Testing Supplies and Capacity

This N.Y. Times article details continuing challenges regarding availability and processing of coronavirus testing kits in Arizona, which has experienced a surge in COVID-19 cases. Drive-up testing sites have 3-mile lines, labs have twice as many samples as they can process, and all 1,000 daily testing appointment slots at a large site at the state fairgrounds in Phoenix are filled within minutes of phone lines opening. Supply bottlenecks for testing machines and testing kits have hampered capacity. Demand at testing sites has overwhelmed local clinics and hospitals, and rising summer temperatures have reduced the ability to offer drive-up testing due to concerns for worker safety. Among other effects, delays in testing or receiving test results can delay the start of treatment with convalescent plasma or remdesivir for patients, cause health care workers to use more scarce PPE for hospitalized patients who turn out to be negative, and contribute to spread of the infection if asymptomatic or pre-symptomatic persons with pending results interact with others believing they are not infected. Other states with recent case surges (California, Texas, Florida) are experiencing similarly severe delays as demand outstrips testing capacity and supply caches, as described in this Bloomberg article.

Drug Pricing and Availability

This STAT article describes the factors involved in pharmaceutical manufacturer Gilead’s recently announced pricing for remdesivir, including independent cost-effectiveness assessments, implications for investors, global pricing strategies, and the bifurcation in the U.S. system between government programs and private insurers. Closely related, this ABC News article explains criticism of the U.S. government’s deal with Gilead to secure the vast majority of remdesivir production over the next three months.

Triage and Resource Allocation

This JAMA viewpoint by White and Angus argues in favor of using centralized lottery systems to distribute scarce supplies of remdesivir on the basis that such a system would more fairly allocate scarce resources and facilitate study of the drug’s effectiveness. The authors argue that a lottery system allows appropriate priority weighting of certain groups, such as those more likely to benefit, those who have been disproportionately harmed by the pandemic, essential workers, or persons from economically disadvantaged areas. They argue that a state-level lottery (overseen by the state health department) is preferable to lotteries at the hospital level because it would be more efficient and would not increase the administrative burden on hospitals by requiring them to develop and administer their own allocation protocols.

As explained in this Arizona Republic article, Arizona’s case surge has also led state leadership to announce that hospitals can activate their crisis standards of care plans, including procedures for scarce resource allocation if necessary. This comes alongside the governor reinstituting statewide closures and restrictions, reversing course on the state’s rapid reopening plan.

Ethics

A new issue of the Hastings Center Report is devoted entirely to questions and lessons related to the COVID-19 pandemic. All articles are available open access. Topics include (among other critical issues):

• Disability rights and crisis standards of care (Guidry-Grimes et al.)
• Ethical challenges for nurses (Morley et al.)
• Vaccine rationing and social justice (Schmidt)
• Systemic injustice, Black lives, and end-of-life care (Elbaum)
• Older adults and long-term care facilities (Powell et al.)