A group of health care professionals recently published an article in the New England Journal of Medicine looking to answer a vital question for the current times: How can medical resources be allocated fairly during the COVID-19 pandemic?
The article, “Fair Allocation of Scarce Medical Resources in the Time of COVID-19,” co-authored by James Phillips, MD, chief of the Disaster and Operational Medicine Section within the Department of Emergency Medicine and director of the disaster medicine fellowship at the George Washington University School of Medicine and Health Sciences, states that “governments and policy makers must do all they can to prevent the scarcity of medical resources.”
However, if resources do become scarce, the authors outline six recommendations that could be followed to create guidelines to help doctors determine how best to allocate resources.
“Such guidelines can ensure that individual doctors are never tasked with deciding unaided which patients receive life-saving care and which do not,” the authors write. “Instead, we believe guidelines should be provided at a higher level of authority, both to alleviate physician burden and to ensure equal treatment.”
Priority, according to the article, should be aimed at maximizing benefits to save the most lives and maximize improvements in individuals’ post-treatment length of life.
“Limited time and information in a COVID-19 pandemic make it justifiable to give priority to maximizing the number of patients that survive treatment with a reasonable life expectancy and to regard maximizing improvements in length of life as a subordinate aim,” they write.
In addition, testing and personal protective equipment should go to front-line health care workers first, “particularly workers who face a high risk of infection and whose training makes them difficult to replace.”
Health care workers should be given priority not because they are more worthy, the authors explain, but because they are essential to pandemic response.
Another recommendation is that guidelines should change in relation to the intervention used, and should evolve in response to changing scientific evidence. That could include prioritizing vaccines for older or at-risk populations, as well as for front-line providers.
They add that there shouldn’t be a difference in “allocating scarce resources between patients with COVID-19 and those with other medical conditions.
“If the COVID-19 pandemic leads to absolute scarcity, that scarcity will affect all patients, including those with heart failure, cancer, and other serious and life-threatening conditions requiring prompt medical attention,” they note. “Fair allocation of resources that prioritizes the value of maximizing benefits applies across all patients who need resources.”
The article, “Fair Allocation of Scarce Medical Resources in the Time of Covid-19,” can be viewed in the New England Journal of Medicine.
