Staffing & Student Volunteers

This article by Bahethi et al. describes the deployment of medical and graduate students via a set of 7 volunteer task forces operating at multiple hospitals within the Mount Sinai system in New York City during the city’s early surge in COVID-19 cases.

• Over 500 students representing all years of medical school, as well as nursing, masters, and PhD programs volunteered for the COVID-19 Student WorkForce developed by students at the Icahn School of Medicine at Mount Sinai to fill essential roles and support physicians, staff members, researchers, and hospital operations.
• Students have been mobilized for prior emergency events in New York City, including the September 11 terrorist attacks in 2001 and the 2003 New York City blackout, and existing processes thus allowed for rapid interdisciplinary cooperation.
• The task forces were designed to be largely autonomous and independent, spanning 7 areas of expertise with coverage of pharmacy, administrative services, hospital operations, labs/research, PPE, telehealth, and morale, each led by 2-4 students who developed relevant content expertise.
• A system was created in which departments within the health system could submit requests for help with urgent tasks through an online form. Requests were screened for infection prevention and student safety standards and approved by a faculty member before being sent to triage leaders to direct tasks to the appropriate task force.
• Student volunteers assisted with a wide range of roles and tasks during the surge, including managing drug supplies, fielding patient calls in command centers, assisting in engineering new ventilator approaches, aiding research efforts, and delivering test results.
• Lessons from this approach are responding to future emergencies and utilizing available student volunteers to extend system capacity to meet rapidly changing needs. Establishing these pathways in advance is a potentially critical part of emergency planning and preparedness.

Scare Resource Allocation & Disability Justice

This article by Andrews et al. provides insights from the psychology field on how ableism, perceptions of quality of life, social determinants of health, and attitudes toward disability affect decisions regarding rationing of scarce resources and access to care.

• Persons with disabilities have faced greater vulnerability to exposure and complications related to COVID-19 during the pandemic, and actual and potential shortages of critical resources have prompted triage guidelines that may disadvantages members of this community, adding to other existing barriers faced by disabled people in obtaining access to care and treatment.
• The authors explore the sociocultural beliefs that create ubiquitous ableism, which they define as social prejudice and discrimination against disabled individuals in favor of non-disabled persons. Ableism may be obvious and direct or it may be subtle or even superficially positive, but it generally follows a pattern of stereotyping, prejudice, and discrimination. In the health care setting, ableism contributes to failure to see disabled persons as fully human and to viewing them through a medical model as in need of repair. In society broadly, attitudes of nondisabled people toward disabled people tend to be negative, and such attitudes are also widespread among health care professionals; however, such attitudes tend to take the form of implicit bias, rather than conscious or explicit bias.
• The paper describes how these beliefs are transferred into policy decisions in ways that disadvantaged disabled persons, with an emphasis on medical rationing decisions that rely heavily on some utilitarian principles such as life years saved (or quality adjusted life years saved). Similar issues arise through the use of assessment tools such as SOFA scores that measure major body system functioning but were not designed for purposes of determining access to care. Such approaches are likely to discriminate against persons with a range of disabilities that affect some functional aspects incorporated into the measurements (e.g., verbal communication) unless appropriate safeguards are in place.
• The paper also describes work within the disability community in opposing threats posed by the COVID-19 pandemic and makes recommendations for advocacy and social justice to improve health system responses and resource allocation to advance equity and justice.

Testing Access & Equity

This article by Kim et al. describes a testing project in Chicago to establish drive-thru and walk-up COVID-19 testing sites to increase testing capacity among the communities most affected by the pandemic with an emphasis on racial/ethnic minority communities.

• The project was established by Mile Square Health Center, a network of Federally Qualified Health Centers (FQHCs) run by the University of Illinois Hospital in Chicago.
• The project resulted in performance of over 7,500 tests over a 6-month period, with the majority of those testing coming from Black and Latinx communities.
• Rapid and reliable testing was critical to quickly identifying and isolating infected individuals to interrupt further transmission, but access to testing in minority communities lagged behind other communities despite the burden of COVID-19 infections and morbidity and mortality falling disproportionately on these populations as a result of several intersecting systemic factors.
• The findings demonstrate the need for equitable resource allocation to counter the disproportionate burden of the pandemic on minority communities and that FQHCs are an effective approach to reducing barriers to testing and thereby reducing other disparities, illustrating their further utility for vaccine outreach and dissemination, as well.