Allocation of scarce medical resources during the COVID-19 pandemic

Bottom Line:

In a time of resource scarcity, the following six recommendations should be used to develop guidelines that can lead to optimal and equal treatment of individuals at risk: maximizing benefits, PPE priority to frontline workers, random selection, prioritization of populations at risk, prioritization of participants in clinical trials, and fair allocation of resources between patients with COVID-19 and those with other medical conditions. 

Reference:

Emanuel, E.J. et al. Fair allocation of scarce medical resources in the time of Covid-19. NEJM [Internet] (2020). https://doi.org/10.1056/NEJMsb2005114

Date Published:

23 March 2020

Synopsis:

As COVID-19 continues to impact individuals around the world, extraordinary pressure has been placed on healthcare workers and health systems, leading to a huge increase in demand on PPE and medical equipment. Given the unavoidable rationing of health resources during this pandemic, the ethics underlying the fair allocation of resources focuses on four fundamental values: maximizing benefits from limited amounts of sources, treating people equitably, giving priority to high risk populations, and giving priority to the worst affected. These values bring about six recommendations. The first recommendation is to maximize benefits, which reflects the importance of stewardship of resources. This means that priority for scarce resources should aim to save the most lives and minimize post-treatment mortality. For example, patients might be informed during admission that ventilators or ICU beds might be removed from them to provide it to other, more sick patients if absolutely necessary to maintain life. The second recommendation is to prioritize frontline workers, because they are essential to the pandemic response. Testing equipment, PPE, ICU beds, and ventilators should be provided first to front-line healthcare workers that care for ill patients, as well as other workers with high risk of exposure and are difficult to replace. The third recommendation is random selection, meaning that equality should be considered and executed through random allocation rather than a first-come, first-served protocol. This ensures equitable healthcare and prevents hospital crowding and potentially violence. The fourth recommendation is to prioritize populations at risk. For example, sick individuals with high likelihood of recovery if treated are given priority over those who may not recover if treated and also those who can likely recover without treatment. The fifth recommendation is to prioritize participants in clinical trials. Their active participation in research helps future patients and should be rewarded for their bravery and contribution, which effectively encourages more research participation. The sixth and final recommendation is to have fair allocation of resources between patients with COVID-19 and those with other medical conditions. For example, patients with heart failure, cancer, and other life-threatening conditions should continue to receive immediate medical care, which also maximizes benefits by using resources across all patients who need resources. 

Summary by: Winston Li