The COVID-19 pandemic is changing a lot right now. Here are three changes to which I’m paying close attention
- How we talk about healthcare reform
- How we talk about rationing ethically
- How the virus is spreading silently
Coronavirus & Healthcare Reform
Christopher Beem writes in The Conversation that the coronavirus pandemic will push Americans to reframe the national conversation about healthcare reform. Up to now the question asked has been, Is healthcare a right or a privilege? But Beem says that COVID-19 now demonstrates that each of us has a direct impact on the “life, liberty, and pursuit of happiness” of all others in society by the way we exercise our right to mingle in close contact with others for business or recreation, and by the way we exercise our right to hoard hand sanitizer, and by how we assert our access to a ventilator. Beem concludes that healthcare is neither the right or privilege of disconnected individuals, but rather the collective responsibility of all under our social contract. “When we all live together in society, we depend on each other. And therefore we have obligations to each other.”
Fixing U.S. Healthcare agrees that the question should be, What kind of healthcare do We the People owe each other? See more discussion at Coronavirus & Healthcare Reform.
Ethical Rationing in a Crisis
What do we owe each other when there are not enough ICU beds and ventilators for everyone who needs one? The coronavirus pandemic has changed this from a theoretical exercise for students of medicine and philosophy into a hard practical question that will face New York City doctors within two weeks and others within two months.
According to doctors writing in today’s New England Journal of Medicine, we owe each other fair allocation of scarce resources. They offer six guiding principles:
- Maximize the benefit – save as many lives (and secondarily, years of life) as possible
- Critical resources and care should go first to front-line health workers, not because they are more worthy but because they can in turn save others
- Given equal prognoses otherwise, resources should be allocated equally, for example by lottery, and not just on a first-come-first-served (which would create and reward perverse incentives)
- Prioritization should be adapted according to intervention and to changing scientific evidence. For example, frail elderly patients will be the ones who benefit most from vaccines, after health workers, but will least derive benefit from ventilators, given their poor survival in ICUs.
- Prioritize patients who volunteer for research trials.
- There should be no difference in allocating scarce resources between patients with Covid-19 and those with other serious medical conditions.
Silent Spread of Coronavirus
Meanwhile, the first reports out of Hubei Province in China are shedding more light on the epidemiology of the novel SARS-CoV2 virus. Li and colleagues, writing in Science report that 79% of confirmed cases in Wuhan arose from “undocumented” (silent) contacts. The virus was spread extensively by people who didn’t realize they carried it. These epidemiologists conclude, “These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.”
This also means that only widespread population testing will allow public health officials to map patterns of spread and to design strategies to control it. Population testing will require both nasal swabs to identify current asymptomatic carriers as well as antibody blood testing to identify persons who have already recovered with natural acquired immunity. Armed with that information, public health officials could be able to predict when a community has sufficient herd immunity to halt the further spread.
Now, take action.