Western experts field COVID-19 ethics, education questions

On April 15, Western professors Prachi Srivastava and Maxwell Smith took part in a special webcast to answer questions from the community regarding the ethical, educational and social impacts of COVID-19 –including inequitable access to remote learning resources, the effects of school closures on children and youth, when to relax social distancing measures and the allocation of scarce health resources like ventilators and respirators. The event was hosted by Sarah Dawson, Western Alumni Career Coach.

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Sarah Dawson: Good afternoon everybody. My name is Sarah Dawson, I’m from Western Alumni. I’d like to welcome you to today’s webcast. We’re going to talk about the ethical, educational and social impacts of the COVID-19 global pandemic today. Thank you to those of you who sent us your questions through social media, and if you’re joining us on Facebook or Zoom this afternoon, we welcome you to send in your questions and we will tackle as many as we have time for. We are recording today’s webcast, and it will be available to view on the Western Alumni homepage.

We’re joined today by two of Western’s leading researchers, Maxwell Smith and Prachi Srivastava.

Max is a professor at Western’s Faculty of Health Sciences and co-directs the Health Ethics Law and Policy Lab. He serves as an ethics adviser to the World Health Organization and is currently leading a Canadian government-funded project, examining how the world’s response to the Ebola virus may serve as an ethics template to the COVID-19 outbreak.

Prachi is a professor at Western’s Faculty of Education and a thought leader in the field of global education. She’s provided research to global institutions like the United Nations, World Bank, and UNESCO to name a few. And she’s currently highly engaged in the ongoing pandemic, focused on the impact of 1.5 billion children and youth currently out of school.

Thank you, to Prachi and Max for joining us today. We have a lot of questions, so I think we’ll jump right in.

My first question, I’m going to send to Prachi. And I wonder if you can start us off by giving us an idea about the scale of the global education emergency caused by COVID-19.

Prachi Srivastava: Thanks, Sarah, and thank you everyone for joining, I can see we have a very long list of attendees. Yes, the scale of the pandemic, the impact of the pandemic is in plain words, huge. We’ve never seen this in human history. It is the largest mass disruption of education on the planet. We have 1.5 billion children and youth who are currently out of school. And that is in addition to the 250 million children that were already out of school because of entrenched inequities. It affects every region, almost every country.

Sarah Dawson: Can you talk about how we might experience those changes and implications as a society in Canada versus other parts of the world?

Prachi Srivastava

Prachi Srivastava

Prachi Srivastava: Absolutely. In Canada, we are much more fortunate than many, many countries, in terms of our socio-economic levels. We are a high-income country. We are a G7 country, that means we’re one of the largest seven economies in the world and we have resources that are unavailable in many other parts.

Having said that, we still have inequities in terms of provision. With this rather quick change to moving all levels of learning online, parents, teachers, principals, university faculty members, all have had to shift the way we teach. And we’ve had to shift that in very quick ways, without necessarily a concerted plan of action.

In terms of the platforms that are available to us, we might not always have those platforms ready. We’re lucky at Western. Western has pretty good technological infrastructure in terms of professors being able to deliver courses in a manner that’s already there for us. But even then, we’re seeing gaps in terms of how our students can access those resources.

Even within the university sector, there are students who depended on the university for their computers, for their high-speed access, for access to high-speed servers. And all of this is sometimes not possible to replicate in the context we’re in.

When we look at the elementary and secondary sectors, the implications of moving learning online very quickly are real, and they are much more complex because learners, especially in the early years are not entirely independent, they require a lot of support and the kind of face-to-face learning is not easily replicable in an online learning environment. Teachers may not have the resources available to them, they have not been teaching on online platforms as a matter of course, and families, households, do not always have the requisite technology or the broadbrand infrastructure.

I heard a statistic that potentially 100,000 learners within Ontario do not have access to high-speed internet or the requisite devices. This will cause, in the short term, a lag in terms of how those households are able to access learning. In the long term [it was announced yesterday that schools are not going to be opening again on May 4th], this can lead to big learning gaps. And those learning gaps are likely to be magnified and heightened for learners in those communities.

Sarah Dawson: Max, you contributed recently to an article that was published in the New England Journal of Medicine about fair allocation of medical resources. Can you help us understand how those decisions are made, and what the implications are in Canada and globally?

Maxwell Smith: Absolutely. In the best of times, we have challenges allocating resources in a fair manner. So even in Canada, where we have sensibly equal access to health care services and important medical services, we know there’s highly entrenched inequities in accessing and benefiting from those resources.

So, in a pandemic, when resources in many cases are even more scarce, the challenge becomes even greater, and the importance of fairness and thinking through an equitable distribution of those resources becomes even more important. For a few decades now, in the ethics and medical communities, we’ve been thinking about the considerations or principles that ought to guide how we make decisions about the allocation of these resources. And I think we’ve come to a consensus that, in part, it depends on the resource. So, if we’re talking about a vaccine, then we might want to allocate that in a particular way but if we’re talking about a ventilator and critical care, then we might have different sort of ethical considerations to guide the decisions.

We need expertise, we need ethical considerations to inform those decision-making processes, but ultimately, we need to hear the perspectives of those that will ultimately be affected by those decisions. So, as you can imagine, this becomes very difficult in a very time-constrained environment, when we’re trying to respond to a pandemic.

Sarah Dawson: Can you both tell us a little bit about what you think the long-term social impacts might be and how those are projected over the course of the next year?

Prachi Srivastava: In terms of long-term impacts on the education emergency within the Canadian context, I’m thinking about underserved communities. Communities that already have a hard time accessing services in education: Northern communities, rural communities, inner city communities, children of refugees, new immigrants, children whose first language is not French or English.

And we know from the literature that when there are disruptions of any kind, it disproportionately affects children and youth who already have gaps and who are coming from underserved communities. Many times, these are long and multifactorial problems; results of issues of exclusion that have occurred over time, again and again. So, the fact that this education emergency affects nearly an entire generation, we cannot take this lightly.

Of course, our immediate focus is on the health impact, to make sure that our transmissions are lower, that we come up with treatments, a vaccine, of course. But Henrietta Fore, the chief of UNICEF, said “children are the invisible victims of this pandemic.” And the reason she said that is because we know that their rates of contraction, and in terms of the effects on mortality of children and youth, are lower than adults. But when we look at the impact on their learning and what this means for their life chances, they are going to be affected en masse, the entire generation, and I cannot stress that enough. I think our political commentary and public discourse has been lagging in this regard.

I think our policy action is still trying to come to grips with the school closures, which in and of itself is quite controversial. There is controversial evidence about the effectiveness of school closures in terms of minimizing transmission. I’m not arguing one way or another here, I think the point where we were at, when the government took this decision, it was the right decision. But in terms of the long-term impact, we have to act now, we have to act fast, we have to think about what this means for this school year.

Premier Doug Ford said yesterday that we are extending the school closures, but this does not mean that the school year is written off. If that is the case, what are we thinking about in terms of September, what are we thinking about in terms of looking at accelerated education programs or catch-up education programs? Are we thinking about the next two years, of reforming the curriculum? What is going to happen to those children? If they were in Grade 2 this year, are they going to re-enter in Grade 2, is it going to be a modified Grade 2, is it going to be Grade 3, but a modified way? These are all questions we don’t have answers to right now. But these are the questions we need to be thinking about if we want to mitigate learning losses and potential exclusion of our children and youth.

MAXWELL SMITH

Maxwell Smith

Maxwell Smith: From a response standpoint, we are focusing on the health care system and on the health of the population. And we need to be thinking about the social implications. But given what we know from public health, and the social determinants of health, all the social implications of this pandemic will, in turn, have health implications. The difficulty there is in balancing immediate health implications and trying to curb the spread of the disease, with the longer-term health implications that will be a product of those social implications. And that becomes a very difficult challenge. We can’t simply look to the evidence to give us a clear answer as to how we ought to balance those.

I see that as a fundamentally ethical question where we need to really consider our values in society and determine an acceptable risk or exposure to the virus. What is acceptable in terms of long-term risks and social implications?

The other thing is that the virus and the pandemic will have social implications, I think that’s manifested in the pandemic itself. But our response and where we want to go in the recovery phase and afterwards, and the social implications of that, I think it’s up to us to a great extent. What do we want to see and modify, given some of the problems that have been exacerbated by the pandemic? The social implications are something that we might be able to have some control over if we have the political will to do so.

Sarah Dawson: A few questions have come to us from social media. There’s a lot of concern about the impact of this crisis for those struggling with mental health and addictions. What can we do to support those whose mental health may be suffering as a result of limited physical and social exposure as well as the anxiety brought on by uncertainty?

Maxwell Smith: I think the mental health burden could be understood in such a multifactorial way. I think it’s a huge issue that we’ll only really understand the gravity of well after the pandemic and it’s going to take some time to come to grips with what that looks like.

One of the things that really concerns me is in our response to the pandemic. I think it’s important that one of the priorities we have is trying to reduce the burden on the health care system. In all the narratives around flattening the curve, we want to make sure there isn’t a high burden on the health care system all at once because that was a large discrepancy in our system. So, by ensuring that we’re not burdening the health system, we’re pushing more of the need and support into the community. And in many cases, that’s in many underserved populations who are now requiring home care, long-term care, mental health care, whatever it might be, with likely inadequate supports because in many cases those supports are inadequate at the best of times. So, I could see this exacerbating mental health supports and mental illness as a result. And the implications of that will probably be very long-term.

Prachi Srivastava: We are currently in a situation where the household, the family, is the core central service provider of almost everything. What happens to families economically, health-wise, socially, psychosocially, will have an impact on children and youth.

For the most vulnerable communities and the most vulnerable families within communities, schools often act as hubs for allied services. Allied services in terms of psychosocial supports, occupational therapy supports, supports for children with learning difficulties, meals, clothing. When schools act as the community liaison, it becomes very hard to replicate when that resource is taken away. And now the household has become the central service provider.

I think countries like Canada, who have not been in situations of mass emergency and conflict, have not had to think as broadly in terms of their policy tools, across sectors. Now we are in a situation where we need to think of new policy models.

And that’s where perhaps experiences of countries that have gone through conflicts, emergencies and mass disruptions of health and education services. What have they done, how have thought of those supports in a more concerted way? If we’ve closed schools, what are all the support services that were essentially being provided through the schools, aside from learning? How do we extend that to households that are now the site of those provisions?

Sarah Dawson: This term, postsecondary students were asked to transition their learning online and take their exams online. What might we expect the implications to be as we approach fall and how can we prepare for that?

Prachi Srivastava: Our ability to control the spread of this virus quickly, our health response, is going to dictate our education response in every sector. I don’t think there’s going to be a ‘return to normal,’ to the way that we were living. In some instances, I don’t think that’s necessarily all bad; I think there are big improvements that we could make.

But in terms of September, there’s a question of, will we have to reorient our school years? Will we have to think of a different timeline? We don’t really know how this is going to progress over the summer so, what happens in September right now is quite unknown.

Speaking as a professor, all of us are trying to think of creative solutions – if we start in September in the normal way – to how we can best serve our students. All the discussions happening within our faculties, with administration and staff are about how can we best serve our students when that time comes. We do have different models that we’re considering in our own pedagogies, but this is going to be a decision that is linked to how we do over the next few months and particularly how we do in the summer.

Maxwell Smith: There are two things that will tell us whether we’re opening back up September or not.

One is how well we do in social distancing and whether we respect public health measures. I think that remains to be seen.

The other thing is, I don’t think evidence alone is going to tell us precisely whether that will occur. We can look at epidemiological models that can predict or indicate that we are on the downward slope of that curve. And it might suggest: well, the fact that we’re going down is good, but really, I think it’s still a collective decision. The degree to which we’re all willing to go on as business as usual, given that existing risk.

So, by September, I’m not an epidemiologist, but I think I can be confident in saying that the virus will still be around with us in the world. And I think that we’re not going to get an all-clear message from the Government saying, ‘we’re good to go, everything can go back to normal.’ In light of that, I think we need to have an explicit discussion about a collective decision regarding the conditions that need to be met for us to feel comfortable going back to school in September and starting up other areas of the economy.

Sarah Dawson: This is a good segue to a question from Beth G. on social media, she just said: When this is over, will society embrace one another gladly or will we remain fearful of one another?

Prachi Srivastava: I think that really depends on us. We are the collective, each and every one of us, and we choose how to go to forward. I have seen incredible shows of support and helping and kindness. There have also been incredible stories of exclusion and xenophobia. But where we are in terms of a moment in history, I cannot think of any other moment in recent history, in which almost every single country on Earth, and almost every single person is affected somehow. There is just no other model for this.

So, we could be free from the shackles of what we have known. But I think, in order for us to capitalize on that we have to start structuring our systems to take that into consideration. How do we change our mental models, how do we infuse that care for excluded vulnerable groups, that care for the collective within an education response, within a home health response, within social security, within issues of employment, within issues of women and children, within our First Nations communities? How do we do that moving forward?

Maxwell Smith: I would add that the extent to which we’ll fear one another when this is all said and done will come back to the extent to which we are able to realize a fundamental ethical value in all of this, which is solidarity.

If at the point of recovery, or after that, we’re looking back on a response and we identify things that we did wrong in ways that were untrustworthy, were illegitimate, then that breeds mistrust and we may remain fearful of one another.

But in our response right now, we can breed and engender trust and solidarity with one another. And I think in the recovery phase we can look back and say, ‘we are all in that together and we made it, we’re in it together now,’ and I think that would go a long way in mitigating some of that fear and mistrust that we have.

Sarah Dawson: Max, say we have a vaccine that is ready to be administered. What are the ethical implications and the thought processes that inform who gets the vaccine and why?

Maxwell Smith: There are a lot of considerations that need answering before we have a concrete answer to that question. Do we have good antibody tests at the time of the vaccine being rolled out? What percentage of the world has been conferred some sort of immunity already?

I think one assumption we can make is that when we do develop a safe and effective vaccine, we’ll need to scale it up in terms of production. But we’ll want to get it out as soon as possible, so we can’t wait until we have 78 billion vaccines when we start allocating it. We will have some prioritization decisions to make as soon as this becomes a viable product. And I think we need to ensure that those who are most at risk of infection and those who are at the highest risk of transmitting the virus need to be prioritized, for example health-care workers. And then, especially those that are most at risk of becoming seriously ill as a result of becoming infected, like those with high levels of multi-morbidity, older adults, and the most vulnerable population. I think that they have a good moral claim to some sort of priority to receiving the vaccine before others do.

Sarah Dawson: Can both of you help us understand why the decision was made to keep public transit open right and how that might impact the community?

Maxwell Smith: I will start by offering an absurd conclusion to say one way to really interrupt the transmission of this virus is for every single person to isolate themselves, even from their family members within their home. If every single human were able to do that, then within a few weeks we would see no more disease transmission. So, we know that could work but, for obvious reasons, find that unacceptable.

And so, there’s things that we require for our society to function and for people to still have livelihoods, basic things like food and grocery stores. And we rely on many essential workers including health-care workers to do their jobs, many of which require public transit to do those jobs, so that’s one of the reasons I suppose that we find it acceptable for that exception to exist.

Prachi Srivastava: I agree, if we want to look at it from a legal standpoint, essential services are defined in a certain way. Education is not defined as an essential service, which we could have a philosophical discussion about, so it’s one of the reasons why schools and universities are closed whereas other institutions are open, like hardware stores or public transit. It’s in terms of how we define certain things, what are those core functions we need to get through our very basic tasks.

Sarah Dawson: What’s the world going to look like once we’re allowed to be together again?

Prachi Srivastava: I don’t have an answer for that. Even though I’m quite critical in what I write, at heart, I’m an optimistic person. And I think that at the end of this, we’re all just going to want to see all the people we love and tell them that we love them. I hope that’s where we go.

Maxwell Smith: I think it’s up to us. But I think it’s critically dependent on remembering the sorts of decisions and reasons we’re making the decisions that we’re making right now. Having a basic income for those that are disadvantaged by this pandemic is the humanitarian decision but it’s something we owe to those disadvantaged members of our society. And now, a lot of us are very much disadvantaged by this pandemic in a way they couldn’t fathom before this.

So, my hope is that we remember that humanity requires that sort of creative thinking that I don’t think was even on the table or was possible prior to this pandemic. And not to say that people weren’t absolutely advocating for that sort of thinking, but hopefully that thread can still exist in our thinking after this.

Prachi Srivastava: But there are two issues with that. There’s an individual level of acceptance of others and there’s the systems and institutional response. In terms of our systems and institutional responses, we, in Canada, are very much limited by the mental models that have guided the way we’ve constructed our systems. There is no reason for the argument of ‘scarce resources’ to continually define these fundamental social structures.

Education has long been under-financed, one in four countries in the world have not spent what they should be spending on education.

I think the one thing that is going to happen, citizens in Canada are going to start questioning when we hear the ‘scarce resources’ response. I hope that we will wake up and say, ‘wait a minute, are the resources really scarce, or do we just decide that we’re not going to do that because it doesn’t affect us, it affects the most vulnerable, it affects the most disenfranchised?’

And I hope that those feelings of love for one another, those feelings of care for one another, translate into different mental models guiding our decisions. I mean, even the problem of homelessness. Every winter, we wonder what’s going to happen to the homeless people. And now, with a public health emergency, we’ve been forced to look at how can we house the homeless and I don’t see as many homeless people on the streets. So, the idea that we cannot quickly mobilize is no longer going to be palatable.

And that is a turning point for democracy, for citizens’ engagement, and for how we can rethink our systems. And until we institutionalize that thinking, we will not be able to move forward.

Maxwell Smith: If we think of this public health emergency or say, 9/11, or other sorts of emergency events, I think we realize this value of solidarity, this acute psychological realization that we’re in this together. It would just be nice if that could hold over to non-emergency time.

Sarah Dawson: Max, how do we administer a vaccine without a long-term study?

Maxwell Smith: I have a lot of confidence in the science that will go into the development of vaccines and therapeutics, that we will demonstrate safety and effectiveness. And that’s why, despite the urgent need to have a vaccine, the predictions are still that we won’t see it for a year or a year-and-a-half.

It’s not because we’re lazy, it’s not because we lack money. We have the whole world behind this, in fact we have a World Health Organization trying to guide the development of a safe vaccine and effective therapeutics. The due diligence is there and being on the ethics group at the World Health Organization, I’ve not heard anything to the contrary, no one’s cutting corners. We are doing everything we can as a global community to speed this up as fast as possible but still within the constraints of ethics and scientific validity.

Sarah Dawson: How do we, with good humanity but also some underlying concern, deal with social distancing, particularly when witnessing those not adhering to the guidelines?

Maxwell Smith: That’s tough, I’ve read articles recently saying we can’t police our way out of this pandemic. I totally agree with that sentiment. The idea of ratting out your neighbour can be deeply problematic.

From an ethics standpoint, we’ve done a lot of research on the use of social distancing and restrictive measures and the conclusion is that these need to be as voluntary as possible in order to get people to buy into the necessity of them, rather than compelling people to comply.

Sarah Dawson: What are the ethical duties of health-care professionals to work during the pandemic, especially if they have limited access to the personal protective equipment?

Maxwell Smith: That’s the million-dollar question. There are a lot of legal and ethical discussions around a physician’s obligation to care in the context of a pandemic or otherwise. And that I think falls squarely on physicians given that they have a fiduciary responsibility to their patients. But we can’t expect that duty to be discharged without safety mechanisms in place like personal protective equipment.

All too often, we hear people talking about the duty of all health-care workers to provide care, including personal support workers, social workers, physical therapists, occupational therapists. It’s a very complicated question that needs to be answered with input from those who are really affected by it, which includes our health-care workers.

Sarah Dawson: Prachi, you mentioned at the top of our webcast, that this is the biggest educational emergency we’ve ever seen. What would you say to parents who are struggling to navigate something that’s so unprecedented?

Prachi Srivastava: Parents have multiple demands in multi-generational families, including taking care of older members who are at higher risk. Many are seeing a severe drop in income or a precarious economic situation. Maybe the home is not the safest place for some (literature shows that instances of domestic abuse and violence increase during times like this).

So again, when the family becomes the sole service provider, all these issues of exclusion, marginalization, vulnerability become exacerbated. I think the school boards are trying their best to respond to this situation, taking into consideration that they’re working with incomplete information.

I think we can only do the best that we can. And I know it sounds like such a kind of a cop-out answer but really, in the context that we’re in without a very clear curriculum framework for the next few months, we are in a situation which I think is reactive.

But even with all the incomplete information, we need to make some decisions in terms of how we’re going to take teaching and learning forward in a way that takes into consideration all the multiple demands and the other vulnerabilities that have appeared during this particular pandemic.

Maybe we forget the idea of a typical school year. Maybe we think of a cohort-based instruction in a different way. Maybe we don’t think about age/grade specific instruction, but we think of abilities-based instruction, all of this. All of these are options, but they’re options that require some kind of decision.

Sarah Dawson: As we see a new wave of supplies coming to the country, who makes the decisions on which hospitals, nursing homes, etc. will receive these products?

Maxwell Smith: That’s a good question and it’s a difficult one. I think the ‘who’ question is likely ‘who procures those goods,’ so largely it’s the government, our Ministry of Health and Ontario Health, procuring resources like personal protective equipment. So, I think it’s incumbent on them to make that decision. And the way that that decision is made is very difficult of course, when we appreciate that it’s not even just health-care workers that require personal protective equipment but those multiple sectors of society and we could include grocery store workers, police and fire and so on and so forth.

So I think when you have a scarcity, I’m not referring to the kind of artificial scarcity that Prachi was mentioning earlier, when we simply don’t have enough of the resource to meet the demand, then we do need to make rationing decisions and we need to appreciate and acknowledge that that will burden a particular population.

And when we do that, then we need to understand that there needs to be a reciprocal element where we can support those who will not receive PPE. For instance, we can’t expect those working in long-term care homes to simply go in and do their job as normal if a conscious decision has been made not to give them that resource. We need to think of more creative ways to support them or reduce the risk to them, if that’s the decision that’s consciously made.

Sarah Dawson: Some grocery stores in Toronto have required shoppers to wear masks before they can enter. Is this policy ethical given the current circumstances, and can businesses force citizens to wear masks, or is it the right to each person to decide?

Maxwell Smith: I have no idea, that’s a good question. Grocery stores can say ‘no shirt, no shoes, no service,’ so perhaps they can make that sort of requirement here. The necessity of food is obvious and if people are being restricted access, I’m not sure how ethical that would be.

Prachi Srivastava: Can I make one point to do with availability of resources in general and I’m going to redirect it into the to the education scenario.

I hope that as a result of this experience that we start looking to use resources that we already have. In terms of the education arena, we have a great resource in the CBC. We have a great resource in public radio and public television, college and university radio frequencies. And yet I am not seeing a mobilization of those resources as viable learning platforms.

Our mental model is to move all learning online and that has shown quite big gaps. In other countries, where they have had to deal with disrupted access for years for particular communities, they have already instituted large-scale radio programming, large-scale television programming, print-based dissemination of materials, correspondence-course-style education.

This is using resources that we already have. Yes, they’re lower tech, but they might even actually be more accessible and more appropriate, especially for the earlier years, children just learning how to read and write, learners that are not particularly independent for whichever reason, they might actually be more appropriate.

And I’m not seeing a big discussion in the public or around policy models of how can we actually use resources that we already have access to, that all of us have, in a way to actually support the education emergency that we’re in here in Canada.

Sarah Dawson: How is this pandemic going to affect children and families in developing countries that don’t have the access to online resources and some of the educational tools you just mentioned?

Prachi Srivastava: The impact of this pandemic globally is probably going to be disproportionately felt in low-income and low-/ middle-income countries. In terms of exacerbating existing inequities, that is going to happen in every society.

There’s a study I read that said that in middle-income households, children, if they’re spending more time at home with their parents, they learn to read more. But the children who are coming from low-income backgrounds in those same societies, forget how to read. So globally, we’re going to see the gaps widen even more. That should be a concern for all of us because if anything, this pandemic has shown how interconnected we are. We cannot have a generation of humanity in which there are such big gaps.

But I’ll also want to end by saying that those countries are also more innovative in terms of thinking around education provision in times of disruption and access. They are able to come up with solutions to deal with those issues in a more community-oriented way because they’ve had to. I think we can learn from them, how to do that here.

Sarah Dawson: I want to thank both of you for taking the time to answer questions and to showcase your expertise.

Prachi Srivastava: Thank you, Sarah. Thank you, Max.

Maxwell Smith: Thanks, everyone, and thanks for your thoughtful questions.