Infectious Disease
Experts discuss the impact of COVID-19 on individual public health responsibilities
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Machado PM, van Laar JM. Are ethics adequately considered in clinical management and research of Covid19 patients? Presented at the EULAR Congress 2021; 2nd-6th June 2021 (virtual meeting).
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Machado and van Laar did not provide any relevant financial information.
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According to speakers at the 2021 EULAR Congressional Debate, balancing broad public health initiatives with the need to respect individual choices and patient needs has been at the heart of the best and worst aspects of responding to the COVID-19 pandemic.
Pedro M. Machado, MD, PhD, Associate Professor of Rheumatology and Muscle Diseases at University College London, presented the ontological side of the ethical argument that emphasized the needs of the individual over broader public health concerns. Jacob M. van Laar, MD, Professor in the Department of Rheumatology and Clinical Immunology at Utrecht University Hospital in the Netherlands, addressed utilitarian concerns that put more strain on public health.
“When faced with a huge tsunami wave, you can’t take the time to sit in your boat until the best decision is made.” Jacob M. van Laar, MD, told the participants. “You have to act.” Source: Adobe Stock
Pedro M. Machado
“When you think of clinical research and doctors, they often develop an ethical view that is individual-centered,” Machado said. “When you think about public health ethics, you think about the general population.”
According to van Laar, COVID-19 has forced clinicians, researchers and policy makers alike to answer this question. “The question for COVID is how to maximize benefits to society as a whole while respecting the interests of each individual,” he said. “That is the balance that needs to be balanced. That is the difficult part. ”
Effects on Individuals
Machado emphasized that despite this obvious dichotomy, the needs of the individual versus the needs of the public are not always on different sides of the equation. In short, serving the general public can also benefit individuals. “But that’s not always the case,” he says.
According to Machado, there has apparently been a “big shift” in resource allocation and research initiatives toward COVID-19. “The allocation of resources should be fair,” he argued.
The question is whether patients with COVID-19 should have priority over patients with other acute and chronic illnesses who also need these resources – in the form of beds in the intensive care unit or the use of ventilators. “The invisible epidemic was created, and that epidemic was the neglect of chronic disease management during the COVID-19 pandemic,” Machado said.
In short, many individual patients with a wide range of medical conditions have had poor outcomes due to the pandemic response.
In a broader sense, Machado suggested examining domestic and international budgetary decisions in more depth before redirecting resources to COVID-19. He suggested that short-term research initiatives suffered because so much money was being withdrawn for new projects. In addition, the ability of individual research groups to conduct the longitudinal studies required to develop new therapies is likely to suffer.
On a personal level, many researchers who have spent their careers thinking about a specific problem – from cardiovascular disease to cancer therapies – have had to quit or retire because the funds to continue their work run out To be available.
“The harm to public health caused by ignoring these measures should not be ignored,” Machado said.
In conclusion, Machado suggested that caring for individual patients with all diseases and conditions “should remain a primary concern” while the response to the pandemic continues. “Interventions related to COVID-19 need to consider unintended consequences,” he said.
Focus on public health
Jacob M. van Laar
In his argument, van Laar described COVID-19 as a “tsunami of disaster on a global scale” that forced clinicians, researchers, policy makers and other interested parties to act first and consider the impact on individual patient outcomes later.
That quick action, according to van Laar, resulted in some things going well and some bad in response to the pandemic. One minus point was the tendency of many high-ranking politicians and politicians to ignore scientific evidence. Another reason was the lack of basic preparation for such an event, despite decades of warnings from global health experts. On the plus side, van Laar highlighted the speed with which vaccines were being developed and the rise of telemedicine as a viable option for patients.
He put this in the context of utilitarianism as a driver of decision-making at all levels.
For van Laar, utilitarianism is based entirely on hard data, which ideally shows the impact of a particular decision on outcomes that could affect the greatest number of people. “It’s a science-driven philosophy,” he said.
While Van Laar acknowledged that it could be difficult to figure out which national and international decisions regarding the pandemic were based on data and which were based on other factors, he suggested that a major reason could be responsible for the world’s failure. “If politicians had been watching utilitarianism closely, they should have considered the long-term consequences of COVID,” he said, implying that many politicians made their decisions based on factors far removed from science and data. “So failure is not a failure of utilitarianism, but a failure of its application.”
One of the main mistakes, according to van Laar, was a lack of transparency. If clinical and policy experts are to make decisions based solely on data, the models they use and the data they enter should be made available to a wider public, which has not always been the case with COVID-19.
Ultimately, van Laar was clear on one point: the excessive morbidity and mortality observed over the past 18 months was entirely from COVID-19. For this reason, the decisions to redirect resources to the public health threat posed by the pandemic were justified, despite the impact they may have had on certain individuals and certain subsets of the patient population.
“When you are faced with a huge tsunami wave, you cannot take the time to sit in your boat until the best decision is made,” he said. “You have to act.”
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