Ethical limits to placebo use and access to Covid-19 vaccines as a human right.

The world is currently facing another severe pandemic, Covid-19, just four decades after the start of AIDS, and the still increasing incidence of HIV infection continues to be one of the greatest global health challenges. The way the latter was confronted is of fundamental importance for a serious discussion on global health, ethics and human rights, and this experience could and can still be applied to Covid-19. The Covid-19 pandemic has specific characteristics and these will be discussed, in relation to vaccine research and especially to the global right to equal access to products proven to be safe and effective. The article focusses primarily on issues related to Covid-19 vaccines, especially the appropriate use and limits on placebo, the right to post-trial access to placebo arm participants, and the use of an active control for subsequent Phase-3 trials after the approval of other safe and efficacious vaccines. Most importantly, it will emphasise that access to Covid-19 vaccines is a human right, which presupposes the establishment of appropriate ethical standards to ensure universal, equal, and affordable access to healthcare and to vaccines for all, and the imperative need for suspension of patents for products developed for Covid-19. It will consider the role of social determinants that contribute to the severity of Covid-19 and that must be addressed to effectively curb the current syndemic.

Use of Telemedicine and Smart Technology in Obstetrics: Barriers and Privacy Issues.

While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable.

When Scarcity Meets Disparity: "Resources Allocation and COVID-19 Patients with Diabetes".

The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.

Oral Health Matters: The Ethics of Providing Oral Health During COVID-19.

Oral health is a critical part of overall health. The current COVID-19 pandemic has highlighted the importance of oral health. In this article, we describe how dental practice has been impacted by COVID-19, identify the public health response to COVID-19, and explain the gradual resumption of dental care after the initial disruption due to the pandemic. Finally, we discuss how long-standing health disparities in oral health have been exacerbated by the current pandemic.

Collateral damage: Impact of SARS-CoV-2 pandemic in people living with HIV.

People living with HIV (PLWH) may be at higher risk for adverse outcomes indirectly associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2). When comparing responses to questionnaires administered when social distancing and quarantine guidelines were first implemented, we found that PLWH were more likely to have restricted access to medical care, increased financial stress, increased symptoms of anxiety and depression, and increased substance use compared to demographically-similar people without HIV.

[Ethical issues in primary care during the coronavirus (SARS-CoV-2) pandemic]. / Problemas éticos en atención primaria durante la pandemia del coronavirus (SARS-CoV-2).

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.

Solidarity in the Time of COVID-19?

This article critically examines how solidarity has been enacted in the first 2 months of the COVID-19 pandemic, mainly, but not exclusively, from a United Kingdom perspective.1 Solidaristic strategies are framed in two ways: aspirations to overcome COVID-19 (utopian anthropocentric solidarity); and those that are illusory, incompatible, contradictory, and disrupting of solidaristic ideals (heterotopian solidarity). Solidarity can also be understood more widely from a biocentric perspective (solidarity with all life). In the context of COVID-19 a lack of biocentric solidarity points to a probable cause of the pandemic; where COVID-19, harmless in bats, jumped species as a consequence of closer contact with humans. Solidarity, therefore, is not only expressed in a fight against a viral "enemy" but is also a reminder of human activity that has upset balances within ecosystems.