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In May 2013, the British website Critical Legal Thinking published a "Manifesto for an Accelerationist Politics," composed by a pair of young British intellectuals named Nick Srnicek and Alex Williams. Although dotted with expressions and allusions that reflected the authors' formal training in British doctoral programs, the text was not a scholarly project. Like its more famous model, the manifesto clearly set out to change the world rather than to interpret it. Srnicek and Williams's MAP, as it is now commonly designated, exhorted fellow leftists to "take advantage of every technological and scientific advance made possible by capitalist society," including quantification, economic modeling, social network analysis, and big data analytics, and to claim "the materialist platform of neoliberalism" as a "springboard to launch towards post-capitalism." Rejecting what it characterized as a backward-looking "folk politics of localism, direct action, and relentless horizontalism," in favor of a "politics at ease with a modernity of abstraction, complexity, globality, and technology," the manifesto cast its lot with Prometheus, sloughing off decades of leftist suspicion and discomfort (especially, one might add, among feminists and environmentalists) toward projects of mastery and domination. 1

Coronavirus disease 2019 (COVID-19) has had a devastating impact on older adult nursing home residents (NHR). NHRs comprise greater than one-third of COVID-19 U.S. deaths, emphasizing the importance of engaging in end-of-life discussions. At South Texas Veterans Health Care System (STVHCS), we implemented early documentation of patient’s Life-Sustaining Treatment (LST) or end-of-life goals-of-care preferences prior COVID-19 infection. We now aim to examine the association between early LST documentation (prior to COVID-19 diagnosis) and hospital admissions for COVID-19 by conducting a retrospective cohort study of Veteran NHRs at STVHCS from March 2020-January 2021. Inclusion criteria were NHRs with COVID-19 diagnosis, LST documentation, and clear timing of whether the LST documentation occurred before or after COVID-19 diagnosis. Logistic regression was used to determine the likelihood of hospitalization by whether LST was documented before or after COVID-19 diagnosis. 208 NHRs were diagnosed with COVID-19 and 160 (76.9%) had LST documentation. Of these, 148 were included in the analysis: 84 (56.8%) had a completed LST note prior to diagnosis and 64 (43.2%) after diagnosis. The hospitalization rate was 46% for those with LST prior to diagnosis compared to 78% in those with LST after diagnosis (OR = 0.24, 95% CI: 0.12-0.50, P<0.001), showing that early LST documentation was associated with 76% lower likelihood of hospitalization. Early interventions for LST documentation can reduce hospitalization in high-risk populations. These findings may have implications for reducing unnecessary hospitalizations, diminishing healthcare costs, and resolving ethical dilemmas related to potential resource allocation during a pandemic.

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