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Table 1 Ethical questions in the application of genomics to COVID-19 management decisions

From: Genomics in the era of COVID-19: ethical implications for clinical practice and public health

Clinical decisions
Is it ethically acceptable …
to withhold scarce resources from patients with higher (or lower) genetic risk of mortality?
to deny hospital admission to patients with higher (or lower) genetic risk of mortality?
to use genetic information to make decisions about which patients are admitted to the ICU or put on a ventilator?
to prioritize access to experimental treatments (which are in short supply) to those who are genetically at higher risk of serious disease?
for visitation policies to be informed by genetic testing of family members to determine their risk of contracting or transmitting COVID-19?
to mandate that adherence to DNR orders should be stricter for patients with higher genetic risk of mortality?
Workforce decisions
Is it ethically acceptable …
for hospitals/ICUs to mandate genetic testing of the workforce to inform work assignment decisions?
for hospitals/ICUs to prohibit a health care worker with increased genetic risk of infection from providing direct patient care?
for hospitals/ICUs to prioritize health care workers with decreased risk of infection to serve as first responders?
to use genetic information on health care workers’ susceptibility to COVID-19 to determine the level of personal protective equipment to which they have access?
Public health policies and practices
Is it ethically acceptable …
for quarantine measures/policies to be informed by genomics, i.e., those who are at lower risk of contracting the disease do not have to stay at home?
for school attendance/closure policies to be informed by genomics, i.e., schools can remain open for students and teachers at lower risk?
for travel and immigration restrictions to be informed by genomics (e.g., super-spreaders face increased restrictions)?
for vaccine (once available) distribution to be prioritized for those most likely to develop severe disease or least likely to show symptoms (and therefore unknowingly spread disease)?