We need ethics NOW!

Those who know me, know that I've been following the coronavirus since literally

the first case became public back in late November/early December. I attribute my interest in viruses to my wife, who sells vaccines for a large pharmaceutical company. When she went to work, I read up and bit; I've maintained my interest since then.

Epidemiology is complicated. But, you don't have to be an epidemiologist to understand the basic ideas behind detecting and fighting an outbreak. In fact, all you really have to do is read the book, 'The Great Influenza,' which is about the influenza of 1918. The techniques pioneered then are still relevant now, of course refined by the evolution science. There are some other things to study, of course, but this book, written for the non-scientist, is a good place to start.

Anyone who looks into viruses learns this first: testing is the prime directive. Testing is to investigating an epidemic what a telescope is to investigating the universe: without it you are blind. Testing is so fundamental to tracking an epidemic that there is absolutely no excuse for our country's lack of preparedness. The testing fiasco is our country's Original Sin of this entire calamity. And, the testing debacle (trying to find new words to describe it) is not merely a case of casting blame in the midst of a crisis; the continued failure to ramp up testing will hamper our ability to re-open society.

The United States has tested less than 1% of the total population. Appalling is not even an adequate word to describe this failure. By virtually any measure, US testing lags behind Italy and until relatively recently, Spain. And it was extremely slow to get off the ground.

At the very least, we need widely available point-of-care testing. This means if you have symptoms, you can go to a health care provider who will test you and have the results essentially immediately--maybe an hour at most. In this way, we can track the disease, quarantine the sick, keep an eye on the symptomatic and keep the curve flat. Flare-ups will happen but with old fashioned detective work based on high-tech testing, we could manage this until a vaccine becomes available. If this doesn't happen--and it won't--re-opening the country is a roll-of-the-dice. Yet, society is going to have to re-open. Locking down America for a year or 18 months is simply impossible.

As we move to reopen society, we are also going to need to avail ourselves of another skill set that is largely unrelated to epidemiology: ethics. We are going to have weigh the relative value of letting population X be exposed at the cost of population Y. For example, we know that children are less likely to get sick and if they do, their symptoms are likely to be less severe. However, children may infect their parents or their grandparents. Is this a risk worth taking? Re-opening schools is a high priority, in the first instance for educational reasons and in the second instance because in order for parents to return to the workforce, school is needed as a form of childcare. How do we balance these competing interests? This is the province of ethics.

Judaism teaches extensively about ethics, however, these teachings are voluminous, complicated andnuanced. For example the Talmud, Sanhedrin 72b, discusses the choice between saving the life of a fetus and the mother. Here, the Talmud determines that the mother's life takes precedence over the fetus until the head of the fetus crowns the birth canal. Then, no choice can be made and equal effort must be made to save both the baby and the mother.

We will face these types of decisions almost daily as we confront COVID19. We will need to balance many competing interests. What weight do we give to economic vs. health considerations? Is there an acceptable level of illness and death we are willing to accept to get the economy up and running again? Framed another way, is there a level of economic distress we are unwilling to accept in order to 'save a life.' Is it worth yet another restaurant going out of business, putting many people out of work in order to save a single life? 1000 lives? Is this an issue that can even be addressed quantitatively?

The ethics of health care are overwhelming in the best of times. Now, it is exacerbated manyfold. Do we prioritize COVID19 patients over cancer patients that need treatment? Or over heart attack patients and other trauma/emergency patients? Who gets a ventilator if there is a shortage? Who gets the vaccine first, if there is one? Are people over, for example, 80 last in line? 90? 60? Rich people? What if you can't pay? What about poor countries?

These issues and the many more ethical issues are not the province of health care professionals alone. Ideally, as a society, we will create a community dialogue and move toward consensus. Ideally, the leaders of our nation will bring together health care professionals, economists, bio-ethicists, policy experts and maybe even philosophers to thoughtfully and intentionally address the many issues. In the best case scenario--which seems highly unlikely, this will be a completely apolitical process. Stay tuned...there's much more.

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