The Ethics of Being Sick

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Our world has changed significantly over the last 3 years. The beginning of the COVID-19 pandemic was almost three years ago. Since then, there have been 651,918,402 cases and 6,656,601 deaths (WHO, 2022). The number of people who are newly disabled or are/have experienced long COVID is still being understood, but the numbers are growing. Post viral disease or long term effects from a viral infection is not unique to COVID-19. Past infections from mono, HIV, enterovirus, etc.. has been linked as one of the possible causes of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) (CDC, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Possible Causes).

In addition to the ongoing COVID-19 pandemic, in the US alone, we are seeing large surges of other respiratory diseases such as the flu and RSV (respiratory syncytial virus) (Schreiber, 2022). In Hyderabad, the location of my Host Organisation, schools are seeing only half of their students attending due to flu-like symptoms, such as fever and cough (Times of India, 2022). Around the world, health care systems are struggling under the strain of COVID-19 and other illnesses, not just due to the increase of cases, but also the loss of staffing and resources since the beginning of the pandemic.

I try to remain aware of what is happening in the world of public health, not only because I am a public health professional, but also because I want to understand my own personal risk, as well as those that I care about. Currently, as an AIF Banyan Impact Fellow, I am placed with Life Circle, an organization that provides home health care to primarily elderly individuals. This population is highly susceptible to moderate to severe illness from even the simplest cold. Whether I am in the office or in the field, I am interacting with caregivers and staff who are engaging with patients. Understanding the increases in specific illness, the new data emerging from the pandemic and the long term effects of infections is critical to the work I do today and the work I do tomorrow.

So the question I continue to ask as these concerns are still very relevant today: what are the ethical considerations for being sick?

Before COVID-19, I was like many people who would come to work even if I was sick. I couldn’t afford the loss of pay if I didn’t have sick leave, and if it wasn’t that bad, then why would I “waste” one of the few sick days I got on something like a cold. Since the pandemic began, I received my Master’s in Public Health and I have been a part of various COVID-19 response activities. Because of these experiences, if I notice even the hint of a cough, fever, or other illness, I’m trying to figure out how to stay home. My new risk assessment takes into account my own health and risk of developing long term effects, but also I’m considering the impact of getting others sick, and the potential to directly or indirectly cause more strain to the healthcare system.

The pandemic continues, and we are learning more and more about COVID-19, long COVID, the impacts of post viral syndromes, and disability caused by viruses. We are seeing our healthcare system becoming more and more strained. Many of us have seen the emotional fatigue of the COVID-19 precautions that have been in place, along with the tension in our society when public health is part of the discussion. Regardless of personal experiences, beliefs, or opinions, we can all agree that there have been some devastating impacts to our communities that are direct results of the pandemic.

As we continue through the pandemic and towards whatever future public health concerns come our way, we have to consider what we can do for community protections, not only from the initial infections but also post-infection effects. What are our choices, what is the path forward, and who is responsible?

Workplaces still have work to do to adjust to the reality that illness can no longer be brushed off as “just a cold”, and that many of these illnesses that we’re seeing increases in can cause illness beyond the current allotments of sick leave provided to employees, but employees still have to make choices. However, the choice is only a mirage when the decision to stay home and protect others is met with the loss of pay or risk of losing employment. With mitigation efforts continuing to taper off, these choices become heavier and heavier to bear.

What is the path forward? The answer requires systematic change across the world, not only in public health, but our workplaces, our schools, our communities. Being sick was never simple, but COVID-19 brought forward the reality that people have been left behind and continue to be pushed aside.

Again, I have to ask not just myself, but everyone: what are the ethics of being sick?

References:
“Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Possible Causes.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 July 2018, www.cdc.gov/me-cfs/about/possible-causes.html.

Schreiber, Melody. “US Sees Surge in Children under Five Hospitalized for Respiratory Viruses.” The Guardian, 1 Dec. 2022, www.theguardian.com/us-news/2022/dec/01/us-surge-respiratory-virus-rsv-influenza-children-hospitalized.

“Flu Leaves Schools in Hyderabad Half Empty Read More at: http://timesofindia.indiatimes.com/Articleshow/96238044.Cms?utm_source=Contentofinterest&utm_medium=Text&utm_campaign=Cppst.” Times of India, 15 Dec. 2022, timesofindia.indiatimes.com/city/hyderabad/flu-leaves-schools-in-hyderabad-half-empty/articleshow/96238044.cms.

“WHO Coronavirus (COVID-19) Dashboard.” World Health Organization, World Health Organization, 23 Dec. 2022, covid19.who.int/.