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Gómez-Bravo R, Ares-Blanco S, Gefaell Larrondo I, Ramos Del Rio L, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Divjak AĆ, Peña MD, Domeyer PR, Feldmane S, Fitzgerald L, Gjorgjievski D, Gómez-Johansson M, Hanževački M, Ilkov O, Ivanna S, Jandrić-Kočić M, Karathanos VT, Ücüncü E, Kirkovski A, Knežević S, Korkmaz BÇ, Kostić M, Krztoń-Królewiecka A, Kozlovska L, Lingner H, Murauskienė L, Nessler K, Parodi López N, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Sattler M, Seifert B, Serafini A, Sentker T, Ticmane G, Tiili P, Torzsa P, Valtonen K, Vaes B, Vinker S, Neves AL, Guisado-Clavero M, Astier-Peña MP, Hoffmann K. The Use of COVID-19 Mobile Apps in Connecting Patients with Primary Healthcare in 30 Countries: Eurodata Study. Healthcare (Basel) 2024; 12:1420. [PMID: 39057562 PMCID: PMC11275920 DOI: 10.3390/healthcare12141420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. OBJECTIVE To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. METHODOLOGY Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. MAIN OUTCOME MEASURES Patient's first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. RESULTS Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania's apps considered social needs. CONCLUSIONS COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases.
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Affiliation(s)
- Raquel Gómez-Bravo
- Centre Hospitalier Neuro-Psychiatrique, CHNP, 43, Avenue des Alliés, L-9012 Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, Maison des Sciences Humaines 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Avenida de la Albufera, 285, 28038 Madrid, Spain
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Avda. de Atenas, s/n., 28922 Alcorcón, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, calle del Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Ileana Gefaell Larrondo
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria (FIIBAP), 28003 Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion-RICAPPS-(RICORS), 28029 Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Avenida de la Albufera, 285, 28038 Madrid, Spain
| | - Limor Adler
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (S.V.)
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, 451 10 Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, Faculté de Médicine Henri Warembourg, University of Lille, 59045 Lille, CEDEX 1, France
| | | | - Iliana-Carmen Busneag
- Kinetic Therapy and Special Motricity, Faculty of Physical Education and Sport, “Spiru Haret” University, 030045 Bucharest, Romania
| | | | - Maryher Delphin Peña
- Department of Geriatric Medicine, Hôpitaux Robert Schuman, L-1130 Luxembourg, Luxembourg
| | | | - Sabine Feldmane
- Department of Family Medicine, Faculty of Medicine, Rīga Stradins University, LV-1007 Riga, Latvia
| | - Louise Fitzgerald
- Irish College of General Practice (MICGP), Royal College of Physician (MRCSI), D02 YN77 Dublin, Ireland
| | - Dragan Gjorgjievski
- Center for Family Medicine, Medical Faculty Skopje, 1000 Skopje, North Macedonia
| | | | - Miroslav Hanževački
- Department of Family Medicine, “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb West, 10000 Zagreb, Croatia
| | - Oksana Ilkov
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Narodna Square, 3, 88000 Uzhhorod, Transcarpathian Region, Ukraine (S.I.)
| | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Narodna Square, 3, 88000 Uzhhorod, Transcarpathian Region, Ukraine (S.I.)
| | | | - Vasilis Trifon Karathanos
- Medical Education Unit, Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
- General Health System (GHS) Cyprus, 6037 Larnaca, Cyprus
| | - Erva Ücüncü
- Department of Family Medicine, Prof. Dr. Cemil Tascioglu City Hospital, 34384 Istanbul, Turkey
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Snežana Knežević
- Department of Medical Sciences, Academy of Applied Studies Polytechnic, 11000 Belgrade, Serbia;
| | | | - Milena Kostić
- Health Center “Dr. Đorđe Kovačević”, 11550 Lazarevac, Serbia
| | - Anna Krztoń-Królewiecka
- Department of Family Medicine, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
| | - Liga Kozlovska
- Department of Family Medicine, Riga Stradins University, LV-1007 Riga, Latvia (G.T.)
- Rural Family Doctors’ Association of Latvia, LV-4501 Balvi, Latvia
| | - Heidrun Lingner
- Center for Public Health and Healthcare, Department of Medical Psychologie OE5430, Hannover Medical School, 30625 Hannover, Germany
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Katarzyna Nessler
- Department of Family Medicine, Uniwersytet Jagielloński—Collegium Medicum (UJCM), 31-061 Krakow, Poland
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary (P.T.)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, 221 00 Malmö, Sweden;
| | - Goranka Petricek
- Department of Family Medicine, “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, Albertov 7, 110 00 Prague, Czech Republic
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena, Laboratorio EduCare, University of Modena and Reggio Emilia, 41121 Reggio Emilia, Italy
| | - Theresa Sentker
- Center for Public Health and Healthcare, Department of Medical Psychologie OE5430, Hannover Medical School, 30625 Hannover, Germany
| | - Gunta Ticmane
- Department of Family Medicine, Riga Stradins University, LV-1007 Riga, Latvia (G.T.)
- Rural Family Doctors’ Association of Latvia, LV-4501 Balvi, Latvia
| | - Paula Tiili
- Communicable Diseases and Infection Control Unit, Wellbeing Services, County of Vantaa and Kerava, P.O. Box 341, 01301 Vantaa, Finland
- Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary (P.T.)
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, Wellbeing Services, County of Vantaa and Kerava, P.O. Box 341, 01301 Vantaa, Finland
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium;
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (S.V.)
| | - Ana Luisa Neves
- Department of Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK;
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, 28035 Madrid, Spain;
| | - María Pilar Astier-Peña
- Universitas Health Centre, SALUD (Servicio Aragonés de Salud), University of Zaragoza, Andres Vicente 42, 50009 Zaragoza, Spain
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
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Brookfield S. What isn't public health? J Public Health Policy 2023:10.1057/s41271-023-00404-x. [PMID: 37012486 PMCID: PMC10068696 DOI: 10.1057/s41271-023-00404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 04/05/2023]
Abstract
By recognizing the structural causes of health and illness, public health has often been associated with values of compassion and solidarity, and a relational understanding of human agency. Rather than supporting the consistent integration and application of these insights, however, public health is now sometimes invoked more as a rhetorical move, used to construct issues as simple questions of neoliberal scientistic rationalism. Public health practitioners must reckon, therefore, with how the field can be discursively deployed in the public square, for multiple divergent political ends. If public health is always positioned as a value-neutral and detached scientific approach to addressing complex subjects, from drug use to pandemics, it not only fails to connect with the arguments of its critics, but further divorces what was once called the public health 'movement' from the strong and progressive political and theoretical positions it was founded upon and should advocate for today.
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Affiliation(s)
- Samuel Brookfield
- School of Public Health, The University of Queensland, Brisbane, Australia.
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de Miguel Beriain Í, Rueda J. Digital Covid Certificates as Immunity Passports: An Analysis of Their Main Ethical, Legal, and Social Issues. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:635-642. [PMID: 36121608 PMCID: PMC9484347 DOI: 10.1007/s11673-022-10209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Digital COVID certificates are a novel public health policy to tackle the COVID-19 pandemic. These immunity certificates aim to incentivize vaccination and to deny international travel or access to essential spaces to those who are unable to prove that they are not infectious. In this article, we start by describing immunity certificates and highlighting their differences from vaccination certificates. Then, we focus on the ethical, legal, and social issues involved in their use, namely autonomy and consent, data protection, equity, and international mobility from a global fairness perspective. The main conclusion of our analysis is that digital COVID certificates are only acceptable if they meet certain conditions: that they should not process personal data beyond what is strictly necessary for the aimed goals, that equal access to them should be guaranteed, and that they should not restrict people's autonomy to access places where contagion is unlikely. We conclude that, if such conditions are guaranteed, digital COVID certificates could contribute to mitigating some of the most severe socioeconomic consequences of the pandemic.
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Affiliation(s)
| | - Jon Rueda
- Department of Philosophy 1, University of Granada, Granada, Spain
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Jecker NS. Vaccine passports and health disparities: a perilous journey. JOURNAL OF MEDICAL ETHICS 2022; 48:957-960. [PMID: 34244344 DOI: 10.1136/medethics-2021-107491] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/22/2021] [Indexed: 05/03/2023]
Abstract
This paper raises health equity concerns about the use of passports for domestic and international travel to certify COVID-19 vaccination. Part I argues that for international travel, health equity objections undercut arguments defending vaccine passports, which are based on tholding people responsible, protecting global health, safeguarding individual liberty and continuing current practice. Part II entertains a proposal for a scaled down vaccine passport for domestic use in countries where vaccines are widely and equitably available. It raises health equity concerns related to racial profiling and fairness to people who are vaccine cautious. Part III sets forth a proposal for a flexible pass that certifies people who have been vaccinated, tested, previously infected or granted a conscientious objection. It sets ethical guidelines for the timing and use of flexible passes that promote equity, public health education, antidiscrimination, privacy and flexibility.
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Affiliation(s)
- Nancy S Jecker
- Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Philosophy, University of Johannesburg, Auckland Park, Gauteng, South Africa
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Barello S, Acampora M, Paleologo M, Schiavone L, Anderson G, Graffigna G. Public views on the Covid-19 immunity certificate: A scoping review. Health Expect 2022; 25:2645-2657. [PMID: 36168916 PMCID: PMC9538975 DOI: 10.1111/hex.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance. METHODS We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions. RESULTS We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure. CONCLUSION The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure. PATIENT OR PUBLIC CONTRIBUTION This does not apply to our work as it was a review paper.
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Affiliation(s)
- Serena Barello
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Marta Acampora
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Michele Paleologo
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Lavinia Schiavone
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Gloria Anderson
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guendalina Graffigna
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, Italy
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Peters MD. Addressing vaccine hesitancy and resistance for COVID-19 vaccines. Int J Nurs Stud 2022; 131:104241. [PMID: 35489108 PMCID: PMC8972969 DOI: 10.1016/j.ijnurstu.2022.104241] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.
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Affiliation(s)
- Micah D.J. Peters
- University of South Australia, Clinical and Health Sciences, Rosemary Bryant AO Research Centre, City East Campus
- Centenary Building P4-32 North Terrace, Adelaide, SA 5000, Australia,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide Nursing School, Adelaide, SA, Australia,The Centre for Evidence-based Practice South Australia (CEPSA): A Joanna Briggs Institute Centre of Excellence, Australia,Australian Nursing and Midwifery Federation (ANMF) Federal Office, Australia,Correspondence to: University of South Australia, Clinical and Health Sciences, Rosemary Bryant AO Research Centre, City East Campus
- Centenary Building P4-32 North Terrace, Adelaide, SA 5000, Australia
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7
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Abstract
OBJECTIVES More than 1 year after the start of the Covid-19 pandemic it is becoming increasingly clear that vaccines will prove to be essential in combating this global pandemic. The demand for such vaccines is great (since nearly everyone is a candidate for vaccination) yet supplies are currently limited. This raises clear ethical questions regarding the current and future Covid-19 vaccines. METHODS In this paper we highlight the several ethical questions that are raised using a three-fold categorization. We will discuss questions concerning: (1) the design and testing of vaccines; (2) who gets the vaccines; and (3) the tensions between public health and individual interest/autonomy. Each of these three more broad categories encompasses many different and concrete ethical questions. RESULTS We argue that different ethical frameworks apply both across these three categories, but also within these categories. CONCLUSION Despite the fact that ethical conflict might not completely disappear, we argue that distinguishing and discussing separate questions from an ethical perspective can help create the necessary clarity and provide an ethical justification in favour of particular vaccination issues.
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Affiliation(s)
- Kasper Raus
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Eric Mortier
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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8
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Jecker NS. What money can't buy: an argument against paying people to get vaccinated. JOURNAL OF MEDICAL ETHICS 2022; 48:362-366. [PMID: 33811111 DOI: 10.1136/medethics-2021-107235] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 05/26/2023]
Abstract
This paper considers the proposal to pay people to get vaccinated against the SARS-CoV-2 virus. The first section introduces arguments against the proposal, including less intrusive alternatives, unequal effects on populations and economic conditions that render payment more difficult to refuse. The second section considers arguments favouring payment, including arguments appealing to health equity, consistency, being worth the cost, respect for autonomy, good citizenship, the ends justifying the means and the threat of mutant strains. The third section spotlights long-term and short-term best practices that can build trust and reduce 'vaccine hesitancy' better than payment. The paper concludes that people who, for a variety of reasons, are reluctant to vaccinate should be treated like adults, not children. Despite the urgency of getting shots into arms, we should set our sights on the long-term goals of strong relationships and healthy communities.
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Affiliation(s)
- Nancy S Jecker
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
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9
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Pugh J, Savulescu J, Brown RCH, Wilkinson D. The unnaturalistic fallacy: COVID-19 vaccine mandates should not discriminate against natural immunity. JOURNAL OF MEDICAL ETHICS 2022; 48:371-377. [PMID: 35256487 PMCID: PMC9132858 DOI: 10.1136/medethics-2021-107956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/17/2022] [Indexed: 05/07/2023]
Abstract
COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: (1) natural immunity is superior to 'artificial' vaccine-induced immunity simply because it is 'natural' and (2) it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the comparison between naturally acquired immunity and vaccine-induced immunity. While we clearly cannot settle the scientific debates on this point, we suggest that we lack clear and convincing scientific evidence that vaccine-induced immunity has a significantly higher protective effect than natural immunity. Since vaccine requirements represent a substantial infringement of individual liberty, as well as imposing other significant costs, they can only be justified if they are necessary for achieving a proportionate public health benefit. Without compelling evidence for the superiority of vaccine-induced immunity, it cannot be deemed necessary to require vaccination for those with natural immunity. Subjecting them to vaccine mandates is therefore not justified. We conclude by defending the standard of proof that this argument from necessity invokes, and address other pragmatic and practical considerations that may speak against natural immunity exemptions.
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Affiliation(s)
- Jonathan Pugh
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Rebecca C H Brown
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Dominic Wilkinson
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Newborn Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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de Andrés-Sánchez J, Arias-Oliva M, Pelegrin-Borondo J. Citizens’ Perception of COVID-19 Passport Usefulness: A Cross Sectional Study. Behav Sci (Basel) 2022; 12:bs12050140. [PMID: 35621437 PMCID: PMC9137592 DOI: 10.3390/bs12050140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
This paper assesses the influence on people’s perception of the utility of the immunity passport (IP) program by sociodemographic factors, infectivity status, and the objective of its use. The material of this paper is a cross-sectional survey of 400 residents in Spain. The relation between utility perception and input variables is fitted with ordinary least squares (OLS) regression and linear quantile regression (LQR). The principal explanatory variable of usefulness perception is being vaccinated, especially when the objective of the IP is regulating mobility. The OLS estimate of the coefficient regression is (cr) = 0.415 (p = 0.001). We also found a positive and significant influence of that factor in all LQRs (cr = 0.652, p = 0.0026 at level (τ) = 0.75; cr = 0.482, p = 0.0047 at τ = 0.5 and cr = 0.201, p = 0.0385 at τ = 0.25). When the objective of the IP is regulating leisure, being vaccinated is relevant only to explain the central measures of usefulness perception. If the IP is used to regulate traveling, variables related to interviewees’ infectivity have greater relevance than sociodemographic factors. When its objective is ruling assembly, the more important variables than being vaccinated are gender and age. To create an effective implementation of the IP, it is advisable to have a general agreement among the population on its convenience. Therefore, the findings in this study have important implications for public health decision-makers.
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Affiliation(s)
- Jorge de Andrés-Sánchez
- Department of Business Management, Social & Business Research Laboratory, Universitat Rovira i Virgili, 43002 Tarragona, Spain;
- Correspondence: ; Tel.: +34-977759833
| | - Mario Arias-Oliva
- Department of Business Management, Social & Business Research Laboratory, Universitat Rovira i Virgili, 43002 Tarragona, Spain;
- Management and Marketing Department, Complutense University of Madrid, 28040 Madrid, Spain
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11
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Nakada H, Takashima K, Maru Y, Ikka T, Yuji K, Yoshida S, Matsui K. Public Attitudes toward COVID-19 Vaccinations before Dawn in Japan: Ethics and Future Perspectives. Asian Bioeth Rev 2022; 14:287-302. [PMID: 35573157 PMCID: PMC9091544 DOI: 10.1007/s41649-022-00207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Haruka Nakada
- Division of Bioethics and Healthcare Law, Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Kyoko Takashima
- Office of Bioethics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuichi Maru
- Faculty of Regional Sciences, Tottori University, Tottori, Japan
| | - Tsunakuni Ikka
- Division of Bioethics and Healthcare Law, Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Koichiro Yuji
- Project Division of International Advanced Medical Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Sachie Yoshida
- Liberal Arts Center, Hyogo University of Health Sciences, Hobe, Hyogo Japan
| | - Kenji Matsui
- Division of Bioethics and Healthcare Law, Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
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12
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Ethical Attitudes toward COVID-19 Passports: Evidences from Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413098. [PMID: 34948708 PMCID: PMC8702180 DOI: 10.3390/ijerph182413098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
A so-called COVID-19 passport or Immunity passport (IP) has been proposed to facilitate the mobility of individuals while the SARS-CoV-2 pandemic persists. A COVID-19 passport can play a key role in the control of the pandemic, specifically in areas with a high density of population, and the help of smart city technology could be very useful to successfully implement IPs. This research studies the impact of ethical judgments on user attitudes toward using vaccine passports based on a Multidimensional Ethics Scale (MES) that contains five ethical constructs: moral equity, relativism, egoism, utilitarianism, and contractualism. Regression analysis shows that MES satisfactorily explains attitude (R2 = 87.82%, p < 0.001) and that a positive evaluation in moral equity, egoism and utilitarianism is significant (p < 0.001). The objective of the passport (variable leisure) shows a significant negative moderating effect on moral equity (coefficient = −0.147, p = 0.0302) and a positive one on relativism (coefficient = 0.158, p = 0.0287). Adjustment by means of fsQCA shows that five ethical constructs satisfactorily explain both favorable and unfavorable attitudes toward IPs. Solutions explaining acceptance attain an overall consistency (cons) = 0.871 and coverage (cov) = 0.980. In the case of resistance, we found that cons = 0.979 and cov = 0.775. However, that influence is asymmetrical. To have a positive attitude toward the passport, it is a sufficient condition to attain a positive evaluation on a single ethical factor. On the other hand, when explaining resistance, and with the exception of the recipe ~utilitarianism (cons = 0.911 and cov = 0.859), explanatory prime implications require the interaction of at least two variables. Likewise, the context in which the passport is required is significant to explain rejection.
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13
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Tretter M, Ehrlich DB, von Ulmenstein U. Easing Restrictions During Vaccine Scarcity. How Mitigation Measures Help Tackling Associated Moral and Behavioral Challenges. Public Health Rev 2021; 42:1604269. [PMID: 34909235 PMCID: PMC8588827 DOI: 10.3389/phrs.2021.1604269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: When vaccines became first available during the Covid-19 pandemic, their demand significantly exceeded their supply. In consequence, the access to vaccines, initially, was distributed unequally. At the same time, governments started easing pandemic restrictions for vaccinated and recovered persons and restoring their freedoms since their risk of transmitting the virus is significantly reduced. Evidence: We show that restoring freedoms for vaccinated and recovered persons - while upholding restrictions for the rest of the population - is morally unfair during vaccine scarcity. Further, it may yield unintended side-effects, including perverse incentives, growing rifts in society, and the expansion of marginalization. Policy Options & Recommendations: We recommend accompanying easing for vaccinated and recovered individuals by mitigation measures for those who are neither vaccinated nor recovered. We propose, first, to temporarily lift the same restrictions for negative-tested individuals, as for vaccinated or recovered people. Second, the state must ensure broad and easy access to testing for everyone - free of charge. Conclusion: If done right, these mitigation measures create (at least temporarily) equal access to freedom for everybody - solving the moral problem of unfair access to freedoms and counteracting possible negative consequences.
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Affiliation(s)
- Max Tretter
- Department of Theology, University of Erlangen Nuremberg, Erlangen, Germany
| | - David B. Ehrlich
- Department of Economics and Management, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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14
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Hu M, Jia H, Xie Y. Passport to a Mighty Nation: Exploring Sociocultural Foundation of Chinese Public's Attitude to COVID-19 Vaccine Certificates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10439. [PMID: 34639739 PMCID: PMC8507679 DOI: 10.3390/ijerph181910439] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 12/14/2022]
Abstract
Vaccination against COVID-19 is essential against the pandemic. There are broad discussions on adopting certificates for vaccination and the immunity obtained after infection. Based on a national sample of over 2000 participants administered in April 2021, the current study examines the Chinese public's attitudes to the so-called COVID-19 vaccination passport and factors contributing to their viewpoints. Generally, the Chinese people had favorable opinions on the passport. Among possible contributing factors, income, personal benefit perception, the subjective norm of COVID-19 vaccination, and nationalism were significantly associated with the public's positive attitude. At the same time, general vaccine knowledge and scientific literacy had an inconstant effect. Echoing recent studies, these findings reveal a collectivism-oriented attitude of the Chinese public towards the proposal to certify vaccination publicly. Theoretical and practical implications of the results were discussed.
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Affiliation(s)
| | - Hepeng Jia
- School of Communication, Soochow University, Suzhou 215123, China; (M.H.); (Y.X.)
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15
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Porat T, Burnell R, Calvo RA, Ford E, Paudyal P, Baxter WL, Parush A. "Vaccine Passports" May Backfire: Findings from a Cross-Sectional Study in the UK and Israel on Willingness to Get Vaccinated against COVID-19. Vaccines (Basel) 2021; 9:vaccines9080902. [PMID: 34452027 PMCID: PMC8402442 DOI: 10.3390/vaccines9080902] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Domestic “vaccine passports” are being implemented across the world as a way of increasing vaccinated people’s freedom of movement and to encourage vaccination. However, these vaccine passports may affect people’s vaccination decisions in unintended and undesirable ways. This cross-sectional study investigated whether people’s willingness and motivation to get vaccinated relate to their psychological needs (autonomy, competence and relatedness), and how vaccine passports might affect these needs. Across two countries and 1358 participants, we found that need frustration—particularly autonomy frustration—was associated with lower willingness to get vaccinated and with a shift from self-determined to external motivation. In Israel (a country with vaccine passports), people reported greater autonomy frustration than in the UK (a country without vaccine passports). Our findings suggest that control measures, such as domestic vaccine passports, may have detrimental effects on people’s autonomy, motivation, and willingness to get vaccinated. Policies should strive to achieve a highly vaccinated population by supporting individuals’ autonomous motivation to get vaccinated and using messages of autonomy and relatedness, rather than applying pressure and external controls.
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Affiliation(s)
- Talya Porat
- Dyson School of Design Engineering, Imperial College London, London SW7 2DB, UK; (R.B.); (R.A.C.); (W.L.B.)
- Correspondence:
| | - Ryan Burnell
- Dyson School of Design Engineering, Imperial College London, London SW7 2DB, UK; (R.B.); (R.A.C.); (W.L.B.)
| | - Rafael A. Calvo
- Dyson School of Design Engineering, Imperial College London, London SW7 2DB, UK; (R.B.); (R.A.C.); (W.L.B.)
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton BN1 9PH, UK; (E.F.); (P.P.)
| | - Priya Paudyal
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton BN1 9PH, UK; (E.F.); (P.P.)
| | - Weston L. Baxter
- Dyson School of Design Engineering, Imperial College London, London SW7 2DB, UK; (R.B.); (R.A.C.); (W.L.B.)
| | - Avi Parush
- The Faculty of Industrial Engineering & Management, Technion Israel Institute of Technology, Haifa 3200003, Israel;
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16
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Abstract
Babylon 5, like other great sci-fi franchises, touched on important ethical questions. Two ethical conundrums relating to the series' main characters included providing life-saving treatment to a child against their parents' wishes and potential involvement with a highly beneficial but morally dubious medication. I use these cases to discuss some aspects of the COVID-19 vaccines' development and roll-out, demonstrating that people (be it patients or clinicians) might object to some vaccines due to reasonable ethics and safety-based concerns rather than due to an anti-vaxxer mind-set. I highlight that it would be disingenuous to lump these two groups of objections together for not all objections to specific vaccines are objections to vaccination in general. Rather, governments and pharmaceutical companies should seriously engage with the concerns of reasonable objectors to provide citizens with the appropriate products and ensure large vaccination uptake - in the case of COVID-19 this should include giving patients the choice of the product they will be inoculated with.
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Affiliation(s)
- Michal Pruski
- Cardiff and Vale University Health Board, Cardiff, UK
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17
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Lin CN, Chan KR, Ooi EE, Chiou MT, Hoang M, Hsueh PR, Ooi PT. Animal Coronavirus Diseases: Parallels with COVID-19 in Humans. Viruses 2021; 13:1507. [PMID: 34452372 PMCID: PMC8402828 DOI: 10.3390/v13081507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus in humans, has expanded globally over the past year. COVID-19 remains an important subject of intensive research owing to its huge impact on economic and public health globally. Based on historical archives, the first coronavirus-related disease recorded was possibly animal-related, a case of feline infectious peritonitis described as early as 1912. Despite over a century of documented coronaviruses in animals, the global animal industry still suffers from outbreaks. Knowledge and experience handling animal coronaviruses provide a valuable tool to complement our understanding of the ongoing COVID-19 pandemic. In this review, we present an overview of coronaviruses, clinical signs, COVID-19 in animals, genome organization and recombination, immunopathogenesis, transmission, viral shedding, diagnosis, treatment, and prevention. By drawing parallels between COVID-19 in animals and humans, we provide perspectives on the pathophysiological mechanisms by which coronaviruses cause diseases in both animals and humans, providing a critical basis for the development of effective vaccines and therapeutics against these deadly viruses.
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Affiliation(s)
- Chao-Nan Lin
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Animal Disease Diagnostic Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Kuan Rong Chan
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore 169857, Singapore; (K.R.C.); (E.E.O.)
| | - Eng Eong Ooi
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore 169857, Singapore; (K.R.C.); (E.E.O.)
- Viral Research and Experimental Medicine Centre (ViREMiCS), SingHealth Duke-NUS Academic Medical Centre, Singapore 169856, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Ming-Tang Chiou
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Animal Disease Diagnostic Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Minh Hoang
- Department of Anatomy and Histology, College of Veterinary Medicine, Vietnam National University of Agriculture, Hanoi 100000, Vietnam;
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung 404332, Taiwan
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10051, Taiwan
| | - Peck Toung Ooi
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia
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18
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Digital Contact Tracing Applications during COVID-19: A Scoping Review about Public Acceptance. INFORMATICS 2021. [DOI: 10.3390/informatics8030048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Digital contact tracing applications (CTAs) have been one of the most widely discussed technical methods of controlling the COVID-19 outbreak. The effectiveness of this technology and its ethical justification depend highly on public acceptance and adoption. This study aims to describe the current knowledge about public acceptance of CTAs and identify individual perspectives, which are essential to consider concerning CTA acceptance and adoption. In this scoping review, 25 studies from four continents across the globe are compiled, and critical topics are identified and discussed. The results show that public acceptance varies across national cultures and sociodemographic strata. Lower acceptance among people who are mistrusting, socially disadvantaged, or those with low technical skills suggest a risk that CTAs may amplify existing inequities. Regarding determinants of acceptance, eight themes emerged, covering both attitudes and behavioral perspectives that can influence acceptance, including trust, privacy concerns, social responsibility, perceived health threat, experience of and access to technologies, performance expectancy and perceived benefits, and understanding. Furthermore, widespread misconceptions about the CTA function are a topic in need of immediate attention to ensure the safe use of CTAs. The intention-action gap is another topic in need of more research.
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Kosciejew MRH. COVID-19 immunity (or vaccine) passports: a documentary overview and analysis of regimes of health verification within the coronavirus pandemic. JOURNAL OF DOCUMENTATION 2021. [DOI: 10.1108/jd-04-2021-0079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Introducing immunity or vaccine passports is one non-pharmaceutical intervention that governments are considering to exempt immune, vaccinated or otherwise risk-free individuals from lockdowns and other public health restrictions during the coronavirus pandemic. The primary objective of these documents would be to begin reopening societies, restarting economies and returning to a pre-pandemic normalcy. This article aims to present the start of a conceptual documentary analysis of (proposed and existing) COVID-19 immunity passports in order to more fully center their documentary status within research, considerations and conversations about their potential roles, impacts and implications.
Design/methodology/approach
Inspired by Paula A. Treichler's argument for the importance of theoretical thought for untangling the socio-cultural phenomena of epidemics, and drawing upon interdisciplinary theories of documentation, identity and public health, combined with recent news coverage of the coronavirus pandemic, this article provides a contemporary overview and conceptual analysis of emerging documentary regimes of COVID-19 immunity verification involving immunity or vaccine passports.
Findings
Three major interconnected objectives could be fulfilled by immunity passports. First, they would establish and materialize an official identity of COVID-19 immune for people possessing the formal document. Second, they would serve as material evidence establishing and verifying individuals' immunity, vaccination or risk-free status from the coronavirus that would, in term, determine and regulate their movements and other privileges. Third, they would create tangible links between individuals and governments' official or recognized identity category of COVID-19 immune. Immunity passports would, therefore, help enable and enforce governmental authority and power by situating individuals within documentary regimes of COVID-19 immunity verification.
Research limitations/implications
In the expanding interdisciplinary literature on COVID-19 immunity passports, sometimes also called certificates, licenses, or passes, there appears to be only minimal reference to their documentary instantiations, whether physical, digital, and/or hybrid documents. As yet, there is not any specific documentary approach to or analysis of immunity passports as kinds of documentation. A documentary approach helps to illuminate and emphasize the materiality of and ontological considerations concerning the coronavirus pandemic and its associated kinds of immunity or vaccination.
Social implications
By beginning an exploration of what makes immunity passports thinkable as a public health response to the coronavirus pandemic, this article illuminates these health and identity documents' material implications for, and effects on, individuals and societies. This article, therefore, helps shed light on what immunity passports reveal about the complicated and contested intersections of identity, documentation, public health and socio-political control and discipline.
Originality/value
This article contributes the start of a documentary analysis of (proposed and existing) COVID-19 immunity passports in order to more fully center their documentary status within research and conversations about them.
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20
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Pinto LM, Nanda V, Sunavala A, Rodriques C. Reinfection in COVID-19: A scoping review. Med J Armed Forces India 2021; 77:S257-S263. [PMID: 34334891 PMCID: PMC8313064 DOI: 10.1016/j.mjafi.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/23/2021] [Indexed: 11/30/2022] Open
Abstract
Reinfections in COVID-19 are being reported all around the world and are a cause for concern, considering that a lot of our assumptions and modeling (including vaccination) related to the disease have relied on long-term immunity. We were one of the first groups to report a series of 4 healthcare workers to have been reinfected. This review article reports a scoping review of the available literature on reinfections, with a discussion of the implications of reinfections.
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Affiliation(s)
- Lancelot Mark Pinto
- Consultant Pulmonologist, P.D. Hinduja Hospital and Medical Research Center, Mumbai, India
| | - Viral Nanda
- DNB Trainee, P.D. Hinduja Hospital and Medical Research Center, Mumbai, India
| | - Ayesha Sunavala
- Consultant Infectious Diseases, P.D. Hinduja Hospital and Medical Research Center, Mumbai, India
| | - Camilla Rodriques
- Consultant Microbiologist, P.D. Hinduja Hospital and Medical Research Center, Mumbai, India
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21
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Gyngell C, Savulescu J. Ethics of genomic passports: should the genetically resistant be exempted from lockdowns and quarantines? JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107297. [PMID: 34172526 PMCID: PMC9554064 DOI: 10.1136/medethics-2021-107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
Lockdowns and quarantines have been implemented widely in response to the COVID-19 pandemic. This has been accompanied by a rise in interest in the ethics of 'passport' systems that allow low-risk individuals greater freedoms during lockdowns and exemptions to quarantines. Immunity and vaccination passports have been suggested to facilitate the greater movement of those with acquired immunity and who have been vaccinated. Another group of individuals who pose a low risk to others during pandemics are those with genetically mediated resistances to pathogens. In this paper, we introduce the concept of genomic passports, which so far have not been explored in the bioethics literature. Using COVID-19 as an illustrative example, we explore the ethical issues raised by genomic passports and highlight differences and similarities to immunity passports. We conclude that, although there remain significant practical and ethical challenges to the implementation of genomic passports, there will be ways to ethically use them in the future.
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Affiliation(s)
- Christopher Gyngell
- Biomedical Ethics Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julian Savulescu
- Biomedical Ethics Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Faculty of Philosophy, University of Oxford, Oxford, UK
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22
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Drury J, Mao G, John A, Kamal A, Rubin GJ, Stott C, Vandrevala T, Marteau TM. Behavioural responses to Covid-19 health certification: a rapid review. BMC Public Health 2021; 21:1205. [PMID: 34162364 PMCID: PMC8221819 DOI: 10.1186/s12889-021-11166-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Covid-status certification - certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 - has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime. METHOD A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity. RESULTS Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing. CONCLUSIONS The limited evidence suggests that health certification in relation to COVID-19 - outside of the context of international travel - has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.
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Affiliation(s)
- John Drury
- School of Psychology, University of Sussex, Brighton, UK
| | - Guanlan Mao
- School of Psychology, University of Sussex, Brighton, UK
| | - Ann John
- Swansea University, Population Data Science, Swansea, UK
| | - Atiya Kamal
- Department of Psychology, Birmingham City University, Birmingham, UK
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, UK
| | | | - Tushna Vandrevala
- Department of Psychology, Kingston University, Kingston upon Thames, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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23
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Hansson SO, Helgesson G, Juth N. Who should be tested in a pandemic? Ethical considerations. BMC Med Ethics 2021; 22:76. [PMID: 34158041 PMCID: PMC8218570 DOI: 10.1186/s12910-021-00640-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the initial phase of the Covid-19 pandemic, difficult decisions had to be made on the allocation of testing resources. Similar situations can arise in future pandemics. Therefore, careful consideration of who should be tested is an important part of pandemic preparedness. We focus on four ethical aspects of that problem: how to prioritize scarce testing resources, the regulation of commercial direct-to-consumer test services, testing of unauthorized immigrants, and obligatory testing. MAIN TEXT The distribution of scarce resources for testing: We emphasize the use of needs-based criteria, but also acknowledge the importance of choosing a testing strategy that contributes efficiently to stopping the overall spread of the disease. Commercial direct-to-consumer test services: Except in cases of acute scarcity, such services will in practice have to be allowed. We propose that they should be subject to regulation that ensures test quality and adequate information to users. Testing of unauthorized immigrants, their children and other people with unclear legal status: Like everyone else, these individuals may be in need of testing, and it is in society's interest to reach them with testing in order to stop the spread of the disease. A society that offers comprehensive medical services to unauthorized immigrants is in a much better position to reach them in a pandemic than a society that previously excluded them from healthcare. Obligatory testing: While there are often strong reasons for universal testing in residential areas or on workplaces, there are in most cases better ways to achieve testing coverage than to make testing mandatory. CONCLUSION In summary, we propose (1) decision-making primarily based on needs-based criteria, (2) strict regulation but not prohibition of direct-to-consumer test services, (3) test services offered to unauthorized immigrants, preferably as part of comprehensive medical services, and (4) broad outreach of testing services whenever possible, but in general not obligatory testing.
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Affiliation(s)
- Sven Ove Hansson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Division of Philosophy, KTH Royal Institute of Technology, Teknikringen 76, 100 44, Stockholm, Sweden.
| | - Gert Helgesson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Niklas Juth
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
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Safiabadi Tali SH, LeBlanc JJ, Sadiq Z, Oyewunmi OD, Camargo C, Nikpour B, Armanfard N, Sagan SM, Jahanshahi-Anbuhi S. Tools and Techniques for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/COVID-19 Detection. Clin Microbiol Rev 2021; 34:e00228-20. [PMID: 33980687 PMCID: PMC8142517 DOI: 10.1128/cmr.00228-20] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory disease coronavirus 2 (SARS-CoV-2), has led to millions of confirmed cases and deaths worldwide. Efficient diagnostic tools are in high demand, as rapid and large-scale testing plays a pivotal role in patient management and decelerating disease spread. This paper reviews current technologies used to detect SARS-CoV-2 in clinical laboratories as well as advances made for molecular, antigen-based, and immunological point-of-care testing, including recent developments in sensor and biosensor devices. The importance of the timing and type of specimen collection is discussed, along with factors such as disease prevalence, setting, and methods. Details of the mechanisms of action of the various methodologies are presented, along with their application span and known performance characteristics. Diagnostic imaging techniques and biomarkers are also covered, with an emphasis on their use for assessing COVID-19 or monitoring disease severity or complications. While the SARS-CoV-2 literature is rapidly evolving, this review highlights topics of interest that have occurred during the pandemic and the lessons learned throughout. Exploring a broad armamentarium of techniques for detecting SARS-CoV-2 will ensure continued diagnostic support for clinicians, public health, and infection prevention and control for this pandemic and provide advice for future pandemic preparedness.
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Affiliation(s)
- Seyed Hamid Safiabadi Tali
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
- Department of Mechanical, Industrial, and Aerospace Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
| | - Jason J LeBlanc
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Zubi Sadiq
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
| | - Oyejide Damilola Oyewunmi
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
| | - Carolina Camargo
- Department of Microbiology and Immunology, McGill University, Montréal, Québec, Canada
| | - Bahareh Nikpour
- Department of Electrical and Computer Engineering, McGill University, Montréal, Québec, Canada
| | - Narges Armanfard
- Department of Electrical and Computer Engineering, McGill University, Montréal, Québec, Canada
- Mila-Quebec AI Institute, Montréal, Québec, Canada
| | - Selena M Sagan
- Department of Microbiology and Immunology, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Sana Jahanshahi-Anbuhi
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
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Wilson K, Flood CM. Création d’un passeport vaccinal numérique contre le SRAS-CoV-2 au Canada. CMAJ 2021; 193:E942-E944. [PMID: 34860697 PMCID: PMC8248456 DOI: 10.1503/cmaj.210244-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kumanan Wilson
- Faculté de médecine (Wilson), École d'épidémiologie et de santé publique, Université d'Ottawa; Institut de recherche Bruyère et Institut de recherche de l'Hôpital d'Ottawa (Wilson); Faculté de droit (Flood), Section de common law, Université d'Ottawa; Centre de droit, politique et éthique de la santé de l'Université d'Ottawa (Flood), Ottawa, Ont.
| | - Colleen M Flood
- Faculté de médecine (Wilson), École d'épidémiologie et de santé publique, Université d'Ottawa; Institut de recherche Bruyère et Institut de recherche de l'Hôpital d'Ottawa (Wilson); Faculté de droit (Flood), Section de common law, Université d'Ottawa; Centre de droit, politique et éthique de la santé de l'Université d'Ottawa (Flood), Ottawa, Ont
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26
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Meister KD, Pandian V, Hillel AT, Walsh BK, Brodsky MB, Balakrishnan K, Best SR, Chinn SB, Cramer JD, Graboyes EM, McGrath BA, Rassekh CH, Bedwell JR, Brenner MJ. Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg 2021; 164:984-1000. [PMID: 32960148 PMCID: PMC8198753 DOI: 10.1177/0194599820961990] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. DATA SOURCES PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. REVIEW METHODS Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. CONCLUSIONS Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. IMPLICATIONS FOR PRACTICE Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
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Affiliation(s)
- Kara D. Meister
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Vinciya Pandian
- Associate Professor, Department of Nursing Faculty, Johns Hopkins University, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alexander T. Hillel
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Brian K. Walsh
- Professor, Department of Health Sciences, Liberty University, Lynchburg, United States
| | - Martin B. Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
- Associate Professor, Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karthik Balakrishnan
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Simon R. Best
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Steven B. Chinn
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Michigan, United States
| | - John D. Cramer
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Evan M. Graboyes
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
- Hollings Cancer Center, Charleston, South Carolina, United States
| | - Brendan A. McGrath
- Anesthesiology Consultant, University of Manchester, NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Christopher H. Rassekh
- Professor, Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua R. Bedwell
- Associate Professor, Baylor College of Medicine, Houston, Texas, United States
- Associate Professor, Division of Pediatric Otolaryngology-Head and Neck Surgery, Texas Children’s Hospital, Houston, Texas, United States
| | - Michael J. Brenner
- Associate Professor, Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States, and President-elect, Global Tracheostomy Collaborative, Raleigh, North Carolina, United States
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27
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DiSantostefano RL, Terris-Prestholt F. Using Societal Values to Inform Public Health Policy During the COVID-19 Pandemic: The Role of Health Preference Research. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:303-307. [PMID: 33886102 PMCID: PMC8060338 DOI: 10.1007/s40271-021-00516-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 01/16/2023]
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Wilson K, Flood CM. Implementing digital passports for SARS-CoV-2 immunization in Canada. CMAJ 2021; 193:E486-E488. [PMID: 33658246 PMCID: PMC8049642 DOI: 10.1503/cmaj.210244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kumanan Wilson
- Department of Medicine (Wilson), School of Epidemiology and Public Health, University of Ottawa; Bruyère Research Institute and Ottawa Hospital Research Institute (Wilson); Faculty of Law (Flood), Common Law Section, University of Ottawa; University of Ottawa Centre for Health Law Policy & Ethics (Flood), Ottawa, Ont.
| | - Colleen M Flood
- Department of Medicine (Wilson), School of Epidemiology and Public Health, University of Ottawa; Bruyère Research Institute and Ottawa Hospital Research Institute (Wilson); Faculty of Law (Flood), Common Law Section, University of Ottawa; University of Ottawa Centre for Health Law Policy & Ethics (Flood), Ottawa, Ont
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Higgins V, Fabros A, Wang XY, Bhandari M, Daghfal DJ, Kulasingam V. Anti-SARS-CoV-2 IgM improves clinical sensitivity early in disease course. Clin Biochem 2021; 90:1-7. [PMID: 33476578 PMCID: PMC7816645 DOI: 10.1016/j.clinbiochem.2021.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is diagnosed by molecular-based detection of SARS-CoV-2 RNA. Serologic testing detects antibodies specific to SARS-CoV-2 and IgM specifically may serve as an adjunct test to PCR early in disease. We evaluated the Abbott anti-SARS-CoV-2 IgM and IgG assays along with DiaSorin anti-SARS-CoV-2 IgG and Roche anti-SARS-CoV-2 Total. METHODS Specimens from 175 PCR-positive patients and 107 control specimens were analyzed using Abbott IgM and IgG, DiaSorin IgG, and Roche Total (IgA, IgG, IgM) assays. Sensitivity, specificity, cross-reactivity, concordance between assays, trends over time, positive predictive value (PPV), and negative predictive value (NPV) were determined. RESULTS Abbott IgM sensitivity was 63.6% at 0 days post-PCR positivity, 76.5% at 1-5d, 76.3% at 6-14d, 85.2% at 15-30d, and 63.6% at > 30d. All assays exhibited highest sensitivity 15-30d post-PCR positivity (83.3-85.2%). Combining Abbott IgM and IgG improved sensitivity by 22.7% compared to IgG alone when tested 0d post-PCR positivity. All assays had a specificity of 100% and only Abbott IgG exhibited cross-reactivity (anti-dsDNA). Cohen's kappa varied between 0.86 and 0.93. Time to seroconversion from PCR positivity was lowest for Abbott IgM and highest for Abbott IgG. NPV was highest for Abbott IgM < 14 days post-PCR positivity and Abbott IgG ≥ 14 days. CONCLUSION The Abbott IgM assay exhibited the earliest response and greatest signal in most patients evaluated for serial sampling and had the highest NPV < 14 days post-PCR positivity, suggesting its potential utility as an adjunct test to PCR early in disease course.
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Affiliation(s)
- Victoria Higgins
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anselmo Fabros
- Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Xiao Yan Wang
- Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | | | | | - Vathany Kulasingam
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
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30
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Wontakal SN, Bortz RH, Lin WHW, Gendlina I, Fox AS, Hod EA, Chandran K, Prystowsky MB, Weiss LM, Spitalnik SL. Approaching the Interpretation of Discordances in SARS-CoV-2 Testing. Open Forum Infect Dis 2021; 8:ofab144. [PMID: 34316498 PMCID: PMC8083692 DOI: 10.1093/ofid/ofab144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/19/2021] [Indexed: 12/18/2022] Open
Abstract
The coronavirus disease 2019 pandemic has upended life throughout the globe. Appropriate emphasis has been placed on developing effective therapies and vaccines to curb the pandemic. While awaiting such countermeasures, mitigation efforts coupled with robust testing remain essential to controlling spread of the disease. In particular, serological testing plays a critical role in providing important diagnostic, prognostic, and therapeutic information. However, this information is only useful if the results can be accurately interpreted. This pandemic placed clinical testing laboratories and requesting physicians in a precarious position because we are actively learning about the disease and how to interpret serological results. Having developed robust assays to detect antibodies generated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and serving the hardest-hit areas within the New York City epicenter, we found 3 types of discordances in SARS-CoV-2 test results that challenge interpretation. Using representative clinical vignettes, these interpretation dilemmas are highlighted, along with suggested approaches to resolve such cases.
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Affiliation(s)
- Sandeep N Wontakal
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert H Bortz
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Wen-Hsuan W Lin
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Inessa Gendlina
- Department of Medicine (Infectious Disease), Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amy S Fox
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kartik Chandran
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael B Prystowsky
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Louis M Weiss
- Department of Medicine (Infectious Disease), Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven L Spitalnik
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
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Randall P, Bernstein J. Reciprocity and the ethics of giving during pandemics. JOURNAL OF SOCIAL PHILOSOPHY 2021; 52:516-535. [PMID: 34230710 PMCID: PMC8251004 DOI: 10.1111/josp.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/24/2020] [Accepted: 11/30/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Pierce Randall
- Alden March Bioethics InstituteAlbany Medical CenterAlbanyNYUSA
| | - Justin Bernstein
- Department of PhilosophyVrije Universiteit AmsterdamAmsterdamNetherlands
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Quantitative Measurement of Anti-SARS-CoV-2 Antibodies: Analytical and Clinical Evaluation. J Clin Microbiol 2021; 59:JCM.03149-20. [PMID: 33483360 PMCID: PMC8092751 DOI: 10.1128/jcm.03149-20] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/20/2021] [Indexed: 11/28/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). While molecular-based testing is used to diagnose COVID-19, serologic testing of antibodies specific to SARS-CoV-2 is used to detect past infection. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Molecular-based testing is used to diagnose COVID-19, and serologic testing of antibodies specific to SARS-CoV-2 is used to detect past infection. While most serologic assays are qualitative, a quantitative serologic assay was recently developed that measures antibodies against the S protein, the target of vaccines. Quantitative antibody determination may help determine antibody titer and facilitate longitudinal monitoring of the antibody response, including antibody response to vaccines. We evaluated the quantitative Roche Elecsys anti-SARS-CoV-2 S assay. Specimens from 167 PCR-positive patients and 103 control specimens were analyzed using the Elecsys anti-SARS-CoV-2 S assay on the cobas e411 (Roche Diagnostics). Analytical evaluation included assessing linearity, imprecision, and analytical sensitivity. Clinical evaluation included assessing clinical sensitivity, specificity, cross-reactivity, positive predictive value (PPV), negative predictive value (NPV), and serial sampling from the same patient. The Elecsys anti-SARS-CoV-2 S assay exhibited its highest sensitivity (84.0%) at 15 to 30 days post-PCR positivity and exhibited no cross-reactivity, a specificity and PPV of 100%, and an NPV between 98.3% and 99.8% at ≥14 days post-PCR positivity, depending on the seroprevalence estimate. Imprecision was <2% at 9.06 U/ml across 6 days, the negative quality control (QC) was consistently negative (<0.40 U/ml), the manufacturer’s claimed limit of quantitation of 0.40 U/ml was verified, and linearity across the analytical measuring range was observed, except at the low end (<20 U/ml). Lastly, antibody response showed high interindividual variation in level and time of peak antibody titer and trends over time.
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Gómez-Ramírez O, Iyamu I, Ablona A, Watt S, Xu AXT, Chang HJ, Gilbert M. On the imperative of thinking through the ethical, health equity, and social justice possibilities and limits of digital technologies in public health. Canadian Journal of Public Health 2021; 112:412-416. [PMID: 33725332 PMCID: PMC7962628 DOI: 10.17269/s41997-021-00487-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic has demonstrated both the positive and negative use, usefulness, and impact of digital technologies in public health. Digitalization can help advance and sustain the core functions of public health, including health promotion and prevention, epidemiological surveillance, and response to emergent health issues. Digital technologies are thus—in some areas of public discourse—presented as being both necessary and inevitable requirements to address routine and emergency public health issues. However, the circumstances, ways, and extent to which they apply remain a subject of critical reflection and empirical investigation. In this commentary, we argue that we must think through the use of digital technologies in public health and that their usefulness must be assessed in relation to their short- and long-term ethical, health equity, and social justice implications. Neither a sense of digital technological optimism and determinism nor the demands of addressing pressing public health issues should override critical assessment before development and implementation. The urgency of addressing public health emergencies such as the ongoing COVID-19 pandemic requires prompt and effective action, including action facilitated by digital technologies. Nevertheless, a sense of urgency cannot be an excuse or a substitute for a critical assessment of the tools employed.
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Affiliation(s)
- Oralia Gómez-Ramírez
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. .,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.
| | - Ihoghosa Iyamu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Aidan Ablona
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Sarah Watt
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Alice X T Xu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hsiu-Ju Chang
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Brown RCH, Kelly D, Wilkinson D, Savulescu J. The scientific and ethical feasibility of immunity passports. THE LANCET. INFECTIOUS DISEASES 2021; 21:e58-e63. [PMID: 33075284 PMCID: PMC7567527 DOI: 10.1016/s1473-3099(20)30766-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
There is much debate about the use of immunity passports in the response to the COVID-19 pandemic. Some have argued that immunity passports are unethical and impractical, pointing to uncertainties relating to COVID-19 immunity, issues with testing, perverse incentives, doubtful economic benefits, privacy concerns, and the risk of discriminatory effects. We first review the scientific feasibility of immunity passports. Considerable hurdles remain, but increasing understanding of the neutralising antibody response to COVID-19 might make identifying members of the community at low risk of contracting and transmitting COVID-19 possible. We respond to the ethical arguments against immunity passports and give the positive ethical arguments. First, a strong presumption should be in favour of preserving people's free movement if at all feasible. Second, failing to recognise the reduced infection threat immune individuals pose risks punishing people for low-risk behaviour. Finally, further individual and social benefits are likely to accrue from allowing people to engage in free movement. Challenges relating to the implementation of immunity passports ought to be met with targeted solutions so as to maximise their benefit.
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Affiliation(s)
- Rebecca C H Brown
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
| | - Dominic Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Department of Paediatrics, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Melbourne Law School, Melbourne University, Melbourne, VIC, Australia
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Public understanding of COVID-19 antibody testing and test results: A qualitative study conducted in the U.K. early in the pandemic. Soc Sci Med 2021; 273:113778. [PMID: 33636445 PMCID: PMC7884253 DOI: 10.1016/j.socscimed.2021.113778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
Background During the COVID-19 pandemic, antibody testing was proposed by several countries as a surveillance tool to monitor the spread of the virus and potentially to ease restrictions. In the UK, antibody testing originally formed the third pillar of the UK Government's COVID-19 testing programme and was thought to offer hope that those with a positive antibody test result could return to normal life. However, at that time scientists and the public had little understanding of the longevity of COVID-19 antibodies, and whether they provided immunity to reinfection or transmission of the virus. Objective This paper explores the UK public's understanding of COVID-19 testing, perceived test accuracy, the meaning of a positive test result, willingness to adhere to restrictive measures in response to an antibody test result and how they expect other people to respond. Methods On-line synchronous focus groups were conducted in April/May 2020 during the first wave of the pandemic and the most stringent period of the COVID-19 restrictive measures. Data were analysed thematically. Results There was confusion in responses as to whether those with a positive or negative test should return to work and which restrictive measures would apply to them or their household members. Participants raised concerns about the wider public response to positive antibody test results and the adverse behavioural effects. There were worries that antibody tests could create a divided society particularly if those with a positive test result were given greater freedoms or chose to disregard the restrictive measures. Conclusion Should these tests be offered more widely, information should be developed in consultation with the public to ensure clarity and address uncertainty about test results and subsequent behaviours.
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Clinical correlates of anti-SARS-CoV-2 antibody profiles in Spanish COVID-19 patients from a high incidence region. Sci Rep 2021; 11:4363. [PMID: 33623101 PMCID: PMC7902674 DOI: 10.1038/s41598-021-83969-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Laboratory testing for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) consists of two pillars: the detection of viral RNA via rt-PCR as the diagnostic gold standard in acute cases, and the detection of antibodies against SARS-CoV-2. However, concerning the latter, questions remain about their diagnostic and prognostic value and it is not clear whether all patients develop detectable antibodies. We examined sera from 347 Spanish COVID-19 patients, collected during the peak of the epidemic outbreak in Spain, for the presence of IgA and IgG antibodies against SARS-CoV-2 and evaluated possible associations with age, sex and disease severity (as measured by duration of hospitalization, kind of respiratory support, treatment in ICU and death). The presence and to some degree the levels of anti-SARS-CoV-2 antibodies depended mainly on the amount of time between onset of symptoms and the collection of serum. A subgroup of patients did not develop antibodies at the time of sample collection. Compared to the patients that did, no differences were found. The presence and level of antibodies was not associated with age, sex, duration of hospitalization, treatment in the ICU or death. The case-fatality rate increased exponentially with older age. Neither the presence, nor the levels of anti-SARS-CoV-2 antibodies served as prognostic markers in our cohort. This is discussed as a possible consequence of the timing of the sample collection. Age is the most important risk factor for an adverse outcome in our cohort. Some patients appear not to develop antibodies within a reasonable time frame. It is unclear, however, why that is, as these patients differ in no respect examined by us from those who developed antibodies.
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Liz J. COVID-19, immunoprivilege and structural inequalities. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:19. [PMID: 33566205 PMCID: PMC7874558 DOI: 10.1007/s40656-020-00356-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/06/2020] [Indexed: 05/30/2023]
Abstract
As cases of COVID-19 continue to rise, some countries, including the US, Chile, and Germany, have considered issuing "immunity passports." This possibility has raised concerns and debate regarding their potential social, political and economic ramifications, especially for marginalized communities. This paper contributes to that debate by exposing that ways in which immunoprivilege already exists and operates within our present system of structural inequalities.
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Affiliation(s)
- Jordan Liz
- San José State University, 201 Faculty Office Building, One Washington Square, San José, CA, 95192-0096, USA.
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Thomas A, Messer WB, Hansel DE, Streblow DN, Kazmierczak SC, Lyski ZL, Lu Z, Slifka MK. Establishment of Monoclonal Antibody Standards for Quantitative Serological Diagnosis of SARS-CoV-2 in Low-Incidence Settings. Open Forum Infect Dis 2021; 8:ofab061. [PMID: 33723513 PMCID: PMC7928679 DOI: 10.1093/ofid/ofab061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 11/14/2022] Open
Abstract
Background Serological confirmation of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical for understanding the dynamics of the pandemic and determining seroprevalence rates within afflicted communities. Common challenges with SARS-CoV-2 serological assays include poor analytical specificity and sensitivity and lack of a serological standard for quantitative assessment of antibody titers. Methods To overcome these obstacles, we developed a quantitative enzyme-linked immunosorbent assay based on an optimized 2-dimensional screening assay that utilizes SARS-CoV-2 receptor binding domain (RBD) of spike protein and SARS-CoV-2 spike S1 subunit. Results A total of 4 SARS-CoV-2-reactive monoclonal antibodies were evaluated for use as serum standards for calibrating assays performed on different days or by different laboratories. This approach provided quantitative analysis of hospitalized reverse transcription polymerase chain reaction–confirmed COVID-19 cases that in some cases reached >100 μg/mL. The assay demonstrated 72% sensitivity based on time points ranging from 2 to 52 days post–symptom onset, with 100% sensitivity at time points measured ≥13 days post–symptom onset and 100% specificity. Conclusions Using these optimized reagents and serological standards, we believe this approach will be useful for sensitive and specific determination of seroconversion rates and quantitatively measuring the durability of antiviral antibody responses following SARS-CoV-2 infection or vaccination.
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Affiliation(s)
- Archana Thomas
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
| | - William B Messer
- Department of Molecular Microbiology and Immunology, Program in Epidemiology, OHSU-PSU School of Public Health, Portland, Oregon, USA.,Division of Infectious Diseases, Department of Medicine, Program in Epidemiology, OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Donna E Hansel
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel N Streblow
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, USA
| | - Steven C Kazmierczak
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Zoe L Lyski
- Department of Molecular Microbiology and Immunology, Program in Epidemiology, OHSU-PSU School of Public Health, Portland, Oregon, USA.,Division of Infectious Diseases, Department of Medicine, Program in Epidemiology, OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Zhengchun Lu
- Department of Molecular Microbiology and Immunology, Program in Epidemiology, OHSU-PSU School of Public Health, Portland, Oregon, USA.,Division of Infectious Diseases, Department of Medicine, Program in Epidemiology, OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
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Fiocchi A, Jensen-Jarolim E. SARS-COV-2, can you be over it? World Allergy Organ J 2021; 14:100514. [PMID: 33552379 PMCID: PMC7846213 DOI: 10.1016/j.waojou.2021.100514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Uncertainty has surrounded the duration of immunity against SARS CoV-2. This concerns both the duration of vaccine immunity and the duration of natural immunity. We aim to critically review the information available today, and draw practical conclusions. METHODS This is a narrative review of the recently published information on the topic, compared with the knowledge we already have of the behavior of various viral infectious agents. RESULTS It is too early to have any meaningful information on the duration of vaccine immunity against SARS CoV-2. For those who already had the infeciton, the rate of reinfection is very low. Most reinfections are due to laboratory errors, to incomplete cure of the primary infection, to the supervening immunodeficiency of the host, or to pre-existing immunodeficiency made evident by the SARS CoV-2 infection. The available studies on the immunology of the infection converge in indicating that it generates a robust and persistent immunity. This behavior does not differ from that of respiratory viruses known to date: in naturally occurring viral respiratory infections, reinfections are exceptional. CONCLUSIONS AND IMPLICATIONS The civil community awaits suggestions from scientists not only to protect susceptible people, but to be able to safely resume activities made uncertain by the pandemic. From the information we have to-date, we suggest that, in principle, patients who have already overcome the infection should not be prioritized to the SARS CoV-2 vaccine. Instead, they could be provided with an immunological passport that allows them to resume a normal social life.
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Affiliation(s)
- Alessandro Fiocchi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Erika Jensen-Jarolim
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectivology and Immunology, Medical University of Vienna, Vienna, Austria
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Lewandowsky S, Dennis S, Perfors A, Kashima Y, White JP, Garrett P, Little DR, Yesilada M. Public acceptance of privacy-encroaching policies to address the COVID-19 pandemic in the United Kingdom. PLoS One 2021; 16:e0245740. [PMID: 33481877 PMCID: PMC7822290 DOI: 10.1371/journal.pone.0245740] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/06/2021] [Indexed: 12/30/2022] Open
Abstract
The nature of the COVID-19 pandemic may require governments to use privacy-encroaching technologies to help contain its spread. One technology involves co-location tracking through mobile Wi-Fi, GPS, and Bluetooth to permit health agencies to monitor people's contact with each other, thereby triggering targeted social-distancing when a person turns out to be infected. The effectiveness of tracking relies on the willingness of the population to support such privacy encroaching measures. We report the results of two large surveys in the United Kingdom, conducted during the peak of the pandemic, that probe people's attitudes towards various tracking technologies. The results show that by and large there is widespread acceptance for co-location tracking. Acceptance increases when the measures are explicitly time-limited and come with opt-out clauses or other assurances of privacy. Another possible future technology to control the pandemic involves "immunity passports", which could be issued to people who carry antibodies for the COVID-19 virus, potentially implying that they are immune and therefore unable to spread the virus to other people. Immunity passports have been considered as a potential future step to manage the pandemic. We probe people's attitudes towards immunity passports and find considerable support overall, although around 20% of the public strongly oppose passports.
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Affiliation(s)
- Stephan Lewandowsky
- University of Bristol, Bristol, United Kingdom
- University of Western Australia, Perth, Australia
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Savulescu J. Provide Vaccines, Not Require Immunity or Vaccination Passports … For Now. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:303-306. [PMID: 34924044 DOI: 10.1017/jme.2021.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In principle, mandatory vaccination in employment could be justified in certain circumstances. These include: (1) the availability of safe and effective vaccination; (2) if alternative, less coercive strategies did not work; and, (3) the costs to the individual were proportionate. However, in COVID-19, the long term safety of vaccines is yet to be established. Vaccines should be made available by employers, and voluntary vaccination encouraged.
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Asselah T, Durantel D, Pasmant E, Lau G, Schinazi RF. COVID-19: Discovery, diagnostics and drug development. J Hepatol 2021; 74:168-184. [PMID: 33038433 PMCID: PMC7543767 DOI: 10.1016/j.jhep.2020.09.031] [Citation(s) in RCA: 237] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) started as an epidemic in Wuhan in 2019, and has since become a pandemic. Groups from China identified and sequenced the virus responsible for COVID-19, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and determined that it was a novel coronavirus sharing high sequence identity with bat- and pangolin-derived SARS-like coronaviruses, suggesting a zoonotic origin. SARS-CoV-2 is a member of the Coronaviridae family of enveloped, positive-sense, single-stranded RNA viruses that infect a broad range of vertebrates. The rapid release of the sequence of the virus has enabled the development of diagnostic tools. Additionally, serological tests can now identify individuals who have been infected. SARS-CoV-2 infection is associated with a fatality rate of around 1-3%, which is commonly linked to the development of acute respiratory distress syndrome (ARDS), likely resulting from uncontrolled immune activation, the so called "cytokine storm". Risk factors for mortality include advanced age, obesity, diabetes, and hypertension. Drug repurposing has been used to rapidly identify potential treatments for COVID-19, which could move quickly to phase III. Better knowledge of the virus and its enzymes will aid the development of more potent and specific direct-acting antivirals. In the long term, a vaccine to prevent infection is crucial; however, even if successful, it might not be available before 2021-22. To date, except for intravenous remdesivir and dexamethasone, which have modest effects in moderate to severe COVID-19, no strong clinical evidence supports the efficacy of any other drugs against SARS-CoV-2. The aim of this review is to provide insights on the discovery of SARS-CoV-2, its virology, diagnostic tools, and the ongoing drug discovery effort.
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Affiliation(s)
- Tarik Asselah
- Université de Paris, CRI, INSERM UMR 1149, Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France.
| | - David Durantel
- INSERM, U1052, Cancer Research Center of Lyon (CRCL), Université de Lyon (UCBL1), CNRS UMR_5286, France
| | - Eric Pasmant
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, AP-HP.Centre-Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université de Paris, CARPEM, Paris, France
| | - George Lau
- Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong SAR, China; Liver disease and Transplant Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Raymond F. Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, 1760 Haygood Drive, Atlanta, GA 30322, USA
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Abstract
Testing for SARS-CoV-2 has attracted a tremendous amount of attention as a tool to manage the ongoing COVID-19 pandemic. Although diagnostic laboratory testing is used ubiquitously by physicians and encountered regularly by individuals receiving medical care, several aspects of test interpretation are incompletely understood by medical communities and the general population, creating a significant challenge in minimizing the damage caused by disease spread through informed decision making and proper testing utilization. Here, general principles of test interpretation are reviewed and applied to specific examples, such as whether asymptomatic individuals should be tested, what it means to test positive (or negative), and how to interpret tests for "immunity passports." Unexpectedly, the answers seem to run contrary to many of the popular narratives about testing as a tool for managing COVID-19. Although testing is an important and essential part of managing diseases such as COVID-19, improper utilization can have unintended negative consequences.
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Affiliation(s)
- Edward C Stites
- Integrative Biology Laboratory, Salk Institute for Biological Studies, La Jolla, CA, 92037 USA
| | - Craig B Wilen
- Departments of Laboratory Medicine and Immunobiology, Yale University School of Medicine, New Haven, CT 06520 USA
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44
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A public health ethic should inform policies on COVID-19 immunity passports. THE LANCET. INFECTIOUS DISEASES 2020; 21:456. [PMID: 33301726 PMCID: PMC7836361 DOI: 10.1016/s1473-3099(20)30918-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022]
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45
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Voo TC, Reis AA, Thomé B, Ho CW, Tam CC, Kelly-Cirino C, Emanuel E, Beca JP, Littler K, Smith MJ, Parker M, Kass N, Gobat N, Lei R, Upshur R, Hurst S, Munsaka S. Immunity certification for COVID-19: ethical considerations. Bull World Health Organ 2020; 99:155-161. [PMID: 33551509 PMCID: PMC7856365 DOI: 10.2471/blt.20.280701] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023] Open
Abstract
Restrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonly called an immunity passport. This document certifies them as having protective immunity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification at present because of uncertainty about whether long-term immunity truly exists for those who have recovered from COVID-19 and concerns over the reliability of the proposed serological test method for determining immunity. Immunity certification can only be considered if scientific thresholds for assuring immunity are met, whether based on antibodies or other criteria. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process. We examine the main considerations for the ethical acceptability of immunity certification to exempt individuals from restrictive measures during the COVID-19 pandemic. As well as needing to meet robust scientific criteria, the ethical acceptability of immunity certification depends on its uses and policy objectives and the measures in place to reduce potential harms, and prevent disproportionate burdens on non-certified individuals and violation of individual liberties and rights.
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Affiliation(s)
- Teck Chuan Voo
- Centre for Biomedical Ethics, National University of Singapore, Blk MD 11, 10 Medical Drive #02-03, Singapore117597, Singapore
| | - Andreas A Reis
- Health Ethics and Governance Unit, World Health Organization, Geneva, Switzerland
| | - Beatriz Thomé
- Preventive Medicine Department, Federal University of São Paulo, São Paulo, Brazil
| | - Calvin Wl Ho
- Faculty of Law, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Ezekiel Emanuel
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, United States of America
| | - Juan P Beca
- Centro de Bioética, Universidad del Desarrollo, Santiago, Chile
| | - Katherine Littler
- Health Ethics and Governance Unit, World Health Organization, Geneva, Switzerland
| | - Maxwell J Smith
- Faculty of Health Sciences, Western University, Ontario, Canada
| | - Michael Parker
- Wellcome Centre of Ethics and Humanities, University of Oxford, Oxford, England
| | - Nancy Kass
- Berman Institute of Bioethics and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Ruipeng Lei
- School of Philosophy and Center for Bioethics, Huazhong University of Science and Technology, Wuhan, China
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland
| | - Sody Munsaka
- School of Health Sciences, University of Zambia, Lusaka, Zambia
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46
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Brown RCH, Savulescu J, Williams B, Wilkinson D. Passport to freedom? Immunity passports for COVID-19. JOURNAL OF MEDICAL ETHICS 2020; 46:652-659. [PMID: 32817362 PMCID: PMC7525773 DOI: 10.1136/medethics-2020-106365] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic has led a number of countries to introduce restrictive 'lockdown' policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people's civil liberties. We make tentative recommendations for the ethical introduction of immunity passports.
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Affiliation(s)
- Rebecca C H Brown
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Bridget Williams
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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de Miguel Beriain I, Rueda J. Immunity passports, fundamental rights and public health hazards: a reply to Brown et al. JOURNAL OF MEDICAL ETHICS 2020; 46:660-661. [PMID: 32907831 PMCID: PMC7525775 DOI: 10.1136/medethics-2020-106814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 05/25/2023]
Abstract
In their recent article, Brown et al analyse several ethical aspects around immunity passports and put forward some recommendations for implementing them. Although they offer a comprehensive perspective, they overlook two essential aspects. First, while the authors consider the possibility that immunological passports may appear to discriminate against those who do not possess them, the opposite viewpoint of immune people is underdeveloped. We argue that if a person has been tested positive for and recovered from COVID-19, becoming immune to it, she cannot be considered a hazard to public health and, therefore, the curtailment of her fundamental rights (eg, the right to freedom of movement) is not legitimate. Second, they omit that vaccine distribution will create similar problems related to immunity-based licenses. Vaccine certificates will de facto generate a sort of immunity passport. In the next phases of the pandemic, different immunity statuses will be at stake, because the need to identify who can spread COVID-19 is unavoidable. If a person does not pose a threat to public health because she cannot spread the infection, then her right to freedom of movement should be respected, regardless of how she acquired that immunity.
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Affiliation(s)
| | - Jon Rueda
- Department of Philosophy 1, University of Granada, Granada, Spain
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Prakash S, Srivastava R, Coulon PG, Dhanushkodi NR, Chentoufi AA, Tifrea DF, Edwards RA, Figueroa CJ, Schubl SD, Hsieh L, Buchmeier MJ, Bouziane M, Nesburn AB, Kuppermann BD, BenMohamed L. Genome-Wide Asymptomatic B-Cell, CD4 + and CD8 + T-Cell Epitopes, that are Highly Conserved Between Human and Animal Coronaviruses, Identified from SARS-CoV-2 as Immune Targets for Pre-Emptive Pan-Coronavirus Vaccines. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020. [PMID: 33024971 DOI: 10.1101/2020.09.27.316018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Over the last two decades, there have been three deadly human outbreaks of Coronaviruses (CoVs) caused by emerging zoonotic CoVs: SARS-CoV, MERS-CoV, and the latest highly transmissible and deadly SARS-CoV-2, which has caused the current COVID-19 global pandemic. All three deadly CoVs originated from bats, the natural hosts, and transmitted to humans via various intermediate animal reservoirs. Because there is currently no universal pan-Coronavirus vaccine available, two worst-case scenarios remain highly possible: (1) SARS-CoV-2 mutates and transforms into a seasonal "flu-like" global pandemic; and/or (2) Other global COVID-like pandemics will emerge in the coming years, caused by yet another spillover of an unknown zoonotic bat-derived SARS-like Coronavirus (SL-CoV) into an unvaccinated human population. Determining the antigen and epitope landscapes that are conserved among human and animal Coronaviruses as well as the repertoire, phenotype and function of B cells and CD4 + and CD8 + T cells that correlate with resistance seen in asymptomatic COVID-19 patients should inform in the development of pan-Coronavirus vaccines 1 . In the present study, using several immuno-informatics and sequence alignment approaches, we identified several human B-cell, CD4 + and CD8 + T cell epitopes that are highly conserved in: ( i ) greater than 81,000 SARS-CoV-2 human strains identified to date in 190 countries on six continents; ( ii ) six circulating CoVs that caused previous human outbreaks of the "Common Cold"; ( iii ) five SL-CoVs isolated from bats; ( iv ) five SL-CoV isolated from pangolins; ( v ) three SL-CoVs isolated from Civet Cats; and ( vi ) four MERS strains isolated from camels. Furthermore, we identified cross-reactive asymptomatic epitopes that: ( i ) recalled B cell, CD4 + and CD8 + T cell responses from both asymptomatic COVID-19 patients and healthy individuals who were never exposed to SARS-CoV-2; and ( ii ) induced strong B cell and T cell responses in "humanized" Human Leukocyte Antigen (HLA)-DR/HLA-A*02:01 double transgenic mice. The findings herein pave the way to develop a pre-emptive multi-epitope pan-Coronavirus vaccine to protect against past, current, and potential future outbreaks.
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Bassareo PP, Melis MR, Marras S, Calcaterra G. Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine. Postgrad Med J 2020; 96:633-638. [PMID: 32907877 PMCID: PMC7439156 DOI: 10.1136/postgradmedj-2020-138370] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece—the cradle of medicine—to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.
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Affiliation(s)
| | | | - Silvia Marras
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
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50
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Affiliation(s)
- Jessica Watson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jonathan Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, UK
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