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Alfred Jones, a recovery support specialist at the Houston Recovery Center, prepares cots for clients. (Johnny Hanson/Genesis)

Health

Sleeping it off

Sobering centers are a new model to help cities handle public intoxication and provide addicts with treatment opportunities, yet some worry they may enable bad behavior

In 2014, Brian Sakaluk was homeless in Houston, addicted to alcohol, marijuana, and cocaine. Though Sakaluk grew up in a Roman Catholic family, he smoked cigarettes with friends as a preteen and then tried alcohol and drugs. As an adult he missed work due to hangovers and was fired from multiple jobs. He spent several nights in the county jail for public intoxication and eventually ended up sleeping under a bridge.

One day in June 2014, police took an intoxicated Sakaluk to the Houston Recovery Center’s “sobering center,” a medical facility where individuals can safely sleep off the inebriation of alcohol. After a Breathalyzer test and a few hours of sleep, Sakaluk was sober. The staff gave him a choice: leave or go into recovery.

“I was just tired of that lifestyle,” says Sakaluk. He chose recovery.

He entered and completed a Salvation Army recovery program but relapsed two years later. At Open Door Mission, a Christian rehab center in Houston, he got sober and took a job maintaining the ministry’s air conditioning and refrigerator. Now Sakaluk, three years sober, looks back at that night in the Houston sobering center as a turning point. 

Houston has one of the nation’s 40 sobering centers. Some focus on specific substances, while others accept people intoxicated from anything. The centers relieve the burden on emergency medical personnel and police officers and provide second chances for those struggling with addiction. But some people fear removing consequences could make addicts less likely to change.

Austin, Texas, opened its sobering center in 2018. Ambulances and police drop off intoxicated individuals, and paramedics examine them for medical needs. Staff members bring each client to a dorm with green cots for them to sleep on until sober. Behind a one-way mirror, a paramedic keeps an eye on clients, who typically stay four to six hours. When sober, each client must answer a questionnaire about his or her drinking habits. Staff members recommend local recovery programs and then let the person go. No bills. No arrest record. No limit to how many visits a person can make.

County Judge Nancy Hohengarten was instrumental in bringing the model to Austin. After seeing countless people charged with misdemeanors for public intoxication, she told Community Impact Newspaper she’d realized incarceration was “largely ineffective” as a method of persuasion. 

Since opening, the center has seen more than 3,500 clients. The city funds the center at about $1.8 million a year, according to the Austin American-Statesman

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A health worker injects a woman during clinical trials for a Covid-19 vaccine at Research Centers of America in Hollywood, Fla. (Eva Marie Uzcategui/Bloomberg via Getty Images)

Health

Lending an arm to end COVID-19

Trials and volunteers assist pharmaceutical companies as they race to make a safe coronavirus vaccine for the public

As a doctor of nursing practice, Tara Cavazos is very comfortable being the one giving the shots. But last month, she found herself in the role of “patient” as a participant in Pfizer’s COVID-19 vaccine trial in Dallas. 

In the trial, participants don’t know whether they’ve received the vaccine or a placebo—a hypertonic saline solution. Cavazos reported feeling “some discomfort” during her first injection, along with residual pain in her bicep. 

“It felt different than a typical flu shot or a tetanus vaccine,” she said. 

After her second injection, she developed a minor headache and felt fatigued, symptoms that went away within a day. Now she’ll undergo regular nasopharyngeal swabs and blood draws to detect the presence of the virus or antibodies. Researchers will also monitor her for any unexpected side effects.

She and other trial participants are playing a key role in ongoing testing of coronavirus vaccines. Health officials say widespread immunization against COVID-19 is essential for society to return to normal. But as pharmaceutical companies race to create effective vaccines, some people wonder whether those shots will be safe.

Despite a pledge in September by nine drug companies to prove vaccine safety and efficacy in large clinical trials, the public is hesitating. Last month, Pew Research Center found that 49 percent of Americans said they “definitely or probably would not” get a COVID-19 vaccine if it were available today. Seventy-eight percent are concerned the process “will move too fast, without fully establishing safety and effectiveness.” 

As of mid-October, Pfizer, Moderna, AstraZeneca, and Johnson & Johnson’s subsidiary Janssen have entered phase 3 testing in the United States—the final phase before FDA approval for marketing. Other vaccine manufacturers, like Novavax, are close behind.

Dr. Anthony Fauci told Congress on Sept. 23 he predicts that “by the end of the year—let’s say November or December,” federal regulators will know if the vaccines in development are “safe and effective.” 

The three trial phases in vaccine testing are designed to catch any potential problems. In phase 1, companies monitor 10-50 individuals for side effects, making necessary adjustments to dosage and formulation. Phase 2 requires hundreds of participants, and by phase 3, trial administrators track immune response and assess side effects in tens of thousands. For many approved vaccines, common side effects include soreness at the injection site, a mild headache, or a low-grade fever.

On Oct. 12, Johnson & Johnson announced it had “temporarily paused” its trial due to an “unexplained illness in a study participant.” The company noted that even serious side effects are “an expected part of any clinical study.”

Dave Thompson is a toxicologist whose company Inotiv works with pharmaceutical companies before their products are ready to be tested on humans. While acknowledging some people have suffered serious reactions to vaccines, he compared vaccine safety to that of the common medication ibuprofen, which is widely regarded as safe even though, for certain people, “life-threatening complications can come” from taking it. He said everyone should weigh their own vaccine risk, but he calls vaccines “very safe. ... There’s a risk involved, but it’s a reasonable risk.” 

Thompson is confident that COVID-19 vaccine manufacturers are not compromising on safety, even though they are speeding up testing. Removing red tape accounts for the faster pace: The government has authorized some steps that have traditionally run consecutively to run concurrently. 

Even Americans who feel assured of the new vaccines’ safety may not be able to get one: Dr. Jeff Barrows, senior vice president of bioethics and public policy for the Christian Medical & Dental Associations (CMDA), says manufacturers almost certainly won’t have enough doses for everyone—at least not at first. 

However, the National Academies of Science, Engineering, and Medicine has recommended a way to prioritize distribution in a manner Barrows calls a “equitable and ethical”: High-risk healthcare workers likely will get the first crack at a vaccine, followed by first responders, people with significant health risks, the elderly, and so on.

In Dallas, Cavazos continues to log any symptoms in a secure app weekly to help Pfizer trial coordinators monitor safety. She hopes she received the vaccine rather than a placebo. Her medical practice in Dallas has been swabbing patients for COVID-19 infection since the beginning of the pandemic, and immunization would allow her to continue serving her patients while keeping them and her family safe. 

She relishes being part of a greater good: “If I can contribute in a small way by being in a clinical trial, it’s a way to give back to medicine.”


Question of ethics

Christians have another issue to wrestle with regarding COVID-19 vaccines. All of the vaccines currently in phase 3 testing have used one of two aborted fetal cell lines at some point along the way. Those cells were gathered from abortions done in 1972 and 1985.

Moderna and Pfizer used them in the research phase, while AstraZeneca and Janssen are using them in production. If the only vaccine to make it to market comes from that group, Jeff Barrows says the CMDA will still encourage its members to get the vaccine: “The good that will be accomplished is much, much greater than any complicity with evil ... [that] occurred at a minimum of 35 to 40 years ago.”

The pro-life Charlotte Lozier Institute has published up-to-date information on COVID-19 vaccine candidates and abortion-derived cell lines. It appears a handful of pharmaceutical companies, including giants such as Sanofi Pasteur (in partnership with GlaxoSmithKline) are not using such cell lines for their COVID-19 vaccines. At the time of this writing, those manufacturers have not entered phase 3 testing.

Barrows said Sanofi’s vaccine will likely enter phase 3 trials before the end of 2020, and if safety and efficacy data hold up, it could be available to the public by summer 2021. One caveat: Sanofi hasn’t published data regarding the development of its vaccine candidate. If the Sanofi vaccine is found to have used a fetal cell line during research, Barrows said the wait for another alternative vaccine could be long—and those waiting for it would have a greater likelihood of contracting COVID-19.  

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A mobile unit for COVID-19, HIV, and tuberculosis testing in Johannesburg, South Africa. (Jerome Delay/AP)

Health

A battle against two viruses

As the coronavirus plagues South Africa, aid groups scramble to provide routine treatments to HIV patients

Portia Makamba-Otto, a South African mother of four, first found out she had contracted COVID-19 in June when her flulike symptoms intensified after a week. Her husband took her to a hospital in the capital city of Johannesburg when she became weak and struggled to breathe. 

The experience was extra harrowing for her because Makamba-Otto is also HIV positive. 

Spending two weeks at an isolation center in the city, she remained on oxygen support as her breathing problems persisted. Her experience with HIV regularly brought her in and out of hospitals, but this was the worst yet: “At one point, I thought this was the end for me.” 

Makamba-Otto made a full recovery and afterward returned to work in July as the treasurer at Sister Mura Foundation, which assists migrants living with AIDS. South Africa has the biggest HIV epidemic in the world, with 7.7 million people living with HIV. At the same time, it is the African country hardest hit by the coronavirus, with more than 680,000 cases and more than 16,000 deaths. The combined health crisis has made the situation especially difficult for HIV patients there, and AIDS organizations have had to find creative ways to reach this vulnerable population.

South Africa went into strict lockdown in late March, closing schools, shutting borders, and urging residents to stay home. The restrictions made it more difficult for people living with HIV to pick up their medicine. In South Africa’s eastern Gauteng province, the Department of Health reported a 20 percent reduction in medicine collections, totaling around 11,000 people.  

“We found that with the lockdown, [HIV patients] were scared to leave their homes,” said Dino Rech of the Aurum Institute, a nonprofit working to eradicate HIV and tuberculosis. “We’ve seen some patients drop off treatment as a result of COVID.” While South Africa began a gradual reopening in June, some restrictions on public gatherings remain.

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