Prioritizing Equity in a Time of Scarcity: The COVID-19 Pandemic
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Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; 3Department of Medicine, Perelman University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 4Penn Medicine Palliative and Advanced Illness Research Center, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 5Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6Johns Hopkins Center for Health Equity, Baltimore, MD, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-05976-y © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
infection has become widespread, affecting C OVID-19 over 4 million individuals worldwide and resulting in
nearly 300,000 deaths as of May 15, 2020.1 Across the globe, including in the USA, the pandemic has raised concerns for exacerbating social and structural inequities in the health care system. Disparities in chronic cardiopulmonary disease prevalence, socioeconomic status, and access to health care have placed vulnerable populations, including racial and ethnic minorities, at higher risk of COVID-19 infection, hospitalization, and death. Black, Hispanic, and Native Americans have been shown to be infected and dying at disproportionately higher rates than their white counterparts in large urban and rural areas across the USA.2 As the number of positive cases rise, so too has the expectation of scarce health care resources including SARS-CoV-2 antigen and antibody testing, antiviral medications, intensive care unit beds, and ventilators, elevating calls by health care leaders and public health officials to develop and implement strategies for rationing of critical resources.3 These calls are especially alarming for marginalized populations whom history has shown are persistently excluded from resources, both scarce and abundant, in the USA. As the current pandemic draws into focus the stark variation in access to limited resources, from personal protective equipment to dialysis machines,4 we caution that equity must be placed at the center of all rationing strategies, citing examples from organ transplantation and end-of-life care to amplify a call for action to protect vulnerable communities in this health crisis.
Received April 6, 2020 Accepted June 11, 2020
LESSONS FROM DISPARITIES IN ORGAN TRANSPLANTATION
As of today, there are approximately 113,000 individuals awaiting a solid organ transplant in the USA, compared with 39,000 who received a transplant in 2019.5 Given the scarcity of this life-saving resource, health systems and national medical societies have established policies to best allocate these organs.6 Nevertheless, countless analyses have reported disparities in receipt of organ transplantation by race, ethnicity, income level, insurance, and immigration status.7 These dis
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