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The Bioethics of Covid-19: Should Governments Let the Virus Run its Course?

Wednesday, April 15, 2020

From downplaying the threat of Covid-19 to nationwide lockdowns, governments around the world have been adopting different measures to cope with the coronavirus crisis. While social distancing has been widely encouraged, 2017 AsiaGlobal Fellow and bioethics expert Florencia Daud urges authorities to pursue a more focused approach to protect the most vulnerable.

The Bioethics of Covid-19: Should Governments Let the Virus Run its Course?

At a rally in Brazil, supporters of President Bolsonaro wore masks but did not keep distance: Some political leaders have downplayed the coronavirus and stressed the need to keep the economy going (Credit: Isbel Dias / Shutterstock.com)

We are facing a global public-health crisis in which almost every country in the world is involved. Most countries are experiencing a shortage of medical equipment and need more rapid and generalized testing for Covid-19.

Forced isolation goes hand in hand with preventing health systems across the world from collapsing. It restricts the movements of the entire population of a country without taking into account the varying risks that individuals face.

Studies claim that most patients infected with Covid-19 recover in a matter of days, and only a small number needs to be hospitalized. Only a tiny percentage — the most vulnerable patients — dies. Considering these findings, the idea of protecting and isolating the most vulnerable from death or long-term damage from Covid-19 and treating the rest of society only when they experience other health threats does not sound so far-fetched.

Would it be possible, as some argue, to minimize the threat to the most vulnerable people and maximize the chances for the greatest number of people to safely return to work as soon as possible?

Argentinean President Alberto Fernández and his Brazilian counterpart Jair Bolsonaro have opposing ideas regarding this issue. Argentina has imposed a strict quarantine on the entire population, while in Brazil, Bolsonaro, who compared the pandemic to a cold, has tried to reassure his citizens that nothing would happen if they went out onto the street.

Everyone fears for their loved ones and most would find strict quarantine measures to prevent the spread of the virus somewhat reassuring. Ironically, vulnerable populations could be exposed to greater risk of getting infected during quarantine if they live with suspected patients. It is important that people at risk are isolated from their families, even in their own homes.

No one knows how mass quarantine would affect mental health and family relationships. The growth of gender violence and depression are two risks that could increase in this context.

Lockdown: The priority has to be to save as many lives as possible while buying time to come up with a vaccine (Credit: Queven/Pixabay)

Lockdown: The priority has to be to save as many lives as possible while buying time to come up with a vaccine (Credit: Queven/Pixabay)

Popular opinion has it that after self-quarantine or social distancing for two weeks, people with symptoms should remain in self-isolation (with or without testing), while those who, after those two weeks have shown no symptoms or are not part of any at-risk group, should be able to return to work or study.

I do not agree. First, it is very difficult to identify people who are the most vulnerable. Second, it is likely that more intense transmissions occur among younger generations, some of whom are known to flout regulations on social distancing, resulting in many more deaths as hospitals become overwhelmed.

Should governments allow people to catch the coronavirus, recover and return to work, while doing as much as possible to reduce health threats to vulnerable populations – or should they apply forced isolation for months to save everyone from the virus, regardless of their risk profile, at the expense of other priorities such as the economy?

It is easier and more efficient to reduce transmission by mass quarantine and social distancing, but studies have shown that social isolation alone cannot stop the spread of the virus and that more comprehensive measures are required.

Now that practically everyone is isolated, we can adopt a more focused approach based on risk variables such as age and health condition. Isolating people who fall under these categories and protecting them in a targeted way would minimize the number of infections among vulnerable populations, and as a consequence, prevent the collapse of health systems. We need an aggressive public health response to find ways to protect and treat those who are especially vulnerable to severe Covid-19 infection.

To take this path, we need to assemble interdisciplinary teams of doctors, biologists, economists, engineers, mental health professionals and bioethicists, among others. Until we find a vaccine for Covid-19 infections and efficient antiviral drugs, it is essential to commit to maintaining good personal hygiene and distance from others and to increasing testing and isolation of suspected patients. Our current priority has to be to save as many lives as possible while buying time for medical advances to provide a lasting solution.

Further reading:

Anderson, Roy M; Heesterbeek, Hans; Klinkenberg, Don; and Hollingsworth, T Déirdre. (March 9, 2020) “How will country-based mitigation measures influence the course of the COVID-19 epidemic?”, The Lancet, vol. 395, issue 10228, pp 931-934, London, UK.

Gardner, Lauren. (January 31, 2020) “Update January 31: Modeling the spreading risk of 2019-nCoV”, Modeling 2019-nCoV, Center for Systems Science and Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA.

Kucharski, Adam J; Russell, Timothy W; Diamond, Charlie; Liu, Yang; Edmunds, John; Funk, Sebastian; and Eggo, Rosalind on behalf of the Centre for Mathematical Modelling of Infectious Diseases COVID-19 working group. (March 11, 2020) “Early dynamics of transmission and control of COVID-19: a mathematical modelling study”, The Lancet Infectious Diseases, London, UK.

Parmet, Wendy E; and Sinha Michael S. (March 18, 2020) “Covid-19 – The Law and Limits of Quarantine”, The New England Journal of Medicine, Waltham, MA, USA.

Read, Jonathan M; Bridgen, Jessica RE; Cummings, Derek AT; Ho, Antonia; and Jewell, Chris P. (January 28, 2020) “Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic predictions”, medRxiv, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA.

Wilder-Smith, A; and Freedman, DO. (February 13, 2020) “Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak”, Journal of Travel Medicine, vol. 27, issue 2, International Society of Travel Medicine, Dunwoody, GA, USA, and Oxford University Press, Oxford, UK.

Opinions expressed in articles published by AsiaGlobal Online reflect only those of the authors and do not necessarily represent the views of AsiaGlobal Online or the Asia Global Institute

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