The ethics of reopening amidst COVID-19

August 18, 2020
Tia Powell, M.D.
Tia Powell, M.D.

We have seen enormous tension across the country when it comes to two important goals: protecting population health, and protecting economic health.

Throughout the fight against COVID-19, every American has made daily choices that could impact their health, their family’s health, and the health of their larger community. These decisions often feel unprecedented and chaotic, especially when the science around this virus is constantly evolving. At some level, every individual, business owner, and politician is grappling with the same questions. However, much of the dialogue around reopening the country lacks the logical and ethical foundations necessary to make the return to normalcy possible or sustainable.

We have seen enormous tension across the country when it comes to two important goals: protecting population health, and protecting economic health. These two goals are not in conflict; the country cannot flourish unless we have both. Politics in the US are in an incredibly divisive state, which is in itself a serious problem. The strategy to maintain the safety and financial wellbeing of our country must be assessed with the best available data, acquired and analyzed through rational processes, rather than wishful thinking. It is an ethical challenge to state clearly the estimated results of various interventions, whether those results are favorable or not to a particular plan or political ideology. Yet we must rise to the occasion—while we face an incredibly complex puzzle, data and technology can be an unbelievably powerful tool to help us through this time.

Reopening must be rooted in a rational decision-making process, not one based on fear or idealized aspirations. A failure to root decisions in that type of process is ultimately a moral failure.

During past crises, we have seen how those moral failures have played out. Fear during the AIDS crisis lead to rampant discrimination against the LGBTQ community, in addition to an irrational fear of individuals from specific countries- most notably, Haiti. Post September 11th, the nation saw an uptick in hate crimes against Sikhs, a religious group with no connection to the attacks on our country, in addition to attacks on Muslims, millions of whom are peaceful and productive US citizens. None of the violence and fear against these groups made Americans safer. They were wrong in themselves, and also distracted us from getting to work on important problems.

These irrational responses to unprecedented circumstances arise from fear, and are unproductive at the end of the day. What is productive – and has been proven to work is transparent and honest information.

Historically, risk communication has been a challenge for the medical community, but big data and artificial intelligence can provide a useful channel for communicating COVID-related information for both employees and employers, if done appropriately. My current work with Buoy Health and its Back with Care™ platform – an AI tool designed to help employers reopen safely – is motivated by the need to incorporate as much transparency as possible into the reopening process for businesses.

When leadership follows the data, the outcomes will follow. In Rhode Island, the smallest state in the country, businesses are reopening, unemployment is falling, and the state government seems confident in their ability to allow children to return to school in the fall. Why? Rather than ignore the impacts of the virus, state leadership looked at what we did know about the pandemic and acted accordingly. Intensive testing, tracing and isolation in addition to clear messaging around wearing masks became the mandate for the state. Now, Rhode Island has one of the best testing rates in the country and death rates have dropped dramatically from more than 20 per day at its peak to fewer than five.

Throughout this journey, the governor and public health officials were very clear about what the risks were, the challenges the state was facing, and the struggles everyone was going through. Despite all that uncertainty, the state still made impressive progress in containing the virus.

Transparency, and ultimately honesty, will help Americans make decisions based on data and facts, not on fear and bias. This morally sound approach can protect human life and also preserve the economic opportunities people need to survive. Honest assessment of data and best practices enables people torespond better to changing circumstances, letting strategies shift and evolve as new information emerges. This pandemic has made it crystal clear that what works one week many not work the next, and as those facts on the ground change, so should the response to those facts.

Tia Powell, MD is a bioethicist and psychiatrist who directs the Center for Bioethics and Masters' in Bioethics at Montefiore Health Systems and Albert Einstein College of Medicine, and is a Fellow of the Hastings Center. She is also a member of the Buoy Health Back with Care™ advisory board.