Scathing COVID-19 book from Lancet editor — rushed but useful

Stephen Buranyi
nature.com
Originally posted 18 June 20

Here is an excerpt:

Horton levels the accusation that US President Donald Trump is committing a “crime against humanity” for defunding the very World Health Organization that is trying to help the United States and others. UK Prime Minister Boris Johnson, in Horton’s view, either lied or committed misconduct in telling the public that the government was well prepared for the pandemic. In fact, the UK government abandoned the world-standard advice to test, trace and isolate in March, with no explanation, then scrambled to ramp up testing in April, but repeatedly failed to meet its own targets, lagging weeks behind the rest of the world. A BBC investigation in April showed that the UK government failed to stockpile neccessary personal protective equipment for years before the crisis, and should have been aware that the National Health Service wasn’t adequately prepared.

Politicians are easy targets, though. Horton goes further, to suggest that although scientists in general have performed admirably, many of those advising the government directly contributed to what he calls “the greatest science policy failure for a generation”.

Again using the United Kingdom as an example, he suggests that researchers were insufficiently informed or understanding of the crisis unfolding in China, and were too insular to speak to Chinese scientists directly. The model for action at times seemed to be influenza, a drastic underestimation of the true threat of the new coronavirus. Worse, as the UK government’s response went off the rails in March, ostensibly independent scientists would “speak with one voice in support of government policy”, keeping up the facade that the country was doing well. In Horton’s view, this is a corruption of science policymaking at every level. Individuals failed in their responsibility to procure the best scientific advice, he contends; and the advisory regime was too close to — and in sync with — the political actors who were making decisions. “Advisors became the public relations wing of a government that had failed its people,” he concludes.

The text is here.

My Bedside Manner Got Worse During The Pandemic. Here's How I Improved

Shahdabul Faraz
npr.org
Health Shots
Originally published 16 May 20

Here is an excerpt:

These gestures can be as simple as sitting in a veteran's room for an extra five minutes to listen to World War II stories. Or listening with a young cancer patient to a song by our shared favorite band. Or clutching a sick patient's shoulder and reassuring him that he will see his three daughters again.

These gestures acknowledge a patient's humanity. It gives them some semblance of normalcy in an otherwise difficult period in their lives. Selfishly, that human connection also helps us — the doctors, nurses and other health care providers — deal with the often frustrating nature of our stressful jobs.

Since the start of the pandemic, our bedside interactions have had to be radically different. Against our instincts, and in order to protect our patients and colleagues, we tend to spend only the necessary amount of time in our patients' rooms. And once inside, we try to keep some distance. I have stopped holding my patients' hands. I now try to minimize small talk. No more whimsical conversational detours.

Our interactions now are more direct and short. I have, more than once, felt guilty for how quickly I've left a patient's room. This guilt is worsened, knowing that patients in hospitals don't have family and friends with them now either. Doctors are supposed to be there for our patients, but it's become harder than ever in recent months.

I understand why these changes are needed. As I move through several hospital floors, I could unwittingly transmit the virus if I'm infected and don't know it. I'm relatively young and healthy, so if I get the disease, I will likely recover. But what about my patients? Some have compromised immune systems. Most are elderly and have more than one high-risk medical condition. I could never forgive myself if I gave one of my patients COVID-19.

The info is here.

A third of Americans report anxiety or depression symptoms during the pandemic

Brian Resnick
vox.com
Originally posted 29 May 20

Here is an excerpt:

The pandemic is not over. The virus still has a great potential to infect millions more. It’s unclear what’s going to happen next, especially as different communities enact different precautions and as federal officials and ordinary citizens grow fatigued with pandemic life.

The uncertainty of this era is likely contributing to the mental health strain on the nation. As the pandemic wears on into the summer, some people may grow resilient to the grim reality they face, while others may see their mental health deteriorate more.

What’s also concerning is that, even pre-pandemic, there were already huge gaps in mental health care in America. Clinicians have been in short supply, many do not take insurance, and it can be hard to tell the difference between a clinician who uses evidence-based treatments and one who does not.

If you’re reading this and need help, know there are free online mental health resources that can be a good place to start. (Clinical psychologist Kathryn Gordon lists 11 of them on her website.)

The Covid-19 pandemic has a knack for exacerbating underlying problems in the United States. The disease is hitting the poor and communities of color harder than white communities. And that’s also reflected here in the data on mental health strain.

As the pandemic continues, it will be important to recognize the growing mental health impacts for such a large portion of Americans — and to uncover who is being disproportionately impacted. Hospitalizations and infection rates are critical to note. But the mental health fallout — from not just the virus but from all of its ramifications — will be essential to keep tracking, too.

The info is here.

Global health without justice or ethics

S Venkatapuram
Journal of Public Health
https://doi.org/10.1093/pubmed/fdaa001

The great promise at the start of the twenty-first century that Anglo-American philosophers would produce transformative theories and practical guidance for realizing global health equity and justice has largely gone unfulfilled. The publication of The Law of Peoples by John Rawls in 1999 formally inaugurated the emerging academic field of global justice philosophy.1 After 2000, numerous monographs, journal articles and conferences discussed global justice. And new academic associations, journals and research centres were established.

One remarkable aspect of the new field was that the stark inequalities in health across societies were often the starting concern. Despite our diverse philosophical and ethical views, reasonable people are likely to be morally troubled about the large inequalities in life expectancies between some sub-Saharan country X and the USA or another rich country. This initially shared moral intuition or indignation, then, motivated diverse arguments about what precisely is morally bad about global health inequalities and global poverty and the possible demands of justice. Some philosophers described what ‘our’ duties are or, indeed, are not, to help ‘those people over there’. Others minimized the distinction between us and them by arguing for theories of radical global equality, the arbitrariness of political borders and duties that follow from our complicity in transnational harms experienced in other countries.

Progress in global justice philosophy seemingly promised real-world progress in global health equity and justice, because health inequality was the foremost issue in philosophical debates on global inequality, poverty and claims of the ‘global poor’. At the same time, largely driven by HIV research, bioethics went global as it was exported alongside medical research to resource poor settings. Bioethicists also began to go beyond clinical and research settings to examine public health ethics, social inequalities in health and social determinants—from local conditions all the way to global institutions and processes. Nevertheless, as of 2020, it is difficult to identify any compelling conceptions of global justice or global health justice or to identify any significant philosophical contributions to the practical improvement of global health and inequalities. What happened?

The rest of the article is linked above.

Trust in Medical Scientists Has Grown in U.S.

C. Funk, B. Kennedy, & C. Johnson
Pew Research Center
Originally published 21 May 20

Americans’ confidence in medical scientists has grown since the coronavirus outbreak first began to upend life in the United States, as have perceptions that medical doctors hold very high ethical standards. And in their own estimation, most U.S. adults think the outbreak raises the importance of scientific developments.

Scientists have played a prominent role in advising government leaders and informing the public about the course of the pandemic, with doctors such as Anthony Fauci and Deborah Birx, among others, appearing at press conferences alongside President Donald Trump and other government officials.

But there are growing partisan divisions over the risk the novel coronavirus poses to public health, as well as public confidence in the scientific and medical community and the role such experts are playing in public policy.

Still, most Americans believe social distancing measures are helping at least some to slow the spread of the coronavirus disease, known as COVID-19. People see a mix of reasons behind new cases of infection, including limited testing, people not following social distancing measures and the nature of the disease itself.

These are among the key findings from a new national survey by Pew Research Center, conducted April 29 to May 5 among 10,957 U.S. adults, and a new analysis of a national survey conducted April 20 to 26 among 10,139 U.S. adults, both using the Center’s American Trends Panel.

Public confidence in medical scientists to act in the best interests of the public has gone up from 35% with a great deal of confidence before the outbreak to 43% in the Center’s April survey. Similarly, there is a modest uptick in public confidence in scientists, from 35% in 2019 to 39% today. (A random half of survey respondents rated their confidence in one of the two groups.)

The info is here.

A pandemic plan was in place. Trump abandoned it - and science

Jason Karlawish
statnews.com
Originally posted 17 May 20

Here is an excerpt:

And then on Jan. 21, 2017, Donald Trump became president.

Beginning the morning after his inauguration, a spectacular science-related tragedy has unfolded. The Trump administration has systematically dismantled the executive branch’s science infrastructure and rejected the role of science to inform policy, essentially reversing both Republican and Democrat presidential administrations since World War II, when Vannevar Bush, an engineer, advised Presidents Franklin D. Roosevelt and Harry S. Truman.

President Trump’s pursuit of anti-science policy has been so effective that as the first cases of Covid-19 were breaking out in Wuhan, China, no meaningful science policy infrastructure was in place to advise him. As a consequence, America is suffering from a pandemic without a plan. Our responses are ineffectual and inconsistent. We are increasingly divided by misinformation and invidious messaging. And it’s not even over.

Facts will drive scientific decisions, not the other way around

On April 27, 2009, on the eve of his 100th day in office, Obama made a five-block trip from the White House to 2101 Constitution Ave. There, in the Great Hall of the National Academy of Sciences, he spoke about his administration’s commitment to science.

“Science is more essential for our prosperity, our security, our health, our environment, and our quality of life than it has ever been before,” he announced. He introduced the members of PCAST and explained how his administration would engage the scientific community directly in the work of public policy.

“I want to be sure that facts are driving scientific decisions — and not the other way around,” the president said. The audience broke into laughter.

Obama explained that his science advisers were already briefing him daily on the emerging threat of swine flu, which some were projecting could kill thousands of Americans.

The info is here.

Cultural evolution, Covid-19, and preparing for what’s next

Michael Muthukrishna

London School of Economics
and Political Science
Originally posted 22 April 2020

Here is an excerpt:

A recent analysis suggests that countries with efficient governments and tight, norm-enforcing cultures have the slowest rate of increase in Covid-19 cases adjusted for population size and the fewest deaths controlling for GDP per capita, inequality, and median age, weighting for time. Together, these explain 41% of the variance. Put another way, societies with institutions that advocate behaviours that reduce caseloads and citizens who conform to those behaviours are successful in managing this outbreak. Countries with institutions with behaviours that do not reduce caseloads and citizens who conform, and countries with institutions who advocate appropriate behaviours, but citizens who do not conform have worse outcomes. In addition to general government efficiency and a tendency to enforce norms, past research has implicated a package of behaviours classed as “collectivism” as having evolved as an adaptation to material insecurity, including pathogen prevalence, and other pressures that required avoiding individualistic behaviours that threatened the group welfare or challenges that required collective action. That is, collectivist cultures may have evolved a suite of behaviours that are well adapted to epidemics: less mouth-to-mouth romantic kissing and physical affection in general, more vigilance of others, even in-group members, social learning, conformity, obedience to authority, avoidance orientation, and so on. Indeed, a quick and dirty re-analysis of Gelfand et al’s models replacing tightness with collectivism, shows that collectivism alone predicts 36% of the variance, and together with the controls, predicts 48% of the variance (see Table 1).

The info is here.

Why some nurses have quit during the coronavirus pandemic

Safia Samee Ali
nbcnews.com
Originally posted 10 May 20

Here is an excerpt:

“It was an extremely difficult decision, but as a mother and wife, the health of my family will always come first. In the end, I could not accept that I could be responsible for causing one of my family members to become severely ill or possibly die.”

As COVID-19 has infected more than one million Americans, nurses working on the front lines of the pandemic with little protective support have made the gut-wrenching decision to step away from their jobs, saying they were ill-equipped and unable to fight the disease and feared not only for their own safety but also for that of their families.

Many of these nurses, who have faced backlash for quitting, say new CDC protocols have made them feel expendable and have not kept their safety in mind, leaving them no choice but to walk away from a job they loved.

'We're not cannon fodder, we’re human beings'

As the nation took stock of its dwindling medical supplies in the early days of the pandemic, CDC guidance regarding personal protective equipment quickly took a back seat.

N95 masks, which had previously been the acceptable standard of protective care for both patients and medical personnel, were depleting so commercial grade masks, surgical masks, and in the most extreme cases homemade masks such as scarves and bandanas were all sanctioned by the CDC -- which did not return a request for comment -- to counter the lacking resources.

The info is here.

US 'Deaths of Despair' From COVID-19 Could Top 75,000, Experts Warn

Megan Brooks
MedScape.com
Originally posted 8 May 20

An additional 75,000 Americans could die by suicide, drugs, or alcohol abuse because of the COVID-19 pandemic, projections from a new national report released today suggest.

The number of "deaths of despair" could be even higher if the country fails to take bold action to address the mental health toll of unemployment, isolation, and uncertainty, according to the report from the Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

"If nothing happens and nothing improves ― ie, the worst-case scenario ― we could be looking at an additional 150,000 people who died who didn't have to," Benjamin Miller, PsyD, WBT chief strategy officer, told Medscape Medical News.

"We can prevent these deaths. We know how and have a bevy of evidence-based solutions. We lack the resources to really stand this up in a way that can most positively impact communities," Miller added.

Slow Recovery, Quick Recovery Scenarios

For the analysis, Miller and colleagues combined information on the number of deaths from suicide, alcohol, and drugs from 2018 as a baseline (n = 181,686). They projected levels of unemployment from 2020 to 2029 and then used economic modeling to estimate the additional annual number of deaths.

Across nine different scenarios, the number of additional deaths of despair range from 27,644 (quick recovery, smallest impact of unemployment on suicide, alcohol-, and drug-related deaths) to 154,037 (slow recovery, greatest impact of unemployment on these deaths), with 75,000 being the most likely.

The info is here.

The coming battle for the COVID-19 narrative

Samule Bowles & Wendy Carlin
voxeu.org
Originally posted 10 April 20

The COVID-19 pandemic is a blow to self-interest as a value orientation and laissez-faire as a policy paradigm, both already reeling amid mounting public concerns about climate change.  Will the pandemic change our economic narrative, expressing new everyday understandings of how the economy works and how it should work? 

We think so. But it will not be simply a shift to the left on the now anachronistic one-dimensional markets-versus-government continuum shown in Figure 1. A position along the blue line represents a mix of public policies – nationalisation of the railways, for example, towards the left; deregulation of labour markets, for example, towards the right.

COVID-19, for better or worse, brings into focus a third pole in the debate: call it community or civil society. In the absence of this third pole, the conventional language of economics and public policy misses the contribution of social norms and of institutions that are neither governments nor markets – like families, relationships within firms, and community organisations.

There are precedents for the scale of changes that we anticipate. The Great Depression and WWII changed the way we talked about the economy: left to its own devices it would wreak havoc on people’s lives (massive unemployment), “heedless self-interest [is] bad economics” (FDR),1 and governments can effectively pursue the public good (defeat fascism, provide economic security). As the memories of that era faded along with the social solidarity and confidence in collective action that it had fostered, another vernacular took over: “there is no such thing as society” (Thatcher) – you get what you pay for, government is just another special interest group.

Another opportunity for a long-needed fundamental shift in the economic vernacular is now unfolding. COVID-19, along with climate change, could be the equivalent of the Great Depression and WWII in forcing a sea change in economic thinking and policy.

The info is here.

What needs to happen before your boss can make you return to work

Mark Kaufman
www.mashable.com
Originally posted 24 April 20

Here is an excerpt:

But, there is a way for tens of millions of Americans to return to workplaces while significantly limiting how many people infect one another. It will require extraordinary efforts on the part of both employers and governments. This will feel weird, at first: Imagine regularly having your temperature taken at work, routinely getting tested for an infection or immunity, mandatory handwashing breaks, and perhaps even wearing a mask.

Yet, these are exceptional times. So restarting the economy and returning to workplace normalcy will require unparalleled efforts.

"This is truly unprecedented," said Christopher Hayes, a labor historian at the Rutgers School of Management and Labor Relations.

"This is like the 1918 flu and the Great Depression at the same time," Hayes said.

Yet unlike previous recessions and depressions over the last 100 years, most recently the Great Recession of 2008-2009, American workers must now ask themselves an unsettling question: "People now have to worry, ‘Is it safe to go to this job?’" said Hayes.

Right now, many employers aren't nearly prepared to tell workers in the U.S. to return to work and office spaces. To avoid infection, "the only tools you’ve got in your toolbox are the simple but hard-to-sustain public health tools like testing, contact tracing, and social distancing," explained Michael Gusmano, a health policy expert at the Rutgers School of Public Health.

"We’re not anywhere near a situation where you could claim that you can, with any credibility, send people back en masse now," Gusmano said.

The info is here.

Donald Trump: a political determinant of covid-19

Gavin Yamey and Greg Gonsalves
BMJ 2020; 369  (Published 24 April 2020)
doi: https://doi.org/10.1136/bmj.m1643

He downplayed the risk and delayed action, costing countless avertable deaths

On 23 January 2020, the World Health Organization told all governments to get ready for the transmission of a novel coronavirus in their countries. “Be prepared,” it said, “for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread.” Some countries listened. South Korea, for example, acted swiftly to contain its covid-19 epidemic. But US President Donald Trump was unmoved by WHO’s warning, downplaying the threat and calling criticisms of his failure to act “a new hoax.”

Trump’s anaemic response led the US to become the current epicentre of the global covid-19 pandemic, with almost one third of the world’s cases and a still rising number of new daily cases.4 In our interconnected world, the uncontrolled US epidemic has become an obstacle to tackling the global pandemic. Yet the US crisis was an avertable catastrophe.

Dismissing prescient advice on pandemic preparedness from the outgoing administration of the former president, Barack Obama, the Trump administration went on to weaken the nation’s pandemic response capabilities in multiple ways. In May 2018, it eliminated the White House global health security office that Obama established after the 2014-16 Ebola epidemic to foster cross-agency pandemic preparedness. In late 2019, it ended a global early warning programme, PREDICT, that identified viruses with pandemic potential. There were also cuts to critical programmes at the Centers for Disease Control and Prevention (CDC), part and parcel of Trump’s repeated rejections of evidence based policy making for public health.

Denial
After the US confirmed its first case of covid-19 on 22 January 2020, Trump responded with false reassurances, delayed federal action, and the denigration of science. From January to mid-March, he denied that the US faced a serious epidemic risk, comparing the threat to seasonal influenza. He repeatedly reassured Americans that they had nothing to worry about, telling the public: “We think it's going to have a very good ending for us” (30 January), “We have it very much under control in this country” (23 February),
and “The virus will not have a chance against us. No nation is more prepared, or more resilient, than the United States” (11 March).

The info is here.

COVID-19 Is Making Moral Injury to Physicians Much Worse

Wendy Dean
Medscape.com
Originally published 1 April 20

Here is an excerpt:

Moral injury is also coming to the forefront as physicians consider rationing scarce resources with too little guidance. Which surgeries truly justify use of increasingly scarce PPE? A cardiac valve replacement? A lumpectomy? Repairing a torn ligament?

Each denial has profound impact on both the patients whose surgeries are delayed and the clinicians who decide their fates. Yet worse decisions may await clinicians. If, for example, New York City needs an additional 30,000 ventilators but receives only 500, physicians will be responsible for deciding which 29,500 patients will not be ventilated, virtually assuring their demise.

How will physicians make those decisions? How will they cope? The situation of finite resources will force an immediate pivot to assessing patients according to not only their individual needs but also to society's need for that patient's contribution. It will be a wrenching restructuring.

Here are the essential principles for mitigating the impact of moral injury in the context of COVID-19. (They are the same as recommendations in the time before COVID-19.)

1. Value physicians

a. Physicians are putting everything on the line. They're walking into a wildfire of a pandemic, wearing pajamas, with a peashooter in their holster. That takes a monumental amount of courage and deserves profound respect.

The info is here.

When Google and Apple get privacy right, is there still something wrong?

Tamar Sharon
Medium.com
Originally posted 15 April 20

Here is an excerpt:

As the understanding that we are in this for the long run settles in, the world is increasingly turning its attention to technological solutions to address the devastating COVID-19 virus. Contact-tracing apps in particular seem to hold much promise. Using Bluetooth technology to communicate between users’ smartphones, these apps could map contacts between infected individuals and alert people who have been in proximity to an infected person. Some countries, including China, Singapore, South Korea and Israel, have deployed these early on. Health authorities in the UK, France, Germany, the Netherlands, Iceland, the US and other countries, are currently considering implementing such apps as a means of easing lock-down measures.

There are some bottlenecks. Do they work? The effectiveness of these applications has not been evaluated — in isolation or as part of an integrated strategy. How many people would need to use them? Not everyone has a smartphone. Even in rich countries, the most vulnerable group, aged over 80, is least likely to have one. Then there’s the question about fundamental rights and liberties, first and foremost privacy and data protection. Will contact-tracing become part of a permanent surveillance structure in the prolonged “state of exception” we are sleep-walking into?

Prompted by public discussions about this last concern, a number of European governments have indicated the need to develop such apps in a way that would be privacy preserving, while independent efforts involving technologists and scientists to deliver privacy-centric solutions have been cropping up. The Pan-European Privacy-Preserving Tracing Initiative (PEPP-IT), and in particular the Decentralised Privacy-Preserving Proximity Tracing (DP-3T) protocol, which provides an outline for a decentralised system, are notable forerunners. Somewhat late in the game, the European Commission last week issued a Recommendation for a pan-European approach to the adoption of contact-tracing apps that would respect fundamental rights such as privacy and data protection.

The info is here.

A Test: Can You Make Morally Mature Choices In A Crisis?

Rob Asghar
Forbes.com
Originally posted 10 April 20

Here is an excerpt:

Crisis Ethics in a COVID-19 Context

Of course, SARS-Cov-2 and the rise of the COVID-19 threat have sharpened the issues and heightened the stakes.

At the moment, we do have a global near-consensus on many things: Stay at home. Conduct your religious gatherings online. Do what you can to protect your family's health and that of others.

But the consensus quickly breaks down. How long can we truly afford to do this, especially given evidence that the virus returns once stricter measures are relaxed? How do we judge the misery caused by the virus against other impending miseries? Will an entire generation be economically shattered?

Here, a number of values grind against one another.

For a good number of idealists, sentimentalists and technocrats, it's inconceivable that society could do anything other than to shutter for as long as necessary to prevent further coronavirus spread. Anything else reveals utter contempt for the elderly and the vulnerable. They argue that lockdowns must be draconian and extended, because those countries that initially had success containing the virus witnessed new outbreaks as soon as they loosened restrictions.

Utilitarians, pushing back, raise concerns about how lockdowns have unintended consequences that grow more dangerous over time. Idealists and technocrats tend to dismiss them as Fox News-addicted ogres who are all too eager to dig a grave for Grandma in order to protect their precious stock portfolios.

But at some point, painful realities do have to be reckoned with. As Liz Alderman wrote in the New York Times recently, European officials are walking a high wire in their efforts to provide massive relief efforts. "European leaders are wary of relaunching the economy before the epidemic is proved to be under control," Alderman wrote. "The tsunami of fiscal support by France and its neighbors — over €2 trillion in spending and loan guarantees combined — can be sustained only a few months, economists say."

The info is here.

How to be a more ethical Amazon shopper during the pandemic

Samantha Murphy Kelly
CNN.org
Updated on 13 April 20

Here is an excerpt:

For customers who may feel uneasy about these workplace issues but are desperate for household goods, there are a range of options to shop more consciously, from avoiding unnecessary purchases on the platform and tipping Amazon's grocery delivery workers handsomely to buying more from local stores online. But there are conflicting views on whether the best way to be an ethical shopper at this moment means not shopping from Amazon at all, especially given its position as one of the biggest hirers during a severe labor market crunch.

"If people choose to work at Amazon, we should respect their decisions," said Peter Singer, an ethics professor at Princeton University and author of "The Most Good You Can Do: How Effective Altruism Is Changing Ideas About Living Ethically."

The US Department of Labor announced Thursday that about 6.6 million people filed for unemployment benefits in the last week alone, bringing the number of lost jobs during the pandemic to nearly 17 million. Singer highlighted how delivery services are one of the few areas in which businesses are hiring.

But Christian Smalls, the former Amazon employee who partially organized a protest calling for senior warehouse officials to close the Staten Island, New York, facility for deep cleaning after multiple cases of the virus emerged there, advises otherwise. (The company later fired Smalls, citing he did not stay in quarantine after exposure to someone who tested positive.)

"If you want to practice real social distancing, stop pressing the buy button," Smalls told CNN Business. "You'll be saving lives. I understand that people need groceries and certain items, depending where you live, are limited. But people are buying things they don't need and it's putting workers' health at risk."

Although the issue is complex, shoppers who decide to continue using Amazon, or any online delivery platform, can keep a few best practices in mind.

The info is here.

Intelligence, Surveillance, and Ethics in a Pandemic

Jessica Davis
JustSecurity.org
Originally posted 31 March 20

Here is an excerpt:

It is imperative that States and their citizens question how much freedom and privacy should be sacrificed to limit the impact of this pandemic. It is also not sufficient to ask simply “if” something is legal; we should also ask whether it should be, and under what circumstances. States should consider the ethics of surveillance and intelligence, specifically whether it is justified, done under the right authority, if it can be done with intentionality and proportionality and as a last resort, and if targets of surveillance can be separated from non-targets to avoid mass surveillance. These considerations, combined with enhanced transparency and sunset clauses on the use of intelligence and surveillance techniques, can allow States to ethically deploy these powerful tools to help stop the spread of the virus.

States are employing intelligence and surveillance techniques to contain the spread of the illness because these methods can help track and identify infected or exposed people and enforce quarantines. States have used cell phone data to track people at risk of infection or transmission and financial data to identify places frequented by at-risk people. Social media intelligence is also ripe for exploitation in terms of identifying social contacts. This intelligence, is increasingly being combined with health data, creating a unique (and informative) picture of a person’s life that is undoubtedly useful for virus containment. But how long should States have access to this type of information on their citizens, if at all? Considering natural limits to the collection of granular data on citizens is imperative, both in terms of time and access to this data.

The info is here.

Social Distancing as a Moral Dilemma

E. Litvack
U. A. News
Originally posted 31 March 20

Here is an excerpt:

Q: At this point, is social distancing a moral imperative?

This is an interesting philosophical question. A moral imperative is a command to act in a certain way, which everyone should follow, and, in order to invoke one, we need to explain what makes a particular action right or morally good.

A: In the context of the current health crisis, we can plausibly make the claim that it is a morally good state of affairs if we save the greatest number of lives possible. Not everyone would agree with that claim, but I'll leave that argument aside for now and return to it later. For now, let's assume that promoting health and saving lives is a morally good goal for society. Given that premise – if we also accept the empirical evidence, which suggests that social distancing is a means to halt the spread of the virus – it's easy to see how one would defend their judgment that it is morally wrong not to practice social distancing.

Q: How might someone argue that saving lives isn't a moral imperative?

A: Some people might argue that there is a naturalistic and evolutionary reason to let the virus take its course. It would reduce human population, which, in the long run, could be a good thing in terms of having more resources for fewer people. Notice one thing this view entails, though: The person who holds it must be willing to accept that they or their loved ones might be among those who contribute to the population reduction.

Likewise, some might argue that certain people have more value than others and therefore deserve to live while others do not. This would require a set of criteria by which to judge the value of a life, and unless someone – or some entity – creates that criteria by fiat, then to define "a valuable life" requires us to circle right back around to our original premise.

The info is here.

How Trump failed the biggest test of his life

Ed Pilkington & Tom McCarty
The Guardian
Originally posted 29 Mar 20

Here is an excerpt:

Those missing four to six weeks are likely to go down in the definitive history as a cautionary tale of the potentially devastating consequences of failed political leadership. Today, 86,012 cases have been confirmed across the US, pushing the nation to the top of the world’s coronavirus league table – above even China.

More than a quarter of those cases are in New York City, now a global center of the coronavirus pandemic, with New Orleans also raising alarm. Nationally, 1,301 people have died.

Most worryingly, the curve of cases continues to rise precipitously, with no sign of the plateau that has spared South Korea.

“The US response will be studied for generations as a textbook example of a disastrous, failed effort,” Ron Klain, who spearheaded the fight against Ebola in 2014, told a Georgetown university panel recently. “What’s happened in Washington has been a fiasco of incredible proportions.”

Jeremy Konyndyk, who led the US government’s response to international disasters at USAid from 2013 to 2017, frames the past six weeks in strikingly similar terms. He told the Guardian: “We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.”

In Konyndyk’s analysis, the White House had all the information it needed by the end of January to act decisively. Instead, Trump repeatedly played down the severity of the threat, blaming China for what he called the “Chinese virus” and insisting falsely that his partial travel bans on China and Europe were all it would take to contain the crisis.

The info is here.

The race to develop coronavirus treatments pushes the ethics of clinical trials

Olivia Goldhill
Quartz.com
Originally posted 28 March 20

Here is an excerpt:

But others are more pragmatic. Arthur Caplan, director of NYU Langone’s Division of Medical Ethics says that when doctors are faced with suffering patients, it’s ethical for them to use drugs that have been approved for other health conditions as treatments. This happened with Ebola, swine flu, Zika, and now coronavirus, he says.

Some of the first coronavirus patients in China, for example, were experimentally given the HIV treatment lopinavir–ritonavir and the rheumatoid arthritis drug Actemra. Now, as the virus continues its rampage around the globe, doctors are eyeballing an increasing number of treatment possibilities—and dealing with the challenging ethics of testing their efficacy while making the safest choices for their patients.

Controlled trials—with caveats

When choosing to use an experimental treatment, doctors have to be as methodical as possible—taking careful note of how sick patients are when given treatment, the dose and timing of medication, and how they fared. “It’s not a study, not controlled, but you want observations to be systematic,” says Caplan.

If, after a couple of weeks and 10 or 20 patients the drug doesn’t seem to cause active harm, Caplan says scientists can quickly move to the first stage of clinical research.

Many of the current coronavirus clinical trials are based on those early experimental treatments. Early research on lopinavir–ritonavir suggests that the drug is not effective, though as the first study was small, researchers plan to investigate further. There are also ongoing trials into arthritis medication Actemra,  antimalarial chloroquine, and Japanese flu drug favipiravir.

While clinical trials typically take months to years to get started, Li believes the current coronavirus trials will set records for speed: “I don’t think they could go any faster,” she says. It helps that there are a lot of coronavirus patients, so it’s easy to quickly enroll study participants.

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