According to the BBC, a Coronavirus vaccine could available by mid-2021 at the earliest. When the vaccine has finally been approved for human use, the question arises, “Who should we vaccinate first?” With the production of the vaccine at its maximum, should we give it to healthcare workers or the elderly? Essential workers, or the homeless? Though these questions seem like a dilemma for public health officials to decide in the future, healthcare workers are currently having to make hard choices about rationing their gear and deciding which patients should have priority when it comes to essential supplies like ventilators.
According to The Washington Post, when healthcare systems began getting overwhelmed in Italy, the country prioritized their treatment towards young people and those who were most likely to recover first. This kind of utilitarianism has been used in medicine before; but under non-pandemic circumstances, physicians prefer to treat patients based on what is best for each individual. When there’s a shortage of supplies, however, treating one patient to the fullest extent possible might mean taking away treatment options for another. Deciding who deserves treatment over others has become a major point of contention in the pandemic.
In the context of COVID-19, this “greatest good for the greatest number” thinking can leave a lot of vulnerable populations without the medical support to overcome sickness. In fact, an article in the Journal of the American Medical Association points out the fact that some state government and professional society guidelines for rationing ventilators exclude patients with long-term diseases (such as heart failure, lung disease, kidney disease, and severe cognitive impairment) from accessing ventilators solely based on their comorbidities. The problem with exclusions like these, other than the fact that they arbitrarily condemn patients with certain chronic diseases over others, is that these restrictions disproportionally affect minority groups.
According to the CDC’s 2011 Health Disparities and Inequalities Report, Hispanic and Black Americans and those with low socioeconomic status were more likely to struggle with coronary heart disease, obesity, diabetes, and asthma, all risk factors that make it more likely for a patient to not receive treatment under pandemic guidelines.
In fact, the CDC recognizes that COVID-19 disproportionally infects, hospitalizes, and kills Hispanic and Black Americans over Asian and White Americans. The cause of this difference is multifaceted, but it’s certainly linked to systematic racial issues like lack of insurance for minorities, residential segregation, food deserts, and over-representation in prisons. When doctors try to follow strict guidelines when distributing vital treatments, like those proposed in New York’s Ventilator Allocation Guidelines, they may be unknowingly treating a greater percentage of white patients with higher socioeconomic status based solely on objective criteria. Knowing the racially skewed impact of Coronavirus on American populations, policymakers and public health officials should possibly make guidelines that skew treatment back towards disproportionally affected populations, even if it’s not the most utilitarian choice.
At least in my lifetime, I’ve never seen medicine facing such hard-ethical decisions. It’s difficult enough for healthcare workers to normally decide the best treatment for each patient, so I can’t imagine the added stress of not having enough equipment for everyone that needs it. It’s unfortunate that we are even in this situation, and that we didn’t fully prepare for the scope of this pandemic. I am just hoping that, through the clear burden of illness and death that marginalized groups are facing from COVID-19, more people are able to recognize the obvious systematic oppression that certain Americans face and that we can better orient society to address that oppression and decrease some of those negative health outcomes.