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Jose S, Geller G, Bollinger J, Mathews D, Kahn J, Garibaldi BT. The ethics of using COVID-19 host genomic information for clinical and public health decision-making: A survey of US health professionals. HGG ADVANCES 2024; 5:100255. [PMID: 37978805 PMCID: PMC10746522 DOI: 10.1016/j.xhgg.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
Several genetic variants linked to COVID-19 have been identified by host genomics researchers. Further advances in this research will likely play a role in the clinical management and public health control of future infectious disease outbreaks. The implementation of genetic testing to identify host genomic risk factors associated with infectious diseases raises several ethical, legal, and social implications (ELSIs). As an important stakeholder group, health professionals can provide key insights into these ELSI issues. In 2021, a cross-sectional online survey was fielded to US health professionals. The survey explored how they view the value and ethical acceptability of using COVID-19 host genomic information in three main decision-making settings: (1) clinical, (2) public health, and (3) workforce. The survey also assessed participants' personal and professional experience with genomics and infectious diseases and collected key demographic data. A total of 603 participants completed the survey. A majority (84%) of participants agreed that it is ethically acceptable to use host genomics to make decisions about clinical care and 73% agreed that genetic screening has an important role to play in the public health control of COVID-19. However, more than 90% disagreed that it is ethically acceptable to use host genomics to deny resources or admission to individuals when hospital resources are scarce. Understanding stakeholder perspectives and anticipating ELSI issues will help inform policies for hospitals and public health departments to evaluate and perhaps adopt host genomic technologies in an ethically and socially responsible manner during future infectious disease outbreaks.
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Affiliation(s)
- Sheethal Jose
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Debra Mathews
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Gerber JE, Geller G, Boyce A, Maragakis LL, Garibaldi BT. Genomics in Patient Care and Workforce Decisions in High-Level Isolation Units: A Survey of Healthcare Workers. Health Secur 2021; 19:318-326. [PMID: 33826422 DOI: 10.1089/hs.2020.0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The impact of host genomics on an individual's susceptibility, immune response, and risk of severe outcomes for a given infectious pathogen is increasingly recognized. As we uncover the links between host genomics and infectious disease, a number of ethical, legal, and social issues need to be considered when using that information in clinical practice or workforce decisions. We conducted a survey of the clinical staff at 10 federally funded Regional Ebola and Other Special Pathogen Treatment Centers to understand their views regarding the ethical, legal, and social issues related to host genomics and the administrative and clinical functions of high-level isolation units. Respondents overwhelmingly agreed that genomics could provide valuable information to identify patients and employees at higher risk for poor outcomes from highly infectious diseases. However, there was considerable disagreement about whether such data should inform the allocation of scarce resources or determine treatment decisions. While most respondents supported a confidential employer-based genomic testing system to inform individual employees about risk, respondents disagreed about whether such information should be used in staffing models. Respondents who thought genomic information would be valuable for patient treatment were more willing to undergo genetic testing for staffing purposes. Most respondents felt they would benefit from additional training to better interpret results from genetic testing. Although this study was completed before the COVID-19 pandemic, the responses provide a baseline assessment of provider attitudes that can inform policy during the current pandemic and in future infectious disease outbreaks.
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Affiliation(s)
- Jennifer E Gerber
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Gail Geller
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Angie Boyce
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Lisa L Maragakis
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
| | - Brian T Garibaldi
- Jennifer E. Gerber, PhD, MSc, was a PhD Student and Graduate Research Assistant at the time of the study, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. She is now an Epidemiologist, RTI International, Washington, DC. Gail Geller, ScD, MHS, is a Professor, Department of Health, Behavior, and Society and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Professor, Department of Medicine, Johns Hopkins School of Medicine; and Director of Education Initiatives and Core Faculty, Berman Institute of Bioethics, Johns Hopkins University; all in Baltimore, MD. Angie Boyce, PhD, is a Science and Technology Policy Fellow, American Association for the Advancement of Science, Washington, DC. Lisa L. Maragakis, MD, MPH, is an Associate Professor of Medicine and Executive Director, Johns Hopkins Biocontainment Unit; and Brian T. Garibaldi, MD, MEHP, is an Associate Professor of Medicine, Physiology, and Informatics, Division of Pulmonary and Critical Care, and Director, Johns Hopkins Biocontainment Unit; both in the Johns Hopkins School of Medicine, Baltimore, MD. Lisa L. Maragakis is also Senior Director of Infection Prevention, The Johns Hopkins Health System, Baltimore, MD
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Borromeo Flinn J, Benza JJ, Sauer LM, Sulmonte C, Hynes NA, Garibaldi BT. The Risk of Not Being Ready: A Novel Approach to Managing Constant Readiness of a High-Level Isolation Unit During Times of Inactivity. Health Secur 2020; 18:212-218. [PMID: 32559152 DOI: 10.1089/hs.2019.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The biocontainment unit at Johns Hopkins Hospital is a specially designed, inactive high-level isolation unit designated to care for patients infected with high-consequence pathogens. The unit team designed a facility-specific readiness scale and checklist that focus on infrastructure, consumable supplies, and staffing to assess activation readiness of the biocontainment unit. Over a period of 50 days and 14 days, these tools were used as part of a routine risk assessment to first identify barriers and then tier the impact of these barriers into activation categories of "Ready," "Ready with Considerations," and "Not Ready." The assessment identified the greatest risks to activation readiness were staffing and waste management capabilities. Assessing threats to activation readiness and the risk of not being ready should be a priority for maintaining facility, regional, and national capacity to safely isolate and care for patients infected with high-consequence pathogens while maintaining healthcare worker safety.
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Affiliation(s)
- Jade Borromeo Flinn
- Jade Borromeo Flinn, MSN, RN, CCRN, CNRN, is Nurse Educator, Department of Medicine and Department of Neurosciences, Johns Hopkins Hospital, Johns Hopkins University School of Medicine
| | - Jesse J Benza
- Jesse J. Benza, MHA, is Business Service Analyst, Department of Medicine, Johns Hopkins University School of Medicine
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director of Operations and Assistant Professor, Department of Emergency Medicine, Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins University School of Medicine
| | - Christopher Sulmonte
- Christopher Sulmonte, Jr., MHA, is Project Administrator, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine
| | - Noreen A Hynes
- Noreen A. Hynes, MD, MPH, is Associate Professor/Geographic Medicine Center Director, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, and Departments of Environmental Health and Engineering and International Health, Johns Hopkins Bloomberg School of Public Health
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Medical Director of Biocontainment Unit, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
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