Taking an extremist viewpoint, coronavirus can turn us into silent killers who do not know they have killed. We can have the virus without knowing it, meet family or friends indoors (despite restrictions forbidding that) and inadvertently infect them; they might also be asymptomatic, and then inadvertently infect another family member or friend, who then dies. As harsh as it seems, sadly it could happen and has happened. None of us would want that on our conscience, and yet we do selfishly take some risk, especially as the pandemic drags on. We are only human after all.
There are many factors at play regarding COVID‐19 and our moral obligations. Often called the invisible enemy and only detectable to most of us via observable symptoms, the virus is challenging. Perhaps if we could perceive the virus and see who had it, we would be much more morally aware. In the example above, if the family or friends had known they had COVID‐19, they would have kept their distance from others. As humans, we have a conscience and, for most of us, a desire not to kill others.
However, the complexity of the science involved in understanding COVID‐19 and pandemic fatigue makes it difficult for all of us to engage our moral compass between us and those we could be harming. While people with good morals might be able to envision the harm they are doing to others, most need more help in recognising these dangers. As caregivers that include our patients.
A global, novel virus that keeps us contained in our homes, maybe for years, is already reorienting our relationship to government, to the outside world, and even to each other. Our desire to return to normality is perhaps driving selfishness and challenging our moral compass.
Many governments are warning that adults of any age with certain comorbidities can be more likely to get severely ill from COVID‐19. Severe illness means that a person with COVID‐19 may need: hospitalisation, intensive care, a ventilator to help them breathe or they may even die. Leading comorbidities among COVID‐19 deaths and severe illness include hypertension, diabetes, hyperlipidaemia, coronary artery disease, renal disease, dementia, COPD, cancer, atrial fibrillation, and heart failure.
As wound carers, we recognise many if not all these comorbidities as they are significant in the population we generally treat. Does this pose a dilemma in the way we manage such persons? Does this heighten the need to strengthen the moral compass for both caregivers and more importantly patients?
Patient management has been more challenging during the pandemic. As caregivers, we have found mechanisms to continue care while observing the restrictions of the public health measures imposed. Much of this has been through virtual means. Some assessments and treatments required face‐to‐face consultations, and we learned to manage these clinical challenges. We all know, however, the practicality of maintaining such practice is limited to say the least. So how do we return to pre‐pandemic clinical practice? Or can we?
Vaccination is certainly one of the key drivers of change. However, it remains to date a political divider between government and citizens, family members, and sometimes clinicians and patients. As clinicians do, we have the right to ask our patients to be vaccinated to allow face‐to‐face care—certainly, a moral dilemma and possibly a challenge to the hypocritic oath. We do, however, have the right to protect all our patients, not just some. So how do we efficiently manage the clinical challenge of the vaccine dilemma?
It is possible that if the collective understood the science well enough, we would feel obliged not to have any contact with others until fully vaccinated and for most of us to be vaccinated? Sadly, this is unlikely. Although the COVID‐19 pandemic is a serious public health and economic emergency, and although effective vaccines are the best weapon we have against it, there are groups and individuals who oppose being vaccinated. Some of these may be your patients. Unvaccinated persons require different management, not only to protect themselves, but also to protect others. Perhaps its rapid testing at the point of care and isolated visits to ensure protection. Or it is the continuance of virtual care? Time will tell and we will learn to manage this vaccination status like we have others, while preventing risking both those we care for and those who provide the caring.
This may be a controversial topic for an editorial but I hope it may spark a dialogue for the benefit of all involved in wound care.