The Ethics of Reopening

October 9, 2020
Tia Powell, MD
Volume 37,

At the heart of reopening is protecting both population health and economic health.

FROM THE PAGES OF MEDICAL ECONOMICS®

During the fight against coronavirus disease 2019 (COVID-19), every American has made daily choices that could affect their health, their family’s health, and the health of their larger community. The decision-making process can feel uncertain 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. Unfortunately, much of the dialogue around reopening the country lacks the empirical and ethical foundations necessary to return to normalcy in a sustainable way.

The country cannot flourish unless we have both population and economic health. Fortunately, these 2 goals are not really in conflict. The strategy to maintain the safety and financial well-being of our country must be based on the best available data. It must be acquired and analyzed through rational processes, rather than wishful thinking. Individuals, business owners, and politicians all face an incredibly complex puzzle, but data and technology can help us reopen the economy and preserve the public’s health at the same time.

Politics in the United States are in an incredibly polarized state, which is in itself a serious problem. Reopening must be rooted in a rational decision-making process, not one based on fear or biases. It is an ethical imperative to state the estimated results of various interventions clearly, whether or not those results are favorable to a particular political ideology. A failure to root decisions in data and analysis ultimately leads to moral failures.

During past crises, we have seen how those moral failures have played out. Fear during the AIDS crisis led to rampant discrimination against the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, in addition to an irrational fear of individuals from specific countries, most notably Haiti. After 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 American citizens. None of the fear and violence against these groups made Americans safer.

These irrational responses to unprecedented circumstances arise from fear, and they 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 (AI) can provide a useful channel for communicating COVID-19-related information to both employees and employers. 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, good outcomes will follow. In Rhode Island, the smallest state in the country, businesses are reopening and unemployment is falling. Why? Rather than ignore the impacts of the virus, state leadership looked at what we knew about the pandemic and acted accordingly. The state mandated intensive testing, tracing, and isolation, and they broadcasted clear messages about the importance of wearing masks. 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 5.

Transparency, and ultimately honesty, will help Americans make decisions based on data and facts, not on fear and bias. Throughout this journey, the governor of Rhode Island 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.

This morally sound approach can protect human life and also preserve the economic opportunities individuals need to survive. Honest assessment of data and best practices enables individuals to respond better to changing circumstances. Strategies can shift and evolve as new information emerges. This pandemic has made it crystal clear that what works 1 week may not work the next, and as those facts on the ground change, so should the response to those facts.

Dr Powell 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.

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