Is it unrealistic to believe that phone apps for digital Covid contact tracing can be designed and regulated in ways that prevent the information they collect from being misused? It’s worth remembering surveillance of Vietnam War protesters and Martin Luther King Jr.

With some reluctance, I’ve come to the sad realization the COVID-19 pandemic has been a stress test for bioethics, a field of study that intersects medicine, law, the humanities and the social sciences. As both a physician and medical ethicist, I arrived at this conclusion after spending months at what was once the epicenter of the pandemic: New York City. I was overseeing a 24/7 bioethics consultation service.

In his recent JAMA article, Donald Berwick eloquently describes what he termed the “moral determinants of health,” by which he meant a strong sense of social solidarity in which people in the United States would “depend on each other for securing the basic circumstances of healthy lives,” reflecting a “moral law within.” Berwick’s work should serve as a call to action for bioethicists and clinical ethicists to consider what they can do to be forces of broad moral change in their institutions.

Several states, including Ohio, Alabama, Arkansas, Texas, Iowa, and Oklahoma, declared abortion a nonessential service at some point during the pandemic, meaning that it was effectively banned until the crisis passed. Supporters of the policies maintain that abortion is an elective procedure whose medical resources are better off used in the fight against the pandemic. But abortion opponents have been taking advantage of the current circumstances to limit abortion access.

Before there was the Covid-19 pandemic, there was Pandemic. This tabletop game, in which players collaborate to fight disease outbreaks, debuted in 2007. Expansions feature weaponized pathogens, historic pandemics, zoonotic diseases, and vaccine development races. Game mechanics modelled on pandemic vectors provide multiple narratives: battle, quest, detection, discovery. There is satisfaction in playing “against” disease–and winning. Real pandemic is not as tidy as a game. But can games support understanding about the societal challenges we now face? Yes.

The Covid-19 pandemic is unlikely to end until there is a safe, effective, and widely distributed vaccine. How soon can researchers achieve this goal? The answer largely depends on which strategies researchers are willing to adopt. One potential strategy is to conduct human challenge studies, in which researchers give an experimental vaccine to healthy volunteers and then test—or “challenge”—the vaccine by purposely exposing volunteers to the virus. Although a growing number of voices are calling on researchers to employ this strategy, the proposal is generating a heated debate about the ethics of such research.

The United States leads the world in coronavirus cases and deaths. Although many people have called out the inadequacies of our health care system, Covid-19 has exposed the most significant shortcomings. The need for change can no longer be ignored. Here are three lessons from this pandemic that should be leveraged for change.

Growing isolation, financial challenges and disease burden during the Covid-19 pandemic threaten to worsen the mental health needs of the entire U.S. population. These challenges are heightened among immigrants with untreated chronic mental health conditions as they experience added psychological distress owing to harsh immigration policies and worsening structural barriers to health during the pandemic.

Covid-19 is a matter of public and global health ethics, and the pandemic is currently accelerating cooperation within and contributions from these fields. A meeting on June 27, hosted by the European Union and Global Citizen, is the latest example another global pledging event on June 27, will include governments and large institutions, as well as individuals and communities worldwide.

The rewards of social distancing are beginning to accrue in former hotspots such as Seattle, the New York metropolitan area, and the San Francisco Bay Area, where the number of new Covid-19 cases requiring hospitalization is declining. Assuming the rewards hold in the face of pressures to reopen the economy, hospitals will now face challenges of reopening their own nonpandemic services for patients whose elective surgeries and other procedures were postponed. Which patients should get priority?

One of the factors considered most important by dying patients and their families is the opportunity to be together. For many of our hospitalized patients in palliative care, the presence of loved ones at the bedside is such a given that we don’t even address it explicitly in advance care planning discussions. So, it comes as no surprise that Covid- 19-related visitor restrictions affecting hospitalized patients might impact end-of-life decision-making, potentially in ways that are ethically problematic.

Experts in infectious disease and public health warn that the Covid-19 pandemic will be with us until there is an effective vaccine, possibly 12 to 18 months in the future. This situation has given rise to calls for human challenge studies, in which healthy volunteers are injected with an experimental vaccine and then infected with the disease to test the vaccine’s efficacy. Is this ethically justifiable?