Damian Sendler: Humans have a fundamental right to health, which is rooted in our values as a fundamental necessity of life. Individuals, families, communities, and the economy all benefit from it. The world was caught off guard and unprepared when the coronavirus disease-2019 (COVID-19) pandemic broke out. Everyone’s health and economic systems were put to the test. Several ethical questions have been raised about the management of human endeavor and liberty, particularly public health control measures. Anxieties and panic drive decisions on pandemic control measures, which are complicated by the need to prioritize public good over individual rights.
Damian Jacob Sendler: In order to control the pandemic, global cooperation is being put to the test. It is the duty of national governments to safeguard the public’s health because it is in everyone’s best interest. The best available epidemiological data from pandemic disease dynamics should not be used as a basis for making decisions based on political considerations. There is a strong emphasis on honesty, trust, human dignity and the importance of adherence to values such as solidarity and reciprocity as well as accountability, transparency, and justice. Academic databases and health-related organizations’ websites were searched for relevant publications. When it comes to dealing with the COVID-19 pandemic’s ethical issues, I use the standard ethical principles of autonomy respect, beneficence, nonmaleficence, and social justice (fair distribution).
Dr. Sendler: WHO guidelines are used to control the pandemic at the country level, it has been observed. The complex bottlenecks of allocation and distribution need to be addressed as WHO distributes vaccines to less developed countries through the COVAX strategy. Vaccines must be distributed in a fair and equitable manner throughout the world, and a fair and transparent system is needed to make this possible.
First, the current SARS–COV–2 pandemic is the third known pandemic of an animal coronavirus resulting in a severe acute respiratory syndrome (SARS-COV–2 [COVID-19]).
[1] In light of the COVID-19 pandemic, world leaders, policy-makers, and public health authorities have been compelled to make ethically challenging decisions about public health containment measures. COVID-19 is a topic of ethical concern to the public health community on a global scale. Against the backdrop of the various values and norms that democratic societies present, decisions made under democratic norms must be justified and communicated in a transparent manner. Ethical accountability is crucial in this situation as well. As a result, making tough choices, including trade-offs, is unavoidable. Public health ethics has a wider dimension of not only health and disease but also of social justice and public trust. The centrality of public goods, freedom, justice, reciprocity, and solidarity are also emphasized in this statement. [2,3,4] Biologically, pandemics have a wider social, political, and cultural dimension. [5]
One can see this in action in the COVID-19 pandemic, where politics openly clash with science (epidemiology). It is unavoidable that ethical dilemmas will arise in the face of the ongoing pandemic. Science must be respected and listened to in this situation because the public health measures being implemented to counter the pandemic are in everyone’s best interest. However, the most important aspect of science is the application of value judgments. [6] Responsibility to care, health, non-discrimination, equity, severity and liberty must be taken into account when making decisions during pandemics. Public protection from harm must also be taken into account. Public trust must also be taken into account. Since more and more epidemiological facts are emerging about the COVID-19 pandemic, it is critical that public health authorities and political decision-makers communicate their responses to the pandemic in a way that is transparent, accountable, and well-justified. [7,8,9,10] There must be mechanisms in place that allow for two-way feedback on pandemic control measures, lockdowns, and their impact on citizens in order to encourage compliance. [2,11,12] This is critical because the measures have a disproportionate impact on various public sectors.
Damian Sendler
We are all interconnected in a globalized world, and the pandemic has exposed our human frailties. There is no one nation capable of mounting a sufficient response to control the pandemic. An effective and timely notification of an epidemic to the international community obligates countries to help prevent the disease from spreading. [13] Reciprocity and solidarity impose a duty on countries that are not directly affected by the pandemic to provide logistical support to countries that are.
There’s no better time than now to reflect on how ethics in health care settings has fared as the world adjusts to the “new normal” situation created by the COVID-19 pandemic. Public health ethics considers not only the health of the population, but also the impact of social, political, religious, legal, economic, and societal structures on health and other issues. Because of this, it is imperative that the global response to the pandemic be organized and coordinated.
As the world faces or is affected by serious infectious diseases, ethical and legal questions will continue to arise. A growing awareness of the ethical implications of public health issues has emerged as a result of recent pandemics of HIV/AIDS in the 1980s[14], multi-drug resistant tuberculosis in the 1990s[15], and the SARS pandemic in 2003[16,17]. When the outbreak of COVID-19 began late in 2019, like SARS, the world was taken by surprise, as there was initially no specific case definition, no diagnostic test kits, and to date, no effective treatment for the disease.
Damian Jacob Markiewicz Sendler: WHO says the disease’s epicenters are in the Americas (the United States and Brazil) and Asia Pacific (India), where there have been over one million cases and tens of thousands of deaths as of the time of this writing. First wave of pandemic “apparently” finished, with some countries entering second wave and others transiting into third wave. Despite this, epidemic curve has not been flattened. Evaluation of the global public health response to COVID-19 should focus on surveillance and isolation as well as social seclusion, travel restrictions, universal masking and traceable contact (CT). Ethical and legal principles that will guide future public health approaches or interventions, as the world faces the second wave of the pandemic, and even prepare for the future, will be based on this empirical evidence Public health measures frequently raise complex questions about the relationship between the state and its citizens and organizations affected by public policies. [8] As a result, maintaining public trust and confidence may be made easier by focusing on ethical issues during the outbreak and adopting an ethical approach.
The following are the four cardinal ethical principles that should guide everyone involved in health care: Respect for autonomy, beneficence, non-maleficence, and fairness in the distribution of resources. [19] Medical professionals’ ethical obligations must be demonstrated in their actions. Other important public health ethical principles come into play during a pandemic, such as the obligation to protect public health, the duty of care and public goods, and the rights of individuals to privacy and freedom of expression. [2]
Even though the harm principle[20] restricts individual choice during epidemics and pandemics, it is critical to protect human dignity at all costs. Fairness and justice must be upheld throughout the process. People should be treated with dignity and fairness in society at large. Risk should be minimized to the greatest extent possible when implementing pandemic control interventions.
The ability to effectively communicate risk and other critical information is critical to gaining public trust and confidence in the response to the contagion. Citizens need timely, open, and honest information in order to make well-informed decisions about their lives.[21] Ensuring timely and accurate information as well as technical explanations for decisions taken are available to support informed reporting requires active media engagement. [2] It is emphasized that authorities should neither downplay the risks that may lead to higher rates of preventable infections with consequent excess morbidity and mortality, nor overstate the risks that may lead to panic or a lack of public trust and its aftermath.
COVID-19 has been declared a public health threat, and the government has additional legal powers to control the disease once it has been declared by the government to be a serious and imminent threat.
[22] If an infected member of the community poses a threat to public health, the state has a responsibility to take public health measures such as restricting movement, quarantine, and isolation. These measures may restrict freedom in the short term, but they are necessary.
Damian Jacob Sendler
For public health interventions, epidemiologic data are critical. Data collection that does not reveal a person’s identity (anonymized data) is needed for this, but it is not considered intrusive. Individuals’ right to privacy is violated if nonanonymized data is used. Against this backdrop, it’s important to remember that collecting non-anonymized data about individuals, even without their consent, may be ethically justified if it prevents significant harm to others. Health care providers can report cases of notifiable diseases (COVID-19) to authorities as part of their “duty to care” and “common good” obligations. In this case, there is no need for permission from those who have been infected, and the data can include personal identifying information. Surveillance as a public health tool and privacy claims have been questioned as a result. [23,24] The use of pandemic surveillance data for research may pose ethical issues, such as the ownership and copyright of the information. [25,26]
Dr. Sendler: In order to effectively control any infectious contagion, contact tracing (CT) is essential. A lack of preparedness and adequate information led to the inability to trace exposed/suspected cases during this current COVID-19 pandemic. There are a number of issues that need to be addressed, including people who are unwilling to provide correct contact information upon arrival in the country, the sensitive nature of providing personal data that may infringe on an individual’s right to privacy, fear of stigma, and forced isolation or quarantine in unsanitary facilities. It’s possible that asymptomatic people will find it difficult to accept this. Digital technology has provided us with an enabling environment to develop CT apps to ease this process. COVID-19-related information may be provided by these apps; quarantined individuals may be monitored and their movements traced; users may be warned of their potential exposure to SARS-COV-2 and the virus’ transmission dynamics may also be assessed by these apps[24,27]. Ethical and moral questions have arisen as a result of the widespread use of these apps, including concerns about data security.
Digital surveillance technologies, including CT apps, have been examined as part of the COVID-19 pandemic response by advisory bodies and experts.
[28] An important consideration is how to strike a balance between the rights of individuals and the interests of the community at large. When surveillance data is made public, as with SARS, it can draw unwanted attention and even harm to people of a certain ethnicity or nationality. [29] There was a lot of negative connotation attached to the disease because it originated in China. Discrimination, stigma, and racism against Chinese citizens were also evident in the United States. Stigma, group prejudice, restriction of movement, universal masking (wearing a mask in public places), and other activities must be addressed with sound political judgment based on scientific evidence as the number of cases from the pandemic continues to rise around the world.
In public health practice, these two preventive measures have been used for a long time. In the past, a variety of interventions were used to combat various infectious diseases. Factors such as the pathogen’s mode of transmission, infectiousness and infectivity (virulence), the time it takes to incubate, and the risk groups it affects must be taken into account.
Venice, Italy, made history seven hundred years ago when it established the modern basis for dealing with pandemics by creating a massive public health response.
[30] What happened in Europe during the Black Death (Bubonic plague) and how the Republic of Venice used quarantine to contain the scourge is an excellent example of good public health practice. [30,31] The Venetian Islands of Lazzaretto Vecchio and Nuovo were turned into places of quarantine and seclusion during the Second World War, respectively. As a result, it is understandable that the two terms are frequently used as synonyms. Restrictions on a person who is known to be infected are referred to as “isolation.” Patients with COVID-19 were initially treated in specialized isolation units. People were advised to self-isolate at home and only the most serious cases were taken to the hospital for monitoring and treatment as cases grew in number. However, a healthy person or group suspected of having been exposed to an infectious disease (COVID-19)[20,32] and developing the disease is subject to quarantine (Italian word-quaranta, which means “40 days”).
Restrictions on travel are also common in the United States when it comes to quarantine. Quarantine and isolation can be done voluntarily or in accordance with the letter of the law. [32] SARS epidemic in 2000–2003 necessitated isolation, quarantine, surveillance, CT and restrictions and/or advisory warnings on travel by the World Health Organization (WHO). The quick interruption of transmission was attributed to these strict measures. Some people questioned whether or not these measures violated people’s personal liberties in the name of reducing disease risks for others. [20]
It’s upsetting that the current isolation and quarantine policies around the world have resulted in so many problems. Because of human nature and/or behavior, some situations necessitate the use of forced restrictions, even if they are preferable to voluntary restrictions. Is it possible for an individual to influence a state’s decision to declare a threat to public health during a pandemic? To what extent do those who have been infected have the right to choose where and how they are quarantined? How much help do these people get while they are in a state of isolation?
Consider the ethics of limiting social contact or freedom of interaction in this context. A legitimate and fair process is defined by the government’s health authorities in this case. Key elements of a fair process, however, include openness about the decision-making process, appeals to reasonable health care rationales, and procedures for revising decisions in light of challenges. [35]
Disclosing the reasons and rationales behind decisions is essential to a fair process. When it comes to the administration of justice, no information should be kept a secret. Decisions are more likely to be accepted and adhered to if people understand the reasoning behind them. [36] Misconceptions about those in quarantine and isolation must be dispelled through public education in order to keep them from being stigmatized and harassed.
One of the most important non-pharmaceutical public health (non-pharmaceutical) preventive measures in the fight against the spread of COVID-19 has its own set of challenges in the context of its implementation. Our social interactions have been profoundly altered as a result of lockdowns and social distancing measures. The days of handshakes and hugs with people in person are over. The long-standing social norms that were once a part of life on Earth have all but vanished as a result of the various degrees of social distance experienced around the world.
Although the World Health Organization (WHO) recommends a distance of 2 m, in practice this has been between 1 and 2 m. While it is not autocratic to demand that people maintain physical distance in order to save lives, requiring it without providing the means to do so is autocratic. One meter of physical separation reduces risk by 82% in medical and community settings, according to a lancet report. At a distance of 1 meter more, the relative protection is increased by more than twice as much. [38]
Locating available real estate is a major challenge in urban areas with high densities, especially in developing countries (or developing countries). There are many instances where individuals have chosen to exempt themselves from the measure based on their own understanding of the risk. Is it fair to open markets and shopping malls while keeping places of worship and educational institutions closed to the public? Is there a right of choice for an individual in this situation, given that the order has already been enforced and determined? Can those living in IDP camps who have been displaced by natural or man-made disasters be punished for disobeying these rules? To what extent is it just and fair to apply a common sanction to those who, for reasons of ignorance or incompetence, failed to observe the social distance? The COVID-19 pandemic has raised a number of ethical issues.
For symptomatic cases, this can be used as a stand-alone test, or as part of a CT scan for suspected cases. According to the World Health Organization’s declaration on January 30, 2020 that a global pandemic public health emergency had been declared, both developing and developed countries had reported a lack of preparedness for testing. Taking standardized tests can be agonizing for those who are subjected to the stress, anxiety, and social stigma that go along with it.
What is the reward or incentive for those who test positive for a disease that has no known cure? A positive patient who has travelled hundreds of kilometers in a country that does not even have basic information on its citizens is difficult to track down as people continue to defy travel bans. What incentive is there for volunteers (like whistle blowers) who provide information about their contact with known positive cases without fear of force or coercion? Whether or not the testing is voluntary or mandated. Is it permissible for an asymptomatic person to refuse testing? Is it fair and reasonable to conduct mass testing as a public service?? Is it possible to have an effective, well-coordinated CT program to contain the pandemic now that we’ve gone so far into community transmission, given the current testing strategy? As the restrictions on lockdown are eased, this will be an even greater challenge.
When it comes to the development of COVID-19 vaccines (COVAX), the virus and humanity are at odds. It is a moral and ethical obligation for humanity to vaccinate the world in order to ensure that everyone is protected from disease. All people around the world must unite in a global effort against the COVID-19 pandemic and treat the vaccines as global public health resources. When it comes to containing the COVID-19 virus, the world has paid little attention to the shared mission, vision and sacrifice. We will face a test of humanity if we don’t make vaccines widely available, accessible, and affordable. [39] There is a possibility that vaccinating the entire world could serve as a barometer.
COVID-19 vaccines were initially concerned, and a recent report from the United States found that only 49% of Americans planned to be vaccinated against SARS-COV-2.
[41] It was because of a lack of trust that these fears were born. [42,43] One of the biggest obstacles to successfully vaccinating the entire population against diseases like COVID-19 is vaccine hesitancy. Covid-19 vaccines, on the other hand, were developed at a rapid pace, raising guanine concerns about the vaccine’s safety. The World Health Organization has ranked it as one of the top ten global health threats. [43,44] Getting vaccinated is influenced by a variety of factors, including a person’s sense of civic duty and social solidarity.
It is clear that we live in a globally interconnected and solidaristic society as the COVID-19 pandemic continues to test our global interconnectedness and solidarity. Public health ethics, individual rights and liberty, and human rights have been questioned by the pandemic. The adoption and implementation of pandemic response policies must be based on soundness, transparency, and responsiveness to ensure respect for these ethical values and principles. [55] Adopting a cooperative, equitable, and fair global distribution strategy for COVID-19 vaccines has been shown to improve economic and health outcomes. [56]
The importance of ethical standards and accountability is magnified during times of crisis. There is a duty of care for health care providers, governments around the world, and policymakers to protect public health. As a result, the COVID-19 pandemic can be contained thanks in large part to the numerous public health precautions put in place.
It is morally correct to prioritize the well-being of the greater good. The pandemic necessitates difficult, but unavoidable, political and social choices that are both ethically significant and complex. Governments have a responsibility to ensure public trust by providing timely and accurate information and allowing for open discussion on all decisions made.
Last but not least, governments must ensure that those who are subject to restriction orders receive the basic necessities in an equitable and nondiscriminatory manner. Even though the WHO guidelines may not be a one-size-fits-all model, each country’s context should be taken into consideration.
The WHO COVAX program is a good first step toward ensuring that vaccines are available to all, particularly in less developed countries. COVID-19 pandemic can be controlled fairly through our shared human values, responsibilities, and equitable and cooperative strategies by all nations of the world to promote long-term well-being and development.