New Study Raises Pandemic Triage Equity Concerns

A recent study raises concerns regarding pandemic triage strategies developed by states during the COVID-19 pandemic, which take into account age, handicap, organ failure, chronic illness, and post-hospital survival projections when allocating scarce healthcare resources in a public health crisis. It was recently published in the JAMA Network Open journal.

According to the study, the majority of the state-level pandemic triage plans examined limited access to critical care services for patients with certain health problems and those with a lower estimated chance of recovery following release. These findings highlight concerns regarding equitable access to healthcare during public health crises, particularly for communities with a high prevalence of chronic illnesses, such as people with disabilities and members of marginalized racial and ethnic groups.

“This is an important study showing that the triage plans still on the books in many states need to be reconsidered and revised,” said Susan M. Wolf, JD, a professor of law and medicine at the U of M Medical School and Law School and one of the article’s co-authors.

“More than three years after the start of the COVID-19 pandemic, despite legal challenges, disability advocacy and extensive public discourse, triage plans in many states continue to include potentially discriminatory provisions around life expectancy and presence of chronic medical conditions. I wouldn’t want these plans to be the basis of our nation’s response to the next public health emergency. That is why it is important to continue the conversation about what should – and what should not – factor into allocation decisions in a crisis,” said Erin S. DeMartino, MD, with the Mayo Clinic and senior author of the study.

Several state-level pandemic preparedness plans were updated during the early stages of the COVID-19 pandemic in response to criticism from disability advocates and civil rights groups. Despite these changes, the study finds that many state-level pandemic preparedness plans continue to discriminate against older adults, people with disabilities, and minoritized racial and ethnic groups, endangering patient welfare and eroding public trust. Conditions such as Alzheimer’s disease, coronary artery disease, and end-stage kidney illness, for example, were specified as exclusion or deprioritization triage criteria in some jurisdictions.

As a result of these findings, the study team recommends that critical care triage protocols be reevaluated, highlighting the importance of ensuring fair and equitable resource allocation.

The National Institute on Aging and the Mayo Clinic’s Annenberg Career Development Award both contributed to the study’s funding.

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