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Concerns

  • People are skeptical of the need for masks because at the beginning of the pandemic, public health officials in the U.S. said the general public didn’t need them. National Public Radio
  • Cloth masks are primarily effective at reducing particles from expelling, but are less effective in stopping particles from coming in. A “superspreader” who is not wearing a mask could infect several others who are. Harvard Business Review
  • Some Americans are rejecting face masks and they are not mandated in all U.S. states. Time Magazine
  • Keeping a distance of 6 feet does not guarantee that transmission will not occur. There are several ways that transmission could extend beyond 6 feet. New York Times
  • Scientists are warning the WHO that small, airborne particles can infect people. New York Times

Ethical Principles

  • The ethical principle of transparency requires that decision-makers publicly explain the basis for decisions in language that is linguistically and culturally appropriate. When decisions must be made in the face of uncertain information, the uncertainties should be explicitly acknowledged and conveyed to the public. WHO Ethics in an Outbreak
  • Employ the best available evidence to guide public health work. APHA Code of Ethics, 4.10.1.
  • Recognize and acknowledge when evidence is changing or incomplete and assumptions or contexts change the relevance of evidence. APHA Code of Ethics, 4.10.5. 
  • There should be opportunities to revisit and revise decisions as new information emerges throughout the crisis. There should be mechanisms to address disputes and complaints. University of Toronto 

Recommendations and Practices

  • After experts knew the extent to which people with COVID-19 could spread the virus before symptoms appeared, the CDC updated its guidance to recommend widespread use of simple cloth face coverings. Mayo Clinic
  • Authorities should recognize the reality that the virus spreads through air and recommend that adequate control measures be implemented to prevent further the spread of the virus, in particular the removal of virus-laden droplets from indoor air by ventilation. Environment International

Concerns

  • The United States does not have a coherent plan to safely reopen. Time Magazine
  • The guidelines around social distancing have created confusion and are interpreted differently. New York Times

Ethical Principles

  • Contribute to the development of adequate and effective plans and increase public confidence that policies are reasonable, responsive, non-discriminatory, and in line with local circumstances and values. WHO Ethics in Pandemic Flu
  • The effectiveness of public health policies, practices, and actions depends upon public trust gained through decisions based on the highest ethical, scientific, and professional standards. APHA Code of Ethics
  • Public health practitioners and organizations have an ethical responsibility to prevent, minimize, and mitigate health harms and to promote and protect public safety, health, and well-being. APHA Code of Ethics

Recommendations and Practices

Concerns

  • Individual nerves about spending time with friends who are not as cautious. BBC
  • Some businesses such as gyms are opening, but people wonder if it is safe to go. Vox
  • A rise in coronavirus hospitalizations in several states followed Memorial Day gatherings. The Washington Post

Ethical Principles

  • Promote public compliance and mitigate fears of the unknown and the possibility of social disruption or panic that can result, particularly in circumstances where the public is expected to make sacrifices and possibly incur financial loss or infringements of their personal autonomy. WHO Ethics in Pandemic Flu
  • [Public health policies and practices should] be established by government authorities authorized to enforce public health laws. APHA Code of Ethics, 4.6.1

Recommendations and Practices

Concerns

  • Essential workers need childcare in order to work. EdSurge
  • Essential workers are not able to demand protective gear, family and medical leave, or adequate pay. American Progress
  • Grocery store and warehouse employees say they do not have enough protection at work. They worry they will carry the virus home to their families. New York Times

Ethical Principles

  • Provide adequate institutional and professional support to enable competent performance. APHA Code of Ethics, 4.8.4.
  • Governments and the healthcare sector should institute measures and processes to guarantee provisions and support services to individuals and/or communities affected by restrictive measures. University of Toronto
  • Frontline workers should be given fair remuneration for their work. WHO Ethics in a Outbreak

Recommendations and Practices

Concerns

  • Deaths from a second wave of infections following relaxed physical distancing would be worse for the economy than remaining isolated longer to get the virus more under control. The Verge
  • Due to COVID-19, the economy is reported as a significant source of stress by 7 out of 10 adults in the United States (compared to 46% in 2019). American Psychological Association
  • Rates of depression and anxiety are increasing in Americans, representing the negative mental health effects of coronavirus. The Washington Post
  • Regular care needs have gone unmet because people are afraid to visit the doctor. Child vaccines, including measles, experienced a drastic decline in March and April. Stat News
  • Afraid of catching coronavirus, people with potentially fatal conditions are avoiding the emergency room. This treatment delay leads to worse outcomes or death. ABC News

Ethical Principles

  • Efforts to maximize utility require consideration of proportionality (balancing the potential benefits of an activity against any risks of harm) and efficiency (achieving the greatest benefits at the lowest possible cost). WHO Ethics in an Outbreak
  • Efforts should be made to support the social and professional reintegration of individuals for whom confinement is no longer necessary, including measures to reduce stigmatization and discrimination. WHO Ethics in an Outbreak

Recommendations and Practices

  • CDC Guidelines on coping with stress during coronavirus. CDC
  • Pediatricians urge parents to continue bringing their children to the doctor for routine vaccinations despite coronavirus fear. The Cleveland Clinic
  • Patients are advised to go to the emergency room when immediate medical care is necessary despite coronavirus concerns. Geisinger

Concerns

  • Pandemic shaming is directed at those perceived as violating social-distancing rules. However, complete isolation is not sustainable and has had negative consequences on individuals. The Atlantic
  • Demonstrations around the country have protested restrictive measures. The Washington Post
  • Due to quarantine fatigue, Americans are not going to shut down as they did before. Politico

Ethical Principles

  • Create meaningful opportunities for ongoing dialogue with stakeholder communities and the public at large to identify health challenges, opportunities, and priorities for action. APHA Code of Ethics, 4.4.1
  • Clearly delineate the procedures that must be followed to institute particular public health measures. WHO Ethics in Pandemic Flu

Recommendations and Practices

  • A new outbreak in Beijing led to cancelled flights, suspended schools, and residential compounds ordering to reinstate strict screening. The Guardian
  • Massachusetts General released a guide to overcoming quarantine fatigue. Massachusetts General Hospital

Concerns

  • Retail workers have become public health enforcers and have been met with violent reactions. The New York Times
  • Southwest Airlines instructs flight attendants to inform customers of the mask policy, but not to deny boarding or enforce it if the customer refuses. CNN
  • Law enforcement is hesitant to criminalize the pandemic and use policing to enforce masks. CNY Central

Ethical Principles

  • [Policies and practices used to enforce public health laws should] be established by government authorities authorized to enforce public health laws. APHA Code of Ethics 4.6.1.
  • Requests for voluntary cooperation are generally preferable to public health mandates enforced by law or military authorities. WHO Ethics in an Outbreak
  • Provide authority for appropriate actions that might be necessary in the event of a public health emergency. WHO Ethics in Pandemic Flu

Recommendations and Practices

  • North Carolina is placing the main responsibility on businesses and stores to enforce the use of face coverings. News & Observer
  • Los Angeles will be issuing up to $300 fines to individuals in public who not wearing masks. National Public Radio