New study highlights equity concerns in pandemic triage plans
MINNEAPOLIS/ST. PAUL (09/18/2023) — A new study highlights concerns about the pandemic triage plans created by states during the COVID-19 pandemic that consider age, disability, organ dysfunction, chronic illness and estimates of post-hospital survival when allocating limited healthcare resources in a public health crisis. It was recently published in JAMA Network Open.
The study found that most of the state-level pandemic triage plans analyzed restricted access to critical care resources for patients with specific health conditions and those with a lower expected chance of recovery after discharge. These findings raise concerns about equitable access to healthcare during public health crises, especially for communities with a high rate of chronic illnesses, like individuals with disabilities and minoritized racial and ethnic groups.
“This is an important study showing that the triage plans still on the books in many states need to be reconsidered and revised,” said Susan M. Wolf, JD, a professor of law and medicine at the U of M Medical School and Law School and one of the article’s co-authors.
“More than three years after the start of the COVID-19 pandemic, despite legal challenges, disability advocacy and extensive public discourse, triage plans in many states continue to include potentially discriminatory provisions around life expectancy and presence of chronic medical conditions. I wouldn’t want these plans to be the basis of our nation’s response to the next public health emergency. That is why it is important to continue the conversation about what should – and what should not – factor into allocation decisions in a crisis,” said Erin S. DeMartino, MD, with the Mayo Clinic and senior author of the study.
During the early stages of the COVID-19 pandemic, a number of state-level pandemic preparedness plans were modified following criticism from disability advocates and civil rights groups. Despite these modifications, the study suggests that many state-level pandemic preparedness plans still discriminate against older adults, individuals with disabilities, and minoritized racial and ethnic groups, which could threaten patient welfare in another public health emergency and erode public trust. For example, conditions such as Alzheimer's disease, coronary artery disease and end-stage kidney disease were listed as exclusion or deprioritization triage criteria in some states.
As a result of these findings, the study team encourages reevaluation of critical care triage policies, emphasizing the need to ensure fair and equitable resource allocation.
The study was partially funded by the National Institute on Aging and the Mayo Clinic’s Annenberg Career Development Award.
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