Genomics in the era of COVID-19: ethical implications for clinical practice and public health
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COMMENT
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Genomics in the era of COVID-19: ethical implications for clinical practice and public health Gail Geller1,2,3* , Priya Duggal3, Chloe L. Thio2,4, Debra Mathews1,2, Jeffrey P. Kahn1,3, Lisa L. Maragakis2,5 and Brian T. Garibaldi2,6
Abstract Genomic studies of patients with COVID-19, or exposed to it, are underway to delineate host factors associated with variability in susceptibility, infectivity, and disease severity. Here, we highlight the ethical implications—both potential benefits and harms—of genomics for clinical practice and public health in the era of COVID-19. Keywords: COVID-19, Ethics, Host genomics
COVID-19, genomics, and ethics The novel disease caused by the coronavirus SARSCoV-2 (COVID-19) has resulted in over 46 million confirmed cases and over 1.2 million deaths worldwide, with the USA having the largest number of cases and deaths. COVID-19 is transmitted easily and quickly and is associated with a wide variability in severity of symptoms. Evidence from other infectious diseases suggests that variability in host genomics influences susceptibility to infections, vaccine and treatment response, morbidity, and mortality [1]. Thus, human genetic variation will likely contribute to some of these outcomes with COVID-19. Genomic studies of patients diagnosed with and exposed to COVID-19 are underway to identify genetic similarities among those most at risk for severe outcomes and to guide development of therapeutics [2, 3]. However, prior to using such genomic data in clinical and public health decision-making, it is important to consider a number of ethical, legal, and social implications (ELSI). A recent paper highlights the societal * Correspondence: [email protected] 1 Berman Institute of Bioethics, Johns Hopkins University, Deering Hall, Room 202, 1809 Ashland Ave., Baltimore, MD 21205, USA 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA Full list of author information is available at the end of the article
trade-offs necessitated by COVID-19 between protecting health and risking discrimination and exclusion from public spaces [4]. Outside the context of COVID-19, we have recently argued for the importance of anticipating ELSI issues when conducting research on the genetics of infectious disease more generally [5, 6]. In this paper, we highlight the ethical implications of genomics for clinical practice and public health in the era of COVID-19 and derive a set of key questions that would need to be considered in this context (Table 1). Whereas our previous work considered “in principle” arguments in the context of hypothetical scenarios, COVID-19 provides an opportunity to move from theory to action in a very real context.
Potential uses of genomic information and ethical implications Identifying genomic variants that contribute to COVID19 outcomes would offer potentially useful information, especially if the penetrance of these host genetic variants is high. Such information could inform clinical decision making [patient triage, access to or prioritization
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