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?

We have reached a very sad, painful moment in the United States. It feels like a cascade of calamities, one compounding the next. An infectious disease pandemic that we cannot yet cure has precipitated an economic crisis. An episode of police brutality against a black man has added the name George Floyd to a long list of victims of unfair policing practices in black communities. Bioethicists have not been doing enough in our professional capacities to actively denounce or address the persistent problems of structural racism. We invite our fellow bioethics colleagues to join us in candid, uncomfortable conversations about what we can and should be doing differently.

The major success story of health care ethicists in the pandemic has been their role in establishing ventilator triage policies. But they have more to offer the C-suite of health care institutions.

When scientists first suggested population-wide social distancing as the only feasible way to suppress Covid-19, they were the first to admit it may not work in a free society. We are now months into placing mass restrictions on human behavior to suppress a virus that lacks an effective vaccine or treatment. Now is the time to ask: is this the authoritarian nightmare many feared, or will freedom and democracy survive Covid-19?

In places where Covid-19 is increasing – and in preparation for a possible second wave of the pandemic– hospitals are preparing to triage critical resources if necessary. Some are prioritizing health care workers for ventilators. We think this is a mistake.