The coronavirus disease (COVID-19) pandemic has quickly spread to various countries. As on May 8th, 2020, in India 56342 positive cases of corona had been reported. India with a population of more than 1.35 billion had difficulty in controlling the transmission of coronavirus among its population. Multiple strategies became necessary to handle this outbreak. The Ministry of Health and Family Welfare of India raised awareness about this outbreak and to take all necessary actions to control the spread of COVID-19. Indian Government implemented a 55-day lockdown throughout the country to reduce the transmission of the virus. Schools and colleges had shifted to alternative mode of teaching-learning-evaluation and certification. Online mode became popular during these days. India was not prepared for a sudden onslaught of such a crisis due to limited infrastructure in terms of human resource, money and other facilities needed for taking care of this situation. This disease did not spare anybody irrespective of caste, creed, religion on the one hand and ‘have and have not’ on the other. Deficiencies in hospital beds, oxygen cylinders, ambulances, hospital staff and crematorium were the most crucial aspects. You are a hospital administrator in a public hospital at the time when coronavirus had attacked large number of people and patients were pouring into hospital day in and day out. (a) What are your criteria and justification for putting your clinical and non-clinical staff to attend to the patients knowing fully well that it is highly infectious disease and resources and infrastructure are limited? (b) If yours is a private hospital, whether your justification and decision would remain same as that of a public hospital?

The situation

As administrator of a public hospital during the COVID-19 surge, I must deploy clinical and non-clinical staff to a highly infectious caseload with limited human resources and infrastructure.

Stakeholders

• Patients pouring in and their families.
• Clinical and non-clinical staff facing infection risk.
• The administrator and the wider community.

(a) Criteria and justification for deploying staff

• Safety first: adequate PPE, training and infection-control protocols before deployment — duty of care runs both ways.
• Informed consent and transparent communication of risk.
• Rotation and shift design to cap cumulative exposure and prevent burnout.
• Protecting the vulnerable — exempting pregnant, elderly or comorbid staff from high-risk duty.
• Reciprocal obligations — insurance, hazard pay, quarantine facilities and family support.
• Utilitarian triage of scarce manpower to save the maximum lives, while respecting each worker's dignity.

Justification rests on the professional duty of care and the social contract of a public institution, balanced by beneficence, non-maleficence and justice, and by the state's reciprocal duty to protect those it asks to serve.

(b) Would a private hospital decide differently?

The core medical ethics — beneficence, non-maleficence, justice and the duty to treat — remain identical; a patient's life does not depend on ownership. A private hospital cannot deny emergency care (Parmananda Katara judgment) or discriminate. What differs is context: tighter profit and resource constraints and contractual staff relations. Ethically, however, the justification and the decision to protect staff while serving patients would remain fundamentally the same; only operational means may vary.

Conclusion

Whether public or private, the ethical anchor is the same — protect the caregivers so they can protect patients, and let the duty to save life override the calculus of ownership.