HEALTH CARE WORKERS

This article focuses on the continued problem of nursing home staffing as highlighted by the COVID-19 pandemic. Even before the pandemic, nursing home shortages of direct-care staff were common and persistent. The fact that nursing home residents are highly likely to be among the most vulnerable to the virus has further exacerbated the problem, as many staff have quit, in part due to shortages of PPE and other supplies to deal with the pandemic and protect themselves from infection. Nursing homes currently account for approximately 45% of COVID-19 deaths in the U.S. to date and an even higher proportion in some states.

This article by Albott et al. describes the potentially wide-ranging mental health impacts of COVID-19 on health care workers and proposes a rapidly deployable peer support intervention based on a U.S. Army model for psychological resilience interventions. The pandemic adds to existing stresses for health care workers uncommon uncertainty about resources, availability of adequate PPE, insufficient organizational and public preparedness, threats to their own safety and the health of loved ones and coworkers, and financial pressures on the health system. The authors explain that the anxiety and fear levels generated are similar to military battlefield conditions and that psychological resilience models developed for military applications may be appropriate to mitigate adverse psychological consequences for health care workers. The article details a multi-level approach utilizing one-to-one peer support (“Battle Buddies”) and unit- and department-based anticipate and plan approaches, including involvement of mental health consultants.

TRIAGE AND RESOURCE ALLOCATION

This article by Reid addresses weaknesses in the argument that there is ethical consensus on maximizing medical outcomes (e.g., lives saved) as the primary touchstone of triage and scarce resource allocation during a public health emergency. The author argues in favor of a more prominent role for non-utilitarian considerations, such as social justice and legitimacy, noting that focusing solely on maximizing medical outcomes may exacerbate existing inequities due to the impact of social determinants of health.

This article by Robert et al. assesses the spectrum of ethical dilemmas associated with triage policies from the perspective of intensivists, focusing on four new considerations necessitated by the COVID-19 pandemic, including whether to: prioritize ICU beds for patients with the best prognosis, increase the number of ICU beds at all costs, organize transfer to distant ICUs with available beds, or accelerate withdrawal of life support. The authors assess various ethical approaches to triage and resource priority and their respective strengths and weaknesses, as well as the impact on family members and health care workers, concluding that caregivers must accept that there are no perfect solutions but must do so with full awareness of the ethical dilemmas involved and the impact on all concerned.