COVID-19

Around this time last year, I packed up my office laptop and cheerily bid farewell to colleagues, assuring them I’d see them “in a few weeks” once lockdown was over. Reader, it was not a few weeks. Over a year to the day, I have yet to return to any office and indeed, having joined the Nuffield Council a couple of months into lockdown, have yet to meet many of my new colleagues in the flesh.

Responding to suggestions that the UK Government might introduce immunity or vaccine passports, the Prime Minister in an interview on the 24th February first recognised that doing ‘stuff like this’ was a ‘novelty’.

I followed the example of Professor Jonathan Van-Tam, England's Deputy Chief Medical Officer, who, in the wake of the announcement of two successful COVID-19 vaccines, stated that he had encouraged his elderly mother ‘to be ready.’ I did the same.

The prospect of safe and effective vaccines against COVID-19 is good news for everyone towards the end of a grim year. Of course, caution is still advisable with as yet no certainty as to how long the vaccine might work or whether there might be adverse side effects for certain groups. There are also a host of ethical issues that need to be addressed.

Back in March discussion started as to whether it would be appropriate to consider challenge trials to speed up vaccine development during the COVID-19 pandemic.

One of the most distressing aspects of the COVID-19 pandemic for me has been the treatment of older people living in care homes – and the uncomfortable spotlight cast on the way their fundamental needs and interests are often overlooked.

Just at the point where vaccine trials are showing promise, levels of infection circulating in the general population in the UK are relatively low. This is obviously good news from many perspectives – but makes the next stage of testing more difficult. Is one possible answer human challenge trials?

In order to exit lockdown safely, the UK will need to be able to identify virus hotspots and have a robust track and trace process in place to ensure that people who might be infected know that they need to self-isolate.

For a week or so now the public discourse on the UK’s COVID-19 epidemic has been shifting from the horror of the daily death count to the hope that there may be a way of relaxing the restrictions that have been placed on citizens’ freedom of movement and assembly.

A mantra of recent government policy reporting in recent weeks is that they are only following the science. The science recommended the lockdown, and the science will let us know when it can be relaxed, apparently. It tells us what tests need to be done for whom and what protective equipment is needed for whom. How exactly can it do this?

In their recent statement on digital contact tracing, NHSX, the NHS Unit leading digital transformation of the NHS, acknowledge that the public will need to trust this new technology for it to be effective in tackling COVID-19, and that NHSX will seek to earn that trust by working with ‘transparent standards of privacy, security and ethics’.

Debate about how to exit from lockdown is increasing. What evidence is there that the ethical dimension of that process has been considered? So far there is little or no such evidence.

There is urgency to the situation that we all face. But urgency does not absolve those responsible for decision-making of the moral duty to involve those who are affected; to engage with the communities that they represent and seek to protect; and to be transparent about the basis on which decisions are being considered and are being made.

Two weeks ago, I came down with a respiratory infection that produced a high fever and a persistent, dry cough. Following the current official guidance, I went into isolation and my family entered quarantine...

At some point in this terrible pandemic doctors will have to make some unbelievably difficult life and death decisions. It is the point at which the demand for the intensive life saving resources outstrips their supply. At that point doctors will have to decide who receives care and who does not. No one should have to make such decisions, and yet they will have to be made.

Legal and policy responses to COVID-19 rest on and express the balance of different basic values and principles. Earlier and current regulatory approaches bring into sharp relief how liberty must be understood and weighed against other values. This is for the sake of liberty itself, but crucially too for other compelling aspects of social justice.

So what relevance has our report to the enormous challenges being posed to health systems and governments the world over by COVID-19? Unsurprisingly, quite a lot.