What do philosophers and social scientists say about the novel coronavirus?
Those last weeks both general public and scientific world is concerned about one thing only - and it is of course the pandemic of an infectious disease Covid-19 caused by novel coronavirus SARS-Cov-2. Philosophers and social scientists are among those who analise the global pandemic and the response to it. Below we present an overview of the most interesting philosophical articles about the novel coronavirus.
Allocating medical resources
Julian Savulescu, James Cameron, Dominic Wilkinson, ' British Journal of Anaesthesia (20 April 2020) '
In British Journal of Anaesthesia Julian Savulescu, James Cameron and Dominic Wilkinson analyze ethical and legal aspects of allocating ventilators in times of the COVID-19 pandemic.
Ezekiel J. Emanuel at al., 'Fair Allocation of Scarce Medical Resources in the Time of Covid-19' The New England Journal of Medicine (23 March 2020)
In New England Journal of Medicine specjalists propose six recommendations about how to allocate medical resources in time of the pandemic.
Tyler M. John, Joseph Millum, 'First Come, First Served?' Ethics 130, no. 2 (January 2020): 179-207.
Abstract: Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, but its use is justified across a range of pretheoretically compelling scenarios. First, there is a duty of fairness prohibiting line cutting where a sufficiently just queue exists. Second, where candidates are in relevantly similar circumstances, allocating by waiting time is efficient, maximizes distribution equality relative to other Pareto efficient distributions, and approaches the fairness of an equiprobable lottery.
Richard Yetter Chappell, 'Against ‘Saving Lives’: Equal Concern and Differential Impact' Bioethics 30(3) (2016): 159-164.
Abstract: Bioethicists often present ‘saving lives’ as a goal distinct from, and competing with, that of extending lives by as much as possible. I argue that this usage of the term is misleading, and provides unwarranted rhetorical support for neglecting the magnitudes of the harms and benefits at stake in medical allocation decisions, often to the detriment of the young. Equal concern for all persons requires weighting equal interests equally, but not all individuals have an equal interest in ‘life‐saving’ treatment.
Popular science articles
Robert D. Truog, Christine Mitchell and George Q. Daley propose special triage committees for the purpuse of deciding about allocation of medicas resources to buffer clinitians from harm.
When there is a pandemic, difficult decisions have to be made. Julian Savulescu and Dominic Wilkinson consider how can we allocate medical care and equipment, such as ventilators, in the midst of Covid-19 pandemic. They distinguish five approaches. First is egalitarianism, which can be summed up as the ‚first come, first served’ approach. Second is utilitarianism, which requires the best use of resources. Third is contractualism, introducing ‚the veil of ignorance’. Fourth option is ‚flatten the curve’ strategy imposing restrictions on citizens to stop the spread of the virus. Unfortunately, in many countries it is now too late for that and medical systems will be overwhelmed, even if societies will be very obedient. Fifth is paternalistic approach: some doctors say that ventilating some patients - those who have little chance to survive - is harmful to them.
Joshua Parker, Mikaeil Mirzaali, 'The Moral Cost of Coronavirus' (16 March 2020)
Joshua Parker and Mikaeil Mirzaali point out the moral cost of difficult (but necessary) decisions of doctors in time of the pandemic. In individual cases someone has to make decisions about allocating medical care and equipment. Enormous weight of moral responsibility should not be neglected. What is more, there is a risk of making a moral mistake, enlarged when factors such as stress and busy, overwhelmed system. Those costs are a weight that doctors have no choice but to accept.
Ethics of science in times of health crises
Stephanie Harvard, Gregory R. Werker, Diego S. Silva, ' Social Science & Medicine 253 (May 2020)
Abstract: Modelling is a major method of inquiry in health economics. In other modelling-intensive fields, such as climate science, recent scholarship has described how social and ethical values influence model development. However, no similar work has been done in health economics. This study explored the role of social, ethical, and other values in health economics modelling using philosophical theory and qualitative interviews in British Columbia, Canada. Twenty-two professionals working in health economics modelling were interviewed between February and May, 2019. The study findings provide support for four philosophical arguments positing an essential role for social and ethical values throughout scientific inquiry and demonstrate how these arguments apply to health economics modelling. It highlights the role of social values in informing early modelling decisions, shaping model assumptions, making trade-offs between desirable model features, and setting standards of evidence. These results point to several decisions in the modelling process that warrant focus in future health economics research, particularly that which aims to incorporate patient and public values.
Alex John London, Jonathan Kimmelman, 'Against pandemic research exceptionalism' Science (23 April 2020)
Alex John London i Jonathan Kimmelman argue in Science that crises are no excuse for lowering scientific standards.
Mariusz Maziarz, 'Response to 'Modelling the pandemic': reconsidering the quality of evidence from epidemiological models' The BMJ 2020; 369 (21 April 2020)
Mariusz Maziarz responds to the article on modelling the pandemic in The BMJ journal.
Marc Lipsitch, David Swerdlow, Lyn Finelli, 'Defining the Epidemiology of Covid-19 - Studies Needed' New England Journal of Medicine, DOI 10.1056/NEJMp2002125 (26 March 2020)
Authors analise uncertainty of available knowledge about the novel coronavirus and Covid-19. They show how using different methods to estimate fatality rate of the new disease leads to different results and argue that what governments will do to fight the pandemic depend on those results and their credibility. Exrapoating from studies of SARS and H1N1 flu epidemic, authors point on what types of studies should be conducted.
Graziano Onder i in., 'Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy' The Journal of American Medical Association, New Online. DOI: 10.1001/jama.2020.4683 (23 March 2020)
Authors study the issue of estimating the fatality rate of diseases. Article shows how different strategies of testing in China and in Italy may influence on estimating the fatality rate of the novel coronavirus. They argue that higher fatality rate in Italy is caused by rarer testing and higher number of older people among the sick.
Giuseppe Lippi, 'The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks' Clinical Chemistry and Laboratory Medicine. Ahead of Publication. DOI: https://doi.org/10.1515/cclm-2020-0240 (19 March 2020)
Abstract: Coronavirus disease 2019, abbreviated to COVID-19 and sustained by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the latest biological hazard to assume the relevance of insidious worldwide threat. One obvious question that is now engaging the minds of many scientists and healthcare professionals is whether and eventually how laboratory medicine could efficiently contribute to counteract this and other (future) viral outbreaks. Despite there being evidence that laboratory tests are vital throughout many clinical pathways, there are at least three major areas where in vitro diagnostics can also provide essential contributions to diagnostic reasoning and managed care of patients with suspected or confirmed SARS-CoV-2 infection. These include etiological diagnosis, patient monitoring, as well as epidemiologic surveillance. Nonetheless, some structural and practical aspects may generate substantial hurdles in providing timely and efficient response to this infectious emergency, which basically include inadequate (insufficient) environment and shortage of technical and human resources for facing enhanced volume of tests on many infected patients, some of whom are with severe disease. Some proactive and reactive strategies may hence be identified to confront this serious healthcare challenge, which entail major investments on conventional laboratory resources, reinforcement of regional networks of clinical laboratories, installation of mobile laboratories, as well as being proactive in establishing laboratory emergency plans.
Abrar Ahmad Chughtai, Asim Ali Malik, 'Is Coronavirus disease (COVID-19) case fatality ratio underestimated?' Global Biosecurity 1(3) doi: 10.31646/gbio.56 (11 March 2020)
Abstract: The number of cases of coronavirus disease (COVID-19) is increasing rapidly and case fatality ratio (CFR) is estimated to be around 2 to 3%. However, the epidemic is still ongoing and the outcome of many sick cases of COVID-19, particularly the outcome of severe cases, is not yet available, which may lead to underestimation of CFR. This was observed during the initial phase of severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak as well, where CFR increased with the passage of time. We estimated the CFR of COVID-19 by extrapolating the data using SARS as an analogy. According to our estimates, the actual CFR of COVID-19 may be around 4.4 to 4.8%. However, these results should be interpreted with cautions as we did not adjust for many confounding factors. Various epidemiological and modelling techniques can be used to estimate CFR of COVID-19 during the epidemic. Precise estimates of CFR will be available after the end of the epidemic when the outcome of all cases will be available.
Eugene V. Koonin, Petro Starokadomsky, 'Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 59, 125-134 (2016)
Abstract: The question whether or not “viruses are alive” has caused considerable debate over many years. Yet, the question is effectively without substance because the answer depends entirely on the definition of life or the state of “being alive” that is bound to be arbitrary. In contrast, the status of viruses among biological entities is readily defined within the replicator paradigm. All biological replicators form a continuum along the selfishness-cooperativity axis, from the completely selfish to fully cooperative forms. Within this range, typical, lytic viruses represent the selfish extreme whereas temperate viruses and various mobile elements occupy positions closer to the middle of the range. Selfish replicators not only belong to the biological realm but are intrinsic to any evolving system of replicators. No such system can evolve without the emergence of parasites, and moreover, parasites drive the evolution of biological complexity at multiple levels. The history of life is a story of parasite-host coevolution that includes both the incessant arms race and various forms of cooperation. All organisms are communities of interacting, coevolving replicators of different classes. A complete theory of replicator coevolution remains to be developed, but it appears likely that not only the differentiation between selfish and cooperative replicators but the emergence of the entire range of replication strategies, from selfish to cooperative, is intrinsic to biological evolution.
Thomas Pradeu, Gladys Kostyrka, John Dupré, 'Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 59, 57-63 (2016)
Abstract: Viruses have been virtually absent from philosophy of biology. In this editorial introduction, we explain why we think viruses are philosophically important. We focus on six issues (the definition of viruses, the individuality and diachronic identity of a virus, the possibility to classify viruses into species, the question of whether viruses are living, the question of whether viruses are organisms, and finally the biological roles of viruses in ecology and evolution), and we show how they relate to classic questions of philosophy of biology and even general philosophy.
Siu Ling Wong, Jenny Kwan, Benny Hin Wai Yung, 'Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Resporatory Syndrome' Science & Education, 18, 95-118 (2009)
Abstract: Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research in the rapidly growing field of molecular biology. The story of SARS illustrates vividly some NOS features advocated in the school science curriculum, including the tentative nature of scientific knowledge, theory-laden observation and interpretation, multiplicity of approaches adopted in scientific inquiry, the inter-relationship between science and technology, and the nexus of science, politics, social and cultural practices. The story also provided some insights into a number of NOS features less emphasised in the school curriculum—for example, the need to combine and coordinate expertise in a number of scientific fields, the intense competition between research groups (suspended during the SARS crisis), the significance of affective issues relating to intellectual honesty and the courage to challenge authority, the pressure of funding issues on the conduct of research and the ‘peace of mind’ of researchers, These less emphasised elements provided empirical evidence that NOS knowledge, like scientific knowledge itself, changes over time. They reflected the need for teachers and curriculum planners to revisit and reconsider whether the features of NOS currently included in the school science curriculum are fully reflective of the practice of science in the 21st century. In this paper, we also report on how we made use of extracts from the news reports and documentaries on SARS, together with episodes from the scientists’ interviews, to develop a multimedia instructional package for explicitly teaching the prominent features of NOS and scientific inquiry identified in the SARS research.
Paul Thagard, 'What is a medical theory?' [in:] Paton, R. i McNamara L., (red.) Multidisciplinary Approaches to Theory in Medicine. Elsevier 2006, 48-62.
Thagard uses studies on SARS to argue that cognitive theory of theories (that theories are mind representations of mechanisms) accurately describes medical theories.
Popular science articles
Scientists cannot keep pace on growning number of Covid-19 publications. Is there a way to help them?
Jacob Stegenga wonders what is the role for philosophy of science in times of fast science - which is unarguably what we are experiencing now, when there are hundreds of articles on the novel coronavirus published every day.
Jonathan Fuller, 'What's Missing in Pandemic Models' (6 May 2020)
Jonathan Fuller argues that regarding uncertainty in the pandemic, we - even more then usual - need to clarify and question our assumptions. Especially in pandemic modelling there is a great need for a philosophical approach.
Eric Angner reminds about the importance of epistemic humility and criticises overconfidence - now it is even more pressing than usual when during a pandemic we are facing shortage of data.
Mariusz Maziarz, 'Epidemiologia i poszukiwanie lekarstwa na covid-19 a filozofia nauki' Filozofia w Praktyce 6(5) (8 April 2020)
Mariusz Maziarz, as a philosopher of science, writes about methodological problems with research on the novel coronavirus.
Liam Kofi Bright, Richard Bradley, 'The Masque of Rona' (1 April 2020)
Liam Kofi Bright and Richard Bradley write about uncertainties and assuptions in scientific modelling of the pandemic.
Abraar Karan ask what is the role of experts in fighting the pandemic and points out that we need a pluralistic approach: different questions about anti-pandemic politics and heathcare over sick people should be directed towards different people.
Eric Schliesser and Eric Winsberg point out that we should not compare findings about novel coronavirus and scientific research into climate change. This comparison is unsuitable and dangerous.
Adrian Stencel, 'Człowiek i jego symbiotyczne mikroorganizmy: wielość czy jedność?' Filozofia w Praktyce 3(2) (10 February 2017)
Adrian Stencel shows how the debate about biological individuality in the context of a 'holobiont' concept. It tells us that a human plus all of its symbiotic microorganisms (bacteria, viruses, etc.) are the biological individual.
Review of the book 'On the Coming Plague', which suggested that we are entering the age of epidemics. It is interesting to go back and see how this idea was reciprocated more than two decades ago.
Conditions which need to be met for for public health measures (such as quarantine, forced isolation and others) to be acceptable
Justin Bernstein, Brian Hutler, Travis N. Rieder, Anne Barnhill, 'Grappling with the Ethics of Social Distancing: A Framework for Evaluating Social Distancing Policies and Reopening Plans' (draft, 17 April 2020)
Justin Bernstein, Brian Hutler, Travis N. Rieder and Anne Barnhill give the framework for evaluating the various plans considering how to reopen countries after the Covid-19's pandemic lockdown.
Mark A. Rothstein, ‘From SARS to Ebola: Legal and Ethical Considerations for Modern Quarantine’ Indiana Health Law Review 12(1) (2015)
Author analise historical development of quarantine and its role in stopping the spread of infectious diseases and suggest the ethical framework for regulation of this institution.
Leslie E. Gerwin, ‘Planning for Pandemic: A New Model for Governing Public Health Emergencies’ American Journal of Law & Medicine, 37 (2011)
Is there a possibility to maintain constitutionalism, when the fight with the epidemic calls for extraordinary prerogatives for government? The author answers 'yes' and propose her own original conception.
Popular science articles
John P. A. Ioannidis, 'The Totality of the Evidence' (26 May 2020)
John P. A. Ioannidis emphasizes that as policymakers debate the right response to COVID-19, they must take seriously the harms of pandemic policies, not just their benefits.
Eric Winsberg wonders how big of a cost for pandemic mitigation is acceptable.
Nuffield Council on Bioethics released a statement regarding basics of democratic governance, equally important for times of crisis such as current pandemic.
As government mandated lockdowns to combat the coronavirus pandemic affect a rising share of the global population, fewer will die of COVID-19, as well as other transmissible diseases. But how should we weigh those benefits against the costs of unemployment, social isolation, and widespread bankruptcies?
Alberto Giubilini explains why we do have a moral obligation to stay in during the lockdown, even in situations when we are not harming anyone.
Ethicists answer questions from State Institute for Health, Bavarian Health and Food Safety Authority about ethical criteria on which to base their decisions.
This article is a friendly polemic with Ioannidis. Michał Zamdyr-Jamróz argues that there is a need for distinction between science and science-based policies. Waiting for better data cannot lead to apathy and indecision when there is a need for action.
Polish translation available here.
John P. A. Ioannidis points out that data on Covid-19 is unreliable. Among reasons there is shortage is testing - a lot of cases are overlooked and fatality rate is - likely - significantly lower. It is difficult to estimate what is a scale of the underestimation. Not always deaths of people infected by SARS-Cov-2 is caused by Covid-19, especially that deaths are mostly among elderly population and people who have other chronic diseases. United Kingdom at the beginning developed another strategy than most other countries fighting pandemic and (for example) kept schools open. In the absence of reliable data, it is difficult to estimate if this approach would be brilliant or catastrophic. It is also difficult to estimate effectiveness of ‚flatten the curve’ approach introduced in most countries now. If it is only moderately effective, heath systems will be overwhelmed much longer than it would be otherwise - which can cause more deaths not only on Covid-19, but also on other diseases.
Nuffield Council on Bioethics points out that public health measures to manage the Covid-19 pandemic should be evidence-based, proportionate and clearly communicated to the general public. Coertion and intrusion should be minimum possible consistent with achieving the aim sought. People should be treated respectfully, as moral equals. Solidarity is essential - among countries, as well as businesses and individuals.
Kamil Mamak, 'Karalność medycznych fake newsów' (15 March 2020)
Kamil Mamak proposes to penalize spreading of medical fake news.
Stefano Canali shows that interpreting values out of data (in case of Covid-19 among others) is based on specific interpretations, assumptions and values, what has wide social implications. When drastic measures are implemented it is especially important for politicians as well as for all of us to critically consider the manipulations, assumptions and interpretations of data. That is why Canali argue for transparency - not only when it comes to collection and use of data, but also when it comes to assumptions and tools used in counting practices. Reasons for public health measures should be transparent and explained in detail to general public.
Alex Broadbend, as panic over the novel coronavirus spreads, points out what governments should consider when it comes to making decisions about public health measures during the pandemic. Among those he offers seven viewpoints: effectiveness; speed of response; economic impact on human welfare, including health; upside of economic downturn, both human and non-human; identification of losers and winners, and weighing of their rights; assessment of quantity of life; egalitarian considerations. Cost-benefit analysis should precede any restrictions imposed by governments.
INCET's debates (in Polish)
Włodzimierz Galewicz, Andrzej Kübler, Anna Paprocka-Lipińska, Tomasz Pasierski, Janina Suchorzewska, Mariusz Piechota, Jakub Pawlikowski, Krzysztof Kusza, Piotr Grzegorz Nowak, Anna Duława, Jan Duława, Kazimierz Szewczyk
Włodzimierz Galewicz, Wojciech Ciszewski, Jan Piasecki, Arkadiusz Sobczyk, Joanna Haberko, Barbara Chyrowicz