Personal protective equipment or PPE has been a major topic of discussion across the nation. The COVID-19 pandemic has exposed major shortages of PPE and health care workers are being asked take care of patients with what some would argue is inadequate protection. The guidelines set by the CDC have changed and recommendations have even gone so far as to approve bandannas as a means for respiratory protection. Some have argued that it is unethical for health care workers to not have adequate protection, while others think it's their duty, protected or not. Adding to this debate has been theft, hoarding and disparate distribution of these critical supplies. During this panel discussion moderator Carmel Shachar, Stephen P. Wood, Christine Mitchell and Dr. Michael Mina explored the ethics of PPE in the COVID-19 pandemic.

1. Ethical Dilemmas in Mask and
Equipment Shortages:
Health care during
the COVID-19 pandemic

2. 2
Personal Protective Equipment
• Masks and respirators
• Gloves
• Gowns and aprons
• Goggles/Face shields
• Booties
• Sanitizers

3. 3
All U.S. healthcare facilities should begin using
PPE contingency strategies now (CDC*)
“U.S. healthcare facilities
experiencing PPE shortages
may need to consider crisis
capacity strategies, which
must be carefully planned
before implementation.
The effectiveness of crisis
strategies is uncertain and may
pose a risk for transmission
between HCP and patients.”
https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf

4. 4
Masks
Need: ~3.5 - 7.3B N95 masks/year
Cloth face coverings are not
considered PPE because their
capability to protect healthcare
personnel (HCP) is unknown.
Facemasks, if available, should be
reserved for HCP. [CDC 4-13-2020]

5. 5
Individual HCP: Duty to care
EMS personnel, RTs, RNs, MDs: Codes of ethics
“Because of their commitment to care for the sick and injured,
individual physicians have an obligation to provide urgent medical
care during disasters. This ethical obligation holds even in the
face of greater than usual risks to their own safety, health or life.”
[AMA Code of Ethics’ Opinion on Physician Duty to Treat]
The nurse provides services…unrestricted by considerations of
social or economic status, personal attributes, or the nature of
health problems. [ANA]

6. 6
Duty to care
• What is my ethical duty to care for patients in the
absence of proper PPE?
• Am I obligated to care for CoVID19 patients if I am in
a high risk group?
• Do I have to care for infected patients if I live with
family members in a high risk group?
• How do I weigh the duty to care against risks to
myself and my family?
• Do professional duties have limits?

7. 7
Organizational duties to protect
• Standards
• Protection
• Information
• Re-assignment
• Equity
• Support

8. Civilian Action in Pandemic
Rachel Popkin, #findthemasks Founder | Harvard class of ‘08
“I majored in psych/minored in CS & am now am a Senior Product
Manager at Google. My freshman roommate is a pulmonologist in the
Bay Area & told me how terrified she was for her team without PPE supply
4100+ locations requesting PPE
”

9. Civilian Action in Pandemic
Linda Yang, 3D-printer & #findthemasks Canada | MBE class of ‘20
”
I was the oddball in undergrad who did biochemistry & became a
scientist. The majority of my friends went onto medical school. 14 years
later, they are on the frontlines & who I think about in the pandemic.
Mask Straps & Ear Savers
“

10. Come study and work with us
Twitter.com/HMSbioethics
Facebook.com/HMSbioethics
Bioethics.hms.harvard.edu
Harvard Medical School Bioethics Journal
Pandemics call for new attention
to the common good, social justice
and global health