When COVID-19 arrived in the United States earlier this year, leaders and individuals faced new questions, including those about life and death. While the toughest choice for many of us was to simply stay home, health professionals and elected leaders made decisions about complex problems that often had no clear solution. At the heart of these choices is bioethics, and DePaul faculty members, Dr. Craig Klugman and Professor Valerie Gutmann Koch, have been studying and preparing to answer these questions for a long time. 

Dr. Klugman is a DePaul professor of Health Sciences and Professor Koch teaches Health Law at DePaul; both are bioethicists who assisted with statewide planning efforts to prepare for a pandemic. They join me today to discuss the response to COVID-19 and what may come next. Welcome Craig and Valerie. 

CRAIG KLUGMAN: Thank you for having us. 

VALERIE KOCH: Thank you for having us. 

LINDA BLAKLEY: Craig, I'd like to start with some questions for you. What is the role of a bioethicist during a pandemic? 

CRAIG KLUGMAN: Well a bioethicist is someone who examines the moral issues in life sciences. So our job is to help analyze what is going on, to help make recommendations that are based in good, sound moral philosophy and logic, and to provide support for the hospital administrators, for the physicians, for the elected officials who are making these very tough choices. 

LINDA BLAKLEY: Could you give our listeners a better idea of what responsibility bioethicists have before and during a pandemic? 

CRAIG KLUGMAN: Well I think it varies by location. But bioethicists who work with hospital systems often are involved with education efforts, bedside consultations, helping families make tough decisions about end-of-life choices or different sorts of – what sort of techniques they're going to pursue as far as procedures go, as well as helping to write policy. 

And we're still doing those things in the pandemic, but instead of focusing on individual patients as much as we used to, we're now focused on systems and populations and communities. We're not just looking at what is the best choice for this one patient, but what is the best choice for the community and how to distribute scarce resources. We often in regular times assume that every patient can get everything they need and that insurance will pay for. But in times like pandemic, we have limited resources, such as there are a limited number of trained healthcare professionals, there may not be PPE enough for everyone, we may not have enough ventilators to go around so we're suddenly now making decisions where everybody can't get everything they want or need anymore. 

LINDA BLAKLEY: So, Valerie, based on the recent global spread of COVID-19, you must be quite busy. How are you spending your days? 

VALERIE KOCH: I'm doing some of the things that I was doing before the pandemic, including teaching and writing, although most of the teaching now, all of the teaching now, of course, is online. 

But my writing has shifted. I tend to focus not just on public health issues but on other issues as well in the areas of genetic testing and informed consent and medical decision-making. But the work that I've been doing since COVID-19 became prevalent in the United States is I've been focused a lot more on advising hospitals, healthcare providers and policymakers on various ways to approach these incredibly thorny, difficult questions that Craig mentioned just a minute ago about allocation of resources and how decisions get made at a population level rather than necessarily at the individual level as we're used to. And then I've been doing a fair share of writing on these topics as well in order to education and inform the public. 

LINDA BLAKLEY: Could you share some examples that you have seen of people who are making effective choices to help one another during these times? 

VALERIE KOCH: Well, I think a lot of – at a very personal level, the most effective choices that we have been making and can make are social distancing, staying at home, doing our best to contain the population-wide spread of the virus, and therefore reduce the burden on hospitals and healthcare providers during this time. 

From a more professional level of what I've been advising and some of the choices that folks are making, one of the questions that arises a lot because I come from a legal background and I teach in the law and write in the law, is the question of when we have rules or guidelines about how resources can or should be allocated during times like these; how do we ensure that healthcare providers and institutions follow them because there's always the concern that they might be reluctant to follow guidelines if they're worried about the threat of liability. 

Because, as Craig just mentioned earlier, we have shifted our focus from an individual emphasis to the population, which means that resources are going to be allocated in ways that are not sort of the norm, they're not the standard of care that we're used to. And so they're concerned about physicians and institutions, so therefore concerned about legal liability. 

One of the things that I've been working with providers and institutions is trying to figure out various ways to make sure that they are protected from a liability perspective in order to most effectively follow the guidelines and hopefully save the most lives possible.

LINDA BLAKLEY: So, Craig, looking back at the national state and local efforts to prevent the spread of the virus, can you share a few examples of other tough choices that our leaders have had to make, and did bioethicists help leaders make those decisions? 

CRAIG KLUGMAN: I think the hardest choice that our leaders have had to make – I can think of two. 

One is to sort of shut down our economy, not only – I completely agree with Valerie that the best ethical choice we're all making right now is to stay at home, but that creates challenges for not everybody has a home. 

We have a large homeless population in the United States, and we have a lot of children who the school is the only place where they get their meal for the day, and suddenly they're not going to that school anymore. Those are the kinds of challenges that we have faced and that people have come up with creative solutions for. If not always ideal, they have been definitely on the radar. 

I think also we have this dichotomy between getting people back to work. We've seen record numbers of people making unemployment claims, and now we're seeing protests, organized protests for people who want to reopen the economy at the cost of people's lives. I think those have been challenges. 

We also, you know, one of the basic foundational principles of bioethics is that good stacks make for good ethics, and we don't necessarily have great stacks right now. We are learning about this virus every day. We are learning that it affects different populations differently. We are learning that it affects different parts of the world differently. What we saw in Asia and we saw in Italy was that it was affecting older people more, but that has not necessarily been the case in the United States where it has been more of an even split. We've seen a lot of young people dying from this. I think those are among the issues. 

We had a strong debate over wearing masks in public, whether the public should be wearing masks. At first, the CDC told us that we should not because there was a lack of PPE. This is personal protective equipment that prevents healthcare providers from being affected from the virus. And so to preserve what little resources there were, we made the decision as a country that people wouldn't wear them. 

Well, when we looked at the fact that there are asymptomatic carriers, people walking around spreading the virus who have no symptoms, don't even know they have it, and that people even once they can spread this for several days before they have symptoms, we looked at Asia which had lower amounts of spread of the disease, we noticed they have a culture of wearing masks. 

We now have a cottage home industry of people making masks out of good cotton and not using the medical grade equipment but making their own in the attempt of if they are carriers and aren't aware of it that they are not spreading it to others. 

This has created not just a political change asking people to do that, and you've probably noticed some politicians wearing masks and some politicians not, and that again is a very distinct decision, but we are now choosing to do this. We're not used to in this country making sacrifices to protect others. We haven't had to do that for a very long time, and that's the reason we're making these actions. I think those are some of the tough decisions. It's based on the changing facts as we're trying to make good choices as we go along to reduce the morbidity and reduce the mortality. 

LINDA BLAKLEY: Looking ahead, public health researchers seem to be pointing to testing, tracing, and treatments. What are each of you keeping an eye on? Valerie, can we start with you? 

VALERIE KOCH: One of the major concerns, of course, is we have been buying time by social distancing, by staying at home as much as possible. We've been buying time in order to implement more universal testing, more contact tracing, or any contact tracing really. 

And so what we're really looking toward in the future is making sure that we actually take advantage of that time that we've been buying and ensure that folks are being tested in a way that is effective and thoughtful because, otherwise, we're just sort of waiting for the next wave, which is obviously a concern. That's sort of where we're looking towards. 

And, of course, a lot of my focus generally is on resource allocation, so where are we getting these tests, how are we allocating them, to whom are we allocating them, how often are we testing. These are things that we're grappling with currently that we need to be making some decisions on in order to actually be able to eventually and hopefully reopen our economy and reopen our businesses. 

LINDA BLAKLEY: And Craig? 

CRAIG KLUGMAN: Well, I think, you know, Valerie is right. We need testing. It needs to be accurate. The current tests aren't necessarily proven to be that. It needs to be rapid where you wait 15 minutes instead of five days. And it needs to be available to a lot of people. 

We also need to do contract tracing. Massachusetts just hired 1,000 people to do this. There are proposals from Google and Facebook for their cell phones apps so that if someone is near a person who has COVID or is showing the virus, that their contacts around them can be notified and they can be isolated to prevent the spread further. 

A vaccine is definitely something we need to pursue, but it may not be possible. We actually don't know if even having had the virus conveys any sort of immunity. There is some suggestion it may not in some circumstances. A vaccine may be tough. It may be an annual vaccine like the flu, or it might be something that we have to get once in your lifetime or a couple times in your lifetime. We're still working on that. 

There are the privacy issues over contact tracing and the cell phones that are tracking your different places. 

There is also this proposal for something called an immunity passport. It started in Italy and it's being discussed in the United States now. It's a way for people who have had the disease or somebody gets the immunization that they have a passport that allows them to sort of go back out into the world. 

There is some danger to this with creating disparities and two classes of people. It assumes, again, that having antibodies confers immunity. But it is one of the possibilities for sort of how do we protect the vulnerable people in our society but not suffer a complete economic collapse? That is a fear of many, many people at the moment.

LINDA BLAKLEY: So, Craig, I know you're also helping to inform DePaul's response to COVID-19 as a part of the taskforce working on the university's response. What are some questions you think university leaders should be asking themselves right now? 

CRAIG KLUGMAN: It has been interesting being involved with the DePaul COVID Taskforce because I have seen – gotten a bigger perspective on what it takes to have an operation running like a large university. 

I think the questions we need to be asking are how do we keep our population safe, and this is not just physically safe but how do we keep them emotionally safe and mentally safe. 

There is a cost to not being in the classroom, not having interactions between students and with students and faculty. I mean, I'm missing being in the classroom and seeing my students' faces and whether they grasp an idea or not. That's not so easy to do online and the spontaneity that can happen with a conversation that comes out of what's going on that online doesn't do because you need a lot more planning for it. 

I think we need to be thinking about the safety issues. We need to be thinking about how do we keep the nature and the culture of our universities and the dynamisms and the energy that comes from being located on campuses, how do we keep that identity going, how do we keep our Vincentian values when we're all sitting at home. I'm concerned about those. 

I'm also concerned that academia may change for the long term as a result of this. Will we go back to having these dynamic learning environments, these communities, or will it become something where there is a lot more online presence and a lot less of a physical footprint? 

But I think the safety of our people is the first value. I've been very proud of that as something that DePaul decided on at an early stage that, even if it costs money, even if it costs some time, that taking care of our people was the most important thing. That's a very bioethical way of making a decision. 

LINDA BLAKLEY: I would agree. COVID-19's 24/7 news coverage can be quite overwhelming. I would like to ask each of you what is one piece of advice that you want listeners to take away from this episode to help them get through the current pandemic? Valerie, would you start? 

VALERIE KOCH: My biggest piece of advice at this stage, we're in week – what is it now – five, six even of classes being remote, classes in my very last week of teaching coursework at the last school, and there is a fair share of burnout for all of us, I think. 

There is this tendency to follow – be on Twitter or the news or whatever kind of constantly because it feels like things are changing so rapidly and there's always something happening and something we need to be on top of, but we really have to remember to take time for our own wellbeing, our own mental health and psychological health, and take those moments to ourselves and have a moment to breath and put down the phone or walk away from the computer. 

I know, as a professor, I've made a lot of effort in order to acknowledge the fact that my students and everyone, we're all struggling and we're all in this and we're all trying to get through this in our own ways. And so that would be from not so much of a bioethical perspective and a policy perspective but more just my own piece of advice that I try to take, that I'm not always so great at, but I try to do for myself every so often as well. 

LINDA BLAKLEY: Craig? 

CRAIG KLUGMAN: Yeah. I have adopted the habit of I get up in the morning, I look at the paper, and then I don't turn on the news until about 5:00, so that I am managing my intake of the news and it's not assaulting me all the time. 

Granted, Valerie and I are both spending a lot of time looking at the news, seeing what the issues are, analyzing them, writing about them, but I think you need to do that. 

I've also been taking Sundays as electronic break days. I'm taking kind of an e-Sabbath where I do not answer the phone or the text messages or the emails, and so I don't do that. I would say pick a couple of really reputable news sources and follow them. And don't just repost things onto your social media until you have verified that it is, in fact, true because there is so much misinformation going on out there and we have elected officials who are making life and death decisions for their communities based on information that is not true or that has been made up, which is the same thing. And so before you pass on a piece of information, make sure that it actually is true. That would be my advice. 

LINDA BLAKLEY: There's a lot that the virus has yet to tell us. I thank you both for taking time out of what I can imagine is a very busy schedule to talk today. And thank you for all of your work in guiding others through this pandemic. 

I'm Linda Blakley. Thank you for listening to this episode of DePaul Download presented by DePaul's Division of University Marketing and Communications.