Health Care Workers

This article by Feinstein et al. addresses the potential for a mental health crisis among frontline health care workers as a result of the pandemic and surrounding circumstances, such as lack of PPE, shortages of critical care supplies, and the need to adapt to social distancing and stay-at-home orders. The authors developed and launched a mental health hotline for health care workers in Austin, TX, based on crisis intervention principles. The article describes 13 steps in the development of the hotline as a potentially replicable model for other similar services.

Resource Allocation

This letter from a group of Attorneys General (authored by those from California and Louisiana with the support of those representing 29 other states, D.C., and 2 territories) to the heads of the U.S. Department of Health and Human Services, the NIH, and the FDA calls for the federal government to exercise “march-in rights” regarding remdesivir, or authorize states to do so. March-in rights allow the government to retain and exercise patent rights on drugs (among other items) developed using federal funds, allowing the government to take actions such as licensing production by third parties to ensure sufficient supply or lower price. In response, remdesivir manufacturer Gilead issued a statement disputing the factual accuracy of some statements in the letter, arguing that most patients are not eligible to receive remdesivir under the terms of its Emergency Use Authorization, that Gilead has invested substantially in increasing manufacturing capacity for the drug, and that the AGs’ proposed action would not speed access due to the timeline required to manufacture the drug.

This Politico article updates on developments surrounding challenges to state Crisis Standards of Care (CSC) guidelines and related hospital triage plans. Several sets of guidelines have been challenged on the basis that they may discriminate against persons with disabilities or other protected groups, and advocacy groups are currently focusing on Texas and Arizona, two states that are COVID-19 hot spots. These concerns are also tied to health care providers’ and facilities’ requests for legal protections during the pandemic, which may protect them from liability when they act in accordance with CSC guidelines (such as rationing scarce resources) but which others argue could lead to both direct and indirect discrimination.

This review by Kirkpatrick et al., commissioned by the American College of Cardiology, details the application of conventional vs. contingency vs. crisis standards of care in the field of cardiology. The discussion includes the differences between the three standards and the underlying principles and values that guide scarce resource allocation and reallocation and decisions regarding resuscitation, advance care planning, and withholding or withdrawing life-sustaining therapies.

Supplies

This article by Manero et al. explores the challenges and successes of using 3D printing to produce various types of equipment for hospitals, including PPE and ventilator components, to fill gaps in manufacturing supply chains and meet demand surge. Various technologies are available, each with advantages and limitations. The authors recommend that hospitals and municipalities develop capacity for short-run custom production to validate new designs and increase access through distributed manufacturing and that regulatory authorities provide clear and steamlined guidance for these efforts.