Facilities

This article by Bowblis and Applebaum analyses the prevalence of COVID-19 in nursing homes in Ohio, finding that prevalence was not associated with facility quality ratings. Due to factors including resident frailty and staff inability to social distance at work (and often during commute), nursing homes have borne a massive share of mortality during the pandemic. This study uses prevalence data across multiple months from the state health department and combines this with nursing home data from the department and public CMS datasets. In all, over 900 facilities were included in the study.

Resource Allocation

This article by Fallucchi, Faravelli, and Quercia reports the results of a study of public opinion and agreement with proposed resource allocation guidelines. The authors surveyed over 1,000 Americans using hypothetical scenarios related to ICU bed allocation in a situation of resource scarcity, altering stated patient characteristics to assess respondents’ views and their consistency with proposed ethical guidelines related to benefit maximization, instrumental value, and equal treatment. Responses demonstrated significant heterogeneity, but in general were more consistent with saving the most lives (vs. most life-years), were only moderately supportive of prioritizing instrumental value (e.g., priority for health care workers), were more supportive of first-come first-served allocation compared to random allocation when patients were otherwise similarly situated, and were supportive of priority for COVID patients over non-COVID patients with the same prognosis. Several of these results are in conflict with the ethical principles reflected in many allocation guidelines (for example, first-come first-served allocation may unfairly benefit patients who live closer to medical facilities). Accordingly, the authors note the importance of communication to the public and to patients to explain decision-making rationales to avoid the perception that ethically justified rules are arbitrary or unfair.