Contingency Measures During the COVID-19 Pandemic in China: An Analysis Based on a New Ethical Framework
Contingency Measures During the COVID-19 Pandemic in China: An Analysis Based on a New Ethical Framework
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中国 COVID-19 大流行期间的应急措施：基于新伦理框架的分析
DOI：
10.1080/15265161.2021.1940364
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发表时间：
2021
影响因子：
13.4
通讯作者：
Zhiping Guo
中科院分区：
文献类型：
--
作者：
Yuming Wang;Hui Zhang;Yongguang Yang;Zhenxiang Zhang;Zhiping Guo
大卫阿尔方德等（2021）的目标文章提供了一个新的道德框架，以指导COVID-19应急激增计划和应对，并将此道德框架应用于三个案例。作为第一个受到COVID-19疫情打击的国家，中国采取了许多措施进行医院激增能力规划，包括方舱医院、定点医院和互联网医院，沿着新兴技术，如人工智能、大数据分析、云计算和5G（Sun et al. 2021）。然而，在中国，还没有任何组织或学者提出一个伦理框架来指导权变实践。在这篇评论中，我们选择了在COVID 19大流行期间在中国广泛使用的两种应急措施（远程医疗和定点医院），并基于Alfandre et al.（2021）提供的伦理框架的应用分析了两个例子。我们旨在说明COVID-19大流行期间的应急措施如何调解中国以患者为中心的护理和公共卫生价值观之间的紧张关系，并希望通过分析跨文化的医疗实践来验证伦理框架的适用性。首先，我们尝试识别中国COVID-19疫情的应急阶段。正如作者所指出的，识别应急阶段的开始非常困难，因为通常没有标志性事件或标志性事件（Alfandre等人，2021）。从武汉市首次报告的不明原因肺炎病例（2019年12月27日）到确认新型冠状病毒在人与人之间传播（2020年1月19日）（中华人民共和国国务院理事会新闻办公室2020），我们认为可以算是“平时阶段”，因为物资、人员、在此期间，使用的空间与医院内的日常实践一致（Hick等人，2009）。在此阶段，中国开展了病原学和流行病学调查，并公布了新型冠状病毒的基因组序列。2020年1月20日起，中国决定将新型冠状病毒肺炎定为B类传染病，适用甲类传染病防控措施。我们认为，这可被视为标志着“应急阶段”开始的一个事件。2020年1月23日，武汉市对外交通关闭，2020年1月23日至1月29日，中国大陆所有省份启动一级突发公共卫生事件响应（中华人民共和国国务院理事会新闻办公室2020）。但随着湖北省新增确诊病例的迅速增加，形势变得非常严峻。在全国动员一切资源驰援武汉、驰援湖北的情况下，震中武汉艰难度过“危机阶段”，逐步过渡到“应急阶段”。相反，由于采取了最极端的措施，武汉76天的封锁，以及中国各地的有效预防和治疗，所有其他省份，
The target article by David Alfandre et al. (2021) offers a new ethical framework to guide COVID-19 contingency surge planning and response, and applies this ethical framework to three case examples. As the first country hit by the COVID-19 outbreak, China adopted many measures for hospital surge capacity planning, including Fangcang shelter hospitals, designated hospitals, and internet hospitals, along with emerging technologies, such as artificial intelligence, big data analysis, cloud computing, and 5G (Sun et al. 2021). However, no organizations or scholars have proposed an ethical framework to guide contingency practices in China. In this commentary, we chose two contingency measures (telehealth and designated hospitals) which have been widely used in China during the COVID19 pandemic, and analyze two examples based on the application of the ethical framework provided by Alfandre et al. (2021). We aim to illustrate how the contingency measures during the COVID-19 pandemic mediated the tensions between the values of both patient-centered care and public health in China, and wish to verify the applicability of the ethical framework through the analysis of the healthcare practices across cultures. First, we try to identify the contingency phase of the COVID-19 pandemic in China. As the authors note, it is exceedingly difficult to identify the beginning of the contingency phase because there is usually no sentinel or hallmark event that marks the occasion (Alfandre et al. 2021). From the first reported cases of pneumonia of an unknown cause in Wuhan City (December 27, 2019) to the confirmation that the new coronavirus was transmitted between humans (January 19, 2020) (The State Council Information Office of the People’s Republic of China 2020), we think that it can be regarded as the “usual phase” because the supplies, staff, and spaces used were consistent with daily practices within the hospitals during this time (Hick et al. 2009). During this phase, China conducted etiological and epidemiological investigations and released the genome sequence of the novel coronavirus. From January 20, 2020, China decided to classify the novel coronavirus pneumonia as a Class B infectious disease and apply measures for the prevention and control of Class A infectious diseases. We think that this can be regarded as an event that marked the beginning of the “contingency phase.” On January 23, 2020, Wuhan’s outbound traffic was closed, and from January 23 to January 29, 2020, all provinces on the Chinese mainland activated the Level 1 public health emergency response (The State Council Information Office of the People’s Republic of China 2020). However, the situation became very serious with the rapid increase in newly confirmed cases in Hubei Province. With all the resources mobilized nationwide to assist Wuhan and Hubei, the epicenter Wuhan struggled through the “crisis phase” and gradually transited to the “contingency phase.” Instead, due to the most extreme measure, the 76-d lockdown of Wuhan, as well as the effective prevention and treatment across China, all provinces other