Ethics and equity in the time of coronavirus

Government responses and lockdowns, even done well, have also caused increased morbidity and mortality by a reduction in patients seeking treatment for non-COVID-19 conditions, and the postponement of therapy such as surgery and preventive screening. This opportunity cost of the lockdown also includes the morbidity and mortality induced by unemployment and mental health issues. Whether these risks of lockdown are outweighed by the projected lives saved from dying of COVID-19 has still to be adequately analysed both here and overseas, but such analyses are essential in understanding the circumstances under which such measures are ethically justified. Equity of information-provision has been problematic. There have been issues of access to digital information and telehealth, especially for people who are poor or homeless.29 Understanding the risks, benefits and ethics of virtual healthcare is evolving concurrently with its widescale implementation.

Soldiering on only goes so far: How a qualitative study on Veteran loneliness in New Zealand influenced that support during COVID-19 lockdown

Introduction: On April 25, 2020, Veterans' Aff airs in New Zealand (NZ) contacted approximately 3,000 of 8,000 known military Veterans by phone during the SARS-CoV-2 pandemic to ensure they were safe during the government-imposed lockdown. The impetus to this initiative were the findings of a cross-sectional quantitative survey of NZ Veterans, followed by the qualitative survey reported here, both carried out in 2019. The former report found 33% of 89 respondents were lonely and reported barriers to seeking support, and over half of Veterans felt uncomfortable accessing it. Methods: To understand the factors underlying loneliness, a qualitative survey was developed based on the barriers previously identified and a literature review. A purposeful sample based on gender, age, and ethnicity identifi ed 20 respondents from the initial survey: 10 lonely and 10 non-lonely. Interviews were followed by an inductive thematic analysis, and themes and sub-themes were developed. Results: Ten of the 20 potential participants responded: 6 lonely and 4 non-lonely. Social and geographic isolation, problems with re-integration into the civilian community, and health problems were found to contribute to Veteran loneliness. Social connectedness, particularly to service peers, was the primary mitigating factor. Barriers included stoicism and perceptions of ineffective and inaccessible services. Inequity in the Veteran support system also emerged as a barrier for Veterans who had not deployed on operational missions. Discussion: During the pandemic, social connectedness will have decreased, and loneliness increased. Designing interventions with these factors in mind, and ensuring equity of access to support, should help combat Veteran loneliness. © 2020 Journal of Military, Veteran and Family Health. All rights reserved.