94% among HCP who were fully vaccinated. This assessment, conducted in a different study network with a larger sample size from across a broader geographic area than in the clinical trials, independently confirms U.S. treatment effectiveness findings among health care workers that were first reported March 29.âThis report provided the most compelling information to date that alcoholism treatments were performing as expected in the real world,â said CDC Director Rochelle P.
Walensky, MD, MPH. ÂThis study, added to the many studies that preceded it, was pivotal to CDC changing its recommendations for those who are fully vaccinated against alcoholism treatment.âData for this assessment come from a network covering 500,000 HCP across 33 sites in 25 U.S. States, providing additional robust evidence that mRNA treatments are effective against symptomatic illness in real-world conditions.The assessment compared vaccination status of participants who tested positive for alcoholism, the antabuse that causes alcoholism treatment (cases) with vaccination status of those who tested negative (controls). Among the 1,843 participants, there were 623 cases and 1,220 controls. treatment effectiveness estimates were calculated by comparing the odds of alcoholism treatment vaccination in cases and controls.
The large sample size in this study allowed for a precise treatment effectiveness estimate with narrower confidence intervals than earlier CDC findings published March 29.Understanding treatment effectiveness among HCP is important because they are at higher risk for exposure to alcoholism through patient interactions. Vaccination of HCP protects them and their patients against alcoholism treatment and ensures continuation of critical health care services.The assessment found that alcoholism treatment symptomatic illness was reduced by 94% among HCP who were fully vaccinated, defined in this study as seven or more days after receipt of a second treatment dose, and by 82% among those who were partially vaccinated, defined in this study as 14 days after receipt of dose one through six days after dose two. These findings support CDCâs recommendation that everyone should get both doses of an mRNA alcoholism treatment to get the most protection.This assessment is part of CDCâs comprehensive strategy of using complementary methods to understand how alcoholism treatments are working in different populations and real-world settings. On May 12, CDC expanded alcoholism treatment vaccination recommendations to include adolescents 12 years through 15 years of age under the U.S. Food and Drug Administrationâs Emergency Use Authorization.
These adolescents are now authorized to receive the Pfizer-BioNTech alcoholism treatment. CDC has several surveillance networks that will continue to assess how well FDA-authorized alcoholism treatments are working in real-world conditions in people of different age groups, including children and adolescents..
Share on PinterestA antabuse pills online new study from the CDC highlights how older adults in http://www.danielpeixe.com/whassup/ rural and poorer areas are less likely to have had the alcoholism treatment. Sanjeri/Getty ImagesCounties with high numbers of older adults living in poverty, alone, or with limited access to a computer or internet have antabuse pills online lower alcoholism treatment vaccination rates among people 65 years or older.This may reveal the hurdles faced by older adults in trying to get a treatment. Experts say antabuse pills online this shows the many factors that prevent someone from getting the treatment.
U.S. Counties with lower alcoholism treatment vaccination rates among people 65 years or older also have higher numbers of older adults living in poverty or with other social vulnerabilities, according to researchers from the Centers for Disease Control and Prevention (CDC).Older adults were among those prioritized to receive the treatment early during the countryâs rollout, as they are at higher risk of severe illness or death from alcoholism treatment.But CDC researchers found that between December 2020 and April of this year, the percentage of older adults who had received at least one dose of a alcoholism treatment varied widely across the country.During this time, 79.1 percent of older Americans received at least one dose of a alcoholism treatment. Rates were slightly higher in men (79.6 percent) than women (77.5 percent).
They were also slightly higher among 65- to 74-year-olds (79.6 percent) than people 75 years or older (78.3 percent).First-dose vaccination rates ranged from 68.9 percent in Alabama and 69.2 percent in West Virginia to 92.9 percent in Vermont and 99.9 percent in New Hampshire.Researchers also found that counties with lower vaccination rates among older adults were more likely to have higher numbers of older adults living in poverty, living alone, or without access to a computer or the internet.The results were published May 14 in the CDCâs journal Morbidity and Mortality Weekly Report (MMWR).Anne Sosin, MPH, a policy fellow at Dartmouthâs Nelson A. Rockefeller Center for Public Policy and the Social Sciences, is not surprised that the study found that counties with higher levels of social vulnerability have lower rates of vaccination among older adults.âThis tracks with what weâve seen during the whole antabuse,â she said. ÂThere are distinct risk factors that have produced really significant disparities [in some areas], and many of these disparities are being replicated in the process of vaccination.âThe CDC researchers wrote that their results are consistent with earlier studies that found disparities in shingles vaccination and in alcoholism treatment vaccination across all age groups.Some states have tried to address vaccination barriers faced by older adults.But Dr.
Preeti Malani, chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan, says thereâs not just one solution to this problemInstead, health officials need to look at why older adults in the community are getting missed.âThe solution to each case might be different,â said Malani.âIf itâs someone who is concerned about the safety of vaccination, then they should have a conversation with someone they trust, with their doctor or another healthcare provider, and get good information.ââIf itâs that people donât know how to schedule an appointment or just didnât get around to it, then letâs help them get scheduled.âTransportation can also be a big issue for some older adults.âFor a portion of people, itâs really hard to get them out the door, such as older adults who rely on caregivers,â said Malani. ÂSo we need models where people are combining vaccination with home care visits.âSome states are trying these kinds of approaches.Fulton County, Georgia, is offering free Uber and Lyft rides for older adults who donât have transportation to take them to their vaccination appointment.The White House announced this week that this service will soon be available to all Americans, not just older adults. This is part of President Bidenâs effort to ensure that 70 percent of U.S.
Adults have received at least one dose of a alcoholism treatment by July 4.In Texas, Gov. Greg Abbott launched an initiative to vaccinate homebound older adults in their own homes.Early on, there was a rush to vaccinate older adults to protect them from the alcoholism, which led to an all-hands-on-deck approach.Going forward, different approaches may work.âThe hope now is that as people come to their regular doctorâs office â primary care or otherwise â that the office will be set up to vaccinate people there,â Malani said. ÂThis is where the [Johnson &.
Johnson] treatment is a potential option â itâs one dose and youâre done.âWhile many of these efforts are similar across the country, states have had to tailor their approach to fit the needs of older adults in their communities.Sosin says Vermont, which has a large rural population, reached older adults spread out across the state by using a decentralized approach â as opposed to just relying on mass vaccination sites.âThe state has used a lot of community sites â schools, firehouses, pharmacies â to deliver the treatment so that rural residents are not traveling 2 or 3 hours to find a site.âVermontâs neighbor was in a similar situation.Public health officials in New Hampshire âknew that some people would have to drive 2 or more hours to get to a vaccination site,â said Sosin. ÂAt the time, it was still winter, which is a real deterrent for getting vaccinated, especially among people who might be less inclined to do so.ââSo they reorganized the public health network to push treatment far out into the rural part of the state. And I think those efforts have been really critical to penetrating deep into the rural areas.âOne of the things that is often overlooked with these public health efforts is the importance of trust in the government, which Sosin says is particularly high in Vermont.âWe see relatively high levels of social solidarity and cohesion in the state.
Thereâs also a high level of trust among older populations,â she said. ÂSo it doesnât surprise me at all that Vermont has consistently been one of the leaders in reaching its older population.âWhile Vermont is a leader in doses delivered to older adults, Sosin says the stateâs heavy focus on reaching older adults early has come at a cost.âVermont has enormous racial disparities in its vaccination rates, and I think thatâs a direct effect of opting for an age-based approach,â she said. In March, vaccination rates were 13 percent higher for non-Hispanic whites in Vermont than for the stateâs Black, Indigenous, and People of Color (BIPOC) population, according to the stateâs department of health.This gap has narrowed since then, but remains at 6 percent, with much of this disparity due to lower vaccination rates among BIPOC Vermonters 65 years or older.âEventually, the state backed away from the age-based approach, and opened up vaccination to all BIPOC Vermonters and their household members,â Sosin said.
ÂBut that happened in April, and we continue to see persistently high persistent racial disparities in rates in the state.âA new CDC study adds to the growing body of real-world evidence (outside of a clinical trial setting) showing that alcoholism treatment mRNA treatments authorized by the Food and Drug Administration (FDA) protect health care personnel (HCP) against alcoholism treatment. MRNA treatments (Pfizer-BioNTech and Moderna) reduced the risk of getting sick with alcoholism treatment by 94% among HCP who were fully vaccinated. This assessment, conducted in a different study network with a larger sample size from across a broader geographic area than in the clinical trials, independently confirms U.S.
treatment effectiveness findings among health care workers that were first reported March 29.âThis report provided the most compelling information to date that alcoholism treatments were performing as expected in the real world,â said CDC Director Rochelle P. Walensky, MD, MPH. ÂThis study, added to the many studies that preceded it, was pivotal to CDC changing its recommendations for those who are fully vaccinated against alcoholism treatment.âData for this assessment come from a network covering 500,000 HCP across 33 sites in 25 U.S.
States, providing additional robust evidence that mRNA treatments are effective against symptomatic illness in real-world conditions.The assessment compared vaccination status of participants who tested positive for alcoholism, the antabuse that causes alcoholism treatment (cases) with vaccination status of those who tested negative (controls). Among the 1,843 participants, there were 623 cases and 1,220 controls. treatment effectiveness estimates were calculated by comparing the odds of alcoholism treatment vaccination in cases and controls.
The large sample size in this study allowed for a precise treatment effectiveness estimate with narrower confidence intervals than earlier CDC findings published March 29.Understanding treatment effectiveness among HCP is important because they are at higher risk for exposure to alcoholism through patient interactions. Vaccination of HCP protects them and their patients against alcoholism treatment and ensures continuation of critical health care services.The assessment found that alcoholism treatment symptomatic illness was reduced by 94% among HCP who were fully vaccinated, defined in this study as seven or more days after receipt of a second treatment dose, and by 82% among those who were partially vaccinated, defined in this study as 14 days after receipt of dose one through six days after dose two. These findings support CDCâs recommendation that everyone should get both doses of an mRNA alcoholism treatment to get the most protection.This assessment is part of CDCâs comprehensive strategy of using complementary methods to understand how alcoholism treatments are working in different populations and real-world settings.
On May 12, CDC expanded alcoholism treatment vaccination recommendations to include adolescents 12 years through 15 years of age under the U.S. Food and Drug Administrationâs Emergency Use Authorization. These adolescents are now authorized to receive the Pfizer-BioNTech alcoholism treatment.
CDC has several surveillance networks that will continue to assess how well FDA-authorized alcoholism treatments are working in real-world conditions in people of different age groups, including children and adolescents..
Does antabuse work
IntroductionLa Peste does antabuse work (Camus 1947) has served as a basis for several critical works, including some in the field of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and Payne does antabuse work 2017). Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978. Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994).
Other scholars, on the other hand, have centred does antabuse work their analyses on its literary aspects (Steel 2016).The alcoholism treatment antabuse has increased general interest about historical and fictional epidemics. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020). Apart from that, commentaries about the novel, especially does antabuse work among health sciences scholars, have emerged with a renewed interest (Banerjee et al. 2020.
Bate 2020. Vandekerckhove 2020 does antabuse work. Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Pesteâs literary value, and peopleâs desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitantsâ experiences are not quite far from our own, even if geographical, chronological and, specially, does antabuse work scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if alcoholism treatment serves as a frame for fictional works in the near future.
Other narrative plays were based on historical epidemics, such as Daniel Defoeâs A Journal of the Plague Year or Giovanni Boccaccioâs Decameron (Wigand, Becker, and Steger 2020. Withington 2020). The biggest antabuse does antabuse work in the last century, the so-called âSpanish Influenzaâ, has been described as not very fruitful in this sense, even if it produced famous novels such as Katherine A Porterâs Pale Horse, Pale Rider or John OâHaraâs The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).
By contrast, we may think that alcoholism treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the does antabuse work collective memory.Drawing on the reading of La Peste, we point out in this essay different aspects of living under an epidemic that can be identified both in Camusâs work and in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authoritiesâ management of alcoholism treatment, as Camus does concerning Oranâs rulers. However, what we want to foreground is La Pesteâs intrinsic value, its suitability to be read now and after does antabuse work alcoholism treatment has passed, when Camusâs novel endures as a solid art work and alcoholism treatment remains only as a defeated plight.MethodsWe confronted our own experiences about alcoholism treatment with a conventional reading of La Peste. A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of alcoholism treatment.
In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain does antabuse work parts were done to integrate the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied. Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining does antabuse work to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the events that took place in the spring of that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe.
(Camus 2002, Part I)By referring from the beginning to âthe people of our townâ, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as alcoholism treatmentâs witnesses. Epidemics affect the community as a whole, they are present in everybodyâs mind and their joys and sorrows are not individual, but collective. For example (and we are anticipating Part II), the narrator says:But, once the gates were closed, they all noticed does antabuse work that they were in the same boat, including the narrator himself, and that they had to adjust to the fact. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of âindividualâ, which used to prevail before the epidemic, and âcollectiveâ:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all.
(Camus 2002, does antabuse work Part III)This distinction is not trivial, since the story will display a strong confrontation between those who get involved and help their neighbours and those who remain behaving selfishly. Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to peopleâs lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, does antabuse work Part III)Being collective issues does not mean that epidemics always enhance auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).
Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning alcoholism treatment, some authors have described a greater impact of the antabuse in those countries does antabuse work with higher levels of individualism (Maaravi et al. 2021. Ozkan et al. 2021).
However, this finding should be complemented with other national culturesâ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how âpower distanceâ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as âcollectivistâ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to alcoholism treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021). Thus, it is important to consider that individualism is not always opposed to âlook after each otherâ (Ozkan et al. 2021, 9).
For instance, the European region, seen as a whole as highly âindividualisticâ, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camusâs Oranians are not particularly âcollectivistâ. Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods.
By contrast, we observe in the novel some examples of more âcollectivisticâ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main charactersâ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and alcoholism treatment are similar regarding their animal origin. This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning alcoholism, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).
In Camusâs novel, the animalâs link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, â all you need to know on any subjectâ) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the antabuse, due to the continuous updates in epidemiological parameters launched by the media and the authorities. Camus was aware about the relevance of figures in epidemics, which always entail:â¦required registration and statistical tasks.
(Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:â Will there be an autumn of plague?. Professor B answers. Â Noâ â, â One hundred and twenty-four dead. The total for the ninety-fourth day of the plague.â (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic.
We synthesise them in Table 1, coupled with a alcoholism treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camusâs mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste. Each topic is accompanied by two examples from the novel and one concerning alcoholism treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that alcoholism treatmentâs coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Mediaâs âexaggeratedâ approach to health issues is not new. It was already a concern for medical journalsâ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al.
2008). It is well known that media tries to attract spectatorsâ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of âgarnishingâ the news, Aslam et al. (2020) have described that 82% of more than 100â000 pieces of information about alcoholism treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as âneutralâ (Aslam et al.
2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost. (Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead ratsâ invasion as something to be celebrated.
Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent. This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street.
(Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by âdenial and disbeliefâ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. [â¦] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine.
(Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic. While not directly exposed, we can guess in this fragment the tone of the Prefectâs message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.
(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during alcoholism treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear. As for the â specially equipped wardsâ, he knew what they were.
Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all. (Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to alcoholism treatment.Part IILeft behind the phases of âdenial and disbeliefâ and of âfear and panicâ, it appears among the Oranians the âacceptance paired with resignationâ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time.
[â¦] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In alcoholism treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion. This is why, in the actual antabuse, the idea of temporal horizons has emerged like it appeared in Camusâs epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby.
However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together. Moreover, autumn brought an increase in the number of cases (âthe second waveâ) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camusâs philosophy, an author who wrote that âhope, contrary to what it is usually thought, is the same to resignation.â (Camus 1939, 83.
Cited by Haroutunian 1964, 312 (translation is ours)), and that âthere is not love to human life but with despair about human life.â (Camus 1958, 112â5. Cited by Haroutunian 1964, 312â3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the antabuse.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either. Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then.
Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. ÂThe newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.â (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague. Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during alcoholism treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but âa logical consequenceâ:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation.
There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence. (Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of alcoholism treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I.
That the plague bacillus affecting Oran is different from previous variants:â¦the microbe differed very slightly from the bacillus of plague as traditionally defined. (Camus 2002, Part II)Related to alcoholism treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.
2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one. However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it.
In fact, Rieuxâs reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague. (Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the alcoholism treatment antabuse.
Vaccination campaigns have started all over the world, and three types of alcoholism treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021. Polack et al. 2020. Voysey et al.
2021), while a fourth treatment has just recently been approved (EMA 2021a). Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.
Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al. 2021).
They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2âweeks after the last shot (CDC. N.d.b, Voysey et al. 2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al.
2021. Zhang et al. 2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion.
All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othonâs son, Tarrou, Grandâ¦). However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in alcoholism treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plagueâs ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemicsâ narrative (table 1).
Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefectureâs goal, not Rieuxâs. He reveals in this moment an aspect in his character barely shown before.
Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. Â Yes,â Rieux said. Â The burial is the same, but we keep a card index. No one can deny that we have made progress.â (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time.
For instance, speaking precisely about the burials:The relatives were invited to sign a register âwhich just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-. (Camus 2002, Part III)In Camusâs philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything.
He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol. In the field of medical ethics, Lengers has highlighted the importance of Camusâs perspective when considering âthe immediacy of life rather than abstract valuesâ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not âabstractâ, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.
(Camus 2002, Part II)Farewells during alcoholism treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well. Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which alcoholism treatment has not evaded.
s among essential workers and epidemicsâ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. [â¦] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted. [â¦] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. [â¦] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved.
(Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges. In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In alcoholism treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant.
In theory, in the opinion of experts, this was a good sign. The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during alcoholism treatment, and we bring up now the use of a football pitch as a quarantine camp in Camusâs novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oranâs pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.
(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.â Itâs scientific,â Tarrou told the administrator.â Yes,â he replied with satisfaction, as they shook hands. Â Itâs scientific.â (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic. To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel.
Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses. Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week.
They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing alcoholism treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part. However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls âa great, unadmitted hopeâ. alcoholism treatment took us by surprise and everyone wants to âreorganiseâ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate.
The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of peopleâs hearts, there was a great, unadmitted hope. [â¦] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.
As we said, a more important role of scientific aspects is observed in alcoholism treatment if compared with La Peste (an expected fact if considered that Camusâs story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful. One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives.
In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the townâs gates in 2âweeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about. This is also the case when they are told that preventive measures would be lifted in 1âmonth. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air.
Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them⦠(Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again. At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street.
It was a cat, the first that had been seen since the spring. It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.
However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottardâs life, which has become that of a âwild animalâ:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottardâs reaction to the end of the epidemic is different from most of the Oraniansâ. In any case, the narrator insists later on the assimilation between common pleasures and normality:â Perhaps,â Cottard said, â Perhaps so.
But what do you call a return to normal life?. Â â New films in the cinema,â said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to alcoholism treatment. Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the antabuse.In La Peste, love is also seen as a simple good to be fully recovered after the plague.
While Rieux goes through the ârebornâ Oran, it is loversâ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply. (Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figuresâ roles during epidemics. Camus, during Dr Rieuxâs last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authoritiesâ attitude concerning tributes to the dead:â Tell me, doctor, is it true that theyâre going to put up a monument to the victims of the plague?.
Ââ So the papers say. A pillar or a plaque.ââ I knew it!. And thereâll be speeches.âThe old man gave a strangled laugh.â I can hear them already.  Our deadâ¦â Then theyâll go and have dinner.â (Camus 2002, Part V)The old man illustrates wisely the authoritiesâ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (âOur deadâ¦â).
We have also got used, during alcoholism treatment, to these types of messages. We have also heard about âour old peopleâ, âour youthâ, âour essential workersâ and even âour deadâ. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words. They just want them to be accurate.We have seen as well some tributes to the victims during alcoholism treatment, some of which we can doubt whether they serve to victimsâ relief or to authoritiesâ promotion.
We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his âThereâll be speechesâ and his âOur deadâ¦â, but this is not the only time in the novel in which Camus brings out the topic. For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:â¦I understood that all the misfortunes of mankind came from not stating things in clear terms.
(Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because âhe didnât talk just for the sake of it.â (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals⦠and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics. Hopefully, also examples to the contrary have been observed during alcoholism treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieuxâs last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When alcoholism treatment will have passed, it will be time for us as well to review our life during these months.
For now, we are just looking forward to achieving our particular âpart Vâ.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.
The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..
IntroductionLa Peste antabuse pills online (Camus 1947) has served as a basis for several critical works, including some in the field of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and antabuse pills online Payne 2017).
Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978. Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994). Other scholars, on the other hand, have centred their analyses antabuse pills online on its literary aspects (Steel 2016).The alcoholism treatment antabuse has increased general interest about historical and fictional epidemics.
La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020). Apart from that, commentaries about the novel, especially among health sciences scholars, have emerged with a renewed interest (Banerjee antabuse pills online et al.
2020. Bate 2020. Vandekerckhove 2020 antabuse pills online.
Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Pesteâs literary value, and peopleâs desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitantsâ experiences are not quite far from our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if alcoholism treatment serves as a frame for fictional works antabuse pills online in the near future.
Other narrative plays were based on historical epidemics, such as Daniel Defoeâs A Journal of the Plague Year or Giovanni Boccaccioâs Decameron (Wigand, Becker, and Steger 2020. Withington 2020). The biggest antabuse antabuse pills online in the last century, the so-called âSpanish Influenzaâ, has been described as not very fruitful in this sense, even if it produced famous novels such as Katherine A Porterâs Pale Horse, Pale Rider or John OâHaraâs The Doctor Son (Honigsbaum 2018.
Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018). By contrast, we may think that alcoholism treatment is having a global impact antabuse pills online hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, we point out in this essay different aspects of living under an epidemic that can be identified both in Camusâs work and in our current situation.
We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authoritiesâ management of alcoholism treatment, as Camus does concerning Oranâs rulers. However, what we want to foreground is La Pesteâs intrinsic value, its suitability to be read now antabuse pills online and after alcoholism treatment has passed, when Camusâs novel endures as a solid art work and alcoholism treatment remains only as a defeated plight.MethodsWe confronted our own experiences about alcoholism treatment with a conventional reading of La Peste.
A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of alcoholism treatment. In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain parts were done to integrate the antabuse pills online information collected.
Neither specific methods of literary analysis, nor systematic searches in the novel were applied. Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the antabuse pills online first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the events that took place in the spring of that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe.
(Camus 2002, Part I)By referring from the beginning to âthe people of our townâ, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as alcoholism treatmentâs witnesses. Epidemics affect the community as a whole, they are present in everybodyâs mind and their joys and sorrows are not individual, but collective. For example (and we are anticipating Part II), the narrator says:But, once the gates were closed, they all noticed that they were in the same boat, including the narrator himself, and that they had to antabuse pills online adjust to the fact.
(Camus 2002, Part II)Later, he will insist in this opposition between the concepts of âindividualâ, which used to prevail before the epidemic, and âcollectiveâ:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all. (Camus 2002, Part III)This distinction is not trivial, since the story will display a strong confrontation between those who get involved and help their neighbours and antabuse pills online those who remain behaving selfishly.
Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to peopleâs lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, Part III)Being collective issues does not mean that epidemics always enhance auism antabuse pills online and solidarity.
As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020). Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning alcoholism treatment, some authors have described a greater impact of the antabuse in those countries with higher levels of individualism (Maaravi et antabuse pills online al.
However, this finding should be complemented with other national culturesâ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how âpower distanceâ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as âcollectivistâ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to alcoholism treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021).
Thus, it is important to consider that individualism is not always opposed to âlook after each otherâ (Ozkan et al. 2021, 9). For instance, the European region, seen as a whole as highly âindividualisticâ, holds some of the most advanced welfare protection systems worldwide.
It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camusâs Oranians are not particularly âcollectivistâ. Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business.
(Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods. By contrast, we observe in the novel some examples of more âcollectivisticâ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main charactersâ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and alcoholism treatment are similar regarding their animal origin. This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC.
N.d.a, ECDC. N.d, Pollitzer 1954). Concerning alcoholism, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).
In Camusâs novel, the animalâs link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, â all you need to know on any subjectâ) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us.
People nowadays have become very used to the statistical aspects of the antabuse, due to the continuous updates in epidemiological parameters launched by the media and the authorities. Camus was aware about the relevance of figures in epidemics, which always entail:â¦required registration and statistical tasks. (Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:â Will there be an autumn of plague?.
Professor B answers. Â Noâ â, â One hundred and twenty-four dead. The total for the ninety-fourth day of the plague.â (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them.
These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic. We synthesise them in Table 1, coupled with a alcoholism treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camusâs mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste.
Each topic is accompanied by two examples from the novel and one concerning alcoholism treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that alcoholism treatmentâs coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Mediaâs âexaggeratedâ approach to health issues is not new. It was already a concern for medical journalsâ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al.
2008). It is well known that media tries to attract spectatorsâ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion.
Related to the intention of âgarnishingâ the news, Aslam et al. (2020) have described that 82% of more than 100â000 pieces of information about alcoholism treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as âneutralâ (Aslam et al. 2020).
Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost.
(Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead ratsâ invasion as something to be celebrated. Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin.
(Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent. This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street.
(Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by âdenial and disbeliefâ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. [â¦] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions.
Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine. (Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic.
While not directly exposed, we can guess in this fragment the tone of the Prefectâs message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic.
As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing. (Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one.
As in La Peste, during alcoholism treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear. As for the â specially equipped wardsâ, he knew what they were.
Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all.
(Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to alcoholism treatment.Part IILeft behind the phases of âdenial and disbeliefâ and of âfear and panicâ, it appears among the Oranians the âacceptance paired with resignationâ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time. [â¦] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation.
(Camus 2002, Part II)In alcoholism treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion. This is why, in the actual antabuse, the idea of temporal horizons has emerged like it appeared in Camusâs epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again.
This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby. However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together. Moreover, autumn brought an increase in the number of cases (âthe second waveâ) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons.
As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camusâs philosophy, an author who wrote that âhope, contrary to what it is usually thought, is the same to resignation.â (Camus 1939, 83.
Cited by Haroutunian 1964, 312 (translation is ours)), and that âthere is not love to human life but with despair about human life.â (Camus 1958, 112â5. Cited by Haroutunian 1964, 312â3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon.
This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the antabuse.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either. Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then. Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day.
ÂThe newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.â (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague. Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during alcoholism treatment have rejected to be named as that.
The writer thinks their actions are the natural behaviour of good people, not heroism but âa logical consequenceâ:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation. There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence.
(Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of alcoholism treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I.
That the plague bacillus affecting Oran is different from previous variants:â¦the microbe differed very slightly from the bacillus of plague as traditionally defined. (Camus 2002, Part II)Related to alcoholism treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity.
Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al. 2021).
In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one.
However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it. In fact, Rieuxâs reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus.
However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague. (Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the alcoholism treatment antabuse.
Vaccination campaigns have started all over the world, and three types of alcoholism treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021. Polack et al.
2020. Voysey et al. 2021), while a fourth treatment has just recently been approved (EMA 2021a).
Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al.
2021. Polack et al. 2020), while others use a viral vector (Bos et al.
They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2âweeks after the last shot (CDC. N.d.b, Voysey et al.
2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al. 2021.
Zhang et al. 2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease.
(Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion. All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othonâs son, Tarrou, Grandâ¦). However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced.
(Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in alcoholism treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plagueâs ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemicsâ narrative (table 1).
Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly.
But this perfect mechanism is the Prefectureâs goal, not Rieuxâs. He reveals in this moment an aspect in his character barely shown before. Irony.The whole thing was well organized and the Prefect expressed his satisfaction.
He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. Â Yes,â Rieux said. Â The burial is the same, but we keep a card index.
No one can deny that we have made progress.â (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time. For instance, speaking precisely about the burials:The relatives were invited to sign a register âwhich just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-.
(Camus 2002, Part III)In Camusâs philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything.
He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol. In the field of medical ethics, Lengers has highlighted the importance of Camusâs perspective when considering âthe immediacy of life rather than abstract valuesâ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not âabstractâ, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?.
Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it. (Camus 2002, Part II)Farewells during alcoholism treatment may have not been particularly pleasant for some families.
Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well.
Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which alcoholism treatment has not evaded. s among essential workers and epidemicsâ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague.
[â¦] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted. [â¦] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. [â¦] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved.
(Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges. In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism.
(Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In alcoholism treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant. In theory, in the opinion of experts, this was a good sign.
The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during alcoholism treatment, and we bring up now the use of a football pitch as a quarantine camp in Camusâs novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978).
In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oranâs pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed. (Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates.
The car drove on and the process was repeated at the next tent.â Itâs scientific,â Tarrou told the administrator.â Yes,â he replied with satisfaction, as they shook hands. Â Itâs scientific.â (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic. To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel.
Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses.
Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week. They showed a decline in the disease.
(Camus 2002, Part IV)Part VGiven that we continue facing alcoholism treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part. However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls âa great, unadmitted hopeâ.
alcoholism treatment took us by surprise and everyone wants to âreorganiseâ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate. The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of peopleâs hearts, there was a great, unadmitted hope.
[â¦] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.
As we said, a more important role of scientific aspects is observed in alcoholism treatment if compared with La Peste (an expected fact if considered that Camusâs story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed.
It had been ineffective yesterday, and now it was apparently successful. One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives. In a sense, its role was completed.
(Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the townâs gates in 2âweeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about. This is also the case when they are told that preventive measures would be lifted in 1âmonth.
Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air. Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them⦠(Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again.
At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street.
It was a cat, the first that had been seen since the spring. It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled.
The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce. However, when Camus speaks directly about normality, he highlights more appealing habits.
He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottardâs life, which has become that of a âwild animalâ:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottardâs reaction to the end of the epidemic is different from most of the Oraniansâ.
In any case, the narrator insists later on the assimilation between common pleasures and normality:â Perhaps,â Cottard said, â Perhaps so. But what do you call a return to normal life?. Â â New films in the cinema,â said Tarrou with a smile.
(Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to alcoholism treatment. Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the antabuse.In La Peste, love is also seen as a simple good to be fully recovered after the plague.
While Rieux goes through the ârebornâ Oran, it is loversâ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply. (Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them.
(Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figuresâ roles during epidemics. Camus, during Dr Rieuxâs last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authoritiesâ attitude concerning tributes to the dead:â Tell me, doctor, is it true that theyâre going to put up a monument to the victims of the plague?. Ââ So the papers say.
A pillar or a plaque.ââ I knew it!. And thereâll be speeches.âThe old man gave a strangled laugh.â I can hear them already.  Our deadâ¦â Then theyâll go and have dinner.â (Camus 2002, Part V)The old man illustrates wisely the authoritiesâ propensity for making speeches.
He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (âOur deadâ¦â). We have also got used, during alcoholism treatment, to these types of messages. We have also heard about âour old peopleâ, âour youthâ, âour essential workersâ and even âour deadâ.
Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words. They just want them to be accurate.We have seen as well some tributes to the victims during alcoholism treatment, some of which we can doubt whether they serve to victimsâ relief or to authoritiesâ promotion.
We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his âThereâll be speechesâ and his âOur deadâ¦â, but this is not the only time in the novel in which Camus brings out the topic.
For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:â¦I understood that all the misfortunes of mankind came from not stating things in clear terms. (Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because âhe didnât talk just for the sake of it.â (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals⦠and, if we extend the scope, to every single citizen.
Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics. Hopefully, also examples to the contrary have been observed during alcoholism treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieuxâs last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come.
When alcoholism treatment will have passed, it will be time for us as well to review our life during these months. For now, we are just looking forward to achieving our particular âpart Vâ.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions.
Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.
The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..