743 10 20655 https://www.socictopen.socict.org/files/original/ea8217d5a7db2269ae5fa31ec0c3ee6d.pdf 639ade41d68136dc463b432356a9e122 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Antiviral, Anti-Inflammatory Effects of Natural Medicinal Herbs and Mushrooms and SARS-CoV-2 Infection Creator An entity primarily responsible for making the resource Fanila Shahzad, Diana Anderson, Mojgan Najafzadeh Description An account of the resource The 2019 novel coronavirus, SARS-CoV-2, producing the disease COVID-19 is a pathogenic virus that targets mostly the human respiratory system and also other organs. SARS-CoV-2 is a new strain that has not been previously identified in humans, however there have been previous outbreaks of different versions of the beta coronavirus including severe acute respiratory syndrome (SARS-CoV1) from 2002 to 2003 and the most recent Middle East respiratory syndrome (MERS-CoV) which was first identified in 2012. All of the above have been recognised as major pathogens that are a great threat to public health and global economies. Currently, no specific treatment for SARS-CoV-2 infection has been identified; however, certain drugs have shown apparent efficacy in viral inhibition of the disease. Natural substances such as herbs and mushrooms have previously demonstrated both great antiviral and anti-inflammatory activity. Thus, the possibilities of natural substances as effective treatments against COVID-19 may seem promising. One of the potential candidates against the SARS-CoV-2 virus may be Inonotus obliquus (IO), also known as chaga mushroom. IO commonly grows in Asia, Europe and North America and is widely used as a raw material in various medical conditions. In this review, we have evaluated the most effective herbs and mushrooms, in terms of the antiviral and anti-inflammatory effects which have been assessed in laboratory conditions. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource coronavirus, antiviral, covid-19, SARS-CoV-2, herbs, mushrooms Identifier An unambiguous reference to the resource within a given context 10.3390/nu12092573 Source A related resource from which the described resource is derived Biotemas Publisher An entity responsible for making the resource available Universidade Federal de Santa Catarina Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Nutrition. Foods and food supply https://www.socictopen.socict.org/files/original/3b8daf27c374272fa73428b002cd3bba.pdf 97b7716688cb828730164f677921ab57 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Reply to a Comment Published on Acta Med Port 2020; May 25; doi:10.20344/amp.14155 about the Article Published on Acta Med Port 2020; Apr 27; doi:10.20344/amp.13928 Creator An entity primarily responsible for making the resource Paulo Jorge Nogueira, Cristina Furtado, António Vaz Carneiro, Miguel De Araújo Nobre, Paulo Jorge Nicola Description An account of the resource N/a. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource coronavirus, mortality, coronavirus infections, Disease Outbreaks, covid-19, pandemics, Portugal Identifier An unambiguous reference to the resource within a given context 10.20344/amp.14378 Source A related resource from which the described resource is derived Acta Médica Portuguesa Publisher An entity responsible for making the resource available Ordem dos Médicos Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Medicine, Medicine (General) https://www.socictopen.socict.org/files/original/2a2a70d86b5e51979bdfde671970cf96.pdf 18e63f91a34f933feaf5fa9f159600ac Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Preliminary investigation of individuals as information sources among two language minorities during COVID-19 pandemic in Finland Creator An entity primarily responsible for making the resource Anu Ojaranta, Hamed Ahmadinia, Eeva-Liisa Eskola Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource information behavior [http://www.yso.fi/onto/yso/p24916], minorities [http://www.yso.fi/onto/yso/p5740], COVID-19 [http://www.yso.fi/onto/yso/p38829] Identifier An unambiguous reference to the resource within a given context 10.23978/inf.99084 Source A related resource from which the described resource is derived Informaatiotutkimus Publisher An entity responsible for making the resource available Informaatiotutkimuksen yhdistys ITY ry Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Bibliography. Library science. Information resources https://www.socictopen.socict.org/files/original/d87b6dc2a223653539fd7efc4cbfc44d.pdf fa685e08027ab9308d27747bd164a394 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Intrinsic Cultural Factors That Helped Vietnam Overcome the COVID-19 Pandemic Compared with Other Countries. Creator An entity primarily responsible for making the resource Ngoc Cindy Pham, Tofazzal Hossain, Claudio Schapsis, Yuanqing Li, Huan Henry Pham, Dov Fischer, Jun Yang Description An account of the resource The Coronavirus Disease 2019 (COVID-19) pandemic emerged in Wuhan, China, spread nationwide and then onto many other countries between December 2019 and early 2020. The implementation of strict quarantine measures in Vietnam has kept a large number of people in isolation and has eventually put the disease under control. Social and physical distancing turned to be an efficient way of slowing the spread of disease and stopping chains of transmission of COVID-19 as well as preventing new ones from appearing (World Health Organization, 2020). Analyzing the World Health Organization (WHO) data, we could see a clear difference in the reported numbers between Vietnam, a developing country, and the USA, one of the leading developed countries in the western hemisphere. We tried to address the question if there are factors that helped local governments to implement helpful rules. We argue that Eastern Asian cultural traits played a role in reducing the spread of COVID-19. We recommend to take this commentary paper, and further research those cultural factors that positively affected the slowdown of the spread of the COVID-19 pandemic in Vietnam. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource covid-19, Confucius, intrinsic cultural factors Identifier An unambiguous reference to the resource within a given context 10.24083/apjhm.v15i3.425 Source A related resource from which the described resource is derived Asia Pacific Journal of Health Management Publisher An entity responsible for making the resource available ACHSM Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Public aspects of medicine, Medicine (General) https://www.socictopen.socict.org/files/original/a921ccea8e1a39b9596c7eedc2c6c9c7.pdf 95489b444e61e80979790234c010fd7f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource COVID-19 – A Tale of Two Cities: Seattle and Vancouver Creator An entity primarily responsible for making the resource Ben Yuk Fai Fong, Vincent T. S. Law Description An account of the resource The coronavirus pandemic has been affecting many countries in the world over the past six months. Nowhere sees the light at the end of the tunnel. Precautionary measures, lockdown, as well as control of crowd gathering and movement have been implemented by all governments, with the sacrifice of economic activities. It is interesting to review how things were happening in North America where the United States has been hard hit by the coronavirus disease 2019 (COVID-19), scoring over two million confirmed cases and about 120 thousand deaths at the top of the list of the world. Canada ranked eighteenth with about 100 thousand cases and just about 8 thousand deaths. Both the cases and deaths per capita are lower in Canada, which shares the same border and similar culture with the United States. Seattle and Vancouver have some of the highest incomes and educational levels in both countries. These two West coast cities are only 200 kilometres apart and are near the U.S.-Canada border. They are selected for this review to study the different approaches in managing the COVID-19 pandemic. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource coronavirus; pandemic; covid-19; health care systems; public health; social distancing; masks Identifier An unambiguous reference to the resource within a given context 10.24083/apjhm.v15i3.455 Source A related resource from which the described resource is derived Asia Pacific Journal of Health Management Publisher An entity responsible for making the resource available ACHSM Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Public aspects of medicine, Medicine (General) https://www.socictopen.socict.org/files/original/0ca7af5391e3f397c7e37ae442c32803.pdf 18688b3b5c3840e7288964bbf3803aa5 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prediction of Single Point Mutations in Human Coronavirus and Their Effects on Binding to 9-O-Acetylated Sialic Acid and Hidroxychloroquine Creator An entity primarily responsible for making the resource Petar M Mitrasinovic Description An account of the resource Due to the current spreading of the new disease CoViD-19, the World Health Organization formally declared a world pandemic on March 11, 2020. The present trends indicate that the pandemic will have an enormous clinical and economic impact on population health. Infections are initiated by the transmembrane spike (S) glycoproteins of human coronavirus (hCoV) binding to host receptors. Ongoing research and therapeutic product development are of vital importance for the successful treatment of CoViD-19. To contribute somewhat to the overall effort, herein, single point mutations (SPMs) of the binding site residues in hCoV-OC43 S that recognizes cellular surface components containing 9-O-acetylated sialic acid (9-O-Ac-Sia) are explored using an in silico protein engineering approach, while their effects on the binding of 9-O-Ac-Sia and Hidroxychloroquine (Hcq) are evaluated using molecular docking simulations. Thr31Met and Val84Arg are predicted to be the critical – most likely SPMs in hCoV-OC43 S for the binding of 9-O-Ac-Sia and Hcq, respectively, even though Thr31Met is a very likely SPM in the case of Hcq too. The corresponding modes of interaction indicate a comparable strength of the Thr31Met/9-O-Ac-Sia and Val84Arg/Hcq (or Thr31Met/Hcq) complexes. Given that the binding site is conserved in all CoV S glycoproteins that associate with 9-O-acetyl-sialoglycans, the high hydrophobic affinity of Hcq to hCoV-OC43 S speaks in favor of its ability to competitively inhibit rapid S-mediated virion attachment in high-density receptor environments, but its considerably low specificity to hCoV-OC43 S may be one of the key obstacles in considering the potential of Hcq to become a drug candidate. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource coronavirus, covid-19, Pandemic, single-point-mutation, hidroxychloroquine Identifier An unambiguous reference to the resource within a given context 10.17344/acsi.2020.6009 Source A related resource from which the described resource is derived Acta Chimica Slovenica Publisher An entity responsible for making the resource available Slovenian Chemical Society Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Chemistry https://www.socictopen.socict.org/files/original/6d71b37d67a13a80e068393148ec9a76.pdf 7b8ad05cfaa03441d8916ef881e36426 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Analyzing COVID-19 Impacts on Vehicle Travels and Daily Nitrogen Dioxide (NO₂) Levels among Florida Counties Creator An entity primarily responsible for making the resource Alican Karaer, Nozhan Balafkan, Michele Gazzea, Reza Arghandeh, Eren Erman Ozguven Description An account of the resource The COVID-19 outbreak and ensuing social distancing behaviors resulted in substantial reduction on traffic, making this a unique experiment on observing the air quality. Such an experiment is also supplemental to the smart city concept as it can help to identify whether there is a delay on air quality improvement during or after a sharp decline on traffic and to determine what, if any, factors are contributing to that time lag. As such, this study investigates the immediate impacts of COVID-19 causing abrupt declines on traffic and NO2 concentration in all Florida Counties through March 2020. Daily tropospheric NO2 concentrations were extracted from the Sentinel-5 Precursor satellite and vehicle mile traveled (VMT) estimates were acquired from cell phone mobility records. It is observed that overall impacts of the COVID-19 response in Florida have started in the first half of the March 2020, two weeks earlier than the official stay-at-home orders, and resulted in 54.07% and 59.68% decrease by the end of the month on NO2 and VMT, respectively. Further, a cross-correlation based dependency analysis was conducted to analyze the similarities and associated time lag between 7-day moving averages of VMT and NO2 concentrations of the 67 counties. Although such reduction is unprecedented for both data sets, results indicate a strong correlation and this correlation increases with the identification of a time lag between VMT and NO2 concentration. Majority of the counties have no time lag between VMT and NO2 concentration; however, a cluster of South Florida counties presents earlier decrease on NO2 concentration compare to VMT, which indicates that the air quality improvements in those counties are not traffic related. Investigation on the socioeconomic factors indicates that population density and income level have no significant impact on the time lag between traffic and air quality improvements in light of COVID-19. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource covid-19, traffic, remote sensing, nitrogen dioxide (NO₂), Sentinel-5P, vehicle mile traveled (VMT) Identifier An unambiguous reference to the resource within a given context 10.3390/en13226044 Source A related resource from which the described resource is derived Epidemiology and Health Publisher An entity responsible for making the resource available Korean Society of Epidemiology Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Technology https://www.socictopen.socict.org/files/original/38cf0deef7ecaea24dfe9ce600c03e44.pdf 9bb3cbd4efa83e585a6dc618bfb5cc82 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Recommendations about the Use of Psychotropic Medications during the COVID-19 Pandemic Creator An entity primarily responsible for making the resource Gabriela Andrade, Frederico Simões do Couto, Luis Câmara-Pestana Description An account of the resource Introduction: The COVID-19 pandemic is a particularly relevant threat to mentally ill patients, and it constitutes a new challenge for health care providers. To the best of our knowledge, there is not any embracing published review about the use of psychotropic drugs during the COVID-19 pandemic. Materials and Methods: Non-systematic literature review. A search in the PubMed database was performed, with the terms ‘psychotropic drugs’, ‘COVID-19’, ‘psychiatry’ and ‘pandemic’. Consensus and clinical guidelines about psychotropic drugs and COVID-19 approach, published by scientific societies, governmental entities and drug regulatory agencies were included. Results and Discussion: We present the recommendations about the use of psychotropic drugs during the COVID-19 pandemic, in the outpatient and inpatient settings. The treatment of affective bipolar disorder and schizophrenia have now added increased difficulties. Some psychotropic drugs interfere with the pathophysiology of the novel coronavirus infection and they could interact with the drugs used in the treatment of COVID-19. Some patients will need pharmacological interventions due to the presence of delirium. Smoking cessation changes the serum levels of some psychotropic drugs and may influence their use. Conclusion: The COVID-19 pandemic has created new challenges in clinical practice. Psychiatric patients are a vulnerable population and often a careful clinical, laboratorial and electrocardiographic evaluation may be needed, particularly in those diagnosed with COVID-19. The regular treatment of mentally ill patients with COVID-19 presents increased complexity. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource covid-19, pandemia, psiquiatría, Fármacos psicotrópicos Identifier An unambiguous reference to the resource within a given context 10.20344/amp.13976 Source A related resource from which the described resource is derived Acta Médica Portuguesa Publisher An entity responsible for making the resource available Ordem dos Médicos Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Medicine, Medicine (General) https://www.socictopen.socict.org/files/original/d3772c575cc1622331cb4596de43be65.pdf 2c676245b3b9287429891bb1c68ebf46 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Roles of <it>TNF</it>-α gene polymorphisms in the occurrence and progress of SARS-Cov infection: A case-control study Creator An entity primarily responsible for making the resource Su Bing, Yang Zhen, He Li, Zhang Keju, Han Yi, Wei Maoti, Wang Shixin, Zhang Zhilun, Hu Yilan, Hui Wuli Description An account of the resource Abstract Background Host genetic factors may play a role in the occurrence and progress of SARS-Cov infection. This study was to investigate the relationship between tumor necrosis factor (TNF)-α gene polymorphisms with the occurrence of SARS-CoV infection and its role in prognosis of patients with lung interstitial fibrosis and femoral head osteonecrosis. Methods The association between genetic polymorphisms of TNF-α gene and susceptibility to severe acute respiratory syndromes (SARS) was conducted in a hospital-based case-control study including 75 SARS patients, 41 health care workers and 92 healthy controls. Relationships of TNF-α gene polymorphisms with interstitial lung fibrosis and femoral head osteonecrosis were carried out in two case-case studies in discharged SARS patients. PCR sequencing based typing (PCR-SBT) method was used to determine the polymorphisms of TNF-α gene in locus of the promoter region and univariate logistic analysis was conducted in analyzing the collected data. Results Compared to TT genotype, the CT genotype at the -204 locus was found associated with a protective effect on SARS with OR(95%CI) of 0.95(0.90–0.99). Also, TT genotype, CT and CC were found associated with a risk effect on femoral head necrosis with ORs(95%CI) of 5.33(1.39–20.45) and 5.67(2.74–11.71), respectively and the glucocorticoid adjusted OR of CT was 5.25(95%CI 1.18–23.46) and the combined (CT and CC) genotype OR was 6.0 (95%CI 1.60–22.55) at -1031 site of TNF-α gene. At the same time, the -863 AC genotype was manifested as another risk effect associated with femoral head necrosis with OR(95%CI) of 6.42(1.53–26.88) and the adjusted OR was 8.40(95%CI 1.76–40.02) in cured SARS patients compared to CC genotype. Conclusion SNPs of TNF-α gene of promoter region may not associate with SARS-CoV infection. And these SNPs may not affect interstitial lung fibrosis in cured SARS patients. However, the -1031CT/CC and -863 AC genotypes may be risk factors of femoral head necrosis in discharged SARS patients. Date A point or period of time associated with an event in the lifecycle of the resource 2008 Identifier An unambiguous reference to the resource within a given context 10.1186/1471-2334-8-27 Source A related resource from which the described resource is derived Epidemiology and Health Publisher An entity responsible for making the resource available Korean Society of Epidemiology Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Infectious and parasitic diseases https://www.socictopen.socict.org/files/original/be16f6c079341760bb6ef1079c18e5d5.pdf bced2cdc47a12a1bd39f7b881cf74bb1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Non-COVID-19 Patients Left out in the Cold Creator An entity primarily responsible for making the resource Camille Castelyn Description An account of the resource  I. Introduction Countries across the globe including the United States (US) and South Africa have recently reported a surge of non-COVID-19 related deaths.[1] As there is limited accurate and reliable data of this new problem emerging during the COVID-19 pandemic,[2]  the full extent of the problem is unknown. The lack of data makes it difficult to understand the gravity of the situation and to address it. Medical professionals are asking why these non-COVID related cases did not present at hospitals. Aside from each country’s unique demographics influencing the ability to treat pre-existing chronic diseases alongside COVID-19, resource allocation may lie at the heart of the problem.[3] The World Health Organization’s[4] declaration that COVID-19 was a pandemic on March 12, 2020 placed the fight against COVID-19 front and center in most countries across the world. Italy was one of the first countries to be hit hardest, as localized lockdowns expanded to a countrywide lockdown in a desperate attempt to stop the outbreak. In the US, the first case was confirmed on January 21, 2020.[5] Presidential actions lagged in decisiveness[6] leading to disproportionate loss of life[7] and diminishing hopes of containing the outbreak. In South Africa, swift action included a lockdown long before community spread was confirmed, [8] which slowed the initial spread of the virus. This swift response may be attributed to the fresh memories of Malaria and HIV, which remain a threat. A proactive lockdown like this does come at a price. Buying time for Emergency Departments (EDs) and medical professionals to prepare[9] meant slowing the economy to a halt. In different countries across the world, healthcare was accessible to varying degrees prior to the pandemic. In South Africa, the healthcare system is severely strained[10] in comparison to nations like the US. A non-COVID-19 patient’s ability to access healthcare during this time has been limited. For example, routine child vaccinations have been disrupted,[11] critical delivery of anti-retroviral drugs for HIV treatment has been disrupted, non-elective surgeries have been suspended, cancer patients have been receiving limited treatment,[12] and mothers have had limited labor and delivery care.[13] While these disruptions occur in other nations as well, countries with more robust healthcare systems may be able to bear the brunt of this burden more successfully than nations like South Africa.  These disruptions are not trivial and add pressure on healthcare systems in both the short and long run. 2.     Status quo of Resource Allocation Re-evaluated The status quo of resource allocation both within and outside a clinical setting in this pandemic prioritizes COVID-19 tacitly and overtly. If two patients of equal need and prognosis arrive at an ED, it is more likely that the patient with COVID-19 symptoms will be treated first, or at the very least be transferred to a separate room or hospital section. Furthermore, non-COVID-19 patients have avoided EDs due to fear of contracting COVID-19.[14] Up until now, most people would argue that this is a necessary sacrifice to mitigate the impact of COVID-19. However, increased deaths of non-COVID-19 patients have brought a re-evaluation of the current status quo. This re-evaluation is further complicated by a global shortage of medical staff and medical equipment (including PPE and ventilators). Many ethical frameworks and guidelines have been issued to help navigate these uncharted waters of pandemic ethics in the 21st century.[15] All of these frameworks inevitably have underlying value judgements and prevalent ethical principles that guide resource allocation. These principles can be divided into four categories – maximizing total benefits, treating people equally, promoting and rewarding social usefulness, and favoring those that are worst off.[16] Prioritizing COVID-19 patients in a pandemic maximizes total benefits for all in a pandemic situation.[17] However, this approach has also led to people dying at home from conditions that could have been effectively treated in a hospital setting. Maximizing total benefits is a utilitarian approach.  However, the tension between providing the best possible care and respecting an individual’s autonomy, while also saving the greatest number of lives, has once again been re-evaluated.[18] Often, pandemic ethics single out one principle, such as utilitarianism; however, this has proven to be detrimental. Consequently, there is a shift toward utilizing multi-principle allocation systems. In the past, a multi-principle allocation system as described by Persad et al., has ensured distributive justice when applied to scarce medical interventions on allocation of organs and vaccines.[19] In these instances, choosing only one of the principles, such as youngest first or  favoring those with the best prognosis or those who are worst-off, may favor a certain group of people at the cost of another. This is inefficient if we consider the concept of distributive justice as first described by John Rawls.[20] Rawls described the veil of ignorance, where in order for one to gauge whether decisions are adequate, one must conduct a thought experiment from behind the veil of ignorance. For example, if you choose to prioritize those who are youngest first, without knowing whether the person standing behind the veil is young or old, your decision should be fair to whoever is behind the veil. Amid COVID-19, a multi-principle approach would address the moral complexities of these perplexing decisions better than a one principled approach such as maximizing the most lives. It would take into account numerous principles even though they may seem to be in tension with one another. This would include socio-economic factors as well, while aiming to treat people equitably and also taking into account those who are worst off. Opposing critics might argue that saving the most lives, with specific reference to triage protocols, is the only way to enable healthcare workers to make fast and efficient decisions in hospital settings. These approaches do have their rightful place in resource allocation. However, this article makes a plea toward the complexities of pandemic ethics that should be factored in.  3.     Drawing on Past Experiences South Africa and other African countries have experienced other severe infectious disease outbreaks such as AIDS and Ebola, an extremely valuable occurrence that should be drawn upon.[21] For example, allocating scarce resources amid outbreaks of Ebola  trained medical professionals to act efficiently and intuitively. Ebola and HIV also sparked innovation and identification of creative uses for available resources. South Africa has been grappling with the HIV crisis for 20 years. It has vast experience in tracking and studying viruses. Furthermore, a lot of specialized research has been done for the past 15 years to study people’s immune responses to HIV.[22] Technologies are being repurposed to investigate what immune responses can be expected from patients infected with SARS-CoV-2.[23] South Africa is also well suited for vaccine trials as it has been a major contributor of sites for internationally funded clinical trials. Consequently, a landmark COVID-19 treatment trial has already been lined up. [24] In West Africa, surveillance techniques that were developed for the 2014-2015 Ebola outbreak, which infected 28,000 people and killed 11,000 people in Guinea, Liberia, and Sierra Leone, are now being deployed in the fight against COVID-19.[25] [26] Across the continent, lessons learned include the critical importance of adequate respect for culture, appropriate community engagement and education, vigilance in reports of symptoms, and leveraging past research and laboratory capacities for testing and clinical vaccine trials. 4.     Limitation to This Approach and Proposed Interventions   Already strained healthcare systems may risk great losses in regarding the overall health of the population if the limited care that has been offered before this pandemic is jeopardized.  For example, the disruption of anti-retroviral treatments has serious consequences for the patients due to the high mutation rate of HIV, which makes the treatment plan time sensitive.  Other examples include many homeless people who are on methadone treatment, who at the moment are still receiving mobile delivery of their treatments. If there were complications in delivering these medications, we could see many people with extreme symptoms of withdrawal and great setbacks for people wanting to ‘come clean.’ Cancer patients also report that they find themselves having to decide whether they are willing to risk contracting COVID-19 when going in for routine treatments or skipping treatments now and risking cancer later. Interventions, including telemedicine, should be prioritized. Although there may also be unique challenges of exposure to healthcare professionals upon home visits, these risks must be evaluated and mitigated to ensure continuation of care. Some hospitals in the US are currently evaluating the impact and effectiveness of current telemedicine approaches. Midwives and other healthcare workers should also be trained adequately and dispersed to deliver care at home. Furthermore, this challenging time may also serve as an impetus for all stakeholders to prioritize improving healthcare delivery for all, albeit through seemingly unrelated victories, such as adequately communicating and educating local communities on basic healthcare or delivering basic sanitary services like running water and improved infrastructure. 5.     Conclusion The very nature of pandemic ethics provides unforeseen challenges such as the one that has been described here. A multi-principle approach, which also draws on past experiences, will empower all global stakeholders (governments, leaders, patients and medical professionals alike) to make choices that enable equitable resource allocation.   Photo by Benjamin Voros on Unsplash [1] Krumholz, Harlan. 2020. “Where Have All the Heart Attacks Gone?,” April 6, 2020. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack stroke.html?algo=identity&fellback=false&imp_id=450663239&imp_id=67343380&action=click&module=Science%20%20Technology&pgtype=Homepage. Walsh, James D. 2020. “The Mystery of ‘Excess Fatality.’” Intelligencer, April. https://nymag.com/intelligencer/2020/04/coronavirus-is-only-part-of-the-excess-fatality-mystery.html. [2] Gillum, Jack, Lisa Song, and Jeff Kao. 2020. “There’s Been a Spike in People Dying at Home in Several Cities. That Suggests Coronavirus Deaths Are Higher Than Reported.” ProPublica, April 14, 2020. https://www.propublica.org/article/theres-been-a-spike-in-people-dying-at-home-in-several-cities-that-suggests-coronavirus-deaths-are-higher-than-reported. [3] Bettina Taylor, Jeannette Parkes, and Johannes J Fagan, “How Should Health Resource Allocation Be Applied during the COVID-19 Pandemic in South Africa?,” South African Medical Journal (Online), May 20, 2020, https://doi.org/. https://doi.org/10.7196/SAMJ.2020. v110i7.14916. [4] World Health Organization. 2020. “Rolling Updates on Coronavirus Disease (COVID-19),” April 28, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. [5] Centers for Disease Control and Prevention. 2020. “Coronavirus Disease 2019: Cas in US,” February 5, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. [6] Larry Buchanan, Rebecca KK Lai, and Allison McCann, “U.S. Lags in Coronavirus Testing After Slow Response to Outbreak,” The New York Times (Online), March 17, 2020, https://www.nytimes.com/interactive/2020/03/17/us/coronavirus-testing-data.html. [7] John Eligon et al., “Black Americans Face Alarming Rates of Coronavirus Infection in Some States,” The New York Times (Online), April 14, 2020, https://www.nytimes.com/2020/04/07/us/coronavirus-race.html. [8] Cyril Ramaphosa, “Message by President Cyril Ramaphosa on COVID-19 Pandemic 30 March,” March 30, 2020, http://www.thepresidency.gov.za/speeches/message-president-cyril-ramaphosa-covid-19-pandemic; Cyril Ramaphosa, “Message by President Cyril Ramaphosa on COVID-19 Pandemic 9 April,” April 9, 2020, http://www.thepresidency.gov.za/speeches/message-president-cyril-ramaphosa-covid-19-pandemic-0. [9] Road accident fatalities over the Easter weekend decreased from 128 people in 2019 to 28 in 2020 (Saleka 2020). Emergency Departments (ED) were also eerily quiet - decreasing from 34 000 cases per week to 12 000 cases per week. BBC. 2020. “South Africa Coronavirus Lockdown: Is the Alcohol Ban Working?,” April 22, 2020. Saleka, Ntwaagae. 2020. “28 Died in Accidents during the Easter Weekend, While 719 Arrested for Traffic Violations.” News24, April 17, 2020. https://www.news24.com/SouthAfrica/News/28-died-in-accidents-during-the-easter-weekend-while-719-arrested-for-traffic-violations-20200417. [10] N Aikman, “The Crisis within the South African Healthcare System: A Multifactorial Disorder,” South African Journal of Bioethics and Law 12, no. 2 (n.d.): 52–56. [11] UNICEF. 2020. “COVID-19 Putting Routine Childhood Immunization in Danger: UN Health Agency.” United Nations News, April. https://news.un.org/en/story/2020/04/1062712. [12] Vanderpuye, Verna, Moawia Mohammed, Ali Elhassan, and Hannah Simmonds. 2020. “Preparedness for COVID-19 in the Oncology Community in Africa,” April. https://doi.org/10.1016/ S1470-2045(20)30220-5. [13] Menconi, Michael. 2020. “NY Hospitals Issue Problematic Ban on Birthing Support Persons from Labor & Delivery Units.” Voices in Bioethics, March. http://www.voicesinbioethics.net/voices-in-bioethics/2020/3/28/ny-hospitals-issue-problematic-ban-on-birthing-support-persons-from-labor-amp-delivery-units. [14] Krumholz, Harlan. 2020. “Where Have All the Heart Attacks Gone?,” April 6, 2020. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack stroke.html?algo=identity&fellback=false&imp_id=450663239&imp_id=67343380&action=click&module=Science%20%20Technology&pgtype=Homepage. [15] The South African Medical Association. 2020. “SARS-CoV-2 (COVID-19) Guidance for Managing Ethical Issues (Living Document).” The South African Medical Association. Wisner, Benjamin, John Adams, and World Health Organization, eds. 2002. “Environmental Health in Emergencies and Disasters: A Practical Guide.” World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/42561/9241545410_eng.pdf?sequence=1. Nuffield Council on Bioethics. 2020. “Rapid Policy Briefing: Ethical Considerations in Responding to the COVID-19 Pandemic.” Rapid Policy. London: Nuffield Council on Bioethics. https://www.nuffieldbioethics.org/assets/pdfs/Ethical-considerations-in-responding-to-the-COVID-19-pandemic.pdf. Berlinger, Nancy, Matthew Wynia, Tia Powell, Micah Hester, Aimee Milliken, Rachel Fabi, Felicia Cohn, et al. 2020. “Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2 (COVID-19) Guidelines for Institutional Ethics Services Responding to COVID-19 Managing Uncertainty, Safeguarding Communities, Guiding Practice.” The Hastings Center. thehastingscenter.org/ethicalframeworkcovid19. [16] Persad, G, Alan Wertheimer, and Ezekiel J Emanuel. 2009. “Principles for Allocation of Scarce Medical Interventions.” Lancet 373: 423–31. [17] Ibid. [18] Dale, Samuel. 2020. “Utilitarianism in Crisis.” Voices in Bioethics, August. http://www.voicesinbioethics.net/voices-in-bioethics/2020/5/8/utilitarianism-in-crisis. [19] G Persad, Alan Wertheimer, and Ezekiel J Emanuel, “Principles for Allocation of Scarce Medical Interventions,” Lancet 373 (2009): 423–31. [20] John Rawls, A Theory of Justice (Oxford: Oxford University Press, 1999). [21] MM Kavanagh et al., “Access to Lifesaving Medical Resources for African Countries: COVID-19 Testing and Response, Ethics, and Politics,” The Lancet, July 5, 2020, https://doi.org/10.1016/ S0140-6736(20)31093-X. [22] Sarah Wild, “How HIV Expertise Is Helping South Africa Tackle Coronavirus,” The World Economic Forum, September 4, 2020, https://www.weforum.org/agenda/2020/04/south-africa-hiv-coronavirus-covid19-pandemic-health-virus. [23] Wild. [24] Wild. [25] Medecins sans frontiers, “Crisis Update - May 2020,” Medecins sans Frontiers, May 18, 2020, https://www.msf.org/drc-ebola-outbreak-crisis-update. [26] Medecins sans frontiers, “Crisis Update - May 2020,” Medecins sans Frontiers, May 18, 2020, https://www.msf.org/drc-ebola-outbreak-crisis-update.   Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource Public health, covid-19, Bioethics, scarcity, global ethics, emergency ethics Identifier An unambiguous reference to the resource within a given context 10.7916/vib.v6i.6198 Source A related resource from which the described resource is derived Epidemiology and Health Publisher An entity responsible for making the resource available Korean Society of Epidemiology Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Ethics, Medical philosophy. Medical ethics