On March 11, 2020, the WHO declared the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19) to be a global pandemic. The world watched the virus ravage Italy, which responded with a nation-wide lockdown resembling the plague years of medieval Europe. The United States began to see the same emerging pattern, and pre-emptively shut down its institutions and economy in an effort to “flatten the curve” and also preserve its healthcare system, which would collapse from the burden of cases and the shortage of PPE, hospital equipment and ICU beds. Due to an absence of testing and tracing – a gold standard for controlling an outbreak – evidence-based projections for the United States were a mass-casualty event of at least half a million dead Americans without extreme measures of mitigation: physical distancing.  

As we approach July, more Americans are dead from COVID-19 than who died in World War 1 (over 126,000 as of this writing). Those deaths occurred in the short time frame of four months. We surpassed 9/11 casualties in March; we next surpassed combined casualties from 9/11, and the post-9/11 wars of Afghanistan and Iraq in March. We surpassed Vietnam War casualties in April, and reached 100,000 casualties in May. The United States is currently the most infected country with the worst response to the COVID-19 pandemic due to another virus: disinformation and science denialism in which sound public health policy is being rejected and refuted by both American leadership and a significant portion of the U.S. population. With its CDC in ruins (see The Lancethttps://doi.org/10.1016/S0140-6736(20)31140-5), functioning as an attenuated version of its former self, there is no public health expert currently in charge of COVID-19  at a national level, while individual states are making decisions that are heterogenous. Some states never actually shut down; some opened prematurely without following CDC guidelines. Basic public health principles we learned a century ago have become controversial, such as mask-wearing. Many Americans do not agree on common facts of the virus reported by health experts, medical journals, and the media. As a result, our COVID Fall is probably going to resemble our COVID Spring, as shut-downs may become necessary in states that were hit by the pandemic later in the year. This month, two super-spreader biohazard events – political rallies planned by the Trump re-election campaign —   have been held in two states with surges, which have alarmed all public health experts, infectious disease experts and bioethicists. In fact, from the European perspective, the United States is now considered such a malign pandemic actor, it is banning Americans from entering EU countries to help control resurgence of outbreaks (see: https://www.nytimes.com/2020/06/26/world/europe/europe-us-travel-ban.html).

This COVID blog series tracks the specific ethical issues bioethicists were dealing with throughout the COVID Spring. In Part 1, “When in Rome”: American Healthcare Prepares for the Surge, I look at March 2020 (http://endocrineethicsblog.org/journal-of-the-covid-spring-part-1-march-2020-when-in-rome-american-healthcare-providers-prepare-for-the-surge/). In March, bioethicists were concerned with many difficult questions surrounding rationing.

In COVID Spring, Part 2, “New York State of Mind”: Ethics of Shut-Down and Harm Reductions, I look at April 2020 (http://endocrineethicsblog.org/journal-of-the-covid-spring-part-2-april-2020-new-york-state-of-mind-ethics-of-shutdown-and-harm-reductions/ ). Here I review the surge issues in New York City, the bioethics debates surrounding shelter-in-place and economic shut down. In this timeframe, the White House Coronavirus Task Force held  daily briefings, and accurately predicted that with mitigation, between 100,000 and 240,000 Americans would die.

In COVID Spring Part 3, “American Carnage”: Covid and Health Disparities, I look at May 2020 (http://endocrineethicsblog.org/journal-of-the-covid-spring-part-3-may-2020-american-carnage-covid-and-health-disparities/). In May, it became clear that COVID-19 was decimating vulnerable populations such as nursing home residents and African Americans. The African American COVID story is about long-standing health disparities and systemic racism. Bioethicists were already discussing how racism was frankly infecting public policy decisions surrounding premature opening, and I discussed it in a May presentation (https://youtu.be/yOrTvTHrfUs). When George Floyd was killed May 25, it became the last straw as African Americans who felt uniquely vulnerable to COVID-19 in addition to daily systemic racism, took to the streets in protests that lasted over 20 days. 

In COVID Spring, Part 4, “Juneteenth: Systemic Racism, Moral Awakening, and Tulsa”. I look at June 2020 (http://endocrineethicsblog.org/covid-spring-part-4-june-2020-juneteenth-systemic-racism-moral-awakening-and-tulsa/).  In June, the bioethics community published a Statement about its stance on systemic racism in the field of bioethics as the protests continued, and Americans of all backgrounds and ethnicities awakened to the harsh truths the pandemic helped to lay bare. By the end of the month, the pandemic began to surge in states that refused to heed earlier public health warnings about premature opening: Texas, Florida and Arizona become the new hot spots, as hospitals reach capacity. 

For a good Spring retrospective on where we are, see: https://www.nytimes.com/interactive/2020/us/coronavirus-spread.html?action=click&module=Spotlight&pgtype=Homepage