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This paper comprises two cases illustrating ethical challenges experienced by people working with residents and staff in congregate settings (residential homes) during Covid-19. In congregate settings restrictions were more stringent due to residents' vulnerability and high risks of the virus spreading. In the first case, a UK social worker recounts his proactive advocacy on behalf of a young woman living in residential care, enabling easing of some restrictions for her. In the second case, a German researcher discusses how limits on entering nursing homes resulted in postponing and then ending a participatory research project, with the researcher regretting loss of contact with a home. Following each case is a commentary from an outsider's perspective. Both authors foreground their responsibilities to care about people facing difficult circumstances and to take action for change. This suggests that situated approaches to ethics, focussing on particular people, roles and relationships in context (such as the ethics of care and virtue ethics) are helpful in understanding the ethical challenges described. The cases illustrate the extra cognitive and practical effort required to engage in ethical reflection on the implications of new circumstances, in which taken-for-granted ways of being, thinking and acting are difficult or impossible.

Background Nursing homes in Germany are still often associated with the idea of a daily routine determined by the institution, linked to losses of self-determination and participation. Residents, as well as carers and caregivers, perceive chances for co-determination and co-creation as limited. Methods The research project PaStA (Participation in Inpatient Care for Older People) examined and analyzed opportunities and limits of improved participation in nursing homes in Germany with the help of a participatory action research design. Experiences and findings with participatory research processes in two nursing homes are presented. Results Access to people both living and working in nursing homes is demanding and time-consuming. Building a trusting cooperation requires commitment and resources. However, if a research team - including residents - is successfully installed, the participatory process enables all those involved to explore, try out and shape participation possibilities. The reflection that takes place in the process leads to learning processes that (can) result in empowerment. Discussion However, there is a danger that participatory research may primarily reach people better provided with resources for participation based on life-long circumstances (participation dilemma), highlighting the need for responsibly designed access. Likewise, the question of impact must be critically discussed. Sustainability must be considered from the beginning. Conclusions Participatory action research is a worthwhile endeavor, even in settings that are rather unfamiliar with participation, such as residential care for older people. However, researchers should not underestimate the time and commitment required, because preconditions and resistance of people and structures can compromise progress.

The protocol presents a research project that explores the relationship between science and politics in the COVID-19 pandemic from the perspective of public health (PH) scientists in Germany with situational analysis (SA). In context of this global crisis, we ask how PH scientists negotiate their roles as scientists and political citizens; how PH scientists perceive the relationship between their own and other scientific disciplines; and which normative assumptions PH scientists make in the production and dissemination of research findings. To conduct SA, we combine qualitative interviews with PH experts and published documents from scientific societies in PH and related disciplines (e.g., position and opinion papers) to analyze the complexity of integrating evidence-based knowledge into politics. Data are analyzed using different SA mapping tools, focusing on social worlds/arena maps and positional maps. The approach will reveal both explicit positions in the PH community and implicit or hidden voices and will reflect normative assumptions as well as internal structures of PH in Germany. The findings will be discussed with the philosophy sub-project and in a stakeholder workshop with politicians and the public. Further insights will be gained for politics and PH responses to future global crises.

Background During the COVID-19 pandemic politics was in search of scientific evidence to underpin decision making like never before. It is remarkable that voices from public health were less noticeable than those of virologists or immunologists. The aim of our ongoing study is to explore how public health scientists perceive their role in the relationship of their discipline and politics. Methods We conducted 10 reflexive interviews with epidemiologists and public health scientists from Germany and collected documents (official statements and policy briefs of scientific societies). Data from both sources were analysed using situational analysis (Clarke, 2018), an approach used to map and analyse discourses in complex situations. To ensure data quality we used respondent validation. Results According to participants, (1) improving population health was the top priority. Politicians tended to focus on short-term goals rather than long-term consequences. (2) Recognition of public health was increased by the pandemic in Germany. (3) However, politicians favoured virology, biomedical and clinical perspectives. (4) The strong motivation of public health scientists to support politics at the beginning of the pandemic turned into disillusionment. (5) The composition of advisory boards was described as non-transparent. (6) Initiatives by the public health community were not sufficiently impactful. (7) Expectations of policymakers regarding future cooperation were not clear to participants. Conclusions The results present different facets of a delicate relationship between public health sciences and politics. The pandemic increased the visibility and impact of public health in Germany on the one hand but also demonstrated that the realms of public health (science) and politics were not well connected. Involving scientific expertise in politics requires more transparency and the normative assumptions underlying the logics of science and politics need to be made more explicit. Key messages • The potential of public health to address the covid-19 pandemic has not been sufficiently acknowledged by policymakers, and the involvement of its experts requires greater transparency. • Reflecting on the normative assumptions underlying the different logics of public health sciences and politics can support their cooperation in the future.