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Why We Must Test Millions a Day
From the Abstract: "There is growing consensus from leading think tanks such as the American Enterprise Institute [AEI] and the Center for American Progress [CAP] that the way out of lockdown is through a massive testing and tracing infrastructure. Yet there is much less clarity on how large this infrastructure must be to allow a safe return to work. Both the AEI and CAP proposals suggest that hundreds of thousands of tests per day might suffice. However, to date, we are not aware of epidemiological models that attempt to estimate the scale of required testing. This paper tries to fill this gap with rough and preliminary but easily explicable calculations. These suggest that, depending on what tracing technology is used in conjunction with testing, at least millions and possibly hundreds of millions of tests per day will be needed. While we estimate that such capacity is possible by late spring or early summer, we believe that the AEI and CAP timetables and cost estimates are unrealistic and that we must invest much more aggressively if we are to allow a return to work."
Edmond J. Safra Foundation Center for Ethics
Siddarth, Divya; Weyl, E. Glen (Eric Glen), 1985-
2020-04-08
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Roadmap to Pandemic Resilience: Massive Scale Testing, Tracing, and Supported Isolation (TTSI) as the Path to Pandemic Resilience for a Free Society
From the Executive Summary: "We need to deliver 5 million tests per day by early June to deliver a safe social reopening. This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy. We acknowledge that even this number may not be high enough to protect public health. In that considerably less likely eventuality, we will need to scale-up testing much further. By the time we know if we need to do that, we should be in a better position to know how to do it. In any situation, achieving these numbers depends on testing innovation. [...] This policy roadmap lays out how massive testing plus contact tracing plus social isolation with strong social supports, or TTSI, can rebuild trust in our personal safety and the safety of those we love. This will in turn support a renewal of mobility and mobilization of the economy. This paper is designed to educate the American public about what is emerging as a consensus national strategy."
Edmond J. Safra Foundation Center for Ethics
2020-04-20
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Pandemic Resilience: Getting it Done
From the Executive Summary: "On April 27, the CDC [Centers for Disease Control and Prevention] changed its guidance to support broader use of testing not only for therapeutic purposes, but also for disease control. In the most recent guidance, released May 3, first priority goes to hospitalized patients, first responders with symptoms, and residents in congregate living contexts with symptoms. But there is now also a second priority category that includes asymptomatic individuals from groups experiencing disparate impacts of the disease and 'persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to: public health monitoring, sentinel surveillance, or 'screening of other asymptomatic individuals according to state and local plans' (bold in original, italics added). The last phrase supports broad testing of contacts of COVID [coronavirus disease]-positive individuals and of essential workers, even when they have mild symptoms or none at all. This Supplement to our Roadmap to Pandemic Resilience offers guidance to help state and local governments develop TTSI (testing, tracing, and supported isolation) programs in support of such testing for purposes of disease control and suppression."
Edmond J. Safra Foundation Center for Ethics
Allen, Danielle S., 1971-; Bassuk, Alicia; Block, Sharon . . .
2020-05-12
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When Can We Go Out? Evaluating Policy Paradigms for Responding to the COVID-19 Threat
From the Abstract: "This paper seeks (1) to explain why public officials in the U.S. are having such difficulty addressing the question of a timetable for their imposition of collective quarantine orders; (2) to explain the two available viable policy approaches and timetables for bringing the COVID-19 [coronavirus disease 2019] pandemic under control (rather than, as on a third possible approach, simply allowing it to run its course); and (3) to argue for the superiority of one approach and timetable, namely, the one we call 'Mobilize and Transition,' which contrasts to a timetable we call 'Freeze in Place' and also to the third approach, which we call 'Surrender.' In the case of COVID-19, our under-preparation for a coronavirus pandemic (in contrast to an influenza pandemic) requires that we fold what should have been a stage of activity undertaken prior to an outbreak into our current efforts to fight the pandemic. This highlights the importance of the mobilization concept. We should understand ourselves as needing simultaneously to meet the requirements of interval 4 and interval 6 in the Department of Health and Human Services' Pandemic Interval Framework. This requires an intensification of investment of resources--financial, human, industrial, and organizational."
Edmond J. Safra Foundation Center for Ethics
Allen, Danielle S., 1971-; Stanczyk, Lucas; Sethi, Rajiv, 1963- . . .
2020-03-25
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Mobilizing the Political Economy for COVID-19
From the Abstract: "COVID-19 [coronavirus disease 2019] threatens every aspect of global society. Addressing it requires a full mobilization of our political economy. This contrasts with a typical 'endogenous' recession arising from internal failures of the financial and market system. As such, we must repurpose much of the economy, rather than simply supporting or stimulating it as in a typical downturn. This paper lays out the fundamentally different policies required for mobilization, with the hope of providing a coordinating framework that can then be modularized to further flesh out strategies across industrial sectors."
Edmond J. Safra Foundation Center for Ethics
Weyl, E. Glen (Eric Glen), 1985-; Sethi, Rajiv, 1963-
2020-03-26
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Outpacing the Virus: Digital Response to Containing the Spread of COVID-19 While Mitigating Privacy Risks
From the Abstract: "There is a growing consensus that we must use a combined strategy of medical and technological tools to provide us with response at a scale that can outpace the speed and proliferation of the SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] virus. A process of identifying exposed individuals who have come into contact with diagnosed individuals, called 'contact tracing,' has been shown to effectively enable suppression of new cases of SARS-CoV-2 (COVID-19). Important concerns around protecting patient's confidentiality and civil liberties, and lack of familiarity with available privacy-protecting technologies, have both led to suboptimal privacy implementations and hindered adoption. This paper reviews the trade-offs of these methods, their techniques, the necessary rate of adoption, and critical security and privacy controls and concerns for an information system that can accelerate medical response. Proactive use of intentionally designed technology can support voluntary participation from the public toward the goals of smart testing, effective resource allocation, and relaxing some of physical distancing measures, but only when it guarantees and assures an individual's complete control over disclosure, and use of data in the way that protects individual rights."
Edmond J. Safra Foundation Center for Ethics
Hart, Vi; Siddarth, Divya; Cantrell, Bethan . . .
2020-04-03
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Building Solidarity: Challenges, Options, and Implications for COVID-19 Responses
From the Abstract: "Social solidarity is a critical tool in the response to the COVID-19 [coronavirus disease 2019] pandemic, as political leaders call for major disruptive changes to everyday life and sacrifices for collective well-being. In this white paper, we shed light on the nature of social solidarity; how it might the affect attitudinal and behavioral changes needed to confront the crisis; potential obstacles to solidarity as a result of the particular biomedical properties of the virus and of society and politics more generally; and factors aiding in the building of solidarity. We conclude with several plausible strategies to foster solidarity, including those focused on public messaging - such as cueing 'linked fate' or emphasizing high-risk behaviors rather than groups-- and policies - such as fair and transparent rules for public health tools, sustained economic support funds, and excess profits taxes. Promoting solidarity must supplement 'technical' solutions because the efficacy of the latter will depend on the former."
Edmond J. Safra Foundation Center for Ethics
Cammett, Melani; Lieberman, Evan S.
2020-03-30
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Educational Ethics During a Pandemic
From the Abstract: "This paper examines districts' and states' distributive choices during March and April 2020 to explore the ethics of educating in a pandemic. Section 2 investigates our revealed preferences around the aims of schooling, concluding that we value schools as providers of care before and even above their roles as deliverers of learning opportunities. Section 3 shifts to policy makers' decisions about schools specifically as providers of academic learning. It finds that school closures under COVID-19 [coronavirus disease 2019] 'intensify' existing ethical dilemmas in education policy and practice, but they generally have not posed novel ethical challenges. In contrast to public health ethics in emergency contexts of scarcity, however, egalitarian rather than utilitarian principles seem to motivate policy makers and educators. This led many districts and states to decide initially to offer no educational services to anyone rather than violate substantive equality of educational opportunity. Section 4 finds similar motivations at work in more recent decisions to eliminate high-stakes grading through adoption of mandatory pass/no credit approaches. The paper concludes that while the pandemic has not changed the nature of existing ethical challenges, it has raised the stakes if we fail to realize our ethical commitments--and demonstrated our capacity to have realized them all along."
Edmond J. Safra Foundation Center for Ethics
Levinson, Meira
2020-05-16
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Mitigate/Suppress/Maintain: Local Targets for Victory Over COVID
From the Abstract: "There is growing consensus around a strategy centered on testing, tracing, and supported isolation (TTSI) to suppress COVID [coronavirus disease], save lives, and safely reopen the economy. Given the high prevalence the disease has reached in many OECD [Organisation for Economic Co-operation and Development] countries, this requires the expansion of TTSI inputs to scales and with a speed that have little precedent (Siddarth and Weyl, 2020). AAs scarcity of testing supplies is expected to remain during the build-up to a surge, authorities will need to allocate these tests within and across localities to minimize loss of life. This paper documents a preliminary framework that aims to provide such guidance to multiscale geographies, in conjunction with our previous recommendations. Given unfortunate limits in current testing capacity, we describe a testing and tracing regime in which orders of magnitude fewer resources can be used to suppress the disease."
Edmond J. Safra Foundation Center for Ethics
Siddarth, Divya; Charpignon, Marie; Foster, Dean P. . . .
2020-05-14
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Preparedness and Unpreparedness: The Military Vs. Medicine
From the Abstract: "As the COVID-19 [coronavirus disease 2019] pandemic intensified in the spring of 2020, many Americans were shocked to see how quickly hospitals were overwhelmed in affected cities. Our medical and public health infrastructure was clearly not prepared, leading to problems with emergency medical services, acute care hospitals, nursing homes, access to adequate protective equipment, and mortuary capacity. How could this be? For several decades, the United States government has run pandemic simulations and this outcome-- overwhelmed health care systems--has been identified as a possible scenario time and time again. Yet preparations for this eventuality were halting and inadequate at best. In this essay we review the historical and policy contexts of pandemic preparedness to understand why we have been caught off-guard by something we had repeatedly foreseen. We explore the reasons for our current predicament and whether alternative approaches ought to be pursued. It is not that preparedness is impossible: the federal government invests substantial resources in military preparedness, seemingly with good effect. The problem is specific to health care and bears the imprint of our fragmented systems of financing and government oversight."
Edmond J. Safra Foundation Center for Ethics
Rosenthal, Meredith Beaven; Jones, David S. (David Shumway)
2020-05-07
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Interstate Compacts: A Primer
From the Introduction: "Analysts have recently focused their attention on two pathways for the United States to reopen prior to the development of a vaccine for COVID-19 [coronavirus disease 2019]. The first is to accept a series of rolling openings and closings: reopening as infection rates decrease, then reclosing as they rise again due to increased interactions. This approach is generally thought to be enormously costly both economically and socially, as people will be kept in their homes and commerce restrained for considerable amounts of time. The second approach is to massively ramp up the production of testing, either through a universal testing regime (which would require capacity to test all 300+ million Americans once a week) or a system of testing, tracing, and supported isolation (which would require testing 5 million Americans a day, plus tracing those who were in contact with the infected and isolating them). The testing pathway would enable the United States to reopen without having to close repeatedly and it would, as a result, save billions of dollars. [...] This paper provides an introduction to interstate compacts, in order to inform the design of a possible Pandemic Testing Board."
Edmond J. Safra Foundation Center for Ethics
Hansmann, Lisa
2020-04-30
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Designing an Interstate Compact for a Pandemic Testing Board
From the Introduction: "Analysts have recently focused their attention on two pathways for the United States to reopen prior to the development of a vaccine for COVID-19 [coronavirus disease 2019]. The first is to accept a series of rolling openings and closings: reopening as infection rates decrease, then reclosing as they rise again due to increased interactions. This approach is generally thought to be enormously costly economically and socially, as people will be kept in their homes and commerce restrained for considerable amounts of time. The second approach is to massively ramp up the production of testing, either through a universal testing regime (which would require capacity to test all 300+ million Americans every week or two) or a system of testing, tracing, and supported isolation (which would require testing 5 million Americans a day, plus tracing those who were in contact with the infected and isolating them). The testing pathway would enable the United States to reopen without having to close repeatedly and it would, as a result, save billions of dollars. The problem is that we do not have the number of tests necessary to pursue a testing pathway to reopening. [...] This paper offers a blueprint for how to design a pandemic testing board via an interstate compact."
Edmond J. Safra Foundation Center for Ethics
Sitaraman, Ganesh; Hansmann, Lisa
2020-05-04
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Schools During the COVID-19 Pandemic: Sites and Sources of Community Resilience
From the Abstract: "Along with the economy and health care system, schools are an essential third pillar in promoting community resilience and rebuilding communities' physical, economic, emotional, social, and cultural health in the wake of the global COVID-19 [coronavirus disease 2019] pandemic. Schools serve as sites and sources of community resilience in five distinct ways: they distribute social welfare services, promote human development, care for children, provide stable employment, and strengthen democratic solidarity. Yet long-term physical school closures--along with impending budget cuts driven by cratering state and local economies and tax revenues--make it extremely difficult for schools to perform any of these roles. We recommend three steps for restoring schools' capacities to support community resilience. First, state and district leaders should set metrics for achieving access and equity in each of the five roles that schools play, not just in academic achievement. Second, to establish these metrics, policymakers should develop or strengthen mechanisms to engage diverse community voices, as local community members often best understand the specific ways in which their own schools support or impede community resilience. Finally, Congress should allocate significant increases in federal funding to support public schools and districts for at least the next two years; these allocations should include strong supports for high-needs districts in particular."
Edmond J. Safra Foundation Center for Ethics
Fay, Jacob; Levinson, Meira; Stevens, Allison . . .
2020-06-11
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Pandemic Resilience on Campus
From the Abstract: "A college campus is a quintessential congregate environment with crowded and bustling living and learning spaces, vulnerable to rapid contagion. Yet online education as currently conceived is a poor substitute for the on-campus experience, and may exacerbate existing educational inequities. Many Colleges and Universities are accordingly keen to re-open their doors. In this paper we consider a range of criteria that must be considered as these decisions are made. In this process, institutions must look to and support the communities in which they are embedded, and determine whether disease prevalence outside their campuses allows for disease suppression within. We highlight that institutions must adopt not just population thinning, social distancing, and restrictions on mobility, as many are now preparing to do, but also that they need to build, maintain, and vigorously use an infrastructure for testing, tracing, and supported isolation. They need to demonstrate to students, faculty, and staff that they have little to fear from each other, and provide resources and care to those most vulnerable within their jurisdictions. If they can accomplish this, even with the delivery of classes having a significant online component, students may be able to safely return to campus life."
Edmond J. Safra Foundation Center for Ethics
Sethi, Rajiv, 1963-; Austin, Rachel Narehood; Siddarth, Divya . . .
2020-06-17
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Who is Dying, and Why?
From the Abstract: "It is commonly asserted, with some justification, that viruses do not recognize social boundaries. And yet the statistics on the demographics of those afflicted and felled by Covid-19 [coronavirus disease 2019] show startling disparities by race, ethnicity, and socioeconomic status that emerged early in the US epidemic. This paper documents and considers the reasons for this. Since the disease is especially deadly for the elderly, it is important to keep in mind that different demographic groups have very different age distributions. As a result, inferences from data that are not age-adjusted must be made with great care. With this in mind, we explore some of the particularities of disparities across groups, including intersections between race-ethnicity and socioeconomic status. We consider the composition of the essential workforce, and of facilities such as prisons, detention centers, long-term care establishments, and specific industrial sites such as meatpacking plants that have been prominent loci for the spread of disease. Finally, we address the question of how policy responses can actively work to mitigate these disparities."
Edmond J. Safra Foundation Center for Ethics
Sethi, Rajiv, 1963-; Siddarth, Divya; Johnson, Nia . . .
2020-05-20
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Ethical Implementation of Wearables in Pandemic Response: A Call for a Paradigm Shift
From the Abstract: "Wearable technologies, a class of information technology devices uniquely designed to be worn on an individual's body, are being implemented in the strategic response to COVID-19 [coronavirus disease 2019]. Their form and function establish a unique degree of intimacy with the human body, raising a set of distinct ethical concerns related to use of the data they create, record, analyze and transfer. We discuss two paradigmatic applications of wearables in this setting: tracking persons via GPS [Global Positioning System] and bluetooth and harnessing of biometric surveillance for disease management and prevention. We then highlight the nuanced ethical concerns for privacy and respect for persons, autonomy, and justice related to the design, oversight and embedded structure of wearable technology, the nature of relevant informed consent regarding use of data collected by wearable devices, and potential for these applications to exacerbate underlying disparities. Finally, we propose three prospective solutions for keeping data both decentralized and concealed and for application of Mediating Institutions of Data (MIDs) which may enable appreciation of potential benefits of wearables, both during COVID-19 specifically, and more broadly, while minimizing the ethical harms."
Edmond J. Safra Foundation Center for Ethics
Gross, Marielle S.; Miller, Robert C.; Pascalev, Assya
2020-05-18
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Policing in a Time of Pandemic: Recommendations for Law Enforcement
From the Abstract: "This white paper notes the novel law enforcement challenges created by COVID-19 [coronavirus disease 2019] and describes the different approach police must take in light of these challenges in order to serve their traditional public safety function. Traditional law enforcement practices such as stops, searches, and arrests currently create a substantial risk of infection for police, suspects and community members alike. We conclude that until stay-at-home and social distancing orders have been lifted, law enforcement agencies should suspend enforcement measures requiring close proximity or physical contact between law enforcement personnel and members of the public, except in cases where the failure to stop, search, or arrest a suspect creates an imminent danger of death or serious bodily injury to police officers or others. In particular, stay-at-home orders should not be enforced through arrests; instead, police should give oral or written warnings whenever possible, and the police role should focus on public education and connecting citizens to essential services."
Edmond J. Safra Foundation Center for Ethics; Georgetown Law
Brooks, Rosa; Lopez, Christy E.
2020-04-10
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Digital Tools for COVID-19 Contact Tracing: Identifying and Mitigating the Equity, Privacy, and Civil Liberties Concerns
From the Abstract: "Many state governments and public health authorities in the United States are turning to digital tools to assist contact tracing efforts in response to the coronavirus pandemic despite equity, privacy, and civil liberties concerns. The digital divide, pronounced lack of trust in government among certain communities, and privacy risks posed by collecting personal data at scale make effective deployment of digital contact tracing tools challenging. But if governments decide they need to supplement manual contact tracing due to capacity issues, digital tools that use exclusively Bluetooth-based technology may be useful, as long as public health authorities implement proper safeguards. This paper outlines the equity, privacy, and civil liberties risks posed by digital tools as well as safeguards that policymakers can adopt to mitigate these concerns. Further, the paper recommends that policymakers take affirmative steps to address vulnerable populations that are unlikely to be reached by digital apps, partner with developers and community organizations, promote public education campaigns when deploying digital tools, take steps to close the digital divide, and pass comprehensive privacy legislation with effective enforcement mechanisms."
Edmond J. Safra Foundation Center for Ethics; Open Technology Institute
Bagchi, Koustubh; Bannan, Christine; Franklin, Sharon Bradford . . .
2020-07-02
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Path to Zero and Schools: Achieving Pandemic Resilient Teaching and Learning Spaces
From the Document: "Facing the reality, however, that this cannot be achieved before the start of the new school year and that the mounting costs to children of school shutdowns are significant, the second best policy, and path we should pursue, is to re-open in-person Grades K-5 (1st priority) and Grades 6-8 (second priority) in lower risk level jurisdictions, provided there is a sufficient supply of pandemic resilient teaching and learning spaces in the district to do so equitably."
Edmond J. Safra Foundation Center for Ethics; Harvard Global Health Institute
2020?
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Recommendations for Prioritization and Distribution of COVID-19 Vaccine in Prisons and Jails
From the Document: "Prisons and jails across the country have been epicenters of the COVID-19 [coronavirus disease 2019] pandemic. Since the beginning of the pandemic, correctional facilities have accounted for a majority [hyperlink] of the largest single-site, cluster outbreaks across the country. Nearly 20% of the prison population has tested positive for COVID-19, with an infection rate [hyperlink] that is higher than five times and an age-adjusted mortality rate that is three times that of the general population. Yet, to date, recommendations [hyperlink] on vaccine distribution, set forth by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices, have not given incarcerated people priority in COVID-19 vaccine distribution. This is in stark contrast to the explicit and appropriate prioritization of people in long-term care facilities, another group that has experienced marked rates of COVID-19 and resultant morbidity and mortality. Prisons and jails are not places apart from the community. Outbreaks in correctional facilities spill over to the community and further burden healthcare systems that are overtaxed, especially in rural communities with local jails. That is why we conclude that prioritization for vaccination for those who live and work in correctional systems is critical to public health."
AMEND; François-Xavier Bagnoud Center for Health and Human Rights; University of California, Los Angeles. School of Law . . .
Wang, Emily A.; Brinkley-Rubinstein, Lauren; Puglisi, Lisa . . .
2020-12-16
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