4 May 2020 – Policy Brief

Continued confinement of those most vulnerable to COVID-19

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Executive summary

In our policy brief on ELSI benchmarks for transition strategies, we had stated that:

Specific interventions should target the risks associated with isolation and immobilization in the >65 population: put in place «safe spaces» for the elderly (clubs, gym classes, walks); support local shopping options, without queueing, or maintain provision by volunteers while allowing some contacts (move away from the zero contact of dropping bags behind a door and no interactions between volunteers and elderly people) ; allow older persons who are willing to take the risk of becoming infected to not quarantine themselves from persons in low-risk groups (for example grand-children).

In this policy brief, we more systematically examine requirements for the protection of vulnerable persons, the situation in institutions, legal implications, requirements to sustain vulnerable persons, and self-determination. We recommend the following:

  1. Confinement cannot be the only measure in place to protect vulnerable persons. Protections are needed to enable participation in the public sphere and the exercise of rights for persons particularly vulnerable to COVID-19.
  2. Many long-term care homes have currently banned visits from residents’ next of kin and legal representatives. This situation must be corrected and solutions developed to enable contacts with these persons while still limiting the risk of contagion. Strategies enabling this should be shared among institutions in order to facilitate the diffusion of successful processes. Concepts of care compatible with accepted standards of care (both curative and palliative) must exist on site. These institutions have to be staffed with adequate resources to fulfil these tasks. Those confined in long-term care institutions should also continue even in confinement to have access to some forms of social contacts, as well daylight, sun and fresh air daily similar to the rights of persons under detention. Residents of institutions have the same rights to clear, loyal, and truthful information regarding the pandemic situation and the reasons why measures are in place, as the rest of the population. The authorities must monitor these measures.
  3. Vulnerable persons should retain the choice to place themselves at risk, as long as they do not impose risks on others. Continued confinement should be a recommendation and a right, not a duty or an obligation.
  4. Vulnerable persons who choose to remain in confinement should be protected against loss of their jobs or income, and against the risk of discrimination in the labor market. If people vulnerable to Coronavirus are allowed to opt out of working obligations, the duty of the employer to pay wages must be limited. After this period, social security should step in. If confinement persists, retraining through invalidity insurance may have to be considered in these cases. As the elderly may place themselves at risk if they take care of their grand-children, free access to child-care for parents should also be part of a protection strategy.
  5. Risk and crisis communication stresses the importance to listen to the people and to set up participatory approaches. Associations and lobbies representing the views of groups of those particularly vulnerable to COVID-19 (both the elderly and those with diseases placing them at particular risk) should be consulted. Most vulnerable persons are autonomous, competent and should be allowed to voice their own opinion.

Date of request: 
Date of response: 4/5/2020

In response to request from:

Comment on planned updates:

Expert groups and individuals involved: Ethical, legal, social 

Contact persons: samia.hurst@unige.ch