COVID-19

virus

Table of contents

Research Project: Project Grant from ETH Zurich and the State Secretariat for Education, Research and Innovation

Nikola Biller-Andorno, together with Calvin Ho (University of Hong Kong) and Renate Schubert (Singapore ETH Center) receives a Special COVID-19 Project Grant from ETH Zurich and the State Secretariat for Education, Research and Innovation. The grant will allow the team to explore if the PubliCo platform for the study of COVID-19-related public perception is transferable to selected Asian contexts. 

date: 29.10.2020

Media: Supriya Subramani interviews Valerie Luyckx (Podcast)

The growth of Non-Communicable Diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are concerning, and are among the leading causes of death and disability in the world. Prevention and control of NCDs are important during this pandemic because NCDs are major risk factors for patients with COVID-19. Furthermore, some of the restrictive measures such as lockdowns, social distancing, and travel restrictions to reduce the spread of infection in many countries impact specifically on people living with NCDs. In today’s podcast, we will be talking to Valerie Luyckx, who is a trained medical professional and strong global advocate for patients with kidney disease.

Speaker: Valerie Luyckx, Faculty, Institute of Biomedical Ethics and History of Medicine,  University of Zurich, Switzerland; and Brigham and Women’s Hospital, Harvard Catalyst, Boston, MA, USA.

Anchor and producer: Supriya Subramani, Postdoctoral Fellow (ESKAS Scholar) at the Institute of Biomedical Ethics and History of Medicine, University of Zurich.

date: 29.8.2020

Media: Settimio Monteverde spricht über den Lockdown in Pflegeeinrichtungen

Bewohnerinnen und Bewohner von Langzeiteinrichtungen wurden in der Corona-Pandemie schon früh als besonders vulnerable Gruppe identifiziert. Als Reaktion darauf wurden in der Schweiz und in den meisten anderen Ländern Freiheitsrechte eingeschränkt, wie z.B. das Recht auf Bewegung und der Besuch durch Angehörige. In einem Interview mit der Zeitschrift Zeitlupe von Pro Senectute nimmt Settimio Monteverde, Mitarbeiter am Institut für Biomedizinische Ethik und Medizingeschichte sowie Klinischer am Universitätsspital Zürich, dazu persönlich Stellung und zeigt ethische Perspektiven im Spannungsfeld zwischen Lebensschutz und Lebensqualität auf (Upload mit freundlicher Genehmigung  der Zeitschrift Zeitlupe / Pro Senectute). 

PDF des Interviews (PDF, 801 KB)

date: 26.8.2020

Publication: Tanja Krones, Gabriele Meyer and Settimio Monteverde published: «Medicine is a social science: COVID-19 and the tragedy of residential care facilities in high-income countries»

In the context of the pandemic spread of COVID-19, the majority of high-income countries have witnessed an extraordinary high death toll of people living in residential care facilities.

Social epidemiology makes an important contribution to better understand this phenomenon, attributable to the biological impact of the pathogen on vulnerable high-risk populations and to the place of care as a decisive social determinant of health.

The tragedy of COVID-19 related deaths in nursing homes is primarily due to its iatrogenic spread and aggravated by socioeconomic circumstances.

Current isolation and confinement policies, including the prolonged separation of residents from their loved ones have failed to show their effectiveness in preventing these developments and are therefore disproportionate. They have to be replaced by policies that respect both the needs of safety of all residents and basic human rights.

In addition to the questionable effectiveness, these policies bear considerable opportunity costs, as they negatively affect quality of life and health outcomes of isolated residents.

Seen through the lens of medicine as a social science and of social epidemiology in particular, the COVID-19 crisis provides opportunities to better understand and fundamentally improve framework conditions within residential care facilities as well as other ‘large households’ all over the globe and to build safer institutions for all people in need of continuous care.

fulltext

date: 14.8.2020

Publication: COVID-19 and the ethics of quarantine: a lesson from the Eyam plague

Giovanni Spitale published a new paper in Medicine, Health Care and Philosophy on the ethical aspects of quarantine ethics.

Abstract

The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur’s Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place.

Keywords

History of medicine, History of epidemiology, Eyam, Plague, SARS-CoV-2, COVID-19, Public health ethics

Full text

https://link.springer.com/article/10.1007%2Fs11019-020-09971-2

date: 6.8.2020

Media: SRF 4 News aktuell: Interview mit Nikola Biller-Andorno

Nikola Biller-Andorno argumentiert im Interview mit SRF 4 News aktuell vom 3.8.2020 dafür, dass der Basler Pharmakonzern Roche sich in der aktuellen Pandemie mit anderen Pharmafirmen austauschen und Hand dafür bieten sollte, das Problem der fehlenden Testkapazitäten für Coronatests zu lösen.

date: 3.8.2020

Publication: Science Alone Can’t Solve Covid-19. The Humanities Must Help.

Anna Elsner and Vanessa Rampton have published an opinion piece in Undark Magazine, published through the Knight Science Journalism Program at the Massachusetts Institute of Technology, about the role of humanities research in shaping responses to the COVID-19 pandemic:  https://undark.org/2020/06/04/covid-19-humanities/

date: 16.7.2020

Publication: The Ethical Use of Telepsychiatry in the Covid-19 Pandemic

Julia Stoll, John Z. Sadler and Manuel Trachsel published a new article on telepsychiatry ethics during the COVID-19 pandemic.

Introduction
In a statement to the press, Dr. Hans Henri P. Kluge, World Health Organization (WHO) Regional Director for Europe, stressed that it is important not to lose sight of the mental health implications of Covid-19 for everyone, noting that “[i]t is absolutely natural for each of us to feel stress, anxiety, fear, and loneliness during this time” (1). If mentally healthy individuals react with fear and stress to the Covid-19 pandemic, it is not difficult to imagine that such reactions make those who have mental disorders especially vulnerable to harm.

Challenges for Patients With Mental Disorders in Times of Covid-19
Yao, Chen, and Xu (2) listed four reasons to explain why patients with mental disorders may be at particular risk in the Covid-19 pandemic. First, patients with mental disorders may be at increased risk of infection because they are less aware of the dangers or because they adhere less to official measures. Second, poor symptom recognition combined with stigmatization means that Covid-19 infection may not be detected as quickly, and treatment following infection may be compromised by various psychiatric comorbidities. Third, patients with mental disorders may be more vulnerable to the public panic and anxiety triggered by the pandemic, which may aggravate the symptoms of the underlying mental disease. Finally, face-to-face outpatient treatment may be impeded as a result of various government measures, including quarantine. Importantly, the undersupply of services for patients with mental disorders not only increases existing healthcare inequities but potentially facilitates the spread of Covid-19 through increased infection and difficulties with adherence with public health restrictions among these patients (2). How can continuous care for patients with mental disorders be guaranteed within the confines of social distancing?

Telepsychiatry as a Possible Solution
Telepsychiatry has been discussed as a possible solution for the care of patients with mental disorders (3, 4) and is increasingly used worldwide during the Covid-19 pandemic (5). Telepsychiatry is already well established in some countries like Australia and Canada and the effectiveness of telepsychiatry, as well as the satisfaction of its users, has been shown in various studies (6–8).

Especially in a crisis like the Covid-19 pandemic, the treatment of patients through telepsychiatry shows some specific advantages: Because telepsychiatry services maintain social distance, they eliminate the risk of infection for both patients and therapists; the patient can remain at home, and the therapist can work from their home, office, or practice. In this way, psychotherapy can be maintained or initiated even under quarantine. Patients who would otherwise attend for outpatient psychotherapy can continue their treatment remotely with the same therapist, so ensuring continuity of care and potentially improving compliance and adherence. Telepsychiatry makes even brief crisis intervention possible when physical distance prevents inpatient treatment, so potentially reducing the number of hospitalizations during the Covid-19 pandemic.

Full text

date: 15.7.2020

Media: Settimio Monteverde launches call for urgent reflection about ethical isolation policies in nursing homes in the case of a „second wave“

Within the actual pandemic, lockdown policies and bans of visits in nursing homes have followed the objective of protecting the lives of the most vulnerable. But they have also provoked much suffering for residents, relatives, and healthcare professionals. In a declaration published in the Swiss Medical Review, over 100 medical ethicists have highlighted that the protection of life cannot be pursued without protecting the quality of life, the rights and interests of the person, and, if lacking decision-making capacity, the right of being legally represented in medical decisions.  

Swiss Medical Review

Interview Radio DRS

date: 9.7.2020

Media: NZZ-Standpunkte: Corona-Massnahmen in der Kritik: «Mit dem Besuchsverbot sind wir definitiv zu weit gegangen»

In Alters- und Pflegeheimen sterben Menschen seit Corona oft allein. Die Medizinethikerin Tanja Krones spricht in «NZZ Standpunkte» über Verfehlungen der Wissenschaft, eine zweite Welle und darüber, wie viel ein Menschenleben wert ist.

Link

date: 8.6.2020

As the Corona Virus (SARS-CoV-2) continues to spread globally, causing severe human disease and death (COVID-19), citizens around the world have been exposed to crisis communication from a diverse spectrum of media outlets, including websites of public health authorities and universities, newspapers, television broadcasts, and social media platforms.

These policy briefings, expert opinions, popular sentiments as well as dashboards, interactive maps and visuals, have not only become sources of information but also an incubator for emotional responses, moral judgements, and behavioral changes in daily routines, during a public health emergency. 

An interdisciplinary team of researchers from the DSI, the Collegium Helveticum, the IBME, and the SwissTPH has come together to develop an experimental, interactive online platform that helps tackle the “infodemic” manifested in the COVID-19 context, with a focus on a nuanced and in-depth understanding of public perception. 

Building on real-time data, continuous data collection through a participatory citizen science approach and advanced, AI-based analytics, the highly adaptable platform aims to foster effective and tailored risk and crisis communication in Switzerland and other countries, to help mitigate negative social effects of COVID-related policies and to provide insights for an emerging ethical framework for public health crisis communication and policy-making.

http://www.snf.ch/en/researchinFocus/newsroom/Pages/news-200518-the-snsf-funds-36-new-coronavirus-research-projects.aspx

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date: 19.5.2020

Publication: Ethics guidelines on COVID-19 triage - an emerging international consensus

Susanne Joebges and Nikola Biller-Andorno published in "Critical Care" a paper reviewing international guidelines on the triage of COVID-19 patients.

Introduction

COVID-19—classified as a pandemic by the WHO on March 11, 2020—is expected to put tremendous strain on many healthcare systems. Early epidemiological analyses show that compared to the seasonal flu, COVID-19 patients may require ventilation much more frequently. This can lead to a shortage of ventilators and intensive care resources, resulting in limited medical care and death. Whereas some countries have been exposed very early, others had the opportunity to prepare for the ethical challenges that emerge when intensive care resources become scarce.

In everyday medical practice, ventilation may be withheld or withdrawn if it is not or no longer indicated or against a patient’s will. In crisis situations, such as pandemics, this practice is superimposed by an additional triaging process. Medical factors of triage recommendations typically contain exclusion criteria, a mortality assessment (e.g., Sequential Organ Failure Assessment (SOFA) score), and a re-evaluation requirement. Beyond the medical aspects, however, triaging unavoidably involves moral choices. The main ethical considerations for making such choices concern equity and maximizing benefits. Other criteria such as considering life stages, rewarding prosocial behavior, or giving priority to the worst off have been subject to long-standing controversy.

Full text

https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02927-1

date: 13.5.2020

Media: Salience of effective public communication and transparency during Covid-19

Supriya Subramani, postdoctoral fellow at the IBME, recently published an article on the blog of HEaL Institute & IJME discussing public communication strategies, transparency and inclusivity during the Covid-19 epidemic.

Abstract

On April 14, 2020, the three-week lockdown was extended till May 03. Following the announcement, Bandra Railway station and few other places saw thousands of migrant workers coming out in protest and demanding to be allowed to return to their homes. We all witnessed the hardships of migrant workers following the initial announcement of the lockdown on March 25, 2020. One wonders if the governments—both at the center and state—considered inclusive approaches in planning out their strategies, while also considering how they affect citizens, particularly the marginalized and vulnerable groups. In this piece, I emphasize that the two intertwined ethical issues, transparent effective communication and inclusive decisions, based on justice are non-negotiable ethical obligations by the state during pandemics, such as Covid-19.

Full text:

https://fmesinstitute.org/blog-4-heal-institute-ijme-covid-19-insights-april-15-2020/

date: 17.4.2020

Media: Schreiben und Lesen in Zeiten von Corona

Wie beeinflusst der medizinische Alltag das literarische Schaffen? Und wie wirken sich die Arbeiten von Autorinnen und Autoren auf unsere Wahrnehmung von Medizin aus? Literaturwissenschaftlerin Anna Elsner erforscht am Beispiel der französischen Literatur diese Phänomene, die gerade in Zeiten von Corona besonders interessieren.

Zum Interview

date: 16.4.2020

Research Project: Individual experiences with pandemic SARS-CoV2 (COVID-19)

The DIPEx Team of IBME decided to start a module on COVID-19. This research project aims to clarify what we can comprehend from the experiences of COVID-19 survivors from the countries that participate to this study. 
This research project aims to provide information and support to patients, families, carers, friends and healthcare professionals about the experience of and recovery from COVID-19, and consequently to understand how response strategies (intended both on a clinical and on a social level) to the current public health crisis and to future significant threats to public health can be reshaped and ameliorated, learning from recovered patients with lived experience of COVID-19. 

Project Page

date 15.4.2020

Media: Warum wir wirkliches ACP und kein «ACP light» brauchen

In der aktuellen Corona-Krise wendet sich Tanja Krones, leitende Ärztin Klinische Ethik am Universitätsspital Zürich, mit einem eindringlichen Votum an die Öffentlichkeit, angeregt durch einen Leitartikel im digitalen Magazin «Republik». «ACP light» - in der Hektik der Pandemie erstellte Patientenverfügungen - berge die Gefahr, nicht den Menschen ins Zentrum zu stellen, sondern das Bedürfnis des Systems nach klaren Anweisungen zu erfüllen.

Zum offenen Brief

date: 8.4.2020

Media: Leben und Sterben in Zeiten der Seuche. Artikel von Nina Streeck über ethische Fragen der Triage in der Republik

Die Ausbreitung des Coronavirus könnte dazu führen, dass die Betten auf den Intensivstationen und die Beatmungsgeräte knapp werden. In diesem Fall müssten die Behandlungsteams eine Triage durchführen und entscheiden, welche Patienten die Intensivtherapie erhalten. Mit den ethischen Aspekten solcher Entscheidungen hat sich Nina Streeck in einem Artikel für die "Republik" befasst.

Zum Artikel

date: 30.3.2020

Publication: Checkliste ÄNO (Ärztliche Notfallanordnung) für Ärztinnen und Ärzte

Tanja Krones und Isabelle Karzig waren an der Erstellung der Checkliste Ärztliche Notfallanordnung für Ärztinnen und Ärzte (ÄNO) als Autorinnen beteiligt. Diese ist Teil der Gesundheitliche Vorausplanung mit Schwerpunkt Advance Care Planning. Siehe dazu das Rahmenkonzept des Bundesamtes für Gesundheit Gesundheitliche Vorausplanung mit Schwerpunkt Advance Care Planning. Sie steht auf pallnetz.ch unter «ACP und Covid-19» mit anderen Dokumenten zum Thema zum Download bereit.

date: 26.3.2020

Publication: Wegleitung für die «Patientenverfügung ACP-Kurzform»

Tanja Krones und Isabelle Karzig waren an der Erstellung der Wegleitung für die «Patientenverfügung ACP-Kurzform» für Patientinnen und Patienten als Autorinnen beteiligt. Sie steht auf pallnetz.ch unter «ACP und Covid-19» mit anderen Dokumenten zum Thema zum Download bereit.

date: 26.3.2020

Media: Tanja Krones bei SRF Sternstunde Philosophie: Corona – Eine Mikrobe stellt unsere Stärke in Frage

Die Pandemie hat die Welt im Griff. Die moderne Gesellschaft, die alles im Griff zu haben meint, kollabiert vor einer Mikrobe. Dem Virus sind die Menschen egal, es hat es nicht auf sie abgesehen. Wie geht der Mensch mit dieser Kränkung um? Und wie bleibt man menschlich angesichts der Krise?

«An Viren zu sterben, ist voll Achtziger, der moderne Mitteleuropäer stirbt vorwiegend an seinen schlechten Gewohnheiten, die ihm irgendwann die Gefässe dichtmachen», schrieb Barbara Plagg, italienische Dozentin für Sozialmedizin, kürzlich in einem Blog. Die Coronakrise erschüttert die Gesellschaft in ihrem Fortschrittsglauben und ihrem Vertrauen in die Spitzenmedizin. Sie hat die Natur nicht mehr im Griff, sondern kann nur versuchen, auf Zeit zu spielen, sich einzuigeln, sich abzuschotten. Das Virus trifft die Menschheit damit auch im Urmenschlichen, nämlich im Bedürfnis nach Gemeinschaft. Wie wird die Gesellschaft die Krise bewältigen? Barbara Bleisch diskutiert mit dem Physiker und Philosophen Eduard Kaeser, mit der Medizinethikerin Tanja Krones und dem Journalisten und Philosophen Daniel Binswanger über den taumelnden Menschen in Zeiten der Unsicherheit.

Link

date: 22.3.2020