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Comment by coding123 | Hacker News Reader

It's really weird right? On the one hand there's evidence that COVID destroys people's lung function even if you end up being asymptomatic (aka people not noticing they are sick). On the other hand the virus has killed millions so far, and it's going to infect people anyway so why not do it intentionally to better test vaccines or other fixes.

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Respectfully, saying there is "evidence that COVID can destroy asymptomatic people's lung function" makes no sense. I think this safely falls into the FUD category, and it really bothers me when I hear things like this.

I seriously doubt there is evidence of this claim. I don't think we can go around saying it can destroy people's lung function who show no symptoms. If a person's lung function is damaged to the point where we would describe it as 'destroyed', then that person is not asymptomatic. That's a clear symptom.

Maybe I misunderstand, and you are saying folks who start out with no symptoms, then develop damage latter.

Anyway, we can reasonably say that asymptomatic people might still receive minor damage to their lungs, and such damage could be observed on a CT scan or other test later. Irreversible damage? Probably not.

Our bodies are in a constant state of being damaged and repairing themselves. If we went through life with the goal of avoiding any and all damage to our bodies, that would be a terrible way to live.

It's unclear whether you can sustain permanent damage, and be asymptomatic.

We definitely go through life trying to avoid damaging our bodies.

>We definitely go through life trying to avoid damaging our bodies.

Depends on your risk tolerance.

Some people are agoraphobics, while others are BASE jumpers.

Well, actually there has been a Scripps paper out there since August. It's abstracted here, but it depends on whether you believe 'ground glass' abnormalities in lungs represent destruction. Certainly, it seems like some "asymptomatic" and many mild to moderate cases of COVID cause loss of lung function, which could be permanent (e.g. equivalent to having a history of pneumonia). That could be enough to make you no-longer able to compete at a professional level in sports.

I personally know that a major research hospital is doing (unpublished) research on medium to long term effects of mild-moderate COVID (non-hospitalized) on lung function and that the initial radiological results 3-6mo after symptoms are fairly shocking to those running the study.

So there is at least some published evidence from multiple sources and there continues to be study on this and based on the known action of the disease. Covid "long-termers" do also come from mild-moderate and perhaps even "asymptomatic" cases so I'm not sure FUD really makes sense here.

https://www.webmd.com/lung/news/20200811/asymptomatic-covid-...

https://www.uchealth.com/en/media-room/covid-19/short-and-lo...

p.s. these articles were trivial to find and are in no way exhaustive.

Fair enough. I read a couple of similar articles before this, but maybe I'm ignorant on the current science. I'll check the links out in more detail. But honestly a quick look at the WebMD link was not very convincing.

They cite two studies from China in April of last year. One study had 16 participants, the other had 4. 20 people total studies between the two. Not really enough for any of us to make any claims with confidence. WebMD article says, "Nobody knows exactly what those changes mean yet or whether they will persist and form scar tissue or simply heal and go away after the infection is gone."

I'm not saying we shouldn't be cautious. But in my opinion, if a person was truly asymptomatic then they weren't really sick. If it affected them so little that they weren't ever aware they had the virus, it seems like a stretch to believe that they would have permanent, debilitating damage. It's in the realm of possibility, but I'm not going to lose sleep over it.

It's unfortunate asymptomatic people still carry the virus & spread it around. But is that quality really unique to Covid-19? I doubt it. I suspect it's probably a quality of many diseases and sicknesses that we just didn't fully appreciate before. How many people every year carry around the common cold or the flu with no symptoms, and end up spreading it around. Probably a lot.

I'll concede that it's possible to still be harmed by Covid, even if you have very few or no symtpoms. Maybe my gripe is that I'm just exhausted from hearing talk of Covid as if it has 'magical' properties that we all need to be afraid of.

It really depends on where you define the threshold for "symptomatic". If reduced lung perforce is a symptom, then it's tautological to say "no damage in the asymptomatic". If your threshold is "feeling bad enough to call emergency services", then there is plenty of room for massive performance loss without ever coming close to that threshold.

People who don't routinely measure athletic performance wouldn't even notice losing the equivalent of an entire lung lobe as long as the loss doesn't come in a very short time.

Because it is unethical to intentionally harm someone for the benefit of medical research.

I need to read up on it, but I expect that this challenge trial has been given ethical approval because there is now some evidence from the larger (non challenge) trials that a vaccinated person being exposed has a low risk of harm (for the relevant age group).

Interestingly, they only mention vaccination in the second phase of the trial. It's not clear to me if this is misreported, or they're planning to expose unvaccinated healthy people to small amounts of the virus in phase 1.

Yes, that's right.

> The first stage of this project will explore the feasibility of exposing healthy volunteers to COVID-19. In this initial phase, called the Virus Characterisation Study, the aim will be to discover the smallest amount of virus it takes to cause a person to develop COVID-19. [...] Once the characterisation study is completed, this Human Challenge Study model can be utilised to conduct COVID-19 Human Challenge Studies from mid-2021 subject to regulatory approvals.

There are some more detailed writeups at https://www.gov.uk/government/news/worlds-first-coronavirus-... and https://hvivo.com/the-human-challenge-programme/

"Because it is unethical to intentionally harm someone for the benefit of medical research."

People incur additional risk for enjoyment, money or to contribute to a social cause in many aspects of life.

If you work as a deep-sea-diver, go skydiving, join the army or even frequently drink a lot of alcohol this can increase personal risk significantly.

Voluntary challenge trials with well informed, healthy, young participants testing novel vaccines and treatments during pandemics has a very high net utilitarian impact.

A < 1/10,000 risk for several hundred 20-30 year old participants is dwarfed by the death and suffering prevented by more quickly having efficacy information.

I'm 27, and shy away from many risks, but signed up for '1 day sooner' soon after the pandemic reached the UK, and would be proud to participate in a challenge trial if needed.

People framing it as 'unethical' should lay out exactly what their ethical framework is.

I think the problem isn't that it's unethical to intentionally put someone in harms way, but rather whether or not there can be an informed consent. When the virus first came up, it was completely unknown that the risk of long term impairment might have been, and now we know it was/is pretty severe.

This is incorrect. Informed consent requires that people be given the best available information. If that contains a lot of unknowns, and they understand that, and consent to it, that is completely valid.

>When the virus first came up, it was completely unknown that the risk of long term impairment might have been, and now we know it was/is pretty severe.

Only 10% of positive cases (not including untested infections) have any impairment after 3 weeks.

https://covid.joinzoe.com/post/covid-long-term?fbclid=IwAR1R...

> People framing it as 'unethical' should lay out exactly what their ethical framework is

I didn't because I thought it clear and obvious from context. We're talking about medical ethics, which is a well developed field of research and practice. There are established procedures in the US and UK to get ethics approval for studies and those panels are not just making it up as they go along (mostly).

I suppose when I say 'it is unethical' what I really mean is 'the medical community in the developed world has come to a strong consensus that it is unethical'. Even with informed consent.

To sum up, the notion of “medical ethics” doesn’t actually have much to do with ethics and with what is morally right, and as such should be routinely disregarded when considering how to fight the pandemic crisis.

A long time ago i was a soldier... so, in a sense i signed up to have a risk of getting shot (or blown up, stabbed... you get the point) for the benefit of my society. How is this different?

Because we're not talking about the ethics of the individuals concerned, we're talking about the ethics of the people conducting the study. People volunteering for this and the army have made the choice to put others ahead of themselves, and (as long as they are suitably informed and competent to make the judgement) have the right to make it.

The ethics from the other side are broader and subtler - they are not of the individual they are of the masses. Whether the Army acts ethically by recruiting soldiers and sending them to kill and die is a subject of much debate. A large number of people think that it is unethical, and that is why they protest against war.

But in this case, the enemy who shall be destroyed is a virus, and compared to a human enemy is see no ethical problem as long as the "soldiers" in this "campaign" are volunteering...

Not if they're okay with it. Humans harm themselves (or risk harm) in pursuit of some perceived higher good all the time, anything from smoking a cigarette to fighting in a battle to participating in a risky medical experiment. This is just a natural and normal part of the human experience. Relax.

Individuals are allowed to risk their own lives. Organisations can and should be made to jump through many hoops before risking the loves of members of the public (however well informed). This is a good thing and why medics research ethics approval is needed before any clinical trial.

No, not necessarily. People donate kidneys all the time, which is a serious procedure with non-negligible chances of short- and long-term complications. And non-medically, people risk their lives to help others all the time. The difference between ethical medical research and the Tuskegee experiments is informed consent.

Informed consent is by far the most important thing missing in the Tuskegee study, but it is not the only thing.

To give one example of the complexity of medical ethics: occasionally when running clinical trials, the results are so GOOD that it becomes unethical to not stop the trial and give the drug to the control group.

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