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A Bioethicist’s Guide to COVID-19

How can we behave better during a pandemic?

A shopper looks for dried pasta in limited supply at a Jewel-Osco store in Lincoln Park on Monday, March 16.   Photo: John J. Kim/Chicago Tribune

DePaul University’s Craig Klugman has spent a career pondering the moral quandaries of health and medicine — he’s a bioethicist who’s worked with the city and state public health departments on emergency preparedness plans, among other thorny topics. He’s also knee-deep in the current crisis, serving on a task force working with the school’s administration on the response to the Coronavirus Disease 2019 (COVID-19).

Klugman took time between virtual classes and conference calls to chat with Chicago magazine about the steps we should be taking now for our collective well-being. This is an edited version of our conversation.

Klugman Photo: Craig Klugman

Is there an overarching message you’d offer Chicagoans about making choices in the face of so much uncertainty?

Be calm, but also act in solidarity, coming together as a community to take care of one another. We’re asking people to stay at home to minimize the spread of the disease, so we don’t overwhelm the health care system and we protect the people who are most vulnerable. In this case, that’s people who are elderly, who have diseases that decrease their immunity, or who have an underlying lung disease. By most of us trying to stay healthy and uninfected, we protect them as well.

The other value that I believe is critical at this point is compassion. Everybody’s having anxiety. We’re all worried, did I buy enough soap? (The answer is, you probably bought too much, and you definitely bought too much toilet paper.) But take a deep breath and look out for one another, especially the people who are struggling right now. Realize the world is changing for everyone for the next few months, and we need to be kind to one another.

Should healthy people be refraining from all unnecessary activities right now — practicing social distancing?

Yes, I think at this point we owe it to each other to avoid social situations. As of March 16, the CDC has recommended no gatherings of people larger than 50 for the next eight weeks — I think that is probably being generous. There are some places now, such as Spain, where they’re recommending gatherings of no more than 10 people.

Anybody who’s a senior, but especially over 80, is at particular risk of death — not just not catching the virus, but of death if they get sick. If I have somebody who’s more vulnerable at home, I might take even more precautions than if I live by myself or with somebody who’s young. Same if I’m a health care provider.

For most generations now, government has never asked anything of us. Since Vietnam, there hasn’t been a draft. We haven’t seen rationing like we had in World War II. This is the first time that our country’s asking what we can do for it, like that JFK speech. Our country is now asking us to stay at home, and we need to heed that call.

What about meeting up with others outdoors — say, for a group run or a hike?

Being in the fresh air and sunlight is a great thing to do. It’s also important to keep our physical activity up, because it’s part of mental well-being as well. We don’t know how long we’ll be at this, and we want to keep healthy habits.

If you’re meeting with other people, make it a smaller group and space yourself out more. Even if you’re just walking your dog outside, make sure you are six feet away from anyone else — that’s about how far droplets carrying the virus can spread. Maybe bring some hand wipes and use hand sanitizer before you start your run or walk and afterward.

What about small businesses and workers who might be impacted by these choices?

If you’re fortunate enough that your income doesn’t depend on people walking through your business door or your hourly wage, one thing we can do is continue to pay people for the services they would be providing us — cleaning our homes, walking our dogs, taking care of our kids.

You can frequent a restaurant that’s open if you use curbside pickup and leave immediately, or curbside delivery. If you belong to a local gym and there’s a monthly pull on your account, rather than freezing it, think about leaving it. By doing so, you are helping them to keep going. At the end of this, we want to still have a vibrant, economically viable community.

People are also talking about sharing art online. Theaters are starting to broadcast productions virtually. So that’s something else you can look into. I think it’s important that we have art in our life right now because it helps us make meaning of what’s going on and helps us process it. Personally, I’m a knitter, and I knitted a coronavirus; it was one way I could have a sense of control over this.

Are there ways we can help others even as we practice social distancing?

Part of compassion and solidarity is to check on your neighbors, especially those who are older or sick. Some people are putting together community watches and check-in lists. They’re organizing so that if somebody is going to venture into a store, they can get things for others, too.

Also ask people, do they just need to chat? In Seattle, they’ve shuttered a lot of nursing homes so nobody can come in from outside, but there are people visiting through the windows, talking on the phone while they’re looking at each other. Connecting with others through the phone, through text, through Skype and FaceTime, is very important.

Yes, this is our physical health but we also have to be aware of our mental health. Cabin fever is a real thing. We in Chicago know this well; we know winter. It’s not a bad idea to think about how you would react and respond in a bad snowstorm and act similarly.

What do the values of compassion and solidarity tell us about how to react when something is closed or canceled?

I think the appropriate response is, “I’m disappointed. I was looking forward to this. But I understand.” We’re trying to avoid having people congregate because that is a really efficient way to spread a virus.

I’m also an improvisational actor. This is what we talk about in improv as the “yes, and.” Last Thursday at DePaul, we moved a genetics conference online at the last minute. So I thought, yes, it’s canceled — and we can do this instead. Yes, we can’t have people traveling from all over and congregating in a room together, and we can still have people sharing their ideas and information online. I did my presentation from my apartment.

Are there other ways we can or should reduce the strain on the health care system?

Health care workers are already exhausted. Anything we can do to alleviate strain is good. Some hospitals have canceled all their elective surgeries. If you have something scheduled — like, say an annual physical — I would call the office and ask if it makes sense to postpone it. That doctor might be needed to help somewhere else, and the supplies they have in that office can be used to help people who are stricken with the virus, or with another emergency.

If you have a chronic illness already, I would call as well because they might want to do some monitoring at home. If you have a lung illness that makes you vulnerable, you should definitely be in touch with your doctor. But be patient because everybody’s going to be calling. It might take some time to hear back or get through.

What about supplies? When does providing for your family cross the line into hoarding?

The CDC and the Chicago Department of Public Health recommend that you have two weeks’ worth of supplies in your home, because if you don’t feel well or are symptomatic or have been in contact with somebody who becomes diagnosed with the disease, then you are supposed to isolate yourself for 14 days. So I would definitely have two weeks’ worth of stuff. There have been some recommendations to double that, to a month.

If you get more than what you or your family could use in, say, a month, that’s where you’re taking supplies from others who might need them. If you are going around getting things with the intention of reselling them when they’re scarce, that’s price gouging. Not only is it unethical, it’s actually illegal in an emergency.

The thing about a pandemic is we’re probably not going to lose electricity. There will still be trucks rolling. There will still be some things in the store. It’s not a situation where there’s a total collapse of civilization and nothing is happening anymore.

How much information do we have a responsibility to consume? Should we be glued to our screens?

Keeping the news on in the background all the day — you’re absorbing that, and it is going to cause you more tension and anxiety. Sign up for alerts from your business or school and from the Chicago Department of Public Health — those are really important. Otherwise, make deliberate times of the day when you’re going to get news, and unplug the rest of the time.

And what should you do if you feel sick?

Stay home if you don’t feel well. If it’s an emergency — you’re having a heart attack — call 911 or go to the hospital. But don’t go to the emergency room if you think you have COVID-19. If you have symptoms such as fever, cough and difficulty breathing, call your doctor’s office, the hospital helpline, or the nurse line from your insurance company, if you have insurance. (Editors note: The Chicago Department of Public Health has the latest guidance on when and how to obtain testing, and how to isolate yourself if you have been exposed to the virus.)

Any other general life advice right now?

Slow down a little bit. Take your time, so you’re less likely to do things like cutting your finger when you’re chopping your vegetables or getting into a car accident. Think twice about whether going to a place or meeting with people is a really important thing to do. We’re trying to slow down the spread of the virus and flatten the curve — avoiding a huge spike in the number of people who get sick at the same time. If we slowed the pace in all parts of our life, we’d probably be better off.

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