A Reasonable and Virtuous Response to a Pandemic

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Larissa Fluegel, MD, MHS

Within five days of the first two registered cases here in Michigan, social media traffic about COVID-19 visibly ramped up, with a significant amount of COVID-19-related posts on my news feeds. This was the same for my friends. People were posting photos of entire local store aisles almost empty. I went to the store and to my astonishment, checkout lanes had long lines of individuals with carts filled with toilet paper, water, and hand sanitizer. Every single cart looked the same. I thought, what is happening? The apocalypse? Where have the virtues of altruism and selflessness gone? Anyway, this blog is not about toilet paper or human responses to fear, but about the question of what is safe, appropriate, and virtuous to do at the individual level, all things considered.

no-toilet-paper-flickr-raed-mansour

Image description: Empty shelves that normally contain toilet paper in a Walgreens store, shared on March 13, 2020. Image source: Raed Mansour/Flickr Creative Commons.

What we know.

  • This is a new virus. The fact that it is new means that humans lack the immunity to mount a quick and sufficiently strong response to clear the virus before it causes disease.
  • Based on all 72,314 cases in the Chinese population, most (80.9%) are ‘mild’ respiratory flu-like (but also gastrointestinal); 4.7% turn critical and 2% are fatal.
  • Severity and risk of death increase with age and with pre-existing conditions.
  • There is a two to fourteen-day incubation time (this is the period of time from when the virus first enters one’s body and the time one shows symptoms).
  • Mild soap and water used as recommended are highly effective in eliminating the virus.
  • There is no effective treatment or vaccine against the virus yet.
  • Michigan’s Governor declared a state of emergency on March 10 and mandated all Michiganders to stay home as of March 23. This state of emergency declaration is not intended to cause panic, but instead is to allow the State to quickly deploy resources to support local responses in combatting the spread. This also is done to avoid overwhelming the healthcare system, where patients are being treated in hospital hallways, cared for by exhausted healthcare workers who might be pressed to decide which patients warrant oxygen assistance and which die.

Why do we want to stop the spread?

What we really hope to achieve is to flatten the curve of the spread. The goal is to decrease the rate of infection so that too many people don’t get sick at the same time, going beyond our current health care system’s capacity to safely and effectively treat. By doing so, we protect our fellow citizens. How? By preserving access to necessary medical resources.

What do these things mean to us?

We should understand that eventually we might all get sick. We must not make decisions based on fear. We instead should make decisions based on what we know about the virus and its spread, i.e., the facts and recommendations from reputable health authorities like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) who are carefully monitoring and studying the situation, while avoiding unsupported advice appearing on social media. This is ethical, responsible, and virtuous behavior.

When public health officials strongly recommend that we stay home, we follow their recommendations to the best of our ability because this helps save lives. Remember the issue is no longer about us individually but about us as a community and a nation:

“…[T]o prevent the state’s health care system from being overwhelmed, to allow time for the production of critical test kits, ventilators, and personal protective equipment, and to avoid needless deaths, it is reasonable and necessary to direct residents to remain at home or in their place of residence to the maximum extent feasible.” -The Office of Governor Gretchen Whitmer, Executive Order 2020-21 (COVID-19)

When public health officials strongly recommend that we immediately practice appropriate social distancing, we do that. What this means is that whenever we are able to do so, we should anticipate and avoid places where we cannot be at least 6 feet from another person—except, of course, family members who we live with. If you work in an industry that requires you to show up, do not fret. If the rest of us altruistically do what we can, you should also be okay. If you have a friend or relative who may be at increased risk because of a prior condition, stay away from them—again, let us take care of each other.

But be mindful that social distancing does not mean social isolation. We can and should stay connected through technology that enables us to reach out and connect. This is also good for our emotional and mental health.

Of course, we must not forget to practice respiratory and hand washing etiquette, washing our hands the right way, with soap and running water, when:

  1. You arrive at your location (if leaving home is necessary) and when you return home.
  2. Before and after handling food.
  3. After toileting.

None of these cautions and behavioral virtues suggest that it is necessary to freak out and purchase all the available toilet paper or hand sanitizer. All indications are that food and basic necessities will continue to be available. It does not mean to be obsessively and compulsively spraying disinfectant on every surface of your home multiple times a day, every day. If we practice social distancing or stay home where mandated and practice appropriate hand washing and respiratory etiquette, this is not necessary.

Times like this call for bolstering virtuous behavior. Do what we are told for the sake of all. Do what we can to reconnect with our families and our local community. Do remember those in need. We can go out for a walk or a run or a hike. With appropriate distance these are all okay.

The bottom line is that it is appropriate and virtuous to calmly and sensibly take measures to slow the spread, following guidelines from valid sources while taking care of each other… keeping our distance but keeping in touch.

fluegel-larissa-blogLarissa Fluegel, MD, MHS, is an Adjunct Assistant Professor with the Center for Ethics and Humanities in the Life Sciences and the College of Human Medicine at Michigan State University where she teaches bioethics and the social context of clinical decisions. Her academic interests include the integration of bioethics, social determinants of health, shared decision-making, and health policy into medical education.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, April 9, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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References

  1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity. Epub February 26, 2020. Retrieved March 24, 2020. Available from https://doi.org/10.1016/j.jaut.2020.102433.
  2. Centers for Disease Control and Prevention. “Corona Virus (COVID-19)”. U.S. Department of Health & Human Services. Retrieved March 24, 2020. Available from https://www.cdc.gov/coronavirus/2019-ncov/index.html.
  3. Centers for Disease Control and Prevention. “People who are at higher risk for severe illness.” S. Department of Health & Human Services. March 22, 2020.Retrieved March 24, 2020. Available from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/people-at-higher-risk.html.
  4. Jabr F. Why Soap Works. New York Times. March 13, 2020. https://www.nytimes.com/2020/03/13/health/soap-coronavirus-handwashing-germs.html.
  5. “Coronavirus.” State of Michigan. https://www.michigan.gov/coronavirus/.
  6. Van Beusekom M. “Doctors: COVID-19 pushing Italian ICUs toward collapse”. CIDRAP News. March 16, 2020. Retrieved March 24, 2020. Available from http://www.cidrap.umn.edu/news-perspective/2020/03/doctors-covid-19-pushing-italian-icus-toward-collapse.
  7. Pueyo T. “Coronavirus: Why You Must Act Now.” Updated March 19, 2020. Retrieved March 24, 2020. Available from https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca.
  8. Sousa A. Dean’s Update March 13, 2020. Michigan State University College of Human Medicine. Retrieved March 24, 2020. Available from http://humanmedicine.msu.edu/Deans_Update/2020/03.13.20.htm.
  9. “Stay-at-home executive order now in effect for State of Michigan.” WXYZ Detroit. March 23, 2020. https://www.wxyz.com/news/coronavirus/read-the-full-stay-at-home-executive-order-signed-by-gov-whitmer.
  10. The Office of Governor Gretchen Whitmer. Executive Order 2020-21 (COVID-19). State of Michigan. Retrieved on March 24, 2020. Available from https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-522626–,00.html.
  11. University of Wisconsin Hospitals and Clinics Authority. “COVID-19 Information: What is Social Distancing?” UW Health. Retrieved March 24, 2020. Available from https://coronavirus.uwhealth.org/social-distancing/.
  12. Center for Disease Control and Prevention. “Respiratory Hygiene/Cough Etiquette”. U.S. Department of Health & Human Services. Retrieved March 24, 2020. Available from https://www.cdc.gov/oralhealth/infectioncontrol/faqs/respiratory-hygiene.html.
  13. Center for Disease Control and Prevention. “Keeping Hands Clean”. U.S. Department of Health & Human Services. Retrieved March 24, 2020. Available from https://www.cdc.gov/healthywater/hygiene/hand/handwashing.html.

About Center for Ethics and Humanities in the Life Sciences

Devoted to understanding and teaching the ethical, social and humanistic dimensions of illness and health care since 1977.
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