The Gross National Happiness Framework and the Health System Response to the COVID-19 Pandemic in Bhutan.

Bhutan is a lower-middle-income country with limited tertiary-care health infrastructure and shortage of human resources. The country's response to the COVID-19 pandemic is guided by the principle of Gross National Happiness (GNH), which prioritizes the well-being and happiness of people over conventional socioeconomic indicators. The king's leadership and government's decisions based on public health science helped in the control of the pandemic and reduce economic losses. The government implemented some unique and unconventional public health measures such as facility quarantine for those with high-risk exposure, an increase in quarantine period to 21 days, free testing and treatment, and population-based screening tests. Early and extensive contact tracing, extensive testing, effective communications, zoned travel restrictions, and adoption of physical distancing and hygiene measures limited COVID-19 transmissions within the country. Community participation from voluntary groups and civil society organizations helped deliver non-health services while hospitals provided uninterrupted routine health services through its primary healthcare network. All COVID-19 cases were treated in hospitals, and the country has had zero reported COVID-19 deaths. This article describes how the concept of GNH provided the framework for the government to respond to this pandemic.

The Political Determinants of China'S New Health Constitution.

The Basic Healthcare and Health Promotion Law 2019 became the new constitution of China's health system in June 2020, giving legal effect to ambitious health reform programmes like Healthy China 2030. The concurrent outbreak of coronavirus disease 2019 must not distract us from appreciating the fact that this Law will comprehensively overhaul the health regulatory framework of the world's most populous country during the coming decade, if not beyond. This article offers an original evaluation of the Law in its political context. The Law commendably promises to safeguard the right to health, assist citizens to live a 'complete cycle of life', and promote health using the resources of the public health system. However, it is also deeply politicised, guaranteeing extensive and penetrative political control in health campaigns, digitalised health data, the governance of health institutions, and the resolution of medical disputes. This can be explained by the consequential roles played by epidemics in China's historical dynastic cycles, but even more so by powerful tendencies of centralisation on the part of the Leninist Party-state. The Law's potential is thus subject to the overriding caveat that the Party-state's existence and influence over law and public health must be secured.

Misalignment between coronavirus financial aid and public health policies: negative incentives for outpatient clinics in the United States.

The United States Coronavirus Aid, Relief, and Economic Security Act (CARES Act) led to creation of the Paycheck Protection Program, as well as an expansion of reimbursements for telemedicine. CARES Act drafters over emphasized maintaining employment and overlooked negative downstream effects the policies had on outpatient clinics. The misalignment between this financial aid package and public health policy is most apparent in the pressure administrators face to maintain clinic operations, without a transition plan to adopt telemedicine and associated best practices. If this continues, the result will be suboptimal clinical practices and an increased risk of COVID-19 infection to both staff and patients. Particularly in times of crisis, financial aid packages should not be evaluated in isolation; policymakers should consider their implications for public health while designing, enacting, and implementing such measures.

Medicolegal Aspects of Teledermatology. / Aspectos médico-legales de la teledermatología.

Teledermatology has facilitated specialist care during the crisis caused by the coronavirus disease 2019 pandemic, eliminating unnecessary office visits and the possible exposure of patients or dermatologists. However, teledermatology brings forward certain ethical and medicolegal questions. A medical consultation in which the patient is not physically present is still a medical act, to which all the usual ethical and medicolegal considerations and consequences apply. The patient's right to autonomy and privacy, confidentiality, and data protection must be guaranteed. The patient must agree to remote consultation by giving informed consent, for which a safeguard clause should be included. Well-defined practice guidelines and uniform legislation are required to preserve the highest level of safety for transferred data. Adequate training is also needed to prevent circumstances involving what might be termed «telemalpractice¼.