POINT: Is Considering Social Determinants of Health Ethically Permissible for Fair Allocation of Critical Care Resources During the COVID-19 Pandemic? Yes

Balancing the Needs of Acute and Maintenance Dialysis Patients during the COVID-19 Pandemic

“…Any final tie breaking proceeds by random allocation (lottery). Developing a weighted lottery system that considers, for example, socioeconomic deprivation status, may be helpful in further delineating fairest allocation (35,36). To limit the possibility that anyone will be denied resources unnecessarily, dialysis capacity and the need for triage should be assessed on an ongoing basis to support timely de-escalation.…”

Historical Structural Barriers and Cardiovascular Inequities

“…This study by Deo et al raises questions on how clinicians can screen for and triage patients experiencing these disparities, especially when studies have shown that triaging based on race or other demographics has exacerbated racial inequities by disproportionately denying care to Black patients? One recommendation is to use correction factors based on Area Deprivation Index (ADI) or historically redlined neighborhoods, as the study by Deo and colleagues would suggest. These correction factors would be added to the triage scores of patients based on highly disadvantaged neighborhoods, such as historically redlined neighborhoods .…”

“…One recommendation is to use correction factors based on Area Deprivation Index (ADI) or historically redlined neighborhoods, as the study by Deo and colleagues would suggest. These correction factors would be added to the triage scores of patients based on highly disadvantaged neighborhoods, such as historically redlined neighborhoods . These patients could then be prioritized for certain treatments and other services, which would target structural inequities rather than simply triaging based on race or other sociodemographic characteristics.…”

Who Receives ICU Care during Times of Strain? Triage and the Potential for Racial Disparities

“…Other admission models, such as those based on clinical prognostication or severity of illness, also have faults during times of strain. For example, White and colleagues estimated that, in the setting of a moderate to severe shortage of ICU resources, the use of prognostication-based triage would result in disproportionately more deaths for Black patients than for White patients ( 5 ).…”