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COVID-19: Reflecting on the Ethical Ramifications of Flattening the Curve

The year 2020 started off like any other year, a time of hope and opportunity to make changes for the better. This sense of hope was however interrupted in March when we were informed about COVID 19, a virus that affected its victims in unprecedented ways. In response to this crisis, the world developed strategies not necessarily to cure the victims of the virus or to kill the virus itself.  Rather, the goal of the strategies was to ensure that the world would not be overwhelmed by too many cases of infections happening at once, hence creating a sharp curve as in the graphic presentation of the crisis below.

(Graphic created by biologist Carl T. Bergstrom,

Multiple strategies towards flattening the curve were consequently proposed. It is my thesis here that these strategies themselves raise significant ethical concerns. The goal is to unmask these ethical ramifications of the strategies themselves.

A key, if not the key strategy was the application of stay at home orders that went to effect almost immediately and globally. Often these orders were reinforced by curfews and mandatory quarantines if  one were exposed or even suspected to have been exposed to the virus. 14 days of voluntary self-quarantine or quite often forced quarantine was the standard. These stay at home orders were global with virtually all nation states in the world adopting them. Initially the exception was Sweden where people were encouraged to mix despite the virus, ostensibly to develop what the epidemiologists there described as “herd immunity.[1]

The stay at home orders were accompanied with the exhortation that people should not only stay at home but should work at home, remotely. Colleges, universities and schools were closed in March 2020 and the teaching hence forth would be done online, via zoom (synchronistic or asynchronistic presentations!)  The short term and long term impact of this sudden pivoting in  the world of work is yet to be quantified or analyzed.

And so just like that, COVID revolutionized how and where we work. These work at home orders were intended for the majority of the world’s workers with the exception of some workers who were designated as “Essential Workers.” Broadly speaking, these essential workers are in 2 categories: those who work as caregivers and those who work to ensure flow of food from farm to table in the food chain. Those who are in the food chain world of work include farmworkers (who grow the food) as well as those who work in food outlets wholes sale and retail shops such as Safeway in the US.

Now, while those who work as caregivers include doctors in hospitals and clinics, the majority of the caregivers are nurses, both regular registered nurses (RNs) as well as the rather informal group called of nurses CNAs (“Certified Nurse Assistants”). Most of the CNAs have minimal training in nursing yet they do the most basic and necessary nursing care: feeding, cleaning and ensuring that their patients are comfortable.

The CNAS’s work station quite often is not in the hospital or in clinics but in nursing homes or in personal homes where they are hired as “Live-in” care givers. It is for these reasons that when the virus first struck in nursing homes, both patients and nurses were disproportionately affected.

It is also noteworthy that these workers did not have the option or the privilege of “sheltering in place” or working at home to protect themselves from the ravaging impact of the virus. The categorization of some workers as essential workers became a rationalization by the majority of us to place these workers in the “frontline” of “the battle” with COVID very much like soldiers are sent to battle and risk their lives on behalf of the rest. It is also the assumption behind this rationale that the caregivers are “duty bound” to follow through with the caregiving despite the palpable risk to their lives. I argue that designating certain workers as essential workers raises questions regarding society’s obligations to protect such workers rights, including their underogable right to live. It seems to me that in designating caregivers as essential workers in the context of COVID 19, we simultaneously rendered them “disposable people.” Such an attitude to fellow humans is palpably morally problematic.

One strategy that was proposed to “protect” the workers was to provide them with PPE (Personal Protective Equipment) including gloves and special protective garments. Alas, for a variety of reasons, such PPE was not available in sufficient quantities and quality and the caregivers continued to be vulnerable.[2] It is only rather belatedly that “plastic glass shields between the cashier and the customer in grocery stores were installed in places like Safeway and other grocery outlets which were considered “essential businesses” that needed to be kept open during the pandemic.


One of the most basic forms of PPE was and is the mask. While the caregivers at times could not access masks, the general population was also urged to wear a mask at least in public. The push back in many places was palpable particularly when wearing the mask was made mandatory in some places.  Some argued that mandating masks was subversive to their rights and freedoms.[3]

It is only recently and rather belatedly that the mask began to be acknowledged as a major prophylactic intervention against COVID 19. It offers a double protection: i.e. protecting the wearer from breathing in potentially virus-laden droplets from others and protecting others from breathing ones’ own equally potentially loaded droplets. The mask seems to serve a dual prophylactic purpose.   For this intervention to work, however, all parties must heed the moral imperative of the “duty to protect”. Where this obligation has been heeded such as in New Zealand, the “Curve” has been relatively flat or negligible.  In contrast, in places where there has been equivocation, the Curve has been rather sharp and threatens to continue upwards , leading analysts to speak of “surges’’ and “peaks.” In turn, the surges have ultimately led to crises in terms of hospital bed availability to treat COVID related emergencies. In some cases, hospital bed availability has been reduced to zero. Meanwhile, the death toll continues to rise in morally alarming ways.[4]

It is also noteworthy that the nurses in the COVID 19 frontlines are more often than not immigrant women. Such women have made the longest commute (both in distance and duration). They “commute” from countries in the Global South (Africa, Asia, and Latin America) and head to the Global North (e.g. the US where they meet what concerned analysts call the “care deficit “in the global “care supply chain.”[5]

Alas, as it has recently been documented, many of the caregivers that have lost their lives to COVID are nurses from the Global South; many are from the Philippines where specific recruitment of such nurses was deliberately done.[6] Concerned analysts have pointed out the disproportionate incidence of death particularly among Filipino nurses who are said to make up to 30% of those who have succumbed.[7] Recognizing that many of these nurses have died “nameless” thus compounding  the sense of  being “disposable people,” an online digital memorial dabbed Kanlungan (i.e. refuge or shelter) has been set up to rectify the situation.[8]

Considering the problematic of the efforts to flatten the curve discussed here, it seems to me that the strategies themselves raise alarming ethical concerns. Not only are the essential workers’ right to life palpably compromised, their rights as workers are also compromised. They work many hours non-stop leading to great emotional and psychological toll among them. Such is the case for example of one care giver, a doctor in an intensive COVID 19 care unit, who reported having worked over 200 consecutive days! He saw it as part of his job to make sure that his patients who could not go home due to the virus were comfortable and comforted[9].  As I argued in a recent forum article, the question of caregiver burn out makes it imperative for us to raise the question, who cares for the caregivers? While we euphemistically hail caregivers as heroes, many are expressing the pain and the trauma of working in the frontlines of COVID without the requisite protection or attention to their needs as humans traumatized by daily encounter with death. It would seem to me that there is a moral duty to care for caregivers, a duty which, alas, has been neglected for the most part.

As I come to a tentative conclusion of these reflections of an enduring and complicated crisis.   there is some good news in the air these last few days, namely: i.e. the approval of vaccines against the virus. These include the Moderna and Pfizer vaccines, said to have 95% efficacy. The news of vaccines has been hailed as a light at the end of the tunnel. It may well be that finally the world has a tool, not merely to “flatten the curve,” but to eliminate the virus altogether.  One hopes that in the application of this tool in the battle against COVID 19, the rules of distributive justice will prevail as we determine who should be prioritized in getting the vaccine.  It is my hope also that in seeking the cure for COVID 19, we shall consider that this is not merely a pandemic but a syndemic, i.e. the virus thrives where other metaphorical viruses, e.g. racism, also thrive. As concerned analysts have pointed out, COVID 19 for example takes a disproportionate toll among impoverished communities facing preexisting conditions of economic deprivation compounded by the “virus” of racism.

As we continue to wrestle with the  complicated problem of COVID 19, it is imperative to consider the syndemic nature of the problem and the implications of what Paul Farmer calls “Pathologies of Power,” namely racism, poverty, sexism and political oppression.[10]

[1]  For details of this controversial strategy, see

[2] See article discussing this shortage here :

[3] See discussion of anti mask movement here:

[4]  To date, the death toll in the US is over 300000  .

[5] For a detailed analysis of the problematic   of Global South women’s  commute to meet the Care-deficit in the global North, see  essay by Arlie Hochischild in Ehrenreich  and Hochschild: Global Woman : Nannies , Maids and Sex Workers in the New Economy: Sage Publishers 2004:

[6] For a detailed discussion of this intentional recruitment and its link with the colonialism in the Philippines, see Choy C. C. Empire of Care : Nursing and Migration in  Filipino American History. Duke University Press, 2003.

[7] See discussion of this statistics here:

[8] For  details of this digital memorial, see link here:

[9] For details of  the story of a doctor who worked non stop  for 256 days  and the toll it took , see

[10] See Paul Farmer: Pathologies of Power: Health , Human Rights and The New War on The Poor University of California Press 2003