Evolving an ethical framework for Covid-19 management in India

Abstract

The Covid-19 pandemic has caused millions of cases and deaths worldwide and has caused a massive global economic contraction. Governments, policymakers, and medical professionals have been confronted with several complex bioethical dilemmas during these exceptional circumstances. In developing countries like India, having a large population base, inadequate preexisting public health infrastructure, and a multi-level government system with complex administrative mechanisms imposes enormous barriers and challenges in the effective and ethical management of the pandemic. Furthermore, endemic corruption, limited bureaucratic and organisational accountability, and weak oversight, especially among stakeholders in the vast private and non-government health and allied services sector, complicate the assessment of their adherence to ethical public health practices. All this constitutes a moral imperative for practitioners of medical ethics in India to develop a framework for ethical preparedness during a pandemic. Failure to do so runs the grave risk of moral and ethical chaos from ad-hoc decision making that is deprived of ethical guidance when confronted with an unprecedented public health crisis. In this narrative, we provide some of the building blocks for a comprehensive ethical framework for decision making and shaping public health responses to pandemic situations and associated challenges.

On a model-based approach to improve intranasal spray targeting for respiratory viral infections

“…Consequently, we did not track the bigger droplets which tend to deposit mostly anteriorly, owing to the inertia-dominated initial phase of their trajectories when injected out of the nozzle; see our earlier publication (Basu S. et al, 2020) for an extensive related discussion. Also, as a side-note to this, it is relevant to consider that administered droplets, under nebulized conditions in the same two test subjects and with comparable material density (1.3 g/mL), had resulted in an ideal size range of 2.5-19 μm (i.e., comfortably smaller than 24 μm) for at least 5% targeted nasopharyngeal deposition; see another of our earlier publications (Basu, 2021) for details.…”

“…Subsequently, by varying the spray direction-a new usage condition that would significantly augment droplet deposition at the target site was detected. See our earlier publications (Basu S. et al, 2020;Basu, 2021) for additional details on the numerical setup.…”

“…Observed count distribution of droplet sizes in 1-mg sprayed mass from over-the-counter Flonase™ (Fluticasone Propionate) and Nasacort™ (Triamcinolone Acetonide) spray products, over the test size range of ~1-24 μm used for in silico tracking. Note that rigorous numerical testing for droplets > 24 μm clearly show (Basu S. et al, 2020;Basu, 2021) that they would mostly deposit along the anterior nasal cavity and will largely miss the posterior target site of the nasopharynx.…”

“…The anterior regions of the nasal cavity, however, present a relatively thick mucosal coating (Mittal et al, 2020), which provides a level of protection and prevention against viral invasions. Consequently, the nasopharynx at the back of the nasal cavity and situated immediately posterior to the convergence region of the two airway sides (see Figure 1)-has been identified (Hou et al, 2020;Matheson and Lehner, 2020;Basu, 2021) as the predominant trigger zone for infection onset owing to SARS-like airborne viral respiratory pathogens. Significant to note as well that the nasopharyngeal region contains the nasal-associated lymphoid tissue or NALT (Brandtzaeg, 2011), which provides a direct connection to the immune system.…”

“…Of critical interest here: based on the brisk pace at which lower airway infections often ensue after the emergence of initial symptoms, it has been conjectured that the nasopharynx also acts as the seeding zone for the spread of a respiratory viral disease to the lungs via lower airway aspiration of virus-laden boluses of nasopharyngeal fluids (Hou et al, 2020;Basu et al, 2022a;Chen et al, 2022). Such boluses would typically carry viral load far in excess of the virusspecific infectious dose, which, for example, has been shown to be on the order of a few hundred virions for SARS-CoV-2 (Basu, 2021;Ryan et al, 2021;Geddes, 2022). Another continuing concern is the mutation rate of a virus and how the nature of the fitness landscape renders it amenable to evolution, potentially resulting in more virulent strains (Pachetti et al, 2020;Van Egeren et al, 2021).…”