Viral Heroism: What the Rhetoric of Heroes in the COVID-19 Pandemic Tells Us About Medicine and Professional Identity.

Throughout the COVID-19 pandemic the use of the term "hero" has been widespread. This is especially common in the context of healthcare workers and it is now unremarkable to see large banners on hospital exteriors that say "heroes work here". There is more to be gleaned from the rhetoric of heroism than just awareness of public appreciation, however. Calling physicians and nurses heroes for treating sick people indicates something about the concept of medicine and medical professionals. In this essay, I will examine three aspects of the social role of medicine exposed by the language of heroism. One, if a hero is someone who goes above and the call of duty, then does that mean exposing oneself to risk of infection is no longer a duty of physicians (as it used to be)? If so, does that mean the "profession" of medicine is much like any other business? Two, physicians and nurses are not the only "heroes" this go-around. Anyone deemed essential to the US "infrastructure" is designated by the US government as having "special responsibilities" to remain at their posts for the public good, which explicitly puts physicians in the same category as sewage workers and grocery store cashiers. Three, what does it mean to belong to a profession that does (or does not) have self-sacrifice and risk-taking as part of its mission-especially a profession that rarely gets called upon to practice these obligations?

Topical Adjuvant Application during Subcutaneous Vaccination Promotes Resident Memory T Cell Generation.

Skin tissue resident memory T cells (TRM) provide superior protection to a second infection. In this study, we evaluated the use of topical CpG oligodeoxynucleotide (ODN) as adjuvant to generate skin TRM in mice. Topical or s.c. CpG ODN adjuvant administration at the time of a s.c. Ag injection led to an accumulation of CD103- CD8 T cells in the epidermis. However, only mice with CpG ODN administered topically had significant numbers of CD103+ Ag-specific CD8 T cells persisting in the local epidermal skin, enhanced circulating memory cells in the blood, and showed protection from intradermal challenge with melanoma cells. Generation of Ag-specific CD8 T cells was dependent on TLR9 expression on hematopoietic cells and partially dependent on receptor expression on stromal cells. Topical challenge of immunized mice at a distal site led to significant expansion of Ag-specific T cells in the blood and accumulation in the challenged skin. We demonstrate that local and systemic T cell memory can be generated with topical CpG ODN at the time of s.c. immunization, suggesting a new method of enhancing current vaccine formulations to generate tissue TRM.