Ethical framework for managing the health services response to Covid-19 proposed by UK experts The authors of “Ethical anchors and explicit objectives: ensuring optimal health outcomes in the Covid 19 pandemic” attempt to fill a gap caused by what they see as a lack of “an overall ethical framework for managing the health service response to the covid-19 pandemic” being offered by either the UK government or national professional bodies. While action plans have been created, the authors fear this effort “falls short of providing a clear set of objectives for desired patient and population outcomes which can be adopted by institutions and professional and patient bodies.”
They suggest that the health system be guided by a primary ethical requirement: to achieve the best possible health outcomes while working to address issues such as the distribution of finite resources and balancing the need to protect care providers as well as provide care to patients. This results in the creation of four objectives for health services pursuing the best possible outcomes:
- for those infected with covid-19;
- for those suffering from non covid-19 related illnesses and long term conditions;
- for the workforce looking after all of these patients;
- and for future generations of patients that the health care system will need to continue to look after.
The authors also suggest adopting the ethical principle: Treat people as equals, requiring that any decision to treat people differently within the system be justified on morally and legally defensible grounds. Finally, they suggest a third guiding ethical principle: Treat people with respect, as a way to support the following fifth objective:
5. People—at both individual and population levels – should be kept as informed as possible; they should have the chance to express their views on matters that affect them (for example in decisions about admission to hospital or ICU or the risks of visiting infected relatives); and their views about their treatment and care should be appropriately respected.
How has Japan succeeded without lockdowns or mass testing? According to Bloomberg Law, Japan is on the verge of ending their emergency, and they achieved this without restricting peoples’ movements, closing restaurants or hairdressers, testing most of its population (they’ve only tested 0.2% of their residents), or high tech tracking apps. While there has been no silver bullet, experts point to the Japanese peoples’ strong health consciousness, as well as the following, as contributors to their success:
- Strong contact tracing that began with the discovery of the first infections in January and has focused on tracking and then containing clusters of infections that may have arisen in clubs and/or hospitals. Japan has invested in strong local public health infrastructures, including their local public health centers, who prior to the outbreak already employed more than 25,000 public health nurses experienced in contact tracing.
- Lessons learned from the Diamond Princess cruise ship response, which (a) helped their residents to see the seriousness and contagiousness of the virus, and (b) led the Japanese public to look to medical and scientific leaders, rather than politicians, for response guidance.
- “The Three C’s” – Closed Spaces, Crowded Spaces, and Close-Contact Settings – this easy-to-understand messaging campaign helped people learn the most dangerous situations to avoid.
Mitch Daniels Opinion piece in the Washington Post: Purdue has a duty to reopen with in person classes this Fall According to the former Indiana governor, the core pieces of data driving this decision include that “[m]ore than 80 percent of the total campus population is 35 and under” and that “this bug…poses a near-zero risk to young people.” He continues, “The challenge for Purdue is to devise maximum protection for the unusually small minority who could be at genuinely serious risk in order to serve the young people who are our reason for existing at all.” The piece describes ways they will reduce campus density, including requiring “at least one-third of our staff” to work remotely, redesigning classrooms, labs and dormitory rooms to reduce occupancy, and offering courses online as well as in person. Daniels also promises systematic testing and tracing, and not allowing “concerts, convocations and social occasions” such as fraternity parties.
New Medicare rule encourages Medicare Advantage plans to increase telehealth offerings to those living in rural areas. The new rule will make Medicare Advantage plans “eligible to receive a 10-percentage point credit towards the percentage of beneficiaries residing within published time and distance standards when they contract with telehealth providers in the following provider specialty types: Dermatology, Psychiatry, Cardiology, Otolaryngology, Neurology, Ophthalmology, Allergy and
Immunology, Nephrology, Primary Care, Gynecology/ OB/GYN, Endocrinology, and Infectious Diseases.”
Courts uphold Executive Orders of California & Michigan governors. The 9th Circuit Federal Court of Appeals, in a 2-1 decision, upheld the California governor’s authority to apply its stay at home order to restrict in-person religious services along with other types of gatherings. The challenge to the order was being led by a southern California church. According to the Court, “We’re dealing here with a highly contagious and often fatal disease for which there presently is no known cure. In the words of Justice Robert Jackson, if a ‘[c]ourt does not temper its doctrinaire logic with a little practical wisdom, it will convert the constitutional Bill of Rights into a suicide pact.'” An appellate court in Michigan upheld an executive order by that state’s governor over a challenge by their state legislature, indicating that the governor had authority under a 1945 state emergency powers law.