Legal rights during pandemics: federalism, rights and public health laws--a view from Australia

Ethics and Health Security in the Australian COVID-19 Context: A Critical Interpretive Literature Review

Background The concept of "health security" is often used to motivate public health responses, yet the ethical values that underpin this concept remain largely unexamined. The recent Australian responses to COVID-19 serve as an important case study by which we can analyse the pre-existing literature to see what ethical values shaped, and continue to shape, Australia's response. Methods We conducted a critical interpretive literature review of academic and grey literatures within key databases, resulting in 2,220 sources. After screening for duplicates and relevance, we analysed ninety-six sources. Results First, risk and uncertainty are a leading focus, with a heavy concentration on risks to life and health. Second, free movement, safety, and security were recurringly emphasized, albeit narrowly focused upon the safety of the population. Third, legitimacy was a recurring theme, and it is here that discussions of "health security" figured highly. Conclusion Discussions of harm from government and associated official bodies fail to adequately distinguish between various senses of harm. Moreover, while the literature often discusses the balancing of rights, the steps involved in the weighing of these rights is rarely adequately explained and defended. We suggest that decision-makers should endeavour to clearly identify and defend the values undergirding their decisions in the public sphere.

The implications of COVID-19 legislation on chronic ailments patients: perspectives from Botswana

Purpose

COVID-19 is one of the greatest public health challenges in the 21st century. The World Health Organisation recommended physical distancing to halt the upward trajectory of the infections. Countries including Botswana imposed lockdown for non-essential workers. This paper aims to argue that lockdown as imposed by the Government of Botswana was a necessary measure given the nature of transmission of COVID-19.

Design/methodology/approach

The paper uses exploratory research to unpack impacts of the novel COVID-19 regulations or be responsive to new concerns by breaking new ground through delving into new problem areas. The paper used a use case to explain a single outcome for a single case.

Findings

The restriction on the freedom of movement is necessary to protect citizens, particularly, those with chronic illness from contracting the deadly virus. The paper further observes that while the legislative intent of the GOB was to protect those with chronic illnesses from COVID-19, the lockdown resulted in near death experiences for some chronic ailment patients. These experiences result from unfettered discretion of functionaries who were policing and manning the streets and those who are conferred with authority to issue travel permits to seek and obtain medical assistance, lack of public transport and the processes of applications for the permits, which exposed citizens to COVID-19.

Research limitations/implications

The study was desk based. It may have yielded different results. Lockdowns limited mobility for non-essential services. The full impact of the restrictions and the attendant defaulting was yet to be fully realised. Observing the COVID-19 protocols and bureaucratic requirements for obtaining information from the government offices were major challenges.

Practical implications

Achieving total lockdown as an end in itself may amount to a pyrrhic victory – the authorities may successfully achieve total lockdown but with heavy costs on gains made in combating ailments. Botswana has fought many other pandemics and chronic illnesses still subsist and need to be catered for. For patients, there is not only the complexity of dealing with one chronic condition but also the work of trying to live “normal” lives in the face of co-morbidity, which can be overwhelming. The COVID-19 pandemic adds to the “work” that patients must do to manage and live with such health conditions and the psychological distress.

Social implications

Authorities need to be fully aware of the consequences of their actions. Abrasive actions may lead to a higher constituency of discontent. Botswana has had a good track record of being democratic, and this needs to be strengthened.

Originality/value

The implementation of the COVID-19 regulations particularly the requirement for a travel permit to seek health-care services may hinder access to essential health services and ultimately increase the pressure on emergency services or, at worst, increase mortality. Clear guidelines and sober interpretation of the regulations are necessary. This will also make it easier for the frontline security officers manning the streets to correctly understand the prevailing circumstances. In view of the massive gains garnered in combating chronic illnesses, it is important that such gains are not reversed, while the GOB fights COVID-19. People living with HIV/AIDS, the elderly and people with pre-existing health conditions are known to be at significantly higher risk of developing severe illness when contracting COVID-19. Achieving total lockdown as an end in itself may amount to a pyrrhic victory – the authorities may successfully achieve total lockdown but with heavy costs on gains made in combating other chronic ailments.

A Mixed Approach on Resilience of Spanish Dwellings and Households during COVID-19 Lockdown

The confinement by COVID-19 has meant a re-reading of housing for Spanish households, resulting in the only available and safe space to carry out daily activity. This complex phenomenon has generated a completely different way of inhabiting it, as well as of relating to domestic spaces. For this reason, the home perception and its characteristics must be evaluated, highlighting those perceived as deficiencies, or as preferences in such an unusual context as lockdown, where the experience was different depending on the dwelling characteristics, and the family in question. To deepen in this double perception home-dwelling, a mixed method was used, with two online forms. The first is a quantitative questionnaire, while the second asks the participants for photographs and narratives about such images. More than 1800 surveys and 785 qualitative responses were obtained. From both approaches, the joint discourse arose, allowing an exploratory analysis of the current situation of the Spanish residential park, and the resilience demonstrated in this period by both households and their usual dwellings. This study should facilitate the development of new proposals on housing in contexts similar to the COVID-19 pandemic.

Evidence compendium and advice on social distancing and other related measures for response to an influenza pandemic

The role of social distancing measures in mitigating pandemic influenza is not precisely understood. To this end, we have conducted a systematised review, particularly in light of the 2009 pandemic influenza, to better inform the role of social distancing measures against pandemic influenza. Articles were identified from relevant databases and the data were synthesised to provide evidence on the role of school or work place-based interventions, case-based distancing (self-isolation, quarantine), and restriction of mobility and mass gatherings. School closure, whether proactive or reactive, appears to be moderately effective and acceptable in reducing the transmission of influenza and in delaying the peak of an epidemic but is associated with very high secondary costs. Voluntary home isolation and quarantine are also effective and acceptable measures but there is an increased risk of intra-household transmission from index cases to contacts. Work place-related interventions like work closure and home working are also modestly effective and are acceptable, but likely to be economically disruptive. Internal mobility restriction is effective only if prohibitively high (50% of travel) restrictions are applied and mass gatherings occurring within 10 days before the epidemic peak are likely to increase the risk of transmission of influenza.

Pandemic preparedness in Asia: a role for law and ethics?

Management of pandemic influenza relies on complex coordination of many different dimensions of the health and social care systems, emergency services, levels of national and local government, civil society, communications and media, and cultural expectations. Law is one small but important component of those arrangements, which touch on fundamental ethical debates. This review demonstrates that the Asian region is actively engaging those issues in diverse ways in light of their varied socioeconomic and cultural backgrounds, but scope remains for prioritising further research into these relationships.

Self-reported anticipated compliance with physician advice to stay home during pandemic (H1N1) 2009: results from the 2009 Queensland Social Survey

Background

One strategy available to public health officials during a pandemic is physician recommendations for isolation of infected individuals. This study was undertaken during the height of the Australian pandemic (H1N1) 2009 outbreak to measure self-reported willingness to comply with physician recommendations to stay home for seven days, and to compare responses for the current strain of pandemic influenza, avian influenza, seasonal influenza, and the common cold.

Methods

Data were collected as part of the Queensland Social Survey (QSS) 2009, which consisted of a standardized introduction, 37 demographic questions, and research questions incorporated through a cost-sharing arrangement. Four questions related to respondents' anticipated compliance with a physician's advice to stay home if they had a common cold, seasonal influenza, pandemic (H1N1) 2009 influenza or avian influenza were incorporated into QSS 2009, with responses recorded using a balanced Likert scale ranging from "very unlikely" to "very likely." Discordance between responses for different diseases was analysed using McNemar's test. Associations between demographic variables and anticipated compliance were analysed using Pearson's chi-square or chi-square for linear-by-linear association, and confirmed using multivariate logistic regression; p < 0.05 was used to establish statistical significance.

Results

Self-reported anticipated compliance increased from 59.9% for the common cold to 71.3% for seasonal influenza (p < .001), and to 95.0% for pandemic (H1N1) 2009 influenza and 94.7% for avian influenza (p < 0.001 for both versus seasonal influenza). Anticipated compliance did not differ for pandemic (H1N1) 2009 and avian influenza (p = 0.815). Age and sex were both associated with anticipated compliance in the setting of seasonal influenza and the common cold. Notably, 27.1% of health and community service workers would not comply with physician advice to stay home for seasonal influenza.

Conclusions

Ninety-five percent of people report they would comply with a physicians' advice to stay home for seven days if they are diagnosed with pandemic (H1N1) 2009 or avian influenza, but only 71% can be expected to comply in the setting of seasonal influenza and fewer still can be expected to comply if they are diagnosed with a common cold. Sub-populations that might be worthwhile targets for public health messages aimed at increasing the rate of self-imposed isolation for seasonal influenza include males, younger people, and healthcare workers.