COVID-19 Ethics Resources

Resources are added frequently and placed in a light green shaded box when added.  Also visit COVID-19 Health Humanities and COVID-19 Narratives pages.


Clinical care and public health

Allocation of scarce treatments

Volume 20, Issue 7 of The American Journal of Bioethics, is a special issue on COVID-19 and allocation of scarce resources, with articles by Center faculty members Lisa Parker, Doug White, and Mark Wicclair, July 8, contact bioethics@pitt.edu regarding AJOB’s limited article access

Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force, July 8, contact bioethics@pitt.edu regarding AJOB’s limited article access

Contingency and Crisis Standards of Care – Palliative Care and Hospice Services, issued by Colorado’s Governor’s Expert Emergency Epidemic Response Committee, was updated to take into consideration the challenges presented by COVID-19, and join the Colorado Crisis Standards of Care documents the Committee approved on April 5

Ethical Allocation Framework for Emerging Treatments of COVID-19, from the Commonwealth of Pennsylvania, articulates an allocation framework embracing the public health goal of redressing inequities that make health and safety less accessible to disadvantaged groups and, within this broader framework, provides an example of how somewhat increased chances to receive treatment for COVID-19 may be given to members of disadvantaged communities

Model Hospital Policy for Fair Allocation of Scarce Medications to Treat COVID-19 from contributing authors at the University of Pittsburgh/UPMC Health System, Boston College, MIT, University of Denver, and Harvard University, May 28 draft

A Conversation about Allocating Scarce COVID-19 Medications: The Case for Increasing Disadvantaged Groups’ Access, with University of Pittsburgh Professor of Medicine Mark Schmidhofer, part of the Pandemic Policies & Practices series co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, July 7

A Proposed Lottery System to Allocate Scarce COVID-19 Medications: Promoting Fairness and Generating Knowledge, by Doug White and Derek Angus,  JAMA, June 24

Fair Allocation of Scarce Medical Resources in the Time of Covid-19 by Zeke Emanuel et al. with arguments supporting six recommendations, including that “prioritization guidelines should differ by intervention and should respond to changing scientific evidence,” that priority should be given to “front-line health care workers and others who care for ill patients and who keep critical infrastructure operating, particularly workers who face a high risk of infection and whose training makes them difficult to replace” and that some priority should be given to those “who participate in research to prove the safety and effectiveness of vaccines and therapeutics, NEJM, May 21  

On Being an Elder in a Pandemic, by Larry Churchill, discuss the special obligations he believes elders have during this pandemic, not as a matter of policy, but as the result of embracing a lifespan approach to ethics, April 13

Covid-19 Crisis Triage — Optimizing Health Outcomes and Disability Rights, arguing that “crisis triage protocols should focus on identifying the patients who are most likely to die without a ventilator yet most likely to survive with one, using the best available clinical survivability scores,” particularly immediate and near-term survival, by Mildred Solomon, Matthew Wynia, and Larry Gostin, May 19

Respecting Disability Rights — Toward Improved Crisis Standards of Care, arguing for the inclusion of near-term survival, but not long-term life expectancy in policies, among triage criteria in policies regarding allocation of scarce resources like ventilators and ICU, including some comment on some state policies, and recommending four substantive and two process considerations for such policies, by Michelle Mello, Govind Persad, and University of Pittsburgh faculty member, Doug White, May 19

AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond, from the American Geriatrics Society, arguing against use of criteria such as “life-years saved” and “long-term predicted life expectancy” that might disadvantage older people in the allocation of scarce resources like ventilators, May 6

Is It Ethical to Unilaterally Withdraw Life-Sustaining Treatment in Triage Circumstances?, analyzing from a Roman Catholic perspective, employing the doctrine of double effect, the question of “whether mechanical ventilation may be unilaterally withdrawn from one patient, who has a relatively poor expected outcome, to benefit another who is predicted to survive to discharge,” May 15

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated with Members of the Association of Bioethics Program Directors, characterizing development of ventilator triage policies and comparing policy content, by a Task Force of the Association, April 28

The Way We Ration Ventilators Is Biased: Not every patient has a fair chance, a New York Times  opinion piece by Harald Schmidt, April 15, prior to the April 15, 2020 revision of the policy discussed

When Medical Resources Are Scarce, Doug White’s Letter to the Editor in response, published April 28 (scroll to the bottom of the letters)

Allocation of Scarce Critical Care Resources During a Public Health Emergency: A Model Hospital Policy for Allocating Scarce Critical Care Resources, by Doug White, UPMC Endowed Chair for Ethics in Critical Care Medicine, with Scott D. Halpern of the University of Pennsylvania (Original version)

A Conversation about Allocating Scarce Resources, with Doug White, as part of the Pandemic Policies & Practices series co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, May 12; the presentation begins at minute 7

A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic by UPMC Endowed Chair for Ethics in Critical Care Medicine Douglas B. White and UCSF’s Bernard Lo, published in JAMA March 27, with a related JAMA podcast on March 28

Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines, developed by the Pennsylvania Department of Health and The Hospital & Healthsystem Association of Pennsylvania, April 10 (March 22 version)

Fair Allocation of Scarce Medical Resources in the Time of COVID-19 by Ezekiel Emanuel et al. in NEJM, March 23

The Toughest Triage — Allocating Ventilators in a Pandemic by Robert Truog, Christine Mitchell, and George Daley in NEJM, March 23

Ventilator Allocation Guidelines—New York State Task Force on Life and the Law, 2015

Diversity and Solidarity in Response to Covid-19, responding to arguments presented by Ne’eman (April 13) and others, Govind Persad and David Wasserman argue there “are better ways to address disparities than abandoning the goal of saving more lives,” May 13

When It Comes to Rationing, Disability Rights Law Prohibits More than Prejudice, by Ari Ne’eman, April 10

US Civil Rights Office Rejects Rationing Medical Care Based on Disability, AgeNew York Times, March 28  

Preventing Discrimination in the Treatment of COVID-19 Patients: The Illegality of Medical Rationing on the Basis of Disability, Disability Rights Education & Defense Fund, March 25

If Covid-19 gets bad, triage will be needed. Are we ready for that?, a STAT First Opinion, by Matthew Wynia & John Hick providing an overview of ethical principles and considerations in making triage decisions for COVID19, March 10

Minnesota Department of Health clinical guidance on triage: Patient Care Strategies for Scarce Resource Situations. This includes specific guidance for shortages of oxygen (section 1), hemodynamic support (section 5), ventilators (Section 6), and ECMO (section 12) among other resources

From the CDC: Strategies for Optimizing the Supply of N95 Respirators, updated February 29, 2020

Guidance on pandemic influenza from the Pandemic Influenza Ethics Initiative Work Group of the Veteran’s Health Administration’s National Center for Ethics in Health Care (2010): 
Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care Professionals in the Veterans Health Administration

HHS Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) resource page on crisis standards of care

Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review  (2017)

Care of the Critically Ill and Injured During Pandemics and Disasters: Chest Consensus Statement (2014)

Who Should Receive Life Support During a Public Health Emergency?  Using Ethical Principles to Improve Allocation Decisions (2009)


Allocation of vaccines

Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine from the National Academies of Sciences, Engineering, and Medicine (NASEM), 2020

Why COVID-19 vaccines need to prioritize ‘superspreaders’, by two economists and a data scientist, writing for the Conversation, September 3

Who Gets the Covid-19 Vaccine First? Here’s One Idea, by Gina Kolata, quotes UPMC Endowed Chair for Ethics in Critical Care Medicine Doug White and presents proposals for a weighted lottery to allocate scarce vaccine, New York Times, July 23

The line is forming for a COVID-19 vaccine. Who should be at the front? Discusses scientific and ethical considerations in the future allocation of scarce COVID-19 vaccines, Science, June 29

Vaccine Rationing and the Urgency of Social Justice in the Covid‐19 Response, by Harald Schmidt in The Hastings Center Report, argues that “ethical, epidemiological, and economic reasons demand that rationing approaches give priority to groups who have been structurally and historically disadvantaged, even if this means that overall life years gained may be lower,” May 28


Healthcare professionals’ duties to care and issues of legal liability

“We Signed Up for This!” — Student and Trainee Responses to the Covid-19 Pandemic—a NEJM perspective piece reflecting on a survey of ~300 trainees, June 18

A Conversation about Providers’ Liability and Immunity for Providing COVID-19 Care with Diane Hoffman, Professor of Law at the University of Maryland, part of the Pandemic Policies & Practices series co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, May 26

Ethics, Pandemics, and the Duty to Treat—a critical examination of the grounds claimed for asserting that healthcare workers have a duty to treat in the context of an infectious disease pandemic, by Heidi Malm, Thomas May, Leslie Francis, et al., 2008

Ethical Dimensions of COVID-19 for Frontline Staff—published by the Royal College of Physicians, this short document identifies issues such as physicians working outside their specialty and physicians over the age of 70 and/or with co-morbid conditions, as well as the need to have advance care planning with patients in light of the pandemic; the document will be updated with specialty-specific guidance and is available for download here

In a Pandemic, Do Doctors Still Have a Duty to Treat?—a New York Times opinion piece by Sandeep Jauhar, author of Heart: A History and Doctored: The Disillusionment of an American Physician

Doctors Need Room to Make the Wrenching Decisions They Face-- Robert Klitzman urges other states to join New York’s Gov. Cuomo who issues an executive order granting healthcare providers immunity from criminal and civil liability during this pandemic

Protect the Doctors and Nurses Who Are Protecting UsNew York Times opinion piece by Doug White, UPMC Endowed Chair for Ethics in Critical Care Medicine, with Harvard Law School professors Glenn Cohen and Andrew M. Crespo, April 2

Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19Assessing the Risks and Identifying Needed Reforms by I. Glenn Cohen, Andrew M. Crespo, and Douglas B. White, JAMA, April 1


Institutional/hospital planning, responsibilities, privacy, reporting

Responding to Covid-19 as a Regional Public Health Challenge, guidance from The Hastings Center regarding collaboration among hospitals within a region, April 29

Ethical Framework for Health Care Institutions & Guidelines for Institutional Ethics Services Responding to the Coronavirus Pandemic from The Hastings Center, March 16

COVID-19 and Underinvestment in the Public Health Infrastructure of the United States and COVID-19 and Underinvestment in the Health of the US Population in The Millbank Quarterly discuss features of US policy that made it more susceptible to COVID-19 and its lingering effects, June 2020

Lessons from Covid-19: Why Treating Sick Patients is Bad Business for Hospitals places in the broader context of the US health insurance system the economic challenges of caring for COVID-19 patients faced by healthcare institutions and society

COVID-19 and Health Data Privacy—from The Network for Public Health Law, this FAQ addresses HIPAA compliance and disclosures to various entities (e.g., housing authorities, law enforcement, media)

Limited Waiver of HIPAA Sanctions and Penalties During a Nationwide Public Health Emergency—from the Department of Health and Human Services, March 2020

Hasting Center Ethical Framework for Health Care Institutions and Guidelines for Institutional Ethics Services Responding to the Novel Coronavirus Pandemic

John Hick, Dan Hanfling, Matthew Wynia, & Andrew Pavia National Academies of Sciences, Engineering, and Medicine (NASEM) Perspective article on hospital planning for COVID-19 triage: Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2

Guidance on hospital preparation from the Johns Hopkins Center for Health Security: What US Hospitals Should Do Now to Prepare for a COVID-19 Pandemic

Optimizing Surge Capacity: Hospital Assessment and Planning This AHRQ issue brief discusses tools that can assist hospitals and other healthcare facilities with an assessment of their current capacity and develop a plan to achieve optimal surge capacity

Altered Standards of Care in Mass Casualty Events This AHRQ report is a summary of findings that emerged from experts’ discussion of the provision of health and medical care in a mass casualty event. It also includes recommendations for action that could be undertaken to support planning an effective response to a mass casualty event

Addressing Ethical Issues in Pandemic Influenza Planning, World Health Organization, 2007

CDC page on clinical guidance for state and local readiness

Guidance on pandemic influenza from the Pandemic Influenza Ethics Initiative Work Group of the Veteran’s Health Administration’s National Center for Ethics in Health Care (2010): Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care Professionals in the Veterans Health Administration

ASPR TRACIE resource page on crisis standards of care

During A Pandemic, States’ Patchwork Of Crisis Strategies Could Mean Uneven Care—Kaiser Health News article on the state-by-state nature of pandemic preparedness and response, with quotes from Matthew Wynia, John Hick, & James Hodge


Clinical care, prognosis, research findings

A Conversation about Ethical Issues Arising with Use of Telemedicine during This Pandemic, with Gary Fischer, Professor of Medicine and Biomedical Informatics, and Medical Director, Clinical Decision-Support and Analytics, Ambulatory eRecord at the University of Pittsburgh, part of the Pandemic Policies & Practices series co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, June 23

ICU and Palliative Care services have been profoundly affected during the pandemic in ways that raise ethical questions for care during the pandemic and in general:

Life After COVID-19: The Road to Recovery, May 14, surveying the wide range of symptoms and immediate and longer-term outcomes observed thus far

In Should New Mothers with Covid-19 Be Separated From Their Newborns? the authors analyze conflicting guidance and the empirical evidence regarding this question and conclude that “unless a mother consents to separation, there is currently no basis for a medical team to override parental decision-making rights for their child,” May 11

ICU Delirium’ is Leaving COVID-19 Patients Scared and Confused—In “regular” times, delirium has been infrequently discussed with patients entering or likely to enter the ICU; this brief article from The Atlantic (May 5) can help to prepare patients and families during this pandemic. See also The Atlantic’s June 7 article The Overlooked Danger of Delirium in Hospitals (not part of its free COVID-19 coverage).

DoD COVID-19 Practice Management Guide – Clinical management of COVID-19

Some special issues related to pediatrics are described in this 2011 paper: Ethical issues in pediatric emergency mass critical care

University of Washington resources, on its public site, including protocols regarding personal protective equipment, staff precautions, patient care, and autopsy

The COVID-19 Open Research Dataset (CORD-19)

LitCovid is a literature hub for tracking up-to-date scientific information about the 2019 novel Coronavirus, curated by the NIH National Library of Medicine (NLM)


Vulnerable populations and health disparties during the pandemic

What Young, Healthy People Have to Fear From COVID-19, by Atlantic staff writer Derek Thompson, explains that COVID-19 is not quite benign for younger people and why seeking to establish herd immunity is an inappropriate strategy to combat it, September 6

In Why Some People Get Terribly Sick from COVID-19 science journalist Claudia Wallace analyzes some findings about variation in the severity of COVID-19, Scientific American, August 20

A Conversation about the Ethical Concerns of People with Disabilities, with Mary Crossley, Professor of Law at the University of Pittsburgh, part of the Pandemic Policies & Practices series co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, June 9

Science Friday produced a ~35 minute podcast The Many Ways COVID-19 Exacerbates Pre-existing Inequality. Among the resources it recommends are these:

In How Racism Is Shaping the Coronavirus Pandemic, Evelynn Hammonds, Chair of Harvard’s Department of History of Science, is interviewed by Isaac Chotiner for The New Yorker, May 7

The Catholic Health Association of the United States has collected articles reporting on COVID-19 and health disparities

African Americans are disproportionately represented among those infected and among those dying:

Rural communities face particular challenges during the pandemic:

Coronavirus Exposes Public Health Inequities in Indigenous CommunitiesThe Takeaway, April 2 (minutes 1:04 – 13:20)—a report about challenges of COVID-19 facing indigenous people living in both urban and reservation locations

COVID-19: a potential public health problem for homeless populations

Pennsylvania Prison Society supports a COVID-19 resources page related to those incarcerated, which includes an interactive map tracking the spread and mitigation of COVID-19 in Pennsylvania prisons and jails

Flattening the Curve for Incarcerated Populations — Covid-19 in Jails and Prisons—elaborating arguments supporting measures to protect incarcerated and nonincarcerated communities— NEJM, April 2

Older adults are at increased risk:

Pregnant women face particular health- and healthcare-related concerns during the pandemic:


Explaining the pandemic

COVID-101: Doctor-reviewed answers to all your COVID-19 questions. This website states “Our consortium of public health experts, medical doctors, and experts-in-training rapidly review the scientific literature and tell you what you need to know. Each post is reviewed for accuracy by our doctors.”

Estimates of the prevalence of COVID-19 infection and predictions about the course of the current pandemic play a major role in public health and public policy responses to it. Differing views of epidemiologists and philosophers of science reveal the roles played by models and evidence. See, for example:

Anatomy of a Coronavirus - An Interview with Virologist Barbara Sherry, who explains basic issues—e.g., what is a virus, what is the ACE2 receptor, how soap stops the spread of the virus—in an interview with science communicator Brian Malow on April 8

Embracing the Uncertainties—While the unknowns about coronavirus abound, a new study finds we ‘can handle the truth’, New York Times, April 7

How To Test A CountryPlanet Money Episode 981, from March 18, explaining why testing has taken so long to become available in the US

How the Virus Got Out—a New York Times online graphic from March 22

Measuring the basic reproduction rate (R0), dispersion (k), and case fatality rate of coronavirus:

Here’s How the Pandemic Finally Ends gathers comments from 11 experts, including Paul Offit and Zeke Emanuel, on the next one to three years, Politico, September 25

How the Pandemic Will End: The US may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.—by Ed Yong in The Atlantic, March 25

Naming the New Coronavirus – Why Taking Wuhan out of the Picture Matters by the Center affiliated faculty member Mari Webel from the Department of History, writing for The Conversation

Johns Hopkins Corona Virus Resource Center, including its Coronavirus COVID-19 Global Cases map

How Coronavirus Hijacks Your Cells, a New York Times article by Jonathan Corum & Carl Zimmer with helpful graphics

Why outbreaks like coronavirus spread exponentially, and how to “flatten the curve,” an article in the Washington Post by Harry Stevens with a simulation of virus spread

Why the [UK] Government changed tack on COVID-19, Saloni Dattani’s analysis of the UK’s approach—and change in approach—to the pandemic, published by UnHeard

The Imperial College COVID-19 Response Team modeling report that helped to persuade the UK to change its approach, March 16

Two commentaries in tension:


Public health and social policy

Ethics of "reopening"

The Plan That Could Give Us Our Lives Back, by Atlantic staff writers Robinson Meyer and Alexis C. Madrigal, report on a plan that doesn’t depend on a vaccine, but emphasizes testing, August 14

Justin Bernstein, PhD, provides  A Conversation about Lives and Livelihoods: Evaluating What’s at Stake in Reopening in a one-hour webinar co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, August 4

America Is Giving Up on the Pandemic discusses the risk of a resurgence of COVID-19 in the current contest of both venues reopening and responses to police abuse of power, and points to both the role of luck and the role of injustices in the cases and patterns of infection that will result, The Atlantic, June 7

Democracy and Pandemics is a series of essays by social scientists investigating “the implications of Covid-19, pandemics, and major crises more generally, for democratic governance” as “public safety concerns are weighed against foundational freedoms and the norms and expectations of a democratic citizenry.”

Society after Pandemic, by Alondra Nelson, President of the Social Science Research Council, poses this question for social scientists: “how do the social conditions exposed, exacerbated, and created by the novel coronavirus demand that we substantively rethink our ideas of society and, therefore, some of the prevailing assumptions, methods, and theories of social science?”

Mitigating Economic Impacts of the COVID-19 Pandemic and Preserving U.S. Strategic Competitiveness in AI, from the National Security Commission on Artificial Intelligence, “offers recommendations for using AI to mitigate the economic impact of COVID-19, and for protecting AI and other emerging technologies as strategic assets and sources of US and allied economic strength.”

When to Reopen the Nation is an Ethics Question—Not Only a Scientific One elaborates the normative dimensions of the decision about relaxing shelter at home orders, April 28.

COVID-19 Why We Can’t Test Our Way Out of This describes types of testing available and argues that testing is not the panacea it is purported to be, May 6.

What the Proponents of ‘Natural’ Herd Immunity Don’t Say—a May 1 New York Times opinion piece arguing that in the absence of a vaccine attempting to achieve herd immunity would involve “catastrophic loss of lives”

Grappling with the Ethics of Social Distancing: A Framework for Evaluating Social Distancing Policies and Reopening Plans—Plans for “reopening” society by relaxing, replacing, or eliminating at least some social distancing policies raise difficult ethical questions, as well as theoretical questions about modeling and empirical questions with answers that remain uncertain. This article provides a framework for evaluating various plans, and provides a step-by-step process for their evaluation. It also provides a table displaying key features of different plans.

When Can We Go Out? Evaluating Policy Paradigms for Responding to the COVID-19 Threat—this white paper from Harvard’s Edmond J. Safra Center for Ethics is in the Center’s repository containing all of its pandemic-related white papers and opinion pieces by faculty member Danielle Allen

Roadmap to Pandemic Resilience is the product of a bipartisan group of experts in economics, public health, technology, and ethics from across the country gathered by the Edmond J. Safra Center for Ethics with support from The Rockefeller Foundation

The Four Rules of Pandemic EconomicsThe Atlantic staff writer Derek Thompson discusses four key points and notes that saving the economy or saving lives is a false choice, along with his opinion piece, The Economy Is Ruined: It Didn’t Have to Be This Way, both on April 2

Disease Control, Civil Liberties, and Mass Testing — Calibrating Restrictions during the Covid-19 Pandemic, by David M. Studdert and Mark A. Hall (from, respectively Stanford’s and Wake Forest’s Schools of Law and Medicine)

Restarting America Means People Will Die. So When Do We Do It?—in this April 10 issue of The New York Times Magazine, five public scholars, including Ezekiel Emanuel and Peter Singer, discuss “reopening”

Inequality During a Pandemic, Part I: Shared Suffering and Self-Quarantine, by Robert L. Tsai, author of Practical Equality: Forging Justice in a Divided Nation, writing in the Harvard Law Review Blog, April 9

In When Will the Pandemic Cure Be Worse Than the Disease? Peter Singer and Michael Plant argue that directly focusing on well-being enables comparison of physical distancing policies and “reopening,”  April 6

In Pandemic Ethics: Infectious Pathogen Control Measures and Moral Philosophy, Jonathan Pugh and Tom Douglas, Senior Research Fellows at the Oxford Uehiro Centre for Practical Ethics, succinctly discuss utilitarian considerations, “the least restrictive alternative,” and the constraint of proportionality  in developing a pluralist justification for interventions, March 16

Isolated By The Law is the Wake Forest Journal of Law and Policy archive of two webinar series it hosted: one from 2018 on the legal and ethical implications surrounding quarantine during public health emergencies, and the second, a set of 2020 responses to the issues presented in 2018, in light of COVID-19

Building Solidarity: Challenges, Options, and Implications for COVID-19 Responses, a white paper from the Edmond J. Safra Center for Ethics discussing why social solidarity is a prerequisite for the success of more technical interventions during the pandemic and providing some strategies for fostering solidarity, March 30


Face covering and physical distancing

The Unequal Cost of Social Distancing discusses the disparate impact of social distancing on already disadvantaged individuals and households.

A Harm Reduction Approach to Physical Distancing, by Daniel Weinstock suggests thinking about space and time more creatively to make maintaining distance more plausible in the longer term, April 21

Center faculty member Alan Meisel is quoted in this USA Today Fact check: No mask? You can ask why — it isn’t against HIPAA or the Fourth or Fifth Amendments, July 20

Angela Merkel explains the risks of loosening social distancing too rapidly in this video clip with subtitles

Scientific and Ethical Basis for Social-Distancing Interventions Against COVID-1, a March 23 article from The Lancet Infectious Diseases that foretold many of the consequences experiences, while providing the rationale for the policies pursued

This 3-D Simulation Shows Why Social [sic. Physical] Distancing Is So Important; it the spread of coronavirus from a cough, sneeze, or conversation. A video at the end demonstrates through augmented reality technology what physical distancing looks like as one moves through a supermarket; the augmented reality technology may be downloaded for personal use in one’s own space.

Cannonsburg-based Ansys is also developing 3D simulations to encourage physical distancing, such as this comparison of the difference between 3 feet and 6 feet distancing in the presence of a cough.

Dr. David Price of Weill Cornell Medical Center in New York City shares information in a Zoom call with family and friends on empowering and protecting families during the COVID-19 pandemic. Note that this was produced March 22; nevertheless, much of the advice and explanation remains relevant, and its practical, measured approach seems both empowering and comforting. Further note: Since this video was made, all individuals are now being asked, and in many cases required, to cover their nose and mouth—using a nonmedical face mask or scarf—when they leave their homes, to avoid unknowingly transmitting the coronavirus. See:

  • A User's Guide To Masks: What's Best At Protecting Others (And Yourself), NPR, 1

The evolution of advice regarding mask-wearing reflects evolving evidence that the virus is transmitted in ways not initially appreciated; see these articles and a two-day workshop from the National Academies:


Contact tracing and surveillance

Privacy and Ethics Recommendations for Computing Applications Developed to Mitigate COVID-19, from the National Security Commission on Artificial Intelligence, “offers recommendations to put civil liberties at the center of contact tracing methods, and to ensure that federally funded AI tools used in pandemic response account for potential bias and avoid introducing additional unfairness into healthcare delivery and outcomes.”

Transcript: Re-Opening the Nation: Privacy, Surveillance and Digital Tools for Contact Tracing, the transcript of The Hasting Center’s May 18 discussion focused on digital tools and the ethical considerations they raise

A National COVID-19 Surveillance System: Achieving Containment, an April 7 policy report from Duke University’s Margolis Center for Health Policy describing features of a national surveillance system to mitigate the current pandemic wave and to limit and suppress future outbreaks

The European Data Protection Board’s Statement on the Processing of Personal Data in the Context of the COVID-19 Outbreak, adopted March 19

The Value and Ethics of Using Technology to Contain the COVID-19 Epidemic surveys ethical issues presented by some countries’ uses of technology to support nonpharmaceutical interventions in the pandemic, including digital contact tracing and use of geolocation data, April 23

The Value and Ethics of Using Phone Data to Monitor Covid-19, a March 30 analysis in Wired

Ethics and the Conduct of Public Health Surveillance by Amy Fairchild and Ronald Bayer addresses the question of whether the collection and analysis of data should always be considered research and thus be subject to ethical oversight, and whether this oversight should be welcomed or regarded as an impediment, 2004

Ethical Issues in Public Health Surveillance: A Systematic Qualitative Review, 2017 

With more students taking courses online due to the pandemic, an additional form of surveillance is unnerving some: remote proctoring of them taking examinations, as Monica Chin reports in Exam Anxiety: How Remote Test-proctoring Is Creeping Students Out—As Schools Go Remote, So Do Tests and So Does Surveillance, April 29


Immunity testing

Show Me Your Passport: Ethical Concerns About Covid-19 Antibody Testing as Key to Reopening Public Life discusses the scientific limitations of currently available antibody testing and ethical concerns associated with uses of proof of immunity

Should We Turn to Immunity Testing? is the video of The Hastings Center’s May 28 virtual discussion of immunity certification; companies are racing ahead with the creation of digital immunity tools despite unclear science and both legal and ethical concerns. Also available is video of The Hastings Center’s May 18 discussion on Privacy, Surveillance, and Digital Tools for Contact Tracing.

Immunity Passports and the Perils of Conferring Coronavirus Status examines problems with using Smartphone apps to verify whether someone has been infected with COVID-19, May 19, in The New Yorker

Ten Reasons Why Immunity Passports are a Bad Idea, an article in Nature arguing that “restricting movement on the basis of biology threatens freedom, fairness and public health,” May 21

Privileges and Immunity Certification During the COVID-19 Pandemic, by Mark Hall and David Studdert, explains how the prospect of immunity certification would be unparalleled in several ways and raises urgent ethical, legal, and policy concerns

Coronavirus 'Immunity Passports' are not the Answer, commentary from the ACLU (American Civil Liberties Union), May 18

COVID-19 ‘Immunity Passports’ and Dystopian Segregation: A Few Concerns, by Daniel Tigard of the Institute for History & Ethics of Medicine at the Technical University of Munich, in an April 6 bioethics.net post


COVID-19 misinformation

The Epic Battle against Coronavirus Misinformation and Conspiracy Theories, a news report from Nature, May 27

Cognitive attraction and online misinformation, by Alberto Acerbi, finds that misinformation spreads effectively due to its ability to appeal to cognitive preferences without being constrained by adherence to truth, February 19, 2019

Apply Federal Research Rules on Deception to Misleading Health Information: An Example on Smokeless Tobacco and Cigarettes contains ethical and regulatory lessons for addressing COVID-19 misinformation, 2003

In April, the Reuters Institute for the Study of Journalism published a fact sheet based on the analysis of 225 pieces of misinformation rated false or misleading by fact-checkers and published in English January – March 2020. In Types, Sources, and Claims of COVID-19 Misinformation, the investigators report that “rather than being completely fabricated, much of the misinformation … involves various forms of reconfiguration where existing and often true information is spun, twisted, recontextualized, or reworked. Judging from the social media data collected, reconfigured content saw higher engagement than content that was wholly fabricated.”

The World Health Organization published Coronavirus Disease (COVID-19) Advice for the Public: Myth Busters on May 26.

With co-authors, Ron Carico (formerly of the University of Pittsburgh) published Community Pharmacists and Communication in the Time of COVID-19: Applying the Health Belief Model “to explain how community pharmacists can use the constructs of the HBM as a communication guide to move patients toward behaviors that will limit the spread of COVID-19 …  [particularly] patients who may present with anxiety, uncertainty, skepticism, or apprehension regarding COVID-19 mitigation behaviors.” “The HBM was originally developed to study why patients may not seek screening for tuberculosis, and is one of the most prominent public health frameworks for understanding why individuals may or may not act in the face of a threat to personal or community health.”  

In this ~20 minute audio interview, Finding Reliable Information about Covid-19, NEJM editors discuss trustworthy sources of COVID-19 information, May 14.

The Prophecies of Q: American conspiracy theories are entering a dangerous new phase by Adrienne LaFrance in The Atlantic on QAnon, which is the source of the viral “Pandemic” video that is spreading misinformation about COVID-19, June 2020 issue

How the ‘Plandemic’ Movie and Its Falsehoods Spread Widely Online, The New York Times presents this analysis of how the hoax video “Plandemic” entered the mainstream before it was taken down by YouTube and Facebook, May 21

Published on April 30, The Coronavirus Conspiracy Boom, in The Atlantic found “Nearly a third of the people we polled believe that the virus was manufactured on purpose,” and asks “Why?”

Suggestions for combatting misinformation: If Someone Shares the ‘Plandemic’ Video, How Should You Respond?, May 9

 ‘How Could the CDC Make That Mistake?’—On May 21, The Atlantic reports that “the government’s disease-fighting agency is conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies. Pennsylvania, Georgia, Texas, and other states are doing the same.”


Comparative responses to the pandemic

African nations have particular advantages and challenges in addressing COVID-19:

New Zealand has sought to eliminate the virus within its borders.

A Tale of Two Cities: Seattle And New York’s Response To The Pandemic, a 12 minute, April 27 segment of 1A, explores the view of former CDC director Tom Frieden that if New York had learned from Seattle’s experience and implemented stay-at-home orders “ten days earlier than it did, it might have reduced COVID-19 deaths by 50 to 80 percent”

Boris Johnson and COVID-19: A Timeline, Medscape News UK, April 7

Covid-19 and the Stiff Upper Lip — The Pandemic Response in the United Kingdom, NEJM, March 20

Thinking Globally, Acting Locally — The U.S. Response to Covid-19—a policy analysis of state and federal policies, including stay-at-home orders and federal funding initiatives, by Rebecca L. Haffajee and recent Pitt visitor Michelle M. Mello, NEJM, April 1

The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance

Responding to Covid-19 — A Once-in-a-Century Pandemic? by Bill Gates in the NEJM

COVID-19 and the Global Ethics Freefall from The Hastings Center’s Sridhar Venkatapuram

Quarantined Italians’ messages to their earlier (10 days ago) selves and, by extension, to the rest of the world

Lessons from Italy’s Response to Coronavirus from Harvard Business Review writers applying management decisionmaking, in retrospect, to Italy’s response, March 27

Why Germany's Coronavirus Death Rate Is Far Lower Than In Other Countries, NPR, March 25


Research

Vaccine research ethics

The Hastings Center has collected articles from the medical and bioethics literatures regarding COVID-19 vaccine and treatment research

Fair Compensation for Rare [COVID-19] Vaccine Harms, by Art Caplan and Dorit Reiss, advocates expansion of the National Childhood Vaccine Injury Compensation Program, rather than limiting manufacturers’ liability and providing claimants compensation under the Public Readiness and Emergency Preparedness Act, September 9

How the race for a Covid-19 vaccine is getting dirty by Laura Spinney, author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World, reports on global competition to develop a COVID-19 vaccine, The Guardian, August 30

Center faculty member Alex John London was quoted in We can’t skip steps on the road to a COVID-19 vaccine, arguing that emergency conditions should be allowed to rush vaccine research and undermine rigorous scientific standards, The Verge, August 4

Researchers Debate Infecting People on Purpose to Test Coronavirus Vaccines; bioethicists Art Caplan (NYU) and Jeff Kahn (Johns Hopkins) comment on the ethics of human challenge trials for a COVID-19 vaccine, New York Times, July 7

Decades-Old Soviet Studies Hint at Coronavirus Strategy reports on the potential repurposing of polio vaccine to confer protection against the coronavirus, and ethical considerations associated with testing such repurposing, New York Times, June 25

Can a Vaccine for Covid-19 Be Developed in Record Time?—a discussion moderated by Siddhartha Mukherjee, New York Times Magazine, June 14

Human Challenge Studies for Covid-19 Vaccine: Questions about Benefits and Risks, by Ruth Macklin, concludes that it is ethically unjustifiable to begin human challenge trials for a COVID-19 vaccine, a “grave disease lacking an effective treatment,” June 15

Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure argues that by accelerating vaccine evaluation, such studies could reduce the global burden of coronavirus-related mortality and morbidity, and that volunteers could autonomously authorize the risks to themselves and such risks could be acceptable under particular conditions and eligibility criteria, March 31

What risks should be permissible in controlled human infection model studies? evaluates proposals for different risk thresholds for human challenge studies, March 1

Challenge studies of human volunteers: ethical issues argues that such studies are not necessarily unethical, but that the level of risk is critical to ethical assessment of them, 2004

In Compensation for cures: Why we should pay a premium for participation in ‘challenge studies’ Jonathan Anomaly and Julian Savulescu argue that standard worries about paying for participation in risky research, including challenge studies, are reducible to concerns that can be addressed with appropriate screening mechanisms, 2018

The Road to Immunity During COVID-19 — Developing and Distributing a Vaccine—From the American Public Health Association and the National Academy of Medicine, this recorded panel discussion outlines types of vaccines and process of their development and testing, with attention to the manufacture and supply chain, as well as challenges of distribution of what will be an initially short supply of vaccines against COVID-19 (recorded June 10, posted with video and transcript)

Addressing the Coronavirus Challenge, and hour-long talk describing the process of creating vaccines against a previously unknown virus, by Michael Farzan, PhD, Professor and Co-Chair of the Department of Immunology and Microbiology at Scripps Research, April 22, with the talk beginning at minute 6:14

The race for coronavirus vaccines: a graphical guide—Eight ways in which scientists hope to provide immunity to SARS-CoV-2—this graphical guide in Nature explains different vaccine designs.

What risks should be permissible in controlled human infection model studies?—Most agree that controlled human infection model (CHIM) studies deliberately infecting volunteers with pathogens “should be permissible in some circumstances.” Some endorse establishing risk thresholds to protect research participants from the risks of deliberate infection and to maintain public trust, but whether and why risk thresholds are justifiable have not been addressed in great detail. This 2020 paper argues “that there is no clear reason to develop a risk threshold uniquely for CHIM studies” and suggests “that the same constraints that should apply to the risks of non‐therapeutic procedures in other research designs, involving competent, healthy, fully informed adults, should also be invoked for CHIM studies.”

The ethical challenge of infection-inducing challenge experiments—by G. Miller Franklin and Christine Grady, writing in Clinical Infectious Diseases in 2001, offer a framework for evaluating the ethical acceptability of infection-inducing challenge experiments that focuses on their “scientific and public health rationale …, the risks that they pose …, the symptoms experienced by healthy volunteers …, the exclusion of vulnerable research subjects, the informed consent process, the payment of volunteers, and the use of isolation of volunteers to prevent infection of others.”

In 2017, an ethics panel convened by the National Institute of Allergy and Infectious Diseases and the Walter Reed Army Institute of Research published its recommendations regarding a proposal to conduct a controlled infection study in healthy human volunteers to develop a vaccine against the Zika virus. Ethical Considerations for Zika Virus Human Challenge Trials contains considerations pertinent to development of a vaccine for COVID-19.

Ebola vaccine development plan: ethics, concerns and proposed measures—Of particular relevance for this pandemic is this paper’s discussion of whether healthcare workers should be prioritized for vaccine research, as well as the need to counter misinformation in order to facilitate research on a vaccine.

Vaccine testing for emerging infections: the case for individual randomization—Focusing on the 2014-2015 Ebola outbreak, authors Nir Eyal and Marc Lipsitch discuss the debate about using individually randomized controlled trials (iRCTs) to test candidate Ebola vaccines, a debate that centered on “statistical efficiency, logistical feasibility and public acceptability,” as well as ethical concerns. They make an ethical case for employing iRCTs based on benefits to non-participants, post-trial benefits to participants (including post-trial access to the study intervention), participants’ prospects before randomization, and the near-inevitable disparity between arms in any RCT.

Are placebo controls necessary in controlled human infection trials for vaccines?—The authors of this 2020 Personal Viewpoint article in The Lancet review considerations supporting the view that data from past studies (historical data) could be used as a valid alternative to a placebo control group.

"We are the heroes because we are ready to die for this country”: Participants' decision-making and grounded ethics in an Ebola vaccine clinical trial—This 2018 paper in Social Science and Medicine reports participant motivations for volunteering for a vaccine trial, in spite of anxieties, rumors and mistrust surrounding the Ebola outbreak.

Ethics and pre-exposure prophylaxis for HIV infection—Although this article focuses on ethical challenges of testing the effectiveness of PrEP in preventing HIV infection, there are relevant parallels to be drawn for testing of a COVID-19 vaccine, because while “providing preventive modalities besides what is being tested in the trial … may protect participants, it may also undermine the ability of the trial to answer the research question at hand.”

Microneedle array delivered recombinant coronavirus vaccines: Immunogenicity and rapid translational developmentEbioMedicine publication reporting promising vaccine research, tested in mice, by the University of Pittsburgh (with Erasmus Medical Center Rotterdam), April 1

Coronavirus (COVID-19) Update: Vaccines and ImmunityJAMA audio interview with Mayo Vaccine Research Group Director Gregory Poland, MD, who discusses antibody responses, duration of immunity, vaccine safety, and the prospects for using convalescent serum to passively immunize people unexposed to SARS-CoV-2.

Making Emergency Use of Experimental Vaccines Safer (2020)—Reflecting on the Ebola epidemic, the authors analyze challenges of deploying experimental vaccines and present recommendations of the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group.

Guidance for Managing Ethical Issues in Infectious Disease Outbreaks (2016), World Health Organization—“Research is an integral part of the public health response—not only to learn about the current epidemic but also to build an evidence base for future epidemics. Research during an epidemic ranges from epidemiological and socio-behavioral to clinical trials and toxicity studies, all of which are crucial.”

Ethical Considerations of Experimental Interventions in the Ebola Outbreak (2014)—Reflecting on the Ebola epidemic, Rid and Emanuel argue that “experimental Ebola treatments or vaccines should only be deployed in clinical trials. If trials are done, they must meet the eight ethical principles for research.”

Ethics and Etiquette in an Emergency Vaccine Trial. The Orchestration of Compliance (2020)—cautioning readers about generalizing from the Ebola vaccine trial reported, the author analyzes “the practices that contributed to very high compliance rates [in an Ebola vaccine trial]. … This analysis uses the notion of bioetiquette—the set of rules specifying “proper” and “improper” trial subjects and behaviours—which runs in the shadow of formal bioethics in trials and requires careful transdisciplinary examination.”

Infectious Disease Research and Dual-Use Risk (2006)—presents general recommendations to address the dual-use risk presented by vaccine and treatment research on infectious

Ethics Review of Studies during Public Health Emergencies: The Experience of the WHO Ethics Review Committee during the Ebola Virus Disease Epidemic (2017)—Based on a review of 24 new and 22 amended protocols for studies reviewed by the WHO ethics review committee during the Ebola epidemic, including vaccine and drugs trials, the authors make 8 recommendations to accelerate study approval in future public health emergencies.

Ethical considerations in post-market-approval monitoring and regulation of vaccines—This 2014 paper provides a framework for evaluating post-approval oversight of vaccines to minimize potential harms, including both direct harms to health and indirect harms resulting from withdrawal of vaccines from the market, and concomitant special harms to vulnerable populations.


Research on COVID-19 and its treatment

The Hastings Center has collected articles from the medical and bioethics literatures regarding COVID-19 vaccine and treatment research

Where Is America’s Groundbreaking Covid-19 Research? In this New York Times opinion piece, Penn bioethicists Ezekiel J. Emanuel, Cathy Zhang, and Amaya Diana identify 6 lessons from the British COVID-19 research effort which could improve the US effort, September 1

How the World Missed COVID-19’s Silent Spread reports how journals’ publication practices, as well as the effects of competition between laboratories and even countries, shaped understanding of virus transmission, The New York Times, June 28

The Pandemic Claims New Victims: Prestigious Medical Journals, June 15 New York Times front-page report on the retraction of two studies inadequately vetted by The Lancet and NEJM and the challenges for peer review of detecting fraudulent studies, especially in the face of the pandemic’s pressure

‘It’s Just Everywhere Already’: How Delays in Testing Set Back the U.S. Coronavirus Response reports the effect of federal and state authorities not permitting the repurposing of samples from the Seattle flu study to test for the presence of coronavirus, March 10 

In her NEJM letter, Early Detection of Covid-19 through a Citywide Pandemic Surveillance Platform, and related supplement, Helen Chu et al. explain how the Seattle flu study was employed to test for coronavirus and report results under a public health surveillance exemption, May 1

Against pandemic research exceptionalism, by Center faculty member Alex John London from CMU and Jonathan Kimmelman, who argue that rigorous standards for scientific research should not be abandoned in COVID-19 clinical research, April 23

Three related articles by Alex John London:

Also see Placebo use in vaccine trials: Recommendations of a WHO expert panel, 2014, to which he contributed

Companies researching COVID-19 interventions are considering allocation issues regarding the products they are seeking to produce; for example, Johnson & Johnson has issued an Ethical Framework for Decision-Making During the COVID-19 Pandemic.

The Inflated Promise of Genomic Medicine, by Eric Parens, argues that COVID-19 “has laid bare the need to reconsider the hope and money we invest in genetics research,” June 1

The Danger of Rushing Through Clinical Trials During the Coronavirus Pandemican interview in The New Yorker with Peter B. Bach, who runs the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, and who cautions against relaxing rigorous standards for conducting clinical trials in the search for COVID-19 treatments, May 14

Clinical Trials vs. Right to Try: Ethical Use of Chloroquine for Covid-19—Robert Veatch argues that “whether hydroxychloroquine is beneficial or harmful depends not only on the results of trials, but also on the unique value systems of individual patients,” April 29

Ethical Responsibility in Publishing Research Results on Covid-19 Treatments—a brief commentary by Michael Erdek on the risks and ethics of premature publication, April 30

Against pandemic research exceptionalism, by Alex John London and Jonathan Kimmelman, arguing that rigorous standards for scientific research not be abandoned in COVID-19 clinical research, April 23 

Ethics and Evidence in the Search for a Vaccine and Treatments for Covid-19—placing the push to relax scientific standards in the historical context, this brief Hastings Center review recommends against acceding to this pressure, April 15

UPMC led global trial fast tracks testing of hydroxychloroquine, other COVID-19 therapies—in this April 9 news report, Derek Angus, Professor and Chair of Department of Critical Care Medicine at Pitt and UPMC, explains an adaptive clinical trial model that relies on reinforcement learning (a type of artificial intelligence) to identify an evidence-backed therapy for COVID-19 more rapidly than can be achieved through traditional clinical trial approaches

Compassionate Use of Remdesivir for Patients with Severe Covid-19—reporting on a Gilead Sciences funded study of 53 patients, with 36 showing “clinical improvement,” following compassionate use of Remdesivir

FDA Expedites Treatment of Seriously Ill COVID-19 Patients with Experimental Plasma, an NPR news report that includes brief discussion of research risks, March 24

Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics—Arguing for the importance of RCTs with appropriate control groups, the author states: “The administration of any unproven drug as a “last resort” wrongly assumes that benefit will be more likely than harm. However, when a drug with unknown clinical effects is given to patients who have severe illness from a new disease (like COVID-19), there is no way to know whether the patients had benefited or were harmed if they were not compared to a concurrent control group. A common interpretation of off-label use and compassionate use of drugs is that is that if the patient died, they died from the disease, but if the patient survived, they survived because of the given drug. This is not true.”

Ethics Committee Reviews of Applications for Research Studies at 1 Hospital in China During the 2019 Novel Coronavirus Epidemic—Based on an analysis of protocols reviewed by the Ethics Committee of the Henan Provincial People’s Hospital during the COVID-19 epidemic, the authors conclude that “the high frequency of issues with the research proposals and informed consent forms reflect that during an outbreak, researchers may use experimental drugs on affected patients, relax inclusion and exclusion criteria, and fail to offer reasonable compensation or to inform vulnerable patients of trial risks. Because the climate of fear may induce patients to agree to participate in research, the ethics committee paid special attention to such issues.”
 

Infectious Disease Research and Dual-Use Risk, a brief overview of the dual-use research concern that research on infectious agents, their prevention, and their treatment can be diverted and “weaponized”


Conducting research during the pandemic

Social Research and Insecurity—a collection of essays examining “how the pandemic has changed research practice and how researchers and institutions can navigate the insecurity and ethical concerns raised by remote research and transregional collaborations in the age of Covid.”
Cancer Research Ethics and COVID-19—This brief editorial in The Oncologist describes the need to balance responsibilities to oncology trial participants, particularly those in studies that may provide them direct therapeutic benefit, and the constraints imposed by the pandemic.
Preserving Clinical Trial Integrity During the Coronavirus Pandemic by Mary M. McDermott and Anne B. Newman, Chair and Professor of Epidemiology at Pitt
Office of Human Research Protections Guidance on COVID-19, April 8
University of Pittsburgh’s Human Research Protections Office (HRPO) COVID-19 webpage provides guidance on continuing/ceasing research operations and other resources and communications from University leadership
Johns Hopkins Hub on COVID-19 and Research Preparedness: Human Subjects
The COVID-19 Webinar Series (including panelist Art Caplan) from the  WCG Institute, which focuses on clinical research

'It's Quite Painful': Research Labs Shut Down Non-Coronavirus Work Amid Outbreak, a report from Boston’s NPR station, WBUR, March 17


Collections on various issues

Pandemic Ethics: 8 Big Questions of COVID-19, is a very readable (and downloadable) discussion of major ethical challenges revealed by the current pandemic by Ben Bramble, a philosopher at the Australian National University.

Democracy and Pandemics is a series of essays by social scientists investigating “the implications of Covid-19, pandemics, and major crises more generally, for democratic governance” as “public safety concerns are weighed against foundational freedoms and the norms and expectations of a democratic citizenry.”

COVID-19 – ethical issues. A guidance note—British Medical Association, March 2020

AMA Code of Medical Ethics: Guidance in a pandemic

Adapting Standards of Care Under Extreme Conditions, American Nurses Association, 2008

Responding to COVID‐19: How to Navigate a Public Health Emergency Legally and Ethically, an overview by public health law and ethics scholar Larry Gostin with Eric Friedman and Sarah Wetter

New England Journal of Medicine’s collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary

AMA Journal of Ethics COVID-19 Ethics Resource Center

Hastings Center COVID Resources

COVID-19 Responses & Resources from the National Academies of Sciences, Engineering, and Medicine (NASEM) also makes available for public comment a range of plans, including for example, vaccine allocation plans

Pandemic Ethics Literature, a Google Drive repository for Covid-19 resources, developed by Thomas Cunningham, Bioethics Director, Kaiser Permanente, West Los Angeles (and a graduate of Pitt’s MA Program in Bioethics), with the resources categorized as ‘academic’, ‘government’, and ‘other’ (guides, templates, news)

The Medical Ethics of the Coronavirus Crisis, an article by Isaac Chotiner in The New Yorker with quotes from Christine Mitchell

The New York Times is making its COVID-19 coverage available for free, as is the Coronavirus archive at The Atlantic

The UNC Center for Bioethics provides Pandemic Ethics Resources, including webinars, articles, and guidance documents on a range of ethical issues, as well as the field of bioethics and COVID-19

 


Meeting the psychosocial & emotional demands of the pandemic

Soothing, uplifting, or outdoors:

Zoo-Boo Drive-Thru—providing Halloween treats for children and much needed fund-raising for the Pittsburgh Zoo & Aquarium—on October 17, 18, 24, and 25. Featuring contactless distribution of candy and noncandy treats, a guided audio tour, and an opportunity to be part of the Car-stume Parade.

Pittsburgh Zoo Penguins Webcam—Moreover, the zoo itself is open year-round, most of it is outdoors, and it needs the financial support of visitors. Timed tickets are no longer required, but face masks are, both indoors and out.

Monterey Bay Aquarium Webcams:  Jellyfish (1:00 pm – midnight EDT), Kelp Forrest (1:00 pm – 1:00 am EDT), Moon Jelly (1:00 pm – 1:00 am EDT); brief prerecorded clips are available at all times

Some museums are sharing their most “Zen like” works: #MuseumMomentofZen.

 
Art, music, and theater:

Contemporary Craft has opened in its new location in Lawrenceville, with timed ticketing for an exhibition by Swoon, the first woman to gain large-scale recognition in the male-dominated world of street art: The Heart Lives Through the Hands, through January 2021.

The four Carnegie Museums have reopened with timed ticketing: Carnegie Museum of Art and of Natural History, The Warhol, and the Carnegie Science Center. The Heinz History Center is also open.

Traver Gallery in Seattle provides this virtual walking tour of Dale Chihuly's exhibition Chihuly Merletto, which he tours and discusses in this <3 minute video. Chihuly’s process may be seen in this 8 minute video.

For those seeking a brief gallery tour, view these works in glass, “an homage to the future generations of Indigenous people” by Preston Singletary

Virtual tours of over 1200 art museums

A 5-Hour, One-Take Cinematic Tour of Russia’s Hermitage Museum, Shot Entirely on an iPhone

Attack Theatre—founded in 1994 “as a collaboration between two dancers and a city”— is a modern dance company using original live music and interdisciplinary art forms. During the pandemic, it is producing Cello Diary, posted here on April 29, International Dance Day.

The Rotterdam Philharmonic teamed up with a Dutch healthcare provider to film the finale of Beethoven’s 9th with all the musicians playing their parts by video from their homes.

The Metropolitan Opera is streaming its video broadcasts—one per day, available on demand beginning at 7:30 pm. Nightly Met Opera Streams.

The  Folger Shakespeare Library is offering free streaming of Macbeth in an especially vivid production—with violence, magic, and humor—brought to the stage by Emmy-winning magician Teller (of Penn & Teller), Helen Hayes Award-winning director Aaron Posner, and the Two River Theater Company. This “startling, supernatural show brimming with magic, mayhem, and madness” is presented in two parts on YouTube.

You can laugh, you can cry, it may be better than Cats:  With stages dark, several theaters and streaming services are making past productions free for the viewing. See Where to Find Drama Now? All the Internet’s a Stage for a listing, including: the National Theater at Home initiative that uploads an archived production on its YouTube channel every Thursday, where it can be seen, for free, for a week; several free Shakespeare’s Globe productions; and The Show Must Go On! that posts Andrew Lloyd Webber musicals.

Visit the Center’s COVID-19 Health Humanities Resources page.


Mental health, legal support, and on-line access:

The Digital Literacy, Inclusion and Safety Council’s Guide To Internet Plans For Low And Fixed-Income Households is available to assist students (and others with limited income) in accessing the internet during the pandemic.

Being outside is good for physical and mental health, and this video of a truly great natural site in the Pittsburgh region may also help to keep things in perspective. Penn Tree, the white oak featured in the video is estimated to have taken root in 1598. The world was here long before us, and will almost certainly persist long after us, pandemic or not.  Tree Pittsburgh Heritage Nursery collected acorns from the tree to ensure that even if this particular tree does not endure, its genetics will.

When the Well Runs Dry: Compassion Fatigue and the Work of Caregiving—a four-part webinar series providing resources to understand and address the stresses of providing care during this pandemic and at other times, with University of Pittsburgh Department of Medicine faculty members Donna Posluszny and Matthew Muldoon, Pittsburgh Theological Seminary Associate Professor of Pastoral Care Leanna Fuller, and Yoga Therapist Joanne Spence, co-sponsored by the Pittsburgh Theological Seminary and Center for Bioethics & Health LawPart 1-June 18, Part 2-June 25, Part 3-July 2, and Part 4-July 9.

Reading Navigating the Legal Landscape During a Pandemic, from Online Master of Legal Studies Programs, may help to inform questions to ask a lawyer

Sustaining Clinical Empathy During the Pandemic—recommends strategies of engaged curiosity and self-awareness to avoid empathy depletion

Telehealth and Online Mental Health Resources During COVID-19 Pandemic—resources recommended by Sunshine Behavioral Health, which provides substance abuse treatment services

For some people, identifying a way to help other people helps them address their own anxiety, thereby fueling mutual aid efforts like those described in The New Yorker’s What Mutual Aid Can Do during a Pandemic, May 11

The best thing you can do for your health: sleep well—The Guardian, February 9, and as The Guardian also suggests, make a donation if you can to support journalism, or perhaps the arts, your local bookstore, or your local restaurant worker (Virtual Tip Jar); you may sleep better

How Not To Be A Coronavirus Jerk, an article from Vice.com, quoting Center faculty member from CMU, Alex London, on how concepts like patience and empathy, can be helpful during these anxious times

Headspace is offering free subscriptions to all US healthcare workers in 2020, given the circumstances. This is a mindfulness meditation app that comes highly recommended, though not usually inexpensive. To redeem a free subscription, one must provide his/her state and NPI, name, and email address.

Ten Percent Happier is another program/app offering free access for health care workers, with a PROMO Code of HEALTHCARE (in ALL CAPS). One needs to download the app onto a mobile device—a desktop computer will not work—and must log into the app using the same method used to redeem access on the website. The company asks that no one create more than one account and cautions that the website has been overwhelmed, thus necessitating multiple attempts to redeem access.