Pandemics, Protocols, and the Plague of Athens: Insights from Thucydides

Historical microbiology: researching past bioevents by integrating scholarship (re)sources with paleomicrobiology assets

The analysis of past epidemics and pandemics, either spontaneous or of human origin, may revise the physical history of microbiota and create a temporal context in our understanding regarding pathogen attributes like virulence, evolution, transmission and disease dynamics. The data of high-tech scientific methods seem reliable, but their interpretation may still be biased when tackling events of the distant past. Such endeavors should be adjusted to other cognitive resources including historical accounts reporting the events of interest and references in alien medical cultures and terminologies; the latter may contextualize them differently from current practices. Thus 'historical microbiology' emerges. Validating such resources requires utmost care, as these may be susceptible to different biases regarding the interpretation of facts and phenomena; biases partly due to methodological limitations.

[Prioritization of health resources in contexts of scarcity. SESPAS Report 2022]

La pandemia de COVID-19 ha supuesto un desafío tanto clínico como jurídico y bioético. Se desarrollan estos tres pilares fundamentales en el abordaje de la priorización de recursos sanitarios en pandemia: criterios clínicos, marco legal correspondiente y principios éticos aplicables. Inicialmente se aplicaron criterios clínicos para identificar a los pacientes con mejor pronóstico de supervivencia, combinando una evaluación clínica y el uso de variables de pronóstico a corto y largo plazo. Sin embargo, la decisión de priorizar la atención de un paciente sobre otro tiene una carga jurídico-política, que presenta el riesgo de caer en la discriminación ya que están en juego derechos fundamentales. Los criterios de priorización deben basarse en principios que reflejen como filosofía vehicular la que hemos asumido constitucionalmente como Estado social y democrático de Derecho, que no responde al utilitarismo, sino al personalismo. Cualquier filosofía de distribución de recursos tiene que tener presente la perspectiva científica, constitucional y, con ellas, las de los derechos fundamentales y los principios bioéticos. En la priorización de los recursos deberían consolidarse principios éticos como el respeto a la dignidad de las personas, el principio de necesidad (igual necesidad, igual acceso al recurso), el principio de equidad (que aconseja priorizar a los grupos de población más vulnerables), la transparencia (fundamental en la confianza de la sociedad) y el principio de reciprocidad (que exige proteger a los sectores de la población que asumen más riesgos), entre otros.

Should healthcare workers be prioritised during the COVID-19 pandemic? A view from Madrid and New York

While COVID-19 has generated a massive burden of illness worldwide, healthcare workers (HCWs) have been disproportionately exposed to SARS-CoV-2 coronavirus infection. During the so-called 'first wave', infection rates among this population group have ranged between 10% and 20%, raising as high as one in every four COVID-19 patients in Spain at the peak of the crisis. Now that many countries are already dealing with new waves of COVID-19 cases, a potential competition between HCW and non-HCW patients for scarce resources can still be a likely clinical scenario. In this paper, we address the question of whether HCW who become ill with COVID-19 should be prioritised in diagnostic, treatment or resource allocation protocols. We will evaluate some of the proposed arguments both in favour and against the prioritisation of HCW and also consider which clinical circumstances might warrant prioritising HCW and why could it be ethically appropriate to do so. We conclude that prioritising HCW's access to protective equipment, diagnostic tests or even prophylactic or therapeutic drug regimes and vaccines might be ethically defensible. However, prioritising HCWs to receive intensive care unit (ICU) beds or ventilators is a much more nuanced decision, in which arguments such as instrumental value or reciprocity might not be enough, and economic and systemic values will need to be considered.

The COVID-19 pandemic and the "Plague of Athens": comparable features 25 centuries apart

Motivated by the up to now disastrous outcomes of the COVID-19 pandemic, we attempted a flashback to the so-called "Plague of Athens," which indicated a serious contagious disease, having taken place between 430 and 426 BC. The ancient pandemic was meticulously described by the Athenian historian and general Thucydides. We compared, as much as possible, the following parameters: background conditions, spreading of the pandemics, preceded and concurrent adverse events, duration and waves of the pandemics, symptoms, implicated infectious agents/diseases and mental/psychosocial consequences. The current pandemic was preceded by a global economic crisis, which particularly affected deprived population groups, while the ancient one started on the second year of a catastrophic civil war. Rivalry and different political systems between now (US/China) and then (Athens/Sparta) superpowers were the basis for conspiracy scenarios, concerning origins of the pandemics, which resulted to huge numbers of deaths, particularly in overcrowded and poor areas/cities. Both pandemics not sparing any age, sex, nationality, social group, may have had a zoonotic component, besides being air-born. However, their spreading is/was remarkably rapid, presenting 3-4 waves and lasting for several years. Some somatic signs and symptoms of the diseases coincide. Although for COVID-19, SARS-CoV-2 has been identified as causing agent, the antique pandemic has most probably been attributed to typhoid fever, although this is still a matter of debate. Additionally, both pandemics affected mental health and psychosocial behavior in close similarity. It is noteworthy, that in both eras physicians and healthcare workers, despite physical and psychological exhaustion, in the majority, presented admirable resilience and willingness to help suffering fellow people, often at the expense of their own lives. The considerable number of comparable features between COVID-19 and the "Plague of Athens" confirms that pandemics may present over time important similarities in their origin, evolution and outcomes.

Sophocles' Philoctetes and Moral Injury in the COVID-19 Pandemic

Strong emotional responses of health-care professionals to the unusual stress of providing care during the COVID-19 pandemic may be consistent with the experience of moral injury. This term, originally used to explain the feelings of guilt, shame, and righteous anger resulting from trauma experienced by US soldiers who felt betrayed by their leaders in combat, has recently been applied to the experiences of health-care workers who know the right thing to do but lack the autonomy, latitude, or authority to do it. Ancient Greek tragedy, which often explores stories about moral challenges, can provide a fruitful context for communicating about this kind of traumatic experience. Sophocles' Philoctetes is particularly relevant for health care since it describes the psychological pain of a would-be caregiver who is ordered by a superior to deny care to someone suffering with chronic pain, providing a clear example of betrayal through failed leadership and lack of authority to do the right thing. A more detailed reading of Sophocles' Philoctetes demonstrates that it also describes the kind of moral distress that results from being forced to respond to an unsolvable ethical dilemma when there is no clear right thing to do or when doing the right thing requires violating personal moral values.