System to allocate scarce resources during COVID-19 associated with racial inequities

Editor's Note

This retrospective cohort analysis led by researchers at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, finds that a crisis standards of care (CSOC) scoring system designed to allocate scarce resources during the COVID-19 pandemic was associated with racial inequities.

A total of 498 adult patients (with and without COVID-19) at six hospitals who were admitted to the ICU were preemptively scored by acute severity of illness and chronic severity of illness, and then they were stratified by race, ethnicity, and residence in a socially vulnerable neighborhood.

In a simulation model, Black patients were more likely than others to be in the lowest priority group (15.2% vs 8.1%) based on severity of illness scoring. Using the scores for ventilator allocation, with only those in the highest priority group receiving ventilators, there were 43.9% excess deaths among Black patients vs 28.6% among all others. When the highest and intermediate priority groups received ventilators, there were 4.9% excess deaths among Blacks and 3.0% among others.

Results show that CSOC policies must be evaluated for their association with racial disparities, the researchers say.