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3.
Epidemiol Health ; 43: e2021012, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33541010

RESUMEN

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly throughout the human population, the concept of "herd immunity" has attracted the attention of both decision-makers and the general public. In the absence of a vaccine, this entails that a large proportion of the population will be infected to develop immunity that would limit the severity and/or extent of subsequent outbreaks. We argue that adopting such an approach should be avoided for several reasons. There are significant uncertainties about whether achieving herd immunity is possible. If possible, achieving herd immunity would impose a large burden on society. There are gaps in protection, making it difficult to shield the vulnerable. It would defeat the purpose of avoiding harm caused by the virus. Lastly, dozens of countries are showing that containment is possible.


Asunto(s)
/inmunología , Inmunidad Colectiva , Salud Pública/ética , /epidemiología , Salud Global , Humanos , Salud Pública/métodos , Responsabilidad Social
4.
Bull World Health Organ ; 99(2): 155-161, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33551509

RESUMEN

Restrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonly called an immunity passport. This document certifies them as having protective immunity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification at present because of uncertainty about whether long-term immunity truly exists for those who have recovered from COVID-19 and concerns over the reliability of the proposed serological test method for determining immunity. Immunity certification can only be considered if scientific thresholds for assuring immunity are met, whether based on antibodies or other criteria. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process. We examine the main considerations for the ethical acceptability of immunity certification to exempt individuals from restrictive measures during the COVID-19 pandemic. As well as needing to meet robust scientific criteria, the ethical acceptability of immunity certification depends on its uses and policy objectives and the measures in place to reduce potential harms, and prevent disproportionate burdens on non-certified individuals and violation of individual liberties and rights.


Asunto(s)
/ética , Certificación/ética , Pandemias , Salud Pública/ética , Humanos , Inmunidad Humoral
5.
J Hosp Palliat Nurs ; 23(2): 120-127, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33633091

RESUMEN

Outbreaks of COVID-19 among nursing homes, assisted living facilities, and other long-term care facilities in the United States have had devastating effects on residents. Restrictions such as banning visitors, sequestering residents, and testing health care staff have been implemented to mitigate the spread of the virus. However, consequences include a decline in mental and physical health, decompensation, and a sense of hopelessness among residents. We present and explore a case study at an assisted living facility addressing the ethical issues in balancing the management of the community versus the resident's right to autonomy and self-determination. A team of palliative care experts was brought into assisted living facilities to manage patients, care for well residents, and provide input in advance care planning and symptom management. The principles of self-determination and autonomy, stewardship, and distributive justice were explored. The use of nursing skills in triage and assessment, principles in public health, and the 8 domains of palliative care provided a comprehensive framework for structuring emergency operations. Palliative interventions and the role of palliative care nurses played an integral part in addressing ethical challenges in the containment of the virus and the deleterious effects of social isolation among the elderly.


Asunto(s)
Instituciones de Vida Asistida/ética , Brotes de Enfermedades , Enfermería de Cuidados Paliativos al Final de la Vida/ética , Salud Pública/ética , Anciano , Instituciones de Vida Asistida/organización & administración , Humanos , Cuidados a Largo Plazo/ética , Estudios de Casos Organizacionales , Estados Unidos/epidemiología
6.
AMA J Ethics ; 23(2): E166-174, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33635197

RESUMEN

Using the inequality exposed by the COVID-19 pandemic as a vivid example, this article focuses on health equity from the standpoint of structural marginalization-here, described as being marked as an "other" outside of the circle of human concern. This process leads to tension between the principles of liberty and equality and contributes to the creation of systemic disadvantage as manifested in health disparities. Creating an equitable health system must begin with this root understanding and generate greater belonging through the policy process of targeted universalism. Targeted universalism replaces a disparities framework with one in which a universal goal is identified but targeted strategies to meet each population group's needs are employed.


Asunto(s)
Equidad en Salud/ética , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Salud Pública/ética , Racismo , /etnología , Humanos
7.
AMA J Ethics ; 23(2): E189-195, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33635200

RESUMEN

Following the US Civil War, newly freed Black Americans had significantly poorer health than Whites. Founded in 1865, the Freedmen's Bureau offered a range of support (eg, food, health care, shelter, legal aid) to try to improve health among the newly freed. The COVID-19 pandemic has exposed the persistence of racial health inequity in American life. Ethical obligations to address it exist now, just as they did in 1865.


Asunto(s)
Afroamericanos , Disparidades en Atención de Salud/historia , Salud de las Minorías/historia , /epidemiología , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Salud Pública/ética , Estados Unidos/epidemiología
9.
Vaccine ; 39(6): 994-999, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33423839

RESUMEN

Vaccination plays an important role in pandemic planning and response. The possibility of developing an effective vaccine for a novel pandemic virus is not assured. However, as we have seen with SARS-CoV-2 vaccine development, with sufficient resources and global focus, successful outcomes can be achieved in a relatively short period. However even when vaccine is available it will initially be scarce. When one becomes available, how should it be distributed? In this paper we explicate how ethical thinking that is carefully attuned to context is essential to decisions about how we should conduct vaccination in a pandemic where demand exceeds supply. We focus on two key issues. First, setting the aims for a pandemic vaccination programme. Second, thinking about the means of delivering a chosen aim. We outline how pandemic vaccine distribution strategies can be implemented with distinct aims, e.g. protecting groups at greater risk of harm, saving the most lives, or ensuring societal benefit. Each aim will result in a focus on a different priority population and each strategy will have a different benefit-harm profile. Once we have decided our aim, we still have choices to make about delivery. We may achieve at least some ends via direct or indirect strategies. Such policy decisions are not merely technical, but necessarily involve ethics. One important general issue is that such planning decisions about distribution will always be made under conditions of uncertainty about vaccine safety and effectiveness. However, planning how to distribute vaccine for SARS-CoV-2 is even harder because we understand relatively little about the virus, transmission, and its immunological impact in the short and long term.


Asunto(s)
/prevención & control , Programas de Inmunización , Pandemias/prevención & control , Vacunación/ética , Vacunación/métodos , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/normas , Humanos , Programas de Inmunización/ética , Programas de Inmunización/métodos , Salud Pública/ética , Salud Pública/métodos , Vacunación/psicología
11.
Genome Med ; 12(1): 95, 2020 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-33168072

RESUMEN

Genomic studies of patients with COVID-19, or exposed to it, are underway to delineate host factors associated with variability in susceptibility, infectivity, and disease severity. Here, we highlight the ethical implications-both potential benefits and harms-of genomics for clinical practice and public health in the era of COVID-19.


Asunto(s)
Infecciones por Coronavirus/patología , Predisposición Genética a la Enfermedad/genética , Pruebas Genéticas/ética , Genómica/ética , Neumonía Viral/patología , Salud Pública/ética , Betacoronavirus , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/terapia , Genómica/métodos , Humanos , Pandemias , Neumonía Viral/terapia , Salud Pública/métodos
16.
Rev Esp Salud Publica ; 942020 Sep 07.
Artículo en Español | MEDLINE | ID: mdl-32894259

RESUMEN

The SARS-CoV-2 pandemic (Covid-19) has had a major impact on residents of assisted-living facilities. While it is plausible that the characteristics of these patients and their special clinical fragility have contributed to their greater vulnerability to infection, other related factors cannot be ruled out, such as the quality of management at these centers and the lack of planning for actions taken before and during the health crisis. Both aspects pertain to the field of public health, where the ethics of the common good conflicts with the autonomy of the individual.


Asunto(s)
Instituciones de Vida Asistida/ética , Planificación en Salud Comunitaria/ética , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Salud Pública/ética , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Factores de Riesgo , España/epidemiología
17.
Cuad Bioet ; 31(102): 167-182, 2020.
Artículo en Español | MEDLINE | ID: mdl-32910670

RESUMEN

In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights.


Asunto(s)
Betacoronavirus , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Derechos Humanos/ética , Pandemias/prevención & control , Salud Pública/ética , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Comités de Ética , Unión Europea , Libertad , Recursos en Salud/ética , Recursos en Salud/provisión & distribución , Accesibilidad a los Servicios de Salud/ética , Derechos Humanos/legislación & jurisprudencia , Humanos , Pandemias/ética , Pandemias/legislación & jurisprudencia , Derechos del Paciente/ética , Derechos del Paciente/legislación & jurisprudencia , Autonomía Personal , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Salud Pública/legislación & jurisprudencia , Cuarentena/ética , Cuarentena/legislación & jurisprudencia , Sujetos de Investigación , Asignación de Recursos/ética , España , UNESCO
18.
BMC Med Ethics ; 21(1): 91, 2020 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-32962671

RESUMEN

BACKGROUND: In response to COVID-19 pandemic, the Government of Uganda adopted public health measures to contain its spread in the country. Some of the initial measures included refusal to repatriate citizens studying in China, mandatory institutional quarantine, and social distancing. Despite being a public health emergency, the measures adopted deserve critical appraisal using an ethics and human rights approach. The goal of this paper is to formulate an ethics and human rights criteria for evaluating public health measures and use it to reflect on the ethical propriety of those adopted by the government of Uganda to contain the spread of COVID-19. MAIN BODY: We begin by illustrating the value of ethics and human rights considerations for public health measures including during emergencies. We then summarize Uganda's social and economic circumstances and some of the measures adopted to contain the spread of COVID-19. After reviewing some of the ethics and human rights considerations for public health, we reflect upon the ethical propriety of some of Uganda's responses to COVID-19. We use content analysis to identify the measures adopted by the government of Uganda to contain the spread of COVID-19, the ethics and human rights considerations commonly recommended for public health responses and their importance. Our study found that some of the measures adopted violate ethics and human rights principles. We argue that even though some human rights can sometimes be legitimately derogated and limited to meet public health goals during public health emergencies, measures that infringe on human rights should satisfy certain ethics and human rights criteria. Some of these criteria include being effective, strictly necessary, proportionate to the magnitude of the threat, reasonable in the circumstances, equitable, and least restrictive. We reflect on Uganda's initial measures to combat the spread of COVID-19 and argue that many of them fell short of these criteria, and potentially limit their effectiveness. CONCLUSION: The ethical legitimacy of public health measures is valuable in itself and for enhancing effectiveness of the measures. Such legitimacy depends on the extent to which they conform to ethics and human rights principles recommended for public health measures.


Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Derechos Humanos , Neumonía Viral/epidemiología , Salud Pública/ética , Betacoronavirus , Países en Desarrollo , Humanos , Pandemias , Uganda/epidemiología
19.
J Med Ethics ; 46(11): 732-735, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32958693

RESUMEN

A recent update to the Geneva Declaration's 'Physician Pledge' involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi ('ultra-orthodox') religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public's best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach.


Asunto(s)
Educación en Salud/ética , Obligaciones Morales , Pandemias/ética , Médicos/ética , Rol Profesional , Responsabilidad Social , Acceso a la Información , Beneficencia , Betacoronavirus , Códigos de Ética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Competencia Cultural , Cultura , Teoría Ética , Equidad en Salud , Promoción de la Salud/ética , Humanos , Internet , Pandemias/prevención & control , Paternalismo , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/virología , Salud Pública/ética , Religión , Justicia Social
20.
S Afr Med J ; 110(9): 858-863, 2020 08 13.
Artículo en Inglés | MEDLINE | ID: mdl-32880268

RESUMEN

As COVID-19 spreads rapidly across Africa, causing havoc to economies and disruption to already fragile healthcare systems, it is becoming clear that despite standardised global health strategies, national and local government responses must be tailored to their individual settings. Some African countries have adopted stringent measures such as national lockdown, quarantine or isolation, in combination with good hand hygiene, mandatory wearing of masks and physical distancing, to prevent an impending healthcare crisis. The impact of stringent measures in low- to middle-income African countries has bought time for healthcare facilities to prepare for the onslaught of COVID-19 cases, but some measures have been challenging to implement. In some settings, public health measures have been associated with serious violations of individual rights owing to abuse of power and gaps in implementation of well-intentioned policy. Collateral damage with regard to non-COVID-19 diseases that were suboptimally managed in pre-pandemic times may mean that lives lost from other diseases could exceed those saved from COVID-19. While individuals complying with lockdown regulations have embraced an acceptance of the concept of the common good, at a broad community level many are finding the transition from individualism to collective thinking required during a pandemic difficult to navigate. In this article, we look at government responses to the pandemic in six African countries (Malawi, South Africa, Uganda, Zambia, Zimbabwe and Botswana), and highlight ethical concerns arising in these contexts.


Asunto(s)
Derechos Civiles/ética , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Autonomía Personal , Neumonía Viral/prevención & control , Salud Pública/ética , África , Betacoronavirus , Botswana , Derechos Civiles/legislación & jurisprudencia , Infecciones por Coronavirus/epidemiología , Libertad , Humanos , Malaui , Neumonía Viral/epidemiología , Salud Pública/legislación & jurisprudencia , Sudáfrica , Uganda , Zambia , Zimbabwe
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