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Pandemic outbreak of COVID-19 is the largest of its kind of this century. All countries throughout theglobe are trying their best to contain the disease and eliminate at the earliest. Efforts are continuingto improve the outcome of the infection in terms of minimizing the morbidity and mortality. As apublic health strategy every state has the responsibility of protecting the health of the communityand such measures includes the preventive measures like social distancing or even lockdown ofthe state as a whole restricting the movement of the people, diagnostic measures like testing thesuspects, contact tracing and isolation of the patients. Treatment of the infected requires decisionsin resource constraint situation particularly ICU beds and ventilators. In the meantime, protectingdoctors, nurses, other health workers as well as frontline workers need personal protective equipmentwhich is a scarce commodity. While doing so there might be a compromise in the individualautonomy, privacy, confidentiality, and social justice for the beneficence for the larger community.This is an attempt to explore the ethical quandaries in relation to combating COVID-19 in Nepal byrelating the issues with the principles of biomedical ethics.

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PURPOSE The purpose of the study was to compare efficacy and toxicity of olanzapine (OLN; a higher-cost drug) and haloperidol (HAL; a lower-cost drug) in the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC). PATIENTS AND METHODS In a randomized, phase II trial, patients were randomly assigned to receive either OLN 10 mg orally on days 1 to 4 or HAL 1 mg orally on day 1 and 0.5 mg twice daily on days 2 to 4. Both groups received ondansetron 16 mg and dexamethasone 12 mg intravenously on day 1. Patients recorded their nausea using the Edmonton Symptom Assessment Scale (ESAS) and recorded daily episodes of vomiting from day 1 to day 5. The primary end point was complete nausea prevention (CNP; ie, ESAS of 0). Secondary end point was complete emesis prevention (CEP). RESULTS Sixty-five patients were randomly assigned, and 64 received their allocated treatment (n = 32 in each arm). There was no difference in CNP during the overall period (days 1 to 5) between OLN and HAL (68.7% v 71.8%; P = .78). In the acute period (day 1) and the delayed period (days 2 to 5), CNP was similar between OLN and HAL (acute: 84.3% v 81.2%; delayed: 68.7% v 75%). No difference was identified in the rate of CEP during the overall period (81.2% with OLN v 78.1% with HAL; P = .75), during the acute period (93.7% with OLN v 90.6% with HAL), or during the delayed period (84.3% with OLN v 84.3% with HAL). No difference in toxicities was noted between treatment arms. CONCLUSION In this study, HAL had comparable efficacy to OLN in the management of CINV, which suggests that it is the higher-value option in patients who receive HEC in resource-scarce countries.