LAUSR

ne of the main challenges the public health system is acing nowadays is coping with the threat posed to socity by infectious/transmissible diseases,1 which may involve utting into practice measures that include restrictions on ivil liberties to serve the common good such as isolation or uarantine in the event of an epidemic/pandemic. The beginning of the outbreak of COVID-19, both globally2 nd domestically, and the subsequent declaration of a Public ealth Emergency of International Concern,3 has meant a aradigm shift in the way we conceive of medicine and the urrent public health system, which has faced a process of ecision-making and a course of action inconceivable just a ew months ago. March 25th the Spanish Bioethics Committee published: ‘Informe del Comité de Bioética de España sobre los aspecos Bioéticos de la priorización de recursos sanitarios en el ontexto de la crisis del coronavirus’’,4 and April 3rd the aper ‘‘Informe del Ministerio de Sanidad sobre los aspectos ticos en situaciones de pandemia: el SARS-CoV-19’’5 was ublished, the latter submitted a series of recommendations o ‘‘aid decision-making on the implementation of therapeuic and patient care measures.’’ Both reports focused mostly n aspects related to healthcare rather than those related o ethical values and issues. The procedures to control the transmission (standard reventive measures, specific preventive measures, hand ygiene, barrier measures, isolation precautions etc.) hould be well known amongst professionals and impleented in accordance with the mode of transmission of he microorganism involved. Whether standard or contact easures designed to prevent droplet spread or airborne ransmission, they all should respect the time frame and ther specific guidelines as described by the CDC.6 Both in primary health care and the hospital envionment, we are moving into uncharted territory, where e are unsure of the ‘‘utility’’ of our actions or their ‘benevolence,’’ where the resource constraints call the ‘justice’’ of our decisions into question, where we are ndermining the ‘‘autonomy’’ of the population and associting ‘‘stigmatization’’ to a part of it. On top of everything, w The use and optimization of resources has been overome as we have suffered from a shortage of the most basic aterials for infection control in the healthcare environent (lab coats, masks, hand-hygiene products etc.), tools or diagnosis (microbiological analysis tests etc.), materials or the treatment and care of the sick (life support equipent, respirators, hospital beds, drugs etc.), not to mention he scarcity in human resources caused by the lack of proessionals as a result of sick leave caused by the infection tself, and the quality of care for patients with non-COVID-19 athology that may be diminishing. The word isolation, which was removed from most docments regarding infection control due to its negative or ejorative nature, is being widely used again and with arying degrees that go from the generalized confinement stablished by the government for a large part of the opulation, to the quarantine for asymptomatic individuls in contact with people at risk, to the self-isolation for hose with mild symptoms who had to carry out such isoation at home, and finally to the strict isolation of those atients admitted to health centers with a diagnosis of OVID-19. In terms of training and briefing, we were faced with massive number of protocols, procedures and recomendations which were modified and updated almost aily. They were based on poor scientific evidence and ame in gradually from our own experience as the outreak/epidemic/pandemic evolved, often based on the pinion of ‘‘experts.’’ These sometimes contradictory mesages have caused mistrust amongst society and our own olleagues, who had to implement protocols and guidelines f unspecified timelines. As far as research is concerned, we must undoubtedly se the information available in the different countries ffected, albeit in a cautious way, given the disparity of riteria when collecting this information (different epiemiological surveillance systems), in order to base future ecisions and actions on reliable data and verified informaion. We must also share this information and facilitate the ork of the different research groups, not only to publish ut to generate scientific knowledge. We consider an in-depth analysis by bioethics commit-