hospital equipment, including heart rate monitor and oxygen monitor functioning at bedside.

The Ethical Allocation of Scarce Resources in the US During the COVID-19 Pandemic: The Role of Bioethics

By Beatrice Brown

Critical resources for handling the COVID-19 pandemic, including ventilators and ICU beds, are quickly becoming scarce in the US as the number and density of infections continue to rise. Leading bioethicists have crafted guidelines for the ethical rationing of these scarce resources during the pandemic. On March 16, The Hastings Center published “Ethical Framework for Health Care Institutions and Guidelines for Institutional Ethics Services Responding to the Novel Coronavirus Pandemic,” detailing three ethical duties for health care leaders: 1) duty to plan; 2) duty to safeguard; and 3) duty to guide. The report also contains a compilation of materials on resource and ventilator allocation.

More recently, on March 23, two insightful pieces were published in the New England Journal of Medicine: “The Toughest Triage — Allocating Ventilators in a Pandemic” by Truog, Mitchell, and Daley, and “Fair Allocation of Scarce Medical Resources in the Time of Covid-19” by Emanuel et al. These two pieces complement each other well and lay a crucial foundation for the inevitable resource allocation that clinicians and hospitals will be forced to practice in the coming weeks. As such, here, I summarize the central takeaways from these two articles while understanding their recommendations in tandem, as well as reflect on the importance of bioethics during these times of medical crisis and how the work of this field must adapt to changing circumstances. Read More

Preemption, Paid Leave, and the Health of America

As the United States continues its response to a seemingly inevitable coronavirus epidemic, experts in law and public health are stressing the importance of supportive social safety nets to ensure an equitable and fair response to the virus’s spread.

If you are one of the nearly two million Americans who works for minimum wage, for much of the service industry, or in the contingent labor force, a situation that forces you to stay home from work – because of illness, or government- or self-imposed quarantine or social distancing measures – could create dire financial circumstances and inhibit measures to mitigate the impact of an infectious disease like COVID-19.

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Gloved hand holding medical rapid test labeled COVID-19 over sheet of paper listing the test result as negative.

Controlling the Novel Coronavirus: Should we have stopped the COVID-19 coronavirus more effectively? Could we still?

By Margaret Battin, Leslie Francis, Jay Jacobson, and Charles Smith

What if, instead of closing airports, shutting down trains and buses, quarantining travelers from China, and enclosing 50 million people inside the city of Wuhan and Hubei province, we had a sophisticated technology that could identify travelers who might spread an emerging infectious disease? This question is not hypothetical. We do have an available technology: polymerase chain reaction (PCR) rapid testing, one among several forms of nucleic acid amplification technology.

But PCR rapid testing has been deployed imperfectly at best, especially in the United States. The initial case of what is thought to have been community transmission in the United States was not tested for several days. The result was preventable exposures to infection of health care workers and potentially others. Testing criteria were set very narrowly. Rapid test kits designed by CDC did not work successfully because of problems with one of the reagents. On February 29, the FDA issued guidance allowing laboratories CLIA-certified for high complexity testing to use tests they had developed and validated before receiving emergency use approval.

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