Glad to be able to contribute to growing discussion on a timely and crucial topic--fair health care allocation in the Covid-19 pandemic--alongside Zeke Emanuel & @DrPhillipsMD: nytimes.com/2020/03/12/opi…. A quick summary of our recommendations (mini thread)
1.The group getting first priority should be health care workers and other first responders.
2.For scarce curative interventions, like ICU beds and ventilators, the priority should be (1) saving as many people as possible, and (2) treating those who are likely to benefit most from care. This means treatment should not be allocated on a first-come-first-served basis.
3.For preventive interventions like vaccines, priority should go to those likeliest to die or need lots of resources if they get sick. This priority should be modified if other groups (e.g. kids) prove to be a much greater source of virus transmission even if they get less sick.
4.When there are not enough preventive interventions to go around, it would be fair to use random selection, such as a lottery, among those in the highest risk category of dying from coronavirus.
5.Medical societies and states should develop guidelines to enable ethical and consistent decisionmaking, rather than placing the burden of tragic and wrenching decisions on docs & nurses and forcing them to make well-intentioned, but ad hoc choices under extreme pressure.
Some thoughtful statements on how to allocate scarce resources ethically in a pandemic, by Australia www1.health.nsw.gov.au/pds/ActivePDSD…; the UK www2.gov.scot/Resource/Doc/9…; and most recently an Italian medical society, partial translation by @Yascha_Mounk at theatlantic.com/ideas/archive/…
(Mounk says he has no idea if the Italian society is right or wrong. Lots to debate, but they got two things clearly right: first-come, first served is not enough, and fair allocation will impact every patient, not just those with Covid-19.)
Two last little quibbles. As usual for op-eds, I didn't pick the title. I don't think doctors should decide who lives and who dies. This is an issue of justice, not purely medical expertise. Ethical guidelines can ensure that doctors don't have to make those decisions alone.
And social distancing - marketwatch.com/story/social-d… - (cancelling big events, staying home when you can) and hygiene remain crucial. They probably won't save us from needing to make hard choices. But they mean fewer people will end up on the short end of those choices.
Along with social distancing and hygiene, we need more testing. I speak just for me here, but call your Senator/Congressperson and support the bill to have Covid-19 testing treated as preventive care and so made free of charge for insured patients: degette.house.gov/media-center/p…
