Promoting racial equity in COVID-19 resource allocation

Abstract

Due to COVID-19’s strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient’s racial affiliation has been considered but may be divisive and difficult to implement. And while COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as front-line healthcare workers, older physicians, pregnant women and patients with disabilities. These exceptions demonstrate creativity and ingenuity—hallmarks of policymakers’ abilities to flexibly respond to urgent societal concerns—which should also be extended to patients of colour. This paper dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources.

A Neoadjuvant Chemotherapy Trial for Early Breast Cancer is Impacted by COVID-19: Addressing Vaccination and Cancer Trials Through Education, Equity, and Outcomes

“…While "most lives saved" (MLS) approaches for vaccine distribution may have some merit, they may fail to adequately help underserved minority groups which suffer from increased risk of COVID-19 hospitalization. 37 Health equity issues leading to "long COVID" may also lead to under-enrollment of EBC patients to trials in areas with low vaccine acceptance and in underserved minority communities where vaccine access may be limited.…”

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“…Black, indigenous and Latinx communities also have a higher prevalence of comorbid conditions such as hypertension, cardiovascular disease, diabetes, obesity and asthma, which increases the risk of contracting severe COVID-19, which may lead to delays in recovery, prolonged symptoms, increased hospitalisations, and increased rate of mortality 5 8. In New York, a cohort study (n=5902) of COVID-19 patients at a single academic medical centre observed that non-Hispanic black and Hispanic patients had a higher rate of two or more underlying comorbidities than their non-Hispanic white counterparts 9…”

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“…O debate sobre escassez de recursos toca em problemas estruturais, em especial quando consideramos aspectos relacionados a determinantes socais de saúde e interseccionalidades como racismo, classe ou desigualdade de gênero 10,21 . Quando as iniquidades são ignoradas, as respostas podem apenas exacerbar os efeitos danosos que impactam desproporcionalmente as populações historicamente discriminadas, perpetuando essas iniquidades.…”