This Health Affairs article by Kanter, Segal & Groeneveld (also covered in this STAT article) discusses the role of income disparities in access to ICU beds as related to the COVID-19 pandemic. The authors examine disparities by median household income across the US, comparing communities at the hospital service area (HSA) level, which generally identifies the hospital where residents in a particular ZIP code would most likely seek emergency care. They find a large gap in resource access that includes a lack of ICU bed access in 49% of the lowest-income communities (vs. only 3% of the highest-income communities), with more acute disparities in rural areas. These findings highlight the need for hospital, county, state, and federal coordination to address bed shortages and mitigate negative impacts on COVID-19-related mortality in low-income communities, as well as the need to consider emergency transportation protocols and emergency funding. In the absence of appropriate efforts on these factors, the impacts of the pandemic are likely to disproportionately affect lower-income populations.
This forthcoming law review article by Gutmann Koch addresses the proper scope of state liability shields for health care providers and institutions for actions under crisis standards of care (CSC). The article examines existing liability shields under state law and arguments for and against these protections, including the need to ensure accountability and protect vulnerable patients. The article concludes that blanket immunity protections are inappropriate but that protections may be proper when CSC rules and guidelines are provided by a government, professional society, or medical institution; those standards are followed in good faith; and there is an identified need for these protections based on perceived reluctance to follow CSC due to fear of liability.
Liability shields have also been a point of contention in proposed additional federal relief legislation. One proposal (the Safe to Work Act) would place medical malpractice suits and personal injury suits under federal courts’ jurisdiction (such cases are typically litigated in state courts) and establish an unusually high evidentiary standard for plaintiffs; that proposal has been criticized by groups of attorneys who represent both plaintiffs and defendants in such cases.
This Washington Post article describes the alliance of seven states to form a purchasing compact to spur production of rapid-detection antigen tests. Governors of seven states (Louisiana, Massachusetts, Maryland, Michigan, North Carolina, Ohio, and Virginia), with the financial backing of the Rockefeller Foundation, have agreed to request a total of 3.5 million rapid tests, intending to reduce reliance on existing testing infrastructure that has caused long delays. Testing systems have been left largely to states with little federal coordination, but the compact states hope to use their collective purchasing power to encourage manufacturers to ramp up production. The compact is also open to other states, cities, and local governments.
HEALTH CARE WORKERS
This article by Ruiz & Gibson highlights stress on U.S. health care workers during the pandemic, the potential for damaging mental health impacts, and the implications for policy and treatment. The authors discuss similarities and differences between the current circumstances and prior events (e.g., SARS, 9/11 terrorist attacks), and they warn that many health care workers, like military veterans, may tend to minimize their own distress and delay or avoid seeking mental health treatment due to a variety of factors and barriers.
This JAMA Internal Medicine article by Sterling et al. provides a qualitative analysis of the experience of home health care workers in New York City during the city’s case surge in March-April 2020. Participants reported heightened risk of infection and transmission while providing integral care, but they also reported a lack of adequate support (e.g., information, PPE, transportation) and visibility despite their frontline role in responding to the pandemic.