Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 30 (4) May 2020
www.eubios.info
ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)
Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2020 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contents

page

Wearing Masks in COVID-19 Pandemic, thePrecautionary Principle, and the Relationships between
Individual Responsibility and Group Solidarity
129-Darryl Macer
Japan’s management of COVID-19-Nader Ghotbi
133
Ethical implications of ‘Rationing’ vs ‘Rationalization’- Maria Patrão Neves
134
Recognitive and redistributive claims in
COVID-19 outbreak - Rogelio P. Bayod
136
Relationships between Sri Lankan culture, diets and
COVID-19 disease control- Omalpe Somananda
143
A search for a COVID-19 cure in Siddha medicine
148- Dhastagir Sultan Sheriff
Healing mind & body by Mantras, Ayurveda & Yoga 150- Lakshmi Vyas
How not to face coronavirus: the case of Spain
152- Manuel Lozano Rodríguez
Who is the most vulnerable during a pandemic? The
social model of disability and the COVID-19 crisis
158- Christopher Ryan Maboloc
Cybercrime pandemic - Marites V. Fontanilla161
3ndstage COVID-19 spread can be contained with HITT
(hydrate, isolate, train, & test) and virtual contact 166- Osama Rajhkan
COVID-19 and Healthcare professionals: The principleof the common good - Randy A. Tudy
170
Negotiating the “Good Death”: Saying Goodbye in theTime of COVID-19 - Zehra Edisan
175
The Economics of COVID-19 in the Philippines178- Leandro S. EstadillaSocial Cohesion, Trust, and Government Action Against
Pandemics - Marlon Patrick P. Lofredo
182
COVID-19 Debates in Thailand
189- Ananya Tritipthumrongchok
Commentary on Tritipthumrongchok
190- Leonard H. Le Blanc, III
We need to work together to find a cure and vaccine
for COVID-19 - Mei Lu
190
Ozamiz Politics in the Time of COVID-19 Pandemic 191- Gerry Arambala
Role of information and communication technology during
the COVID-19 Pandemic- Dennis L. Alfaro
195

Ordering Renewal

Editorial address, and all correspondence to:Prof. Darryl Macer
Email: darryl@eubios.info

196

Wearing Masks in COVID-19
Pandemic, the Precautionary
Principle, and the Relationships
between Individual Responsibility
and Group Solidarity-Darryl Macer, Ph.D., Hon.D., MPH
President, American University of Sovereign Nations andDirector, Eubios Ethics Institute, Japan, New Zealand &Thailand
Email: darryl@eubios.info
Abstract
This paper argues that a number of medical professionals,
medical authorities, governments and the World HealthOrganization, have acted unethically during the COVID-19
epidemic and pandemic by advising members of the public
not to wear masks to protect their own health and thehealth of those around them. Although by April 2020 mostauthorities have changed their advice to recommend oreven compel citizens to wear face coverings and masks
when in public, we need to examine the question of failed
moral responsibility and the accountability for thiserroneous advice.
Failure to apply the ethical principles of nonmaleficence and the precautionary principle
The precautionary principle is widely recognized ininternational law, yet it was not used during the COVID-19
crisis by most governments, presidents, chief medical
officers, national medical associations and even the World
Health Organization (WHO). They have failed to apply thisprinciple to a very simple public health measure thateveryone can do to protect themselves and theircommunity, wearing face covers and masks. At last we cansee by April 2020 a change of heart in these so-called wise
people to change their previous paternalistic
recommendations not to wear masks or face coverings, tonow please wear face coverings or even face a penalty if
you do not wear face coverings in some countries. I wish toaddress the question of moral responsibility for thiserroneous advice that was provided by many medical
professionals and medical associations. I would go so far as
to suggest that these persons have blood on their hands
and should be disturbed in their sleep at night. Tens of

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

thousands of lives have been lost because of theirrecommendations not to wear masks.
Actually many people thought that they should wear
masks, and most in East Asia just went ahead to wear
masks, but in Western countries, and in many othercountries around the globe, people were specificallyadvised not to wear masks. This was counter to scientificevidence despite the false claims to advise people not towear masks. For example, Jefferson et al. (2011) in a
Cochrane Review of dozens of studies already had shown adecade ago that ordinary masks were effective andrecommended to wear masks. Wu et al. (2014) had alreadypresented evidence from the SARS epidemic in Beijing thatuse of face masks by the public reduced risk of infection
significantly for those who used them. It is no surprise thatthe community transmission of SARS-CoV-2 would also be
reduced by use of masks and face covers, since it worked
in the SARS-CoV-1 epidemic.
Fortunately, we can see some dramatic change of heartin the USA which has the highest number of infections anddeaths from COVID-19. For example, on 29 February, theU.S. surgeon general Dr. Jerome Adams tweeted in capitals“STOP BUYING MASKS” and said that masks do not offer
any benefit to the average citizen. On 3 April 2020 the U.S.
Centers for Disease Control and Prevention recommended
that Americans wear "cloth face coverings fashioned fromhousehold items or made at home from common materials... as an additional, voluntary public health measure."
There have been criticisms of WHO by many persons
about many things, but I question how they could ignore
scientific evidence and be so reluctant to have people wear
a face cover. In the WHO statement, “There is limited
evidence that wearing a medical mask by healthy individuals
in the households or among contacts of a sick patient, oramong attendees of mass gatherings may be beneficial as apreventive measure. However, there is currently no evidence
that wearing a mask (whether medical or other types) byhealthy persons in the wider community setting, including
universal community masking, can prevent them from
infection with respiratory viruses, including COVID-19.”(WHO, 2020a). They start to admit some use for masks,
however, “We can certainly see circumstances on which theuse of masks, both home-made and cloth masks, at thecommunity level may help with an overall comprehensive
response to this disease.”
Actually in 2019 WHO (2019) issued advice to wear
masks in times of an epidemic and pandemic in WHO
guidance on “Non- pharmaceutical public health measures
for mitigating the risk and impact of epidemic andpandemic influenza”. That statement recommends facemask use in the community for asymptomatic individuals
in severe epidemics or pandemics in order to reducetransmission in the community; this is based onmechanistic plausibility for the potential effectiveness of
this measure.
A study in Singapore in March 2020 had alreadydemonstrated how asymptomatic persons were spreading
the SARS-CoV-2 virus (Wei et al., 2020), which led to achange in the Singapore government’s recommendations.
However, the Singapore government had already ordered
the Armed Forces to deliver 5.2 million masks to 1.3
million households across the city, on 1 February 2020,
when Singapore had recorded just 13 cases of thecoronavirus. There have been some medical voices against
the voices of authorities not to wear masks. Burch (2020)
wrote, “Despite hearing that face masks “don’t work,” youprobably haven’t seen any strong evidence to support thatclaim. That’s because it doesn’t exist.“, and also provided
some easy to use guidelines on how to make more effective
face coverings. As Wei et al. (2020) wrote, “The possibilityof presymptomatic transmission of SARS-CoV-2 increases thechallenges of COVID-19 containment measures, which are
predicated on early detection and isolation of symptomatic
persons.”
Even three weeks after Singapore, the American
Medical Association President said, “there is “little benefit
to wearing a mask”, and “the CDC does not recommend thatpeople wear face masks to protect themselves from
respiratory viruses.” This includes COVID-19” (Berg, 2020a;
21 Feb). The American Medical Association (2020)“Statement on CDC’s recommendation for public on clothmasks” on 3 April, 2020 accepted the public use of masks,
and also it was reported that some healthcare institutions
had been refusing to allow physicians from wearing theirown mask when the physicians had made a medical
judgment that their own mask was safer than the ones theinstitution had provided to them (Berg, 2020b). There
were reports that some institutions only had enoughmasks to provide one mask a day to their professionals. In
some countries, there were reportedly even less masks.
There are still other authorities that remain against
general mask use, such as European Centre for Disease
Prevention and Control (2020) who wrote in their “Using
face masks in the community” statement, “There is noevidence that non-medical face masks or other face covers
are an effective means of respiratory protection for thewearer of the mask” At the same time they state, “Forcommunication purposes, it is important to emphasize thatthe people who use face masks in the community want toprotect their fellow citizens in case they are infected. They
do not want to unknowingly spread the virus, and wearing
a mask should not be misconstrued that they want toprotect themselves from others. Wearing a mask is not an
act of selfishness and should be promoted as an act ofsolidarity.” Perhaps this is a way for medical authorities tosave their public face while not further causing the deathsof citizens.
Individual responsibility and group solidarity
It has been quite a contrast to look at the policies
announced in different countries over whether people
should wear masks to protect themselves, and/or othersfrom infection during the time of COVID-19. This is a very
simple example to illustrate the evolution of individual
responsibility and group solidarity, although it is related torather diverse cultural traditions around the world.
Personally, I found it very interesting because I lived inJapan for several decades and am totally used to seeing
people wear masks especially during the pollen season in
the spring. It was also common sense that everyone would
wear a mask if you had any infection to avoid spreading thedisease to other people. Almost every household has masks
as a regular item in their cupboards. Throughout 2020 East
Asians have continued to use masks to attempt to prevent
COVID-19 infection. In China, Hong Kong, Taiwan, South
Korea and Japan mask-wearing has become the norm, withsome stores refusing entry to those without face covers.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
Hong Kong authorities gave advice to wear masks in public
on 24 January, and in China on 31 January. Taiwan had
even stockpiled enough masks that they did not have ashortage.
When we compare the situation in different countries
we can see a full range of policy statements and actual
practice between countries (and/or individual institutions
and commercial premises) which make it compulsory towear a mask before you enter into a supermarket, or enter
to a medical clinic, pharmacy or hospital, and countries
who publicly state that you have no advantage to wear amask so you shouldn't be wearing masks. Some of thecountries with mandatory face mask use include Austria,
Bosnia-Herzegovina, Czech Republic, Indonesia, Israel,
Kenya, Morocco, Panama, Slovakia, Ukraine, Vietnam; andthe island of Luzon, the Philippines, and the city of Jena in
Germany. Some countries recommend using masks, but
unless there are sufficient masks available a fabric face
cloth can be used as an alternative, For some examples see
Andelane (2020), Feng et al. (2020), Huo (2020), Ting
(2020). I also found it interesting to be a mask wearer
during mid-March 2020 in Geneva, London and Istanbul,
noting that in all these places I was almost the only person
wearing a mask. On my last day in Geneva on the 12 MarchI did see several other people wearing masks, and on aflight from Istanbul to Los Angeles on the 14 March
surprisingly I was among 20% of the people wearing amask on the flight – being one of 4% on the flight in thereverse direction 2 weeks earlier.
One of the rationales that the U.S. Centers for Disease
Control provided for their previous statements to ask the
public not to wear a mask, or statements notrecommending to wear a mask earlier, was that there wasa shortage of surgical masks and the mask should be
provided to first responders, including medical staff
because there was a shortage of masks in the country. It isinteresting if that is the same rationale that is given inother countries, nevertheless it raises a number ofindividual and collective issues of expectations andresponsibilities for public health. Since we know that inmany viral infections of the respiratory tract there aremany asymptomatic persons who can spread the virus, andthat among young adults perhaps more than half thepersons are asymptomatic, it is simple public healthprevention to let people wear masks.
In article 4 of the Universal Declaration on Bioethics
and Human Rights it states that human beings have bothautonomy and responsibility and that these should bebalanced. So when the government tells citizens whowanted to wear a mask that they should not wear a mask,
it is providing a directive like a paternalistic big brother totell citizens do not wear masks because we do not haveenough masks and you should give your masks to the
medical staff who really need it. They actually made callsthat citizens should give any N-95 masks they have as adonation to medical staff. The same government was
actually negligent not to have a national stockpile after
decades of discussions of pandemic preparedness.
For those of us who felt that it was a matter of
responsibility to wear a mask so as not to have any risk ofinfecting others, it's a very strange message from publichealth officials. The fact that when you go to a hospital evenunder normal circumstances medical staff are wearing
masks suggest that mask have an important function in131

preventing infection. It would therefore seem to be
unethical for the double standards to allow medical staff
not to be infected by wearing masks, while also telling the
public you can go to the supermarket and your essential
work without a mask. They said the mask is not going tohelp you.
In fact, providing this misinformation is unethical for
public health authorities to have recommended not towear masks. It is also a complete contradiction that after
two months of saying don't worry now they suddenly say,“Yes you need to wear a face covering when you go in
public.” This is such basic knowledge that actually I saw
many people in the USA wearing masks and thus“contravening the advice of the CDC” throughout March
2020, especially immigrants in the USA from divergent
spaces such as East Asia, Persia and Latin America.
On the positive side I think that the police in California
have been quite rational about the enforcement of social
distancing, when compared to some other Western styledemocracies that fine or imprison apparently healthy
individuals who went out of their house. There have beentragedies in some countries where police have killed
persons who seem to be breaking the rules of social
distancing and quarantine. That is a topic for anotherpaper, and of course physical distancing has had positive
impacts in the pandemic.
An Erosion of Trust
When we have a public health emergency, trust is very
critical and I don't know how citizens will feel about publichealth officials who have earlier said they should not wear
a mask or face covering. The same officials also tried toblame citizens who wanted to go to the beach or on anature walk, and some parts of California closed beaches
while saying there was no advantage to wear a mask.
Further epidemiological analysis will let us examine
how many deaths were caused by the erroneous advice not
to wear masks which has been admitted to now be
inappropriate guidance from the health authorities. How
much did this contribute to the spread of disease?
Probably not washing hands was more of a factor, or
failure to keep physical distance from each other.
Ignorance may also have been a cause of a rapid rise in
COVID-19. Given the need for economies to restart, andafter a realization of the broader impacts of the recession
caused by stay at home orders, the new normal will be towear masks. This is not rocket science, but a lesson of SARS
that many countries failed to learn. Let us see when
governments will actually change their advice and admit
their mistake of telling persons not to wear masks. At least
some governments, and some medical professionals, have
now admitted their mistake and changed their policies.
In this paper we can see how exploring
recommendations of mask use is an issue of accountability
for public health officials and medical professionals who
told their patients and people don't wear masks because it
doesn't help you. This is certainly an issue of individual
responsibility and group solidarity, but I think everyone
should wear a cover over their mouth and nose from the
beginning. In the age of informed choice I did not expect
erroneous paternalism to have arisen again in 2020.

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

The World Emergency COVID19 Pandemic Ethics
Committee (WeCope)Terms of Reference
The World Emergency COVID19 Pandemic Ethics
Committee (WeCope) is a multidisciplinary group of
persons from a variety of professional backgrounds who areof cross-cultural and global background who are
independent of government, who are living in different
countries under different conditions during the same COVID19 crisis are tasked with the following:1) To act as an independent forum to gather accounts ofthe experiences and perspectives, specially concerning
good practices, and alleged human rights abuses.
2) To consider the interface between the theory andpractice of ethics around the world and the need for
ethical initiatives in research, policy, and information
sharing in the world emergency responses and aftermathofthe
COVID-19
pandemic.
3) To compile and produce reports and policy statementsthat may guide individuals, civil society organizations(both non-profit and for-profit), governments, andinternational entities in their responses to the global
health emergencies linked to COVID-19, which have
utility both in the current pandemic and further ones.
4) To be of service to those who seek our assistance, andto the most vulnerable among us.
5) To act quickly and issue reports and statements
quickly.
For more information:
https://www.eubios.info/world_emergency_covid19_pan
demic_ethics_committee
References

American Medical Association (2020) “Statement on CDC’s
recommendation for public on cloth masks” on 3 April, 2020.
Accessed on 6 April 2020 from https://www.amaassn.org/press-center/ama-statements/statement-cdc-srecommendation-public-cloth-masks
Andelane, Lana (2020) Coronavirus: Countries where face masks
are mandatory in COVID-19 fight, Newshub 07/04/2020.
Accessed
on
8
April
2020
from
https://www.newshub.co.nz/home/world/2020/04/coronav
irus-countries-where-face-masks-are-mandatory-in-covid-19fight.html
Berg, Sara (2020a). “COVID-19: 6 key points physicians shouldshare with patients”, American Medical Association website.
(21 Feb 2020). Accessed on 6 April 2020 fromhttps://www.ama-assn.org/delivering-care/publichealth/covid-19-6-key-points-physicians-should-sharepatients
Berg, Sara (2020b). “COVID-19 safety: Don’t bar physicians fromwearing their own PPE”, American Medical Association
website. (2 April 2020). Accessed on 6 April 2020 fromhttps://www.ama-assn.org/delivering-care/publichealth/covid-19-safety-don-t-bar-physicians-wearing-theirown-ppe
Burch, Adrien (2020). “What’s the Evidence on Face Masks? What
You Heard Was Probably Wrong”. Accessed on 6 April 2020
fromhttps://medium.com/better-humans/whats-theevidence-on-face-masks-5f3c27a18cc
Feng, Shuo et al., (2020) Rational use of face masks in the COVID19 pandemic, Lancet Respiratory Medicine, Accessed on 6 April
2020 from
Huo Jingman (2020) Why There Are So Many Different Guidelines
For Face Masks For The Public, National Public Radio (April 10,2020).
Accessed
on
11
April
2020
from
https://www.npr.org/sections/goatsandsoda/2020/04/10/8

29890635/why-there-so-many-different-guidelines-for-facemasks-for-the-public
Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA,
Bawazeer GA, van Driel ML, Nair NS, Jones MA, Thorning S,
Conly JM. Physical interventions to interrupt or reduce thespreadofrespiratory
viruses.
Cochrane Database of Systematic Reviews 2011, Issue 7. Art.
No.: CD006207. DOI: 10.1002/14651858.CD006207.pub4.
Ting, Victor (4 April 2020). "To mask or not to mask: WHO makes
U-turn while US, Singapore abandon pandemic advice and tellcitizens to start wearing masks". South China Morning Post.
https://www.scmp.com/news/hong-kong/healthenvironment/article/3078437/mask-or-not-mask-whomakes-u-turn-while-us
Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. PresymptomaticTransmission of SARS-CoV-2 — Singapore, January 23–March
16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:411–415.
DOI: http://dx.doi.org/10.15585/mmwr.mm6914e1external
icon.
Wu, Jiang, et al. (2004). “Risk Factors for SARS among Persons
without Known Contact with SARS Patients, Beijing, China”,
Emerg Infect Dis. 2004 Feb; 10(2): 210–216.
doi: 10.3201/eid1002.030730
World Health Organisation (WHO) (2019). Non-pharmaceutical
public health measures for mitigating the risk and impact of
epidemic and pandemic influenza: WHO. Available from:https://apps.who.int/iris/bitstream/handle/10665/329438/
9789241516839-eng.pdf
World Health Organization (WHO, 2020b). Advice on the use ofmasks in the context of COVID-19. Interim guidance. (6 April
2020)
https://apps.who.int/iris/bitstream/handle/10665/331693/W
HO-2019-nCov-IPC_Masks-2020.3eng.pdf?sequence=1&isAllowed=yA
usefulwebsiteishttps://en.wikipedia.org/wiki/Face_masks_during_the_2019–20_coronavirus_pandemic(This paper was presented on 9 April 2020, at the Second
International Public Health Ambassadors Conference).

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and Ethical Global Health
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Certificate Program - classes from March 2020.
Do not delay to join us to prepare yourself andyour community to respond to COVID-19.
https://ausn.info/postgraduate_certificate_in_epidemics_and_ethical_global_healthInternational Public Health Ambassadors
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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Japan’s management of COVID-19-Nader Ghotbi MD, PhD
Professor, Ritsumeikan Asia Pacific University (APU)
Beppu city, Oita, Japan
Email: nader@apu.ac.jp
The Japanese government has been strictly controllingthe use of PCR tests by medical doctors, requiring them toshow that a patient has been affected with severe
symptoms before they can ask for the permission to havethe test done. The limitations were so strict that theJapanese Medical Association complained reporting that
hundreds of doctors’ requests for these tests weredenied. This policy is wrong, because the main function of
PCR tests in COVID-19 is for case-finding not clinicaldiagnosis.
COVID-19 can be ‘clinically’ diagnosed based on anumber of criteria in patient history and symptoms,
physical examination, blood tests (lymphopenia, high CRP,
thrombocytopenia, etc.), X-ray and/or CT-scan. In fact, thePCR tests have a relatively high false-negative test result,which is about 30% for deep nasal swabs, and 40% in deep
throat swabs. The PCR tests are useful when clinicaldiagnosis is difficult or there are doubts, such as when
symptoms are not specific, or do not exist at all, but it isimportant to rule out COVID-19, for example in a person
who may have been exposed to an infected person.
Otherwise, the doctor may send a symptomless carrierback to the community to infect others. In other words,
the main use of PCR test is for case-finding; it is for
population surveillance. That is why doing a lot of it isrecommended. Using these tests, medical doctors may findpotential carriers even if they do not show symptoms.
However, the Japanese government by wrongly using
the PCR test as an ‘official confirmation’ of COVID-19
without which the diagnosis is not accepted and notcounted, even in the most clinically apparent cases, is only
creating difficulty in the job of medical doctors to control
the infection and treat their patients. It is worth
remembering that the sooner the treatment of COVID-19 isstarted (with Avigan, for example), the prognosis will bebetter. By not allowing the medical doctors to use the PCR
test to ‘confirm’ their clinical diagnosis, the treatment ofclinically apparent cases is delayed which may aggravate
the prognosis and final outcome.
One may ask why the Japanese government may
intrude into medical diagnosis as such? The most possible
explanation is that they may want to downplay the risk ofinfection in Japan, so as to salvage the Olympics as well as
the economy which is under pressure especially in the
tourism and hospitality sector. This suspicion got more
support after the announcement that the Olympics has
been delayed to 2021; there was a surge in the number of
infected people in the days following the cancellation.
Moreover, keeping the number of infections down by
not allowing those who have not been tested to be counted,
can be very dangerous. It sends the wrong message to thecommunity about the level of safety. Also sending a
potential carrier home is dangerous if he/she has a familyliving together. Other countries do the quarantine outside
home, in a special facility for all such cases, but not sending
the potential carrier back to their family members.

133

I knew about the COVID-19 cluster in Oita a few weeks
before it was announced in the news, because a famous
Japanese doctor who sees my Iranian friend in Oita had
told him about it. This is their conversation:
Doc: Be careful! I have about 30 Coronavirus patients
under my care in Oita!
Friend: But there was no public announcement?!
Doc: It is not announced as long as we cannot confirm ourdiagnosis because the PCR tests are controlled and wecannot have them performed. But I am sure about thesepatients because I could see the changes in their chest CT
scan.
Friend: So, what do you do with them?
Doc: They are sent home for self-quarantine. If theircondition gets worse, we may admit them to hospital.
Then we can ask for a PCR test.
This intrusion of politics into health policy is unethical.
The desire to have the Olympics in place even if it may put
people at danger, or the desire to run businesses as usual
even if it put workers and their customers at danger,
should not lead to deception and mismanagement of a lifethreatening epidemic. In other words, the policies of agovernment, whether the policies are directly related tohealth or indirectly impact health, including those of theministry of health, should be ‘healthy policies’; this meansthat any government policy should consider the possible
impact on the health of people. Also, as it has been shownin other parts of the world, transparency of thegovernment and communication of the information at
hand can lead to trust and compliance with regulations
such as social distancing.
Fortunately for Japan, people are well familiar with theuse of masks to prevent spread of respiratory infections,and it is less common to receive guests in one’s home;
people commonly visit a café or restaurant to meet friends.
However, opening of the schools can increase the risk ofinfection spread as kids can take the infection home after
catching it from other kids in school activities. The issue ofwhen to open the schools and whether to start work fromhome for company employees has been a hot topic.
References

Carver, Catherine & Jones, Nick. (2020). Comparative accuracy oforopharyngeal and nasopharyngeal swabs for diagnosis of
COVID-19. Centre for Evidence-Based Medicine, Nuffield
Department of Primary Care Health Sciences, University of
Oxford.
Mainichi Japan. (Feb 27, 2020). Japan Medical Assoc. to probe
public health centers' refusal to conduct coronavirus tests.
https://mainichi.jp/english/articles/20200227/p2a/00m/0
na/006000c
Reynolds Isabel. (March 17, 2020). Abe turns vague on timing ascoronavirus leaves Tokyo Olympics in doubt. Bloomberg.
Tao Ai, Zhenlu Yang, Hongyan Hou, Chenao Zhan, et al. (2020).
Correlation of Chest CT and RT-PCR Testing in Coronavirus
Disease 2019 (COVID-19) in China: A Report of 1014 Cases.
Radiology. Feb 26 2020. https://doi.org/10.1148/
radiol.2020200642
The Asahi Shimbun. (Feb 27, 2020). Anger grows as rigid rulesdenypatients
testing
forcoronavirus.
http://www.asahi.com/ajw/articles/13169040
Yang Y, Yang M, Shen C, Wang F, Yuan J, Li J, et al. (2020).
Evaluating the accuracy of different respiratory specimens in thelaboratory diagnosis and monitoring the viral shedding of 2019nCoV infections. medRxiv. 2020.02.11.20021493.

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Ethical implications of ‘Rationing’vs ‘Rationalization’- Maria Patrão Neves, PhD
Professor, Universidade dos Açores,
Ponta Delgada, Portugal
Email: m.patrao.neves@gmail.com
www.mpatroaneves.pt
Abstract
Public health manages the largest possible volume ofresources for health. However, and regardless of thenational budget for healthcare, there is a chronic
incapacity to respond positively to all healthcare needs ofall people, in all circumstances. This reality is aggravatedin exceptional situations. When resource scarcity worsens,
the need for resource allocation intensifies.
“Rationing” and “Rationalization” are two different
scarce resource allocation strategies. However, mostauthors use the two terms interchangeably, with great
detriment to the establishment of ethically soundguidelines for priority setting in healthcare. Therefore, it isurgent to revisit the two concepts, particularly in thecurrent pandemic situation in which the allocation of
resources for healthcare is reaching extreme and unseen
levels, with a dramatic impact on patient care.
This paper presents a conceptual comparative
definition of “Rationing” and “Rationalization”, stresses thedifferent ethical requirements and implications of both,
identifying the ethical principles that are at stake, andcircumscribes the ethically legitimate specific fields oftheir application. Examples of the different outcomes
deriving from either rationing or rationalization will bepresented.
Keywords: Ethics, Public health, Resource allocation,
Rationing, Rationalization, Discrimination, Justice, Humandignity, COVID-19
Introduction
Public health manages the largest possible volume ofresources for health, namely human, technical andpharmacological resources. Although there are strong
discrepancies in each country's investment in publichealth, they all suffer from an incapacity to respondpositively to all healthcare needs, of all people, in all
circumstances.
Chronic scarcity of healthcare resources
Notwithstanding how much the healthcare budget
increases (and it does tend to increase in the Westernworld), it still remains chronically insufficient, mostly due
to: cutting-edge technologies and state-of-the-art drugs
which, although very expensive, are also highly efficientand frequently the last and only resource to prevent deathor permanent injuries; increasing number of patients withchronic diseases, which were fatal in the past (e.g. HIV)
and, although cannot yet be cured, are reasonably wellcontrolled to allow people to live; significant increases inlife expectancy, worldwide, but mostly in the Westernworld, increasing also the number of years each person
needs healthcare; demographic growth all over the world,but mostly in the Southern hemisphere, increasing also thenumber of persons in need for healthcare.

The powerlessness of national healthcare systems toprovide everyone with all the health services they need, is(naturally and unavoidably) aggravated in exceptionalsituations, such as wars, natural disasters and pandemics.
When resource scarcity worsens, the need for resource
allocation intensifies; and when allocation of scarce
resources intensifies, the need to convey fair criteria of
distribution scarce resources and the prioritization ofpatients sharpens.
“First-come, first-served” and “high-severity,
high-priority”
Daily resource management systems do not apply to the
exceptional and challenging conditions of a pandemic, inwhich both the scarcity of resources and the number ofpeople who need them to survive, worsen. We refer to theusual “first-come, first-served”, combined with the “highseverity, high-priority” triage systems.
The first system corresponds to the lottery model,
which some advocate in extreme situations in the sense
that, in the impossibility of formulating a criterion ofjustice that is consensually recognized as objective,“drawing lots” avoids any subjective assessment. Thisimplies, however, the lack of responsibility of those whohave the power and duty to make decisions. Nevertheless,no clinical management can alienate its responsibilities, itsduties, which would be equivalent to resigning from its
functions.
The second model, that of prioritizing the most serious
patients, would be imperative from a human point of view,providing relief to those in greater suffering. However, itcannot be applied in an aggravated situation of scarce
resources, because it would imply using the most efficienttherapeutic resources in patients who are least likely tobenefit from them.
The overriding of these two systems is not specific tothe current pandemic or even to other exceptionalsituations mentioned above. Also, in the day-to-day
management of health services, they are overlooked in
specific situations, as is the case, for example, amongtransplant candidates: patients in a more serious clinicalsituation may not even be admitted on the waiting list andthose who enter on the list may go straightaway to a highposition due to the combination of several clinical factors.
From an ethical point of view, it is important to save life
and to promote the health and well-being of the largest
number of people (utilitarian perspective), which the“first-come, first-served” and the “high-severity, highpriority” triage system does not always guarantee; andthey most certainly compromise it when the scarcity ofresources is the reality (a good example is, once again, theprioritization in the transplantation’s list). These common
triage systems do not work when resources are very
limited and specifically in cases of life and death.
In these extreme contexts (more than in any others)
there is a need to “rationing” and “rationalization” of scarce
resources. Regrettably many authors use the two terms
interchangeably, what entails a serious loss for theestablishment of ethically sound guidelines for theunavoidable priority setting. In the current pandemic
situation, in which the scarcity of resources for healthcare
is reaching extreme and unseen levels, with a dramatic
impact on patient care, it is urgent to revisit the twoconcepts.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)“Rationing” versus “Rationalization”“Rationing” and “Rationalization” are two different
resource allocation and prioritization setting strategies.
They are different concepts, they have different
foundations, they entail different consequences, and theydraw different guidelines for patient’s care. Therefore,
they should not be mistaken.
Conceptual definition“Rationing” and “Rationalization” they both derive
etymologically from the Latin word ratio, onis, which could
mean both the “calculation”, a numerical calculation, andthe capacity to calculate, intelligence or judgment.
Conceptually, “rationalization” focuses on the humanfaculty to make good judgments; “rationing” focuses on the
result of the judgment, on its product. Through time, bothconcepts
received
particularsignificancesandconnotations according to their uses.
Today, “rationing” refers to official restrictions to theconsumption of essential goods, to the limits to thequantity of a product available when there is a shortage ofgoods. It has a negative connotation by focusing on thelimits. A good example of the rationing of goods is thelimited number of items of the same product that aresuperiorly authorized to be sold/bought during a social
crisis, as it happened with groceries when the coronavirus
lockdown was declared.
Within the healthcare sector, “rationing” refers to the
distribution of limited resources by a limited number ofpeople, following specific criteria. These criteria focus on
the person’s features, such as the profession. For instance,
considering the current shortage of medical face masks,
the few available should be delivered to whoever has thegreatest need, such as healthcare professionals and otherprofessionals, who are in the front line, in direct contact
with the public. Rationing criteria focus on the person’s
features (such as profession, but also age, gender,
nationality, etc.).
Today, “rationalizing” refers to the most rational, logic,
reasonable use of limited resources solely under thecriterion of making the most of it. The goal is the
optimization of the resources available, making them as
efficient as possible. It has a positive connotation byfocusing on the performance. Within the healthcare sector,
a paradigmatic example is the allocation of human organs
for transplantation, which follows a strict criterion ofrationalization: the scarce organs are allocated to those
persons who can do better by receiving them.
Briefly, while rationing focus on persons and theircharacteristics, rationalizing focus on resources and theirperformance.
Ethical implications“Rationing”, by distributing the resources available by asmall group of people in need, discriminates this group
positively. Positive discrimination can be ethicallyjustifiable when contributing to a broader compliance tosocial justice. In this case, it requires transparency in thecriteria and in the procedure of distribution, as well as in
the results foreseen. The norms should be transparent andconsensual.
Nevertheless, the application of “rationing” tohealthcare resources also entails a negative discrimination

135

towards all the other persons who are left without
adequate assistance, thus challenging the ethical principleof justice. From a utilitarian perspective, rationing
healthcare resources can be ethically legitimate or
justifiable if it contributes to maximize the overall good.
“Rationalizing”, by optimizing of the resources
available, by promoting their efficiency, focuses solely on
the resources available, and requires only their best use.
The procedure of assigning health resources to patients isobjective and rigorous. Therefore, although only few
patients receive what many needed, the rationalization
system does not discriminate (positively or negatively)
against anyone, therefore neither does it infringe theprinciple of justice.
Furthermore, only the rationalization of scarce
resources respects the principle of human dignity. Indeed,
the rationing of resources allocates them according to aprevious evaluation of the patients, based on different
personal criteria. The rationalization system respects theabsolute, equal, unconditional and inalienable value of all
persons, and the selection of patients or their prioritization
is established by aiming at the higher efficiency from theresources available.
The rationalization system combines the utilitarian
perspective, maximizing the efficiency of the healthcare
resources, with a deontological perspective that,regardless of consequences, requires respect for axial
principles, namely human dignity and justice.
Specific domains of ethical legitimacy“Rationing” and “Rationalization”, being two different
concepts, with different ethical foundations andimplications, can both be ethically used in healthcare,although not in the same context.
“Rationing” should only be applied to the distribution of
non-vital scarce resources and when promoting the wellbeing of the majority, under a utilitarian perspective. It is
ethically arguable that, to maximize the well-being of the
majority, few can be affected. However, no life can besacrificed to save another, what would imply the different
value of human lives. Therefore, and retaking a previous
example, the rationing of medical face masks is possible –enhancing the protection of those more exposed to the riskof infection –, but not of the life-saving ventilator –selecting people to be cared, and others to be left to die.
“Rationalizing” is the only ethically legitimate system
for the distribution of vital scarce resources, when the lackof access to those means causes death. Any other allocation
system entails choosing the life and death of people, andtherefore are not ethically acceptable. Rationalizing
acknowledges the utilitarian, and consequentialist
requirement to maximize the general well-being, but also
complies with the deontological requirement to respect
key ethical principles such as justice, at the social level, andhuman dignity, at the personal level.
Conclusion
The concepts of “rationing” and “rationalization” cannot be
used as synonyms, and their ethical legitimacy depends onthe contexts they are applied to, leading their respective
application to the same clinical situation toward different
management of scarce resources: the rationing ofventilators to COVID-19 patients would most probably
exclude an otherwise healthy 80 years old person, and136

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

consider a 50 years old chronic disease patient; therationalization of the ventilators, would just provide theventilator to the patient who could benefit the most.
The
distinction
between“rationing”
and“rationalization” and their ethical application contributes
to mitigate the scarcity of resources and to guarantee theequally respectful treatment of each and every person.
References (5-30)

B. Brecher, Rational Rationing?, Clinical Ethics 3 (2), 2008: 53-54.
Daniel Callahan, Must We Ration Health Care for the Elderly?,
Journal of Law, Medicine and Ethics 40 (1), 2012:10-16.
Drew Carter, Jason Gordon & Amber M. Watt, Competing
Principles for Allocating Health Care Resources, Journal of
Medicine and Philosophy 41 (5):558-583 (2016)
Jessica Price, Agnes Binagwaho,, “From medical rationing torationalizing the use of human resources for AIDS care andtreatment in Africa: A case for task shifting”, April 2010,
Developing
World
Bioethics 10(2):99-103,
DOI: 10.1111/j.1471-8847.2010.00281.x
Philip M. Rosoff, “Who should ration?” AMA J
Ethics. 2017;19(2):164-173.
doi:
10.1001/journalofethics.2017.19.2.ecas4-1702.
S. Brauer, Age Rationing and Prudential Lifespan Account in
Norman Daniels' Just Health, Journal of Medical Ethics 35 (1),2009:27-31.
William R. Smith, The Many Uses of Legitimacy in Medical Ethics,
AMA
J
Ethics. 2017;19(2):135-140.
doi:
10.1001/journalofethics.2017.19.2.fred1-1702.
Winkler E., “Rationalization, rationing, prioritization:
terminology and ethical approaches to the allocation of limited
resources in hematology/oncology”, Onkologie, 2011; 34 Suppl
1:2-5. doi: 10.1159/000323063. Epub 2011 Jan 17.

Recognitive and redistributive
claims in COVID-19 Outbreak- Rogelio P. BayodCor Jesu College, the Philippinesroger.bayod@gmail.com
Abstract
In every disaster that occurs in a country, the most affected
are the poor and the vulnerable sectors. Whileinternational and national aid agencies and national
government usually provide immediate support, most of
their responses fall into “dole-out” system motivated by
the concept of “tulong” and “awa” (help and pity) for thevictims. On the other hand, local people and civil society
organizations in the Philippines also responded todisaster-stricken communities and people but with theconcept of “pagtutulungan” and “bayanihan” (helping eachother and working together) with a strong motivation toempower the people and their communities to cope up theadverse effects of disasters. This paper will explore the twodifferent disaster response paradigms (“tulong” at “awa”
which
promotes
only
redistribution
versus“pagtululungan” at “bayanihan” which promotes both
recognition and redistribution) of the different responders
during this covid-19 outbreak in the Philippines anddiscover its effects among the masses. This paper willargue that to be able to pacify the agitation and anger thatexist among some of the poor and vulnerable sectors in the
country, the government and other aid agencies must

employ both recognition and redistribution as importantcomponents in their engagements with these people.
Introduction
The intention of this paper is to explore and assess the two
prevailing paradigms (“awa” at “tulong” and“pagtutlungan” or “bayanihan”) in responding to the needsof persons especially the poor that are the usual victims ofdisasters in a country or society. The paper starts with thebasic definition of a person and what constitutes
personhood. The paper then argues that the different
engagements of aid agencies to the poor have their own
built-in assumptions about the personhood of the poor.
These different assumptions have resulted in different
treatments which have produced different psychologicaleffects in the poor. This paper will further argue that in
disaster response such as in COVID-19, recognition of theinherent worth of the persons regardless of social status is
an imperative while working on the redistribution of goods
and other economic benefits to appease the cry of the poor
during the COVID-19 crisis and empower them to takecharge of their own destiny. While recognitive andredistributive justice can be considered as separate, they
are complementary approaches to solving the problems of
injustices and inequalities that for so long had been
afflicting the poor in the Philippines. However, it is not theintention of this paper to dwell deeply into the different
arguments for and against these two approaches of justice.
The humble aim of this paper is just to evaluate thedifferent paradigms of engagements being used by aid
agencies both from the government and civil society
organizations to respond to the needs of the poor during
this pandemic and evaluate where these paradigms ofengagement fall in the spectrum of recognition andredistribution. After evaluation, the paper offers a possible
paradigm of engagement that aid agencies and thoseworking to respond to the needs of the poor might
consider.
Let me begin with this basic question, what is a person?
In the psycho-spiritual world, we speak of two dimensionsof a person: the core and the periphery. The core
constitutes the being of a person. The core is the source of
his dignity and worth as a person. The periphery
constitutes the other faculties of a person. This is about hisachievements, possessions and positions. The core is the“being” while the periphery is in the “doing” or the “having”
domain. We are told that the most important of the two is
the core because this is the being of the person. But the
periphery is also important although in a lesser degree.
Taken properly, the periphery adds flavor to the core. Just
like a gift that is wrapped beautifully, a wrapper makes thegift so attractive externally but wrappers are not the real
gifts.
Gabriel Marcel said that man is an incarnate
subjectivity. For him, man is a body but he is more than his
body. Man also, is a spirit. Because man is not only a body
but also a spirit; man has inner freedom and autonomy. His
freedom and autonomy make him above animals andplants. Because of his freedom and dignity, man is an end
in itself, according to Kant. For Kant the autonomy of manis the basis of his dignity. Because of his dignity, man
should never be used as a mere instrument for others’
happiness (Maboloc, 2012).

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
In the political context, a person is defined according to
his citizenship. His membership to a state or a society gives
him rights and privileges. Sometimes, his citizenship is thesole basis of the granting of his rights and privileges, nothis being a person with inherent rights and dignity. In
some association or groups, membership signifies
requirements. Hence, if you are not qualified you cannot bea member, ergo you cannot have rights and privileges thatthe members of that organization enjoy.
Axel
Honneth’sformsofintersubjective
recognition (love, respect and solidarity)
In this section, I will briefly discuss Axel Honneth’s conceptof personhood in his theory of recognition. Honneth(1995) outlines patterns of intersubjective recognition
which are love, rights and solidarity in chapter five of hisbook, “The Struggle for Recognition: The Moral Grammar ofSocial Conflicts”. These three forms of recognition
according to Honneth are important in the making of theperson. For him, without the experience of love, respectand solidarity, the person will not develop his true identity.
To be able to develop his identity and to contributesomething to the society, a person needs recognition of
who he is – as an equal member of a society endowed withequal rights and liberties. In short, he must be recognized
as a full citizen of the society. This struggle for recognition
is not only political, but basically moral. Renante Pilapil, ascholar of Honneth, who is currently based in Mindanao,
said that “beyond the political, there is an inherent moral
character of recognition struggles that are largely based on
individuals’ normative expectations upon the society,central to which is the recognition of their identity”(Pilapil, 2015: 60). When we speak of identity here, we are
not simply talking about the external or the peripheral
dimensions of the person such as his achievements,
possessions and positions but more on the inside or the
being of that person. Identity then refers to that whichmakes a man truly human.
Love and self-confidence
Drawing insights from Hegel, Honneth (1995: 95) says thatlove is the first stage of the reciprocal recognition because
in the experience of loving and being loved, the subjects
mutually recognize and confirm their needs for each other.
In short, in the experience of loving care, both the subjects
know and reassure themselves to be united in theirneediness of each other as well in their dependence fromeach other (Honneth, 1995). With the experience of mutual
love, the person’s existence is not only affirmed but alsoenhanced. The absence of love might lead to negation anddenial of self and its capacity to love. Not allowing theperson to experience and give love constitutes a kind ofevil in the world because it runs contrary to the very natureof the person, which is love. For love to be called love, it
must be shared. Sharing of love requires the recognition of
the existence of the other.
Honneth (1995: 107) says that recognition is aconstitutive element of love. It is an affirmation of person’s
autonomy that is guided and supported by love. Although
this experience of love is basically planted in the family, its
seeds may, through commitment, germinate and spreadtowards the larger circle of social relationships wanting to
be fulfilled and recognized. Just like the child who develops
trust because of the loving care and attention of his

137parents, the adult who experiences genuine love and care
not only in relationships with family but also with othersin larger circles of relationship, develops self-confidence.
This sense of confidence in oneself is needed as the person
climbs up the ladder towards self-actualization in the
Eriksonian sense. In Honneth, this self-confidence which isthe product of an experience of love is a necessary
psychological condition for self-realization (Pilapil, 2015:
68). However, the experience of love and its expressions
may differ from one person to the other, from one culture
to other and even from one era to another. Thus, Honneth
moves to his second patter of intersubjective recognition:legal recognition.
Rights and self-respect
In his second form of recognition of persons, Honneth
wants that individuals should have equal rights and berecognized as legal persons by virtue of being a person andnot based on social standing, status or roles in the society.
Honneth (1995: 110) asserts that individual rights must be
detached from concrete role expectations. He endorses
three categories of rights, namely, (1) the civil rights that
protect the person’s life, liberty and property fromunauthorized state’s interference; (2) political rights thatguarantee the person’s the opportunity to participate in
the processes of public will-formation, and (3) the social
rights that ensure a person’s fair share in the distributionof basic goods (Honneth, 1995: 115). For Honneth theserights make a person a full-fledged member of a politicalcommunity.
As a full-fledged member of an organization, a person isentitled to an equal share not only of the benefits but also
the burdens of the organization subject to existing rules
and regulations of the organization. Thus, a full-fledged
member of the society should not only claim his entitledbenefits but also share something to the society. As a freeand rational being, he has a duty to also contributesomething for the betterment of the society. This duty
should not be imposed on him from the outside but must
be coming from his inner conviction. Through mutual
recognition of their rights as free and equal members of apolitical community, Honneth says that a person develops
self-respect (Honneth 1995: 118). It is clear that without
recognition of their rights, the individuals will not develop
a sense of self-respect. If a person has no sense of selfrespect, it is very difficult for him to give respect to others.
This implies that there must be institutionalization ofthese rights and the state should ensure that all individuals
will receive these rights. But in the actual practice in manysocieties, a person really needs to demand these rightsfrom the state. It is not automatic that the moment you areborn, you will immediately have these rights. In manycases, you really have to demand them from the state. This
prompts Pilapil (2015: 71) to ask this important question:“if rights enable persons to develop self-respect, does itmean that those who are incapable of demanding theirrights would have no chance of developing self-respect?
In the Philippines, there are many people who are notcapable of demanding their rights. While some are capableof demanding their rights, not all of them are granted therights that they are demanding, for so many reasons. In thecontext of this pandemic, a lot of people, especially thepoor, demand that they should be given the freedom tomove and continue their livelihood. In a sense, they are

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

demanding their right to live. Not only the poor but also therich whose businesses are hampered by the lockdown, arealso clamoring for their right to continue with theirbusiness activities. But the government has to impose thislockdown for public safety and security. While the rich canstill bear the burden of this policy, the poor people are theones who are hurt the most. Thus, they are demanding fortheir right to live.
Solidarity and self-esteem
The third form of intersubjective recognition for Honneth
is solidarity. This solidarity can easily be established if
persons not only recognize and respect each other but also
appreciate each other’s unique contribution to the society.
This appreciation should not be accorded only to those ofhigh status and roles in the society like the doctors,
scientists, engineers and the like. This appreciation should
also be accorded to ordinary people like farmers, janitors,
security guards, garbage collectors, street vendors andthose that fall under this category of jobs. Honneth (1995)
says that when a member of the society is given
appreciation and also the chance to appreciate themselves
and others, solidarity can be easily established. This isbecause esteem or appreciation inspires not just passive
tolerance but also felt concern about the person throughwhich the shared goals of the community are realized(Pilapil, 2015; Honneth 2007). Honneth’s concept ofsolidarity is not only about shared feelings of sympathy but
more on the shared concern and interests (Pilapil, 2015).
Thus, a collective uprising of the poor that is based on ashared interest or concern is an expression of solidarity inthe same manner that a collective action to care for thevictims can also be an expression of solidarity. Following
the rules on quarantine not through coercion but througha shared concern for the safety of all can also be an
expression of solidarity.
For Honneth, a democratic society that values andtolerates free expression is helpful in the development ofsolidarity among the people (Honneth, 1995: 129). In thecontext of a health emergency situation such as the COVID19 pandemic, how can we judge and support the “best”
expressions of solidarity? Can we say that those who
continue to stay at home as mandated exhibit the best
expression of solidarity? How about those who joined incollective demonstrations to demand for their rights and topressure the government to recognize them as persons ofequal value as the rest of the people in the country? Howabout those who joined in the relief operations to help thefront-liners and the people in need? Can there be
evaluative framework to judge the validity of these
expressions of solidarity? There should be. However, it is
not the intention of this paper to dwell deeply into thismatter.
Injustice, moral suffering and political resistanceFor Honneth, the struggle for equality of rights and justiceis not only political but also moral. He considers the moral
implications to the persons in his analysis of the different
issues of injustices in the society. In his theory of justice,
Honneth is concerned with the actual happening or casesof injustice or moral suffering as a result of unrecognition
or misrecognition, disrespect and maltreatment (Pilapil,
2015). It is important for Honneth to go back to theexperiences of the individual person and how theseexperiences enhanced or constrained his psychological
growth as a person. To be able to combat the forces that
may cause moral wounds of the person, Honneth proposes
three forms of recognition, namely, love, respect andsolidarity or esteem which for him, constitute the social
preconditions for the formation of the moral self of theperson (Honneth, 1995). As a social being, man has to enter
into a mutual relationship with others to be able toexperience and satisfy his needs for love, respect andesteem as well as affirm his capacities to also give the sameto others. Without the experience of the different forms ofrecognition in the person’s relationships with others, itwould be very difficult for that person to develop selfconfidence, self-respect and self-esteem which arenecessary ingredients in the formation of his healthy
psychological and moral self (Pilapil, 2015).
It is then important for Honneth that society must haveinstitutional rules that are publicly affirmed and justified
to satisfy the moral expectations of individuals, to berecognized for who they are as persons. If institutionalrules and practices deny and violate their claims to berecognized, respected and have a fair treatment of theirunique identity, works and contributions to the society, afeeling of social injustice may happen that may result torebellion or uprising (Honneth, 2003).
One instance of unfair treatment that the poor or themasses experienced during this health emergency
situation was the implementation of the enhanced
community quarantine guidelines. While there are many ofthe poor who were arrested for violating curfew rules, therich and the powerful who violated the protocols are notyet given sanctions by the authorities. Why is that so? Is it
because of their status as “rich persons” and maybe
contribution as politicians that they are accorded “respect”
by the implementing authorities? Are the authorities afraidof them because of their status in the society? What about
the poor who also contribute a lot in the society such as
janitors, drivers, street vendors, and the like? Are theircontributions not enough? Are they not worthy of respect?
Since most of these poor rely solely on their daily work tohave food on their table, denying them their rights to do
and perform these tasks is tantamount to slowly
annihilating them in the society. In the first place, the poor
people were not consulted and therefore, not consideredin the deliberation and decision to implement the ECQ
protocols and guidelines. There is no doubt that theimplementation of the ECQ is needed during thispandemic; but imposing this immediately without
consulting the poor and listening to their side is an
example of disrespect and misrecognition of their rights
and capacities as equal members of the society. However,in a public health emergency situation, time is very crucial
and the government has to decide immediately for thegood of all. Since grassroots consultations take so muchtime, it is quite impossible to have a series of consultations
with all the sectors who will be affected before coming up
with a decision. This is understandable of course. But when
it becomes a pattern in the way the government and theelites treat the poor in the society – like they are treated as“less” because of their status, this will result to an
experience of moral suffering which can be a breeding
ground for political resistance.
These individual experiences of suffering inspirecollective sharing of the same stories and narratives on theEubios Journal of Asian and International Bioethics 30(4) (May 2020)
ground. A lot of poor people can resonate with theexperience of moral injuries suffered by their “kababyans”(fellow, companions or comrades). This sharing ofstruggles may ultimately result in collective works ofemancipation. Benhabib (2002) said that moral or
psychological injuries occur not only in individuals but also
in groups since he links the distorted processes ofrecognition of individual identities to the process ofcollective oppression or marginalization. It is very likelythat the uprising among the poor residents of San Roque,
QC, on 1 April 2020 is a microcosm of the collective
aspirations of the poor and the masses to be emancipatedfrom all experiences of injustice, disrespect,misrecognition and ill treatment they suffered from thehands of the powerful, the elite and the ruling class.
When they are pressed further why they are violating
the protocols of social distancing and the enhanced
community quarantine by staging a street protest or
demonstration, their leader said that they don’t have any
intention to cause trouble, they just want to be noticed andto be recognized that they need food (GMA News Online,
April 2, 2020). If you try to examine the statement of theleader of the protesters, it is very clear that their need forfood is just secondary to their needs for recognition as
persons and as full-fledged members of the society. Giving
them food will probably silence them for a while but it does
not heal their broken self because their deeper need is not
food but due recognition and respect of their moral worth
as persons. When they are only treated as troublesome“beggars”, they are only given food but the giver does noteven bother to talk to them, or ask them questions thatmatter to them. In short, there is no effort on the part of thegiver to enter into their world, understand them andestablish relationship with them as persons and as humans
with agency and endowed with dignity.
This has been the paradigm of the government andother aid agencies mostly coming from the elite, in theirdisaster response to poor victims. The victims and theordinary people are made to feel powerless in the midst ofdisaster. When they are only seen as passive objects of pity,
their agency is diminished (Gaspar, 2014: 92). I haveobserved this awful scenario in my experiences as a
responder to Typhoon Pablo which hit Mindanao in 2012.
As we arrived to the places of disaster after establishinglegwork from local people, there were responders from thenational government and other aid agencies who treatedthe victims badly. For them, these people were under themercy of the government and other donors. Thus, theyshould behave properly and obey their rules andregulations. Part of the rule was to ensure that the cameras
were in placed before they lined up to get their share andthen they had to write their names and have them signedin three separate sheets of paper. The people who got therelief goods did experience temporary relief from theirhunger. But certainly, they did not feel the genuine loveand care from these responders because they were neverrecognized as persons with moral dignity and agency andthey articulated that during our interviews and psychosocial interventions with them.
Engagement through “Pagtinabangay” (helping
each other) in the grassroots
What should be the purpose of disaster response such as
food packs and cash assistance in a disaster such as COVID-

139

19? Is it just to give relief goods for the poor to have foodon their table during the lockdown? What will happen after
the lockdown if most of these people are not still
empowered psychologically to take control of theirdestiny? What if most of them still do not have jobs or anymeans of getting income?
Last year a series of earthquakes jolted the provinces of
Davao del Sur and North Cotabato, as one of the early
responders (who is also a victim), we (local people, eventhe victims themselves) mobilized the community to beable to help each other in this time of need. The frameworkof engagements that we embraced was “pagtinabangay” inour local dialect and “pagtutulungan” in Filipino which canbe both translated into “helping each other” in English
language. We considered the victims as partners in our
mission or work. In our weeks of going to the disasterstricken communities, we saw Mindanawons helping theirfellow Mindanawons. We did not limit our engagement to
distribution of relief goods (although we really see to it that
relief goods kept coming to them) but we expanded our
engagements. We coordinated with the community leaders
to be able to do psycho-social and spiritual interventions,
livelihood support and even rehabilitation to thecommunity. We gathered many volunteers and we
experienced overwhelming support from fellow
Mindanawons. We aimed to create and maintain enabling
conditions for the people to take control and hold theirhealthy psychological self despite the trauma caused by thedisaster. We provided avenues for them to articulate theirfears, worries, disappointments and also their dreams andaspirations for the future.
In a sense, through our engagement (though minimaland small scale), we tried to help the victims of disasters
regain and restore their self-confidence, self-respect andself-esteem. We treated them as partners in the road torecovery. We listened to their ways of dealing with theirfears and trauma. We affirmed their courage and faith. In
short, we recognized and treated them as persons withhuman agency and capacities. According to Honneth(1995), recognition of persons is precondition for theformation of an intact identity. Since the victims did not
only suffer the loss of their homes, their livelihoods, andtheir loved ones, but also their sense of self, recognition of
their person and treating them as such helps in therestoration not only of their broken dreams but more so
their broken selves.
Ideally, this should be done by the national government
and the aid agencies given their huge material and also
human resources. But sadly, this kind of framework is not
yet instituted and institutionalized in this country. This ispartly due to the requirement of time given by theseagencies to operate in a disaster-stricken community, notto mention the different bureaucracies that they have to go
through before, during and also after their engagements.
But for me, the main reason is the kind of attitude thatmany of these responders have towards the poor,
especially in the provinces. In our experiences here in
Mindanao, for so many years we have been neglected by
the national government so we really did not wait for thenational government to help us even if the president of therepublic, President Rodrigo Roa Duterte (PRRD) is comingfrom our place. The Mindanawons are known for their
spirit of “bayanihan” which helped them cope with any
disaster. In fact, weeks after the series of earthquakes,

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

many communities were seen as “rising from the ashes”.
But it does not mean that they don’t need help from thegovernment and the rich sectors especially from thecapital.
Since we have been used to help each other because of
our “bayanihan” spirit and our attitude of “panagtibangay”,
we were able to pull ourselves from the abyss of miseryand despair and rise up as one community to continue toface life and build our future even if we have to start it fromscratch. One concrete example of that is how our school
was able to rise up after all our tall buildings collapsed. Our
alumni engineers came to the rescue by building 50
classrooms as our temporary classrooms so as not to
disrupt the education of the students. Other alumni andstakeholders also pledged financial and material support.
Despite being a victim ourselves we still organized many
community outreach activities to provide material andmoral support to the communities especially those at the
peripheries because they are most often not reached in the
distribution of relief goods coming from other agencies.
PPRD is an alumnus of our high school department but we
did not really pressure him to come and help us because
we know he has plenty of concerns in the country. He only
came on the 30th of December 2019 during the alumni
homecoming. During this time, operation of the school was
already back to its “normal” course. I don’t even know if hegave financial assistance. For us, his coming to our schoolis already enough to console us that our “Tatay” (Father)
did not forget us.
Another concrete expression of the characteristic of“pagtinabangay” that I have experienced during myengagements with the victims of earthquakes in our region
was their concerns not only for themselves but also forothers during the distribution of relief goods. Normally wegave rice, canned good, eggs, noodles, biscuits and galloonsof potable water since a lot of water sources weredestroyed due to the earthquakes. People were reallythirsty. They can survive for days without food but
certainly they cannot survive without potable water. A
large number of people flocked towards our vehicles
loaded with potable water to have their share as they had
been thirsty for many days. The reason of the delay of
distribution was usually because the roads were not yet
passable many days after the earthquakes due tolandslides. Thus, you can imagine how thirsty the people
were. However, there were communities that when wearrived the people through their “pagtinabangay” hadalready restored their water system. They were notanymore in need of water. Instead of taking advantage ofthe free galloons of distilled and mineral waters, theyrefused to accept these and suggested that it would be good
if we could give these items to the communities that werein dire need. There were also communities who only
needed rice or canned goods or tents and they only took
what they needed saying that other people might be in direneed of those items and it would be better to share their
portion to them. I was amazed by this attitude of thesepeople. Despite their awful situations, they still had
concern and care for the other victims. They were nottaking advantage of the situations to satisfy their wants
and greed. Some of them even volunteered to help us inorder to have a smooth and peaceful distribution of goods
and to ensure that everyone had their share of the goods

according to their needs. Thus, our series of distribution of
goods were very smooth, peaceful and fulfilling.
What I am trying to emphasize in this section is theimportance of embracing a framework of “pagtibangay”
because there is an equal treatment between the helper ordonors (usually the rich) and the helped (the victims ofdisasters, usually the poor) unlike in the paradigm of“tulong” (help) and “awa” (pity) that the donors always
assume a superior standing (moral and material) over therecipients of help. When the engagement is motivated by
the paradigm of “pagtinabangay”, there is recognition andrespect for the people. When the people are recognized
and respected, they will be motivated to participate in the
programs and projects for the recovery, rehabilitation anddevelopment not only of their own communities but also ofothers. Among the victims themselves, their sense of“pagtibangay” allows them to show concern for their fellow
victims. Thus, there was no hoarding of the relief goods.
They wanted everyone to have their share of the blessings
they received. Indeed, when you engage the local people
to value “pagtinabangay” through genuine participatory
approach to reconstruction by recognizing their capacities
to contribute for the solution of the problems they haveexperienced, people reclaim their agency and movetowards restoration of their own sense of meaning anddirection (De Wet, 2006).
Engagement Via “Awa” at “Tulong” (pity andhelp) by the governments and aid agencies
The whole country now is battling with the threats of
COVID-19. After the government implemented a strict
protocol as regards community quarantine and physicaldistancing, the poor and the daily wage earners havesuffered the most. PRRD assured the public that help will
be given to them especially to the poor. However, becauseof high bureaucracy and colorful party politicking in thiscountry, some poor people and communities in many
Barangays (villages) have not yet received the food packs
and other forms of assistance that are intended to themwhich prompted some groups (particularly from the left)
to stage protests and demonstrations. The natural
response of the government and other aid agencies
especially the elite, is to distribute these goods so that they
will not cause further trouble that might result to social
unrest. When there is social unrest, the businesses of theseelites will be affected. Thus, to avoid that possibility, theyurged the government to distribute food packs. They also
did their share of distributing relief goods to the poor.
However, the paradigm of their engagement is mostly“dole-out” and motivated by “awa” or a sense of (pity) tothese poor that is why they feel obligated to do “tulong” or
any kind of (help) which is basically food packs and cash
assistance. There is nothing wrong in giving help to thepoor because we pity the poor. In fact, because we pity
them, we feel obligated to help them.
However, this kind of engagement only treats people aspassive objects of pity. The problem with this approach isthat there is no equality in the relationship as the donor
assumes a superior standing compared to the needy
recipients of help. Another problem of this approach is thatit only considers the problem of hunger as a physicalproblem which can only be solved by mere distribution offood from the national government and other aid agencies.
There is no conscious effort on the part of the responders

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
to sit down and talk to the people intimately, person toperson, subject to subject. When governments and disasteragencies take the local and the grassroots people for
granted because they are helpless and just passive objectsof pity and monopolize their disaster responses andinitiatives through a centralized command system, humanagency is not empowered and tends to disappear (Gaspar,2014). When people are not given due recognition of their
human agency, it will result not only in a sense of
dependency on the part of the poor and the victims but also
create in them a deep psychological and moral wound. This
moral wound cannot be cured by mere distribution ofmaterial goods such as food packs and redistribution of
economic benefits like cash assistance, subsidy,
scholarship and work opportunities.
What the national governments and some aid agencies
are doing right now are just repeating and even reinforcing
the cycle of poverty and dependency by neglecting themoral agency of the person and treating them as passive
objects of “awa” (pity) and “tulong” (help) from them who
are of advantaged status. In the distribution of food packs,
many poor people are even neglected because the national
agency that is in-charge of the distribution did not consult
the local people and only relied on their list of poor people
from the Department of Social Welfare and Development(DSWD) baseline data which was conducted in 2015.
Another problem in the Philippines today is the lack of
updated data on the status of the people on the ground.
Many of those who are listed in 2015 survey for the
implementation of the Conditional Cash Transfer (CCT)
might have already recovered from poverty and those thatare in dire need of help are not in the lists. Instead ofhelping these people, they might drown into the valley ofdependency. Some of them even buy unnecessary things
because they received cash assistance. While those that are
in dire need but not in the lists, are drowned into poverty
and despair because of the government’s unrecognition of
their situation. In the first case, the government destroys
their moral agency to take control of their destiny while inthe second case, the government inflicts deep
psychological wounds to the poor by neglecting them.
The relation of recognition and redistribution in adisaster response
On April 1, 2020, a group of protesters in Quezon City (QC),
which is in the National Capital Region, staged a rally,
demanding food and other assistance from thegovernment in the midst of the intensive implementationand monitoring of the enhanced community quarantine
and lockdown status in the region. Instead of listening totheir cries and sentiments, the Philippine National Police(PNP), according to the report, used violence in trying todisassemble them and even arrested those who they
believed to be the leaders and instigators of the protest.
(CNN Philippines, April 1, 2020). The same report said that
before they arrested them, the PNP made an appeal tothem to return to their homes because what they are doingis against the law but since the protesters remained to be
defiant, they were forced to implement the law and arrest
them (CNN Philippines, April 1, 2020).
Meanwhile, the local government of QC denied theclaims of the protesters and asserted that the distributionof food packs was on-going and continuous throughout the141city and the barangays to ensure that affected families arelooked after during this crisis period. The mayor even
instructed her staff to review the lists to ensure that no one
would be left out in the distribution of food packs and otheraids (CNN Philippines, April 1, 2020).
This prompted me to ask this question: can distributionof food packs and other aids help in the healing andrebuilding of the broken psychological self of theprotesters and the masses after for so long, they were
neglected, maltreated and oppressed by the society who
considered them as “less” in terms of their dignity because
they were poor and “pasaway” (nuisance) who did notwork so hard but always complained to the government by
joining in street protests and demonstrations?
For me the protesters need both recognition of theirdignity as persons and also concrete economic aid such as
food packs. Due to lockdown, they were not able to work toearn money for their basic needs. Wanting to voice out
their sentiments, they joined protests and demonstrations
to demand their rights. While many others (especially inthe provinces) who also experienced difficulties because of
the lockdown due to this pandemic just waited silently forthe government to give them what was promised to them,it does not mean that they are not complaining. They might
not be too vocal about it in public but when you try to ask
them, they have many stories of disappointments and you
can sense that they are starting to lose their hope. This has
been the sentiments of many of my neighbors who are
tricycle drivers, street food vendors, and daily wage
earners. Until this writing, they have not yet received therelief goods and cash assistance from the government.
They are not even sure if they will be included because thegovernment has criteria for those who can receive theassistance. Unlike during earthquakes that many local
people (rich and the middle class) who were well-meaning
reached out to them and helped them, this time it isdifferent. People are compelled to stay in their respective
homes because of lockdown.
Listening to their sharing, I have come to realize thatindeed, their claims are not only food packs to appease
their hungry stomach. They are also longing forrecognition, love and respect for who they are. Honneth isright when he says that recognition is a vital human need.
This need for recognition does not exist only among thepoor. They are also evident now among the middle class –the professionals, the government workers and those whohave small businesses. In the food and cash assistance ofthe government during this time of pandemic, they aremostly excluded. They used the social media as theirplatform to express their disappointments, rants as well as
hope. They want to be treated as equal. For me their
sentiment is anchored on their need to be recognized as
members of the society with all their rights and privileges.
I do not really think that they are after the food. I think,they just want that the government also talk to them andexplain to them why they are not included. It would evenbe better for the government to tap their generosity forhelp whether through cash or through volunteering in thepacking and distribution of these goods to the poor.
Honneth says recognition of the contribution of individuals
to the community enhances self-esteem (Honneth, 1195).
As mentioned above, this is not the intention of thispaper to dwell deeply on the debate between distribution
and recognition paradigms. However, to have some142

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theoretical grounding, I would like to mention John Rawls’
theory of justice which focuses mainly on theredistribution of primary goods such as rights and liberties
of individuals as well as economic opportunities asimportant component of justice. Then I will argue that evenin Rawls’ theory of justice, the concept of recognition of
persons is implied and in Honneth’s theory of recognition,
he is also talking about redistributive justice.

advantage because the state also recognizes their situation.
Thus, subsidies and other forms of aids and welfare
policies are directed towards the poor. Rawls’ theory ofjustice promotes fairness to all by recognizing the different
needs and capacities of the people. In the redistribution of
economic benefits, Rawls allows inequality so long as it will
benefit the poor. In short, he has preferential option for thepoor but without neglecting the rich.

John Rawls and redistributive justiceIn the chapter two of his “A Theory of Justice”, Rawls
mentions the two principles of justice that people underthe veil of ignorance should adhere to in setting up a justand fair society. The first principle states that “each person
should have an equal right to the most extensive scheme ofequal basic liberties compatible with a similar scheme ofliberties for others.” The second principle states that“social and economic inequalities are to be arranged sothat they are both (a) reasonably expected to be toeveryone’s advantage, and (b) attached to positions andoffices open to all” (Rawls, 1999: 53). According to Rawls,
these two principles of justice are a special case of a moregeneral conception of justice which can be expressed as “allsocial values – liberty and opportunity, income and wealth,and the social bases of self-respect – are to be distributed
equally unless an unequal distribution of any, or all, of
these values is to everyone’s advantage.” (Rawls, 1999:54).
For Rawls, among the primary goods such as rights,
liberties, opportunities, income and wealth, the primary
good of self-respect has a central place (Rawls, 1999). The
rights and liberties he mentions in his theory are those thatare defined and instituted in the public structure. Thus, for
him the question whether man is free or not can be
answered by the determining his rights and duties
established by the government and other major
institutions of society (Rawls, 1999). When we try to
discover his general conception of justice, we can find out
his concern about recognition of persons by highlighting
the social bases of self-respect as central in theredistribution of primary goods to the citizens. Rawls
defines self-respect or (self-esteem) as having two aspects.
Firstly, it includes a person’s sense of his own value which
includes his conception of a good life, and his plans that hethinks worth carrying out. Secondly, self-respect implies a
confidence in one’s ability and his power to fulfill his
intentions (Rawls, 1999: 386). It is clear then that Rawls
recognizes that self-respect is the essential fuel thatsustains the individuals in their search for a meaningful life
(Pilapil, 2015). Without self-respect, nothing is worth
doing and people lack the will to pursue the things thatthey see as valuable. Thus, all their desires and activities
become empty and vain (Rawls, 1999: 386).
How do people gain self-respect? According to Rawls(1999: 477) the bases of self-respect are not only the
person’s income or his social status but the publicrecognition of his rights and liberties. In short, his two
principles of justice must be implemented in the society sothat people will acquire self-respect. His two principles ofjustice can be acceptable to all (rich and poor). For the richand those that contribute so much to the society, theirefforts are recognized and rewarded in terms of highsalaries and other benefits. Thus, they will be expected tohave the motivation to contribute more. For the poor, laws
and practices in society are arranged properly to their

Axel Honneth and recognitive justiceIn his theory of justice, Honneth treats redistribution
issues as cases of misrecognition. He speaks of three formsof recognition (love, respect and solidarity) and theircorresponding effects to the person (self-confidence, selfrespect and self-esteem) (Honneth 1995). For him, thesethree forms of recognition are the necessary ingredientsfor the making of the person. Does this mean that Honneth
is only concerned about recognition in his theory ofrecognition and does not care about just redistribution of
resources? I do not think so. In fact, if you examine his three
categories of justice or rights (mentioned above), hisnumber three category is the social rights which ensureeach person a fair share in the distribution of basic goods(Honneth, 1995: 115). In his theory of recognition,
Honneth did not categorically say that redistribution of
goods and other economic benefits is not needed. He did
not also insist that recognizing and loving the person
without giving concrete material help is enough. He
mentions however, that the injustice and the unequal
distribution of basic goods are not really redistribution
issues but issues of (mis)recognition of the equal dignity of
persons by those who are supposed to implement a fair
distribution of these goods. In short, for Honneth, this lackof recognition results in inequality in the redistribution ofbasic goods. The problem of redistribution happens
because people lack recognition of the inherent worth of aperson regardless of his status, role or contribution in thesociety. If government and other aid responders recognize
the inherent worth of each one as equal members of thesociety, they will see to it that all will have an equal sharein the redistribution of goods and other economic benefits
during disasters or emergency situations.
Conclusion
In this paper we have shown the two different (butcomplementary) engagement paradigms of thegovernment and other aid agencies in responding to theneeds of the most affected persons in the society during
this time of pandemic. On one hand, there is theengagement (normally from the government and other aid
agencies) motivated by “awa” and “tulong” (pity and help)
which sometimes only focuses on the redistribution of
goods and treats the victims as passive objects of their pity.
In this engagement, there is no conscious effort to listen
and talk to the people and consider them as partners in theprocess. This engagement lacks recognition of the agency
of persons. On the other hand, there is another form ofengagement (normally from the civil society organizations
and Church-based groups) motivated by a concept of“pagtutulungan” “pagtinabangay” (helping one another)which treats the poor and the victims of disasters as
partners in the process of recovery, rehabilitation andreconstruction. In this engagement, the poor and thevictims of any disaster are recognized and treated asEubios Journal of Asian and International Bioethics 30(4) (May 2020)
persons with capacity and agency. Most of the works of theagents of this form of engagement are centered oncommunity organizing, psycho-social and spiritualintervention, education, and a portion on livelihood
support and relief operations.
I would like to argue that in any engagement with thepoor people (whether during disasters or in the normal
situation) a healthy balance between recognition andredistribution should be used as the paradigm ofengagement. The “tulong” at “awa” should be coupled andcoordinated with “pagtutulungan” so that people feel thatthey are genuinely loved and cared for by the government
and those of the privileged class in the society. In fact,“awa” (pity) as a cultural nuance among the Filipinos given
their collective experiences of being colonized andsubjugated by foreign rulers can be a unifying force thatbinds people together towards collective actions to help
and support each other to be emancipated from different
forms of evil that beset them. One of those is poverty andinequality.
There is no competition between recognition andredistribution in the works of helping the poor to beliberated from poverty and oppression. John Rawls andAxel Honneth can actually complement each other in theactual establishment of a just society. In fact, recognition of
the equal worth of persons regardless of status, roles andcontributions in the society fuels fair redistribution of
goods and other economic benefits. The fair redistributionof goods as a result of recognition satisfies not only the
economic and material needs of people, it also heals theirwounded psychological selves. During this time ofpandemic, giving the poor the food that they need but
without letting them feel the love will not be of real help
for them. On the contrary, we might inflict more wounds totheir already shattered psychological selves. However,loving and recognizing their worth as persons without
having the concrete means to provide them the material
things they badly need for the moment and theopportunities to earn income in the future so that they will
not be dependent on help from others is not also complete
since as concrete beings, they also need concrete solutions
to their concrete problems.
References
Benhabib, S. (1999). “Nous et “Les Autres”: The Politics ofComplex Cultural Dialogue in a Global Civilization. In
Multicultural Questions, ed. Christian Joppke and Steven Lukes.
Oxford University Pres
CNN Philippines. April 1, 2020. “21 protesters demanding foodaid arrested in Quezon City”, accessed last April 2, 2020 athttps://www.cnnphilippines.com/news/2020/4/1/quezoncity-protesters-arrested-.html
De Wet, C. (2006). “Risk, Complexity and Local Initiative in
Involuntary Resettlement Outcomes”, New York: BerghahnBooks.
Gaspar, K. (2014). “Desperately God’s Saving Action: Yolanda
Survivors’ Hope Beyond Heartbreaking Lamentations”, Instituteof Spirituality in Asia.
Honneth, A. (1995). “The Struggle for Recognition: The Moral
Grammar of Social Conflicts”, Cambridge University Press
Honneth, A. (2007). “Disrespect: The Normative Foundations of
Critical Theory”, Cambridge: Polity Press
Maboloc, C.R. (2012). “The Pursuit of Being Human: An
Introduction to the Philosophy”, SMKC PrintShoppe, Davao City.
Pilapil, R. (2015). “Recognition: Examining Identity Struggles”.
Ateneo de Manila University

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Rawls, J. (1999). “A Theory of Justice”, Revised Edition, Harvard
University Press.

Relationships between Sri Lankan
culture, diets and COVID-19
disease control- Rev Omalpe Somananda.
Senior Lecturer Buddhist and Pali University of Sri Lanka;
Visiting Researcher, Asian Research Institute forInternational Social Work, Chiba, Japan
Email: omalpes@bpu.ac.lk
Abstract
The coronavirus disease (COVID-19) pandemic is a tragedy
that plagues the world today and is confronting everyone
in today's world. The world community has come together
to face the virus without any previous experience. Sri
Lanka, a South Asian country, has taken steps to combat
the virus in a manner different from the rest of the world.
Cultural values, medical interventions and diplomacy of Sri
Lanka have been used for this purpose. This paper asks
how Sri Lankan culture contributes to the control of
COVID-19 in Sri Lanka.? The objective of this study is to
explore the role of culture and diet in the control of the
COVID-19 in Sri Lanka. Food habits, cultural customs andreligious beliefs vary from country to country. I propose
the culture of Sri Lanka has been helpful with medical
doctors to control the Sri Lankan condition. Sri Lanka's
culture is endemic and its survival is influenced by climate,geography and socio-economic background. This situation
may change in comparison to other countries.
Introduction
Disasters can come before us in different ways. Disasterscholars have separated disasters into two maincategories. These are man-made disasters and natural
disasters. Disasters in any way can harm human life.
"COVID-19" has influenced the lives of people around theworld. This affects the entire country of Sri Lanka
irrespective of caste and ethnicity or religion. The
coronavirus disease (COVID-19) pandemic is a "tragedy"that plagues the world today and is confronting everyone
in today's world. The world community has come together
to face the virus without any previous experience. Sri
Lanka, a South Asian country, has taken steps to combat
the virus in what I think is a manner different from the restof the world. Cultural values, medical interventions anddiplomacy of Sri Lanka have been used for this purpose.
Currently there is no specific antiviral treatment for
COVID-19. People with COVID-19 receive supportive careto help relieve symptoms. But to prevent infection there
are many mechanisms by applying traditional culturalvalue systems and respecting new medical instructions.
The objective of this study is to identify the role of culturein the control of the COVID-19 virus in Sri Lanka
Geographical situation of Sri Lanka
Sri Lanka is officially a Democratic Social Republic country,
and an island country in South Asia. It is located in the
Indian Ocean to the southwest of the Bay of Bengal and to144

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

the southeast of the Arabian Sea. The geography of Sri
Lanka includes coastal plains in the north and hills andmountains in the interior. According to Akimoto (2020)
geography and environment is as in Table 1.
Table 1: Geographical Situation of Sri Lanka
Location
Southern Asia, island in the Indian Ocean,south of India
Total Area 65,610 sq. km
Land Area
64,630 sq. km
Water
980 sq. km
Area
Coastline
1,340 km
ClimateTropical monsoon; northeast monsoon(December to March); southwest
monsoon (June to October)
TerrainMostly low, flat to rolling plain; mountains
in south- central interior
LowestIndian Ocean 0m
point
HighestPidurutalagala 2,524m
point
Sources: Buddhist Social Work in Sri Lanka- (p.3)
The maximum length is 435 km and the maximum width is
225 km and the total land area is 65,610 sq km. (p.3). The
total population of this country was 2i.32 million in 2019
(21,481,334). Sri Lanka's population practices a variety of
religions. Wikipedia, the free encyclopedia mentions that
as of the 2011 census, 70.1% of Sri Lankans were
Theravada Buddhists, 12.6% were Hindus, 9.7% were
Muslims (mainly Sunni) and 6.2% Roman Catholic and1.4% other. Buddhism is considered the state religion of Sri
Lanka, and has been given special privileges in the Sri
Lankan constitution such as government protection andfostering of Buddhist Dharma. However, the constitution
also provides for freedom of religion and the right toequality among all its citizens.
Coronavirus disease (COVID-19)
On 31 December 2019, the World Health Organization(WHO) China Country Office was informed about cases ofpneumonia of unknown cause, detected in Wuhan City,
China. The Chinese authorities identified a new type ofcoronavirus, subsequently named COVID-19. On 30
January 2020, WHO Director-General declared theoutbreak of COVID-19 as a Public Health Emergency ofInternational Concern (PHEIC), and on 11 March 2020; hedeclared the outbreak a pandemic. “Coronavirus disease(COVID-19) is an infectious disease caused by a newly
discovered coronavirus” (para.1). “Most people infectedwith the COVID-19 virus will experience mild to moderate
respiratory illness and recover without requiring special
treatment. Older people and those with underlying medical
problems like cardiovascular disease, diabetes, chronic
respiratory disease, and cancer are more likely to develop
serious illness.” At this time, there are no specific vaccinesor treatments for COVID-19. However, there are many
ongoing clinical trials evaluating potential treatments.
“WHO will continue to provide updated information as soon
as clinical findings become available” (para.4) WHO(2019)”. Coronaviruses are a large family of viruses which
may cause illness in animals or humans. In humans, several

coronaviruses are known to cause respiratory infections
ranging from the common cold to more severe diseases suchas Middle East Respiratory Syndrome (MERS) and Severe
Acute Respiratory Syndrome (SARS). The most recently
discovered coronavirus causes coronavirus disease COVID19”. Thus, Coronavirus disease (COVID-19) is an infectious
disease caused by a newly discovered coronavirus.
CultureCulture differs from country to country. Culture refers to
the cumulative deposit of knowledge, experience, beliefs,
values, attitudes, meanings, hierarchies, religion, notionsof time, roles, spatial relations, concepts of the universe,
and material objects and possessions acquired by a groupof people in the course of generations through individualand group striving. "Man is a cultural animal" is a populardefinition. “Civilization” builds on culture. Sri Lankan
culture has a history of more than 2,500 years. Culture is
not easily defined. A culture is a tool. A culture is createdbased on religion. Sri Lankan culture has developed with
the influence of Buddhism. That is why in a multi-religious,
multicultural country, similar cultural identity is built.
“Culture is the characteristics and knowledge of a particulargroup of people, encompassing language, religion, cuisine,social habits, music, and arts”. Wikipedia includes: “A
cultural norm codifies acceptable conduct in society; itserves as a guideline for behavior, dress, language, anddemeanor in a situation, which serves as a template for
expectations in a social group.” According to The Center for
Advanced Research on Language Acquisition: "Culture
encompasses religion, food, what we wear, how we wear it,
our language, marriage, music, what we believe is right orwrong, how we sit at the table, how we greet visitors, how webehave with loved ones, and a million other things," Cristina
De Rossi, an anthropologist at Barnet and Southgate
College in London, told Live Science. Healy & Link (2012)claim that: “Multicultural social work focuses onunderstanding the importance of culture in people’s lives,
access to resources, and way of communicating with one
another.” (p.12). Thus, Culture is the characteristics andknowledge of a particular group of people, encompassing
language, religion, cuisine, social habits, music, and arts.
Pandemic
According to WHO, a pandemic is the worldwide spread ofa new disease. It’s most often used with reference toinfluenza, and generally connotes that an epidemic has
spread to two or more continents with sustained, personto-person transmission. Initially WHO on 24 February2020 said, “For the moment, we are not witnessing theuncontained global spread of this virus, and we are notwitnessing large-scale severe death or disease,” WHO
Director-General Mr. Tedros Adhanom Ghebreyesus said
in a news conference. This pandemic, which is confined toChina, is rapidly spreading beyond the reach of anyone
around the world. Merriam Webster defined that; “anoutbreak of a disease that occurs over a wide geographic
area and affects an exceptionally high proportion of the
population: a pandemic outbreak of disease” WHO haspublishing reports on the coronavirus epidemic andproposing various measures to combat it. Lambert (25February 2020) said; “The coronavirus outbreak that beganlate last year in China has now spread to 29 countries,
touching every continent except South America andEubios Journal of Asian and International Bioethics 30(4) (May 2020)
Antarctica. While the vast majority of cases are still in China,
the virus is gaining a foothold in other countries, raisingfears the world is on the brink of a pandemic.”Over the last century, there have been four flu
pandemics, including the most recent 2009–2010 “swine”
or H1N1 pandemic. The deadliest pandemic, which began
in 1918, was also caused by an H1N1 virus, of avian origin.
Though often popularly called the Spanish flu, there is noconsensus on where that virus originated. It’s estimatedthat the 1918 pandemic caused about 675,000 deaths in
the United States. Thus, a pandemic is the global spread ofa new disease, according to the WHO. The term is mostoften used in reference to influenza.
Social sensitivity"Social sensitivity" refers to people who are alert to social
activities or problems and mentally associated with them.
“Social sensitivity describes the proficiency at which anindividual can identify, perceive, and understand cues andcontexts in social interactions along with being sociallyrespectful to others. This is an important social skill andhaving high levels of social sensitivity can make you morewell-liked and successful in social and business
relationships.” Around the world there are people working
against the coronavirus (COVID-19) for the same purpose,and there is a community of people who think and act only
for themselves. They have no sense of social empathy; an
example of someone with low social sensitivity would be
an individual who only talks about themselves, interrupts
and talks over others, and who ignores social cues to stoptalking. An example of someone with high social sensitivity
would be a person who understands conversational cuesand stops talking in order to listen at the appropriate time.
Let’s consider how Sri Lankan culture contributes to thecontrol of COVID-19 in Sri Lanka?
Sri Lankan situation
The rapidly spreading COVID-19 pandemic worldwide has
had an impact on Sri Lanka. The way of facing the situationof Sri Lanka, compared to the rest of the world, is quite
different. The Ministry of Health and Indigenous Medical
Services in collaboration with welfare service institutions
and organizations are closely working together. Presidentof Sri Lanka is closely monitoring the situation andstrengthening preparedness. As of 10 April 2020, thespread of coronavirus (COVID-19) in Sri Lanka and its
disadvantages are as shown in Table 2.
Table 2: Sri Lankan situation-COVID-19
Source: Health Promotion Bureau (Last updated on
2020.04.09)
According to the above statistics, the spread of
Description
NumberTotal Confirmed Case
189
Active Cases
135
Recovered & Discharged
47
Deaths7
Total number of individuals in hospitals
242
coronavirus in Sri Lanka has been curbed. According to the
Sri Lankan Director General of Health, the main "method"they use is prevention. Sri Lanka has a free and universal
healthcare system. It scores higher than the regional

145

average in healthcare having high life expectancy and alower maternal and infant death rate than its neighbors.
It is known for having one of the world's earliest known
healthcare systems and has its own indigenous medicine
system. Sri Lanka has its own indigenous scheme of
traditional medicine which is called "Hela wedakama"(apart from Ayurveda). This system has been practiced formany centuries in the island nation. The Sri Lankan
Ayurvedic tradition is a mixture of the Sinhala traditional
medicine, Ayurveda and Siddha systems of India, Unani
medicine of Greece through the Arabs, and mostimportantly, the Desheeya Chikitsa, which is the indigenous
medicine of Sri Lanka.
Suggestions were put forward by the Government
Medical Officers’ Association in order to manage thecurrent COVID-19 crisis in the next 14 days (26-03-2020)(Base on WHO). This disease condition can be classified in
to 04 stages: I. No cases; II. Sporadic cases; III. Clusters; (a)Home clusters, (b) Small group clusters; IV. Community
Transmission.
At present Sri Lanka is at stage III a. (GMOA Sri Lanka26 March 2020). We can ask what measures Sri Lanka hastaken to control the coronavirus? Early intervention; a
special announcement issued by the Presidential
Secretariat on 11 March 2020 said that the risk of COVID19 coronavirus spreading in the country is high andrequested the public to support the program launched by
the government to prevent the spread of the virus. Sri
Lanka has taken several measures to control thecoronavirus.
Establishment of an anti-corona prevention national
unit ; Chief of members is the Sri Lanka Army Commander.
Some other key persons: Health Minister of Sri Lanka,
Senior Deputy Inspector General of Sri Lankan police,
chairman of the Medical Council, specialist doctors, welfare
officers, attorneys, representatives of the Presidential
Secretariat and key government officials.
Here is a list of some more:
1. Closing (lockdown) the country on time
2. Systematically imposing curfews in selected areas
3. Early identification of risk zones and districts
4. Identifying the affected people
5. Identifying patient-associated groups/ networks
6. Establishment of home based prevention services
7. Home based quarantine
8. Open 47 quarantine centers
9. Establishment of prevention centers
10. Rebuild hospitals
11. Improve welfare services
12. Closure of airports/ports
13. Strengthening of public health services
14. Proper management of the Sri Lanka army/police
15. Build a strong public opinion
16. Perform religious rituals
17. Utilization of indigenous medical systems in Sri Lanka
The Director-General of Health Services Dr. Anil
Jasinghe said: “The support of the public in planning andimplementing the above measures was high.” All religious
leaders came forward to educate the public on the successof the above program. Sri Lankan society considers“altruism” to be of high value. It is a cultural value derived
from the influence of Buddhism. Sharing, caring, andhelping each other is considered a virtue.

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Sri Lanka has very strong family relationships. In Sri
Lankan culture, the family has a deep spiritual inseparable
bond. The Buddhist philosophy has been inspired by
Buddhist culture for this bond. So, the family itself has theirown mechanisms to share their support among family
members and mutual support. Gamage (2012) stated that:“From childhood Sri Lankans are encouraged to tell all of
their thoughts to their parents and submit to their direction,
counsel and advice. The husband and wife work together andco-operate in raising the children. Each has different
assigned duties and responsibilities, as do the older andyounger siblings and grandparents. The father acts as an
authoritarian figure and the mother takes the major role asa mediator between children and their father incommunication. They are admonished to be good because
any disgrace that is committed is a disgrace to the family. In
times of misfortune they are assured of the family’s support,
sympathy and love. This background of sharing and caring
with responsibility and accountability creates commitment,
trust and strong work ethics within the family.” (p. 68)
These cultural value systems have contributed to thesuccess of the government programs. It received the
maximum support of the public in the implementation of
the state assistants. The role of the religious leaders was
also effective in maintaining the welfare services to therural level. Facebook page Somananda (27 March 2020- at1.25) published; (English translation of an advertisement
displayed in front of a Buddhist temple in Sri Lanka) “Is
your child hungry because of the curfew? If you haveanything you need here, please come and take and go it for
free. If there is a poor family these days, please inform”.
Buddhism has done a great job in developing theculture of Sri Lanka. This is supported by the following
research reviewed finding by Gohori (2017), “Sri Lanka
researchers interviewed and held discussions with highranking Buddhist, senior governmental officials,
researchers- including University professors-and otherpeople during the research. An idea to set up a college ofsocial work education for Buddhist monks came up as a byproduct of the research. The purpose was to make Buddhist
monk practices more effective by providing contemporarysocial work knowledge and skills to the monks. As soon as
they started discussing social work among themselves,questions arose. While WPSW has been around some 150
years, Buddhist monks have been practicing similar
activities for over 2500 years. Even today, there are many
examples of “good practice” by Buddhist temples and monks”(p. 19)
Sri Lanka is a multi-ethnic, multi-religious country.
Each community had its own unique set of religious andcultural values. Religious harmony is very high. The Indian
Express Newspaper (2016) reported that: “Sri Lanka is amulti-ethnic, multi-religious country. Each community had
its own unique set of religious and cultural values. Religious
harmony is very high.” The Indian Express News Paper(2016) reported that: Rev. Cardinal Malcolm Ranjith, who
is Colombo’s (Sri Lanka) Archbishop, had said that:
Respect reserved for Buddhism should remain intact in theconstitution, He expressed this view while participating ina Buddhist ceremony at the Sri Sambodhi Viharaya in
Colombo, Daily Mirror reported. Justifying his contention,
Cardinal Ranjith said that the teachings of Buddhism bringpeople relief whenever they are confronted with mental
pain and discomfort. He then went on to say that Sri

Lanka’s prominence rests on Buddhism, and therefore,
there should be no change in the “foremost place” which it
currently enjoys in the country’s constitution. “We all live
in a country nourished by Buddhism,” Cardinal Ranjith
pointed out” (https://www.newindianexpress.com/world/2016/aug/08/Does-Vatican-disapprove-of-Cardinals-nod-togive-Buddhism-foremost-place-in-Sri-Lanka-1507022.html.
Retrieved on 9 April 2020).
This indicates that Buddhism has been influenced by
the existence of other religions. Some of the Christianrituals are in line with the influence of Buddhism, forexample.
Foods Habits in Sri Lanka
I would like to propose that food is also linked to theimmunological response of persons to disease, though I do
not yet have any evidence of specific links to COVID-19.
Food customs in any country are based on culture, or “foodis a symbol of culture”. It is also important to mention thatthe country has a unique food culture with a long history.
Sri Lanka’s culture of food is still deeply rooted in theancient teachings of Buddhism and the underlying
message of it all seems to share without thought. The
website culturalgov.lk - mentioned that:“There were evidences on the cultivation of cereal by the
Aryans before other human groups. As explained in theancient writings, the meals of our ancestors were mainly
based on rice. There was interesting information about
paddy cultivation in historical sources. According to thehistorical evidence, the tank which is an essential factor forthe cultivation of paddy was introduced in the days of King
Pandukabhaya. There were around 20,000 tanks in theSouth and North. The ancient Pali writings stated about
seven varieties of cereal. There were 317 kinds of paddy
varieties in the past. It was said in the folklore that there
were more than 1,000 paddy varieties. The cereal-likesesame green gram, millet, kurakkan, thanahal, undu, gram,dhal and cowpea were cultivated in Chenas (Shifting
Cultivation” (para.3)
According to the above factors, it is clear that theancient Sri Lankans had rice and other cereal for their main
food. Generally the level of nutrition in Sri Lanka is high,which prepares people for facing disease. In addition to themain stable, they have other food items such as meat, fish,
eggs and vegetable and fruits. In ancient Sri Lanka, there
were a number of methods in relation to cooking rice. They
can be identified as rice gruel, milk rice, tempered rice,
ambul bath, cooked rice with bee honey, cooked rice withghee, and cooked rice with spices. Among the other typesof cooked rice, rice mixed with cereal tempered rice withvegetable, rice kept in water and mixed with onion, chilies,
coconut milk, lemon juice, salt water, and so on, sunsahal
rice, yellow rice, rice mixed with green gram, agiti hal rice,and kudu bath were important. The kings had offered milk
rice for Buddhist priests and even today it is a meal withhigh cultural value.
In Sri Lankan food culture, fish and meat were widely
consumed by our ancestors. The freshwater fish varieties
like Lula, Madakanaya, Magura, Kavaiya, Pethiya, Prawn
and Crab were taken for food in the past. However, there
was no evidence for eating sea fish varieties. Now sea fish
has become a popular food item. Among the eggs that
consumed in the past Chicken eggs, Thara eggs, (Duck)
Kalukum eggs and Kesbe eggs (Turtle) were very popular.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
Fruits native to Sri Lanka
People in Sri Lanka eat a lot of fruits which prepare us tobetter survive disease. Some fruits native to Sri Lanka
include Coconut, Jambu or (“wax fruit”), Sugar Apple,
Soursop, Pomegranate, Guava, Jackfruit, Papaya, Avocado,
Mangosteen, Pineapple, Banana, Rambutan, Woodapple,
Durian, Mango, Passion fruit. There are also somevegetables and fruit imported from the West such as
Carrot, Beet, Leaks, Cabbage, Mangoes, Rambutan, Papaya,
Pineapple, Grapes, Apple and Pears. The Muslim culture
also inherited some food items in Sri Lanka and theymainly include musket, boondi, date and watalappam.
Use of spices in Sri Lanka
Doctors believe that the Sri Lankan method of cooking isgood for health. They believe that the spices used in Sri
Lanka are responsible for this. Dr. Anurudha Padeniya,
who is the Government Medical Officers Association(GMOA) President, (March 24, 2020- Hiru Youtube)
advised using Sri Lanka's spice with food to strengthen the
body capacity to prevent coronavirus. (Go to Dr. Anurudha
Padeniya YouTube channel to listen to him). According toLakpura.com it mentions that; “Spices enhance the color,fragrance, and flavor of food. In addition many of them also
have many health benefits. Used in the right combination,
spices can turn the simplest food into an aromatic and richexperience in the world of cooking. Of course, used
incorrectly, if the wrong spices are combined, they will makefood taste terrible and bitter.” A few spices in Sri Lanka
include: Curry Leaves (Karapincha) (The Curry Tree(binomial name: Murraya koenigii) is a tropical tree native
to India and Sri Lanka), Turmeric (Kaha) Turmeric(binomial name: Circuma longa), Clove (Karambunatti),(Cloves, which are the flower buds of a form of evergreen
tree; originate from the Maluku Islands, Indonesia.),
Cinnamon (Kurundu), (Cinnamon refers to Cinnamomum
Verum or ‘true cinnamon,’which is a plant endemic to Sri
Lanka.), Pepper (Gam Miris) (Pepper generally refers toblack, white and green pepper.), Cardamom (Enasal)(Cardamom, also known as Cardamon, is a small spindle
shaped seedpod with black seeds inside), Lemon Grass(Sera), Nutmeg and Mace (Sadikka and Wasawasi), Vanila,
Ginger. There are many other spices in Sri Lanka, but these
are the main ones.
In nourishing the Sri Lankan food culture, theinfluence of Buddhism and Ayurvedic medicine
contributed in a big way. This is evident from the customs
and ethics that prevailed in the country. Further, different
beliefs, blessings and worships have also contributed to
the nourishment of the country’s food habits.
Thus, the above information suggests that Sri Lanka
possessed an inherited and culturally valuable foodculture. Although there were some changes, this culture
has been existing without any danger.
Ayurvedic medicine in Sri Lanka
Ayurvedic medicine in Sri Lanka has been influenced bycountries like India and China. But Sri Lanka has a uniquesystem of medicine. This is called "Helavedakama”. Daily
Mirror (10 April, 2020) said that; “Prevention is the bestway. Herbal plants are known to possess excellent
immunomodulatory, (same word in web) immunostimulant
and immunoenhancing properties and generally act by

147

stimulating both innate and acquired immune systems.
Some compounds found in the medicinal plants perform
anti-viral activities. They can inhibit viral replication, block
viral attachment and prevent viruses from entering hostcells” (internalization). Dr. Sandun Liyanage, (Interview
with Daily Mirror- 10 April, 2020; Dr. Sandun Liyanage,
BAMS (University of Colombo), at present serves as theCommunity Medical Officer (Soranathota division)
Department of Ayurveda, Uva Province.
There are many home remedies with the above
properties which have been used traditionally in Sri Lanka
for a long time. The best and the most popular method isboiling Ginger and Coriander or ‘Paspanguwa’ anddrinking half a cup in the morning and in the evening. Also
drinking half a cup of the following, Venivelgeta, Nelli and
Rasakinda, garlic water, Heen maduruthala/Bin kohomba
are effective home remedies. Their medicinal properties
are scientifically proven. Adding garlic and cinnamon tocurries or when preparing foods may also be effective in
producing anti-viral effects. Preparing porridge from
Monarakudumbiya, Heen bovitiya, Yakinaran, Elabatu
leaves are similarly effective.
Vitamin C plays an important role in the immune
system. It contributes to the immune strength bysupporting various cellular functions in the immune
system. ‘Masan, Lime, Naran, Oranges, Nelli, Guava’ containmore vitamin C compared to other fruits. Fumigation with
Agil, Gugul, Haldummala, Neem oil/leaves, turmeric
kill/sedate the germs in the atmosphere. Tie a threadwhich bears a piece of Perunkayam (Asafoeitida) or Vada
Kaha; which is a traditional method to prevent germs (http://www.ayurveda.gov.lk/)/
Research methods are used in medical science to findsolutions. But in Ayurvedic medicine, that knowledge has
been acquired through the optional knowledge. It is
hereditary wisdom. There is evidence that traditional
medicine existed in Sri Lanka before the development ofWestern Medicine. Therefore, the above ideas cannot beeasily dismissed.
Conclusion
When we look at Sri Lanka's numerical information
regarding the Corona Prevention Campaign, it is clear that
it is in control. Culture has a major impact on the existenceof a nation. Culture helps to showcase the personality of acountry, also helps to show the morality of a nation.
Similarly, the culture of a country can be influential indetermining the existence of a nation. Those who possessa great "civilization" are the owners of a good culture.
People in Sri Lanka have quit smoking. Drinking is undercontrol. It is based on this culture that a "flexible humancommunity" has been created to support the government's
activities, following religious practices and living in theirhomes. An important factor revealed here. It is a "race as anation" to take care of the poor even in the face of
oppression. Religious leaders have done their best. It is thereligious leaders who nurture and take care of the"culture" that is created through religion.
Sri Lanka has adopted a "preventative model” By usingthat model, hospitals around the world can avoid thecrowd of patients. The death toll will be reduced. The"culture and human nature" of the country will be an
important factor for that.

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Reference

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Akimoto, T. (ed). (2020). Buddhist Social Work in Sri Lanka:
Exploring Buddhist Social Work. ARIISW- Shukutoku
University, Gakubunsha , Chiba
Daily Mirror (10 April, 2020). What can Ayurveda do during suchan emergency? http://www.dailymirror.lk/plus/Coronavirus-Prevention-is-the-best-way/352-184830
Gohori, J. (Ed). (2017). From Western-rooted Professional Social
Work to Buddhist Social Work, Part 1. ARIISW. Shukutoku
University - Chiba.
Gamage, H.R. (2012). Culture of social institutions and behavioral
manifestations in entrepreneurship development: a SouthAsian case. Research Online. University of Wollongong
Healy, L. M., Link, R. J. (eds) (2012). Hand Book of International
Social Work: Human Rights, Development, and the Global
Profession. Oxford University Press.
Lambert, J. (FEBRUARY 25, 2020 AT 1:51 PM). We may be on thebrink of a coronavirus pandemic. Here’s what that means.
Science news. Retrieved on 9 March
2020. Fromhttps://www.sciencenews.org/article/what-coronaviruspandemic-would-mean-outbreak-epidemic-who
Merriam
Webster(2020)
Whatispandemic?
https://www.merriam-webster.com/dictionary/pandemic,
Retrieved on 9 March 2020.
GMOA Sri Lanka (26.3.2020) Suggestions put forward by theGovernment Medical Officers’, Association in order to manage
the current COVID-19 crisis in the, next 14 days (26-03-2020)
Retrieved on 9 March 2020. From https://www.gmoa.lk/
wp-content/uploads/2020/03/ Suggestions-put-forwardby-the-Government-Medical-Officers%E2%80%99Association-in-order-to-manage-the-current-COVID-19crisis-in-the.pdf
Wikipedia. Com. (2020) “Religion in Sri Lanka”- Redirected
9.March2020
From
https://en.wikipedia.org/
wiki/Religion_in_Sri_Lanka
WHO, (2020). There is a current outbreak of Coronavirus (COVID19) Disease - Retrieved on 9 March 2020.
https://www.who.int/health-topics/coronavirus#tab=tab_1
WHO, (2019).
Q&A on coronaviruses (COVID-19)
https://www.who.int/news-room/q-a-detail/q-acoronaviruses, Retrieved on 9 March 2020.
Culture.
http://people.tamu.edu/~i-choudhury/culture.html,
Retrieved on 9 March 2020.
https://lanka.com/fruits-in-sri-lanka/, Retrieved on 9 March2020.
https://www.who.int/srilanka/covid-19, Retrieved on 9 March2020.
https://www.who.int/health-topics/coronavirus#tab=tab_1
Retrieved on 9 March 2020.
https://www.cultural.gov.lk/web/index.php?option=com_conte
nt&view=article&id=65%3Asri-lankan-foodculture&catid=34%3Aleft&Itemid=72&lang=en Retrieved on
9 March 2020.
https://en.wikipedia.org/wiki/Sri_Lankan_traditional_medicine
Retrieved on 9 March 2020.
https://pdfs.semanticscholar.org/2131/53930515858d3291a8
d779e0737c137a7735.pdf Retrieved on 9 March 2020.
Zimmermann, K. A.
(2017). What Is Culture?
https://www.livescience.com/21478-what-is-culturedefinition-of-culture.html Retrieved on 9 March 2020.

A search for a COVID-19 cure in
Siddha medicine- Dhastagir Sultan Sheriff, MD, PhD
Reprolabs, Chennai,TN India
Email: drdsheriff@gmail.com
Abstract
A traditional Tamil system of medicine is known as Siddha
medicine, practiced for years in Tamilnadu, a South Indianstate of India. There is a central institute devoted to thepractice of Siddha medicine in Chennai. The origin for thepractice of Siddha goes back to BC 4000. Archeologicalevidence suggests that the practice of Siddha wasprevalent in the Dravidian civilization in a land called
Kumarikandam, a Lemuria continent present in the Indian
Ocean. Kumarikandam is now submerged in the ocean.
This Dravidian practice of medicine is contemporary to thepractice of medicine in the submerged lands of Egypt,
Mesopotamia, China and Greece. The practice of Siddha for5000 years or more stands as proof for its service to thehumanity in maintaining health and preventing disease inthat ancient period.
Siddha is rooted with mythology as its origin was
devoted to Lord Shiva. Lord Shiva is supposed to have
handed over such a practice to Parvathi known as Shakti
who passed on the divine knowledge to Nandi. Nandhi had
passed on that sacred knowledge to the practitioners
called Siddhars. The Tamil Siddhi is the origin for the word
Siddha which means having precision and heavenly
blessings.

Figure 1 The script of Siddha medicine written andrecorded in Olai Chuvadi
Siddhars had great yogic power which sharpened theirintellect with heightened intuition. Using such intellectual
power, they explored the natural resources surrounding
them. They researched and learned knowledge about thecharacteristics of plants, metals, minerals and animal
products which led them to create concoction of drugs.
The process involving purification, dose determination,
setting limits to toxicity, antidote and clinical application
were preserved in the form of palm leaves scripts calledolai chuvadi.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Figure 2. Saint Thiruvalluvar
To maintain and perpetuate the unique legacy of Siddha
Medicine, disciples of Siddhars were trained, with anancestral lineage of 18 Siddhars with Agasthya, the primearchitect of this form of medicine. These disciples recorded
and transcribed the oral instruction of formulation andtherapy on palm leaf manuscripts which became thetreasure house of Siddha medicine. Siddhars were men of
great intellect, poets, philosophers and humanist and hadlaid the foundation stone for the practice of Siddha
Medicine.
The individual was considered as a microcosm of theuniverse. They suggested that the human body is made up
of primordial elements, earth, fire, air and space. There arethree humors –vatha, pitta and kapha and seven physicalconstituents. It is said that food is the basic building block
which gets processed into humors, tissues and wastes. The
equilibrium maintained between the humors is considered
as health and its imbalance as disease state.
The greatest poet of Tamil is Thiruvalluvar )Figure 2)
who has written the immortal Thirukural. Thirukkural
consists of 1330 couplets (kurals in Tamil). There are 133
sub divisions (Adhigaram) containing 10 couplets each.
These 133 subdivisions lie under 3 main divisions such as
Arathupal (deals with life), Porutpal (finance) and love life.
It is translated into 85 languages.
The saint poet has succinctly given a definition of healthand medicine as shown by the following couplet.
Thirukkural - Maxims for life. Once a day # 948. Diagnosethediseaseandunderstandits
seeds;
Identify the cure and make sure it succeeds.
Siddha medicine trusts in cosmic oneness whichsuggests that the five senses correspond with the fiveelements. Ether (Veli) is responsible for hearing; air(katru) for sense of touch; fire (thee) for sight; water (neer)
for taste; and earth (mann) for the sense of smell.

149

Siddha believes in the harmony of body, mind andspirit. It aims to bring the innate harmony of the individual.
Therapy aims in restoring the balance between the mindbody system. It emphasizes the importance of diet andlifestyle for maintaining health and disease. Siddha
medicine advocates pathiam (diet restriction) andapathiam (non-restriction), which is essentially a list of
do's and don'ts. Siddha lays emphasis on the concept that“Food itself is medicine and medicine itself is food".
The diagnosis is based on clinical acumen of thepractitioner using pulse, tongue, complexion, speech, eye,stools and urine examination, named as “eight types of
examination”. The examination of pulse is very importantin confirming the diagnosis.
Treatment consists of three distinct categories: Deva
Maruthuvam, (divine method); Maanida Maruthuvam(rational method); and Asura Maruthuvam (surgicalmethod). Siddha drugs are classified as herbal product(Thaavaram , inorganic substances (Thaathu), and animal
products (Jangama). In the divine method, medicines likeparpam, chenduram, guru, kuligai prepared from mercury,sulphur and pashanams are used.
In the rational method, medicines prepared from herbs
like churanam, kudineer, vadagam are used. In surgicalmethod, incision, excision, heat application, bloodletting,leech application etc. are practiced. This branch also deals
with traumatology and accidental injuries called Varma.
There are more than 100 vital points that are junctions ofbones, tendons, ligaments, blood vessels and nerves called
Varma points. Pranic energy is found concentrated in thesepoints which, upon manipulation, produce curative effect.
Such a practice of medicine has not reached world wide
application. In the present pandemic of Coronavirus
infection few practitioners of Siddha claim that they have acure for such viral infections as it is recorded in the Olai
Chuvadi. One of the Siddhar family in one of the villages
practices such medicine and wants to share theirknowledge to cure such a pandemic disease which cripples
human lives and economy. The scientific basis of suchclaim is not based on literature available but because of thefamily having a Olai chuvadi with instructions for such atherapy.
There is no scientific validation or support in any form
from different agencies that deal with approving drugs fortherapy with clinical trials. The practitioners are poor; they
do not have financial support or modern technology tosupport such mode of treatment. The ethical question how
to deal with such a claim – ignore it or support it or how todeal with a such situation is for everyone to ponder. Folk
medicine and tribal medicine have their places in thecommunities they deal with and who believe it.

References

Karunamoorthi K., Jegajeevanram K., Xavier J., Vijayalakshmi J.,
Melita L. Tamil traditional medicinal system – siddha: an
indigenous health practice in the international perspectives.
Tang. 2012;2:1–11. [Google Scholar]
Saikat Sen∗ and Raja Chakraborty. Revival, modernization andintegration of Indian traditional herbal medicine in clinicalpractice: Importance, challenges and future. J Tradit
Complement Med. 2017 Apr; 7(2): 234–244.
Thiruvalluvar, Thirukural.

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Healing mind and body by
Mantras, Ayurveda and Yoga
- Lakshmi Vyas, PhD
Former Principal Elphinstone College, Mumbai &President of Hindu Forum of Europe
Email: vyasnili@gmail.com
Mantra is a Sanskrit word that is derived from two rootwords: ‘man’ referring to mind, and ‘tra’ referring to an
instrument. Therefore, a mantra is a mind-instrument thatuses sound vibrations to channel the mind.
The universal Mantra is Om, or Aum, a deeply divinesound, an all-embracing sound of the universe. It is a single
syllable that is the sound of harmony itself, and when we
chant it, we invite that harmony within us. The sound of
Om is considered the first sound of the universe, the lifebreath of the Creator. So chanting Om as we breathe in andbreathe out fills us with the creation’s energy.
There are several chants for world harmony, forexample (Lokah Samstah Skhino Bavantu), may all being in
the entire Universe be happy.
Chant for world harmony Lokah Samastah Sukhino
Bhavantu; translation: May all beings in the entire universe
be happy and free. This is a popular mantra for peace, notjust for one's own self or family, but for the world, and theuniverse (literally, all the worlds in the entire universe). It
encourages one to go beyond his own identity and his small
world, to identify with the entire creation and all its beings,
since the Being is the same in all creatures.
There are Mantras for truth and of course there is also
mantra for healing. It is the Mrityunjaya (mrit-yoon-jaya),a secret mantra that was only passed along verbally for
generations. It is widely known now, as a healing mantra
to ward off illness, improve health (mental and physical),and even untimely death.
Om Trayambakam Yajamahe Sugandhim Pushti
Vardhanam. Urvarukam Iva Bandhanan Mrityor Mukshiya
Mamritat.
How are mantras chanted? Generally, one picks afavorite mantra, a quiet spot, and an undisturbed time.
Start by chanting your mantra out loud 7 times, then chantit softly 7 times, then silently 7 times. After that, you canstop counting, and simply repeat it silently over and overagain. Note: If you have trouble with the enunciation of the
Mantras, YouTube has clips of how to pronounce them. You
should be able to look up each Mantra by its first few
words.
How to chant OM: Wherever you are right now, adjust
your posture to sit up straight, and close your eyes. Take a
deep breath and let it go. With your next deep exhale, let an
Aaaaaa slip out low and rumbly from your belly. Keep it
going as it rolls itself into an AUM sound. When you are
half-way through your breath, slowly bring your lips
together into an Mmmmmmmmm. And then taper off intosilence. That’s one Om! Chant Om 3 times to feel yourself intune with your inner being.
Here is a Mantra for seeking truth:
Asato Ma Sat Gamaya
Tamaso Ma Jyotir Gamaya
Mrityor Ma Amritam Gamaya
Translation: from unreal lead me to real, from darkness
lead me to light, from death lead me to transcend it. This isa deeply meaningful mantra, of a seeker searching for truth
and light beyond death. And not just any truth, but the
Eternal Truth, that is not limited by body, mind andintellect. These mantras exhibit their healing properties by
inner peace, cleaning lungs and attaining purity.
Here's one last mantra that is recited often at the end of
prayers, rituals or invocations. It is meant to be a call (aswell as a reminder for oneself) for Shanti, meaning peacein Sanskrit. Peace within, peace without, and peace divine.
Om Shanti: Shanti: Shanti:
Ayurveda and Yoga are two limbs of Vedas, which help
us heal and cure several illnesses. Traditionally, yoga
(which has presently become popularized in the West) was
therapeutically used as a part of Ayurvedic practices todelve into the actualization of the true self (atman) and thenature of reality (Brahman). Spiritually speaking, theAyurveda and the practice of yoga ultimately seek toliberate the soul (jiva) from the cycle.
To understand spirituality and spiritual healing in
Hinduism one must first understand the ultimate goal in
Hindu philosophy, which is to free oneself from the cyclicalnature of existence. This liberation is termed moksa, whichis essentially the same ultimate goal in the practice of yoga,
termed kaivalya.
Techniques such as mantras and meditation used inyoga, which have been adopted from Ayurveda, attempt tospiritually link the self and consciousness to the natural
world that surrounds it. This is a broad look at the spiritualfocus of Hindu philosophies to maintain the well-being of
rebirth (samsara) and the tremendous constraining moral
principle that is karma
This paper attempts to present how by using Mantras,
Ayurveda and Yoga many health issues and illnesses can be
resolved without using any chemicals and toxins.
However, if there is an emergency, one should seek anallopath.
Ayurvedic healing procedures
Various healing tools and methods are utilized by
Ayurveda as follows: diet, herbs, colors, Pancha Karma,
lifestyle recommendations, aromas, sound, meditation,and yoga. Over the years people have started recognizing
the easy applicability of various Ayurvedic methods/
products/tactics in day-to-day life.
How does Ayurveda cure diseases?
The main aim of Ayurveda is re-establishing thebalance/harmony in the person for attaining optimal
health. The treatment process targets specific healthproblems and recommends medicines for internalcleansing, by getting rid of the substance that can cause thedisease by internal cleansing, by getting rid of thesubstance that can cause the disease.
Who practices Ayurveda?
In ancient India, Ayurveda was the only way of healing andscriptures like Charaka. Samhita and Sushruta wereconsidered the holy texts of healing. Today, the practice isregaining its prominence with more and more Ayurvedic
learning and healing centers springing up in rural andurban India, equally. There are over 6 hundred thousand
registered Ayurvedic practitioners and 3 thousandproviding Ayurvedic treatments. More and more of the
population is now resorting is to Ayurvedic treatments andEubios Journal of Asian and International Bioethics 30(4) (May 2020)
the nation is again going back to its roots for health andharmony.
Principles of Ayurveda
The basic principles of Ayurveda comprise of
three Fundamental universal energies: viz.
•Satva, Rajas and Tamas. Ayurvedic therapies take
into account the five basic energies namely –•Akasha (Space), Vayu (Air), Teja or Agni (Fire), Jala
(Water), and Prithvi (Earth)
Medicines in Ayurveda are prescribed after
understanding the body type of the person. Their
proportion varies from person to person.
Practitioners believe that well-being is affected byconstant fluctuating of vital energies, or doshas, andtreatment aims to restore the doshic balance. There are –•Vata dosha – combination of ether and air.
•
Pitta dosha (process of metabolism) – governs
movement, seen as force which directs impulses,
respiration, circulation, and elimination.
•
Kapha dosha – combination of water and earth
elements, responsible for growth, gives protection,•
Seven types of body tissues (or dhatus) which
provide nourishment to the mind and body: viz.
Rasa (fluid) Dhatu, Rakta (blood) Dhatu, Mamsa Dhatu,
Meda (fat) Dhatu, Asthi Dhatu, Majja Dhatu, and Sukra
Dhatu.
‘Stomach fire’ – jatharagni and twelve other types of firein the body, are responsible for diverse metabolic
activities. There are three types of body waste: viz. Purisa(faeces), Mutra (urine) and Sveda (sweat)
Pancha Mahabhutas is the foundation of all Ayurvedic
diagnosis and treatment routines.
“Mahabhutani
khamvayuragnirapah
ksitistatha!
sabdah sparsasca rupam ca raso gandhasca
tadgunah !!
According to Ayurveda, everything
in the Universe is composed of the Pancha
Mahabhutas. The five mahabhutas alongwith their properties, in complex multicellular organisms like human beings, arementioned as below:•
Akasa (Space) – corresponds tospaces in the body, for instance abdomen,mouth and nostrils.
•
Vayu (Air) – signifies the
movement, essentially muscular movement
and movement of the nervous system.
•
Agni (Fire) – controls the enzyme
functions like digestive system, metabolism,
intelligence etc.
•
Ap or jala (Water) – present in allbody fluids such as saliva, plasma, digestive
juices.
•Prthivi (Earth) – manifests thesolid structure of the body including flesh,teeth, bones, hair.
Yoga for health
1.Yama(ethics) truth, ahimsa, asteya (notstealing), 2. Niyama(discipline), 3. Asana(posture), 4. Pranayama (rhythmic control

151

of breath), 5. Pratyahara (looking inward) ,6. Dharna(concentration) ,7. Dhyana (meditation), 8. Samadhi (stateof super consciousness)
The asanas are not created out of the blue. They havecome into existence as a methodical approach to living.
The asanas have a great potential to change the behavioral
pattern of the practitioner which in turn changes themental stature, enabling the practitioner to proceedfurther and remain in a positive path.
We have standing, sitting, twisting, asana with forward,
backward, inverted movements and contractions. The
main path of Iyengar Yoga is precision: If hands have to bestraight, they have to be absolutely straight. If you have tobend the knee it has to be at right angles. The precision in
the asana is not merely meant for the alignment of the part,but for the proper functioning of the human being. If the
body is aligned with precision then the breath is alignedwith that same precision, if the breath is balanced then themind, emotions and senses get balanced. We have to study
the connections of how these precise adjustments work on
the entire human being.
Regular practice of yoga, keeps one healthy, agile,
disciplined, and coupled with vegetarianism keeps awayfrom diseases.

Conclusion

During testing and epidemic times regular practice of Yoga,
chanting of Mantras and intake of Ayurvedic medicine
helps to build immunity and keeps several infections anddisease at bay.

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

How not to face coronavirus:
the case of Spaingive a partial but different explanation of the Spanishspine-chilling figures.

- Manuel Lozano Rodríguez, PhD
AUSN Visiting Professor, Bioethics of Displacement, Spain
Email: perennidad@gmail.com
Abstract
A country’s political idiosyncrasies can shape its pandemic
response. Both the recent history and the factors thatmight make governance uncomfortable set the context inwhich this happens. Among the many causes, stands out
the lack of cohesion coming from questioned leadersusually eager to rule. These cravings don’t rely uponpolitical colors and pave the road for spine-chillingmortality just like any demographic vulnerability, e.g. an
overaged population or an extreme weather. In the bottom
there is a surging thirst for pastoral power that can be
traded for such essential things like the life of the ruled
ones.
Introduction“Epidemics reveal the truth about the societies they hit”
(Applebaum, 2020)
Spain was, from the very beginning of the COVID-19
crisis, a very vulnerable country/economy. However, thedeadly outlier results we face here, make the mere
statistical chance a fishy explanation. In this case study I
will focus on the more idiosyncratic components of COVID19 outbreak from a Barcelona metropolitan area dweller
compared with the situations I see, mainly, in the rest ofEurope, on 4 April 2020. I’ve found three main traits that

Pig-headed ignorance Le sain imaginaire
The way that European countries’ leaders have faced the
COVID-19 pandemic has determined the life (and death) of
thousands of people in their respective countries and far
beyond. The common people’s perception of COVID-19 as
well as the consensus built around it is that coronavirus
has just any biochemical feature as in the virus category;
this is not in a biological sense, for sure, but in the socialside of what a disease means. In spite of the fact that R0 is
an undeniably valid indicator in epidemiology, I’ve learned
first-hand that it’s more context-sensitive than describedin books. The Spanish case is like an upside-down scriptfrom the Molière’s Le malade imaginaire (Molière, 2004)
with plenty of VIPs boasting they cannot get sick!
Decision-makers’ pigheaded ignorance in the mandateof preserving the citizens’ life has whipped some countries
with avoidable deaths. Definitely, Spain and Italy havedone it in thoroughly and in unaccountable ways. For thispurpose, I’ve established three ignorance levels according
to the expeditious readiness taken.
3 degrees of COVID-19 ignorance in a European sample
Here we can see at least three great groups of decisionmakers, the ones who have been proactive and have notwaited for casualties before cancelling events, those whohave not reacted timely, but have kept at bay the relative
number of deaths, and finally, the ones who have proven to
be a true nullity at work.

Table 1: Passivity and results before the COVID19

Country

Eventssuspended
before first
death

First
Coronavirus
reported case

Deathsbeforecancelling
eventsDeaths per million
April 2

Health system

Germany0

Jan 26

Mar 2054

267

10.94533302

Bismarck

Italy0

Jan 29

Mar 5

36

148

217.5818723

Beveridge

UnitedKingdom0

Jan 30Mar 174771

34.64427751

Beveridge

Spain

0

Jan 30Mar 1040

36

195.315508

Beveridge

Belgium0

Feb 03

Mar 1440

471.44089733

Bismarck

France0

Jan 23

Feb 2937261.77416884

Bismarck

Portugal1

Mar 01

Mar 1110

018.33333333

Beveridge

Czech
Republic

1

Feb 29Mar 1111

03.641456583

Bismarck

Hungary1

Mar 03

Mar 11802.070393375

Bismarck

Austria1

Feb 24

Mar 1015

016.20421754

Bismarck

Poland1

Mar 03

Mar 9

6

0

1.136063408

Bismarck

Greece1

Feb 25

Mar 8

12

0

4.798464491

Bismarck

Reaction time
Eventssince firstcancelledcaseEubios Journal of Asian and International Bioethics 30(4) (May 2020)
Table 2: Groups of countries regarding behavior before
COVID-19
Level

Behavior

0

Facing coronavirus

1

Playing withcoronavirus

2

Meh!

153

celebrate Women's Day. 2 To cap it all, we didn’t lackdifferent sorts of political meetings:

Country
Portugal
Czech RepublicHungary
Austria
PolandGreeceGermany

Italy
Spain
Belgium
United Kingdom
FranceThis last group is formed by: Italy, Spain, Belgium,
United Kingdom and France. The five countries shareborders and have their weakest point in their factionalized
elites or group grievance issues that worried their rulingclasses more than COVID-19.
Some people might say that the smartest group enjoyedprivileged information since they saw what the virus could
do. Not so tricky: the WHO declared COVID-19 a Public
Health Emergency of International Concern on 30 January
2020 and then declared COVID-19 a pandemic on March
11, 2020.1 These announcements were for everybody andboth groups’ median date for cancelling events is the same:the day before the pandemic declaration. The true
difference was the readiness and vision of the situation.
Let’s delve into it.

Figure 2: Far-right populist political formation VOX’s
meeting in Madrid, there it was, at least, another one in
Galicia.3
And, of course, plenty of people went to see the soccer
match at the Stadium.

Figure 3: FC Barcelona Stadium March 7, 20204
About public transportation, we’ll talk later since it
didn’t peak in that weekend. Now let’s see the inflexion
point at a glance. It was the share of COVID19 casualties on
March 7:

Figure 1: 8M feminist demonstration in Seville. José
Angel García picture retrieved from a Diario de Sevillaarticle by Diego J. Geniz (Geniz, 2020).
The Spanish inflexion point
Spain, timely, suspended public events the day before thepandemic was declared by the WHO but only 2 days before
the situation was as shown in the pictures (Fig 1, 2, 3).
There were about 900 demonstrations planned to1
http://www.euro.who.int/en/health-topics/healthemergencies/coronavirus-covid-19/news/news/2020/3/whoannounces-covid-19-outbreak-a-pandemic
2
https://www.publico.es/sociedad/ano-mas-movimientofeminista-tomara.html

Figure 4: Donut chart with the share of coronavirus
disease among a wide sample of European countries (EU27
minus Luxembourg plus the United Kingdom, Norway,
Switzerland and Iceland) on 8 March
And two weeks before the situation was as in Figure 5.

https://www.lasvocesdelpueblo.com/video-vistalegre-iii-laalternativa-con-9-mil-simpatizantes-y-afiliados-de-vox/
4
https://real-sociedad.diariovasco.com/aficion-real-sociedadcamp-nou-20200307193915-nt.html
3

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Spain's share of COVID-19 casualties among the EU15
sharply rose between the 7-21 March 2020. Even if weweigh this increment by the cases confirmed on 8 March,
the results jump in our faces.

So Irene Montero trust in experts is almost a lie since,
seemingly, she only trusted in the Spanish government
expert, Fernando Simón, director of the Center for
Coordination of Health Alerts and Emergencies, who said
on January 31: "Spain will not have, at most, beyond adiagnosed case."7 He was not satisfied with this, and, theday before the 8M demonstration, he said: “if my son asks
me if he can go to the 8-M demonstration, I will tell him to do
whatever he wants”. 8 I wonder how much experience hehas telling others what they want to hear considering thaton 30 January, the WHO warned on COVID-19 social
distance prevention.9

Figure 5: Donut chart with the share of coronavirus
disease among a wide sample of European countries(EU27 minus Luxembourg plus the United Kingdom,
Norway, Switzerland and Iceland) on 21 March.

Figure 7: Carmen Calvo, Spanish Vice, on the 8M
demonstration

Figure 6: Relative rise in COVID-19 (7-21 March) acrossthe EU15 (weighted by total cases)
How pigheaded ignorance became greater thanlife
1- Before
The unifying thread in this case of study is how politicaldrags, when backed up properly, can become greater thanlife. Carmen Calvo, the Spanish Vice President, in a
premonitory quote said: “it is a matter of life or death”,
when asked if it was dangerous going to 8M
demonstrations, a Public Health Emergency ofInternational Concern (as declared by the WHO on 30
January 2020). 5 Three days later, the March 8 concern
turned into an official pandemic, as it was expected(McDonnell, 2020; Frieden, 2020).
In a similar situation, the Spanish Equality Minister,when asked if we were going to regret not havingsuspended on 8 March and Las Fallas in view of what ishappening in Italy with 17 provinces closed now and manyother places said: "I think that no one doubts the
management that the experts are doing to make eachdecision...".6

5
https://www.who.int/emergencies/diseases/novelcoronavirus-2019/events-as-they-happen
6 https://www.youtube.com/watch?v=tkDEBonk754
7 https://youtu.be/zHimS96F4QA
8blob:https://www.abc.es/7063c8ce-b126-41af-a7fd1d14023500d3

Figure 8: Equality Minister Irene Montero, in the middle,
hardly not spreading COVID-19 in the 8M strike10

Figure 9: The director of the Coordination Center for
Health Alerts and Emergencies, Fernando Simón, at thepress conference Friday 18 March (Europa Press). Jm
Cuadrado Jiménez (Handout / EPA) picture retrieved from a The
Guardian article by John Henley (Henley & Guardiancorrespondents, 2020).
https://www.who.int/emergencies/diseases/novelcoronavirus-2019/events-as-they-happen
10
https://www.elindependiente.com/wpcontent/uploads/2020/03/7025b32aee6c177f478b13a1f297ff
65-1440x808.jpg
9Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
Besides a clumsy seer, Fernando Simón is also amember of the advisory committee of the European Centre
for Disease Prevention and Control (ECDC). And, by theway, the European Centre for Disease Prevention andControl (ECDC) reported on 2 March: “Additional steps toconsider include school and day care measures or closures,
measures at the workplace, and measures related to mass
gatherings.”11
But it’s not about ideologies; on the opposite side of thepolitical spectrum, the populist far right also bears its
share of grunt. VOX, the most successful retrograde
political option in the Spanish menu, ignored common
sense, too.

155

they self-quarantined, since unlike Pablo Iglesias, they are
not living with a person with Coronavirus. This shows
initiative in dealing with COVID-19; the cockiness to skip it
over stopped being useful time ago.

Figure 11: Pablo Iglesias (right) in a speech on COVID19(EFE)14; ironically the screen says “we will stop this virus
together”.

Figure 10: Javier Ortega Smith, number two in the populist
far-right party VOX, hardly not spreading COVID-19 in theVistalegre event. Javier Lizón (EFE) picture retrieved from
La Vanguardia website.12
2- After
It must be said that Spanish politicians honestly
underestimated some features of COVID-19, like theirscary contagiousness, so much so that they got sick withcoronavirus. However, their attitude before and after
hardly will be considered exemplary.
Irene Montero herself, during her quarantine, kept
hammered away at the same drag and said about the
COVID-19 crisis and the 8M: “It is essential that each person
follow the instructions given by the health authorities at all
times”. She showed no regret over ignoring the European
CDC warning against this kind of crowded events in the
aforementioned March 2 report 13 (Prieto, 2020); (Güell,2020). Furthermore, her own husband, the Spanish Vice
Pablo Iglesias, has been criticized for skipping overquarantine twice in less than a week (Méndez, 2020). This
is while there were more than 30,000 complaints and 350
arrested in Spain for doing the same as the Vice (Rincón,
2020).
Fulfilling a quarantine is not a detail; it says a lot abouta politician’s maturity. Germany PM Angela Merkel selfquarantined herself and kept ahead with her tasks fromhome since she was in contact with an infected physician;the Canadian PM Justin Trudeau did a similar thing and theIsraeli PM Benjamin Netanyahu too (Delfs & Donahue,
2020; Landau, 2020). And the most important thing is thathttps://www.ecdc.europa.eu/sites/default/files/documents/
RRA-outbreak-novel-coronavirus-disease-2019-increasetransmission-globally-COVID-19.pdf
12 https://www.lavanguardia.com/politica/20200314/4741301
86160/embajada-china-ortega-smith-racista-malditos-viruschinos-coronavirus.html
13 https://www.ecdc.europa.eu/sites/default/files/documents/
RRA-outbreak-novel-coronavirus-disease-2019-increasetransmission-globally-COVID-19.pdf

About exemplary maturity, on the other extreme of theCongress, Javier Ortega Smith, after being confirmed as
COVID-19 positive, said: "My Spanish antibodies will defeat
the bloody Chinese viruses."10 According the Worldometerdata 15 , on 25 March, Spain ranked as registering thehighest daily deaths and overtook China as the second
most affected by the virus. Even the Spanish epidemics
expert, Fernando Simón was tested positive for COVID19.16
3- BehindIt’s not just about a bunch of plain stupid Spanish
politicians; the government hid a dose of malice, too.
Spanish PM Pedro Sánchez hid emergency measuresagainst the coronavirus six days before 8M demonstrations(Semprún & Ruiz-Tagle, 2020). On March 2, thirteen days
before the state of emergency declaration, the Spanish
government was stockpiling masks. It put aside theapothecaries.
In the same vein, the Police had knowledge of thenecessary preventive measures against the Coronavirus
since January 24 when the Chief of Risk Prevention, José
Antonio Nieto González, prepared a manual to prevent
contagion. However, on March 14, three months before hisretirement, he was suddenly dismissed (Montero, 2020).
In his recommendations, Nieto González, included thematerial that the policemen should use, considering the
airports as risky points, the use of disposable nitrile gloves
for pat-downs, baggage searches and identifications frompeople coming from China; finally, he also recommended
the use of FFPP2 masks: that’s the current standard(Montero, 2020).
In order to cover all this dirty politics and stop
publishing the dunce comments weeks before thelockdown, the government gave a generous 15 million
euros gift/grant/ bribe/whatever to private media in the
middle of this catastrophic crisis (Olmos, 2020). It’s plainly

11

14 https://www.elindependiente.com/politica/2020/03/19/criti

cas-a-pablo-iglesias-por-saltarse-la-cuarentena-dos-veces-enseis-dias/
15https://www.worldometers.info/coronavirus/country/spain/
16
https://elpais.com/sociedad/2020-03-30/fernando-simonda-positivo-por-coronavirus.html

156

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

manipulating the people’s perception so that they
endanger themselves, which is partisan, exploitative,
treacherous and opposed to what an ethicalcommunication means (Lozano, 2018).
Then, there is how the 2008 indignant crisis (the Spanish
Occupy Wall Street) was solved.

Figure 14: Barcelona subway in rush hour on March 12,
2020This image was taken two days after mass gatherings werecancelled but before the national lockdown.

Figure 12: Protester being beaten in the ground by antiriot police. Josep Lago (AFP) picture retrieved from a El
País article (El País, 2011).

Figure 15: Barcelona subway in rush hour on March 16,
202017

Figure 13: Protester being beaten in the ground by antiriot police (BBC News, 2019).
This is how the 2017 Catalan independence politicalcrisis was solved. Let’s see another perspective. On
October 13, 2008 amidst a global financial crisis, theSpanish Council of Ministers approved a 100,000 million
bail out destined to guarantee the banks’ debt. Twelve
years later, on March 24, 2020 amidst a global pandemic,
the Spanish Council of Ministers approved the first trancheof the 100,000 million destined to safeguard the interestsof the banks in their loans to companies in problems
caused by the coronavirus (Gómez et al., 2020). Therefore,
thanks to this background, the next images on how
common people face COVID-19 makes sense.

This image was taken six days after mass gatherings
were cancelled and the day after the national lockdown.
The subway on April 5 was eerie partly because over
800,000 people lost their jobs, in addition to half a million
autonomous workers who stopped their activity, andanother 620,000 people who have been affected by a work
schedule reduction; it’s just like nose diving in the darkest
moments of 2008 recession only in a couple of weeks(Durán, 2020). The poor and vulnerable in my city,
Barcelona, are hitting the bullet very hard: they face seventimes greater COVID-19 infection rate (Jones, 2020). It’s
misery in its widest meaning. Thankfully, we have niceministers who crack themselves up on it! (Europa Press,
2020)

Figure 16: Press conference of the Minister of Labor
Yolanda Díaz and the Minister of Social Security José Luis

17
https://www.65ymas.com/sociedad/vagones-metroautobuses-abarrotados-hora-lunes-barcelona_13570_102.html

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
Escrivá, Streamed live on 2 Apr 2020 in El Mundo YouTube
channel.18

Conclusions

If you were cheered to go to a demonstration on March 8,then two days later told that there is a very menacing
pandemic in your country but not for your Vice President
who cares a damn about quarantine, how would you feel?
It must be said that the situation in Spain was very fragileand even an apt government would have led to depressing
results. Spain had a huge amount of international arrivals
and an overaged population as well as one of the greatest
Chinese diasporas in Europe before Pedro Sánchez’s
tenure. However, the death toll might have been less thanhalf of the ones we lament today, just like France or the
UK’s rates.
Fernando Simón in his most insightful declaration (thebar was very low anyways) said on Feb 29 that banningmassive gatherings “may bring very big consequences”(Rojas, 2020). Ten days later the consequences were not so
big anymore. In those ten days, the 8M demonstrations
happened, so that the political power of a government thathas turned hegemonic feminism into a sort of political
identity merrily sailed. According to UN women figures,
Spain is one of the safest countries for a woman with agender violence rate three-four times lesser than Germany,
Italy or Finland. 19 The real goal of these demonstrations
was not to save women but save a political agenda from a
Spanish ruling class that is more volatile now than it has
been in this country’s recent history. For this reason, thebehavior of the government points to a greater concern forhaving the people quiet than safe and any true
commitment against COVID-19 was delayed. It was adelayed politics of pain (Lozano, 2020).
Indeed, the ruling coalition as well as part of the
opposition bet the Spanish citizens’ health against their
pastoral power, with their ability to create an identity thatpeople follow and keep lucrative to manage. Obviously, we
have been lost in the bet and the only thing we have in thisterminus are laughs on a screen in a repression-color
closed room.

References

Applebaum, A. (2020, March 2). Epidemics Reveal the Truth AbouttheSocieties
They
Hit.
The
Atlantic.
https://www.theatlantic.com/ideas/archive/2020/03/italys-response-to-coronavirus/607306/
BBC News. (2019, October 14). Violent clashes as Spain jails
Catalanseparatists.
BBC
News.
https://www.bbc.com/news/world-europe-49974289
Delfs, rne, & Donahue, P. (2020, March 22). Merkel Quarantine
Puts Another Crack in Europe Virus Defense. Bloomberg.Com.
https://www.bloomberg.com/news/articles/2020-0322/merkel-in-quarantine-at-home-after-contact-withinfected-doctor
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903fc6c83c82a8b4676
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Who is the most vulnerable during
a pandemic? The social model ofdisability and the COVID-19 crisis- Christopher Ryan Maboloc, PhD
Ateneo de Davao University, the Philippines
Email: ryanmaboloc75@yahoo.com

Abstract

According to the World Health Organization (WHO), 15%of the global population lives with some form of disability,of whom 2% to 4% experience significant difficulties infunctioning. Persons with impairment are the mostneglected sector in society. This inquiry looks into thesocial and medical model in terms of analyzing the impactof the COVID-19 pandemic on persons with developmental
disorder. The paper argues that the medical model isinsufficient to account for the needs of persons withdisability. While the medical model requires that
individuals with impairment should be given priority interms of access to effective treatment, policies in the midstof public emergencies must be based on a comprehensive
awareness of the social context of cognitive disability.
What is disability?
The World Health Organization (2011, p:213) defines
disability as “an umbrella term for impairments, activity
limitations, and participation restrictions. It denotes thenegative aspects of the interaction between an individual(with a health condition) and that individual’s contextual
factors (environmental and personal factors).” Impairment
could be physical or mental. Physical disability prevents
individuals from exercising their freedom of movement. In
contrast, mental impairment affects the functions of thebrain. Motor abnormality stirs the behavior of the person
as in the case of Autism Spectrum Disorders (ASD).
Disability has an effect on social, economic, and political
functionality of people. On the social side, persons withdisability suffer from discrimination which not only
restricts their flourishing but also the chance for ameaningful socialization of individuals with impairment.
Economically, persons with physical disability are
constrained in terms of the availability of jobs. It is usually
the case that good jobs are given to members of society
with normal functioning. Politically, persons with

impairment are unable to become a part of important
public discussions on issues that affect them.
According to the Center for Disease Control in the US,
there is a lack of data in terms of the experience of people
with cognitive disabilities during emergencies. Present
data on the COVID-19 Pandemic do not indicate theheterogeneities of victims. Recent reports, however, saythat in the United States, a big number of those who
succumb to the disease are Latinos or African-Americans.
Dr. Deborah Birx explains that the high death rate comesfrom preexisting conditions of patients. In the Philippines,
the Department of Health has not revealed any information
on cases involving persons with impairment due to theright to privacy of patients.
Persons with disabilities are the most neglected sector
in society. Individuals with cognitive impairment are
discriminated in everyday life. Emergency situations inthis regard only exacerbate their already difficult
condition. For this reason, the present strategy of rationing
food for the general population as is the case in thePhilippines is a source of frustration for parents andcaregivers of persons who suffer from cerebral palsy,
Down’s syndrome, and autism, among others. The COVID19 pandemic, with enforced lockdowns and restrictions inmovement, means that children with autism cannot get
their regular therapy. In a way, staying at home is the rightthing to do insofar as the suspension of classes inIntervention Centers is a matter of public safety. However,discussion on matters of policy in terms of education does
not consider the difference between children enrolled inregular schools and those who attend special schools.
The above attitude on the part of the general public andeven the government is reflective of the discriminationthat individuals with disability are subjected to. Of thethousands of registered businesses in the Philippines,
those who include the concerns of persons with disability
in their corporate social responsibility are very few.
Overall, the stigma imposed on autistic children force
parents to isolate their children from the public since themajority of the population do not have a basic
understanding of the case of these children and their needfor special care. It is for this reason that many parents fear
for the future of their children knowing the lack of insightof the general population about their issues and concerns.
Disability in the Philippines
When it comes to disability in the Philippines, the biggest
problem is the lack of an effective national strategy toaddress the issues and problems that prevent thedevelopment of the members of this sector. For instance,
there is not enough regulation to ensure that intervention
centers and special schools are following protocols in
handling cases and in observing policies that will protect
the good or well-being of children with disability. Without
proper regulations from government agencies, caregivers
may be susceptible to abusive and incompetent behavior.
Teachers, therapists, and their administrators, require
training and accreditation. However, the government has
not implemented any rational plan nor designed a program
to regularly improve the knowledge and competence of
caregivers. The social services department need tomonitor that schools and intervention centers are safe. The
problem may be rooted in the lack of looking for the reason
why families of persons with disability often findEubios Journal of Asian and International Bioethics 30(4) (May 2020)
themselves working doubly hard in order to provide forthe care of a child or an adult with special needs in thehousehold. A survey from the National Statistics Office(2013) reveals the following:“In the Philippines, the results of the 2010 Census ofPopulation and Housing (CPH, 2010) show that of thehousehold population of 92.1 million, 1.443 million Filipinos
or 1.57%, have a disability. Region IV-A, with 193 thousand
PWDs, was recorded to have the highest number of PWD
among the 17 regions, while the Cordillera Administrative
Region (CAR) had the lowest number with 26 thousand
PWDs. There were more males, who accounted for 50.9% of
the total PWD in 2010, compared to females, with 49.1%
with disability. For every five (5) PWD, one (18.9%) was
aged 0 to 14 years, three (59.0%) were in the working age
group (15-64 years old), and one (22.1%) was aged 65 years
and above.”
The Center for Disease Control in the US says theprevalence of autism in the United States is 1.8% of thetotal US population or 1 in every 54 persons, according to
the Autism and Developmental Disabilities Monitoring
Network. In the Philippines, the Department of Health puts
the number between 500,000 to 1,000,000 of the
population. This suggests that the country lacks clear data
and for this reason, any form of intervention on the part of
the government appears limited at best, and problematicat worst, due to the lack of insight as to the situation andreal struggles of persons with cognitive impairment in the
country. The Magna Carta for Persons with Disability (RA7277) has mandated the Department of Health to come up
with a national health program for persons with disability.
However, evidence of a successful program is wanting. The
agency, on its website, acknowledges the wide gaps andproblems. It says:“In 2013, a Medium-Term Strategic Plan (2013-2017)
was developed to strengthen the existing health program for
PWDs. However, in the review done for the purpose, it wasnoted that in the implementation of the program in the past
years, there were operational issues and gaps identified thatneed to be addressed. These include among others, the needto strengthen multi-sectoral action to harmonize efforts ofstakeholders; clarify delineation of roles and responsibilities
of concerned government agencies working for PWDs;
strengthen national capacity, both facilities and manpower,
to provide rehabilitation services for PWDs from primary totertiary level of care; provide access to health facilities andservices for PWDs; and, strengthen registration database for
PWDs”. (DOH, April 10, 2020)
Public emergency and the medical model ofdisability
Policy makers emphasize on the medical model during apublic emergency. Local government units in thePhilippines have problems in access to information during
pandemics. To give an example, rumors often circulate onsocial media in terms of those who are suspected ofinfection. This causes a burden not only on the people wholive around the neighborhood of Persons under
Investigation (PUI) but also the family of a person who issuspected of being positive. The situation is unimaginably
difficult if the case involves a child with some form of
disability. People ostracize others for no apparent or
logical reason than their unfounded fear or ignorance.

159

The medical model of understanding an emergency canstigmatize people. The problem with respect to this stigma
is not limited to patients. Front-liners also suffer frombeing ostracized. This is a new phenomenon insofar as thepresent generation has not really been exposed to any
form of pandemic. The Asian flu of 1957 that killed two
million people and the Hong Kong Flu that killed a million
have not been a cause of concern for Filipinos. The recent
scare from SARS or MERS or H1N1 have not affected
Filipinos. But COVID-19 is a different case. According to thePhilippine Daily Inquirer (April 8, 2020):“Doctors, nurses, and other medical personnel are
literally putting themselves in harm’s way to protect thegreater Filipino population against COVID-19. And yet, in an
alarming twist, an increasing number of them, instead ofbeing accorded the hero’s treatment they deserve, are being
subjected to discrimination, harassment, and violence,
mainly due to unfounded COVID-19 fears.”
The issue becomes more problematic when we speak of
persons with disabilities. Many of them reside in various
community and institutional settings. Community settings
include homes or households where children live withparents. Typhoons which occur in the Philippines
devastate people and crops, but there is not enough studies
or investigations done in terms of how it traumatizes oraffects a person with mental impairment. In urban centerslike Manila or Cebu, it is common to see persons withcognitive disability in the streets. It is difficult to determine
if the country’s social services department has concrete
programs to provide protection to this sector of the
population during emergencies.
Institutional settings refer to care centers and/or
hospitals that house persons with cognitive disability.
These places are viewed as treatment centers but not as
holistic institutions. In a visit to one of these facilities in the
country, the situation of patients is appalling. Some of themplay with their feces. They are denied the full attention ofcaregivers or the medical staff. It is often the case that theimmediate family of the patients no longer visits them.
Indeed, such is a manifestation of a grave violation ofhuman dignity. Just imagine if the COVID-19 infects one ofthese facilities. The effect would be devastating to persons
whose lives are precious and yet have been deprived oflove and meaningful support.
The COVID-19 Pandemic is often seen in terms of its
impact on the economy and the social life of the general
population. But reports say nothing about the potential
impact of the disruptions of services needed by persons
with mental disabilities in mental healthcare centers. In
fact, it is difficult to find data as to how people withdisabilities have been affected by previous outbreaks.
There are lessons to learn like preparing the community
and the bureaucracy. But as is often the case, thepreparation is limited to that sector of society which isconsidered productive. Jonathan Wolff (2010, p:149)
explains:“We can see that what is commonly called the medical
model of disability suggests that people with disabilities
have a less extensive set of internal resources than others,
and recommends that society act to boost this set largely by
medical means. By contrast, the social model prefers to saythat social structures discriminate against people withcertain resource bundles, and thus we need to change social
structures to eliminate such discrimination.”

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Unjust structures undermine the well-being of people.
The medical model does not give a full picture of the
problem. People suffer because of the lack of concern ofothers. But at the same time, the systems that are operativein society can be the source of oppression. Policies andrules restrict people with disability from achieving the
public good. Oppression is created by systemic problems
and so it is best that the society address the same bydismantling unjust systems. In this regard, a more
appropriate model would be necessary in order tohighlight the ethical dimension of the issue.
Vulnerability and the social model of disability
It is inevitable that people should act in order to prepare
for the next pandemic. But people with disabilities haveimmense difficulty in getting involved when it comes tostrategic planning. For obvious reasons, persons withmental impairment cannot participate in discussions. Still,even their immediate family is not given the opportunity to
be able to express their concerns. As a consequence, thewell-being of persons with disabilities is compromised.
Knowledge and insight depend on dialogue and discussion.
But when government authorities limit such only to a few
stakeholders, vulnerable individuals are put at a great risk.
Another problem is the situation of caregivers,
including parents who might be required to be isolated due
to a confirmed contagion. While the communitarian natureof our society might be helpful, this is not something thatcan be relied upon, though Eva Feder Kittay (2001, p:571)
thinks “family members are often the only shield against
the slings and arrows of an uncaring society.” Social
isolation results in disrupted care as paid caregivers areprevented from travelling. In such a situation, the rightthing to do is for families to sacrifice their personal
concerns. In fact, caring for children with mental
impairment should be the most important concern ofparents.
When it comes to the social model of disability, itmatters that all hospitals and healthcare facilities
understand why they must provide immediate care topersons with autism and other disorder. It is about
respecting the value of people. Persons with disability are
not faceless human beings. They are wonderful individuals
who have unique qualities. It is helpful for policy makers tolook into heterogeneities in terms of the unique attributesof persons. Normally, government institutions categorize
children together and disregard the special need of a child.
The problem is not only a matter of lack of foresight interms of social planning. It is a foundational issue thatinvolves how society as a whole must put an end to our
prejudice against others.
Emphasizing on the social model means human society
must give utmost value to the dignity of all persons.
Policies should be slanted toward the welfare of persons
with cognitive impairment. Care for individuals with
developmental disorders must include provisions thatrecognize the needs of families and every caregiver.
Indeed, the respect for equality of human dignity can beenshrined in laws, social policy, and in social activities.
Institutions do matter in this regard. Parents can only doso much given their other concerns and limited income.
The government and its functionalities, therefore, must
perform their moral role. The implementation of aneffective program will require an understanding of every
situation.
Society has a moral obligation to care for every humanperson. Martha Nussbaum (2006, 101) is firm in thisrespect by saying that “we must also recognize that the
problem of respecting and including people with
impairments, and the correlative problem of providing
care for people with impairments and disabilities, are vast,affecting virtually every family in every society.” The social
model in this respect is about understanding the role ofjustice and how the same matters in terms of realizing aworld that sees persons in terms of their equal dignity.
Ingrid Robeyns (2016, p:3), for instance, thinks that
researchers have been inclined to investigate theneurobiological basis of autism, instead of considering theexperience of impairment. All forms of disability, in reality,
are fundamentally social in context. (Maboloc 2019, 1193)
On the account of the above, it is fair to say that caring
for persons with impairment is both a moral obligation on
the part of parents, and an institutional duty on the part of
the government. For this reason, policies and rules must
not hinder parents from providing immediate care for
their child. The government and society as a whole must
help promote a world in which each and every person isrespected. The problem must be approached not just fromthe medical point of view, but from a social perspective as
well. This would require “the knowledge and participationof parents and social workers in order to craft an
appropriate, child-specific intervention for each child witha disability.” (Bricout et al. 2004, p:51)
The lack of record or data simply indicates the lack ofconcern and attention on the part of the general public andthe government as well. As a matter of recommendation,
the government should begin to make a survey and createa national database that will serve as a repository of therequired information so that in the future, disasterplanning and resilience would include the concerns ofchildren and persons with special needs. The failure to do
so only indicates the lack of willingness on the part ofsociety to be more inclusive. Indeed, “to enjoy a dignified
life, certain things should be improved to make society
truly just.” (Maboloc 2019, 16)Conclusion
The medical model is important, but when it comes to ahuge problem such as a pandemic, human society must
employ holistic approaches and measures that consider
the social context of impairment. Notwithstanding theextent of poverty in the Philippines and how it impacts ourlives, it is the moral imperative of any just society thatevery person with cognitive disability has to receive due
equal respect when there is a pandemic or even if there isnone. The legitimacy of every public institution depends on
the ability to protect and promote the well-being of those
who are helpless. By this, we mean that social institutions
must serve human persons as ends in themselves. This is
the essence of our responsibility for justice.

References

Bricout, J.; Porterfield, S.; Tracey, C.; Howard, M. 2004. “Linking
Models of Disability for Children with Developmental
Disabilities.” In Journal of Social Work and Rehabilitation 3(4): 45-67.

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Center for Disease Control. 2016. Autism and Development
Disorder Monitoring.
Department of Health. April 10, 2020. Persons with Disabilities.
https://www.doh.gov.ph/persons-with-disabilities
Editorial. April 8, 2020. “Stop the Stigma.” In Philippine Daily
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https://opinion.inquirer.net/128738/stop-thestigma
Kittay, E. 1999. Love’s Labor. New York: Routledge.
Maboloc, C.R.B. 2019. “What is Structural Injustice?” Philosophia:
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Maboloc, C.R.B. 2019. “Practical Ethics and the Principle of Merit:
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National Statistics Office. 2013. Census of Population and Housing.
Nussbaum, M. 2006. Frontiers of Justice. Cambridge, Mass.:
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Robeyns, I. 2016. “Conceptualizing Well-being for Autistic
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Wolff, J. 2010. “Cognitive Disability in a Society of Equals.” In
Cognitive Disability and its Challenge to Moral Philosophy.
Edited by Eva Feder Kittay and Licia Carlson. Malden, MA:
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World Health Organization. 2011. International Classification of
Functioning, Disability and Health. Geneva: WHO.

Techopedia defined cybercrime as a crime in which acomputer is the object of the crime such as hacking,phishing, spamming or is used as a tool to commit anoffense such as child pornography, hate crimes and thelike. Cybercriminals may use computer technology toaccess personal information, business trade secrets or use
the Internet for exploitative or malicious purposes.
Criminals can also use computers for communication anddocument or data storage. Criminals who perform theseillegal activities are often referred to as hackers.
COVID-19 was first detected in China at the end of lastyear and it has spread to more than 150 countries andterritories. WHO Coronavirus disease (COVID-2019)
situation as of April 8, 2020 reports the following total(new) cases in the last 24 hours (Table 1).

Cybercrime pandemic

Western Pacific Region- Marites V. Fontanilla
St. Paul University Quezon City, Philippines
Email: mfontanilla@spuqc.edu.phAbstract
With the rising of the reported cases of COVID-19 andhome quarantine being implemented, the Internet becamea channel for effective human interaction. Doing most of
the work online brought an increasing number of online
fraudsters to exploit the public fear of the pandemic toattack people through cybercrime. This paper introduces
what cybersecurity is all about. It also lists some of thecybersecurity issues that are being faced at this time.
Further, it discusses forms of attacks being encountered
and lists recommendations on how to be safe online.

Introduction

Ethics govern a person’s behavior and is a critical part ofcybersecurity approach. The study of cybersecurity ethics
does not offer a simple solution to the many complex
ethical dilemmas the IT professionals and organizations
face on a daily basis.
Cybersecurity is about defending computers, servers,
mobile devices, electronic systems, networks, and datafrom malicious attacks. It's also known as information
technology security or electronic information security. It
can be divided into a few common categories such as
network security, application security, information
security, operational security, disaster recovery andbusiness, end-user education (Kaspersky).
A cyberattack is defined by Cisco as a malicious anddeliberate attempt by an individual or organization tobreach the information system of another individual ororganization. Usually, the attacker seeks some type of
benefit from disrupting the victim’s network.

Table 1. Countries, territories or areas with reported
confirmed cases of COVID-19, 8 April 2020 (Source:
Coronavirus disease 2019 (COVID-19) Situation Report –79)
Countries/territories/areas
Globally

European Region
South-East Asia Region
Eastern Mediterranean Region
Region of the Americas
African Region
WHO Risk Assessment

Confirmed(new) cases
1,353,361 (73639)
114,667(1026)
720,219(33,881)
10,707(1575)
81,993(3428)
417,416(33,174)
7,647 (555)
Global level

Deaths
79,235(6,695)
3,922 (30)57,639(4,904)426 (64)
4314(165)
12 597(1,500)326 (32)
Very high

The fields of public health and cybersecurity crossedwith the COVID-19 pandemic in ways that nobody has everimagined would ever happen. Although cybersecurity andpublic health are different challenges, yet the COVID-19
pandemic has cybersecurity relevance because it has
become a serious reminder of long-standing problems,unresolved controversies, and unheeded warnings.
Businesses and public-sector organizations haveincreasingly offered or enforced work from home policies,
and social interactions have rapidly become confined tovideo calls, social media posts and chat programs. As many
companies adopt work-from-home policies in response to
the COVID-19 pandemic, cybersecurity is a growing issue.
Cybercriminals are seeking to exploit coronavirus to target
companies and individuals.
COVID-19 has forced everyone else to become more
dependent on the Internet as desperate measures, such associal distancing, disrupt economic activity and everyday
life. Dependence on cyberspace creates vulnerability, andmalicious attempts to exploit this sudden unplannedsocietal shift online have proliferated. Law enforcement
officials report that criminals are, among other things,
selling fake COVID-19 cures online, posing as
intergovernmental or governmental health organizations
in phishing emails, and inserting malware into online
resources tracking the pandemic. This COVID-19-related

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

spike underscores that policy efforts to flatten the curve on
cybercrime have not succeeded.
It was reported that cybercriminals are taking
advantage of the increasing amount of time that people
spend online due to new measures taken to stop the spreadof the virus. Cybercriminals are following coronavirus
concerns online and exploiting it. The health crisis has
become their business opportunity according to theEuropean Commission President, Ursula von der Leyen
where hospitals, research hubs and medical centers aretargeted
The World Economic Forum stated that as thecoronavirus pandemic continues to disrupt global health,and economic, political and social systems, the risk ofcyberattacks is another unseen threat rising in the digitalspace. It is taking advantage of the increased reliance on
digital tools and the uncertainty of the crisis.

are immediately advised to go through the cases above forsafety hazard,” the text of one phishing email reads.

Types of attacks
Below are some of the COVID-19-related cyberattacks.

Figure 2. Example of a fake health-advice email. (Source:
US Health and Human Services website)

Ransomware
Cybercriminals could encrypt large amounts of critical
hospital data and demand a large ransom to restore it. A
ransomware attack against a hospital or any other healthorganization can put patients at risk. This might also resultin a loss of human lives, either because the resources
required to treat them are no longer available or theprocesses in the hospital are severely slowed down. It candisrupt the function of the institution and can cause
procedure postponements. A group of hackers may
publish personal data of thousands of former patients after
the company fails to pay their demand.
10x Genomics Inc. was said to have experienced an
attempted ransomware attack that also involved the theftof company data. The company is part of an international
alliance that is sequencing cells from patients who haverecovered from COVID-19 as part of an effort tounderstand possible treatments for the disease.

Phishers have sent emails that offer purported medical
advice to help protect someone against the coronavirus.
The emails might claim to be from medical experts near
Wuhan, China, where the coronavirus outbreak began.
Spam
Cambridge dictionary defined spamming as the activity of
sending advertisements by email to people who do notwant to receive them. The US Secret Service warned
corporate America about fraudulent emails related to
COVID-19 that contain malicious attachments. The agency
said in the alert that it is investigating attempts in which
the malicious email attachments, usually a Microsoft Officeor WordPad file, would allow attackers to remotely installmalware on computers to potentially harvest credentials,
install key loggers or lock down the system withransomware.

Phishing
Cybercriminals may send emails claiming to be legitimate
organizations with information about the coronavirus.

Figure 3. This attachment was found in malicious emails
pretending to be from a CEO. (Source: Menlo Security)
Figure 1. Example of a fake Center for Disease Control andPrevention (CDC) email. (Source: U.S. Health and Human
Services website)
Figure 1 shows an email designed to look like it is fromthe US Centers for Disease Control; the email might falsely
claim to link to a list of coronavirus cases in your area. “YouSocial Engineering
The attacker uses social skills to obtain information about
an organization or its computer systems. He may claim to
be unassuming and respectable, to be a new employee,
repair person, or researcher and even offering credentials
to support that identity. By asking questions, he or she may
be able to piece together enough information to infiltrate
an organization's network.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
COVID-19 crisis is being used to carry out social
engineering attacks themed around the pandemic todistribute different malware packages.
Vishing
Vishing is the social engineering approach that leverages
voice communication. This technique can be combinedwith other forms of social engineering that entice a victim
to call a certain number and divulge sensitive information.

Figure 4. Sample vishing content. (Source: DICT
Cybersecurity, Philippines)
Smishing
Smishing is a form of social engineering that exploits SMS,
or text, messages. Text messages can contain links to suchthings as webpages, email addresses or phone numbersthat when clicked may automatically open a browser
window or email message or dial a number.

163

against WHO's own computer systems and its partners
have increased during the coronavirus outbreak. The
reason behind cyberattacks is said to be unclear yet but amultitude of motives may be presumed for attacking
prominent health organizations during this crisis.
Cybercriminals may be looking for information aboutcures, tests or vaccines relating to the coronavirus to sellin the black market, encrypt sensitive data and hold it for
ransom, or simply disrupt the operability of the institution.
Criminals may disguise themselves as WHO to steal
money or sensitive information. (https://www.who.int/
about/communications/cyber-security) WHO reminds
everyone to verify the authenticity before responding if
anyone on their behalf is asking for any of the following:
asking for your username or password to access safety
information, email attachments you didn’t ask for, asking
you to visit a link outside of www.who.int, asking you tocharge money to apply for a job, register for a conference,or reserve a hotel, asking you to conduct lotteries or offer
prizes, grants, certificates or funding through email.
Further, it stated that the only call for donations WHO
has issued is the COVID-19 Solidarity Response Fund andany other appeal for funding or donations that appears tobe from WHO is a scam. WHO is aware of suspicious email
messages attempting to take advantage of the COVID-19
emergency. This fraudulent action is called phishing. It
asks the recipient to: give sensitive information, such asusernames or passwords, click a malicious link, open amalicious attachment. Using this method, criminals caninstall malware or steal sensitive information.
United Nations has warned the public about the sellingof fake coronavirus cures online to a cyberattack on
hospitals’ critical information systems. The criminals are
exploiting the COVID-19 crisis as it steps up its fight against
a proliferation of false information about the virus. Tedros
Adhanom Ghebreyesus, Director-General of the World
Health Organization (WHO) at a gathering of foreign policy
and security experts in Munich, Germany, in mid-February
said that aside from fighting the pandemic, they are also
fighting an infodemic, referring to fake news that spreads
faster and more easily than the virus.

Figure 5. Text from scam email asking for aid for the
WHO (Source: Trend Micro Security News)
Cybersecurity Issues
On March 23, 2020 Digital Watch website report thatHammersmith Medicines Research, a British company that
previously tested the Ebola vaccine and is on standby toconduct the medical trials on any COVID-19 vaccine, hasbeen hit by a ransomware group that initially promised not
to target medical organizations. The criminals managed to
ex-filtrate patient records, and published some of them
online.
World Health Organization (WHO) warned aboutsuspicious email messages attempting to take advantage of
the COVID-19 emergency by stealing money and sensitive
information. Also, it was reported that hacking attempts

Figure 6. Map of threats using COVID-19 (Source: Trend
Micro Security News)
According to WHO, infodemics are an excessive amountof information about a problem, misinformation,
disinformation and rumors during a health emergency
which make it difficult to identify a solution. It can hamper
an effective public health response and create confusionand distrust among people. To address this, a team of WHO

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

are working with search and media companies like
Facebook, Google, Pinterest, Tencent, Twitter, TikTok,
YouTube and others to counter the spread of rumors,which include misinformation. According to news reports,
these companies are aggressively filtering out unfounded
medical advice, hoaxes and other false information thatthey say could risk public health. In a rare move, Facebook
and Twitter have taken down a post from a head of State
that falsely stated that a drug was working everywhereagainst the coronavirus. Cybercriminals may disguisethemselves as WHO to steal money or sensitive
information.

Figure 7. Top countries with users accessing malicious
COVID-related URL’s (Source: Trend Micro Security
News)

Figure 8. Instances that malicious COVID-related URL’s
were accessed (Source: Trend Micro Security News)

Figure 9. Spam email detections from 1 January 1 to 31
March 2020. (Source: Trend Micro Security News)
TrendMicro Smart Protection Network provide thedata below which represents information collected fromJanuary 1, 2020 to March 31, 2020 of the COVID-19 related
threats.
Ways to stay safe online
Listed below are recommendations on how to stay safe
online, as well as how to avoid cyber threats and scams
during this pandemic.
User Side•Strengthen your home network.
•Manage social media profiles.
•Check privacy and security settings.
•Backup online and offline files securely.
•Avoid opening and delete suspicious emails or
attachments.
•Be suspicious of unsolicited phone calls, visits, or email
messages from individuals asking about employees orother internal information.
•Do not give out your personal data in suspicious COVIDthemed emails and messages or information about yourorganization, including its structure or networks, unless
you are certain of a person's authority to have theinformation.
•Make trusted government and other legitimate websites
your go-to source for the latest COVID information.
•Do not reveal personal or financial information in email,and do not respond to email solicitations for thisinformation.
•Ensure that the charity or crowdfunding campaign you
plan to donate to is legitimate.
•Don't send sensitive information over the internet before
checking a website's security.
oPay attention to the Uniform Resource Locator (URL) of a
website. Look for URLs that begin with "https"—anindication that sites are secure—rather than "http.”
oLook for a closed padlock icon—a sign your information
will be encrypted.
•If you are unsure whether an email request is legitimate,
try to verify it by contacting the company directly. Do notuse contact information provided on a website connectedto the request; instead, check previous statements forcontact information.
•Install and maintain anti-virus software, firewalls, andemail filters to reduce some of this traffic.
•Update your software and operating system: This means
you benefit from the latest security patches.
•Use strong passwords.
Administration side
•Keep server operating system and any software you may
be running on your website up to date which is vital to keep
your site secure.
•Beware of error messages by keeping detailed errors inyour server logs and showing the users only the
information they need.
•Check your passwords is a good password that canprotect the security of all user accounts in the organization.
•Avoid file uploads which could contain a script that when
executed on your server completely opens up yourwebsite.
•Use HTTPS which is a protocol used to provide security
over the Internet.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)•Get website security tools often referred to as penetration
testing.
•Back-up the most sensitive data in your organization.
•Prepare and update an incident response plan and an
information security policy

Conclusion

Cybercrime is the greatest threat to every company in theworld and might become the greatest threat to every
person, place and thing in the world.
As the cybersecurity experts continuously work toclose hacking ambiguities and prevent zero-day events,
cybercriminals are persistently creating new attacks to fit
new trends and fine-tuning existing attacks to avoid
detection. With progressing technology comes evolving
hackers; we are behind in security. The most ethical andhighly technical cybersecurity teams cannot even preventthe most determined attackers.
COVID-19 is being used in a variety of malicious
campaigns. As the number of those afflicted continue tosurge by thousands, campaigns that use the disease as alure likewise increase.
Understanding the cyber terminology, threats andopportunities is critical for every individual and for every
person in every business across all industries. Everyorganization should strongly consider implementing an
ethical practice policy, guidelines and code of conduct for
the IT and security staff to follow. Reviewing this policy
regularly and engaging the employees by conducting
training and guidance is best.
In addition, it is also wise to thoroughly prepare acybersecurity incident response plan that will encompass
the technical details, practical instructions for executive
and legal teams, and any key ethical considerations.

References

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Madsen, C. (2020). The Evolution of Cybercrime. Retrieved April
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Nicolas, E. (2020, 25 March). Cybercrime rises during
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3ndstage COVID-19 spread can becontained with HITT (hydrate,isolate, train, and test) and virtual
contact- Osama Rajhkan, MPH, PhD
AUSN Professor of Bioethics and Integrative Health; Saudi
ArabiaEmail: osamarajkhan@gmail.com
Abstract
Healthcare includes a mountain of complex holistic issues.
The time of coronavirus continues to reveal much about
this insight. What health signs meet the eye is only the tipof the iceberg. What flows underneath the surface of thewater represents the rest of our health, our life style, which
is 90%, and which is the root cause of many of our serious
and harmful diseases – even infectious ones, like the
COVID-19 that can spread to others silently around us. Thismeans when it comes to coping with this pandemic, weneed to realize that certain behaviors lead to disease andinfection, and as most people cannot change due to theinertia of habit, in this time of danger and uncertainty andin light of the value of community survival considerations,
it is ethically justifiable based on biology and physics torestrict social engagements now that many countries areeither in the 3rd or 4th stage of the spread (there are 4
stages).
There are communities affected more than others in the
population due to harmful environmental and culturalissues, like those living in densely and poorly ventilated
settings, settings that suffer from Nature Deficit Disorders.
In the 4th stage - so many deaths in certain populations, asis the case now (29 March 2020), nurses, doctors, and lungventilators can save lives when enough per capita can beaccessed by patients, but where communities fall short of
securing these assets, a good way to contain the spread is
to use HITT, that is to tell people to Hydrate, Isolate, Train,
and Test until they can be vaccinated and reintegrated withsociety. Virtual contact can facilitate communication while
waiting to getting back to normal life.
Data on a case-by-case study is not available yet tomake a proper assessment of the threat to the population,
but from the observed risks associated with the infection,
we can summarize the impact in two phases: those whowill recover and those that go to the hospital. What makes
the difference is the strength of their immune system andunderlying conditions. Morbidity tend to make people
immunocompromised, like diabetics and hypertensive
older persons.
The current circumstances warrant incentivized
policies as the virus is serious. In the absence of a cure or
vaccination, directive measures are probably more
effective than voluntary ones if the number of infections
continue to rise.
So how do countries avoid this damaging stage; i.e., 4th?
Start with the individual. Go back to the basics.

What is a given
The pandemic will end, according to science (WHO). Thisis because those that get infected will become immune toit, if they survive, they will not get sick after a second
infection. Time will tell if infection induces immunity withthis new strain of the coronavirus.
It’s a viral infection so, there are no medicines to cure it
as of today 29 March 2020 (existing medicines are indebate as they are remedial and not agreed to by all
scientists). Regardless of age, those with underlying
conditions are more susceptible to become sick and risk
death. Doctors and nurses are strained and many are
getting sick themselves as hospitalizations are rapidly
increasing. Testing was ramped up in some countries but
in others it stalled due to resource shortages or scientificknowledge about the behavior of the virus.
So far we have seen the pandemic going through fourstages:1st. Arrival: arrivals from abroad. Airports were the key
portal paths. this stage evolved quickly and as a precaution,
most airports closed and travel limited between cities inmany countries.
2nd. Incubation: Once inside the country, passengers
that have arrived with the virus infected others throughsocial mixing. Governments responded by orderingcorona-virus related movement restrictions to the protect
citizens and residents.
3rd. Contagion: In the 3rd stage governments took
invariably drastic measures to protect its citizens andresidents from catching the virus, with measures likeisolating, sanitizing and improving wellness in general.
4th. The super-spread: like what happened in somecountries, which others want to avoid. No country wants to
go to this stage.
For countries in the 4th stage, life changes every day formany with grim news. Table 1 shows the current infection
numbers, whose values are very dynamic; within two days,
for instance, the United States surpassed both Italy andChina in total infections; 133,039.
Table 1: Corona virus pandemic covid-19 live world Map/countSource: channel 24 KSA (29 March 2020, 20:00: Hrs
Country
USA
Italy
China
Spain
Germany
IranFranceUK
Switzerland
Saudi Arabia

infected
121,914
97,68981,44578,79960,73938,30937,575
19,522
14,829
1299

dead
2,054
10779
3,300
6,606
500
2,640
2,314
1,235
300
8

recovered
4,378
13,03075,454
14,70915,386
12,391
5,700
135
1,595
66

% infection
4.0 (4th stage)
9.5 (4th stage)
Unique case(4th stage)(3rd stage)(4th stage)(3rd stage)(2nd stage)(2nd stage)(2nd stage)

Lessons learned so far:social distancing works, but is not working fast enough indensely populated and poorly ventilated locations. Daily
self-evaluation of one’s health can help.
Gaps: what do people do when they come down with a coldor flu? Are Asia’s containment lessons applicable in
America, Africa and the Middle East? Do people
understand the holistic approach of illness and wellness?

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
Managing wellness in the time of a viral infection canbenefit from two concepts:
1. The holistic approach to healthcare prevention is better
than acute care because it reduces the pressure on
hospitals – especially in times of crisis
In 1972, John Travis developed an “illness-wellness”
concept that explained health as a continuum from early
death to the highest level of health, like that of a world classathlete, with the middle point characterized by the absenceof physical/mental illness and disabilities. Thus, from thisperspective, health is not absolute but rather relative andcan be measured by degrees of wellness, which he also
likened to an iceberg; the idea that it is of little value toassess someone’s health condition by the symptoms thatthey complain of, and it’s only when we know the root
causes of these symptoms that we can treat the person.
This means we need to implement a holistic approach tohealthcare.
It is hypothesized that the symptoms only represent
10% of the whole of health and the rest, like the hidden
part of the iceberg, can hide a lot of serious and harmful
diseases, even infectious ones, like the COVID-19 that cansilently spread to others. This means when it comes tocoping with this pandemic, we need to realize that the tipof the iceberg is not independent from the rest of themountain, and by the same token, treating only what meetsthe eye is superficial as it does not treat the entire person;that is because the removal of one layer of the iceberg willquickly be replaced by another from the bottom whichtakes its place, as if nothing changed.
Thus, this analogy can be extended to staying healthy.
That is the person needs a holistic wellness management
plan with goals that consider the entire mountain. Treatinga viral infection then means diving in to identify the root
causes of the disease, from the person’s lifestyle andhabitual behaviors to what they drink, eat, do or don’t, andhow much they sleep.
Many know that their lifestyles are damaging to theirhealth yet may feel paralyzed to care for themselvesbecause it means changing certain behaviors, likeunhealthy social mixing and improper hygiene. The
implication of this understanding is significant, especiallyin times of crisis, as is today. For primary healthcare
facilities, it means sustainability can be gained by treating
the whole person, not just the symptoms of their disease.
Infection does not control sickness on its own – the virus
will interact with our lifestyle and environment.
Everything the person does contributes to their wellness
in general, and getting infected or not with the virus. This
understanding can probably help reduce the pressure on
hospitals that may be on the brink of collapse if thousandsof people demand acute care or treatment at once.
Regarding aging, this concept is important for older
persons today to understand, as the data emerging from
Italy and Spain is showing. Wrongly, many people think
infection has to do with age; that is a perception based on
past experience. The current experience is telling us that itis the person’s holistic condition that matters. In particular,
the condition of the circulation system.
This is because from biology we know that the immune
system makes many different types of cells to fightinfections, like a viral infection, which has no cure other167

than the person’s own body manufacturing the antidote
for. For the immune system to deliver the white blood cells
to kill the coronavirus, a virus that specializes in the
respiratory system, it has to be activated. Nothing activatesthe immune system better than intense exercise; exercise
means higher oxygenation, which in turn means higher
levels of hydration, better food and isolation can protect us
from infected others.
2. Infection is possibly tied to inactivity and proximity toanimals
This brings me to the second point of this presentation.
Research has shown that outdoor exercise can be safe andprotect our immune system as physically active people
benefit from a 50% reduction in the number of annual sickdays with severe respiratory infections.
The opposite is true: spending most of our time inactive
under artificial lighting, like couch potatoes, fills our lungs
with sputum, which in turn keeps us highly susceptible torespiratory infections from allergies, colds, flu, asthma andeven pneumonia, and can pass it to our wives/husbands,
children, and friends. Inactivity can be a silent killer.
Biology tells us that we humans are built in with
nuclear receptors for xenobiotic and intracellular signaling
in the cytoplasm of the cell that maintain the receptors inthe ‘off’ or ‘on’ states, depending on which genes areactivated. We can turn these switches (genes) on or off tostrengthen our immune system with physics, i.e., outdoors
exercise under the sun.
Once activated, the receptor molecules travel to the
nucleus in the cell to release a helpful molecule aka Nrf2,
which attaches to our chromosomes and activates a seriesof antioxidant and antidote genes, which in turn stimulate
the manufacture of mRNAs that instruct the information tosynthesize the right proteins and enzymes and protect thecell from dysfunction or worse, death. Without the rightgene activation, the path to illnesses becomes easier andeasier for us and our family members.
However, once we are exposed to direct sunlight (for 30
seconds at a time), our skin, the largest organ in the bodywhere most of the nerves are located, xenobiotic signaling
activates the brain, and confers the ability to the immune
system to tweak our ancient but dormant metabolic
pathways aka Glycolytic pathways that get catalyzed bymany enzymes to make ATP (energy), which is importantfor healthy aging.
All of the above means our genes interact with ourenvironment and the diet (including water) connection isimportant in reducing the infection numbers by thisepidemic. Hence, breathing fresh air during day lightoutside urban centers can help our body access the rightinformation that is stored in our genome to strengthen our
immune system. However, as the food we eat is nothing
but an information retrieval system and water manages it,
we cannot use this information to trigger the right gene
expression without ample sunlight and hydration (8glasses a day).
Hydrate: Naturally, this process requires ample hydration(H2O) to proceed as all living organisms are mostly water.
75% of the human organism is composed of water andbacteria and training consumes it, not only to build
antidotes but also to remove the debris and waste from the

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

ultra-processed carb- and lectin-based foods most people
eat, among other things.
With sufficient water in in the system, as mentioned
above, the nucleus in the cell manufacture the antidote thatwill kill the virus (which is made of a protein shell that
contains the messenger RNA, and which requires 5 to 10
days to happen, depending on the person’s condition).
Aging: It is generally said that age is a factor because
statistically older persons tend to have co-morbidity due toinactivity and other lifestyle issues. In all living organisms,
any metabolic substance or process that goes unregulated
poses danger, and in the end, it leads to cancer. Eating six
times and sitting down all day has severe consequences tohumans: our cells become lazy and stop cleaning the house
regularly which leads to accumulation of waste, which inturn leads to oxidative stress and inflammation in theentire body. Without good exercise to blow out the pipes,
metaphorically speaking, we become obese, get diabetes
type II, hypertension, develop autoimmune disorders,cardiovascular disease, stroke, neural disorders, mental
health problems, dementia, Huntington’s disease, severe
respiratory inflammation when a new virus attacks, andcancer. These are possibly stark examples of this metabolic
damage to the cell, which accumulates over time.
However, if the person is active, hydrates well and getsthe sun on their skin directly, while restricting their caloric
intake to meet the recommended daily nutrition needs,
they tend to have a stronger immune system and may beable to manufacture the antidote that will kill the virus
with temporary isolation at home to relieve the pressure
on precious hospital assets to meet the changing
expectations of the population who need care.
What older persons need to do now is first to fix thecontent of their dietary intake to reduce the accumulationof waste and debris in their bodies. This change reduces
the harmful genetic expression that usually happens withaging. The aforementioned holistic approach can provide
the nutritional tools that can help older persons tone down
the danger and reduce their need for acute respiratory
hospital care, which is making the healthcare systemdysfunctional according to doctors, even killing them(Spain said 51 hospital doctors had died due to ICU
exposure by 28 March 2020).
What is important to realize then is that people with
underlying conditions, young or old, tend to suffer fromnature deficiency disorders (NDD) due to insufficientnutrition, especially Vitamin D. Holistic medicine researchshows that without sun-derived vitamin D, the bodycannot beam out its kinetic energy.
Holistic medicine is also proving to be better at coping
the massive differentials in the underlying physiologicaland mental conditions amongst older persons living in
multi-generational homes. Look at the data. Moving thelegs makes the sunbeam flare in the body (healthy people
report feeling it climbing up from the waist up to the head
and then going down the arms and legs). This is to say thatthose that spend 23 hours a day on average indoors in
artificial lighting deprive their bodies of the production of
day-time hormones and enzymes that are crucial for
regulating health losses with aging and maintaining
homeostasis that become easy victims for infection, likenow is the case.

Thus, once this blows over, we need to pay more
attention to NDD as it is possibly the weakest link inpeople’s health and wellness today. This is crucial in thenear future as the next epidemic and the emerging
pathogens will increasingly originate in animals that fly
long distances in mass and transfer them to humans via
consumption or proximity, especially exotic animals. Thismeans the chain of infections will only get worse in the
future if we do not strengthen our immune systems withphysical training, bad-eating-habits changing and proper
hydration.
Isolate: Every country now wants their populations tomaintain their distance from one another to cope with thedifficult challenges of the epidemic. Stay-at-home is crucial
now to avoid infection while finding creative ways torelease the mental stress of being cooped inside. This step
helps reduce the pressure on hospitals as are they are
already running on full capacity.
Training: Research shows that people that exercise or
better, do training 150 minutes a week in fresh air tend tohave stronger immune systems than those who aresedentary indoors because they tend to sleep better by
65% compared to the latter, and they feel less tired during
the day while they enjoy more energy.
Sun rays are important; by stimulating your skinnerves, they trigger the body’s natural defense
mechanisms that promote the manufacture of Vitamin D.
Vitamin D is essential for activating all the other vitamins,
like Vitamin C, and substances like bio-magnesium, whichis responsible for 300 functions important for the immune
system.
These benefits are not limited to their physiologicalcondition but also extends to their mental health: researchshows that exercise also increases the brain’s mass andimproves memory.
In 2014, scientists discovered that exercise induces thebrain to release a chemical in the brain known as BrainDerived Neurotrophic Factor, BDNF, which stimulates thedevelopment of new brain cells; i.e., it stimulates theprocess of neurogenesis, which increases cognition not
only in high school students but also for older retired
people.
Exercise also helps people make better choices anddecisions (British Journal of Sports Medicine, 2013). In
addition, it also enables people to resist pain and become
more resilient and less likely to get sick (Fitihi, 2018).
Thus, the human brain will not produce sufficient BDFN
without regular exercise. You just cannot improve yourself
without exercise. This is possible because of hormesis; theidea that nature’s biological response to physical stress or
strain (discomfort) confers health gains that help maintainhomeostasis through proper gene expression, as alluded toabove, or epigenetics, which enable the nucleus to
manufacture antioxidants and antidotes that protect theorganism in the long-run.
When the mRNA of the virus migrates to the humannucleus during the incubation period, some helpful
molecules are activated, called Nrf2, who will read thehuman DNA, create short mRNA to turn ‘on’ theappropriate genes to synthesize the needed antidote to killor contain the virus. Once the mRNA exits the nucleus, theEubios Journal of Asian and International Bioethics 30(4) (May 2020)
genetic information stays the same (although in somespecies it can change again).
The process is similar to the genetic results of eating anapple. The apple’s bitter polyphenols, i.e., antioxidants, get
oxidized in the gut, which in turn activates the helpful
molecule Nrf2 protein complex, which in turn migrates tothe nucleus of the cell and pulls the information stored in
the DNA to trigger the appropriate gene expression leading
to the synthesis of antioxidants and or antidote enzymes
that speed up the absorption of proteins and quickly
defend the cell and protect its functions. This is perhaps
why it is said that an apple a day keeps the doctor away.
Thus, training on a regular basis not only increases therelease of happiness hormones and reduces stresshormones, like cortisol and insulin, it also helps the brain
focus its energy more on the body for building it (catabolic)rather than destroying it (anabolic) as happens when weare under stress.
It is like medicine for both the body and mind and cango a long way in reducing the risk of complications fromviral infections. So far, we know the virus can be fatal forsome of those with co-morbidities and thus, hydration andphysical training can facilitate the manufacture of theantidote as it treats many chronic diseases thatcompromise the immune system.
Testing: Testing as experience shows can help prevent ICU
incubation in hospitals to prevent a spike in the system. It
can also help countries in ramping up their resources tofight the virus spread to the healthy population.
Few countries have ample resources to test large
sections of the population, and most don’t. Thus, while weneed to test those that need testing, care must be taken not
to overwhelm hospital and those affected by severe
respiratory issues as incubation in intubation can shift
their body’s energy from fighting the virus to fighting theequipment they are connected to.
So, to recap, the best-known way to prevent infection is
to hydrate, isolate, train, and test. Once someone is
infected, they need care obviously but we should know that
intensive clinical care is costly in terms of energy; it drains
the body of its energy and can kill the person rather thanheal them.
Conclusion
The purpose of this brief paper is to help folks easily
understand how to stay safe and protect themselves andtheir loved one from infection by the corona virus. An easy
way to remember is to compress the what-to-do into an
acronym of four verbs; i.e., Hydrate, Isolate, Train and Test
into HITT.
As a foreign virus (except for China), it has gone
through 4 development stages in all countries, and today,
most are in the 3rd (containment) or 4th (viral) stage of theinfection. The coronaviruses have been with us since the1960s; the most dangerous iteration emerged in 2003 in
Hong Kong, China; i.e., SARS, which was treated withisolation (not a cure or a vaccine) SARS only killed about
700 people, most of home were immunocompromised
older people. Animal droplets (not consumption) are thesource of transmission from the first mammal to humans.
Because there is no cure or vaccine for this virus(SARS2), only you have your back. Although it is saidmalaria pills can increase the level of zinc in the cell and169

thus can improve its immunity it remains experimental.
Those infected can be divided into two groups: those who
get infected and recover, and those who due to underlying
conditions (diabetes and hypertension) become criticallyill and go to the hospital. What makes the difference is thestrength of the immune system. The elderly tends to suffer
more because they have had more time to accumulate
toxins. Diseases compromise the immunity.
Until immunity is conferred, nation-wide social
distancing and testing those who need testing seems towork in most territories around the globe, as governments
are taking a whole-of-government approach and a wholeof-society approach (like Saudi Arabia). The total
recovered number is showing encouraging signs but
infections are rising everyday.
Where healthcare assets are fragile and or spent,holistic home remedies for treating viral infections are still
effective for most people, at least those with decent
immune systems (not the immune system compromised).
It’s not our age. It’s our condition. In particular, thecirculation system condition. For the immune system todeliver the white blood cells to kill the coronavirus, which
specializes in the respiratory system, it has to be activated.
Nothing activates the immune system better than intense
exercise.
For the immune system to manufacture the antidote tokill the virus, which is made of a protein shell and mRNA, it
needs 5 to 10 days depending on our physiologicalcondition (not age). Moderate exercise outdoor can reducestress hormones, inflammation, and oxidation because it
increases immune-related proteins in the plasma which
boost the immune system by 50%, regardless of age.
Moderate exercise is hard enough to use the sugar(glycogen) stored in the muscles but not enough to cause
oxidative stress; like getting out during day light for a 30minute easy jog.
So, why everyone is focused on age? It is generally said
that age is a vulnerability factor because statistically, older
folks tend to be co-morbid due to lifestyle issues that
accumulate over time, which sustains dysfunction in the
immune system. So once infected, they easily get thesymptoms, painful muscles, fever, severe headaches,
weakness, nasal passage inflammation, dizziness,
imbalance, cough, sweats, difficulty breathing, loss of smell
or taste, among others things. But young people can alsofeel the same. The reported data in countries that make itavailable (like USA), shows that co-morbid youth also get
infected and can get severely ill - even die (not just the old).
So, what we need to do regardless of our age, whether
or not we are 80 or 20, is to stay alive for 5 to 10 days after
we suspect infection with our immune system to be able torespond and deliver the punch and kill the virus. Staying
home relaxed and eating real food can help because it
rebuilds the immune system as we await its comeback.
The immune system manufactures antidotes. It’s very
smart; the best defense system in nature. When the virus
enters through the nose or mouth, it attaches to the throat
because it wants to enter a respiratory cell and replicate. It
starts to make 1000 copies of itself every 24 hours andthen each will invade another cell leaving the old cellbehind dead. However, if we drink water, it sends the virus
down the digestive tube and stomach acid kills it
immediately.

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

This is an exceptional time and technology has flattened
the communication hierarchy to some extent. Many
governments and universities are switching to digitalplatforms for communicating and hold virtual conferences.
The American University of Sovereign Nations, is a pioneerin this approach and this paper will be presented using thistechnology.
So, what to do?
Increase awareness of the holistic approach to disease
prevention and managing wellness to avoid compromising
the immune system, and for now do the following:
1. Hydrate: Drink lots of warm water every day.
2. Isolate: stay 10 feet (3 meters) from others in yourhome or street and don’t share food or drinks out of
habit; stay home and sleep alone to avoid all vectors ofthe virus.
3. Train: exercise in fresh air under direct sun rays toactivate the brain.
4. Test: those that need testing and watch out for theirmental health (things like anxiety).
Avoid Nature Deficiency Disorders by going outdoors
alone (or just one close person). Virtual contact canfacilitate communication while waiting to getting back tonormal life. Read the research on the blind spot of the
medical system related to diet and life style. Avoid
emotional stress, poor diets and not sleeping enough. Feelgrateful for your health care responders.

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cience.abb6105.full

COVID-19 and Healthcare
professionals: The principle of thecommon good
- Randy A. Tudy
Cor Jesu College, Philippines
Email: randytudy@cjc.edu.phAbstract
COVID-19 pandemic has claimed thousands of lives aroundthe world. Among the casualties are doctors, nurses, andother health care professionals (HCP). Those who defy thedanger of death and continue to render their services haveto deal with psychological and mental stress due to the lackof protective measures and equipment, the overwhelming
number of patients, and the experience of discrimination.
In fact, some left their job. In this paper, I will argue thatthe motivation of health care professionals and theoutcome of their sacrifices, as against assuring personalsafety, can be explained by the principle of the common
good. First, they are faithful to their oath as health care
professionals since it is their commitment as part of an
institution that assumes the responsibility of providing
health care to people in need. Second, restoring thepatients’ condition goes beyond health issues since therecovery of each COVID-19 patient diminishes the spreadof the virus, which, if not for the care of HCPs, could worsen
the situation with snowballing consequences to society as
a whole. While it is expected for any health care
professional as a frontliner in times of pandemic, theirmotivation to serve exemplifies the greater value for thecommon good.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
Introduction
One of my former students, a practicing nurse, could nottake an allowed work leave during her birthday because
she had to continue her duties in the hospital amidst thegrowing demands for medical attention due to theshortage of hospital personnel. When asked why for justone day she could not take a breather, the answer
astounded me. She was badly needed because some of thenurses and other HCPs resigned from their jobs. They wereafraid to get infected by the COVID-19. While sheunderstood the situation of her co-workers, she also had toattend to her chores at home, more so that her
laundrywoman suddenly left, again afraid to get infected
knowing she goes to the hospital every day. Many healthcare professionals, if not all, feared for their lives. Whilethey work to save lives, they knew theirs is also in danger.
Added to the problem is the shortage of HCPs, especiallyfor countries badly hit by the pandemic. A case in point is
Italy, which had to deal with the enormous number ofpatients (Kaixuan, 2020). People around the world put
their trust in the commitment and bravery of HCPs, though
the latter know very well the menace they are in. As
reports from around the world kept coming in, many of
those who died are medical practitioners like doctors,
nurses, and other HCPs.
In this paper, I will present a brighter side amidst thenegative and painful reality brought by the COVID-19
pandemic in this time of global crisis. I will argue based on
the principle of the common good as to the motivation andcontribution these HCPs gave, particularly those who died.
They gave up their lives to save others’ lives. While they
have an oath as professionals, the COVID-19 pandemic
puts their commitment to the limits. They also havefamilies whom they fear would be compromised if they
could become carriers of the said virus. They look at thebigger picture by not only focusing on their patients but therecovery of the latter so that they would not contaminate
others. Hence, they have a concern for the common good. I
will discuss using the lens of several scholars and theteachings of the Church on the principle of the common
good. This paper contributes to the body of literature on
the importance of the services of HCPs with implications
on the deeper meaning of their profession, particularly intimes of crisis like a pandemic.
Threats of COVID-19 to the Health Care
Professionals (HCPs)
Reports from around the world of the deaths due to COVID19 are staggering with US, Italy, Spain, France, and United
Kingdom taking the top five spots (See Table 1). But, what
is more disturbing is to note that some of these victims are
HCPs (See Table 2). Though there are specific data per
country as reported by John Hopkins Corona Virus
Resource Cenetr, there are only sporadic reports on the
fatalities of HCPs. For example, in March 2020 alone,
COVID-19 already claimed 12 doctors in the Philippines(ABS CBN News, 2020) and 61 doctors and healthprofessionals in Italy (Chustecka, 2020). Other countries
must have similar situations, especially those with highvolumes of patients. Moreover, Medscape, a website thatprovides access to medical information for clinicians andother health professionals, launched a survey using its
networks to report names, age, profession, and location ofhealthcare workers who have died of COVID-19. Based on

171

its records as of April 13, 2020, there were already 300
reported fatalities. Top on the list were doctors and nurses(See Table 2). Among the countries with highest number of
HCP fatalities were US, Iran, United Kingdom, Philippines,
and Indonesia (See Table 3). In the Southeast Asian region,
the Philippines topped the list (See Table 4).
The quick outpouring of patients and theunpreparedness of hospitals overwhelmed the healthsector, including the HCPs who could be infected by thevirus (Zhu & Li, 2019). In short, HCPs are vulnerable if noappropriate extra measures are in place (Bayne, Norris, &Timmons, 2020; Jha, Dinnesh, & Nair, 2020; Saglietto,
D’Ascenzo, Zoccai, & De Ferrai, 2020; Worznitza, Hare, &Nair, 2019). Moreover, being exposed to positive COVID19 patients, they are vulnerable and could potentially be
the vectors of virus transmission (Driggin et al., 2020).
Healthcare professionals also have to deal with many
inconveniences aside from the threats, as mentioned
earlier. For those who disregard danger and continue their
mission, they struggle with psychological and mental
stress (Guile, 2020; Lu, Wang, Lin, & Li, 2020). In Italy, forexample, there are two cases of nurses who committed
suicide (Winfield, Wilson, & Rising, 2020). In thePhilippines, the Department of Health (DOH) appealed tothe public to respect the HCPs following reports about
doctors and nurses who were kicked out from where they
live because of the neighbors' fear that they carried thevirus as maliciously reported in social media (Madarang,2020). There were also reports of verbal and physicalabuse against nurses in the United Kingdom (Gilroy, 2020).
Based on the aforementioned scenarios, the pandemic
causes a lot of psychological and mental stress due to theoverwhelming number of patients they have to take careof, plus they have to deal with discrimination and the lackof protection. The saddest part is the death of HCPs (SeeTable 2). They were those who were considered heroes in
the fight against the recent pandemic.
The frontliners, particularly the HCPs, put themselvesin a vulnerable situation. It is no wonder why a few of themleft their job. Rand (1964), in his book “The Virtue of
Selfishness”, explained the new concept of egoism, whichargues the concern for one’s own interest. For her, it isabout the ethics of rational selfishness, which is the
avoidance of sacrifice. The decision of HCPs to resign fromtheir job is about their safety and the safety of theirfamilies. At first, it is reasonable using the concept
postulated by Rand. However, amidst the threat to life andthe resignation of the few, the majority of the HCPs
willingly or reluctantly answer the call of duty. They
remain faithful to the Hippocratic Oath, the FlorenceNightingale Pledge, and Public Health Professional Oath.
They set aside the danger and instead focus on the bigger
picture. Lawrence Gostin, a law professor at Georgetown
University, in his discussion about health in America,
proposed an examination of the concepts of public healthand the common good (Gostin, 2010).
The correlation between the two signifies the great
importance of the contribution of those in the public healthsectors. What the HCPs are doing is beyond the call of duty
and personal safety. It is sacrificing oneself for thecommon good.

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Table 1: Report on COVID-19 cases for Top 20 Countries, plus the Philippines
Total Confirmed Cases= 1,789,985
Total deaths= 109,823
Countries/Regions= 185
Country
Confirmed Cases
DeathsCase-Fatality
1. US
526,396
20,4633.9%
2. Italy
152,271
19,468
12.8%
3. Spain
163,027
16,606
10.2%
4. France
130,727
13,851
10.6%
5. United Kingdom
79,8749,892
12.4%
6. Iran
70,0294,357
6.2%
7. Belgium
28,0183,346
11.9%
8. China
83,0143,343
4.0%
9. Germany
124,9082,736
2.2%
10. Netherlands
24,571
2,653
10.8%
11. Brazil
20,727
1,124
5.4%
12. Turkey
52,1671,101
2.1%
13. Switzerland
25,107
1,036
4.1%
14. Sweden
10,157887
8.7%
15. Canada
23,316654
2.8%
16. Portugal
15,987470
2.9%
17. Austria
13,806337
2.4%
18. Indonesia
3,842
327
8.5%
19. Ireland
8,928
320
3.6%
20.Ecuador
7,275
315
4.3%
25. Philippines
4,428
247
5.6%
Source: John Hopkins Coronavirus Resource Center (as of April 12, 2020)
Table 2: Number of HCP’s fatalities
Profession
Number%Doctors
180
60%
Nurses66
22.0%
Other Health54
18.0%
Professionals
Total
300
100.0%
Source: Medscape (as of April 13, 2020).
https://www.medscape.com/viewarticle/927976
Table 3: Top 10 countries with the highest number of
HCP’s fatality
Profession
Number% to the total
300 cases
Italy
74
24.67%
US
42
14.0%
Iran
68
22.67%
United Kingdom
21
7.0%
Philippines
18
6.0%
Indonesia
14
4.67%
Spain
13
4.33%
China
4
1.33%
Pakistan3
1.0%
Moldova3
1.0%
Argentina
3
1.0%
Source: Medscape (as of April 13, 2020).
https://www.medscape.com/viewarticle/927976
In response to the enormous task ahead, streamlining of
workflows for the different medical services was proposed
for better management and protection for both patientsand HCPs (Phua et al., 2020). The American Society ofRegional Anesthesia and Pain Medicine (ASRA) andEuropean Society of Regional Anesthesia and Pain Therapy

Deaths/100k
Population
6.25
32.22
35.54
20.68
14.88
5.33
29.29
0.24
3.30
15.40
0.54
1.34
12.16
8.71
1.76
4.57
3.81
0.12
6.59
1.84
0.23

(ESRA) came up with a joint statement for safety
procedures to protect practitioners from acquiring thevirus (Shanthanna et al., 2020). There is also a need fornon-medical measures to address the spread of the virus
and to protect HCPs. People need to follow certain
measures, such as the use of face masks, travel restrictions,and the practice of social distancing (Khosravi, 2020).
Table 4: Number of HCP’s fatality in Southeast Asia
Profession
Number%Brunei0
0.0%
Cambodia0
0.0%Indonesia
1442.42%
Laos0
0.0%
Malaysia
1
3.03%
Myanmar0
0.0%
Philippines
18
54.540%Singapore0
0.0%
Thailand0
0.0%
Timor Leste00.0%
Vietnam
0
0.0%
Total
33
100.0%
Source: Medscape (as of April 13, 2020).
https://www.medscape.com/viewarticle/927976
In the Philippines, through the Republic Act No. 11469 or
known as the "Bayanihan to Heal as One Act," HCPs areprovided with the necessary equipment and protective
gear. Also, Philippine President Rodrigo R. Duterte
showed a kind of leadership, which according to Bayod(2020) as the ethics of care, to ensure that all sectors unite
to combat the unseen enemy and to bring back everything
to normalcy. Everyone is a participant to the solution, butEubios Journal of Asian and International Bioethics 30(4) (May 2020)
there has to be clear leadership and concerted efforts,
especially for the protection and support of the frontliners.
Saving Others’ Lives or Saving One’s Life?
I was reminded by the story about the resignation of myformer student’s co-workers. Actually, there was still nosingle case of COVID 19 positive among the patients in thehospital and city where she worked, yet, fear engulfedamong HCPs, including her colleagues. The situation is not
only in her hospital. Several medical practitioners also
resigned from their jobs amid the COVID-19 crisis such as
the reported resignation of Bulgarian doctors (Petkova,
2020) and the resignation of a nurse (Al Jazeera News,
2020) and a psychiatrist (Olivo, 2020) in the United Statesof America due to lack of protective equipment. Also, six
doctors in Telangana’s Kamareddy district tendered theirresignation for fear of spreading the virus to their families(Parasa, 2020). Thankfully, they returned to work a week
after. These scenarios are very alarming. If the HCPs,
especially doctors and nurses, would surrender, we expect
more chaos. I am not in the position to judge theirintentions, but it is indeed alarming.
Governments around the world are calling for help toaugment the depleted and overworked hospital personnel.
There were calls for retired HCPs to return to work.
However, some were hesitant or even strongly against theidea. For instance, most of the 120 former members of the
National Health Service (NHS) in the United Kingdom,
when contacted for a possible return to service, did notwant to respond. One major reason is the threat to their
physical and mental health (Weaver, 2020). Now, if HCPs
are hesitant or even adamant about responding to the callof duty, how much more for other frontliners like thesoldiers, local officials, and among others? In thePhilippines, the government officials at the grassroots level
like the barangay (village) kapitan (captain) and konsehal(councilors) are doing house to house distribution of relief
goods. They also patrol their barangays to make surepeople follow the quarantine policy. Individuals,
government agencies, and private sectors need to unite tohelp HCPs. This is an expression of human solidarity if wewant to end this crisis we are facing (Maboloc, 2020). Now,
what if everybody is afraid, who will be running the needed
services, like medical services? We understand those whoare afraid since the situation is not ordinary. It is between
life and death, fighting an unseen enemy. It is either theirlives or the lives of others.
The principle of the common good
Why, despite the threat to their lives, they continue toexercise their tasks as HCPs? This brings me to reflect on
the principle of the common good. In his article entitled“Law and ethics in population health”, Gostin (2004)
argued that every person has a duty to one another, andthat is to promote the common good. The concept of thecommon good is not something new. This principle has
deep philosophical and religious foundations.
For
example, Plato (1968) defined good as “every soul pursues
and for the sake of which it does everything” (p. 185).
Aristotle (1941, p.1188) talked about “a polis exists for thesake of a good life.” Both Plato and Aristotle provided aframework of the common good as ensuring the interest ofa good life for individuals and communities (Etzioni, 2014).
Roman philosopher Cicero (1928: bk. 1 ch. xxv) defined a173

republic as “not any collection of human beings brought
together in any sort of way, but an assemblage of people inlarge numbers associated in agreement concerning justice
and a partnership for the common good.” Getting
inspiration from the concept of the common good from
Cicero, St. Augustine and St. Thomas Aquinas equated thecommon good with the love and worship of God, theultimate good (Etzioni, 2014).
Some modern scholars explained the notion of thecommon good. For example, neo-liberal philosopher
Rawls’ (1971) concept of justice is about fairness, whereinpeople can have their own idea of the good. For him, thegovernment has the role of "maintaining conditions andachieving objectives that are similar to everyone's
advantage" (p. 233). He emphasized the principle ofjustice, which assures equal life chances for all. Hence, hisconcept of the common good is about the individual's basic
liberties. Some critics to Rawls’ theory like Taylor (1985),
Walzer (1983), and Sandel (1982), emphasize thecommunitarian nature of justice and, thus, for thedevelopment of people. For example, Taylor (1985)
pushed the idea that “the common form of life is seen asa supremely important good, so that its continuance andflourishing matters to the citizens for its own sake and notjust instrumentally to their several individual goods” (p.
213). He is basically saying the importance of community
as against individualism.
As opposed to political rights, Sandel (2005) proposed
the “politics of the common good”. One of its themes is thethrust of forming people to have concern for the common
good. Michael Walzer, in one of his interviews, preferred touse the term “common goods” to indicate the various
spheres of justice such as physical security, freedom orpolitical liberty, and social equality. He also pointed out aculture wherein the majority of the people are engaged at
a higher level. There is a common understanding whichleads people to live in a certain way. Kymlicka (2017p.467), another communitarian, explained the common
good as “a substantive conception of the good that deﬁnes
the community’s way of life. This way of life forms the basis
for a public ranking of conceptions of the good, and theweight given to individuals’ preferences depends on how
much they conform or contribute to this common good.”
These scholars have championed the connection ofindividuals to the community, which is all the more
expressed concretely in the promotion of the common
good. Taking the concept of the common good, specificallyon the need for individuals to contribute to the common
good as pointed out by Kymlicka (2017) and Sandel(2005), the actions of HCPs, which are not just focused on
the patients under their care, one can argue on theircontribution to the common good.
Though neo-liberalist like Rawls pointed out the rights
and liberties of people while the proponents ofcommunitarianism like Taylor, Walzer, and Sandel argued
on communal values, both schools of thought agree on thenotion of the common good. Applying it in the case of HCPs,
curing the sick during the COVID-19 pandemic isrespecting the rights of each patient but at the same timeensuring the safety of the community by eliminating the
spread of contamination. The higher value of theirmotivation and the result of their actions are for thecommon good.

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The church’s teachings on common good
Every person has the responsibility to contribute to thecommon good, the worldly vocation of society (Argandona,1998). Moreover, concern for the common good has a
deeper meaning in the context of the Church. According to
the Catechism of the Catholic Church (CCC), the common
good is "the sum total of social conditions which allow
people, either as groups or as individuals, to reach theirfulfillment more fully and more easily." (CCC, 1906).
Similarly, Pope Benedict XVI offered his explanation sayingthat “to desire the common good and strive towards it is arequirement of justice and charity. To take a stand for thecommon good is on the one hand to be solicitous for, and on
the other hand to avail oneself of, that complex of
institutions that give structure to the life of society,juridically, civilly, politically and culturally, making it thepolis, or city” (Benedict XVI, 2009, CV 7). In the case of the
HCPs, they have the health institutions where they practicecharity and compassion.
The Catechism of the Catholic Church(CCC) alsomentions three essential elements of the common good.
These are (1) respect for the individual, (2) the social wellbeing and development of the group, and (3) peace, which
results from the stability of a just society (CCC, 19071908). First is respect for the individual. The work andcontribution of HCPs are to bring back the dignity ofpatients by restoring their health condition. It is the coreof their oath as medical professionals to care for those
persons under their care with respect and compassion.
While this is a universal practice, respect for individuals
connotes a deep value for Christians. It is connected totheir faith following the compassionate healing ministry ofJesus.
Second is the social well-being and development of thegroup. Though the Catechism of the Catholic Church
highlights public authorities to observe this essential
element, it is very much applicable to all, especially to the
HCPs who work for the physical well-being that eventuallyfacilitates their social well-being and development. During
this crisis brought about by the COVID-19 pandemic, theoutcome of providing health care is not just limited topatients but to the overall health of society since making
people healthy again prevents the spread of the virus itself.
The third is peace, which results from the stability ofsociety. The effect of COVID-19 creates a lot ofinconveniences disrupting the normalcy of life of almost all
sectors in society. There is chaos everywhere, whether
poor or advanced countries. While the best solution, as
proposed by medical practitioners and government
officials, is social distancing, the role of the HCPs is crucial
for the cure and recovery of the victims. They remain thefrontliners against the COVID-19 pandemic that causes
havoc to the stability of the world. They subscribed to thehigher value of the common good.
Conclusion
The threats to life are very evident for the HCPs as aconsequence of fighting against COVID-19. Many of themsuccumbed to the ultimate price of death. Some raised thewhite flag, but the majority continued to serve. Thosesacrifices of the fallen HCPs go beyond restoring health aspart of their professional oath. These new heroes are
witnesses of concretizing the principle of the common
good. Against securing the safety of one’s life, they savepeople’s lives and the lives of others who could have been
infected if not healed, which could affect more people, thus
contributing to a bigger problem in society. Making people
healthy helps flatten the curve, hence, applying theprinciple of the common good. The pandemic heightens theawareness of HCPs on their dignity as human beings andtheir crucial contribution to society. Though there aredifferences in philosophical underpinnings, both the neoliberal and communitarian philosophies agree on the
primacy of the common good. Similarly, from the Catholic
Church’s perspectives, the higher value of serving others is
the promotion of the common good, a concept closely
related to the Christian faith. Applying these different
lenses, I argue that the motivation of the HCPs is driven notjust by their professional oath, but all the more emphasizedon their contribution to the common good.
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175

Negotiating the “Good Death” :Saying Goodbye in the Time of
COVID-19- Zehra Edisan, Ph.D.
TurkeyEmail: zedisan@hotmail.com
Abstract
COVID-19, a contagious disease, with more than a million
infected cases and over a hundred thousand deaths
worldwide, is spreading as a global pandemic. While some
infected people may show no symptoms, a great number ofpatients require hospitalization and ventilator support for
acute respiratory distress. Patients admitted to thehospital are in isolation; and to avoid transmission, they
are not allowed to have any visitors. While some of thepatients recover and are then discharged, some of themwith end stage COVID-19 die, from acute respiratory
distress syndrome. They die alone, far from their loved
ones, without having the chance to say goodbye. This is an
important issue for not only the patient, but is also
important for family and friends. As death is an inevitablepart of human life, it plays a central role in all societies andcultures. People’s common desire is to achieve a good
death, when it’s time, but what constitutes a good death issubject to discussion. Different opinions on the subject
have been expressed over time. Saying goodbye as a partof life completion, is a significant theme among them.
Unfortunately, during COVID-19 outbreak, when everyone
is forced to adapt physical distancing and stay-at-homeorders, many people have no chance to say goodbye, which
is a big deficiency. Video chat applications can contributeto lessen this burden by providing some sense of closure
and offering a virtual farewell, but support from heath carestaff is needed. However, with the increasing number of
COVID-19 patients, it will be difficult for the health careteam to spare individual time for this. Therefore turning
this individual help and sacrifice into a practice, offered by
the health institution itself, would be more useful andeffective.
Key Words: Good death, COVID-19, Goodbye, Virtual
Introduction
Since first being recorded late last year in China, the
COVID-19 coronavirus has spread around the world, andhas been declared a pandemic by the World HealthOrganization (World Health Organization, 2020).
According to the COVID-19 situation report of WHO, there
are total 1.914.916 confirmed cases, and total 123.010
deaths until 15 April 2020 (WHO; World HealthOrganization, 2020). These rates are increasing steadily
day by day.
COVID-19 produces a spectrum of disease, from mild
respiratory illness to severe acute respiratory distresssyndrome, among infected peoples. Clinical features of
COVID-19 encompass asymptomatic infection, acuterespiratory distress syndrome, multi organ dysfunction,and in a subset of patients, by the end of the first week thedisease can progress to pneumonia, respiratory failure andeven death (Singhal, 2020). A great number of patients

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

require hospitalization and ventilator support for acuterespiratory distress.
Patients admitted to the hospital are in isolation; and to
avoid transmission, they are not allowed to have any
visitors. While some of the patients recover and are thendischarged, some of them with end stage COVID-19 die.
The last person they may see before dying is an unfamiliar
healthcare worker, dressed from head to toe in protective
equipment that can make them look like an astronaut.
Although healthcare professionals make great efforts totake care of patients, and try to support them, some people
die alone, far from their loved ones, without having thechance to say goodbye. This is an important issue for thepatient and for their family and friends.
Death and Good DeathAs death is an inevitable part of human life, it plays acentral role in all societies and cultures. Throughout
history, humans have always tried to answer questions
about death and dying. To answer those questions, deathhas been the common interest of disciplines like sociology,
anthropology, psychology, and theology since the past(Granda-Cameron & Houldin, 2012)
The traditional understanding of death is ‘thepermanent cessation of functioning of the organism as awhole’. Death has often been described as a process rather
than an event (Bernat et al., 1981). By his statement,“Death is one of the attributes you were created with;death is part of you. Your life's continual task is to build
your death.” Montaigne expresses the truth that death isaround somewhere, waiting for our final slip in order tosweep us away (Merrick & Ventegodt, 2003).
Humans have different perceptions of death. As a partof human life it sometimes causes fear and anxiety amongpeople, and sometimes it becomes a desired and expected
event. Peoples common desire is to achieve a “good death”,
when it’s time, but what constitutes a good death is subject
to discussion. Different opinions on the subject have been
expressed over time. In the scientific literature, similar
expressions such as ‘‘dying well,’’ ‘‘dying peacefully,’’‘‘appropriate death,’’ ‘‘desired death,’’ or ‘‘dignified death’’are used, sometimes synonymously and sometimes as
distinct from each other (Krikorian et al., 2020).
Ideas about good death can be examined at several
levels. It can be determined by whom it meets, where,
when and how, if it occurs sudden or expected and if it isaccompanied with pain. Besides it can be determined byreligious, cultural and societal thoughts. It can also be
defined medically. The American Institute of Medicine
defines a good death as ‘one that is: free from avoidable
distress and suffering for patients, families, and caregivers;in general accord with patients' and families' wishes; andreasonably consistent with clinical, cultural, and ethicalstandards’ (Gustafson, 2007). A good death is sometimes
determined by its causes. According to this a death can benatural or medicalized. Hospice and decisions against
continued aggressive therapy even in other hospitals are a
final cultural method of creating a "good death", by moving
the dying process from that of a medicalized battle to oneof acceptance of "nature” (Long, 2003).
There are numerous definitions of a good death, avariety of disciplines including nursing, medicine,
behavioral science and psychiatry represented theiropinions on the theme from different perspectives.

Different research methods were used, and good death
criterions were classified. These criterions are called asfactors, domains, components or elements of a good death.
They sometimes share similarities and sometimes
discrepancies among different cultures and societies,
which shapes the meaning people give to illness, suffering,and dying (Krikorian et al., 2020).
Good Death Criterions
A good death encompasses important social, psychological,
and philosophical elements, such as maintaining close
relationship with loved ones during the final days,
accepting one’s impending death, dying at the end of a longand fulfilling life, and not feeling one is a burden to loved
ones (Leichtentritt & Rettig, 2000).
According to a study, conducted among 1409 membersof the American Association of Critical-Care Nurses, a good
death means, “facilitating dying with dignity”, “notallowing patients to be alone while dying”, “managing
patients’ pain and discomfort”, “knowing, and thenfollowing, patients’ wishes for end-of-life care”,“promoting earlier cessation of treatment or not initiating
aggressive treatment at all”, and “communicating
effectively as a health-care team” (Beckstrand et al., 2006).
Miyashita et al. (2007) conducted a nationwide
qualitative study to explore components of a good death inJapanese cancer care. Here ten domains were classified asconsistently important: “physical and psychological
comfort”, “dying in a favorite place”, “good relationshipwith medical staff”, “maintaining hope and pleasure”, “notbeing a burden to others”, “good relationship with family”,“physical and cognitive control”, “environmental comfort”,“being respected as an individual” and “life completion”(Miyashita et al., 2007). In another study performed in thesame country, eight more domains have been mentioned
and discussed besides these ten. These were; ‘natural
death’, ‘preparation for death’, ‘role accomplishment andcontributing to others’, ‘unawareness of death’, ‘fighting
against cancer’, ‘pride and beauty’, ‘control over the future’and ‘religious and spiritual comfort’ (Sanjo et al., 2007).
According to Rietjens et al. (2006), preferences of the
Dutch general public for a good death, were: “thepossibility to say goodbye to loved ones” (94%), “dying
with dignity” (92%), “being able to decide about end-of-lifecare” (88%), and “dying free of pain” (87%) (Rietjens et al.,2006).
In spite of these studies, people in Kwahu-Tafo, a rural
town in Southern Ghana, regard a peaceful death as a ‘good
death’. ‘Peaceful’ refers to the dying person having finished
all business and made peace with others before his/her
death and implies being at peace with his/her own death.
It further refers to the manner of dying: not by violence, anaccident or a fearsome disease, not by foul means andwithout much pain. A good and peaceful death comes‘naturally’ after a long and well spent life. Such a death
preferably takes place at home, which is the epitome ofpeacefulness, surrounded by children and grandchildren.
Finally, a good death is a death which is accepted byrelatives (Van Der Geest, 2004).
In a literature review on what constitutes a good death
conducted by Meier et al. (2016) the definitions of a good
death were categorized into core and subthemes.
According to the 36 articles investigated in this study, 11
core themes of a good death were identified as:Eubios Journal of Asian and International Bioethics 30(4) (May 2020)“preferences for a specific dying process”, “pain-freestatus”, “religiosity/spiritualty”, “emotional well-being”,“life completion”, “treatment preferences”, “dignity”,“family”, “quality of life”, “relationship with health carepersonnel”, and “other” (Meier et al., 2016).
In the literature there is no ‘one size fits all’ checklist fora good death, but there are some overarching principles,
which appear to be relatively uniform across variations inage, outlook and culture (Evans & Davison, 2014).
Saying Goodbye in the Time of COVID-19
Saying goodbye as a part of life completion, is a significant
theme among the good death criteria (Meier et al., 2016).
Saying goodbye provides a close relationship with loved
ones during the final days. Good family relationships are
considered as key requirements for a good death in many
cultures (Krikorian et al., 2020). Patients don’t want to diealone, they really want to know that their life had purpose,that they made a difference and that their lives mattered(Caring, n.d.). Therefore for many people, the days andhours at the end of a loved one’s life are especiallypoignant. Normally, people can hold a loved one’s hand,
have meaningful conversations, affirm the bond, and makeamends. I love you, thank you, I forgive you, forgive me, areexpressed as the four things that matter most at the end oflife, a dying person needs to express.
Being able to practice these things, softens the blow ofloss, but in the age of COVID-19 these final moments are
missing (Caring, n.d.; Weir, 2020). Unfortunately, during
COVID-19 outbreak, when everyone is forced to adapt
physical distancing and stay-at-home orders, people haveno chance to say goodbye, which will always be a big
deficiency, an irrecoverable situation, making it difficultfor people to deal with grief. The coronavirus isundoubtedly changing the way we live, and for many
people, it is changing the way we die (Weir, 2020). Dyingin this wise is not preferred among people, and fear of
dying in this way can even cause some people hide theirinfection and run away from being hospitalized. So what
can be done to prevent these problems?
A Virtual Final Farewell
People tried to find solutions for the final farewell. A nurse
at a hospital in Washington used her personal cell phone tohelp a woman say goodbye to her 75-year-old mom, who
was “nearing the end of her life” when the nurse called herdaughter to let her know. Then she put on protective gearand brought the phone into the room. “I’m going to put thephone up to her face so you can tell her you love her andsay your goodbyes,” Using FaceTime on her personal
cellphone, the nurse allowed the daughter to grant thepermission she believes her mom needed to let go. “It’s OK
to go, you can go,” she recalled telling her mom, as thenurse holding the phone cried with her. “And an hour later,
she left.” (Vera, 2020). Another family used a walkie-talkie
to say goodbye to their mom dying of coronavirus (Hanna,n.d.).
Conclusion and Recommendations
People need to distance themselves, in time of an epidemic,
because of fears of contagion, but they need to do
distancing while staying connected to each other. Manydifferent technologies are available helping people toconnect with each other. FaceTime, Skype and Zoom could
maintain face-to-face contact, the sense of being together.

177

At the final days and hours, when family members may nothave been able to spend time with the dying person, thesecommunication resources may offer a solution.
Video chat applications can contribute to lessen theburden of not being able to say goodbye in person by
providing some sense of closure and offering a virtual
farewell, but support from heath care staff is needed.
However, with the increasing number of COVID patients, itwill be difficult for the health care team to spare individual
time for this. Therefore, turning this individual help andsacrifice into a practice, offered by the health institution
itself, would be more useful and effective. Technologicalinfrastructure could be designed to handle this problem.
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COVID-19 - 11 March 2020. WHO Director General’s
Speeches.
https://www.who.int/dg/speeches/detail/whodirector-general-s-opening-remarks-at-the-media-briefingon-covid-19---11-march-2020

The Economics of COVID-19 in thePhilippines- Leandro S. Estadilla
St. Paul University Quezon City, the Philippines
Email: kurtlean@yahoo.com
Abstract
The emergence of COVID-19 places the economy at risk ofrecession or worst, depression. A sharp decline in the
country’s economic growth is primarily caused by the
weak consumption of locals and non-existence of foreign
tourists in the country. On the other hand, disruptions of
the supply chain in the manufacturing and retails sectors
make the situation much worse. With clear uncertainties inmind, government agencies must lay down economic
policies, monetary and fiscal, that would boost theconfidence of the consumers and producers. Lastly, a clear
and coordinated efforts of the national and local
government together with economic agencies of thecountry must be present at this time of the pandemic.
Keywords: COVID-19, economic growth, economic
policies.

Introduction
The whole world is in a hurry to find different ways to limit
the effects of the coronavirus disease, later named as
COVID-19 by the World Health Organization (WHO). On 11
March 2020, the WHO’s Director-General declared theeffect of the virus as pandemic, the decision was based on
the “alarming levels of spread and severity” of the outbreak
not only is a country but all over the world (WHO, 2020).
This declaration made all countries’ leaders enter in an
emergency mode on how each can at least “flatten the
curve” while waiting for a cure or a vaccine to combat thesaid virus. At the time of this writing (April 11) the numberof infected persons all over the world already reached the
1.7 Million mark, with 102 thousand deaths and people
whorecoveredpostedat
376,323
persons(https://worldometers.info/coronavirus). This figure is
still expected to increase in an exponential rate over the
next few months due to the widespread of the virus.
Though COVID-19 is a public health issue, we cannot
take away the fact that this would hamper the country’s
economy as well. The effect of this pandemic is already felt
in the commerce caused by the interruptions on the
production of goods—especially necessity goods. Many
people because of the different implementing rules of theirgovernment like quarantine and lockdowns are no longer
expected to work by a month or two and are requested tomaintain physical distancing with one another. This
scenario would expectedly affect the supply of food in themarket due to the disruptions of the supply chain.
Moreover, since most companies were asked to shut down,
a trickle-down effect to their workers in terms ofcompensation is also experienced. This phenomena would
tighten the amount of money in circulation and would havea bigger impact to the economy—where health of theeconomy is primarily dependent on the swift circulationand transfer of money from one hand to another, a concept
called velocity of money.
Although China, Singapore, Taiwan and South Korea toname a few reported that they managed to keep the
infections at its lowest pace, this pandemic greatly
impacted their economy. The economic growth of China(one of the largest economies in world) is expected to be at
5.6% for this year, which is 0.4% percentage points lower
than their previous forecast (IMF, 2020), the decline on
their forecasted growth rate is primarily dependent on the
restriction of local and foreign travels of Chinese.
Moreover, on February 14, the Prime Minister of Singapore
also mentioned that the country’s economy will surely takea hit if not an economic recession in the coming months(https://www.channelnewsasia.com). Likewise, in South
Korea, their Deputy Minister for economic affairs HondNam-ki claimed that the country will experience aneconomic slowdown this year but is expected to bounceback next year—showing a U-shaped rebound in theeconomy. (https://www.thestar.com.my).
It is not only the Asian economies who will experience aneconomic downturn. In Denmark, their economic growth
was cut short early this year due to the pandemic, insteadof expecting huge push on their Gross Domestic Product(GDP), they are expecting a contraction of around 3% to
10% this year (AFP, 2020), while Swedish GDP by 6% and3.2% in the 2nd and 3rd quarter respectively (Rappler,2020). Moreover, S&P global even anticipated that theEubios Journal of Asian and International Bioethics 30(4) (May 2020)
Eurozone expects a recession and expecting theireconomies to contract by 2%.
The International Monetary Fund (IMF) Managing
Director declared on March 27, that the world will faceagain an economic recession which can be the same orworse than what the world experiences in year 2009 (CNN
Philippines, 2020). This report had been updated on April
10, where IMF managing Director Kritalina Georgieva said“the pandemic sweeping the world will turn global
economic growth “sharply negative” in 2020, triggering
the worst fallout since the 1930s Great Depression withonlyapartialrecovery
seen
in
2021”
(https://msn.com/en-ph).
Pandemics in the Philippines
In the country, the number of affected persons moved to
4,428, as increase in the supply of testing kits is achieved.
Thousands of these kits were primarily donated by firstworld nations like China, South Korea, and Brunei who
donated a total of 120,500 testing kits. The majority ofthese (100,000) came from China (CNN Philippines).
Moreover, different foundations and personalities also
lend their helping hand to the government by contributing
and helping the combat the virus. On early April, Jack Ma
Foundation through the efforts of his friend Senator Manny
Pacquiao donated 50,000 testing kits while the latter gves
700,000 face masks (Rappler, 2020), other celebrities(especially singers) also stood and provided help, some arein the form of financial donations using their talents thru
“online concerts” to pool millions of pesos, some actors
also ask their supporters to contribute part of their money
to different foundations that would cater to the needs ofthe “front liners” or the health care professionals.
The most important contribution however is thecreation of a localized testing kits made by the mostprominent state-funded university of the country,
University of the Philippines. The university, led byscientist Dr. Raul Destura, managed to produce a testing kit
that could detect the virus in a person at a much lower cost.
In comparison, the locally produced kit will be sold for only
P1,320, a six (6) times cheaper than its foreign counterpart
which is around (P8,500), according to GMA News (March
11). After waiting for weeks for the Food and Drug (FDA)
and the World Health Organization (WHO,) the kit is finallyapproved for government use and is expectedly elevate thenumber of testing to be done in the country for early
detection of the virus and isolation and treatment of thesepeople.
On 17 March 2020, under Proclamation order No. 929,
the President declared a state of emergency, placing thelargest island, Luzon, in strict quarantine measures (latercalled as Enhanced Community Quarantine, ECQ),
suspension of works and mass transportation, and travel
restrictions are then implemented under ECQ. This also
paved way for the Armed Forces of the country to assist in
the implementation of the rules set under the proclamation(CNN Philippines). These restrictions among other rules
and regulations will be the assignment and will be underthe monitoring of the Inter-agency Task Force (IATF)
created by the President under the proclamation(https://primer.com.ph).
At present, the country is still lagging from its
neighboring countries in combatting the virus. On thelatest data from Worldometers, compiled by Earth Shaker

179

and published by Rappler the Philippines has the mostcases of infections among ASEAN (recently taken over
Malaysia), with lots of patients dying (second in mostnumber of deaths, behind Indonesia) and only 157 people
recovered as of 11 April.
Furthermore at the time of writing, the country had thehighest rate of fatalities among healthcare workers in theworld, 9.95%, among those who had at least 3 HCP
fatalities. This means that of all healthcare workers who
died, almost ten percent (10%) of them came from thePhilippines. See the figure below from Medscape.org(https://www.medscape.com/viewarticle/927976#vp_8)
with the help from John Hopkins University data
(https://data.humdata.org).

These data show how the health care system of thecountry fares with other neighboring countries and reflect
how unprepared the country is when facing such scenario.
This continue to happen and expected to increase eventhough the government already exerted massive efforts inmitigating the pandemic.
Government budgetary actions
Recently, the president requested from two houses (Senate
and Congress) and later approved an emergency fund of
P275 Billion. The budget is mainly used to serve as a
stimuli package for the people, health care and health carefacilities. On his recent report, the president shows thebreakdown of usage of the money: majority is allotted tothe social amelioration fund (more than P140 Billion) to be
managed by the Department of Social Welfare andDevelopment (DSWD) and to be given to the poorest of thepoor. One of their programs is for every family considered
to be the poorest will received an initial amount of P8,000(and is expected to receive another if the budget allows) tohelp them cope up with the lockdown or Enhanced
Community Quarantine (ECQ). This is aside from the foodpacks distributed Luzon-wide coming from the national
and local government. Moreover, DSWD will also continue
its program of doling out the “Pantawid Pamilyang Pilipino
Program (4Ps), this is an ongoing program of the180

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

government started by the administration of Benigno
Aquino. 4P’s is a human development program of thegovernment with the objectives of social assistance to thepoor and social development. This is the answer of thegovernment in achieving one of the Millennium
Development Goals (MGDs).
Another agency that received a huge part of the budget
is the Department of Health (DOH) with almost PHP12
Billion allotment, the said amount should be allotted to the
medical assistance of indigent people and those who are
infected of the virus and of course to acquire facilities,
equipment, and needed materials to help them attend to
the needs of sick patient.
In addition, the Department of Labor and Employment(DOLE) is given a budget of around PHP7 Billion thatwould help and assist workers who lost their jobs or called
as displace workers because of the pandemic(https://msn.com/en-ph). Other government agencies
receiving extra fund allotment are Government
Corporations (PHP195 Billion) and the rest given to the
Local Government Units. All with a purpose of helping thecommunity in time of the pandemic.
Pandemic effects to the economy
Prior to the pandemic, the country had been experiencing
significant economic growth for the past years. Posting on
the average an annual sustained growth of 6.4% from 2010
– 2018, and still expected to grow by around 6% in the
future (www.worldbank.org). This growth had been due tothe strong performances in the service sector and financerelated industries and strongly affected by theadministration’s economic policy and the “Build, build,build project” but these targeted growth and projects arethen revised by the different economic agencies in the
country. Due to the disruptions in the local productions
and consumption, and its dependency with international
economies, like that in US, China among others, the AsianDevelopment Bank (ADB) projected a fall to 2.0% in
economic growth of the Philippines. This is coming from astrong performance of the economy in 2019, postingaround 6.4% growth. They however predicted though thatthe economy will have a strong recovery of 6.5% percent
in year 2021, using the assumption that the virus iscontained by June of this year (ADB, 2020).

The effect to the economy of the pandemic is expected to
be devastating in different sectors. According to the

National Economic Development Authority (NEDA) of thePhilippines, the most vulnerable is the tourism sector. The
Philippines attributes 1.5% of its GDP to the tourism
industry, tourists are largely coming from South Korea andChina, respectively. With these countries closing theirdoors to one another in preventing the spread of the virus,
Philippine tourism industry is expected to lose almost
P127 billion from the people of South Korea and roughly
P111 billion from Chinese tourists alone.
Another sector that would take a hit is the exportindustry, the country enjoys selling their products(minerals, electronics and agricultural products) to its
major trading partner, China. With the virus spreading in
China and in the Philippines, the GDP of the country would
shrink by 0.02 to 0.05% this year, as a result of a weaktrade exchanges between these two countries. This is aside
from the unemployment effect to the Filipinos, with thegloomy performance in trade, it is expected that around3,000 to 6,700 people will lose their job this year (NEDA,2020).
A 0.02 to 0.04% loss in the country’s GDP is also expected
due to a reduction in remittances (NEDA, 2020).
Thousands of Filipinos are working abroad and support
their families thru sending their hard-earned money
abroad here in the Philippines. With their jobs put in a
delicate situation, their remittances would be affected.
Consumption on the other hand would slow down as
people are hesitant to spending their money with nonbasic commodities (luxury goods) due to ECQ
implementation. Alcoholic beverages, recreation andculture, clothing and footwear spending are someexamples that are expected to decline this year.
Consumption accounts to affect around 0.2 to 0.5 percentof the country’s GDP (NEDA, 2020). Though consumption
accounts to the bigger part of the GDP, small incremental
effect is only realized since people and someestablishments are remained to open in selling essential
goods that trigger a sudden increase in spending in
preparation of lockdown in the country.
All in all, NEDA expected a decrease of PHP298 billion to
PHP1.1 trillion, equivalent to 1.5 to 5.3 percent of thecountry’s GDP and an unemployment of 61,000 to 1 million
persons this year.
Mitigating the impact
One of the agencies that the government assigned to solve
this crisis is the Inter-agency Task Force (IATF). The IATF,
with the approval of the president, implemented thefollowing guidelines to at least lessen the impact of thepandemic to the economy while different countries are stillseeking cures or vaccine to COVID-19. Firstly, with theimplementation of ECQ, the agency made it clear that foodand non-food cargoes are allowed to pass through roads
without any delays, this action is made in order for the
supply-chain not to be distracted by the said lock down.
Moreover, this free flow of goods would ensure that atleast, manufacturers of essential goods will still be
managed to cater to the needs of the people while
continuing their economics. Secondly, the agency allows
the skeletal workforce of selected enterprise:
manufacturing of food, essential and hygiene product,
medicines and medical products; retail establishments likegroceries, supermarkets convenience stores, pharmacies
and drug stores; and the continuous service of export andEubios Journal of Asian and International Bioethics 30(4) (May 2020)
business
process
outsourcing(BPO).
These
pronouncements will help in its little way the economy not
to experience an abrupt decline in its growth (DILG
Memorandum related to Proclamation No. 922 Series2020).
Moreover, National Economic Development Authority(NEDA) proposes a three-phased program of interventions
that would help mitigate the social and economic impact of
COVID-19:
Phase 1 focuses on the health care response of thegovernment related to the pandemic and is further divided
into three parts (a) Clinical / Medical Response, thisconcentrates on how the whole healthcare systemmanages the health situation, (b) Public Health Response,
this centers on the public cooperation of the guidelines
issued by the IATF, and (c). Short-term augmentation ofhealth systems capacity which focus on how the healthcare services be easily available to the people and inproviding personal protective equipment (PPE) andremote quarantine facilities (RQF).
While phase 2 puts emphasis on rebuilding consumer
and business confidence by showing to them the adequacyof the country’s improved health systems; and lastly, phase
3 to resume a new normal state of economic activity that ismore prepared for another pandemic. This zeroes in on thedeveloping concrete plans that would be implemented if
there will be another pandemic in the future. A detailed
program can be seen here http://www.neda.gov.ph/wpcontent/uploads/2020/03/NEDA_Addressing-the-Socialand-Economic-Impact-of-the-COVID-19-Pandemic.pdf.
In addition, the Bangko Sentral ng Pilipinas (BSP) withthe mandate issued by the “Bayanihan to Heal as One Act”
implemented (a) thirty (30) day grace period for thepayment of all loans made in the financial industry of thecountry (https://www.officialgazette.gov.ph), (b) on
March 19 decided to cut the interest rate on overnight
reverse repurchase (RRP) by 50 basis points to 3.25%; and(c) reduction on overnight lending and deposit facility to
3.75%
and
2.75%
rate
respectively(http://www.bsp.gov.ph/monetary/monetary.asp). Thesemonetary operations ensure that there will be enoughmoney supply circulating in the economy while thepandemic is experience. A reduction of these rates willencourage financial intermediaries to borrow large
amount of money from the BSP while paying only alowered rate. These financial intermediaries are expected
to lend this borrowed money to consumers/depositors to
support their financial needs and transactions in the
future.
Conclusion
The government cannot hide the fact that the economy willtake a great hit and will fall in the coming quarters, and the
IMF has declared that the world will experience a
recession, the worse depression of our time. But thelingering effect of this pandemic to the economy can belessened if correct policies (whether fiscal or monetary)
will be created and implemented as swiftly and truthfully
as possible.
The administration of President Duterte has a clear
vision, that is, ensuring that every Filipino are safe and thewhole nation will pass through this stage at a lesser
damage. But the implementation and guidelines of theadministration is seemingly in disarray, with many

181

problems being experienced in the barangays (villages)
and even in the municipalities because of the different andunprecedented decisions and implementations made by
the IATF. If proper execution of the plan and good people
are put in place, we can see a shorter yet brighter future in
the coming months.
In battling the timid consumption response of thepeople, the government needs to ensure that every
essential good at this trying time is made available to them.
Establishing the market nearer to the consumers will help
solve this while keeping the people inside their homes(lessen the infection). Money to be used in this spending
can be dole out by BSP. Lower interest rates once thepandemic eases will greatly motivate the different sectorsof the economy to start all over again (in the case of totally
disrupted business) especially in the tourism andexport/manufacturing sectors. A moral suasion to
boosting the confidence of the market producers andinvestors will drive the economy an inch higher than whatis expected (this is one of the factors considered in theinvestment market) and will have a domino effect to thedifferent sectors on the economy as well.
Though it is a good thing that inflation rate in the country
is still at a manageable rate (2.4%), continuous monitoring
and a ready-to-use measure must be in place. At thesetimes when consumption is encouraged, an increasing
price of basic commodities is a big no. Thus, government
needs to ensure once the pandemic subsides that
producers will not take advantage of maneuvering theirprices to keep up with their recent losses. Further, if there
are still money left, the executive department should
continue its “Build, build, build project”, (a series ofprojects that enhance the transportation system of thecountry). This will not only provide jobs for the people but
will also drive the economy at a higher notch in the future.
Lastly, with proper communication and collaboration
among different agencies of the country, national and local
and economic agencies, and the cooperation of theFilipinos, the problems in the health care system and theeconomy will be solved whilst keeping the harm at its
minimum.
References

Abdullah, Z. (2020, Feb. 14). “COVID-19 to have significant impact
on economy: PM Lee Hsein Loong.” Retrieved fromhttps://www.channelnewsasia.com/news/singapore/covid
19-significant-impact-economy-lee-hsien-loong-12435256
ABS-CBN News Team. (2020, March 25). “COVID-19 pandemic
highlights need for emergency fund: poll.” Retrieved fromhttps://news.abs-cbn.com/business/03/25/20/covid-19pandemic-highlights-need-for-emergency-fund-poll.
Bangko Sentral ng Pilipinas. (2020, March). “Monetary Policy
Decisions.”
Retrievedfrom
http://www.bsp.gov.ph/monetary/monetary.asp
CNN Philippines Staff (2020, March 17). “Philippines under stateof calamity due to COVID-19.” Retrieved fromhttps://cnnphilippines.com/news/2020/3/17/ph-state-ofcalamity-coronavirus.html.
CNN Philippines Staff (2020, March 21). “Foreign countries tosend over 100k COVID-19 test kits to the Department of
Health.”Retrievedfromhttps://cnnphilippines.com/news/2020/3/21/covid-19test-kids-to-arrive-philippines.html
https://www.facebook.com/earthshakerph/
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nes/

182

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IMF Communications Department. (2020, Feb 22). Remarks by
IMF Managing Director Kristalina Georgiva to G20 on
Economic
impactof
Covd-19.”
Retrievedfromhttps://www.imf.org/en/News/Articles/2020/02/22/pr20
61-remarks-by-kristalina-georgieva-to-g20-on-economicimpact-of-covid-19
Kupferschmidt, K. and Cohen J. (2020, March 2). “China’s
aggressive measures slows down the coronavirus. They may
not work with other countries.” Retrieved fromhttps://www.sciencemag.org/news/2020/03/china-saggressive-measures-have-slowed-coronavirus-they-maynot-work-other-countries
John Hopkins University for covid-19 fatality data. Retrieved
from https://data.humdata.org/dataset/novel-coronavirus2019-ncov-cases.
Limos, M. A. (2020, Apr 3). “Finally, here’s a breakdown ofgovernment’s P275 billion Covid fund.” Retrieved fromhttps://l.facebook.com/l.php?u=https%3A%2F%2Fwww.ms
n.com%2Fen-ph%2Fnews%2Fnational%2Ffinally-heres-abreakdown-of-governments-p275-billion-covid-fund%2FarBB126z8i%3Fli%3DBBr8Mkn%26fbclid%3DIwAR2p_gxzCUt9jj32z_Xhb9OviiBCx9mu1E6TA5_fZ6pCow8knJBpMuXzU&h=AT0DqdLc1hi7JWisj3Ku9gBQlcM7B2vdpp_MgBtK760
bVwwKeqgQVjPmTb_3hBwdMIck13VZNI2RP_xWW9kX2L8P
inUK2087BFkxonHVlBArMO0Kb2SYaLAQgepTgPFcaNJ1Cw
Medscape Medical News. (2020, April). “In Memoriam:
Healthcare Workers Who Have Died of COVID-19-Medscape”.
Retrievedfromhttps://www.medscape.com/viewarticle/927976#vp_8.
National Economic Development Authority (NEDA) Report.
(2020, March). Retrieved from http://www.neda.gov.ph/wpcontent/uploads/2020/03/NEDA_Addressing-the-Socialand-Economic-Impact-of-the-COVID-19-Pandemic.pdf
No author. (2020, March 13). “Duterte Announces Travel
restrictions and Community Quarantine in Metro Manila amid
COVID-19
Threats.”
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Presidential Communications and Operations Office. (2020,
March
23).
Retrievedfromhttps://www.officialgazette.gov.ph/2020/03/24/republicact-no-11469/
Rey, Aika. (2020, March 17). “Jack Ma to donate 50,000 corona
virus testing kits to the Philippines.” Retrieved fromhttps://www.rappler.com/business/254844-jack-ma-todonate-coronavirus-testing-kits-philippines
Yang, A. (2020, March 11). “UP developed COVID-19 testing kit is
6 times cheaper than foreign counterparts.” Retrieved fromhttps://www.gmanetwork.com/news/lifestyle/healthandwellness/729120/up-developed-covid-19-testing-kit-is-6times-cheaper-than-foreign-counterparts/story/Social Cohesion, Trust, andGovernment Action Against
Pandemics- Marlon Patrick P. Lofredo, PhD
Institutional Review Board Chair, St. Paul University
Quezon City; Professor in Bioethics and Ethics in Hospital
Administration, SPUM Graduate School of Health Sciences,
Philippines; Visiting Professor in Bioethics, Public Policy,
and Environmental Ethics, American University ofSovereign Nations; Vice President for the Philippines,
Asian Bioethics Association
Email: mpplofredo@spuqc.edu.phAbstract
The rapid spread of SARS-CoV-2 and its corresponding
COVID-19 is challenging national preparedness andresponse ability to pandemics. No one is prepared well, butgovernments around the world must respond as effectively
and efficiently as possible to pandemics, and every
occurrence of such worldwide disease must be a lesson for
preparedness. While plans and programs may be in place
to arrest the rapid spread of the virus, the success of any
state intervention relies much on how cohesive the society
is, how trusting the people are, and how trustworthy thegovernment is. Social cohesion begets trust, and trust
engenders obedience and calm. The absence of social
cohesion produces social unrest and social erosion, lack or
absence of social trust creates risk societies, disobedience.
When these conditions exist, the spread of a virus isinevitable. Furthermore, they create a pandemic ofconfusion and fear, of stigmatization and discrimination.
The ways that nations respond to the pandemic today andhow the society responds to state actions will principally
determine their lots and destinies in the next decades oreven in the next elections. The pandemic reveals thequality of leaders and people a nation has. Governmentsthat are successful at controlling the spread of SARS-CoV-2
and minimizing fatalities of COVID-19 will enjoy even moresocial cohesion and public trust, while those that deferredvigorous interventions to control its spread will see
greater social stress and distrust, resulting in theparalyzation of the public’s faith in leaders andgovernment institutions.
Keywords: COVID-19, SARS-Cov-2, social cohesion, trust,
pandemic
Introduction
The rapid worldwide spread of SARS-CoV 2 and COVID-19
has put the world at a standstill, literally, and figuratively.
With lockdowns and community quarantines around theword, the International Monetary Fund has declared an
economic recession which is predicted to “be worse than
the global financial crisis” (Bluedorn, 2020). There is chaosand violence in many countries as governments suspended
work, transportation, and restricted movements of people.
Supply of necessities and food has been disrupted leading
to rationing of supplies in some countries and hunger tothose who doesn’t have access to such help. For example,
in the Philippines each household is given a relief good ofrice, canned goods, noodles, coffee, and other goods almost
every week, especially to poor families. There are alsoEubios Journal of Asian and International Bioethics 30(4) (May 2020)social amelioration programs laid out by the government
providing monetary aid to families of individuals who losttheir jobs or source of income, senior citizens, and otheridentified beneficiaries (CNN 2020; Gita-Carlos 2020; LuciAtienza 2020).
Responses to lockdowns are varied, and enforcement insome countries is rather violent. In the early days of Italy’s
lockdown, thousands of people defied the order and it
caused the country thousands of deaths and myriads ofinfections, and more stringent rules against movement ofpeople, transportation, and business operations. The rigid
lockdown is set to end in May (EURACTIV 2020; Ruiz
2020). In India, we see the biggest lockdown in the world
because of COVID-19, restricting the movement of morethan 1.3 billion people. We have seen in the news and insocial media how some Indian police used blocking,chasing, beating, yelling, or punishing people for venturingout, even deaths and higher domestic violence occurred,showing us the extreme difficulty of enforcing social andphysical distancing and nationwide quarantine (Agence
France-Presse 2020; Mohan 2020; Nigam, Saha, Pandey2020).
In the Philippines, long lines in groceries and markets
posed a great challenge for enhanced community
quarantine implementers. Of particular difficulty is
enforcement of the quarantine rules in slum areas. Fears
of food shortage and stranded workers, long lines of people
in checkpoints in the capital haunts the lockdown in themainland Luzon. Although there have been no violent
police acts against violators of the quarantine rules,
besides simple punishments and penalties, enforcement
remains a problem in densely populated areas (Fonbuena
2020; Philippine Daily Inquirer/Asia News Network 2020;
Ratcliffe 2020).
Pandemics are complex situations and problems. They
are not only a matter of health, but also matters of politics,
culture, science, technology, religion, social systems,
economy, etc. They are not merely anthropo-medical
conditions but also geopolitical and environmental
concerns. Each pandemic is different and thereby
demanding diverse approaches and responses. They
happen not only because of the presence of rapidly
spreading virus, but also from the lack of, or ill-crafted preemptive public policies and structures. Such situation
creates waves of social confusion and panic, uncontrolled
wave of infection, and political and social unrest.
We have polarizing issues now that truly hamper
effective and efficient response, like granting emergency
powers to a government who cannot be trusted with such,use of armed forces to enforce quarantine or lockdown,
availability, sourcing, realignment and allocation ofbudget, unprepared health departments, absence or lack oftesting policies and unavailability of testing kits andcentres, centralization vs. decentralization of donations,and response-ability of frontliners and related government
departments. Critical voices have also been raised on the
confusing rules on community quarantine, curtailment ofsome freedoms, protection of human rights during thequarantine period, continuity of delivery of basic social
services and goods, ameliorations to the poor anddisplaced workers, protection and well-being of healthcare
workers, travel restrictions, among others.
And then we have disobedience to social quarantine
rules among many of our people. Either they are utterly

183

unconcerned and do not care at all, or their social context
does not give them the luxury of complying, like in areas
where poverty and lack of education exist, in slum areas
where social distancing is impossible, people who beg forfood and money everyday just to survive, those who arepaid for work on a daily basis, etc. It can also be that people
are misappreciating their rights, privileges, and freedoms,
or are unable to comprehend risks and dangers of COVID19. Or maybe, just plain stupid hard-headedness andgreater confidence in one’s personal opinion and beliefs
rather than authority directives.
In Italy alone, more than 8,200 people were charged forviolating the lockdown rules as of 18 March 2020, andanyone caught on the streets without a valid reason werefined €206. In Spain, disobedient citizens to confinement
rules were fined €100, or more, for minor infractions or up
to a year in prison to those who resisted arrest or fine.
French police handed fines of up to €135 to 4,095 people
who breached the order to stay home. In the United
Kingdom, Manchester lockdown police raided and stopped
600 parties and the government imposed a minimum
penalty of £30 for violators. Similar incidents happened allover the United Kingdom with people ignoring
government calls for citizens to stay home. In the UnitedStates some people still flocked to beaches and holiday
areas, had parties and celebrations even as thegovernment tried to stop the rapid spread of the virus(Aspinwall 2020; Davies 2020; Samuel 2020; The Straits
Times 2020).
The effects of the pandemic can be aggravated bypeople’s distrust of government due to widespread
corruption,
unorganizedbureaucracy,
political
disintegration, distant government, and untrustworthy
leaders who misused and abused power These conditions
produce disobedient and fragmented citizenry andemboldens them to either be extremely critical or utterly
oblivious to government interventions in time ofpandemic. Furthermore, there appears to be common
disregard and distrust in science among politicians and the
populace. Scientists and medical specialist’s opinions,recommendations and researches abound on SARS-CoV 2
and COVID-19 but these are perceived as alien to common
experience and, due to ignorance and lack of scholarly
orientation, unreal (i.e., detached from human reality, only
for the books and conferences, too technical and difficult tounderstand, too elite, etc.). Governments ignored some of
the warnings and recommendations and even downplayed
the fears and predictions of researchers, resulting to thedeath and suffering of many, including healthcare workers(Bhanot 2020; Miller 2020; MSN News 2020; Reuters
2020; Siegel 2020; The Guardian 2020; UN News 2020).
Political conditions can also worsen the effects ofpandemic, like politicizing the situation and responses,
conflict between diplomatic interest vs. national interest,i.e., the Secretary of the Department of Health of thePhilippines was hesitant to recommend travel ban against
Chinese for fear that diplomatic relations with China may
turn sour (Rosario 2020), division in government, election
mentality, political bickering and mudslinging, party
politics vs. national interest, etc. Business conditions canalso contribute to pandemic spread. When companies
value income and profit more than the safety and wellbeing of their workers, thus requiring them to report towork amidst pandemic. People need to work to earn and184

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

have something to eat and to support their families,
especially those daily wage earners. So, they would rather
choose to go to work than be quarantined.
All these situations are symptoms of a sick society andgovernment. When societies and government cannot
function as one, pandemic thrives. Strong institutions,trusting populace, and durable social cohesion serve as
antibodies of a country against pandemics. In particular,social cohesion and trust are foundations of an effective
pandemic response, and conversely, effective pandemic
response can produce a socially cohesive and trusting
communities.
Social Cohesion as Foundation and Consequenceof Effective Pandemic Response
The success in any response to national disasters rests
primarily on how the people trust their politicalinstitutions and leaders, and in how much a community iscohesive. While relief operations and social amelioration
programs may help, albeit provisionally, general andpositive public response in theform of universal acceptance ofcommon objective or purpose set
by government and cooperationof majority of the population
creates more lasting effect andsuccess. Such condition can only
exist when people are sociallycohesive.
Social cohesion is the social
foundation of effective pandemic
response.
Social cohesion is
generally understood as “thewillingness of members of asociety to cooperate with eachother in order to survive andprosper” (Stanley 2003, 5). It canalso be understood as the “extent
of connectedness and solidarity among groups in society.
It identifies two main dimensions: the sense of belonging
of a community and the relationships among members
within the community itself” (Manca 2014). These two
definitions focus more on the aspect of willingness tocooperate, or solidarity to achieve a common goal which
results from a deep sense of connectedness or
belongingness among members of a given society.
Another understanding gives attention to social
cohesion as a “state of affairs in which a group of people
demonstrate an aptitude for collaboration that produces a
climate for change” (Ritzen, Easterly, Woolcock 2000, 6).
Within the concept of social cohesion are cognitive
components like feelings of trust and trust-related
sentiments, as well as behavioural components likeengagements in public social life, in association and othercivic structures (Schaeffer 2014, 8-9). Thus, social
cohesion may be impossible or lacking when people are
disunited, society is fragmented, there is ignorance anddistrust to common goals and objectives, there is conflict
between personal/family interest vs. public/national
interest, etc.
A community with robust social cohesion ischaracterized by a common sense of unity and oneness,spirit of care and concern, of common moral duty andresponsibility. These allows each member to behave andact for the greater good of the community to which they
belong. Moreover, a cohesive society have a sense ofcommon moral cause that permits each members to live
and work harmoniously together, thereby promoting
resilient social relationships and positive connectedness
between members and the community, and has apronounced focus on the common good (Dragolov et al.
2016, 6; Bertelsmann Stiftung 2020; Delhey et. al. 2018,
430; Walkenhorst 2018). Each member of a cohesivesociety exhibits a sense of community, duty andresponsibility, oneness with a common cause and end, hasspirit of care and concern, sense of unity with othermembers, mutual support and cooperation, emotional
connectedness with other members, and a sense of thecommon good vis-à-vis personal good. They have trust insocial institutions, respect for social rules, see fairness inthe management and distribution of resources and goods.
These characteristics of social cohesion is aptly illustrated
in the figure below.

Figure 1. The Social Cohesion Radar (SCR) showing thedomains and dimensions of social cohesion (Adopted from
Bertelsmann Stiftung by Delhey et. al., 2018, 431).
Although there is no universal agreement on whethersocial cohesion is a cause or a consequence of other aspectsof socio-economic and political life, it is believed that it iseither an independent variable that generates outcomesfor a given community, or a dependent variable, that is, “theresult of actions in one or more realms” (Beauvais andJenson 2002, 2).
Success of pandemic response of any given government
is not only dependent on the capacity and capability ofhealth care professionals in treating the patients, as well as
the efficiency of scientists in finding a cure and vaccine, butalso, on the quality of the community and its people. If a
government leads in a socially cohesive community, thenits programs and plans against pandemics can be easily
accepted and implemented and will generate beneficial
outcomes for the people and the government itself. On theother hand, an effective response and acceptable policies
of a government can effect a socially cohesive community.
In this case, the government was able to unite its people toa common cause through effective and credible leadershipand reasonable program and plans.

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
Disobedience to and rejection of anti-pandemic policies
results from many factors. It can be that the government
has lost its credibility because of bad leadership,
prevalence of graft and corruption, pervasive politicalbickering, poor implementation of projects and programs,
or utter disregard for social services. Social conditions canalso contribute to such risky behaviours, such as,
unemployment, prevalence of poverty, poor health andeducation, pervasive social ignorance, herd mentality,
unjust social structures, etc. Cultural conditions can also
promote disobedience, like pathological hard-headedness
or stubbornness of many who would rather subscribe totheir own opinion and belief rather than accept and comply
with authority directives, blind belief to unfoundedsuperstitions, unreasonable religious practices, andsupernatural remedies, perception of science as distant,exclusive, and elitist, social insensitivity and nonchalance,
individualism, etc.
These
conditionsofnon-cohesivesocieties
fragmentalizes communities and foster vulnerability andsusceptibility to dangers and risks. Whatever intervention
a government implements in such societies will either fail,derailed, or met with great opposition and suspicion
because it will never be able to solicit the respect,
cooperation, solidarity, care and concern that one
normally gets from a cohesive society.
Shaeffer designates the term social cohesion to thosecollective resources like general levels of trust and civic
engagement. These two helps a community to work
together and achieve identified goals or objectives. He
further differentiated behavioural and cognitive
dimensions of social cohesion, the former related to civic
participation or engagement, and the latter to trust-related
sentiments. He opined that social cohesion results fromthe synergy of the two (Shaeffer 2014, 9). That brings us
to the second foundation and consequence of effective
pandemic response – trust.
Trust as Foundation and Consequence of Effective
Pandemic Response
The key to the development and sustainability of social
cohesion is trust. Edelman claims that we are living in trust
paradox, an antimony. He noted the developments
experienced around the world, the rise of employment andbetter standard of living, and yet the 2020 Edelman Trust
Barometer tells us that no government, business, NGOs andmedia are ever trusted. It was further claimed that “thecause of this paradox can be found in people’s fears about
the future and their role in it, which are a wake-up call for
our institutions to embrace a new way of effectively
building trust: balancing competence with ethicalbehaviour” (Edelman 2020). Trust, then, is a behaviour
and an outcome at the same time.
There are three levels of trust involved in effective
pandemic response: personal, system and social. Personal
trust “involves an emotional bond between individuals,
and the emotional pain that each would experience in theevent of betrayal serves as the protective base of trust even
where other types of short-term gains could be realized bybreaking the trust” (Lewis, Weigert 1985, 974). This is thegeneral trust we each accord to others, that when broken,
we detached from the object of trust and may have an effectin the way we trust systems and institutions. Nonetheless,such emotional bond does not exist in system trust which185

is activated by the appearance that everything seems inproper order (Luhman 1982, 40-41).
Social trust, on the other hand, “is a belief in the honesty,
integrity and reliability of others – a faith in people” (Pew
Research Center 2007). It is also characterized by“perceived objectivity, consistency, competence andfairness” in the functioning of a society (Boslego 2005,1454). There are certain macro circumstances that fuel aculture of (social) trust, and these are the normative
ordering of social life (law, morality, and custom), stabilityof the social order, transparency of the social organization,
presence of a familiar environment, and accountability
mechanisms (Sztompka 1999, 122–125).
The characteristics mentioned above shows theindispensability of social trust for the effective functioningof political power or government. Without social trust in
the reliability, effectiveness, and legitimacy of laws andgovernments, modern social institutions would soon
collapse. One definitive sign that a social system is under
severe pressure is generalized loss of social trust in thelegitimacy of political leadership and authority and ininterpersonal trust in everyday life. Durkheim (2013)
believes that institutional trust underwrites interpersonal
trust, so, as social trust in common public institutions wear
away, trust in other persons ultimately is also eroded.
Now, trust as a behavioural manifestation of a person’scommitment to the values and norms of a community,
entails faith that the other members of the community will
cooperate for a common good, even though benefits may
not be equal (Fukuyama1995: 25; Schaeffer 2014, 38-39).
This is the very foundation of cooperation and solidarity.
When social trust is high, people are more likely have acollective sense of well- being. If people do not trust others
to be trustworthy, then you can never expect them tocooperate. When people do not trust their government,
then government will not find it easy to implement plansand programs or enforce ordinances and laws. What agovernment set as a common good may not be perceived
as such by the people, especially if this runs counter totheir values and norms.
On the other hand, social trust can also be a by-product,a consequence of something that is favorable to common
good or is aligned to common moral commitment. In thecase of pandemic, a government that is perceived to beeffective and efficient in responding to the effects of theplague, will enjoy greater social trust now and in the future,and foster active citizenship. “Trust is one of the mostbeneficial byproducts of effective leadership; it underpins
any successful functioning of a government, an economy,
and a functioning civil society” (Schoen 2013, 57).
Conversely, the absence of social trust in government
indicates a leadership that has failed or gone askew. This
loss of trust in government and leadership renders acountry incapable of facing enormous challenges, like the
COVID-19 pandemic.
Loss of social trust disables leadership and governancein the midst of pandemic since they will find it moredifficult or challenging to win the public’s support, and to
implement policies and rules addressing the problem. So,
we see public disobedience to enhanced community
quarantine or lockdowns, resistance to limitation of
movement, myriads of complaints, uncooperative
populace, public intolerance to procedural blunders andunintended utterances of political leaders, and blatant186

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opposition to any government plan or action. And insituations like this, some governments resort to violence,
intimation, and threat to command public obeyance.
Social and Cohesion and Trust in Pandemic
Response
Social trust between citizens is said to be indispensable forsocial cohesion, integration and stability (Newton, Stolle,
and Zmerli 2013, 38). If social cohesion and trust arelacking, or is deficient in each community, it leads to social
erosion or breakdown of unities and solidarities, andhinders social identification to a common purpose, as wellas, collective action against pandemics. A pandemic
prepared and responsive community is resilient and isconscious of its ontological safety, but in the absence ofsocial cohesion and trust, it becomes a society at risk,fragile, and susceptible to danger. Rather than promoting
greater well-being and good, it indorses pandemic of fearand confusion, stigmatization and discrimination, andineffectiveness and inefficiency. We have seen howhealthcare providers are maltreated because of lack of careand concern and strong sense of common good, howfamilies of COVID-19 positive patients are discriminatedand stigmatized because of lack of solidarity, howvolunteers in quarantine checkpoints are scorned andcursed because of inability to comprehend and inculcate
the primacy of greater good, etc.
We see governments in quandary because the publiccannot see the effectiveness of their plans and solutions,
not the reasonableness of their policies. We see leaders
publicly scorned, called to reassign in the midst of thepandemic, satirized and demonized in social media
because people don’t see them as credible and effective,
thus they cannot be trusted. Schoen believes that “so longas the trust crisis goes unaddressed, don’t expect thetwenty-first-century challenges of epidemic and pandemic
alleviation to take major steps forward” (2013, 42). The
rapid rise of positive cases and deaths in the United States
is said to be due to lack of social cohesion among
Americans,” showing that, obviously, a startling lack of
civic solidarity among Americans (Caren, 2020).
Building Cohesive and Trusting Communities
through Effective Pandemic Response
Every government, to be effective in responding to future
pandemics must do two things: first, implement effective
measures against COVID-19 now to build greater trust in
government’s credibility and abilities, and, second, dosocial engineering aimed at building greater local andnational social cohesion after this pandemic so that future
governments and communities will be better prepared andunited in combating future pandemics.
To do these, government leaders, when responding topandemics, must be able to strike a balance between social
needs and resource constraints, peace and order, people’s
rights, varied interests, and conflicting values. While it isnecessary to have armed forces to man check points andenforce quarantine or lockdown rules, government mustensure that no human rights are violated in imposing
sanctions, punishments, rules, and regulations, that basicsocial needs are not denied nor their fulfilment not
impeded severely, and that limited resources are
distributed justly (e.g., test for COVID-19 should not
obviously prioritize politicians and their families who are

merely suspected to have been infected at the expense of
those who are already exhibiting symptoms and yet they
don’t have access to testing kits, some dying without evenknowing whether they are positive or not). People must be
convinced that all programs and plans to combat the
pandemic are meant for the greater good and public
interest and not to further any political interest of a partyor any individual (e.g., no name of politician should appear
in the relief goods or in donations and assistance provided
to hospitals and other frontline facilities, etc.).
On the other hand, people must also be reassured thatgovernment programs are not simply to product of whims
or haphazard planning and shallow information, nor arethese plans and programs a creation of politicians and exmilitary generals who doesn’t have any idea of the
dynamics of a virus in a pandemic. Government must
actively involve, or even give leadership roles to scientists,
healthcare professionals, and other related experts, so that
judgments and plans are in conjunction with research,science, and medicine. In the Philippines, for example, theInter-Agency Task Force created by the President to
respond to the COVID-19 pandemic has more politiciansthat medical doctors and scientists. While the State
Department of Health is tasked to lead the response,
decisions are rather more political, and weighed down byelection interest, corruption, bickering, red tape, anddelays due to bureaucratic protocols and priorities. It is not
the Health Secretary who is the chief implementer of thegovernment’s response to the COVID-19 pandemic, but an
ex-military general and the current Presidential Peace
Adviser, igniting fears of social conditioning for martial law
declaration, a fear that’s been in the air in Philippine
politics since President Duterte was elected into office.
For governments to be assured of the public’s trust, andthus, become compliant and responsive to emergency
pandemic rules and policies, the following principles canbe adopted. First, the principle of maximization, asubstantive principle which, in the context of pandemic,
dictates that we must do the most good, i.e., health care forthe greater majority, amidst limited available resources.
Policies and decisions based on this principle must aim tosave the most lives or maximize the health benefits withthe available resources. Reasonable triage rules must be inplace, and people well informed about them to avoid
unrest and complaints.
Second principle is that of equity and fairness(distributive justice). Fairness and distributive justicedemand that government should give equal weight toequal claims of individuals. It also requires avoidance of
discrimination and partiality towards different classes ofpeople (i.e., rich vs. poor, powerful vs. powerless,politicians vs. commoners, rural vs. urban, etc.). The
principle of distributive justice provides “moral guidance
for the political processes and structures that affect the
distribution of benefits and burdens in societies” (Lamont,
Favor 2017).
Distributive justice necessitates thatavailable resources or goods and burdens are to be
distributed according to the individual’s needs,
contribution and responsibility and the society’s ororganization’s responsibility to the common good. So, it
may be just that the national capital area receives morebudget and supplies than provincial areas, considering its
centrality in business, finance, governance, andinternational importance, and is of high risk for mass

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
infection. The principle also demands that more resourcesmust be given to areas with greater infection cases, or
people with greater responsibility in society be given
priority in testing and treatment.
In the context of health care, distributive justice requiresthat everyone receive equitable access to basic health careservices that are necessary for living a quality human life
as required by right to health. It also implies that society
has a duty to the individual in serious need and that allindividuals have duties to others in serious need. In suchcase, there may be some rights and privileges that needs tobe sacrificed for the greater good. In decisions regarding
the allocation of available resources (i.e., rationing
decisions), the duty of society is not diminished because of
the person’s status or nature of illness. So, it will be unjust
to deny or delay health care to people who are poor andunderprivileged since all must equitably share in thebenefits of public health care. Triage policies must
recognize the indispensable and objective equality ofpatients so that allocation decisions should not begrounded upon judgments of the subjective quality ofpatients. And, of course, all must also share not only of thebenefits but also the burdens of pandemic response.
Distributive justice and fairness enjoins all to be
responsible citizens, i.e., not compromising public healthby following quarantine rules, not hoarding or panic
buying at the expense of the poor and underprivileged, etc.
On the other hand, distributive justice and fairness also
demands that governments must be aware that unequal
weight is given to unequal claims. This is important indecision of equitable distribution of limited resources andequitable services of limited workforce. COVID-19 positive
patients have stronger claims to life-saving resources thanpersons under monitoring or under investigation(suspected COVID-19 patients). High-risk population may
have greater claims to resource and services than low-risk
population, healthcare workers may have higher claim toavailable resources than the rest of the population by
virtue of responsibility and function, and in the language ofutilitarianism, younger people may have greater claim
than older people based on productivity and utility (alsoknown as fair innings argument - this is debatable andunacceptable to some, especially when seen in light ofequal access to benefits and equal right to health).
The third principle of effective government pandemic
response is impartial procedures and accountability. This
demands fairness in government procedures in the justdistribution of resources and services, and benefits andburdens. Fair procedure and accountability entails
transparency in procurement and distribution of
resources, allocation and spending of budget, and in theacceptance and utilization of donations from private
entities and countries. Accountability also requires a clear
and well-established chain of command, with publicly
identified key persons and their responsibilities, as well asreporting procedures and publicity rules. In this way, thepublic feel more secured knowing that their taxes are wellspent and that they benefit from it, and with the assurance
that there are people in government who are ready to takegood care of them in times of pandemic. Rules on social
amelioration programs, relief goods distribution, financial
support for indigents and unemployed, continued social
services (i.e., transportation, market hours, bills payment,etc.), work and education suspension, face ask and187

personal protective equipment use, lockdown, etc., mustall be weighed vis-à-vis fairness and justice. In thePhilippines, when Congress crafted a law giving thePresident emergency powers, they required him to submit
to the legislative department and to the people a weekly
accountability report on the use of approved budget andallocation of available resources, as well as implemented
and planned COVID-19 countermeasures.
Suchrequirement aims to solicit the trust of the people to thegovernment and their leaders.
And lastly, the principle of adequate and well-defined
information. This mandates that all information about the
COVID-19 pandemic and government programs and plans
must be presented in a way that it can be understood by all,including the terms and conditions of response, and theprinciples (legal, ethical, and moral) from which thesewere founded. Trust and confidence comes easy whenpeople are well-informed, and governments can expect
them to obey easily. So, press conferences or briefings, andpublic information campaigns should be done in thecommon language of the people. While English is thesecond national language of the Philippines, press
conferences of the Inter-Agency Task Force, theDepartment of Health, and even of the President (who is
not so fluent in Filipino), are mostly given in English andnot in Filipino, which is the primary language of the people.
These principles, when complied with, may usher a moretrusting a more cohesive citizenry, to the benefit of thepeople and the government, and those who are in positionsof power now and are planning to run for public office inthe next election – call it mutual benefit.
Promoting social cohesion through effective pandemic
response may not be easy for governments whose leaders
are no credible and effective. For any government who
wishes to promote social cohesion after pandemics, theymust display confident and credible leadership that unites
people under one cause, the common good, rather thansowing division, fear, and confusion. Government mustensure that the elected leaders can be trusted to stir
successfully their communities away from pandemic, or toencourage solidarity among its constituents by being
active, fair, and exhibiting good interpersonal relationship.
The leader must eb able to fully inform and rally his people
to achieve a goal and lead them to work together for thecommon good of their community. A socially cohesive
community will easily respect quarantine rules because
they know that the common good is far greater than theirindividual entitlements, rights, and privileges. A sociallycohesive community will have care and concern for theneeds of their members, as well as admiration and support
to their frontliners.
Conclusion
The COVID-19 pandemic is a test of public trust in theirgovernment and social cohesion and they can either fall orrise depending on how effective the government
responded to it. No matter how carefully planned COVID19 countermeasures are, when the government is notcredible and trustworthy and the people are not united insolidarity for the common good, these will fail and the
spread of the virus will be rapid and unabated to thedetriment, or even decimation, of the population.
Social cohesion and trust can be promoted after
pandemics if government shows that everyone matters

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and that they must be treated with respect, care andconcern, and they can make people understand and accept
that everyone matters equally but may not be treatedsimilarly and each person’s interest concerns everyone
and society. It is also paramount that government andpeople recognise that any harm to anyone matters, thus, it
must be minimized by ensuring that preservation of life is
the priority and number of COVID-19 deaths and patientsare minimized. The climate of trust and solidarity must be
sustained in times of pandemic through honest, fair, just,and humane governance, just and orderly distribution of
scarce resources, goods and services, maintenance ofessential public services, and public order and peace.
Social cohesion and public trust can also be achieved after
pandemics if government’s decision-making structure andsystem, from national to local, are well in place - striking abalance between effective centralized authority anddecentralized decision-making and ensures that pandemic
preparedness involves all sectors and remains dynamic.
Strong and trustworthy institutions and social cohesion
are a country’s “protective equipment” and antibodies
against pandemics.
The common missing factors
explaining failure to counter effectively pandemics is theabsence or lack of capable, accountable, and credible
government and leaders, and non-cohesive communities.
These also explain why some societies are highly at risk topandemics and others more resilient. Fragility of societies
caused by poverty, unemployment, disunity, politicalpolarization, economic and social disparities, inequality inopportunity, lack of education, distrust in government, etc.,
results to lack of social cohesion. Such can be seen incountries that are performing poorly in pandemic
response. In the recent Asia-Pacific region safety countries
ranking by the Deep Knowledge group, the Philippines
ranked lowest (20th), and one of the reasons mentioned is
the inefficiency of government management and severely
strained health systems (Hand-Cukierman 2020).
The COVID-19 pandemic is a test for governments andcivil societies. The ways that nations respond to thepandemic today and how the society responds to state
actions will principally determine their lots and destinies
in the next decades, and in the next elections. The
pandemic reveals the quality of leaders and people a nationhas. Governments that are successful at controlling the
spread of SARS-CoV-2 and minimizing fatalities of COVID19 will enjoy even more social cohesion and public trust.
Those that deferred vigorous interventions to control its
spread will see greater social stress and distrust, resulting
in the loss of public faith in leaders and government
institutions.
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20

21(https://www.bangkokpost.com/thailand/general/1878215/ac
tor-matthew-deane-infected-with-coronavirus#cxrecs_s)(https://www.thestar.com.my/news/regional/2020/03/20/aut
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COVID-19 Debates in Thailand- Ananya Tritipthumrongchok, Ph.D., MSc, MBGPH
Professor of Fortune Telling and Leadership Development,
American University of Sovereign Nations (AUSN) ,General Manager, Eubios Ethics Institute, New Zealand,
Japan and Thailand; Vice President, Asian Bioethics
Association (for South East Asia)
Email: ananya@eubios.info
Since March 2020 there is a nightly curfew on people goingout at night in Bangkok. Thai people are concerned, as we
see in every country, that has found COVID-19 coronavirus
in their society, Because it is dangerous and easy to spreadfrom person to person, COIVD-19 cases are now widelydistributed in Thailand’s provinces. The Ministry of Public
Health (MOPH) asks all persons coming from Bangkok toreport to the designated Communicable Diseases Officers
in their sub-district, remain at home, and maintain adistance of at least 1 meter from other persons.
Health authorities also ask people who have had contact
with anyone who might be infected in the past week tohave a check at the hospital. A hot topic in the news inThailand in March 2020 was the news that a TV star,
Matthew Deane contracted COVID-19. After testing it was
found that he and his wife had COVID-19 and they will stayin hospital for 14 days at least. 20 He owns a Thai Kick
Boxing stadium. There are reportedly many cases linked
to Kick Boxing stadiums.21
The Dean of the Faculty of Medicine, Siriraj Hospital,
Mahidol University, made a prediction of the situation that
if a lockdown is kept from 16 March to 15 April (30 days),
the number of patients will be 24,269 instead of 351,948
patients. There will be 485 deaths instead of 7,039, and1,213 persons in ICU compared to 17,597 without alockdown, and only 3,640 persons in hospital compared to190

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

52,792. From the perspective of mid-April it seems thatthe curve of hospital admissions was flattened compared
to before. we will be able to see if these predictions were
accurate, because looking at the numbers around theworld for a country the size of 65 million people thesenumbers seem low. All Thai people know the Campaign#StayHomefor . People trust the Thai epidemiologists who
have warned the public to stay home to avoid the virus
surge.
On 25 March 2020 107 new cases of laboratoryconfirmed COVID-19 were announced by the Ministry of
Public Health of Thailand (MoPH), bringing the total
number of cases to 934. 9 cases are linked to previous
clusters involving pubs and Boxing stadiums. 14 cases areclose contacts of other cases and 4 are related to religious
events in Malaysia. 11 cases are related to foreigners andThais returning from abroad or those working withinternational travelers. 2 healthcare providers havebecome infected and 67 other cases remain underinvestigation. There is a trend for more cases in rural areasalso, which is a concern given the way that the disease
spreads.
• Of the 934 COVID-19 cases reported in Thailand, 70
have recovered, 860 are receiving treatment in healthcare
settings. About 20% of cases did not have symptoms at thetime they were tested. Four cases are in serious condition
and four have died. One of the 4 who was diabetics for 10
years, which is a risk group as people who have NCD (noncommunicable diseases)• There is now a cumulative total of 13,027 Patients
under Investigation (PUIs) in Thailand since the COVID19
outbreak began, including 6,736 people being actively
investigated or treated. This group includes people being
treated for other conditions who are no longer suspectedof having COVID-19 infection.
The World Health Organization (WHO) announced that
Thailand has joined a multi-country clinical study forpotential treatments for COVID-19, as part of a rapid global
search for drugs to treat COVID-19. In addition to Thailand,
the “Solidarity trial” will include the participation ofArgentina, Bahrain, Canada, France, Iran, Norway, South
Africa, Spain and Switzerland. “This global problem
requires urgent global solutions,” said Daniel Kertesz,
WHO Representative to Thailand. “Thailand will be avalued partner in hosting studies to evaluate whether
potential treatments are effective – The goal is to identify
medicines that will save lives in the global battle to fight
this virus.”
The Solidarity trial will test four different drugs or
combinations to compare their effectiveness on thestandard of care — the regular support hospitals treating
COVID-19 patients use now. These options are: 1)
remdesivir; 2) a combination of two drugs - lopinavir andritonavir, 3) the two drugs plus interferon beta, and 4)
chloroquine.
Although there is currently no confirmation from the
medical community of any drugs that can cure COVID-19
100%, we can protect ourselves from it in various ways. An
effective and sustainable protection is to emphasize
personal self-health care in order to build immunity foroneself. Control and preventive measures start with eating
habits and consuming enough healthy foods, getting goodrest, and exercising properly. However, for those who do

not have much time to take care of themselves or those
who are at risk of being infected with the disease such as
medical personnel getting an intravenous vitamin drip
might be the most suitable answer or preventative steps
against infection. Our mind also affects the world. I takeUnicity products as a method to boost my immune system,
while also practicing the stay at home strategy.
There will be a significant economic impact on Thailand,
which has extended through 30 April 2020 a ban oninternational passenger flights landing in the country as
part of its effort to control the spread of COVID-19. There
are some exceptions, but all who do enter are subject tohealth crisis regulations, including a 14-day state
quarantine. Thailand has a huge tourism industry and lastyear welcomed about 40 million visitors.
There were 30 new confirmed cases of COVID-19
announced on 15 April 2020, bringing the total to 2,643.
Two more deaths were announced, bringing the total to 43,
while 1,497 infected people have recovered.

Commentary on Tritipthumrongchok- Leonard H. Le Blanc, III, PhD
Dean, American University of Soveiregn Nations, USA
Email: leblancleonard@gmail.com
The Thai government should be lauded for their rapid,
initial response to the COVID-19 pandemic.
Theyrecognized very early on that strong measure were going
to be needed to contain the epidemic. Because of thoseearly measures, the death total in Thailand has remained
low. The number of infections are lower than othernations. The Thailand government continues to refine
their response by adding more restrictions andprohibitions. The country is well-poised to come out of thepandemic in excellent shape at the rate they are going.

We need to work together to find acure and vaccine for COVID-19- Mei Lu, PhD
Lecturer of Medical Ethics, Guilan Medical School, Guilan,
P.R. China
Email: lumei502@126.com
I teach medical ethics in China. At the time when Wuhan
was quarantined I was doing research in the United States,
so I extended my stay in the USA through the Chinese New
Year. In late February I could get a flight back to China.
According to the Chinese government's requirements,
when I came back from abroad, I needed to enter
centralized isolation. So, from that day on, I was isolated ina hotel for 14 days, free of charge. The conditions werevery good. There was good Internet access, TV and air
conditioning. I could teach my students online every day
from my room.
I have a question that many Chinese people have about
the origin of COVID-19, which is often reported as "acoronavirus-caused illness that originated in Wuhan,
China, and has since spread to most of the world." Viruseshave no borders, and the origin of COVID-19 virus is stillEubios Journal of Asian and International Bioethics 30(4) (May 2020)
not proven. Therefore, in order to avoid stigmatization, theWorld Health Organization (WHO) named the virus
COVID-19. WHO embodies the basic principles of bioethics:
respect for persons, beneficence, non-harm and justice.
There are many conspiracy theories that COVID-19 wasa result of human research, and these will continue forsome time. We have a global pandemic that we need tosolve together; however, the rumors that the virus did not
simply occur as a natural mutation crossing animals andhuman viruses are common in many countries. No matter
who is sick, they are a patient, and we need to promote
global solidarity. I urge all leaders to focus on the ethicalissues of public health, and good medical ethics, and not
use this so-called war on the virus, as a “Cold War” to attack
each other. At the same time, we need transparency andindependent scientists to verify all the facts, otherwise wewill struggle to deserve people’s trust as professionals.

Ozamiz Politics in the Time of
COVID-19 Pandemic- Gerry Arambala
La salle University, Ozamiz City, the Philippines
Email: Gerryarambala33@yahoo.com
Abstract
While Ozamiz city’s politics is in its early stage of recovery
from its previous political deterioration proliferated by its
former ruling power predators, the city’s politics is yet
again put to the test with the advent of a global pandemic.
As the disease progresses in the Philippine archipelago
over the past five weeks some 5, 453 Filipinos (as of April
15, 2020 during the time the paper is written) are infected,
with 349 deaths and 353 recoveries; such are the numbers
even if the entire country is in strict community lockdown.
The local government unit headed by the city Mayor, incoordination with the provincial government in fighting
against the COVID-19 pandemic has placed the entire city
undercommunity
quarantine.
Nonessential
establishments are closed; however, grocery stores,
pharmacies and the city’s public market remain open;classes in both public and private institutions in all levels
and school functions are suspended. Under the city’scommunity quarantine memorandum 24 hours of curfew
for students and high risk adults is implemented;
everybody are encouraged to stay in their respective
houses and ration of food packs are distributed for every
household; checkpoints are placed in national roads in theentrance and exit of the city in order to limit engagementfrom the people outside Ozamiz; social distancing policy isstrictly implemented. The radical means the city has
undertaken is directed towards stopping any possibility ofcontagion in the city. However, with the majority of the
population being poor, problems of subsistence in the
midst of vast work displacements and the lack of income
among the city’s poor arise. It is for this reason that the
paper is intended to assess in particular the program andthe steps undertaken by the local government to answer
the cries of the poor during this difficult time.
Keywords: COVID-19, Ozamiz Politics, Community
Quarantine, Social Cohesion, Collective Action

191

Introduction
Weeks after the World Health Organization (WHO)announced COVID-19 as a global pandemic its cases hasreached to 1, 914, 916 across 213 countries, with 123,010
deaths at the time of writing (WHO, Corona diseasesituation reports). COVID-19 reduced the world into
pandemonium, with most of the affected countries in total
lockdown and cities closed. It has become a global horrorthat has caused the global economy to plummet and has
posed an imminent threat to the overall wellbeing of
humanity across the globe. In the Philippines, from its first
confirmed case of a 38 year old Chinese woman on 30
January 2020, the cases of COVID-19 have ballooned to5,453, with 349 deaths by mid April. Such is despite of thecountry’s radical measures of containing the virus.
Following the Department of Health’s announcementof the first positive case of COVID-19 in the country,
President Rodrigo Rua Duterte on 12 March 2020
announced the placing of Manila into a lockdown(community quarantine) from March 12 to April 14, 2020,
this in order to stop the virus from spreading in the
country’s capital (Aspinwall: 2020). However, with therapid increase of the number of cases within days, thePresident on March 16, 2020 in a televised national
address has extended his prior proclamation of placing
Manila under community quarantine to placing the entire
island of Luzon under enhance community quarantine.
Thus, placing under strict lockdown 57 million people
mostly are ordinary daily wage earners and poor (Santos:2020).
Following the guidelines of enhanced community
quarantine, nonessential establishments are forced toclose, however supermarkets, banks, pharmacies, water
refilling stations and hospitals are urged to remain open.
Schools are closed, classes are suspended until further
notice; social gatherings are banned, religious gatheringsand other unnecessary social engagements; public
transportations are prohibited, sea and air both indomestic and international flights are suspended. Citizens
are encouraged to stay at home and are ordered to practicesocial distancing. The drastic measure of enhance
quarantine has launched the entire Luzon island into
pandemonium (Aspinwall, 2020). Following theannouncement, long lines of people queuing in bus
terminals, checkpoint stations and airports scrambling to
fly from the capital to get home; supermarkets are
crowded by panic buyers causing unreasonable fear for
shortage of food supply and necessary commodities. This
happened despite the government’s clarification that cargo
trucks carrying vegetables and basic commodities areallowed to enter in lockdown cities and municipalities inorder to avoid shortage of food supplies.
The meandering measure of enhanced community
quarantine with its inevitable effect to the country’s overall
economy causes unnecessary burden to the country’s
poorest of the poor. Due to lack of sufficient and clear
measures in securing social safety nets intended toguarantee the poor of their subsistence during the monthlong enhance quarantine, fear among the poor rises that if
the government will not take adequate and sufficientmeasures to address the imminent threat the poorest of
the poor will die not of contagion of the virus but of hunger
and starvation. Neda explicates that the COVID-19
pandemic appears to include class dimensions (Neda192

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

Report: 2020), while its impact is primarily felt by theupper and middle classes due to possibilities of travel
abroad, the most devastating blow is felt by the poor
population; and the gravity of its effects to the poor
depends on the actual response measure the government
undertakes to secure health and economic well-being of
the people below. NEDA further specifies that with the“estimated accumulative loss of PHP 428.7 million to PHP
1, 355.6 billion in gross value which is equivalent to 2.1 to
6.6 percent of nominal GDP in 2020. Without mitigating
measures, this would imply a reduction in the Philippines’s
real GDP growth to -0.6 to 4.3 percent in 2020.
The government’s swift and appropriate response
remains crucial in the softening the blow of COVID-19,
particularly on the most vulnerable members of oursociety” (Neda Report:2020). The need for a sufficient andfeasible response measure that will intricately balance thehealth and economic well-being of the people is derived
from the socio-economic class dimension of COVID-19.
Social safety nets must be based from the understandingthat the impact of the global pandemic to the members of
the community varies by economic class. The fate of thepoorest of the poor Filipinos during this health andeconomic crisis rests solely in the kind of response
measure the government is crafting. And certainly so, they
are the ones who will suffer most. And that NEDA further
accentuate that if the government fails to provide
measures that will ascertain the balance between thehealth and economic objectives, the situation may further
deteriorate to a social and political crisis (Neda
Report;2020).
Ozamiz politics and the threat of a global
pandemicWith the threat of COVID-19 already in the country’s
capital and almost in the door steps of the city, Ozamiz city
Mayor Sancho Fernando “Ando” Oaminal was quick to
respond to the imminent threat the virus may bring to thepeople of Ozamiz. On 14 March 2020 the office of the city
mayor promulgated the executive order no. 2020 -SFO-10
instituting preemptive measures to combat the spread of
the virus within the city’s jurisdiction in accordance to thepresidential proclamation no. 922s.2020 which places theentire country in the state of health emergency amid
worsening COVID-19 scare (Luna:2020). However, withthe worsening scare and the rapid rise of the numbers of
COVID-19 cases in the country, Mayor “Ando”, reflecting on
the susceptibility and the vulnerability of the city for a
possible virus contagion due to the influx of people whoare not from the place, reconfigured the first executive
order and promulgated the executive order no. 2020-SFO11 “An Order Prohibiting, barring, and suspending the nonessential entry of persons travelling by land, air and sea
within the city of Ozamiz to fully prevent and further
contain the spread of COVID-19 from March 18 to 31”(Office of the city Mayor executive Order no. 2020-SFO11:2020). The enhance executive order no. 11 effectively
places the city of Ozamiz and roughly 141,828 people
under community quarantine. Following the guidelines set
by the Department of Health and the provincial
government’s executive order no.42, the city closed
nonessential
externalbusinesses,
touristsandnonresidents are denied entry with few exemptions, forinstance, persons seeking immediate healthcare service,frontliners (Doctors, Nurses, Hospital staffs, pharmacy
tellers, supermarket tellers who are working in Ozamiz but
are living outside the city), food delivery cargos, transient
people who are merely passing through the city are
escorted by the police until they exit the city’s vicinity(Office of the city Mayor executive Order no. 2020-SFO11:2020). Strict implementation of quarantine protocols
such as, strict social distancing, 24 hours curfew for
students and high risk individuals (senior citizens),
suspension of classes in all levels in both public and private
institutions, restrictions for mass gatherings, closure offactories and nonessential establishments, limitation for
public transportations (PUVs must accommodate only one
passenger per travel), everyone are encouraged to stay intheir respective homes during the quarantine period. All
these restrictions imposed by the local government are
intended to contain and stop the possible intrusion of thevirus within the city’s jurisdiction. Essentially, containing ahighly infectious disease in its earlier stage of contagion isthe best alternative measure that a city or municipality
must take upon itself, especially in most provinces where
resources are scares and the local budget is limited.
The US Centers for Disease Control and the WHO insist
to flatten the epidemic curve, that is to contain andslowdown the rapid acceleration of the cases of COVID-19
infections by implementing lockdowns. The local
government in adhering to the necessity of containing
early contagion of the disease has placed the entire city
into community quarantine. Although it is noteworthy toemphasize that in the early implementation of theenhanced executive order many have feared and somehave complained over the inconveniences the “lockdown”
may cause, especially to those who will be displaced fromtheir jobs and the inevitable effects of home quarantine tothe livelihood of the poorest of the poor of Ozamiz.
However, because of the strong sense of solidarity thatevery Ozamiznon possesses the concerns were readily
answered by the LGU in cooperation with some private
individuals and institutions who provided aid to thepoorest of the poor citizens of Ozamiz. It is noteworthy toemphasize that during the period of the implementation up
to the present there are still private individuals andinstitutions who are providing aid to the least fortunate
members of the city.
This and the point of social cohesion will be further
discussed in the proceeding sections. Furthermore,
notwithstanding the coercive measures which the LGU of
Ozamiz implemented in order to contain the virus fromspreading, over the past five weeks the city health office ofOzamiz recorded only four persons under monitoring(PUMs) and one person (in home quarantine) underinvestigation (PIU) in all 51 barangays. In summary, as ofApril 15, 2020 (during the time of writing the paper) thecity health office of Ozamiz in its COVID-19 situation reportannounced that there are, 4 ongoing PUMs; and 4358 PUMs
who completed the mandated home quarantine period; 0
ongoing PUI hospital quarantine; there were 4 PUIs who
were discharged from hospital quarantine; only 1 PUI who
is currently completing home quarantine; there were 30
PUIs who completed their required home quarantine; 4
PUIs tested negative for COVID-19; and 0 PUI tested
positive for COVID-19 (Ozamiz city Health Office COVID-19
Report).

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)
The numbers show that the coercive measure of
putting the city in lockdown seems effective. Locking down
the city from the world outside has proven efficient incontaining any possible contagion in Ozamiz. However,such is not realized simply by forcing the people to stay athome and enforcing sheer draconian measures to isolate
the city’s population from possible contact with outsiders
and from among the city’s local residents. The city Mayor,
during the time of the implementation continuously holdpress meetings through Facebook in order to disseminate
vital information as to what is the present state of the city,
in terms of coping with the health crisis and the economic
difficulty that most of the population of Ozamiz are
suffering from; and the necessary response measure that
the LGU has taken to balance the health and economic
objectives. He is often heard asking the cooperation of thepeople in order to bring about the projected positive resultof the measures the LGU crafted in fighting against COVID19 pandemic.
Transparency on the part of the local government
during the time of crisis is of vital importance in order tokeep the people in tune with what is happening and inorder to build a strong communal connection. Whentransparency is lacking, fear and anxiety among the people
arise thus causing unnecessary havoc and pandemonium
among the blinded population. It is enough to observe how
the people from the capital are reacting to the imposed lockdown to see how transparency is important in keeping thepeople’s trust the government and to the response
measure that the government crafted to answer thepresent health crisis. In Ozamiz, on the other hand, the
LGU’s transparency towards the people in disclosing vital
information helped a lot in securing the trust of the people
despite imposing draconian measure of locking down theentire population. Social cohesion is absolutely needed inorder to contain the rapid increase of the cases of infectionof a highly contagious disease. “Controlling the spread ofcommunicable diseases within and across borders
requires strong cohesion, or a unity of purpose around thiscollective action challenge” (Dayrit and Mendoza:2020).
Such can only be realized when there is constantinternal dissemination of information and the government
exhibits transparency. In his press conferences the city
mayor often admonishes the people to do their part in
helping the cause of battling against the pandemic aside
from giving reports about the COVID-19 situation in thecity. Relief operations had started weeks ago, as of April 9,
2020, 33, 369 households in 46 barangays out of the 51
received their food aids consisting of 10 kilos of rice,
noodles and canned goods. The money from thegovernment’s cash aid program will soon be distributed,
the LGU is currently finalizing the final number ofhouseholds that are to be given the prescribed amount as
identified in the guidelines of the 200 billion social
amelioration program. Furthermore, the city’s health care
subsidy will continue; accordingly, the city in providing aid
for hospitalization of the poorest of the poor Ozamiznons
had spent from its budget 6 million pesos over the courseof its implementation.
The majority of the Ozamiznons support the local
government’s response measure in stopping any possible
contagion by means of community quarantine. Suchunwavering trust in the current bureaucracy by the people
is rooted in its novel system brought about by the193

radicalization of its politics when its previous warlords
were dethroned and all their shadows removed by theradical shift of institutional order last two years ago. The
new system, however infant, brought hope to the people ofOzamiz for authentic democracy and freedom, so that it is
not surprising that when the local government announced
the placing of the entire city into lockdown the
promulgation did not meet repulsive actions from thepeople. The radicalization of the previous politics in thecity gave birth to a unified consciousness among
Ozamiznons; a consciousness that enables them to act
collectively in matters of politics and development. The
key element, I suppose, to the current success of the LGU’s
response measure in containing further infections of thevirus is a strong sense of social cohesion among the people.
The collective commitment of embracing the responsibility
to help realize the common purpose of containing the
pandemic and in mitigating its devastating effects to theworst offs of Ozamiz is the most vital element and the key
to unlocking the success of the city in containing the virus.
What is Radical politics?
The idea of radical politics is derived from thepresuppositions of radicalizing democracy. Proponents ofradical democracy argues that the conventional
deliberative democracy with its insistence of a consensual
and representative agreement is inefficient to truly
represent the sentiments of diversified individuals. The
tendency to reduce the pluralistic value of the good life into
the supposed universal consensus agreed upon by therational representatives is what makes deliberative
democracy implausible. The project therefore of radical
democracy is to radicalized democracy from within byallowing the people to freely engage in the political processof deciding the good life that fits for everyone. That is, thecitizens in this regard are “given direct roles in public
choices or at least engage more deeply with substantive
political issues and be assured that officials will be
responsive to their concerns and judgments” (Cohen:
2020, 23). Radical democracy opens the path of a populist
conception of democracy.
Chantal Mouffe argues that the role of liberal
democracy must not to create a general consensus that will
be agreed by all, rather the role of democracy must to
create a space where conflicting consensus may thrive
among rationally diversified individuals. And that in every
conflicting discourse the opposing side must not be
identified as an enemy to be destroyed but as a worthy
adversary whose claims posit equal merit as yours. This isvital in most developing countries, where the majority arepoor and their representatives do not truly represent theircries and needs. The demise of the power of contestationin the public sphere that is brought about by the insistenceof a rational consensus through a supposed rational
deliberation is what makes conventional representative
democracy problematic. Mouffe offers an alternative
project whereupon everyone’s pluralistic values are taken
consideration and are made to be the ground in which
every democratic discourse is based. The legitimization of
power in the public sphere is vital for Mouffe, this is in so
far as, it is only when power is legitimized in every
democratic discourse that the call for equality in thetreatment and consideration of everyone’s call for justiceand development is secured. Mouffe asserts that power

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must not be seen as “external relation taking place
between two pre-constituted identities, but rather as
constituting the identities themselves” (Mouffe: 2000, 14).
What this means is that power is not something that comesfrom outside of the individual, as something that demands
recognition due to a claimed advantaged in terms of socialand economic state of being but rather as being part ofeveryone’s realities. The poor has equal claim fordevelopment the same as the rich. Both the rich and thepoor posit the same legitimacy of the life they findreasonable to live despite being different in all their forms
and that every democratic discourse must allow suchconflicting consensus to thrive for an authentic
development to happen in the polity.
Mouffe further adds that, “Democracy requires,
therefore, that the purely constructed nature of social
relations finds its complement in the purely pragmaticgrounds of the claims of power legitimacy” (Mouffe; 200,
14). To this Mouffe proposes here conception of anagonistic democracy. Accordingly, agonistic democracy
insists that antagonism and contestations among thepolitical is vital for the flourishment of every democratic
institutions. And that “the aim of democratic politics is toconstruct the “them” in such a way that it is no longer
perceived as an enemy to be destroyed, but an “adversary”,
i.e., somebody whose ideas we combat but whose right todefend those ideas we do not put into question” (Mouffe:
1993, 13). For Mouffe, the foundation of a truly functioning
democracy is the persistent recognition of the legitimacyof antagonism among diversified individuals; that is when
the citizens are given their right to contest any institutionalarrangements that they see to be rather unfair and to insist
for the kind of life that they find reasonable to live.
Radical Politics and Social Cohesion
As was mentioned in the above section, the key element in
the exemptional success of the LGU’s containment
measures against possible contagion of the virus in thecity’s jurisdiction is the Ozamiznons deep commitment tosocial cohesion and their strong sense of solidarity. A
commitment to collectively act and embrace the moral
responsibility to help in realizing the set goals of the
proposed measure and to provide aid to those who will
suffer most as a consequence to the imposed lockdown.
This is reflected in the admirable solidarity that thecitizens exhibited during the month -long isolation.
Absolute cooperation and trust to the LGU’s measures forcontainment was exhibited by everyone, social distancing
and other means of avoiding contact and possible
contagion is observed by everyone in public places. Suchstrong sense of solidarity enabled the city to cope with thepressing crisis despite its lacking of resources and budget
Private institutions and the Church provided aid in
distributing food to the poor and procuring healthmaterials which are distributed to the city’s frontliners.
Moreover, in particular, La salle University-Ozamiz
headed by Br. Antolin “Butch” Alcudia III, the Br. Directorof the community of La Salle brothers in Ozamiz, organized
two projects directed upon containing the virus andhelping the poorest of the poor members of Ozamiz andthose nonteaching personnel who because of the imposed
lockdown and suspension of classes were displaced fromtheir jobs. The LSU Crisis Response Team in their effort tocontain and eliminate the virus helped in the production ofsurgical masks and in the construction and distribution ofdisinfectant tents that are placed in key public places in thecity. They are at the present working on the production of
handwashing and footbath stations which will be
distributed in all of the public and crowded spaces in thecity. Private individuals are often seen to distribute foodpacks to the poorest of the poor aside from the LGU’s food
help. In connection with the above discussion ManuelDayrit explains that “COVID-19 will … test the social
cohesion of each country, since much will depend on the
behavior of individuals. And individuals either think about
the public good and act accordingly, or they may revert to“ever man for himself” if there is a lack of trust in
government, or weak trust and cohesion withincommunities” (Dayrit and Mendoza:2020) Certainly what
is being exhibited by the success of the city’s containment
measure is a remarkable presentation of solidarity among
the citizens and a deep trust to the politics of the city.
For over three decades the city was under the rule of apredatory system, the local politics was designed to serve
the interests of the ruling family while the majority of thepeople are deprived of their right to development.
However, through the radicalization of the city’s politics anovel system grounded in a populist perspective was born.
The people are set free from their political captivity, there
were given the freedom to open what is for them the bestalternative and the most reasonable life, which in the past
was deprived of them. The radicalization of the city’ssystem has brought about a collective consciousness thatevery Ozamiznon embraces. The trust that they have overthe current political system is the inevitable consequenceof their previous battle which they won against theirformer political rulers. The radical shift of the local politics
in the city has paved the way for the entrenchment of astrong social cohesion among the people and the local
government. That unsurmountable sense of communal
solidarity and unity of purpose is what makes the goal offlattening the curve of the local transmission of the virus in
the city possible. The coordinative and cooperative actions
between the LGU and the people of Ozamiz are the vital
aspects which made Ozamiz COVID-19 free for over 5
weeks.
Conclusion
The COVID-19 pandemic poses a threat to the global
community’s overall well-being. So that ending it as soon
as possible is undoubtedly a global good. However
inasmuch as not all of the countries in the world have thesame capacity and state of economic and technologicaldevelopment, response measures may radically vary fromeach country. And insofar as the world is in the process ofcreating vaccines that will serve to protect us from thedanger; what the world can best do is to buy our intelligent
women and men some time to create the cure for the
disease. The Philippines being one of the countries infectedby COVID-19 having cases 5, 453 and 349 deaths has taken
the coercive measure of putting the entire country in total
lockdown; with the hope that by limiting all instances ofsocial interactions it will somehow contain the rapid
acceleration of COVID-19 cases in the country.
However, with the meandering proclamation ofenhance community quarantine, many of the poor
population had voiced out their concerns and theiranxieties of not dying because of being infected but due toEubios Journal of Asian and International Bioethics 30(4) (May 2020)
starvation. In response the Philippine National
Government provided food and cash assistance to thepoorest of the poor Filipinos. In Ozamiz city knowing about
to the pressing threat of COVID-19 to the city, the local
government opted to place the entire city in lockdown.
However, despite the negative connotations of theimplementation of a coercive measure to contain thepossible contagion of the virus within the city’sjurisdiction, it is noteworthy that such measure is proveneffective. For the past five weeks there has been norecorded case of the pandemic, and the poorest of the poor
Ozamiznons are constantly given aid even with the city’s
limited budget and resources.
What actually transpires in the city’s implementationof lockdown is a lively and interactive sense of social
cohesion. The people are the ones taking the responsibility
to act as one and to project to that same purpose and goal
set by the local government at the start of theimplementation of its response measure of containing thevirus. The success of the local government’s measure ofcontaining and flattening the curve is rooted in the people’s
trust to the LGU and their collective sense of social
cohesion. The united effort and the remarkable solidarity
among Ozamiznons to help the least fortunate and act
accordingly as prescribed by the guidelines set in theexecutive order are the key factors of the success of the
response measure undertaken by the local government ofOzamiz.
References

Aspinwall, Nick (2020). Coronavirus Lockdown Launches Manila
Into Pandemonium: Duterte announced unprecedented
measures, but nobody knows what they mean. 14 March.
Available at: https://foreignpolicy.com/2020/03/14/dutertequarantine-philippines-coronavirus-lockdown-launchesmanila-into-pandemonium/. (Accessed on April 6, 2020).
Cohen, Joshua (2020). Radical Democracy. Available at.
https://static1.squarespace.com/static/5ce018c4d711f30001
ff4dab/t/5ce0afffd7031b000190a447/1558228991512/Coh
en_Fung_Debate_SPSR2004.pdf. (Accessed on April 15, 2020).
Dayrit M. and Mendoza R (2020). COVID-19: Countering the
Economic
Contagion.
24
March.
Availableat:https://thediplomat.com/2020/03/covid-19-countering-theeconomic-contagion/COVID-19: Countering the Economic
Contagion. (Accessed on April 7, 2020).
Dayrit M. and Mendoza R (2020). Social Cohesion vs COVID-19.
18
March.
Availableat.
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=35551
52. (Accessed on April 7, 2020).
Luna, Franco (2020). Duterte signs proclamation declaring stateof public emergency. Available at. https://www.philstar.com.
(Accessed on April 8, 2020).
Mouffe, Chantal (2000). Deliberative Democracy or Agonistic
Pluralism, Reihe Pl;oitikwissenschaft Political Science Series,
December 2000.pp.23-34.
Mouffe, Chantal (1993). The Return of the Political. London:
Verso.
Neda Report (2020). Addressing the Social and Economic ImpactofCovid-19
Pandemics.
Availableat.
http://www.neda.gov.ph/wpcontent/uploads/2020/03/NEDA_Addressing-the-Social-andEconomic-Impact-of-the-COVID-19-Pandemic. (Accessed on
April 7, 2020).
Office of the City Mayor, Republic of the Philippines Office of thecity Mayor Executive Order NO. 2020-SFO-11.
Office of the City Mayor, Ozamiz City Health Office COVID-19
Situation Report.

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Santos, Ana (2020) Coronavirus: Philippines quarantines islandof 57 million people: For daily wage earners, no work meansno pay 'so no choice' and social distancing is impossible, critics
say.
17
March.
Availableat:https://www.aljazeera.com/news/2020/03/coronavirusphilippines-quarantines-island-57-million-people200316161225532.html. (Accessed on April 6, 2020).
Santos, Elmer (2020). More COVIS-19 recoveries than deaths ascases hits 5,453, DOH reports. 14 April. Available at:https://www.cnnphilippines.com/news/2020/4/15/philippi
nes-covid-19-cases-recoveries-deaths.html. (Accessed on April
16, 2020).
World Health Organization (2020). WHO Director-General's
opening remarks at the media briefing on COVID-19. 11 March.
Available at: https://www.who.int/dg/speeches/detail/whodirector-general-s-opening-remarks-at-the-media-briefingon-covid-19---11-march-2020. (Accessed on April 7. 2020).
World Health Organization (2020). Coronavirus disease (COVID19) outbreak situation. 16 April. Available at:https://www.who.int/emergencies/diseases/novelcoronavirus-2019. Accessed on April 16, 2020.

Role of information andcommunication technology during
the COVID-19 Pandemic- Dennis L. Alfaro
St. Paul University Quezon City, Philippines
Email: dlalfaro@spuqc.edu.phAbstract
Information and Communication Technology plays animportant role in the industries like healthcare, finance,
manufacturing, education, forecasting and businesses todevelop a sustainable and resistant infrastructure. During
the COVID-19 outbreak, community quarantine has been
imposed or practice in different countries to stop the
spread or as they said it, to flatten the curve. Flattening the
curve refers to community isolation measures that keep
the daily number of disease cases at a manageable level for
medical providers (B. Specktor, 2020). The Curve shows or
represent a projection of how fast COVID-19 cases will
peak before it will go down or project how many people
will be affected and recovered over a period of time.
Big data in COVID-19 Pandemic
Data science is an inter-disciplinary field that uses
scientific methods, processes, algorithms and systems to
extract knowledge and insights from many structural andunstructured data. Data science is related to data mining
and big data.
With the rapid transformation of Information andCommunication Technology (ICT) in Global Development,
researchers and developers has increased the use oftechnology like artificial intelligence, machine learning,data analytics to monitor, track, analyze on how to contain
COVID-19. Data can help in the tracing of movement,
contact, isolation and mapping of population. Big names in
the IT industry like Google, Amazon, Microsoft and othercompanies has launched services for researchers’ freeaccess to their data analytics tools and open data sets to
help developed solutions faster.

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Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

The use of trackers to continuously get data from sourcesfrom the different parts of the world are helping healthcare
workers, epidemiologists and government units analyze
and synthesize the data on a global basis. Data gathered
will be put up together in a single website and represented
by a dashboard, so all pertinent information are displayed.
Drones and Robotics
In other countries, they use technology to respond to
COVID-19 pandemic by developing and deploying
automated robots to supply equipment’s, medicines andfood for healthcare workers. By deploying this, it
minimizes the point of contact to limit the spread of thevirus. Some counties also used drones with thermal
imaging scanner to improve virus detection, disinfect andmonitor the movement of people. In the Philippines, Pasig
city used drones to disinfect the whole city. The drone canload up to 10 liters of disinfectant and spray a wide rangeof 500 up to 1000 square meters and can fly for up to 30
minutes. These drones used by Pasig City were the samemodel used in China and South Korea to fight COVID19
according to Pasig City Disaster Risk Reduction andManagement Office chief Bryant Wong.
Another company Alibaba announced that it has developed
a new diagnostic tool based on artificial intelligence.
According to the Chinese giant, its algorithm is capable ofdetecting infections with an accuracy rate of up to 96%, allin about 20 seconds.
Chatbots
A chatbot is a computer program that simulates humanconversations. It allows a form of interaction between ahuman and a machine to communicate via messages orvoice. A chatbot is programmed to work independently
from a human operator and interacts on a format likeinstant messaging. By artificially replicating the patterns ofhuman interactions in machine learning, it allows
computers to learn by themselves without programming
natural language processing.
In the report of the World Economic forum, it states that“many companies and organizations are leading the charge
in deploying chatbots to provide COVID-19 information. The
two most authoritative voices of the pandemic, WHO and
CDC, have also included chatbots in their websites to provide
up-to-date information to billions on the spread of thedisease and its symptoms. Many governments are also
launching chatbots to provide validated information to theircitizens.”
Digital Epidemiology
Digital epidemiology is epidemiology that uses data thatwas generated outside the public health system. (Marcel
Salathé, 2018). This idea of a health population can beassessed through digital traces, in real time. It has thepotential to be a powerful benefit for traditional
epidemiology. Researchers have already started to develop
methods and strategies for using digital epidemiology tosupport infectious disease monitoring and surveillance orunderstand attitudes and concerns about infectious
diseases.
Google Flu Trends was one example of digitalepidemiology that was launched in 2008 to help predict flu
epidemics. Usually people will search for symptoms andcure in the internet which data mining can be a tool.

Work from Home and Physical Distancing
Since the WHO declared that COVID-19 is a global
pandemic, different countries has implemented a physicaldistancing policy and work from home. Even schools anduniversities have cancelled classes to minimize the spreadof the virus. This is also one area where ICT is greatly used.
Some schools and universities offered distancing learning
through the use of a Learning Management System
platform. There are free online sites that offers this kind oftechnology like Edmodo, and Google classroom. During theoutbreak of COVID-19, most of the big names in the IT
industry has offered their paid online platform for free
until 90 days like Adobe connect and Microsoft Teams.
Online communications, meetings and teleconferencing
have become the new normal today during the physicaland social distancing. People became creative and havecommunicated with their family, friends and colleagues.
Musicians have collaborated online just to share theirmusic with the use of technology and some organization
offers free webinar.
In summary, ICT plays a vital role during the COVID-19
outbreak. It has helped the different sectors especially thehealthcare systems in monitoring, analyzing andprojecting the trends. It also helps people incommunication,
collaboration
andinformation
dissemination through social media, websites and another
online platform.
What has happened to the use of technology during the
COVID-19 pandemic can be the new normal or point ofconsideration after the pandemic.
Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
President, American University of Sovereign Nations(AUSN), https://www.ausovereignnations.org
Email: darryl@eubios.info
EJAIB adopts and complies with the Committee on
Publication Ethics (COPE) Publication ethics andmalpractice policy. Our policy is on the EJAIB website. All
potential authors should have read these guidelines and bysubmission of an article for publication you acknowledge
that you have complied with this policy. Violations will behandled in proportion to the intention and seriousness ofthe violation. Registered address of EJAIB: P.O. Box 16329, Hornby, Christchurch 8441, New Zealand
For forthcoming conferences see: www.eubios.info or
www.ausn.info Email to Darryl@eubios.info.
EJAIB Editor: Darryl Macer (Chair, Accredited Universities ofSovereign Nations)
Associate Editor: Nader Ghotbi (Ritsumeikan Asia Pacific
University, APU))

Editorial Board: Akira Akabayashi (Japan), Sahin Aksoy (Turkey),
Martha Marcela Rodriguez-Alanis (Mexico), Angeles Tan Alora(Philippines), Atsushi Asai (Japan), Alireza Bagheri (Iran), Gerhold Becker(Germany), Rhyddhi Chakraborty (India/UK), Shamima Lasker(Bangladesh), Minakshi Bhardwaj (UK), Christian Byk (IALES; France),
Ken Daniels (New Zealand), Ole Doering (Germany), Amarbayasgalan
Dorjderem (Mongolia), Hasan Erbay (Turkey), Soraj Hongladarom(Thailand), Dena Hsin (Taiwan), Rihito Kimura (Japan), Abby Lippman(Canada), Umar Jenie (Indonesia), Nobuko Yasuhara Macer (Japan),
Masahiro Morioka (Japan), Anwar Nasim (Pakistan), Jing-Bao Nie (China,
New Zealand), Pinit Ratanakul (Thailand), Qiu Ren Zong (China),
Hyakudai Sakamoto (Japan), Sang-yong Song (Republic of Korea), Takao
Takahashi(Japan),Noritoshi
Tanida(Japan),AnanyaTritipthumrongchok (Thailand), Yanguang Wang (China), Daniel Wikler(USA), Jeong Ro Yoon (Republic of Korea).

Eubios Journal of Asian and International Bioethics 30(4) (May 2020)

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