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LETTER TO THE EDITOR
Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 259-261

COVID-19 pandemic: Envisaging delivery of public health services and research activities in an ethical manner


1 Member of the Medical Education Unit and Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpaet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpaet District, Tamil Nadu, India

Date of Submission29-Apr-2020
Date of Decision02-May-2020
Date of Acceptance13-May-2020
Date of Web Publication10-Jul-2020

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpaet District, Tamil Nadu - 603108
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_70_20

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How to cite this article:
Shrivastava SR, Shrivastava PS. COVID-19 pandemic: Envisaging delivery of public health services and research activities in an ethical manner. Curr Med Issues 2020;18:259-61

How to cite this URL:
Shrivastava SR, Shrivastava PS. COVID-19 pandemic: Envisaging delivery of public health services and research activities in an ethical manner. Curr Med Issues [serial online] 2020 [cited 2020 Oct 24];18:259-61. Available from: https://www.cmijournal.org/text.asp?2020/18/3/259/289424



The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health-care delivery system and the public health authorities owing to the sudden rise in the caseload and associated mortality. The global estimates depict that till date, 3,175,207 cases and 224,172 deaths have been reported, which equates to a case fatality rate of 7%.[1] It is worth noting that the disease is predominantly affecting the European and the American regions at present, nevertheless, even other regions have been affected and hence the possibility of the sudden upsurge in the number of cases or a community-based transmission cannot be completely ruled out.[1]

Owing to the novel nature of the disease, with no availability of a drug or a vaccine, clinical trials (preventive or therapeutic) are bound to be conducted to improve the prognosis of the infection in future, and there arises the need to strictly adhere to the standard principles of ethics while being involved in any aspects of patient care.[2],[3] On a similar note, we are still not aware of the multiple epidemiological (viz., the distribution of the disease based on the age, gender, type of work, etc.) and clinical spectrum (such as prognostic factors, factors improving the course of the disease, and development of complications) of the disease.[3],[4] Thus, we have to perform data collection to get significant insights about the disease, and it should be conducted in a dignified manner without compromising the privacy of the person and preserving the collected information in a confidential manner.[2],[3],[4]

Regardless of the reason for data collection (whether it is for research or for the public health priorities), we have to ensure that all the activities are performed in an ethical way and with a single intention to minimize the risk to the individual and the society.[2] In general, for the containment of a pandemic of such enormous magnitude, we have to implement a wide range of public health strategies for the welfare of the masses, but all these strategies should be implemented in a responsible and transparent manner. Further, all actions should be taken to offer the services equitably to all those who need it most, as it will improve the trust of people on the health system and enhance their compliance to the proposed recommendations.[2],[4]

As the disease has been often linked with the sudden upsurge in the cases, the health system can be outstretched beyond their capacity and shortage of logistics is very much possible.[5] This is an ethical scenario wherein we have to establish a triage mechanism and offer immediate care to high-priority group of people in terms of their management.[4],[5] In Italy, a significant upsurge of cases was reported and thus to respond to the challenge of limited number of intensive care unit (ICU) beds and available resources, the nation formulated recommendations to admit and discharge patients in the ICU not only based on the clinical attributes, but also on the principle of distributive justice and appropriate allocation of the scarce health resources.[6]

Moreover, ethically, it is the responsibility of the health authorities to inform the people about the status of the disease, do's and the don'ts, the need to not stigmatize the confirmed cases, and not pass any information to the people which is not evidence based. From the disease containment perspective, it is the ethical duty of the stakeholders to first implement those interventions which have delivered effective results and not aim for innovative solutions right from the start.[3],[4],[5] It is understandable that it will be difficult to implement these measures at the start, but then, it has to be done and the general population can be sensitized about the same through reliable modes of communication. Further, the health authorities can utilize the Forecast tool developed by the World Health Organization to estimate the requirement of the health resources and workforce and be prepared for the large scale of transmission. In fact, the patients can be diverted to other hospitals to avoid unnecessary delay and prompt medical attention, and this tool will help to equally distribute the caseload and manage patients in an innovative and scientific manner.[7]

Time and again, the general population should be sensitized about the need to perform research activities during this emergency, and this will improve their participation in all such planned studies.[2] However, it is important that the same principles, such as obtaining permission from the ethical committee, need to be obtained prior to the start of the study (involving human participants), but the possibility of expediting the review can be definitely tried.[2],[8] Further, it is essential to obtain informed consent from the participants involved in research during this emergency. However, it can be waived by the ethics committee in those studies where it is not feasible to obtain consent or the study has important social consequences or poses minimal risk to the study respondents. Finally, it is our duty to communicate the research findings at the earliest by publishing the same in an open-access journal so that all the stakeholders can use the findings of the study for accomplishing better prevention and care.[2],[3],[6]

In conclusion, in the global efforts to effectively contain the COVID-19 pandemic, it is our duty to offer public health services in a respectful, transparent, and dignified manner and conduct research activities within the purview of ethical principles to ultimately improve the prevention and control services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report – 99. World Health Organization; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation- reports/20200501-covid-19-sitrep.pdf?sfvrsn=742f4a18_2. [Last accessed on 2020 May 02].  Back to cited text no. 1
    
2.
Pan American Health Organization. Ethics Guidance on Issues Raised by the Novel Coronavirus Disease (COVID-19) Pandemic. Washington: WHO Press; 2020. p. 1-7.  Back to cited text no. 2
    
3.
Luo Q, Qin T. Managing clinical trials for covid-19: The importance of ethics committees. BMJ 2020;369:m1369.  Back to cited text no. 3
    
4.
Kramer JB, Brown DE, Kopar PK. Ethics in the time of Coronavirus: Recommendations in the COVID-19 Pandemic. J Am Coll Surg 2020. pii: S1072-7515(20)30309-4.  Back to cited text no. 4
    
5.
Rosenbaum L. Facing Covid19 in ItalyEthics, logistics, and therapeutics on the epidemic's front line. N Engl J Med 2020;382:1873-5.  Back to cited text no. 5
    
6.
Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G, et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: The Italian perspective during the COVID-19 epidemic. Crit Care 2020;24:165.  Back to cited text no. 6
    
7.
World Health Organization. Coronavirus Disease (COVID-19) Technical Guidance: Essential Resource Planning - Forecasting Supplies, Diagnostics and Equipment Requirements. World Health Organization; 2020. Available from: https://www.who.int/emergencies/diseases/no vel-coronavirus-2019/technical-guidance/cov id-19-critical-items. [Last accessed on 2020 May 02].  Back to cited text no. 7
    
8.
World Health Organization. COVID 19 Public Health Emergency of International Concern (PHEIC) –Global Research and Innovation Forum: Towards a Research Roadmap. Geneva: WHO Press; 2020. p. 1-7.  Back to cited text no. 8
    




 

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