In the midst of a surge in coronavirus cases, Massachusetts health officials revised a guidance for making decisions about which patients will receive potentially life-saving care if the system is overwhelmed, and which patients may not.
The guidance, issued earlier this month by state health officials, seeks to help hospitals answer such questions and offer transparency to the families of sick loved ones ahead of the expected surge of COVID-19 cases this month.
It asks hospitals to assign patients a score, ranking them based on likely long-term survival to determine priority for care. Younger, healthier patients were given preference over older adults, as are medical professionals and pregnant women. The highest priority is given to healthy, young patients with the potential to live longer after recovery.
After the document became public, many critics were vocal, worried some in the community would be penalized for health disparities that wouldn’t impact long-term survival.
In response, the guidelines were revised to acknowledge the impact of race and poverty on a person’s health and make clear that a patient’s disability alone is not an appropriate basis to disqualify a patient for potentially life-saving treatment in the event of a shortage of ventilators or beds available in the ICU.
The guidelines now focus on short-term survivability in recommendations for resources including ventilators.
“These voluntary guidelines were the work of an advisory group with extensive experience in medicine, ethics and public health and have been revised to reflect the direct input of stakeholders to develop guidelines that clarify concerns regarding equity and disparities,” a spokesperson for the Department of Public Health said. “The recommendations were created to prevent unconscious bias against people of color, people with disabilities and other community members who are marginalized.”
In addition to sharing the revisions, the Department of Public Health recommends hospitals include diversity officers on review and oversight committees overseeing the use of hospital resources.
“Crisis care must be the best care it can be in light of the circumstances and available resources,” the guidance states. “The purpose of this document is to provide guidance for the triage of critically ill patients in the event that the public health emergency caused by the COVID-19 pandemic creates demand for critical care resources that outstrips the supply.”
The guidelines are not mandatory but offered to assist medical staff in establishing priority of care.
The 34-page document was issued by the Crisis Standards of Care Advisory Committee, members of which include chief physicians at medical centers across the state, ethical leaders and counsel for health systems.
Just under 2,000 people have died from coronavirus-related illnesses, with the announcement from state health officials Tuesday that another 152 people died from the virus.
The number of confirmed COVID-19 cases climbed to 41,199. Of those with the virus, 9% of patients have been hospitalized.
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