Disparities
This article by Ogedegbe et al. examines racial/ethnic disparities in COVID-19 hospitalization and mortality among patients of a large New York City health system. Consistent with other existing data, this study found that Black and Hispanic patients were more likely than white patients to test positive for COVID-19. However, after hospitalization, Black patients were less likely than white patients to have a critical illness or to die when adjusting for comorbidities and neighborhood characteristics. As the authors conclude, this is consistent with an assessment that structural determinants explain the disproportionately high out-of-hospital COVID-19-related mortality rates among Black populations during the pandemic. Critical structural determinants in this context may include crowding and occupations that make social distancing more difficult, as well as reduced access to care, delay in seeking care, or receipt of care in low-resourced settings, all of which may increase disease severity. Put simply, it is not race itself but rather the social inequities disproportionately affecting Black and Hispanic communities that negatively impacts health outcomes in these communities, including those related to the current pandemic.
Facilities
As reported in this NPR article, the federal Department of Health and Human Services has recently released its first data set on hospital capacity and bed use that includes facility-level data (rather than aggregated state-level data). Facility-level data have been collected by the agency and shared internally since the summer, but the data were not publicly available. The datasets are available through HealthData.gov. Facility-level data provides a more detailed picture of the current strain on hospitals nationally and particularly in several areas of the Midwest and South, enabling identification of regional hot spots even when overall state data do not indicate a crisis.
Resource Allocation
This article by Mun, Hale & Hennrikus reports the results of a survey of the remdesivir allocation policies as of June–July, 2020. Survey respondents represented 66 hospitals across 28 states and included 45 academic health centers and 21 community hospitals. The survey found that 98% of responding institutions used a multidisciplinary team to develop their allocation criteria, with most teams including a clinical pharmacist (97%), adult infectious disease physician (94%), and adult intensivist (69%). A smaller proportion included adult hospitalists (49%) or ethicists (35%). Prioritization was determined on a first-come, first-served basis in 47% of responding facilities and less frequently by respiratory status (29%), clinical course (24%), or random lottery (23%). Rarely used criteria included laboratory results, comorbidities, and essential worker status, and no institutions reported consideration of socioeconomic status or use of a validated scoring system. Most striking about these results, as the authors note, is the level of inconsistency among facilities’ approaches to allocation. Inconsistent methodology for scarce resource allocation makes it vastly more difficult to achieve fair, ethical, and equitable distribution of resources locally, regionally, nationally, or globally.
